Cardio questions- TBC
C
A 12-year-old boy with Wolff-Parkinson-White syndrome presents with palpitations for the past hour. His blood pressure is 110/62 mm Hg and pulse is 166 bpm. The ECG reveals a narrow-complex tachycardia. Vagal maneuvers are ineffective. Which of the following is the next most appropriate management? AAdenosine BCardioversion CProcainamide DRadiofrequency ablation
D
A 14-day old boy is brought to clinic for a well-child check. The boy was born full-term via normal spontaneous vaginal delivery to a G2, P2 mother who had limited prenatal care. There were no complications at delivery. The boy has not yet regained birth weight and has been breastfeeding poorly. On physical examination, you note bluish discoloration of the lips and oral mucosa, clear breath sounds and a harsh left upper sternal border murmur. Which of the following chest X-ray findings is consistent with Tetralogy of Fallot? AEgg-shaped heart BHeart shaped like a snowman CIncreased pulmonary blood flow DLack of vascular congestion
B
A 16-year-old girl presents to the ED for a minor laceration repair of her forehead after a picture frame fell off the wall and hit her. Her vital signs are blood pressure 175/75 mm Hg, HR 80, and RR 14. The patient states on review of systems that she has had headaches, chest pain, and fatigue over the previous few months. You note a systolic murmur in the left infraclavicular area and under the left scapula. Which of the following is the most important next step in management? AArrange for outpatient follow-up for repeat blood pressure BObtain blood pressure readings in the upper and lower extremities COrder a renal ultrasound to evaluate for fibromuscular dysplasia of the renal arteries DSend electrolytes and urinalysis in preparation to begin antihypertensive therapy
C
A 19-year-old man presents to the ED after a syncopal event. The patient states that he was moving a large pile of wood in his backyard and then suddenly became dizzy. He awoke with his neighbor standing over him asking if he was okay. On exam, you note a loud crescendo-decrescendo systolic murmur at the left lower sternal border. He has a family history of a "heart condition." Which of the following maneuvers will accentuate the murmur? ALeg elevation BSquatting CStanding DTrendelenburg
D
A 24-year-old woman with no past medical history presents with left wrist pain after a fall. The left extremity is grossly deformed and the patient complains of severe pain. The patient has a blood pressure of 183/100 mm Hg. While awaiting X-rays, what management is indicated for the patients elevated blood pressure? AArrange admission for blood pressure control BStart an oral beta-blocker and monitor for response CStart intravenous beta-blocker and admit to the intensive care unit DTreat the patient's pain and reassess the blood pressure
C
A 30-year-old woman with no past medical history presents to the emergency department complaining of substernal chest pain for two hours. It is not worse with exertion and was not relieved by sublingual nitroglycerin. She admits to some mild nausea. She does not smoke cigarettes or use any illicit drugs. Her family history includes a grandmother who died of a myocardial infarction at 84-years-old. Labs in the emergency department are unremarkable. Point of care troponin is negative and ECG reveals sinus rhythm. What is your next step in management? ADobutamine stress test BExercise stress test CReassurance DStress echocardiography
C
A 34-year-old man presents to the emergency department with complaints of worsening chest pain, fever, and malaise. The pain is pleuritic, worsens when he lies down and improves when he leans forward. On exam, he appears unwell, but is not in acute distress. Auscultation over the precordium reveals a scratchy, grating sound with a normal S1 and S2. Which of the following is the most likely electrocardiogram finding in this patient? AShortened PR interval and slurring of the QRS complex BST segment depression in leads V2-V4 CST segment elevation with reciprocal ST depression in leads aVR and V1 DU waves and flat T waves
B
A 37-year-old woman with a history of Wolff-Parkinson-White presents to the emergency department with shortness of breath and lightheadedness. Her vital signs on arrival are T 36.9°C, HR 160, BP 80/50, RR 27. Her ECG reveals a narrow complex regular tachycardia. Which of the following is the most appropriate next step in the management of this patient? AAdenosine BCardioversion CFluid bolus DProcainamide
D
A 39-year-old man presents to the ED complaining of general weakness. He has signs of an upper respiratory infection on exam. His rhythm strip is seen above. Which of the following is the most appropriate next step in management? AAdminister 325 mg aspirin and send for a troponin BApply transcutaneous pacemakers and admit CConsult cardiology DSymptomatic care and discharge
C
A 5-week-old infant suffers from dyspnea and fluid overload, but not cyanosis. Auscultation reveals a loud, holosystolic murmur at the lower left sternal border. You suspect a congenital cardiac defect. Echocardiography would most likely show which of the following abnormalities? AAorta is connected to the right ventricle BPulmonary artery is connected to the left ventricle CVentricular septal defect in the membranous portion DVentricular septal defect in the muscular portion
