Cardiology

Question 1

Young woman with history of migraines, chest pain, St segment elevation. Dx?

Answer 1

Coronary vasospasm

Question 2

Young person with chest pain following a party. Dx?

Answer 2

Cocaine

Question 3

Tall, thin person with long arms with acute chest and back pain., normal EKG, aortic diastolic murmur. Dx?

Answer 3

Marfan syndrome and aortic dissection

Question 4

Person who recently traveled or with immobility, Sharp, Pleuritic Chest Pain, Nondiagnostic EKG. Dx?

Answer 4

PE

Question 5

Tall., thin young man who smokes with sudden pleuritic, chest pain and dyspnea. Dx?

Answer 5

Spontaneous pneumothorax

Question 6

Post menopausal women with substernal chest pain following severe emotional stress with St elevation, an unremarkable coronary angiography. Dx?

Answer 6

Stress induced cardiomyopathy. Look for characteristic apical ballooning on ventriculogram

Question 7

Young man with substernal chest pain, deep T wave inversions and a harsh systolic murmur that increases with Valsalva. Dx?

Answer 7

Hypertrophic cardiomyopathy

Question 8

Abrupt pulmonary edema or hypotension and a loud holosystolic murmur and thrill s/p mi. Dx?

Answer 8

VSD Or papillary muscle rupture

Question 9

Sudden hypotension or cardiac death associated with pulseless electrical activity. S/p mi Dx?

Answer 9

LV Free wall rupture

Question 10

Coronary vasospasm Dx and tx?

Answer 10

Echocardiography, long acting nitrate, calcium channel blocker

Question 11

Marfan syndrome and aortic dissection. Dx and tx?

Answer 11

MRA, CTA, TEE, immediate surgery for type a dissection

Question 12

PE Dx and tx?

Answer 12

CTA, heparin

Question 13

Spontaneous pneumothorax Dx?

Answer 13

CXR

Question 14

Stress induced cardiomyopathy. Look for characteristic apical ballooning on ventriculogram Tx?

Answer 14

Beta blocker, Ace inhibitor

Question 15

Hypertrophic cardiomyopathy dx and tx?

Answer 15

Echocardiography, beta blocker

Question 16

Strong family history of premature heart disease + patient has a low HDL. What level is likely to be elevated?

Answer 16

Lipoprotein a or Lp(a)

Question 17

Aortic aneurysm, abdominal associated w/what dz?

Answer 17

Atherosclerosis

Question 18

Aortic aneurysm, ascending or arch associated w/what dz?

Answer 18

3º syphilis (syphilitic aortitis), vasa vasorum destruction

Question 19

Aortic aneurysm, thoracic associated w/what dz?

Answer 19

Marfan syndrome (idiopathic cystic medial degeneration)

Question 20

S3 heart sound

Answer 20

↑ ventricular filling pressure (eg, mitral regurgitation, HF), common in dilated ventricles

Question 21

S4 heart sound

Answer 21

Stiff/hypertrophic ventricle (aortic stenosis, restrictive cardiomyopathy)

Question 22

Rapid fire txt: Arrhythmia in damaged cardiac tissue

Answer 22

Class IB antiarrhythmic (lidocaine, mexiletine)

Question 23

Cardiac manifestation of lupus?

Answer 23

Marantic/thrombotic endocarditis (non-bacterial)

Question 24

Constrictive pericarditis MCC?

Answer 24

TB (developing world); idiopathic, viral illness (developed world)

Question 25

Cardiac tumor (adults)? "Tumor plop" on auscultation

Answer 25

Metastasis, myxoma (90% in left atrium; "ball and valve")

Question 26

Rapid fire assoc: Electrical alternans (alternating amplitude on EKG)

Answer 26

Pericardial tamponade

Question 27

Rapid fire assoc: "Delta wave" on EKG, short PR interval, supraventricular tachycardia

Answer 27

Wolff-Parkinson-White syndrome (Bundle of Kent bypasses AV node)

Question 28

What cardiac condition has a loud holosystolic murmur w/ palpable thrill along left sternal border over 3rd or 4th intercostal space?

Answer 28

Ventricular septal defect(VSD)

Question 29

What condition does a patient likely have if on physical exam you hear a loud systolic ejection murmur at the right 2nd intercostal space?

Answer 29

Aortic stenosis

Question 30

What degree of stenosis is an indication for carotid endarterectomy in female patients?

Answer 30

70-99% stenosis

Question 31

What degree of stenosis is an indication for carotid endarterectomy in male patients who are symptomatic? And asymptomatic?

Answer 31

50-99% in symptomatic. 60-99% in asymptomatic

Question 32

Rapid fire assoc: Cardiomegaly with apical atrophy

Answer 32

Chagas disease (Trypanosoma cruzi)

Question 33

Rapid fire assoc:Rib notching (inferior surface, on x-ray)

Answer 33

Coarctation of the aorta

Question 34

Rapid fire assoc: "Boot-shaped" heart on x-ray

Answer 34

Tetralogy of Fallot (due to RVH)

Question 35

What is the best management in an individual who has overdosed on TCAs and has widened QRS on EKG?

