Cardio Exam Questions With Complete Solutions
4 forms of heart failure Correct Answer left sided vs right
sided
systolic vs diastolic
high output vs low output
acute vs chronic
abdominal aortic aneurysm (AAA) dx Correct Answer
*abdominal ultrasound*: initial imaging study of choice in
suspected AAA to determine aneurysm presence, size, and
extent. also used to monitor for progression in size (expansion).
bedside US often done in ER to r/o AAA in pts presenting w/
nonspecific abdominal pain >60y
*CT scan*: test of choice for thoracic aneurysms and for further
evaluation in pts w/ known AAA
*angiography: gold standard*, often used before surgical
intervention
*MRI/MRA*: increased use in lieu of angiography
abdominal radiography: may show calcified aorta in 65% of pts
w/ aneurysmal disease
abdominal aortic aneurysm (AAA) pathophysiology Correct
Answer proteolytic degeneration of the aortic wall, connective
tissue inflammation and an immune response
,*laplace's law*: wall tension -- (pressure x radius)/tensile force
dictates that as the aorta dilates --> the force on the aortic wall
increases --> further dilation (larger aneurysms expand more
quickly)
-avg rate 0.25-0.5cm/yr. all expanding aneurysms will
eventually rupture
focal dilation of the aortic diameter at least 1-1.5x diameter
measured at level of the renal arteries
abdominal aortic aneurysm (AAA) risk factors Correct Answer
*atherosclerosis*
age >60y
*smoking*
males (5x MC in men), caucasians
hyperlipidemia, connective tissue disorder (marfans), syphilis,
HTN
abdominal aortic aneurysm (AAA) sx Correct Answer most
asymptomatic until they rupture. often incidental finding on US,
CT, or MRI when doing workup for other problems or on PE
(palpable, expanding, pulsatile abdominal mass)
acute leakage/rupture: classic presentation -- older male w/
severe back or abdominal pain who presents w/ syncope or
hypotension and tender, pulsatile, abdominal mass. may be
obscured by obesity. may complain of unilateral groin/hip pain.
+/- flank ecchymosis. femoral pulsations usually normal. acute
may be rapidly fatal. >5cm = increased rupture risk
,chronic-contained rupture: uncommon. rupture may be
tamponade by surrounding retroperitoneum
aortoenteric fistula: presents as acute GI bleed in pts who
underwent prior aortic grafting
abdominal aortic aneurysm (AAA) tx Correct Answer
surgical repair definitive tx. endovascular stent graft or open
repair
>5.5cm or >0.5cm expansion in 6mo -- immediate surgical
repair (even if asymptomatic), symptomatic pts or pts w/ acute
rupture
>4.5cm -- vascular surgeon referral
4-4.5cm -- monitor by US q6mo
3-4cm -- monitor by US qyear
beta-blockers reduces shearing forces, increases expansion and
rupture risk. decreases RFs
acute coronary syndrome dx Correct Answer NSTEMI or
unstable angina: +/- ST depressions and/or T wave inversions.
EKG may be normal
STEMI: ST elevations >1mm in >2 anatomically contiguous
leads +/- reciprocal changes in the opposite leads. a new left
bundle branch block is a STEMI equivalent
, hyperacute (peaked) T waves --> ST elevations --> Q waves -->
T wave inversions is natural STEMI progression
cardiac markers: 3 sets q8h. troponin most sensitive and specific
-CK/CK-MB: appears 4-6h, peaks 12-24h, returns to baseline 3-
4 days
-*troponin I and T*: appears 4-8h, peaks 12-24h, returns to
baseline 7-10days
acute coronary syndrome pathophysiology Correct Answer sx
of acute myocardial ischemia 2ry to acute plaque rupture and
varying degrees of coronary artery thrombosis
includes unstable angina, NSTEMI, and STEMI (total
occlusion)
atherosclerosis MC cause of MI caused by plaque rupture -->
acute coronary artery thrombosis w/ platelet
adhesion/activation/aggregation along w/ fibrin formation.
vasculitis, embolism.
coronary artery vasospasm: cocaine induced, variant (prinzmetal
angina)
acute coronary syndrome sx Correct Answer angina that is
new in onset, crescendo, or at rest >30mins. 90% occlusion.
