Cardio/Neuro (40)

Question 1

Vibratory/muscial systolic ejection murmur loudest @ LLSB in a child that increases when the pt lies down. What is it and what do you do next?

Answer 1

parental reassurance of the Still’s murmur. innocent murmur

Question 2

what class of monotherapy for hyperlipidemia shows clear improvement in overall mortality

Answer 2

statins (HMG-CoA reductase inhibitors)

Question 3

second line hyperlipidemia medication to add to statin (never a monotherapy)

Answer 3

ezetimibe (inhibit dietary absorption of cholesterol by binding Niemann-Pick C1-like 1 protein)

Question 4

Diastolic rumbling murmur without an opening snap. Widened pulse pressure, head bobbing, uvula pulsations, etc.

Answer 4

AR

Question 5

Apex. Diastolic rumbling murmur with an opening snap.

Answer 5

MS

Question 6

Apex. Late systolic murmur preceded by a click

Answer 6

MVP

Question 7

L2ICS. Harsh crescendo-decrescendo, mid-systolic ejectino murmur with palpable thrill.

Answer 7

PS

Question 8

L2ICS. early diastolic, high pitched, blowing decrescendo murmur

Answer 8

PR

Question 9

mid diastolic rumbling murmur with opening spap and wide splitting S1

Answer 9

TS

Question 10

holosystolic murmur incrasing intensity with inspiration

Answer 10

TR

Question 11

dx + test: 50+yo w/ HA, tenderness of scalp, jaw caludication, visual changes

Answer 11

temporal arteritis

ESR, then biospy

Question 12

DoC for ALS

Answer 12

riluzole

Question 13

botulism in (

Answer 13

babies - ingestion of clostridial

adults - ingestion of preformed botulinum toxin

Question 14

hyperlipidemia drug that causes myopathy and hepatotoxicity

Answer 14

statins

Question 15

tx for giant cell (temporal) arteritis WITH visual disturbances vs. WITHOUT

Answer 15

WITH = IV methylprednisolone for >3 days then oral prednisone

WITHOUT = oral prednisone

Question 16

Dx and tx: tachycardia, narrow QRS, no P-waves.

Answer 16

SVT

vagal maneuver, then adenosine (AVnode blocking agent)

Question 17

**friction rub = ??

sx: chest pain worse w/ deep inspiration and improves w/ leaning forward

PE: friction run

EKG: ST elevation

Answer 17

pericardial friction rub = pericarditis (inflamm of pericardial sac = thickened pericardial membrane and/or pericardial effusion)

Question 18

MCC of dementia >65 and

Answer 18

> 65 = Alzheimers

Question 19

Tx of moderate to severe migraines in pregnancy

Answer 19

sumitriptan (avoid long half life of frovatriptan)

Question 20

Menstrual migraines DoC

Answer 20

1. NSAIDs
2. triptans(suma)
3. OCP

Question 21

young teen with brief, arrhythmic, involuntary, bilateral UE myoclonic jerks w/o LoC.

Answer 21

Juvenile Myoclonic Epilepsy

Question 22

systolic crescendo-decrescendo ejection murmur loudest at RUSB that radiates to neck.

Elderly w/ syncope, angina, dyspnea dt HF

Answer 22

AS - age related calcification of AV

Question 23

Dx and first line of testing: young active person with crescendo-decrescendo systolic ejection murmur at LLSB worsened w/ valsalva.

Answer 23

Hypertrophic obstructive cardiomyopathy (Interventricular septum hypertrophy)

echocardiogram

Question 24

when is genetic testing appropriate for heart malformaiton?

Answer 24

left ventricular hypertrophy ID’d on echo.

Question 25

infant with FTT, poor feeding, diaphroesis, holosystolic murmur at LLSB

Answer 25

VSD - volume overlaod and CHF. left to right shunt ACYONOTIC (PDA and ASD too)

Question 26

dx test for peripheral arterial occlusive disease

Answer 26

ankle-brachial index (systolic of affected ankle/systolic of arm) THEN angiography

Question 27

asx in childhood. wide fixed, split S2 heart sound that maybe accompanied by systolic ejection murmur at left upper sternal border.

Answer 27

ASD

Question 28

progressive prolongation of PR interval on consecutive beats eentually followed by dropped P wave and no QRS

Answer 28

type one, second degree AV block (Mobitz1) disturbance in conduction through AV node

Question 29

PR interval remains constant with **intermittent dropped P wave** and no QRS (i.e .3 normal cycles:1dropped P wave and no QRS)

Answer 29

type two, second degree AV block (mobitz2) disturbance in AVn His-Purkinje

Question 30

PR interval >0.2sec Narrow QRS, regular P-P interval, slowed conduction of P-waves

Answer 30

first degree AV block

Question 31

wide QRS, regular P-P interval, no conduted P-waves (P-QRS independent)

Answer 31

third degree AV block

Question 32

erb duchenne palsy associated with what?

Answer 32

prolonged 2nd stag elabor (>120min), multiparity, large for gestational age infants (90th percentile, >4000g), previous infant with brachial plexus injury

Question 33

Dx steps for Guillain Barre Syndrome

Answer 33

CSF, Nerve conduction studies

Question 34

recommended Infective Endocarditis prophylaxis

Answer 34

amoxicillin for those with unrepaired cyanotic congenital heart disease and those iwth prosthetic valves. also and congenital heart dz repaired w/ prosthetic material for first 6mo.

Question 35

LDL goal in nondiabetic, very healthy, none-one risk factors LDL goal if two or more risk factors LDL goal if CV disease or DM or CAD, rardless of risk factors

Answer 35

less than 160 less than 140 less than 100 risk factors: Males more than 45y, F greater than 55 y, HDL less than 40, smoker, HTN greater than 140 or controlled with HTN meds, premature CAD in family in M less than 55/female less than 65

Question 36

HDL goal

Question 37

CHF pts should not receive what class of drug for pain?

Answer 37

NSAIDs - they cause Na and H20 retention

Question 38

muscle pain relieved by rest in a smoker/HTN/DM

Answer 38

peripheral artery disease secondary to atherosclerosis intermittent claudications

Question 39

SE and CI to ethosuximide

Answer 39

pancytopenia

Question 40

max HR from SA node = ?

Answer 40

220-age

Question 41

max HR from AV node = ?

Answer 41

40-60 per min

Question 42

max HR fro m ventricles = ?

Question 43

stroke risk factor that is most improtant

Answer 43

HTN

Question 44

recommended age for aspirin to prevent MI in @risk v. not

Answer 44

45-79 55-79

Question 45

central v peripheral nerve palsy

Answer 45

central spares the forehead (involved UMN) - can wrinkle forehead peripheral - unilateral muscle paralysis f entire face

Question 46

most effective first line treatment for insomnia

Answer 46

CBT

Question 47

repair an AAA when?

Answer 47

>5.5cm

Question 48

screen 4-4.5cm AAA how often

Answer 48

q6mo

Question 49

if a person in asystole, when two meds can be used?

Answer 49

epinepherine and vasopressin no electrical defibrillation

Question 50

acute onset unilateral weakness or speech impairment that resolves within 1hr

Answer 50

TIA - MRI is best next step

Question 51

Dx and tx: episodes of severe I/L periorbital HA with ipsilateral lacrimation and/orrhinorrhea

Answer 51

cluster HA 100%O2