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STEP 2CK Review > 2 Cardiology + Vasc surg > Flashcards

2 Cardiology + Vasc surg Flashcards

1
Q

Chest pain in ED, concerning for ACS: What drugs to give

A

MONA BASH
morphine, O2, nitro, aspirin
B-Blocker, ace-i, statin, heparin

Maybe change:
Add: Plavix and/or abciximab/ebtifibitide
Maybe remove: O2, B-blocker

If hypotensive and RCA infarct, give IVF instead of Nitro or morphine

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2
Q

Renovascular HTN

-how to dx

A

Either old man with atherosclerosis of renal arteries, or young woman with fibromuscular dysplasia.

Get Renal Artery Doppler, confirm with arteriogram if necessary. (can also get Ace-i scan instead of renal art doppler)

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3
Q

Pt with hx of CHF comes in ED with AFib with RVR, causing CHF exacerbation. Vitals stable. How to tx?

A

CANNOT use CCB or BB for rate control.

Use Digoxin or amiodarone (amio can do both rate and rhythm control)

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4
Q

mitral valve prolapse

  • murmur, louder with what
  • treatment
A
  • systolic murmur, louder with valsalva

- tx just like HOCM: avoid dehydration (keep preload up) and B-block (increase filling time)

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5
Q

CHADS2 score
CHA2DS2VASc score
-each letter
-what to do with points

A 
CHF (LV systolic dysfunction) 1
HTN 1
Age >75 1
DM 1
Stroke/TIA 2

CHA2DS2VASc
Vascular dz 1
Age 65-74 1
Sex category–female 1

0: ASA
1: NOAC
2: warfarin

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6
Q

Restrictive cardiomyopathy: think what 3 important causes?

  • what hx clues for each
  • how to confirm dx?
A
  1. hemochromatosis–cirrhosis, bronze diabetes. High ferritin. Get genetic test.
  2. amyloidosis–Neuropathy, multiple myeloma. Do fat pad biopsy, myocardial bx if negative.
  3. Sarcoidosis–pulmonary disease/sxs. Do MRI.
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7
Q

Restrictive cardiomyopathy tx:

what to be careful about in treating overload sxs?

A

Gentle diuresis for overload, since heart is also preload dependent. Difficultly filling.

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8
Q

Pt with syncope, has structural heart disease and/or CAD. Do what?

A

Automatic admission for 24h telemetry

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9
Q

Primary hyperaldosteronism: get what test, what are you looking for

A

Renin/Aldo level >20

Possible aldosterone adenoma. Get CT and resect.

Suspect primary hyperaldosteronism in pt with HTN and Hypokalemia

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10
Q

PVD: What is difference betwen CLI and ALI?

A

Critical limb ischemia: chronic, severe progression of PVD

Acute limb ischemia: usu single thrombus, do immediate revascularization (eg thrombectomy)

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11
Q

Pt with syncope and focal neuro deficit: Think what, and what test to do?

A

Vertebrobasilar insuff. (decreased flow to posterior circulation)
-Do CTA, look at vertebrobasilar arteries

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12
Q

STEMI door-balloon time?

  • if facility is __min away, do tpa
  • what to give before transferring to cath facility? (4 according to onlinemeded)
A

90min. If facility is >60min away, do TPA. (onlinemeded)
- CC book says do TPA if unable to do PCI withint 120 min of arrival
- Heparin, then BBlocker, Ace-I, statin

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13
Q

Pericardial disease overview: How to think about 3 main problems and their tx?

A

Etiology not important. Think about how pericardium is responding to dz. Big 3:

  1. Pericarditis–inflammation, so anti-inflammatories
  2. Effusion/Tamponade–Hemodynamic intervention required
  3. Constrictive–Anatomic solution required
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14
Q

You suspect Cushing’s syndrome. What test to start?

