Cardio Flashcards
these can be heard in mitral stenosis, except for
a) apical holosystolic murmur radiating o the axilla
b) low freq apical diastolic murmur
c) opening snap
d) loud first heart sound
a) apical holosystolic murmur radiating o the axilla
holosystolic radiating to axilla is typical of mitral regurgitation
Part of the therapy of decompensated heart failure, except for
a) mineralocorticoid-antagonists
b) diuretics
c) digoxin
d) parenteral volume expansion
e) ACE inhibitors
d) parenteral volume expansion
in chr decomp HF the body is in a state of fluid overload so diuretics and mineralocorticoid antagonists are essential. Digoxin should be given bc its a positive inotrope and negative chronotrope while ACEIs help long term survival. parenteral fluids (aka infusions) should be avoided
Cause of acute LVF, except for
a) bronchial asthma
b) AMI
c) hypertensive crisis
d) severe aortic stenosis
asthma bronchial
bronchial asthma puts strain on the RV not the L
Characteristic of hypertrophic obstructive cardiomyopathy, except for
a) might be combo with mitral insufficiency
b) digoxin is important in the early stage
c) it often shows a familial distribution
d) diastolic dysfunction is common
e) syncope is a common symptom
digoxin is important in the early stages
it is not recommended in either early or late stages unless the disease has reached its ‘burnout’ dilated phase
features of atrial myxoma, except for
a) the most common form of primary cardiac tumors
b) can be diagnosed with echo
c) often metastatic
d) can mimic mitral stenosis during physical exam
it’s often metastatic
since it’s benign and in situ, mets are rare
which one is true about the mechanism of action of digoxin
a) inhibits intracellular Na/K-ATPase
b) it lowers intracellular Na conc
c) inc ATP levels
d) enhances cAMP production
e) dec Ca release from sarcoplasmic reticulum
it inhibits the Na/K ATPase
this causes a temp rise in intracellular Na levels which inc intracellular Ca via the Na-Ca exchanger. As result the high Ca level inc myocardium contractility and has positive inotropic effect
All of the following statements about NTG are true, except for
a) inc intracellular cGMP levels
b) primarily metabolised in the liver
c) can induce significant reflex tachycardia
d) significantly prolongs AV conduction
e) can lead to postural hypotension
significantly prolongs AV conduction
nitrates don’t alter AV conduction
the typical side effect of nitrates are
a) HTN
b) headache
c) bradycardia
d) sexual dysfunction
e) anemia
headache
should resolve in a few days so they shouldn’t give up on it right away
The typical features of Prinzmetal angina
a) ST segment depression during angina
b) negative T waves during angina
c) pathologic Q waves during angina
d) elevated necroenzymes
e) ST segment elevation during angina
ST segment elevation during angina
Prnzmtl is a type of coronary artery spasm with ST elevation indicating subepi or transmural ischemia. ST depression is seen in subendocardial ischemia.
Types of unstable angina pectoris, except for
a) angina at rest
b) crescendo angina
c) effort angina
d) new onset angina
effort angina
new onset counts as unstable, and crescendo too (inc in freq, severity, and duration), and can dev at rest. effort means it’s the same level of stress that causes it each time
The most common pathology of MI
a) coronary embolism
b) rupture of an ATH plaque
c) dissection of coronary walls
d) growing of ATh plaque
e) coronary inflamm
rupture of ATH plaque
it’s usually the rupture of the plaque the following thrombus. soft plaques are usually worse
normal mean electrical axis in the front plane, except for
a) +60
b) +90
c) -45
d) 0
e) +45
-45
0 to +90 is thought to be normal range while -45 is LAD
if AMI is suspected, the following diagnostic procedures should be carried out except for
a) ECG
b) blood test to see CK-MB and troponin
c) physical exam
d) cardiac stress test
e) echo
cardiac stress test
don’t do it stupid they’re already stressed
IHD can present with , except for
a) AMI
b) stable angina
c) DVT
d) sudden cardiac death
e) ischemic cardiomyopathy
DVT
isn’t directly connected with thrombotic processes in coronary circulation
The most important risk factor of ATH
a) high seLDL
b) high seHDL
c) high seTG
d) high seCholesterol
high seLDL
chronic high cholesterol and changes to the LDL/HDL ratio are key factors in the pathomech of ATH since its the toxic metabolites of oxidation that leads to plaque. high TGs are less significant compared to LDL.
