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Flashcards in Samplex 2015 Deck (45)
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A patient comes to you complaining of cyanosis of the lower extremities but not the upper extremities. Which among the following congenital disorders will you consider?

a. VSD
b. TOF
c. Coarctation of the aorta
d. PDA


This can be caused by severe PDA. Coarctation of the aorta does not typically cause cyanosis. Probably severe coarctation can.


Which of the following heart sounds is absent in patients with atrial fibrillation?

a. S1
b. S2
c. S3
d. S4



How large should a normal adult mitral valve orifice be?

a. 1-2 cm
b. 2-4 cm
c. 4-6 cm
d. 10-12 cm



Which of the following statements is FALSE regarding mitral stenosis?

a. It results in tricuspid and pulmonic valve incompetence and right sided heart failure
b. It can present with hemoptysis once pulmonary hypertension sets in
c. Patients characteristically present with malar rash
d. Typical auscultatory findings include low-pitched rumbling diastolic murmur


Patients present with malar FLUSH not malar rash.


The following treatment strategies are beneficial to patients with mitral stenosis EXCEPT?

a. Increasing the heart rate
b. Giving prophylaxis against infective endocarditis
c. Restriction of sodium intake
d. Prophylaxis against Streptococcus infection


You must control heart rate since ventricular filling is dependent on heart rate. (Consider atrial fibrillation vs sinus rhythm)


Which of the following is NOT a major manifestation of rheumatic fever according to the modified Jones criteria?

a. Carditis
b. Arthralgia
c. Syndenham’s chorea
d. Erythema marginatum


Answer: B. Major Manifestations:
• Carditis – most common among hospitalized patients
• Polyarthritis – most common manifestation overall (migratory)
• Chorea (Syndeham)
• Erythema marginatum (least common)
• Subcutaneous nodule


Which of the following is TRUE regarding rheumatic fever (RF) prophylaxis?

a. It is not given to patients who already had previous episodes of RF.
b. Best results are achieved when benzathine penicillin is given intramuscularly every year.
c. Among patients who had resolved episodes of carditis, prophylaxis is given for a minimum 5 years.
d. Among patients diagnosed with rheumatic heart disease, prophylaxis is given for life


A. It is given to patients who already had previous episodes of RF
B. Benzathine PCN 1.2 M U q 21 for 28 days- best choice because benzathine penicillin is long acting, cost effective and due to good compliance; administered via the intramuscular route
C Minimum 10 years
D. If already RHD, prophylaxis is given for life


Which of the following aortic insufficiency/regurgitation findings is INCORRECTLY paired?

a. Quincke’s sign: capillary pulsations in the fingers upon transillumination
b. De Musset’s sign: Head bobbing for every systole
c. Corrigan’s pulse: rapid upstroke and rapid downstroke of the carotid pulse
d. Duroziez’ sign: water hammer pulse


Duroziez’ sign: to-and-fro murmur with femoral artery compression. Corrigan’s pulse: rapid upstroke and rapid downstroke of the carotid pulse i.e. water hammer pulse


What is the most common cause of mitral stenosis?

a. Rheumatic
b. Myxomatous degeneration
c. Calcification
d. Degenarative


Mitral stenosis are generally rheumatic in origin. In the Philippines, it is about 90-95%. Valve leaflets are diffusely thickened by fibrous tissue and/or calcific deposits:
• Commisural fusion (hallmark of rheumatic)
• Chordae tendiane fuse & shorten
• Valvular cusps become rigid


What pathologic finding best differentiates calcific aortic stenosis from rheumatic aortic stenosis?

a. Presence of cuspal thickening
b. Absence of commisural fusion
c. Normal mitral valve
d. Presence of pulmunary hypertension


Rheumatic lesions always have commissural fusion


Which of the following if TRUE of myxomatous degeneration of the mitral valve?

a. Mostly affects young men.
b. Anatomically characterized by intercordal ballooning or hooding of mitral leaflets.
c. Annular dilation is rare.
d. Characterized by commissural fusion


Myxomatous degeneration is the same as mitral valve prolapse. It has a predilection for young women.


What is the most common type of VSD?

a. Membranous VSD
b. Infundibular VSD
c. Swiss-cheese septum type VSD
d. Sinus venosus type


Sinus venosus is a type of ASD nor VSD.


You noted your patient’s jugular venous pressure (JVP) to be 7cm H2O. What is his central venous pressure (CVP)?

a. 11cm H2O
b. 12cm H2O
c. 13cm H2O
d. 14cm H2O


CVP = JVP + 5cm


Which of the following correctly describes the technique in posterior tibial pulse palpation?

a. The medial malleolus is located and the pulse palpated 2-3cm below and behind it.
b. The lateral malleolus is located and the pulse palpated 2-3cm below and behind it.
c. The ankle joint located and the pulse palpated anterior and midway between the malleoli.
d. The ankle joint located and the pulse palpated posterior and midway between the malleoli.



