Cardiology Flashcards
Which of the following requires a 2D echo for diagnosis?
A. MVP B. Hypertrophic cardiomiopathy C. CHF D. Cardiac Tamponade E. ASD
Hypertrophic cardiomyopathy
In which scenario is 2D echo with DS NOT generally necessary
(a) 25 year old man with grade 2 continous murmur
(b) 45 year old woman with grade 2 mid-diastolic murmur
(c) 20 year old woman with grade 2 mid-systolic murmur but asymptomatic
(d) 50 year old man with grade 3 late systolic murmjr
(e) 20 year old man with grade 2 holosystolic murmur but ASYMPTOMATIC
(e) 20 year old woman with grade 2 mid-systolic murmur but asymptomatic
Malar telangiectasia is cutaneous manifestationnof which cardiovascular disease?
■ Severe mitral stenosis ■ Significant CAD ■ Malignant hypertension ■ Osler- Weber-Rendu syndrome ■ Carney syndrome
Severe mitral stenosis
Presence of peripheral edema in the setting of a normal venous pressure
■ Constrictive Pericarditis ■ Venous insufficiency ■ Cardiac tamponade ■ severe CHF ■ severe atherosclerosis
Venous insufficiency
Patient seen at the ER in respiratory distress with a notable drop in his blood pressure from 110/80 to 90/70 on inspiration. Which is the most likely cause?
■ severe aortic stenosis ■ dilated cardiomyopathy ■ restrictive cardiomyopathy ■ cardiogenic shock ■ pericardial effusion
Pericardial effusion
Patient seen at the ER in respiratory distress with a notable drop in his blood pressure from 110/80 to 90/70 on inspiration. Which is the most likely cause?
■ severe aortic stenosis ■ dilated cardiomyopathy ■ restrictive cardiomyopathy ■ cardiogenic shock ■ pericardial effusion
Pericardial effusion
An anacrotic pulse with shrill is mostly lilely due to
■ aortic stenosis ■ hypertrophic cardiomyopathy ■ advanced aortic regurgitation ■ severe dilates cardiomyopathy ■ premature ventricular contractions
Aortic stenosis
60 year old diabetic man with persistent chest discomfort consults at your clinic. On checking his blood pressure, BP in the right arm is 140/80 while his left arm BP is 120/80. What caused the above finding?
■ Aortic dissection ■ Essential Hypertension ■ Aortic regurgitation ■ Large AV fistula ■ normal finding for age group
Aortic dissection
Reversed split S1
■ Complete RBBB ■ Complete LBBB ■ RA myxoma ■ Normal in young ■ ASD
Complete LBBB
Wide split S2
■ Pulmonary Hypertension ■ Severe Aortic stenosis ■ RBBB ■ Hypertrophic cardiomyopathy ■ Acute MI
RBBB
Which of the following is the systolic sound
■ click murmur complex ■ Opening snap ■ Pericardial knock ■ Tumor Plop of atrial myxoma ■ 4th heart sound
Click murmur complex
A 28 y/o female, White patient presents to the ER with the following: recent onset hypertension of 200/120, maintained on Losartan 50mg OD and Amlodopine 10mg ODHS, abdominal bruit heard on auscultation. Patient is also known to have fibromuscular dysplasia. This patient most likely is diagnosed to have:
■ Essential hypertension ■ Renal Artery Stenosis ■ Renal parenchymal disease ■ Coarctation of aorta ■ Hyperaldosteronsim
Renal artery stenosis
35 yo male patient came in the ER due to hypertension of 190/100. History reveals refractory hypertension for 1 week now despite medications. There was associated polyuria and muscle weakness. There was no vomiting or diarrhea. Laboratory results revealed hypokalemia, 2.7meq/L. The hypertension is most likely due to: *
1/1
■ Essential hypertension ■ Renal Artery Stenosis ■ Secondary hypertension due renal parenchymal disease ■ Coarctation of aorta ■ Hyperaldosteronsim
Hyeraldosteronism
Systolic hypertension with wide pulse pressure include the ff except: *
■ aortic stenosis ■ thyrotoxicosis ■ fever ■ AV fistula ■ PDA
Aortic stenosis
Class I indication for pacemaker implantation, except?
