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ABIM IM Recert > Board Vitals Cardiology > Flashcards

Board Vitals Cardiology Flashcards

1
Q

Which cardiac valve abnormality causes paradoxical splitting of S2?

A

Aortic stenosis

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2
Q

What valvular abnormality does repair of tetralogy of Fallot commonly result in?

A

Pulmonary insufficiency/regurgitation

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3
Q

Systolic murmur heard best at the right upper sternal border.

Diagnosis?

A

Aortic stenosis

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4
Q

Which valve does rheumatic fever effect the most?

A

Mitral value is always involved - regurgitation precedes stenosis.

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5
Q

What percentage of rheumatic fever patients have involvement of the aortic valve?

A

20 - 30%

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6
Q

Does aortic stenosis happen after rheumatic fever in isolation?

A

Rarely - usually mitral valve is involved.

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7
Q

What can streptococcal pharyngitis as a child cause?

A

Rheumatic fever

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8
Q

What is the reason for the ACE inhibitor associated cough?

A

Accumulation of bradykinin

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9
Q

Should you use tricyclic antidepressants for diabetic neuropathy in patients with a recent myocardial infarction?

A

No (they are contraindicated)

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10
Q

Why are tricyclic antidepressants contraindicated with recent myocardial infarction?

A

They can cause prolonged QTc interval.

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11
Q

What is the mortality risk of papillary muscle rupture?

A

10 - 40%

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12
Q

What happens to the pulmonary capillary wedge pressure in cardiogenic shock?

A

Increases

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13
Q

What happens to the central venous pressure in cardiogenic shock?

A

Increases

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14
Q

When a patient is getting a pulmonary wedge capillary pressure measurement; what does the pressure beyond the pulmonary wedge occlusion represent?

A

Left atrial pressure

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15
Q

How long should patients with known atrial fibrillation (> 48 hrs) or unknown duration be anticoagulated for before undergoing direct cardioversion?

A

3 weeks

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16
Q

Why do patients with known atrial fibrillation (> 48 hrs) or unknown duration need to be anticoagulated before or after undergoing direct cardioversion?

A

To decrease thromboembolic risk

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17
Q

How long should patients with known atrial fibrillation (> 48 hrs) or unknown duration be anticoagulated for after undergoing direct cardioversion?

A

4 weeks

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18
Q

A patient with Wolf-Parkinson-White syndrome is treated for atrial fibrillation, and subsequently develops a lupus-like syndrome.

What drug was used?

A

Procainamide (causes reversible lupus-like syndrome)

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19
Q

When do you see Roth spots in the retina?

A

Infective endocarditis

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20
Q

What effect does norepinephrine have on the cardiac pacemaker cells?

A

Reduced time to threshold

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21
Q

What needs to be done before starting a patient on sotalol?

A

Admission to hospital for Qtc monitoring

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22
Q

Should sotalol be started in an outpatient setting?

A

No

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23
Q

What needs to be treated prior to repair of large atrial septal defects?

A

Pulmonary hypertension

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24
Q

Which patients need to begin combination therapy for their hypertension?

A

Patients with blood pressure more than 20/10 mmHg above their goal.

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25
Q

What 2 conditions is pulsus paradoxus present in?

A
  • Cardiac tamponade
  • Constrictive pericarditis
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26
Q

What is the first line drug for SVT?

A

IV adenosine push

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27
Q

Which class of medications increases the risk of aortic aneurysm rupture?

A

Fluoroquinolones

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28
Q

Who is at greater risk of aortic aneurysm expansion or rupture - males or females?

A

Females (4 X compared to males)

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29
Q

Is an increase or decrease in the forced expiratory volume (FEV1) associated with increased risk of aortic aneurysm rupture/dissection?

A

Decrease in FEV1

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30
Q

Does diabetes mellitus increase or decrease the risk of aortic aneurysm expansion or rupture?

A

Decrease

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31
Q

Does metformin increase or decrease the risk of aortic aneurysm expansion or rupture?

A

Decrease

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32
Q

Does smoking increase or decrease the risk of aortic aneurysm expansion or rupture?

