PCR Cardiology

Inferior EKG and Myocardium Location/Coronary artery

RCA II, III, aVF

RV Infarct EKG and Myocardium Location/Coronary artery

RCA V1R, V3R-V6R

Posterior EKG and Myocardium Location/Coronary artery

RCA; circumflex V1, V2

Classification of HTN: Pre hypertension

Systolic 120-139 mm Hg or diastolic 80-89 mm Hg

Classification of HTN: Stage 1

Systolic 140-159 mm Hg or diastolic 90-99 mm Hg

Classification of HTN: Stage 2

Systolic > 160 mm Hg or diastolic >100 mm Hg

Distributive Shock Hemodynamics

Cardiac Index: Elevated SVR: Decreased PCWP: Low to normal Initial change causing compensatory changes: Decreased vascular tone

What is the morphology of TOF?

1. PS 2. VSD 3. Overriding Aorta 4. RVH

A 37-y/o female with a new onset of AF is sent to the ED by her primary care provider. She complains of a recent onset of fatigue and DOE which has now progressed to dyspnea at rest. The patient also admits to associated orthopnea and peripheral edema. On cardiac exam, prominent RV & PA pulsations are visible and palpable. S2 is widely split and does not vary with breathing & a loud SEM is heard in 2nd & 3rd interspaces parasternally. The patient states she was told that she had a murmur when she was a child, but she does not recall what it was or if she had any other testing. Which of the following is the most likely diagnosis? A. ASD B. VSD C. PDA D. Congenital MS E. Coarctation of the Aorta

A. ASD

A 71-y/o man complains of occasional lower back pain. His BP is 150/85 mm Hg, and his HR is 80/min. Cardiac exam reveals an S4 gallop. Abdominal exam reveals a pulsatile mass approximately 5.0 cm in diameter palpable in the epigastric area. Peripheral pulses are normal. Which of the following is the most likely diagnosis? A. Abdominal aortic aneurysm B. Cancer of the proximal colon C. Peptic ulcer disease D. Chronic pancreatitis E. Lipoma of the abdominal wall

A. Abdominal aortic aneurysm

A 59-year-old male with longstanding uncontrolled HTN presents with nausea and a 5- pound weight gain in the last 2 days. He states, "my belly is getting bigger, and I can't fasten my pants." Which of the following PE findings would be most likely in this patient? A. Ankle edema and elevated JVP B. Dry cough and MR murmur C. Hypotension and cyanotic extremities D. S3 heart sound heard along the LSB and bilateral wheezing

A. Ankle edema and elevated JVP

A 63-year-old woman presents to the urgent care facility with complaints of persistent heartburn. The patient has not had any success in alleviating symptoms with antacids or over-the-counter ranitidine. She feels that her heartburn spreads throughout her entire chest and upper abdomen. Vital signs are normal. Blood sample for tests has been obtained and sent for analysis, and reports are awaited. At the intake, ECG has been obtained What is the most probable diagnosis? A. Anterior myocardial infarction B. Wolf-Parkinson-White syndrome C. Inferior wall myocardial infarction D. Left ventricular hypertrophy E. Acute pericarditis

A. Anterior myocardial infarction Heparin, nitrates, BB, remove obstruction

A 68 y/o WF presents to her PA with c/o "fainting spells off and on for a month or so". She is well known to your staff for her history of non-compliance with her antihypertensive medications. On PE you find bilateral carotid bruits, no JVD and clear lung fields. Cardiac exam is significant for a regular sustained apical impulse lateral to the midclavicular line and a 4/6 systolic cresendo- decresendo murmur at the base. The most diagnosis and cause of her symptoms is A. Aortic valve stenosis B. Mitral stenosis C. Pulmonic valve stenosis D. Mitral regurgitation E. Tricuspid valve regurgitation

A. Aortic valve stenosis

A 68-year-old man with a history of hypertension, diabetes, and urinary retention awoke feeling nauseated and light-headed. . He did not respond to questions from his wife. When the emergency medical technicians arrived, his blood pressure was 60 by palpation. IV fluids and oxygen were administered. Vital signs obtained in the ER were blood pressure 60, heart rate 120 and regular, temperature 38.9°C (102°F), and respiratory rate 30. A brief physical examination revealed coarse rales approximately halfway up in the chest bilaterally and inaudible heart sounds An indwelling urinary catheter was placed with drainage of 10 to 20 mL of dark urine. ECG was unremarkable except for sinus tachycardia. A brief physical examination revealed coarse rales approximately halfway up in the chest bilaterally and inaudible heart sounds An indwelling urinary catheter was placed with drainage of 10 to 20 mL of dark urine. ECG was unremarkable except for sinus tachycardia. Antibiotics were administered, and the patient was transferred to the ICU, where a right heart catheterization was performed. Pulmonary capillary wedge pressure was 28 mmHg. Cardiac output was 1.9 L/min. Right atrial mean pressure was 10 mmHg These findings are most consistent with which of the following types of shock A. Cardiogenic B. Hypovolemic C. Septic D. Obstructive E. Distributive