■ Atrial fibrillation with bradycardia and pauses >5 s
■ SA node dysfunction with symptomatic bradycardia or sinus pause
■ Mildly symptomatic patients with waking chronic heart rates <40 beats/min
■ Symptomatic SA node dysfunction as a result of essential long-term drug therapy
Mildly symptomatic patients with waking chronic heart rates <40 beats/min
The patient complained of palpitations and was brought to the ER. BP reading was 80/60. She was hooked to cardiac monitor with a reading of atrial fibrillation in fast ventricular response. What is the most appropriate initial management?
■ Carotid massage
■ Amiodarone 150mg slow IV bolus
■ Adenosine 6mg IV bolus
■ Cardiovert with 200J
Cardiovert with 200J
Patient AB, a 45 years old male, came in due to chest pain, with stable vital signs, suddenly presented with the ECG reading Vtach What is your next step?
■ Adenosine 6 mg IV
■ Defibrillate 360 J
■ Verapamil 2.5 mg IV
■ Amiodarone 150 mg IV
Amiodarone 150 mg IV
Coronary angiography revealed 1-vessel disease with total occlusion of the proximal to mid LAD. Patient underwent subsequent PCI of the culprit vessel. Angiographic success occurs in 95-99% of patients undergoing PCI and is defined by reduction of the stenosis to less than how many percent of the diameter narrowing?
■ 10%
■ 20%
■ 30%
■ 50%
20%
The following are Non-Cardiac / Systemic Causes of Elevated Troponin Reflecting Myocardial Damage Other Than Spontaneous Myocardial Infarction (Type 1), EXCEPT
■ Pulmonary Embolism
■ Sepsis, shock
■ Rhabdomyolysis
■ Amyloidosis
Amyloidosis
A state-of-the art blood test has been developed for the rapid, noninvasive diagnosis of CAD. The assay has a 90% sensitivity and 90% specificity for the detection of at least one coronary stenosis of greater than 70%. In which of the following scenarios is the blood test likely to be of the most value to the clinicians?
■ A 29 year old man with exceptional chest pain, he has no cardiac risk factors.
■ A 41 year old asymptomatic premenopausal woman.
■ A 78 year old diabetic woman with exertion chest pain who underwent 2-vessel coronary stunting 6 weeks ago.
■ A 62 year old man with exertion chest pain; he has HPN, dyslipidemia, and a 2-pack per day smoking history.
■ A 68 year old man with chest discomfort at rest accompanied by 2 mm of ST segment depression in the inferior leads on the ECG.
A 62 year old man with exertion chest pain; he has HPN, dyslipidemia, and a 2-pack per day smoking history.
Unequal upper extremity arterial pulsations are commonly found in each of the following disorders except: *
■ Aortic dissection ■ Takayasu disease ■ Supravalvular aortic stenosis ■ Subclavian artery atherosclerosis ■ Subvalvular aortic stenosis
Subvalvular aortic stenosis
Which of the following ECG features is typical of left anterior fascicular block? *
■ Q waves in the inferior leads
■ Mean QRS axis between 0 and -30 degrees
■ QRS duration >0.12 msec
■ rS pattern in the inferior leads and qR pattern in lateral leads
■ Marked right axis deviation
rS pattern in the inferior leads and qR pattern in lateral leads
All of the following statements about pulses paradoxes are true except:
■ A reduction in systolic arterial pressure of up to 8 mmHg during inspiration is normal.
■ Pulsus paradoxus is observed frequently in cardiac tamponade
■ Pulsus paradoxus is observed in patients with pulmonary disease associated with wide swings in intrathoracic pressure.
■ In the presence of aortic regurgitation, pulsus paradoxus is less likely to develop, despite the presence of tamponade.
■ Pulsus paradoxus is typically present in patients with HCM.
Pulsus paradoxus is typically present in patients with HCM.
