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Question 1

In what position do patients with pericarditis sit in to relieve some of the pain? Does the pain associated with pericarditis get better or worse with inspiration?

Answer 1

seated and leaning forward

worse with inspiration

Question 2

What are the classic ECG findings in pericarditis?

Answer 2

diffuse ST segment elevation and depression of the PR interval

Question 3

What is the most common cause of viral pericarditis?

Answer 3

Coxsackievirus (picornavirus)

Question 4

What are the signs of Marfan’s syndrome?

Answer 4

pectus excavatum, hyperextensible joints, tall stature and long extremities and digits; predisposes to aortic aneurysms and mitral valve prolapse

Question 5

What is the histological characteristics of atrial myxomas? How do atrial myxomas present?

Answer 5

amorphous extracellular matrix

Present with symptoms f mitral valve obstruction, “plop” on auscultation or embolic strokes

Question 6

What are the signs of Kawasaki’s disease?

Answer 6

CRASH and burn
Conjunctivitis
Rash (everywhere but also on palms and soles)
Adenopathy (lymphadenopathy usually cervical)
Strawberry tongue (oral mucositis)
Hands and feet are very red and swollen (erythema and edema)
Burn = fever

Question 7

What is the pathognomonic histologic finding in rheumatic heart disease?

Answer 7

Aschoff bodies which are noncaseating granulomas with multinucleate giant cells. Aschoff bodies at high power show Anitschkow cells

Question 8

What symptom is most concerning after administration of hydralazine?

Answer 8

Hydralazine is a potent arterial vasodilator used to treat refractory HTN but this decrease in after load will cause a reflexive tachycardia that can cause angina/ischemia in a patient with CAD. This is why you always have to give a beta blocker before hydralazine

Question 9

What are the symptoms of digoxin toxicity?

Answer 9

increased parasympathetic tone (N/V, diarrhea), blurry yellow vision, arrhythmias, ECG abnormalities, and hyperkalemia

Question 10

What is the best initial treatment for digoxin toxicity? What else can you do?

Answer 10

Slowly normalize the potassium levels. Other steps are cardiac pacing, anti-digoxin Fab fragments and magnesium

Question 11

What diseases should you suspect if there is pathology of the right-sided valves?

Answer 11

carcinoid syndrome and IV drug use

Question 12

What is the Fick principle?

Answer 12

The rate of oxygen utilization by the body is equal to the cardiac output times the difference between the oxygen content in the arterial blood and the venous blood

Question 13

What does a VSD sound like on auscultation? What does an ASD sound like on auscultation?

Answer 13

VSD = holosystolic murmur best heard at the left sternal border
ASD = fixed splitting of S2

Question 14

What is the gold standard for diagnosing MI within the first 6 hours of onset of symptoms?

Answer 14

ECG changes including ST segment elevation, depression or Q waves

Question 15

What is on the differential for concentric hypertrophy of the left ventricle?

Answer 15

Chronic systemic hypertension and aortic stenosis

Question 16

What is seen on ECGs of patients with hyperkalemia? hypokalemia?

Answer 16

hyperkalemia - peaked T waves

hypokalemia - U waves

Question 17

What physical manipulation can a patient with mitral valve prolapse do to accentuate the murmur?

Answer 17

Valsalva maneuver which increases intrathoracic pressure which decreases venous return to the heart which increases the intensity of the MVP murmur

Question 18

What are the causes of dilated cardiomyopathy?

Answer 18

ABCCCD
alcohol abuse
Beriberi
Coxsackie B myocarditis
Cocaine use (chronic)
Chagas' disease
Doxorubicin toxicity