Cardiology UWorld/Pastest. Questions with accurate answers. Graded A+

Cardiology UWorld/Pastest. Questions with accurate answers. Graded A+ Document Content and Description Below Cardiology UWorld/Pastest. Questions with accurate answers. Graded A+ The use of 5PDE inhibitors is contraindicated in patients using _________________ for the treatment of angina, as the combi nation of these two drugs may cause life-threatening hypotension. - Nitrates (ex. nitroglycerin) IV drug users usually manifest with _______________ valve abnormalities - Tricuspid valvue. When the organism enters the venous circulation, on its way to the heart, the first value it encounters is the tricuspid valve. The FROM JANE mnemonic describes the symptoms of? - Bacterial endocarditis FROM JANE F - Fever R - Roth's spots O - Osler nodes M- Murmur J - Laneway lesions A - Anemia N - Nail bed hemorrhages E - Emboli. The most common infectious organism is IV drug supers is S. aureus. FYI - Crackles upon lung auscultation will be seen when there is black flow of blood into the lungs due to LEFT heart or MITRAL valve abnormalities. SO not this due because this most commonly affect the tricuspid valve. Tetralogy of Fallot presents with pulmonary stenosis, VSD, overriding aorta and right ventricular hypertrophy. Abnormal migration of the __________________, is responsible for malalignment (anterosuperior displacement) of the infundibular septum - Neural crest cells A man presents with fever, recent upper respiratory infection, pleuritic test pain, and diffuse ST-segment elevation with PR-segment depression on ECG consistent with a diagnosis of _________________________ - Acute pericarditis. Pleuritic chest pain is aggravated by deep inspiration and movements that increase pericardial stretch. Acute pericarditis is most often due to a viral infection An apical diastolic rumble with opening snap is heard in __________________ - mitral stenosis A high-pitched apical pan systolic murmur radiating to the axilla is characteristic of ____________________ - mitral regurgitation A continuous systolic and diastolic murmur obscuring the S2 sound and radiating to the back is heard in ______________________ - coarctation of the aorta A patient has both diabetes and hypertension. These type of patients require a specific combination of t antihypertensive medication that not only lowers the blood pressure but also is protective of the kidneys. Diabetes mellitus can have detrimental effects on the kidney; therefore it is important to maintain appropriate rental function. ___________ and __________ are medications that not only help lower blood pressure but are also protective against diabetic nephropathy. - ARBs (angiotensin II receptor blockers) And ACEi In ____________________, patients typically present it hypertension in the upper extremities and relative hypertension in the lower extremities with occasional leg claudication symptoms. - Aortic coarctation - characterized by narrowing of the aortic lumen typically in a post ducal location. This is because blood shunts preferentially through the arch vessels flow is reduced through the descending aorta. What are the symptoms of renal artery stenosis? - Renal artery stenosis - narrowing of the renal artery - Secondary hypertension This causes decreased blood flow to the kidneys, which can be in turn cause fluid retention and hypertension. However, a BRUIT is typically heard on auscultation of the abdomen and CREATININE would be elevated due to decreased renal perfusion. In ________________. a constant, machine-like murmur may be detected on cardiac auscultation - Patent ductus arteriosus . Patients with a patent ductus have a sleet-to-right shunt that can result in left ventricular dilatation and failure if untreated. In _______________ there is left-to-right shunt and can be detected by a fixed, widely split S2 on cardiac auscultation - Atrial septal defect In the presence of secondary hypertension, you should always first rule out _____________ and ________________ - Nicotine AND oral contraceptives. What is most likely the diagnosis? A 4 y/o boy from China with restlessness, chest pain, and abdominal pain. Approximately 8 months ago, he had a suspected viral illness with fever, cervical lymphadenopathy, erythematous oropharynx, and a desquamating rash on his feet that resolved without treatment. An EKG shows ST segment elevations in leads II, III, and aVF - Kawasaki disease Patients with Kawasaki disease may develop coronary artery thrombosis, which can lead to myocardial infarction The symptoms of Kawasaki disease may be remembered with the mnemonic "CRASH and burn": - C: Conjunctivitis - R: Rash (polymorphous - desquamating) - A: Adenopathy (cervical lymph nodes) - S: Strawberry tongue (oral mucositis) - H: Hand-foot erythema and edema - & - Burn: Fever - mnemonic: CRASH and burn Mucocutaneous lumps node syndrome (Kawasaki ideas) may present similar to a self-resolving illness, but has serious implications if left untreated. Left untreated, this insidious vasculitis can cause coronary artery aneurysm and myocardial infarction, which are