Deck 1 Flashcards
What is Papillary Muscle Rupture?
a serious complication that can occur 3-7 days following an MI. Patients present with: -evidence of heart failure -new murmur -hypotension -acute pulmonary edema.
ll of the following are causes of Torsades de Pointes EXCEPT A. Hypomagnesemia B. Hypothermia C. Hyperkalemia D. Hypocalcemia
C. Hyperkalemia
Most obvious change on ECG with hyperkalemia?
Tall, peaked T waves are indicative of Hyperkalemia
Most indicative change on ECG for Hypokalemia?
Hypokalemia is characterized by U waves.
Rheumatic fever can cause what heart murmur?
Mitral stenosis: a diastolic murmur
Acute mitral regurg from inferior wall MI 1 day ago. Now has a new murmur, what do you expect on physical exam? A. Ascites B. Hepatomegaly C. Peripheral edema D. Pulmonary Crackles
D. Pulmonary Crackles
Acute left ventricular failure secondary to myocardial infarction is a cause of acute cardiogenic pulmonary edema. Papillary muscle rupture is most common with an inferior MI. Symptoms may include shortness of breath, cough, and even production of pink, frothy sputum. Physical examination findings include diaphoresis, tachypnea, tachycardia, air hunger, agitation/confusion, bilateral rales and/or wheezes, S3, and possibly jugular venous distention.
A 45 year old female presents with joint pain in her knees and wrists, and fever for the past week. On physical exam you notice the presence of erythematous annular lesions on the trunk and extremities. Patient states that she was recently seen in the urgent care for a sore throat and was treated with supportive therapy. Which of the following is the most likely diagnosis? A. Rheumatic Fever B. Post-strep glomerulonephritis C. Coccidioidomycosis D. Histoplasmosis E. Polymyalgia Rheumatica
A. Rheumatic fever
This is a patient presenting with rheumatic fever. The major criteria for rheumatic fever include: polyarthritis, carditis, erythema marginatum, chorea, subcutaneous nodules. Minor criteria include: fever, polyarthralgias, reversible prolongation of PR interval, elevated ESR and CRP. The diagnosis require 2 major criteria, or 1 major and 2 minor.
A 37 year old male presents to the clinic with a red rash in ring form covering his trunk and portions of his lower extremities as well as a fever. He also complains of bumps under the skin of his arms and legs, that you recognize as subcutaneous nodules. Which of following heart murmurs is most commonly noted as a late sequelae of this disease?
A. Rough continuous murmur
B. Crescendo-decrescendo murmur best heard at the left sternal border
C. Harsh systolic ejection murmur
D. Low-pitched diastolic rumble, possibly with opening snap
E. Late systolic murmur with click
This describes mitral valve prolapse with mitral regurgitation
D. Low-pitched diastolic rumble, possibly with opening snap
The mitral valve is most commonly affected in rheumatic heart disease, the late sequelae of acute rheumatic fever. Mitral stenosis is the classic valvular complication associated with rheumatic heart disease, which is noted to have a low-pitched diastolic rumble, possibly with opening snap early in the course of the disease.
note: E. “Late systolic murmur with click” describes mitral valve prolapse with mitral regurgitation
Which of the following characteristics is classically associated with monomorphic ventricular tachycardia?
A. Alternating QRS complex polarities B. Intact AV conduction C. Narrow QRS complex D. Regular rhythm E. Shortened PR interval
D. Regular rhythm
Monomorphic ventricular tachycardia is a regular, wide-QRS complex tachycardia with only one (“mono”) repeating QRS morphology.
Shortened PR interval
Early treatment with a thrombolytic agent reduces mortality in patients with active myocardial infarction. Which of the following pharmacologic agents should be avoided if the patient has received it on a previous occasion?
A. Retaplase B. Alteplase (t-PA) C. Steptokinase D. Heparin E. Anistreplase (APSAC)
C. Steptokinase
Patients who have received streptokinase may produce streptococcal antibody levels sufficient to render the drug ineffective, and therefore this drug cannot be administered after the initial incident. The other thrombolytic agents are not associated with this sensitivity.
note: D. Heparin
Heparin is an anticoagulant, not a thrombolytic agent.