C
A 5-year-old girl with Turner syndrome is found to have systolic hypertension. Further examination reveals diminished femoral pulses. Which of the following is the best initial test for establishing the most likely diagnosis? ACardiac catheterization BChest X-ray CEchocardiogram DElectrocardiogram
D
A 50-year-old woman with a history of mitral stenosis secondary to rheumatic fever presents with atrial fibrillation. She does not have a history of heart failure, hypertension, diabetes mellitus or previous stroke or transient ischemic attack. What is the most appropriate management for this patient? AAspirin BDabigatran CNo anticoagulation DWarfarin
A
A 59-year-old man presents complaining of a severe headache for three days that came on gradually, and is diffuse in nature. His blood pressure is 205/105 mm Hg. All other vital signs are normal. His physical exam and basic laboratory workup are negative. His electrocardiogram is shown above. Which of the following antihypertensives is contraindicated in this patient? AAtenolol BEnalapril CHydralazine DHydrochlorothiazide
A- Carvadilol, Bisoprolol, Metoprolol are the best cardio-selective BBs
A 60-year-old man presents with nighttime dyspnea. His medical history is significant for chronic hypertension. A recent echocardiogram showed an increase in left ventricular chamber volume but normal ventricular wall thickness. Based on this finding alone, which of the following medications is the most appropriate treatment for this patient's dyspnea? ABisoprolol BPropranolol CSalmeterol DTimolol
B- because he is asx and is not >180/120
A 64-year-old man with a history of hypertension presents to the Emergency Department requesting medication refills. He states that he has not taken his medications for the last 2 weeks. His blood pressure is 190/100 mm Hg. He has no complaints at this time. He has prescription bottles for atenolol and hydrochlorothiazide. What management is indicated? AChange his medications to a calcium-channel blocker BGive the patient a prescription for his medications and refer to his primary doctor in 48 hours CStart intravenous labetalol and admit to the floor DStart intravenous labetalol and admit to the intensive care unit
C- cause he is stable. otherwise D
A 65-year-old man is brought to the ED complaining of nausea for the last two hours. On arrival to the emergency department, he has the cardiac rhythm seen above. His blood pressure is 110/70 mm Hg. He denies any headache, chest pain, or difficulty breathing. Which of the following is the most appropriate next step in management? ADefibrillation BMagnesium sulfate CProcainamide DSynchronized cardioversion
D
A 68-year-old man is being managed on a multi-drug antihypertensive regimen for essential hypertension. His blood pressure is at goal, but he notes persistent constipation and bilateral pedal edema. Which of the following medications is most likely responsible for these side effects? AEnalapril BLosartan CMetoprolol DVerapamil
C
A 71-year-old woman presents with 2 days of dizziness and "almost passing out." Her ECG shows episodes of alternating bradycardia and tachycardia with narrow QRS complexes. Which of the following is the most likely diagnosis? AAtrial flutter BDigitalis toxicity CSick sinus syndrome DVentricular tachycardia
B
A 72-year-old man presents for evaluation of palpitations. He has a regular, wide complex tachycardia at a rate of 140 bpm. Which of the following supports a diagnosis of ventricular tachycardia? ADiscordance of the QRS axis in the precordial leads BFusion beats CLeftward axis DST elevation greater than 5 mm
C
A 73-year-old man with a history of hypertension and COPD presents with the ECG seen above. Which of the following is the correct diagnosis? AAtrial fibrillation BAtrial flutter CMultifocal atrial tachycardia DWandering pacemaker
B
A continuous systolic-diastolic murmur is auscultated in a 3-week-old dyspneic infant. She is tachypneic and diaphoretic. Her mother reports weight loss and poor feeding. Doppler color-flow imaging reveals high velocity jets in the pulmonary artery. This patient will most likely undergo which of the following corrective surgeries? AArterial-switch BLigation CShunting DValvulotomy
D- UA is initial, C is best Dx
A detailed history and examination does not aid in the evaluation of new-onset hypertension in a 47-year-old man. In an attempt to search for an underlying cause, you order a basic metabolic panel, complete blood count, lipid panel and ECG. Which of the following tests should also be added to this standard diagnostic screen of secondary hypertension? AAortic ultrasound BEchocardiogram CRenal angiogram DUrinalysis
B
A patient with dyspnea and angina fails medication management of his symptoms with beta-blockers, ACE-inhibitors and calcium channel blockers. He undergoes complete cardiac evaluation which uncovers the presence of nonobstructive, end-stage hypertrophic cardiomyopathy. Which of the following is the most appropriate treatment at this point in time? AAggressive diuresis BCardiac transplantation CImplantable intracardiac pacing DSurgical myectomy
D
