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[OS 213] Q1 > Samplex 2015 > Flashcards

Samplex 2015 Flashcards

1
Q

A patient comes to you complaining of cyanosis of the lower extremities but not the upper extremities. Which among the following congenital disorders will you consider?

a. VSD
b. TOF
c. Coarctation of the aorta
d. PDA

A

D

This can be caused by severe PDA. Coarctation of the aorta does not typically cause cyanosis. Probably severe coarctation can.

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2
Q

Which of the following heart sounds is absent in patients with atrial fibrillation?

a. S1
b. S2
c. S3
d. S4

A

D

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3
Q

How large should a normal adult mitral valve orifice be?

a. 1-2 cm
b. 2-4 cm
c. 4-6 cm
d. 10-12 cm

A

C

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4
Q

Which of the following statements is FALSE regarding mitral stenosis?

a. It results in tricuspid and pulmonic valve incompetence and right sided heart failure
b. It can present with hemoptysis once pulmonary hypertension sets in
c. Patients characteristically present with malar rash
d. Typical auscultatory findings include low-pitched rumbling diastolic murmur

A

C

Patients present with malar FLUSH not malar rash.

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5
Q

The following treatment strategies are beneficial to patients with mitral stenosis EXCEPT?

a. Increasing the heart rate
b. Giving prophylaxis against infective endocarditis
c. Restriction of sodium intake
d. Prophylaxis against Streptococcus infection

A

A

You must control heart rate since ventricular filling is dependent on heart rate. (Consider atrial fibrillation vs sinus rhythm)

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6
Q

Which of the following is NOT a major manifestation of rheumatic fever according to the modified Jones criteria?

a. Carditis
b. Arthralgia
c. Syndenham’s chorea
d. Erythema marginatum

A

B

Answer: B. Major Manifestations:
• Carditis – most common among hospitalized patients
• Polyarthritis – most common manifestation overall (migratory)
• Chorea (Syndeham)
• Erythema marginatum (least common)
• Subcutaneous nodule

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7
Q

Which of the following is TRUE regarding rheumatic fever (RF) prophylaxis?

a. It is not given to patients who already had previous episodes of RF.
b. Best results are achieved when benzathine penicillin is given intramuscularly every year.
c. Among patients who had resolved episodes of carditis, prophylaxis is given for a minimum 5 years.
d. Among patients diagnosed with rheumatic heart disease, prophylaxis is given for life

A

D

A. It is given to patients who already had previous episodes of RF
B. Benzathine PCN 1.2 M U q 21 for 28 days- best choice because benzathine penicillin is long acting, cost effective and due to good compliance; administered via the intramuscular route
C Minimum 10 years
D. If already RHD, prophylaxis is given for life

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8
Q

Which of the following aortic insufficiency/regurgitation findings is INCORRECTLY paired?

a. Quincke’s sign: capillary pulsations in the fingers upon transillumination
b. De Musset’s sign: Head bobbing for every systole
c. Corrigan’s pulse: rapid upstroke and rapid downstroke of the carotid pulse
d. Duroziez’ sign: water hammer pulse

A

D

Duroziez’ sign: to-and-fro murmur with femoral artery compression. Corrigan’s pulse: rapid upstroke and rapid downstroke of the carotid pulse i.e. water hammer pulse

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9
Q

What is the most common cause of mitral stenosis?

a. Rheumatic
b. Myxomatous degeneration
c. Calcification
d. Degenarative

A

C

Mitral stenosis are generally rheumatic in origin. In the Philippines, it is about 90-95%. Valve leaflets are diffusely thickened by fibrous tissue and/or calcific deposits:
• Commisural fusion (hallmark of rheumatic)
• Chordae tendiane fuse & shorten
• Valvular cusps become rigid

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10
Q

What pathologic finding best differentiates calcific aortic stenosis from rheumatic aortic stenosis?

a. Presence of cuspal thickening
b. Absence of commisural fusion
c. Normal mitral valve
d. Presence of pulmunary hypertension

A

B

Rheumatic lesions always have commissural fusion

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11
Q

Which of the following if TRUE of myxomatous degeneration of the mitral valve?

a. Mostly affects young men.
b. Anatomically characterized by intercordal ballooning or hooding of mitral leaflets.
c. Annular dilation is rare.
d. Characterized by commissural fusion

A

B

Myxomatous degeneration is the same as mitral valve prolapse. It has a predilection for young women.