retrosternal "pressure" not relieved w/ rest or nitro. +/- radiate to
arms, neck, back, shoulders, epigastrium, lower jaw. *levines
sign*
-frequency highest in AM. +/- dyspnea
4 forms of heart failure Correct Answer left sided vs right
sided
systolic vs diastolic
high output vs low output
acute vs chronic
abdominal aortic aneurysm (AAA) dx Correct Answer
*abdominal ultrasound*: initial imaging study of choice in
suspected AAA to determine aneurysm presence, size, and
extent. also used to monitor for progression in size (expansion).
bedside US often done in ER to r/o AAA in pts presenting w/
nonspecific abdominal pain >60y
*CT scan*: test of choice for thoracic aneurysms and for further
evaluation in pts w/ known AAA
*angiography: gold standard*, often used before surgical
intervention
*MRI/MRA*: increased use in lieu of angiography
abdominal radiography: may show calcified aorta in 65% of pts
w/ aneurysmal disease
abdominal aortic aneurysm (AAA) pathophysiology Correct
Answer proteolytic degeneration of the aortic wall, connective
tissue inflammation and an immune response
,*laplace's law*: wall tension -- (pressure x radius)/tensile force
dictates that as the aorta dilates --> the force on the aortic wall
increases --> further dilation (larger aneurysms expand more
quickly)
-avg rate 0.25-0.5cm/yr. all expanding aneurysms will
eventually rupture
focal dilation of the aortic diameter at least 1-1.5x diameter
measured at level of the renal arteries
abdominal aortic aneurysm (AAA) risk factors Correct Answer
*atherosclerosis*
age >60y
*smoking*
males (5x MC in men), caucasians
hyperlipidemia, connective tissue disorder (marfans), syphilis,
HTN
abdominal aortic aneurysm (AAA) sx Correct Answer most
asymptomatic until they rupture. often incidental finding on US,
CT, or MRI when doing workup for other problems or on PE
(palpable, expanding, pulsatile abdominal mass)
acute leakage/rupture: classic presentation -- older male w/
severe back or abdominal pain who presents w/ syncope or
hypotension and tender, pulsatile, abdominal mass. may be
obscured by obesity. may complain of unilateral groin/hip pain.
+/- flank ecchymosis. femoral pulsations usually normal. acute
may be rapidly fatal. >5cm = increased rupture risk
,chronic-contained rupture: uncommon. rupture may be
tamponade by surrounding retroperitoneum
aortoenteric fistula: presents as acute GI bleed in pts who
underwent prior aortic grafting
abdominal aortic aneurysm (AAA) tx Correct Answer
surgical repair definitive tx. endovascular stent graft or open
repair
>5.5cm or >0.5cm expansion in 6mo -- immediate surgical
repair (even if asymptomatic), symptomatic pts or pts w/ acute
rupture
>4.5cm -- vascular surgeon referral
4-4.5cm -- monitor by US q6mo
3-4cm -- monitor by US qyear
beta-blockers reduces shearing forces, increases expansion and
rupture risk. decreases RFs
acute coronary syndrome dx Correct Answer NSTEMI or
unstable angina: +/- ST depressions and/or T wave inversions.
EKG may be normal
STEMI: ST elevations >1mm in >2 anatomically contiguous
leads +/- reciprocal changes in the opposite leads. a new left
bundle branch block is a STEMI equivalent
, hyperacute (peaked) T waves --> ST elevations --> Q waves -->
T wave inversions is natural STEMI progression
cardiac markers: 3 sets q8h. troponin most sensitive and specific
-CK/CK-MB: appears 4-6h, peaks 12-24h, returns to baseline 3-
4 days
-*troponin I and T*: appears 4-8h, peaks 12-24h, returns to
baseline 7-10days
acute coronary syndrome pathophysiology Correct Answer sx
of acute myocardial ischemia 2ry to acute plaque rupture and
varying degrees of coronary artery thrombosis
includes unstable angina, NSTEMI, and STEMI (total
occlusion)
atherosclerosis MC cause of MI caused by plaque rupture -->
acute coronary artery thrombosis w/ platelet
adhesion/activation/aggregation along w/ fibrin formation.
vasculitis, embolism.
coronary artery vasospasm: cocaine induced, variant (prinzmetal
angina)
acute coronary syndrome sx Correct Answer angina that is
new in onset, crescendo, or at rest >30mins. 90% occlusion.
retrosternal "pressure" not relieved w/ rest or nitro. +/- radiate to
arms, neck, back, shoulders, epigastrium, lower jaw. *levines
sign*
-frequency highest in AM. +/- dyspnea
