Answer 40

40.  Choice B is the correct answer.  Loop diuretics work on the ascending loop of henle to block reabsorption of sodium and chloride.  This then prevents passive reabsorption of water.  Hyponatremia, hypokalemia, and ototoxicity are side effects of loop diuretics.  If patients are on loop diuretics routinely, it is given with potassium supplements.

Question 40

40.  Which of the following is not a  side effect of loop diuretics?

A.  Hyponatremia
B.  Hyperkalemia
C.  Hypokalemia
D.  Ototoxicity

Answer 39

39.  Choice D is the correct answer.  Most children do not have this when they are born.  Most small defects close themselves and it is part of Tetralogy of Fallot.  Larger defects almost always warrant surgical repair.

Question 39

39.  Which of the following is not true of Ventricular Septal Defects?

A.  Most defects are small and close spontaneously
B.  It is part of the constellation of defects in Tetralogy of Fallot
C.  Larger defects almost always need surgical repair
D.  Most children have a ventricular septal defect when they are born

Answer 38

38.  Choice D is the correct answer.  Coarctation of the aorta is a narrowing of the aorta usually just below the left subclavian artery.  Will produce a systolic murmur if murmur present.  The fact that there is a significant elevation of the upper extremities compared to the lower extremities implies this is a late finding.  Definitive treatment for this is surgery.  This is not a normal finding.  Blood pressure difference with a thoracic dissection is in the upper extremities in older patients.

Question 38

38.  Your patient is a 3 year old male brought in because of elevated blood pressure.  During the course of your physical exam you find that his upper extremity pressures are significantly higher than the lower extremities.  Which of the following is the most likely diagnosis?

A.  This is a normal finding.  Lower extremity pressures are usually much lower than upper extremity pressures
B.  Dissection
C.  Tetralogy of Fallot
D.  Coarctation of the Aorta

Answer 37

37.   Choice D is the correct answer.  Second Degree Type I AV Block also known as Mobitz Type I or Wenckebach is characterized by increasing PR interval (>0.2 millisec) and the QRS complex eventually drops.  Usually just observe these rhythms.  Third Degree AV block or Complete heart block is characterized by AV dissociation and the P waves and QRS complexes march out but do not have a relationship.  Sinus arrhythmia just shows some variability in strip and varies usually with respiration.  There is no lengthened PR interval or dropped QRS complex.  Sinus bradycardia just has a normal rhythm but a ventricular rate less than 60.

Question 37

37.  Your patient is a 58 year old female to the ER with the EKG strip below.  Which of the following is the correct diagnosis for the strip listed below?

A.  Sinus Arrhythmia
B.  Sinus Bradycardia
C.  Third Degree AV Block
D.  Second Degree Type I AV Block

Answer 36

36.  Choice B is the correct answer.  Hypertrophic cardiomyopathy has a normal or small ventricular size and a thickened inter ventricular septum.  It causes outflow obstruction which can cause diastolic problems and chest pain and shortness of breath with exertion.  It does produce a systolic murmur but can produce a S3 and S4 gallop because of the ventricle becoming stiff.  This is treated ideally with calcium channel blockers.  These patient can have life threatening arrhythmias.

Question 36

36.  Your patient is a 74 year old male that presents with chest pain with activity, dizziness, and dyspnea on exertion.  He last cardiac cath revealed patent coronary arteries.  His ECHO reveals a small left ventricle and a thickened intra-ventricular septum.  Physical exam reveals a systolic murmur and a S3 and S4 gallop.  His ejection fraction is 23 percent.  Which of the following is the likely diagnosis?

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