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EMED EOR Practice Questions- Cardiology |
100% Correct Answers | Verified | Latest
2024 Version
A 72 year old male with new dx of congestive heart failure and atrial fibrillation develops episodes of hemodynamic compromise secondary to increased ventricular rate. A decision to perform elective cardioversion is made and the patient is anticoagulated with heparin. Which test should be ordered to assess for atrial or ventricular mural thrombi? A. Electrocardiogram B. Chest XR C. Transesophageal echocardiogram D. C-Reactive protein - โโC. Transesophageal Echocardiogram A 74 year old pt presents with signs and symptoms of heart failure. EKG shows the patient to be in atrial fibrillation at a rate of 80 bpm. BP is 120/76. The patient denies complaint of palpitations, chest pain or syncope. Which of the following is the most important long term therapy in this patient? A. Verapamil B. Amiodarone C. Furosemide D. Warfarin - โโD. Warfarin A 29 year-old male presents with complaint of substernal chest pain for 12 hours. The patient states that the pain radiates to his shoulders and is relieved with sitting forward. The patient admits to recent upper respiratory symptoms. On examination vital signs are BP 126/68, HR 86, RR 20, temp 100.3 degrees F. There is no JVD noted. Heart exam reveals regular rate and rhythm with no S3 or S4. There is a friction rub noted. Lungs are clear to auscultation. EKG shows diffuse ST segment elevation. What is the treatment of choice in this patient? A. Pericardiocentesis B. Nitroglycerin C. Percutaneous coronary intervention D. Indomethacin (Indocin) - โโD. Indomethacin
A 49-year-old female presents complaining of several episodes of chest pain recently. Initial ECG in the ED shows no acute changes. Two hours later while the patient was having pain, repeat ECG revealed ST segment elevation in leads II, III and avf. Cardiac catheterization shows no significant obstruction of the coronary arteries. Which of the following is the treatment of choice in this patient? A. nifedipine (Procardia) B. Metoprolol (Lopressor) C. Lisinopril (Zestril) D. Carvedilol (Coreg) - โโA- Nifedipine (Procardia)- prophylactic treatment with CCB for coronary vasospasm A 60 year-old male with hypertension is brought to the emergency department 30 minutes after the sudden onset of severe chest pain that radiates to his back and arms. His blood pressure is 180/ mmHg in his left arm; no blood pressure reading can be obtained from the right arm. ECG shows sinus tachycardia with left ventricular hypertrophy. A high pitched decrescendo diastolic murmur is heard along the left mid-sternal border. Which of the following is the most likely diagnosis? A. Acute myocardial infarction B. Aortic dissection C. Pulmonary embolism D. Right subclavian arterial embolus - โโB- Aortic Dissection 26 yo pt is brought to the ED after a head on collision. The pt complains of chest pain, dyspnea and cough. Examination reveals the patient to be tachypneic and tachycardic with a narrow pulse pressure. JVD is noted. ECG reveals nonspecific T wave changes and electrical alternans. Which of the following is most appropriate management for this patient? A. Serial echo cardiogram B. Pericardiocentesis C. Cardiac catherization D. Pericardectomy - โโB - Pericardiocentesis- this is TOC for pleural effusion 22 yo male received a stab wound in the chest 1 hr ago. The diagnosis of pericardial tamponade is strongly supported by the presence of...? A. Pulmonary edema B. Wide pulse pressure C. Distended neck veins
B. Dilated cardiomyopathy C. Restrictive cardiomyopathy D. Tako-Tsubo cardiomyopathy - โโB- Dilated Cardiomyopathy 28 year old female, 3 months post-partum, complains of gradually increasing dyspnea on exertion. She also complains of near syncope last week. She denies chronic medical problems or hospitalizations. Denies tobacco, alcohol or ilicit drug use. Cardiovascular exam is noteworthy of a laterally displaced apical impulse, a S3 and a systolic murmur best heard in the left axilla. Which is the most likely diagnosis? A. pulmonary embolism B. Pericardial effusion C. Tricuspid insufficiency D. Dilated cardiomyopathy - โโD- Dilated Cardiomyopathy A 16 yr old male presents with complaint of syncope after basketball practice today. Physical exam reveals a systolic murmur along the left sternal border that increases with valsava. An ECG reveals LVH. Echo shows asymmetric left ventricular hypertrophy with a hypercontractile LV. Which of the following is the initial medication of choice in this patient? A. Metoprolol B. Losartan C. Lisinopril D. Hydrochlorothiazide - โโA- Metoprolol 60 year old male complains of progressive fatigue and dyspnea. On exam his lungs are clear to auscultation BL, heart with RRR without S3 S4 or murmur and extremities show 1+ edema BL. CXR reveals cardiomegaly. ECG shows low voltage and echo shows EF of 55% with small, thickened LV that has rapid early filling with diastolic dysfunction. Which of the following is the likely etiology of this patient's cardiomyopathy? A. Alcoholism B. Myocarditis C. Amyloidosis D. Chronic HTN - โโC- Amyloidosis
