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Step 2 > Cardiac HY > Flashcards

Cardiac HY Flashcards

1
Q

LLSB Holosystolic murmur + apical diastolic rumble

A

VSD
(Intraventricular Septal Defect)

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2
Q

IVDU
subacute fevers & malaise
new murmur heard on auscultation
Dx/Dxt (2)/Tx

A

Infective Endocarditis
Blood Cx (1st)
TEE (2nd)
empiric abx → Penicillin + Vancomycin

IV drugs get PV meds

–septic emboli on CXR–

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3
Q

What 3 types of pts need ppx antibiotics before surgery?

A

Endocarditis hx
Mechanical Valves in place
Unrepaired Cyanotic Congenital Heart Defect (ToF, TGA, TAPVR, PTA, HPLH)

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4
Q

2 Blood culture (+) bugs that require colonoscopies

A

Clostridium Septicum

Streptococcus BOVIS

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5
Q

Very short female with chronic calf pain (claudication)
Dx/Dxt/Tx?

A

Coarctation of Aorta (Turner syndrome)
Xray (Rib Notching s/t collateral intercostal circulation)
Surgery (repair aorta)

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6
Q

Murmurs associated with wide pulse pressure

SBP–DBP >60mmHg (wide)

A

Aortic Regurgitation/Insufficiency
Patent Ductus Arteriosus

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7
Q

Wide, fixed split of the S2 heart sound

A

ASD

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8
Q

Neonate with heart failure
upward-slanting palpebral fissures
epicanthal folds
transverse palmar crease
protruding tongue/ sandal gap
Dx of heart defect?

A

Endocardial Cushion Defect
(Down’s syndrome)

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9
Q

Life long treatment of new prosthetic aortic valve?
Therapeutic target:

A

Life long anti-coagulation (usually Warfarin)
INR 2.5– 3.5

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10
Q

3m hx of new heart valve
now dark urine and indirect hyperbilirubinemia

A

valvular hemolysis

(valves shearing blood cells)

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11
Q

High pitched mid-systolic click at the apex
worsens with valsalva (lowers pre-load)

A

Mitral Valve Prolapse

(prolapse clacks)

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12
Q

MCC of death within 24hrs of having an MI
(ex: pt dies intra-op during PCI placements)

A

V-Fibrillation

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13
Q

Recent MI now has dyspnea, crackles, and
holosystolic murmur at apex

A

Mitral insufficiency
s/t Papillary Muscle Rupture

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14
Q

Recent MI now has dyspnea, crackles, and
holosystolic murmur at LLSB

A

VSD
s/t Intraventricular Septal Rupture

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15
Q

Recent MI now has
Low voltage EKG (fluid in pericardium)
Cardiac arrest (PEA: pulseless electrical arrest)

A

Cardiac Tamponade
s/t ventricular FREE wall rupture

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16
Q

diastolic murmur at the apex with opening snap

A

Mitral Stenosis

(stenosis snaps)

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17
Q

Always get an Echo for what 4 types of murmurs?

A

Diastolic (deadly)
3/6 (or higher)
Holosystolic
Symptomatic

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18
Q

Presents with fever, malaise, joint pain, non-pruritic red rash, heart problems
± skin nodules
Recent hx of URI
Dx/Tx/Cx?

A

Rheumatic Fever (GAS)
Penicillin V + NSAIDs
Mitral Stenosis → A-fib

(J♡NES criteria: joint pain travels, Pericarditis/Murmur, nodules on skin, erythema marginatum,
Sydenham chorea).

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19
Q

Anticoagulant used to treat A-fib in a pt with
◆Valvular heart problem
or
◆hx of Rheumatic Fever

(probably won’t give away h/o RF but may say pt is an immigrant w/murmur)

A

Warfarin
INR 2-3
(use warfarin if A-fib s/t valvular problem)

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20
Q

Opening snap at the apex diastolic murmur:
Biggest risk factor for this murmur:
Most common arrhythmia present:
Anticoagulant strategy if this arrhythmia is present:

A

Mitral Stenosis
Rheumatic Fever
Atrial Fibrillation
Warfarin (if A-fib s/t valvular problem)

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21
Q

Middle age female, very short, syncopal episodes + systolic murmur (RUSB)
Dx?

A

Turner syndrome

(BICUSPID aortic valve → Aortic Stenosis)

Exercise Stress test is c/i in AS

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22
Q

Hx of RF + Continuous, Involuntary, irregular movements of the extremities
Dx/Tx?

