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Step2CK > Cardio > Flashcards

Cardio Flashcards

1
Q

cardio defect seen in turners

A

coarctation of the aorta

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2
Q

signs of coarctation of aorta

A

weakness lower extremities (from BP discrepency)
rib notching (congestion)
mild continuous murmur all over ( collaterals between HTN and hypoperfused vessels)

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3
Q

what causes the narrowing of aorta in coarctation

A

thickening of tunica media

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4
Q

systolic ejection murmur at left inerscapular area

A

coarctation

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5
Q

causes of amyloidosis

A 
inflammatory arthritis
chronic infections
IBD
malignancy
vasculitis
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6
Q

CHF Sx with proteinuria and easy bruising

A

amyloid

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7
Q

signs of amyloid

A

waxy skin, macroglossia, hepatomegaly and periperhal or autonomic neuropathy

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8
Q

how to confirm amyloidosis causing cardiomyopathy

A

tissue biopsy from fat pad, bone marrow, rectum kidney or endomyocardium

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9
Q

continuous flow murmur in child

A

PDA

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10
Q

management vfib

A

defibrillation

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11
Q

ischemica reperfusion syndrome

A

form of compartment syndrome. confied tissue space with edema
need fasciotomy

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12
Q

suspect renovascular HTN when

A 
elecation serum Cr after ACEI or ARB
severe HTN with recurrent flash pulm edema
severe HTN with idffuse atherosclerosis
severe HTN after age 65
abdominal bruit
resistent HTN to 3 combined medications
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13
Q

risk facotr for aoartic aneurysm

A

atherosclerosis

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14
Q

S4 heard when

A

acute phase of myocardial infarction from ischemia causing dysfunction and stiffening of left ventricular myocardium

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15
Q

acute Tx AF in patients with WPW

A

unstable- elctrocardioversion

stable- ibutilite or procainamide

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16
Q

complication AMI hours-1 week

A

ventricular septal rupture

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17
Q

complication after AMI up to 2 weeks

A

free wall rupture

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18
Q

complication hours to a month post AMI

A

postinfarction angina

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19
Q

When can papillary muscle rupture occur post MI

A

2 days-1 week

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20
Q

when does pericaritis post MI happen

A

1 day to 3 months

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21
Q

when do left ventricular aneurysms occur post mi

A

5 days to 3 months

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22
Q

Signs of ventricular aneurysm psot MI

A

persistent ST elecation after recent MI with deep Q eaves in same leads

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23
Q

sigsn cardiac tamponade

A

hypotension, tachycardia, distended neck veins and pulsus paradoxus

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24
Q

what causes cardiac tamponade

A

fluid in pericardial sack

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25
Q

AS in young adult, cause of chest pain?

A

increased myocardial oxygen demand

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26
Q

innocent murmurs in kids decrease with what maneuever

A

ones that decrease Venous return like standing up

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27
Q

preload increases in what shock

A

cardiogenic

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28
Q

pulmonary capillary wedges pressure increases in what shock

A

cardiogenic

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29
Q

cardiac index increases in what type of schok

A

septic

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30
Q

systemic vascular resistance increases in what shock

A

hypovolemic and cardiogenic

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31
Q

mixed venous oxygen saturation increases in what shock

A

septic

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32
Q

detect VSD in child, next step

A

echo

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33
Q

Afib post CABG patient with low BP, next step?

A

cardioversion

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34
Q

next step for SVT arryhthmia

A

adenosine to identify origin of arrhythmia

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35
Q

when to give statin in new diagnosed DM

A

if above 40 years old with diabetes, give statin

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36
Q

findings on peripheral blood smear in systemic scleroderma

A

shicstocytes

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37
Q

signs primary hyperPTH

A

hyperCa (polyuria and polydispia)
kidney stones
confusion, depression, psychosis

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38
Q

first line antiHTN in pregnancy

A

methyldopa
labetolol
hydralazine
CCB

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39
Q

MVA accident. if PCWP increases after saline IV but BP does not change much

A

myocardial contusion because there is left ventricular dysfunction

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40
Q

patient was having AMI and medically managed, now has pale cold limb. next step?

