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1. Cardiology Flashcards

1
Q

Septic shock criteria 4 Criteria

A

SIRS criteria 2 or more positive

  1. Temp: 100.4<
  2. Heart rate: 90<
  3. WBC: 12000< or 4000> + 10% band
  4. Respiratory: 20
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2
Q

Obstructive shock disease

4 types/Tx

A

4 types

  • Cardiac temponade
  • Tension, Pnuemothorax
  • Aortic dissection
  • PE

Tx: underlying cause

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3
Q

General circulatory shock

Patho/Lab/Tx

A

Patho (lack of O2 in tissue and orgran )

  1. Autonomic - loss of O2 -> increase CO and SVR to maintain
  2. lack of O2 -> anareobic metabolic -> by product lactic acid

Lab: CBC, BMP, Lactate

Tx: ABCDE

Airway(intubation)

Breath (ventilation)

Circulation (IV fluid)

Delivary O2 check - lactate level

End (Urine output check 0.5ml/kg/hr)

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4
Q

Temp >38 (100.4), pulse >90, Respi >20, WBC >12000, <4000, lactate >4mmol/l

Name/Tx (+ anaphylatic)

A

Name: Distribution shock (spetic shock)

Tx: broad spectrum IV

if anyphylactic shock - 1:1000 epi 0.3mg IM

if cardiac arrest, IV 1:10000 epi 1mg

observe at least 4-6 hours

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5
Q

Significant loss of blood, pale cool dry skin/extremities, slow capillary refill >2sec

Name/def/Tx

A

Name: Hypovolumic shock

Patho: Loss of third space fluid

Tx: ABCDE

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6
Q

Most commonly caused by complications of acute MI

Name/Patho/Tx

A

Name: Cardiogenic shock

Path: lack of blood supply -> cardiac output low

Tx: O2, IV (not aggressive small amount) + Dobutamin/Epi

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7
Q

Dizziness occur when pt change position from siting to standing

Name/Dx/Tx

A

Name: Orthostatic hypotension

Dx: sitting vs standing BP change (sys - 20, Dia - 10 difference)

Tx: oral hydration preferred (fludrocortisone)

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8
Q

BP elevation 2 reading 2 different visit

Name/MC cause(2type)/Risk(3type)/PE/Tx

A

Name: Hypertension

MC cause

  1. Primary HTN - Idiopathic
  2. Secondary HTN - MC renal stenosis

Risk:

  1. General predisposition - age, black
  2. Environment - salt, obesity
  3. Exacerbating - smoking, ETOH, lack of exercising

PE:

  1. Funduscopic - AV nicking, arterial narrowing
  2. Cardiac check - bruit, PMI(vulvar dz) or BP arm/femoral check r/o coarctation (children)
  3. Abdomen - check for mass
  4. BMI check

Tx: Goal <140/90, diabetic 150/90 Life style (1st), meds (2nd) most successful tx - DASH diet

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9
Q

Syncope + healthy young man without any health problem + NO exp of post ictal status, bladder/bowel incontinence

Name/Patho/cause

A

Name: Vasovagal hypotension

Patho: due to systemic hypotension cause loss of conciousness

Cause: prolong standing, heat exhaust, fear, blood draw

Most of case not dangerous

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10
Q
  1. HTN + DM =
  2. HTN + AA =
  3. HTN + BPH =
  4. HTN + Gout =
A
  1. ACEI or ARB
  2. Thiazide, CCB
  3. Alpha blocker (zosin meds)
  4. CCB (No diuretic)
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11
Q

HTN grades 4 levels

A

Normal: 120/80

Elevated: 121-129/80

Stage 1: 130-139/80-90

Stage 2: 140/90 above

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12
Q

BP 180/120 + papilledema

Name/Tx

A

Name: HTN Emergency

Tx: BP decrease by Esmolol, labetalol IV (reduce 25% in 1 hour)

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13
Q

BP 160/100

Name/Tx

A

Name: HTN ugerncy

Tx: BP decrease by Clonidine (goal: 25% by 24-48 hr)

