Cardio Flashcards
(91 cards)
1
Q
A 50 yo male presents to the ER with 10/10 chest pain that is ripping and knife like. On exam, there are no murmurs. There is a decreased left-sided femoral pulse compared to the R side. BP in the R arm is 160/120 and 110/90 in the L arm. Which of the following radiologic findings would most likely be present? A. cardiomegaly B. widening of the mediastinum C. rib notching and a "3 sign" of aorta D. Kerley B lines E. Batwing appearance of hilum
A
B, widening of the mediastinum
*Classic description of aortic dissection
2
Q
Systolic dysfunction (heart failure)
Dilated cardiomyopathy
Large pericardial effusions
All have what appearance on a CXR
A
Cardiomegaly
3
Q
Rib notching and a “3 sign” of aorta are signs of…
A
Narrowing (coarctation) of aorta
- coarctation also usually has a systolic murmur that radiates to the back
- coarctation usually present with signs of HF
4
Q
Kerley B lines and batwing appearance of hilum are seen in…
A
CHF
5
Q
In evaluating a pt with progressive dyspnea, an echocardiogram is obtained, showing inadequate relaxation of the heart, a thickened pericardium and diastolic dysfunction. Exam shows increased jugular venous distention, especially with inspiration. Which of the following is most consistent with the suspected diagnosis?
A. pericardial knock
B. bilateral atrial enlargement
C. speckled myocardium
D. vegetation on the mitral valve
E. diastolic collapse of the cardiac chambers
A
A, pericardial knock
*classic description of constrictive pericarditis. in contrive pericarditis, the stiff, inelastic pericardium causes diastolic dysfunction by inhibiting the filling of the ventricles during diastole. The PERICARDIAL KNOCK is due to sudden cessation of ventricular filling by the stiff pericardium
6
Q
the stiff, inelastic pericardium causes diastolic dysfunction by inhibiting the filling of the ventricles during diastole
A
Constrictive pericarditis
7
Q
In constrictive pericarditis, the ______ is due to sudden cessation of ventricular filling by the stiff pericardium
A
pericardial knock
8
Q
bilateral atrial enlargement and speckled myocardium are seen in..
A
Restrive cardiomyopathy
9
Q
BOTH constrictive pericarditis AND restrictive cardiomyopathy are associated with _____ dysfunction
A
diastolic
and impaired diastolic ventricular filling
10
Q
A speckled myocardium is seen with this common cause of restrictive cardiomyopathy
A
Amyloidosis
11
Q
Vegetation on the mitral valve is associated with..
A
infective endocarditis
12
Q
Diastolic collapse of the ventricles is classic for..
A
pericardial tamponade
*Kussmaul’s sign (increased JVP with inspiration) also see with pericardial tamponade
13
Q
_____ ______ is associated with Beck’s triad (muffled heart sounds due to pericardial effusion), systemic hypotension (due to decreased forward flow) and increased jugular venous pressure (from increased back flow of blood)
A
Cardiac tamponade
14
Q
Which class I anti arrhythmic has been shown to prolong depolarization and refractory period
A
Procainamide
15
Q
A 43 yo male presents after a near syncopal episode and is currently dizzy. His EKG shows sinus bradycardia with a HR of around 40 bpm. Which of the following is the management of choice? A. observation B. permanent pacemaker C. IV epinephrine D. IV atropine E. IV amiodarone
A
D, IV atropine
*IV atropine is the first line tx for symptomatic bradycardia. Most bradyarrhythmias are thought to arise from vagal hyperstiumulation. Atropine is an anticholindergic drug that blocks the effects of Ach released by the vagus nerve and therefore is the first line agent in most cases
16
Q
Which of the following drugs is the DOC to increase HDL levels? A. cholestyramine B. ezetimibe C. fenofibrate D. nicotinic acid E. simvastatin
A
D, nicotinic acid
17
Q
HMG-CoA reductase inhibitors, used to lower LDL levels and have been show to reduce cardiovascular morbidity and mortality
A
“statins”
ie..Simvastatin
18
Q
During a routine exam, an abdominal bruit is heard. What is the best initial study of choice if abdominal aortic aneurysm is suspected?
