CLINICALS

September 29

On what day is World Heart Day celebrated annually?

Occam's Razor

Which law of parsimony states that the simplest solution tends to be the right one?

Hickam's Dictum

Which clinical adage states that a patient can have as many diseases as he damn well pleases?

Schamroth's window

What diamond-shaped space disappears in digital clubbing, indicating chronic hypoxia?

Erythema marginatum

What major Jones criterion is defined as pink macules that clear centrally with a serpiginous spreading edge?

Subcutaneous nodules

What major Jones criterion presents as painless small lumps over the extensor surfaces of joints?

Sydenham's chorea

What major Jones criterion is characterized by abnormal, involuntary, uncontrollable jerking movements of the head and upper limbs?

Two to three weeks

What is the typical latent period between Group A Streptococcal pharyngitis and an attack of rheumatic fever?

Children between ages 4 and 15 years

In what age group does acute rheumatic fever occur most frequently?

Janeway lesions

Which vascular phenomenon of infective endocarditis is characterized by macular, blanching, painless lesions on the palms and soles?

Osler's nodes

Which immunologic phenomenon of infective endocarditis is characterized by tender, painful, purple-pink papulopustules on the pulp of the fingers or toes?

Splinter hemorrhages

What vascular phenomenon presents as linear reddish-brown lesions in the nail beds of patients with infective endocarditis?

Roth's spots

What retinal immunologic phenomenon is characterized by round hemorrhages with pale centers seen on fundoscopy?

Jane, No Pain

What is the clinical mnemonic used to remember that Janeway lesions are painless?

Osler, Ouch!

What is the clinical mnemonic used to remember that Osler's nodes are painful?

Two major, or one major and three minor, or five minor

What clinical criteria combinations are required for a diagnosis of definitive infective endocarditis?

One major and one minor, or three minor

What clinical criteria combinations are required for a diagnosis of possible infective endocarditis?

Positive blood culture

Which infective endocarditis major criterion requires typical microorganisms from separate blood cultures?

Endocardial involvement by echocardiography

Which infective endocarditis major criterion is met by showing an oscillating intracardiac mass or abscess on 2D echo?

Fever over 38 degrees Celsius

What temperature elevation serves as a minor Duke criterion for infective endocarditis?

Lying down

What physical position aggravates the chest pain associated with acute pericarditis?

Sitting up and leaning forward

What physical position relieves the chest pain associated with acute pericarditis?

PR depression and diffuse ST elevation

What dual characteristic ECG abnormalities are seen in patients with acute pericarditis?

Electrical alternans

What classic ECG finding in cardiac tamponade is characterized by beat-to-beat variation in QRS amplitude?

Muffled, distant, and low

How do the heart sounds characteristically sound in a patient with a massive pericardial effusion or cardiac tamponade?

Primordial prevention

Which level of prevention is aimed at managing modifiable cardiovascular risk factors at the community level before they establish?

Atrial fibrillation

Which sustained arrhythmia features disorganized atrial contractions that increase the risk of cardioembolic stroke?

Substernal

What is the classic retrosternal location of myocardial ischemic discomfort in typical angina pectoris?

Lower jaw, left arm, and center of back

What are three classic radiation sites for the chest discomfort of typical angina pectoris?

Upper jaw and below the umbilicus

What are two anatomical boundaries where anginal chest pain does not radiate, indicating potential malingering?

Aortic dissection

Which vascular emergency presents with severe tearing or ripping chest pain, unequal limb pulses, and a widened mediastinum on chest X-ray?

Pleuritic pain

What clinical term describes chest pain that is aggravated by breathing in but disappears upon breathing out?

Musculoskeletal pain

What clinical term describes sharp, localized chest wall pain that is reproducible with palpation and movement?

Pulmonary overcirculation

What chronic developmental hemodynamic process leads to vascular remodeling and severe pulmonary hypertension in Eisenmenger syndrome?

Sixty mmHg

Severe pulmonary hypertension in a shunted patient is defined as a pulmonary pressure exceeding what value?

