NBME MS3 - Cardiology

Question 1

Risk factors a/w development of AAA

Answer 1

• Older age (>60)- Cigarette smoking- Family history of AAA- Atherosclerosis

Question 2

Risk factors a/w AAA expansion and rupture

Answer 2

• Large aneurysm diameter- Rapid rate of expansion- Current cigarette smoking

Question 3

Side effects (2) of high-dose niacin therapy to treat lipid abnormalities (hypertriglyceridemia)Mechanism of side effectsTreatment to reduce side effects

Answer 3

Cutaneous flushing and pruritis Niacin causes prostaglandin-induced peripheral vasodilationLow-dose aspirin reduces these side effects

Question 4

Site of infective endocarditis in IV drug user with systolic murmur?

Answer 4

Tricuspid valve endocarditis Systolic murmur

Question 5

Site of infective endocarditis in IV drug user with diastolic murmur?

Answer 5

Aortic valve endocarditis Diastolic murmur

Question 6

Cause of aortic regurgitation (AR) diastolic murmur best appreciated along left sternal border (3rd and 4th intercostal spaces)

Answer 6

Valvular disease (e.g., infective endocarditis)

Question 7

Cause of aortic regurgitation (AR) diastolic murmur best appreciated along right sternal border

Answer 7

Aortic root disease

Question 8

IV drug user, diastolic murmur best appreciated at left sternal border, ECG showing evidence of conduction abnormality with 2:1 second-degree AV block

Answer 8

Aortic valve endocarditis complicated by peri-valvular abscess and resulting AV conduction block and syncope

Question 9

Two primary manifestations of Chagas disease

Answer 9

Megacolon/megaesophagus and cardiac disease (Trypanosoma cruzi protozoal infection)

Question 10

Signs of congestive heart failure

Answer 10

JVD, S3 heart sound, cardiomegaly

Question 11

Inciting events of vasovagal (neurocardiogenic) syncope- Age < 60 years- Age > 60 years

Answer 11

Age < 60 years- Emotional/orthostatic stress (venipuncture, prolonged standing, heat exposure, exertion)Age > 60 years- Micturition, cough, defecation

Question 12

Diagnosis of vasovagal (neurocardiogenic) syncope

Answer 12

• Mainly clinical diagnosis- Upright tilt table testing in uncertain cases

Question 13

Murmurs that get louder with valsalva/standing

Answer 13

• Hypertrophic cardiomyopathy- Mitral valve prolapse

Question 14

Murmurs that get softer with squatting

Answer 14

• Hypertrophic cardiomyopathy- Mitral valve prolapse

Question 15

Murmurs that get softer with handgrip

Answer 15

• Hypertrophic cardiomyopathy

Question 16

Murmurs that get softer with squatting/handgrip

Answer 16

• Aortic regurgitation- Mitral regurgitation- Ventricular septal defect (VSD)

Question 17

Treatment of Dressler syndrome

Answer 17

• Dressler syndrome: pericarditis that occurs weeks after an MI believed to be due to immunologic phenomena - Treatment is NSAIDs- Corticosteroids can be used in refractory cases or when NDSAIDs are contraindicated

Question 18

Complication of treating pericarditis with anticoagulation

Answer 18

Hemorrhagic pericardial effusion

Question 19

Drug(s) that commonly trigger bronchoconstriction (acute-onset dyspnea with wheezing and prolonged expiration) in patients with asthma, especially those with concurrent chronic rhinitis and nasal polyps

Answer 19

• Aspirin- Beta blockers

Question 20

Patient with history of recent upper respiratory infection followed by sudden onset of cardiac failure in an otherwise healthy patient

Answer 20

• Dilated cardiomyopathy 2/2 acute viral myocarditis (Coxsackievirus B infection) - Diagnosis of dilated cardiomyopathy is made by echo, which typically shows dilated ventricles with diffuse hypokinesia resulting in low ejection fraction (systolic dysfunction)