particularly devastating in children. This patient's EKG is diagnostic for an inferior wall infarction. Treatment with aspirin during the symptomatic phase of this child's illness could have prevented this presentation. Since the _____________ nerve runs along the carotid artery it may be damaged during carotid endarterectomy, leading to difficult to control severe hypertension. Hoarseness and dysphagia are also supportive of vagus nerve injury, in particular, the recurrent laryngeal branch. - vagus nerve ____________________ usually follows infection with enterohemorrhagic E. coli. In addition the presence of renal failure and a microangiopathichaemolytic anemia. - Hemolytic uremic syndrome Idiopathic thrombocytopenia purpura is not associated with a ______________ platelet count and the purpic rash is not ____________________ - Normal; palpable _____________________ is a small-vessel vasculitis characterized by palpable purpura - usually located on the buttock area and lower extremities. Additional clinical manifestations include arthralgia, diarrhea, abdominal pain and glomerulonephritis. - Hence-Schonlein purpura Usually seen in children ages of 4 to 7 years old. The following symptoms of characterized by which disorder? Diffuse chest pain that alleviated upon leaning forward. Temperature of 37.9 degrees C, blood pressure of 140/84 mmHg, pulse of 76/min. Cardiac auscultation reveals a faction rub. Electrocardiogram (ECG) shows ST segment elevations in nearly every lead. The 64 y/o women comes to the ED because of worsening chest pain over the past 2 days. She had a sore throat a week ago. She has a history of hypertension and hyperlipidemia. - Pericarditis - inflammation of the pericardium Most likely due to, Post-viral complication The patient reported symptoms of a recent viral infection (sluggishness and sore throat), and then developed pericardial symptoms acutely. A friction rub is often heard on cardiac auscultation and diffuse ST segment elevations are seen on ECG, which can be confused with myocardial infarction. _________________ syndrome refers to post-myocardial infarction pericarditis. There are ST elevation but it is NOT diffuse (diffuse represents transmural infarction) - Dressler Dressler syndrome - pericarditis that arises 6-8 weeks after infarction due to an autoimmune phenomenon where you began to produce antibodies against your own pericardium Pericarditis can be cased by ____________, but we would expect other symptoms such as rash, myalgaia, or joint pain. A positive antinuclear antibodies test is also likely. - Lupus (SLE) _____________________ such as simvastatin, lovastatin, and atorvastatin are used in patients with high low-density lipoprotein (LDL) levels. Inhibition of HMG CoA reductase decrease cholesterol formation via the cholesterol pathway. Common adverse effects include myopathy and liver toxicity. - HMG CoA reductase inhibitors The creatinine phophokinase (CPK) level should be checked in patients with statin-induced myopathy and if it is more than 10 times the normal level the statin should be stopped. Liver function tests should also be checked in patients on statin therapy, and if the enzyme levels are increased to 3 times the normal limit the statin should be stopped. ______________________ is a bile acid resin. It binds with bile salt and prevents reabsorption of cholesterol from the GI that. Common adverse effects include GI upset such as constiptation, diarrhea and bloating, but not muscle ache. It also decreases reabsorption of warfarin and fat-soblue vitamins. - Cholestryamine ____________________ prevents cholesterol absorption from the GI tract. It is not used as a single therapy, rather in conjunction with a statin. - Ezetimbie. _________________ decrease VLDL, LDL, and triglyceride and slightly increase HDL levels. They are most commonly used in patients with very high triglyceride levels. Adverse effects include gall stone formation, rash, myositis. They usually cause muscle damage when used in combination with statin and it is NOT the drug of choice for a patient with high LDL. - Vibrates. __________________ is used in patients with hyperlipidemia. It inhibits very low-density lipoprotein (VLDL), decreases LDL and triglyceride, and increases high-density lipoprotein (HDL) levels. Common adverse effects include flushing and itching, but not muscle ache. Aspirin should be given prior to administration to prevent its side effects - Nicotinic acid A 4-mouth old infant is brought to the physician for a routine examination. Physical examination shows epicanthic folds and a palmar simian crease. Cytogenetic texting shows an autosomal trisomy. Which cardiac anomalies is most common associated with this condition? - Complete atrioventricular septal defect The description with the presence of epicanthic folds and a simian crease should alert to the diagnosis of Down's syndrome or trisomy 21. Complete atrioventricular septal defect is the most common cardiac abnormality associated with this condition, with an estimated prevalence of about 35% in this population Other cardiac abnormalities that CAN