A

Increase

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33
Q

Does family history of AAA rupture increase of aortic aneurysm expansion or rupture?

A

No

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34
Q

Does hypertension increase or decrease the risk of aortic aneurysm expansion or rupture?

A

Increase

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35
Q

Do non-selective beta-blockers increase or decrease systemic vascular resistance?

A

Increase

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36
Q

Which anti-arrhythmic drug causes drug-induced hemolytic anemia?

A

Quinidine

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37
Q

Which anti-arrhythmic drug causes drug-induced lupus?

A

Procainamide

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38
Q

Can a transplanted heart increase its rate in response to exercise as rapidly as a native heart?

A

No

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39
Q

Why can’t a transplanted heart increase its rate in response to exercise as rapidly as a native heart?

A

Lack of sympathetic innervation

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40
Q

Patients with heart transplant can have a syncopal episode as a result of overly intense exercise regimens.

True or false?

A

True

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41
Q

What is the mechanism of action of PCSK9 inhibitors?

A

Prevent LDL receptor degradation

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42
Q

What is the mechanism of action of statins?

A

HMG-CoA reductase inhibition

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43
Q

What is the mechanism of action of ezetimibe?

A
  • Inhibition of intestinal cholesterol absorption
  • Promoting hepatic clearance of cholesterol
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44
Q

What is the mechanism of action of niacin?

A

Inhibition of hormone sensitive lipase in adipose tissue

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45
Q

Which lipid lowering agents work by stimulation of beta-oxidation pathways?

A

Fibrates

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46
Q

How long does elective surgery have to be delayed in patients receiving dual antiplatelet therapy (DAPT) because of coronary stenting?

A

6 months

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47
Q

How long does elective surgery have to be delayed in patients receiving dual antiplatelet therapy (DAPT) because of coronary angioplasty but no coronary stenting?

A

2 weeks

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48
Q

Which has a greater mortality benefit in patients with diabetes - coronary artery bypass grafting or percutaneous coronary intervention?

A

Coronary artery bypass grafting

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49
Q

How much fluid is in the pericardial space in a normal healthy person?

A

15 - 50 mL

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50
Q

How much volume of fluid needs to be in the pericardial space to call it a pericardial effusion?

A

> 50 mL

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51
Q

Diver develops chest pain during ascent and their is a crunching sound over the mediastinum.

Diagnosis?

A

Pneumomediastinum

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52
Q

Athlete suffers direct blow to the chest, with resultant arrhythmia and/or unresponsiveness.

Diagnosis?

A

Commotio cordis

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53
Q

What is polymorphic ventricular tachycardia?

A

Torsades de pointes

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54
Q

What is the treatment of torsades de pointes (polymorphic ventricular tachycardia)?

A

IV magnesium

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55
Q

Should you give ondansetron in torsades de pointes (polymorphic ventricular tachycardia)?

A

No

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56
Q

What does the IV magnesium do in torsades de pointes?

A

Stabilize the myocardium

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57
Q

Should you cardiovert people who are hemodynamically stable?

A

No

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58
Q

Do you give oxygen to STEMI patients if their oxygen saturation is normal?

A

No

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59
Q

What is the predominant cell type in normal pericardial fluid?

A

Lymphocytes

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60
Q

Is frequent non-sustained ventricular tachycardia an indication for ICD in hypertrophic cardiomyopathy?

A

No (not anymore)

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61
Q

Is mitral regurgitation an indication for ICD in hypertrophic cardiomyopathy?

A

No

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62
Q

Is ejection fraction less than 45% an indication for ICD in hypertrophic cardiomyopathy?

A

Yes

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63
Q

What percentage of cryptogenic strokes occur in patients with patent foramen ovale?

A

40%

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64
Q

Where does the transducer need to be aimed while doing a transesophageal echocardiogram in order to see the cardiac structures?

A

Anteriorly

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65
Q

Does furosemide have a negative effect on the fetus?

A

Yes

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66
Q

Should furosemide be given to a pregnant woman who needs it?

A

Yes

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67
Q

Corticosteroids used during post-MI pericarditis interfere with the conversion of myocardial infarction to scar tissue, resulting in greater wall thinning and an increased risk of post-MI wall rupture.

