CMN 574 Cardiac Unit 1 Exam UPDATED
ACTUAL Exam Questions and CORRECT
Answers
Musculoskeletal CP - CORRECT ANSWER - Usually more localized and pt can point to
it
Made worse with movement/deep inspiration
Often reproducible
*Examen for rash associated with zoster
X-rays if hx of trauma
Tx: Rest, anti-inflammatories, ice/heat
Gastrointestinal CP - CORRECT ANSWER - (always ask about OTC pain meds)
Substernal, burning pain, nocturnal cough, flatus, belching, dysphagia
Esophageal spasm -> squeezing or pressure
Epigastric pain radiating to back -->Pelvic Ulcer disease, pancreatitits
Usually recurrent, worsened by meals/supine
Relieved by antacids, PPI, H2 blockers
Tx: PPIs, ABX for H. pylori, Diet, Elevate HOB
Psychogenic CP - CORRECT ANSWER - Precordial CP
constant or intermittent heaviness unrelated to meals or activity
Screening Questions
1. In past 6 mos, any spell/attack where suddenly felt anxious, frightened, uneasy?
2. In past 6 mos, suddenly heart race, felt faint, or couldn't breathe?
,*Yes to either is positive screen. No makes panic disorder unlikely
Mitral Valve Prolapse - CORRECT ANSWER - Usually asymptomatic but can have non-
specific CP, dyspnea, palpitations
Inc risk in healthy females, thin collagen disease (Marfan's, Ehlers-Danlos Syndrome)
Pansystolic or late systole with single to multiple mid-systolic click
Skeletal changes such as pectus excavatum or scoliosis
Diagnosis confirmed by echo, ambulatory ECG (palpitations)
Tx: Low dose BB, mitral valve repair
ACRONYM:
PEEP-EM
PECTUS EXCAVATUM
ECHOCARDIOGRAM
ECG (Ambulatory/Palpitations)
Pansystolic
EHLER'S DANLOS SYNDROME
Marfan's
Aortic aneurysm/dissection - CORRECT ANSWER - abrupt onset severe, tearing, ripping,
knife-like CP radiating to back
s/s: anxiety, dyspnea, hypo/hyperTN, difference between R& L arm BP, absent UE pulses
, harsh holosystolic murmur
Tx: Emergent chest CT and echo--> Surgery!!
Pericarditis - CORRECT ANSWER - Pleuritic substernal CP radiates to shoulders, back,
epigastrium
Worse when supine, +Fever, +dyspnea
Caused by virus/bacteria/autoimmune
Dx: CBC, Sed rate, cardiac enzymes, ECG, echo
Tx: Bedrest, ASA, NSAIDS, Colchicine, Steroids
Risk factors for CAD - CORRECT ANSWER - Male
Increased age
Fam Hx
Dyslipidemia
HTN
DM
Smoking
Sedentary
Obesity (esp abd)
Stress
Poor diet
ETOH (excessive)
Rouan Decision Rule - CORRECT ANSWER - Predicts when pts with CP (but normal
ECG) are at high risk for MI Mnemonic-An MI rouans your life
ACTUAL Exam Questions and CORRECT
Answers
Musculoskeletal CP - CORRECT ANSWER - Usually more localized and pt can point to
it
Made worse with movement/deep inspiration
Often reproducible
*Examen for rash associated with zoster
X-rays if hx of trauma
Tx: Rest, anti-inflammatories, ice/heat
Gastrointestinal CP - CORRECT ANSWER - (always ask about OTC pain meds)
Substernal, burning pain, nocturnal cough, flatus, belching, dysphagia
Esophageal spasm -> squeezing or pressure
Epigastric pain radiating to back -->Pelvic Ulcer disease, pancreatitits
Usually recurrent, worsened by meals/supine
Relieved by antacids, PPI, H2 blockers
Tx: PPIs, ABX for H. pylori, Diet, Elevate HOB
Psychogenic CP - CORRECT ANSWER - Precordial CP
constant or intermittent heaviness unrelated to meals or activity
Screening Questions
1. In past 6 mos, any spell/attack where suddenly felt anxious, frightened, uneasy?
2. In past 6 mos, suddenly heart race, felt faint, or couldn't breathe?
,*Yes to either is positive screen. No makes panic disorder unlikely
Mitral Valve Prolapse - CORRECT ANSWER - Usually asymptomatic but can have non-
specific CP, dyspnea, palpitations
Inc risk in healthy females, thin collagen disease (Marfan's, Ehlers-Danlos Syndrome)
Pansystolic or late systole with single to multiple mid-systolic click
Skeletal changes such as pectus excavatum or scoliosis
Diagnosis confirmed by echo, ambulatory ECG (palpitations)
Tx: Low dose BB, mitral valve repair
ACRONYM:
PEEP-EM
PECTUS EXCAVATUM
ECHOCARDIOGRAM
ECG (Ambulatory/Palpitations)
Pansystolic
EHLER'S DANLOS SYNDROME
Marfan's
Aortic aneurysm/dissection - CORRECT ANSWER - abrupt onset severe, tearing, ripping,
knife-like CP radiating to back
s/s: anxiety, dyspnea, hypo/hyperTN, difference between R& L arm BP, absent UE pulses
, harsh holosystolic murmur
Tx: Emergent chest CT and echo--> Surgery!!
Pericarditis - CORRECT ANSWER - Pleuritic substernal CP radiates to shoulders, back,
epigastrium
Worse when supine, +Fever, +dyspnea
Caused by virus/bacteria/autoimmune
Dx: CBC, Sed rate, cardiac enzymes, ECG, echo
Tx: Bedrest, ASA, NSAIDS, Colchicine, Steroids
Risk factors for CAD - CORRECT ANSWER - Male
Increased age
Fam Hx
Dyslipidemia
HTN
DM
Smoking
Sedentary
Obesity (esp abd)
Stress
Poor diet
ETOH (excessive)
Rouan Decision Rule - CORRECT ANSWER - Predicts when pts with CP (but normal
ECG) are at high risk for MI Mnemonic-An MI rouans your life
