18 Oct In Heart Failure (HF), lack of forward flow can cause decrease perfusion to the kidneys.

In Heart Failure (HF), lack of forward flow can cause decrease perfusion to the kidneys. This will lead to fluid retention and HF exacerbation based on the activation of the ________________.

 

Portal system

 

Systolic/Diastolic system

 

Reno angiotensin (RAS) system

 

Pituitary/Thyroid feedback system

 

Question 2A 40-year-old male with no significant past medical history presents with intermittent shortness of breath when walking more than 2 blocks. He denies chest pain, smoking, and drug/alcohol abuse. He is in no acute distress and has normal vital signs and his lungs are clear to auscultation. Of note, he has a systolic murmur that is heard best at the apex and left lower sternal border. The ECG shows left ventricular hypertrophy. Which of the following is the BEST statement to describe further clinical management?

 

Order an Echocardiogram

 

Start a loop diuretic

 

Start Aspirin and Plavix

 

No further work up is indicated

 

Question 3Which of the following pharmacologic therapies is indicated for Aortic Insufficiency due to Aortic Stenosis?

 

Beta blocker

 

Calcium channel blocker

 

Nitrate

 

ACE Inhibitor

 

Question 4Which of the following is unlikely to be noted in the person experiencing HF?

 

Elevated serum B-type natriuretic peptide (BNP)

 

Kerley B lines noted on CXR

 

Left ventricular hypertrophy on ECG

 

Evidence of hemoconcentration on hemogram

 

Question 5A 30-year-old patient is transferred to your facility from the Caribbean for further treatment. The patient is currently in Atrial Fibrillation (Afib) and has dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. The patient has history of Rheumatic Fever and on auscultation has a low-pitched diastolic murmur best heard at the apex. What is the TOP differential diagnosis for this patient?

 

Mitral valve regurgitation

 

Mitral valve stenosis

 

Tricuspid valve regurgitation

 

Tricuspid valve stenosis

 

Question 6Which of the following best describes the patient presentation of NY Heart Association stage III heart disease?

 

Ordinary physical activity does not cause undue fatigue, dyspnea or palpitations

 

Ordinary physical activity results in fatigue, palpitations, dyspnea or angina

 

Less-than-ordinary activity leads to fatigue, dyspnea, palpitations or angina

 

Discomfort increases with any physical activity

 

Question 7Of the following people, who has no significant increased risk for developing bacterial endocarditis?

 

43-year-old woman with bicuspid aortic valve

 

55-year-old man who was diagnosed with a Still’s murmur as a child

 

45-year-old woman with a history of endocarditis

 

75-year-old man with dilated cardiomyopathy

 

Question 8Almost all cases of Mitral Stenosis are related to ________________.

 

Rheumatic heart disease

 

Left ventricular hypertrophy

 

Kawasaki heart disease

 

Right ventricular hypertrophy

 

Question 9Heart Failure (HF) with an Ejection Fraction (EF) of 20% is most likely due to _____________.

 

Mitral valve dysfunction

 

Aortic valve dysfunction

 

Diastolic dysfunction

 

Systolic dysfunction

 

 

 

Question 10Which of the following initial diagnostic tests is the BEST for confirmation of the diagnosis of Aortic Stenosis?

 

Chest Xray

 

Arterial blood gas

 

Troponin levels

 

Echocardiogram (ECHO)