Item: 1 of 17 ~ 1 • M k -<:J 1>- Jil ~· !:';-~
QIO: 4737 ..L ar Pre v ious Next Lab~lues Notes Calcula t o r
•1
A 28-year-old woman with a history of treat ed Hodgkin lymphoma presents to her physician complaining of dizziness and fatigue .
.2 examination reveals hypertension, narrow pulse pressure, and jugular venous distention, accompanied by an 53 heart sound. I n a
auscultation demonstrates bilateral crackles at the bases. X-ray of the chest shows four-chamber dilation of the heart and a slight
•3
·4 Which of the following likely caused her condition?
•5
•6 A. Acute myocardial infarction
.7
B. Ca rdiac tamponade
·8
c. Dissecting aortic aneurysm
.9
• 10 D. History of treatment with bleomycin
• 11 E. History of treatment with doxorubicin
• 12
F. Recurrence of Hodgkin lymphoma
• 13
• 14
• 15
• 16
• 17
a
Lock
, Item: 1 of 17 ~ 1 • M k -<:J 1>- Jil ~· !:';-~
QIO: 4737 ..L ar Previous Next Lab~lues Notes Calculat or
1
.2
•3 The correct a n swer i s E. 730/o chose this.
This patient is presenting with symptom s of dilated cardiomyopathy (shown In the image), most likely due
·4 to her past use of doxorubicin to treat Hodgkin lym phoma as part of the ABV D regimen (Adriamycin
•5 [doxorublcfn], Bleomycin, Vinblastine, and Dacarba zine). Cardiomyopathy Is a well-known adverse effect of
doxorubldn therapy. Dilation of all four chambers of t he heart leads to systolic dysfunction with subsequent
•6 decreased ejection fraction, narrowing pulse pressure, and jugular venous distention. In late stages it can
lead to left and ri ght heart fa ilure. Dil ated card iomyopathies are more classica ll y assoc1ated w ith an 53
.7 rather than an 54 heart sound on auscultation.
·8 Do o 1bocin o·lated cardiomyopathy Ejection fraction Pulse pressure Auscultation P~.oomonary heart disease Heart
Congestive heart failure Cardiomyopathy Systole Jugular venous pressure Systolic dysfunction Heart sounds
.9
Heart failure Fourth heart sound Jugular vein Lymphoma
• 10
• 11
• 12 I mage courtesy of Ne
• 13
A is not co rrect . 2 0/o chose this •
• 14
Acute m yocardial infarction ( MI) is ca used by coronary artery occlusion that leads to ischemia of the heart wa ll. It genera lly m an
• 15 pain/tightness radiating to the j aw, left arm, and/ or left shoulder. It Is Interesting to note that this is an exa m ple of referred pain
most organs, Is insensitive to pain. Howeve1; it is believed that by-products of Ischemia lead to stimulation of som atic afferent ne
• 16 sensory Impulses to the sam e ve1tebral levels as t hose nerves that affect the heart. This process is not fully understood. An acut
with the symptoms seen in this patient .
• 17
Referred pain Myocardial infarction Ischemia Somatic nervous system Afferent nerve fiber Jaw Coronary circulation Somatic symptom d
Infarction
B i s n o t correct. 8% ch ose this.
Cardiac tamponade results when fluid (commonly blood) enters the pericardia! sac and prevents the heart from filling during dias
caused by trauma to the chest. Sym pt oms of ca rdiac ta mponade include hypotension, increased jugular venous pressure, distant
tachycardia, and pulsus paradoxus, defined as > 10 mm Hg decrease in systolic pressure with inspiration. Normally, inspiration dr
a
Lock
,Item: 1 of 17 ~ 1 • M k -<:J 1>- Jil ~· !:';-~
QIO: 4737 ..L ar Previous Next Lab~lues Notes Calculat or
1 Referred pain Myocardial infarction Ischemia Somatic nervous system Afferent nerve fiber Jaw Coronary circulation Somatic symptom d
.2 Infarction
•3 B i s n ot correct. 8 0/o ch ose this.
