Cardio

Question 0

Tetralogy of fallot

Answer 0

Prov

Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy

Question 1

Dressler’s syndrome

Answer 1

Inflammatory response characterized by low grade fever, chest pain, pericardial effusion. Typically occurs 1 to 6 weeks status post MI . can cause constrictive pericarditis or cardiac Tamponade

Question 2

Ebsteins anomaly

Answer 2

Congenital. Downward displacement of septal and posterior leaflets of the tricuspid valve into right ventricle below the AV junction

Question 3

Infective endocarditis affects what valves first?

Answer 3

Prosthetic valves and typically on the left side of the heart for example a prosthetic mitral valve.

Question 4

Preload

Answer 4

End diastolic volume. Increased right ventricular preload from CHF inspiration or exercise. Decreased right ventricular preload by decreasing left ventricular output, exhalation

Question 5

Pulse pressure

Answer 5

The difference between systolic and diastolic blood pressure

Question 6

Jones Criteria

Answer 6

Must be 2 Major or 1 Major + 2 Minor
MAJOR: PACES: PolyArthritis, Chorea, Erythema Marginatum, Subcutaneous nodules
MINOR: Fever, Arthralgia, Labs (elevated ESR), Prolonged PRI (FALPP)

Question 7

1 cause of Mitral Stenosis

Answer 7

Rheumatic Fever. Will cause atrial irritation and A. Fib

Question 8

Tx Myocarditis

Answer 8

Lasix + ACEI/ARB

Question 9

Sx Myocarditis

Answer 9

Antecedent viral syndrome (Coxsackie)
DOE
Palpitations
\+/- fever
Tachycardia out of proportion to fever
JVD, crackles, edema
Can cause dilated cardiomyopathy

Question 10

SBE: Subacute bacterial endocarditis: ETIO

Answer 10

Typically strep viridian’s (usually occurs in pts with established VHD)

Question 11

Triad Sx of Endocarditis

Answer 11

Fever, murmur, + blood cultures

Question 12

ETIO Acute bacterial Endocarditis

Answer 12

Staph aureus

Question 13

ETIO Pulmonic Stenosis

Answer 13

typically congenital disease of the young

Question 14

TX Infective Endocarditis

Answer 14

PCN and Ceftriaxone
ETio: IVDU: Tricuspid valve, staph aureus
Non IVDU: Mitral valve: strep viridans

Question 15

3 drugs associated with Myocarditis

Answer 15

Cocaine, Lithium, AZT

Question 16

ETIO: Mitral Regurg

Answer 16

AMI–> papillary muscle dysfunction or rupture of the chordae tendineae

Question 17

Pulsus Paradoxus

Answer 17

Drop in systolic pressure > 10mmHg with INSPIRATION. = pericardial tamponade

Question 18

ETIO: Pericarditis

Answer 18

VIRAL: Coxsackie
If it is bacterial, typically Strep Pneumoniae
Pain is relieved by leaning forward

Question 19

CKMB Vs Troponin

Answer 19

Both rise in appx 4 hours (trop faster?)
CKMB normal in 2-3d
Troponin normal in 7 days

Question 20

Goal Digoxin level in HF pt

Answer 20

Between 0.5 and 0.8ng/dl

Good in pts with A. Fib

Question 21

AHA/ACC HF Staging

Answer 21

Focused on prevention
Stage A: at RISK but no sx or structural changes of HF
Stage B: Structural changes but no sx HF
Stage C: Structural change with prior or current sx
Stage D: Refractory HF requiring specialized interventions

Question 22

NYHA Classification

Answer 22

Class I: Cardiac disease without limitation. No sx with normal activity
Class II: Slight limitation. Ok at rest but sx with normal activity
Class III: Marked limitation. Ok at rest but sx with less than normal activity
Class IV: Sx at rest. Unable to do any physical activity

Question 23

EF in Diastolic HF?

Answer 23

Normal or “Preserved”

Question 24

L sided HF vs R sided

Answer 24

L sided: pulmonary congestion | R sided: venous congestion (liver and periphery)

Question 25

Hypertrophic vs Dilated Cardiomyopathy cause what kind of heart failure

Answer 25

Hypertrophic--> Diastolic | Dilated--> Systolic

Question 26

Pts with what type of VHD have a higher incidence of nitroglycerin induced syncope?

