Cardiology Exam 3 Review

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Cardiology Quizzes & Trivia

Questions and Answers
  • 1. 

    Which of the following is a common finding in constrictive pericarditis?

    • A.

      Thickened, very compliant fibrotic pericardium

    • B.

      Elevated systemic venous pressure

    • C.

      Increased cardiac output

    • D.

      Increased left ventricular preload

    • E.

      Increased diastolic filling

    Correct Answer
    B. Elevated systemic venous pressure
    Explanation
    Constrictive pericarditis is characterized by the thickening and fibrosis of the pericardium, leading to reduced compliance and restriction of cardiac filling. This results in elevated systemic venous pressure due to impaired filling of the heart during diastole. Other findings may include decreased cardiac output, increased left ventricular preload, and impaired diastolic filling due to the constriction of the heart by the rigid pericardium. However, the most prominent and common finding in constrictive pericarditis is elevated systemic venous pressure.

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  • 2. 

    Ventricular interdependence in constrictive pericarditis refers to which of the following?

    • A.

      Dependence of amount of blood flow into each ventricle during a typical breathing cycle

    • B.

      Shifting of interventricular septum towards the left ventricle during expiration

    • C.

      Greater increase in blood flow into the left ventricle during inspiration compared to that for the right ventricle

    • D.

      Permanent shifting of the interventricular septum towards the left ventricle due to thickened pericardium

    • E.

      Inadequate blood flow into the ventricles during inspiration

    Correct Answer
    A. Dependence of amount of blood flow into each ventricle during a typical breathing cycle
    Explanation
    Ventricular interdependence in constrictive pericarditis refers to the dependence of the amount of blood flow into each ventricle during a typical breathing cycle. In constrictive pericarditis, the thickened pericardium restricts the expansion of the ventricles during inspiration, leading to decreased filling of both ventricles. This causes an imbalance in the blood flow between the left and right ventricles. During inspiration, the increased blood flow into the left ventricle is dependent on the decreased blood flow into the right ventricle. This interdependence is a characteristic feature of constrictive pericarditis.

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  • 3. 

    Which of the following findings should be utilized in the diagnosis of constrictive pericarditis and its differentiation from restrictive cardiomyopathy?

    • A.

      Doppler echocardiogram – ventricular interdependence

    • B.

      Endomyocardial biopsy – absence of amyloidosis or other infiltrative disease

    • C.

      CT/MRI imaging – thickened pericardium

    • D.

      Chest radiography – pericardial calcification

    • E.

      All of the above

    Correct Answer
    E. All of the above
    Explanation
    All of the above findings should be utilized in the diagnosis of constrictive pericarditis and its differentiation from restrictive cardiomyopathy. Doppler echocardiogram can show ventricular interdependence, which is a characteristic feature of constrictive pericarditis. Endomyocardial biopsy can help rule out amyloidosis or other infiltrative diseases that can present with similar symptoms. CT/MRI imaging can show thickened pericardium, another characteristic finding in constrictive pericarditis. Chest radiography can reveal pericardial calcification, which is often seen in chronic constrictive pericarditis. Therefore, all of these findings are important in making a definitive diagnosis and differentiating it from restrictive cardiomyopathy.

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  • 4. 

    Pericardial stripping is a surgical procedure where the entire pericardium is peeled away from the heart.  Which of the following pathologies may require this type of intervention?

    • A.

      Primary cardiomyopathy

    • B.

      Infective endocarditis

    • C.

      Restrictive cardiomyopathy

    • D.

      Constrictive pericarditis

    • E.

      Hypertrophic cardiomyopathy

    Correct Answer
    D. Constrictive pericarditis
    Explanation
    Constrictive pericarditis is the correct answer because it is a condition characterized by inflammation and scarring of the pericardium, which leads to the thickening and stiffening of the pericardial sac. This can result in impaired filling of the heart and decreased cardiac output. Pericardial stripping may be necessary in severe cases of constrictive pericarditis to remove the thickened and scarred pericardium, allowing for improved heart function. Primary cardiomyopathy, infective endocarditis, restrictive cardiomyopathy, and hypertrophic cardiomyopathy are not typically treated with pericardial stripping.