A

anticoagulation, vasc surgery consult and a Transthoracic echo to look for left ventricular thrombus

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41
Q

dyspnea dry cough and holosystolic murmur

A

mitral regurg

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42
Q

recommended Tx for afib secondary to hyperthyroid

A

beta blockers

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43
Q

cyanotic 1 week old with decreased pulmonary vascular markings and normal size heart.

A

tricuspid valve atresia

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44
Q

EKG findings on tricuspid atresia

A

left axis deviation

small R waves and tall peaked P waves

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45
Q

normal heart deviation in newborn

A

RAD because right atrium is larger due to PDA

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46
Q

explain the murmur in tricuspid atresia

A

loud holosystolic at Left lower sternal border because there is usually a VSD associated with the defect

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47
Q

common heart anomoly with downs

A

complete AV canal defect. large ventricles

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48
Q

what is ebsteins anomaly

A

displacement of malformed tricuspid valve into right ventricle. causes tricuspid regurg. and Right atrial enlargement. cardiomegaly

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49
Q

boot shaped heart

A

tetralogy of fallot

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50
Q

what is total anomalous pulmonary venous return

A

all 4 pulmonary veins fail to connect to left atrium and go to right. (some go to proper place) results in pulmonary overcirculation

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51
Q

hemoptysis raises suspicion for what valvular disease

A

mitral stenosis likely from rheumatic in most cases

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52
Q

increase risk for what with mitral stenosis or regurg

A

afib. increased risk for stroke etc. cardiac emboli

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53
Q

5 common side effects of amoidarone

A 
pulmonary fibrosis
thyroid dysfunction (hypo>hyper)
hepatotoxicity (stop if LFT more that 2x high)
corneal deposits
skin changes (blue grey discoloration)
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54
Q

risk factor contributing to aortic dissection

A

systemic HTN longstanding

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55
Q

decrescendo diastolic murmur

A

aortic regurg.

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56
Q

risk factor associate with aortic aneurysms

A

atherosclerosis

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57
Q

inspiratory stridor in a child 6 months

A

6 months most common is croup- laryngotracheobronchitis. barky cough

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58
Q

persistent stridor that worsens in supine and improves in prone

A

laryngomalacia

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59
Q

persistent stridor that improves with neck extension

A

vascular ring

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60
Q

Dx of vascular ring causing stridor in infant

A

barium contrast esophagogram, bronchoscopy or CT or MRIangiogram

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61
Q

diagnosis of aortic dissection

A

stat TEE

if hemodynamically stable and no TEE around then CT or MRI

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62
Q

what type of aortic dissection causes pericardial effusion

A

Acute Type A

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63
Q

prinzmental angina is similar to what pathology in extremities

A

raynauds, vasospasms

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64
Q

what cardiac medication cna limit ventricular remodeling post MI

A

ACEI

start within 24 hours of MI

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65
Q

What happens with large AVF

A

shunting blood decreases SVR and increases cardiac preload and cardiac output

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66
Q

signs of large AVF

A

widened pulse pressure, strong peripheral arterial pulsation and a systolic flow murmur

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67
Q

causes of high output cardiac failure

A 
AVF
anemia
thyrotoxicosis
paget disease
anemia
thiamine deficiency
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68
Q

change in murmur from hypertrophic cardiomyopathy with valsalva.

A

increases

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69
Q

vascular signs of infective endocarditis

A

janesway lesions- macular erythematous nodular lesions on palms and soles
mycotic aneurysm
systemic emboli

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70
Q

immunologic signs if infective endocarditis

A

osler nodes- painful violaceous nodules on fingertips and toes
roth spots- edematous, hemorrhagic lesions of the retina

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71
Q

what is adults stills disease

A

inflammatory disorder with recurrent high fevers, rash, and arthritis
rash is maculopapular and nonpruritic, only affecting trunk and extremities

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72
Q

what causes hypotension, hyperpigmentation and hyponatremia

A

adrenal insufficiency

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73
Q

most appropriate Tx for a patient with aortic dissection

A

labetolol- type B (descending) can be managed medically

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74
Q

signs of dig toxicity

A

nausea, vomiting, decreased appetite, confusion and weakness

can also have scotomata, blurry vision with changes in color

75
Q

what other cardiac drug increases risk of dig toxicity

A

loop diuretics

76
Q

what arrythmia is caused by dig toxicity

A

Atrial tachy with AV block

slower atrial rate (150-250) with p waves but p waves may look different.