A. Cardiogenic PCWP increased PCW normal or decreased in RV infarction CO decreased SVR increased

Which of the following is not a correct description of vasovagal syncope A. Caused by excessive sympathetic nervous system tone B. Caused by an increased parasympathetic tone and withdrawal of sympathetic nervous system tone C. Common faint experienced by normal persons, accounts for ~ 50 % of all episodes of syncope D. Frequently provoked by emotional distress such as pain or the sight of blood and may be recurrent

A. Caused by excessive sympathetic nervous system tone

65-year-old woman, with a history of HTN , presents with a 3-week history of an ulcer on her left ankle. Patient is a non-smoker. On physical examination the ulcer is located over the left medial malleolus. The edges are rough, and the surrounding skin is darkly pigmented, edematous, and atrophic. Pedal pulses are 2+ and the feet are warm. Sensory exam is normal. Which of the following is the most likely diagnosis? A. Chronic venous insufficiency B. Arterial insufficiency C. Buerger's disease D. Cellulitis

A. Chronic venous insufficiency

A 67 y/o patient with a 15-year history (COPD) presents with worsening respiratory symptoms and abdominal pain. On PE , you observe peripheral edema, JVD , epigastric pulsations, and tender hepatomegaly. You auscultate a SEM . Echocardiogram reveals a dilated RV with decreased EF and a normal appearing LV. Which of the following is the most appropriate diagnosis for this patient? A. Cor pulmonale B. Hepatitis C. Portal hypertension D. Pulmonic stenosis

A. Cor pulmonale Cor pulmonale denotes RV hypertrophy, MCC by CPOD

A 76 y/o female with known chronic AR has a 3-week history of arthralgia, weakness, and low-grade fever. BP is 135/65, pulse is 90, and resp. is 22. Axillary temp is 100.2 degrees. Exam showed an alert, oriented patient with conjunctival petechiae and a 2/6 LSB diastolic murmur. Hgb is low at 9.4 g/dL and WBC count is high at 18.2 K/UL. Which of the following is the most likely diagnosis? A. Endocarditis B. Multiple myeloma C. Ankylosing spondylitis D. Waldenstrom's macroglobulinemia E. Idiopathic thrombocytopenic purpura(ITP)

A. Endocarditis MCC for acute = S. aureus MCC Prosthetic Valve = S. Epidermidis MCC Subacute = Strep Viridans

An 18-year-old male high school basketball player comes to clinic for a routine physical exam. His height is 193 cm (76 in.); arm span is 201 cm (79 in.). He has long fingers and toes. BP is 146/62mmHg and HR 64/min. Which of the following exam findings is most consistent with the diagnosis? A. Grade 2/6 high-frequency diastolic murmur at the third right intercostal space B. Grade 2/6 systolic ejection murmur at the second left intercostal space with a fixed widely split S2 C. Grade 2/6 continuous murmur heard best at the high left sternal border D. Grade 2/6 systolic murmur at the fourth left intercostal space that decreases with squatting

A. Grade 2/6 high-frequency diastolic murmur at the third right intercostal space

A 26-year-old male presents with increased dyspnea with exercise. He has noted a decrease in his exercise tolerance over the past several months. He denies chest pain or skipped heart beats. Echocardiogram reveals LVH with asymmetric septal hypertrophy. EF is 65%. Which of the following is the most likely presenting history or physical exam finding? A. He has an older brother with the same diagnosis B. An S3 gallop is heard C. Patient notes completing a course of Adriamycin D. Elevated jugular venous distension is noted

A. He has an older brother with the same diagnosis HCM can be genetic and present in 25% of 1st degree relatives

A 15-year-old male has anterior chest pressure radiating into his left arm while playing soccer. The pressure ends in 5 minutes with rest. BP is 145/95, pulse is 90 and regular, and respirations are 20. Exam shows a rapid carotid pulse upstroke, double apical impulse, and 2/6 SEM in the 4th ICS along the LSB that radiates to the apex. Which of the following is the most likely diagnosis? A. Hypertrophic obstructive cardiomyopathy(HOCM) B. Variant angina pectoris C. Mitral valve prolapse D. Ventricular septal defect E. Ruptured chordae tendineae

A. Hypertrophic obstructive cardiomyopathy(HOCM) Increases with Valsalva or standing abruptly (Decreased filling (preload) increases the obstruction)

A 55-year-old male with Class D NYHA stage IV HF with a severely depressed ejection fraction is brought to the emergency room via ambulance and is difficult to arouse, diaphoretic, and has had no urine output for the last 24 hours. He is hypotensive (BP 80/palp) and tachycardic (125/min). Physical exam reveals elevated JVP to the angle of the mandible, s1, s2 +s3 heart sound, pulmonary rales throughout auscultation of the lungs, and 4+ b/l lower extremity edema. Which of the following would best describe the hemodynamic profile in this patient? A. Increased pulmonary capillary wedge pressure B. Increased cardiac output C. Decreased systemic vascular resistance D. Decreased left atrial pressure E. decreased pulmonary capillary wedge pressure

A. Increased pulmonary capillary wedge pressure

When performing a pre-participation sports PE in adolescent population, a murmur with which of the following qualities indicates a risk for sudden death during exercise? A. Increases with the Valsalva maneuver B. Increases with squatting maneuver C. Associated with a mid-systolic click D. Mid-systolic without radiation to the carotids

A. Increases with the Valsalva maneuver HCM known cause of sudden death during or just after physical exertion and competitive sports