According to JNC-8, patients older than 60 years with hypertension and no other medical history, should be treated to which of the following blood pressure goals? A< 120/80 mm Hg B< 130/85 mm Hg C< 140/85 mm Hg D< 150/90 mm Hg
D- Brugada syndrome causes you to die from Ventricular arrhymias
An 18-year-old male undergoes an electrocardiogram as part of a sports physical for his college soccer team. The electrocardiogram was read as abnormal, and he was sent to the ED for evaluation. His electrocardiogram is shown above. Which of the following is the most common complication found with the suspected diagnosis? AAtrial fibrillation BEisenmenger's syndrome CType 2 second-degree heart block DVentricular fibrillation
B
Closure of the ductus arteriosus begins when levels of which of the following substances increases in the immediate post-natal period? AAdrenocorticotrophic hormone BBradykinin CProstaglandin E1 DPulmonary surfactant
C
During a well-child visit, a 9-year-old boy and his father ask about health safety and sports activity. The boy wants to play baseball. His medical history is significant for tetralogy of Fallot, which was surgically corrected when he was 3-years-old. His last echocardiogram shows a right ventricular pressure to be < 50 mm Hg. Which of the following recommendations do you make? AA functional capacity evaluation is needed first BHe may only play leisure sports, like golf or cycling CIt is safe for him to play any sport, including baseball DThe boy should abstain from all sports and physical education class
B
In which of the following conditions is hypoxemia caused by a right-to-left shunt? AAsthma BEisenmenger syndrome CPatent foramen ovale DPulmonary embolism
C
What is the most common cause for syncope in a patient with a non-specific history, normal physical exam and normal ECG? ADysrhythmia BHypovolemia CIdiopathic DVasovagal
B
Which of the following agents is first line for rate control in atrial fibrillation with rapid ventricular response in the setting of compensated systolic heart failure? AAmiodarone BCarvedilol CDigoxin DDiltiazem
D- can cause V-Tach
Which of the following antiarrhythmic medications is contraindicated in the setting of coronary artery or structural heart disease? AAmiodaroner BDofetilide CDronedarone DFlecainide
B- think of this ANY TIME YOU SEE A SHORT PR INTERVAl. (Delta wave is due to delayed conduction)
Which of the following describes ECG findings in Wolff-Parkinson-White Syndrome? AThe delta wave reflects rapid conduction through the AV node BThe PR interval is shortened in sinus rhythm CThe QRS complex is typically narrow in sinus DThe QT segment is prolonged in sinus rhythm
C- think lOw things. HYPO- calcemia, HYPO-kalemia, lOng QT
Which of the following is a cause of torsades de pointes? ADrugs that shorten the QT interval BHyperkalemia CHypocalcemia DMarijuana use
C- aka pericarditis after MI
Which of the following is a late complication of acute myocardial infarction? ACardiogenic shock BComplete heart block CDressler syndrome DPulmonary edema
C- biggest Risk with long QTC is Torsades which is caused by tachy rhythm. So you want to rate control to avoid this with a BB.
Which of the following is a medical treatment for congenital long QT syndrome? AFlecainide BPropafenone CPropranolol DQuinidine
D
Which of the following is recommended for the treatment of systolic heart failure according to New York Heart Association (NYHA) functional class? AAnticoagulation for NYHA class I-IV heart failure regardless of ejection fraction BCalcium channel blockers for NYHA class III-IV heart failure and ejection fraction < 40% CHydralazine plus nitrates for white patients with NYHA class III-IV heart failure and ejection fraction < 40% DSpironolactone for NYHA class III-IV heart failure and ejection fraction < 35%
B
Which of the following patients should be classified as having unstable angina? AA 51-year-old woman who had chest pain three days ago but now is chest pain free and is found to have a positive troponin with Q waves in leads II, III, and aVF, without ST elevations BA 55-year-old woman with a history of hypertension but no prior cardiac disease who complains of one episode of chest pressure that began while pushing her grocery cart and lasted 30 minutes CA 65-year-old man with a known history of coronary artery disease who gets chest pain and shortness of breath every time he climbs the steps to his bedroom DA 71-year-old man who underwent a coronary catheterization one month ago for early morning chest pain that showed minimal coronary artery disease with no fixed lesions presents with recurrent early morning chest pain that is relieved by nitroglycerin
B
Which of the following patients with atrial fibrillation has the greatest risk for complications from anticoagulation therapy? AA 64-year-old woman with hypertension and history of colon cancer BA 66-year-old man with a history of hypertension, diabetes, and ethanol abuse CA 79-year-old man with a history of congestive heart failure DA 90-year-old otherwise healthy woman
A
While performing a routine physical examination, a provider notices a distinct decrease in the strength of the patient's radial pulse during inspiration. Which of the following conditions does this patient likely have? AConstrictive pericarditis BDiabetes mellitus CSubclavian steal syndrome DTietze syndrome