Cardiac tamponade results when fluid (commonly blood) enters the pericardia! sac and prevents the heart from filling during dias
·4 caused by trauma to the chest. Symptoms of cardiac tamponade include hypotension, increased jugular venous pressure, distant
•5 tachycardia, and pulsus paradoxus, defined as > 10 mm Hg decrease In systolic pressure with inspiration. Normally, inspiration dr
pressure and increases venous return. The increased blood flow to the right side of the cardiopulmonary system reduces stroke v
•6 reduces blood pressure. When pulsus paradoxus is present, this gradient Is exaggerated-for example, in cardiac tamponade, the
into the right ventricle at inspirat ion causes the card iac septum to move toward the left ventricle, thereby further redudng the s
.7 would normally be seen on inspiration a lon e. Pulsus paradoxus is associated with neoplaSia, uremia, trauma, and ventricular rup
complication of myoca rdial infa rction . Ca rdiac tamponade would not manifest with the constellation of symptoms seen in this pa
·8
Cardiac tamponade Uremia Pulsus paradoxus Myocardial infarction Jugular veno •s p essu e Stro e volume Diastole Hypotension Myocar
.9 Ventricle (heart) Pericardium Blood pressure Heart sounds Thoracic cavity Cardiac cycle Systole Jugular vein Stroke Thorax Blood flow
• 10 Septum oamponade Circulatory system Venous return curve
• 11 C is n ot co rrect. 30/o chose this.
• 12 A dissecting aortic aneurysm is a life -threatening emergency that generally manifests acutely with ripping chest pain that radiate
may also experience syncope, Horner syndrome, stroke symptoms, or altered mental status. They may have a distant or absent
• 13 examination. Dissecting aortic aneurysm would not manifest with the symptoms seen in this patient .
Stroke Aortic dissection Aortic aneurysm Aneurysm Horner's syndrome Syncope (medicine) Chest pain Altered level of consciousness
• 14
D is not co rrect . 110/o chose this .
• 15
Bleomycin Is used to treat a number of cancers, including both Hodgkin and non-Hodgkin lymphomas. The most serious side effe
• 16 which can be heard as fine interstitial crackles at the lung base. It is not associated with cardiac toxicity.
Bleomycin Pulmonary fibrosis Cardiotoxicity Lymphoma Fibrosis Side effect Crackles Adverse effect Toxicity Lung
• 17
F is not co rrect. 30/o ch ose this.
A recurrence of Hodgkin lymphoma would m anifest with the symptoms of Hodgkin lymphoma . Many patients with Hodgkin lymph
asymptomatic lymphadenopathy. Patients m ay also present with fatigue, fever, night sweats, pruritus, and unintentional weight
Hodgkin lymphoma would not likely manifest with the symptoms seen In this patient.
Lymphadenopathy Lymphoma Asymptomatic Itch Night sweats Weight loss Hodg~ ins lymphoma Fatigue (medical) Fever
a
Lock
, Item: 1 of 17 ~. I • M k <:] t> al ~· ~
QIO: 4737 .l. ar Previous Next lab 'Vfllues Notes Calculator
1
F is not co rrect. 3% chose this .
. 2 A recurrence of Hodgkin lymphoma would manifest with the symptoms of Hodgkin lymphoma. Many patients with Hodgkin lymph
asymptomatic lymphadenopathy. Patients may also present with fatigue, fever; night sweats, pruritus, and unintentional weight
•3
Hodgkin lymphoma would not likely manifest with the symptoms seen in this patient.
.4 lymphadenopathy lymphoma Asymptomatic Itch Night sweats Weight loss Hodgkin' s lymphoma Fatigue (medical) Fever
•5
•6 Botto m Line:
.7 Doxorubicin causes dilated cardiomyopathy, which leads to decreased ej ection fraction, narrowing pulse pressure, and jugular v
Doxorubicin Dilated cardiomyopathy Ejection fraction Pulse pressure Cardiomyopathy Jugular venous pressure Jugular vein
•8
•9
• 10
I iii I;fi 1!1 I•J fo r year:l 2 0 1 7 ..
· 11 FI RST AI D FA CTS
• 12
• 13
Cardiomyopathies
• 14
Dilated Most common cardiomyopathy (90% of cases). Systolic dysfunction ensues.
• 15
cardiomyopathy Often idiopathic or familial. Other etiologies Eccentric hypertrophy · (sarcome
• 16
include chronic Alcohol abuse, wet Beriberi, series).
• 17 Coxsackie B viral myocarditis, chronic ABCCCD.
Cocaine use, Chagas disease, Doxorubicin Takotsubo cardiomyopathy: "broke
toxicity, hemochromatosis, sarcoidosis, syndrome"-ventricular apical ba
peripartum cardiomyopathy. likely due to increased sympatheti
Findings: H F, S3, systolic regurgitant murmur, (stressfu l situations).
dilated heart on echocardiorzram. balloon
6
lock
QIO: 4737 ..L ar Pre v ious Next Lab~lues Notes Calcula t o r
•1
A 28-year-old woman with a history of treat ed Hodgkin lymphoma presents to her physician complaining of dizziness and fatigue .
