Cardio

Question 1

• Antihyperlipidemic medication therapy
• Muscle pains

Answer 1

Statins (need to be stopped)

Question 2

• Hypotension
• Venous hypertension (jugular venous distention)
• Muffled or distant heart sounds

Answer 2

Cardiac tamponade (Beck’s triad)

Question 3

Change in heart rate/ECG with respiration

• increased with inhalation
• decreased with exhalation

Answer 3

Sinus arrhythmia

Question 4

• Claudication
• weak lower extremity pulses with high blood pressure in the upper extremities
• rib notching
• “3” sign

Answer 4

Coarctation of the aorta

Question 5

• Headache with scalp tenderness
• Jaw claudication with mastication, talking
• Visual changes (monocular vision loss)
• Elevated erythrocyte sedimentation rate (ESR)
• Associated with polymyalgia rheumatic

Answer 5

Giant cell/temporal arteritis

Question 6

• Hypertension that is refractory to several medications (patient is on several antihypertensives)
• bruit in abdomen

Answer 6

Renovascular disease (secondary hypertension)

Question 7

• Increased jugular venous pressure
• Clear lung sounds
• Positive Kussmaul sign

Answer 7

Right ventricular myocardial infarction

Question 8

• Intermittent claudication
• Decreased or absent pulses in feet
• Atrophic skin changes (loss of hair, shiny skin, thick nails)
• Ankle-brachial index < 0.90

Answer 8

Peripheral arterial disease

Question 9

Irregularly irregular cardiac arrhythmia

Answer 9

Atrial fibrillation

Question 10

Machinery-like continuous murmur

Answer 10

Patent ductus arteriosus

Question 11

• Mid-systolic click
• young female with chest pain and palpitations

Answer 11

Mitral valve prolapse

Question 12

Most common acyanotic heart lesion

Answer 12

(Perimembranous) ventricular septal defect

Question 13

• Most common cyanotic heart lesion
• Four components: pulmonic stenosis, right ventricular hypertrophy, overriding aorta, ventricular septal defect
• “Boot-shaped” heart
• Tet spells

Answer 13

Tetralogy of Fallot

Question 14

• Opening snap
• history of acute rheumatic fever or untreated streptococcal pharyngitis

Answer 14

Mitral stenosis

Question 15

• Paresthesias (often early)
• Pain
• Pallor
• Pulselessness
• Poikilothermia (cold extremities)
• Paralysis (late finding with poor prognosis)

Answer 15

Acute arterial occlusion

Question 16

• Pericardial knock
• Square root sign
• Kussmaul’s sign
• Increased jugular venous pressure
• Pericardial thickening or calcification on CT/MRI

Answer 16

Constrictive pericarditis

Question 17

• Post-myocardial infarction
• Fever
• Pulmonary infiltrates on CXR

Answer 17

Dressler syndrome

Question 18

• Post-myocardial infarction with hypotension
• Severe systolic heart failure
• Wet lung sounds

Answer 18

Cardiogenic shock

Question 19

• Post-viral illness
• Chest pain
• Worse with deep breathing, thorax movement
• Better with leaning forward
• Pericardial friction rub (pathognomonic)
• Global ST segment elevation
• PR interval depression in inferior leads

Answer 19

Acute pericarditis

Question 20

• Severe emotional stress manifestations of heart failure
• absence of obstructive coronary artery disease
• apical ballooning

Answer 20

Takotsubo (stress) cardiomyopathy

Question 21

• Smoking history
• Abdominal or flank pain
• Pulsatile abdominal mass (the “pulsating lemon”)

Answer 21

Abdominal aortic aneurysm

Question 22

• Spinal cord injury with hypotension
• Bradycardia
• Absence of sweating below the site of injury

Answer 22

Neurogenic shock

Question 23

• Sudden cardiac death in young male athlete
• family history of young sudden cardiac death
• murmur at RUSB

Answer 23

Hypertrophic obstructive cardiomyopathy

Question 24

• Tearing or ripping chest pain
• Radiation to intrascapular region
• History of hypertension
• Widened mediastinum on CXR

Answer 24

Aortic dissection

Question 25

Wide, fixed split S2

Answer 25

Atrial septal defect