Cardiology

Question 1

Name two things that would constitute a positive stress test.

Answer 1

A drop in blood pressure, a new arrhythmia, an increase in angina symptoms, ST depressions

Question 2

Are ulcers from venous insufficiency painful or painless?

Answer 2

Painless

Question 3

A patient has just received a cardiac stent. How long will he be on aspirin and clopidogrel?

Answer 3

One year

Question 4

Where is disease of the mitral valve best heard?

Answer 4

At the apex

Question 5

What is the initial treatment for a myocardial infarction?

Answer 5

MONA - morphine, oxygen, mitroglycerin and aspirin

Question 6

Clot busting drugs should be used within 3 hours of which two cardiac events?

Answer 6

STEMI and new left bundle brance block

Question 7

List three catastrophic complications of a myocardial infarction.

Answer 7

Papillary muscle rupture, myocardial wall rupture and left ventricular aneurysm

Question 8

An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely diagnosis?

Answer 8

Supraventricular tachycardia

Question 9

An EKG shows a regular heart rate of 200 bps. QRS is narrow. What is the most likely diagnosis?

Answer 9

Supraventricular tachycardia

Question 10

Acute endocarditis is most commonly caused by what organism?

Answer 10

Staph aureus

Question 11

List three congenital heart diseases.

Answer 11

Atrial dental defect, ventricular dental defect, coarctation of the aorta, patent ductus arteriosus, tetralogy of Fallot

Question 12

What is the most common cause of an atrial septal defect?

Answer 12

Patent foremen ovale

Question 13

Where on your patient should you listen for the murmur associated with an atrial septal defect?

Answer 13

At the left second or third interspace

Question 14

What side effect might make a patient stop taking an ACEI?

Answer 14

Cough

Question 15

Define orthostatic hypotension.

Answer 15

A drop in systolic blood pressure of > 20 mmhg when standing up.

Question 16

You feel a pulse that seems to be vibrating. What term do you use to describe it?

Answer 16

Thrill

Question 17

What are three things in your differential if you have a paradoxical pulse?

Answer 17

Cardiac tamponade, pericarditis and obstructive lung disease

Question 18

On palpation, what size is normal for the aorta?

Answer 18

Less than 3 cm

Question 19

A fixed or consistent split S2 should make you think of what diagnosis?

Answer 19

Atrial septal defect

Question 20

A pathologic S3 is most commonly associated with what diagnosis?

Answer 20

CHF

Question 21

If you hear a midsystolic click you should immediately be thinking about what diagnosis?

Answer 21

Mitral valve prolapse

Question 22

An opening snap on auscultation of the heart should make you think of what diagnosis?

Answer 22

Mitral stenosis

Question 23

A continuous murmur most likely involves what area of the heart?

Answer 23

It is most likely a septal defect

Question 24

You hear a continuous machine-like murmur. What is the most likely diagnosis?

Answer 24

Patent dusctus arteriosis (PDA)

Question 25

List three medications which may be used for pharmacological stress test.

Answer 25

Adenosine, dobutamine, dipyridamole and persantine

Question 26

What is the gold standard for diagnosing coronary artery disease?

Answer 26

Cardiac catheterization

Question 27

Define stage hypertension according to JNC 7.

Answer 27

Systolic pressure of 140-159 and diastolic of 90-99

Question 28

What is the treatment goal for a diabetic with hypertension?

Answer 28

130/80

Question 29

What is the most common cause of secondary hypertension?

Answer 29

Chronic kidney disease

Question 30

No matter what medications you use you are having trouble keeping a patient's blood pressure under control. You also notice hyperpigmented skin and truncal obesity. What is the most like diagnosis?

Answer 30

Cushing's disease

Question 31

List three signs or symptoms which will likely be included in a description of a patient with a pheochromocytoma?

Answer 31

Thin, diaphoretic, tachycardic, agitated and hypertensive

Question 32

You have a patient with diagnosis of a pheochromocytoma. While waiting for surgery, should you use an alpha blocker or a beta blocker?

Answer 32

Alpha blocker. You should never use a pure beta blocker

Question 33

A young boy comes into your office. He has elevated blood pressure when taken in his arm, but no femoral pulses can be palpated. What is the most likely diagnosis?

Answer 33

Coarctation of the aorta

Question 34

According to the CDC, what is the range for a normal BMI?

Answer 34

18.5-24.9

Question 35

What is the first line medical treatment for stage 1 hypertension?

Answer 35

Thiazide diuretic

Question 36

After a thiazide diuretic, what medication should you start in a hypertensive patient who also has diabetes?

Answer 36

An ACE or an ARB

Question 37

Following a myocardial infarction, what medication should you be using to treat hypertension?

Answer 37

Beta blocker

Question 38

Paroxysmal nocturnal dyson's should make you think of what diagnosis?

Answer 38

CHF

Question 39

What is the most common cause of CHF?

Answer 39

Coronary artery disease

Question 40

What ejection fraction is typical for a patient with CHF?

Answer 40

35-40%

Question 41

What is the most likely diagnosis for a young man who experiences sudden death while playing sports?

Answer 41

Hypertrophic cardiomyopathy

Question 42

Bat wing vessels or Kerley B lines on a CXR should make you think of what diagnosis?

Answer 42

CHF

Question 43

A beta natriuretic peptide below what level rules out CHF?

Answer 43

<100

Question 44

What is the therapeutic range for INR following a mechanical valve replacement?

Answer 44

2.5-3.5

Question 45

What is the first line IV inotropic agent when dealing with cardiogenic shock?

Answer 45

Dopamine

Question 46

What diagnosis is most likely in an IV drug user with a new heart murmur and fever?

Answer 46

Endocarditis

Question 47

Lost two diagnoses which require antibiotic prophylaxis for "dirty procedures?"

Answer 47

Prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congenital cyanotic heart defect

Question 48

Does a patient with mitral valve prolapse require prophylactic antibiotics for dental work?

Answer 48

No, a recent change moves mittal valve prolapse from high risk to moderate risk.

Question 49

What are the 3 major criteria for endocarditis?

Answer 49

2 positive blood cultures, a positive transesophageal echocardiography, new murmur

Question 50

Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?

Answer 50

Osler nodes

Question 51

List the 4 minor criteria for diagnosing endocarditis.

Answer 51

Fever, embolic event (Janeway lesions or or petechiae, splinter hemorrhages), immunological event (osler nodes, glomerulonephritis), 1 postive blood culture.

Question 52

What are the five components of tetralogy of Fallot?

Answer 52

Ventricular septal defect, right ventricular hypertrophy, right ventricular outflow obstruction (pulmonary valve stenosis), overriding aorta, right sided aortic arch

Question 53

What is the gold standard for diagnosing myocarditis?

Answer 53

Myocardial biopsy

Question 54

Where do most aortic dissections occur?

Answer 54

The ascending or descending thoracic aorta

Question 55

A patient complains of severe pleuritic chest pain that is relieved with sitting and leaning forward. What is the most likely diagnosis?

Answer 55

Pericarditis

Question 56

What is the first line medical treatment for pericarditis?

Answer 56

Aspirin and NSAIDS

Question 57

What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?

Answer 57

Dressler syndrome

Question 58

A patient presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all the leads. What is the most likely diagnosis?

Answer 58

Pericarditis