77
Q

most common pathogens for viral myocarditis

A

coxsackie B and adeno

78
Q

kawasaki

A 
fever x 5 days
cervical lymph node >1.5 cm
rash
bilateral nonexudative conjunctivitis
mucositis
swelling or erythema of palms and soles
79
Q

Indications for urgent dialysis

A

Acidosis
Electrolyte abnormalities like hyperkalemia
Ingestion ot toxins, lithium, valproate
Overload of volume
Uremia (encephalopathy, pericarditis, bleeding)

80
Q

diagnosis vasovagal syncope

A

tilt table testing

81
Q

appropriate management of kawasaki

A

aspirin and IV Ig

82
Q

inability to palpate the point of maximal impulse

A

large pericardial effusion

83
Q

what causes the outflow obstruction in HCM

A

hypetrophied interventricular septum and the abnormal motion of the mitral valve leaflets–> “systolic anterior motion”

84
Q

electrical alterans

A

pericardial effusion

85
Q

what is BUN/Cr in hypovolemic patient

A

increased ratio like 20:1

86
Q

stable wide complex tachycardia with fusion/capture beats, next step

A

IV amiodarone

87
Q

what to do for unstable v tach

A

synchronized cardioversion

88
Q

where do the ectopic foci for AF originate

A

pulmonary veins

89
Q

most common cause of secondary HTN in children

A

fibromuscular dysplasia

90
Q

what electrolyte is a good indication of severe heart failure

A

hyponatremia

from release of renin and ADH. water reabsorption leading to dilutional hyponatremia

91
Q

how does cold water immersion affect PSVT

A

decreases conduction through the AV node

92
Q

managemetnt third degree heart block

A

temporary pacing

93
Q

which murmur maneuvers decrease preload

A

valsalva
abrupt standing
nitroglycerin

94
Q

which murmur maneuvers increase afterload

A

hand grip

squatting

95
Q

which mrumur maneuver increase preload

A

passive leg raise and squatting

96
Q

if patient has chronic rhinitis and nasal polyps and just put on beta blocker

A

watch for dyspnea and bronchoconstriction

97
Q

signs of edwards

A

micrognathia, microcephaly, rocker bottom feet, overlapping fingers and absent palmar creases

98
Q

common heart defect in edwards

A

VSD

99
Q

basic workup for HTN

A

UA, chem panel, lipid profile, baseline EKG

100
Q

kid with congenital QT syndrome

A

propanolol and pacemaker

101
Q

what electrlyte abnormalities can cause long QT

A

hypoK
hypoCa
hypoMg

102
Q

what drugs increase warfarin’s effect (CYP450 inhibitors)

A 
acetominophen, NSAIDs
antibiotics/antifungals
amiodarone
cimetidine
cranberry juice, binko, vit E
omeprazole
thyroid hormone
SSRIs
103
Q

what drugs decrease warfarin’s effect (CYP450 inducers)

A 
carbamazepine
ginseng
green vegetables (spinach) (Vitamin K)
oral contraceptives
phenobarbital
rifampin
St johns wort
104
Q

after arterial puncture, within 12 hours become hypotensive

A

suspect retroperitoneal hemorrhage and order CT non contrast

105
Q

how does knee to chest help with tetralogy

A

increase sysmteic resistance

106
Q

4 parts of tetralogy

A

right ventricular outflow tract obstruction from pulm stenosis or atresia)
right ventricular hypertrophy
overriding aorta
VSD