risk factors for CAD except for
a) positive family history
b) DM
c) smoking
d) high seHDL
e) metabolic syndrome X
high seHDL
HDL is protective against the dev of ATH
The ideal target value of seLDL in a DM patient after an MI
a) < 1.8 mmol/L
b) > 2.6 mmol/L
c) < 3.5 mmol/L
d) > 3.5 mmol/L
< 1.8 mmol/L
target value in very high risk pt is lower than primary prevention
A 65 pt with a history of smoking presents with sudden pain in his left leg. The limb feels cold and the toes are pale and peripheral pulse can’t be felt.
a) DVT
b) Buerger’s disease
c) embolism in the peripheral arteries
d) Raynauds disease
embolism in the peripheral arteries
symptoms developed quickly unlike in DVT which would have a pulse. Buerger’s is also slow.
Paramedics arrive to a 55yo pt with chest pain that started 3h ago. On the ECG there’s elevations in I, aVL, V5, and V6. What should they do?
a) transfer the pt to the regional ER
b) transfer the pt to the regional coronary care unit
c) transfer the pt to the regional cardio dept for a troponin test and if positive transfer to a PCI center
d) transfer the pt to the closest PCI center
transfer to the closest PCI center
they have a STEMI which is almost always bc of coronary occlusion and PCI is the best way to fix it so don’t delay at all
Upon physical exam of a 45yo man w/o symptoms of a soft systolic murmur and ejection click can be heard in 2L2. This has been known since he was a child so what was the diagnosis?
a) patent DA
b) coarctation of the aorta
c) ventricular septal defect
d) Ebstein’s anomaly
e) pulmo valve stenosis
pulmonary valve stenosis
organic heart disease since childhood without any symptoms is likely pulmo stenosis. patent DA causes continuous murmur, coarctation causes high BP in the upper limbs, VSD causes very loud systolic murmur,
Correct statement about aortic stenosis, except for
a) it causes pulus parvus et tardus
b) it can cause syncope
c) it can cause angina like chest pain
d) Austin-Flint murmur can be heard upon auscultation
e) it causes concentric left ventricular hypertrophy
Austin-Flint murmur
AF murmur can be heard in aortic regurgitation, not stenosis
Correct statements about aortic insufficiency, except for
a) it causes pulsus celer et altus (Corrigan’s pulse)
b) it can be acute and chronic
c) usually doesn’t lead to LV dilation
d) can be congenital
e) it predisposes to infective endocarditis
it doesn’t usually lead to LV dilation
it does lead to LV dilation due to volume overload
Accessory pathway-mediated reentry tachycardia (AVRT) can be terminated with, except for
a) propafenone
b) adenosine
c) lidocaine
d) RF ablation
e) verapamil
lidocaine
lidocaine cannot delay the conduction in the AV node or in the bundles that can carry signal
A regular wide QRS complex tachycardia can not be
a) ventricular tachycardia
b) SVT with BBB
c) Afib with BBB
d) antidromic AV reentry tachycardia (WPW)
e) Aflutter with BBB
Atrial fibrillation with BBB
Afib might have narrow and wide QRS complex but they’re always regularly irregular
A pt was admitted to the ED bc of palpitation that started 3h ago. On ECG an Afib with rapid (150bpm) ventricular response was seen. His BP was 130/90. In the pts history there wasn’t anything that indicated structural heart disease. What’s the best first step in this situation?
a) pharma conversion
b) immediate electrical cardioversion
c) coronarography
d) immediate anticoag to prevent TE
e) cardiac stress test
pharma cardioversion
they are hemodynamicallys table so they don’t need electro tx and long term anticoag isn’t needed if it’s only a few hrs old.
