Rosh 2

Question 1

What med is contraindicated in inferior wall STEMI

Answer 1

nitroglycerin

Question 2

ultrasound findings are concerning for testicular cancer- what is the next step in diagnosing/

Answer 2

radical inguinal orchiectomy

(testicular biopsy CI due to risk of seeding into scrotum)

Question 3

serum markers for seminoma testicular cancer

Answer 3

HCG and LDH

Question 4

serum markers for nonseminoma testicular cancer

Answer 4

HCG and alpha-fetoprotein

Question 5

Which condition commonly coexists with polymyalgia rheumatica?

Answer 5

giant cell arteritis

Question 6

symmetric aching/stiffness about the shoulders, hip girdle, neck, and torso

Answer 6

Polymyalgia rheumatica

Question 7

triad of:

GRADUAL ipsilateral hearing loss

ataxia

tinnitus

(also: ipsilateral sensorineural hearing loss in the high tones and a poor word discrimination score- c/o not being able to talk on the phone in that ear)

Meniere’s is LOW tones

Answer 7

Vestibular schwannoma

Question 8

vestibular schwannomas affect what nerve

Answer 8

CN VII (facial)

Question 9

what nerve injury causes foot drop

Answer 9

common peroneal

Question 10

tx for BPH

Answer 10

• Alpha blockers (urethral relaxation, rapid sx relief): Tamsulosin
• 5 ∝ reductase (REDUCE THE SIZE) inhibitors shrink an enlarged prostate: Finasteride

Question 11

Obstructive vs restrictive lung disease:

FEV1/FVC= <0.8

Answer 11

obstructive= <0.8

restrictive= normal

Question 12

tx for chronic, stable angina

Answer 12

lifestyle modifications

statin

antihypertensive (BB)

antiplatelet therapies

Question 13

MCC tricuspids stenosis

Answer 13

rheumatic heart dz

(almost always occurs with mitral stenosis)

Question 14

What are Signs of more serious cardiac disease heard on auscultation

Answer 14

S4

grade >3/6 intensity

any diastolic murmur

fixed splitting of S2

Question 15

what is seen on ekg in pericarditis

Answer 15

PR depression (I, II, III, aVF, aVL, V2-V6)

PR elevation (aVR)

diffuse ST-segment elevation (concave)

Question 16

What is the minimum time s/p cardioversion should someone with A.fib be anticoagulated for

Answer 16

at least 4wks

(may be lifelong depending on CHADVASC score)

Question 17

what is the most specific finding for myocardial ischemia during exercise stress test

Answer 17

2 mm downsloping ST-segment depression

Question 18

pericardial knock

Answer 18

pericarditis

Question 19

in patients with a myocardial infarction, which four drugs have been shown to decrease mortality?

Answer 19

ASA

BB

ACE

Statin

Question 20

tx for endocarditis in an IV drug abuser w/ native valve

Answer 20

vanco + Ceftriaxone or cefepime

Question 21

What 2 conditions LOWER BNP

Answer 21

Obesity

pericardial constriction

Question 22

What is commonly hypertrophied in mitral stenosis

Answer 22

Right ventricular hypertrophy

(b/c MS causes “pressure backup” into pulmonary circulation and ultimately back to the right ventricle–> R vent hypertrophy +/- R HF)

(long standing MS can lead for L atrial dilation–> A.fib)

Question 23

decrescendo diastolic blowing murmur at left sternal border w/ WIDE PULSE PRESSURE

water hammer pulse

Answer 23

AORTIC REGURG

Question 24

medical tx for STABLE pts w/ WPW that have antidromic (widecomplex) tachycardia

Answer 24

procainamide

Question 25

medical tx for STABLE pts w/ **WPW** that have **orthodromic (narrow complex) tachycardia**

Answer 25

adenosine

Question 26

MC causative organism of endocarditis: Tricuspid (IVDU) vs mitral valve

Answer 26

Tricuspid (IVDU)= S. aureus Mitral= Strep viridans, S. aureus

Question 27

what is a serious complication of Kawasaki disease

Answer 27

coronary artery aneurysm

Question 28

Those with surgically **repaired tetralogy of Fallot,** with right ventricular pressure \> ____ mm Hg or cardiomegaly, should not participate in rigorous or contact sports

Answer 28

**_\> 50_** (if RV pressure \<50, no restrictions recommended)

Question 29

Which of the following antiarrhythmic medications is contraindicated in the setting of coronary artery or structural heart disease? A) Amiodarone B) Dofetilide C) Dronedarone D) Flecainide

Answer 29

**_D) Flecainide_** (increased risk of polymorphic ventricular tachycardia)

Question 30

Which of the following medications has the greatest impact on reducing mortality in patients presenting with acute coronary syndrome? A) Morphine B) Beta blocker C) Aspirin D) Nitroglycerin

Answer 30

ASA

Question 31

Stanford type A aortic dissections involve what part of the aorta? Stanford type B?

Answer 31

Type **_A_**= **_A_**scending Type B= Descending