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  • 5. 

    Which of the following key signs is found in acute pericarditis?

    • A.

      Chest pain

    • B.

      Audible pericardial friction rub

    • C.

      Dyspnea on exertion

    • D.

      ST segment changes on ECG

    • E.

      Fever

    Correct Answer
    B. Audible pericardial friction rub
    Explanation
    In acute pericarditis, an audible pericardial friction rub is a key sign. This is a scratching or grating sound heard on auscultation of the heart, caused by the inflamed pericardial layers rubbing against each other. Chest pain is also commonly present in acute pericarditis, along with fever. Dyspnea on exertion can occur due to the inflammation and fluid accumulation in the pericardial sac. ST segment changes on ECG may also be seen in acute pericarditis, but the most specific and characteristic sign is the audible pericardial friction rub.

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  • 6. 

    Beck's triad is a collection of three medical signs associated with acute cardiac tamponade, an emergency condition wherein fluid accumulates around the heart and impairs its ability to pump blood.   Which of the following Beck’s triad sign are consistent with diagnosis of cardiac tamponade?

    • A.

      Jugular vein distension, exaggerated heart sounds, hypertension

    • B.

      Hepatojugular reflux, pericardial friction rub, T-wave depression

    • C.

      Hypotension, jugular vein distension, muffled heart sounds

    • D.

      Hypotension, tachycardia, tachypnea

    • E.

      Dullness to percussion beneath the angle of left scapula, accumulation of pericardial fluid, muffled heart sounds

    Correct Answer
    C. Hypotension, jugular vein distension, muffled heart sounds
    Explanation
    The signs of hypotension, jugular vein distension, and muffled heart sounds are consistent with the diagnosis of cardiac tamponade. Hypotension indicates low blood pressure, which can be caused by the impaired ability of the heart to pump blood due to fluid accumulation. Jugular vein distension occurs when there is increased pressure in the veins leading to the heart, which can be a result of fluid accumulation. Muffled heart sounds suggest that the fluid around the heart is interfering with its normal functioning and ability to produce clear sounds. Therefore, these signs together indicate the presence of cardiac tamponade.

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  • 7. 

    Which of the following tests is useful in late diagnosis of myocardial infarction?

    • A.

      Troponin test

    • B.

      Prothrombin test

    • C.

      Creatine kinase (CK-MB) test

    • D.

      Myoglobin (Mb) test

    • E.

      Ischemia-modified serum albumin (IMA) test

    Correct Answer
    C. Creatine kinase (CK-MB) test
    Explanation
    The Creatine kinase (CK-MB) test is useful in the late diagnosis of myocardial infarction. CK-MB is an enzyme found predominantly in the heart muscle, and its levels in the blood rise within a few hours after a heart attack. By measuring CK-MB levels, doctors can determine if there has been damage to the heart muscle and confirm the diagnosis of myocardial infarction. Other tests like the Troponin test, Prothrombin test, Myoglobin test, and Ischemia-modified serum albumin (IMA) test may also be used in the diagnosis of myocardial infarction, but the CK-MB test specifically detects heart muscle damage.

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  • 8. 

    A 45-year-old man is admitted to the hospital for symptoms of severe congestive heart failure, including dyspnea on exertion, swelling in the legs, and difficulty lying down flat in bed.  Which of the following would be most consistent with chronic alcohol consumption?

    • A.

      Restrictive cardiomyopathy

    • B.

      Valvular stenosis

    • C.

      Pericardial effusion

    • D.

      Dilated cardiomyopathy

    • E.

      Acute coronary syndrome

    Correct Answer
    D. Dilated cardiomyopathy
    Explanation
    Chronic alcohol consumption can lead to dilated cardiomyopathy. This condition is characterized by the enlargement of the heart chambers, resulting in decreased pumping ability and heart failure symptoms such as dyspnea on exertion, leg swelling, and difficulty lying flat in bed. Restrictive cardiomyopathy, valvular stenosis, pericardial effusion, and acute coronary syndrome are not directly associated with chronic alcohol consumption.

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  • 9. 