Which one is the most common permanent arrhythmia
a) ventricular extrasystoles
b) atrial fibrillation
c) ventricular tachycardia
d) SVT
e) junctional escape rhythm
afib
depending on the age prevalence is 0.4-14% with permanent meaning 30s+ (excluding ventricular extrasystoles)
A pt who has been taking amiodarone for a long time was prescribed a fluoroquinolone AB bc of a respiratory infection. She had recurring, short-term syncopes that had never occurred before. Which one is the most likely cause of the syncopes?
a) hypotension bc of the meds
b) torsade de pointes VT bc of the meds
c) sinus bradycardia bc of the meds
d) symptoms aren’t linked, they’re just a coincidence
e) AV block induced by the meds
TdP bc of the meds
both class III antiarrhythmic agents and fluoroquinolone can prolong the QT interval and inc the chances of TdP. if you get symptoms then remove the meds
These could be the first ECG findings in an acute phase of MI, except for
a) pathological Q wave
b) inverted T waves
c) ventricular fibrillation
d) ST segment elevation
e) ST segment depression
pathological Q waves
patho Q waves take hours to days to show up
PAtho Q waves in leads II, III, and aVF with isoelectric ST segments and positive T waves indicate
a) acute ischemia
b) acute phase of a progressing MI
c) previous MI
d) aneurysm after MI
e) subendocardial ischemia
previous MI
patho Q waves are indicative of an old infarct and ST changes +/- T wave inversions are more for acute MIs. Aneurysms show elevated ST segments 2-3 weeks after the onset of symptoms
In the diagnostic workup of a 60yo pt with a history of smoking who has chest pain at exertion the first step should be
a) stress echo
b) exercise test
c) stress perfusion scintigraphy
d) holter ECG
e) stress MRI
exercise test
most likely caused by CAD and so stress test should be next step
The best first choice drug for bradycardia during MI is
a) isoproterenol
b) theophylllin
c) atropine
d) dobutamine
atropine
Most common side effect of ACEIs is
a) diarrhea
b) cough
c) vomiting
d) erythema
e) anasarca
cough
result of high bradykinin conc (its metabolism is inhibited)
Which disease causes systolic hypertension
1 aortic insufficiency
2 thyreotoxicosis
3 beriberi
4 ATH
a) 1 2 3
b) 1 3
c) 2 4
d) only 4
e) all
all
Aortic aneurysm can be caused by
1 arterioscleorsis
2 Marfans
3 vascular syphilis
4 giant cell arteritis
a) 1 2 3
b) 1 3
c) 2 4
d) only 4
e) all
1 2 3
they can call damage the arterial tunica media and that leads to its weakening, the loss of elastic elements, and resulting dilation. GCA usually leads to throbbing pain of temporal arteries
Possible causes of pericarditits
1 uremia
2 transmural MI
3 TB
4 metastatic cancer
a) 1 2 3
b) 1 3
c) 2 4
d) only 4
e) all 4
all
transmural MI is a less common cause but still valid
Secondary CMP can be caused by
1 hyperthyroidism
2 beriberi
3 amyloidosis
4 glycogenesis
a) 1 2 3
b) 1 3
c) 2 4
d) only 4
e) all 4
all
hyperthyroidism and beriberi can cause dilated CMP, amyloidosis can come before restrictive infiltrative CMP, and glycogenosis can lead to hypertropic restrictive secondary CMP
ACEIs
1 dec BP
2 dec aldosterone
3 inc bradykinin
4 stop deterioration of LVEF
a) 1 2 3
b) 1 3
c) 2 4
d) 4
e) all
all
Which ones are correct
1 aspirin has no effect on prostacyclin production of the endothel cells
2 according to multicenter trials aspirin dec the chance of a second MI
3 takes 24h for heparin to build up its anticoag effect
4 heparin and alteplase are tx options in pulmo embolism
a) 1 2 3
b) 1 3
c) 2 4
d) 4
e) all
2 4 are correct
aspirin blocks cyclooxygenase enzyme that makes prostacyclin and both subQ and IV heparin have rapid onset and fibrinolytics (alteplase) are used to dissolve fibrin bound thrombin
Which diuretic side effect combo is/are correct
1 furosemide - hyperuricemia
2 chlortalidone - ototoxicity
3 spirinolactone - gynecomasty
4 etacrynic acid - hyperuricemia
a) 1 2 3
b) 1 3
c) 2 4
d) 4
e) all
1 and 3
furosemide (and chlortalidone) dec uric acid secretion leading to gout and spirinolactone can cause gynecomasty bc of its antialdosterone effect
RFs for ischemic heart disease
1 smoking
2 hypercholesterolemia
3 hypertension
