Medicine- Cardiology

Question 1

General indications for surgical treatment of infective endocarditis and the treatment of choice?

Answer 1

congestive heart failure, uncontrolled infection, systemic embolization, a prosthetic valve, or fungal endocarditis.

Tx: Mechanical valve replacement is the treatment of choice in a young (< 65 years old)

Question 2

Diastolic murmur + sharp sound after S2 (Opening snap)

Answer 2

Mitral stenosis

Question 3

Otherwise healthy male, with high cholesterol on examination for pre-employment… next best step?

Answer 3

Serum lipid studies while fasting

Question 4

What is the normal jugular venous pressure

Answer 4

less than <3 cm H2O above the sternal angle at 30-45 degrees recumbency

Question 5

What drugs should be avoided in RVMI (Right ventricular Myocardial infarction)

Answer 5

Nitrates, diuretics and opiods

Question 6

Clinical presentation of cardiac outflow obstruction

Answer 6

progressive dyspnea on exertion, fatigue and exertional syncope

Question 7

Clinical presentation of Beta blocker overdose

Answer 7

bradycardia and hypotension leading to cardiogenic shock

Question 8

Aortic regurgitation murmur

Answer 8

Early diastolic murmur

Question 9

Vasovagal syncope pathophysiology

Answer 9

Response to from increased parasympathetic activity leading to bradycardia and asystole due to sinus arrest

Question 10

Holosystolic murmur that increases in intensity with inspiration

Answer 10

Tricuspid regurgitation

Question 11

What are the most important factors improving patient survival in cardiac arrest

Answer 11

1. Prompt effective resuscitation with adequate bystander cardio-pulm resuscitation
2. Promt rhythm analysis and defibrillation in a shockable rhythm (eg. V-fib)

Question 12

Physical Characteristics of a patient with Pericarditis

Answer 12

Pleaurtic chest pain that can radiate to bilateral trapezius ridges
Triphasic pericardial friction rub

Question 13

ECG findings in a patient with sick sinus syndrome

Answer 13

Sinus bradycardia
Sinus pauses (delayed P waves)
SA nodal exit block (dropped P waves)

Question 14

Clinical features of sick sinus syndrome

Answer 14

Elderly patients
Bradycardia (fatigue, dyspnea, syncope, dizziness)
bradycardia-tachycardia syndrome (A-fib, palpitations)

Question 15

Treatment of sick sinus syndrome

Answer 15

1. Pacemaker

2. +/- rate control meds eg. BB (if tachyarrhythmias)

Question 16

Best modalities for diagnosing of Aortic Dissection

Answer 16

TEE (Preferred in patients with renal insufficiency)
CT Angio (preferred study in hemodynamically stable pts)
MRA

Question 17

What is the next best step in a Asx patient with a diastolic murmur

Answer 17

Transthoracic echo (these type of murmurs are almost always pathological)

Question 18

ECG findings that are consistent with LV Hypertrophy

Answer 18

High voltage QRS
Lateral T wave inversions
Lateral ST segment depressions

Question 19

Symptoms of Coartation of the aorta in an adult

Answer 19

Headaches
Epixtasis
Lower extremity claudication

Question 20

Initial evaluation of coarctation of the aorta

Answer 20

1. Simultaneous palpitaion of brachial and femoral pulse to look for delay
2. UE and LE BP difference by measuring UE supine and LE in prone position

Question 21

Prolonged infusion of Nitroprusside especially in renal failure patients can lead to what?

Answer 21

Cyanide Toxicity

Question 22

Dilated cardiomyopathy that begins in the last month of pregnancy or within 5 months of delivery and what murmur is it associated with?

Answer 22

Peripartum Cardiomyopathy associated with mitral regurg

Question 23

Intermittent prominent A waves caused by surge in JVP and why this happens

Answer 23

Cannon A waves (right atrial contraction against a closed tricuspid valve)

Question 24

What pathology are cannon A waves associated with

Answer 24

Atrioventricular dissociation (eg. V-tach)

Question 25

What is the net result of a cardiac tamponade

Answer 25

Decrease preload, cardiac output and stroke volume

Question 26

What is the most common endocrine disorder associated with A-fib

Answer 26

Hyperthyroidism

Question 27

Transient loss of consciousness along with loss of postural tone or motor tone during micturition

Answer 27

Situational syncope (cardioinhibitory or vasodepressor or mixed)

Question 28

It typically presents as a high-frequency, mid-systolic click combined with a high-frequency, mid-to-late systolic murmur heard best at the apex.

Answer 28

MVP

Question 29

What is given to keep the PDA open

Answer 29

PGE1

Question 30

In the context of a serious motor vehicle collision, this patient’s hypotension and tachycardia refractive to fluid resuscitation, including vasopressors, combined with atrial fibrillation on EKG and a negative FAST, are highly suspicious for what?

Answer 30

Cardiac contusion

Question 31

The patient has acute aortic regurgitation and left-sided CHF from infective endocarditis, which together are an indication for what type of intervention.

Answer 31

Surgical Mechanical valve replacement is the treatment of choice in a young (< 65 years old) patient with no contraindications for anticoagulation.

Question 32

What is the treatment of choice in a patient who is >65 yrs or has contraindications for anticoagulation with severe Aortic regurgitation with CHF symptoms

Answer 32

Porcine valves

Question 33

Do patients with HOCM have abnormal mitral leaflet motion

Answer 33

YES.. they have a systolic anterior motion