Cardio

Question 1

CHF

Answer 1

DOE
PND
edema
Echo w/ LVH or RVH
hypokinesis

Question 2

CHF
dilated cardiomyopathy
pregnancy

Answer 2

S3

Question 3

Hypertrophic CM or fatal arrhythmia, get EKG or echo

Answer 3

young athlete with syncope during athletic event or practice. No physical exam abnormalities

Question 4

Atrial fibrillation (holiday heart)

Answer 4

alcoholic with palpitations, arrhythmia

Question 5

Atrial fibrillation; (if >48 or chronic - anticoagulate)

Answer 5

irregularly irregular

Question 6

Do exercise stress test

Answer 6

Hx angina but no acute sx. EKG no acute changes

Question 7

Angina (if lasts minutes), AMI if lasts > 30 minutes. Acute ischemia - ST elevation; Injury - T wave depression; Infarct - Q wave

Answer 7

Crushing CP, dyspnea, palpitations, radiation to neck or left arm

Question 8

Warfarin (2-3 for Afib; 2.5 - 3.5 for valve); Tx Warfarin OD is vitamin K

Answer 8

Atrial fibrillation or prosthetic valve

Question 9

Pericarditis

Answer 9

Constant, sharp CP worse lying down, better sitting up and leaning forward

Question 10

Pericardial effusion/tamponade (Beck’s triad)

Answer 10

JVD, Hypotension, muffled heart sounds

Question 11

Aortic dissection

Answer 11

Sudden onset ripping, tearing chest pain, diminished pulses

Question 12

AAA

Answer 12

Flank pain, hypotension, pulsatile abdominal mass

Question 13

Digoxin toxicity (hypokalemia will make worse)

Answer 13

EKG changes, N/V, yellow-green visual disturbances

Question 14

ACEI is cause

Answer 14

HTN tx w/ meds, cough, or angioedema

Question 15

ACEI is best choice

Answer 15

DM and HTN

Question 16

Think secondary HTN most likely Renal artery stenosis (infrarenal artery)

Answer 16

HTN not responsive to basic meds

Question 17

Bacterial endocarditis (strep viridians) prevention

Answer 17

Mechanical valve or prosthesis and dental, GU, GI, or ortho procedure prophylaxis

Question 18

Bacterial endocarditis (staph aureus, strep viridians)

Answer 18

IVDA w/ new murmur

Question 19

Aortic stenosis (due to calcifications - age related) or bicuspid valve - congenital

Answer 19

Elderly w/ systolic murmur

Question 20

Aortic stenosis

Answer 20

Diamond shaped, blowing systolic murmur. May have angina, syncope, CHF

Question 21

Aortic regurgitation/insufficiency:
Quincke’s pulse (subungual capillar pulsation), Corrigan (rapid rise and fall), Austin flint (low pitch middiastolic murmur at apex)

Answer 21

Lateral displaced PMI, canon “a” waves, Quincke’s pulse, Corrigan’s pulse, Austin flint murmur, deMusset’s sign, water

Question 22

Mitral stenosis (ARMS are BAD)

Answer 22

Diastolic murmur best heart at apex without radiation

Question 23

Mitral valve prolapse

Answer 23

Female or post MI systolic murmur best at apex preceded by click without radiation

Question 24

Mitral regurgitation

Answer 24

Systolic murmur heard best at apex with radiation to left axilla (apical systolic)

Question 25

Mitral regurgitation (caused by papillary muscle rupture)

Answer 25

New murmur after MI (esp. if apical systolic)

Question 26

PDA

Answer 26

Continuous harsh, machine-like murmur

Question 27

VSD

Answer 27

Infant with dyspnea, difficulty feeding, holosystolic murmur @ LSB 3rd ICS. LVH and RVH

Question 28

Hs and Ts hypovolemia hypoxia Hypothermia hydrogen ion (acidosis) hyper-hypokalemia hypoglycemia tamponade cardiac tension pneumo thrombosis - PE or cardio Toxins Trauma

Answer 28

Pulseless electrical activity

Question 29

Coarctation of aorta

Answer 29

Peds w/ leg pain after physical activity, abnormal heart sounds, unequal UE and LE pulses

Question 30

Arterial insufficiency/PAD, intermittent claudication (ABI best choice, arteriogram gold standard) Tx is arterial bypass

Answer 30

LE rubor, no hair, brittle nails, palloe on elevation, calf or LE pain esp. with walking short distances relieved with rest or at PM Claudication with rest pain, (ABI < 0.4)

Question 31

Varicose veins. Tx w/ compression stockings

Answer 31

LE pain after long periods of standing. Dilated, tortuous, veins

Question 32

AS

Answer 32

Murmur that causes weak carotid pulse

Question 33

Liver toxicity

Answer 33

Side effect of statin drugs

Question 34

Cocaine

Answer 34

Illegal substance that causes MI secondary to acute coronary vasospasm

Question 35

Infective endocarditis Scaly plaques on palms and soles

Answer 35

Janeway lesions

Question 36

Infective endocarditis Tender nodules on tips of fingers and toes

Answer 36

Osler nodes

Question 37

Volume of blood in ventricles at the end of diastole

Answer 37

Pre-load

Question 38

Amount of blood being pumped out of the L ventricle during contraction

Answer 38

Ejection fraction

Question 39

Aortic dissection

Answer 39

Tearing, ripping pain between scapula

Question 40

Widened mediastinum

Answer 40

CXR with aortic dissection

Question 41

Coarctation of the aorta

Answer 41

BP higher in arms than the legs

Question 42

300-150-100-75-60-50

Answer 42

EKG - rate assessment

Question 43

First degree AV block

Answer 43

PR interval greater than 0.2 sec consistently in every cycle

Question 44

Wenchebach Second degree AV block

Answer 44

PR interval gradually lengthens in successive cycles , last P wave fails to conduct ventricles

Question 45

Complete third degree AV block

Answer 45

AV block in which there is a total block of conduction to the ventricles so no atrial depolarizations are conducted to ventricles

Question 46

Mobitz and Wenchebach

Answer 46

Types of second degree AV blocks

Question 47

Confirm in a second lead

Answer 47

asystole