DIT Cardiac Path End session Quiz

Question 1

What is the classic presentation of a patient with temporal arteritis? What lab findings help diagnose temporal arteritis?

Answer 1

Jaw claudication, unilateral headache, blindess (late). Elevated ESR (definitive diagnosis is temporal artery biopsy)

Question 2

What are the differences b/w acute and subacute bacterial endocarditis?

Answer 2

Acute is caused by staph aureus-> even normal valves can be effected. Rapid onset (days)

Subacute -> classically is strep viridans with pre-existing valvular damage. More insidious onset (weeks to months)

Question 3

What are the Jones criteria for acute rheumatic fever?

Answer 3

JONES
Joints- Migratory polyarthritis
O = heart- pancarditis
N- nodules (subQ -> contain Aschoff bodies)
E- Erythema marginatum (rash w/ red edges)
S- Syndenham’s chorea (chorea of the tongue, face and upper limbs)

Question 4

Why do the kidneys retain fluid in CHF pts?

Answer 4

Kidneys are sensing poor perfusion because the heart is not pumping out enough blood (hence the name heart failure). The JG apparatus senses this low perfusion and secretes renin. Renin converts angiotensinogen (from liver) to angiotensin 1 which is then converted by ACE (from lungs) to angiotensin 2. Ang II causes vasoconstriction via AT1 receptors on vessels. But ultimately to answer the question, Ang II causes aldosterone release from the adrenal gland leading to sodium and water reabsorption.

Question 5

What are the common causes of restrictive cardiomyopathy?

Answer 5

Anything that bulks up heart tissue.
Sarcoid, amyloid, hemochromatosis, Loffler’s syndrome (endomyocarial fibrosis w/ eosinophils), post radiation fibrosis, endocardial fibroelastosis (congenital, thick fibroelastic endocardium in young children).

Question 6

Crescendo-decrescendo systolic murmur best heard in the 2nd-3rd right interspace close to the sternum

Answer 6

Aortic stenosis

Question 7

Rumbling late diastolic murmur with an opening snap

Answer 7

Mitral stenosis

Question 8

Pansystolic (aka holosystolic or uniform) murmur best heard at the 4th-6th left intercostal space

Answer 8

Tricuspid regurgitation or VSD

Question 9

Continuous machine like murmur in systole and diastole

Answer 9

PDA

Question 10

What is dressler’s syndrome?

Answer 10

autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post-MI)

Question 11

What are the two most common complications after an MI?

Answer 11

Arrhythmias (most common lethal = ventricular fibrillation) and Left ventricular failure

Question 12

Evolution of an MI
0-4 hours-
4-12 hours-
12-24 hours-
1-3 days-
3-14 days-
2 weeks- several months-

Answer 12

Fill this out later
0-4 hours-
4-12 hours-
12-24 hours-
1-3 days-
3-14 days-
2 weeks- several months-

Question 13

What are the most common locations for atherosclerosis?

Answer 13

1. Abdominal aorta (leads to aneurysms)
2. Coronary arteries (angina and MI’s)
3. Popliteal arteries (claudication and PVD)
4. Carotid arteries (TIAs, strokes, multiple infarct dementia)

Question 14

** An adult patient with a history of hypertension presents with a sudden sharp, tearing pain radiating to the back. What would you expect to see on CXR?

Answer 14

Widening of the mediastinum (caused by aortic dissection)

Question 15

** On auscultation of a patient, you hear a pansystolic murmur at the apex with radiation to the axilla. What is the most likely cause of this murmur?

Answer 15

Mitral regurgitation

Question 16

A 25 year old pregnant woman in her 3rd trimester has a normal BP when standing and sitting. When supine, her BP drops to 90/50. What is the diagnosis?

Answer 16

Compression of the inferior vena cava (this is why woman in the third trimester should lie on their left or right side). Less preload going to the heart -> less CO.

Question 17

What pathology? “Onion-skin” periosteal reaction

Answer 17

Ewing sarcoma of bone

Question 18

What pathology? Pseudopalisading tumor cell arrangement

Answer 18

Gliobastoma multiforme (the most common adult tumor of the brain and the most deadly)

Question 19

Which pathology? Elevated serum uric acid?

Answer 19

Gout, Lesch nyhan syndrome, myeloproliferative disorders, Loops and thiazides (which is why we dont give these diuretics to patients with gout)