107
Q

when to definitely anticoagulate for Afib

A

CHAD score 2-6

108
Q

CHADS2 score

A 
CHF
HTN
Age >75
DM
Stroke or TIA
109
Q

murmur with acute aortic dissection in marfanoid patient

A

early diastolic murmur

110
Q

pulsus parvus et tardus

A

aortic stenosis

111
Q

clopidogrel is what R blocker

A

P2y12

112
Q

Malignant HTN criteria

A

severe HTN with retinal hemorrhages, exudates or papilledema

113
Q

systemic arterial P that falls >10mmHg with inspiration

A

asthma- pulsus paradoxus

114
Q

Mitral valve prolapse occurs due to what

A

myxomatous degeneration of leaflets

115
Q

murmurs with complete AV septal defect

A

loud S2 due to pulmonary HTN
systolic ejection murmur
hososystolic murmur of VSD

116
Q

bradycardia, AV block, hypotension and diffuse wheezing. OD on what drug

A

beta blocker

117
Q

management of beta blocker OD

A

secure ariway and give isotonic fluid and IV atropine

glucagon IV

118
Q

common side effect of CCB in women

A

peripheral edema from dilation of precapillary vessels

119
Q

combine what drug with CCB to decrease edema

A

ACEI

120
Q

at what degree stenosis do you do surgery for carotid stenosis

A

60-99% if asymptomatic
>50% is sypmtomatic

women >70% surgery!

121
Q

strongest predictor for stent thrombosis within 12 months of placement

A

is medical noncompliance

122
Q

what murmur is best heard during expiration

A

aortic regurg

123
Q

PAD patients are greatest risk to suffer what in 5 years

A

MI

124
Q

initial Tx of chronic venous disease

A

leg elevation, exercise and compression stockings

125
Q

murmur in tetralogy

A

harsh systolic ejection murmur in left upper sternal border and a single S2 from poor pulmonary blood flow

126
Q

constrictive pericarditis causes

A

idiopathic or viral
cardiac surgery or radiation
TB pericardiitis (endemic areas)

127
Q

Tx for prinzmetals angina

A

diltiazem

128
Q

what happens to preload in cardiac tamponade

A

decreases

129
Q

treatment and management for acute arterial occlusion

A

IV heparin

130
Q

complication of nitroprusside for HTN emergency

A

can cause cyanide toxicitiy which can cause lactic acidosis and seizures

131
Q

PCI for STEMI patients in what time

A

12 hours since onset

90minutes with contact personnel

132
Q

most likely impact on high BP non pharmacologic

A

weight loss then dietary modification to DASH

133
Q

what happens to RAAS system with CHF

A

RAAS is activated and causes vasoconstriction of the efferent renal arterioles increasing intraglomerular pressure to maintain GFR

134
Q

presentation late aortic coarctation

A

chest pain, claudication, HA, epistaxis, heart failure and aortic dissection

135
Q

exam for aortic coarctation

A

brachio femoral delay

check BP in upper and lower extremities

136
Q

what happens to ribs in longstanding coarctation of aorta

A

notching ribs 3-8 from enlarged intercosals

137
Q

aortic stenosis murmur

A

mid late peaking systolic murmur with soft and single second heart sound

138
Q

smoking cessation or weight loss for HTN

A

weight loss

139
Q

furosemid causes what abnormalities for electrolytes

A

hypoMg and kypoK

140
Q

mild persistent HTN in young woman on OCP

A

switch to different birth control

141
Q

vasodilation is what type related reaction

A

prostaglandin related reaction

142
Q

heart defect with turners

A

bicuspid aortic valve

143
Q

bloody diarrhea and fever after surgery correcting infrarenal AAA

A

bowel ischemia

144
Q

fatigue, cough dyspnea with hemoptysis and early diastolic sound

A

myxoma tumor

do a TEE or TTE

145
Q

DiGeorge

A 
Catch 22
cotruncal cardiac defects
abnormal facies
thymic aplasia
cleft palate
hypocalemia
146
Q

