Cardiology 2

Question 1

A patient with a history of sarcoidosis presents with fatigue and dyspnea. On exam, you note JVD, ascites, peripheral edema, and bi-basilar crackles in the lungs. There are no specific EKG changes, but you do note that the QRS amplitude appears reduced. Which of the cardiomyopathies is the most likely culprit?

Answer 1

Restrictive cardiomyopathy

Question 2

A patient presents to the ED with fatigue and palpitations that have persisted for the past week. The EKG shows an irregularly irregular rhythm without discernible p-waves. You diagnose the patient with which dysrhythmia?

Answer 2

Atrial fibrillation

Question 3

A patient presents to the ED with fatigue and palpitations that have persisted for the past week. The EKG demonstrates and irregularly irregular rhythm without discernible p-waves. Vital signs are stable and the patient denies chest pain. You start the patient on anticoagulants, with the goal of eventually attempting cardioversion. For how long (minimum) should the patient be anticoagulated before the procedure?

Answer 3

3 weeks

Question 4

An obese 34 year-old female presents for 1-week follow-up after giving birth to her fifth child. The patient complains of fatigue and dyspnea. On exam, you note an S3 heart sound. What is the most likely diagnosis

Answer 4

Peripartum cardiomyopathy

Or just dilated cardiomyopathy, depending on source

Question 5

A 26 year-old male patient presents with syncope and chest pain on exertion. On exam, you note a loud, crescendo/decrescendo murmur at the right upper sternal border that becomes louder when the patient performs a valsalva maneuver. What is the most likely diagnosis?

Answer 5

Hypertrophic obstructive cardiomyopathy (HOCM)

Question 6

A patient presents with a sudden onset of midsternal chest pain that radiating to the left arm, partially relieved by NTG. EKG shows 3 mm ST segment elevation in leads II and III. What is the most likely diagnosis?

Answer 6

Myocardial infarction

Question 7

A patient presents with a sudden onset of midsternal chest pain that radiating to the left arm, partially relieved by NTG. EKG shows 3 mm ST segment elevation in leads II and III. Where might you expect to see reciprocal changes on this EKG?

Answer 7

Leads I and avL

Question 8

A patient presents with a sudden onset of midsternal chest pain that radiating to the left arm, partially relieved by NTG. EKG shows 3 mm ST segment elevation in leads II and III. Which vessel is most likely occluded?

Answer 8

Right coronary artery

Question 9

A patient presents with a sudden onset of midsternal chest pain that radiating to the left arm, partially relieved by NTG. EKG shows 3 mm ST segment elevation in leads II and III. Because the RCA usually supplies the SA node, this patient is at high risk for developing which common complication of ACS?

Answer 9

Bradycardia

Question 10

The etiology of infective pericarditis is usually ______, while the etiology of infective endocarditis is typically ______.

Answer 10

Viral, bacterial

Question 11

A patient with a history of IV drug use presents with fever of unknown origin. Blood cultures are positive for MRSA. On exam, you note a holosystolic murmur at the apex, Osler’s nodes and Janeway lesions. What is the most likely diagnosis?

Answer 11

Infective Endocarditis

Question 12

A patient presents with chest pain that is aggravated by lying flat and relieved by leaning forward. The EKG shows diffuse, concave ST-segment elevation in the anterior, lateral, and inferior leads. What is the most likely diagnosis?

Answer 12

Pericarditis

Question 13

A patient who is currently receiving chest radiation for a tumor presents with dyspnea. On exam, you find that the patient is tachycardic, has a cardiac friction rub, and pulsus paradoxus. What is the most likely diagnosis?

Answer 13

Pericardial effusion

Question 14

A patient presents with hypotension, JVD, and muffled heart sounds. This is known as ______ ______, and is associated with ______ ______. You expect that this patient’s pulse pressure will be ______.

Answer 14

Beck’s triad, pericardial tamponade, narrow

Question 15

Complete atrial/ventricular disassociation is the hallmark feature of ______ heart block.

Answer 15

Third-degree or complete

Question 16

A patient presents with palpitations and bradycardia. The EKG shows a P:QRS ratio of 4:3. The PR intervals become progressively longer before dropping a beat and repeating the pattern. What is your diagnosis?

Answer 16

Second-degree heart block, type I or Wenchebach or Mobitz I

Question 17

In second degree type II AV block, impulses conducted from the atria to the ventricles will have a ______ (consistent/inconsistent) PR interval.

Answer 17

Consistent

Question 18

An 18 year-old female presents with palpitations, dizziness, and syncope. The EKG shows a slurred S-wave. What is the most likely diagnosis?

Answer 18

Wolff-Parkinson White Syndrome

Question 19

In junctional rhythms, the p-wave is usually ______ or ______.

Answer 19

Absent or inverted

Question 20

An EKG shows a sinus rhythm with slight irregularities that appear at regular intervals across the tracing. What is this rhythm called?

Answer 20

Sinus arrythmia

Question 21

A patient with a remote history of rheumatic fever presents with fatigue, dyspnea on exertion, and orthopnea. The EKG shows atrial fibrillation. Which murmur do you expect to hear and where?

Answer 21

low diastolic rumble at apex

Question 22

A patient with a remote history of rheumatic fever presents with fatigue, dyspnea on exertion, and orthopnea. The EKG shows atrial fibrillation. On exam, you hear a low diastolic rumble at the apex. What is the most likely diagnosis?

Answer 22

Mitral stenosis

Question 23

To be considered pathologic, q-waves must be at least ______ seconds wide and ______ (a fraction) of the height of the QRS complex.

Answer 23

.03, 1/3

Question 24

You are evaluating an EKG for LVH. To do this, you add the deepest ______ wave in leads ______ and ______ to the tallest ______ wave in leads ______ and ______. If the total is greater than ______ mm, LVH criteria is met.

Answer 24

S, V1, V2, R, V5, V6, 35

Question 25

Right ventricular hypertrophy is often accompanied by ______ ______ enlargement, which is indicated by a tall, peaked ______ wave.

Answer 25

Right atrial, P

Question 26

Wellen’s syndrome is associated with t-wave inversions across the ______ leads and is highly specific for LAD occlusion.

Answer 26

precordial

Question 27

You are evaluating an EKG and suspect right bundle branch block. What are the EKG criteria for this condition?

Answer 27

QRS width > 0.12 sec
Slurred s wave in leads I and V6
RSR’ (biphasic QRS) morphology in V1
Positive QRS deflection in V1

Question 28

Left bundle branch block is indicated by a ______ QRS deflection in V1.

Answer 28

Negative

Question 29

A right bundle branch block and a left bundle branch block are on a first date. They can only find one thing that they have in common. What is it?

Answer 29

Wide QRS complex (>0.12 sec)

Question 30

Many drugs can prolong the QT interval. Prolonged refers to a QT interval greater than ______ seconds. The QT interval tends to ______ as heart rate increases.

Answer 30

0.42, shorten

Question 31

A 60 year-old male patient with a history of HTN and HLD (both controlled on meds) presents to the ED with mid-sternal chest pain radiating to the left shoulder and some associated nausea. The EKG and cardiac enzymes are normal, and the pain is relieved completely with NTG. The patient is admitted for overnight observation with no change in clinical condition, EKG, or cardiac enzymes. Assuming no contraindications, what is the most appropriate diagnostic test for this patient?

Answer 31

Stress EKG