Cardiology Scenarios Flashcards

1
Q

A pt with a long hx of innocent palpitations comes to the clinic complaining now of pre syncopal symptoms. She is admitted for evaluation and definitive therapy. Which condition is likely an indication for implantation of a permanent cardiac pacemaker?

a) first degree AV block
b) Mobitz type I heart block with HR of 72 bp
c) third degree heart block
d) fascicular block without AV block

A

c: The American college of Cardiology recommendations for permanent pacing include symptomatic third degree heart block. First degree AV block is not an indication for a pacemaker unless the PR interval is longer than 300ms. Moritz type I heart block generally does not progress to complete heart block, so it is unlikely to require permanent pacing. Asymptomatic fascicular block without AV block is considered a rare indication for pacemaker insertion

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2
Q

A 62yo woman comes into the office complaining of substernal CP and diaphoresis. Her ECG indicates ST elevation in leads II, III, and aVF. What is the next step of care for this pt?

a) Obtain a stat CXR
b) Start a verapamil drip
c) Have the pt chew an aspirin
d) Repeat the ECG

A

c: Evidence suggests that aspirin in a pt with acute ischemia is beneficial. There is no need to get further tests to confirm the pts condition until the pt gets to the hospital . Verapamil is c/i in acute ischemia

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3
Q

Indications for abdominal aortic aneurysm repair include

a) asymptomatic aneurysm greater than 5.5 cm
b) 5 cm aneurysm in a pt with coronary artery disease
c) asymptomatic aneurysm of 3.4 cm in diameter
c) 4 cm aneurysm in a pt with a recent CVA

A

a: An aneurysm that is 5.5 cm is size requires surgical intervention. Pts who have an aneurysm between 4-5 cm require surgical intervention only if their co-morbidities are low.

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4
Q

A 33yo healthy woman during a routine physical exam 3 months ago was found to be hypertensive with a BP of 150/98. She has no family hx of hypertension but her provider was concerned so she was started on an ACE inhibitor. Her BP improved slightly but on a routine blood draw her creatinine was noted to be 2.3. She is asymptomatic but is noted to have an abdominal bruit. Based on her history and lab evaluation, which of the following is her likely dx?

a) essential (primary) hypertension
b) isolated systolic hypertension
c) secondary hypertension
d) pheochromocytoma

A

c: This pt likely has renovascular disease, which is responsible for her secondary HTN. Pts with renovascular stenosis have decreased blood flow to one kidney. This ischemic state initiates renin release, which increases the vascular tone in the remaining normal renal artery. Essential HTN usually responds to meds and is more likely to be dx in a pt who is older. Secondary HTN is also associated with pheochromocytoma, but these pts generally have HA, palpitations, anxiety attacks, and hyperglycemia. Isolated systolic HTN is defined as a systolic BP of greater than 140 but a diastolic pressure less than 90.

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5
Q

A 73yo man with a hx of rheumatic fever and coronary atherosclerosis presents to the ED with dyspnea on exertion and orthopnea. He called 911 because he could not catch his breath. On exam, he was found to have jugular venous distention (JVD), hepatic congestion, and peripheral edema. A blowing holosystolic murmur along the left sternal border that is intensified during a Valsalva maneuver and inspiration is noted. A fib is noted on his ECG. What is his most likely dx?

a) aortic stenosis
b) mitral regurgitation
c) mitral stenosis
d) tricuspid regurgitation

A

d: Tricuspid regurgitation is associated with HOLOSYSTOLIC soft murmur heard best at the left sternal border and the intensity may increase with inspiration. Aortic stenosis is associated with a paradoxical split of S2, a murmur that is loudest at mid systole and is heard best at the base of the heart. Severe disease also is associated with a murmur, which can be heard near the carotid arteries. The murmur of mitral regurgitation is heard best at apex and radiates to the axilla. The Valsalva maneuver reduces it. Mitral stenosis is associated with an opening snap, which is followed by a low pitched rumbling murmur in diastole.

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6
Q

A retired operating room nurse comes to the clinic complaining of a dull ache in her legs after prolonged standing. She notes her legs feel heavy and she has mild ankle edema when she spends the day shopping. The aching pain and the edema resolve spontaneously if the pt elevates her legs. She denies calf tenderness or dyspnea. Physical exam reveals +1 ankle edema bilaterally. What is her most likely dx?

a) DVT
b) lymphedema
c) varicose veins
d) intermittent claudication

A

c: Varicose veins develop when individuals spend a prolonged amount of time on their feet. Lymphedema is a condition also associated with calf heaviness and edema but the symptoms do not resolve spontaneously. DVT edema is usually unilateral, may be associated with calf tenderness or a palpable cord, and does not resolve on its own. Intermittent claudication is not associated with peripheral edema generally and while the pain is resolved with rest, walker exacerbates the pain.

