Cardiovascular

Question 1

Classic ECG finding in atrial flutter

Answer 1

“Sawtooth” P waves

Question 2

Definition of unstable angina

Answer 2

Angina that is new, is worsening, or occurs at rest.

Question 3

Antihypertensive for a diabetic patient with proteinuria.

Answer 3

ACEI

Question 4

Beck’s triad for cardiac tamponade.

Answer 4

Hypotension, distant heart sounds, and JVD.

Question 5

Drugs that slow heart rate.

Answer 5

B-blockers, calcium channel blockers (CCBs), digoxin, amiodarone.

Question 6

Hypercholesterolemia treatment that leads to flushing and pruritus.

Answer 6

Niacin.

Question 7

Murmur-hypertrophic obstructive cardiomyopathy (HOCM).

Answer 7

A systolic ejection murmur heard along the lateral sternal border that increases with decreased preload (Valsalva maneuver).

Question 8

Murmur-aortic insufficiency.

Answer 8

Austin Flint murmur, a diastolic, decrescendo, low-pitched, blowing murmur that is best heard sitting up; increases with increasing afterload (handgrip maneuver).

Question 9

Murmur-aortic stenosis.

Answer 9

A systolic crescendo/decrescendo murmur that radiates to the neck; increases with increasing preload (squatting maneuver).

Question 10

Murmur-mitral regurgitation.

Answer 10

A holosystolic murmur that radiates to the axilla; increases with increasing afterload (handgrip maneuver).

Question 11

Murmur-mitral stenosis

Answer 11

A diastolic, mid to late, low pitched murmur preceded by and opening snap.

Question 12

Treatment for atrial fibrillation and atrial flutter.

Answer 12

If unstable, cardiovert. If stable or chronic, rate control with CCBs or B-blockers.

Question 13

Treatment for ventricular fibrillation.

Answer 13

Immediate cardioversion.

Question 14

Dressler’s syndrome.

Answer 14

An autoimmune reaction with fever, pericarditis, and increased ESR occurring 2-4 weeks post MI.

Question 15

IV drug use with JVD and a holosystolic murmur at the left sternal border. Treatment?

Answer 15

Treat existing heart failure and replace the tricuspid valve.

Question 16

Diagnostic test for hypertrophic cardiomyopathy.

Answer 16

Echocardiogram (showing a thickened left ventricular wall and outflow obstruction).

Question 17

Pulsus paradoxus.

Answer 17

A decrease in systolic BP > 10 mm Hg with inspiration; seen in cardiac tamponade.

Question 18

Classic ECG findings in pericarditis.

Answer 18

Low-voltage, diffuse ST-segment elevation.

Question 19

Definition of hypertension.

Answer 19

BP > 140/90 mm Hg on 3 separate occasions 2 weeks apart.

Question 20

Eight surgically correctable causes of hypertension.

Answer 20

Renal artery stenosis, coarctation of the aorta, pheochromocytoma, Conn’s syndrome, Cushing’s syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism.

Question 21

Evaluation of a pulsatile abdominal mass and bruit.

Answer 21

Abdominal ultrasound and CT.

Question 22

Indications for surgical repair of abdominal aortic aneurysm.

Answer 22

> 5.5 cm, rapidly enlarging, symptomatic, or ruptured.

Question 23

Treatment for acute coronary syndrome.

Answer 23

ASA, heparin, clopidogrel, morphine, O2, sublingual nitroglycerin, IV B-blockers.

Question 24

Metabolic syndrome.

Answer 24

Abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states.

Question 25

Appropriate diagnostic test?

• A 50 year old man with stable angina can exercise to 85% of maximum predicted heart rate.
• A 65 year old woman with left bundle branch block and severe osteoarthritis has unstable angina.

Answer 25

Exercise stress treadmill with ECG.

Pharmacological stress test (eg, dobutamine echo).

Question 26

Target LDL in a patient with diabetes.

Answer 26

< 70 mg/dL.

Question 27

Signs of active ischemia during stress testing.

Answer 27

Angina, ST-segment changes on ECG, or decrease BP.

Question 28

ECG findings suggesting MI.

Answer 28

ST-segment elevation (depression means ischemia), flattened T waves, and Q waves.

Question 29

Coronary territories in MI.

Answer 29

Anterior wall (LAD/diagonal), inferior (PDA), posterior (left circumflex/oblique, RCA/marginal), septum (LAD diagonal).

Question 30

A young patient with angina at rest and ST-segment elevation with normal cardiac enzymes.

Answer 30

Prinzmetal’s angina.

Question 31

Common symptoms associated with silent MIs.

Answer 31

CHF, shock, and altered mental status.

Question 32

Diagnostic test for pulmonary embolism (PE).

Answer 32

Spiral CT with contrast.

Question 33

Protamine

Answer 33

Reverses the effects of heparin.

Question 34

Prothrombin time.

Answer 34

The coagulation parameter affected by warfarin.

Question 35

A young patient with a family history of sudden death collapses and dies while exercising.

Answer 35

Hypertrophic cardiomyopathy.

Question 36

Endocarditis prophylaxis regimens.

Answer 36

Oral surgery - amoxicillin for certain situations; GI or GU procedures - not recommended.

Question 37

Virchow’s triad.

Answer 37

Stasis, hypercoagulability, endothelial damage.

Question 38

The most common cause of hypertension in young women.

Answer 38

OCPs.

Question 39

The most common cause of hypertension in young men.

Answer 39

Excessive EtOH.

Question 40

Figure 3 sign.

Answer 40

Aortic coarctation.

Question 41

Water-bottle-shaped heart.

Answer 41

Pericardial effusion. Look for pulsus paradoxus.