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12
Q

What is the most common type of VSD?

a. Membranous VSD
b. Infundibular VSD
c. Swiss-cheese septum type VSD
d. Sinus venosus type

A

A

Sinus venosus is a type of ASD nor VSD.

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13
Q

You noted your patient’s jugular venous pressure (JVP) to be 7cm H2O. What is his central venous pressure (CVP)?

a. 11cm H2O
b. 12cm H2O
c. 13cm H2O
d. 14cm H2O

A

B

CVP = JVP + 5cm

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14
Q

Which of the following correctly describes the technique in posterior tibial pulse palpation?

a. The medial malleolus is located and the pulse palpated 2-3cm below and behind it.
b. The lateral malleolus is located and the pulse palpated 2-3cm below and behind it.
c. The ankle joint located and the pulse palpated anterior and midway between the malleoli.
d. The ankle joint located and the pulse palpated posterior and midway between the malleoli.

A

A

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15
Q

Which of the following associated symptoms decreases the likelihood as acute myocardial infarction in a patient with chest pain?

a. pain radiating to the left arm.
b. associated with diaphoresis
c. described as sharp
d. associated with nausea or vomiting

A

C

All other choices are classic symptoms. Pain is described as heavy, crushing… not sharp.

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16
Q

patient comes to you complaining of burning substernal chest pain lasting for 10-60minutes worsened by postprandial recumbency. What is the most plausible clinical diagnosis?

a. acute myocardial infarction
b. biliary colic
c. esophageal reflux
d. Tietze’s syndrome

A

C

acute myocardial infarction- retrosternal/precordial location
bilary colic- quality of pain: colicky, crampy or spastic
Tietze’s syndrome- associated with MSK disease, sharp localized pain

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17
Q

The following neurohormonal events result from systolic hear failure EXCEPT

a. renin-angiotensin-aldosterone system activation
b. decreased levels of arginine vasopressin
c. sympathetic activation
d. increased levels of catecholamines

A

B

a. activation of sympathetic nervous system
b. activation of renin-angiotensin system
c. neurohormonal alteralations of renal functions
d. neurohormonal alterations in the peripheral vasculature
* catecholamines secreted by medulla to increase heart rate
* vasopressin- induces vasoconstriction: should be increased in this case!

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18
Q

Which of the following findings is LESS commonly associated with diastolic heart failure?

a. Hypertension
b. Preserved ejection fraction on 2-D echocardiography
c. Third heart sound
d. Concentric left ventricular hypertrophy

A

C

Systolic HF: large dilated heart, normal or decreased BP, broad age group, decreased ejection fraction, s3 gallop, mainly systolicimpairment, prognosis poor

Diastolic HF: small LV cavity, concentric LV hypertrophy, systemic HPN, hypertrophic cardiomyopathic disease, elderly women, normal or increased ejection fraction, S4 gallop, systolic and diastolic impairment, prognosis not so poor

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19
Q

Which of the following belongs to the minor Framingham criteria for heart failure?

a. Exertional dyspnea
b. Neck vein distention
c. Rales
d. Paroxysmal nocturnal dyspnea

A

A

Framingham Criteria for HF:
Major: PND/orthopnea, neck vein distention, rales,cardiomegaly, s3 gallop, acute pulmonary edema, increased venous pressure, hepatojugular reflex
Minor: extremity edema, night cough, exertional dyspnea, hepatomegaly, pleural effusion, vital capcity 120bpm)

20
Q

A 60-year old male iwth cornoary artery disease comes in the ER due to shortness of breath. you ____ _____ rales on all lung fiels and distended neck veins during Physical examination. The patient’s BP is 110/70. What group of drugs will best address pulmonary congestion of the patient?

a. beta-blockers
b. angiotensin converting enzyme inhibitors
c. cardiac glycosides
d. loop diuretics

A

D

In pulmonary congestion give loop diuretics ie Furosemide

21
Q

Which among the following etiologic agents most commonly cause early (

A

C

For prosthetic valve endocarditis: Early (12 months): Streptococcus.