Answer 35

Bicarbonate

Question 36

What is the best next step in a patient with aspirin allergy who will be undergoing elective coronary angioplasty?

Answer 36

Aspirin desensitization. Pts undergoing elective angioplasty should be pre-treated with aspirin and clopidogrel.

Question 37

Systolic ejection murmur (crescendo-decrescendo)

Answer 37

Aortic stenosis

Question 38

Muffled heart sounds, distended neck veins, hypotension

Answer 38

Beck triad of cardiac tamponade

Question 39

What is the ideal LDL goal in CAD patients or CAD equvialent patients?

Answer 39

Less than 70 mg/dl

Question 40

What is the leading cause of sudden cardiac death in young athletes?

Answer 40

Hypertrophic cardiomyopathy

Question 41

Chest pain, pericardial effusion/friction rub, persistent fever following MI Dx?

Answer 41

Dressler syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 2 weeks to several months after acute episode)

Question 42

Chest pain with ST depression on EKG

Answer 42

Unstable angina (- troponins) or NSTEMI (+ troponins)

Question 43

Which two murmurs decrease in intensity with leg raising and squatting?

Answer 43

Hypertrophic obstructive cardiomyopathy (HOCM) and Mitral valve prolapse (MVP)

Question 44

Which type of beta blockers are okay to give to patients with hypertension and asthma? BAMN

Answer 44

Cardioselective beta blockers (metoprolol, atenolol, bisoprolol, nebivolol)

Question 45

Which congestive heart failure medication is used for symptomatic relief but does not decrease mortality?

Answer 45

Furosemide (Lasix)

Question 46

What two conditions are associated with bisferiens (biphasic pulse) pulse in the carotids?

Answer 46

Aortic regurgitation and hypertrophic cardiomyopathy

Question 47

What is the valvular abnormality that can result from dissection of the ascending aorta?

Answer 47

Aortic regurgitation

Question 48

What is the valvular condition most commonly associated with pulsus tardus in the carotids?

Answer 48

Aortic stenosis

Question 49

What is the treatment of choice for unstable pt with wide complex tachycardia?

Answer 49

Immediate synchronized cardioversion

Question 50

Within what age range does USPSTF recommend one-time screening for AAA in men with a smoking history?

Answer 50

65 to 75 years

Question 51

Achilles tendon xanthoma Dx?

Answer 51

Familial hypercholesterolemia (decreased LDL receptor signaling)

Question 52

Bounding pulses, widening pulse pressure, diastolic heart murmur, head bobbing

Answer 52

Aortic regurgitation

Question 53

What is the classic echo finding in hypertrophic cardiomyopathy?

Answer 53

Systolic anterior motion of mitral valve.

Question 54

What drug class is contraindicated in multifocal atrial tachycardia MAT?

Answer 54

Beta blockers

Question 55

What is the most common mutation seen in patients with HOCM?

Answer 55

Beta myosin heavy chain mutation

Question 56

How is sudden death prevented in patients with HOCM?

Answer 56

ICD implantation

Question 57

Calcifications of pericardium on chest imaging | Dx?

Answer 57

Constrictive pericarditis

Question 58

You must treat asymptomatic LV systolic dysfunction with ejection fraction less than 40% with what two medications?

Answer 58

Ace Inhibitors and beta blockers

Question 59

What drug toxicity causes patients to present with GI disturbances, neurologic dysfunction, vision changes, electrolyte imbalances & cardiac arrhythmia?

Answer 59

Digoxin

Question 60

What is the earliest and most sensitive sign of cardiac tamponade?

Answer 60

Right atrial collapse

Question 61

What is mcconnell sign and what is it suggestive of?

Answer 61

Right ventricular dilation and free wall hypokinesia with sparing of the Apex. Acute pulmonary embolism

Question 62

Murmur? | Systolic murmur best heard at right upper sternal border

Answer 62

Aortic stenosis

Question 63

murmur? Diastolic murmur best heard at L upper sternly border

Answer 63

aortic regurg

Question 64

Murmur? Opening snap followed by low pitched diastolic murmur at apex best heard in L lat decubitus

Answer 64

mitral stenosis

Question 65

pansystolic murmur w/palpable thrill

Answer 65

VSD

Question 66

Fixed,,split second heart sound

Answer 66

ASD

Question 67

dx? RV heave, wide, fixed splitting of 2nd sound, midsystolic pulm flow or ejection murmur, R axis Deviation and incomplete R bundle branch block

Answer 67

ASD

Question 68

What are the EKG findings of ASD?

Answer 68

R axis Deviation and incomplete R bundle branch block

Question 69

What are the 3 components of Beck's triad? What diagnosis is this classic of?

Answer 69

Hypotension, Distended neck vv, muffled heart sounds. Cardiac Tamponade

Question 70

What medication needs to be added to DAPT in pts >65, w/hx of UGI bleed, PUD, active h pylori?

Answer 70

PPI

Question 71

What drug is absolutely contraindicated in atrial fibrillation?

Answer 71

Digoxin