eisenmenger syndrome

A

cyanosis and dyspnea from right to left shunting through large VSD

147
Q

management of cocaine overdose

A

IV benzos for BP and anxiety
aspiring
nitro and CCB for pain
NO NO beta blockers

148
Q

situational syncope

A

autonomic dysregulation

149
Q

narrow complex tachycardia causing hypotension

next step

A

synchronized cardioversion

150
Q

CHA2DS2VASc

A 
CHF
HTN
Age>75 2 pts
DM
Stroke/TIA/DVT 2 pts
Vascular disease
Age 65-74
Sex (female)

maximum 9

151
Q

S4 heart sound

A

corresponds with left ventricular hypertrophy most likely secondary to long standing HTN

152
Q

Water hammer pulse

A

aortic regurg

153
Q

Pulseless electrical activity management

A

CPR and vasopressor therapy

154
Q

reversible causes of pulseless electrical activity

A 
Hypovolemia
Hypoxia
Hydrogen ions (acidosis)
hypo or hyperK
hypothermia
Tension pneumo
tamponade
toxins
thrombosis
trauma
155
Q

type 1 HIT vs type 2

A

type 1 is in first 2 days

type 2 is from Ab to platelet factor 4 and presents 5-10 days after initiation heparin

156
Q

what is the effect of dipyridamole and adenosine in cardiac stress testing

A

cause coronary steal

the obstructed coronary aa are already maximally dilated

157
Q

Tx for hypertrophic cardiomyopathy

A

Beta blockers

158
Q

what murmurs get louder with squatting

A

AR MR and VSD

159
Q

what murmurs get softer with squatting

A

MVP and HCM

160
Q

what murmurs get louder with standing

A

HCM and MVP

161
Q

what murmurs get louder with valsalva

A

HCM and MVP

162
Q

what murmurs get louder wtih handgrip

A

AR MR and VSD

163
Q

what murmrs get softer with handgrip

A

HCM and AS

164
Q

rhemuatic fever is from what infection

A

GAS

165
Q

management of rheumatic fever in child with recurrent pharyngitis

A

IM penicillin q4 weeks

166
Q

pericalcular abscess indications

A

aortic valve endocarditis causing AR and a AV conduction block with syncope

167
Q

tricuspid regurg murmur

A

holosystolic that is accentuated with inspiration

168
Q

features of cholesterol emboli

A 
levedo reticularis, ulcers, gangrene, blue toe syndrome
renal injury
CNS like stroke and amaurosis fugax
ocular involvement
GI like ischemia and pancreatitis
169
Q

lab studies in cholesterol emboli

A

eosinophilia, hypocomplementemia

170
Q

abnormal Ankle brachial index

A
171
Q

ABI of >1.30

A

calcified uncompressible vessels

172
Q

Tx for sinus bradycardia

A

IV atropine 0.5 mg bolus every 3-5 minutes for up to 3.0 mg

173
Q

Tx for hemochromatosis

A

phlebotomy

174
Q

early onset HTN with bilateral upper abdominal masses

A

PKD auto dominant so do abdominal US

175
Q

secondary effects of fibromuscular dysplasia

A

decrease perfusion kidneys causing increased renin and aldosterone
the ratio is

176
Q

inheritance of HCM

A

auto dominant

177
Q

common anatomical cause of aortic stenosis

A

bicuspid valve

178
Q

what is kussmaul

A

increase JVD with inspiration

179
Q

Tx for endocarditis susceptible to penicillin

A

IV penicillin G or IV ceftriaxone

180
Q

mid diastolic sound and signs of R side CHF

A

constrictive pericarditis because there is mid diastolic sound

181
Q

rupture of left ventricular wall results in what

A

pericardial tamponade

182
Q

ventricular septal rupture results in what murmur

A

pansystolicand is best heard at left sternal border with a thrill and does not radiate

183
Q

papillary muscle wall rupture murmur

A

mitral regurug

and has pansystolic murmur loudest at apex and radiates to axilla

Step2CK (26 decks)

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