The major hazard associated with antihypertensive therapy in the elderly is: A. Orthostatic Hypotension B. Depression C. Hypokalemia D. Congestive heart failure E. Central nervous system effects

A. Orthostatic Hypotension

A 65 y/o female patient complains of fatigue and SOB.• Objective findings note an elevated JVP and a Kussmaul's sign. There is low voltage on the EKG with nonspecific repolarization changes. An echocardiogram shows impaired diastolic filling with preserved contractile function. You suspect which of the following? A. Restrictive Cardiomyopathy B. Dilated Cardiomyopathy C. Hypertrophic Cardiomyopathy D. RHD E. Pericardial effusion

A. Restrictive Cardiomyopathy Increased myocardial "stiffness" Impairs ventricular filling and relaxation

The 4 cardinal symptoms of aortic stenosis are: A. Syncope, dyspnea, angina, sudden death B. Fatigue, syncope, hemoptysis, weakness C. Pounding in the head, palpitations, fatigue, dizziness D. Angina, sudden death, palpitations, syncope E. Dyspnea on exertion, PND, orthopnea, angina

A. Syncope, dyspnea, angina, sudden death

A 4-week-old infant presents with cyanosis. Workup of the patient reveals a VSD, overriding aorta, PS & RVH. Which of the following is the most likely diagnosis? A. Tetralogy of Fallot B. Coarctation of aorta C. PDA D. Complete transposition of the great vessels

A. Tetralogy of Fallot

A 72-year-old man collapses while playing golf. He has a 5-year history of angina and type 2 DM . Paramedics arrive in 10 minutes. Examination shows no respirations or BP. CPR is attempted for 10 minutes without success. Which of the following is the most likely cause of death in this patient? A. Ventricular fibrillation B. Rupture of the papillary muscle C. Necrosis of the myocardium D. Embolus to the right middle cerebral artery E. Cardiac tamponade

A. Ventricular fibrillation

Which 2 forms of shock frequently occur together during a acute MI? A. cardiac shock and hypovolemic shock B. cardiac shock and septic shock C. distributive shock and hypovolemic shock D. cardiac shock and neurogenic shock E. cardiac shock and anaphylaxis

A. cardiac shock and hypovolemic shock

A two-week-old female is being evaluated in the clinic, and on examination she is noted to have bounding pulses with a widened pulse pressure. There is a rough, machinery sounding murmur present at the second left intercostal space. Cyanosis is not present. Which of the following is the most likely diagnosis? A. patent ductus arteriosus(PDA) B. ventricular septal defect(VSD) C. tetralogy of Fallot D. coarctation of the aorta

A. patent ductus arteriosus(PDA)

Virchow's triad identifies three factors that can contribute to the development of thromboembolic disease. Considering this, all of the following patients would fall under the category of "high risk for DVT" EXCEPT: A. A 30-year-old MVA victim with compound fractures B. A 60-year-old female with tuberculosis C. A 50-year-old male with a casted right arm D. A 40-year-old female with metastatic breast cancer

B. A 60-year-old female with tuberculosis

A 53-year-old man presents to the ED after the acute onset of CP . The episode occurred 8 h prior to his arrival and lasted for a total of 20 to 30 min. The CP is now resolved. The patient has a long Hx of DM and hypercholesteremia and has smoked approximately 1 to 1 1/2 packs per day of cigarettes for past 30 years. On PE, BP of 84/52, and HR is 54. He has JVD to angle of mandible and clear lung fields. His rhythm strip reveals a Wenckebach pattern. Given his hypotension, a SG catheter is placed. RA pressure is estimated at 16 mmHg (normal 0-5), PA pressure at 20/10 mmHg (normal 12-28/3-13), and PCWP s 8 mmHg (normal range 3-10). Which of the following is most consistent with this clinical picture? A. An anterior wall myocardial infarction B. A right ventricular infarction C. A ruptured mitral valve leaflet D. A constrictive pericarditis following a myocardial infarction E. A lateral wall myocardial infarction

B. A right ventricular infarction Should suspect if IWMI or PWMI plus hypotension

A 23-year-old student presents to your office for health clearance to play collegiate sports. He is asymptomatic and exercises daily. On PE, his BP is 160/50 mm hg and his HR 60/min. there is pulsus bisferiens. Heart examination reveals a blowing diastolic murmur at the LSB. Nail beds reveal a Quincke pulse. Which of the following is the most likely diagnosis? A. Cardiac tamponade B. Aortic insufficiency C. Mitral stenosis D. Atrial septal defect(ASD) E.Tetralogy of Fallot

B. Aortic insufficiency Incompetency of the AV causing flow from the aorta into LV during diastole

A 56-year-old male with a known history of polycythemia suddenly complains of pain and paresthesia in the left leg. PE reveals the left leg to be cool to the touch and the toes to be cyanotic. The popliteal pulse is absent by palpation and Doppler. The femoral pulse is absent by palpation but weak with Doppler. The right leg and upper extremities have 2+/4+ pulses throughout. Given these findings what is the most likely diagnosis? A. Venous thrombosis B. Arterial thrombosis C. Thromboangitis obliterans D. Thrombophlebitis