A

Sydenham’s Chorea (s/t molecular mimicry)
self resolves

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23
Q

Involuntary, irregular movements of the extremities
+ new or worsening OCD and/or a tic disorder
Dx/Tx?

A

PANDAS
(Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)
Self-Resolves

Hx of RF

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24
Q

SBP decreases by more than 10 with inspiration
Low voltage EKG (tiny QRS complex) or alternans (QRS points up and down)
Dx/Tx?

A

Cardiac Tamponade
u/s guided pericardiocentesis

CXR: Water bottle shaped heart

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25
Q

Neck veins distend on inspiration
Prominent JVP waves
Dx/Tx

A

Constrictive Pericarditis → (calcified pericardial tissue)
Pericardiectomy (CT guided?)

(Kussmaul sign)

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26
Q

On EKG Diffuse ST elevations and diffuse PR depressions
Dx/Tx?

A

Acute Pericarditis
NSAIDs+Colchicine (together)

(if recent MI, Aspirin only)

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27
Q

Fib vs tach rule

A

Fib rule: → unequal spaces between QRS (A-fib/V-fib)
Tach rule: → equal spaces between QRS complex (v-tach/SVT)

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28
Q

ventricle vs atrial (above ventricle) rule

A

ventricle (V-fib/V-tach) → Wide QRS
atrial/above (A-fib, SVT, WpW) → Narrow QRS

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29
Q

Pt is Hemodynamically unstable (≤ 90/50s)

Bradycardia <60 bpm → NBSIM

Tachycardia >100 bpm → NBSIM

A

Unstable + Brady → Transcutaneous Pacer

Unstable + Tachy → Synchronized Cardioversion

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30
Q

Management for V-Fibrillation

A

Defibrillate (Unsynchronized cardioversion)

V-fib → D-fib

31
Q

Regular, Wide QRS, Tachycardia

A

V-Tach

32
Q

Management for mono-morphic
1. Pulseless V-tach
2. BP <90/50 (pulse + unstable) V-tach
3. stable V-tach

Management for
4. Pulseless poly-morphic V-tach (TdP)
5. BP <90/50 (pulse + unstable) TdP
6. Stable Tdp

A
  1. Defibrillate (Unsynchronized cardioversion)
  2. Synchronized cardioversion
  3. Amiodarone
  4. Defibrillate
  5. Defibrillate
  6. IV Magnesium
33
Q

Regular, Narrow QRS, Tachycardia

A

Supraventricular Tachycardia (SVT)

34
Q

Treatment algorithm for
Supraventricular Tachycardia (SVT)

A

1st: vagal maneuver (massage carotids, cold water, blow a straw)
2nd: Adenosine (if, 1st fails)
3rd: Verapamil, Diltiazem, or Beta Blocker (after Adenosine)

35
Q

sawtooth pattern on EKG

A

Atrial Flutter

36
Q

Management of A-Fib & A-Flutter:
1. Unstable (BP <90/50s)
2. Any pt NOT unstable

A
  1. Synchronized Cardioversion
  2. 1st give a Beta Blocker or (Diltiazem/Verapamil) → Rate Control
    ───
    2b. Anticoagulation
    2c. Amiodarone → Rhythm Control
    ───
    AC can be anything: DOACs, Heparin, LMWH (enoxaparin), Warfarin
    (MUST be Warfarin if h/o valvular dz)
37
Q

Pt presents with palpitations and tachycardia
h/o smoking or COPD
EKG shows irregular tachycardia with messed up/weird looking P waves all over
Dx/Tx/BRF?

A

Multifocal Atrial Tachycardia
Diltiazem/Verapamil (NDDHP-CCB)

Stop smoking! (biggest risk factor)

38
Q

Bradycardia + Long PR interval only
(aka bigger than one big box)
Dx/Tx?

A

1º heart block
no treatment

39
Q

Bradycardia + Long PR interval that keeps getting longer until QRS disappears
Dx/Tx?

A

2º heart block (Mobitz I)
no treatment

40
Q

Bradycardia + Long PR interval and QRS disappears after 1-2 beats
(QRS complex present once then disappears the reappears and disappears etc.)
Dx/Tx?

