Answer 35

35.  Choice D is the correct answer.  The Jones Criteria includes:  Major criteria (carditis, polyarthritis, chorea, erythema marginatum, and subcutaneous nodules) and Minor Criteria (fever, arthralgias, and previous rheumatic fever).  To make the diagnosis you need 2 major criteria or 1 major criteria and 2 minor criteria.

Question 35

35.  Which of the following is not part of the Major Jones Criteria for the diagnosis of rheumatic disease?

A.  Carditis
B.  Erythema Marginatum
C.  Subcutaneous Nodules
D.  Scarletina Rash

Answer 34

34.  Choice D is the correct answer.  Aortic regurgitation has a decrescendo diastolic murmur that is accentuated with leaning over and forcefully exhaling.  It can come from rheumatic heart disease.  Mistral stenosis is a diastolic murmur that is accentuated with laying on the left side.  Rheumatic fever is the most common cause of that.  Mitral regurgitation and aortic stenosis are systolic murmurs.  Mitral regurgitation is commonly caused by rheumatic heart disease.

Question 34

34.  Your patient is a 54 year old female that presents with dyspnea on exertion, paroxysmal nocturnal dyspnea and fatigue.  Her vitals are normal.  She has not chest pain or shortness of breath at rest.  Her EKG is normal.  Physical exam reveals a diastolic murmur that is accentuated with the patient leaning over and exhaling.  Which of the following is the most likely diagnosis?

A.  Aortic Stenosis
B.  Mitral Stenosis
C.  Mitral Regurgitation
D.  Aortic Regurgitation

Answer 33

33.   Choice A is the correct answer.  This patient has varicose veins likely from incompetent venous valves.  TED hose is the best conservative treatment for this.  Weight loss may help but would not help him right now.  Vein stripping is a more invasive procedure that is done after treatment failure.  Anticoagulants are not indicted for this.  Low dose diuretic may be beneficial also.  

Question 33

33.  Your patient is a 63 year old male that presents with +2 edema BLE that he has had for two years.  His CBC and Chem 7 are normal.  His legs are pictured below?  Which of the following is the best first management option?

A.  TED Hose
B.  Vein Stripping
C.  Weight Loss
D.  Start on anticoagulants

Answer 32

32.  Choice A is the correct answer.  Labetolol and Vasotec are considered first line in the management of hypertensive emergency (malignant) hypertension.  Hctz will be not enough to lower this patients blood pressure.  The mean arterial pressure should not be lowered more than 25% in the first hour.  If it is lowered faster than that the patient is at risk for a watershed stroke.  Mannitol is only appropriate in certain situations to lower intracranial pressure.  Clonidine would help lower BP but would not give the steady control needed in this situation.  There is frequently rebound hypertension associated with clonidine.

Question 32

32.  Your patient is a 69 year old female that presented with headache and dizziness.  CT scan of the head is negative.  Her vital signs are as follows BP-234/130, HR-109, Temp-98.4, SpO2-98%.  Which of the following is the best management option?

A.  Labetolol 20 mg IV
B.  Mannitol IV
C.  Clonidine 0.2 mg PO
D.  Hctz 25 mg PO

Answer 31

31.  Choice A is the correct answer.  Dilated cardiomyopathy causes systolic dysfunction and systolic murmur.  Hypertrophic and Restrictive Cardiomyopathy are causes diastolic dysfunction. Think of dilated cardiomyopathy as having extra large that can fit more blood in them.  The problem is the blood gets into the ventricle and cannot be pumped out because it is much larger than the atria.  The most common cause of dilated cardiomyopathy is idiopathic.  Other causes of dilated cardiomyopathy are genetic, thyrotoxicosis, starvation, post partum, sarcoidosis, hemochromatosis, radiation, thiamine deficiency, alcohol, catecholamine induced, infectious, and radiation.   Treatment of dilated cardiomyopathy is similar to heart failure which involves increasing preload and decreasing after load.  ACE inhibitors and beta blockers are ideal for the appropriate patients.

Question 31

31.  Your patient is a 65 year old male that presents with a shortness of breath with exertion, edema, and a III/VI systolic murmur.  ECHO reveals enlarged right ventricle and left ventricle.  Ejection fraction is 32%.  ECHO also confirms decreased wall motion symmetrically.  Which of the following is the most likely diagnosis?

A.  Dilated Cardiomyopathy
B.  Hypertrophic Cardiomyopathy
C.  Restrictive Cardiomyopathy
D.  None of the above