A

“low Then high”

  1. 24h urinary cortisol, or low dose dexamethasone suppression test. This is to confirm Cushing’s syndrome.
  2. ACTH
  3. High dose DST
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15
Q

Main side effects:

  1. Statins (2)
  2. Fibrates (2)
  3. Ezetimibe (1)
  4. Niacin (1)
  5. Cholestyramine (1)
A
  1. myositis, hepatotox
  2. (same) myositis, hepatotox
  3. diarrhea
  4. flushing (tx with ASA)
  5. diarrhea
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16
Q

Stress test types (3)

who gets what

A
  1. Treadmill–normal EKG, can exercise
  2. Dobutamine+echo–Abnormal EKG, or can’t exercise
  3. Nuclear–reserved for ppl with BBB, poor echo image, previous bypass
17
Q

Pt with tamponade. Do what as you set up for emergent pericardiocentesis?

A

Start IVF to increase preload.

Preload-dependent state! Absolutely do not do positive pressure ventilation

18
Q

Effects on LDL, HDL, TG?

  1. fibrates
  2. niacin
A
  1. fibrates: decrease TG

2. niacin: incease HDL

19
Q

Orthostatic hypotension definition

A

Within 3 minutes of standing:
SBP up by 20, or
DBP up by 10.

Also, HR up 10

20
Q

Pheo 5 Ps

A 
Paroxysmal
Perspiration
Pressure (HTN)
Pain (HA)
Palpitations (Tachy)
21
Q

Subclavian steal syndrome

A

arm claudication and posterior CN sxs (vertigo, presyncope). Bypass the arm stenosis.

22
Q

Surgery for which AAA’s? (3)

A

AAA >5.5cm, >0.5 cm/year, or tender

23
Q

Coronary stents: drug eluting vs bare metal.

  • When to use one over other?
  • what meds required after each stent
A

-Always drug eluting, unless homeless or unreliable and cannot guarantee clopidogrel

  • Drug eluting: 1 year plavix
  • bare metal: 1 month plavix
24
Q

BNP in diagnosing CHF: what pts is test less reliable

A

Obese. BNP can ‘hide in fat’ so artificially lower BNP value

25
Q

PVD: what vessels get stented vs bypassed?

A

Lesion in femoral a. and <3cm gets stent.

Everything else: bypass

26
Q

Pt with Orthostatic hypotension. IVF does not help. You should think of what rare causes? (4)

A

Failure of reflex sympathetics:

  1. Broken autonomics: eldery/DM
  2. Sepsis (vasodilation)
  3. Anaphylaxis
  4. Addision’s disease
27
Q

Arterial embolization to extremity:

  • 5 P’s
  • treatment time window
  • what to watch out for with treatment
A 
5 P's of embolism
Painful
Pale
Pulseless
Pareshtesia
Poikilothermia

6h to fix until ischemia (same for tourniquets). Embolectomy or TPA or heparin

-watch out for compartment syndrome with return of blood

28
Q

Difference btwn NSTEMI and UA.

-how to tell apart?

A

NSTEMI causes elevated cardiac enzymes (however may take a few hours to elevate).
Cardiac enzymes can take up to 18h to peak. So, to r/o NSTEMI, must have 2 negative Trops 6h apart, or negative after 18h ongoing chest pain.

29
Q

CHF acute exacerbation drugs

A

LMNOP: lasix, morphine, nitrates, O2, position

REDUCE PRELOAD. Nitro and BIPAP most important! BIPAP also helps to reduce preload

30
Q

ACS Chest pain, concern for UA. What to do after r/o STEMI and NSTEMI?

A

Concern for UA: Do Stress test. (treadmill, dobutamine/adenosine+echo, or Nuclear)

31
Q

NSTEMI treatment

A

48h to do cath

32
Q

HTN in JNC 8 (most recent)

4 main categories

A
  1. >
    1. goal <150/90

all others goal <140/90

  1. <60
  2. > 18, CKD
  3. > 18, DM
33
Q

Coronary cath: when to do PCI vs CABG

A

CABG: Left mainstem or 3-vessel
PCI: 1,2 vessel

34
Q

CHF, systolic. NYHA classes and drugs.

Also, when to get AICD?

-What water and salt limit per day?

A
  1. BB, Ace-i
  2. Lasix
  3. Spironolactone, or ISDN-hydralazine.
  4. LV assist, transplant, inotropes (dobutamine, milrinone)

If EF<35% and less than class4, get AICD

H2O: <2L/day
Salt: <2g/day

STEP 2CK Review (20 decks)

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