Most common site for arterial aneurysm? A. Ascending aortic arch B. Descending aortic arch C. Suprarenal aorta D. Infrarenal aorta E. Iliofemoral vessels
D. Infra-renal aorta
The most common location of an aortic aneurysm is the distal aorta, below the level of the renal arteries.
A 56 year old male, with a history of intermittent bouts of heart palpitations, is admitted to the hospital for further evaluation after a 24 hour Holter monitor reveals two runs of sustained ventricular tachycardia. While in the hospital his ECG reveals Delta waves, but he is asymptomatic at this time. Which study would you recommend to evaluate his ventricular excitability?
Repeat ECG Dobutamine stress testing Transesophageal echocardiogram Coronary angiography Electrophysiology study
E. Electrophysiology study
Electrophysiology testing is used to evaluate the excitability of the myocardium, and may also reproduce the tachycardia. This patient most likely has a diagnosis of Wolff-Parkinson-White syndrome, for which Delta waves are characteristic. WPW is a syndrome of excitability in which re-entry pathways lead to tachyarrhythmias.
A febrile 42-year-old woman is found to have petechiae on her hands and lower extremities, as well as new diastolic murmur. Which of the following diagnostic tests would be most helpful in determining whether surgical intervention is required in this patient’s treatment plan?
A. EKG B. Blood cultures C. Cardiac angiography D. Transesophageal echocardiography E. Pericardiocentesis
EKG
This patient presents with concerns of infective endocarditis. Signs and symptoms include fever, petechiae, splinter hemorrhages, Osler nodes, Janeway lesions, and Roth spots. A patient found to have myocardial vegetations may require surgical intervention. An EKG can not assess for myocardial vegetations.
Blood cultures
This patient presents with concerns of infective endocarditis. Signs and symptoms include fever, petechiae, splinter hemorrhages, Osler nodes, Janeway lesions, and Roth spots. A patient found to have myocardial vegetations may require surgical intervention. While blood cultures are important in establishing the diagnosis of infective endocarditis, they do not assess for myocardial vegetations.
Cardiac angiography
This patient presents with concerns of infective endocarditis. Signs and symptoms include fever, petechiae, splinter hemorrhages, Osler nodes, Janeway lesions, and Roth spots. A patient found to have myocardial vegetations may require surgical intervention. Cardiac angiography does not assess for myocardial vegetations.
Transesophageal echocardiography
This patient presents with concerns of infective endocarditis. Signs and symptoms include fever, petechiae, splinter hemorrhages, Osler nodes, Janeway lesions, and Roth spots. A patient found to have myocardial vegetations may require surgical intervention. A transesophageal echocardiogram (TEE) is the diagnostic modality of choice to assess for myocardial vegetations.
Pericardiocentesis
This patient presents with concerns of infective endocarditis. Signs and symptoms include fever, petechiae, splinter hemorrhages, Osler nodes, Janeway lesions, and Roth spots. A patient found to have myocardial vegetations may require surgical intervention. Pericardiocentesis does not assess for myocardial vegetations.
What is Pentoxyphylline
Pentoxyphylline
This patient is presenting with chronic venous insufficiency. Pentoxyphylline is a treatment for claudication associated with peripheral arterial disease. Each of the other treatments is acceptable for use in chronic venous insufficiency with symptoms such as this patient is experiencing.
What is a concern with Atrial flutter?
Atrial flutter
Atrial flutter is a more worrisome finding than each of the other listed options, even atrial fibrillation. Atrial flutter generally has a rate of 250-350 bpm, and therefore has the risk of transferring that rate to the ventricles, sending the patient into ventricular tachycardia. A fib, with the rate well over 350 bpm, generally does not transfer that high a rate to the ventricles, and therefore is the most common chronic sustained arrythmia.
A 6-month old male with known Tetralogy of Fallot is brought in by his mother for a “Tet spell”. Which of the following class of medication is best used to treat a “Tet Spell”?
A. Phenylephrine
B. Calcium Channel Blocker
C. Ace-Inhibitor
D. Angiotensin Receptor Blocker
A. Phenylephrine
Patients with Tetralogy of Fallot (in addition to other cardiac defects) have varying degrees of right ventricular outflow tract obstruction. The larger amount of blood that is shunted from the right ventricle directly to systemic circulation, the less the amount of blood that is oxygenated.