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14
Q

Every P wave followed by QRST, regular rhythm, 60-100 bpm, no abnormality Name

A

Name: Normal sinus

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15
Q

HR more than 100 bpm

Name/Cause/Tx

A

Name: Sinus tachycardia

Cause: infection, hemorrahge, anxiety, hypovolemia

Tx: underlying cause

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16
Q

HR less than 60 bpm

Name/Cause/Tx

A

Name: Sinus bradycardia

Cause: meds - beta blocker, CCB Some well controlled athlete (normal)

Tx: Atropine

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17
Q

HR changed by expiration and inspiration

Name/SC(3)/Tx

A

Name: Sinus arryhthmia

SC: Irregular rythm, heart rate increase = inspiration, heart rate decrease = expiration

Tx: none, watch

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18
Q

hx of corrective cardiac surgery, brady-tachy heart rate

Name/Risk/Tx

A

SSS (sick sinus syndrome)

Risk: strong relationship with A Fib, corrective heart surgery

Tx: PPM

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19
Q

EKG: Constant prolonged PRI

Name/Tx

A

Name: 1st degree block

Tx: Observe

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20
Q

EKG: Progressive PRI lengthening, dropped QRS

Name/Patho/Tx

A

Name: 2nd degree block I (mobitz 1 = wenckerbach)

Patho: not all atria signal reach at ventricle

Tx

  • sx - atropine
  • Nonsx - observe
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21
Q

EKG: Constant/ prolong PRI, dropped QRS

Name/Patho/SC/Tx

A

Name: 2nd degree block II (mobitz II)

Patho: not all atria signal reach at ventricle

SC: always involve secondary organ disease

Tx: PPM

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22
Q

EKG: P wave no related with QRS

Name/Patho/Tx

A

Name: 3rd degree block

Patho: No communication with atria and ventricle

Tx: PPM

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23
Q

EKG: Flutter “saw tooth” wave, regular rhythm (3:1, or 4:1 ratio)

Name/Tx

A

Name: AV flutter

Tx

  • Stable: vagal (1st), BB or CCB
  • Unstable: DCC (50J),
  • Definitive: radiofrequency ablation
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24
Q

hx of alcohol use, irregularly irregular rhythm with narrow QRS

Name/Tx

A

Name: AF

Tx

  • Stable - BB, CCB, if pt with AF + CHF - better with digoxin
  • Unstable: DCC
  • anticoagulation: CHADS2 to check risk, 4-6 weeks of warfarin
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25
Q

CHADS2 list explain

A

CHF

HTN

Age75

DM

Stroke+TIA - 2< warfarin

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26
Q

hx of using macrolide, TCA, recurrent syncope, palpitation

Name/Tx

A

Long QT syndrome

Tx

  • Disc med
  • BB (control rate)
  • AICD for congenital prolong QT
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27
Q

Tachycardia, regular NARROW complex QRS, no P morphology

Name/Patho/Tx

A

Name: Orthodromic PSVT

Patho: goes normal AV node

Tx:

  • Stable: Vagal (1st), adenosine, (2nd), BB CCB (3rd)
  • Unstable: DCC
  • Definitive - Radiofrequency abalation
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28
Q

Tachycardia, regular WIDE complex QRS, no P morphology

Name/Patho/Tx

A

Name: Antidromic PSVT

Patho: goes accessory pathway

Tx:

  • procainamide
  • Unstable: DCC
  • Definitive - Radiofrequency abalation
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29
Q

Delta wave + wide QRS + Short PRI

Name/patho/Tx

A

Name: WPW (AVRT)

Patho: AV send signal to bundle of kent = accesory pathway cause pre-exite venticle

Tx:

  • Vagal (1st)
  • Procainamide
  • Unstable: DCC
  • Definitive: ablation
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30
Q

Meds need to avoid WPW (4)

A

ABCD - adenocine, BB, CCB, digoxin

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31
Q

2 type of PSVT

A

AVNRT - 2 pathway in AV node (MC type)

AVRT - 1 pathway in AV node + 1 accessory pathway (WPW)

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32
Q

HR 100< + less 3 morpho P

Name/Tx

A

Name: WAP (wandering)

Tx: BB, CCB

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33
Q

HR 100< + more 3 Morpho P + COPD

Name/Risk/Tx

A

Name: MAT (multifocal)

Risk: strong associated with COPD

Tx: BB, CCB

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34
Q

P wave inverted + narrow QRS

Name

A

AV junctional dysrhythmias

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35
Q

Wide Bizarre QRS less than 3

Name/Tx

A

Name: PVC (premature ventricular complexes)

