Medicine: CVS Exam Quiz!

1. Case: A patient with mitral regurgitation, exercise intolerance, and his left ventricular end-diastolic diameter (LVEDD) is 6.8 cm, how do you manage him?

Do mitral valve replacement

Check & follow up every year

Medical treatment

Reference:
Cardiology Pocket Book.
Comment:
Surgery is indicated here due to progressive symptoms and valvular damage (normal ventricular end diastolic diameter is 3.5-5.6).

Explanation

Reference:
Cardiology Pocket Book.
Comment:
Surgery is indicated here due to progressive symptoms and valvular damage (normal ventricular end diastolic diameter is 3.5-5.6).

2. Angina pectoris + syncope, can be symptoms of which of the following:

MS

MR

TR

AR

AS

In severe cases of AS, a patient can present with both angina pectoris and syncope
Reference: Dr. Akhtar's lecture VHD

Explanation

In severe cases of AS, a patient can present with both angina pectoris and syncope
Reference: Dr. Akhtar's lecture VHD

3. All of the following are true about Lidocaine except:

Half life is hours

Metabolized in liver

Effective in ventricular arrhythmia

Reference:

Dr. Akhtar lecture (antiarrhythmia) - 6th year.
The elimination half-life of lidocaine is approximately 1.5–2 hours in most patients.

Lidocaine undergoes extensive first pass metabolism in the liver.

it is used for the acute management of ventricular arrythmias, especially in patients with myocardial infarction

Explanation

Reference:

Dr. Akhtar lecture (antiarrhythmia) - 6th year.
The elimination half-life of lidocaine is approximately 1.5–2 hours in most patients.

Lidocaine undergoes extensive first pass metabolism in the liver.

it is used for the acute management of ventricular arrythmias, especially in patients with myocardial infarction

4. Regarding the previous EEG, what's the proper/best treatment:

CD shock

Digoxin

Amiodarone

Amiodarone is the proper/best treatment for the previous EEG. Amiodarone is an antiarrhythmic medication that is commonly used to treat irregular heart rhythms, including ventricular fibrillation and ventricular tachycardia. It works by slowing down the electrical signals in the heart, helping to restore a normal heart rhythm. This medication is often preferred over other options like CD shock or digoxin due to its effectiveness and safety profile.

Explanation

Amiodarone is the proper/best treatment for the previous EEG. Amiodarone is an antiarrhythmic medication that is commonly used to treat irregular heart rhythms, including ventricular fibrillation and ventricular tachycardia. It works by slowing down the electrical signals in the heart, helping to restore a normal heart rhythm. This medication is often preferred over other options like CD shock or digoxin due to its effectiveness and safety profile.

5. All of the following drugs reduce the ventricular rate in atrial fibrillation, except:

Procainamide

Verapamil

Digoxin

Propranolol

Dialtiazem

Kumar page 775, and Dr.Akhtar lecture

Explanation

Kumar page 775, and Dr.Akhtar lecture

6. All of the following will show ventricular rate in atrial fibrillation, EXCEPT:

Disopyramide

Amiodarone

Diltiazem

Verapamil

Tremolol

Answer is: a, according to Dr. A5tar lecture: one of the side effects of class I (quinidine and Disopyramide) is ventricular tachycardia, which is a life-threatening condition. As A. fib is not a life-threatening condition and the quinidine has this serious side effect, it should be avoided. However, if you are willing to give quinidine, give another drug which reduces HR such as CCB or digoxin.

Explanation

Answer is: a, according to Dr. A5tar lecture: one of the side effects of class I (quinidine and Disopyramide) is ventricular tachycardia, which is a life-threatening condition. As A. fib is not a life-threatening condition and the quinidine has this serious side effect, it should be avoided. However, if you are willing to give quinidine, give another drug which reduces HR such as CCB or digoxin.

7. All are found in chronic mitral regurgitation ,except:

S3 gallop

S4 gallop

Left atrial enlargement

Left ventricular enlargement

Heave apical pulse

In chronic MR both left ventricle & left atrium are enlarged. (Davidson 622)
Apex beat is heaving due to left ventricular dilatation. A loud third heart sound (S3) may be present due to sudden rush of blood back into the dilated left ventricle in early diastole (Danish 102)
An S4 gallop is uncommon in chronic mitral regurgitation. However, in acute mitral regurgitation, an S4 gallop is common because the left atrium and ventricle are noncompliant.
So, the most likely answer is S4 gallop

Explanation

In chronic MR both left ventricle & left atrium are enlarged. (Davidson 622)
Apex beat is heaving due to left ventricular dilatation. A loud third heart sound (S3) may be present due to sudden rush of blood back into the dilated left ventricle in early diastole (Danish 102)
An S4 gallop is uncommon in chronic mitral regurgitation. However, in acute mitral regurgitation, an S4 gallop is common because the left atrium and ventricle are noncompliant.
So, the most likely answer is S4 gallop

8. Severe Aortic stenosis criteria:

Loud S1

Loud murmur

None of the above

this was an incomplete question, the right answer wasn't remembered
from dr Akhtar's lectures..
AS is considered to be severe when:
1. AVOA 2. Systolic Pressure Gradient Across AV > 50 mmHg
Symptoms in severe cases:
- Low CO symptoms (Syncope)
- Angina
- CHF
- SCD = Sudden cardiac death

Explanation

this was an incomplete question, the right answer wasn't remembered
from dr Akhtar's lectures..
AS is considered to be severe when:
1. AVOA 2. Systolic Pressure Gradient Across AV > 50 mmHg
Symptoms in severe cases:
- Low CO symptoms (Syncope)
- Angina
- CHF
- SCD = Sudden cardiac death

9. Regarding paroxysmal supraventricular tachycardia (SVT), which is TRUE:

Common in acute MI

Ventricular rate = atrial rate

Atrial rate 300 bpm, ventricular 150 bpm

DOC is amiodarone

Digoxin IV reduces paroxysmal SVT rate

( Harrison’s principles of internal medicine , 16th edition , table 214-4 , p.1348 )

Explanation

( Harrison’s principles of internal medicine , 16th edition , table 214-4 , p.1348 )

10. All of the following are a feature of tricuspid regurgitation except:

Prominence a wave

Pulsatile liver

Left parasternal heave

Pan-systolic murmur

Right atrial enlargement

In TR a wave is not prominant, v wave is the one that will be prominant

Explanation

In TR a wave is not prominant, v wave is the one that will be prominant

11. Regarding mitral valve prolapse all are true except:

Mid systolic click.

Pansystolic murmuer.

Late systolic murmur.

Atypical chest pain.

Concentric left ventricular Hypertrophy.

In MVP there is mid diastolic click in mild cases and pansystolic murmur if significant mitral regurgitation. The click is believed to be produced by sudden tensing of elongated chordae tendineae of prolapsing leaflets
Most patients are asymptomatic. In symptomatic patient it presents as chest pain (atypical), dyspnea, palpitation, syncope and sudden death. chest pain is similar to angina but may last for hours or for days, not related to exertion, and punctuated by brief attacks of severe stabbing pain at the apex.
Reference: Danish 103-104

Explanation

In MVP there is mid diastolic click in mild cases and pansystolic murmur if significant mitral regurgitation. The click is believed to be produced by sudden tensing of elongated chordae tendineae of prolapsing leaflets
Most patients are asymptomatic. In symptomatic patient it presents as chest pain (atypical), dyspnea, palpitation, syncope and sudden death. chest pain is similar to angina but may last for hours or for days, not related to exertion, and punctuated by brief attacks of severe stabbing pain at the apex.
Reference: Danish 103-104