“Tet spells” are presumed to be due to acute increase in pulmonary vascular resistance, clinically manifesting as acute episodes of systemic cyanosis followed by syncope, which may result in hypoxia and death. The treatment of a “tet spell” is to increase systemic vascular resistance to allow for temporary reversal of the shunt. Phenylephrine is a vasopressor that increases systemic vascular resistance.
Which of the following is not a cyanotic congenital heart disease?
A. Atrial septal defect B. Tetralogy of Falot C. Pulmonary atresia D. Hypoplastic left heart syndrome E. Transposition of the great vessels
A. Atrial septal defect
ASD is the only listed option that is not a cyanotic heart defect.
The ostium secundum is the embryologic site of occurance of which of the following congenital heart diseases?
A. Atrial septal defect B. Coarctation of the aorta C. Patent ductus arteriosus D. Pulmonic valve stenosis E. Truncus arteriosus
Atrial septal defect
Atrial septal defect (ASD) is a congenital heart defect in which blood flows between the atria of the heart. During development, the interatrial septum develops to separate the left and right atria. The foramen ovale maintains patency between the atrial chambers allowing blood from the right atrium to enter the left atrium to bypass the nonfunctional fetal lungs while the fetus obtains its oxygen from the placenta. The ostium secundum atrial septal defect is the most common type of atrial septal defect, and comprises 6–10% of all congenital heart diseases.
Which of the following adverse effects is most likely to be associated with the use of thiazide diuretics used in the treatment of hypertension?
A. Hyperglycemia B. Hyperkalemia C. Hypermagnesemia D. Hypernatremia E. Hypocalcemia
Hyperglycemia
Thiazides have been associated with hyperglycemia, new-onset diabetes, hyperlipidemia, hypokalemia, hyperuricemia, hypomagnesemia, hyponatremia, and
What is afterload?
the pressure in the wall of the left ventricle during ejection. It is the pressure against which the heart must work to eject blood during systole.
What is Ejection Fraction?
the fraction of blood ejected from a ventricle during systole. It is calculated by dividing the stroke volume by the end-diastolic volume, and it is a measure of the pumping efficiency of the heart.
What is Preload?
the initial stretching of the heart prior to contraction. When venous return to the heart is increased, the end-diastolic pressure and volume of the ventricles are increased (stretching the heart), which increases the preload. In contrast, hypovolemia resulting from a loss of blood volume (e.g., hemorrhage) leads to less ventricular filling, and therefore reduces preload.
What is Pulmonary capillary wedge pressure?
The pressure measured by wedging a pulmonary catheter with an inflated balloon into a small pulmonary arterial branch. It provides an indirect measure of the left atrial pressure.
What is Stroke volume?
The volume of blood pumped from the left ventricle per beat. The stroke volumes for each ventricle are generally equal, both being approximately 70 mL in a healthy 70-kg man.
A 57 year old female presents with a severe unilateral headache and associated visual changes. She has recently been more fatigued than usual and is now running a low grade fever. She has been complaining of musculoskeletal pain worse in the morning, sore throat, and pain in her jaw after chewing. With a suspected diagnosis of giant cell arteritis, what other condition is also likely to be present in this patient? A. Polymyalgia rheumatica B. Fibromyalgia C. Rheumatoid arthritis D. Polymyositis E. Multiple myeloma
A.Polymyalgia rheumatica
Polymyalgia rheumatica can be associated with temporal arteritis in 50% of cases.
Which of the following is the most common cause of pulseless electrical activity?
A. Pneumothorax B. Myocardial infarction C. Pulmonary embolism D. Hypovolemia E. Hyponatremia
D.Hypovolemia
All of the options are causes of PEA, with hypovolemia being the most common.
Which of the following is the most common cause of restrictive cardiomyopathy?
A. Hemochromatosis B. Scleroderma C. Sarcoidosis D. Amyloidosis E. Carcinoid heart disease
D. Amyloidosis
All of the options are causes of restrictive cardiomyopathy, but amyloidosis is the most common of those listed.
What are ABSOLUTE contraindications for exercise stress testing?
- Unstable angina
- Presence of pericarditis or other active cardiac inflammation
- Deep vein thrombosis
- Hemodynamically significant aortic stenosis
- acute MI
- severe CHF
- severe arrhythmias (especially tachyarrhythmias)
- severe HTN
- PE
- extreme obesity
- severe disabilities
Atherosclerotic plaque buildup occurs in which of the following?