Tx: no tx need observe

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36
Q

Wide bizarre QRS more than 3, regular, tachy

Name/Tx

A

Name: VT

Tx:

  • Stabe: BB, CCB
  • Unstable: DCC
  • Pulseless VT: defib + CPR
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37
Q

hypomag, tachy, twisted around baseline

Name/Risk/Tx

A

Name: Torsades de point

Risk: antipsychotic meds related

Tx: IV mag + stop medication, if offending Recurrent -> needs PPM

38
Q

Coarse, fine, no visible PQRST

Name/Tx

A

Name: V Fib

Tx: Defib (1st) + CPR

39
Q

Rhythm presents on machine but no palpable pulse

Name/Cause/Tx

A

Name: PEA (pulseless electrical activity)

Cause: MC hypovolemia

Tx: CPR (1st) + EPI(2nd) + Defib

40
Q
  1. ST depression or horizon means
  2. Convex vs Concave
A
  1. pathological
  2. Convex(sad) - patho, Concave(smile) - benign
41
Q

RBB pattern (bunny) + ST elevation w/ downsloping + Asian male

Name/Risk/Tx

A

Name: Brugada syndrome

Risk: asian male MC

Tx: AICD

42
Q
  1. In CAD what is worst factor?
  2. In CAD what is most important modifiable risk factor?
  3. In CAD what is most common cause?
A
  1. DM
  2. stop Smoking
  3. atherosclerosis
43
Q

Path plaque of CAD 3 steps

A
  1. fatty streak formation - lipid enter to WBC
  2. LDL enter endothelium bring macropage to ingest LDL becoming foam cell
  3. mature plaque
44
Q

Chest pain less than 30 mins + relieved with nitro or rest

Name/PE/DX/TX

A

Name: Angina pectoris

PE: often normal

Dx: ECG(1st), stress test (2nd if ok ECG)

Tx: Nitro(acute), BB(chronic)

Classic outpatient: ASA + nitro (prn) + BB + statin

45
Q

PTCA vs CABG

A

PTCA - used when 1-2 vessel involve w/o left main coronary artery

CABG - 3 vessel or main coronary artery involve, EF less than 40%

46
Q

New onset of chest pain more than 30 mins + not relieved with nitro + troponin Negative + pain at rest

Name/Patho/Dx/Tx

A

Name: UA

Patho: partial occulsion

Dx: ECG - ST depression or T wave inverted

Tx:

  1. antithrombotic therapy - ASA, clopidogrel, enoxaprin (heparin)
  2. adjuctive therapy - BB(start in 24hr), NGT
47
Q

New onset of chest pain more than 30 mins + not relieved with nitro + troponin positive + pain at rest + ECG ST depression/T wave inverted

Name/Patho/Dx/Tx

A

Name: NSTEMI

Patho: partial occlusion

Dx

  • ECG - ST depression or T wave inverted
  • cardiomarker - troponin +

Tx

  1. antithrombotic therapy - ASA, clopidogrel, enoxaprin (heparin)
  2. adjuctive therapy - BB(start in 24hr), NTG
48
Q

New onset of chest pain more than 30 mins + not relieved with nitro + troponin positive + pain at rest + ECG ST elevation

Name/Patho/Dx/Tx

A

Name: STEMI

Patho: 100% occluision

Dx:

  • ECG - ST elevation
  • Cardiomarker - troponin +

Tx:

  1. PCI or thrombolytic (alteplase, tenectaplase, reteplase)
  2. antithrombotic therapy - ASA, clopidogrel, enoxaprin (heparin)
  3. adjuctive therapy - BB (start in 24hr), ACEI (start in 24hr) - slow progression on HF
49
Q

Cardiomarker 3 type/ appear time/return time

A

1) myoglobin - 1-2 hr appear/ return in 24 hr
2) CK/CK-MB - 4-6 hr appear/ 3-4 day return to baseline
3) troponine - 4-8 hr appear/ 7-10day return to baseline (most specific/sensitive)

50
Q

What are complication of MI?