    A 39-year-old man arrives at the emergency department with 2 weeks of fever, night sweats, and arthralgias.  The physical examination discloses a heart murmur, lower extremity petechiae, splinter hemorrhages on his nail beds, and small nonpainful hemorrhagic patches on his palms and soles of his feet.  What is the most likely diagnosis in this patient?

    • A.

      Acute rheumatic fever

    • B.

      Infective endocarditis

    • C.

      Marfan's syndrome

    • D.

      Primary cardiomyopathy

    • E.

      Secondary cardiomyopathy

    Correct Answer
    B. Infective endocarditis
    Explanation
    The most likely diagnosis in this patient is infective endocarditis. The presence of fever, night sweats, arthralgias, heart murmur, lower extremity petechiae, splinter hemorrhages, and hemorrhagic patches on the palms and soles are all consistent with the clinical manifestations of infective endocarditis. Acute rheumatic fever is unlikely as it typically presents with migratory polyarthritis and carditis, which are not described in this patient. Marfan's syndrome is not associated with the specific findings mentioned. Primary and secondary cardiomyopathies do not typically present with the same constellation of symptoms and physical examination findings as seen in this patient.

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  • 10. 

    A 55-year old male presents with complaints of chest pain and dyspnea of several days duration.  He further describes his chest pain as worst while lying down and somewhat better with sitting up.  His physical exam is unremarkable, except for a pericardial friction rub and an elevated temperature of 101.2°F.  What is the most likely etiology for this clinical presentation?

    • A.

      Congestive heart failure

    • B.

      Endocarditis

    • C.

      Pericarditis

    • D.

      Pleural effusion

    • E.

      Coronary artery disease

    Correct Answer
    C. Pericarditis
    Explanation
    The patient's symptoms of chest pain that worsens while lying down and improves with sitting up, along with the presence of a pericardial friction rub and an elevated temperature, are indicative of pericarditis. Pericarditis is inflammation of the pericardium, the sac-like membrane surrounding the heart. It commonly presents with chest pain that is sharp and pleuritic in nature, worsened by lying down and improved by sitting up. The pericardial friction rub heard on physical examination is a classic finding in pericarditis.

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  • 11. 

    A 28 y/o male comes to the emergency room complaining of 6 days of fever with shaking chills. Over the past two days he has also developed a productive cough with greenish sputum. He has also noticed that occasionally the sputum is blood streaked. He reports to having no dyspnea, but sometimes he does experience chest pain upon deep inspiration. He does not have headaches, abdominal pain, urinary symptoms. No nausea, vomiting, or diarrhea. No significant past medical history. He does smoke. He drinks several beers daily. Denies IV drug use. Upon physical examination, his oral temperature was recorded at 102.5 degrees F. His heart rate was 109 bpm and his BP was 128/76. His respiration count was 23 per minute. He was alert awake and oriented. He has no oral lesions and his fundoscopic exam was normal. He has no JVD and his heart was appreciated with tachycardia and had a harsh holosystolic murmur heard at the left lower sternal border that increased with inspiration. His lung exam exhibited inspiratory rales bilaterally. On both forearms, he has linear streaks of induration, hyperpigmentation, with small nodules overlaying the superficial veins.  The labs ran were appreciative of the following: WBC: 17,500/mm3 84% polymorphonuclear cells Platelets: 189,000 Liver function: normal Urinalysis: normal CXR: showed multiple peripheral ill-defined nodules with some cavitations What kind of valvular problem does this patient elicit?

    • A.

      Mitral valve regurgitation

    • B.

      Mitral valve prolapse

    • C.

      Tricuspid valve regurgitation

    • D.

      Tricuspid valve prolapse

    • E.

      Aortic valve regurgitation

    Correct Answer
    C. Tricuspid valve regurgitation
    Explanation
    Based on the patient's symptoms and physical examination findings, as well as the laboratory and imaging results, the patient is likely experiencing tricuspid valve regurgitation. The patient has a history of fever, productive cough with greenish sputum, and blood streaked sputum, which are suggestive of a respiratory infection. The presence of a harsh holosystolic murmur heard at the left lower sternal border that increases with inspiration indicates tricuspid valve involvement. The inspiratory rales bilaterally suggest pulmonary involvement. The CXR findings of multiple peripheral ill-defined nodules with some cavitations further support the diagnosis of tricuspid valve regurgitation.