4 fam hx
a) 1 2 3
b) 1 3
c) 2 4
d) 4
e) all
all
Treatments that reduce morbidity and mortality after myocardial infarction (secondary prevention):
1) beta-blockers
2) antiplatelet drugs
3) HMG-CoA reductase inhibitors
4) ACE inhibitors
a) Answers 1, 2 and 3 are correct
b) Answers 1 and 3 are correct
c) Answers 2 and 4 are correct
d) Only answer 4 is correct
e) All of the answers are correct
all
Diagnostic options to determine myocardial viability:
1) low-dose dobutamine stress test
2) positron-emission tomography
3) stress perfusion scintigraphy with Tl-201 reinjection
4) Doppler ultrasound
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
1 2 3
Contraindications of cardiac exercise tests:
1) acute myocardial infarction
2) chronic heart failure
3) unstable angina
4) beta-blocker therapy
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
1 and 3
Diagnostic tests with the ability to detect asymptomatic angina pectoris (silent ischemia):
1) dobutamine stress echocardiogram
2) Holter ECG monitoring
3) exercise test
4) ABPM
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
1 2 3
ambulatory BP monitoring won’t detect anything useful
Early and late complications of acute myocardial infarction:
1) ventricular fibrillation
2) left ventricular aneurysm formation
3) cardiogenic shock
4) pericardial effusion
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
all
Vfib and shock can be acute complication while LV aneurysm and pericardial effusion are seen as late and very late complications (like weeks)
Treatment option(s) of heart failure:
1) pharmacotherapy
2) heart transplant
3) mechanical circulatory support devices
4) cardiac resynchronization therapy
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
all
Risk factors of atherosclerosis:\
1) stress
2) AV-nodal reentry-tachycardia
3) smoking
4) hypotension
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct
1 and 3
Drugs that lower serum cholesterol level:
1) rosuvastatin
2) ezetimibe
3) atorvastatin
4) ivabradine
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct
1 2 3
statins dec cholesterol levels
ezetimibe dec serum cholesterol by blocking the absorption of cholesterol in the small intestine
Drugs that lower serum triglyceride levels:
1) special diet
2) niacin
3) fibrates
4) alcohol
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
1 2 3
Characteristic features of Prinzmetal angina:
1) it usually occurs at dawn during rest
2) ST segment elevation can be seen during angina
3) it is caused by coronary spasm
4) it should be treated with calcium-channel blockers
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
all
Possible complication(s) of deep vein thrombosis:
1) pulmonary infarction
2) crural ulcer
3) pulmonary embolism
4) Raynaud’s syndrome
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
1 2 3
Raynauds has vasospastic attacks and its not a TE disease
Possible complication(s) of atherosclerosis:
1) dry gangraena of the feet
2) aortic aneurysm
3) myocardial infarction
4) stroke
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
all
Might mimic the ECG findings of myocardial infarction:
1) pericarditis
2) pancreatitis
3) myocarditis
4) pulmonary embolism
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
all
Enzyme(s) that is/are elevated in myocardial infarction:
1) creatine kinase (CK-MB)
2) lactate dehydrogenase
3) troponin
4) alkaline phosphatase
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
1 2 3
high ALP is seen in GI, bone, or blood diseases
A 55 year old patient with a history of hypertension has been rushed to the emergency room because of severe chest pain and ST segment elevation. Possible diagnosis/diagnoses:
1) peptic ulcer
2) acute myocardial infarction
3) mitral valve prolapse
4) aortic dissection
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct
2 4
peptic ulcers and mitral valve prolapse both cause chest pain but no ST elevations
A 70-year-old patient had an anterior wall myocardial infarction three weeks ago. He suddenly develops a fever and complains of chest pain. On his ECG there are no new Q waves and his CK-MB level is normal. What is/are the most likely diagnose(s)?
