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1、CardiovascularMain.87-92优培景程砺mmuuwrmuruQ41A45yearoldmancomeslotheofioeduetoftequenteplgasticbumingnotrelevedbyantacidslorhepast4monihsThesensatonsypicalybroughtonbyheavyfingatworkandakes10-15minulesogoayay.Thepatenthashadnoassociatedanmorneckpain,cough,shoressofbreath,ordifioulyswalowing-Hsmedialhis
2、tonyssignifoantlorsystenmiclupuse“iemalosusdagnosed5yea200forwfichheakeslowdosepredrisoneandhydiexychioroquine.HesaletmenonsmokerAyearago,thepatentswWiewasdagosedwitpeptculcerdiseasethatrequiedeatmentWiantibiotcs.Onphysialexamination,bloodpressurejs14080mmHgandpulseis80IminandegularBheathsoundsareeq
3、ualonbolhsddes.MowheezesororackesaneheardFfstandsecondheatsoundsarepresentNoheartmunnursormubsarenoled.Theabdomenssoftandnonlendertodeeppajpaton.ThereisnoskinashorperpheraledemaEGGsnormalWhichofiheofowingisthebestnextstepinmanagementoftfispatentAAbdominalCTscanstiWitnoutcontstBAbdominalulrasoundC.Ch
4、estCTscanithoutcontastD.CoronaryangooraphyEEchocardiogramFEsophagealmolitystudsGExereiseECGH.StoolHeHcobacierpylofiantigentestngLUppergastoitestnalendoscopy优培景程砺muuuwrmuruA41cooncenororgmaCoreotanewerGThispatentscinicalpresertaton-epigasticbumineoueseresneoenmprovokedbyexerionfheawyWfing)andrelevedo
5、vere|ssnseveralminulesbyest-isconcemingloratypicalanginan(gvenhelackofypicalchestdiscomonj.Systemiclupuseoyematosuslsaknownskfactorforacceleratede|atherosderosisandprematurecoronaryheartdiesseM|comooesemeosmneceeIeonloaenninpieswtesnennocouzwienmeailongenierndecsetiopenoppyynpercbynegndnloneenonondo
6、nnioniotesoeminonctepmstngsciyEnretcemennendedssaniitlirnatetgndogroiandrttantlcionofnozpoieeoitoopecedoolietoenchetdoeseCooanongognpyspetormediopuiensffningponhiclqesiesebatoiiosdinpstereihieapeteiyaencheondueeDocs0LberuesesedocdoponkocaorsiyundorbedogrosofidencheutenagowdongtJnocoudonycqensoneeiov
7、howeeroneangeoadognnsonemyieurenstaoeloeeg1DocnAndalTepsietiononomstionimlnnimtonndrogmpoeseeanganpicueabonnipstoogvnierinsgnewinaonimicricneoinienderetnieedIDocegIesanuoagnponsritryolpinonsyorionccstelontowelenepptsdppoahestendeaCrinserssreiniesed(and1Wepemcolipoeyerencconnittrotrnndyoetstonerreran
8、ecpstoogietontyposbegoiminetnlioopeptieocopgdnycannhndecdnnnoeeecafmpcndidenonoeeetatochnicteaeEoieseetcemonnenedsraniitilietlordoeroioninitsnifotoninmespoterewtharpecedotetiencheordeae优墙赢榨懵”叭mM咖Q42A60-yearoidmancomeslotheoficeforevaluationofa6-monthhistoryofintermittentchestpain.Hedescribessubstern
9、alightnessandpainthatoccurwhenhewalksquicklyorclimbsstais.Thesymptomslastabout0minutssandslowiyfadeawayWihrestTheseepisodesdonothappenatrestThepatienthasaknownhistoryofcoronaryarlerydiseasewithcoronayarterybypassgrafingsurgery7yearsag0.Othermedicalproblemsincudehyperensionandhyperipidemia.Bloodpress
10、ureIs14078mmHgandpulseis78/minandregular.Therearenomurmursoncardiacauscultation-LungsareclearbiateralyTieadmilstresstestisperlormed.Sevenminutesintothelestthepatientdevelopschestpainandtheeadmilsstopped.Sublngualnirogycerinsadministeredwhiihalmostimmediatelyrelievesthepatientspain.Whatisthepredomina
