ACCsap

Question 1

Chylous pericardial effusion after surgery

Answer 1

Try diet with medium chain triglycerides

Question 2

Most common cardiac mass?

Answer 2

Malignant metastasis

Question 3

Factor V Leiden

Answer 3

Causes activated protein c resistance and is autosomal dominant. Low lifetime risk of DVT.

Question 4

Contraindicated with dofetilide

Answer 4

Hctz, increases dofetilide concentration

Question 5

Avoid these medications with ticagrelor

Answer 5

Rifampin
Phenytoin
Carbamazepine 
Phenobarbital 
Dexamethasone

Question 6

Contraindications to treadmill stress

Answer 6

Preexcitation
LBBB
paced ventricular rhythm
>1 mm st depressions

Question 7

Symptomatic mesenteric ischemia meds

Answer 7

Needs statin regardless of LDL

Does not need warfarin or DOAC

Question 8

Rf ablation vs cryoablation

Answer 8

RF more permanent but higher risk of permanent heart block

Question 9

Coronary anolomy associated with TOF

Answer 9

Lad off rca or right sinus

Question 10

Vorapaxar

Answer 10

Inhibits PAR-1, thrombin receptor on plt.

Increased risk of intracranial hemorrhage, contraindicated in stroke or TIA.

Question 11

Serve-HF

Answer 11

Harm associated with adaptive servoventilation in patients with heart failure and central sleep apnea

Best to optimize HF therapy to treat Cheyne stokes respirations

Question 12

Carney complex

Answer 12

Nevi
Other tumors
Endocrinopathies
Myxomas

Question 13

Cardiac fibroma

Answer 13

More common in kids

Arrthymia medically refractory

Question 14

Nevoid basal cell carcinoma syndrome

Answer 14

Cardiac fibromas

Bifid ribs

Question 15

Rhabdomyoma

Answer 15

Tuberous sclerosis

Question 16

Side effect of VEGF inhibitors like bevacizumab

Answer 16

Hypertension

Preferred tx is ace-I or dihydropyridine CCB

Question 17

Chronic HTN in pregnancy

Answer 17

Goal is same, less than 140/90

Question 18

Waveform in constriction vs tamponade

Answer 18

Steep y descent- constriction
Rapid early filling

Blunted y descent - tamponade
No early diastolic filling

Question 19

Tuberculous pericardial effusion

Answer 19

Adenosine deaminase > 40, elevated protein, and high LDH

Question 20

Pulmonary arterial hypertension numbers

Answer 20

Mean PA > 25
PCWP < 15 (normal LV filling pressure)
PVR >=3 units
Exercise mean PA >30-35

PVR = TPG/CO
TPG = MEAN PA - PCWP

Question 21

In high risk PAH patients, what is first line drug?

Answer 21

Epoprostenol

Question 22

Goal for PH patients walk distance with treatment

Answer 22

> 380-440m

Question 23

Class IV pulmonary hypertension

Answer 23

Syncope defines class 4

Question 24

Vasodilators in PHTN

Answer 24

Nifedipine, amlodipine, diltiazem

NOT VERAPAMIL!!!

Question 25

Cilostazol contraindicated in...

Answer 25

Heart failure. It’s a PDE inhibitor, can lead to arrhythmic death

Question 26

Fix a popliteal artery aneurysm at

Answer 26

>2 cm

Question 27

Post exercise ABI

Answer 27

Drop by 20% or ankle pressure drop by >30 mmHg

Question 28

Colesevelam effect on labs

Answer 28

Can lower LDL and A1C | May raise triglycerides

Question 29

With HIV hyperlipidemia

Answer 29

Use pravastatin | Can use rosouvastatin

Question 30

Ivabradine contraindications

Answer 30

Liver disease | Qt prolonging meds

Question 31

Ranolazine contraindications

Answer 31

Liver disease | Qt prolonging meds

Question 32

Syntax score in - LM THREE VESSEL

Answer 32

LM: 33, bypass superior THREE VESSEL: 22, bypass superior

Question 33

Blunted Y descent Rapid x and y Blunted x

Answer 33

Tamponade Constriction Restrictive CM

Question 34

Torsades

Answer 34

EAD

Question 35

Cryoballoon vs rf ablation

Answer 35

Similar efficacy and complication rate More phrenic nerve injury Right phrenology nerve

Question 36

Macrolide antibiotics

Answer 36

Block Ikr so can prolong QT interval

Question 37

SCD with swimming

Answer 37

Long qt 1 - iks mutation, loss of function in potassium channel

Question 38

Amiodarone and warfarin

Answer 38

DECREASE dose of warfarin

Question 39

Tyrosine kinase inhibitors

Answer 39

Hypertension

Question 40

Checkpoint inhibitors

Answer 40

Myositis and myocarditis

Question 41

Fabry’s inheritance pattern

Answer 41

X linked

Question 42

Scimitar syndrome

Answer 42

Hypoplastic right lung Rlpv to ivc

Question 43

Patent ductus with pulmonary htn hands and feet

Answer 43

Pink hands blue feet

Question 44

LBBB on resting ECG

Answer 44

Exercise echo or pharm MPI - class 1

Question 45

CCB as anti anginal

Answer 45

Verapamil and diltiazem, not the dihydropyridine ones

Question 46

Pioglitazone

Answer 46

Can increase risk of HF

Question 47

In stable ischemic HD

Answer 47

Plavix 6 months No ticagrelor or prasugrel