Cardio and pulm

Question 1

Symptoms of beta blocker intoxication

Answer 1

Bradycardia, AV block, Hypotension, diffuse wheezing

Question 2

Treatment for beta blocker intoxication

Answer 2

Secure airway
Isotonic fluid
IV atropine
if no change, IV glucagon

Question 3

Patient OD with sx bradycardia, AV block, hypotension, diffuse wheezing

Answer 3

Beta blockers

Question 4

OD with sx: fatigue anorexia, nausea, blurred vision, disturbed color perception, arrhythmias

Answer 4

Digoxin

Question 5

Next steps if hear diastolic murmur

Answer 5

Echo

Question 6

gradually decreasing diastolic murmur best heard with full expiration

Answer 6

Aortic regurgitation

Question 7

Aortic regurg murmur

Answer 7

Diastolic, high-pitched blowing on left sternal border.

best heard with full expiration

Question 8

Work up for mid systolic murmur in young asymptomatic adults

Answer 8

NONE

Question 9

What is isolated systolic hypertension?

Answer 9

systolic >140 with diastolic

Question 10

Pathophysiology of isolated systolic HTN

Answer 10

Increased stiffness or decreased elasticity of aortic and arterial walls in elderly.

Question 11

Murmur for aortic insufficiency

Answer 11

early diastolic murmur with echo showing aortic regurg

Question 12

Hyperdynamic states

Answer 12

anemia, hyperthyroid, av fistula

Question 13

Signs of hyper dynamic circulation

Answer 13

ventricular heave, hyper dynamic precordium

Question 14

Features of chest pain caused by MSK

Answer 14

• Persistant pain
• worse with movement
• often after repetitive activity

Question 15

Features of chest pain caused by GI or esophageal

Answer 15

• Nonexertional pain lasting more than 1hr
• Upper abd and substernal
• Associated with regurgitation, nausea, dysphagia
• NOCTURNAL pain

Question 16

Chest pain due to pericarditis

Answer 16

sharp/stabbing

• worse with inspiration
• worse when laying flat

Question 17

Signs and sx of constrictive pericarditis

Answer 17

fatigue and dyspnea (2/2 decreased CO)
-elevated JVP, ascites, pedal edema (signs of venous overload)

• Pericardial knock
• Kussmaul’s sign–lack of inspiratory decline in CVP
• pericardial calcifications

Question 18

Causes of constrictive pericarditis

Answer 18

Idiopathic or viral
cardiac surgery or radiation therapy
TB

Question 19

Causes of cor pulmonale

Answer 19

COPD and PE

Question 20

complicated parapneumonic effusion characteristics

Answer 20

EXUDATIVE
HIGH protein
low glucose (

Question 21

uncomplicated vs. complicated parapneumonic effusion

Answer 21

Uncomplicated: just fluid- high pH, nl to low glucose, responds to antibiotics

Complicated: bacteria growing in fluid- low pH, low glucose, usually needs drainage
CXR–loculation

Empyema: purulent with positive culture

Question 22

Exertion dyspnea, chest pain, fatigue, palpitations, pre syncope, syncope

Answer 22

Hypertrophic cardiomyopathy

Question 23

Maneuvers that decrease intensity of HCM murmur

Answer 23

reduced by increasing after load or preload:

sustained hand grip, squatting from standing, passive leg raise

Question 24

Murmur of HCM

Answer 24

harsh crescendo-decrescendo systolic murmur at apex

Question 25

What makes HCM murmur louder

Answer 25

decrease preload:
valsava
standing up from sitting
Nitroglycerine

Question 26

Management of acute aortic dissection

Answer 26

• Pain relief (morphine)
• IV BB
• ICU
• Vasodilator (nitroprusside) if BP remains high
• surgery

Question 27

Think it is a PE? What criteria to use?

Answer 27

Wells:
(+3): signs of DVT or alternate dx less likely
(+1.5): previous PE or DVT, HR>100, Recent surgery
(+1): hemoptysis, cancer

> 4=PE likely

Question 28

Cardiovascular features of Marfan syndrome

Answer 28

Aortic dilation, regurg, or dissection

Mitral valve prolapse

Question 29

Pulmonary features of Marfan syndrome

Answer 29

Spontaneous pneumothorax from apical blebs

Question 30

Murmur of aortic regurgitation

Answer 30

early decrescendo diastolic murmur on left sternal border.

Question 31

Characteristics of atheroembolism (cholesterol embolism)

Answer 31

• skin findings (blue toe syndrome, lived reticularis)
• cerebral or intestinal ischemia
• AKI
• Hollenhorst plaques (yellow plaques in retina)

Question 32

Timing of cholesterol embolism

Answer 32

immediately or > 30 days after cardiac catheterization.

Question 33

Tumor that produces beta-HCG and AF

Answer 33

nonseminomatous germ cell tumor

Question 34

ABG in pt with acute asthma exacerbation

Answer 34

Resp alkalosis (hyperventilation)
Low PCO2

Question 35

Empiric tx for postnasal drip

Answer 35

Oral first-generation antihistamines or combined antihistamine-decongestant

Question 36

Acute right heart strain

Answer 36

JVD, RBBB

Question 37

Massive PE

Answer 37

hypotension, syncope, right heart strain, JVD

Question 38

Ventricular aneurysm EKG

Answer 38

5d to 3 mo post MI

persistent ST-segment elevation after recent MI and deep Q waves in the same leads.

Question 39

infective endocarditis + new conduction abnormality

Answer 39

perivalvular abscess

Question 40

Signs of severe aortic stenosis

Answer 40

• delayed and diminished carotid pulse (pulses parvus and tradus)
• Presence of single and soft second heart sound
• mid to late peaking systolic murmur

Question 41

Signs of cyanide toxicity

Answer 41

AMS, lactic acidosis, seizures, coma

can be due to nitroprusside infusion