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Question of the Week

Question: A 19 yo woman presents with complaints of DOE and mild fatigue. She has no significant medical history, does not use tobacco and takes no regular medications. On exam, her lungs are clear and cardiac exam reveals a II/VI systolic murmur at the 2nd left intercostal space, which varies with inspiration. What is the most likely diagnosis for this patient?

A. Atrial septal defect
B. Pulmonary stenosis
C. Bicuspid aortic valve
D. Ventricular septal defect
E. Hypertrophic obstructive cardiomyopathy

Answer Explained

This patient presents with a systolic murmur that varies with respiration. This makes it likely that the etiology is right sided, and given the location, pulmonary stenosis is more likely than tricuspid regurgitation. These right sided murmurs vary with respiration because filling of the right heart is influenced by changes in thoracic pressure.

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Which of the following therapies has been demonstrated to improve survival and hospital discharge with favorable neurologic outcomes in out of hospital cardiac arrest?

A. Amiodarone
B. Epinephrine
C. Hypothermia
D. Time to initial defibrillation < 10 min
E. Vasopressin

Answer Explained

Hypothermia has been confirmed as a benefit following out of hospital arrest in 2 studies. These trials showed that rapidly cooling to 32-34⁰C and maintaining these temperatures for 12-24 hours decreased in-hospital mortality and patients were 40-85% more likely to have good neurologic outcomes upon hospital discharge. None of these medications have ever demonstrated any effects on neurologic outcomes and only defibrillation within 5 minutes has the greatest likelihood for good neurologic outcomes.

Question 2

Answer Explained

Answer to question 2

Antiarrhythmic drugs can be separated into four main groups, types I to IV. All of the following are type I antiarrhythmic drugs EXCEPT:

A. Quinidine
B. Lidocaine
C. Procainamide
D. Phenytoin
E. Propranolol

Answer Explained

Propranolol is a beta blocker and beta blockers form the antiarrhythmic group II.

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