Uworld Cardiology 9/22

Question 1

Edema in the right ankl, heaviness and cramping in the same leg after a LONG DAY. Its better after sleeping. JVP normal, Lungs are clear, No hepatomsplenomegaly, no thrombosis. Most likely cause?

Answer 1

Venous Valve Incompetence

Question 2

What could cause edema from LYMPHATIC OBSTRUCTION?

Answer 2

Malignant obstruction of lymph nodes, lymph node resection, trauma, and filiarsis. affects DORSUM of the feet

THINK SURGERY

Question 3

Where are the ectopic foci that causes atrial fibrillation?

Answer 3

Pulmonary veins, most commonly

Question 4

What is the mechanism/cause of exertional dyspnea in a person with Cardiac Tamponade?

Answer 4

Decreased Left ventricular preload - the fluid accumulation in the pericardium is restricting venous return and ventricular filling.

Question 5

JVD, Hypotension, muffled heart sounds

Answer 5

Cardiac Tamponade, meaning fluid in the pericardium

Question 6

What does Valsalva maneuver do?

Answer 6

Decreases preload, thus increasing intensity of HOCM/MVP, but decreasing everything else

Question 7

How does squatting help with Tetrollogy of Fallot

Answer 7

Increasing systemic vascular resistance. WIth more afterload, its harder for blood to go forward, thus DECREASING the RIGHT TO LEFT shunting.

Question 8

Arterial Embolism vs Arterial Thrombosis

Answer 8

Emboli originate from the heart. A Thrombus develops right at the sight of the plaque.

Question 9

23 year old 29 week pregnant lady has sudden SOB. She woke up with fluttering sensation in her chest, and progressed to dyspnea, dry cough, and cant lie flat. She had recurrent sore throat as a kid, and is an immigrant. ECG shows afib with RVR. What is the diagnosis?

Answer 9

Mitral Stenosis - she alreayd had it from before, and the pregnancy increased the HR and volume of blood, thus precipitating the symptoms.

Question 10

What is Paripartum Cardiomyopathy, and does it have anything to do with afib?

Answer 10

Rapid onset systolic HF at >36 weeks. Rarely see AF with RVR.

Question 11

Patient has symptoms of compartment syndrome. Would the cause of symptoms be “Soft tissue swelling” or Venous Thrombosis?

Answer 11

Soft tissue swelling. Venous thrombosis is more in line with DVT, and compartment syndrome is caused by trauma or recent surgery. Basically theres not enough pressure for blood to go UP

Question 12

Management of Cocaine chest pain?

Answer 12

Benzos, aspirin, Nitro, CCB.

DO NOT USE BB

Question 13

When do you suspect Chagas disease, and what causes it?

Answer 13

Signs of cardiomegaly and heart failure with TOXIC MEGACOLON. Its a PROTOZOAL disease. not rickettsial.

Question 14

Cardiac features of Marfans syndrome?

Answer 14

Aortic Dilation, Regurgitation, or dissection.

See MVP - early diastolic murmur

Question 15

Patient with past history of WPW syndrome and 3 prior episodes of SVT. Now she has Afib. How do you treat?

Answer 15

Procainamide. Treatment is directed towards WPW. If you treat the Afib with the regular antinodals, there would be MORE conduction in the accessory pathway and cause VENTRICULAR TACHYCARDIA

Question 16

What suggests SEVERE Aortic Stenosis?

Answer 16

Diminished carotid Pulse - Pulsus Parvus and tardus

MID TO LATE PEAKING SYSTOLIC MURMUR

Presence of Soft and single S2***

Question 17

Why do you get a “sfot single S2 with AS?

Answer 17

The aortic valve leaflets are calcified, thus a softer aortic valve closure.

Question 18

Clinical Features of atherosclerotic Embolism

Answer 18

• Livedo reticularis, ulcers, gangrene
• Acute Kidney Injury
• Stroke, amurosis fugax
• Hollenhorst Plaques, which are in the retina.
• Intestinal Ischemia

Question 19

What would you find on CBC for cholesterol embolsim?!?

Answer 19

EOSINOPHILIA and EOSINOPHILURIA

Question 20

Aortic Dissection - what are the risk factors?

Answer 20

Htn, Marfans, Cocain use

Question 21

Treatment for FAST and WIDE complex tachy?

Answer 21

IV Amiodarone

Question 22

What arrythmia do you attempt vagal maneuvers?

Answer 22

PSVT - narrow complex tachycardia thats REGULAR. Since PSVT is generally benign

Question 23

Conditions associated with Afib?

Answer 23

• HTN, CAD, Rheumatic.Valvular disease, CHF, HOCM,

- Hyperthyroidism

Question 24

T/F? Aortic Dissection is associated with Afib?

Answer 24

NO.

Question 25

Patient has an abdominal Aortic Aneurism. What is associated with the highest rate of aneurysm expansion and rupture?

Answer 25

Active Smoking.

RF: Older age, cigarette smoking, family history of AAA, white, and atherosclerosis.