The timing of an “innocent” murmur is usually: *
■ Early systolic ■ Presystolic ■ Midsystolic ■ Holosystolic ■ Early diastolic
Midsystolic
Each of the following statements regarding auscultatory findings of mitral stenosis is correct except: *
■The opening snap is an early diastolic sound
■ A long A2-OS interval implies severe MS
■ In AF, the A2-OS interval varies with cycle length
■The “snap” is generated by rapid reversal of the position of the anterior mitral valve
■ The presence of an opening snap implies a mobile body of the anterior mitral leaflet
A long A2-OS interval implies severe MS
Digitalis is of potential benefit in all of the following conditions except: *
■ Mitral stenosis with atrial fibrillation and normal RV function
■ Dilated cardiomyopathy with LV EF of 25% and normal sinus rhythm
■ Hypertrophic cardiomyopathy with LV EF of 70% and AF
■ Mitral stenosis with normal sinus rhythm and normal RV function
Mitral stenosis with normal sinus rhythm and normal RV function
The following statement is true regarding the cardiac cycle.*
■ The third heart sound corresponds to the rapid early diastolic filling of the ventricles.
■ The presence of the a wave on the right atrial pressure is typical of atrial fibrillation.
■The QRS complex corresponds to the initiation of the isovolumic relaxation.
■ The mitral valves opens in systole when the left ventricular pressure falls below the left atrial pressure.
The mitral valves opens in systole when the left ventricular pressure falls below the left atrial pressure.
All of the following conditions are associated with high-output heart failure except: *
■ Iron overload
■ Hyperthyroidism
■ Systemic arteriovenous fistulas
■ Thiamine deficiency
■ Paget’s disease
Thiamine deficiency
Which of the following is associated with increased left ventricular preload? *
■ Sepsis ■ Right ventricular infarction ■ Mitral regurgitation ■ Dehydration ■ Pulmonary embolism
Mitral regurgitation
The most common cause of heart failure is: *
A. Regurgitant valvular heart disease
B. Viral infection
C. Drug-induced
D. Coronary artery disease
CAD
A 60 year old male patient was complaining of 1 month history of dyspnea, easy fatigability and edema. You started him on Furosemide, Losartan and Carvedilol with subsequent improvement. A 2DED was done revealing global hypokinesia with an ejection fraction of 30%. What stage of heart failure does he belong?*
A. Stage A
B. Stage B
C. Stage C
D. Stage D
Stage C
Patients with a low-to-moderate likelihood of DVT or PE should undergo initial diagnostic evaluation with d-dimer testing alone without obligatory imaging tests. The S1Q3T3 is relatively specific but insensitive.
a. Both statements are true.
b. Only the first statement is true.
c. Only the second statement is true.
d. Both statements are incorrect.
A. Both statements are True
Patients with venous thromoboembolism in the setting of suspected heparin-induced thrombocytopenia, one may utilize the following parenteral direct thrombin inhibitors EXCEPT *
a. Dabigatran
b. Argatroban
c. Bivalirudin
d. None of the above
A.
What is the second line diagnostic test for pulmonary embolism?