.2 examination reveals hypertension, narrow pulse pressure, and jugular venous distention, accompanied by an 53 heart sound. I n a
auscultation demonstrates bilateral crackles at the bases. X-ray of the chest shows four-chamber dilation of the heart and a slight
•3
·4 Which of the following likely caused her condition?
•5
•6 A. Acute myocardial infarction
.7
B. Ca rdiac tamponade
·8
c. Dissecting aortic aneurysm
.9
• 10 D. History of treatment with bleomycin
• 11 E. History of treatment with doxorubicin
• 12
F. Recurrence of Hodgkin lymphoma
• 13
• 14
• 15
• 16
• 17
a
Lock
, Item: 1 of 17 ~ 1 • M k -<:J 1>- Jil ~· !:';-~
QIO: 4737 ..L ar Previous Next Lab~lues Notes Calculat or
1
.2
•3 The correct a n swer i s E. 730/o chose this.
This patient is presenting with symptom s of dilated cardiomyopathy (shown In the image), most likely due
·4 to her past use of doxorubicin to treat Hodgkin lym phoma as part of the ABV D regimen (Adriamycin
•5 [doxorublcfn], Bleomycin, Vinblastine, and Dacarba zine). Cardiomyopathy Is a well-known adverse effect of
doxorubldn therapy. Dilation of all four chambers of t he heart leads to systolic dysfunction with subsequent
•6 decreased ejection fraction, narrowing pulse pressure, and jugular venous distention. In late stages it can
lead to left and ri ght heart fa ilure. Dil ated card iomyopathies are more classica ll y assoc1ated w ith an 53
.7 rather than an 54 heart sound on auscultation.
·8 Do o 1bocin o·lated cardiomyopathy Ejection fraction Pulse pressure Auscultation P~.oomonary heart disease Heart
Congestive heart failure Cardiomyopathy Systole Jugular venous pressure Systolic dysfunction Heart sounds
.9
Heart failure Fourth heart sound Jugular vein Lymphoma
• 10
• 11
• 12 I mage courtesy of Ne
• 13
A is not co rrect . 2 0/o chose this •
• 14
Acute m yocardial infarction ( MI) is ca used by coronary artery occlusion that leads to ischemia of the heart wa ll. It genera lly m an
• 15 pain/tightness radiating to the j aw, left arm, and/ or left shoulder. It Is Interesting to note that this is an exa m ple of referred pain
most organs, Is insensitive to pain. Howeve1; it is believed that by-products of Ischemia lead to stimulation of som atic afferent ne
• 16 sensory Impulses to the sam e ve1tebral levels as t hose nerves that affect the heart. This process is not fully understood. An acut
with the symptoms seen in this patient .
• 17
Referred pain Myocardial infarction Ischemia Somatic nervous system Afferent nerve fiber Jaw Coronary circulation Somatic symptom d
Infarction
B i s n o t correct. 8% ch ose this.
Cardiac tamponade results when fluid (commonly blood) enters the pericardia! sac and prevents the heart from filling during dias
caused by trauma to the chest. Sym pt oms of ca rdiac ta mponade include hypotension, increased jugular venous pressure, distant
tachycardia, and pulsus paradoxus, defined as > 10 mm Hg decrease in systolic pressure with inspiration. Normally, inspiration dr
a
Lock
,Item: 1 of 17 ~ 1 • M k -<:J 1>- Jil ~· !:';-~
QIO: 4737 ..L ar Previous Next Lab~lues Notes Calculat or
1 Referred pain Myocardial infarction Ischemia Somatic nervous system Afferent nerve fiber Jaw Coronary circulation Somatic symptom d
.2 Infarction
•3 B i s n ot correct. 8 0/o ch ose this.