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  • 12. 

    A 28 y/o male comes to the emergency room complaining of 6 days of fever with shaking chills. Over the past two days he has also developed a productive cough with greenish sputum. He has also noticed that occasionally the sputum is blood streaked. He reports to having no dyspnea, but sometimes he does experience chest pain upon deep inspiration. He does not have headaches, abdominal pain, urinary symptoms. No nausea, vomiting, or diarrhea. No significant past medical history. He does smoke. He drinks several beers daily. Denies IV drug use.  Upon physical examination, his oral temperature was recorded at 102.5 degrees F. His heart rate was 109 bpm and his BP was 128/76. His respiration count was 23 per minute. He was alert awake and oriented. He has no oral lesions and his fundoscopic exam was normal. He has no JVD and his heart was appreciated with tachycardia and had a harsh holosystolic murmur heard at the left lower sternal border that increased with inspiration. His lung exam exhibited inspiratory rales bilaterally. On both forearms, he has linear streaks of induration, hyperpigmentation, with small nodules overlaying the superficial veins.  The labs ran were appreciative of the following: WBC: 17,500/mm3 84% polymorphonuclear cells Platelets: 189,000 Liver function: normal Urinalysis: normal CXR: showed multiple peripheral ill-defined nodules with some cavitations  What is your differential diagnosis?

    Correct Answer
    infective endocarditis
    bacterial infective endocarditis
    infective endocarditis with septic embolus
    endocarditis
    bacterial endocarditis
    bacterial endocarditis with septic embolus
    bacterial endocarditis with bacteremia
    infective endocarditis with bacteremia
    infective endocarditis with septic embolus and bacteremia
    Explanation
    The patient's presentation is consistent with infective endocarditis. The presence of fever with shaking chills, productive cough with greenish sputum, and blood streaked sputum suggest an infectious process. The patient also has a harsh holosystolic murmur heard at the left lower sternal border that increases with inspiration, which is indicative of a valvular abnormality. The linear streaks of induration, hyperpigmentation, and small nodules overlaying the superficial veins on the forearms are suggestive of Janeway lesions, which are seen in infective endocarditis. The CXR findings of multiple peripheral ill-defined nodules with cavitations further support the diagnosis of infective endocarditis with septic embolus. The elevated WBC count and presence of polymorphonuclear cells indicate an inflammatory response.

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  • 13. 

    A 28 y/o male comes to the emergency room complaining of 6 days of fever with shaking chills. Over the past two days he has also developed a productive cough with greenish sputum. He has also noticed that occasionally the sputum is blood streaked. He reports to having no dyspnea, but sometimes he does experience chest pain upon deep inspiration. He does not have headaches, abdominal pain, urinary symptoms. No nausea, vomiting, or diarrhea. No significant past medical history. He does smoke. He drinks several beers daily. Denies IV drug use.  Upon physical examination, his oral temperature was recorded at 102.5 degrees F. His heart rate was 109 bpm and his BP was 128/76. His respiration count was 23 per minute. He was alert awake and oriented. He has no oral lesions and his fundoscopic exam was normal. He has no JVD and his heart was appreciated with tachycardia and had a harsh holosystolic murmur heard at the left lower sternal border that increased with inspiration. His lung exam exhibited inspiratory rales bilaterally. On both forearms, he has linear streaks of induration, hyperpigmentation, with small nodules overlaying the superficial veins.  The labs ran were appreciative of the following: WBC: 17,500/mm3 84% polymorphonuclear cells Platelets: 189,000 Liver function: normal Urinalysis: normal CXR: showed multiple peripheral ill-defined nodules with some cavitations  How would you proceed? (Check all that apply)

    • A.

      Run a sputum culture

    • B.

      Treat immediately with Ampicillin

    • C.

      Treat immediately with Gentamicin

    • D.

      Run a blood culture at least twice from different sites at different times

    • E.

