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Cardiac Pathology :)

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Courtesy of Dayo's Maturity 1 teach. Content credited to him.
Plymouth Med
Quiz by Plymouth Med, updated more than 1 year ago
Plymouth Med
Created by Plymouth Med about 6 years ago
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Resource summary

Question 1

Question
ACE inhibitors work by:
Answer
  • Blocking the sympathetic effect of noradrenaline on blood vessels.
  • Preventing the conversion of angiotensin I to angiotensin II.
  • Blocking angiotensin II receptors
  • Rapid degradation of angiotensin II.

Question 2

Question
A 53-year-old man complains of erection difficulty. He recently had some transient angina and was given some medications. His symptoms started soon after the consultation. Which drug is likely to be causing his symptoms?
Answer
  • Nifedipine
  • Ramipril
  • Labetalol
  • Spironolactone
  • Bendroflumethiazide

Question 3

Question
An older man arrives at ED with swollen lips. Not anaphylactic shock. His regular prescriptions are nifedipine, simvastatin, warfarin, lansoprazole and Ramipril. Which is causing this angioedema?
Image:
Screen Shot 2018 03 08 At 1.45.43 Am (binary/octet-stream)
Answer
  • Ramipril

Question 4

Question
A 65-year-old man presents with central crushing angina for the first time. He is transferred immediately to the closest cardiac unit to undergo a primary percutaneous coronary intervention. There is thrombosis of the left circumflex artery only. Angioplasty is carried out and a drug-eluding stent is inserted. What are the most likely changes to have occurred on ECG during admission?
Answer
  • ST elevation in leads V1–4
  • ST elevation in leads V1–6
  • ST elevation in leads I, aVL, V5, V6
  • ST elevation in leads II, III and aVF

Question 5

Question
The ECG shows an antero-lateral STEMI. Which coronary artery is most likely to have been occluded?
Answer
  • Left Circumflex artery
  • Left anterior descending artery
  • Right main coronary artery.
  • Right posterior descending artery
  • Left main coronary artery

Question 6

Question
Which of the following will be observed in a patient that has mitral regurgitation
Answer
  • Diastolic murmur, 5th intercostal space, left midclavicular line
  • Diastolic murmur, 4th intercostal space, left midclavicular line
  • Diastolic murmur, apex of the heart
  • Systolic murmur, apex of the heart.
  • Systolic murmur, 2nd intercostal space, right sternal border.

Question 7

Question
A murmur is heard just to the left of the sternum in the 2nd intercostal space during systole, what kind of murmur do you suspect?
Answer
  • Aortic Stenosis
  • Aortic regurgitation
  • Pulmonary stenosis
  • Pulmonary regurgitation
  • mitral stenosis

Question 8

Question
A 25-year-old woman with known mitral valve prolapse develops a low-grade fever, malaise and night sweats after a couple of weeks of a major dental procedure. Examination reveals tender vasculitic lesions on the finger pulps and microscopic haematuria. Which is the most appropriate initial step in management?
Answer
  • Give antibiotics
  • Chest X-ray.
  • Give NSAIDs
  • Sputum sample
  • Get blood cultures

Question 9

Question
A middle aged female has central retrosternal angina. The pain is worse lying flat and when she takes a deep breath. It is relieved by sitting up, and leaning forward. An ECG is performed as below. What is the most likely diagnosis?
Answer

Question 10

Question
A 54 years old man presents to the emergency department with chest pain which does not go away with GTN spray. He sits down and the pain persists and he begins to feel an ache in his arm, and feels extremely sweaty. An ECG is performed.
Image:
Screen Shot 2018 03 08 At 2.12.24 Am (binary/octet-stream)
Answer
  • antero-lateral STEMI

Question 11

Question
At ED, an elderly woman with Type 2 diabetes mellitus, Hypertension and BMI of 33.6 was admitted to your department via ambulance after experiencing an episode of central crushing chest pain that radiated to her left arm. It came on while she was watching TV and has not been relieved despite rest and GTN spray. Vital signs: RR: 35; BP:105/62; SpO2:90%; Temperature: 37.0oC Based on the ECG, what is the most appropriate initial management for this?
Answer

Question 12

Question
A [blank_start]heart[blank_end] [blank_start]murmur[blank_end] is an extra or unusual sound heard during a heartbeat.
Answer
  • heart
  • murmur

Question 13

Question
Murmurs can either be [blank_start]systolic[blank_end] (S1) or [blank_start]diastolic[blank_end] (S2). Valvular murmurs: 2 main reasons [blank_start]Stenosis[blank_end]: Valve is too narrow for the blood to pass through. [blank_start]Regurgitation[blank_end] (Incompetence): Valve does fully shut so there is backflow
Answer
  • Stenosis
  • Regurgitation
  • systolic
  • diastolic

Question 14

Question
Fill in the Table.
Image:
Screen Shot 2018 03 08 At 8.22.10 Pm (binary/octet-stream)
Answer
  • diastole
  • diastole
  • diastole
  • systole
  • systole
  • systole
  • systole