Cardiac tamponade results when fluid (commonly blood) enters the pericardia! sac and prevents the heart from filling during dias
·4 caused by trauma to the chest. Symptoms of cardiac tamponade include hypotension, increased jugular venous pressure, distant
•5 tachycardia, and pulsus paradoxus, defined as > 10 mm Hg decrease In systolic pressure with inspiration. Normally, inspiration dr
pressure and increases venous return. The increased blood flow to the right side of the cardiopulmonary system reduces stroke v
•6 reduces blood pressure. When pulsus paradoxus is present, this gradient Is exaggerated-for example, in cardiac tamponade, the
into the right ventricle at inspirat ion causes the card iac septum to move toward the left ventricle, thereby further redudng the s
.7 would normally be seen on inspiration a lon e. Pulsus paradoxus is associated with neoplaSia, uremia, trauma, and ventricular rup
complication of myoca rdial infa rction . Ca rdiac tamponade would not manifest with the constellation of symptoms seen in this pa
·8
Cardiac tamponade Uremia Pulsus paradoxus Myocardial infarction Jugular veno •s p essu e Stro e volume Diastole Hypotension Myocar
.9 Ventricle (heart) Pericardium Blood pressure Heart sounds Thoracic cavity Cardiac cycle Systole Jugular vein Stroke Thorax Blood flow
• 10 Septum oamponade Circulatory system Venous return curve
• 11 C is n ot co rrect. 30/o chose this.
• 12 A dissecting aortic aneurysm is a life -threatening emergency that generally manifests acutely with ripping chest pain that radiate
may also experience syncope, Horner syndrome, stroke symptoms, or altered mental status. They may have a distant or absent
• 13 examination. Dissecting aortic aneurysm would not manifest with the symptoms seen in this patient .
Stroke Aortic dissection Aortic aneurysm Aneurysm Horner's syndrome Syncope (medicine) Chest pain Altered level of consciousness
• 14
D is not co rrect . 110/o chose this .
• 15
Bleomycin Is used to treat a number of cancers, including both Hodgkin and non-Hodgkin lymphomas. The most serious side effe
• 16 which can be heard as fine interstitial crackles at the lung base. It is not associated with cardiac toxicity.
Bleomycin Pulmonary fibrosis Cardiotoxicity Lymphoma Fibrosis Side effect Crackles Adverse effect Toxicity Lung
• 17
F is not co rrect. 30/o ch ose this.
A recurrence of Hodgkin lymphoma would m anifest with the symptoms of Hodgkin lymphoma . Many patients with Hodgkin lymph
asymptomatic lymphadenopathy. Patients m ay also present with fatigue, fever, night sweats, pruritus, and unintentional weight
Hodgkin lymphoma would not likely manifest with the symptoms seen In this patient.
Lymphadenopathy Lymphoma Asymptomatic Itch Night sweats Weight loss Hodg~ ins lymphoma Fatigue (medical) Fever
a
Lock
, Item: 1 of 17 ~. I • M k <:] t> al ~· ~
QIO: 4737 .l. ar Previous Next lab 'Vfllues Notes Calculator
1
F is not co rrect. 3% chose this .
. 2 A recurrence of Hodgkin lymphoma would manifest with the symptoms of Hodgkin lymphoma. Many patients with Hodgkin lymph
asymptomatic lymphadenopathy. Patients may also present with fatigue, fever; night sweats, pruritus, and unintentional weight
•3
Hodgkin lymphoma would not likely manifest with the symptoms seen in this patient.
.4 lymphadenopathy lymphoma Asymptomatic Itch Night sweats Weight loss Hodgkin' s lymphoma Fatigue (medical) Fever
•5
•6 Botto m Line:
.7 Doxorubicin causes dilated cardiomyopathy, which leads to decreased ej ection fraction, narrowing pulse pressure, and jugular v
Doxorubicin Dilated cardiomyopathy Ejection fraction Pulse pressure Cardiomyopathy Jugular venous pressure Jugular vein
•8
•9
• 10
I iii I;fi 1!1 I•J fo r year:l 2 0 1 7 ..
· 11 FI RST AI D FA CTS
• 12
• 13
Cardiomyopathies
• 14
Dilated Most common cardiomyopathy (90% of cases). Systolic dysfunction ensues.
• 15
cardiomyopathy Often idiopathic or familial. Other etiologies Eccentric hypertrophy · (sarcome
• 16
include chronic Alcohol abuse, wet Beriberi, series).
• 17 Coxsackie B viral myocarditis, chronic ABCCCD.
Cocaine use, Chagas disease, Doxorubicin Takotsubo cardiomyopathy: "broke
toxicity, hemochromatosis, sarcoidosis, syndrome"-ventricular apical ba
peripartum cardiomyopathy. likely due to increased sympatheti
Findings: H F, S3, systolic regurgitant murmur, (stressfu l situations).
dilated heart on echocardiorzram. balloon
6
lock