Reversal of the shunt from right to left

What hemodynamic event occurs when pulmonary vascular resistance exceeds systemic vascular resistance in Eisenmenger syndrome?

Myokarditis

Which myocardial disease is caused by cardiotropic viruses such as COVID-19, RSV, or paramyxovirus?

Atrial myxoma

What primary cardiac tumor acts as a physical mass inside the heart, occasionally mimicking mitral stenosis?

Pulsus alternans

Which arterial pulse abnormality features alternating strong and weak beats and indicates severe left ventricular failure?

Pulsus paradoxus

Which arterial pulse abnormality features a decrease in pulse amplitude during inspiration and is seen in cardiac tamponade?

Subclavian artery stenosis

What arterial vascular blockage should be suspected when there is a blood pressure difference of more than 10 mmHg between the two arms?

Constrictive pericarditis

Which pericardial pathology produces a steep x and y descent in the JVP waveform?

Cardiac tamponade

Which acute fluid-accumulation pathology causes a blunted y descent with a steep x descent in the JVP waveform?

Tricuspid regurgitation

Which right-sided valvular lesion creates a massive v wave or cv wave in the JVP waveform?

Kussmaul's sign

What clinical sign is defined as an abnormal rise in jugular venous pressure during inspiration?

Hepato-jugular reflux

What bedside test is positive when sustained pressure on the right subcostal margin causes a persistent rise in JVP?

Eighty percent

The bladder of a blood pressure cuff should have a length equal to what percentage of the arm circumference?

First audible Korotkoff sound

What acoustic event during blood pressure measurement corresponds to the systolic blood pressure?

Cannon A waves

What type of massive JVP waves are generated by disorganized, asynchronous atrial contractions against closed AV valves?

Central cyanosis

What type of cyanosis is caused by significant right-to-left shunting of deoxygenated blood, causing a smurf appearance?

Xanthomas

What subcutaneous lipid deposits occur along tendon sheaths or extensor surfaces, pointing to premature coronary artery disease?

Pulmonary embolism

What acute life-threatening cause of pulmonary hypertension is linked to stasis from long flights, presenting with tachypnea and tachycardia?

Differential cyanosis

What unique physical finding in a patent ductus arteriosus with a reversed shunt is characterized by blue lower extremities and pink upper extremities?

Leads II, III, and aVF

Which limb leads are evaluated on a 12-lead ECG to detect an inferior wall myocardial infarction?

Leads I and aVL

Which limb leads are evaluated on a 12-lead ECG to detect a lateral wall myocardial infarction?

Upright P waves in Leads I, II, and aVF

What are the characteristic P-wave morphological criteria for identifying a normal sinus rhythm?

Zero point twelve to zero point twenty seconds

What is the normal time duration of the PR interval on a standard ECG?

First-degree AV block

What conduction block is diagnosed when the PR interval exceeds 0.20 seconds with all P waves followed by a QRS?

Myocardial infarction

What does an acute ST segment elevation indicate on a 12-lead ECG?

Myocardial ischemia

What does an ST segment depression or T-wave inversion indicate on a 12-lead ECG?

Depolarization-repolarization phase

What physiological phases of the ventricular action potential are encompassed by the QT interval?

Arrhythmia

What clinical term is used for any electrical deviation from a normal sinus rhythm?

Junctional rhythm

Which escape rhythm presents as a slow heart rate with a narrow QRS and an absent or retrograde P wave?

Ventricular fibrillation

Which cardiac arrest rhythm presents as chaotic, disorganized electrical activity without any recognizable QRS complexes?

Magnesium sulfate

What is the primary intravenous chemical treatment of choice for suppressing stable Torsades de Pointes?

Third-degree AV block

What conduction block is characterized by regular P waves and regular QRS complexes that beat completely independently of each other?

Brugada syndrome

What congenital channelopathy is characterized by sodium channel mutations, a high risk of nocturnal sudden death, and coved ST elevations in V1-V3?

P wave

Which wave on the standard ECG represents the summation of the electrical impulses of both atria, indicating atrial depolarization?

