1. A 25-year-old woman presents with a history of recurrent episodes of fever, joint pain, and migratory polyarthritis. Physical examination reveals a new diastolic murmur. Which of the following is the most likely diagnosis?
A. Acute rheumatic fever
B. Chronic rheumatic heart disease
C. Systemic lupus erythematosus
D. Rheumatoid arthritis
E. Ankylosing spondylitis
2. A 35-year-old man with a history of rheumatic heart disease presents with progressive dyspnea, orthopnea, and lower extremity edema. Echocardiography reveals severe mitral stenosis with a mitral valve area of 1.0 cm^2. Which of the following is the most appropriate next step in management?
A. Initiate diuretic therapy
B. Perform percutaneous mitral balloon valvuloplasty
C. Perform mitral valve replacement
D. Initiate anticoagulation therapy
E. Recommend palliative care
3. A 45-year-old woman with a history of rheumatic heart disease presents with sudden-onset chest pain, shortness of breath, and hypotension. Echocardiography reveals a flail posterior mitral valve leaflet with severe mitral regurgitation. Which of the following is the most appropriate next step in management?
A. Initiate diuretic therapy
B. Perform percutaneous mitral balloon valvuloplasty
C. Perform mitral valve replacement
D. Initiate anticoagulation therapy
E. Perform emergency mitral valve repair
4. A 30-year-old man with a history of rheumatic heart disease presents with progressive dyspnea, orthopnea, and lower extremity edema. Echocardiography reveals severe aortic stenosis with a peak gradient of 70 mmHg. Which of the following is the most appropriate next step in management?
A. Initiate diuretic therapy
B. Perform transcatheter aortic valve replacement (TAVR)
C. Perform surgical aortic valve replacement
D. Initiate anticoagulation therapy
E. Recommend palliative care
5. A 40-year-old woman with a history of rheumatic heart disease presents with recurrent episodes of atrial fibrillation and thromboembolism. Which of the following is the most appropriate management strategy?
A. Initiate antiarrhythmic drug therapy
B. Perform electrical cardioversion
C. Perform pulmonary vein isolation
D. Initiate long-term anticoagulation
E. Perform maze procedure
6. A 20-year-old woman with a history of rheumatic fever presents with fever, migratory polyarthritis, and a new diastolic murmur. Which of the following is the most appropriate initial treatment?
A. Aspirin
B. Corticosteroids
C. Penicillin
D. Nonsteroidal anti-inflammatory drugs (NSAIDs)
E. Anticoagulation
7. A 55-year-old man with a history of rheumatic heart disease presents with progressive dyspnea, orthopnea, and lower extremity edema. Echocardiography reveals severe mitral stenosis with a mean gradient of 15 mmHg. Which of the following is the most appropriate next step in management?
A. Initiate diuretic therapy
B. Perform percutaneous mitral balloon valvuloplasty
C. Perform mitral valve replacement
D. Initiate anticoagulation therapy
E. Recommend palliative care
8. A 35-year-old woman with a history of rheumatic heart disease presents with sudden-onset chest pain, shortness of breath, and hemodynamic instability. Echocardiography reveals a flail posterior mitral valve leaflet with severe mitral regurgitation. Which of the following is the most appropriate next step in management?
A. Initiate diuretic therapy
B. Perform percutaneous mitral balloon valvuloplasty
C. Perform mitral valve replacement
D. Initiate anticoagulation therapy
E. Perform emergency mitral valve repair
9. A 45-year-old man with a history of rheumatic heart disease presents with progressive dyspnea, orthopnea, and lower extremity edema. Echocardiography reveals severe aortic stenosis with a peak gradient of 80 mmHg and a left ventricular ejection fraction of 35%. Which of the following is the most appropriate next step in management?
A. Initiate diuretic therapy
B. Perform transcatheter aortic valve replacement (TAVR)
C. Perform surgical aortic valve replacement
D. Initiate anticoagulation therapy
E. Recommend palliative care
10. A 25-year-old woman with a history of rheumatic fever presents with fever, migratory polyarthritis, and a new diastolic murmur. Which of the following is the most appropriate diagnostic test?
A. Antistreptolysin O (ASO) titer
B. Echocardiography
C. Electrocardiography
D. Erythrocyte sedimentation rate (ESR)
E. C-reactive protein (CRP)
11. A 40-year-old woman with a history of rheumatic heart disease presents with recurrent episodes of atrial fibrillation and thromboembolism. Echocardiography reveals moderate mitral stenosis and severe mitral regurgitation. Which of the following is the most appropriate management strategy?
A. Initiate antiarrhythmic drug therapy
B. Perform electrical cardioversion
C. Perform pulmonary vein isolation
D. Initiate long-term anticoagulation
E. Perform mitral valve repair or replacement
12. A 30-year-old man with a history of rheumatic heart disease presents with progressive dyspnea, orthopnea, and lower extremity edema. Echocardiography reveals severe tricuspid regurgitation with significant right ventricular dilatation. Which of the following is the most appropriate next step in management?
A. Initiate diuretic therapy
B. Perform tricuspid valve repair
C. Perform tricuspid valve replacement
D. Initiate anticoagulation therapy
E. Recommend palliative care
13. A 50-year-old woman with a history of rheumatic heart disease presents with recurrent episodes of chest pain, palpitations, and syncope. Electrocardiography reveals atrial flutter with 2:1 atrioventricular block. Which of the following is the most appropriate management?
A. Initiate antiarrhythmic drug therapy
B. Perform electrical cardioversion
C. Perform atrial flutter ablation
D. Initiate anticoagulation therapy
E. Recommend pacemaker implantation
14. A 60-year-old man with a history of rheumatic heart disease presents with progressive dyspnea, orthopnea, and lower extremity edema. Echocardiography reveals severe mitral stenosis and severe aortic stenosis. Which of the following is the most appropriate next step in management?
A. Initiate diuretic therapy
B. Perform percutaneous mitral balloon valvuloplasty
C. Perform surgical double-valve replacement
D. Initiate anticoagulation therapy
E. Recommend palliative care
15. A 35-year-old woman with a history of rheumatic heart disease presents with sudden-onset chest pain, shortness of breath, and hypotension. Echocardiography reveals a flail anterior mitral valve leaflet with severe mitral regurgitation. Which of the following is the most appropriate next step in management?
A. Initiate diuretic therapy
B. Perform percutaneous mitral balloon valvuloplasty
C. Perform mitral valve replacement
D. Initiate anticoagulation therapy
E. Perform emergency mitral valve repair