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7
Q

A 55yo man presents to the ED with CP that started 30 min ago, diaphoresis, and nausea. An ECG shows ST elevation in I, aVL, and V2-V6. What is the dx?

a) inferior infarction
b) lateral infarction
c) anterior infarction
d) posterior infarction

A

c: Anterior infarctions are characterized by ST elevation in I, aVL, and chest leads. Inferior wall MI is consistent with elevations in II, III, and aVF. Lateral wall and posterior infarctions have a loss of depolarization, which my be noted simply by increases in R wave amp in V1 and V2.

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8
Q

A 77yo woman with a hx of hypertension presents to the office with an ulcer on the anterior aspect of the right leg. She presents to the office because she shopped all day yesterday and has developed significant edema. The skin in the pretibial region appears thin and has excessive brown pigment. What is the most likely dx?

a) venous insufficiency
b) arterial insufficiency
c) expected complication of DM
d) peripheral neuropathy

A

a: Pts with chronic venous insufficiency note occasional pain with prolonged standing, edema, hyper pigmentation, dermatitis, and erythema. Pts with arterial insufficiency complain of claudication and they are found to have decreased pulses, distal hair loss, thick nails, and pallor. Pts with diabetes that is well controlled may have no symptoms in the lower extremities. Peripheral neuropathies are not associated with pigmentation changes or edema, although ulcers may develop if the pt have lost their proprioception

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9
Q

A 34yo woman with a hx of tobacco use comes to the ED complaining of severe substernal anginal symptoms. She has never had these symptoms before. She states that she had been watching TV this afternoon and the pain was not related to physical exertion. ECG demonstrates ST elevation. What is the pts most likely dx?

a) acute coronary syndrome
b) stable angina
c) unstable angina
d) Prinzmetal angina

A

d: Prinzmetal angina occurs in younger pts AT REST, with no preceding angina. It is associated with ECG changes and is thought to be related to transient coronary vasospasm rather than atherosclerosis. A squeezing chest pressure that is crescendo-decrescendo in nature, which lasts 2-5 min, characterizes stable angina. It is often exacerbated by exertion. Unstable angina is noted in an individual with coronary artery disease who notes severe, new-onset pain at rest lasting greater than 10 min that is crescendo in character. It may be associated with ECG changes as well. Acute coronary syndrome is usually seen in older pts who have a hx of anginal symptoms.

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10
Q
(not sure if we learned this) 
Pts with SLE have a predilection to which cardiovascular abnormality?
a) congestive heart failure
b) acute myocardial infarction
c) abdominal aortic dissection
d) pericarditis
A

d: Pericarditis occurs in about ⅔ of pts with lupus. It generally follows a benign course. Pts with lupus may also develop valvular endocardial lesions. It is less common for pts to develop acute coronary syndrome, dissection, or CHF although these complications are seen in pts with antiphospholipid syndromes

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11
Q

A 45yo pts with a hx of hypertension, DM, and cocaine abuse presents to the ED with acute 10/10, non radiating, substernal CP. She denies recent cocaine use but appears very anxious. ECG reveals sinus tachycardia with no other significant changes. Which test(s) should be ordered to determine this pts disease?

a) arterial blood gases
b) CPK enzymes
c) troponin levels
d) AST and ALT

A

c: We must determine whether there is a life threatening etiology of her CP. Troponin levels are useful in the dx of acute coronary syndrome because this amino acid does not exist in skeletal muscle. Troponins have a high sensitivity and specificity for acute coronary syndromes. The enzyme levels rise after 6hrs and peak at 12hrs. Abnormalities in arterial blood gases exist for many reasons but are not sensitive or specific to acute coronary syndromes. CPK enzymes vary in their specificity because of the distribution of these enzymes in other parts of the body. CPK release can occur from the myocardium as well as skeletal muscle. AST and ALT levels may be elevated but these are not specific markers for acute coronary syndrome

