A 52 year-old has chest pain as the main complaint. He has a sedentary

1.A 38 year-old male presented with mild and occasional SOB for the past several weeks. Recently, he has had cough with severe SOB. Upon asking, he reported no chest pain, fever, or bloody sputum. History included asthma which required ED treatment on several occasions. He has stopped using his inhalers as he was feeling much better. Blood pressure was 120/78 and heart sounds were normal. Lung sounds were normal at rest respiration but positive for wheezing on a forced exhale. Which action would you take? 选项： A:have family member transport patient to emergency department (ED) B:call 911 for emergency transport C:urgent (same day) referral to their primary care physician D:advise patient to avoid allergens, refer to a nutritionist

2.A 33 year-old requested acupuncture treatment for sudden attacks of "extreme anxiety" during the day and sometimes during the middle of the night where she would suddenly wake up with chest heaviness, SOB, and a dread that she was dying. During previous episodes she went to the ED for a complete cardiac workup which was negative. She avoided leaving her home as much as possible for fear that she would have an anxiety attack. Which action would you take? 选项： A:call 911 for emergency transport to a psychiatric outpatient clinic B:have friend or family member drive patient to a psychiatric outpatient clinic C:a semi-urgent (next day) referral to a cardiologist D:treat patient with Traditional Chinese Medicine

3.Who will experience the least chest pain when he or she has a heart attack？A．A 67-year-old 选项：A、Who will experience the least chest pain when he or she has a heart attack？ A．A 67-year-old man who has a history of stroke for 5 years.B．A 30-year-old lady who is always sweating and fainting.C．A 67-year-old black woman who has diabetes since her birth.D．A 40-year-old sportsman who suffers arms pain very often.

4.A 52-year-old man is brought to the emergency department with severe chest pain. Angiography demonstrates a severe coronary occlusion. A thrombolytic agent is administered to reestablish perfusion. Which of the following does the thrombolytic agent activate?

5.中国大学MOOC: A 41-year-old man is admitted to the emergency department with complaints of shortness of breath, dizziness, and sharp chest pain. As shown in the following figure, the abnormal area in his chest radiograph indicates the region of pathology. What is this structure?【图片】

6.Has he told you where he _________ his holiday next month? 选项：spent|has spent|will spend|would spend

7.Has he told you where he ______ his holiday next month？选项：A、spentB、has spentC、will spendD、would spend

8.A 55-year-old man with a history of portal hypertension is brought to the emergency department with severe abdominal pain. A CT scan of his chest, at the vertebra level T7, reveals a circular grey structure immediately anterior to the vertebral bodies and just to the right of midline. The structure appears to be much larger than usual. Given the location and the patient’s history what is this structure?? Azygos veinPulmonary veinSuperior vena cavaEsophagus

9.中国大学MOOC: A 55-year-old man with a history of portal hypertension is brought to the emergency department with severe abdominal pain. A CT scan of his chest, at the vertebra level T7, reveals a circular grey structure immediately anterior to the vertebral bodies and just to the right of midline. The structure appears to be much larger than usual. Given the location and the patient’s history what is this structure?

10.A 55-year-old man with a history of portal hypertension is brought to the emergency department with severe abdominal pain. A CT scan of his chest, at the vertebra level T7, reveals a circular grey structure immediately anterior to the vertebral bodies and just to the right of midline. The structure appears to be much larger than usual. Given the location and the patient’s history what is this structure?? Superior vena cavaPulmonary veinAzygos veinInferior vena cava

11.A 66-year-old man with Parkinson disease develops pleuritic chest pain. On exam, he has guarding over the right lower lung with dullness to percussion. A chest CT scan shows a focal, wedge-shaped pleural based area of hemorrhage in the right lower lobe. Which of the following is the most likely cause for his pulmonary lesion?选项： A:Embolism B:Atherosclerosis C:Vasculitis D:Arteriolosclerosis E:Thrombosis

12. Has he told you where he （） his holiday next month? 选项： A:spent B:has spent C:will spend D:would spend

13. . Has he told you where he _________ his holiday next month? 选项： A、 spent B、 has spent C、 will sepnd D、 would spend

14.A 52-year-old man is brought to the emergency department with severe chest pain. Angiography demonstrates a severe coronary occlusion. A thrombolytic agent is administered to reestablish perfusion. Which of the following does the thrombolytic agent activate?选项： A:Heparin; B:Kininogen; C:Plasminogen; D:Prothrombin

15.Has he told you where he _____ his holiday next month?

16.A 45-year-old man with a history of stable angina presents to the emergency department with an episode of chest pain that is not relieved by rest or nitroglycerin. After stabilization in the telemetry unit for 2 days, he undergoes a thallium stress test. The results show reduced perfusion of lateral wall of the left ventricle. Which artery is most likely occluded?? ; Right coronary; Left circumflex; Right posterior ; descending; Left anterior ; descending

17.Questions 11 to 18 are based on the conversation you have just heard. 选项： A、He has lost his history book. B、He doesn’t like the history course. C、He has to read a lot of history books. D、He finds history books difficult to understand.

18.单选题]Has he told you where he ______ his holiday next month? 选项： A:spent B:has spent C:will spend D:would spend

19.The patient is a 46-year-old male. He was admitted to hospital after one-month paroxysmal chest pain. With each attack, sublingualnitroglycerincould relieve chest pain. We consider the disease as coronary heart disease and angina. The most commonly used method of examinationis 选项： A、Coronary CTA B、Radionuclide inspection C、DCG D、 UCG

20.A 72-year-old man presents to the emergency department complaining of severe shortness of breath. He has long-standing poorly controlled hypertension and history of coronary artery disease and two myocardial infarctions. About 1 week before admission, he had an episode of substernal chest pain lasting approximately 30 minutes. Since then he has noted progressive shortness of breath to the point that he is now dyspneic on minimal exertion such as walking across the room. He notes a new onset of shortness of breath while lying down. He is only comfortable when propped up by three pillows. He is occasionally awakened from sleep acutely short of breath. On examination he is afebrile, with a blood pressure of 160/100 mm Hg, heart rate of 108/min, respiratory rate of 22/min, and oxygen saturation of 88% on room air. He is pale, cool, and diaphoretic. Jugular venous pressure is 10 cm H2O. Chest auscultation reveals rales in both lungs to the mid lung fields. Cardiac examination reveals tachycardia, with an audible S3 and S4 . No murmurs or rubs are heard. Extremities are without edema. The ECG shows left ventricular hypertrophy and Q waves in the anterior and lateral leads, consistent with this patient’s history of hypertension and myocardial infarction. Chest x-ray film reveals bilateral fluff y infiltrates consistent with pulmonary edema. He is admitted to the ICU with a diagnosis of heart failure and possible myocardial infarction.Questions1. What are the etiological factors of HF?2. What are probably responsible for this patient’s pulmonary edema?3. Is the HF compensatary or decompensatary?What are the critical proofs that support your judgement?