Cardio reversed

Question 1

DOE, PND, edema. Echo w/ LVH or RVH hypokinesis

Answer 1

CHF

Question 2

S3

Answer 2

CHF, dilated cardiomyopathy, pregnancy

Question 3

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

Answer 3

Hypertrophic CM or fatal arrhythmia. Get EKG or Echo

Question 4

Alcoholic with palpitations, arrhythmias

Answer 4

Atrial fibrillation (holiday heart)

Question 5

Irregularly irregular

Answer 5

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

Question 6

Atrial fibrillation or prosthetic valve

Answer 6

Warfarin (2-3 for Afib; 2.5-3.5 for valve); Tx warfarin is Vit K

Question 7

Hx angina but no acute symptoms. EKG no acute changes

Answer 7

Do exercise stress test

Question 8

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

Answer 8

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

Question 9

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

Answer 9

Pericarditis

Question 10

JVD, hypotension, muffled heart sounds

Answer 10

Pericardial effusion/tamponade (Beck’s triad)

Question 11

Sudden onset ripping, tearing chest pain, diminished pulses

Answer 11

Aortic dissection

Question 12

Flank pain, hypotension, pulsatile abdominal mass

Answer 12

AAA

Question 13

EKG changes, N/V yellow-green visual disturbances

Answer 13

Digoxin toxicity (hypokalemia will make worse)

Question 14

HTN tx w/ meds, cough or angioedema

Answer 14

ACEI is cause

Question 15

DM and HTN

Answer 15

ACEI is best choice

Question 16

Post MI

Answer 16

Beta blockers

Question 17

HTN not responsive to basic meds

Answer 17

Think secondary HTN most likely Renal artery stenosis

Question 18

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

Answer 18

Bacterial endocarditis (strep. viridians) prevention

Question 19

IVDA w/ new murmur

Answer 19

Bacterial endocarditis (staph aureus, strep. viridians)

Question 20

Elderly w/ systolic murmur

Answer 20

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

Question 21

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

Answer 21

Aortic stenosis

Question 22

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

Answer 22

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

Question 23

Diastolic murmur best heart apex without radiation

Answer 23

mitral stenosis (ARMS are BAD)

Question 24

Female or Post MI, systolic murmur best @ apex preceded by click without radiation

Answer 24

Mitral valve prolapse

Question 25

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

Answer 25

Mitral regurgitation

Question 26

New murmur after MI (esp. if apical systolic)

Answer 26

Mitral regurgitation (caused by papillary muscle rupture)

Question 27

Continuous harsh, machine-like murmur

Answer 27

PDA

Question 28

Infant w/ dyspnea, difficulty feeding. Holosystolic murmur @ LSB, 3rd ICS. LVH and RVH

Answer 28

VSD

Question 29

Pulseless electrical activity

Answer 29

Hs and Ts Hypovolemia Hypoxia Hypothermia Hydrogen ion (acidosis) Hyper-hypokalemia Hypoglycemia Tamponade cardiac Tension pneumo Thrombosis - PE or cardio Toxins Trauma

Question 30

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

Answer 30

Coarctation of aorta

Question 31

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

Answer 31

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

Question 32

LE pain after long periods of standing, dilated, tortuous veins

Answer 32

Varicose veins. Tx with compression stockings

Question 33

Murmur that causes weak carotid pulse

Answer 33

AS

Question 34

Illegal substance that causes MI secondary to acute coronary artery vasospasm

Answer 34

Cocaine

Question 35

Side effect of statin drugs

Answer 35

Liver toxicity

Question 36

Janeway lesions

Answer 36

Infective endocarditis scaly plaques on palms and soles

Question 37

Osler nodes

Answer 37

Infective endocarditis tender nodules on tips of fingers and toes

Question 38

Pre-load

Answer 38

Volume of flood in ventricles at the end of diastole

Question 39

Ejections fraction

Answer 39

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

Question 40

Tearing, ripping pain between scapula

Answer 40

Aortic dissection

Question 41

CXR with aortic dissection

Answer 41

Widened mediastinum

Question 42

BP higher in arms than the legs

Answer 42

Coarctation of the aorta

Question 43

EKG - rate assessment

Answer 43

300-150-100-75-60-50

Question 44

PR interval greater than 0.2 sec consistently in every cycle

Answer 44

first degree AV block

Question 45

PR interval gradually lengthens is successive cycles, last P waves fails to conduct ventricles

Answer 45

Wenchebach Second degree AV block

Question 46

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

Answer 46

Complete third degree block

Question 47

Types of second degree AV blocks

Answer 47

Mobitz and Wenchebach

Question 48

Asystole

Answer 48

Confirm in a second lead