A

2º heart block (Mobitz II)
Permanent Pacemaker

41
Q

Bradycardia + QRS complexes very far apart (like ~ 10 boxes apart), but regular
2-3 P waves without a QRS complex before one shows up
(Kinda looks like A-Fib except its brady/not tachy & regular/not irregular)
Dx/Tx?

A

3º heart block (Complete heart block)
Permanent Pacemaker

42
Q

Unstable (BP <90/50s or AMS) Bradycardia management

A

Transcutaneous pacing

(seems like NBME doesn’t care for first-line: IV atropine; but Q banks)

43
Q

Hemodynamically stable + Polymorphic V-Tach (TdP)
NBSIM?

A

IV Magnesium

44
Q

Tachycardia on EKG
Wide QRS, with a slurred, slanted start
short PR interval (< 1 big box)
Dx/Acute Tx/Long-Term Tx?

A

Wolf Parkinson White

Acute: Procainamide
Long-Term: Electrical Ablation (via cardiac cath)

Ablate accessory pathway (bundle of Kent) that connects atria to ventricles & bypasses AV node
→ ventricular pre-excitation.

45
Q

AMS + flushed skin + dilated pupils + dehydrated
Wide QRS Tachycardia + short fat QRS in aVR
Dx/Tx?

A

Tricyclic Antidepressants (TCA) Toxicity
Sodium Bicarbonate

(TCAs: Desipramine/Imipramine, Amitriptyline/Nortriptyline)

Anticholinergic toxidrome: fast fiddle/ hot hare/ blind bat/ dry bone/ empty flask/ red beet/ mad hatter
s/t sodium channel blockade

46
Q

Dx/Tx?

A

Hyperkalemia
1. Calcium Gluconate
2. Insulin + D5W (glucose)
3. Albuterol (Beta 2 agonist)
4. Kayexelate
────
EKG shows Wide QRS + Tall, peaked P waves

47
Q

Treatment for A-Fib with WpW
(irregular tachycardia, wide complex QRS, short PR)

What about unstable WpW?

A

Procainamide (stable)

Synchronized Cardioversion (unstable)

48
Q

EKG shows a small bump at the end of the S in the QRS complex
(looks like an ST elevation, but it’s not. There’s a discrete bump as the S ends)
aka Osborn or J wave

Dx?

A

Hypothermia

49
Q

7 Drugs that improve survival/mortality in patients with CHF?

(one of which primarily in Black pts)

A

ACE inhibitors (Ramipril, Enalapril, Lisinopril)
ARBs Angiotensin Receptor Blockers (Valsartan, Losartan)
ARNI: ARBs + Neprylysin inhibitors (Valsartan + Sacubitril)
Beta blockers (Carvedilol, Metoprolol)
Spironolactone, Eplerenone (MR antagonist)
SGLT-2 Inhibitors (Empagliflozin)

In African Americans combo of
Dinitrite Isosorbide + Hydralazine

50
Q

Acute Coronary Syndrome management (5)

A

(1st) Aspirin full dose
(2nd) Heparin Anti-Coagulation
(3rd) Clopidogrel Anti-Platelet

for chest pain:
Morphine or Nitrate
–––

(NO nitrate if II,III, aVF changes)

51
Q

Chest pain worse at night w/ hx of ST elevations & non-occluded coronary arteries
Patient is an active smoker and middle aged or younger
± stimulant/cocaine use
Dx/Tx?

A

Variant Angina
CCB (any kind) + advise smoking cessation

(Transient coronary vaso-spasms → avoid Beta Blockers)

52
Q

Pulmonary Embolism
1. ABG findings __pH __Co2
2. Calcium & Potassium levels
3. NBSIM
4. Diagnostic confirmatory test

A
  1. ↑ pH (Respiratory Alkalosis) ↓ CO2 (Hyperventilating)
  2. ↓Ca2+ ↓K+
  3. IV Heparin
  4. CT Angiography (+ct)

––––

FYI: basic blood is negatively charged thus positive ions are bound

53
Q

When is Tissue plasminogen activator (tPA) indicated in Pulmonary Embolism

A

Unstable (AMS, ≤90/50s)
or
Echo has evidence of R heart strain
•RV enlarged/bulging/abnormal septal motion
•RV same size as LV

54
Q

Biggest risk factor for Mitral Stenosis?
associated with what arrhythmia?

A

Rheumatic Fever history
Atrial Fibrillation

55
Q

Recent MI with sudden onset severe LLE pain.
pulses are absenet
Dx/Tx(2)/Dxt?