Answer 26

Aortic Stenosis

Question 27

Water hammer pulse

Answer 27

(variable pulse) seen with aortic regurg

Question 28

Mitral Stenosis: where best heard? What sound? | Associated with what other heart problem ?

Answer 28

Diastolic opening snap New onset A. Fib in 80% of pts Most common valvular disorder caused by rheumatic fever Sx best heard at apex

Question 29

Mitral Regurg etiology

Answer 29

Spontaneous chordae tendineae rupture s/p MI typically LAD. | MVP most common cause

Question 30

Patent Ductus Arteriosus: location and type of sound?

Answer 30

Continous machinery murmur | Heard best at L middle and L upper sternal border with radiation to back

Question 31

TX A. Fib

Answer 31

Hemodynamically stable: 1st line Cardizem. 2nd line B blockers (becomes 1st line if pt has A. Fib from Graves Disease) 3rd line= Cardioversion 100-200 Joules. Only if less than 6 hours Use PO Digoxin to control the ventricular rate

Question 32

V Tach treatment

Answer 32

If Hemodynamically unstable 1st step is cardioversion | If Hemodynamically stable: 1st line Lidocaine 2nd line Amiodarone

Question 33

V Fib tx

Answer 33

``` CPR Defib 200J or 360J CPR Defib 200J or 360 J CPR Epi 1mg IV Defib Amiodarone 300mg once or Lidocaine 1 to 1.5mg/kg Defib Repeat Amiodarone 150mg once or lidocaine 0.5 to 0.75mg max of three doses ```

Question 34

PSVT TX

Answer 34

1st line: Adenosine 2nd line: Diltiazem 3rd line: Electrical cardioversion

Question 35

Group A Strep: how soon does it cause post strep glomerulonephritis vs Rheumatic heart disease

Answer 35

Post Strep Glomerulonephritis: 2-4 weeks after infection | Rheumatic Heart Disease: years after infection

Question 36

Avoid CCBs in what heart problem ?

Answer 36

CHF

Question 37

HTN tx for pregnant women?

Answer 37

Methlydopa 1st line | Hydralazine 2nd line

Question 38

Most common cardiac malformation

Answer 38

VSD

Question 39

Suspect what pediatric CV abnormality if patient squats after exercising?

Answer 39

Tetralogy of Fallot

Question 40

Where does Mitral Regurg radiate?

Answer 40

Axilla

Question 41

Hoarseness is a sx of what valvular disorder?

Answer 41

Mitral Stenosis: RA enlargement pushes on L recurrent laryngeal nerve

Question 42

How can the sound of A. Regurg be accentuated?

Answer 42

Sit up, lean forward and hold breath, or after deep inspiration or squatting

Question 43

Where does A. Stenosis radiate?

Answer 43

Carotids

Question 44

PDA is associated with what disease during the 1st trimester?

Answer 44

Rubella

Question 45

PDA: what vessel?

Answer 45

Persistence of the vessel joining pulmonary artery and aorta

Question 46

Tetralogy of Fallot vs ASD: shunting/cyanosis?

Answer 46

ASD: Acyanotic, L to R shunt | Tetralogy of Fallot: cyanotic, R to L in VSD

Question 47

ASD: which way is the shunting? ASD is associated with increase in the pressure of the _______

Answer 47

L to R shunt. (typically high to low flow from L to R side of the heart during diastole). Associated with increased pressure in the pulmonary arteries causing Pulmonary HTN.

Question 48

Coarctation of the Aorta

Answer 48

narrowing of the aorta, typically found just after the vessels are given off to the left arm

Question 49

Response of the kidneys in Coarctation of the Aorta

Answer 49

Kidneys release more renin in attempt to increase pressure and flow to the kidneys which was decreased because of narrowing of the aorta. This causes HTN, especially in the arms, with LOW BP in the legs. pulses in the legs may be decreased in intensity or delayed compared with the arms.

Question 50

Coarctation of the Aorta occasionally co-exists with what other congenital heart disease?

Answer 50

Aortic valve abnormality

Question 51

Ductus Arteriosus

Answer 51

A normal fetal structure that allows blood to bypass circulation to the lungs (shunts blood from the L pulmonary artery to the aorta)

Question 52

What causes the ductus arteriosus to close after birth?

Answer 52

High levels of oxygen (in a normal baby- typically closes in 24 hours)

Question 53

What type of intervention required with PDA?

