Quiz 7 practice qs

Question 1

Austin-Flint murmur is associated with what?
a) AS
b) MS
c) AR
d) MR

Answer 1

c) AR

Question 2

When are Austin-Flint murmurs heard?
a) Mid diastolic
b) End diastolic
c) Mid systolic
d) End systolic

Answer 2

a) Mid diastolic

Question 3

Which of the following murmurs increase with squatting? Select all that apply
a) AS
b) MS
c) AR
d) MR
e) MVP
f) Hypertrophic cardiomyopathy

Answer 3

b) MS
c) AR
d) MR

Question 4

Which of the following are preload dependent? Select all that apply
a) AS
b) MS
c) AR
d) MR
e) MVP

Answer 4

a) AS
b) MS
e) MVP

Question 5

Which of the following is described as a “water hammer pulse”?
a) Quincke pulse
b) De Musset sign
c) Mueller sign
d) Corrigan pulse
e) Austin flint murmur

Answer 5

d) Corrigan pulse

Question 6

Which is described as rhythmic bobbing of the head in sync with the heartbeat?
a) Quincke pulse
b) De Musset sign
c) Mueller sign
d) Corrigan pulse
e) Austin flint murmur

Answer 6

b) De Musset sign

Question 7

Which is heard best at Erb’s point?
a) AS
b) MS
c) AR
d) MR
e) MVP

Answer 7

c) AR

Question 8

_____ and _____ are systolic murmurs; ____ and ____ are diastolic murmurs
a) AS and MR; AR and MS
b) AR and MS; AS and MR
c) AS and AR; MR and MS
d) MR and MS; AR and AS

Answer 8

a) AS and MR; AR and MS

Question 9

T/F: Management of HTN can reduce afterload

Answer 9

True

Question 10

Which of the following is strep pharyngitis most strongly associated with?
a) AS
b) MS
c) AR
d) MR

Answer 10

b) MS

Question 11

Which of the following are associated with AFIB due to enlarged left atria? Select two
a) AS
b) MS
c) AR
d) MR

Answer 11

b) MS
d) MR

Question 12

Which is more associated with rales due to pulmonary congestion?
a) AS
b) MS
c) AR
d) MR

Answer 12

b) MS

Question 13

For which of the following is intervention recommended before symptom onset?
a) MVP
b) AS
c) MS
d) AR
e) MR

Answer 13

c) MS

Question 14

MS has a _____ pitched murmur, and AR has a _______ pitched murmur.

Answer 14

Low; high

Question 15

Which of the following was Scarlet fever mentioned to be associated with?
a) AS
b) MS
c) AR
d) MR

Answer 15

d) MR

Question 16

Which of the following lasts longer, but requires lifelong anticoagulation?
a) Mechanical valves
b) Bioprosthetic valves

Answer 16

a) Mechanical valves

Question 17

Which are better tolerated in pregnancy, regurgitant lesions or stenotic lesions?

Answer 17

Regurgitant

Question 18

What is the mnemonic for the life threatening causes of ACS?

Answer 18

DEATH

Dissection of Aortic Aneurysm
Emboli - PE
ACS
Tension Pneumothorax
Hole in GI tract (Esophageal rupture + Perf PUD)

Question 19

T/F: Unstable angina is an NSTE ACS, but does NOT have elevated troponins

Answer 19

True

Question 20

A patient has a father who was diagnosed with unstable angina at the age of 60. Is this a risk factor for your patient?

Answer 20

No (male = <55)

Question 21

Where do the coronary arteries go through?
a) Subendocardium
b) Endocardium
c) Myocardium
d) Epicardium

Answer 21

d) Epicardium

Question 22

What is the most common symptom of ACS for both men and women?

Answer 22

Chest pain

Question 23

T/F: Pain that gets worse with exertion and better with rest is characteristic of ACS

Answer 23

True

Question 24

What are the clinical decision tools to estimate cardiac risk and mortality in ER or inpatients? Select two
a) Marburg Heart score
b) HEART score
c) Thrombolysis in MI risk score

Answer 24

b) HEART score
c) Thrombolysis in MI risk score

Question 25

A patient has a HEART score of 3. What is their risk of a major adverse cardiac event within the next 6 weeks? a) Low (1.7%) b) Intermediate (17%) c) High (50%)

Answer 25

a) Low (1.7%)

Question 26

Which of the following is generally a consequence of coronary artery disease (CAD)? a) Pericarditis b) Myocarditis c) Ischemia d) Aortic dissection

Answer 26

c) Ischemia

Question 27

List 3 things that are evidence of ischemia on an EKG

Answer 27

1) Hyperacute T waves (first few minutes) 2) ST segment & T wave changes 3) Q wave

Question 28

A patient has elevated cardiac enzymes and ischemic symptoms. Is this enough to diagnose an MI?