Question 21

Concentric hypertrophy

Answer 21

• Seen following chronic pressure overload- Valvular stenosis, untreated hypertensionCONcentric hypertrophy to CONtract fluid across stenosed valves

Question 22

Eccentric hypertrophy

Answer 22

• Seen following chronic volume overload

Question 23

Systolic ejection murmur heard at RUSB

Answer 23

Aortic stenosis

Question 24

Systolic ejection murmur heart at LUSB

Answer 24

• Pulmonic stenosis- Flow murmur- Atrial septal defect

Question 25

Systolic ejection click heart at LUSB

Answer 25

Pulmonic stenosis

Question 26

Systolic ejection murmur heart at LSB

Answer 26

Hypertrophic cardiomyopathy

Question 27

Early diastolic murmur heart at LSB

Answer 27

• Aortic regurgitation- Pulmonic regurgitation

Question 28

Holosystolic murmur heart at LLSB

Answer 28

• Tricuspid regurgitation - Ventricular septal defect

Question 29

Mid/late diastolic murmur heart at LLSB

Answer 29

• Tricuspid stenosis- Atrial septal defect

Question 30

Holosystolic murmur heart at apex

Answer 30

Mitral regurgitation

Question 31

Mid/late systolic click heard at apex

Answer 31

Mitral valve prolapse

Question 32

Mid/late diastolic murmur heard at apex

Answer 32

Mitral stenosis

Question 33

Signs of chronic mitral regurgitation

Answer 33

Displaced apical impulse, holosystolic murmur, S3

Question 34

Mitral valve prolapse

Answer 34

Secondary to myxomatous degeneration of the mitral valve leaflets and chordae causing a mid systolic click followed by a mid-to-late systolic murmur

Question 35

Medical treatment for hypertensive patients with aortic dissection

Answer 35

IV labetalol

Question 36

Aortic dissections requiring medical/surgical intervention

Answer 36

Type A - involving ascending aorta

Question 37

Aortic dissections requiring medical intervention only

Answer 37

Type B - involving descending aorta

Question 38

Digoxin toxicity

Answer 38

• Nausea/vomiting, decreased appetite, confusion, weakness- Visual symptoms of scotoma, blurry vision with changes in color, blindness An inciting event (viral illness, excessive diuretic use) can lead to volume depletion or renal injury that acutely elevates the digoxin levelHypokalemia, often a/w loop diuretic use, increases susceptibility to toxic effects of digoxin

Question 39

Recurrent fevers (>39C), rash (maculopapular and non-pruritic, affecting the trunk and extremities), and arthritis

Answer 39

Adult Still’s disease

Question 40

Isolated systolic hypertension (ISH)

Answer 40

• Important cause of HTN in elderly patients- Secondary to decreased elasticity of the arterial wall, which leads to an increased systolic BP without a significant change in diastolic BP

Question 41

Treatment of isolated systolic hypertension (ISH)

Answer 41

• ISH should always be treated due to its a/w increased risk for cardiovascular events- Initial treatment = monotherapy with a low dose thiazide, an ACE inhibitor, or long-acting Ca channel blocker

Question 42

Diastolic dysfunction (heart failure with preserved left ventricular ejection fraction)

Answer 42

• Diastolic dysfunction refers to impaired filling of left or right ventricle, either b/c of impaired myocardial relaxation or a stiff, non-compliant ventricle- Contractility (EF) may remain normal but diastolic pressures are elevated, consequently reducing cardiac output - Systemic HTN is the classic cause of diastolic dysfunction- Treatment = diuretics and BP control

Question 43

ST elevations I, aVL, V2-V6ST depressions II, III, aVF

Answer 43

Anterolateral MI 2/2 occlusion of LAD artery

Question 44

Initial medical therapy for MI

Answer 44

• Oxygen- Full-dose aspirin (chewed so that it enters the bloodstream quickly)- Adequate pain control with morphine and nitroglycerin (contraindicated in hypotension)- Platelet P2Y12 receptor blocker (clopidogrel)- Beta blocker- AnticoagulationPercutaneous coronary intervention (PCI) > fibrinolytic therapy