Deck1

Question 1

Jugular venous distention (JVD > 4 cm above the sternal angle)

Answer 1

Most typically from volume overload, stemming from conditions such as right heart failure or pulmonary hypertension.

Question 2

Hepatojugular reflux (distention of neck veins upon applying pressure to the liver)

Answer 2

Seen in same conditions as JVD.

Question 3

Aortic stenosis

Answer 3

A harsh systolic ejection murmur that radiates to the carotids.

Question 4

Mitral regurgitation:

Answer 4

A holosystolic murmur that radiates to the axilla.

Question 5

Mitral valve prolapse:

Answer 5

A midsystolic or late systolic murmur with a preceding click.

Question 6

Flow murmur:

Answer 6

Usually a soft murmur that is position-dependent (very common and does not imply cardiac disease).

Question 7

Aortic regurgitation:

Answer 7

An early decrescendo murmur.

Question 8

Mitral stenosis:

Answer 8

A mid to late low-pitched murmur.

Question 9

S3 gallop

Answer 9

A sign of fluid overload (ie, heart failure, mitral valve disease); often normal in younger patients and in high-output states (eg, pregnancy).

Question 10

S4 gallop

Answer 10

A sign of decreased compliance (ie, hypertension, aortic stenosis, diastolic dysfunction); usually pathologic but can be normal in younger patients and in athletes.

Question 11

Peripheral pulses: Increased

Answer 11

: Compensated aortic regurgitation (bounding pulses); coarctation (greater in arms than in legs); patent ductus arteriosus.

Question 12

Peripheral pulses: Decreased

Answer 12

Peripheral arterial disease; late-stage heart failure.

Question 13

Peripheral pulses: Collapsing (“waterhammer”)

Answer 13

Aortic incompetence; AV malformations; patent ductus arteriosus; thyrotoxicosis, severe anemia.

Question 14

Peripheral pulses: Pulsus paradoxus (↓ systolic BP > 10 mm Hg with inspiration):

Answer 14

Cardiac tamponade; pericardial constriction; also seen in obstructive lung diseases (eg, severe asthma), tension pneumothorax, and foreign body in airway.

Question 15

Peripheral pulses: Pulsus alternans (alternating weak and strong pulses):

Answer 15

Cardiomyopathy; impaired left ventricular systolic function (LVF). Poor prognosis.

Question 16

Peripheral pulses: Pulsus parvus et tardus (weak and delayed pulse)

Answer 16

Aortic stenosis.

Question 17

Peripheral pulses: Jerky

Answer 17

hypertrophic obstructive cardiomyopathy (HOCM).

Question 18

Peripheral pulses: Pulsus bisferiens (bifid pulse/“twice beating”)

Answer 18

Aortic regurgitation; combined aortic stenosis and aortic regurgitation, HOCM.

Question 19

Statins: action

Answer 19

↓ LDL, ↓ triglycerides

Question 20

HMG-CoA reductase inhibitors (statins)

Answer 20

↓ LDL, ↓ triglycerides

Question 21

Statins: side effects

Answer 21

↑ LFTs, myositis, warfarin potentiation

Question 22

Gemfibrozil Class

Answer 22

Lipoprotein lipase stimulators (fibrates)

Question 23

Gemfibrozil action

Answer 23

↓ Triglycerides, ↑ HDL

Question 24

Gemfibrozil side effects

Answer 24

GI upset, cholelithiasis, myositis (especially in combination with statins), ↑ LFTs, pancreatitis

Question 25

Ezetimibe

Answer 25

Cholesterol absorption inhibitors

Question 26

Ezetimibe action

Answer 26

↓ LDL

Question 27

Cholestyramine, colestipol, colesevelam

Answer 27

Bile acid resins

Question 28

Cholestyramine

Answer 28

↓ LDL

Question 29

Proprotein convertase subtilisin/ kexin type 9 (PCSK9) inhibitors

Answer 29

↓↓ LDL

Question 30

Aortic stenosis Exam/Diagnosis

Answer 30

PE: Pulsus parvus et tardus (weak, delayed carotid upstroke) and a single or paradoxically split S2 sound; systolic crescendo- decrescendo murmur at the right second intercostal space radiating to the carotids Severe AS characterized by soft and single S2 Dx: Echocardiography

Question 31

Aortic regurgitation Exam/Diagnosis

Answer 31

PE: Early blowing diastolic murmur at the left sternal border, mid-diastolic rumble (Austin Flint murmur), and midsystolic apical murmur Widened pulse pressure causes de Musset sign (head bob with heartbeat), Corrigan sign (water-hammer pulse; wide and bounding), and Duroziez sign (femoral bruit) Dx: Echocardiography

Question 32

Mitral valve stenosis Exam/Diagnosis

Answer 32

PE: Opening snap and mid- diastolic murmur at the apex; pulmonary edema Dx: Echocardiography

Question 33

Mitral valve regurgitation Exam/Diagnosis

Answer 33

PE: Holosystolic/pansystolic murmur radiating to the axilla Dx: Echocardiography will demonstrate regurgitant flow; angiography can assess the severity of disease

Question 34

Mitral valve regurgitation Etiology

Answer 34

Primarily 2° to rheumatic fever or chordae tendineae rupture after MI Myxomatous degeneration due to mitral valve prolapse Infective endocarditis

Question 35

Mitral valve stenosis Etiology

Answer 35

The most common etiology continues to be rheumatic fever Uncommon in the US