      Run a blood culture when the patient is spiking a fever

    Correct Answer(s)
    A. Run a sputum culture
    D. Run a blood culture at least twice from different sites at different times
    E. Run a blood culture when the patient is spiking a fever
    Explanation
    After hearing a recording of our cardiology lecture, Santana said specifically: "You want to wait until after you get your lab results back to treat the patient with medication". His reasoning was that you don't know if it's a fungal infection or bacterial and if it's bacterial... you dont know what kind of bacteria it is.....

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  • 14. 

    A 28 y/o male comes to the emergency room complaining of 6 days of fever with shaking chills. Over the past two days he has also developed a productive cough with greenish sputum. He has also noticed that occasionally the sputum is blood streaked. He reports to having no dyspnea, but sometimes he does experience chest pain upon deep inspiration. He does not have headaches, abdominal pain, urinary symptoms. No nausea, vomiting, or diarrhea. No significant past medical history. He does smoke. He drinks several beers daily. Denies IV drug use. Upon physical examination, his oral temperature was recorded at 102.5 degrees F. His heart rate was 109 bpm and his BP was 128/76. His respiration count was 23 per minute. He was alert awake and oriented. He has no oral lesions and his fundoscopic exam was normal. He has no JVD and his heart was appreciated with tachycardia and had a harsh holosystolic murmur heard at the left lower sternal border that increased with inspiration. His lung exam exhibited inspiratory rales bilaterally. On both forearms, he has linear streaks of induration, hyperpigmentation, with small nodules overlaying the superficial veins.  The labs ran were appreciative of the following: WBC: 17,500/mm3 84% polymorphonuclear cells Platelets: 189,000 Liver function: normal Urinalysis: normal CXR: showed multiple peripheral ill-defined nodules with some cavitations  This patient is allergic to Penicillin. What medications can you use to treat this patient? (choose all applicable options)

    • A.

      Cephalexin

    • B.

      Amoxicillin

    • C.

      Clindamycin

    • D.

      Apmicillin

    • E.

      Azithromycin

    Correct Answer(s)
    A. Cephalexin
    C. Clindamycin
    E. Azithromycin
    Explanation
    Based on the patient's symptoms and physical examination findings, as well as the CXR results, it is likely that the patient has community-acquired pneumonia with lung abscesses. The presence of blood streaked sputum and the harsh holosystolic murmur suggest the possibility of septic emboli from the lung abscesses. Given that the patient is allergic to Penicillin, Cephalexin, Clindamycin, and Azithromycin can be used as alternative antibiotics for the treatment of this patient's condition.

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  • 15. 

    A 28 y/o male comes to the emergency room complaining of 6 days of fever with shaking chills. Over the past two days he has also developed a productive cough with greenish sputum. He has also noticed that occasionally the sputum is blood streaked. He reports to having no dyspnea, but sometimes he does experience chest pain upon deep inspiration. He does not have headaches, abdominal pain, urinary symptoms. No nausea, vomiting, or diarrhea. No significant past medical history. He does smoke. He drinks several beers daily. Denies IV drug use. Upon physical examination, his oral temperature was recorded at 102.5 degrees F. His heart rate was 109 bpm and his BP was 128/76. His respiration count was 23 per minute. He was alert awake and oriented. He has no oral lesions and his fundoscopic exam was normal. He has no JVD and his heart was appreciated with tachycardia and had a harsh holosystolic murmur heard at the left lower sternal border that increased with inspiration. His lung exam exhibited inspiratory rales bilaterally. On both forearms, he has linear streaks of induration, hyperpigmentation, with small nodules overlaying the superficial veins.  The labs ran were appreciative of the following: WBC: 17,500/mm3 84% polymorphonuclear cells Platelets: 189,000 Liver function: normal Urinalysis: normal CXR: showed multiple peripheral ill-defined nodules with some cavitations  This patient is allergic to Penicillin and is unable to take oral medications. What medications would you use to treat this patient?

    • A.

      Ampicillin

    • B.

      Clindamycin

    • C.

      Cefazolin

    • D.