A
Abdominal ultrasound
19
Q
A 43 yo male with a hx of hyperlipidemia, HTN and diabetes presents with crushing, substernal chest pain of 45 minutes of duration with radiation to the L arm. His prior ECG a month ago showed normal sinus rhythm with no abnormalities. Which of the following new ECG findings are considered an ST elevation myocardial infarction equivalent?
A. “m” shaped P waves in lead II, biphasic p waves in V1
B. R waves larger than S waves in V1, with the R waves measuring greater than 7 mm
C. Wide QRS complexes with broad, slurred R waves in V5 and V6 with a deep S wave in V1
D. Deep S waves in lead I, isolated Q waves in lead III, inverted T waves in lead III
E. Wide QRS complexes with an RSR’ pattern in leads V1 and V2. Wide S waves in V6
A
C, Wide QRS complexes with broad, slurred R waves in V5 and V6 with a deep S wave in V1
*these findings are consistent with a LBBB. LBBB are considered a myocardial equivalent because MIs can present with new bundle branch blocks
20
Q
Why is a LBB considered a myocardial equivalent?
A
MIs can present with new bundle branch blocks
21
Q
A pt with no noted risk factors for DVT develops unilateral R leg swelling. A venous doppler is performed, showing non-compressibility of the superficial femoral vein. What is tx for first episode of idiopathic DVT?
A
initiation of heparin with warfarin. Warfarin therapy continued for 6-12 months
22
Q
Which of the following is most reliably seen in peripheral venous dz?
A. redness with dependency of leg
B. leg pain worse w ambulation
C. thin, shiny skin with loss of hair on foot
D. cool extremities
E. presence of a medial malleolus ulcer with uneven ulcer margins
A
E, presence of a medial malleolus ulcer with uneven ulcer margins
*medial ulcers are classically associated with peripheral venous dz
23
Q
Medial ulcers are classically associated with..
A
Peripheral venous disease
24
Q
Leg pain an cyanosis worse w dependency
stasis dermatitis with brownish pigmentation
peripheral edema with normal temp and pulses
A
Peripheral venous disease
25
Redness w dependency of leg
Leg pain worse w ambulation
Thin, shiny skin with loss of hair on foot
Cool extremities
Peripheral arterial disease
26
What is the most common cause of transudative pleural effusion?
CHF
27
45 yo male with a history of diabetes presents with sudden onset of chest pain while shoveling snow. EKG shows ST elevation with large T waves in V1, V2, V3. What is likely the dx?
Anterior wall MI
28
```
A 43 yo previously healthy female presents to the ER with chest pain and palpitations. The symptoms continue despite O2 and IV fluids. her BP is 80/60. She is diaphoretic, dizzy, unable to speak in full sentences. her pulses are palpable but rapid. an ECG is performed, showing a regular, narrow complex tachycardia at 180 bpm. No ST or T wave changes. What is the recommended tx?
A. atropine
B. synchronized cardioversion
C. adenosine
D. amiodarone
E. unsynchronized cardioversion
```
B, synchronized cardioversion
*this pt is having unstable tachycardia, so first line is synchronized cardioversion
29
unsynchronized cardioversion (aka defibrillation) is indicated for:
1. v tach without a pulse
| 2. v fib
30
A 20 yo thin female presents to clinic with multiple episodes of chest pain, panic attacks and dizziness whenever she exercised or exerts herself. Exam reveals the presence of a systolic ejection click. Which is recommended for this pt?
A. reassurance the dz is self limiting
B. education that she may develop the murmur of mitral stenosis
C. propranolol for the autonomic symptoms
D. aspirin to reduce chest pain
E. nitro PRN for chest pain
C, propranolol for the autonomic symptoms
*in pts with mitral valve prolapse with autonomic symptoms, beta blockers can be given to reduce symptoms
31
Pulmonary fibrosis and thyroid disorders are classic side effects of..
Amiodarone
32
```
Which of the following is NOT a side effect of lisinopril?
A. teratogenicity
B. hypotension
C. hypokalemia
D. azotemia
E. dry cough and angioedema
```
C, hypokalemia
33
```
A pt with chest pain has an EKG showing:
3 mm ST elevations in leads II, III, aVF. ST depressions in leads V1, V2, V3, V4.
Most appropriate tx?