Question 15

Question
Non-valvular murmurs also exist.
Answer
  • True
  • False

Question 16

Question
Label the different valves.
Image:
Screen Shot 2018 03 08 At 8.25.47 Pm (binary/octet-stream)
Answer
  • Aortic
  • Pulmonary
  • tricuspid
  • mitral

Question 17

Question
[blank_start]Calcification[blank_end] of the aortic valves (due to naturally [blank_start]aging[blank_end]) mainly causes [blank_start]aortic[blank_end] [blank_start]stenosis[blank_end]. The most common cause of [blank_start]mitral[blank_end] [blank_start]stenosis[blank_end] is rheumatic heart disease due to the bacteria of group [blank_start]A[blank_end] Streptococcus.
Answer
  • Calcification
  • aortic
  • stenosis
  • aging
  • stenosis
  • mitral
  • A

Question 18

Question
What is the correct ordering of the heart layers?
Answer
  • fibrous pericardium, parietal serous pericardium, pericardial cavity, pericardial fluid, visceral serous pericardium, epicardial fat, myocardium, endocardium
  • fibrous pericardium, epicardial fat, visceral serous pericardium, pericardial cavity, pericardial fluid, parietal serous pericardium, myocardium, endocardium
  • fibrous pericardium, parietal serous pericardium, visceral serous pericardium, pericardial cavity, pericardial fluid, epicardial fat, emyocardium, endocardium
  • epicardial fat, fibrous pericardium, parietal serous pericardium, visceral serous pericardium, pericardial cavity, pericardial fluid,endocardium, myocardium

Question 19

Question
What is true regarding endocarditits?
Answer
  • Inflammation of the endocardium
  • common cause: Staph Aureus
  • common cause: Strep viridans
  • New murmur
  • Fever
  • Splinter Hemorrhage
  • Janeway lesions and Osler nodes
  • Diagnosis: Echocardiograms and electrocardiograms
  • Diagnosis: Blood culture and echocardiograms
  • Manage: antibiotics and NSAIDS

Question 20

Question
What is true regarding pericarditits?
Answer
  • inflammation of pericardium
  • Common cause: Coxsackie B virus
  • Chest pain which feels better when sitting forward
  • Auscultation: pericardial friction rub audible
  • Widespread saddle shaped ST-elevation on ECG = diagnosis
  • 1-2 weeks course of NSAIDs
  • complication: cardiac tamponade
  • Auscultation: crackles
  • Chest pain better from lying down
  • dispersed ST-elevation on ECG leads = diagnosis

Question 21

Question
What are these clinical symptoms?
Image:
Screen Shot 2018 03 08 At 8.56.05 Pm (binary/octet-stream)
Answer
  • osler nodes
  • splinter hemorrhages

Question 22

Question
[blank_start]Unstable[blank_end] angina is due to problems in blood supply. It comes about at [blank_start]rest[blank_end] or [blank_start]minimal[blank_end] [blank_start]exertion[blank_end], like walking.
Answer
  • Unstable
  • rest
  • minimal
  • exertion

Question 23

Question
Stable angina is due to [blank_start]myocardial[blank_end] [blank_start]ischemia[blank_end]. It is a [blank_start]central[blank_end] chest tightness or heaviness, which is relieved by [blank_start]rest[blank_end]. It may radiate to one or both [blank_start]arms[blank_end], the neck, jaw or [blank_start]teeth[blank_end].
Answer
  • myocardial
  • ischemia
  • central
  • rest
  • arms
  • teeth

Question 24

Question
GRAB to treat stable angina: [blank_start]Glycerol[blank_end] [blank_start]Trinitrate[blank_end] spray for symptomatic relief [blank_start]Risk[blank_end] Factor modification like stop smoking and reduced cholesterol [blank_start]Aspirin[blank_end] reduces mortality by 34% (fact) [blank_start]Beta[blank_end] [blank_start]blockers[blank_end] to reduce symptoms unless contraindicated
Answer
  • Glycerol
  • Trinitrate
  • Risk
  • Aspirin
  • blockers
  • Beta

Question 25

Question
Unstable angina, NSTEMI and STEMI are a group of conditions that occur due to decreased blood flow in the [blank_start]coronary[blank_end] arteries, leading to heart muscle [blank_start]ischemia[blank_end]. This is known as [blank_start]acute[blank_end] [blank_start]coronary[blank_end] [blank_start]syndrome[blank_end].
Answer
  • coronary
  • ischemia
  • acute
  • coronary
  • syndrome

Question 26

Question
How does ACS (acute coronary syndrome) present?
Answer
  • Angina pectoris pain
  • noticeable sweating
  • tachypneia
  • nausea
  • vomiting
  • progresses--> radiating pain

Question 27

Question
Which is NSTEMI and which is STEMI?
Image:
Screen Shot 2018 03 08 At 9.09.36 Pm (binary/octet-stream)
Answer
  • STEMI
  • NSTEMI

Question 28

Question
Acute management of ACS: MONA IV [blank_start]Morphine[blank_end] Oxygen (if Sats < 94%) [blank_start]Nitrates[blank_end] [blank_start]Aspirin[blank_end]
Answer
  • Morphine
  • Nitrates
  • Aspirin

