Cardiology

Question 1

What are the most common life-threatening causes of acute chest pain?

Answer 1

Acute coronary syndrome (ACS), aortic dissection, pulmonary embolism (PE), tension pneumothorax, pericarditis with tamponade, and esophageal rupture (Boerhaave’s syndrome).

Question 2

What clinical features differentiate cardiac from non-cardiac chest pain?

Answer 2

Cardiac pain is often substernal, exertional, and relieved with rest or nitroglycerin, while non-cardiac causes (e.g., GERD, musculoskeletal) are positional, sharp, and reproducible with palpation.

Question 3

What initial diagnostic tests should be obtained in a patient presenting with acute chest pain?

Answer 3

ECG, troponins, chest X-ray, D-dimer (if PE suspected), and bedside echocardiography if unstable.

Question 4

What are the classic symptoms of acute pericarditis?

Answer 4

Pleuritic chest pain relieved by sitting up and leaning forward, pericardial friction rub, and diffuse ST-segment elevations on ECG.

Question 5

How does pericarditis differ from myocardial infarction on ECG?

Answer 5

Pericarditis shows diffuse ST elevations and PR depressions, while MI shows focal ST elevation in specific leads.

Question 6

What is the first-line treatment for viral or idiopathic pericarditis?

Answer 6

NSAIDs and colchicine; corticosteroids are reserved for refractory cases.

Question 7

What are the distinguishing features of an aortic stenosis murmur?

Answer 7

Systolic ejection murmur, crescendo-decrescendo, heard best at the right upper sternal border and radiates to the carotids.

Question 8

How does mitral regurgitation differ from aortic stenosis on auscultation?

Answer 8

Mitral regurgitation produces a holosystolic murmur heard best at the apex and radiates to the axilla.

Question 9

What are the causes of a diastolic murmur, and why is it always considered pathologic?

Answer 9

Aortic regurgitation and mitral stenosis; diastolic murmurs are always due to structural heart disease and require echocardiography.

Question 10

What are the three major classifications of syncope?

Answer 10

Cardiac (arrhythmia, structural heart disease), neurogenic (vasovagal, orthostatic hypotension), and metabolic (hypoglycemia, anemia).

Question 11

How does vasovagal syncope differ from syncope due to an arrhythmia?

Answer 11

Vasovagal syncope has a prodrome (lightheadedness, nausea), while arrhythmic syncope is sudden with no warning signs.

Question 12

What are red flags that indicate high-risk syncope requiring hospitalization?

Answer 12

History of heart disease, syncope during exertion, abnormal ECG, persistent low BP, and lack of prodrome.

Question 13

What are the key differences between systolic and diastolic heart failure?

Answer 13

Systolic HF (HFrEF) has reduced ejection fraction (<40%), while diastolic HF (HFpEF) has preserved EF (>50%) with impaired relaxation.

Question 14

What physical exam findings suggest congestive heart failure?

Answer 14

JVD, crackles/rales, S3 heart sound, lower extremity edema.

Question 15

What medications improve mortality in heart failure with reduced ejection fraction (HFrEF)?

Answer 15

Beta-blockers (carvedilol, metoprolol), ACE inhibitors, aldosterone antagonists, and SGLT-2 inhibitors.

Question 16

What is the pathophysiology of hypertrophic cardiomyopathy?

Answer 16

Autosomal dominant genetic disorder causing left ventricular hypertrophy and dynamic left ventricular outflow tract (LVOT) obstruction.

Question 17

What is the hallmark murmur of hypertrophic cardiomyopathy?

Answer 17

Systolic crescendo-decrescendo murmur at the left sternal border, increasing with Valsalva and decreasing with squatting.

Question 18

What is the first-line treatment for symptomatic hypertrophic cardiomyopathy?

Answer 18

Beta-blockers or calcium channel blockers (verapamil) to reduce heart rate and improve diastolic filling.

Question 19

What are the ECG findings of atrial fibrillation?

Answer 19

Irregularly irregular rhythm, absent P waves, and narrow QRS complexes.

Question 20

How can supraventricular tachycardia (SVT) be distinguished from ventricular tachycardia (VT)?

Answer 20

SVT has a narrow QRS, while VT has a wide QRS and often originates from diseased ventricles.

Question 21

What is the first-line treatment for stable atrial fibrillation?

Answer 21

Rate control with beta-blockers or calcium channel blockers (diltiazem, verapamil).

Question 22

What are common causes of palpitations?

Answer 22

Cardiac arrhythmias, anxiety, hyperthyroidism, caffeine, and stimulant use.

Question 23

What key historical factors help differentiate benign from serious palpitations?

Answer 23

Palpitations with syncope or exertion suggest arrhythmia, while palpitations with stress or caffeine intake are more benign.

Question 24

What is the initial workup for palpitations in a stable patient?

Answer 24

ECG, Holter monitor (if episodic), thyroid function tests, and electrolytes.

Question 25

What lifestyle modifications are recommended for new-onset hypertension?

Answer 25

DASH diet, sodium restriction, weight loss, exercise, and reduced alcohol intake.

Question 26

What medications are first-line for primary hypertension?

Answer 26

ACE inhibitors, thiazide diuretics, calcium channel blockers.

Question 27

What are the signs of end-organ damage in hypertensive emergency?

Answer 27

Papilledema, encephalopathy, stroke, myocardial ischemia, renal dysfunction.

Question 28

What differentiates hypertensive urgency from hypertensive emergency?

Answer 28

Urgency is severe hypertension (>180/120) without organ damage; emergency includes acute end-organ damage.

Question 29

What is the treatment goal in hypertensive emergency?

Answer 29

Lower BP by 25% in the first hour, then gradually over 24 hours using IV medications (labetalol, nicardipine).

Question 30

Why should blood pressure not be lowered too quickly in hypertensive emergency?

Answer 30

Rapid lowering can cause cerebral, myocardial, or renal ischemia.

Question 31

What are the most common causes of microcytic anemia?

Answer 31

Iron deficiency, thalassemia, anemia of chronic disease, and lead poisoning.

Question 32

What is the best initial test for suspected iron deficiency anemia?

Answer 32

Serum ferritin (low in iron deficiency, normal or high in anemia of chronic disease).

Question 33

How does vitamin B12 deficiency differ from folate deficiency?

Answer 33

B12 deficiency has neurological symptoms (paresthesia, ataxia), while folate deficiency does not.

Question 34

What are the five types of shock?

Answer 34

Hypovolemic, cardiogenic, obstructive, distributive (septic, anaphylactic, neurogenic).

Question 35

What are the first steps in managing a patient with suspected shock?

Answer 35

IV fluids, oxygen, identify and treat underlying cause, and monitor vital signs closely.

Question 36

How does lymphangitis present?

Answer 36

Painful red streaking along lymphatic drainage pathways, fever, swollen lymph nodes.

Question 37

What are the hallmark signs of lymphoma?

Answer 37

Painless lymphadenopathy, night sweats, weight loss, and fever.