A. IV nitro
B. IV morphine
C. IV fluids
D. IV labetalol
E. IV furosemide
```
C, IV fluids
*inferior ST elevations and ST depressions in anterior leads reflect right coronary artery involvement. bc right side infarctions are PRELOAD dependent, IV fluids help to preserve preload, thereby protecting the cardiac output
34
```
Which is FALSE* regarding pain associated with acute pericarditis?
A. CP is persistent
B. CP is sharp
C. CP is worsened with inspiration
D. CP is relieved with lying supine
E. CO radiates to trapezius and back
```
D, CP is relieves with lying supine
35
Which of the following is classically associated with mitral stenosis?
A. bounded pulses with a wide pulse pressure
B. weak, delayed carotid upstroke
C. mid systolic ejection click
D. opening snap
E. increase in murmur intensity when the pt sits up and leans forward
D, opening snap
36
Bounding pulses with a wide pulse pressure seen in...
aortic regurgitation
37
Weak, delayed carotid upstroke seen in..
aortic stenosis
38
```
55 yo male presents with symptoms and echocardiogenic evidence consistent with infective endocarditis. On exam, there are painless macule that are seen on his palms and soles. Which of the following is most likely the diagnosis?
A. Olser's nodes
B. Janeway lesions
C. Keratoderma blenorrhagicum
D. Roth spots
E. Erythema marginatum
```
B, Janeway lesions
*Janeway lesions are seen in infective endocarditis and described as painless macule seen on the palms and soles, representing embolic and immune phenomena
39
Tender, painful nodes on the pads of the digits that represent immunologic phenomena
Olser Nodes
40
Retinal hemorrhages with pale centers
Roth spots
41
Which of the following echocardiogram findings is most consistent with restrictive cardiomyopathy?
A. diastolic dysfunction with marked dilation of both atria
B. global systolic dysfunction
C. thickened septal wall greater than 15 mm
D. apical ballooning of L ventricle
E. diastolic collapse of ventricles
A, diastolic dysfunction with marked dilation of both atria
*restrictive cardiomyopathy is increased ventricular rigidity leading to diastolic dysfunction with preserved systolic function. Bc the ventricles are stiff and noncompliant, it leads to some backup of blood in the atria, leading to bilateral atrial enlargement on echocardiography
42
Global systolic dysfunction is seen with...
dilated cardiomyopathy
systolic HF
massive MI
43
a thickened septal wall of greater than 15 mm is seen in...
HCM
44
Apical ballooning of L ventricle
Takotsubo cardiomyopathy
45
diastolic collapse of the ventricles
cardiac tamponade
46
```
An 11 yo previously healthy male with recent symptoms of myalgias and runny nose presents with a 3 week onset of gradual exercise intolerance, abdominal pain and SOB. There is no periorbital edema or skin lesions. Exam shows rales and a third heart sound. CXR shows cardiomegaly. Biopsy of cardiac tissue shows infiltration of lymphocytes with myocardial tissue necrosis. Which of the following most likely caused the symptoms?
A. herpes simplex virus
B. enterovirus
C. adenovirus
D. influenza virus
E. trypanosoma cruzi
```
B, enterovirus
*viruses are the most common cause of myocarditis, which is an inflammation of the heart muscle. Of all of the viruses, the enteroviruses (i.e. Echovirus and Coxsackie viruses) are the most common
47
Echovirus and Coxsackie virus are the most common causes of...
Myocarditis
48
Hypotension with BRADYCARDIA and decreased pulmonary capillary wedge pressure is hallmark for..
Neurogenic shock
49
Hypotension with TACHYCARDIA and decreased pulmonary capillary wedge pressure is hallmark for....
Hypovolemic shock
50
Cool, clammy skin, decreased cardiac output with increased pulmonary capillary wedge pressure can be seen with...
Cardiogenic shock
51
```
Which of the following is not a side effect of propranolol?
A. depression
B. second degree heart block
C. impotence
D. masking hypoglycemia sxs
E. bronchodilation
```
E, bronchodilation
52
```
Which of the following medications are contraindicated in the management of a cocaine induced MI?
A. beta blockers
B. aspirin
C. calcium channel blockers
D. benzodiazepines
E. nitroglycerin
```
A, beta blockers.
53
```
Which of the following exam findings is most consistent with isolated L sided CHF?
