Cardiology 1

Question 1

A patient presents with severe chest pain radiating to the neck that is palliated by sitting up and leaning forward. The troponin is indeterminate. The EKG shows diffuse ST-segment elevation and PR-segment depression. What is the most likely diagnosis?

Answer 1

Acute pericarditis

Question 2

You are treating a patient for acute pericarditis. On exam, you note hypotension, muffled heart tones, and jugular venous distention. What potentially life-threatening complication do you suspect?

Answer 2

Cardiac tamponade

Question 3

A previously healthy 38 year-old patient presents with chest pain that onset acutely at rest but is relieved with NTG. EKG shows ST-segment elevation in leads II, III, and avF. The patient is taken to the cath lab where no occlusive lesions are found. What is the most likely diagnosis?

Answer 3

Prinzmetal’s (vasospastic) angina

Question 4

A 64 year-old male patient presents with 8/10 substernal chest pain that radiates to the left arm. EKG shows ST-segment depression and t-wave inversions in leads I, avL, V5, and V6. Troponin is elevated. What is the most likely diagnosis?

Answer 4

NSTEMI

Question 5

A patient presents with pedal edema, JVD, and hepatomegaly. What is the most likely cause of this patient’s right heart failure?

Answer 5

Left heart failure

Question 6

A patient with a history of HTN and T2DM presents with midsternal chest pain and mild dyspnea on exertion (DOE). There are no acute ST segment changes on the EKG, and cardiac enzymes are negative. What is the minimum amount of time that the patient should expect to be observed in the hospital?

Answer 6

12 hours

Question 7

A patient presents with DOE and PND. On exam, you note a holosystolic crescendo/decrescendo murmur at the right upper sternal border radiating to the carotids What is the most likely diagnosis?

Answer 7

Aortic stenosis

Question 8

A patient presents with DOE and PND. On exam, you note a holosystolic crescendo/decrescendo murmur at the right upper sternal border radiating to the carotids. Which diagnostic study would be most useful in confirming your clinical suspicion?

Answer 8

Echocardiogram

Question 9

A patient presents for electrical cardioversion of atrial fibrillation. Which echocardiogram modality would be most helpful in ruling out left atrial blood clots before the procedure?

Answer 9

Transesophageal echocardiogram (TEE)

Question 10

An IV drug user presents with fever, fatigue and dyspnea. On exam, you note a holosystolic murmur at the apex. The echocardiogram shows a vegetative growth on the mitral valve and blood cultures are positive for S. Aureus. What is the most likely diagnosis?

Answer 10

Infectious endocarditis

Question 11

A patient presents with chest pain. On exam, you note a blowing diastolic murmur at Erb’s point that the patient has not previously had. What is causing the murmur?

Answer 11

Aortic regurgitation

Question 12

A patient presents with chest pain. On exam, you note a blowing diastolic murmur at Erb’s point that the patient has not previously had. CXR shows a widened mediastinum. What do you suspect is causing the patient’s aortic insufficiency?

Answer 12

Aortic aneurysm

Question 13

A patient presents with chest pain. On exam, you note a blowing diastolic murmur at Erb’s point that the patient has not previously had. CXR shows a widened mediastinum. Name a connective tissue disorder that might predispose this patient to aortic aneurysm.

Answer 13

Marfan’s Syndrome

Ehler’s Danlos Syndrome

Question 14

A pediatric patient develops right heart failure secondary to valvular dysfunction. Which disorder do you suspect?

Answer 14

Pulmonic stenosis

Question 15

A patient presents with fever, acutely onset headache and unilateral vision loss. Which disorder do you suspect?

Answer 15

Giant cell arteritis

Question 16

You diagnose a patient with secondary hypertension and tell her that the condition is curable. What is the most likely cause of this patient’s hypertension?

Answer 16

Renal artery stenosis

Question 17

An asymptomatic patient presents for a routine exam. On exam, you find that his blood pressure is 192/116. How would you classify this hypertensive crisis?

Answer 17

Hypertensive urgency

Question 18

A 68 year-old male patient with a history of HTN and HLD presents with a 4-hour history of non-radiating chest pain that he describes as “squeezing” and constant. There are no palliative measures. HR=72, BP=132/74, RR=18, T=98.6, spO2=98%. EKG shows ST-segment elevation in leads I, avL, V5, and V6. There are ST-segment depressions in II, III, and avF. What is the most likely diagnosis?

Answer 18

ST-segment myocardial infarction (STEMI)

Question 19

A 68 year-old male patient with a history of HTN and HLD presents with a 4-hour history of non-radiating chest pain that he describes as “squeezing” and constant. There are no palliative measures. HR=72, BP=132/74, RR=18, T=98.6, spO2=98%. EKG shows ST-segment elevation in leads I, avL, V5, and V6. There are ST-segment depressions in II, III, and avF. Which area of the heart is infarcting?

Answer 19

Lateral

Question 20

A 68 year-old male patient with a history of HTN and HLD presents with a 4-hour history of non-radiating chest pain that he describes as “squeezing” and constant. There are no palliative measures. HR=72, BP=132/74, RR=18, T=98.6, spO2=98%. EKG shows ST-segment elevation in leads I, avL, V5, and V6. There are ST-segment depressions in II, III, and avF. What is the significance of the ST-segment depression?