22
Q

The most common presenting sign of infective endocarditis.

a. fever
b. new murmur
c. weight loss
d. splenomegaly

A

A

23
Q

You are treating a patient with tricuspid valve endocarditis. He has been afebrile after receiving a week’s course of intravenous antibiotics. He suddenly developed pleuritic chest pain, shortness of breath, and decreased sensorium. Physical examination revealed clear breath sounds. What is your diagnosis?

a. acute stroke
b. pulmonic septic embolization
c. pulmonary embolism
d. tricuspid leaflet rupture

A

C

24
Q

True of proper blood pressure measurement.

a. The patient should not have eaten, smoked, taken caffeine, or engaged in vigorous exercise within the last 3 minutes.
b. The stethoscope is placed above the radial artery.
c. Blood pressure should be taken in all extremities during the first encounter.
d. The sphygmomanometer is inflated 40 to 50 mm Hg above the estimated systolic pressure.

A

C

25
Q

True about the Korotkoff sounds.

a. Phase I: indicative of diastolic blood pressure
b. Phase II: sound first heard during the release of the pressure cuff
c. Phase IV: sound starts to muffle
d. Phase V: soft muffled sound

A

C

26
Q

The following statements describe the carotid artery pulsations.

a. Carotid artery pulsation is more palpable than jugular pulsation.
b. Carotid artery has two pulsations per systole.
c. Carotid artery is best seen halfway up the neck.
d. Carotid artery does not cease upon compression of the root of the neck.

A

C

27
Q

A giant “a” wave of the jugular venous pulse is seen in which of the following conditions?

a. atrial fibrillation
b. tricuspid stenosis
c. tricuspid regurgitation
d. restrictive cardiomyopathy

A

B

Tricuspid stenosis will cause greater atrial contraction

28
Q

During precordial examinations, pulsations are best analyzed using the:

a. fingertips
b. palm
c. thumbnail
d. dorsum of the hand

A

A

29
Q

A 54 year old female patient with aortic stenosis is admitted to ER for syncope. Based on natural history of the disease, how long will the patient survive if the valvular disease is not corrected?

a. 1 year
b. 2 years
c. 3 years
d. 4 years

A

C

Remember ASH A- 5 years; S- syncope - 3 years; H-1 year

30
Q

Straightened left border of cardiac silhouette (cardiac waistline) is seen in which of the following diseases:

a. Tricuspid stenosis
b. Pulmonic regurgitation
c. Mitral stenosis
d. Tricuspid regurgitation

A

C

Mitral stenosis will cause left atrial hypertrophy

31
Q

Which of the following is a sign consistent with isolated right-sided failure?

a. neck vein distension
b. abdominal enlargement
c. bilateral auscultatory crackles
d. exertional dyspnea

A

A

A because B. abdominal enlargement is a symptom not a sign

32
Q

This term refers to chnages in left ventricular (LV) mass, volume, shape and composition following cardiac injury and/or abnormal hemodynamics loading conditions:

a. heart failure
b. LV remodeling
c. LV fibrosis
d. LV hypertrophy

A

B

33
Q

Which of the following is false regarding the diagnosis of heart failure?

a. A good index of LV function in the 2-dimensional echocardiogram is the ejection fraction (stroke volume divided by end-diastolic volume)
b. Patients in the stage B of heart failure is more easily diagnosed compared to patients in stage C
c. The 12 lead electrocardiogram and x-ray are routine tests done to evaluate a patient with suspected heart failure
d. an ejection fraction of more than 55% is consideredd normal

A

B

Asymptomatic patients are harder to diagnose. The more severe the symptoms, the easier to see.

