Cardiology

Question 1

What is the clinical triad that you see that would make you suspect right ventricular infarct in an inferior MI patient?

Answer 1

1. hypotension
2. clear lung fields
3. elevated JVP

Question 2

What should you think about in this clinical scenario? A young man with intermittent claudication of the calf or foot arch with walking - not running.

Answer 2

popliteal artery entrapment

Question 3

What is the clinical history of a patient with Buerger disease?

Answer 3

Thromboangiitis obliterans occurs in men

Question 4

What should you suspect in a patient with unilateral headache associated with either TIAs or a dilated pupil?

Answer 4

spontaneous dissection of the internal carotid artery

Question 5

What is the classic triad that the CXR shows in mitral stenosis?

Answer 5

1. prominent pulmonary artery revascularization
2. an enlarged left atrium
3. normal sized LV

Question 6

What kind of effect can carcinoid cause on the heart valves? If you see carcinoid affecting the valves what does this imply?

Answer 6

Can affect either right sided heart valve

It implies a hepatic tumor

Question 7

If you have mitral regurgitation, is it better to repair or replace the valve?

Answer 7

repair

Question 8

Valsalva ___ (increase/decrease) the murmur of aortic stenosis, ____ the murmur of hypertrophic cardiomyopathy, _____ the murmur of mitral valve prolapse

Answer 8

Decrease, increase, increase

Question 9

In what scenarios do you not shock a patient with an abnormal tachycardia atrial rhythm?

Answer 9

digitalis intoxication and hypokalemia

Question 10

which anti arrhythmic do I definitely not want to prescribe in CHF?

Answer 10

dronaderone

Question 11

What meds do you never give to a WPW patient who also has a-fib?

Answer 11

digoxin, verapamil, beta blockers

Question 12

Never use _______ with any wide complex tachycardia in the emergency setting.

Answer 12

Verapamil - 30% of the time the v tach will rapidly deteriorate

Question 13

If a patient has pericarditis and it doesn’t go away after 2 weeks, what should you suspect?

Answer 13

TB

Question 14

What do valsalva and sustained handgrip do to the murmur of HOCM?

Answer 14

Valsalva increases it; handgrip decreases it

Question 15

What’s the difference in BNP levels between restrictive cardiomyopathy and constrictive pericarditis?

Answer 15

Restrictive - BNP is elevated

Constrictive - BNP is normal - no actual CHF

Question 16

What does the cardiac cath show in both tamponade and constrictive pericarditis?

Answer 16

the same pressure during diastole in all 4 chambers

Question 17

What congenital syndrome is associated with coarctation of the aorta and a bicuspid aortic valve?

Answer 17

Turner syndrome

Question 18

What do you need to rule out in the pregnant patient presenting with new onset a-fib and pulmonary edema?

Answer 18

mitral stenosis and secundum ASD

Question 19

How do you differentiate acute tamponade from constrictive pericarditis based off of the x and y descents?

Answer 19

tamponade - rapid x but normal y

constrictive pericarditis - rapid x and y descent

Question 20

“Wide fixed split” is a buzzphrase for what cardiac defect?

Answer 20

ASD

Question 21

When do you see canon A waves?

Answer 21

In cases of AV dissociation

Question 22

Large JV pulsations are seen when?

Answer 22

1. right heart failure
2. Tricuspid valve dz
3. pericardial compressive physiology
4. SVC syndrome

Question 23

What does accelerated junctional rhythm (>60) signify?

Answer 23

digitalis toxicity

Question 24

What does the JVP pulse tracing show for constrictive pericarditis? What is the other hallmark of constrictive pericarditis?

Answer 24

Rapid x and y descent

Other hallmark: Kussmaul’s sign (paradoxical rise in jugular venous pressure (JVP) on inspiration)

Question 25

What is Kussmaul’s sign?

Answer 25

paradoxical rise in jugular venous pressure (JVP) on inspiration

Question 26

Pulsus bisferiens

Answer 26

aortic regurgitation or HCM

Question 27

Pulsus alternans

Answer 27

severely depressed systolic function