True or false?

A

True

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68
Q

Corticosteroids used during post-MI pericarditis weaken the ascending aortic wall, leading to an increased risk of aortic dissection.

True or false?

A

False

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69
Q

Should you give a fluid bolus if the pulmonary capillary wedge pressure is high?

A

No

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70
Q

What is the treatment of cardiogenic shock after a myocardial infarction?

A

Dobutamine and nitroprusside infusions

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71
Q

How high does the risk need to be on the ACC/AHA calculator before a statin is recommended?

A

> 7.5%

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72
Q

Which valvular abnormality can be seen in Eisenmenger syndrome?

A

Tricuspid regurgitation

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73
Q

In a patient with a stent and aspirin exacerbated respiratory disease should you continue the aspirin?

A

Yes - after aspirin desensitization

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74
Q

Is cardiac output increased or decreased in hypovolemic or hemorrhagic hock?

A

Decreased

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75
Q

If the patient has hypotension and a pulsatile abdominal mass are they more likely to have an abdominal aortic aneurysm or an aortic dissection?

A

Abdominal aortic aneurysm

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76
Q

ECG with ST coving in lead V1, ST elevations in leads V1-V3, and incomplete right bundle branch block.

Diagnosis?

A

Brugada syndrome

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77
Q

What echocardiogram findings are expected in Brugada syndrome?

A

Normal findings

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78
Q

What is the treatment of Brugada syndrome?

A

ICD

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79
Q

Does surgery need to be delayed for further testing in case of a left bundle branch block in a patient with no symptoms?

A

No

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80
Q

Does phenylephrine significantly increase heart rate?

A

No

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81
Q

Does moderately dosed dopamine (2 - 10 mcg/kg/min) increase heart rate?

A

Yes

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82
Q

If a mechanical aortic valve develops insufficiency, then what is the patient at risk for at the site of the faulty valve?

A

Thrombus formation

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83
Q

In patients with hypertriglyceridemia have fibrates demonstrated a benefit in cardiac events when added to statins?

A

No

84
Q

In patients with hypertriglyceridemia has icosapent ethyl demonstrated a benefit in cardiac events when added to statins?

A

Yes

85
Q

What is the main benefit of fibrates in hypertriglyceridemia?

A

To prevent pancreatitis

86
Q

Is antibiotic prophylaxis required for routine colonscopy in patients with prosthetic valves?

A

No

87
Q

Is antibiotic prophylaxis required for routine colonoscopy in patients with prosthetic valves?

A

No

88
Q

How are pulmonary venous malformations diagnosed on an echocardiogram?

A

Late bubbles are seen on a bubble study

89
Q

How is congenital heart disease with right-to-left shunt diagnosed on an echocardiogram?

A

Immediate bubbles are seen on a bubble study

90
Q

Patient presents with telangiectasias, skin discoloration, pulmonary arteriovenous malformation, GI bleeding, and hematuria.

Diagnosis?

A

Hereditary hemorrhagic telangiectasia

91
Q

Why should patients not have caffeine prior to a cardiac stress MRI?

A

Caffeine can inhibit adenosine receptors (interferes with the response to adenosine)

92
Q

Transplanted heart has coronary vessels showing diffuse concentric narrowing with intimal proliferation - what is this called?

A

Cardiac allograft vasculopathy

93
Q

Does cardiac allograft vasculopathy involve lipid deposition?

A

No

94
Q

Is the coronary narrowing seen in transplanted hearts concentric or eccentric?

A

Concentric

95
Q

Is arterial ballooning characteristic of coronary disease in transplanted hearts?

A

No

96
Q

Does left ventricular outflow collapse occur as a result of remodeling after myocardial infarction?

A

No

97
Q

Does mitral valve annulus widening occur as a result of remodeling after anterior myocardial infarction?

A

Yes

98
Q

Does left ventricular dilation occur as a result of remodeling after anterior myocardial infarction?

A

Yes

99
Q

Is a patent ductus arteriosus caused by a fetal remnant?

A

Yes

100
Q

Is atrioventricular nodal reentrant tachycardia (a supraventricular tachycardia) more common in men or women?

