Cardiovascular

Question 1

left axis vs right axis deviation

Answer 1

L: upright QRS lea I, downward aVF
R: downward QRS lead I, upright aVF

Question 2

LBBB vs RBBB

Answer 2

LBBB: wide QRS with no R wave V1, wide, tall R wave I, V5, V6
RBBB: wide QRS, RSR’ V1, Wide S wave I, V5, V6

Question 3

R vs L atrial enlargement

Answer 3

R (P pulmonale): P wave lead II >2.5

L (P mitrale): P wave lead II >120msec

Question 4

Incr JVP with inspiration

Answer 4

Kussmaul sign: RV infarct, ccardiac tamponade, tricuspid regurg, constrictive pericarditis

Question 5

Holosystolic murmur that radiates to axilla

Answer 5

mitral regurg

Question 6

Midsystolic or late systolic murmur with preceding click

Answer 6

mitral valve prolapse

Question 7

early decrescendo diastolic murmur

Answer 7

aortic regurg

Question 8

mid to late, low-pitched diastolic murmur

Answer 8

mitral stenosis

Question 9

S3 vs S4 gallop

Answer 9

S3: dilated cardiomyopathy, mitral valve disease, can be normal
S4: hypertension, diastolic dysfxn, aortic stenosis

Question 10

L sided vs R sided HF

Answer 10

L: dyspnea (basilar rales, pleural effusion, pulm edema, orthopnea)
R: fluid retention (JVD, hepatojug reflex, periph edema, hepatomegaly)

Question 11

Tx pulm congestion (LMNOP)

Answer 11

Lasix
Morphine
Nitrates
O2
Position

Question 12

S4 gallop, pulm cong, normal heart size, LVH, normal EF; dx and tx

Answer 12

nonsystolic heart dysfxn
Tx: diuretics, bbl/ACEi/ARB/CCB for rate/BP ctrl
Digoxin NOT helpful

Question 13

ECG shows nonspecific ST-T changes, low-voltage QRS, LBBB: dx and tx

Answer 13

dilated cardiomyopathy
Tx: ACEi/ARB/bbl
Avoid CCB
ICD if EF

Question 14

Defn dyslipidemia, recommended screening

Answer 14

LDL >130 or HDL 35y, q5y

>20 with risk

Question 15

Stage I vs Stage II HTN and tx

Answer 15

Stage I: 140-159/90-99
Thiazide (or ACEi, ARB, bbl, CCB)
Stage II: >160/>100
Two drug combo (thiazide + ACEI, ARB, Bbl or ccb)

Question 16

Hypertension, hypokalemia, metabolic alkalosis: dx, workup, tx

Answer 16

Conn’s syndrome
Incr aldost, decr renin
Tx surgical removal

Question 17

hypertensive urgency vs emergency, tx

Answer 17

Urgency: incr BP and sx, no end organ failure; tx oral meds (bbl, clonidine, ACEI), lower over 2448h
Emergench: signs end organ damage (AKI, papilledema, ECG change)
Tx IV meds (labetalol, nitroprusside, nicardipine), lower 25% over 2 hrs

Question 18

hypotension, distant heart sounds, JVD: dx and tx

Answer 18

Beck triad, cardiac tamponade

Tx fluids, emergent pericardiocentesis

Question 19

indications for tx of aortic aneurysm

Answer 19

abdominal: >5.5cm
Thoracic: >6cm

Question 20

tearing/ripping pain of ant chest or back, asymmetric pulses or BPs, neuro deficit: dx, workup, tx

Answer 20

aortic dissection
CT angio
Ascending: emergent surgery
descending: can manage medically