NOT HTN. The administration of BB and ACEis have not been shown to reduce the rate.

Question 26

Alcohol’s effect on CAD?

Answer 26

associated with DECREASED incidence of coronary heart disease and cardiovascular mortality

Question 27

Findings of a congenital bicuspid aortic valve?

Answer 27

Diastiolc Decrescendo Murmur, widened pulse pressure.

Question 28

Most commone heart defect in a baby with overlapping fingers, absent palmar creases, small face and jaw with a prominence on the back of the head?

Answer 28

VSD. the child has Trisomy 18 aka Edwards. See rocker bottom feet as well.

Question 29

When and how do you screen for AAA?

Answer 29

men between 65-75, SMOKER, one time screen with US. if no smoke, no screen

Question 30

Ptnt has crushing midsternal chest pain ten days after coronary angiography and surgery from a everlimus eluting stent. ECG shows 2mm ST segment elevation in leads I, aVL, and V1 to V4. What happened?

Answer 30

Medication noncompliance. His new symptoms are consistent with a NEW Myocardial infarction just 10 days after already having an MI and a stent put in.

Question 31

What medications would a patient be on after having a stent put in?

Answer 31

Aspirin and Clopidogrel (or Prasugrel, ticagrelor)

Question 32

25 year old woman has transient right eye vision loss. Her BP is 164/103. Her BMI is 26 She has a bruit below the right mandibular angle. Labs show a borderline low -normal K, a HIGH RENIN activity, and a PAC/PRA of 10. Next step? and what is her vision loss?

Answer 32

CT Angio of the abdomen. She has fibromuscular dysplasia, most likely in the renal arteries, so need to check for that.

The vision loss is from “Amaurosis fugax”

Question 33

When do you use Adrenal Vein sampling with unusually high BP?

Answer 33

when you suspect adrenal hyperplasia and adenoma. See a plasma aldosterone of >15, hypokalemia, a SUPRESSED renin activity, thus a ratio of >20.

Question 34

Young woman has chest pain for the past 3 weeks, thats episodic and sharp. She has a systolic murmur at the apex that shortens with squatting. What is the DX?

Answer 34

MVP.

Remember, anything that decreases a murmur by adding more blood to the heart, its MVP or HOCM.

Question 35

What would decrease a murmur from Rheumatic Heart Disease

Answer 35

This leads to Mitral Stenosis, so a decrease in preload would decreased preload. Valsalva and standing.

Question 36

What murmurs get softer with Handgrip?

Answer 36

HCM, MVP, and AS

Question 37

Old man has syncope while walking. He’s had light headedness twice over the past month. He has a pulse of 64. He has a prolonged PR interval and prolonged QRS complex, normal QTc, with occasional Premature Ventricular Contractions. Cause?

Answer 37

Bradyarrhythmia.

Question 38

What is another phrase for “autonomic dysfunction”

Answer 38

Postural Hypotension

Question 39

Causes of Dialated Cardiomyopathy?

Answer 39

HTN, Alcohol, and VIRAL - parvo B19, HHV8, coxsackievirus, adenovirus, influenza, and HIV.

Question 40

Old man has LE swelling, JVD when now lying down, but no chest pain. He has a permanent pacemaker in. Has a 3/6 holosystolic mumur over the LSB. The liver is enlarged and tender. DX?

Answer 40

Tricuspid Regurgitation due to the pacemaker, explaining the Right sided HF.

Holosystolic may lead you into MR, VSD, but none of those have symptoms of right heart failure.. VSD not associated with pacemaker.

Question 41

Indication for Statin Therapy

Answer 41

LDL of over 190, past MI, Stroke, or if they have a estimated 10 year risk.

Question 42

What is the function of IV Adenosine in chemical stress test?

Answer 42

Augments blood flor in nonobstructive coronary arteries. Blood flow is increased in the stenosed coronary arteries, but to a lesser extent.

Question 43

When do you used Dobutamine instead of Adenosine/Dypyridamole in pharmacological stress test

Answer 43

Reactive airway disease, or patients already on dipyridamole or theophylline

Question 44

When would a Papillary Muscle Ruputre happen post MI>

Answer 44

Acute or within 3-5 days. RCA. See severe pulmonary edema, new holosystolic murmur. Here Severe mitral regurg with flail leaflet.

Question 45

Interventricular septum rupture?

Answer 45

Acute or within 3-5 days. LAD. New holosystolic murmur, biventricular failure, shock

Question 46

Free wall rupture?

Answer 46

Within 5 days to 2 weeks - LAD, see pericardial effusion with tamponade

Question 47

Left Ventricular Aneurysm?

Answer 47

Up to several months, LAD. see subacute HF, stable angina.

Question 48

Blocked vessel for STE in V1-6?

Answer 48

LAD

Question 49

STE in II, III, aVF?

Answer 49

INFERIOR - RCA (see aditional DEPRESSION in V1 and 2) or LCX

Question 50

STE in I, aVL, V5 and 6?

Answer 50

LATERAL - LCX, with DEPRESSION in leads II, III, and aVF