Cardio

Question 1

Pt has a loud harsh holosystolic murmur in heard at the 4th intercostal space w/wo palpable thrill. Dx? Location of the step up 02% saturation?

Answer 1

VSD. Right atrium to Right ventricle.

Question 2

Associated with mid-systolic murmur and mid-diastolic rumble around the upper left sternal border. Dx?

Answer 2

Associated with wide-fixed splitting. ASD

Question 3

Best 3 beta blockers to lower BP, HR and reduce contractility in aortic aneurysm?

Answer 3

labetalol, Esmolol, propanolol

Question 4

Common complication of bicuspid aortic valve?

Answer 4

Aortic root dilatation which can lead to aortic aneurysm and rupture.

Question 5

Best treatment for cocaine related CP?

Answer 5

Benzos (lorezepam) - reduce sympathetic flow which reduces ischemia and reduces cocaine induced psychomotor agitiation.

Question 6

1. First line agent for patients with PAfib and structural heart dz? 2. Drug used for patients w/o structural heart dz? 3. Anti-arrhythmic to avoid in severe heart failure? 4. Drugs ok to use in HF?

Answer 6

1. Amiodarone and Dronedarone. 2. Flecainide 3. Dronedarone 4. Amiodarone and Dofiltilide

Question 7

Name 4 indications for starting high dose statin therapy?

Answer 7

1. LDL > 190, 2. Diabetes 3. 10 year risk > 7.5% 4. Cardio vascular dz (ACS, MI, TIA, Stroke < 75 age , > 75 give moderate statin

Question 8

Name affects of these maneuvers on the asymptomatic pts with AV block. 1. Exercise and Atropine? 2. Carotid sinus (vagal maneuvers)

Answer 8

1. Improves Mobitz Type I, worsens mobitz type II 2. Worsens Mobitz type 1, improves mobitz type II

Question 9

Pt hx of DM2 presenting with unstable angina. Next step in management?

Answer 9

Coronary angiography (cath) for possible PCI or CABG

Question 10

What is the treatment for pulmonary edema associated with A. Fib, A. Flutter, SVT or Vtach with pulse?

Answer 10

Synchronized cardioversion

Question 11

What medications are used in chronic CHF management if ACE/ARB cant be used?

Answer 11

Hydralazine and nitrates

Question 12

What medication is used next if pt is still dyspenic after beta blockers, ACE, dig, spiranolactone?

Answer 12

Ivabradine or Entresto (Sacubitril/Valsartan)

Question 13

What medications are best used in diastolic dysfunction?

Answer 13

Beta blockers and duiretics, everything else (dig, Ace, spiranolactone) is unclear

Question 14

Pt with CHF on lisinopril, metoprolol, spironolactone and lasix with and EF of 23%, what could also benefit the patient? What if the patient has a QRS > 120msec?

Answer 14

1. Implantantable Defibrillator 2. Resynchronize with biventricular pacer (wide QRS means ventricles are not beating together, the pacemaker will allow them too)

Question 15

Systolic murmur heard at the apex radiating to axilla? What is the indication for surgery?

Answer 15

MR. Primary MR with impaired LV dysfunction LVEF < 60%.

Question 16

Murmur heard at the 2nd right intercostal space radiating to the carotids? Best initial test? Rx and Why?

Answer 16

AS. TTE, confirm with TEE and left heart cath will show gradient and size of opening. Diuretics (decrease pre-load, standing, valsva , handrip (increase afterload) improve AS) but TAVR is best.

Question 17

Murmur heard at the left 2nd intercostal space?

Answer 17

Pulmonary valve mumurs

Question 18

Which murmurs improve with hand grip?

Answer 18

Increases after load so AS, MVP, HCOM. (MR and AR will increase with increase afterload)

Question 19

Which murmurs worsen with valsava and standing?

Answer 19

MVP, HCOM, all others get better (decrease the flow)

Question 20

Diastolic rumble after opening snap Dx?

Answer 20

MS

Question 21

Diastolic decresendo murmur Dx?

Answer 21

AR

Question 22

Rx for all dilated cardiomyopathy?

Answer 22

ACE/ARBs, beta blockers, spiranolactone

Question 23

Rx HCOM?

Answer 23

beta blockers and diuretics. Alcohol septal ablation if pt fails medical therapy.

Question 24

Rx for Restrictive cardiomyopathy?

Answer 24

Correct underlying cause.

Question 25

Pericarditis. Best initial test? Rx?

Answer 25

EKG (Diffuse ST segment depression with PR segment depresssion in lead II) NSAID + Colchicine

Question 26

Pericardial Tamponade

Answer 26

EKG (showing electrical alterans in the QRS complex) and Echo. Pericardiocentesis Long term therapy is pericardial window.

Question 27

Rx for PAD?

Answer 27

Exercise first. if fails cilostazol.

Question 28

Next step if pretest probability of is Low, High, Intermediate?

Answer 28

Low - no additional testing, high- start therapy, intermediate- able to exercise, normal ecg then do exercise ecg. if pt cant exercise then pharmcologic stress imaging test. If ecg is not normal then exercise imaging test. If any test positive then next step coronary angio.

Question 29

Indications for valve replacement in AS?

Answer 29

Severe AS (Aortic jet velocity > 4.0msec or gradient > 40), Angina, Syncope, LVEF <50%, if pt undergoing CABG.

Question 30

Management for pts who have DVT with no cancer? What if they have cancer?

Answer 30

rivoraxaban (factor Xa inhbitor) for 3 months. LMWH.

Question 31

Management of AAA? Follow up?

Answer 31

Smoking cessation (most important modifiable risk factor) Asa. Statin. >5.5 or grows >0.5 in 6 months –> surgery. Follow up with US every 6-12 months or years depending on size.

Question 32

Management of STEMI?

Answer 32

PCI w/in 90 minutes. or 120 min to transfer pt. if no PCI hospital w/in 120 minutes then tenectaplase.

Question 33

Management of PVD?

Answer 33

Aspirin, Statin and exercise regime. If fails then cilastazol. If no improvement and impending limb ischemia the bypass.

Question 34

Drugs that delay warfarin affect?

Answer 34

amiodarone, Flagyl, flouroqunolones, azole, acetaminophen.