Answer 20

Reciprocal changes

Question 21

A 68 year-old male patient with a history of HTN and HLD presents with a 4-hour history of non-radiating chest pain that he describes as “squeezing” and constant. There are no palliative measures. HR=72, BP=132/74, RR=18, T=98.6, spO2=98%. EKG shows ST-segment elevation in leads I, avL, V5, and V6. There are ST-segment depressions in II, III, and avF. What is the preferred definitive treatment?

Answer 21

Coronary angioplasty/stenting

Question 22

A patient presents with STEMI and receives a drug-eluting stent to the LAD. How many anti-platelet medications will you start the patient on afterwards, and for how long?

Answer 22

Two, one year

Question 23

You are treating a patient who is in cardiogenic shock and elect to use an intra-aortic balloon pump (IABP). The end of the balloon should be inserted into the aorta, just distal to the ______ ______ artery. You time the counterpulsations with the EKG r-wave such that the balloon is inflated during ______ (systole/diastole) and deflated during ______ (systole/diastole).

Answer 23

left subclavian, diastole, systole

Question 24

A potentially disastrous complication associated with the Swan-Ganz catheter is inadvertent “wedging”. This results in occlusion of which vessel?

Answer 24

Pulmonary artery

Question 25

A patient with a history of CAD develops chest pain after walking to the mailbox. She sits down, and the pain subsides within a couple of minutes. How would you classify this patient’s condition?

Answer 25

Stable angina

Question 26

A mother brings her infant to you clinic stating that he has been sweating, “breathing fast” and becoming easily fatigued while feeding. On exam, you hear a harsh holosystolic murmur at the LLSB. What is the most likely diagnosis?

Answer 26

Ventricular septal defect

Question 27

In cardiogenic shock, you expect cardiac output to be ______ (high/low/normal) and right atrial and pulmonary artery pressures to be ______ (high/low/normal).

Answer 27

Low, high

Question 28

A 38 year-old male patient presents for a routine physical. HR=88, BP=132/82, RR=16, T=98.6, spO2=99%. How would you classify this patient in terms of blood pressure?

Answer 28

Prehypertension

Question 29

A 42 year-old black female presents for a routine physical. BP=146/98. How would you classify this patient in terms of blood pressure?

Answer 29

Stage I HTN

Question 30

A 42 year-old black female presents for a routine physical. BP=146/98. Which two classes of medications would you prescribe initially?

Answer 30

CCB, thiazide

Question 31

You are seeing a 45 year-old patient for follow-up four weeks post-PCI for acute MI. What is your target blood pressure for this patient?

Answer 31

<130/80

Question 32

If essential hypertension is so essential, why do we try to get rid of it?

Answer 32

Beats me

Question 33

You diagnose a 64 year-old patient with HTN. Months later, the HTN remains uncontrolled despite appropriate doses of an ACEI, thiazide, and beta blocker. This patient’s HTN is probably ______ (primary/secondary).

Answer 33

Secondary

Question 34

A patient presents with acutely onset severe pain in the right leg. On exam, you note that the leg is cool to the touch, pale, and you cannot locate the pedal pulses even with a doppler. What vascular emergency do you suspect?

Answer 34

Acute arterial occlusion

Question 35

An elderly patient presents with pain in the lower extremities when she walks more than a few steps. The pain is relieved shortly after she stops walking. Assuming that the etiology of her symptoms is vascular, how would you describe this condition in your chart?

Answer 35

Intermittent claudication

Question 36

A patient presents with cool, shiny, atrophic skin in the lower extremities. There is dependent rubor, and the patient endorses some numbness and hair loss in the affected area. What is the gold standard test for confirming your clinical suspicion?

Answer 36

Angiography

Question 37

A patient presents for follow-up after hip replacement. On exam, you find that the left leg is red, swollen, and warm to the touch. What is the most likely diagnosis?

Answer 37

DVT

Question 38

A patient develops acute ST-segment elevation in the inferior EKG leads secondary to an aortic dissection. In which Stanford classification would this dissection most likely fit?

Answer 38

Stanford A

Question 39

A 50 year-old male patient with a history of HTN and 30 pack-year history of smoking presents with acutely onset “stabbing” chest pain that radiates to the back. What characteristic finding do you expect to see on CXR?

Answer 39

Widened mediastinum

Question 40

A child on the playground suddenly develops cyanosis. He sits down and pulls his knees to his chest in an attempt to relieve the symptoms. What are the four components of this child’s congenital heart disorder?

Answer 40

RV outflow obstruction
VSD
Overriding aorta
Concentric RV hypertrophy

Question 41

You are managing a patient in a chronic heart failure clinic. She reports that she has mild symptoms with routine activities, but that her activity is only limited slightly. In which NYHA heart failure class do you categorize this patient?

Answer 41

NYHA class II

Question 42

A patient presents with dyspnea. On exam, you note basilar rales, JVD, 2+ pitting edema in the lower extremities, and a PMI that is displaced laterally. Which laboratory test would be the single most useful in confirming your clinical suspicion?

Answer 42

BNP

Question 43

A patient presents with dyspnea. On exam, you note basilar rales, JVD, 2+ pitting edema in the lower extremities, and a PMI that is displaced laterally. You insert a central line, expecting to find that the right atrial pressure will be ______ (high/low/normal). [right atrial pressure is analogous to jugular venous pressure]

Answer 43

high

Question 44

A patient presents with dyspnea. On exam, you note basilar rales, JVD, 2+ pitting edema in the lower extremities, and a PMI that is displaced laterally. What is the most likely diagnosis?

Answer 44

Heart failure