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12
Q

A 48yo pt with a hx of ionizing radiation to the chest wall presents to the ED with dyspnea and fatigue. Physical exam reveals tachycardia, 4cm JVD, and slight peripheral edema of the extremities. ECG shows low voltage GRS complexes and CXR demonstrates normal lung fields and cardiac silhouette. What test should be ordered next in this pt?

a) Holter monitor
b) echocardiogram
c) cardiac catheterization
d) stress test

A

b: This pt is suffering form pericarditis. Pericarditis is dx using the Doppler echocardiography. Holter monitor should be used to aid in the dx of arrhythmias and to work up syncope. Cardiac catheterization is generally used to evaluate individual coronary arteries and cardiac function. Electrocardiographic stress tests are used to screen for coronary artery disease in an ambulatory pt who is complaining of chest discomfort.

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13
Q

A febrile pt with petechiae and a new onset murmur or aortic regurgitation should have which of the following diagnostic tests to determine if surgical intervention is required ?

a) Holter monitor
b) transthoracic echocardiogram
c) Cardiac catheterization
d) transesophageal echocardiogram

A

d: The most likely dx in this pt is infective endocarditis. Evaluation of the blood flow and the functional status of the myocardium can be evaluated with either transthoracic or transesophageal echocardiogram. However, vegetations can be detected with more sensitivity and specificity using the transesophageal (TEE) echocardiogram. Hotter monitors and cardiac catheterization do not detect valvular lesions or vegetations.

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14
Q

A late systolic murmur that may be preceded by a systolic click describes this valvular abnormality..

a) aortic stenosis
b) mitral valve prolapse
c) aortic regurgitation
d) mitral valve stenosis

A

b: Mitral valve prolapse is characterized by a mid systolic click and a late systolic murmur. The murmur associated with aortic stenosis is a mid systolic murmur, also known as systolic ejection murmur. Aortic regurgitation is characterized by a high pitched decrescendo murmur in early diastole. Mitral valve stenosis is associated with a low-pitched, mid-diastolic murmur.
Remember:
Systolic murmurs= AS, MR
Diastolic murmurs= AR, MS

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15
Q

Which pt population is most predisposed to developing varicose veins?

a) men
b) women
c) those with a hx of DVT
d) those with a hx of lymphedema

A

b: Women are 2-3x more likely then men to develop varicosity’s of their lower extremities. Pts who develop secondary varicosities may have a hx of deep venous insufficiency. Pts with lymphedema generally have a different physical presentation, which is inconsistent with varicose veins. Lymphedema does not increase ones risk of developing varicosities.

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16
Q

A pt found to have a split of the second heart sound that persists unchanged with expiration may have which of the following conditions?

a) pulmonary embolus
b) increased pulmonary vascular resistance
c) pulmonary valve stenosis
d) atrial septal defect

A

d: Physiologic splitting of the second heart sounds occur in inspiration as the aortic and pulmonic valves close at different times. Fixed splitting of the S2 heart sound is heard in patients with atrial septal defects. Pts with pulmonary embolus and pulmonary valve stenosis have a split that is prolonged and is noted in expiration. Pts with increased pulmonary vascular resistance have a narrowing of the second heard sound split.

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17
Q

A 53yo man who is of relatively good health except his hx of tobacco use, is brought to the ED complaining of severe substernal CP that radiates to his back. The pain began with an acute onset of “a ripping sensation.” He called 911 immediately. After arriving in the ED, he was placed on the monitor. His BP was 190/128. Based on his hx, what is the most likely dx?

a) acute coronary syndrome
b) mitral valve stenosis
c) cardiogenic shock
d) aortic dissection

A

d: The differential dx includes acute coronary syndrome. However, if the pt is hypertensive, a tobacco user, and complains of a severe pain that radiates to the back, the pt most likely is experiencing an aortic dissection. Mild mitral stenosis may be asymptomatic but moderate stenosis is associated with dyspnea on exertion and cough. Cardiogenic shock is characterized by hypotension and chest pain

18
Q

An 81yo woman with a 10yr hx of well controlled a-fib complains of a 3-day hx of fatigue, dyspnea, and a 10lb weight gain. She denies angina or diaphoresis. Based on the hx what would be the most likely dx?

a) acute coronary syndrome
b) congestive heart failure (CHF)
c) sinus tachycardia
d) cardiac tamponade

A

b: CHF is associated with fatigue, dyspnea, and sudden weight gain. MI may be a preciptiation case for the pts CHF but would generally present with CP. Sinus tachycardia is unlikely because this pt has had long-standing atrial fibrillation. Cardiac tamponade is a possibility; however, generally while there is fatigue and dyspnea, pts with this condition do not experience such a sudden change in their weight.

