Cardiology and Patient Care Quiz

Previous myocardial infarction (MI) is the most significant risk factor for future MI, even in the presence of other risk factors like diabetes, smoking, and hypertension.

Smoking cessation is the most impactful lifestyle modification for promoting healing of duodenal ulcers caused by H. pylori, even more so than reducing alcohol intake.

Smoking cessation is a crucial step in managing autoimmune diseases like SLE and RA, as it helps reduce the frequency and severity of flares.

Parental smoking cessation is the most effective way to reduce recurrent otitis media in children, even if they only smoke outside, due to the harmful effects of secondhand smoke.

Recent pet introduction into a household can be a trigger for allergy-like symptoms, especially in children with no prior history of allergies.

Smoking cessation is the most vital intervention for improving the condition of a patient with Buerger disease, characterized by digital gangrene, especially prevalent in middle-aged men who smoke heavily.

While smoking cessation is important, hypertension is the leading risk factor for stroke, outranking smoking in terms of its impact on stroke occurrence.

Lisinopril, an ACE inhibitor, is the most effective treatment for reducing the risk of recurrent stroke in a patient with hypertension, even if they also have a history of smoking.

A heart sound associated with stiff left ventricle from high afterload. Often associated with systemic hypertension or aortic stenosis.

A paradoxical splitting of S2, left bundle branch block (LBBB), and left-axis deviation on ECG all indicate left ventricular hypertrophy, which can be caused by high afterload.

The main treatment for patients with endarterectomy % thresholds involves a combination of antiplatelet therapy, statins and ACEi or ARB.

Atrial fibrillation is a major risk factor for stroke, even surpassing hypertension and smoking in patient risk profiles.

Chronic hypertension contributes to left ventricular hypertrophy (LVH). It's important to manage hypertension to mitigate the risk of LVH.

Smoking contributes to cardiovascular disease, however, in a patient presenting with ECG and heart sound abnormalities clearly indicative of hypertension, management of hypertension is the most critical preventive measure.

Atrial fibrillation can lead to the formation of left atrial mural thrombi, which can travel and cause a stroke. Hypertendion can cause carotid atheromatous plaques that break off and cause a stroke.

Atrial fibrillation is frequently seen in patients over 75 years of age or in individuals with thyroid issues.

The CHADS2 score assesses stroke risk in patients with atrial fibrillation. Each factor contributes one point: Congestive heart failure, Hypertension, Age over 75, Diabetes. Stroke history or transient ischemic attack (TIA) is worth 2 points. A score of 0 or 1 indicates aspirin therapy is sufficient, while a score of 2 or higher calls for warfarin.

Weight loss is the most impactful lifestyle change for reducing blood pressure, even more effective than smoking cessation. While smoking cessation is beneficial, weight reduction directly targets hypertension, the primary stroke risk factor.

A prosthetic valve is the most significant indication for anticoagulation. Even in a patient with venous disease (valvular insufficiency), the prosthetic valve takes precedence. While DVT and elevated CHADS2 also require anticoagulation, they are less important than a prosthetic valve.

Ischemic bowel necrosis is a severe complication characterized by bowel tissue death due to lack of blood supply. Risk factors include underlying conditions like cirrhosis and lung cancer, which compromise the blood supply. Surgery can be a trigger, as the procedure can disrupt the blood flow, and also puts stress on the already weakened body.

Maintaining optimal blood sugar levels is the most effective way to prevent long-term complications in patients with diabetes. This includes regular monitoring, adjusting medication, and lifestyle adjustments.

ACE inhibitors (ACEi) or Angiotensin II Receptor Blockers (ARB) are first-line treatment for heart failure, and for hypertension in patients with diabetes, prediabetes, atherosclerotic disease, proteinuria, or elevated creatinine or renin.

Switching from oral medications to insulin is the most effective approach to improve glycemic control when HbA1c is significantly elevated (above 12%) and the patient exhibits signs of metabolic acidosis, indicating inadequate pancreatic function.

Metformin is associated with lactic acidosis, a serious complication, especially in patients with renal insufficiency (creatinine levels greater than 1.5 mg/dL) or low bicarbonate levels. Discontinuing metformin is crucial in such cases.

Dihydropyridine Calcium Channel Blockers (dCCBs) like nifedipine or HCTZ are first-line treatment for hypertension in patients without diabetes, prediabetes, atherosclerotic disease, proteinuria, elevated creatinine or renin.

Hypertension in diabetic patients is defined as blood pressure above 130/80 mmHg.

Metformin itself does not cause high creatinine levels. The reason for discontinuing metformin in patients with high creatinine is the increased risk of lactic acidosis due to impaired renal function.

Intravenous hydration is a critical preventative measure against contrast nephropathy, a condition that can occur after exposure to intravenous contrast media, particularly in those with pre-existing kidney issues.

Hypertension in non-diabetic patients is defined as blood pressure above 140/90 mmHg.

ACEi or ARB are the first-line treatment for hypertension in diabetic patients even if they don't have proteinuria. For non-diabetic patients with hypertension, ACEi or ARB are only first-line if they have specific risk factors like pre-diabetes, atherosclerotic disease, proteinuria, or elevated creatinine or renin.

Lisinopril is an ACE inhibitor and would be the most effective treatment for reducing morbidity in a diabetic patient with an LDL of 95 mg/dL, a BP of 135/80 mmHg, and an HbA1c of 7%.

Hydrochlorothiazide or a dihydropyridine calcium channel blocker (dCCB) are the best initial treatment options for a non-diabetic 48-year-old male with a blood pressure of 150/90 mmHg on multiple visits and a normal BMI. The patient is not diabetic, has no evidence of proteinuria, and has no elevated creatinine or renin.

Patients can have normal glucose levels but elevated HbA1c, indicating diabetes.

Peripheral artery disease (PAD) is a condition caused by narrowing or blockage of arteries, usually due to atherosclerosis. This leads to reduced blood flow to the legs and feet, causing pain during walking (claudication), numbness, and potentially ulceration.

Comfortable-fitting shoes are crucial for managing peripheral artery disease (PAD) by preventing foot ulcers and promoting proper blood flow to the feet. Choosing well-fitting shoes minimizes pressure points and reduces the risk of injury.

Fetal alcohol syndrome (FAS) is a condition caused by prenatal alcohol exposure that leads to various developmental issues. It is characterized by a distinctive smooth philtrum, widely spaced eyes, and other facial abnormalities.

Cystic fibrosis is a genetic disorder affecting multiple organs, including the lungs and pancreas. It can lead to vitamin E deficiency, which can manifest as peripheral neuropathy.

Celiac disease is an autoimmune disorder triggered by gluten consumption, leading to damage to the small intestine. This damage impairs iron absorption, increasing the risk of iron deficiency anemia.

Lactose intolerance is a condition where the body cannot digest lactose, a sugar found in milk. It's often triggered by a recent gastrointestinal infection like gastroenteritis, causing temporary loss of lactase enzyme.

A small, shrunken kidney with tubular atrophy on biopsy suggests chronic kidney disease (CKD). Various factors can contribute to CKD, including underlying genetic conditions, autoimmune diseases, and recurring infections.

Down syndrome, also known as trisomy 21, is a genetic disorder caused by an extra copy of chromosome 21. It can result in various physical and mental developmental challenges, including a single palmar crease and slanted palpebral fissures.