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Cardiology PANCE PANRE Exam with Accurate Solutions
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What is the most common cause of shock - ANSWER-Gram negative sepsis What lab test can identify and monitor sepsis? - ANSWER-Lactate How should urine output be monitored in a patient with shock? - ANSWER-Indwelling catheter with a urine output of 0.5mL/kg/hour How long should it take to lower a patient with a HTN urgency? - ANSWER-Hours How long should it take to lower a patient with HTN emergency? - ANSWER-1 hour What are the findings of malignant HTN? - ANSWER-Papilledema, encephalopathy or renal failure What is the most common symptom of HTN? - ANSWER-Headache What is recommended as the initial agent for HTN? - ANSWER-Diuretic What diuretic should be used in patients with renal disease? - ANSWER-Loop Diuretics In which patients are B-blockers most effective? - ANSWER-Younger/Caucasian What is the initial drug of choice in a diabetic patient with HTN? - ANSWER-ACE Inhibitors What is the major side effect of an ACE Inhibitor? - ANSWER-Cough What two acute coronary syndromes are treated the same? - ANSWER-Unstable and NSTEMI What is the rhythm that most people die from? - ANSWER-V. Fib When is an AMI most likely to present? - ANSWER-Early morning What is Dresslerís syndrome (post MI syndrome?) - ANSWER-Pericarditis, fever, leukocytosis, pericardial or pleural effusions
What is the EKG findings of a STEMI? - ANSWER-1 MM ST segment elevation in two contiguous leads What EKG finding is highly suspicious for STEMI? - ANSWER-LBBB What are the contraindications to a B-blocker? - ANSWER-Slow hearts, weak hearts (CHF) or bad pulmonary patients When should aspirin or clopidogrel be used in a patient with a STEMI? - ANSWER- Immediately Name the 4 cyanotic heart anomalies - ANSWER-Tetralogy of fallot, pulmonary atresia, hypoplastic left heart syndrome, and Transposition of the great vessels Name the non-cyanotic heart anomalies - ANSWER-ASD, VSD, PDA, AV septal defect (seen in Downís syndrome) & Coarctation of aorta What is the most common ASD? - ANSWER-Ostium Secundum What is the most common congential heart anomaly? - ANSWER-VSD How do we treat PDA pharmacologically? - ANSWER-Indomethacin How do we keep the ductus arteriosus open? - ANSWER-IV prostaglandins E What is the most common valvular disease? - ANSWER-Aortic Stenosis What is the most common presentation of valvular heart disease? - ANSWER-Dyspnea on exertion/exercise intolerance What is the definitive method to identify heart structure and functional abnormalities? - ANSWER-Echocardiogram or TEE How is the murmur of Tetralogy of Fallot identified? - ANSWER-Crescendo/decrescendo holosystolic at left sternal border that radiates to back What heart defect gives a ìmachinery murmur? - ANSWER-PDA How are all regurgitation murmurs identified? - ANSWER-Blowing and higher pitch What valvular pathology has an Austin Flint murmur? - ANSWER-Aortic regurgitation What is the most common arrhythmia? - ANSWER-A.Fib
What agent is preferred for HTN in blacks and elderly? - ANSWER-Calcium Channel Blocker What medications are recommended for BP control in aortic dissection? - ANSWER- Nitroprusside and a B-blocker What is the anti-HTN medication of choice in a pregnant patient? - ANSWER- Hydralazine What are the cardiac signs of CHF? - ANSWER-Enlarged heart, diminished first heart sound and S What is the most useful image with CHF? - ANSWER-Echocardiogram What two medications prolong life in a patient with CHF? - ANSWER-ACE Inhibitor and B-Blockers When is an implantable cardio-defibrillator indicated in a patient with CHF? - ANSWER- EF<35% What is the most common cause of cardiovascular death and disability? - ANSWER- Atherosclerosis What are the risk factors for arterial disease? - ANSWER-Smoking, Age (M > 55 and F > 65,) DM, Cholesterol, HTN and family history Name the three kinds of angina - ANSWER-Stable (predictable,) unstable (unpredictable) and Prinzmetal What is the most common presentation of unstable angina? - ANSWER-Resting chest pain What is Levine sign? - ANSWER-Clenched fist and teeth to describe angina pain How long does stable angina last? - ANSWER-Less than 3 minutes What is the most sensitive clinical sign of angina on an EKG? - ANSWER-Horizontal or down sloping ST segment depression What percent of patients with unstable angina will have a normal EKG? - ANSWER- 25% What is the most useful and cost effective noninvasive test for angina? - ANSWER- Exercise stress testing
What is the definitive diagnosis for angina? - ANSWER-Coronary angiogram What is the primary pharmacotherapy for angina? - ANSWER-Sublingual nitroglycerine What is the first line therapy for chronic angina? - ANSWER-B-Blockers What medication prolongs exercise duration and time to angina? - ANSWER- Ranolazine What disease encompass acute coronary syndrome? - ANSWER-Unstable angina, Non-STEMI and STEMI What is our primary decision point for patient with chest pain? - ANSWER-EKG What is the drug of choice for endocarditis prophylaxis - ANSWER-Amoxicillin What valve is most commonly affected in Rheumatic heart disease? - ANSWER-Mitral Name the major criteria for rheumatic heart disease? (AKA Jones Criteria) - ANSWER- Carditis, erythema marginatum, Subcutaneous nodules, chorea, polyarthritis What medication can provide symptoms relief with PVD? - ANSWER-Cilostazol What is recommended to prevent travel associated DVT? - ANSWER-Frequent ambulation, leg exercises and compression hose What are the key demographics of temporal arteritis? - ANSWER-Age greater than 50 and a history of polymyalgia rheumatic What are the signs and symptoms of giant cell arteritis - ANSWER-Unilateral temporal HA, scalp tenderness, jaw claudication, elevated ESR What is the most common cause of aortic aneurysms? - ANSWER-Atherosclerosis Who is the classic patient with aortic dissection? - ANSWER-Elderly male smoker with COPD, CAD and renal insufficiency What is the diagnostic test of choice for AAA? - ANSWER-Ultrasound What is the diagnostic test of choice for thoracic aneurysms? - ANSWER-Aortagram