LE 3 Flashcards

Question

25. “Agonal breathing” is a form of struggling breathing that sounds like gasping or gurgling. A person who shows signs of agonal breathing should get CPR right away. A. TRUE B. False

Answer 1

FALSE. The majority of sudden cardiac arrest victims do not survive, and one of the reasons is that bystanders often do not know how to perform CPR or are hesitant to do so. Immediate CPR can double or triple a victim's chance of survival.

Answer 2

D In obtaining blood pressure measurement from the posterior tibial artery, the chest piece of the stethoscope is placed in front of the medial malleolus

Answer 3

A. < 8 cm Typically, the normal range for CVP is 2-8 cmH2O (or approximately 2-10 cm of blood). However, it’s important to note that the exact “normal” range can vary based on the source and the clinical context.

Answer 4

All of the above

Answer 5

B. Aortic dissection. Aortic dissection is a medical emergency where there’s a tear in the wall of the main artery carrying blood out of the heart (aorta). This can cause severe, sudden chest or back pain.

Answer 6

B. Aggravated by sitting up and leaning forward. Rationale: In acute pericarditis, the typical chest pain is often described as sharp or stabbing and can be relieved by leaning forward. The pain can be aggravated or intensified when lying flat or during inspiration.

Answer 7

B hyperthyroidism

Answer 8

D. Abdominojugular Reflux Test. The abdominojugular reflux test (also known as hepatojugular reflux) is used to assess right heart function by observing the jugular venous pressure while applying pressure to the abdomen. An exaggerated or sustained rise in jugular venous pressure during this test can suggest right ventricular dysfunction or failure.

Answer 9

A. False Edema of cardiac origin is typically bilateral, affecting both legs, especially when related to conditions like congestive heart failure. Unilateral edema is more commonly due to local causes such as venous obstruction or lymphatic obstruction on one side.

Answer 10

B. All of the above

Answer 11

B Ventricular fibrillation

Answer 12

C Ventricular tachycardia

Answer 13

B. Ventricular fibrillation

Answer 14

D. Pulseless electrical activity

Answer 15

D. S3 is more prevalent among heart failure patients without left ventricular systolic dysfunction. S3 is often associated with left ventricular systolic dysfunction and can be a sign of heart failure. In older adults, its presence is typically pathological, while in younger individuals, it can be a normal finding.

Answer 16

D. all of the above All the statements given are true regarding the fourth heart sound (S4). S4 occurs due to the vibration of the ventricular wall with atrial contraction and is often associated with conditions that cause decreased ventricular compliance. An S4 is not present in atrial fibrillation because there’s a lack of coordinated atrial contraction in this arrhythmia.

Answer 17

aortic stenosis

Answer 18

C. Pulmonic valve stenosis with or without an ejection sound. A. Fever - Accelerated blood flow can occur with fever, leading to a mid-systolic murmur. B. Anemia and thyrotoxicosis - Both conditions can lead to increased cardiac output and therefore can cause a mid-systolic murmur. D. Normal childhood/adolescence; pregnancy - Both states can have increased cardiac output without structural heart disease, leading to a mid-systolic murmur. C. Pulmonic valve stenosis with or without an ejection sound - This is a structural heart disease. Pulmonic valve stenosis is a condition where there is a narrowing at the pulmonic valve, leading to an obstruction of blood flow out of the right ventricle into the pulmonary artery. This would cause a mid-systolic murmur due to the structural abnormality, not just accelerated blood flow.

Answer 19

D. All of the above In HOCM, the murmur's intensity is related to the degree of outflow tract obstruction. - Maneuvers that increase left ventricular (LV) preload or afterload, such as passive leg raising and squatting, will cause an increase in LV volume, which can reduce the degree of outflow tract obstruction and thus decrease the intensity of the murmur. - Conversely, maneuvers that decrease LV preload, like the strain phase of Valsalva and suddenly standing from squatting, will reduce LV volume and exacerbate the outflow tract obstruction, making the murmur louder. So both statements B and C are correct, which means the answer is D. All of the above.

Answer 20

All of the above

Answer 21

A. TRUE Holosystolic (or pansystolic) murmurs can indeed be seen in chronic mitral regurgitation. Holosystolic (or pansystolic) murmurs are seen or associated with: • Chronic Mitral Regurgitation (MR): Best heard at the apex and radiates to the axilla. • Ventricular Septal Defect (VSD): Best heard along the left parasternal border and may be associated with a palpable thrill. • Chronic Tricuspid Regurgitation (TR): Best heard along the lower parasternal border, and its intensity typically increases with inspiration (known as Carvallo’s sign).

Answer 22

TRUE • Chronic Mitral Regurgitation (MR): Best heard at the apex and radiates to the axilla. • Ventricular Septal Defect (VSD): Best heard along the left parasternal border and may be associated with a palpable thrill. • Chronic Tricuspid Regurgitation (TR): Best heard along the lower parasternal border, and its intensity typically increases with inspiration (known as Carvallo’s sign).