      Clarithromycin

    Correct Answer
    C. Cefazolin
    Explanation
    Based on the patient's symptoms and physical examination findings, as well as the CXR results, the most likely diagnosis is community-acquired pneumonia with lung abscess formation. The patient's symptoms of fever, productive cough with greenish sputum, and blood streaked sputum, along with the physical examination findings of tachycardia, harsh holosystolic murmur, and inspiratory rales, are consistent with this diagnosis. The CXR findings of multiple peripheral ill-defined nodules with cavitations further support this diagnosis. Cefazolin is an appropriate choice for the treatment of community-acquired pneumonia, especially in patients who are allergic to penicillin.

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  • 16. 

    A 68 y/o male is hospitalized with Streptococcus bovis. He has endocarditis involving the mitral valve. He recovers completely with the appropriate therapy. What's your next step?

    • A.

      Suggest good dental hygiene plus proper dental fitting of false teeth to prevent reinfection and damage of the mitral valve

    • B.

      Repeat echo in six weeks to ensure that the vegetations have resolved

    • C.

      Do a colonoscopy to look for mucosal lesions

    • D.

      Mitral valve replacement to prevent systemic embolic events

    Correct Answer
    C. Do a colonoscopy to look for mucosal lesions
    Explanation
    Streptococcus bovis is known to contribute to colon carcinoma. You want to look at the colon!

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  • 17. 

    A 24 y/o IVDA is admitted with 4 weeks of fever. He has 3 blood cultures that are positive for candidiasis. He suddenly develops a cold blue toe. What's your next step?

    • A.

      Repeat the echo to see if the large aortic vegetation previously seen has embolized

    • B.

      Cardiovascular surgery consult for aortic valve replacement

    • C.

      Aortic angiography to evaluate if that is where the mycotic infection is and if it's a mycotic aneurysm

    • D.

      Switch him from Fluconazole to Amphoterecin B

    Correct Answer
    C. Aortic angiography to evaluate if that is where the mycotic infection is and if it's a mycotic aneurysm
    Explanation
    The patient's presentation of a sudden cold blue toe suggests a possible embolization from the large aortic vegetation. Aortic angiography would be the next step to evaluate if the mycotic infection has caused a mycotic aneurysm and to determine the location of the infection. This would help guide further management decisions, such as the need for surgical intervention or a change in antifungal therapy. Switching the antifungal medication alone would not address the underlying cause of the embolization.

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  • 18. 

    Which of the following patients needs antimicrobial prophylaxis before dental surgery?

    • A.

      Patient with Atrial Septal Defect

    • B.

      Patient with Mitral Valve Prolapse without Mitral Regurgitation

    • C.

      Patient with previous Coronary Artery Bypass Graft

    • D.

      Patient with previous Infectious Endocarditis

    Correct Answer
    D. Patient with previous Infectious Endocarditis
    Explanation
    Patients with previous Infectious Endocarditis need antimicrobial prophylaxis before dental surgery. Infectious Endocarditis is an infection of the inner lining of the heart chambers and valves. Dental procedures can introduce bacteria into the bloodstream, which can then travel to the heart and cause an infection in individuals with a history of Infectious Endocarditis. Therefore, to prevent this complication, these patients should receive antimicrobial prophylaxis before dental surgery. Atrial Septal Defect, Mitral Valve Prolapse without Mitral Regurgitation, and previous Coronary Artery Bypass Graft do not necessarily require antimicrobial prophylaxis before dental surgery.

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  • 19. 

    A 35 y/o woman is noted to have a positive Kussmaul sign. Which of the following conditions does she most likely have?

    • A.

      Constrictive pericarditis

    • B.

      Cardiac tamponade

    • C.

      Dilated cardiomyopathy

    • D.

      Diabetic ketoacidosis

    Correct Answer
    A. Constrictive pericarditis
    Explanation
    A positive Kussmaul sign refers to an abnormal increase in jugular venous pressure (JVP) during inspiration. This is commonly seen in constrictive pericarditis, a condition characterized by the thickening and stiffening of the pericardium, the sac that surrounds the heart. In constrictive pericarditis, the pericardium restricts the heart's ability to expand during diastole, leading to increased JVP. Cardiac tamponade, dilated cardiomyopathy, and diabetic ketoacidosis are not typically associated with a positive Kussmaul sign.

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  • 20. 

    Which of the following is the most sensitive finding in patients with cardiac tamponade?

