Cardiology

Question 1

murmur of mitral stenosis

Answer 1

low-pitched, rumbling, diastolic with loud S1 and opening snap

Question 2

causes of mitral stenosis

Answer 2

rheumatic fever, atrial myxoma

Question 3

murmur of mitral valve regurgitation

Answer 3

loud holosystolic murmur best heard at the apex that radiates to the base

Question 4

murmur of mitral valve prolapse

Answer 4

early to midsystolic click with with late systolic murmur best heard at left lateral heart border

Question 5

causes of acute mitral regurgitation

Answer 5

endocarditis, AMI, trauma

Question 6

murmur of aortic stenosis

Answer 6

crescendo-decrescendo systolic murmur radiating to the neck

Question 7

causes of aortic stenosis

Answer 7

calcific valve degeneration, bicuspid aortic valve

Question 8

murmur of aortic regurgitation

Answer 8

high-pitched, blowing diastolic murmur best heard at left sternal border, decreases with valvsalva

Question 9

causes of acute aortic regurgitation

Answer 9

endocarditis, aortic dissection

Question 10

hypertrophic cardiomyopathy murmur

Answer 10

harsh systolic ejection murmur that increases with standing/Valsalva and decreases with squatting and handgrip

Question 11

signs associated with aortic regurgitation

Answer 11

water hammer pulse, de Musset sign (head bobbing with pulse), Quincke sign (pulsating nailbed), wide pulse pressure, Muller sign (visible pulsations of uvula)

Question 12

symptoms of mitral valve prolapse

Answer 12

asymptomatic or may have dyspnea, palpitations, nonexertional chest pain, fatigue

Question 13

most common cause of aortic regurgitation

Answer 13

endocarditis

Question 14

symptoms of aortic regurgitation

Answer 14

exertional dyspnea, angina, symptoms of heart failure

Question 15

what is austin flint murmur

Answer 15

late diastolic murmur best heard at apex.

Question 16

high intensity statins

Answer 16

atorvastatin 40-80 mg
rosuvastatin 20-40 mg

Question 17

moderate intensity statins

Answer 17

lovastatin 40-80 mg, pravastatin 40-80 mg, simvastatin 20-40 mg, atorvastatin 10-20 mg, rosuvastatin 5-10 mg

Question 18

low-intensity statins

Answer 18

pravastatin 10-20 mg, lovastatin 20 mg, fluvostatin 20-40 mg, simvastatin 10 mg

Question 19

most common type of cardiomyopathy

Answer 19

dilated

Question 20

most common cause of dilated cardiomyopathy (NOT in the setting of CAD)

Answer 20

idiopathic

Question 21

most common infectious causes of dilated cardiomyopathy

Answer 21

Viruses (especially enteroviruses, coxsackie virus)

Question 22

toxic causes of dilated cardiomyopathy

Answer 22

ETOH abuse, cocaine, anthracyclines (doxorubicin), radiation

Question 23

metabolic causes of dilated cardiomyopathy

Answer 23

thyroid disorders, thiamine deficiency

Question 24

less common infectious causes of dilated cardiomyopathy

Answer 24

postviral myocarditis, HIV, Lyme disease, Parvovirus B19, Chagas disease

Question 25

echocardiogram findings of dilated cardiomyopathy

Answer 25

left ventricular dilation, thin ventricular walls, decreased ejection fraction, ventricular hypokinesis

Question 26

hallmark PE finding for dilated cardiomyopathy

Answer 26

S3 gallop

Question 27

Cause of S3 gallop

Answer 27

filling of a dilated ventricle

Question 28

Agents for mortality reduction in dilated cardiomyopathy

Answer 28

ACE inhibitors/ARBs, beta blockers

Question 29

when to use AICD in dilated cardiomyopathy

Answer 29

EF<30-35%

Question 30

Normal axis

Answer 30

predominantly positive QRS in lead I and aVF (unless it is also predominantly negative in lead II, in which case it is left axis deviation)

Question 31

Left axis deviation

Answer 31

predominantly positive QRS in lead I and negative in aVF OR predominantly positive QRS positive in lead I and in lead aVF and predominately negative in lead II

Question 32

right axis deviation

Answer 32

QRS is mostly negative in lead I and positive in lead aVF

Question 33

normal PR interval

Answer 33

0.12-0.2 seconds (3-5 boxes)

Question 34

left atrial enlargement ECG

Answer 34

m-shaped P-wave in lead II >0.12 seconds, biphasic P in V1 with larger terminal component