A

V fib, dressler syndrome (pericarditis)

51
Q

Emergency ACS protocol (3step)

A
  1. ECG in 10 min
  2. thrombolytics in 30 min or PCI in 90 min
  3. MONA
52
Q

Recent hx of MI + chest pain

A

Dressler syndrome = pericarditis

53
Q

ACS important 3 ‘NO’ meds

A
  1. cocain induced MI - NO BB (unopposed alpha 1 constriction)
  2. Right ventricular MI - NO nitrate or morphine due to preload decrease
  3. hx of use viagra - NO nitrate
54
Q

Early morning chest pain + transient ST elevation on EKG

Name/Patho/Dx/Tx

A

Name: Variant (Prinzmetal) angina Patho: vasospasm in the morning (if emotional - takasubo)

Dx:

  • ECG - transient ST elevation
  • Echo - if takasubo - LV apical balloon

Tx: CCB

55
Q

useful tool to assess the risk of death & ischemic event

A

TIMI score

56
Q

Thrombolytic absolute vs relative contraindication

A

Absolute: active bleeding, hx of ICH, stroke in 6month, aortic dissection

Relative: BP 180, internal bleeding 2 week ago

57
Q
  1. I, V5, V6, AVL
  2. II, III, AVF
  3. ST depression V1, V2
  4. V1-V4
  5. I, aVL, V4-6
A
  1. lateral - CFX
  2. inferior - RCA
  3. posterior - RCA, CFX
  4. anterior - LAD
  5. anterolateral - LAD or CFX
58
Q

In heart failure,

  1. Right side MC/SS

2, Left side MC/SS

  1. Systolic vs diastolic
A
  1. left HF (Edema, JVD, hepatic congestion)
  2. CAD, HTN (congest pulmonary, cough, fatigue)
  3. systolic - thin wall + EF low + S3 Diastolic - thick wall + EF normal/high + S4
59
Q

Dyspnea + rale + S3 gallop

Name/Dx/Tx

A

Name: HF (systolic)

Dx: Echo (1st), BNP

Tx: ACEI (1st) + diuretic (out patient)

Acute: LMNOP (lasix/morphine/nitrate/O2/postion)

60
Q

CXR finding of CHF progress

A

cephalization -> kerley B line->butterfly pattern -> CHF sign -> pulmonary edema

61
Q

diffuse ST elevation with PR depression, sharp & acute pleuritic chest pain (sharp), leaning forward feel better

Name/Cause/Dx/Tx

A

Name: Acute Pericarditis

Cause: MC idiopathic, virus (2nd, coxsackie), dresslar = hx of MI

Dx: ECG - diffuse ST elevation, PR depression, Echo (find 2nd problem like effusion)

Tx: ASA or NSAID, 2nd colchicine

62
Q

Muffled heart sound + low voltage QRS complex + electran alternan + waterbottle heart

Name/Dx/Tx

A

Name: Pericardia effusion

Dx: ECG (low voltage QRS/alternan), Echo

Tx: Obsevation

63
Q

Muffled heart sound, JVD, hypotension

Name/Dx/Tx

A

Name: Cardiac temponade (WORST Form effusion)

Dx: Echo

Tx: Pericardiocentesis

64
Q

Dypsnea + pericardial knock (high pitched 3rd heart sound) + kassumaul’s sign

Name/Patho/Dx/Tx

A

Name: Constrictive pericarditis

Patho: stiff or thickened pericardium

Dx: Echo

Tx: pericardiectomy

65
Q

Dyspnea + fever + myalgia + chest pain + rales + S3

Name/Patho/Cause/Risk/Dx/Tx

A

Name: Myocarditis

Patho: heart musle inflammed

Cause: MC coxsakie B

Risk: MC children

Dx: Echo, biopsy is gold

Tx: Supportive tx (same as HF)

66
Q

hx of alcohol use + pregnancy + dyspnea

Name/Cause/Dx/Tx

A

Name: DCM (systolic)

Cause: MC idiopathic, alcohol, pregnancy

Dx: echo - thin ventricle, dilated heart, EF low

Tx: HF tx

67
Q

hx of amyloidosis + kussmaul sign

Name/Risk/Dx/Tx

A

Name: RCM (diastole)