A. positive Kussmaul's sign
B. peripheral edema
C. nausea and vomiting
D. positive hepatojugular reflex
E. ronchi
```
E, ronchi
54
An 18 yo male presents to clinic with intermittent SOB while playing sports. The pt is otherwise healthy and states that his dad died at 24 while playing sports. An echocardiogram shows asymmetrical septal wall thickening. Which of the following physical exam findings supports the most likely diagnosis?
A. systolic crescendo-decrescendo murmur that radiates to the neck
B. presence of a weak, delayed carotid upstroke
C. systolic crescendo-decrescendo murmur that decreases intensity with squatting
D. systolic crescendo-decrescendo murmur that increased in intensity with handgrip
E. systolic crescendo-decrescendo murmur that decreases intensity with Valsalva maneuver
C, systolic crescendo-decrescendo murmur that decreases intensity with squatting
* this describes HCM. Anything that makes the LV smaller (i.e. valsalva, standing) or thing that increase contractility (exercise, positive interpose) lead to a MORE intense murmur
* making the heart bigger, i.e. squatting, decreases the intensity of the murmur
55
Valsalva DECREASES all murmurs except...
HCM
| Mitral valve prolapse
56
Syndrome that is commonly seen in Asian males. Often found incidentally but can cause syncope, v fib and sudden death.
*Hallmark is an EKG with a RBBB pattern seen in V1 and V2, ST elevations in V1 -V3
Brugada syndrome
tx= cardioverter defibrillator
57
```
On cardiac exam, a holosystolic murmur is best heard at the apex and is accentuated when the pt is lying on the left side. The murmur radiates to the axilla and is associated with a mid-systolic ejection click. Which of the following is most likely the cause?
A. rheumatic heart dz
B. mitral valve prolapse
C. hypertension
D. degenerative atherosclerotic dz
E. congenital heart dz
```
B, mitral valve prolapse
58
Fibrates are the most effective drug to lower....
triglyceride levels
59
Mitral valve prolapse, tall stature, arachnodactyly, pectus carinatum, joint laxity, ectopia lentis. All exam findings consistent with..
Marfan's syndrome
60
```
A 65 yo female with poor dentition presents to the clinic with a 4 week history of fever of unknown origin. During the workup, she is noted to have splinter hemorrhages and new onset of holosytolic murmur that radiates to the axilla. She denies IV drug use. Which of the following are the most likely echocardiogram and blood culture findings?
A. staph aureus and pulmonic valve
B. strep viridans and mitral valve
C. staph aureus and tricuspid valve
D. staph epidermidis and mitral valve
E. enterococcus and aortic valve
```
B, strep viridans and mitral valve
*this is endocarditis. the most common cause of subacute endocarditis is streptococcus viridians, which is part of the normal oral flora. In a pt with poor dentition or gingivitis, transient bacteremia with S. viridian's causes subacute endocarditis. Subacute endocarditis most commonly affects the mitral, aortic, tricuspid, and pulmonic (in that order).
61
DOC for PSVT?
Adenosine
62
This classically presents with a continuous, machinery murmur heard loudest at the left upper sternal border
Patent ductus arteriosus
63
```
Which of the following most reliably distinguishes unstable angina from stable angina pectoris?
A. CP radiating to arm
B. dull chest pressure
C. SOB
D. CP lasting 55 minutes
E. CP brought on by exertion
```
D, CP lasting 55 minutes
*acute coronary syndrome (unstable angina, STEMI, NSTEMI) is classically associated with CP that lasts more than 30 minutes and if often not relieved with rest of multiple trials of nitro. All other choices are nonspecific and can be seen in both stable and unstable angina.
64
```
45 yo brought to ER unresponsive. Exam shows increased jugular venous pressure worsened with inspiration, a BP of 90/60, muffled heart sounds and normal breath sounds. Which of the following is recommended management of this pt?
A. chest tube thoracostomy
B. pericardial window
C. pericardiocentesis
D. pericardiectomy
E. IV furosemide
```
C, pericardiocentesis
*the presentation of Beck's triad: systemic hypotension, smuggled heart sounds and increased jugular venous distention are hallmark for pericardial tamponade! First line management is pericardiocentesis. Needle decompression removes the fluid in the pericardium that is reducing the cardiac output.
