Cardio Review 1. Which of the following best describes Einthovens Triangle? a.

Lead I is represented by a + charge in the left arm b. Lead II is represented by a + charge in c. Blah blah blah (didnt type fast enough) 2. A 46-year-old male with shortness of breath is found to have clear lungs, ascites, and lower extremity edema with a decrease in blood pressure on inspiration. The most likely diagnosis is? a. Constrictive pericarditis b. Restrictive cardiomyopathy c. Right heart failure d. Left heart failure 3. A 68-year-old female presents with shortness of breath, an apical diastolic murmur, and a blood pressure of 150/40. What is the most likely cause of her shortness of breath? a. Aortic valve insufficiency b. Mitral valve insufficiency c. Aortic stenosis d. Mitral stenosis 4. A 16-year-old evaluated for a sports physical presents with a moderate apical systolic ejection murmur with a diminished S2. The most likely etiology of the murmur is most likely to be associated with which of the following? a. Bicuspid aortic valve b. Fibrocalcific aortic stenosis c. Aortic valve insufficiency d. Mitral valve insufficiency 5. A 54-year-old smoker complains of left lower extremity pain on ambulation. Evaluation of this patient is most likely to reveal which of the following? a. Increased ABI in both legs b. Decreased ABI in both legs c. Increased ABI in left leg d. Decreased ABI in left leg 6. A 37-year-old female from South America presents with palpitations and syncope, blood pressure 105/70, an irregularly irregular rhythm, and an opening snap on diastole. Which is the most likely cause of the arrhythmia? a. Reentry tachycardia b. Mitral valve insufficiency c. Ventricular automaticity d. Mitral stenosis 7. A 42-year-old female presents with shortness of breath, lower extremity edema, a blood pressure of 110/70, heart rate of 110 bpm, S4 gallop which varies with respiration, a fixed second heart sound, and an apical systolic murmur. Which is the most likely cause of shortness of breath?

a. Left heart failure b. Pulmonic stenosis c. Pericardial tamponade d. Atrial septal defect 8. A 45-year-old male smoker presents with sudden onset chest pain radiating to the back. ECG shows ST elevation in leads II, III, and aVF consistent with an inferior wall myocardial infarction. Which is the most likely occluded artery? a. Diagnoal of the left anterior descending b. Obtuse maginal from a dominant circumflex c. Obtuse marginal rom a non-dominant circumflex d. Posterior descending from the right coronary artery 9. A 67-year-old smoker with a blood pressure of 175/90 is found to have decreased femoral pulses with normal radial pulses and an abdominal pulsatile mass. Which of the following is the most likely cause for the abdominal aortic aneurysm? a. Aortic dissection b. Aortic coarctation c. Marfans syndrome d. Atherosclerotic disease 10. A newborn is found to have cyanosis, loud S2 with a continuous systolic and diastolic machinery murmur, and a lower upper sternal thrill. The most likely diagnosis is which of the following? a. Pulmonic atresia b. Atrial septal defect c. Tetralogy of Fallot d. Patent ductus arteriosus

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

A A A A D D D D D D

vary with respirationright sided Squatting/positional thingraises volume to left side

Pulmonary Review 1. A 24-year-old woman with no chronic medical conditions comes to the ER with two days of right sided pleuritic pan and no other symptoms. 5 days ago she had fallen down stairs while texting on her iphone and had a complex fracture of the distal right fibula. 3 days ago she had an outpatient surgical repair of the fracture. T: 37.2, P: 96, BP: 115/70, RR: 24, SPO2: 95% PE: Mild splinting, mild palpation pain over the right lower chest, decreased breath sounds over both bases, no rubs right leg in short leg case, mild edema to the knee. She has bruises on her right lateral chest, both thighs, left knee, and right shoulder. Which test will be of least benefit? a. CXR b. Rib X-rays c. D-Dimer d. Venous sonogram of legs 2. A CXR is normal. Rib films show no fractures. EKG is normal. IV ketorolac (a NSAID) is given with complete relief of pain. She wants to go home. What is the most appropriate next step? a. Do a ventilation-perfusion scan b. Do a CT angiogram of the chest c. Do a venous sonogram of the legs d. Reassure her that she has musculoskeletal pain, give her a prescription for high dose ibuprofen (a NSAID), berate her for walking down stairs and texting at the same time, and send her home. 3. She is sent home with a prescription for ibuprofen, reassurance, and verbal chastisement. 4 days later she has abrupt onset of dyspnea followed within minutes by a near-syncope. She has vague chest pain and is diaphoretic and says I think Im going to die. T: 37.0, P: 145, BP: 85/45, RR: 32. PE: IN obvious distress, anxious, diaphoretic, with retractions, symmetric slightly diminished breath sounds, and faint wheezes. Regular rate rhythm, with JVD and a loud P2. On the monitor she has several short episodes of ventricular tachycardia. Which of the following is most likely to help guide further therapy at this point? a. CT angiogram of chest b. Echocardiogram c. Venous sonogram d. EKG and serial cardiac enzymes 4. Which of the following is least likely to help guide further therapy at this point? a. CT angiogram of chest b. Echocardiogram c. Venous sonogram d. EKG and serial cardiac enzymes