A

Women

101
Q

Is atrioventricular nodal reentrant tachycardia (a supraventricular tachycardia) more common in structurally normal or structurally abnormal hearts?

A

Structurally normal hearts

102
Q

Is the bundle of His below the node a necessary part on the reentrant circuit in atrioventricular nodal reentrant tachycardia (a supraventricular tachycardia)?

A

No

103
Q

Does the pathway which conducts rapidly in atrioventricular nodal reentrant tachycardia (a supraventricular tachycardia) have a relatively long or short refractory period?

A

Long

104
Q

Does troponin rise immediately after cardiac insult?

A

No

105
Q

Does a negative troponin rule out a STEMI?

A

No

106
Q

Can the murmur of mitral regurgitation be holosystolic?

A

Yes

107
Q

What is the difference between the holosystolic murmur of acute mitral regurgitation versus that of interventricular septum rupture?

A

The murmur of interventricular septum rupture is heard all over the precordium; the mitral regurgitation murmur is loudest at the apex

108
Q

Which medication used for hypertensive crisis causes throat burning and scalp tingling?

A

Labetalol

109
Q

Which medication used for hypertensive crisis causes tinnitus?

A

Nitroprusside

110
Q

Most cases of Marfan syndrome are because of mutations in which gene?

A

FBN1

111
Q

First-degree relatives of patients with a gene mutation associated with aortic aneurysms should undergo genetic testing.

True or false?

A

True

112
Q

What is the name for restrictive cardiomyopathy in the setting of parasitic infections?

A

Loffler endocarditis

113
Q

What type of ventricular septal defect causes aortic regurgitation?

A

Perimembranous VSD

114
Q

What is the only type of VSD that causes a diastolic murmur?

A

Perimembranous VSD

115
Q

Does exercise cause an increase or decrease in systemic vascular resistance?

A

Decrease

116
Q

Can diltiazem cause torsades de pointes?

A

No

117
Q

Can sotolol cause torsades de pointes?

A

Yes

118
Q

Which medication is more likely to cause torsades de pointes…

Sotalol or digitalis?

A

Sotalol

119
Q

What does a mature coronary plaque consist of?

A

Fibrous capsule and lipid core

120
Q

Does a history of Kawasaki disease indicate ischemia or arrhythmia as cause of palpitations?

A

Ischemia

121
Q

Can severe aortic insufficiency cause liver failure?

A

Yes (cardiac cirrhosis)

122
Q

Can an aberrant focus in a pulmonary vein cause atrial fibrillation?

A

Yes

123
Q

What’s the mechanism of action of adenosine?

A

Blocks conduction through AV node

124
Q

Which class of medications prevents coronary artery spasm?

A

Calcium channel blockers

125
Q

What lifestyle changes are more important of lowering cholesterol…

Dietary changes or exercise?

A

Dietary changes

126
Q

A patient undergoes valvular surgery and the histopathology shows Aschoff bodies, Anitschkow cells and valve fibrosis with calcification.

What’s the etiology?

A

Rheumatic fever

127
Q

Which test should be used in patients with suspected ischemia who have ECG changes that would make an exercise ECG hard to interpret?

A

Nuclear myocardial perfusion imaging

128
Q

In patients with stable angina - does revascularization reduce morbidity and mortality?

A

It reduces morbidity (symptoms) but not mortality

129
Q

Which diastolic phase contributes the most to left ventricular filling?

A

Early rapid left ventricular filling

130
Q

What is digoxin’s primary mechanism of action in treating supraventricular arrhythmias?

A

Increased parasympathetic tone

131
Q

What percentage of patients develop sinus node dysfunction after a heart transplant?

A

50%

132
Q

How does sinus node dysfunction typically present in heart transplant patients?

A

Bradycardia

133
Q

In left-sided dominant circulation which artery supplies the posteromedial papillary muscle?

A

Posterior descending artery

134
Q

What is the most common heart rhythm expected in acute pericarditis?

A

Sinus tachycardia

135
Q

Where are pericardial cysts typically located?

A

Within the pericardial space; usually along the right heart border.

