MKSAP IV

Question 1

What is Noonan’s syndrome?

Answer 1

Autosomal dominant disorder associated with short stature, neck webbing, hypertelorism (wide spacing between eyes), and pulmonary stenosis.

Question 2

Most common cardiac defects in Down syndrome?

Answer 2

• ostium primum atrial septal defect
• inlet ventricular septal defect
• complete AV septal defect
• tetralogy of Fallot

Question 3

Most common cardiac defects in Turner syndrome?

Answer 3

• bicuspid aortic valve
• aortic coarctation
• aortic aneurysm

Question 4

In patients with mitral stenosis (diastolic murmur) who have a discrepancy between clinical findings and ECHO findings, what is the next step to evaluate the patient for need for surgery?

Answer 4

Exercise ECHO

Question 5

Patients with bicsupid aortic valve and thoracic aortic aneurysm should undergo ECHO every 6 months if aortic diameter is larger than ____ or rate of enlargement exceeds ____.

Answer 5

• 4.5cm

- 0.5cm/year

Question 6

What is normal aortic root size?

Answer 6

<4.0 cm for Men

<3.4 cm for Women

Question 7

What diameter is AAA diagnosed?

Answer 7

> 3.0 cm

Question 8

When is operative aortic valve repair and thoracic aortic aneurysm repair indicated in an asymptomatic patient?

Answer 8

When thoracic aortic aneurysm is 5.5cm or larger

If has other risk factors such as FHx of aortic dissection or growth >0.5 cm/year, can repair at 5.0 cm

Question 9

When do you use an implantable loop recorder?

Answer 9

Very infrequent arrythmia episodes (>30 days)

Question 10

What influences BNP levels?

Answer 10

Increase: kidney failure, older age, female

Decrease: obesity

Question 11

Clinical findings in critical limb ischemia in PAD

Answer 11

1. ABI <0.40
2. Flat waveform on pulse volume recording/low or absent pedal flow on duplex US
3. ischemic rest pain
4. ulceration

Immediate invasive angio with revascularization is indicated

Question 12

What are the indications for surgery for severe aortic regurgitation?

Answer 12

• symptoms
• EF <50%
• significant LV dilation

Otherwise ECHO 6-12 months

Question 13

In a STEMI, an ACEI/ARB should be initiated within ____ of presentation.

Answer 13

24 hours

Question 14

In patients with aortic stenosis who have a discrepancy between clinical findings and ECHO findings, what is the next step to evaluate the patient for need for surgery?

Answer 14

Cardiac catherization

Question 15

When do symptoms usually start in aortic stenosis (what area)?

Answer 15

When valve area is <1.0 cm^2