Cardiovascular Disorders Flashcards

0
Q

Which cyanotic heart disease mimics RDS?
A. Tetralogy of Fallot
B. Total anomalous pulmonary venous return
C. Tricuspid atresia
D. Truncus arteriosus

A

B Ch 95 Respiratory Tract Disorders.
Cyanotic heart disease (total anomalous pulmonary venous return) can also mimic RDS both clinically and radiographically.

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1
Q
Most common immediate lesion in ARF:
​a. Mitral insufficiency
​b. Mitral stenosis
​c. Aortic Insufficiency
​d. Aortic stenosis
A

A. mitral insufficiency

*Nelsons 19th in ARF Chapter: Valvular insufficiency is characteristic of both acute and convalescent stages of acute rheumatic fever, whereas valvular stenosis usually appears several years or even decades after the acute illness.
RHD Chapter: The mitral valve is affected most often, followed in frequency by the aortic valve. Mitral stenosis of rheumatic origin results from fibrosis of the mitral ring, commissural adhesions, and contracture of the valve leaflets, chordae, and papillary muscles over time. It takes 10 yr or more for the lesion to become fully established, although the process may occasionally be accelerated. Rheumatic mitral stenosis is seldom encountered before adolescence and is not usually recognized until adult life.

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2
Q

Which congenital heart disease has increased pulmonary markings?
A. Tetralogy of Fallot
B. Total anomalous pulmonary venous return
C. Tricuspid atresia
D. Transposition of the great arteries with obstruction

A

B

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3
Q
Case of a patient with high-pitched holosystolic murmur at the apex that radiates to the axilla and has a short mid-diastolic rumbling murmur. 
A. Mitral insufficiency 
B. Mitral regurgitation 
C. Aortic insufficiency 
D. Tricuspid regurgitation
A

A
NTP19 432
Rheumatic Heart Disease The physical signs of mitral insufficiency depend on its severity. With mild disease, signs of heart failure are not present, the precordium is quiet, and auscultation reveals a high-pitched holosystolic murmur at the apex that radiates to the axilla. With severe mitral insufficiency, signs of chronic heart failure may be noted. The heart is enlarged, with a heaving apical left ventricular impulse and often an apical systolic thrill. The 2nd heart sound may be accentuated if pulmonary hypertension is present. A 3rd heart sound is generally prominent. A holosystolic murmur is heard at the apex with radiation to the axilla. A short mid-diastolic rumbling murmur is caused by increased blood flow across the mitral valve as a result of the insufficiency. Auscultation of a diastolic murmur does not necessarily mean that mitral stenosis is present. The latter lesion takes many years to develop and is characterized by a diastolic murmur of greater length, usually with presystolic accentuation.

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4
Q
In a patient with ARF presenting with arthralgia, which of the following medications can be given for pain that will not interfere with the development of characteristic migratory polyarthritis?
​a. salicylates
​b. paracetamol
​c. methotrexate
​d. prednisone
A

B. Paracetamol

*Nelson’s ARF chapter: Anti-inflammatory agents (e.g., salicylates, corticosteroids) should be withheld if arthralgia or atypical arthritis is the only clinical manifestation of presumed acute rheumatic fever. Premature treatment with 1 of these agents may interfere with the development of the characteristic migratory polyarthritis and thus obscure the diagnosis of acute rheumatic fever. Agents such as acetaminophen can be used to control pain and fever while the patient is being observed for more definite signs of acute rheumatic fever or for evidence of another disease.

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5
Q

BP in the lower extremities is higher than in the upper extremities

a. Coarctation of the aorta – BP in uppers is higher than lower extremity
b. Takayasu arteritis – radial artery pulse decreased
c. ? ​BP in both arms with >10 mmHg difference

A

? B

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6
Q

BP in the lower extremities is higher than in the upper extremities

a. Coarctation of the aorta
b. Takayasu arteritis

A

B ?
Takayasu arteritis – radial artery pulse decreased
​BP in both arms with >10 mmHg difference
Coarctation of the aorta – BP in uppers is higher than lower extremity

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7
Q

Px w/ a unilateral mass on the submandibular area, red eyes and fever lasting for 5 days. PE was normal, no murmurs.

a. viral myocarditis
b. rheumatic fever
c. Kawasaki disease
d. infectious cardiomyopathy

A

c. Kawasaki disease p. 823

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