    • A.

      Disappearance of radial pulse during inspiration

    • B.

      Drop in systolic blood pressure more than 10 mm Hg during inspiration

    • C.

      Rise in heart rate more than 20 bpm during inspiration

    • D.

      Distant heart sounds

    Correct Answer
    B. Drop in systolic blood pressure more than 10 mm Hg during inspiration
    Explanation
    A drop in systolic blood pressure more than 10 mm Hg during inspiration is the most sensitive finding in patients with cardiac tamponade. Cardiac tamponade is a condition where fluid accumulates in the pericardial sac, compressing the heart and impairing its ability to fill and pump blood effectively. During inspiration, the negative intrathoracic pressure causes an increase in venous return to the heart. In patients with cardiac tamponade, this increased venous return further compromises cardiac output, leading to a significant drop in systolic blood pressure. This finding is considered the most sensitive because it directly reflects the hemodynamic consequences of cardiac tamponade.

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  • 21. 

    While awaiting pericardiocentesis, immediate supportive care of a patient with cardiac tamponade should include which of the following?

    • A.

      Diuresis with furosemide

    • B.

      Intravenous fluids

    • C.

      Nitrates to lower venous congestion

    • D.

      Morphine to relieve dyspnea

    Correct Answer
    B. Intravenous fluids
    Explanation
    Intravenous fluids should be included in the immediate supportive care of a patient with cardiac tamponade. Cardiac tamponade is a condition where fluid accumulates in the pericardial sac, putting pressure on the heart and impairing its ability to pump blood effectively. Intravenous fluids help to increase the volume of circulating blood, which can improve cardiac output and blood pressure. This is important in managing cardiac tamponade as it helps to maintain organ perfusion and prevent further deterioration. Diuresis with furosemide, nitrates, and morphine may be used in certain cases, but intravenous fluids are the most essential initial intervention.

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  • 22. 

    Which of the following is most likely to cause restrictive cardiomyopathy?

    • A.

      Endomyocardial fibrosis

    • B.

      Viral myocarditis

    • C.

      Beriberi (thiamine deficiency)

    • D.

      Doxorubicin therapy

    Correct Answer
    A. Endomyocardial fibrosis
    Explanation
    Endomyocardial fibrosis is the most likely cause of restrictive cardiomyopathy. This condition involves the thickening and hardening of the endocardium, the inner lining of the heart chambers. This leads to a restricted filling of the ventricles, impairing their ability to relax and fill with blood properly. Other options such as viral myocarditis, beriberi, and doxorubicin therapy can cause different types of cardiomyopathy but are less commonly associated with restrictive cardiomyopathy.

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  • 23. 

    19 y/o male comes to the emergency room because of a MVA in which he was the driver and sustained blunt trauma to the anterior trunk from striking the steering wheel and dash board. The patient is alert, short of breath, hypotensive, and complains of acute chest pain. On auscultation, you hear muffled heart sounds. What's his diagnosis?

    Correct Answer
    cardiac tamponade
    tamponade
    Explanation
    The patient's presentation of acute chest pain, muffled heart sounds, and hypotension following blunt trauma to the anterior trunk is consistent with cardiac tamponade. Cardiac tamponade occurs when fluid accumulates in the pericardial sac, causing compression of the heart and impaired cardiac function. This can result from trauma, such as in this case, leading to rupture of blood vessels and subsequent accumulation of blood in the pericardial sac. The muffled heart sounds are due to the fluid surrounding the heart, impairing its ability to transmit sound. Prompt intervention, such as pericardiocentesis, is necessary to relieve the pressure on the heart and restore cardiac function.

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  • 24. 

    A 39 y/o male presents to the ER with a one week history of severe chest pain. He states that the pain seems to worsen when he lays down. He describes the pain as radiating to the back and it also worsens when he takes a deep breath. His blood pressure 124/84, respirations 18, temperature 101 F, pulse 74. On auscultation of the chest, you cannot distinguish between S1 and S2, but you hear a grunting sound. Which of the following would be your first step in managing this patient?

    • A.

      Pericardial window

    • B.

      Beta blocker

    • C.

      Rest and NSAIDS

    • D.