A 23-year-old male presents with syncope. On physical examination you note a medium pitched, mid systolic murmur that decreases with squatting and increases with straining. Which of the following is the most likely diagnosis? A. Hypertrophic cardiomyopathy B. Aortic stenosis C. Mitral regurgitation D. Pulmonic stenosis - โโA- Hypertrophic Cardiomyopathy Which of the following physical exam findings will be associated with hypertrophic cardiomyopathy? A. Murmur worse with squatting B. Murmur will decrease with deep breathing C. Fixed splitting of S D. Narrowed S2 - โโB- Murmur will decrease with deep breathing 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 left ventricular hypertrophy with assymetric septal hypertrophy. Ejection fraction is 65%. Which of the following is most likely presenting history or physical exam findings? A. He has an older brother with the same dx B. A S3 gallop is heard C. Pt notes completing a course of Adriamycin D. Elevated JVD is noted - โโA- He has an older brother with the same dx When performing a pre-participation sports physical in the adolescent population, a murmur with which of the following qualities indicated a risk for sudden death during exercise? A. Increases with valsava maneuver B. Increases with squatting maneuver C. Associated with mid-systolic click D. Mid-systolic without radiation to carotids - โโA- Increases with valsalva maneuver In addition to Verapamil, which of the following medications is considered the treatment of choice in patients with hypertrophy cardiomyopathy?
When instituting diuretic therapy for a patient with heart failure, which of the following is considered the treatement of choice as a first line therapy in a failing kidney due to improved sodium clearance? A. Hydroclorothiazide (Diuril) B. Bumetanide (Bumex) C. Spironolactone (Aldactone) D. Acetazolamide (Diamax) - โโB- Bumetanide Which of the following is the earliest symptom for the pt with LV failure? A. Dependent edema B. Dyspnea on exertion C. Congestion D. Chest pain - โโB- Dyspnea on Exertion According to the American college of cardiology/AHA classification of heart failure, which of the following patients fits the stage B classification system? A. Asymptomatic patient with no structural disease or pts. who are at high risk for development of heart failure B. Asymptomatic patient with structural disease C. Symptomatic patient with structural disease D. Pts. with refractory symptoms despite intervention - โโB- Asymptomatic patient with structural disease Which of the following conditions would cause a positive Kussmauls sign on physical exam? A. LV failure B. Pulmonary edema C. Coarctation of the aorta D. Constrictive pericarditis - โโD- Constrictive Pericarditis Which of the following would provide the most specific information regarding the functional status of a patient with chronic heart failure? A. ECG
B. CXR
C. Serum electrolytes D. Echocardiogram - โโD- Echocardiogram A 36 year old patient with cardiomyopathy secondary to viral myocarditis develops fatigue, increasing dyspnea, and lower extremity edema over the past 3 days. He denies fever. A CXR shows no significant increase in heart size, but reveals prominence of the superior pulmonary vessels. Based on these clinical findings which of the following is the most likely diagnosis? A. Heart failure B. Subacute bacterial endocarditis C. Pulmonary embolus D. Pneumonia - โโA- Heart Failure 78 yo male with hx of coronary artery dz s/p CABG and ischemic cardiomyopathy presents with complaint of progressive dyspnea and orthopnea. He also complains of lower extremity edema. The patient denies fever, chest pain or cough. On physical examination, vs are bp 120/68 HR 75 and regular RR 22 and afebrile. You note S3 heart sound, JVD and 2+ lower extremity edema. The patient is admitted and treated. Upon discharge from the hospital the pt should be educated to monitor which of the following at home? A. daily weights B. daily Spirometry C. daily blood glucose D. daily fat intake - โโA- Daily Weights Which of the following is a cause of high output heart failure? A. MI B. Complete heart block C. Aortic stenosis D. Thyrotoxicosis - โโD- Thyrotoxicosis 56 year old male s/p MI is noted to have LVH and EF of 38%. Which of the following medications should be prescribed to prevent the development of heart failure symptoms? A. Amlodipine (Norvasc)
Which is the most likely mechanism responsible for retinal hemorrhages and neurologic complications in a patient with infective endocarditis? A. metabolic acidosis B. embolization of vegetations C. hypotension and tachycardia D. activation of the immune system - โโB- Embolization of Vegetations Which of the following is a systemic manifestation of infective endocarditis? A. Hemarthrosis B. Petechiae C. Cafรฉ au lait spots D. Bronzing of the skin - โโB- Petechiae
