cardio Flashcards
CARDIOLOGY
CARDIOLOGY
What side effect might make a patient stop taking an ACEI?
Cough
Define orthostatic hypotension.
A drop in systolic blood pressure of >20 mmhg when standing up.
You feel a pulse that seems to be vibrating. What term do you use to describe it?
Thrill
What are three things in your differential if you have a paradoxical pulse?
Cardiac tamponade, pericarditis and obstructive lung disease
On palpation what size is normal for the aorta?
Less than 3 cm
A fixed or consistent split S2 should make you think of what diagnosis?
Atrial septal defect
A pathologic S3 is most commonly associated with what diagnosis?
CHF
If you hear a midsystolic click you should immediately be thinking about what diagnosis?
Mitral valve prolapse
An opening snap on auscultation of the heart should make you think of what diagnosis?
Mitral stenosis
A continuous murmur most likely involves what area of the heart?
It is most likely a septal defect.
You hear a continuous machine-like murmur. What is the most likely diagnosis?
Patent ductus arteriosus (PDA)
List three medications which may be used for pharmacological stress test.
Adenosine, dobutamine dipyridamole, and persantine
What is the gold standard for diagnosing coronary artery disease?
Cardiac catheterization
Define stage 1 hypertension according to JNC 7.
Systolic pressure of 140-159 and diastolic of 90-99
What is the treatment goal for a diabetic with hypertension?
130/80
What is the most common cause of secondary hypertension?
Chronic kidney disease
No matter what medications you use you are having trouble keeping a patient’s blood pressure under control. You also notice hyperpigmented skin and truncal obesity. What is the most likely diagnosis?
Cushing’s disease
List three signs or symptoms which will likely be included in a description of a patient with a pheochromocytoma?
Thin, diaphoretic, tachycardic, agitated and hypertensive
You have a patient with diagnosis of a pheochromocytoma. While waiting for surgery, should you use an alpha blocker or a beta blocker?
Alpha blocker. You should never use a pure beta blocker.
A young boy comes into your office. He has elevated blood pressure when taken in his arm, but no femoral pulses can be palpated. What is the most likely diagnosis?
Coarctation of the aorta
According to the CDC what is the range for a normal BMI?
18.5-24.9
What is the first line medical treatment for stage 1 hypertension?
Thiazide diuretic
After a thiazide diuretic what medication should you start in a hypertensive patient who also has diabetes?
An ACEI or an ARB
Following a myocardial infarction what medication should you be using to treat hypertension?
Beta blocker
Paroxysmal nocturnal dyspnea should make you think of what diagnosis?
CHF
What is the most common cause of CHF?
Coronary artery disease
What ejection fraction is typical for a patient with CHF?
35-40%
What is the most likely diagnosis for a young man who experiences sudden death while playing sports?
Hypertrophic cardiomyopathy
Bat wing vessels or Kerley B lines on a CXR should make you think of what diagnosis?
CHF
A beta natriuretic peptide below what level rules out CHF?
< 100
What is the therapeutic range for INR following a mechanical valve replacement?
2.5-3.5
What is the first line IV inotropic agent when dealing with cardiogenic shock?
Dopamine
What diagnosis is most likely in an IV drug user with a new heart murmur and fever?
Endocarditis
List two diagnoses which require antibiotic prophylaxis for “dirty procedures?”
Prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congential cyanotic heart defect
Does a patient with mitral valve prolapse require prophylactic antibiotics for dental work?
No, a recent change moves mitral valve prolapse from high risk to moderate risk.
What are the three major criteria for endocarditis?
2 positive blood cultures, a positive transesophageal echocardiography, new murmur
Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?
Osler nodes
List the 4 minor criteria for diagnosing endocarditis.
Fever, embolic event (Janeway lesions or petechiae, splinter hemorrhages), immunological event (osler nodes, glomerulonephritis), 1 positive blood culture
What are the five components of tetralogy of Fallot?
- Ventricular septal defect, 2. RVH, 3. right ventricular outflow obstruction (pulmonary valve stenosis), 4. overriding aorta, 5. right sided aortic arch
What is the gold standard for diagnosing myocarditis?
Myocardial biopsy
Where do most aortic dissections occur?
The ascending or descending thoracic aorta
A patient complains of severe pleuritic chest pain that is relieved with sitting and leaning forward. What is the most likely diagnosis?
Pericarditis
What is the first line medical treatment for pericarditis?
Aspirin and NSAIDS
What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?
Dressler syndrome
A patient presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all of the leads. What is the most likely diagnosis?
Pericarditis
Define paradoxical pulse.
There is a large difference in pulse pressure between inhalation and exhalation.
Define pulsus alternans.
EKG waveform changes from beat to beat
What is the definitive treatment for cardiac tamponade?
Pericardiocentesis
On physical exam, you hear a harsh systolic murmur along the right sternal border. What is the most likely diagnosis?
Aortic stenosis
A wide pulse pressure with a blowing diastolic decrescendo murmur at the right 2nd intercostal space should make you think of what diagnosis?
Aortic regurgitation
What is the best location to hear problems with the aortic valve?
2nd right intercostal space
Where is disease of the pulmonary valve best heard?