Risk: hx of amyloidosis(1st), sarcoidosis

Dx: Echo - normal/large ventricle, atria dialated

Tx: no specific tx

68
Q

Sudden cardiac death during sports + fm hx of sudden death in young age

Name/Patho/PE/Dx/Tx

A

Name: HCM

Patho: septum is enlarged

PE: squatting, lying supine - murmur decreased, standing & valsalva - murmur increase

Dx: Echo - thick septum

Tx: Early detection and ICD placement is key BB (1st),

Definitive: Myodectomy

Avoid extreme sport and dehydration

69
Q

Join pain + chest pain + erythema marginatum

Name/SC/Risk/Cause/Dx/Tx

A

Name: Rheumatic fever

SC: MC mitral valve involve

Risk: children *(5-15)

Cause: GAS bacteria

Dx: Jones major, fever minor (joint/oh my carditis/nodule/erythema marginatum/sydeham’s chorea)

Tx: ASA + PEN G (if allergic - erythro)

70
Q

Trigriceride 200< + LDL 100

Name/Cause/Dx/Screen/Tx

A

Name: Hyperlipidemia

Cause: Hypercholestrolemia, hypertriglyceridemia

Dx: 10year CVD risk screening

Screen: initial normal person age 35 male, 45 female

  • Statin guideline -
      1. DM
      1. LDL >190, >21 yo,
      1. ASCVD score >7.5,
      1. hx of CVD

Tx: LDL lower - statins, HDL higher - niacin, Trigly lower - fibrates *Weight loss/exercise*

71
Q

fever + roth spot + osler node + murmur + Janeway + anemia + nail hemorrage

Name/Cause/SC/Dx/Tx

A

Name: Infective endocarditis

Cause: Acute - staph A, subacute - strep viridin (relate with dental disease), Enterococci - Man in 50y with hx of GI/GU procedures

SC: MC valve - mitral (Staphy A, strep viridin), IV drug - tricuspid (staphy A)

Dx: 3 sets of blood draw before abx 1 hr apart, ECHO(TTE)

  • DUKE criteria - Blood 2 set +, Echo (major), Fever (minor)

Tx:

  • acute: Naf + genta
  • subacute: pen/amx + genta,
  • IF IVDA - VANCO
72
Q

Dental procedure prophylaxis of infective endocarditis meds

3 case/Tx

A

Only recommended for

  1. prosthetic heart valves
  2. previous bacterial endocarditis
  3. congenital heart defects

Tx: 2g amox 30-60 min (clinda if allergy)

73
Q

Uni-vision impairment + temporal pain

Name/Related dx/Dx/Tx

A

Name: Giant cell arthritis

Related Dz: Polymyalgia rheumatica

Dx: ESR first/biopsy definitive

Tx: before diagnosis must start prednisone (no vision loss)

If vision loss - methylprednisolone

74
Q

Decreased/absent pulse + atropic skin change + worse with walking/better with rest + pale, dusky red

Name/Dx/Tx

A

Name: PAD

Dx: ABI (1st) - <0.9, Arteriography (gold)

Tx: Cilostazol + ASA + clopidogrel, Surgical: PTA

75
Q

hx of smoking, atherosclerosis, pulsatile abd mass, bruit heard on abd, hypotension/syncope

Name/Cause/Dx/Tx/Screen

A

Name: AAA

Cause: MC risk factor Artherosclerosis, Strongest factor SMOKING

Dx: US (1st), test of choice CT scan w/ contrast

Tx:

  • surgical repair - >5.5cm or 0.5 cm every in 6month
  • 4.5cm - referral for surgery
  • 4-4.5cm - Q6Mo monitor
  • 3-4cm Q1yr monitor

Screen: Task force: recommanded screen who ever smoked before 65 year old

76
Q

hx of HTN, severe tearing (ripping knife-like) chest pain (10/10), R/L arm BP different 20 or more

Name/Dx/Tx/Caution

A

Name: Aortic dissection (intimal wall tearing)

Dx: CT, CXR - widening of the mediastinum

Tx:

  • Surgical - standford A/debakey I/II
  • Medical - Esmolo, labetalol (1st) + nitroprusside (negative inotrope)

Caution: vasodilator will cause tachycardia rebound

77
Q

IV catherization has done, redness, swollen

Name/Cause/Dx/Tx

A

Name: Superficial thrombophlebitis

Cause: MC IV cath, trauma, pregnancy

Dx: duplex US

Tx: supportive

78
Q

Long Smoking hx + finger toes claudication

Name/Cause/PE/Dx/Tx

A

Name: Thromboangiitis obliterans (buerger’s disease)

