Cardiology

Question 1

Define pulsus alternans.

Answer 1

EKG waveform changes from beat to beat

Question 2

If you suspect temporal arteritis what test gives a definitive diagnosis?

Answer 2

Biopsy of the temporal artery

Question 3

You have a patient with paradoxical pulsus. What two diagnosis should you be thinking of?

Answer 3

Pericarditis and pericardial effusion

Question 4

Define paradoxical pulse.

Answer 4

There is a large difference in pulse pressure between inhalation and exhalation

Question 5

You hear a murmur with a fixed split S2 over the left 2nd intercostal space. What diagnosis should you be thinking of?

Answer 5

Atrial septal defect

Question 6

Kerley B lines should make you think of what diagnosis?

Answer 6

CHF

Question 7

At what size aortic aneurysm would you consider doing an elective surgical repair?

Answer 7

> 5.5cm

Question 8

Patient arrives in acute distress. Chest x-ray shows a wide mediastinum. What diagnosis should you be thinking of?

Answer 8

Aortic dissection

Question 9

In a subacute case of endocarditis what is the most common pathogen?

Answer 9

Strep viridans

Question 10

You have a patient with pulsus alternans. What two diagnosis should you be thinking of?

Answer 10

Pericarditis and pericardial effusion

Question 11

In Cushing’s syndrome is the serum corticosteroid elevated or low?

Answer 11

Elevated

Question 12

In an acute case of endocarditis what is the most common pathogen?

Answer 12

Staph aureus

Question 13

Where is disease of the pulmonary valve best heard?

Answer 13

2nd left intercostal space

Question 14

What is the treatment for polymyalgia rheumatica?

Answer 14

low dose prednisone

Question 15

You hear a midsystolic click. What diagnosis should you be thinking of?

Answer 15

Mitral valve prolapse

Question 16

A BNP below what value will allow you to rule out CHF?

Answer 16

<100

Question 17

Where is disease of the tricuspid valve best heard?

Answer 17

Along the left lower sternal border

Question 18

What are the three major criteria for endocarditis?

Answer 18

2 positive blood cultures, a positive transesophageal echocardiography, new murmur

Question 19

What is the most common cause of an atrial septal defect?

Answer 19

Patent foramen ovale

Question 20

What is the first line medical treatment for an a pheochromocytoma?

Answer 20

Alpha blockers. Do not give Beta blockers

Question 21

What is the therapeutic range for INR following an organic valve replacement?

Answer 21

2 to 3

Question 22

What is the best patient position to hear aortic regurge and aortic stenosis?

Answer 22

Sitting up and leaning forward

Question 23

What is the one contraindication for pharmacological stress testing?

Answer 23

Aortic stenosis

Question 24

Which EKG leads are used to diagnose an anterolateral MI?

Answer 24

V5 and V6

Question 25

Jaw claudication should make you think of what diagnosis?

Answer 25

Temporal arteritis

Question 26

On physical exam you hear a harsh systolic murmur along the right sternal border. What diagnosis should you be thinking of?

Answer 26

Aortic stenosis

Question 27

The EKG shows ST elevations in all leads. What diagnosis should you be thinking of?

Answer 27

Pericarditis

Question 28

What it the medical treatment of temporal arteritis?

Answer 28

High dose prednisone

Question 29

Which EKG leads are used to diagnose an anterior wall MI?

Answer 29

V1, V2 and V3

Question 30

A boot shaped heart on CXR should make you think of what diagnosis?

Answer 30

Tetralogy of Fallot

Question 31

What is the first line medical treatment for an aortic dissection?

Answer 31

Beta blocker - labetalol

Question 32

What are the three components of Virchow's triad?

Answer 32

DVT risk - Stasis, vascular injury, hypercoagulability

Question 33

Where is disease of the mitral valve best heard?

Answer 33

At the apex

Question 34

What is the therapeutic range for INR following a mechanical valve replacement?

Answer 34

2.5-3.5

Question 35

List the 4 minor criteria for diagnosing endocarditis.

Answer 35

Fever, embolic event (Janeway lesions or petechiae, splinter hemorrhages), immunological event (osler nodes, glomerulonephritis), 1 positive blood culture.

Question 36

Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?

Answer 36

Osler nodes = Ouch

Question 37

You have diagnosed a patient with high blood pressure. If he is otherwise healthy, what is the target blood pressure you're shooting for?

Answer 37

less than 140/90

Question 38

You hear a story about a young boy who recently died during a basketball game. What diagnosis should you be thinking of?

Answer 38

Hypertrophic cardiomyopathy

Question 39

On physical exam you hear a loud harsh holosystolic murmur at the left sternal border. What diagnosis should you be thinking of?

Answer 39

Ventral septal defect

Question 40

What causes an S4 sound?

Answer 40

A stiff left ventricle

Question 41

You notice a machine like murmur heard best over the left second intercostal space. What diagnosis should you be thinking of?

Answer 41

Patent ductus

Question 42

Wide pulse pressures with a decrescendo murmur at the left 3rd intercostal space should make you think of what diagnosis?

Answer 42

Aortic regurgitation

Question 43

On physical exam where are aortic issues best auscultated?

Answer 43

2nd right intercostal space

Question 44

What are the three inferior leads?

Answer 44

II, III and aVF

Question 45

On physical exam you hear a blowing murmur at the apex which is pansystolic. There is also a brisk carotid upstroke. What diagnosis should you be thinking of?

Answer 45

Mitral valve regurge

Question 46

On physical exam you hear an opening snap & low pitched murmur at the apex. What diagnosis should you be thinking of?

Answer 46

Mitral stenosis

Question 47

What is the target blood pressure in a patient with diabetes or renal disease?

Answer 47

less than 130/80

Question 48

List three medications which may be used for pharmacological stress test.

Answer 48

Adenosine, dobutamine, dipyridamole

Question 49

What is Tietze syndrome?

Answer 49

Costochondritis

Question 50

Child comes into the office with notable HTN but a weak femoral pulses. What diagnosis should you be thinking of?

Answer 50

Coarctation of the aorta

Question 51

What is the initial treatment for an MI?

Answer 51

MONA - Morphine, oxygen, nitroglycerin and aspirin