136
Q

What autoimmune condition develops after myocardial infarction?

A

Dressler syndrome

137
Q

Mutations in which genes are implicated in hypertrophic cardiomyopathy?

A

Sarcomere genes

138
Q

Does “athelete’s heart” cause left ventricular hypertrophy?

A

Yes (adaptive mechanism)

139
Q

Can obstructive sleep apnea cause resistant hypertension?

A

Yes

140
Q

Can hypertrophic cardiomyopathy cause resistant hypertension?

A

No

141
Q

What is the downward displacement of the tricuspid valve into the right ventricle along with abnormalities of tricuspid leaflets causing regurgitation known as?

A

Ebstein anomaly

142
Q

Can amiodarone cause pulmonary fibrosis?

A

Yes

143
Q

Which statins are preferred in severe renal impairment?

A

Atorvastatin
Fluvastatin

144
Q

Which statins are least likely to cause muscle toxicity?

A

Pravastatin
Fluvastatin

145
Q

What happens to the pulmonary capillary wedge pressure in severe mitral regurgitation?

A

Increases (elevated)

146
Q

What does the pressure beyond the pulmonary wedge occlusion represent?

A

Left atrial pressure

147
Q

Which method offers the most accurate blood pressure reading?

A

Arterial line

148
Q

What is the next step in patients presenting with syncope and significant cardiac risk factors?

A

Hospitalization (and evaluation for arrhythmias)

149
Q

Should blood cultures be drawn when infective endocarditis is suspected?

A

Yes

150
Q

What is the treatment of coronary microvascular disease?

A

Sublingual nitroglycerin
Risk factor modification

151
Q

What should you add if there is continued angina despite sublingual nitroglycerin in patients with coronary microvascular disease?

A

Beta-blocker

152
Q

What drug can be used to treat malignant hypertension associated with thrombotic microangiopathy?

A

Labetalol

153
Q

Physical findings on cardiac exam include: jugular venous distension, ankle edema, left parasternal systolic lift, holosystolic murmur, tricuspid regurgitation murmur, a loud S2, and narrow splitting of S2.

Diagnosis?

A

Cor pulmonale

154
Q

What is aortic stenosis at an older age usually due to?

A

Calcification

155
Q

What screening should be done in men aged 65 - 75 years with a history of smoking?

A

Duplex US of the abdominal aorta for AAA

156
Q

What should be started for patients with gain of function PCSK9 mutation?

A

High intensity statin (PCSK9 inhibitor is only added on to maximally tolerated statin)

157
Q

What does procainamide do to the rate of rise of phase 0 of the action potential?

A

Decreases it

158
Q

What does procainamide do to the duration of the action potential?

A

Increases it

159
Q

Do most patients with congenital absence of pericardium have symptoms?

A

No (but some patients can have chest pain, shortness of breath and palpitations)

160
Q

What is the most common arrhythmia after myocardial infarction?

A

Atrial fibrillation

161
Q

What is the usual mechanism for atrial fibrillation after myocardial infarction?

A

Heart failure

162
Q

What extra heart sounds are heard when there is increased cardiac pressure and volume?

A

S3 and S4

163
Q

What is the primary mechanism of action of adenosine?

A

Potassium channel activation

164
Q

Should sotalol be used for atrial fibrillation in severe heart failure?

A

No - increased mortality risk

165
Q

Should flecainide be used for atrial fibrillation in severe heart failure?

A

No - increased mortality risk

166
Q

Which drug is preferred for rhythm control in patients with atrial fibrillation and heart failure?

A

Amiodarone

167
Q

What is the most posterior aspect of the heart?

A

Left atrium

168
Q

What drug is used to try to convert atrial flutter to normal sinus rhythm pharmacologically?

A

Ibutilide

169
Q

What is the pathogenesis of the occluding lesion in case of myocardial infarction?

A

Plaque rupture with thrombosis

170
Q

What can happen with sudden discontinuation of clonidine and short-acting beta-blockers?

A

Rebound hypertension

171
Q

Why is nitroglycerin not very effective if given orally rather than sublingually or intravenously?

