Harrison's Medicine Comprehensive Self-Assessment: Cardiology & Pulmonology

100 high-yield clinical practice questions and detailed explanations covering cardiology and pulmonology, based on Harrison's Principles of Internal Medicine.

In patients with acute STEMI, when is thrombolytic therapy preferred over primary PCI?

Thrombolytic therapy is preferred (ideally within $30\,\text{minutes}$ of medical contact) if the door-to-balloon time is expected to exceed $120\,\text{minutes}$.

What is the characteristic murmur of acute mitral regurgitation secondary to papillary muscle rupture?

A soft, low-pitched decrescendo murmur (due to rapid pressure equalization in a non-compliant left atrium).

What is the first-line therapy for symptomatic bradycardia in the setting of acute inferior wall myocardial infarction?

Atropine ($0.5$ to $1.0\,\text{mg IV}$).

What is the indicated target temperature for comatose adult patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest?

$32^\circ\text{C}$ to $36^\circ\text{C}$ (Targeted Temperature Management).

Which primary cardiac tumor is the most common in adults?

A myxoma, most commonly located in the left atrium.

What is the definitive treatment for an acute Stanford Type A aortic dissection?

Urgent surgical repair, as it involves the ascending aorta and is a surgical emergency.

Which medications are contraindicated in patients with Wolff-Parkinson-White (WPW) syndrome presenting with pre-excited atrial fibrillation?

Intravenous verapamil, diltiazem, and digoxin, as they block the AV node and may risk inducing ventricular fibrillation (VF).

What is the classic ECG finding for Brugada syndrome type 1 in precordial leads $V_1-V_3$?

Coved ST-segment elevation of at least $2\,\text{mm}$ followed by a negative T wave.

How is orthostatic hypotension defined clinically?

A sustained reduction of systolic blood pressure of at least $20\,\text{mmHg}$ or diastolic blood pressure of at least $10\,\text{mmHg}$ within $3\,\text{minutes}$ of standing.

What is the primary physiological mechanism of action of nitrates in relieving angina?

Venodilatation, which reduces preload and left ventricular wall stress, thereby lowering oxygen demand.

How do beta-blockers function in the management of congenital long QT syndrome?

They are the mainstay of therapy (e.g., nadolol or propranolol) used to prevent adrenergic-triggered ventricular tachycardia.

What defines Eisenmenger syndrome in patients with a ventricular septal defect (VSD)?

A reversal of shunt direction from left-to-right to right-to-left due to pulmonary vascular resistance exceeding systemic resistance.

In cases of right ventricular (RV) infarction, what is the primary clinical step to manage systemic venous congestion?

Aggressive volume expansion (IV fluids) to maintain preload; diuretics and nitrates should be avoided.

How is peripartum cardiomyopathy defined according to diagnostic criteria?

Development of heart failure ($LVEF < 45\%$) in the last month of pregnancy or within $5\,\text{months}$ of delivery, in the absence of another cause.

Which ion current drives phase 4 of the action potential in the sinoatrial (SA) node?

The inward funny current ($I_f$) carried by hyperpolarization-activated cyclic nucleotide-gated (HCN) channels.

Which part of the lungs is predominantly affected by panacinar emphysema in alpha-1 antitrypsin deficiency?

The lower lobes.

What pleural fluid $pH$ value serves as an absolute indication for chest tube drainage in parapneumonic effusion?

A pleural fluid $pH < 7.20$.

Why is hypoxemia from a large anatomical right-to-left shunt not fully corrected by $100\%$ supplemental oxygen?

Because the shunted blood entirely bypasses ventilated alveoli.

What is the standard 6-month treatment regimen for drug-susceptible tuberculosis?

An intensive phase of $2\,\text{months}$ of Isoniazid (H), Rifampin (R), Pyrazinamide (Z), and Ethambutol (E), followed by a continuation phase of $4\,\text{months}$ of H and R.

What are the diagnostic criteria for obesity hypoventilation syndrome (OHS)?

$BMI \ge 30\,\text{kg/m}^2$ and chronic daytime hypercapnia ($PaCO_2 > 45\,\text{mmHg}$) in the absence of other causes.

What is the potentially curative treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH)?

Pulmonary endarterectomy.

Which mutation is most common in heritable pulmonary arterial hypertension (HPAH)?

Mutations in the $BMPR2$ gene (bone morphogenetic protein receptor type 2).

What is the gold standard therapeutic intervention for severe pulmonary alveolar proteinosis (PAP)?

Whole-lung lavage under general anesthesia to clear lipoproteinaceous material.

What is the most common type of lung cancer in both smokers and non-smokers?

Adenocarcinoma.

How is auto-PEEP (intrinsic PEEP) measured in a mechanically ventilated patient?

By performing an expiratory hold maneuver at the end of expiration to measure circuit pressure under zero flow.