cardiology 4

Question 1

What is the next step for cardiac catheterization?

Answer 1

Cardiac catheterization with coronary angiography within 12 to 24 hours.

Question 2

Is dyspnea on exertion (DOE) and chest pain (CP) likely present in left outflow tract obstruction?

Answer 2

True.

Question 3

What are the initial symptoms of Lyme disease?

Answer 3

Fever, myalgias, arthralgias, and erythema migrans.

Question 4

Why should Amiodarone be used with caution for rate control of atrial fibrillation?

Answer 4

Due to the risk of pharmacologic cardioversion with subsequent risk of thromboembolism.

Question 5

What is a typical cardiac manifestation of Lyme disease?

Answer 5

High degree AV block.

Question 6

What can frequent ventricular ectopy be associated with?

Answer 6

Reversible cardiomyopathy if the ectopic beats represent more than 10 to 20% of overall heartbeats.

Question 7

What are nonclassical symptoms of myocardial infarction?

Answer 7

Jaw, neck, ear, arm, and epigastric pain.

Question 8

What does Dressler syndrome typically result in?

Answer 8

Pleuritic chest pain, fever, and occasionally a pericardial effusion after an MI.

Question 9

What are the most appropriate procedures for diagnosing aortic dissection in hemodynamically stable patients?

Answer 9

CXR, TTE, or POCUS.

Question 10

What are typical cardiac involvements with sarcoidosis?

Answer 10

AV block, bundle branch block, arrhythmias, and heart failure.

Question 11

What should be administered to patients with symptomatic bradycardia and hemodynamic distress?

Answer 11

Atropine.

Question 12

What is a Bifascicular block?

Answer 12

An RBBB with either left anterior fascicular block or left posterior fascicular block.

Question 13

What are the ECG findings of left bundle branch block (LBBB)?

Answer 13

No R wave in lead V1, deep S waves, wide notched R waves in leads I, aVL, V5, V6, and loss of Q waves in the lateral leads.

Question 14

What is the recommended antihypertensive therapy for a patient with type 2 diabetes, CKD, and blood pressure > 130/80?

Answer 14

An ACE inhibitor or ARB.

Question 15

What should be done if atropine is ineffective in reversing symptomatic bradycardia?

Answer 15

Chronotropic drugs should be given until pacing can be performed.

Question 16

What is the most appropriate preoperative test for a patient at risk for coronary artery disease?

Answer 16

Cardiac catheterization with coronary angiography.

Question 17

What are the CHA2DS2-VASc score indications for anticoagulation?

Answer 17

Greater than or equal to 2 in men or 3 in women.

Question 18

What are the heart failure symptoms in patients with aortic stenosis?

Answer 18

Exertional dyspnea rather than orthopnea or paroxysmal nocturnal dyspnea.

Question 19

What are the three main components of a right bundle branch block (RBBB)?

Answer 19

An rsr complex, tall secondary R wave in lead V1, and wide slurred S wave in leads I, V5, V6.

Question 20

What should a patient with coronary artery disease (CAD) be managed with?

Answer 20

Aspirin, a statin, and at least one of the following: a beta-blocker, a CCB, and/or a long-acting nitrate.

Question 21

What is the recommended treatment for a patient with STEMI?

Answer 21

Early cardiac catheterization with coronary angiography within 24 hours.

Question 22

What are cardiac myxomas?

Answer 22

Rare, benign, primary cardiac tumors that typically manifest with symptoms of cardiac obstruction, systemic inflammation, or embolization.

Question 23

What is indicated for a patient with severe aortic stenosis who is asymptomatic?

Answer 23

Confirm the lack of symptoms with exercise testing.

Question 24

What are tendinous xanthomas pathognomonic for?

Answer 24

Familial hypercholesterolemia.

Question 25

What is the next step to address persistent mild hyperkalemia in a patient taking an ACE-I?

Answer 25

Increase the dose of the loop diuretic.

Question 26

What is the diagnosis for acute severe retrosternal chest pain radiating to the back and neck?

Answer 26

Aortic dissection.

Question 27

What is routinely recommended for patients with symptomatic coronary artery disease?

Answer 27

Aspirin and a beta-blocker.

Question 28

Is an echo and ECG necessary to diagnose heart failure?

Answer 28

False; heart failure is a clinical diagnosis.

Question 29

What is indicated in cyanotic congenital heart disease with erythrocytosis?

Answer 29

Therapeutic phlebotomy if hematocrit exceeds 65% or hemoglobin exceeds 20 with symptoms of hyperviscosity.

Question 30

Is a beta-blocker routinely recommended for a patient with symptomatic coronary artery disease?

Answer 30

Yes.

Question 31

Is an echo and EKG necessary to diagnose heart failure (HF)?

Answer 31

False.

Question 32

Is heart failure (HF) a clinical diagnosis?

Answer 32

Yes.

Question 33

In cyanotic congenital heart disease and erythrocytosis, when is therapeutic phlebotomy indicated?