appear but are not the MOST common are: atrial septal defect, mitral stenosis, patent ductus arteriousus, Tetralogy of Fallot Case: A 75 yo man is brought to the ED because of a 2-hour history of crushing, substernal pain that radiates to the left jaw. He is administered morphine, oxygen, sublingual nitroglycerin, and metoprolol. One hour later, he has ventricular fibrillation, is unable to be resuscitated, and dies.. Which of the following microbic changes is most likely to be found on autospy of the patient? - No change This clinical vignette is consistent with acute myocardial infarction (MI). Medical treatment for MI includes oxygen, beta-blocker, nitroglycerin, aspirin, and morphine for pain. If percutaneous coronary intervention (PCI) is available, gold standard treatment for acute MI is a door-toballon time of under 90 minutes. When PCI is not available, thrombolytic therapy is indicated in the absence of any contraindications. Between *0 and 4 hours*, NO CHANGE is obsessed, either grossly or microscopically. Between *4 and 12 hours* coagulative necrosis and wavy fibers are evident as surrounding viable myocardium continues to contract. Neutrophilic infiltrate is generally present between 1 and 4 days post-MI. Fibrinous pericarditis with chest pain may mimic symptoms of reinfarction. In this case CKMB is useful to rule out reinfarciton. Granulation tissue with capillary proliferation and macrophage infiltration is most apparent beginning *one week* after infarction Acellular fibrosis and scar do not become evident until approximately one month after infarction. Case: A 64 y/o is brought to he ED after complaining of crushing best pain and shortness of breath. ECG reveals ST-segment elevations in leads I, aVL, and V5, V6. CK-MB levels are also elevated. She is treated according to protocol for her condition. However, ten hours latter, despite aggressive resuscitative measures, she dies. What is most likely the reason for her death? - Ventricular fibrillation This patient pretend to the ED experiencing a MI. In patients with MI, the MOST COMMON cause of sudden death is arrhythmia, particularly ventricular fibrillation. Complications 0-24 hrs: Arrhythmia, cariogenic shock, heart failure 1-3 days: Fibrinous pericarditis 3-7 days: Myocardial rupture (free wall or septum depending on the location of MI), papillary muscle rupture. LV pseudoaneursym (high chance of rupture). 2 months: Dressler's Syndrome, Ventricular aneurysm (which can cause mural thrombus), heart failure Case: A 42 y/o man comes to the physician because of High blood pressure. Physical examination shows yellow flat plaques of the lower eyelids. He says it has been present for many years. His father died of a MI at 50 years old. He feels well and exercises regularly without difficulty. His body mass index is 24 kg/m2. Which of the following physical signs would most likely be present in the examination? - Tendon xanthomata The appearance is of yellow flat plaques over the lower eyelids. They represent areas of lipid-containing macrophages. The diagnosis is xanthelasma. It is possible given the premature death of his father that he has familial hypercholesterolemia. In that case he may well have tendon xanthomata*. These are hard, non-tender nodular enlargement of tendons. The y are most commonly found on the knuckles and the Achilles tendon. What kinds of diseases do you see an enlarged liver? - An enlarged liver or hepatomegaly is present in conditions like 1) Hepatitis (infectious, drug-induce, alcoholic, or nonalcoholic) 2) Storage disorders (glycogen storage diseases or hemochromatosis) 3) Impaired hepatic venous outflow (Budd-chairir or right heart filature), 4) Biliary tract idosderes 5) Infiltrative diseases What condition would you see *speckled iris* (Brushfield spots) - A speckeld iris (brush field spots) is due to small white or greyish/brown spots on the periphery of the iris due to aggregation of connective tissue These are normal in children, but are also a feature of Down syndrome. Case: A 64 yo man is brought to the ED because of pleuritic chest pain over the past 3 hours. The pain began while lying in bed. He has a history of diabetes mellitus and a MI 4 weeks prior, for which he underwent coronary artery bypass surgery. The surgery was uncomplicated and the patient recovered uneventfully.He smokes 1.5 packs of cigarettes per day and does not drink alcohol. The patient appears colorable and has a regular pulse, a pericardial rub, and no cardiac murmurs. Serum inflammatory market are elated. ECG and serial cardiac troponin levels are normal. What is most likely the diagnosis? - Dressler syndrome Dressler syndrome is a complication of transmural myocardial infarction thought to arise from formation of autoantibodies against cardiac antigens released from necrotic myocytes. Symptoms include mild fever and pleuritic chest pain often several weeks after an MI. It is usually similar to pericardial type pain: often received by leaning forward and exacerbated in the supine position. Case: A 16 y/o boy with beta thalassemia requiring regular blood transfusions is