Questions: 25

System: Cardiovascular Emergencies

Topics: Valvular emergencies, Cardiomyopathies and pericardial disease, VTE, Systemic and
pulmonary hypertension, Aortic dissection, Aneurysmal disease, Arterial occlusion

1. Pick the correct pairing:

a) Muller’s sign – bobbing uvula with systole

b) de Musset sign – capillary pulsations visible in the nail bed
c) Quincke sign – pulsatile head bobbing
d) Duroziez sign – systolic murmur over the brachial artery

2. Which of these is not a criterion for Well’s score for DVT?

a) Unilateral pitting edema

b) Prior VTE
c) Heart rate > 100 bpm
d) Paralysis or paresis of lower extremity

3. Following are factors that can cause potential false positive D-dimer levels except:

a) Pregnancy
b) Warfarin treatment
c) Liver disease
d) Infections

4. 58 year old patient with tearing central chest pain radiating to the interscapular region was
brought to your ED. T 37, P 99 bpm, RR 24/min, BP 168/102, SpO2 96% (room air), ECG non-specific
ST-T changes. You noted an interarm pulse deficit, and BP deficit of 20mmHg, so the left arm BP was
148/90 mmHg. You treat:

a) The higher BP, and target SBP 100-140 and HR 75 - 90

b) The higher BP, and target SBP 100-120 and HR < 60
c) The lower BP, and target SBP 100-120 and HR < 60
d) The lower BP, and target SBP 100-140 and HR 75 - 90

5. The following medications can be used in pheochromocytoma

a) IV Phenoxybenzamine in a hypertensive emergency

b) Oral Phentolamine in perioperative settings
c) IV Phentolamine in a hypertensive emergency
d) Oral Urapidil in a hypertensive emergency

6. Nifedipine use is discouraged in hypertensive emergencies except in which of the following

patients:

a) Subarachnoid haemorrhage
b) Ischaemic stroke
c) Acute myocardial infarction
d) Peripartum patients
7. The following antihypertensive medication is contraindicated in patients with soy allergy:

a) Clonidine
b) Nitroglycerin
c) Phentolamine
d) Clevidipine

8. A 4 year old child was brought it by mother after an accidental pseudoephedrine overdose. She
had an elevated blood pressure, was diaphoretic, irritable, and complained of a headache. You use
your locally available vitals percentile charts and have diagnosed a hypertensive emergency. Your
drug of choice to treat the crisis is:

a) Nitroprusside
b) Phentolamine
c) Hydralazine
d) Labetolol

9. True or false: Pulmonary venous hypertension is the most common cause of pulmonary
hypertension.

a) True
b) False

10. Following is a common dysrhythmia in patients with pulmonary hypertension:

a) Accelerated idiopathic ventricular rhythm

b) Atrioventricular nodal re-entrant tachycardia
c) Bifascicular heart block
d) Second degree Mobitz II heart block

11. True or false: In patients with severe pulmonary hypertension, intubation and ventilation are
indicated early after presentation to ED.

a) False
b) True

12. You diagnose a patient as having right ventricular failure secondary to pulmonary hypertension.
You prescribe:

a) High-dose norepinephrine
b) High-dose phenylephrine
c) Dobutamine
d) Dopamine

13. Choose the correct statement:

 a) For the acutely ill pulmonary hypertension patient receiving outpatient IV
prostanoid, administer phenylephrine
b) Endothelin receptor antagonists are administered intravenously to delay the time to
clinical worsening in pulmonary hypertension patients
c) PDE-5 inhibitors, sildenafil and tadalafil are approved for use in patients with
pulmonary hypertension
d) Reducing RV afterload with vasopressors is a critical component in management of
stable pulmonary hypertension patients

14. Following are predisposing and risk factors for aortic dissection except:

a) Marfan’s syndrome
b) Bicuspid aortic valve
c) Previous cardiac surgery
d) Previous acute MI

15. Choose the incorrect statement:

a) Ruptured AAA may present with Upper or lower GI bleeding

b) An abdominal aortic aneurysm is defined as an aorta >5.0 cm in diameter
c) Male patients aged > 60 years old are at greater risk of AAA
d) Syncope occurs in about 10% patients with ruptured AAA

16. Choose the correct statement:

a) A technically adequate US study has > 90% sensitivity for demonstrating the
presence of AAA and measuring its diameter
b) An aortic diameter of < 5.0 cm excludes acute aneurysmal disease
c) CT scanning without contrast is adequate to detect anatomic details of AAA and
associated haemorrhage
d) CT-Angiogram is absolutely contraindicated in patients with renal impairment

17. Pick the correct pairing:

a) Blue toe syndrome – autoimmune inflammation of small arteries

b) Raynaud’s disease – chronic inflammation of arteries
c) Popliteal artery entrapment – thigh pain and numbness in cyclists
d) Takayasu’s arteritis – autoimmune vasculitis of aortic arch and branches

18. A 22-year-old male patient attends the ED with a history chest pain worsening over the last 9
days, fatigue, myalgias, and exertional dyspnoea. He had “flu-like symptoms” 1 week ago. He denies
use of nicotine, alcohol, and illicit drugs. He denies family history of heart disease. Vitals: T 37.7°C,
HR 130 bpm, normotensive. Examination reveals scattered bilateral crepitations. ECG demonstrates
sinus tachycardia. Chest X-ray reveals mild pulmonary oedema and cardiomegaly. Labs report a mild
rise in troponin. Which of the following is the most likely aetiology?

a) Acute MI
b) Aortic dissection
c) Viral myocarditis
d) DKA

19. Which of the following is the most common presenting symptom in patients with a ruptured
AAA?

a) Abdominal distention
b) Urinary retention
c) Constipation
d) Back pain

20. Which of the following is a possible complication of LVADs?

a) Driveline infection
b) Right heart failure
c) Pump thrombosis
d) All of these

21. A 68-year-old female patient, who is normally fit and well, presents to the ED with acute onset of
shortness of breath and dry cough. She denies any fever, chill, or rigors. Vitals: T 37.5°C, P 100bpm,
RR 22/min, BP 120/70mmHg, SpO2 90% on RA. Her physical examination is unremarkable but for
regular tachycardia on manual palpation. Her full blood count, metabolic panel and Chest Xray are
normal. Her ECG shows sinus tachycardia. Which of the following is the most appropriate next step
in management?

a) Check BNP level

b) Check D-dimer level
c) Administer a broad-spectrum antibiotic
d) Administer salbutamol nebulizers

22. Which of the following is the most common valve affected in rheumatic heart disease?

a) Tricuspid
b) Mitral
c) Aortic
d) All are equally affected

23. Peripartum cardiomyopathy most commonly manifests as:

a) Restrictive cardiomyopathy
b) Obstructive cardiomyopathy
c) Dilated cardiomyopathy
d) Hypertrophic cardiomyopathy
24. Which of the following is the most common peripheral aneurysm?

a) Popliteal artery
b) Brachial artery
c) Femoral artery
d) Radial artery

25. True or false:

Paradoxical embolization occurs when a venous clot passes from the left to the right side of the
heart through an intracardiac shunt, most commonly, a patent foramen ovale.
a. True
b. false

Answer key

1 a 2 c 3 b 4 b 5 c

6 d 7 d 8 b 9 a 10 b

11 a 12 c 13 c 14 d 15 b

16 a 17 d 18 c 19 d 20 D

21 b 22 b 23 c 24 a 25 b