Cardiology - Questions

Question 1

Long term Murmur s/p tetralogy of Fallot repair p/w murmur that decreases with inspiration - Valve dysfunction?

Clinical features?

Answer 1

Aortic regurgitation

Question 2

Long term Murmur s/p tetralogy of Fallot repair p/w holosystolic murmur located at the lower left sternal border that increases with inspiration?

Answer 2

Tricuspid regurgitation

Question 3

Long term Murmur s/p tetralogy of Fallot repair that p/w systolic murmur heard at the left sternal border, which often obliterates the S1 and S2?

Answer 3

Recurrent VSD

Question 4

Test to risk stratify patients with intermediate 10-year risk of coronary event?

Answer 4

High sensitivity CRP

Question 5

When to get ECHO for murmur?

Answer 5

#asymptomatic patients with grade 3+/6 systolic murmur
#late or holosystolic murmur
#Diastolic or continuous murmur
#murmur and accompanying symptoms.

Question 6

Patient 6 months s/p EP for atrial fibrillation without symptoms. How to determine need for anticoagulation?

Answer 6

CHADS-VASc

Question 7

Patient with hypertrophic cardiomyopathy - do NOT give these medications?

Answer 7

Preload decreasing drugs
#ACE inhibitor
#Diuretics
#Vasodilators

Question 8

Patient presents with jugular venous pulse contour with diminished y descents after prior pericarditis, and elevated right atrial pressure. Next therapeutic step?

Diagnosis if no change in right atrial pressure?

Answer 8

Pericardiocentesis

Effusive constrictive pericarditis (persistent symptoms and hemodynamic derangements after relief of the pericardial effusion)

Question 9

Long term Murmur s/p tetralogy of Fallot repair p/w RV heave - murmur?

Other clinical features?

Answer 9

Pulmonary regurgitation 
#R heart volume overload/parasternal heave
#soft systolic pulmonary outflow murmur
#single S2 (pulmonic valve damaged on repair)

Question 10

Who should get high intensity statin?

Answer 10

#CHF, cerebrovascular disease, or peripheral arterial disease
#LDL cholesterol >190 mg/dL
#Diabetes with LDL under 190 mg/dL and 10-year CHD risk over 7.5%
# LDL under 190 and 10-year CHD risk over 7.5%

Question 11

Patent foreman ovale found on ECHO – when to start anticoagulation? When to perform surgical closure?

Answer 11

start anticoagulation if stroke (with no other cause found)

surgical closure if 
#recurrent stroke on anticoagulation
#Left to right shunt with right heart enlargement

Question 12

First-line therapies for patients with stable angina?

Second line?

Answer 12

Beta blocker and nitrates

Calcium channel blockers

Question 13

Duke treadmill score breakdown and recommendations?

Answer 13

Under -11 – high risk (3+% mortality/year)
-11 to 4 – Intermediate risk (1-3%)
Over 6 – Low risk

Question 14

Noninvasive stressed his findings that require follow-up angiogram?

Answer 14

# ST-segment depression at a low work load
#ST-segment elevation
#Hypotension.

Question 15

No drugs have been shown to reduce mortality in patients with this type of heart failure?

Main goal in management?

Answer 15

Heart failure with preserved ejection fraction HFpEF

Appropriately manage hypertension and fluid status

Question 16

Evidence of pericardial effusion on ECHO?

Answer 16

# diastolic conversion of the right sides Chambers
#Respiratory Variation of mitral inflow 
#Ventricular septal shift
#Plethora of IVC

Question 17

Worst risk factor for an MI?

Answer 17

dyslipidemia

Then smoking, psychosocial stressors, diabetes mellitus, hypertension, obesity, alcohol consumption, physical inactivity, and diet low in fruits and vegetables.