Heart

Question 0

What quality and regularity of pulses are observed in aortic stenosis

Answer 0

Pulsus parvus et tardus (pulses are weak and late)

= narrow pulse pressure

Question 1

What are signs and symptoms of heart disease (7)

Answer 1

Dyspnea, peripheral edema, chest pain, palpitations, hemoptysis, syncope, fatigue

Question 2

Which valve problem has a wide pulse pressure

Answer 2

Aortic insufficiency

“Water-hammer pulse”

Question 3

What does the apical impulse feel like in LVH

Answer 3

Increased and displaced laterally

Question 4

What may be palpated in RVH

Answer 4

A parasternal heave

Question 5

Studies used in detection of heart disease

Answer 5

CXR, ECG, echocardiography, cardiac catheterization

Question 6

Which two drugs are used for cardiotonic effects in cardiac arrest

Answer 6

Epinephrine, calcium

Question 7

Which drug reverses bradycardia from cardiac arrest

Answer 7

Atropine

Question 8

How can the myocardium be protected from ischemia in cardiopulmonary bypass

Answer 8

Hypothermia and cardioplegia

Question 9

When is surgery indicated for aortic stenosis

Answer 9

Presence of symptoms

Angina, syncope, dyspnea

Question 10

Myxomatous degeneration, aortic dissection, bacterial endocarditis, rheumatic fever, or aortic root aneurysm may cause what

Answer 10

Aortic insufficiency

Question 11

What signifies the severity of aortic insufficiency

Answer 11

The duration of murmur during diastole

Question 12

Symptomatic aortic insufficiency with LVEF <50% and LV dilation requires what intervention

Answer 12

Aortic valve replacement surgery

Question 13

Triad of apical diastolic rumble, opening snap and loud S1 indicates what

Answer 13

Mitral valve stenosis

Question 14

Tx of mitral stenosis in less severe cases

More severe cases?

Answer 14

Less: commissurotomy (open or balloon mitral valvuloplasty)

More: mitral valve replacement

Question 15

Leaflet thickening (proteoglycans) and chordae elongation is called what, and where is it commonly seen

Answer 15

Myxomatous degeneration

Commonly in mitral insufficiency

Question 16

Dyspnea on exertion, fatigue, palpitations with holosystolic blowing murmur that radiates to axilla

Answer 16

Mitral valve insufficiency

Question 17

Most important diagnostic test for mitral insufficiency

Answer 17

Echocardiography

Question 18

Most accurate diagnostic test for tricuspid stenosis and insufficiency

Answer 18

Cardiac catheterization

Question 19

What syndrome can produce pulmonic stenosis

Answer 19

Carcinoid syndrome

Question 20

What causes multiple valvular disease

Answer 20

Rheumatic fever

TR and TS rare without mitral involvement

Question 21

What ECG changes may be seen in CAD

Answer 21

ST segment changes, T wave changes

Question 22

Which test evaluates induction of angina

Answer 22

Exercise stress test

Question 23

Which test delineates ischemic and infarcted areas of myocardium

Answer 23

Radio thallium scan

Question 24

Which two studies provide the most accurate info on the extent of CAD

Answer 24

Cardiac catheterization | Coronary angiography

Question 25

When is coronary obstruction physiologically significant on angiography

Answer 25

50% narrowed diameter

Question 26

Surgical Tx for CAD

Answer 26

Balloon angioplasty with stenting (single vessel disease) Coronary artery bypass grafting (triple vessel)

Question 27

When is CABG preferred to catheter-based interventions

Answer 27

Anatomic considerations like chronic total occlusions, left main stenosis, extensive lesions

Question 28

What is the conduit of choice for CABG

Answer 28

Internal mammary artery

Question 29

Which MI complications warrant surgery

Answer 29

Ventricular aneurysm, ruptured ventricle, ruptured interventricular septum, mitral valve papillary rupture

Question 30

Which type of heart tumor is most common

Answer 30

Metastatic tumor

Question 31

Where do most metastatic heart tumors arise

Answer 31

Melanoma, lymphoma and leukemia

Question 32

Tx of cardiac tumors

Answer 32

Surgical excision if possible

Question 33

Signs of pericardial tamponade

Answer 33

Distended neck veins, hypotension, pulsus paradoxus, distant heart sounds

Question 34

Workup for blunt trauma to the sternum

Answer 34

ECG, cardiac enzymes, echocardiogram, cardiac catheterization (if new murmur).

Question 35

What may new murmurs indicate in blunt trauma and what is the tx

Answer 35

Valve rupture requiring surgical repair or replacement

Question 36

Tx for pericardial effusion

Answer 36

Pericardiocentesis or pericardiostomy

Question 37

How are chronic pericardial effusions managed

Answer 37

Pericardiotomy via thoracotomy or sternotomy

Question 38

Possible causes of pericarditis

Answer 38

Bacterial, viral infections, uremia, trauma, malignant disease, connective tissue disorders

Question 39

Tx for chronic constrictive pericarditis

Answer 39

Pericardiectomy

Question 40

Which first trimester infection may cause congenital heart disease

Answer 40

Rubella (togavirus) can cause patent ductus arteriosus

Question 41

What are the signs of congenital heart disease

Answer 41

Easy fatigability, poor feeding and weight gain, pulmonary infections, cyanosis

Question 42

What is the best study for congenital heart disease

Answer 42

Echocardiography

Question 43

Tx for PDA and indications

Answer 43

Ligation of the ductus | in premature infants with pulmonary dysfunction, CHF in first year of life, persistence until age 2-3

Question 44

Headaches, epistaxis, lower extremity weakness, dizziness

Answer 44

Symptoms of coarctation

Question 45

Which procedure is used to define the location of coarctation

Answer 45

Cardiac catheterization

Question 46

Possible surgical tx of coarctation includes

Answer 46

End to end anastomosis Prosthetic patch graft Subclavian flap procedure

Question 47

What can occur secondary to uncorrected ASD

Answer 47

Pulmonary vascular obstructive disease

Question 48

Systolic murmur in L 2nd intercostal space | Fixed split S2

Answer 48

ASD

Question 49

Diagnosis of ASD from cardiac catheterization comes from what observation

Answer 49

Step-up in oxygen saturation between VC and right atrium

Question 50

Tx of ASD

Answer 50

Surgical closure before school age | Percutaneous closure possible in cath lab

Question 51

What is Eisenmenger's syndrome

Answer 51

Irreversible pulmonary vascular obstructive disease leading to reversal of flow across VSD

Question 52

When is closure of a septal defect necessary

Answer 52

When pulmonary blood flow is 1.5-2x greater than systemic blood flow

Question 53

What are the major causes of death in TOF

Answer 53

Cerebrovascular accidents and brain sepsis

Question 54

What tx can be performed in TOF before definitive correction

Answer 54

A systemic to pulmonary shunt

Question 55

What tx can be performed in TGA before definitive correction

Answer 55

Balloon atrial septostomy | To increase mixing of blood

Question 56

Tx of mitral valve regurgitation

Answer 56

Annuloplasty | Preferred to valve replacement