11、ntmechanismresponsiblefortherapidpainrefefinhispatientACoronaryvasodiationB.DecreasedlettventicularcontractiiyC.DecreasedeftyentfcolerwallstessD.DiationofsmallartericsE.Negativechronotoficeflac优培景程砺wuuwreurumA42comeesevercEpanaTspalentntoooraysteydicasehasacusscpesenilonolohoncseyesngnaleetenaoespan
12、eieedbyesl.ninnpdalohicamponsdowngesnnantonolsttirgualnioyceinNineseetleraleabydedvicitrnoonmusteaaloncuengoysencvonoqiiionsndinicesepopeluenotscipscncaTierpinayniheohencaleashedsedbyencvsodlionanddecessenosdacpecadesiinginadecsisinletvenicitretduslcandendysqevouneTntumudcpanducionpletenpicitratlcwe
13、less-wcftcealetoadandipopotonaloeseuedusl1Hinesg-andaicesenmyccuseloygendenetesitnpnmeislolangnasmponsApoughniatss英pnayesodiiosWadecitiaionolcoonaascoarsnoolmescecslshetereloaefeaiolitspesnansunestan(CrecayTecopoaynonoesnesesllowinitngcoonasencsssealesdydiaedbyInaemechanensaiowgnanensnceoheangSoodjo
14、vicoesesenolclesonalcndicodcoonayeoditionpesdoccalydecesiecoonagPetisonpessuecosaenolclsonbyvetngcodinvoarenoessppyrgieremaimpcesiun(ChacssBand日BaabocesandcltsunenmalbcdesenetinaienoralsledpetalyMasdecessonheheataienegaehorotopcafecyorcriaityfegaivenompceleal.iaistonweadecfeaoncudeccheneoprieymaycau
15、neecesednanpydiepdsceesedpioadbierantingnaeleslstoghtpteduopimanypaedcionnmelstesr(ChecsDJAioviosssuniousednatingualngogycennpeptaiong.ninieshmneoyamciesasfeaonaneaanderetoionandciunoninnalornochangeinaycencinenceHOherdostscanleadgadopinaencbeodesaueEdicaonlooeeeSuiingailnicgycoinisuesdtinsannneiali
16、nppshnpatinewininonapsecisTianiechenceteaorntasnedosdbyencoeseilepnna余cideenenajindecessednyccadilogoondenand优墙赢榨懵”叭mM咖Q43人65-year-oidmalepresentstoyourofficewithaSi-monthhistoryofperiodicsubsternalpain.Thepainepisodesareexperiencedduringstrongemotion,lastfor10-15minutes,andresoepontaneous.Hehasaion
17、ghistoryofhypertensionanddiabetesmelitus,Vpe2.Hisrightfootwasamputatedtwoyearsagoduetodiabetes-relatedcomplications.YouSuspectanginapectorisanddecidetoperformmyocardialperfusionscanning.Itrevealsunilormdistrbutionofisotopeatrestbutinhomogenesityofthedistributionafterdipyridamoleinjection.Youconclude
18、thatthepatienthasischemicheartdisease.Whichofthefollowingeffectsofdipyridamolehelpedyouinmakingthediagnosis?AncreasedheartcontractyB.CoronarystealC.DilationofdiseasedvesselsD.nhibitionofplateletaggregationE.Placeboeffect优培景程砺mmuwrmuruA43CoreotanswerExpanatonThehistonyissugoestveofanginapeclonsinthis
19、patent(episodesofsubstemalpainprovokedbyemotonj|Exercielestngisnotpossibe,becauseIhipatentsactviyisImiledbyampulaton.MyocardialperusonscamningcanbeemployednsleadusingdipyrdamoletoevealheareasofesticledmyocardialperusionDipyidamoleandadencsiearecoronaryvasodiatorsInfusionofthesesubsiancesinpatentswif