65
up to 70% of patients with coarctation of the aorta also have a...
bicuspid aortic valve
66
```
A 70 yo female has an echocardiogram performed for follow up eval after having positive cardiac enzymes with a negative angiography. The echocardiogram shows apical left ballooning. What is likely the dx?
A. unstable angina
B. Brugada syndrome
C. Takayasu arteritis
D. Takotsubo cardiomyopathy
E. restrictive cardiomyopathy
```
D, Takotsubo cardiomyopathy
*most common in menopausal women. usually presents with symptoms of acute coronary syndrome
67
```
43 yo otherwise healthy female has been having recurrent episodes of episodic dull chest pain that usually occurs at rest or awakens her at night. She denies any pain currently and is asymptomatic. CXR shows no acute cardiopulmonary dz. EKG shows normal sinus rhythm at 88 bp with no ST-T wave changes. An exercise stress test is performed and showed no acute ST depression, ST elevations or T wave inversions. What is likely the dx?
A. acute pericarditis
B. stable angina
C. unstable angina
D. prinzmetal's angina
E. NSTEMI
```
D, Prinzmetal's angina
*due to coronary vasospasm, leading to transient ST elevations and a normal ECG in-between episodes. Chest pain is classically non exertional and often occurs at night and at rest.
68
```
In a hemodynamically stable patient with A fib, which of the following is considered the management of choice if vagal maneuvers fail to decrease HR?
A. adenosine
B. unsynchronized cardioversion
C. synchronized cardioversion
D. amiodarone
E. verapamil
```
E, verapamil
*beta blockers or calcium channel blockers are the first line management for a fib or aflutter
69
```
A 14 yo male comes in for wellness visit. Cardiac exam shows a systolic ejection crescendo-decrescendo murmur best heard at the left upper sternal border with a loud first hear sound and a widely fixed second heart sound that does not vary with respirations. BP in the right arm is 120/80 and left arm is 125/80. Carotid and femoral pulses are 2+. Which of the following is the dx?
A. coarctation of aorta
B. patent duct arteriosus
C. atrial septal defect
D. aortic stenosis
E. aortic regurg
```
C, atrial septal defect
70
```
Which of the following is a class II anti-arrhythmic drug that antagonizes the alpha-1, beta-1, and beta 2 receptors?
A. atenolol
B. propranolol
C. metoprolol
D. nadolol
E. carvedilol
```
E, carvedilol
71
50 yo male with no PMH presents with substernal chest pain. He is found to have an anterolateral MI on electrocardiogram. A coronary angiogram is performed, showing a critical occlusion of the L main coronary artery. Which of the following is the most appropriate management of this pt?
A. percutaneous transluminal coronary angioplasty with stent
B. coronary artery bypass graft
C. percutaneous transluminal coronary angioplasty without stent
D. initiation of an ACE inhibitor
E. Aspirin and clopidogrel for 6 months
B, coronary artery bypass graft
*CABG is the definitive management of patients with coronary artery disease if the occlusion involves the left main coronary artery, occlusion involving 3 or more coronary arteries and/or decreased left ventricular ejection fraction
72
definitive management of patients with coronary artery disease if the occlusion involves:
* the left main coronary artery
* occlusion involving 3 or more coronary arteries and/or
* decreased left ventricular ejection fraction
Coronary artery bypass graft (CABG)
73
Definitive tx for:
* CAD NOT involving left main coronary artery
* less than 3 coronary vessels
* pts with normal or near normal EF
Percutaneous transluminal coronary angioplasty with or without stent
74
Long term management of STEMI once pt is stabilized
ACE inhibitor
| prevent long term progression from STEMI to HF
75
```
56 yo female presents to the ER with worsening dyspnea. Her home medications include HCTZ, carvedilol and lisonpril. Exam reveals a S3 gallop and rales are heard throughout both lung fields. CXR shows cardiomegaly. An echocardiogram shows a dilated cardiac chamber, thin ventricular walls and an EF of 40%. BP is 180/96 mmHg. Which of the following is NOT part of the routine management of this pt?
A. d/c carvedilol temporarily
B. IV furosemide
C. elevate head of bed
D. IV morphine
E. IV verapamil
```
E, IV verapamil
**nondihydropyridine Ca channel blockers are NOT used in the management of systolic HF. Systolic HF is diagnosed by echocardiogram evidence of dilated thin chamber walls and decreased EF. In systolic HF, CCBs will often exacerbate the symptoms
76
Can calcium channel blockers be used in systolic or diastolic HF?