B. Arterial thrombosis Evidenced by loss of pulses, emergency. Note venous occlusion will NOT cause loss of pulses

How is secondary HTN different from essential HTN? A. Systolic BP does not exceed 200 mm Hg B. BP is often refractory to antihypertensives C. The onset is in the patient's late twenties D. There is a positive history of HTN• E. In the majority of cases no cause can be established

B. BP is often refractory to antihypertensives

A 55-year-old presents with orthopnea and PND. On PE, JVD and pulmonary rales are noted. Which of the following laboratory tests would most likely be elevated in this patient? A. Thyroid stimulating hormone B. Brain natriuretic peptide C. Myoglobin D. Renin

B. Brain natriuretic peptide >500 predictive of CHF

Which of the following coronary arteries is typically involved in a lateral wall myocardial infarction? A. Right coronary artery B. Circumflex artery C. Left anterior descending artery D. Left coronary artery

B. Circumflex artery

A 65-year-old male 5 days status-post MI is evaluated for anterior CP . The pain improves with sitting up. The patient has associated fever, leukocytosis and a pericardial friction rub. Which of the following is the most likely diagnosis? A. Tako-tsubo cardiomyopathy B. Dressler syndrome(postmyocardial infarction pericarditis) C. Rupture of papillary muscles D. Recurrent myocardial infarction

B. Dressler syndrome(postmyocardial infarction pericarditis)

A 35 y/o male status-post PDA repair at 5 years of age, presents with low-grade fever, fatigue and dyspnea worsening over the past 10 days. Prior to the onset of these symptoms, he was healthy and free of any complaints. Examination is significant for petechiae on the palate, a high pitched holo-systolic murmur heard best at the apex, and splinter hemorrhages on both hands under his fingernails. Which of the following is the most appropriate next step in the evaluation of this patient? A. Cardiac catheterization B. Echocardiogram C. MUGA scan D. Chest radiograph

B. Echocardiogram Infectious endocarditis

You are seeing in your office a patient with the chief complaint of relatively sudden onset of SOB and weakness, but no CP. ECG shows nonspecific ST-T changes. You would be particularly attuned to the possibility of painless, or silent, MI in the.. A. Advanced coronary artery disease patient with unstable angina on multiple medications B. Elderly diabetic C. Premenopausal female D. Inferior MI patient E. MI patient with PVCs

B. Elderly diabetic Five causes of silent/atypical MI presentations: diabetes, elderly, alcohol, trauma, hypertension

A 45-year-old man is diagnosed with essential hypertension based on two blood pressure readings of 150/100 and 156/102 mm Hg during two separate visits. Which of the following would most likely provide prognostic information regarding this patient? A. Vascular biopsy B. End-organ effects from his hypertension C. Patient enrollment is a clinical trial D. Measurement of serum homocysteine levels.

B. End-organ effects from his hypertension

A 56-year-old man is admitted to the hospital for chest pain of 2-hour duration. His heart rate is 42bpm, with sinus bradycardia on ECG, as well as ST-segment elevation in leads II, III, aVF. Which of the following is the most likely diagnosis? A. He is in good physical condition with increased vagal tone B. He likely has suffered an IWMI C. He likely has a LV aneurysm D. The low heart rate reflects a good cardiac EF

B. He likely has suffered an IWMI Sinus bradycardia often seen in IWMI because RCA supplies inferior wall of the LV and the sinoatrial node.

A 55-year-old male with Class D NYHA stage IV HF with a severely depressed EF is brought to the ER via ambulance and is difficult to arouse, diaphoretic, and has had no U/O for the last 24 hours. He is hypotensive (BP 80/palp) and tachycardic (125/min). PE reveals elevated JVP to the angle of the mandible, S1, S2 +S3 heart sound, pulmonary rales throughout auscultation of the lungs, and 4+ b/l lower extremity edema. the following would best describe the hemodynamic profile in this patient? A. Decreased systemic vascular resistance B. Increased pulmonary capillary wedge pressure C. Decreased left atrial pressure D. Increased cardiac output Which of

B. Increased pulmonary capillary wedge pressure PCWP = LA Pressure

A 26-year-old female comes into the ER with complaints of dyspnea on exertion. On further questioning, she gives a history of increasing cough over the last week and limitation of her daily activities. She also gives a history of breathlessness at night after going to bed. Her PMH is significant for a bout of RF at age 15. Examination shows a female in distress. There is peripheral and facial cyanosis. There are prominent 'a' waves in the JVP . Palpation yields a diastolic thrill at the apex in the left lateral position. Auscultation shows the presence of a mid-diastolic murmur best heard in the mitral area. What condition does this patient most likely have? A. Mitral insufficiency B. Mitral stenosis C. Aortic stenosis D. Aortic insufficiency E. Tricuspid stenosis

B. Mitral stenosis

Primarily, diagnosis of valvular heart disease is made by A. Chest x-ray, arterial blood gases (ABGs) B. Patient history, physical exam, echocardiography, and Doppler C. Physical exam, cardiac catherization, ABG's and echocardiography D. Physical exam, ejection fraction, loud murmur, Doppler E. Electrocardiogram (ECG), CXR, echocardiography, cardiac catherization