A. In the intima layer of the arterial wall
B. Only in patients with low levels of HDL cholesterol
C. In the media layer of the arterial wall
D. In the adventitia layer of the arterial wall
E. In response to consumption of Omega-3-fatty acids
A. In the intima layer of the arterial wall
Atherosclerotic plaques develop in the intima layer of the arteries.
Which of the following is the most potent positively chronotropic agent?
A. Isoproterenol B. Dobutamine C. Epi D. Norepi E. Diltiazem
Isoproterenol > Epi > Dobutamine > Norepi;
Diltiazem is a negatively chronotropic agent.
The cardiac output in pregnant patients increases during the first half of pregnancy. Which of the following is responsible for this change?
A. Increased mean arterial pressure B. Decreased heart rate C. Decreased preload D. Increased systemic vascular resistance E. Increased blood volume
E. Increased blood volume
Women have up to a 50% increase in their blood volume during pregnancy. This is the factor most responsible for increasing their cardiac output
Premature babies are at increased risk for development of which of the following conditions?
A. Atrial septal defect B. Coarctation of the aorta C. Patent ductus arteriosus D. Tetralogy of Fallot E. Ventricular septal defect
C. Patent ductus arteriosus
In preterm infants, closure of the ductus arteriosus is delayed, remaining open at 4 days of age in approximately 10% of infants born at 30-37 weeks’ gestation, 80% of those born at 25-28 weeks’ gestation, and 90% of those born at 24 weeks’ gestation. The ductus is likely to close without treatment in infants born at >28 weeks’ gestation, in those whose birth weight >1000 g, and in infants born at 26-29 weeks’ gestation who do not also have respiratory distress syndrome.
You are conducting a newborn exam in the hospital and note upon auscultation a rough continuous murmur. Otherwise the baby appears to be healthy and the parents do not report any abnormal symptoms. Given this patient’s suspected condition, which of the following would be the initial treatment of choice?
A. Begin IV indomethacin B. Schedule surgery immediately C. IV furosemide D. Watch and wait E. Oral ibuprofen
D. Watch & Wait
A. IV indomethacin is considered the DOC for closure of a PDA, in this asymptomatic newborn, however, the first step would be to wait and see if the PDA closes spontaneously.
B. Cardiac catheterization can close a PDA surgically, but is generally reserved till after more conservative measures have been taken.
C. IV furosemide - Loop diuretics aren’t indicated in the treatment of this condition.
D. Watch and wait
Many cases of PDA close spontaneously. Given this patient’s asymptomatic presentation, watchful waiting would be the first step. If the child were to develop symptoms, then more aggressive treatment plans should be considered, especially since indomethacin has been shown to be most effective when given in the first 10-14 days.
E. Oral ibuprofen
Ibuprofen has also been used (given IV, not orally), with similar efficacy to indomethacin in helping to close a PDA. It is also promising since it may reduce risk of transient renal insufficiency or necrotizing enterocolitis.
What do you do with thyroid nodule if FNA causes the cyst to disappear or cytology is benign?
No additional treatment is necessary
What is the most frequently used treatment in children with enuresis?
-behavioral therapy
record dry nights on calendar & reward with stary as gift.
What are the signs/symptoms of viral encephalitis?
Abrupt onset,
rapid confusion & seizures
What is the most characteristic finding on CT scan in a patient with viral encephalitis?
Pathologic lesions that consist of hemorrhagic necrosis of the temporal lobes.
What is the most characteristic finding on CT scan in a patient with viral encephalitis?
Pathologic lesions that consist of hemorrhagic necrosis of the temporal lobes.
What is the most common etiologic agent of SPORADIC viral encephalitis, in an otherwise healthy adult?
HSV type 1
Round, ring-enhancing intracerebral masses, that can develop anywhere in the brain are indicative of
Brain Toxoplasmosis, affecting severely immunocompromised patients, most frequently those with AIDS
What is Echovirus encephalitis?
One of the MC etiologic agents of the so-called lymphocytic meningoencephalitis, (aka septic meningitis).
How does echovirus encephalitis present?
Symptoms are mild, often limited to headache and malaise.
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