Cardiology 1: The Audio PANCE and PANRE Podcast Topic Specific Review Episode 27

Welcome to episode 27 of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast.

Over the next few episodes I will be covering topic specific PANCE and PANRE review from the Academy course content following the NCCPA content blueprint.

This week we will be covering 10 topic specific Cardiology board review questions.

Below you will find an interactive exam to complement the podcast.

I hope you enjoy this free audio component to the examination portion of this site. The full cardiology review includes over 147 cardiology specific questions and is available to all members of the PANCE and PANRE Academy.

You can download and listen to past FREE episodes here, on iTunes or Stitcher Radio.
You can listen to the latest episode, take an interactive quiz and download your results below.

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Cardiology Questions 1-10

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Question 1

Which of the following conditions would cause a positive Kussmaul's sign on physical examination?

A	Left ventricular failure Hint: Left ventricular failure results in the back-up of blood into the left atrium and then the pulmonary system so it would not be associated with Kussmaul's sign.
B	Pulmonary edema Hint: Pulmonary edema primarily results in increased pulmonary pressures rather than having effects on the venous inflow into the heart.
C	Coarctation of the aorta Hint: Coarctation of the aorta primarily affects outflow from the heart due to the stenosis resulting in delayed and decreased femoral pulses; it has no effect on causing Kussmaul's sign.
D	Constrictive pericarditis

Question 1 Explanation:

Kussmaul's sign is an increase rather than the normal decrease in the CVP during inspiration. It is most often caused by severe right-sided heart failure; it is a frequent finding in patients with constrictive pericarditis or right ventricular infarction.

Question 2

A 60 year-old male complains of progressive fatigue and dyspnea. On examination his lungs are clear to auscultation bilaterally, heart exam reveals regular rate and rhythm without S3, S4 or murmur, and extremities show 1+ edema bilaterally. Chest x-ray reveals cardiomegaly. The electrocardiogram shows low voltage, and echocardiogram shows an ejection fraction of 55% with a small, thickened left ventricle that has rapid early filling with diastolic dysfunction. Which of the following is the most likely underlying etiology of this patient's cardiomyopathy?

A	Alcoholism Hint: Chronic alcohol use is commonly associated with a dilated left ventricle with left ventricular dysfunction.
B	Myocarditis Hint: Myocarditis is associated with a dilated, not small, left ventricle.
C	Amyloidosis
D	Chronic hypertension Hint: Chronic hypertension is associated with a hypertrophic, hypercontractile left ventricle.

Question 2 Explanation:

Amyloidosis is the most common cause of restrictive cardiomyopathy and is associated with a small thickened left ventricle that has rapid early filling with diastolic dysfunction.

Question 3

A 45 year-old male presents to the Emergency Department complaining of sudden onset of tearing chest pain radiating to his back. On examination the patient is hypertensive and his peripheral pulses are diminished. Electrocardiogram shows no acute ST-T wave changes. Which of the following is the diagnostic study of choice in this patient?

A	Computed tomography (CT) scan
B	Transthoracic echocardiogram Hint: CT scan is better than transthoracic echocardiogram for the diagnosis of acute aortic dissection. Transesophageal echocardiogram (TEE) is a good diagnostic modality, however it is not always available in the acute setting.
C	Magnetic resonance imaging Hint: MRI is good in the diagnosis of a chronic aortic dissection, but the longer imaging time and the difficulty in monitoring the patient during the test makes it not the first choice in the setting of an acute dissection.
D	Cardiac catheterization Hint: Cardiac catheterization is not indicated in the diagnosis of an acute aortic dissection.

Question 3 Explanation:

This patient has signs and symptoms of acute aortic dissection for which CT scan is the diagnostic study of choice.

Question 4

A 26 year-old patient is brought to the emergency department after a head on collision. The patient complains of chest pain, dyspnea and cough. Examination reveals the patient to be tachypneic and tachycardic with a narrow pulse pressure. Jugular venous distension is noted. Electrocardiogram reveals nonspecific t wave changes and electrical alternans. Which of the following is the most appropriate management plan for this patient?

A	serial echocardiogram Hint: Serial echocardiograms would be indicated if a patient had a small pericardial effusion and no intervention was immediately needed. This patient has signs and symptoms of cardiac tamponade and needs immediate intervention.
B	pericardiocentesis
C	cardiac cahterization Hint: There is no indication for cardiac catheterization in the management of cardiac tamponade.
D	pericardiectomy Hint: A partial pericardiectomy may be needed in patients with recurrent pericardial effusions that occur secondary to neoplastic disease and uremia, but there is no indication for partial pericardiectomy in the acute management of cardiac tamponade.

Question 4 Explanation:

Urgent pericardiocentesis is the initial treatment of choice in a patient with cardiac tamponade.

Question 5

A 10 year-old female experiences fever and polyarthralgia. On examination you note a new early diastolic murmur. Laboratory results are positive for antistreptolysin O. The patient has no known drug allergies. Which of the following is the recommended prophylaxis for this condition?