Answer 53

Typically corrects itself within several months of birth but may require infusion of chemicals, placement of "plugs" via catheters or surgical closure. Also may be treated with high flow O2 and Indomethacin.

Question 54

What EKG findings associated with pericarditis?

Answer 54

ST elevation in all leads

Question 55

IVDU with infective endocarditis what bacteria and what valve?

Answer 55

Staph aureus, Tricuspid

Question 56

Non IVDU with endocarditis what bacteria and what valve

Answer 56

Strep viridans, mitral

Question 57

In 80% of these patients (new onset) they have A. Fib and typical diastolic opening snap accentuated S1

Answer 57

Mitral stenosis

Question 58

What valve most commonly affected by rheumatic fever?

Answer 58

Mitral

Question 59

Most common heart abnormality in children?

Answer 59

VSD

Question 60

What class of drugs is contraindicated in pts with 1st degree AV block?

Answer 60

CCBs

Question 61

Which coronary artery is associated with a LATERAL MI?

Answer 61

L circumflex

Question 62

Which coronary artery is associated with an ANTERIOR Mi?

Answer 62

LAD

Question 63

Which coronary artery is associated with INFERIOR MI

Answer 63

RCA

Question 64

Why do ACEI not work well in the black male population?

Answer 64

Tend to have lower levels of Renin. Can use ARBs instead.

Question 65

What antihypertensives work well in pts with osteoporosis?

Answer 65

Thiazides (low dose, may prevent fractures)

Question 66

Lipid lowering agent of choice in pts with liver disease

Answer 66

Bile acid sequestrants

Question 67

Pt with Von Willebrands will affect the PT or PTT?

Answer 67

PTT (will have normal PT, normal platelets and abnormal PTT)

Question 68

Heparin will affect the PT or PTT?

Answer 68

PTT

Question 69

ASA will affect PT or PTT?

Answer 69

PT

Question 70

1st and 2nd line treatment of pericarditis?

Answer 70

Typically viral: 1st: Indomethacin 2nd: Steroids (unless it is bacterial in which case treat with antibiotics)

Question 71

Rheumatic heart disease commonly affects what 3 valves (in order)

Answer 71

Mitral Aortic Tricuspid

Question 72

General rule regarding where murmurs are heard?

Answer 72

Sound radiates in the direction of blood flow

Question 73

Murmur of Aortic Stenosis vs Hypertrophic cardiomyopathy relationship to squatting

Answer 73

AS Murmur increases with squatting, improves standing | Hypertrophic Cardiomyopathy increases standing and decreases with squatting

Question 74

Why is the murmur of AS better heard when pt sits up and exhales?

Answer 74

It decreases the after load and the murmur can blow without resistance

Question 75

You give adenosine to a pt suspected to have PSVT and they get worse: V fib or V tach, what is the dx?

Answer 75

WPW

Question 76

New L BBB concerned about what?

Answer 76

AMI

Question 77

Tx stable angina vs Prinzmetal's angina?

Answer 77

BBblocker stable angina | CCB Prinzmetal's (coronary vasospasm)

Question 78

Difference between unstable angina and NSTEMI/STEMI

Answer 78

Enzymes elevated in NSTEM/STEMI

Question 79

AAA tx

Answer 79

5.5 repair

Question 80

Aortic Dissection tx

Answer 80

Type A= ascending aorta= surgery | Type B= descending aorta= B blockers. If complete rupture or end organ damage--> surgery

Question 81

RX for hypertrophic cardiomyopathy

Answer 81

Verapamil

Question 82

Physical exam finding of LVH

Answer 82

S4 gallops, apical lift or heave. LVH is compensatory response to systemic HTN or aortic valve stenosis and can cause diastolic heart failure as the L ventricle becomes stiff.f

Question 83

Diastolic heart failure associated with what changes in the heart?

Answer 83

LVH

Question 84

What is anginal equivalent

Answer 84

Is dyspnea without anginal discomfort caused by ischemia.

Question 85

What medication should be avoided in cocaine induced HTN?

Answer 85

B blockers. Instead use CCBs and alpha blockers or combined alpha beta like labetolol.

Question 86

Xray shows rib notching and 3 sign?

Answer 86

Coarctation of the aorta

Question 87

Fixed wide splitting S2

Answer 87

ASD