A

First pass metabolism

172
Q

What baseline testing must be done before amiodarone is started?

A
  • Thyroid function tests
  • Liver function tests
  • Pulmonary function tests
173
Q

What lung disease can amiodarone cause?

A

Interstitial lung disease

174
Q

What is the most important intervention in Buerger’s disease (thromboangiitis obliterans)?

A

Smoking cessation

175
Q

Patient presents with hands turning blue in cold weather. Lower extremity arteriography demonstrates segmental occlusive lesions with interspersed normal areas, normal proximal arteries with atherosclerosis, and “spider leg collaterals”.

Diagnosis?

A

Buerger’s disease (thromboangiitis obliterans)

176
Q

Which medication can be used for rate control in the setting of atrial fibrillation and heart failure?

A

Digoxin

177
Q

Does pharmacologic conversion of atrial fibrillation with rapid ventricular rate (RVR) need to be done in case of a hemodynamically stable patient?

A

No

178
Q

Injury to pulmonary vascular endothelium can result in pulmonary hypertension.

True or false?

A

True

179
Q

Can amyloidosis cause restrictive cardiomyopathy?

A

Yes

180
Q

Cardiac tissue shows apple-green birefringence with stained with Congo red dye.

Diagnosis?

A

Cardiac amyloidosis

181
Q

What is the most common pathophysiologic mechanism causing stable ischemic heart disease?

A

Atherosclerotic epicardial coronary artery obstruction

182
Q

Are ACE inhibitors used in heart failure related to tetalogy of Fallot?

A

No - can decrease systemic vascular resistance and promote cyanotic spells

183
Q

What is a complication of pulmonary valvuloplasty to address pulmonary stenosis?

A

Eventual pulmonary regurgitation with associated right heart failure

184
Q

Does patent ductus arteriosus increase the risk of infective endocarditis?

A

Yes

185
Q

What drug is the optimal choice in case of hypertensive emergency in the setting of chronic kidney disease?

A

Fenoldopam

186
Q

What are the most common mutations in familial hypercholesterolemia?

A

LDL receptor mutations

187
Q

Should diltiazem be used in NYHA class III and IV heart failure?

A

No - because of negative inotropic effects

188
Q

What should you also screen for in patients with coarctation of the aorta?

A

Berry aneurysm

189
Q

Should you cardiovert atrial fibrillation with RVR when the atrial fibrillation has been present for more than 48 hours?

A

No - might dislodge thrombus

190
Q

Is PR depression on ECG found in Dressler syndrome?

A

Yes

191
Q

What is the treatment of isolated systolic hypertension in older people?

A

Chlorthalidone 12.5 mg p.o. daily

192
Q

In heart failure there is constant turnover of the extracellular matrix resulting in left ventricular remodeling including dilation or thinning.

True or false?

A

True

193
Q

Tertiary syphilis can cause aortic wall calcification, dilation of the aortic valve annulus and aortic root and coronary ostial stenosis.

True or false?

A

True

194
Q

What agent reverses apixaban?

A

Andexanet alfa

195
Q

What happens to the myocytes in left ventricular hypertrophy?

A

Lengthen

196
Q

What does the combination of Tetralogy of Fallot and hypocalcemia suggest?

A

Di George syndrome

197
Q

Can anemia cause high output heart failure?

A

Yes

198
Q

What is the most common effect of hydrochlorothiazide on potassium levels?

A

Potassium will decrease

199
Q

What does coronary angiography show in stress induced (Takotsubo) cardiomyopathy?

A

Akinesis of left ventricular apex

200
Q

How is rejection ruled out in a transplanted heart?

A

Endomyocardial biopsy

201
Q

How long after cardioversion does the patient need to continue to be anticoagulated?

A

4 weeks

202
Q

S4 occurs when the atrium pumps blood into a stiff ventricle.

True or false?

A

True

203
Q

Can scleroderma cause pulmonary hypertension?

A

Yes

204
Q

What does tadalafil treat?

A

Pulmonary hypertension

205
Q

What is the most common ECG change during tricyclic antidepressant toxicity?

A

Sinus tachycardia

ABIM IM Recert (42 decks)

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