Quick Ref. Pathology

Question 1

Pancystolic (holosystolic) murmur best heard at the apex, often radiates to the left axilla.

Answer 1

Mitral regurgitation

Question 2

Crescendo/decrescendo systolic murmur heard best in the 2nd-3rd RIGHT interspace close to the sternum.

Answer 2

Aortic stenosis

Question 3

Most common heart murmur. Late systolic murmur usually preceded by a mid-systolic click.

Answer 3

Mitral valve prolapse

Question 4

Early diastolic decrescendo murmur heard best along the left side of the sternum.

Answer 4

Pulmonic regurgitation

Question 5

Late diastolic decrescendo murmur heard best along the lower left side of the sternum.

Answer 5

Tricuspid stenosis

Question 6

Chromosome 22q11 deletion can cause what (2)?

Answer 6

Truncus arteriosus and Tetralogy of Fallot

Question 7

Congenital rubella can cause (2)?

Answer 7

PDA or Pulmonary Artery Stenosis

Question 8

Bicuspid aortic valve results from?

What heart murmur is associated with this?

Answer 8

Turner’s syndrome - in addition to coarctation of the aorta

Aortic regurgitation

Question 9

Aortic insufficiency can arise from what syndrome?

Answer 9

Marfan

Question 10

Rumbling late diastolic murmur with an opening snap? How is it heard best?? Head best along the apex of heart (4th stethoscope heart space)

Answer 10

Mitral stenosis

Heard better when Px is in left lateral decubitus position

Foco mitral

Question 11

High-pitched diastolic murmur associated with a widened pulse pressure?

Answer 11

Aortic regurgitation

Question 12

Crescendo/decrescendo systolic murmur heard best in the 2nd-3rd LEFT interspace close to the sternum.

Answer 12

Pulmonic stenosis

Question 13

Continuous machine like murmur occurring both in systole and diastole?

Answer 13

Patent ductus arteriosus (PDA)

Question 14

Focal myocardial inflammation with multinucleate giant cells. Type of granuloma. Due to what infection?

Answer 14

Aschoff Bodies (rheumatic fever/ heart disease)

Question 15

What murmur is being described: Holosystolic, loudest at apex, heard best at left lateral decubitus, and enhanced by squatting and expiration.

Answer 15

Mitral Regurgitation

Question 16

What murmur is being described: Diastolic, heard best along the left sternal border, and is associated with widening of pulse pressure.

Answer 16

Aortic regurgitation

Question 17

What are the symptoms of left sided heart failure??

Answer 17

Pulmonary symptoms:

• Dyspnea on exertion
• Orthonea
• Paroxomal nocturnal dyspnea
• Pulmonary edema and maybe rales on exam

Question 18

CF: painful raised lesions on finger pads, fever, AKA-Osler nodes, is indicative of what?

Answer 18

Infective Endocarditis

Question 19

What are the most common causes for DIC?

Answer 19

Stop making thrombi!!
Sepsis
Trauma
Obstetrics 
Pancreatitis 
Malignant neoplasm
Transfusions

Question 20

What is the MOST common coronary artery involved in thrombosis?

Answer 20

Left anterior descending

Question 21

What is the MC congenital heart anomaly?

Answer 21

Ventral septal defect (VSD)

Question 22

What heart sound is associated with dilated congestive heart failure?

Answer 22

Dilated congestive heart failure:

-S3 heart sound

Question 23

What heart sound is associated with chronic hypertension and stiffened L ventricle?

Answer 23

S4 heart sound

Question 24

When would you have wide splitting?

Answer 24

Pulmonic stenosis

Right bundle branch block

Question 25

What heart murmur is louder with Valsalva maneuver? Why?

Answer 25

Makes the murmur of hypertrophic cardiomyopathy louder because it increases intrathoracic pressure and thus reduces preload and afterload. Usually, all other murmurs become quieter

Question 26

A 3 day old patient presents with a Holosystolic murmur loudest at the tricuspid region of the chest that gets louder with inspiration. What is the likely pathology?

Answer 26

VSD

Question 27

A 46 yo patient presents with a Holosystolic murmur loudest at the tricuspid region of the chest that gets louder with inspiration. What is the likely pathology? What is the likely cause??

Answer 27

Mitral regurgitation due to IV drug use that may cause endocarditis

Question 28

Pansystolic (holosystolic) murmur best heard along the left lower sternal border and generally radiates to the right lower sternal border. What murmur is this?

Answer 28

tricuspid regurgitation Or Ventricular septal defect

Question 29

56 YO hospitalized patient presents with acute onset of dyspnea, tachycardia, and confusion. What should your DX be until you can rule out/discard otherwise?

Answer 29

Pulmonary Embolism

Question 30

20 yo patient presents with rapid onset of sharp chest pain in association with dyspnea. What is the likely diagnosis?

Answer 30

Spontaneous pneumothorax

Question 31

Patient presents with ST segment elevation only during brief episodes of chest pain. What is the likely diagnosis?

Answer 31

Prinzmetal’s Angina

Question 32

Patient presents with sharp pain lasting hours to days and is somewhat relieved by sitting forward. What is the likely diagnosis?

Answer 32

Pericarditis

Question 33

What are the symptoms seen in patients with right sided heart failure?

Answer 33

Right sided heart failure usually shows signs in the body, vs Left sided heart failure usually is seen with pulmonary symptoms. ``` Peripheral edema -pedal edema -pre-sacral edema Jugular Venous Distention Hepatic congestion ```

Question 34

What is Beck’s Triad? What is it’s association?

Answer 34

Hypotension Distended neck veins Distant heart sounds Associated with cardiac tamponade

Question 35

Patient presents with the following symptoms: Hypotension Increased venous pressure, JVD Distant heart sounds Increased heart rate Pulsus Paradoxus (exaggerated decrease in the amplitude of the systolic BP during inspiration). What is the most likely diagnosis?

Answer 35

Cardiac tamponade

Question 36

What is being described: JVD during inspiration Decreased capacity of RV Associated with constructive pericarditis >> tamponade

Answer 36

Kussmaul’s Sign

Question 37

What is being described: Decreased SBP by more than 10mmHg during inspiration Decreased capacity of LV Associated with tamponade >> constructive pericarditis

Answer 37

Pulsus paradoxus

Question 38

What are the diagnostic criteria for rheumatic fever?

Answer 38

``` J - joint pain <3- pancarditis N- nodules (skin, subcutaneous) E- erythema marginatum S - syndenham chorea ```