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PANCE Cardio

Question	Answer
A 65 -year-old man with CAD has a total cholesterol of 250 mg/dL, an HDL of 35 mg/dL, and an LDL of 180 mg/dL. He has followed a low-fat/cholesterol diet for 6 months & started a exercise program.Which of the following is most appropriate at this time?	Prescribe atorvastatin(Lipitor)
Which of the following statements is true concerning the measurement of blood pressure?	The bladder should encircle approximately 80% of the circumference of the limb
60yoM HTN, hyperlip presents w chest heaviness and dyspnea x 1 mo w exertion. Relieved w rest. Normal vitals, no edema, norm card exam, norm EKG, what next?	Nuclear exercise stress test
A 45-year-old woman with new-onset aortic regurgitation is found to have an aortic dissection of the ascending aorta and aortic arch by CT scan.She is relatively asymptomatic. Which of the following is the best management?	Surgical correction
Car accident, SOB, pressure 80/60, EKG non-specific T wave changes and low QRS voltage. What next?	Echo
A 75-year-old male with a hx of essential HTN & hyperlipidemia reports insidious onset of fatigue & dyspnea, as well as recent episodes of exertional syncope. Which of the following is most likely to be found on PE.	a systolic eejection murmur that peaks at mid-systole, heard best at the 2nd ICS with radiation to the meck & apex
A tall, thin 16 year-old male comes into your office: Height greater than 95% for age, weight 50 % for age, pectus carinatum, scoliosis, hyperflexibilitys, arm-span-to-height ratio > 1.05 and arachnodactyly. Which is main cardiac concern for this patient?	Aortic root dilatation
The carotid pulse coincides with which heart sound	S1
A 65 year-old male 5 days status-post myocardial infarction is evaluated for anterior chest pain that improves with sitting up. He has associated fever, leukocytosis and a pericardial friction rub. Which of the following is the most likely diagnosis?	Dressler syndrome
In addition to verapamil (Calan), which of the following medications is considered the treatment of choice for patients with hypertrophic cardiomyopathy?	beta-blockers
When evaluating jugular venous pulsations a prominent a wave represents which of the following?	Atrial contraction against a closed tricuspid valve
A patient has developed greater than normal (10mm Hg) inspiratory decreases in systolic blood pressure. The arterial pulse disappear when palpated during inspiration. These findings are most consistent with:	Cardiac tamponade
S3 and S4 gallops are both signs of which type of cardiac abnormality?	ventricular dysfunction
3rd degree heart block treatment?	Consult pacemaker
Chest pain, sick for 2 weeks prior, normal vitals, + troponin, ejection fraction 40%, global hypokinesis. Diagnosis?	myocarditis
A neonate is found to have RVH, right ventricular outflow obstruction, and an over-riding aorta via cardiac imaging. What additional findings would you expect to see in this child?	VSD
55-year-old overweight male smoker complains of cramping pain located in the calfs bilaterally. The pain is brought by exercise & relieved with rest. In addition to smoking cessation, what is best conservative care intervention?	walking & weight loss
A newborn presents with blue discoloration of the peripheral extremities which worsens with exposure to cold and improves with warming. Which of the following is the most likely cause?	Acrocyanosis
37yo, new onset a fib, dyspnea, split S2, loud systolic ejection murmur. Had murmur as child. Most likely congenital heart defect?	ASD
Following an episode of syncope, a 32-year-old male is diagnosed with long QT syndrome. Should he become ill with a bacterial infection, he should be advised to avoid antibiotic drugs from which of the following classes?	macrolides
10yo fever and poly arthralgia, early diastolic murmur, Laboratory results are positive for antistreptolysin O. What is recommended prophylaxis?	Benzathine penicillin G
15yo male syncope after running. Fam history of young sudden death. Most approp test?	EKG
Which of the following is the earliest symptom for patients with left ventricular failure?	Dyspnea on exertion