A	Doxycycline Hint: Doxycycline and Bactrim are not indicated for the prophylaxis of recurrent rheumatic fever.
B	Erythromycin Hint: Erythromycin is considered second line for prophylaxis of recurrent rheumatic fever in a patient with a penicillin allergy.
C	Benzathine penicillin G
D	Trimethoprim/sulfamethoxazole Hint: See A for explanation

Question 5 Explanation:

Recurrences of rheumatic fever are most common in patients who have had carditis during their initial episode and in children. The preferred method of prophylaxis and secondary prevention of recurrence is penicillin G benzathine as a monthly IM injection, but oral daily penicillin or erythromycin is acceptable in areas of low prevalence. Duration is based on clinical presentation and degree of cardiac involvement: ARF without cardiac involvement: 5 years or until age 18 years, whichever is longer ARF with mild or resolved carditis: 10 years or until age 25 years, whichever is longer ARF with severe carditis or cardiac surgery: lifelong

Question 6

A 59 year-old male with history of hypertension and dyslipidemia presents with complaint of substernal chest pain for two hours. The pain woke him from sleep, does not radiate, and is associated with nausea and diaphoresis. Electrocardiogram reveals ST segment elevation in leads II, III, and AVF. Which of the following walls of the ventricle is most likely at risk?

A	Anterior Hint: See answer for explanation
B	Inferior
C	Lateral Hint: See answer for explanation
D	Posterior Hint: See answer for explanation

Question 6 Explanation:

Inferior wall myocardial infarction is characterized by ST segment elevation in leads II, III and AVF.

Question 7

An 80 year-old female presents with syncope and recent fatigue and lightheadedness over the past month. She denies chest pain or dyspnea. Physical examination reveals BP 130/70 mmHg, HR 40 bpm, regular, and RR 16. Electrocardiogram reveals two p waves before each QRS complex. Which of the following is the treatment of choice for this patient?

A	Cardio defibrillator insertion Hint: Cardio defibrillators treat ventricular tachycardia and are not indicated in the management of second degree AV block.
B	Atropine as needed Hint: Atropine can be used in the acute management of second degree AV block Mobitz type II, but it should not be used as long-term therapy.
C	Permanent dual chamber pacemaker insertion
D	Ritalin therapy daily Hint: Ritalin therapy is not indicated in the management of second degree heart block.

Question 7 Explanation:

This patient has findings consistent with symptomatic second degree AV block Mobitz type II for which permanent pacing is the treatment of choice.

Question 8

A 78 year-old male with history of coronary artery disease s/p coronary artery bypass grafting, hypertension, and dyslipidemia presents for routine physical examination. He feels well except for occasional brief episodes of substernal chest pain with exertion that are relieved with rest. He denies associated dyspnea, nausea or diaphoresis. Physical examination reveals a BP of 110/70 mmHg, HR 56 bpm, regular, RR 14, unlabored. Lungs are clear to auscultation, heart is bradycardic, but regular with no S3, S4 or murmur. Electrocardiogram done in the office shows no acute ST-T wave changes. Which therapy is indicated for the acute management of this patient's symptoms?

A	Sublingual nitroglycerine
B	Metoprolol Hint: Beta-blockers are preventative and not the first choice for the acute management of chronic stable angina. Beta-blockers may worsen this patient's bradycardia.
C	Verapamil Hint: Calcium channel blockers are the third-line antiischemic agent and may also reduce the patient's heart rate.
D	Lisinopril Hint: ACE inhibitors will not provide acute relief of anginal symptoms.

Question 8 Explanation:

Sublingual nitroglycerine is the drug of choice for the acute management of chronic stable angina.

Question 9

A 20 year-old male presents with complaint of brief episodes of rapid heart beat with a sudden onset and offset that have increased in frequency. He admits to associated shortness of breath and lightheadedness. He denies syncope. Electrocardiogram reveals a delta wave prominent in lead II. Which of the following is the most appropriate long-term management in this patient?

A	Implantable cardio defibrillator Hint: Implantable cardio defibrillators are indicated in the treatment of ventricular arrhythmias, not Wolf-Parkinson- White (WPW) syndrome.
B	Radiofrequency ablation
C	Verapamil (Calan) Hint: Calcium channel blockers and beta-blockers are not the best options for the long-term management of WPW. They may decrease the refractoriness of the accessory pathway or increase the refractoriness of the AV node in patients with atrial fibrillation or atrial flutter who have an antegrade conducting bypass tract. This may lead to faster ventricular rates.
D	Metoprolol (Lopressor) Hint: See C for explanation

Question 9 Explanation:

Radiofrequency ablation is the procedure of choice for long-term management in patients with accessory pathways (WPW) and recurrent symptoms.

Question 10

Which of the following is the optimal therapy for a 76 year-old patient with no allergies who has chronic atrial fibrillation?

A	Aspirin Hint: Aspirin's role to prevent thromboembolism in atrial fibrillation is limited to patients with no risk factors who are under age 65.
B	Clopidorgrel Hint: Clopidogrel is not the optimal therapy for patients with atrial fibrillation.
C	Warfarin
D	Low molecular weight heparin Hint: Due to the increased costs and need for parenteral therapy, daily subcutaneous heparin is not first line therapy unless warfarin therapy is contraindicated.

Question 10 Explanation:

Patients older than age 75 who have chronic atrial fibrillation should be anticoagulated with warfarin to maintain an INR between 2.5 and 3.0 for optimum therapy

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Stephen Pasquini PA-C Physician Assistant

Stephen has been a family practice PA since 2004 and is the creator of The PA Life, Smarty PANCE Board Review, and PASchoolfinder websites. A National Health Service Corps Scholar and a graduate of The University of Medicine and Dentistry of NJ (Rutgers) PA Program and the University of Washington in Seattle, WA. Stephen's goal is to provide one-of-a-kind online resources for those interested in or practicing in the PA profession, to promote better access to healthcare for all, and to foster universal recognition/awareness of the PA profession. Read more about Stephen.

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