19
Q

Which of the following descriptions are characteristic of venous stasis ulcers?

a) painful, erythematous
b) painful, purulent
c) painless, erythematous
d) painless, pallorous

A

c: Ulcerations associated with venous stasis disease are painless, whereas ulcerations associated with peripheral arterial insufficiency are painful. With severe arterial disease, thickened nails, hair loss, pallor with elevation of the extremity, and dependent rubor are common findings. The skin changes with venous disease may include erythema and hyper pigmentation.

20
Q

Which of the following is the most likely cause of paradoxical splitting of S2?

a) pulmonic stenosis
b) left bundle branch block
c) atrial septal defect
d) right ventricular failure

A

b: Paradoxical splitting of S2 occurs on expiration and disappears on inspiration: the opposite of physiologic splitting. The most common cause is LBBB. Atrial septal defect and right ventricular failure are associated with fixed splitting. Pulmonic stenosis is associated with wide split.

21
Q

A 65yo man with a 15yr hx of HIV presents to the ED in florid CHF. Which class of meds should be given to this pt immediately?

a) vasopressors
b) beta-blockers
c) calcium channel blockers
d) diuretics

A

d: The tx of CHF includes preventive measures, control of excess fluid, and enhancement of myocardial contractililty. Diuretics should be used to decrease the fluid overload. ACE inhibitors, Beta blockers, and sympathomimetic agents are important adjuncts to emergent tx. Calcium channel blockers have NO role in tx of CHF

22
Q

A 55yo hypertensive man comes to the office for routine check after his MI. His BP is 145/98 and his BUN is 22 mg/dL and his creatinine is 1.5 ng/dL. Three years ago, you had placed him on HCTZ for his essential HTN. Which medication class might you add first to improve his symptoms and decrease his BP?

a) beta-blockers
b) calcium channel blockers
c) ACE inhibitors
d) spironalactone

A

a: Drug therapy is recommended for pts with a BP of greater than or equal to 140/90. For a pt who has underlying cardiac disease, beta blockers have been shown to decrease morbidity and mortality if the pt has HTN. IF the pts HTN remains recalcitrant, ACE inhibitors may help if the pt has LV dysfunction but should be used cautiously in pts with renal insufficiency. CCB have not been shown to improve the survival of pts who are hypertensive and have known cardiac disease. Spironolactone should be used in pts with HF.

23
Q

A 50yo man called 911 when he developed severe substernal CP. In the ambulance, he is given 3 sublingual nitro tablets, which improved his pain but did not alleviate it. His BP is stable and he is noted to have a ST-T elevation on his EG. When he presents to the ED, which med will you begin while you are evaluating this pt?

a) oral angiotensin II blocking agents (ARBs)
b) IV calcium channel blockers
c) nitroprusside drip
d) nitroglycerin drip

A

d: Nitroglycerin is indicated in this pt. It will improve the myocardial oxygen demand availability because of its vasodilatory effects (dear. preload). Meds by mouth ARE NOT indicated at this time. Calcium channel blockers do not have a tole in the therapy of an AMI!

24
Q

Which medication should be used to control the ventricular rate during rapid a-fib?

a) beta-blocker
b) digoxin
c) warfarin
d) nitroglycerin

A

a: Beta blockers should be used to control the ventricular rate in rapid a-fib. While digoxin will slow the ventricular rate, it is no longer the DOC! Warfarin is used to anticoagulation and the prevention of clot formation that is a risk with the occurrence of a-fib. There is not a clear need for nitroglycerin at the time because the pt is not complaining of angina.

25
Q

Amiodarone may cause all of the side effects listed below, except:

a) thyroid abnormalities
b) photodermatitis
c) liver abnormalities
d) kidney failure

A

d: Major SE of amiodarone are photosensitivity, thyroid, CNS, and liver abnormalities.