20、houtooronamyanemydiseaseincreasescoronarybloodfowthreetofveimesabovethebaseinelevelsHoweverinpatentsWihcomonanyaneydiseasethediessedvesselsdistalioheobstuclonareafeadymaximalydited(ChoiceCl,andtheirabityloincreasemyocardalperusionjsImied:thereloreredistibutonofcoronarybloodlowtnordiseasedareascocurs
21、andtheperusionofdiseasedsegmentsdiminishesThisphenomenondemonstatedbydjpyridamaleiscaledcoronarystealandisusediodiagnoseschemicheatdsesseDipyidamoleisapolentantplateletagregate(CholceD),butthisproperyISnotemployedtoassistindiagnosie-Increasedcandiacconttactiity(ChoiceAcanccurasheresultofvasoditatonb
22、utitisasecondaryphenomenon.Placeboeflot(Choie目isinelevantinthiscaseEducatonaltjeoiveDipydamolecanbeueedduinjniyosaidFarusionjcnnhgieves|theire:s5feshioledyooardilperusion.Theredistibuonofinecomonaryblooiowinodiessed.ssgmentsinducedbyhisdmugiscaledcoronarystealphenomenon优培景程砺smmuuwrmuruQ44A55-yearold
23、mancomeslothephysicianwitha6-monthhistoryofperiodicsubstemalchestpressuteHeexperiencesthispressurewhiewalkinguphiiorclimbing2fightsofstairs.Hispastmedicalhistoryissignifcantforhyperipidemiaandhismedicationsincludeastatn.Hesmokes1packadayandconsumesalcoholoccasionaly,Hisbloodpressureis142/68mmHgandpu
24、lsei75Imin.Restngelectrocardiogramisnormal.TreadmilstesstestshowshorizontalSTsegmentdepressioninieadsllandaVFat73%ofmaxima1iypredicledheartrate.Exerciseechocardiographydemonstratesnormalestingfeftventricularsystolicfunctonwithinteriorwalhypokinesisatpeakexercise.Inaddiiontotow-doseaspiiinandsubiingu
25、alnirogycerinasneededwhichofthefolowingishebestiniialtherapytotreatthispatientscurrentcondiion?AAmiodipineB.ChlorthalidoneClsosorbidednitrateDiLisinopriE.MetoprololFRanolazine优培景程砺wmunwreurowA44coworewetTmeetooeenyeernonpervutnesnespnpeeyeyneconenorrgpeoaoyrospoyoanienpngTemocionaoengndopytnnhnnnnog
26、yteecogonorpoapponescetoerconaovoropeeeeynnedonpoennesnnhpoeeonsinoyoesrneenresuenpetooonadorsooidtoisrensnpereeenreICecshog0SormonoiienanritnninngnnsgnoeIoutororooootonoeeocenoiioontencprolaoedtcoeooapepeeenorretscinetedenayothaenyceeToycinioincndnortnnnpusbnirelepynhotoonessnonenICosgTenePoopyepse
27、naneelhpoesosssmeoiupomgeecowyopeeeICocnDAnesncovennennoniesgcorqloeucninpeeeepnneonanooeenanenanenneEennernEcnopociotoaoatWynneoneepposetorenaeeseopeoee1nnseossegnoeneteceeeeeresgynaeerge|esneeretoreereroarooetrieetesensneneeoe一一一一-一eiecoroeorneetmeeiopeepycreriogreerrorneomeoemenpeeereoegeresnsirt
28、oseeeeyprnesonentoteeeuneneoetpoyeeseeeennPvepmnatotmeen元理玲怡引BuuuwrrurunQ45A58yearcidwomansevaluatedforchestdisoomortthatocourswhieimbngstaisandwalnguphiLShealsocompiinsofassociatedshornessofbreath.ShehasnoknownistoryofcoronayanerydiesseorsfokeHerpastmedioalloryissgniicantioranxetydisorderhyperensio
29、n,yperipdemiaype2dibelesmefitusandarefuxdisease.Herbodymassndex30gBaseineelecocardiogramshowsnormalSnusfyihnuChenisttypanelshowsnommaleleckoylelevelsandcreatnineof1mgdL.Anexercise(teadmiljstessestisohedulediodiagnosecoronamyanerydeesse。Wihichofihefolowingdaiymedicatonsshouldbeheld24-48housbeloretheest7Long-actngMetoprololniedipineRamipnl“Chlorthalidone“SimyastatineeIIIEeEE山cM588EEw5wM山图口w