Answer 33

If the hematocrit exceeds 65% or hemoglobin exceeds 20 with symptoms of hyperviscosity.

Question 34

What are symptoms of hyperviscosity?

Answer 34

Headache, visual disturbance, transient ischemic attack, paresthesias, altered mentation, and fatigue.

Question 35

How can ischemia be diagnosed in a patient with a ventricular paced rhythm?

Answer 35

With ST segment depression greater than or equal to 1 mm that is concordant with the QRS complex.

Question 36

What are the EKG changes associated with left ventricular hypertrophy?

Answer 36

Downsloping ST-T changes and T wave inversion in anterolateral leads I, aVL, and V4-V6.

Question 37

What are the two categories of acute coronary syndrome?

Answer 37

NSTE-ACS and STE-ACS.

Question 38

What is the next step for a patient with nonischemic cardiomyopathy, EF less than 35%, and LBBB with QRS greater than 150 ms?

Answer 38

Refer for placement of ICD with biventricular pacing.

Question 39

What finding in a cardiac examination is consistent with left ventricular hypertrophy?

Answer 39

A sustained apical impulse.

Question 40

What happens to brain natriuretic peptide levels after initiation of sacubitril-valsartan?

Answer 40

Circulating levels of brain natriuretic peptide increase, but not N-terminal pro-brain natriuretic peptide.

Question 41

What are examples of low intensity statin therapy?

Answer 41

Simvastatin 10 mg, Pravastatin 10-20 mg, Lovastatin 20 mg, Fluvastatin 20-40 mg.

Question 42

What class of medications is associated with orthostatic hypotension in older men with hypertension and benign prostatic hyperplasia?

Answer 42

Alpha-blockers.

Question 43

What is the likely cause of sudden loss of consciousness in an older patient with a bifascicular block?

Answer 43

Bradyarrhythmia.

Question 44

What is cholestyramine used for?

Answer 44

To decrease LDL.

Question 45

What are the EKG characteristics of left bundle branch block (LBBB)?

Answer 45

No R wave in lead V1, deep S waves forming a characteristic W shape, wide notched R waves in leads I, aVL, V5, V6 forming a characteristic M shape, and loss of Q waves in the lateral leads.

Question 46

What is the diagnostic test of choice to confirm aortoduodenal fistulas after aortic aneurysm repair surgery?

Answer 46

CT angiography with delayed images.

Question 47

How is severe hypertension defined?

Answer 47

Systolic blood pressure > 180 mmHg or diastolic > 120 mmHg.

Question 48

What should be added for a patient whose angina is not relieved by beta-blocker therapy at max dose?

Answer 48

Either a calcium channel blocker (CCB) or a long-acting nitrate.

Question 49

What are the lateral leads in EKG?

Answer 49

Leads I and aVL.

Question 50

Is Eisenmenger syndrome unlikely without cyanosis or a loud P2?

Answer 50

True.

Question 51

When should an ICD be considered for LV dysfunction after an MI?

Answer 51

If the patient has LVEF less than 35% despite GDMT or has malignant ventricular arrhythmia more than 24 hours after MI.

Question 52

What should patients with HFrEF be treated with?

Answer 52

A beta-blocker and either an ACE-I, ARB, or ARNI.

Question 53

What type of MI is usually a blockage of the right coronary artery?

Answer 53

Inferior MI.

Question 54

What should be performed if a patient with congenital cyanotic heart disease has a hemoglobin level >20 g/dL and a hematocrit >65% with symptoms of hyperviscosity?

Answer 54

Phlebotomy should be performed.

Question 55

What is the next step for a postmenopausal woman with atypical chest pain and resting EKG showing left ventricular hypertrophy with strain?

Answer 55

Exercise echo.

Question 56

How long must sustained VT last?

Answer 56

Greater than or equal to 30 seconds.

Question 57

What are common classes of drugs for treatment of atrial fibrillation (A-fib)?

Answer 57

Beta blockers, calcium channel blockers, amiodarone, and digoxin.

Question 58

What is characteristic of rheumatic mitral stenosis?

Answer 58

A-fib and a diastolic rumbling murmur at the cardiac apex.

Question 59

What are the clear indications for valve repair in chronic mitral regurgitation?

Answer 59

Symptoms, reduction in ejection fraction to less than 60%, and left ventricular end-systolic dimension greater than 40 mm.

Question 60

What is the classic triad of RV infarction in the setting of an inferior MI?

Answer 60

Hypotension, distended neck veins, and clear lungs.

Question 61

Who are the patients that the AHA limits antibiotic prophylaxis for procedures?

Answer 61

1. Patients with prosthetic cardiac valves. 2. Patients with prosthetic material used for cardiac valve repair. 3. Patients with previous infective endocarditis. 4. Patients with unrepaired cyanotic congenital heart disease. 5. Patients with repaired congenital heart disease. 6. Patients with a cardiac transplant with valve regurgitation.

Question 62

What is the PR interval for first degree AV block?

Answer 62

Greater than 200 ms.