Answer 28

Yes

Question 29

Chronic and Acute renal disease may cause what according to the powerpoint? a) Abnormal EKG b) Elevated cardiac enzymes c) Ischemic symptoms d) Coronary thrombus on angiography

Answer 29

b) Elevated cardiac enzymes

Question 30

**A patient presented to the ER with a STEMI MI 100 minutes ago. What do you do?** a) PCI angioplasty only, then DAPT b) Fibrinolytics, then PCI, then DAPT c) PCI angioplasty and DES placement, then DAPT d) Fibrinolytics, then PCI and DES, then DAPT

Answer 30

c) PCI angioplasty and DES placement, then DAPT (don’t need fibrinolytics if within 120 minutes)

Question 31

How long should DAPT typically be continued after MI?

Answer 31

1 year

Question 32

Patients with ACS + AFIB have an increased risk of ____________

Answer 32

bleeding

Question 33

Which of the following medications for DESs should not be used if h/o CVA or increased bleed risk? a) Clopidogrel (Plavix) 75 mg qd b) Ticagrelor (Ticlid) 90 mg bid c) Prasugrel 10 mg qd d) ASA 81 mg daily

Answer 33

c) Prasugrel 10 mg qd

Question 34

A patient has a DAPT score of 2. Do you give prolonged DAPT?

Answer 34

Yes (≥2 = give DAPT)

Question 35

Which of the following should all ACS patients receive? Select all that apply a) High intensity statin therapy b) Cardioprotective B-blockers c) ACEi d) SGLT-2 inhibitors e) GLP-1 agonist f) SL NTG PRN

Answer 35

a) High intensity statin therapy b) Cardioprotective B-blockers d) SGLT-2 inhibitors f) SL NTG PRN (most patients get ACEis, but not all)

Question 36

Celecoxib and meloxicam are examples of what group of meds?

Answer 36

Cox 1 inhibitors

Question 37

Cox-2i and Cox-1i (traditional NSAID) received boxed warnings on their labels regarding ____________ risks

Answer 37

cardiovascular

Question 38

When do T waves invert after the onset of an MI? a) At onset b) A few minutes to hours c) A few hours to days d) A few days to weeks

Answer 38

b) A few minutes to hours

Question 39

T wave inversion from ischemia is typically ____________. a) Symmetric b) Asymmetric

Answer 39

a) Symmetric

Question 40

T/F: J-point elevation has pathologic significance

Answer 40

False

Question 41

STE bowed upward and merge imperceptible with the T wave is indicative of what? a) J-point elevation b) MI c) Neither of the above

Answer 41

b) MI

Question 42

T/F: J-point elevation will not change on serial ECGs

Answer 42

True

Question 43

Brugada syndrome is a genetic condition caused by dysfunctional cardiac ____ channels a) K+ b) Cl- c) Na+ d) H2O

Answer 43

c) Na+

Question 44

With acute MI, which of the following usually persists for life? a) STE elevation b) Reciprocal changes c) T wave inversion d) New Q waves

Answer 44

d) New Q waves

Question 45

What type of MI involves the RCA or descending branch and is seen in leads II, III, & aVF? a) Anterior b) Lateral c) Posterior d) Inferior

Answer 45

d) Inferior

Question 46

de Winter’s T waves and Wellens’ waves may indicate the occlusion of the _________ branch of the LCA a) Anterior septal b) Posterior septal c) Lateral d) Inferior

Answer 46

a) Anterior septal

Question 47

What type of MI is most often misdiagnosed? a) Anterior b) Lateral c) Posterior d) Inferior

Answer 47

c) Posterior

Question 48

With which of the following types of MI may you see RAD? a) Anterior b) Lateral c) Posterior d) Inferior

Answer 48

c) Posterior

Question 49

Which has a higher risk of for further infarction and mortality? *(don’t confuse with initial risk)* a) STEMIs b) NSTEMIs

Answer 49

b) NSTEMIs

Question 50

Takotsubo cardiomyopathy occurs most often in _______________, under extreme psychological or emotional stress? a) Men 18-35 b) Women 18-25 c) Men >55 y/o d) Postmenopausal women

Answer 50

d) Postmenopausal women

Question 51

"Apical ballooning syndrome” was mentioned to potentially occur with what?

Answer 51

Takotsubo cardiomyopathy

Question 52

Takotsubo cardiomyopathy and angina may both involve T wave inversion, but Takotsubo cardiomyopathy involves ST __________ and angina involves ST __________ (excluding Prinzmetal angina)

Answer 52

elevation; depression

Question 53

Inferior MI: What does it involve? What leads is it seen in?

Answer 53

RCA or descending branch. Leads: II, III, aVF

Question 54

Anterior MI: What does it involve? What leads is it seen in?

Answer 54

Anterior IV branch (LAD) of LCA. Leads: V1-6

Question 55

Lateral MI: What does it involve? What leads is it seen in?

Answer 55

Left circumflex br. of LCA. Leads: I, aVL, V5-6

Question 56

Posterior MI: What does it involve? What leads is it seen in?

Answer 56

1) RCA; usually accompany inferior MI or less frequently lateral MI. 2) Reciprocal changes in the anterior leads V1-3 (ST depression, Tall R wave)

Question 57

List the following groups of leads: 1) Anterior 2) Left lateral 3) Inferior 4) Right ventricular

Answer 57

1) V2, V3, V4 2) I, aVL, V5, V6 3) II, III, aVF 4) aVR, V1