1) myocardial reinfarction
2) pulmonary embolism
3) lobar pneumonia
4) Dressler’s syndrome
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
4
Dresslers syndrome (pericarditis) starts usually 3 weeks after an MI and presents with recurring chest pain with normal cardiac markers
Correct statements about mitral insufficiency:
1) it leads to the dilation of all heart chambers
2) it might be the complication of infective endocarditis
3) left atrial pressure can be elevated even when the ejection fraction is preserved
4) its severe form requires surgical treatment.
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
all
Correct statements about mitral stenosis:
1) it doesn’t increase the risk of atrial fibrillation
2) it predisposes to left atrial thrombus formation
3) during auscultation a muffled first heart sound and a mesosystolic click can be heard
4) it might be a late complication of rheumatic fever
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
2 4
loud first heart sound and opening snap can be heard in pts with MV stenosis
Echocardiographic findings of aortic stenosis:
1) the end-diastolic diameter of the left ventricle is not significantly enlarged
2) concentric left ventricle hypertrophy can often be seen
3) the left atrial diameter can be abnormally large
4) a pathologic transvalvular gradient can be measured at the level of the aortic valve with Doppler ultrasound
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
all
Echocardiographic findings of isolated mitral stenosis:
1) large left atrial diameter
2) the unidirectional movement of the anterior and posterior leaflets in M-mode
3) an abnormal transvalvular gradient can be measured in diastole at the level of the mitral valve with continuous wave Doppler ultrasound
4) the calcification of the whole mitral valve can be visualised with 2D-echocardiography
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
all
Characteristic of mitral valve prolapse:
1) it can cause ventricular extrasystoles
2) it can present with chest pain
3) it is common in Marfan’s syndrome
4) an opening snap can be heard during auscultation of the heart
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
1 2 3
Hypertrophic cardiomyopathy:
1) is caused by genetic mutations.
2) can cause dynamic left ventricle outflow obstruction.
3) can cause sudden cardiac death.
4) should not be treated with beta-blockers.
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct
1 2 3
The treatment of ventricular extrasystoles:
1) All cases must be treated with antiarrhythmic agents.
2) Frequent, symptomatic extrasystoles require antiarrhythmic pharmacological therapy.
3) Class Ic agents have been proven to be the best choice.
4) In most cases antiarrhythmic treatment is not required.
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
2 4
In the differential diagnosis of wide QRS complex tachycardia helps:
1) Knowing the organic status of the heart
2) Frequency of tachycardia
3) Physical or ECG signs of atrioventricular dissociation
4) Hemodynamic instability of the tachycardia
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
1 3
Principles of the treatment of wide QRS complex tachycardia:
1) If we are not sure in the mechanism, we should treat it as ventricular tachycardia.
2) Carotid sinus massage should be tried first before the medical treatment.
3) Immediate synchronized cardioversion is required in case of hemodynamic instability.
4) Always start the treatment with group 1/C agent.
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All four answers are correct
1 2 3
Etiologic factors of atrial fibrillation:
1) Hyperthyroidism
2) Mitral valve disease
3) Cardiomyopathy
4) Ischemic heart disease
A) Answers 1, 2 and 3 are correct B) Answers 1 and 3 are correct C) Answers 2 and 4 are correct D) Only answer 4 is correct E) All of the answers are correct
all