a. Chest CT angiography
b. Ultrasonography
c. Lung scanning
d. Echocardiography
C. Lung Scanning
Intraarterial thrombolytic therapy with recombinant tissue plasminogen activator in the following conditions except *
a. If arterial occlusion is one week and caused by thrombus in an arterial bypass graft
b. If arterial occlusion is 30 days and caused by a thrombus in an occluded stent
c. If arterial occlusion is two weeks and caused by a thrombus in an atherosclerotic vessel
d. None of the above
c. If arterial occlusion is two weeks and caused by a thrombus in an atherosclerotic vessel
Compression of a large arteriovenous fistula may cause reflex slowing of the heart rate. *
a. Nicoladoni-Branham sign
b. Bernouli-Pasteori sign
c. Charley-Budd sign
d. Bamm-Harley sign
A. Nicoladoni-Branham sign
Which of the following drugs are thought to increase the duration of exercise in several placebo-controlled studies but not yet confirmed in clinical trials, among patients diagnosed to have peripheral arterial disease. *
a. Cilostazol
b. Vasodilator prostaglandins
c. Pentoxifylline
d. Apixaban
c. Pentoxifylline
Patients with claudication are advised to exercise regularly, prolong walking distance, at what duration and frequency? *
a. 15-20 min sessions, 5 times per week for at least 12 weeks
b. 20-30 min sessions, 3-5 times per week for at least 12 weeks
c. 30-45 min sessions, 3-5 times per week for at least 12 weeks
d. 45 min sessions, 3 times per week for at least 2 months
c. 30-45 min sessions, 3-5 times per week for at least 12 weeks
19-year-old previously healthy hockey player is defending the goal when he is hit in the left chest with a hockey puck. He immediately collapses to the ice. His coach runs to his side and finds him unresponsive and without a pulse. Which of the following is most likely responsible for this syndrome? *
A. Aortic rupture B. Cardiac tamponade C. Commotio cordis D. Hypertrophic cardiomyopathy E. Tension pneumothorax
Blunt, nonpenetrating trauma such as that described here can result in commotio cordis, which occurs when the trauma impacts the heart during the susceptible phase of repolarization just before the peak of the T wave and results in ventricular fibrillation.
A 32-year-old female is seen in the emergency department for acute shortness of breath. A helical CT shows no evidence of pulmonary embolus, but incidental note is made of dilatation of the ascending aorta to 4.3 cm. All the following are associated with this finding EXCEPT: *
A. Syphilis B. Takayasu’s arteritis C. Giant cell arteritis D. Rheumatoid arthritis E. Systemic lupus erythematosus
E. Systemic lupus erythematosus
A 35-year-old woman with a history of tobacco abuse presents to the emergency department because of severe chest pain radiating to both arms. The pain began 8 hours ago and is worse with inspiration. She has been unable to lie down as this markedly exacerbates the pain, but she feels better with sitting forward. Examination is notable for a heart rate of 96 beats/min, blood pressure of 145/78 mmHg, and oxygen saturation of 98%. Lungs are clear and a friction rub with three components is audible and is best heard at the left lower sternal border. Which of the following are most likely to be found on her ECG? *
A. Diffusely inverted T waves in the precordial leads
B. PR elevation in leads II, III, and aVF
C. Sinus tachycardia
D. ST-segment elevation in I, aVL, and V2–V6 with upward concavity and reciprocal depressions in aVR
E. ST-segment elevation V1–V6 with convex curvature and reciprocal depressions in aVR
D. ST-segment elevation in I, aVL, and V2–V6 with upward concavity and reciprocal depressions in aVR
The patient has a classic presentation for acute pericarditis with constant or pleuritic chest pain, exacerbated by lying flat and alleviated by sitting forward. Serum biomarkers may show mild evidence of myocardial injury from myocardial inflammation, but are generally not substantially elevated. Friction rub is frequently present, has three components, and is best heard while the patient is upright and leaning forward. In the acute stages, ECG classically shows ST-segment elevation with upward concavity in two or three standard limb leads and V2 through V6 with reciprocal changes in aVR. Convex curvature is more commonly found in acute myocardial infarction. PR depression may be found. After several days, the ST changes resolve and T waves become inverted. After weeks to months, the ECG returns to normal
Granulomatous vasculitis of the upper and lower respiratory tracts together with glomerulonephritis lower respiratory tracts together with glomerulonephritis
A. Lupus Vasculitis B. Wegeners Granulomatosis C. PAN D. Systemic sclerosis E. Takayasus arteritis
B. Wegeners Granulomatosis
Microvasculopathy, Immune dysregulation, Fibrosis
A. Lupus Vasculitis B. Wegeners Granulomatosis C. PAN D. Systemic sclerosis E. Takayasus arteritis
D. Systemic Sclerosis
Multisystem, necrotizing vasculitis of small- and medium-sized muscular arteries in which involvement of the renal and visceral arteries is characteristic , with sparing of the pulmonary arteries
A. Lupus Vasculitis B. Wegeners Granulomatosis C. PAN D. Systemic sclerosis E. Takayasus arteritis
C. PAN