A 75yo sudden syncopal episode. He is now alert and describes occasional substernal chest pressure and SOB on exertion. His lungs have bibasilar rales, BP 110/80. On cardiac auscultation, the classic finding you expect to hear is	A harsh systolic crescendo-decrescendo murmur heard best at the upper right sternal border
A 60yo M nonsmoker with hx CAD, complaint of worsening DOE x3 weeks. He admits to orthop and LE edema, but denies CP, palpitations, and syncope. The last echocardiogram: ejection fraction of 30%. What would you most likely find on physical examination?	Third heart sound (heart failure)
grade II/VI systolic crescendo-decrescendo murmur at the upper right sternal border; cardiac enzymes were normal, and resting ECG showed right bundle branch block with less than 1 mm ST segment depression. Stress test?	contraindicated. concern of aortic stenosis
The “A” wave of the JVP represents the	RA contraction
The treatment of choice for a patient with WPW (Wolff-Parkinson-White Syndrome) who has recurrent episodes of supraventricular tachycardia is which of the following?	Radiofrequency ablation of bypass tracts
Which of the following population groups represent the greatest risk for developing primary hypertension?	Black non-Hispanic
44yo syncopal episode, increasing DOE and pedal edema, clubbing, tricuspid insuffic, wide split S2. Echo shows large ASD w bidirectional flow. What is secondary complication in this patient?	Pulm HTN
A patient presents to the office following a syncopal episode 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?	atrial myxoma
Which of the following electrocardiographic findings represents a manifestation of digitalis toxicity?	Atrial tachycardia with variable block
Which of the following is a non-invasive quick method of evaluating a patient with suspected lower extremity arterial insufficiency?	Ankle-brachial index
13yo fever 102.5 and rash of enlarging macules, ring or crescent shaped w central clearing, arthralgias, EKG 1st degree block. Elev see rate, leukocytosis.	Acute rheum fever - mitral regurg murmur
A 35-year-old woman complains of easy fatigability. Physical examination reveals a grade II/VI systolic ejection murmur best heard over the pulmonic region and a fixed split second heart sound. Which of the following is the most likely diagnoses?	ASD
A 45-year-old male is diagnosed with acute ST elevation MI(STEMI) BP remains at 90/56 mm Hg despite aggressive fluid resuscitation. Which of the following pressor agents is most appropriate at this time?	dobutamine
Which of the following pathogens has been linked with the development of acute myocarditis?	coxsakie B
The 35 yo syncopal episode while throwing a football with his son. Examine regular heart rate and EKG is normal. no symptoms prior to the episode. Right radial pulse is decreased. Which of the following is the most likely explanation for the syncope?	subclavian steal syndrome
Which of the following can optimize quality of life and is a definitive treatment for a patient with refractory heart failure?	cardiac transplantation
A loud S1 (increased intensity) is heard in which of the following conditions?	Mitral stenosis
Causes of high-output HF	A. Thyrotoxicosis B. Anemia C. Pregnancy D. Beriberi
Which of the following conditions would cause a positive Kussmaul's sign on physical examination?	Constrictive pericarditis
Which of following physiologic changes can occur in MR, but typically does not occur in MS?	Chronic volume overload in the LV
SVT treatment is stable patient	Adenosine (unstable - cardiovert)
A trauma patient who has increased venous distension, loss of arterial pulses peripherally, muffled heart sounds and low voltage on his EKG is most likely to be diagnosed with	pericardial tamp
HTN, 3weeks upcer on left leg. Skin dark pigment, edematous. Pedal pulses +2. Dx?	Chronic venous insuff
Which of the following is true regarding the second heart sound(S2) ?	When it is split, the split may be increased by inspiration
A 55 yo F w diabetes presents with rubor, absence of hair, and brittle nails of L foot. She has leg pain that awakens her at night. Examination reveals a femoral bruit with diminished popliteal/pedal pulses on the L side. most appropriate therapy would be	Bypass surgery.