QRS complex

Which standard ECG waveform represents ventricular depolarization, corresponding to myocardial contraction?

T wave

Which standard ECG waveform represents ventricular repolarization, corresponding to myocardial relaxation?

Ischemic Heart Disease

What is the number one leading cause of mortality in the Philippines as of August 2024?

Hypertensive Disease

What cardiovascular condition is the fifth leading cause of mortality in the Philippines as of August 2024?

Systolic over 139 mmHg and/or diastolic over 89 mmHg

What blood pressure values define hypertension in adult Filipinos?

Renal disease

What is the most common cause of secondary hypertension in both adults and children?

Renovascular hypertension

What secondary cause of hypertension is driven by renal artery stenosis, presenting with unexplained renal function decline after ACEi use?

Metabolic syndrome

What clinical syndrome is defined as a constellation of abdominal obesity, atherogenic dyslipidemia, high blood pressure, and insulin resistance?

Smoking and vaping

What is the single most influential and preventable modifiable risk factor for cardiovascular disease?

Three

The presence of how many cardiovascular risk factors renders a hypertensive patient high-risk?

Syncope, palpitation, chest pain, dyspnea, and edema

What are the five cardinal signs and symptoms of hypertensive cardiovascular disease?

Prehypertension

How is a blood pressure of 120-139 SBP or 80-89 DBP classified under the JNC 8 definition of hypertension?

Hypokalemia, insulin resistance, and hyperuricemia

What are three major metabolic side effects of prolonged thiazide diuretic therapy?

Clonidine

What centrally-acting alpha-2 sympathetic agonist sympatholytic carries a high risk of severe rebound hypertension if stopped abruptly?

Prostate hypertrophy

For what non-cardiovascular urological condition are alpha-1 blockers commonly prescribed, carrying a risk of orthostasis?

Drug-induced lupus erythematosus

What severe autoimmune side effect is associated with the use of the direct vasodilator hydralazine?

Dry cough

What bradykinin-mediated side effect occurs in approximately 15 percent of patients on ACE inhibitors, prompting drug discontinuation?

Hyperkalemia

What electrolyte elevation is a shared side effect risk of both ACE inhibitors and angiotensin receptor blockers?

Angiotensin II Receptor Blockers

Which class of selective AT1 receptor antagonists was developed specifically to prevent the ACE inhibitor-induced dry cough?

Beta-blockers

Which drug class is the standard guideline-directed medical therapy choice post-myocardial infarction to improve survival?

Vasodilators

What pharmacological class of drugs, including ACE inhibitors, ARBs, and CCBs, reduces total peripheral resistance to lower blood pressure?

Less than six grams per day

What is the recommended daily dietary salt restriction limit for patients with hypertension?

Right coronary artery

From which epicardial artery does the SA nodal artery arise in 55 to 60 percent of individuals?

Left circumflex artery

From which epicardial artery does the SA nodal artery arise in 40 to 45 percent of individuals?

Hyperkalemia, hypercalcemia, and hypermagnesemia

What three electrolyte abnormalities serve as reversible causes of SA nodal dysfunction?

First-degree AV block

Which conduction block is characterized on ECG by a regular PR interval exceeding 200 milliseconds?

Tachy-brady syndrome

Which form of sick sinus syndrome is characterized by paroxysmal tachyarrhythmias alternating with profound sinus bradycardia pauses?

Vasovagal syncope

What clinical reflex syncope is triggered by pain, fear, or prolonged standing, presenting with pallor, sweating, and nausea?

Situational reflex syncope

What clinical reflex syncope occurs during or immediately after specific physiological triggers such as micturition?

Cardioinhibition and vasodepression

What are the two pathophysiological mechanisms that drive reflex and orthostatic syncope?

Tilt testing

What diagnostic test is used to evaluate reflex syncope or orthostatic intolerance by tilting a table to 60-80 degrees?

Fibrosis of the cardiac conduction system

What is the most common age-related cause of irreversible bradyarrhythmias and sinus node dysfunction in the elderly?