B. Patient history, physical exam, echocardiography, and Doppler

A patient admitted with substernal CP undergoes cardiac catheterization. Angiography reveals 98% occlusion of the RCA. All other vessels are 100% patent. Which of the following is the most expected? EKG finding in this patient? A. ST elevation in leads I, aVL, V5 and V6 B. ST elevation in leads II, III, and aVF C. ST elevation across V2, V3 and V4 D. Tall upright R and T waves in V1 and V2

B. ST elevation in leads II, III, and aVF The right coronary artery is responsible for inferior wall of the heart. Inferior wall of the heart is seen on EKG in leads II, III, aVF

Which of the following is the most common cause for acute myocardial infarction? A. occlusion caused by coronary microemboli B. thrombus development at a site of vascular injury C. from congenital abnormalities D. severe coronary artery spasm

B. thrombus development at a site of vascular injury

A 55-year-old morbidly obese male is seen in the office for routine examination. He has a history of PHTN and cor pulmonale. Examination reveals a visible JVP and a systolic flow murmur on the right side of the sternum. Which of the following is the most likely diagnosis? A. mitral insufficiency B. tricuspid insufficiency C. hepatic vein thrombosis D. aneurysm of the thoracic aorta

B. tricuspid insufficiency Results in blood being put back into the right side of the body with increased jugular pulsation in the neck, along with a palpable venous pulse in the liver

Lateral EKG and Myocardium Location/Coronary artery

Circumflex I, aVL, V5, V6

A patient has developed greater than normal(10mm Hg) inspiratory decreases in systolic BP. The arterial pulse (taken with the patient's wrist overlying his lap) almost seems to disappear when palpated during inspiration These findings are most consistent with: A. Volume overload B. Aortic regurgitation C. Cardiac tamponnade D. Marfan's syndrome E. Bisferiens pulse

C. Cardiac tamponnade Becks Triad: Hypotension, Increased JVP, and muffled heart sounds

A 57-year-old man is noted to have a BP of 68/50 mm Hg, HR of 140 bpm, elevated jugular venous pressure, inspiratory crackles on exam, and cold clammy extremities. Which of the following is the MOST likely etiology? A. Septic Shock B. Adrenal Crisis C. Cardiogenic shock D. Hypovolemic shock

C. Cardiogenic shock

An 80 y/o male presents with a 6-month history of SOB with exertion. He states his condition has worsened over the past two days and has also noted an 8-pound weight gain. PMH is also positive for a MI 10 years ago and a 40-pack-year smoking history. PE reveals bilateral basilar rales and 2+ pitting edema in the lower extremities. Which of the following is the most likely diagnosis? A. Pneumonia B. Pericarditis C. Congestive heart failure D. Chronic obstructive pulmonary disease

C. Congestive heart failure

A 65-year-old patient presents with dyspnea at rest, two-pillow orthopnea and a 2+ bilateral ankle edema. Which of the following diagnostic tests would be most helpful in the evaluation of this patient? A. 24-hour Holter monitor B. Cardiac stress test C. Echocardiogram D. Chest x-ray

C. Echocardiogram Dyspnea, orthopnea, and edema are consistent with a diagnosis of CHF

Which of the following conditions is most closely associated with DM. A. Hypercholesterolemia B. Hypothyroidism C. Hypertriglyceridemia D. Obesity E. Cholelithiasis

C. Hypertriglyceridemia Patients with significant elevated serum TG should be screened for DM

Which of the following is the primary pathophysiologic abnormality in Eisenmenger syndrome? A. Low systemic vascular resistance B. Increased cardiac output C. Increased pulmonary vascular resistance D. Elevated LV end-diastolic pressure E. Left to right intracardiac shunting

C. Increased pulmonary vascular resistance Eisenmenger's syndrome - Increased PVR resulting in bi-directional flow. Redirection of blood flow through VSD, ASD, or PDA Cyanosis + PHTN + Erythrocytosis

A 13-year-old patient is hospitalized with a fever of 102.5 F and a rash. After 36 hours the rash has rapidly progressed to enlarging macules that appear ring or crescent shaped with central clearing. He also complains of multiple arthralgias involving his ankles, knees, and now his elbows. The EKG shows evidence of a 1st AV block. Labs were significant for an elevated ESR and leukocytosis. Which of the following physical examination findings would be most likely in this patient? A. Cord-like palpable calf vein B. Diminished lower extremity pulses C. Mitral regurgitation murmur D. Oral cyanosis

C. Mitral regurgitation murmur

A 51-year-old patient presents for follow-up after a recent stroke. Cardiac examination reveals a moderately loud SEM in the 2nd and 3rd interspaces parasternally. S2 is fixed and widely split. Which of the following is the most likely diagnosis in this patient? A. AS B. MR C. Patent foramen ovale D. VSD

C. Patent foramen ovale

Which of the following is the first EKG evidence of acute myocardial infarction? A. ST segment depression B. ST segment inversion C. Peaking of T waves D. Q wave formation

C. Peaking of T waves Initial EKG of an acute MI may not reveal any significant changes. First change is peaking of the T waves

A 25 y/o female presents with a three-day history of CP aggravated by coughing and relieved by sitting and leaning forward. She is febrile and a CBC with differential reveals leukocytosis. Which of the following PE signs is characteristic of her problem? A. Pulsus paradoxus B. Localized crackles C. Pericardial friction rub D. Wheezing