26
Q

Which of the following anti arrhythmic drugs MOST POTENTLY blocks sodium channel current in the myocardium?

a) lidocaine
b) procainamide
c) amiodarone
d) flecainide

A

d: Flecainide is a Class 1C anti arrhythmic whose MOA blocks sodium channels. Class 1C meds are indicated for life-threatening ventricular tachycardia or fibrillation. They may also be used in refractory SVT

27
Q

According to the American Diabetes Association, risk reduction for cardiovascular events in the pts with diabetes can be achieved by the use of:

a) antioxidant vitamins
b) statins
c) cholesterol absorption inhibitors (ezetimibe)
d) aldosterone

A

b: STATINS are recommended if the total cholesterol is greater than 135mg/dL. ACE inhibitors have also been shown to be effective in this pt group.

28
Q

Secondary prevention of an STEMI should include all except which of the following measures?

a) beta-blockers
b) ACE inhibition
c) Calcium channel blockers
d) aspirin

A

c: Calcium channel blockers have been shown to increase mortality in pts who have had a previous MI. However, beta-blockers, ACE inhibitors, and aspirin have been shown to improve the morbidity and mortality rates in pts who have had a MI!

29
Q

A pt presents to the ED with ST elevation in leads II, III, aVF (inferior). The pt is hemodynamically stable. What measure should you use to limit the SIZE of infarction in this pt?

a) NSAIDS
b) glucocorticoids
c) calcium channel blockers
d) fibrinolytic agents

A

d: Fibrinolytic agents should be initiated within 30 min of presentation if there are no contraindications. NSAIDS and glucocorticoids have not been helpful to reduce the size of the infarction and are known to impair infarct healing. Calcium channel blockers are not incited in the tx of MI**

30
Q

An increase in which factor is most likely to increase the preload?

a) arterial vascular tone
b) stroke volume
c) heart rate
d) intravascular volume

A

d: Preload is defined as the ventricular end diastolic volume. Factors that increase the ventricular end-diastolic volume include an increase in the intravascular volume. Arterial vascular tone increases the BP, which may decrease the venous return to the heart. Increases in the stroke volume occur when the ventricle is more efficient, thus increasing the cardiac output; increases in the stroke volume have little or no effect on the end-diastolic volume. The HR does not increase the ventricular end-diastolic volume. In fact, if the HR increases, it provides less time for ventricular filling so that is may decrease the ventricular end-diastolic volume

31
Q

Diastolic dysfunction is characterized by:

a) increased systemic vascular resistance
b) decreased ventricular compliance
c) decreased stroke volume
d) decreased afterload

A

b: Diastolic dysfunction affects stroke volume by decreasing it. This is true of systolic dysfunction as well. The distinction between the two is that the increase in intrapericardial pressure and the increased stiffness of the ventricle decreases the end-diastolic volumes in diastolic dysfunction.

32
Q

You have started your pt who has giant cell arteritis on her glucocorticoid therapy. Which test should you use to monitor her repose to this therapy?

a) urine sodium
b) serum CK
c) sedimentation rate
d) CBC

A

c: Pts with giant cell arteritis present with elevated ESRs, which are useful for monitoring therapy because they decrease with steroid intervention. Pts with giant cell arteritis do initially present with anemia but this condition does not respond to steroids. Serum CK level is not generally elevated in this disease.

33
Q

A 72yo woman comes to the office complaining of a recent hx of substernal CP. Her symptoms occur most notably when she brings her laundry up the two flights of stairs from her basement and when she is out shopping for a long period of time. The pain is relieved by rest. She is not complaining of pain now. Her physical exam and ECG are normal. What is the next test you should order?

a) troponin levels
b) technitium 99 sesta-mibi
c) treadmill exercise test
d) echocardiogram

A

c: In this pt, her exercise intolerance needs to be evaluated more formally. She may have stable exertional angina. Troponin levels should be ordered if the pt either has ECG changes consistent with ischemia or if the pain is acute. Technetium 99 should be ordered if the baseline ECG shows pre-excitation, LBBB, or ST segment changes. Echocardiogram should be performed if the pt has a positive exercise stress test result.

34
Q

A 70yo diabetic pt comes to the clinic for a routine examination and his physical exam reveals an irregular heartbeat. HIs BP is 130/80 and his pulse is 84 bpm. ECG reveals a-fib, whereas his ECG from 2 years ago revealed sinus rhythm. Upon further questioning, you learn he felt his heart “flutter” every once in a while for the past 6 months but he did not think to cal the office. What is the first drug this pt should receive?

