Cardiology

Question 1

What is differential cyanosis associated with?

Answer 1

Large PDA, secondary pulmonary hypertension with right-to-left shunting at the great vessel level.

Question 2

What conditions are associated with premature atherosclerosis?

Answer 2

Pseudoxanthoma elasticum, Marfan syndrome, Loeys-Dietz syndrome.

Question 3

What are the physical findings associated with Marfan syndrome?

Answer 3

High arched palate.

Question 4

What is a characteristic finding in Loeys-Dietz syndrome?

Answer 4

Bifid uvula.

Question 5

What is Tangier disease associated with?

Answer 5

Orange tonsils.

Question 6

What condition is indicated by blue sclerae?

Answer 6

Osteogenesis imperfecta.

Question 7

What syndrome increases the risk for mitral valve prolapse?

Answer 7

Straight back syndrome.

Question 8

What condition increases the risk for aortic regurgitation?

Answer 8

Ankylosing spondylitis.

Question 9

What are the signs of severe tricuspid regurgitation?

Answer 9

Systolic pulsations of the liver, large V waves, cv waves.

Question 10

What are Janeway lesions?

Answer 10

Non-tender, slightly raised hemorrhages on palms and soles associated with infective endocarditis.

Question 11

What are Osler nodes?

Answer 11

Tender, raised nodules on the pads of the fingers and toes.

Question 12

What does the Homan sign indicate?

Answer 12

Calf pain elicited on active dorsiflexion of the foot against resistance; sign for deep venous thrombosis.

Question 13

What is the most important bedside measurement to estimate the volume status of a patient?

Answer 13

Jugular venous pressure using the internal jugular vein.

Question 14

What is considered abnormal jugular venous pressure?

Answer 14

> 4.5 cm H2O at 30-degree angle.

Question 15

What does a prominent a wave represent?

Answer 15

Represents RA presystolic contraction.

Question 16

What does a cannon a wave indicate?

Answer 16

AV dissociation, RA contraction against a closed tricuspid valve.

Question 17

What does an absent a wave suggest?

Answer 17

Atrial fibrillation.

Question 18

What does the c wave represent?

Answer 18

Reflects carotid pulsation in the neck and/or early systolic increase in RA pressure as the RV pushes the closed tricuspid valve into the RA.

Question 19

What does the v wave represent?

Answer 19

Represents atrial filling (or atrial diastole) during ventricular systole and peaks as S2.

Question 20

What does the y descent correspond to?

Answer 20

Corresponds to the fall in the RA pressure after opening of the tricuspid valve.

Question 21

What is the Kussmaul sign?

Answer 21

Refers to the rise or lack of fall of the JVP during inspiration.

Question 22

What is the abdominojugular reflux test?

Answer 22

Sustained rise of >3 cm in JVP for at least 15 seconds after performing firm and consistent pressure over the upper abdomen.

Question 23

What does pulsus parvus et tardus indicate?

Answer 23

Severe aortic stenosis.

Question 24

What is a Corrigan pulse?

Answer 24

Also known as water-hammer pulse, indicates chronic severe aortic regurgitation.

Question 25

What does a bifid pulse suggest?

Answer 25

Advanced aortic regurgitation, Hypertrophic obstructive cardiomyopathy.

Question 26

What is pulsus paradoxus?

Answer 26

Refers to a fall in SBP >10 mmHg with inspiration.

Question 27

What does pulsus alternans indicate?

Answer 27

Severe left ventricular systolic heart failure.

Question 28

What heart sound is due to reduced LV compliance?

Answer 28

S4.

Question 29

What heart sound is due to rapid early filling wave in patients with HF?

Answer 29

S3.

Question 30

What is an opening snap associated with?

Answer 30

Mitral stenosis.

Question 31

What does a pericardial knock indicate?

Answer 31

Constrictive pericarditis.

Question 32

What is a nonejection click associated with?

Answer 32

Mitral valve prolapse.

Question 33

What does a tumor plop indicate?

Answer 33

Atrial myxoma.

Question 34

What grade of murmur causes a thrill?

Answer 34

Grade 4 or greater.

Question 35

What is the best initial step in the assessment of diastolic, continuous, grade III or greater, holosystolic or late systolic murmurs?

Answer 35

2D echocardiography.

Question 36

What is the best initial step in the assessment of grade I or II and midsystolic murmurs?

Answer 36

Chest radiograph, 12L ECG.

Question 37

What are the diastolic murmurs?

Answer 37

ARMS PRTS: Aortic Regurgitation, Mitral Stenosis, Pulmonic Regurgitation, Tricuspid Stenosis.

Question 38

How do right-sided murmurs change with respiration?

Answer 38

Increase in intensity with inspiration; decrease in intensity with expiration.

Question 39

Which right-sided murmur does not increase in intensity with inspiration?

Answer 39

Pulmonic ejection sound.

Question 40

How do left-sided murmurs change with respiration?

Answer 40

Decrease in intensity with inspiration; increase in intensity with expiration.

Question 41

What is the first biomarker to increase in MI?

Answer 41

Myoglobin.

Question 42

What is the most common inpatient complication of STEMI?

Answer 42

Pump failure.

Question 43

What is the most common outpatient complication of STEMI?

Answer 43

Ventricular fibrillation.

Question 44

How long do cardiac troponins remain elevated after STEMI?

Answer 44

7-10 days.

Question 45

How long does it take for CK-MB to return to normal?

Answer 45

48-72 hours.

Question 46

What is the FMC-device time for STEMI patients brought to a PCI-capable hospital?

Answer 46

At most 90 minutes.

Question 47

Which beta-blockers can decrease the mortality risk in heart failure?

Answer 47

Bisoprolol, Carvedilol, Metoprolol succinate.

Question 48

What are the components of Beck triad of cardiac tamponade?

Answer 48

Hypotension, soft or absent heart sounds, jugular venous distension.

Question 49

What is the most common cause of chronic constrictive pericarditis in developing nations?

Answer 49

Tuberculosis.

Question 50

What is the most common symptom of pulmonary embolism?

Answer 50

Unexplained breathlessness.

Question 51

What is the most frequently cited ECG abnormality in pulmonary embolism?

Answer 51

Sinus tachycardia.

Question 52

What is the most common ECG abnormality in pulmonary embolism?

Answer 52

T-wave inversion at V1-V4.

Question 53

What is the pathognomonic finding in acute pericarditis?

Answer 53

Pericardial friction rub.

Question 54

What drug classes have a mortality benefit for HFrEF patients?

Answer 54

ACEI/ARBs/ARNI, beta-blockers, SGLT2 inhibitors, mineralocorticoid receptor antagonists.

Question 55

What is the most common valvular abnormality caused by rheumatic fever?

Answer 55

Mitral regurgitation.

Question 56

What is the predominant cause of mitral stenosis?

Answer 56

Rheumatic fever.

Question 57

What is the average time of death in aortic stenosis patients at the onset of syncope?

Answer 57

3 years.

Question 58

What is the average time of death in aortic stenosis patients at the onset of angina?

Answer 58

3 years.

Question 59

What is the average time of death in aortic stenosis patients at the onset of dyspnea?

Answer 59

2 years.

Question 60

What is the average time of death in aortic stenosis patients at the onset of heart failure?

Answer 60

1.5 – 2 years.

Question 61

What is the most frequent and potentially serious complication of thrombolysis?

Answer 61

Hemorrhage.