Answer 23

TRUE • Chronic Mitral Regurgitation (MR): Best heard at the apex and radiates to the axilla. • Ventricular Septal Defect (VSD): Best heard along the left parasternal border and may be associated with a palpable thrill. • Chronic Tricuspid Regurgitation (TR): Best heard along the lower parasternal border, and its intensity typically increases with inspiration (known as Carvallo’s sign).

Answer 24

FALSE MID-SYSTOLIC MURMUR Timing: • Starts after the first heart sound (S1) and concludes before the second heart sound (S2). Clinical Conditions: 1. Aortic Stenosis (AS): • Most common cause. • Interestingly, the severity of AS does not necessarily correlate with the intensity of the murmur. • Best heard at the 2nd intercostal space (ICS) on the right side of the sternum. 2. Other Causes: • Pulmonic Stenosis (PS): Heard best in the 2nd left ICS. • Hypertrophic Obstructive Cardiomyopathy (HOCM): Best heard over the left sternal border and apex. • Large Atrial Septal Defect (ASD) with left-to-right shunting: Best heard in the 2nd ICS near the upper left sternal border. • Aortic Valve Sclerosis: Sounds similar to AS but without the associated symptoms; best heard in the 2nd right ICS.

Answer 25

A. TRUE Lower extremity or presacral edema in conjunction with elevated jugular venous pressure (JVP) does indicate volume overload. Both chronic heart failure and constrictive pericarditis can present with these clinical findings.

Answer 26

B. FALSE Homan's sign is neither very specific nor very sensitive for deep venous thrombosis (DVT). While it's a traditional clinical sign, relying on it alone for the diagnosis of DVT can lead to missed or false diagnoses. Modern diagnostic approaches, such as Doppler ultrasonography, are more accurate and reliable for diagnosing DVT.

Answer 27

B. Patent ductus arteriosus The described clinical picture suggests differential cyanosis, where the lower extremities are cyanotic but not the upper extremities. This can be seen in conditions where there’s a right-to-left shunt after the blood has supplied the upper body. The most classic condition that fits this presentation is: B. Patent ductus arteriosus In some cases of Patent Ductus Arteriosus (PDA), especially when it is large and there is increased pulmonary vascular resistance, oxygen-poor (deoxygenated) blood from the pulmonary artery can flow into the descending aorta, causing the lower body to receive deoxygenated blood. This results in cyanosis of the lower extremities but not the upper extremities.

Answer 28

B. Premature atherosclerosis Pseudoxanthoma elasticum is a genetic disorder that affects connective tissues, leading to fragmentation and calcification of elastic fibers in the skin, retina, and blood vessels. This can cause the blood vessels to become narrowed or blocked, leading to premature atherosclerosis.

Answer 29

B. Tetralogy of Fallot Rationale: Tetralogy of Fallot is a congenital heart defect that consists of four anatomical abnormalities. One of these abnormalities, the right-to-left shunt, can lead to decreased oxygen levels in the blood, resulting in chronic hypoxemia. Chronic hypoxemia is one of the causes of finger clubbing. The disappearance of the Schamroth sign is a clinical test for clubbing. Given the described clinical findings and the provided options, Tetralogy of Fallot is the most likely culprit for the patient's physical finding.

Answer 30

B. osteogenesis imperfecta Rationale: Osteogenesis imperfecta, also known as "brittle bone disease," is a genetic disorder characterized by fragile bones that break easily. One of the characteristic features of osteogenesis imperfecta is the presence of a blue sclera, which results from the underlying choroidal veins being visible through the thin sclera.

Answer 31

A. Decompensated heart failure

Answer 32

D. Chronic severe aortic regurgitation Rationale: Corrigan's pulse (or "water-hammer" pulse) is a rapid and forceful distention of the arterial pulse followed by a rapid fall, typically associated with chronic severe aortic regurgitation. This is due to the rapid ejection of a large stroke volume during systole into a noncompliant aorta, followed by a rapid runoff of blood back into the left ventricle during diastole due to the regurgitation.

Answer 33

C. Marfan’s syndrome Rationale: Marfan's syndrome is a genetic disorder affecting the body's connective tissue. One of its hallmark features is the presence of disproportionately long limbs and fingers. The wrist sign, or Walker-Murdoch sign, is positive when the thumb and fifth finger of one hand overlap when wrapped around the opposite wrist. This sign indicates excessive joint mobility and is suggestive of Marfan's syndrome.

Answer 34

C. All of the above

Answer 35

B. Infective endocarditis

Answer 36

A. Warfarin

Answer 37

C. atrial myxoma Rationale: Carney's syndrome, also known as Carney complex, is an autosomal dominant condition characterized by multiple lentigines and other skin manifestations. Cardiac-wise, it is most notably associated with cardiac myxomas, especially atrial myxomas. These tumors can lead to various complications if not diagnosed and treated promptly.

Answer 38

D. Erythema marginatum ; rheumatic heart disease. Rationale: Erythema marginatum is a skin manifestation characterized by reddish lesions with a pale center and erythematous borders. It is one of the major Jones criteria for the diagnosis of rheumatic fever and can be associated with rheumatic heart disease.

