Cardiac

Question 1

Amiodarone’s effect on digoxin toxicity

Answer 1

Amiodarone can increase serum levels of dig, causing GI upset

Question 2

Mid to late peaking of systolic murmur

Answer 2

SEVERE Aortic stenosis (due to turbulence from stenosis)

If early AS, can be early peaking

Question 3

Soft and single S2

Answer 3

Aortic stenosis (because S2 is due to sudden aortic valve closure) -> reduced mobility of aortic valve -> A2 is delayed and simultaneous with pulmonic valve closure -> single S2

Question 4

mid to late diastolic murmur at cardiac apex

Answer 4

mitral stenosis

when severe -> murmur starts earlier

Question 5

What manuever improves cyanosis in tet spell?

Answer 5

Squatting (increase afterload -> increases blood flow across the RVOT)

Question 6

Treatment of vasospastic angina

Answer 6

Ccb

Question 7

Wide and fixed splitting of S2

Answer 7

ASD

Question 8

Opening snap in early diastole

Answer 8

Mitral stenosis

Question 9

Treatment for congenital prolonged QT

Answer 9

Beta blockers with pacemaker to prevent cardiac arrest!

Avoid meds that block potassium channels

Question 10

Ejection click after S1

Crescendo-decrescendo systolic murmur over the L second intercostal space

Widened splitting of S2, increased further during inspiration

Answer 10

Pulmonic stenosis

S2 is split because pulmonic valve closes later

Question 11

When to defib vs. cardiovert

Answer 11

Defibrillation (unsynchronized) is for ventricular fibrillation or pulseless v tach

Question 12

Systolic murmur- crescendo decrescendo

Answer 12

Aortic stenosis

Question 13

holosystolic murmur

Answer 13

mitral/tricuspid regurg
OR
VSD

Question 14

S3 vs S4

Answer 14

S3 = fluid overload
S4 = stiffness

Question 15

Cannon a wave

Answer 15

Right atrium and ventricle contract simultaneously (due to 3rd degree block) against closed tricuspid, sending huge pressure wave up jugular

Question 16

Other causes of acute Afib besides ischemia, pulm disease, and chronic Afib

Answer 16

Rheumatic heart disease, Anemia, Thyrotoxicosis, Ethanol, Sepsis

Question 17

Digoxin toxicity

Answer 17

GI distress, color changes in vision, arrhythmias (atrial tachy with AV block)

Question 18

Management of WPW (and other types of AVRT)

Answer 18

Do not slow AV conduction! (ie no BB, CCBs, digoxin@)
Problem is direct connection between A and V (bundle of Kent) beats the conduction through AV node, so slowing AV node would make it worse.

Question 19

Management of AVNRT (which presents as SVTs with P wave buried inside QRS)

Answer 19

If hemodynamically stable, try carotid massage, Valsalva, or adenosine to slow conduction at AV node. If unstable, cardiovert.

Question 20

Loops vs thiazides

Answer 20

Both lose K.
Loops Lose Ca, Thiazides Take in Ca.
Thiazides bad for metabolic syn (high glucose and lipids).

Question 21

Side effects of fibrates (Gemfibrozil)

Answer 21

GI upset, gallstones, myositis, elevated LFTs

Question 22

Ezetimbe wtf is that

Answer 22

Cholesterol absorption inhibitor

-> diarrhea, GI upset, angioedema

Question 23

Chest pain improves with bending forward

Answer 23

pericarditis

Question 24

DHPR CCBs

Answer 24

“-dipine”
only peripherally acting (vs non-DHPRs, diltiazem and verapimil)
SE = peripheral edema

Question 25

Beck triad for tamponade

Answer 25

JVD, low BP, distant heart sounds

Question 26

Size of AAA for surgery?

Answer 26

> 5cm

Question 27

Widened pulse pressure, water-hammer pulse, head-bob with heartbeat

Answer 27

AR