CardiovascularMain.87-92优培景程砺mmuuwrmuruQ41A45yearoldmancomeslotheofioeduetoftequenteplgasticbumingnotrelevedbyantacidslorhepast4monihsThesensatonsypicalybroughtonbyheavyfingatworkandakes10-15minulesogoayay.Thepatenthashadnoassociatedanmorneckpain,cough,shoressofbreath,ordifioulyswalowing-Hsmedialhistonyssignifoantlorsystenmiclupuse“iemalosusdagnosed5yea200forwfichheakeslowdosepredrisoneandhydiexychioroquine.HesaletmenonsmokerAyearago,thepatentswWiewasdagosedwitpeptculcerdiseasethatrequiedeatmentWiantibiotcs.Onphysialexamination,bloodpressurejs14080mmHgandpulseis80IminandegularBheathsoundsareequalonbolhsddes.MowheezesororackesaneheardFfstandsecondheatsoundsarepresentNoheartmunnursormubsarenoled.Theabdomenssoftandnonlendertodeeppajpaton.ThereisnoskinashorperpheraledemaEGGsnormalWhichofiheofowingisthebestnextstepinmanagementoftfispatentAAbdominalCTscanstiWitnoutcontstBAbdominalulrasoundC.ChestCTscanithoutcontastD.CoronaryangooraphyEEchocardiogramFEsophagealmolitystudsGExereiseECGH.StoolHeHcobacierpylofiantigentestngLUppergastoitestnalendoscopy优培景程砺muuuwrmuruA41cooncenororgmaCoreotanewerGThispatentscinicalpresertaton-epigasticbumineoueseresneoenmprovokedbyexerionfheawyWfing)andrelevedovere|ssnseveralminulesbyest-isconcemingloratypicalanginan(gvenhelackofypicalchestdiscomonj.Systemiclupuseoyematosuslsaknownskfactorforacceleratede|atherosderosisandprematurecoronaryheartdiesseM|comooesemeosmneceeIeonloaenninpieswtesnennocouzwienmeailongenierndecsetiopenoppyynpercbynegndnloneenonondonnioniotesoeminonctepmstngsciyEnretcemennendedssaniitlirnatetgndogroiandrttantlcionofnozpoieeoitoopecedoolietoenchetdoeseCooanongognpyspetormediopuiensffningponhiclqesiesebatoiiosdinpstereihieapeteiyaencheondueeDocs0LberuesesedocdoponkocaorsiyundorbedogrosofidencheutenagowdongtJnocoudonycqensoneeiovhoweeroneangeoadognnsonemyieurenstaoeloeeg1DocnAndalTepsietiononomstionimlnnimtonndrogmpoeseeanganpicueabonnipstoogvnierinsgnewinaonimicricneoinienderetnieedIDocegIesanuoagnponsritryolpinonsyorionccstelontowelenepptsdppoahestendeaCrinserssreiniesed(and1WepemcolipoeyerencconnittrotrnndyoetstonerreranecpstoogietontyposbegoiminetnlioopeptieocopgdnycannhndecdnnnoeeecafmpcndidenonoeeetatochnicteaeEoieseetcemonnenedsraniitilietlordoeroioninitsnifotoninmespoterewtharpecedotetiencheordeae优墙赢榨懵”叭mM咖Q42A60-yearoidmancomeslotheoficeforevaluationofa6-monthhistoryofintermittentchestpain.Hedescribessubsternalightnessandpainthatoccurwhenhewalksquicklyorclimbsstais.Thesymptomslastabout0minutssandslowiyfadeawayWihrestTheseepisodesdonothappenatrestThepatienthasaknownhistoryofcoronaryarlerydiseasewithcoronayarterybypassgrafingsurgery7yearsag0.Othermedicalproblemsincudehyperensionandhyperipidemia.BloodpressureIs14078mmHgandpulseis78/minandregular.Therearenomurmursoncardiacauscultation-LungsareclearbiateralyTieadmilstresstestisperlormed.Sevenminutesintothelestthepatientdevelopschestpainandtheeadmilsstopped.Sublngualnirogycerinsadministeredwhiihalmostimmediatelyrelievesthepatientspain.WhatisthepredominantmechanismresponsiblefortherapidpainrefefinhispatientACoronaryvasodiationB.DecreasedlettventicularcontractiiyC.DecreasedeftyentfcolerwallstessD.DiationofsmallartericsE.Negativechronotoficeflac优培景程砺wuuwreurumA42comeesevercEpanaTspalentntoooraysteydicasehasacusscpesenilonolohoncseyesngnaleetenaoespaneieedbyesl.ninnpdalohicamponsdowngesnnantonolsttirgualnioyceinNineseetleraleabydedvicitrnoonmusteaaloncuengoysencvonoqiiionsndinicesepopeluenotscipscncaTierpinayniheohencaleashedsedbyencvsodlionanddecessenosdacpecadesiinginadecsisinletvenicitretduslcandendysqevouneTntumudcpanducionpletenpicitratlcweless-wcftcealetoadandipopotonaloeseuedusl1Hinesg-andaicesenmyccuseloygendenetesitnpnmeislolangnasmponsApoughniatss英pnayesodiiosWadecitiaionolcoonaascoarsnoolmescecslshetereloaefeaiolitspesnansunestan(CrecayTecopoaynonoesnesesllowinitngcoonasencsssealesdydiaedbyInaemechanensaiowgnanensnceoheangSoodjovicoesesenolclesonalcndicodcoonayeoditionpesdoccalydecesiecoonagPetisonpessuecosaenolclsonbyvetngcodinvoarenoessppyrgieremaimpcesiun(ChacssBand日BaabocesandcltsunenmalbcdesenetinaienoralsledpetalyMasdecessonheheataienegaehorotopcafecyorcriaityfegaivenompceleal.iaistonweadecfeaoncudeccheneoprieymaycauneecesednanpydiepdsceesedpioadbierantingnaeleslstoghtpteduopimanypaedcionnmelstesr(ChecsDJAioviosssuniousednatingualngogycennpeptaiong.ninieshmneoyamciesasfeaonaneaanderetoionandciunoninnalornochangeinaycencinenceHOherdostscanleadgadopinaencbeodesaueEdicaonlooeeeSuiingailnicgycoinisuesdtinsannneialinppshnpatinewininonapsecisTianiechenceteaorntasnedosdbyencoeseilepnna余cideenenajindecessednyccadilogoondenand优墙赢榨懵”叭mM咖Q43人65-year-oidmalepresentstoyourofficewithaSi-monthhistoryofperiodicsubsternalpain.Thepainepisodesareexperiencedduringstrongemotion,lastfor10-15minutes,andresoepontaneous.Hehasaionghistoryofhypertensionanddiabetesmelitus,Vpe2.Hisrightfootwasamputatedtwoyearsagoduetodiabetes-relatedcomplications.YouSuspectanginapectorisanddecidetoperformmyocardialperfusionscanning.Itrevealsunilormdistrbutionofisotopeatrestbutinhomogenesityofthedistributionafterdipyridamoleinjection.Youconcludethatthepatienthasischemicheartdisease.Whichofthefollowingeffectsofdipyridamolehelpedyouinmakingthediagnosis?AncreasedheartcontractyB.CoronarystealC.DilationofdiseasedvesselsD.nhibitionofplateletaggregationE.Placeboeffect优培景程砺mmuwrmuruA43CoreotanswerExpanatonThehistonyissugoestveofanginapeclonsinthispatent(episodesofsubstemalpainprovokedbyemotonj|Exercielestngisnotpossibe,becauseIhipatentsactviyisImiledbyampulaton.MyocardialperusonscamningcanbeemployednsleadusingdipyrdamoletoevealheareasofesticledmyocardialperusionDipyidamoleandadencsiearecoronaryvasodiatorsInfusionofthesesubsiancesinpatentswifhoutooronamyanemydiseaseincreasescoronarybloodfowthreetofveimesabovethebaseinelevelsHoweverinpatentsWihcomonanyaneydiseasethediessedvesselsdistalioheobstuclonareafeadymaximalydited(ChoiceCl,andtheirabityloincreasemyocardalperusionjsImied:thereloreredistibutonofcoronarybloodlowtnordiseasedareascocursandtheperusionofdiseasedsegmentsdiminishesThisphenomenondemonstatedbydjpyridamaleiscaledcoronarystealandisusediodiagnoseschemicheatdsesseDipyidamoleisapolentantplateletagregate(CholceD),butthisproperyISnotemployedtoassistindiagnosie-Increasedcandiacconttactiity(ChoiceAcanccurasheresultofvasoditatonbutitisasecondaryphenomenon.Placeboeflot(Choie目isinelevantinthiscaseEducatonaltjeoiveDipydamolecanbeueedduinjniyosaidFarusionjcnnhgieves|theire:s5feshioledyooardilperusion.Theredistibuonofinecomonaryblooiowinodiessed.ssgmentsinducedbyhisdmugiscaledcoronarystealphenomenon优培景程砺smmuuwrmuruQ44A55-yearoldmancomeslothephysicianwitha6-monthhistoryofperiodicsubstemalchestpressuteHeexperiencesthispressurewhiewalkinguphiiorclimbing2fightsofstairs.Hispastmedicalhistoryissignifcantforhyperipidemiaandhismedicationsincludeastatn.Hesmokes1packadayandconsumesalcoholoccasionaly,Hisbloodpressureis142/68mmHgandpulsei75Imin.Restngelectrocardiogramisnormal.TreadmilstesstestshowshorizontalSTsegmentdepressioninieadsllandaVFat73%ofmaxima1iypredicledheartrate.Exerciseechocardiographydemonstratesnormalestingfeftventricularsystolicfunctonwithinteriorwalhypokinesisatpeakexercise.Inaddiiontotow-doseaspiiinandsubiingualnirogycerinasneededwhichofthefolowingishebestiniialtherapytotreatthispatientscurrentcondiion?AAmiodipineB.ChlorthalidoneClsosorbidednitrateDiLisinopriE.MetoprololFRanolazine优培景程砺wmunwreurowA44coworewetTmeetooeenyeernonpervutnesnespnpeeyeyneconenorrgpeoaoyrospoyoanienpngTemocionaoengndopytnnhnnnnogyteecogonorpoapponescetoerconaovoropeeeeynnedonpoennesnnhpoeeonsinoyoesrneenresuenpetooonadorsooidtoisrensnpereeenreICecshog0SormonoiienanritnninngnnsgnoeIoutororooootonoeeocenoiioontencprolaoedtcoeooapepeeenorretscinetedenayothaenyceeToycinioincndnortnnnpusbnirelepynhotoonessnonenICosgTenePoopyepsenaneelhpoesosssmeoiupomgeecowyopeeeICocnDAnesncovennennoniesgcorqloeucninpeeeepnneonanooeenanenanenneEennernEcnopociotoaoatWynneoneepposetorenaeeseopeoee1nnseossegnoeneteceeeeeresgynaeerge|esneeretoreereroarooetrieetesensneneeoe一一一一-一eiecoroeorneetmeeiopeepycreriogreerrorneomeoemenpeeereoegeresnsirtoseeeeyprnesonentoteeeuneneoetpoyeeseeeennPvepmnatotmeen元理玲怡引BuuuwrrurunQ45A58yearcidwomansevaluatedforchestdisoomortthatocourswhieimbngstaisandwalnguphiLShealsocompiinsofassociatedshornessofbreath.ShehasnoknownistoryofcoronayanerydiesseorsfokeHerpastmedioalloryissgniicantioranxetydisorderhyperension,yperipdemiaype2dibelesmefitusandarefuxdisease.Herbodymassndex30gBaseineelecocardiogramshowsnormalSnusfyihnuChenisttypanelshowsnommaleleckoylelevelsandcreatnineof1mgdL.Anexercise(teadmiljstessestisohedulediodiagnosecoronamyanerydeesse。Wihichofihefolowingdaiymedicatonsshouldbeheld24-48housbeloretheest7Long-actngMetoprololniedipineRamipnl“Chlorthalidone“SimyastatineeIIIEeEE山cM588EEw5wM山图口w