      Cortisol

    Correct Answer
    C. Rest and NSAIDS
    Explanation
    The patient's symptoms, including severe chest pain that worsens when lying down, radiates to the back, and worsens with deep breaths, along with the auscultation finding of not being able to distinguish S1 and S2 but hearing a grunting sound, are suggestive of pericarditis. Rest and NSAIDs are the initial management options for pericarditis, as they help reduce inflammation and relieve pain. Therefore, the correct first step in managing this patient would be rest and NSAIDs.

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  • 25. 

    A 46 y/o male who is recovering from acute MI complains of sharp pain behind the sternum which is made worse by coughing. He feels relief with sitting forward. On examination, a scratchy superficial sound is heard at the left sternal edge. His heart sounds are muffled. He has some ascites and slightly raised JVP? Which of the following would you most likely see on his EKG?

    • A.

      Sinus tachycardia

    • B.

      ST changes

    • C.

      Increased PR intervals

    • D.

      Atrial fibrillation

    • E.

      High voltage

    Correct Answer
    B. ST changes
    Explanation
    The patient is presenting with symptoms of pericarditis, which is inflammation of the pericardium, the sac surrounding the heart. The sharp pain behind the sternum, worsened by coughing and relieved by sitting forward, is a classic symptom of pericarditis. The scratchy superficial sound heard at the left sternal edge is known as a pericardial friction rub. The muffled heart sounds and the presence of ascites and raised JVP suggest pericardial effusion, which is fluid accumulation in the pericardial sac. In pericarditis, ST changes are commonly seen on the EKG, such as ST segment elevation or depression. Therefore, the most likely finding on the patient's EKG would be ST changes.

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  • 26. 

    A 33 y/o male develops a low grade fever. A week later he develops dyspnea and palpitations. He dies suddenly and unexpectedly. During autopsy, the medical examiner finds a diffusely enlarged floppy heart with no focal lesions. Coronary arteries show minimal atherosclerotic lesions with no narrowing. The most likely etiology for these findings is?

    • A.

      Cocaine overdose

    • B.

      Viral myocarditis

    • C.

      Systemic lupus

    • D.

      Acute rheumatic fever

    • E.

      Endomyocardial fibrosis

    Correct Answer
    B. Viral myocarditis
    Explanation
    The most likely etiology for the findings described in the question is viral myocarditis. This is indicated by the patient's symptoms of low-grade fever, dyspnea, and palpitations, which are commonly associated with viral myocarditis. The autopsy findings of a diffusely enlarged floppy heart with no focal lesions also support this diagnosis. Additionally, the absence of significant atherosclerotic lesions and narrowing in the coronary arteries suggests that atherosclerosis is not the cause of the patient's symptoms and death.

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  • 27. 

    In tuberculous pericarditis, the TB skin test is usually negative.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    In tuberculous pericarditis, the TB skin test is usually positive. This is because tuberculous pericarditis is caused by the bacteria Mycobacterium tuberculosis, which can trigger an immune response in the body. The TB skin test, also known as the Mantoux test, involves injecting a small amount of purified protein derivative (PPD) from the bacteria under the skin. If a person has been exposed to TB, their immune system will react to the PPD, causing a red bump or swelling at the injection site. Therefore, in tuberculous pericarditis, the TB skin test is typically positive, indicating exposure to the bacteria.

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  • 28. 

    Beck's triad includes a decline in systemic arterial pressure, an elevation in systemic arterial pressure, and a small quiet heart.

    • A.

      True

    • B.

      False

    Correct Answer
    B. False
    Explanation
    Beck's triad actually includes three specific signs that are indicative of cardiac tamponade, which is a medical emergency. These signs are low arterial blood pressure, distended neck veins, and muffled or distant heart sounds. It does not include an elevation in systemic arterial pressure. Therefore, the correct answer is false.

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Our quizzes are rigorously reviewed, monitored and continuously updated by our expert board to maintain accuracy, relevance, and timeliness.

  • Current Version
  • Mar 13, 2024
    Quiz Edited by
    ProProfs Editorial Team
  • Nov 20, 2011
    Quiz Created by
    Bikisoucy
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