Cardiovascular System 1

Question 1

When might you suspect congenital long QT syndrome?

Answer 1

Cardiac syncope; sudden cardiac death in kids

Question 2

What’s the tx for congenital long QT syndrome?

Answer 2

Propranolol and pacemaker

Question 3

Which antibiotics can cause long QT syndrome (2)?

Answer 3

1. Macrolides

2. Fluoroquinolones

Question 4

Which psych drugs can cause long QT syndrome (3)?

Answer 4

1. Antipsychotics
2. TCAs
3. SSRIs

Question 5

Which antiemetics can cause long QT syndrome (2)?

Answer 5

1. Ondansetron

2. Granisetron

Question 6

Which antiarrhythmics can cause long QT syndrome (5)?

Answer 6

1. Quinidine
2. Procainamide
3. Flecainide
4. Amiodarone
5. Sotalol

Question 7

What 2 types of drugs can be used in hypertrophic cardiomyopathy?

Answer 7

1. B-blockers

2. Ca channel blockers

Question 8

In patients with CHF, what does the RAAS system do to the efferent arteriole?

Answer 8

Causes preferential vasoconstriction of it to maintain adequate GFR

Question 9

What’s the PCWP in PE?

Answer 9

Normal or low

Question 10

What’s the PCWP in MI?

Answer 10

High

Question 11

What does acute limb ischemia after MI suggest?

Answer 11

Possible embolus from L ventricle thrombus; order echo

Question 12

What’s Beck’s triad for cardiac tamponade?

Answer 12

1. Hypotension
2. Distended neck veins
3. Muffled heart sounds

Question 13

What might be a question stem for cardiac tamponade?

Answer 13

Patient who recently had a viral illness; now has weakness and dyspnea

Question 14

What medication can prevent ventricular remodeling after an MI?

Answer 14

Enalapril (or other ACE inhibitors)

Question 15

What might be the etiology of a young adult with decompensated HF findings?

Answer 15

Viral myocarditis

Question 16

The development of new Afib with rvr during pregnancy likely stems from which childhood illness?

Answer 16

Rheumatic fever

Question 17

What’s a common cause of exertional syncope in elderly patients?

Answer 17

Aortic stenosis

Question 18

What’s “pulsus parvus et tardus?”

Answer 18

Delayed and weak carotid pulse

Question 19

What drugs can stable Afib patients take to stabilize the ventricular rate (3)?

Answer 19

1. B-blockers
2. Diltiazem
3. Digoxin

Question 20

What are the changes to the following parameters after an AV fistula?:

• Afterload
• Preload
• CO

Answer 20

Afterload: decreased
Preload: increased
CO: increased

Question 21

What’s the most common cause of calcifications around the heart in developing countries?

Answer 21

TB

Question 22

What are some features of benign murmurs?

Answer 22

Early or mid-systolic, grade I/II, decrease when standing

Question 23

What are some features of pathologic murmurs?

Answer 23

Harsh, holosystolic, diastolic, grade III, increase with standing/valsalva

Question 24

What post-MI complication can occur acutely?

Answer 24

Right ventricular failure

“That’s a cute RV”

Question 25

What 2 post-MI complications can occur acutely or within 3-5 days?

Answer 25

1. Papillary muscle rupture | 2. IV septum rupture

Question 26

What post-MI complication can occur between 5 days-2 weeks?

Answer 26

Free wall rupture

Question 27

What post-MI complication can occur up to several months later?

Answer 27

Left ventricular aneurysm

Question 28

How can you tell the difference between a papillary muscle rupture vs an IV septum rupture?

Answer 28

Papillary has a softer murmur without a thrill | "nasal septum holes are harsh"

Question 29

What underlying disorder is a risk factor for <40 aortic dissections?

Answer 29

Marfan's

Question 30

How do you differentiate between acute abdominal aortic dissection vs renal infarction?

Answer 30

Aortic: hypotension Renal: hypertension

Question 31

What drug can cause interstitial pneumonitis?

Answer 31

Amiodarone

Question 32

T/F: clonic jerks can occur during any syncopal episode that is associated with cerebral hypoxia?

Answer 32

True

Question 33

What's the initial tx for wide complex tachycardia?

Answer 33

Amiodarone

Question 34

When should you suspect Printzmetal (vasospastic) angina?

Answer 34

Young patients with recurrent chest pain during sleep

Question 35

Which 2 types of shock have increased central venous pressure?

Answer 35

1. Obstructive | 2. Cardiogenic

Question 36

T/F: constrictive pericarditis can cause hepatomegaly and ascites?

Answer 36

True

Question 37

What's a pericardial knock?

Answer 37

Mid-diastolic sound

Question 38

Which 6 drugs are CYP450 inhibitors and therefore increase warfarin effect?

Answer 38

1. Metronidazole 2. Macrolides 3. Azoles 4. Amiodarone 5. Cimetidine 6. Grapefruit juice

Question 39

Which 5 drugs are CYP450 inducers and therefore decrease warfarin effect?

Answer 39

1. Carbamazepine 2. Phenytoin 3. Phenobarbital 4. Rifampin 5. St. John's wort

Question 40

What test is contraindicated in patients with severe AS?

Answer 40

Exercise stress test

Question 41

What causes exertional sx, pulsus parvus et tardus, soft S2, loud S4, and harsh systolic ejection murmur?

Answer 41

AS

Question 42

What test has the highest sensitivity for CHF?

Answer 42

BNP

Question 43

What's the cause of cor pulmonale (impaired R ventricle function)?

Answer 43

Pulmonary HTN (usually due to chronic lung disease)

Question 44

What medication is a good initial treatment for bradycardia and hypotension?

Answer 44

Atropine

Question 45

Which 4 antihypertensives are first-line during pregnancy?

Answer 45

1. Labetalol 2. Nifedipine 3. Hydralazine 4. Methyldopa

Question 46

Which 5 types of antihypertensives are contraindicated during pregnancy?

Answer 46

1. ACE inhibitors 2. Angiotensin II receptor blockers 3. Direct renin inhibitors 4. Nitroprusside 5. Mineralocorticoid receptor antagonists (spironolactone)

Question 47

What might a "water bottle" shaped heart and recent URI illness indicate?

Answer 47

Pericardial effusion/cardiac tamponade

Question 48

Can you palpate the point of maximal apical impulse with a large pericardial effusion?

Answer 48

No

Question 49

What condition is fixed splitting heard in?

Answer 49

ASD

Question 50

The OS is ___?

Answer 50

MS

Question 51

Which type of HF can be caused by chronic, severe tricuspid regurgitation?

Answer 51

RHF

Question 52

Which device can cause tricuspid regurgitation?

Answer 52

Pacemaker