Rosh Review- Cardiology Questions With 100% Correct Answers.

A 28-year-old woman with no past medical history presents to the emergency department with acute dyspnea. Physical exam reveals tachycardia, warm extremities, wide-pulse pressure, bounding pulses, a systolic flow murmur, exophthalmos and a neck mass. Which of the following is the most likely diagnosis? - High Output Heart Failure 2ndary to Thyrotoxicosis! A 32-year-old man presents after a syncopal episode. He was running on the track when he developed shortness of breath followed by witnessed syncope. He was not post-ictal and had no seizure activity. He reports that his father's brother died while playing basketball. Physical examination is notable for a midsystolic crescendo-decrescendo murmur. Which of the following is the most likely diagnosis? - HOCM!! A 4-year-old boy presents with a 5-day history of fever. On exam he is noted to have non-tender anterior cervical lymphadenopathy, non-exudative conjunctival injection, and swollen hands and feet. Which of the following is the most common complication of this condition? - Coronary Artery Aneurysm! Kawasaki Disease is this presentation --> Tx w/ IVIG + ASA A 65-year-old man presents to the emergency department with chest pain and ST-segment elevation in leads II, III, and aVF. The patient is hypotensive and physical exam reveals jugular venous distention, clear lung fields and tachycardia. No murmur or S3 is appreciated. What is the next step in management? - Begin IV Fluid Rehydration! This is presentation of possible Right Ventricular MI where Nitrates are CONTRAINDICATED (because they lower preload)! They are PRELOAD dependent, so give fluids According to JNC-8, special attention is given to which two diseases in hypertensive patients ≥ 18 years old? - Diabetes and chronic kidney disease (goal is < 140/90 mm Hg, no matter what age over 18 years).According to the new JNC8 guideline, how much time needs to pass before any adjustments to medication are made for hypertension management? - One month Antithrombotics include which medications? - Antiplatelets (aspirin, glycoprotein IIb/IIIa, adenosine diphosphate, cyclooxygenase, phosphodiesterase, and thromboxane inhibitors) Anticoagulants (vitamin K, factor Xa and thrombin inhibitors) and thrombo-fibrinolytics (plasminogen activators). How do you treat asymptomatic hypertension? - Usually due to pain, anxiety, or noncompliance with htn meds Refill meds and have patient follow up with PCP in 48 hours How long should an individual undergo treatment for an isolated pulmonary embolism with no other risk factors? - 3 months How many cusps are in aortic and pulmonic valves? - 3! Mitral is the only one with 2, all others are tricuspid If the Aortic valve has congenital abnormality with only 2 leaflets, it is at risk for ascending aortic dilation! --> these patients typically develop aortic stenosis more than aortic regurg How would you differentiate pericarditis from myocarditis? - Echocardiogram! In patients with aortic dissection, what is the recommended blood pressure goal? - Antihypertensives should be titrated to a systolic blood pressure of 110 mm Hg. Isolated tricuspid regurgitation is most often seen in which group of patients? - Intravenous drug abusers, secondary to tricuspid valve endocarditis.List some causes of secondary hypertension? - Diabetes, glomerulonephritis, renal atherosclerosis, Cushing's syndrome, hyperaldosteronism, pheochromocytoma, obstructive sleep apnea, aortic coarctation, meds (OCPs, NSAIDs, steroids, cyclosporine). Essential (primary) doesn't have a known secondary cause!! Nitrate therapy works by which of the following mechanisms? SE? - Reduces both preload and afterload! Increases venous capacitance and improve coronary blood flow by coronary VASODILATION! Decreases Myocardial O2 demand! SE: Headache, hypotension, tachycardia Peripheral arterial disease most commonly affects which vessels? - Superficial femoral artery (calf pain) Aortoiliac system (thigh/buttock pain). The risk of death in unstable angina is four-fold increased if which three biomarkers are elevated? - Troponin I or T High-sensitivity C-reactive protein B-type natriuretic peptide.Treatment for NSTEMI? - ASA, Clopidogrel, Morphine, Oxygen, Nitrates, BB, ACEI Anticoagulant therapy may be used with Enoxaparin, Fondaparinoux (SQ injections) DONT use Thrombolytics What are common causes of High-Output Heart Failure vs Low Output Heart Failure? - High Output: (normal pump fxn, just unable to keep up with high metabolic demand!) Thyrotoxicosis Anemia Pregnancy Beriberi Paget's disease Low Output: Decreased Ejection Fraction Dilated Cardiomyopathy Chronic Htn Valvular Heart Disease