diagnosed with heart filature and new onset diabetes mellitus. He is placed on the waiting list for a heat transplant. What is the most likely cause of heart failure in this patient? - Iron overload cardiomyopathy Frequent blood transfusion result in the *accumulation and deposition of iron* in various organs including the liver, heart, and pancreas. Iron overload cardiomyopathy is a term coined to a secondary cause of cardiomyopathy resulting from the accumulation of iron in the heart, usually from genetic disorders of iron metabolism or repeated blood transfusion. It is deterrable by cardiac MRI and suggestive lab studies, including a ferritin level 300 ng/ml and a transferrin saturation 55%. An _______________________ is due to mismatch between major histocompatibility antigen on blood cells, such as the ABO system. It causes severe intravascular hemolysis, disseminated intravascular coagulation, renal filature and shock and has a high mortality if not recognized quickly. - Acute hemolytic transfusion reaction Case: A 3 y/o boy is brought to the ED because of high fever, cervical lymph node enlargement, conjunctival congestion, redness of lips and palms, and desquamation of fingertips. Physical examination shows erythema of the oral cavity. Lab show hemoglobin 11 mg/dl; platelet count 1,000,000 mm3. Symptoms resolved after 2 weeks. During the third week the child dies unexpectedly. Autospy shows vasculitis of coronary arteries and aneurysm formation. What is the most likely diagnosis? - Kawasaki diseases (mucocutaneous lymph node syndrome) Kawasaki diseases, also known as mucocutaneous lymph node syndrome, is an acute, fertile, multistyem disease of children. Most cases occur prior to the age of 5. A coronary arteritis is an important hallmark feature of this diseases and is often found on autopsy. There is associated intimal proliferation and infiltration of the vessel wall with mononuclear cells. Along the artery, beadlike aneurysms and thromboses may be discerned. Other manifestation include cardiomegaly, myocardial ischemia and infarction, myocarditis, and pericarditis High-dose IV (intravenous) globulin and aspirin have been shown to be effective in reducing the incidence of coronary artery abnormalities when administered early in the course of the disease. Platelet counts are abnormally elevated in Kawasaki's disease A prolonged PR interval (defined as 200 ms) with 1:1 conduction ratio of P waves to QRS complies is characteristic of _______________________ - 1st degree heart block. First Degree Block - A conduction block that occurs at the AV node (or the bundle of His, which is immediately distal) Every atrial impulse does eventually get conducted The only thing that you need to diagnose a First Degree Block is a PR internal longer than 200 msec Better known as a "delay" rather than a true block It is of little clinical consequence, but is seen more frequently in aging hearts where the conduction system is starting to slip. 2nd degree heart block, _________________________ is characterized by progressive lengthening of the PR interval until a QRS complex is dropped. It is usually symptomatic, of no clinical significance and therefore does not require treatment. - Mobritz type 1 or Wenkebach phenomenon 2nd degree heart block, _______________________ is characterized by consistent unchanging PR intervals (usually normal in duration but can be prolonged) followed by the block of one or more P waves that fail to conduct to the ventricles. - Moritz type 2 Moritz type 2 is a high degree AV block with the potential for progressing to complete heart block ___________________________ is identified by P waves and QRS complexes that are independent of each other - Complete heart block (or 3rd degree heart block) A normal PR interval is _____________ ms - 200 Case: A 1-day-old term new born of a diabetic mother is evaluated for blue discoloration of the skin, clubbing of the fingers, poor feeding, and severe shortness of breath. Physical examination shows lethargy and cyanosis. He is started on supplemental oxygen without improvement in oxygenation. Chest X-ray shows normal cardiac silhouette, lung marking and costophrenic angles. Echocardiogram shows an anterior aorta arising from the right ventricle with the pulmonary artery taking off from the left ventricle and he mistreated with intravenous prostaglandin. - Failure of migration of neural crest and endocardial cells The differential diagnosis of neonatal cyanosis and respiratory distress is broad, including aspiration of meconium or amniotic fluid, congenital heart disease, diaphragmatic herina, bronchopulmonary dysplasia, pneumonia, pulmonary immaturity, and transient tachypnea of the newborn. In this case, this newborn is suffering from transposition of great vessels, evidenced by the severe cyanosis immediately after birth without improvement with supplemental oxygen (due to cardiac shunting) and echocardiogram showing the aorta taking off from the right ventricle and pulmonary artery from the left ventricle. Treatment of transposition of the great vessels requires prostaglandin in orde