Answer 39

A. low HDL

Answer 40

A. Hyperthyroidism

Answer 41

B. Aortic aneurysms

Answer 42

A. Mitral valve prolapse. Rationale: Straight back syndrome is a condition where the thoracic spine is straightened, reducing the anteroposterior diameter of the thorax. This can lead to the heart being positioned more anteriorly in the chest. As a result, there can be a mechanical compression or distortion of the heart structures, leading to associated conditions like mitral valve prolapse.

Answer 43

C. chronic infective endocarditis Rationale: Intravenous drug users are at a higher risk for infective endocarditis. Chronic infective endocarditis can lead to septic emboli, which can subsequently cause splenomegaly. The presence of multiple needle marks on the patient's arms suggests a history of intravenous drug use, making this the most likely cause of the observed splenomegaly.

Answer 44

A. True Rationale: Elevated Jugular Venous Pressure (JVP) is a sign of right heart dysfunction and elevated central venous pressure. It indicates fluid overload or congestion, which is commonly seen in heart failure. An elevated JVP has been associated with worse outcomes in patients with symptomatic heart failure (stages C to D) and in those with asymptomatic left ventricular systolic dysfunction.

Answer 45

A. False Cuff length should be 80% of the arm and cuff width should be 40% of the arm.

Answer 46

A. True Rationale: In conditions such as chronic severe aortic regurgitation or a large arteriovenous (AV) fistula, there is increased diastolic run-off. This means that during diastole, there's a significant flow of blood either backward into the left ventricle (in the case of aortic regurgitation) or directly from arteries to veins (in the case of an AV fistula). This increased flow during diastole can result in a lower diastolic blood pressure.

Answer 47

A. False Rationale: The true diastolic blood pressure is determined by the fifth Korotkoff sound, which is when the sounds disappear entirely during blood pressure measurement. The fourth Korotkoff sound represents the point at which the sound becomes muffled, and the fifth is when it disappears. The disappearance of the sound (fifth Korotkoff sound) is used to determine diastolic pressure in adults.

Answer 48

B. All of the above

Answer 49

B. True The Ankle-Brachial Index (ABI) is a non-invasive diagnostic test used to assess peripheral arterial disease (PAD). An abnormal ABI is indicative of atherosclerosis in the peripheral arteries and has been associated with an increased risk of cardiovascular events and mortality.

Answer 50

D. all of the above

Answer 51

B. False white coat hypertension” : at least 3 separate clinic-based measurements >140/90 and at least 2 non-clinic based measurements <140/90 without evidence of target end- organ damage ➤ 24-hour ambul

Answer 52

B. False Orthostatic hypotension is traditionally defined as a decrease in systolic blood pressure (SBP) of at least 20 mmHg or a decrease in diastolic blood pressure (DBP) of at least 10 mmHg within (3) three minutes of standing or head-up tilt on a tilt table. The values given in the statement (SBP >30mmHg or DBP >20mmHg) are not standard thresholds for defining orthostatic hypotension, though they do indicate a significant drop in blood pressure.

Answer 53

B. All of the above

Answer 54

C. Allen’s test. Rationale: The Allen's test is used to evaluate the patency (or openness) of the radial and ulnar arteries in the hand. It helps ensure that both arteries are supplying blood to the hand, which is critical for procedures that might compromise blood flow through one of these arteries. The arcuate system refers to the network of arterial anastomoses in the hand, and Allen’s test can provide information about its integrity.

Answer 55

D. all of the above

Answer 56

B. False Kussmaul's sign is an increase in jugular venous pressure (JVP) during inspiration. While it can be seen in restrictive cardiomyopathy, it is more classically associated with constrictive pericarditis. However, it's worth noting that not all patients with constrictive pericarditis will demonstrate Kussmaul's sign, and not everyone with Kussmaul's sign has constrictive pericarditis.

Answer 57

D) Defibrillate the patient Ventricular fibrillation is a life-threatening heart rhythm that results from rapid, chaotic electrical impulses causing the heart to quiver or tremble instead of contracting normally. Ventricular fibrillation is considered a shockable rhythm, meaning that a defibrillator should be used to deliver an electrical shock to the heart in an attempt to restore a normal rhythm.

Answer 58

A. Sinus rhythm

Answer 59

A. Sinus rhythm

Answer 60

C. Asystole Asystole, often referred to as a flatline, is a state of no cardiac electrical activity. It's vital to recognize that defibrillating asystole is not beneficial and can be detrimental. Instead, the focus should be on providing effective chest compressions and addressing reversible causes. Non-shockable rhythms, like asystole and pulseless electrical activity, do not benefit from defibrillation. This suggests that the immediate intervention for a non-shockable rhythm is to initiate chest compressions. High-quality chest compressions are a fundamental component of cardiopulmonary resuscitation (CPR) and can significantly improve the chance of survival and neurological recovery in cardiac arrest patients.