Question 35

right atrial enlargement ECG

Answer 35

tall P-wave in lead II >3mm, biphasic P in V1 with larger initial component

Question 36

normal QRS width

Answer 36

<0.12 seconds

Question 37

left BBB ECG

Answer 37

Wide QRS, broad/slurred R in V5/V6, deep S wave in V1, ST elevation in V1-V3

Question 38

right BBB ECG

Answer 38

Wide QRS, RsR' in V1/V2, wide S wave in V6

Question 39

right ventricular hypertrophy ECG

Answer 39

R>S in V1 or R>7 mm in height in V1

Question 40

Left ventricular hypertrophy ECG

Answer 40

S in V1 + R in V5 (or V6) > 35 mm in men or 30 mm in women

Question 41

definition of pathological Q waves

Answer 41

greater than 1 box in width or in depth

Question 42

ECG findings for LAD occlusion

Answer 42

ST elevations/Q waves in leads V1-V4

Question 43

ECG findings for proximal LAD occlusion only

Answer 43

ST elevations/Q waves in V1, V2

Question 44

ECG findings for circumflex artery occlusion

Answer 44

ST elevations/Q waves in I, aVL, V5, V6

Question 45

ECG findings for RCA occlusion

Answer 45

ST elevations/Q waves in II, III, aVF

Question 46

ECG findings for mid LAD +/- circumflex occlusion

Answer 46

ST elevations/Q waves I, aVL, V4, V5, V6

Question 47

portion of heart perfused by LAD

Answer 47

anterior wall

Question 48

portion of heart perfused by proximal LAD

Answer 48

septum

Question 49

portion of heart perfused by circumflex

Answer 49

lateral wall

Question 50

portion of heart perfused by RCA (in most people)

Answer 50

inferior wall

Question 51

ECG findings of posterior wall MI

Answer 51

ST depressions in V1-V2

Question 52

What arteries perfuse posterior wall

Answer 52

RCA, circumflex

Question 53

Normal QRS axis numbers

Answer 53

-30 to +90

Question 54

causes of left axis deviation

Answer 54

LBBB, LVH, inferior MI, elevated diaphragm, L anterior hemiblock, WPW

Question 55

causes of right axis deviation

Answer 55

right ventricular hypertrophy, lateral MI, COPD, left posterior hemiblock

Question 56

preferred antiarrhythmic for WPW

Answer 56

Procainamide

Question 57

1st line antiarrhythmic for atrial flutter or atrial fibrillation

Answer 57

Beta blocker or CCB

Question 58

what type of CCBs are antiarrhythmics

Answer 58

non-dihydropyridines

Question 59

hallmark of sinus arrhythmia

Answer 59

heart rate increases with inspiration and decreases with expiration

Question 60

what is sick sinus syndrome

Answer 60

dysfunction of sinus node that leads to combination of sinus arrest with alternating paroxysms of atrial tachyarrhythmias and bradyarrhythmias

Question 61

causes of sick sinus syndrome

Answer 61

sinus node fibrosis, older age, corrective cardiac surgery, medications, systemic diseases affecting the heart

Question 62

definitive treatment of sick sinus syndrome

Answer 62

permanent pacemaker +/- AICD

Question 63

1st degree AV block criteria

Answer 63

PR interval >0.2 seconds with all P waves followed by QRS Complexes

Question 64

1st degree AV block treatment

Answer 64

often none needed, but can try atropine if symptomatic

Question 65

what is a 2nd degree AV block, type I

Answer 65

AKA Wenkebach or Mobitz I, progressive PR interval lengthening followed by a dropped QRS

Question 66

2nd degree AV block, type I causes

Answer 66

high vagal tone, inferior wall MI, AV node blocking agents (BBs, CCBs), hyperkalemia

Question 67

what is 2nd degree AV block, type II

Answer 67

interruption of electrical impulses resulting in occasional non-conducted impulses (constant PR interval except for the dropped QRS complexes)

Question 68

block location in Mobitz I

Answer 68

commonly above the bundle of His

Question 69

block location in Mobitz II

Answer 69

commonly at the bundle of His

Question 70

causes of Mobitz II

Answer 70

rarely seen in Pts without structural heart disease (AMI, myocardial fibrosis, etc.)

Question 71

what is 3rd degree AV block

Answer 71

total AV dissociation (no atrial impulses reach the ventricles)