cardio 8

Question 1

Orthostatic hypotension?

Answer 1

Drop in systolic B/P more than 20 when standing

Question 2

Risk factor?

Answer 2

Elderley
Hypovolumic
Autonomic pnuropaty(parkinson and DM)
Drug(diuretics,adrenergic blocker and vasodilators)

Question 3

Predisposing factor?

Answer 3

Prolonged recumbence

Question 4

Symptom?

Answer 4

Syncop

Presyncop lightheadnes

Question 5

How to differentiate syncope from AS to orthostatic hypotension in an elderly patient?

Answer 5

AS-syncope occur during activity

the patient will have chest pain, dyspnea, and fatigue during activity.

Question 6

What is commonly encounter in PE finding in AR other than regurgitant lesion?

Answer 6

Water hammer pulse

Question 7

What causes water hammer pulse?

Answer 7

Increase in stroke volume

Question 8

When will the patient with AS symptomatic?

Answer 8

when AS is severe (<1cm2)

Question 9

What are these symptoms?

Answer 9

angina, syncope,presyncop, dyspnea, and heart failure symptom

Question 10

PE finding other than being symptomatic that indicate AS severity?

Answer 10

Delayed and diminished puse(Parvus and tardus)
Late picking crescendo decrescendo systolic murmur
Soft and single S2

Question 11

Severity indicator PE finding in MS?

Answer 11

The diastolic murmur that follows the OS and OS itself more comes closer to s2?

Question 12

What movement may syncopal attack the patient will have?

Answer 12

Clonic jerk due to cerebral ischemia.

Question 13

How you d/t it from seizure?

Answer 13

seizure patient will have

• Precipitating factor
• Aura(prodromal symptom in VV syncope)
• Head deviation and unusual body posturing
• lateral toungh laceration(TIP in syncope)
• post ectal prolonged disorientation and confusion

Question 14

What are prodromal symptoms in syncope?

Answer 14

Nausea
Pallor
Diaphoresis

Question 15

syncope which occurs secondary to arrhythmia indicators?

Answer 15

History of heart disease

Absence of prodromal symptoms.

Question 16

The laboratory should be done in patients diagnosed with essential hypertension?

Answer 16

RFT(electrolyte,creatinin,e and urinalysis)
Endocrine(FBS,HA1C,lipid profile and TSH)
Cardiac(ECG and echo(opthional)
Other (CBC,Uric acid optional)

Question 17

Confirmatory diagnosis of Aortic disection?

Answer 17

Renal failure/hemodynamic instability–Do TEE(high sensitivity and specificity)
No renal failure/Hemodynamically stable–Contract CT
Contrast MRI–Not recommended because it took time

Question 18

classification of pretest probability of stable angina?

Answer 18

low, intermediate and high

Question 19

Low(<10%)?

Answer 19

asymptomatic in all age

atypical angina in women age<50

Question 20

intermidiate(20-80%)?

Answer 20

Atypical angina in women age>=50
Atypical angina in a male of all age
Typical angina in women age 30-50

Question 21

High (>90%)?

Answer 21

typical angina in male >40

typical angina in women age >=60

Question 22

what is a typical angina symptom?

Answer 22

Typical location(substernal),duration and quality
provoked by exercise or stress
Relived by rest/nitroglycerin

Question 23

when we say atypical?

Answer 23

<=2 above three criteria

Question 24

diagnosis of stable angina?

Answer 24

exercise stress test