A

Acute Limb Ischemia
IV Heparin (1st step) →
CT Angiogram w/contrast of LE →
Embolectomy (surgical emergency)

56
Q

Treatment of Acute CHF exacerbation

A

1st IV Furosemide

If edema persists → ACE-I → Nitrate

(FAN of CHF management)

57
Q

presents with carditis and migratory (spreading) arthritis
Dx/Tx?

A

Rheumatic fever
penicillin V + NSAIDs
(eradicates GAS)

––––
causes chorea-like movements (Sydenham chorea)
JONES criteria

58
Q

2 medications contraindicated in Right Heart MI
(II, III, avF)

A

Nitroglycerin
Opioids
These are a NO for RHF
—
Divine didn’t mention this, but
Technically, Beta Blockers (if Brady)

59
Q

Treatment of Right Heart MI (II,III,avF)

A

Normal Saline

60
Q

Recent DVT and then stroke.
Dx/NBSIM?

A

Cryptogenic Stroke
PFO (Patent Foramen Ovale)
TEE with a Bubble Study (bubbles travel to left side heart)

61
Q

systolic murmur radiating to the neck and axilla
RUSB

A

Aortic Stenosis

62
Q

Bounding Pulses
Wide Pulse Pressures
Diastolic Decrescendo murmur
Severe stages → harsh, crescendo-decrescendo systolic murmur

A

Aortic regurgitation

63
Q

systolic murmur in the 2nd Left ICS
S2 widely split

A

Pulmonic Stenosis

(wide not fixed split like ASD)

64
Q

Holosystolic murmur at LLSB
that increases with Inspiration
─
VERSUS
─
Holosystolic murmur at LLSB + apical diastolic rumble or Thrill

A

Tricuspid regurgitation
─
VSD

65
Q

Kawasaki disease
•5+ day Fever
•Unilateral cervical LAD
•Edema/Desquamation of hands/feet
•Red Rash/Eyes/Tongue

Mc Age group:
MC Ethnicity:
Tx (2)?

A

children < 5 years
Asian & Pacific-Islander

Tx: IvIg + Aspirin
get an ECHO

66
Q

dx/tx?

Tip: look at how it changes in the center

A

V-Fib
D-Fibrillate

Below is another example

67
Q

dx/tx?

Tip: look at QRS complex (wide or narrow?) & look at R-R interval (Regular or Irregular)

A

V-Tach
Unstable → SCV
Stable → Amiodarone

Below is another more obvious example of V-Tach
again, wide QRS, Regular R-R intervals

68
Q

dx/tx/2 NBME causes
Tip: Look at certain strips and observe the amplitude

A

Torsade de Pointes
(Regular + Wide complex + Sinusoidal ampl)
Unstable: D-Fib
Stable: IV Magnesium
—
•QT prolonging drugs
• Hypo E’lytes (hypokalemia, hypomagnesemia, Hypocalcemia)

(can progress to V-Fib)

69
Q

Flip to compare V-Tach vs TdP

A
70
Q

6 steps to Reading an ECG on NBME
First, r/o MI → ST segments (Elevations/Depressions)
Next:
• Rate (brady/tachy) → 300/150/100/75/60/50
• QRS (wide/narrow or tall/inverted) nl 1.5 little boxes
• R-R interval (regular/irregular)

List the next 5 steps

A

T wave (inverted/peaked) → MI/ Hyperkalemia
PR int. nl 1 big box (depressed/long/sh) → Peri/AVb/WpW
QT int. nl 2 boxes (long/short) → E’Lytes, Meds
P waves (consistent/morphology) → MFAT
Extra waves present?
• U wave (inverted, after T wave) → Hypokalemia
• Delta wave (slurred upstroke start to QRS) → WpW
• J wave (tiny hump after S wave) → Hypothermia

71
Q

QT prolongation causes on NBME?
(4)

A

Ziprasidone (Anti-psychotic)
Hypo– E’lytes (Hypocalcemia)
Sumatriptan (Migraines)
Ondansetron (Nausea)

72
Q

2 Antipsychotics with High Risk of Metabolic Syndrome

A

Olanzapine
Clozapine (agranulocytosis)

73
Q

Harsh, systolic murmur at cardiac base + ↓ S2 sound

A

Aortic Stenosis
(or Crescendo Decrescendo at RUSB)
s/t Chronic RF, Calcified valves, or Bicsupid valves

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