Which of the following associated symptoms decreases the likelihood as acute myocardial infarction in a patient with chest pain?

a. pain radiating to the left arm.
b. associated with diaphoresis
c. described as sharp
d. associated with nausea or vomiting


All other choices are classic symptoms. Pain is described as heavy, crushing... not sharp.


patient comes to you complaining of burning substernal chest pain lasting for 10-60minutes worsened by postprandial recumbency. What is the most plausible clinical diagnosis?

a. acute myocardial infarction
b. biliary colic
c. esophageal reflux
d. Tietze’s syndrome


acute myocardial infarction- retrosternal/precordial location
bilary colic- quality of pain: colicky, crampy or spastic
Tietze’s syndrome- associated with MSK disease, sharp localized pain


The following neurohormonal events result from systolic hear failure EXCEPT

a. renin-angiotensin-aldosterone system activation
b. decreased levels of arginine vasopressin
c. sympathetic activation
d. increased levels of catecholamines


a. activation of sympathetic nervous system
b. activation of renin-angiotensin system
c. neurohormonal alteralations of renal functions
d. neurohormonal alterations in the peripheral vasculature
*catecholamines secreted by medulla to increase heart rate
*vasopressin- induces vasoconstriction: should be increased in this case!


Which of the following findings is LESS commonly associated with diastolic heart failure?

a. Hypertension
b. Preserved ejection fraction on 2-D echocardiography
c. Third heart sound
d. Concentric left ventricular hypertrophy


Systolic HF: large dilated heart, normal or decreased BP, broad age group, decreased ejection fraction, s3 gallop, mainly systolicimpairment, prognosis poor

Diastolic HF: small LV cavity, concentric LV hypertrophy, systemic HPN, hypertrophic cardiomyopathic disease, elderly women, normal or increased ejection fraction, S4 gallop, systolic and diastolic impairment, prognosis not so poor


Which of the following belongs to the minor Framingham criteria for heart failure?

a. Exertional dyspnea
b. Neck vein distention
c. Rales
d. Paroxysmal nocturnal dyspnea


Framingham Criteria for HF:
Major: PND/orthopnea, neck vein distention, rales,cardiomegaly, s3 gallop, acute pulmonary edema, increased venous pressure, hepatojugular reflex
Minor: extremity edema, night cough, exertional dyspnea, hepatomegaly, pleural effusion, vital capcity 120bpm)


A 60-year old male iwth cornoary artery disease comes in the ER due to shortness of breath. you ____ _____ rales on all lung fiels and distended neck veins during Physical examination. The patient’s BP is 110/70. What group of drugs will best address pulmonary congestion of the patient?

a. beta-blockers
b. angiotensin converting enzyme inhibitors
c. cardiac glycosides
d. loop diuretics


In pulmonary congestion give loop diuretics ie Furosemide


Which among the following etiologic agents most commonly cause early (


For prosthetic valve endocarditis: Early (12 months): Streptococcus.


The most common presenting sign of infective endocarditis.

a. fever
b. new murmur
c. weight loss
d. splenomegaly



You are treating a patient with tricuspid valve endocarditis. He has been afebrile after receiving a week’s course of intravenous antibiotics. He suddenly developed pleuritic chest pain, shortness of breath, and decreased sensorium. Physical examination revealed clear breath sounds. What is your diagnosis?

a. acute stroke
b. pulmonic septic embolization
c. pulmonary embolism
d. tricuspid leaflet rupture



True of proper blood pressure measurement.

a. The patient should not have eaten, smoked, taken caffeine, or engaged in vigorous exercise within the last 3 minutes.
b. The stethoscope is placed above the radial artery.
c. Blood pressure should be taken in all extremities during the first encounter.
d. The sphygmomanometer is inflated 40 to 50 mm Hg above the estimated systolic pressure.



True about the Korotkoff sounds.

a. Phase I: indicative of diastolic blood pressure
b. Phase II: sound first heard during the release of the pressure cuff
c. Phase IV: sound starts to muffle
d. Phase V: soft muffled sound



The following statements describe the carotid artery pulsations.

a. Carotid artery pulsation is more palpable than jugular pulsation.
b. Carotid artery has two pulsations per systole.
c. Carotid artery is best seen halfway up the neck.
d. Carotid artery does not cease upon compression of the root of the neck.



A giant “a” wave of the jugular venous pulse is seen in which of the following conditions?

a. atrial fibrillation
b. tricuspid stenosis
c. tricuspid regurgitation
d. restrictive cardiomyopathy


Tricuspid stenosis will cause greater atrial contraction


During precordial examinations, pulsations are best analyzed using the:

a. fingertips
b. palm
c. thumbnail
d. dorsum of the hand



A 54 year old female patient with aortic stenosis is admitted to ER for syncope. Based on natural history of the disease, how long will the patient survive if the valvular disease is not corrected?

a. 1 year
b. 2 years
c. 3 years
d. 4 years


Remember ASH A- 5 years; S- syncope - 3 years; H-1 year


Straightened left border of cardiac silhouette (cardiac waistline) is seen in which of the following diseases:

a. Tricuspid stenosis
b. Pulmonic regurgitation
c. Mitral stenosis
d. Tricuspid regurgitation


Mitral stenosis will cause left atrial hypertrophy