ONLY Diastolic!
**do not use CCBs in systolic HF!!!! THEY WILL EXACERBATE SYMPTOMS
77
What kind of HF is diagnosed by echocardiogram evidence of dilated thin chamber walls and decreased EF
Systolic HF
78
```
On cardiac exam, a high pitched early diastolic murmur is best heard at the left sternal border that is accentuated with deep inspiration, consistent with a Graham Steell murmur. Which of the following valvular abnormalities are most commonly associated with the Graham Steell murmur?
A. tricuspid regurg
B. pulmonary regurg
C. aortic regurg
D. aortic stenosis
E. pulmonic stenosis
```
B, pulmonary regurg
79
Holosystolic murmur best heard at the xyphoid
Tricuspid regurg
80
Diastolic blowing murmur best heard at the left upper sternal border. Inspiration decreases its intensity..heard maximally at end of expiration.
Aortic regurg
81
```
During cardiac exam, a systolic crescendo-descrescendo murmur is best heard at the right upper sternal border and radiates to the carotids that decreases in intensity with the Valsalva maneuver. An electrocardiogram shows L ventricular hypertrophy. Which of the following physical exam findings arrest consistent with the suspected dx?
A. weak, delayed peripheral pulse
B. presence of an opening snap
C. presence of bounding pulses
D. presence of ejection click
E. presence of wide pulse pressure
```
A, weak delayed peripheral pulse
*this pt has aortic stenosis. the stenotic aortic valve decreases the amount of blood that can be ejected from the ventricles leading to pulsus parvus et tardus (a weak and delayed pulse) and a fixed cardiac output
82
Weak, delayed peripheral pulses and a fixed cardiac output seen with...
aortic stenosis
83
Bounding pulses and wide pulse pressure seen with...
aortic regurgitation
84
```
Which of the following medications is used as first line management to reduce pulmonary arterial pressure in patients who are diagnosed with idiopathic pulmonary HTN
A. beta blockers
B. ACE inhibitors
C. CCBs
D. corticosteroids
E. diuretics
```
C, CCBs
85
```
Which of the following is the first line management of choice for torsades de points in a pt with palpable pulses?
A. unsynchronized cardioversion
B. procainamide
C. amiodarone
D. IV magnesium sulfate
E. adenosine
```
D, IV magnesium sulfate
86
```
In evaluation of a pt with dizziness. An EKG shows a constant PR interval of 0.24 seconds with occasional dropped narrow QRS complexes. Which of the following is most likely the dx?
A. third degree heart block
B. first degree heart block
C. second degree heart block Mobitz I
D. second degree heart block Mobitz II
```
D, second degree heart block Mobitz II
87
A pregnant female at 20 wks gestation presents with R leg swelling measured 4 cm bigger compared to the L leg after a 7 hour trip. She is not experiencing any SOB or chest pain. Which of the following is the most next appropriate step in the eval of this pt?
A. venography of lower extremity
B. Helical CT scan
C. D-Dimer
D. venous duplex ultrasound of the lower extremities
E. ventilation-perfusion scan
D, venous duplex ultrasound of the lower extremities
88
```
A 34 yo female is found to have "saw tooth" waves on ECG with a ventricular rate of 140 bpm. QRS complexes are narrow. There is no associated CP or SOB. Her BP is 140/90. Which of the following is the next appropriate management?
A. atropine
B. amiodarone
C. synchronized cardioversion
D. verapamil
E. radiofrequency ablation
```
D, verapamil
89
```
Which of the following physical exam findings is most consistent with acute anterolateral MI?
A. increased JVP
B. sinus bradycardia
C. fourth heart sound (S4)
D. peripheral edema
E. anterior wall chest tenderness
```
C, fourth heart sound (S4)
*a fourth heart sound is the most consistent physical exam findings in patients with MI
90
```
Which of the following medications is the best initial management for the long term management of HF?
A. dobutamine
B. nesiritide
C. lisinopril
D. digoxin
E. spironolactone
```
C, lisinopril
91
```
Which of the following is the first line medical tx of HCM?
A. digoxin
B. propranolol
C. nitro
D. furosemide
E. lisinopril
```
B, propranolol