C. Pericardial friction rub Inflammatory pericarditis

A 25-year-old male presents to the clinic c/o mild DOE. Examination reveals a prominent jugular pulsation and a palpable parasternal lift. There is a harsh systolic murmur best heard at 2nd and 3rd LSB; it radiates to the left shoulder. An early systolic sound precedes the murmur during expiration. ECG demonstrates RAD. What is the most likely diagnosis? A. Aortic stenosis B. Mitral Regurgitation C. Pulmonic Stenosis D. Tricuspid Regurgitation

C. Pulmonic Stenosis

What findings would you suspect on Echocardiogram in a patient with an ASD? A.RAE &LAE B. RVH & LVH C. RAE & RVH D. LAE & LVH E. RAE, RVH, LAE, LVH

C. RAE & RVH

You are completing a physical on a patient and his blood pressure is 160/100. According to The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. What category would this blood pressure qualify as? A. Prehypertension B. Stage 1 hypertension C. Stage 2 hypertension D. Stage 3 hypertension

C. Stage 2 hypertension

Which of the following situations in the periinfarction period would suggest the presence of ventricular septal perforation A. Systolic murmur, large v waves in pulmonary capillary wedge tracing; Po2 in right atrium equals that in right ventricle B. Systolic murmur, large v waves in pulmonary capillary wedge tracing; Po2 in right atrium is greater than that in right ventricle C. Systolic murmur, large v waves in pulmonary capillary wedge tracing; Po2 in right atrium is less than that in right ventricle D. Diastolic murmur, large v waves in pulmonary capillary wedge tracing; Po2 in right atrium is less than that in right ventricle E. Diastolic murmur, large v waves in pulmonary capillary wedge tracing; Po2 in right atrium is greater than that in right ventricle

C. Systolic murmur, large v waves in pulmonary capillary wedge tracing; Po2 in right atrium is less than that in right ventricle

A 40-year-old woman is awakened at 2 AM with anterior CP. ECG taken during the discomfort shows ST segment elevation in leads V1-V4. Five minutes after SL nitroglycerin discomfort ends and repeat ECG is normal. Which of the following is the most likely diagnosis? A. Acute pericarditis B. Dissection of coronary artery C. Variant angina pectoris D. Hypertrophic cardiomyopathy E. Basilar migraine

C. Variant angina pectoris

A two-month-old infant appeared well until three weeks ago when he became dyspneic and had difficulty feeding. A 4/6 holosystolic murmur is heard at the LLSB in the 3rd ICS. An EKG shows both LVH, & RVH. Which of the following is the most likely diagnosis? A. Atrial septal defect B. Pulmonary hypertension C. Ventricular septal defect D. Tricuspid insufficiency

C. Ventricular septal defect

A patient who has long QT syndrome is most likely to have syncope caused by which of the following A. Orthostatic hypotension B. 3rd degree atrioventricular block C. Ventricular tachycardia D. Hypoglycemia E. Atrial fibrillation

C. Ventricular tachycardia

There are many sources of potential emboli that may cause a CVA. The most common source of cerebral emboli is: A. the carotid arteries B. the aortic arch C. the heart D. the vertebral basilar arteries E. posterior/inferior cerebellar artery

C. the heart

Difference between WPW vs HCM on EKG?

Can both have T wave changes in the lateral leads, but in WPW the PR interval is very short

Hypovolemic Shock Hemodynamics

Cardiac Index: Decreased SVR: Increased PCWP: Decreased Initial change causing compensatory changes: Decreased Preload

Cardiogenic Shock Hemodynamics

Cardiac Index: Decreased SVR: Increased PCWP: Increased Initial change causing compensatory changes: Decreased cardiac contractility

Obstructive Shock Hemodynamics

Cardiac Index: Decreased SVR: Increased PCWP: Normal to increase Initial change causing compensatory changes: Obstructive to blood flow

What is the recommended target LDL to reduce the risk of coronary artery disease in a diabetic patient? A. 200 mg/dL B. 160 mg/dL C. 130 mg/dL D. 100 mg/dL

D. 100 mg/dL

A 55-y/o male presents complaining of episodic substernal CP that occurs especially during strenuous exercise. Suspecting CAD, an exercise stress test is ordered. The test is considered to be abnormal if which of the following occurs? A. Systolic blood pressure increases during exercise. B. The heart rate reaches maximal value during exercise. C. Random premature ventricular beats occur at peak exercise. D. A 2 mm ST-segment depression is seen on the ECG at peak exercise.

D. A 2 mm ST-segment depression is seen on the ECG at peak exercise.

A patient had an acute inferior, transmural myocardial infarction 4 days ago. A new murmur raises the suspicion of MR due to papillary muscle rupture. Which of the following murmur descriptions describes this condition? A. A grade III/VI diastolic murmur heard best at the apex without radiation. B. A grade IV/VI systolic ejection murmur heard best at the base with radiation to the left clavicle. C. A grade II/VI systolic murmur heard best at the apex preceded by a click and without radiation. D. A grade IV/VI systolic murmur heard best at the apex with radiation to the left axilla.