Cause: strong relationship with smoking

PE: allen test

Dx: Aortography

Tx: Stop smoking definitive tx, CCB for raynaud

79
Q

PVD vs PAD explain

A

PAD - better with rest, lateral malleolus, atrophic

PVD - worse with rest, medial malleolus, brownish hyperpigment

80
Q

Unilateral calf pain + homan sign

Name/Risk/MC site/Dx/Tx

A

Name: DVT

Risk: car ride/plan flight >4 hours, OCP, pregnancy, malignancy

MC site: calf MC -> lung PE

Dx: duplex US (1s), venography (gold)

Tx: LMWH -> warfarin for 3month (1st), IV filter if failed coagulation

LMWH is initial tx for pregnancy and malignancy

2 or more thrombophillic warfarin for 12 month (deficiencies of antithrombin, protein C, or protein S; factor V Leiden; prothrombin; hyperhomocysteinemia; or high factor VIII)

81
Q

Obesity, Dilated tortuous vein, worsening with long standing

Name/Dx/Tx

A

Name: Varicouse vein

Dx: Clinical, duplex US

Tx: stocking, leg elevation

82
Q

Brownish pigmentation/medial malleoulus + pain/color improves with leg evelation

Name/Cause/Dx/Tx

A

Name: Chronic Venous Insufficiency

Cause: MC occurs after superficial thrombophlebitis or after DVT

Dx: trendelenburg test, US

Tx: stocking, leg elevation If ulcer tx - wet to dry dressing, Unna boot

83
Q

MC cardiac tumor in adults

Name/Patho/Dx/Tx

A

Name: Atrial Myxoma,

Patho: ball valve obstruction at mitral valve (atria 40-50%, Benign)

Dx: Echo

Tx: Surgical remove

84
Q

Harsh holosystolic murmur at lower left sternal border

Name/SC/Dx/Tx

A

Name: VSD

SC: MC type of congenital murmur, MC type membrane

Dx: Echo

Tx: close its own in 10 year, Growth disruptive or sx - surgical correction

85
Q

Rib notching, BP difference top and bottom

Name/Dx/Tx

A

Name: Coarctation of the arota

Dx: Echo

Tx: balloon angioplasty (open up the narrow spot)

86
Q

Machinery murmur (continue murmur)

Name/Patho/Dx/Tx

A

Name: PDA

Patho: bradykin increase and PGE1 decrease to close

Dx: Echo

Tx: indomethacin

Sometimes requires PGE1 to keep it open due to other congenital effect

87
Q

“Boot-shaped” heart on x-ray, tet-spells

Name/Patho/SC/Dx/Tx

A

Name: Tetralogy of Fallot

Patho: PROV - pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta, VSD

SC: Cyanotic

Dx: Echo

Tx: initially squatting knee to chest, ultimately surgical correction, May requires PDA continue open

88
Q

Wide fixed split S2

Name/MC site/Dx/Tx

A

Name: ASD

MC site: ostium secundum

Dx: Echo

Tx: close its own before 1 year, sx - surgical repair (2-4 yrs)

89
Q

headache + siezure + bleeding

Name/MC site/Patho/Dx/Tx

A

Name: Arteriovenous malformation

MC site: MC brain, spine

Patho: tangled aterior + venos

Dx: CT

Tx: Surgery

90
Q

metabolic syndrome criteria (5)

A

3 out of 5

1) waistline (>35 inches for women, >40 inches for men)
2) triglyceride levels (>150 mg/dL)
3) low HDL cholesterol level (<50 mg/dL for women, <40 mg/dL for men)
4) hypertension (>130/85 mmHg)
5) hyperglycemia (fasting blood glucose >100 mg/dL)

91
Q

dyspnea, non-exertional CP + fatigue + Mid systolic Click

Name/Related dz/PE/Dx/Tx

A

Name: MVP

Related Dz: Marfan, ehler-danlos

PE: midsystolic click + later systolic murmur

  • Murmur louder = preload low (standing), Murmur sound decrease = preload high (squatting)

Dx: Echo

Tx: Observation

pance (12 decks)

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