a) digoxin
b) amiodarone
c) metoprolol
d) heparin

A

d: This pt has stable a-fib that likely began in the past 6 months. He is hemodynamically stable and is not tachycardic. His age and diabetes predispose his to emboli formation; therefore, he would benefit from anticoagulation. Digoxin can be used to control the rate of a-fib if tachycardia is present but is not used along in acute a-fib. Amiodarone is used to PREVENT AFIB RECURRENCE but does not work well to convert pts with a 6 month hx of an irregular heartbeat. Beta blockade is used to control the HR is cases of tachycardia

35
Q

Tx of an asymptomatic pt with first degree AV block with a HR of 80 bpm is:

a) pacemaker
b) atropine
c) isoproterenol
d) no tx

A

d: First degree AV block does not require treatment unless the pt is profoundly bradycardic and has left ventricular dysfunction. Pacemakers are used for those who are bradycardic or have an irreversible second or third degree AV block. Atropine and isoprotenerol can increase conduction through the AV node. These meds are used for diagnostic purposes.

36
Q

Which of the following is not an etiology of AV block?

a) hypokalemia
b) Lyme disease
c) AMI
d) lithium ingestion

A

a: AV block can be precipitated by hypErkalemia, Lyme disease, MI, and lithium

37
Q

A 24yo woman with PACs is quite symptomatic with her irregular heartbeat. Her heart rate is causing her to be very anxious about her health as well? What is the first line therapy for this woman?

a) Class 1C antiarrhythmics
b) digoxin
c) metoprolol
d) radiofrequency ablation

A

c: Most pts with PACs do not require intervention unless the pt is profoundly symptomatic. If a pt requires intervention, beta blockade should be initiated as first-line therapy. Class 1C antiarrhythmics can be tried if there is no structural disease. Digoxin is used to control HR in arial flutter and fibrillation.

38
Q

A 69yo woman comes to the ED with dull CP and hypotension. You are trying to distinguish cardiac tamponade from right ventricular infarction. Which of the following clinical features is absent in tamponade but present in right ventricular infarction?

a) elevated JVP
b) Kussmaul sign
c) hypotension
d) absent y descent in jugular venous pulse

A

b: Kussmaul sign (JVP rise with inspiration) is absent in tamponade and present in right ventricular infarction. Cardiac tamponade and right ventricular infarctions share many clinical features such as hypotension, elevated JVP, absent y descent in JVP, and occasionally, pulsus paradoxicus.

39
Q

What is the recommended treatment of a pt who has been diagnosed with the first episode of cardiac tamponade?

a) observe to watch for an increase in effusion
b) echocardiograph guided pericardiocentesis
c) conservative therapy with aspirin and analgesics
d) pericardial window

A

b: Cardiac tamponade should be treated with pericardiocentesis urgently because of the hemodynamic compromise. Patients with acute pericarditis should be monitored for changes in effusion size. Aspirin and analgesics can be used to treat idiopathic acute pericarditis. Pericardial window should be used for recurrent tamponade episodes and cases of chronic constructive pericarditis

40
Q

Activation of neurohormonal systems in heart failure involves multiple physiologic pathways. The first step in the cascade is:

a) release of ADH
b) stimulation of baroreceptors in aortic and carotid sinus
c) retention of sodium and water
d) sympathetic stimulation of the kidneys

A

b: Baroreceptors detect less circulating blood volume because of a decrease in left ventricular function. They signal the brain to release ADH in an effort to increase peripheral vasoconstriction. Free water is reabsorbed by the kidneys, by stimulation of the renin-angiotensin cascade and subsequent retention of salt and water, which increases the afterload.

41
Q

What is the most common pro arrhythmic manifestation of amiodarone?

a) sinus bradycardia
b) torsades de pointes
c) atrial fibrillation
d) accelerated junctional rhythm

A

a: Amiodarone causes sinus bradycardia, AV block, and an increase in the defibrillation threshold. Tornadoes de pointes is rarely associated with amiodarone use. Atrial fibrillation can be associated with adenosine toxicity, and junctional rhythms may occur commonly in pts treated with digoxin.

42
Q

What ECG finding is suggestive of Wenckebach heart block?

a) PR interval greater than 0.2s
b) progressive lengthening of the PR interval with a dropped beat
c) fixed PR intervals with an occasional dropped beat
d) dissociation between P waves and QRS complexes

A

b: Wenckebach (type 1 second degree AV block) is characterized by a progressive lengthening of the PR interval. First degree heart block is characterized by a PR interval that is longer than 0.2s. Type II second degree AV block has a fixed PR interval with occasional dropped beats, while dissociation between P and QRS waves is third degree heart block.