5. A D-dimer will not differentiate between pneumonia and PTE. T/F? 6. Mortality and morbidity in untreated OSAS (sleep apnea) is due mainly to development of cor pulmonale from pulmonary hypertension. T/F? 7. Intrusion of slow wave sleep during wakefulness is characteristic of narcolepsy. T/F? 8. Asthma therapy should be oriented to rapidly eliminate asthma attacks when they occur. T/F? 9. A 70-year-old in previous good health develops fever, blood-stained sputum, and right sided pleuritic pain following 3 days of bed rest for a flu-like illness. Which statement is true in this situation? a. Blood cultures will usually be positive if the patient has pneumonia b. Antibiotics should be started before blood cultures are collected c. Antibiotics should not be started until a definitive diagnosis is established d. A normal PA and lateral CXR provide more useful information than one that shows a small right sided basal infiltrate 10. A 71-year-old woman with no prior pulmonary, cardiac, or neurologic history is referred to a neurologist for several months of headaches that are worse in the mornings, accompanied by general lack of energy, and fatigue with minimal effort. PMH: osteoporosis, hyperparathyroidism. Apart from obvious kyphosis and associated lung findings, the only other PE finding is mild LE edema. Hg: 15.5, chemistries are normal except for Ca of 10.8 and HCO3 of 37. Brain CT, MRI, EEG, nerve conduction studies, and EMG are normal for her age. Which pair of tests and interventions is most abnormal? a. A sleep study/NCPAP b. PFTs/BiPAP c. ABGs/nocturnal O2 d. Echocardiogram/CHG therapy e. PFTs/aerosol therapy 11. A 75-year-old with advanced COPD comes to the ER with severe pain due to an acute zoster eruption over his chest. He is alert, anxious, and complains of difficulty breathing due to pain. T: 37.6, P: 96, BP: 145/80, RR: 26, SPO2: 89% (on room air), ABGs (on room air): pH: 7.34, PCO2: 55, PO2: 59 He is given 1mg IV hydromorphone and put on 2 L/NC. 30 minutes later he is obtunded, RR=14, (nl=12-20), and SPO2=93%. ABGs done now would most likely show: a. pH: 7.23, pCO2: 76, pO2: 67 b. pH: 7.23, pCO2: 43, pO2: 67 c. pH: 7.35, pCO2: 76, pO2: 67 d. pH: 7.23, pCO2: 76, pO2: 47 12. A 25-year-old with a history of childhood asthma, disappearing in adolescence, goes out of town to visit her grandmother, a widow who has a lot of cats and birds. At 3am the first night of the visit she awakens with a cough, chest tightness, and wheezing. She goes to the nearest ER, where she is found to have respiratory distress, a RR of 26, severely diminished symmetric

breath sounds with faint high pitched wheezes, and a SPO2 of 91%. She can speak only 3 words at a time. She is put on 5L O2 and her SPO2 goes up to 97%. An ABG is then done. Of the following ABGs, which is most likely in this patient at this point? a. pH: 7.23, pCO2: 76, pO2: 60 b. pH: 7.35, pCO2: 45, pO2: 60 c. pH: 7.35, pCO2: 45, pO2: 90 d. pH: 7.23, pCO2: 45, pO2: 90

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

C B A D True False (problems due to atherosclerosis-related issues i.e. stroke, heart attack, sudden death arrhythmia) False (REM sleep during wakefulness characteristic of narcolepsy) False (treatment should aim to deal with underlying inflammation) D (if Xray is normal, suspect PE) B A C