34
Q

This is the organism implicated in rheumatic fever.

a. Group A Beta hemolytic Streptococcus
b. Group B Beta hemolytic Streptococcus
c. Group A Alpha hemolytic Streptococcus
d. Group A Alpha hemolytic Streptococcus

A

A

35
Q

Which is considered minor Duke’s criteria in the diagnosis of infective endocarditis?

a. Positive blood culture from two separate cultures
b. Echocardiographically evident oscillating intracardiac mass
c. Fever greater than or equal to 38 degrees Celsius
d. New dehiscence of prostetheticmitral valve on echocardiography

A

C

36
Q

Which is NOT considered an immunologic phenomenon associated with infective endocarditis?

a. Osler’s node
b. Janeway lesion
c. Roth spot
d. Glomerulonephritis

A

B

Janeway lesions are non-tender, small erythematous or hemorrhagic macular or nodular lesions on the palms or soles only a few millimeters in diameter that are pathognomonic of infective endocarditis. Osler’s nodes and Janeway lesions are similar, but Osler’s nodes present with tenderness and are of immunologic origin

Roth’s spots are retinal hemorrhages with white or pale centers composed of coagulated fibrin. They are typically observed via fundoscopy (using an ophthalmoscope to view inside the eye) or slit lamp exam. They are usually caused by immune complex mediated vasculitis often resulting from bacterial endocarditis

37
Q

The following are the criteria for rejected diagnosis of infective endocarditis except:

a. Firm alternative diagnosis for manifestations of endocarditis
b. Sustained resolution of symptoms of endocarditis with antibiotic therapy for less than or equal to 4 days
c. No pathologic evidence of IE at surgery or autopsy after antibiotic treatment for less than or equal to 4 days
d. None of the above

A

NA

38
Q

Which of the following therapeutic regimens will you give to your patient who had mitral valve replacement 6 weeks ago and is proven to harbor methicillin-resistant Staphylococcus by blood cultures?

a. oxacillin + gentamycin
b. vancomycin + gentamycin
c. oxacillin + gentamycin + rifampicin
d. vancomycin + gentamycin + rifampicin

A

D

Can’t give oxacillin (resistant). Must give rifampacin because of prosthetic valve. Vancomycin for staph.

39
Q

The following are correctly described:

a. Janeway lesions: painful macular blanching rashes on the palms and soles
b. Osler’s nodes: painless papules on the pulps of the digits
c. Roth spots: retinal hemorrhages with a white center
d. All of the above

A

C

Janeway = painless; Osler = painful

40
Q

This is the characteristic lesion of infective endocarditis

a. Non-bacterial thrombotic endocarditis (NBTE)
b. Vegetation
c. Peripheral septic embolization
d. Ventricular regurgitation

A

B

41
Q

A 17-year old male with Marfan’s Syndrome and BP 120/10

a. Systolic murmur heard at 4th ICS left parasternal border increasing in intensity with inspiration
b. Systolic murmur at apex
c. Diastolic murmur at 2nd ICS right parasternal border
d. Systolic murmur at 2nd ICS left parasternal border

A

C

aortic regurgitation

42
Q

A 20-year old female previously diagnosed to have mitral valve prolapse and now complaining of shortness or breath and orthopnea

a. Systolic murmur heard at 4th ICS left parasternal border increasing in intensity with inspiration
b. Systolic murmur at apex
c. Diastolic murmur at 2nd ICS right parasternal border
d. Systolic murmur at 2nd ICS left parasternal border

A

B

mitral valve prolapse

43
Q

A 42-year old male allegedly noted to have bicuspid aortic valve when he was 20 years old

a. Systolic murmur heard at 4th ICS left parasternal border increasing in intensity with inspiration
b. Systolic murmur at apex
c. Diastolic murmur at 2nd ICS right parasternal border
d. Systolic murmur at 2nd ICS left parasternal border

A

D

44
Q

A 12-year old girl with large ventricular septal defect

a. Systolic murmur heard at 4th ICS left parasternal border increasing in intensity with inspiration
b. Systolic murmur at apex
c. Diastolic murmur at 2nd ICS right parasternal border
d. Systolic murmur at 2nd ICS left parasternal border

A

D

(increased volume in the right ventricle will cause a murmur during systole as the increased amount of blood moves through the pulmonary artery)

45
Q

A 30-year old female with systemic lupus erythematosus noted to have pulmonary hypertension and tricuspid regurgitation on 2-D echo

a. Systolic murmur heard at 4th ICS left parasternal border increasing in intensity with inspiration
b. Systolic murmur at apex
c. Diastolic murmur at 2nd ICS right parasternal border
d. Systolic murmur at 2nd ICS left parasternal border

A

A

Carvallo’s sign

[OS 213] Q1 (6 decks)

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