A 26 year-old female develops myocarditis after coxsackie B virus. Over time, she continues to developDOE , 2 pillow orthop, JVD, bibasilar crackles, a s3 heart sound, and peripheral edema. Which of the following is the most likely diagnosis?	Dilated Cardiomyopathy
Which of the following treatment modalities has been proven to lower mortality and should be instituted for all patients having a MI (unless contraindications exist)?	Beta blockers
A 55-year-old presents with orthopnea and paroxysmal nocturnal dyspnea. On physical exam JVD and pulmonary rales are noted. Which of the following laboratory tests would most likely be elevated in this patient?	brain natriuretic peptide
A 45 year-old male presents to the ER complaining of sudden onset of tearing chest pain radiating to back. He is hypertensive and his peripheral pulses are diminished. EKG shows no acute ST-T wave changes. diagnostic study of choice in this patient?	CT
26 DOE, increasing cough x 1week, rheumatic fever at 15yo. Periph and facial cyanosis. Diastolic thrill a apex in LLD pos. Mid diastolic murmur in mitral area	Mitra stenosis
A 70-year-old female reports feeling weak with mild SOB for 1 day. EKG reveals ST elevation & new Q waves in leads II. III & AvF. What is the most likely diagnosis?	Inf wall MI
A 62-year-old male with a hx of CAD & HTN presents with altered mental status for 2 hrs. BP is 220/120 mm Hg & papilledema is noted on funduscopic exam. Which of the folowing should be started immediately?	Labetolol
Each of the following patients presents with a BP of 150/100 on 2 separate occasions. For which is a secondary cause most likely?	30-year-old female with BMI 28 & 10-pack-year history of smoking
16 yo syncope after basketball. EKG LVH, echo hyper contractile left ventricle. Med of choice?	Metoprolol
Which diagnostic study is considered to be the strategy of choice for symptomatic patients with recurrent ischemia, hemodynamic instability or impaired left ventricular dysfunction?	Coronary angiography
A 60 y/o male has unstable angina, but is otherwise healthy. A 90% lesion is found in the left main coronary artery. Which of the following interventions is most appropriate?	CABG
Which of the following is associated with an abnormal jugular venous pulse?	Tricuspid valve regurg
Which of the following statements regarding patients admitted to the CCU after presumed MI is(are) true?	Patients with suspected MI’s should have the left ventricular ejection fraction measured before leaving the unit
The most common arrhythmia encountered in patients with mitral stenosis is	Afib
Alcoholic, increasing SOB, 4 pillow orthop, x-ray shows cardiomyopathy. What else?	Left ventricular dilation and systolic dysfunction
A 17 year-old woman presents to the office with recurrent episodes of palpitations and near syncope. Initial ECG was normal. Which of the following is the most appropriate step to pursue in her evaluation?	holter
A 9 yo presents with increasing SOB while playing basketball. On examination, radial pulses are exaggerated while femoral pulsations are weak. Chest radiograph shows rib notching and a mildly enlarged heart. most likely diagnosis for this patient?	Coarc of aorta
A 22 year-old male received a stab wound in the chest an hour ago. The diagnosis of pericardial tamponade is strongly supported by the presence of	distended neck veins
Which of the following is the optimal therapy for a 76 year-old patient with no allergies who has chronic atrial fibrillation?	Warfarin
A 75 yo F eval of syncope. States she was walking to the store when she passed out. 4/6 systolic crescendo-decrescendo murmur at the right second intercostal space that radiates toward the neck. What other physical exam finding could you expect?	delayed and diminished carotid upstroke
A 50-year-old male presents for routine health maintance. PMH & family hx. reveal no risk factors. Exam reveals abdominal obesity(waist circumference 45" and BP of 142/90. What additional finding would confirm the diagnosis of metabolic syndrome?	riglycerides 200 mg/dL