D. A grade IV/VI systolic murmur heard best at the apex with radiation to the left axilla. Description of MR. The papillary muscle rupture is a complication of an AMI

A 30-y/o male has experienced a syncopal episode lasting approximately 45 seconds. He states he is athletic and that this is the first episode of "passing out". The nurse hands you his EKG below What would be your next step? A. Re-assure the patient that he did not experience an AMI but will do some lab B. Let the patient know he has pericarditis and should do just fine with follow up and anti-inflammatory medication C. Draw his blood for a stat Potassium level and start treatment for presumed hyperkalemia D. Admit the patient to a monitor bed with a consult to a cardiologist for placement of a AICD - stat

D. Admit the patient to a monitor bed with a consult to a cardiologist for placement of a AICD - stat Brugada Syndrome - Autosomal Dominant EKG - Incomplete RBBB with coved ST segment elevation in leads V1-V3

When a patient presents with newly diagnosed heart failure, the clinician should search for possible reversible precipitating factors. Which of the following conditions may be surgically correctable. A. Constrictive pericarditis B. Calcific AV stenosis C. Acute MVR 2nd to bacterial endocarditis D. All the above E. None of the above

D. All the above

A patient presents to the office following a syncopal episode. The patient claims that the syncope occurs when he changes position such as rolling over in bed or when he bends over to tie his shoes. Which of the following is the most likely explanation for this presentation? A. Carotid sinus hypersensitivity B. Vasovagal episode C. Subclavian steal syndrome D. Atrial myxoma

D. Atrial myxoma

Which of the following electrocardiographic findings represents a manifestation of digitalis toxicity? A. ST-segment depression B. T-wave inversion C. Atrial flutter D. Atrial tachycardia with variable block E. A shortening of the PR interval

D. Atrial tachycardia with variable block

65-y/o man with a long history of untreated HTN C/O recurrent SOB on minimal exertion. Cardiovascular system exam is normal except for a prominent precordial impulse. CXR normal except for a prominent LV shadow. An exercise tolerance test with thallium scanning reveals no evidence of myocardial ischemia. Two-dimensional echocardiography reveals LVH. Radionuclide ventriculography reveals normal R & L EF's. What is the most likely explanation for the patient's symptoms? A. COPD B. Reactive airways disease C. Systolic heart failure(HFrEF) D. Diastolic heart failure(HFpEF) E. Myocardial ischemia

D. Diastolic heart failure(HFpEF)

A 50 y/o male with history of alcohol abuse presents with complaint of worsening dyspnea. PE reveals bibasilar rales, elevated JVP , an S3 and lower extremity edema. CXR reveals pulmonary congestion and cardiomegaly. EKG shows frequent ventricular ectopy. Echocardiogram shows left ventricular dilatation and an EF of 30%. Which of the following is the most likely diagnosis in this patient? A. Restrictive cardiomyopathy B. Hypertrophic cardiomyopathy C. Tako-Tsubo cardiomyopathy D. Dilated Cardiomyopathy

D. Dilated Cardiomyopathy

A 28-year-old female, 3 months post-partum, complains of gradually increasing DOE . She also complains of near syncope last week. She denies chronic medical conditions and hospitalizations other than for the delivery of her child. She denies tobacco, alcohol or illicit drug abuse. Exam is noteworthy for a laterally displaced apical impulse, an S3 and a SEM best heard in the left axilla. Which of the following is the most likely diagnosis? A. Pulmonary embolism B. Pericardial effusion C. Tricuspid insufficiency D. Dilated cardiomyopathy

D. Dilated cardiomyopathy Can present in the last month of pregnancy to five months postpartum

An 80-year-old male from an assisted living facility is brought in for evaluation of repeated near-syncopal episodes when getting up from a seated position. His past medical history is significant for DM and HTN for which he takes enalapril (Vasotec). Which of the following would you expect on PE? A. A drop in systolic BP of at least 5 mmHg and a rise in pulse rate of 30 beats per minute after arising from a supine position. B. A rise in systolic BP of 10 mmHg and a fall in pulse rate of 10 beats per minute after arising from a supine position. C. A rise in systolic BP of 15 mmHg or a fall in heart rate by more than 15 beats per minute after arising from a supine position. D. Drop in systolic BP of at least 20 mmHg and a rise in pulse rate of more than 15 beats per minute immediately upon arising from a supine position.

D. Drop in systolic BP of at least 20 mmHg and a rise in pulse rate of more than 15 beats per minute immediately upon arising from a supine position. At least 20mmHg fall in systolic pressure At least 10mmHg fall in diastolic pressure

A 13-year-old boy who has a VSD with a large left to right shunt is at increased risk of developing which of the following? A. Acute myocardial infarction B. Ruptured chordae tendineae C. Third degree atrioventricular block D. Eisenmenger syndrome E. Aortic ring abscess

D. Eisenmenger syndrome

In a patient with hypercholesterolemia, which of the following would not be an appropriate treatment to lower the serum cholesterol concentration? A. Cholestyramine B. Nicotinic acid C. Lovastatin D. Gemifrozil E. A low cholesterol diet

D. Gemifrozil

An 8-year-old boy faints while running. He spontaneously awakens. Vital signs are normal. The patient is alert and pink. Cardiac and neurologic exams are normal. Which of the following is the most likely diagnosis? A. Hypertrophic cardiomyopathy B. 3rd degree atrioventricular block C. Vasovagal syncope D. Long QT interval syndrome