Question 29

Question
Secondary management of ACS is [blank_start]revascularization[blank_end]: STEMI [blank_start]reperfusion[blank_end] therapy--> [blank_start]primary[blank_end] PCI ([blank_start]percutaneous[blank_end] [blank_start]coronary[blank_end] intervention) If this cannot be achieved within [blank_start]2[blank_end] hours of diagnosis or PCI is not available, [blank_start]thrombolytic[blank_end] therapy such as streptokinase is to be done.
Answer
  • revascularization
  • reperfusion
  • percutaneous
  • coronary
  • primary
  • 2
  • thrombolytic

Question 30

Question
Secondary prevention of myocardial infarction: AAABC [blank_start]Aspirin[blank_end] (antiplatelet) [blank_start]ACE[blank_end] inhibitor [blank_start]Atorvastatin[blank_end] Beta-blocker [blank_start]Clopridogrel[blank_end] (antiplatelet)
Answer
  • Clopridogrel
  • Atorvastatin
  • ACE
  • Aspirin

Question 31

Question
What morphology is shown below? (2 words)
Image:
Screen Shot 2018 03 08 At 9.23.49 Pm (binary/octet-stream)
Answer
  • ST elevation

Question 32

Question
Which leads are lateral?
Answer
  • AVF
  • AVL
  • AVR
  • II
  • I
  • III
  • V1 and V2
  • V3 and V4
  • V5
  • V6

Question 33

Question
Which leads are anterior?
Answer
  • AVF
  • AVR
  • AVL
  • lead I
  • lead II
  • lead III
  • V1 AND V2
  • V3 AND V4
  • V5
  • V6

Question 34

Question
Which of these leads is not inferior?
Answer
  • II
  • III
  • AVF
  • I

Question 35

Question
Fill in what each abbreviation in the table stands for.
Image:
Screen Shot 2018 03 08 At 9.36.54 Pm (binary/octet-stream)
Answer
  • left anterior descending
  • left main coronary artery
  • right coronary artery

Question 36

Question
Which of these could result from severe or untreated hypertension?
Answer
  • stroke
  • MI
  • blindness
  • renal failure
  • pulmonary disease
  • aneurysms
  • ovarian cancer

Question 37

Question
What are side effects of ACE inhibitors?
Answer
  • Dry cough
  • Angioedema
  • Hypotension
  • Hyperkalemia
  • Hypercalcemia
  • Hypoglycemia

Question 38

Question
Hydrochlorothiazide and Metolazone are examples of thiazide-like diuretics.
Answer
  • True
  • False

Question 39

Question
[blank_start]Angiotenisin[blank_end] [blank_start]Receptor[blank_end] [blank_start]Blockers[blank_end] end in “sartan” e.g. [blank_start]Losartan[blank_end] They're given if side effects of ACE inhibitors are experienced.
Answer
  • Angiotenisin
  • Receptor
  • Blockers
  • Losartan

Question 40

Question
Beta blockers reduce the [blank_start]cardiac[blank_end] [blank_start]output[blank_end] by reducing heart rate and force of contraction (hence the [blank_start]stroke[blank_end] [blank_start]volume[blank_end]). They end in -lol like [blank_start]metoprolol[blank_end].
Answer
  • metoprolol
  • cardiac
  • output
  • stroke
  • volume

Question 41

Question
What is true regarding beta blocker side effects?
Answer
  • bronchoconstriction
  • bradycardia
  • heart failure
  • hypotension
  • AV nodal conduction block
  • polyuria
  • renal failure
  • dehyrdation
  • vertigo

Question 42

Question
If the patien is younger than 8o years, treatment for stage [blank_start]1[blank_end] hypertension is given if: [blank_start]End[blank_end] [blank_start]organ[blank_end] damage [blank_start]Cardiovascular[blank_end] disease (or significant risk of developing it) Renal disease [blank_start]Diabetes[blank_end]
Answer
  • 1
  • organ
  • End
  • Cardiovascular
  • Diabetes

Question 43

Question
NSTE-ACS refers to Unstable Angina and NSTEMI.
Answer
  • True
  • False

Question 44

Question
Cardiac markers: [blank_start]Troponin[blank_end] I/T They are the most specific/sensitive tests for [blank_start]MI[blank_end].
Answer
  • Troponin
  • myocardial infarction

Question 45

Question
Fill in the diagram. (ABREVIATIONS WHERE APPROPRIATE)
Image:
Screen Shot 2018 03 08 At 10.16.12 Pm (binary/octet-stream)
Answer
  • STEMI
  • NSTEACS
  • NSTEMI
  • unstable angina

Question 46

Question
WHICH are side-effects of calcium channel blockers?
Answer
  • peripheral edema
  • flushing
  • headache
  • severe hypotension
  • angina
  • hidrosis
  • miosis

Question 47

Question
CCBs used to treat hypertension end in –dipine such as [blank_start]nifedipine[blank_end]
Answer
  • nifedipine
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