According to the Joint National Commission VII Guidelines, blood pressure targets are lower in patients with diabetes mellitus and what other condition?	renal disease
Which of the following conditions is most closely associated with an increased intensity of the P2 heart sound?	ASD
Aortic dissection treatment	A. Control hypertension with intravenous nitroprusside and esmolol to decrease systolic blood pressure below 120 mmHg B. Emergent cardiac surgery consultation
Chest pain that improves after rest	Stable angina
Which of the following is the most likely initial effect on the LV from AS	Concentric hypertrophy with preserved function
Patients who undergo percutaneous angioplasty or who have coronary artery revascularization often are treated with glycoprotein IIb/IIIa inhibitors. What is the major side effect associated with these agents?	Bleeding
peripherally inserted central catheter (PICC) w linear induration that stretches 3 inches proximal from the antecubital fossa with erythema andtenderness. PICC is removed. Which additional measures should be taken in the treatment of this patient?	Naproxyn sodium (Naprosyn) and local heat
Which of the following is not a secondary cause of hyperlipidemia?	hypothyroid
Which of the following is most likely to develop within 1 hour of an acute arterial occlusion of the lower extremity?	pallor
korotkoff sounds are heard with the cuff completely deflated. The blood pressure is 180/60 mm Hg. examination reveals bounding pulses and a high-pitched, blowing diastolic murmur, heard best along the LSB What is most likely diagnosis?	CorrectA. Aortic regurgitation
Septal and posterior leaflets of the tricuspid valve which are placed downward into the right ventricle, a widely split s1 with a loud s4 and a "rough, scratchy" systolic tricuspid regurgitation murmur component is:	epstein's
His CXR shows a widened mediastinum. Initial management of the above patient includes:	Administration of an intravenous beta-blocker and obtaining a transesophageal echocardiogram, or CT angiography of the chest
Which two bypass pathways in fetal circulation make it possible for most fetuses to survive pregnancy even when severe heart defects are present?	1. Foramen Ovale 2. Ductus Arteriosus
chest pressure, dyspnea on exertion, and diaphoresis that has been present for the last one hour. Electrocardiogram reveals normal sinus rhythm at 92/minute along with ST segment elevation in leads V3-V5. Initial cardiac enzymes are normal. Next step?	Coronary artery revascularization
Which of the following criteria should be met before a patient is given thrombolytics therapy after the history, physical examination, and ECG previously seen?	A. Typical chest pain suggestive of MI B. ECG changes confirming MI C. The absence of other disease that would explain the symptoms
Which of the following is the most common cause for acute myocardial infarction?	Thrombus development at a site of vascular injury
Which of the following is the chief adverse effect of thiazide diuretics?	Hypokalemia
The carotid artery is considered the most suitable artery for evaluation of cardiac function becasue	It is the most accessible artery close to the heart
The most common congenital cyanotic lesion associated with hypoxic episodes, a systolic ejection murmur at the left sternal border, and a classic finding of a 'boot-shaped' heart is	Tetrology of Fallot
Which of the following is not a typical sign of chronic right sided heart failure ?	Pulm edema
Mech valve replace. How long anticoag?	lifetime
Which diagnostic study is considered to be the strategy of choice for symptomatic patients with recurrent ischemia, hemodynamic instability or impaired left ventricular dysfunction?	coronary angiography
CHF, edema. What education should be given to this patient upon discharge to help prevent readmission?	daily weight
“skipped heartbeats” that cause a momentary lump in her throat. The palpations occur several times per day. An ECG and rhythm strip show a sinus bradycardia with a rate of 54 beats/minute and rare PVC’s	take thorough cardiac history