D. Long QT interval syndrome

A 44-year-old female presents to clinic for evaluation of a syncopal episode that occurred while walking her dog two days ago. She denies amnesia or head trauma. She has had increasing DOE and pedal edema. PE reveals clubbing of her fingers and central cyanosis. Auscultation reveals TR, widely split S2 with a palpable P2. Echocardiogram reveals a large ostium secundum ASD with bidirectional flow. Which of the following is a secondary complication in this patient? A. Left heart failure B. Ebsteins anomaly C. Tricuspid stenosis D. PHTN

D. PHTN Eisenmenger's disease, a late finding

A 40-year-old man asks your advice about lipid lowering therapy. He states that his father died of a heart attack at age 48 and that he smokes 1 pack of cigarettes per day. He currently takes no medications and has no known medical problems. You order a fasting lipid profile, with the following results: Total cholesterol = 252, Triglycerides 230, LDL = 174, HDL = 32. You recommend the following, except: A .Start Pravastatin B. Low-cholesterol diet C.A 20-30 minute walk every day for exercise D. Repeat fasting lipid profile after 6 months of a low-cholesterol diet, and start Pravastatin at that time if his cholesterol remains elevated.

D. Repeat fasting lipid profile after 6 months of a low-cholesterol diet, and start Pravastatin at that time if his cholesterol remains elevated. Drug therapy recommended when LDL > 160

What is the hallmark finding that is essential to the diagnosis of primary dilated cardiomyopathy? A. Asymmetric septal enlargement B. Atrial Enlargement C. Infiltrative myocardial disease D. Systolic Dysfunction

D. Systolic Dysfunction

A newborn is being evaluated for perioral cyanosis while feeding associated with sweating. T is 37.8 100 F , BP 80/45, HR 180, and RR 40. A grade 3/6 harsh SEM with a single loud S2 is heard at the LUSB. ECG shows RVH with RAD . CXR shows a boot- shaped heart and decreased pulmonary vascular markings. Which of the following is the most likely diagnosis? A. ASD B. Total anomalous pulmonary venous return C. Coarctation of the aorta D. Tetralogy of Fallot

D. Tetralogy of Fallot

A 76-year-old male presents after returning from a Safari in Africa. Seven days ago, he experienced CP lasting one hour that did not respond to three sublingual nitroglycerin tablets. There was no ability to have lab work or an EKG. The pain has not returned. If the patient had a non-STEMI myocardial infarction, which of the following studies will still be positive? A. Electrocardiogram B. Myoglobulin C. CK-MB index D. Troponin I

D. Troponin I Troponin levels will stay positive for at least one week

A 65-year-old female who recently had an anterior MI returns to clinic for follow-up six weeks after. She has no CP , but reports decreased exercise tolerance. EKG shows persistent ST elevation in leads V2- V4. Which of the following is the most likely diagnosis ? A RV infarction B. Pericarditis C. Re-occlusion of the RCA D. Ventricular aneurysm

D. Ventricular aneurysm

Four days after an anterior MI, a patient abruptly develops severe hypotension. A pansystolic murmur is heard at the LSB. Most likely diagnosis is: A. Pericardial tamponade B. Acute mitral regurgitation C. Right ventricular infarction D. Ventricular septal rupture

D. Ventricular septal rupture

A 56- year-old diabetic smoker describes progressive "tiredness" and "cramping" in his left calf for 6 to 8 months. Two years ago, he jogged 1 to 2 miles every day. Now walking 5 to 6 blocks or climbing stairs produces leg discomfort that is relieved with 2 to 3 minutes of rest. These symptoms are MOST consistent with A. Acute arterial insufficiency B. Deep venous thrombosis C. Thromboangitis obliterans (Buerger's disease) D. Arterial embolus E. Chronic arterial insufficiency

E. Chronic arterial insufficiency

A newborn presents with a possible cyanotic, CHD. Which of the following is in the differential diagnosis? A. Patent ductus arteriosus B. Coarctation of the aorta C. Atrial septal defect D. Aortic stenosis E. Complete transposition of the great arteries

E. Complete transposition of the great arteries Right to left shunt lesions

What diagnostic test will identify the most likely etiology of the patient's symptoms? A. Chest X-ray B. Pulmonary function tests C. Electrocardiogram (ECG) D. Holter monitor E. Echocardiogram

E. Echocardiogram

States associated with increased risk of venous thrombosis include all EXCEPT: A. Severe obesity B. Acute myocardial infarction C. Long periods of cramped sitting D. Malignancies E. Superficial varicosities

E. Superficial varicosities Virchow's Triad: Endothelial injury Hypercoagulable state Venous Stasis

A 62-year-old African-American male is seen for his yearly physical exam. He has no complaints. He denies any current medications or medical problems, but the occupational medicine nurse has taken his blood pressure several times in the past year and told him it was high. He denies any tobacco or alcohol use. His blood pressure is 156/92 today. What is the most likely cause of his elevated blood pressure? A. sleep apnea B. primary aldosteronism C. pheochromocytoma D. renal artery stenosis E. essential hypertension

E. essential hypertension

Septal EKG and Myocardium Location/Coronary artery

LAD V1-V3

Apical EKG and Myocardium Location/Coronary artery

LAD; RCA V3-V6

Anterior EKG and Myocardium Location/Coronary artery

LCA V1-V4, I, aVL