Question 63

What should a patient with severe symptomatic mitral regurgitation undergo before elective surgery?

Answer 63

Preoperative cardiac catheterization to assess for CAD.

Question 64

What is the mean transvalvular pressure gradient associated with severe aortic stenosis?

Answer 64

>40 mmHg or a peak velocity > 4 m/sec.

Question 65

What happens to QRS complexes in patients with LBBBs or who have a paced rhythm?

Answer 65

They are discordant.

Question 66

What is the left ventricular end-systolic dimension greater than?

Answer 66

40 mm

Question 67

Is vision loss more likely to occur with a carotid or cardiac source of embolus?

Answer 67

Carotid source

Question 68

What is the mean transvalvular pressure gradient associated with severe aortic stenosis?

Answer 68

>40 mmHg

Question 69

What is the peak velocity associated with severe aortic stenosis?

Answer 69

> 4 m/sec

Question 70

What do patients with LBBB or a paced rhythm have in their QRS complexes?

Answer 70

Discordant with the ST segments and T waves

Question 71

What is situational syncope similar to?

Answer 71

Vasovagal syncope

Question 72

What is the recommended dose of adenosine in cardiac transplant patients?

Answer 72

Lower dose

Question 73

What is a slurred upstroke of the QRS complex called?

Answer 73

Delta wave

Question 74

What is the treatment for orthostatic hypotension following dialysis?

Answer 74

IV fluids

Question 75

How is ischemia diagnosed in patients with LBBB or a paced rhythm?

Answer 75

If the ST segment depression is > 1 mm and concordant with the QRS complex

Question 76

What suggests cardiac tamponade after a cardiac ablation procedure?

Answer 76

Hypotension and elevated JVP

Question 77

What is the diagnostic test for cardiac tamponade?

Answer 77

Echocardiography

Question 78

What is the treatment for cardiac tamponade?

Answer 78

Pericardiocentesis

Question 79

What is the next diagnostic step for a healthy patient with signs of WPW?

Answer 79

Perform exercise stress test

Question 80

What causes should be ruled out in a patient with symptomatic sinus bradycardia?

Answer 80

Medications, Sleep apnea, Hypothyroidism, MI, Electrolytes

Question 81

What is the most likely cause of acute occlusion of a coronary artery at the site of a recently placed stent?

Answer 81

Stent thrombosis

Question 82

What disease should be considered in a young lady with new onset hypertension difficult to control?

Answer 82

Fibromuscular dysplasia of the renal arteries

Question 83

What is the purpose of the tilt table test?

Answer 83

Distinguish between different types of reflex syncope

Question 84

When should an ascending aortic aneurysm be surgically repaired?

Answer 84

When it exceeds 5.5 cm in diameter or enlarges more than 0.5 cm/year

Question 85

What are the typical manifestations of Dressler syndrome?

Answer 85

Pleuritic chest pain, fever, and occasionally a pericardial effusion

Question 86

What type of murmur is associated with hypertrophic cardiomyopathy?

Answer 86

Systolic crescendo-decrescendo murmur that becomes louder with the Valsalva maneuver

Question 87

What is considered a high ASCVD risk?

Answer 87

>20%

Question 88

What medication should typically be administered to a patient with an ST elevation myocardial infarction facing a delay before PCI?

Answer 88

Thrombolytic drug

Question 89

Does a negative TTE effectively rule out infective endocarditis?

Answer 89

False

Question 90

What is the diagnostic test of choice for infective endocarditis?

Answer 90

TEE

Question 91

What are typical manifestations of Chagas disease?

Answer 91

Esophageal dysfunction, conduction system abnormalities, and dilated cardiomyopathy

Question 92

What do Type A aortic dissections involve?

Answer 92

The ascending aorta, the aortic arch, or both

Question 93

What is an indicator of aortic coarctation?

Answer 93

A systolic blood pressure difference of 20 mmHg between the arms and legs

Question 94

When should we not initiate a beta-blocker in a newly diagnosed A-fib patient?

Answer 94

If the patient is asymptomatic or has a heart rate within normal limits

Question 95

What is routinely recommended along with aspirin and a statin for patients with symptomatic coronary artery disease?

Answer 95

Beta-blocker

Question 96

In which patients are nonclassic presentations of angina most common?

Answer 96

Older patients, diabetes mellitus, and women

Question 97

What should a patient with severe symptomatic mitral regurgitation undergo before elective valve surgery?

Answer 97

Preoperative cardiac catheterization with coronary angiography

Question 98

What is characteristic of rheumatic mitral stenosis?

Answer 98

New onset atrial fibrillation and a diastolic rumbling murmur at the cardiac apex

Question 99

What is the treatment approach for HFpEF?

Answer 99

Usually consists of diuretic and antihypertensive classes of drugs

Question 100

What procedures are deemed to be at greatest risk for infective endocarditis?

Answer 100

Those involving prosthetic cardiac valves, prosthetic material for valve repair, previous infective endocarditis, unrepaired cyanotic congenital heart disease, or repaired congenital heart disease