A 75-year-old male with a hx of essential HTN & hyperlipidemia reports insidious onset of fatigue & dyspnea, as well as recent episodes of exertional syncope. Which of the following is most likely to be found on PE.	a systolic eejection murmur that peaks at mid-systole, heard best at the 2nd ICS with radiation to the meck & apex
acute onset of repeated syncopal episodes. His (ECG) shows wide QRS complexes with fixed R-R interval rate of 40 bpm. The P waves occur with a fixed P-P interval at a rate of 70 bpm. The PR interval is variable. What is most appropriate initial treatment	transthoracic pacemaker
A patient presents with an acutely painful and cold left leg. Distal pulses are absent. Leg is cyanotic. There are no signs of gangrene or other open lesions. Symptoms occurred one hour ago. Which of the following treatments is most appropriate?	embolectomy
A patient presents with dyspnea, hypotension, and echocardiographic evidence of cardiac tamponade. The patient is hemodynamically unstable,receiving oxygen, isoproterenol. What is the most appropriate intervention?	pericardiocentesis
How is secondary HTN different from essential HTN?	BP is often refractory to antihypertensives
A 59 year-old male with 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 physical examination findings would be most likely in this patient?	Ankle edema and elevated jugular venous pressure
A 70-year-old female with a history of AF presents with dyspnea & tachycardia. BP is 88/60 & cardioversion is recommended. Which of the following needs to be done before cardioversion?	transesophageal echocardiography
When evaluating jugular venous pulsations a prominent a wave represents which of the following?	Atrial contraction against a closed tricuspid valve
Causes of secondary hyperlipidemia?	A. diabetes mellitus B. alcohol C. oral contraceptives
Which of the following diagnostic tests should be ordered initially to evaluate for suspected deep venous thrombosis of the leg?	Duplex ultrasound
What type of chest pain is most commonly associated with a dissecting aortic aneurysm?	Ripping, tearing
Who is most likely to require subacute bacterial endocarditis (SBE) prophylaxis prior to a dental procedure?	36 year-old male with a bio-prosthesic mitral valve
Which of the following conditions would cause a positive Kussmaul's sign on physical examination?	Constrictive pericarditis
Which of the following statements is true regarding grading of heart murmurs?	Grade 4 murmurs are loud obvious murmurs with a palpable thrill
Cardiac output is defined as	HR x SV
A hyperactive precordium, a systolic thrill noted at the lower left sternal border, a loud S2 with a possible complication of Pulmonary Hypertension, and a 30-60% occurrence with Down's Syndrome is:	VSD
A 35-year-old woman is found to have elevated BP. All the following may be responsible	alcohol, NSAIDS, decongest
S3 and S4 gallops are both signs of which type of cardiac abnormality?	Vent dysfunction
What is the drug of choice for the treatment of hypertriglyceridemia?	gemfibrozil
What is the most likely mechanism responsible for retinal hemorrhages and neurologic complications in a patient with infective endocarditis?	Hypotension and tachycardia
3 month old There is a grade III/VI high-pitched, harsh, pansystolic murmur heard best at the 3rd and 4th left intercostal spaces with radiation across the precordium. Which of the following is the initial diagnostic study of choice in this patient?	Echo
Initial ECG in the ED shows no acute changes. Two hours later, while the patient was having pain, repeat electrocardiogram revealed ST segment elevation in leads II, III, and AVF. Cardiac cath shows no obstruction of the coronary arteries. Tx?	Nifedipine (procardia)
A 66 yofemale with a history of DM and HTN presents for evaluation. Since beginning her ACE inhibitor and diuretic therapy her blood pressures have averaged 138/85 mmHg. Which of the following is the next best step in the management of this patient?	Increase ACE inhibitor to achieve blood pressure of less than 130/80 mmHg.
A 12 year-old girl is found to have elevated BP readings on 3 separate occasions. Her BP is normal in her legs but femoral pulsations are weak. EKG demonstrates LVH. What is the most likely diagnosis?	coarc of aorta
Which of the following pathogens has been linked with the development of acute myocarditis?	Coxsakie B
recently had a myocardial infarction with a 5-day hospital stay while away on a business trip. He reports being told he had mild congestive heart failure then, but is asymptomatic now with normal physical exam. You recommend which medications	ACE-I
59-year-old severe pain that radiates to his back, had a “viral” syndrome 4 days ago, He feels better when sitting up and leaning forward. He has a scratchy systolic and diastolic extra heart sound. EKG: diffuse ST segment elevation	NSAIDs should be administered to reduce inflammation
SVT diagnosed by	Electrophysiology study
Physical examination reveals a BP of 230/130 mmHg and papilledema. The patient's wife states that the patient developed progressive irritability and confusion today after complaining of a headache.	malignant HTN
dyspnea on exertion. Physical examination reveals a prominent heave, a II/VI systolic ejection murmur over the second and third interspaces left of the sternum, and a widely split S2 that does not vary with respiration.	Right atrial and right ventricular hypertrophy
During physical examination an elderly patient is noted to have a painless, brown-colored ulceration in the area of the medial malleolus. Which of the following is the most likely diagnosis?	venous ulcer
Which of following physiologic changes can occur in MR, but typically does not occur in MS?	Chronic volume overload in the LV
Cardiovascular syphilis is most likely to be manifested by	B. The media of the thoracic aorta is mainly affected C. Patients may have signs and symptoms of aortic regurgitation D. Aortic aneurysms may develop and contain mural thrombus E. The causative infectious agent is Treponema pallidum
The physical exam findings associated with atrial fibrillation include	Answers: A. A “irregular, irregular” rhythm B. Absence of a fourth heart sound C. S1 of varying intensity D. Absence of the “a” wave on examination of the jugular venous pulse
eft bundle branch block on ECG. He is asymptomatic with blood pressure 130/80, lungs clear to auscultation, and no leg edema. On cardiac auscultation, the most likely finding is	Paradoxical (reversed) split S2
The carotid pulse coincides with which heart sound	S1
Which of the following statements concerning dysrhythmias and dysrhythmic drugs in patients who have sustained an MI is (are) true?	ventricular fibrillation accounts for the majority of early MI deaths
his heart "trying to jump out of my chest". He had consumed a large amount of alcohol over the course of the day. He is obviously intoxicated & quite anxious. ECG shows erratic atrial activity with irregular ventricular response.	Afib
Diagnostic studies reveal concentric LVH without significant valvular abnormalities on echocardiogram. Which of the following drugs is beneficial in the treatment of the patient's condition by virtue of both afterload and preload reduction?	ACE-I
A 17 year-old woman presents to the office with recurrent episodes of palpitations and near syncope. Initial ECG was normal. She is concerned about these episodes since they can occur at any time. Which of the following is the most appropriate step	holter
A loud S1 (increased intensity) is heard in which of the following conditions?	Mitral stenosis
A 24 year-old male with Marfan's syndrome presents to the emergency department with "tearing" chest pain that radiates to the back. On physical exam a 4/6 high frequency diastolic murmur is heard and Quickne's sign is seen.	Surgical replacement of aortic valve
A patient 10 years status-post deep vein thrombosis presents with chronic lower extremity edema. Which of the following prevention strategies is most appropriate for this patient?	Compression stocking
Which of the following physical exam findings suggests worsening or severe aortic stenosis?	Palpable thrill over the right second intercostal space
A 62-year-old male with a hx of CAD & HTN presents with altered mental status for 2 hrs. BP is 220/120 mm Hg & papilledema is noted on funduscopic exam. Which of the folowing should be started immediately?	labetolol
patient presents for follow-up after a recent stroke. Cardiac examination reveals a moderately loud systolic ejection murmur in the 2nd and 3rd interspaces parasternally. The second heart sound is fixed and widely split	Patent foramen ovale
A 26 year-old female develops myocarditis following a coxsackie B viral infection. Over time, she continues to develop shortness of breath with exertion, 2 pillow orthop, JVD, bibasilar crackles, a s3 heart sound, and peripheral edema.	dilated cardiomyopathy
Which of the following criteria distinguishes internal jugular pulsations from carotid artery pulsations?	The level changes with position

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