2nd left intercostal space
What two antibiotics are used for empiric treatment of endocarditis?
Vancomycin and ceftriaxone together are first line empiric treatment
What two valvular issues do patients with Marfan’s syndrome often have?
Aortic regurgitation and mitral valve prolapse (you can tell them apart by where they are heard).
What are the two main causes of aortic stenosis?
Congenital bicuspid valve and calcification of the valve secondary to coronary artery disease
An elderly patient presents with dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely diagnosis?
Aortic stenosis
On auscultation, you hear a harsh, blowing, pansystolic murmur at the apex. What is the most likely diagnosis?
Mitral regurgitation
You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis?
Transesophageal echo
A patient with mitral valve prolapse will often have what physical characteristics?
Often a thin female
What is the best patient position to hear aortic regurge and aortic stenosis?
Sitting up and leaning forward
What is Tietze syndrome?
Costochondritis
Are most pulmonary valve problems congenital or acquired?
95% are congenital
What is the therapeutic range for INR following an organic valve replacement?
2 to 3
A 60 year old male presents to the ER with severe dizziness and back pain. His blood pressure is dropping, and you can feel an abdominal pulsatile mass on physical exam. What is the most likely diagnosis?
Ruptured aortic aneurysm
In a patient with aortic stenosis, will the PMI be medially displaced, normal, or laterally displaced?
It will be laterally displaced due to left ventricular hypertrophy.
A patient complains of severe crushing chest pain. EKG shows ST segment elevations. All labs including troponins and CK-MB are negative. What is the most likely diagnosis?
Prinzmetal’s angina
A question about Prinzmetal’s angina will often contain what key thing in the patient’s history?
Cocaine use
Name two things that would constitute a positive stress test.
A drop in blood pressure, a new arrhythmia, an increase in angina symptoms, ST depressions
Are ulcers from venous insufficiency painful or painless?
Painless
A patient has just received a cardiac stent. How long will he be on aspirin and clopidogrel?
One year
Where is disease of the mitral valve best heard?
At the apex
What is the initial treatment for a myocardial infarction?
MONA - morphine oxygen nitroglycerin and aspirin
Clot busting drugs should be used within 3 hours of which two cardiac events?
STEMI and new left bundle branch block
List three catastrophic complications of a myocardial infarction.
Papillary muscle rupture, myocardial wall rupture, and left ventricular aneurysm
An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely diagnosis?
Supraventricular tachycardia
Acute endocarditis is most commonly caused by what organism?
Staph aureus, strep virdans
List three congential heart diseases.
Atrial septal defect (ASD), ventricular septal defect (VSD), coarctation of the aorta, patent ductus arteriosus (PDA), tetralogy of Fallot
What is the most common cause of an atrial septal defect?
Patent foramen ovale
Where on your patient should you listen for the murmur associated with an atrial septal defect?
At the left second or third interspace
A CXR shows a “3” sign with notching of the ribs. What is the most likely diagnosis?
Coarctation of the aorta
What is the appropriate treatment for a patent ductus arteriosus.
Indomethacin
A Blalock procedure is used to correct what congenital heart condition?
Tetralogy of Fallot
You hear a loud, harsh pulmonary murmur along the left sternal border. What is the most likely diagnosis?
Ventricular septal defect
Subacute endocarditis is most commonly caused by what organism?
Strep Viridans
What is the most common place for an aortic aneurysm?
In the abdomen and below the renal arteries
Who is more likely to have an aortic aneurysm males or females?
Males are eight times as likely to have an aortic aneurysm.
The accessory pathway known as the James bundle should make you think of what syndrome?
Lown-Ganong-Levine syndrome
What imaging needs to be done before taking a patient to the OR with an aortic aneurysm?
CT (echo may be used as initial study, but CT is need for surgery)
List two risk factors for an aortic dissection?
Hypertension, Marfan’s syndrome, bicuspid aortic valve, pregnancy
A patient presents to the ER with tearing chest pain radiating to his back. What is the most likely diagnosis?
Aortic dissection
What will a CXR show for a patient with an aortic dissection?
Widened mediastinum
What is the best test to diagnose an aortic dissection?
CT
List the six P’s of an ischemic limb.
Pain, paresthesias pallor, pulselessness, poikilothermia, paralysis
You have a patient with pulsus paradoxus. What two diagnosis should you be thinking of?
Pericarditis, pericardial effusion and an obstructive lung issue
A patient complains of pain in his legs when he walks. It goes away after sitting. What term comes to mind for this symptom? What diagnosis is it associated with?
Intermittent claudication caused by peripheral arterial disease
Giant cell arteritis is associated with what other disease?
Polymyalgia rheumatica
A sawtooth pattern on EKG should make you think of what diagnosis?
Atrial flutter
What is the accessory pathway associated with Wolff-Parkinson-White syndrome?
The bundle of Kent
A biphasic P wave should make you think of what diagnosis?
Left atrial enlargement
What is the gold standard for diagnosis of giant cell arteritis?
Biopsy of the temporal artery
What is the treatment for giant cell arteritis?
High dose prednisone
List the components of Virchow’s triad.
Stasis, vascular injury, hypercoagulability
Calf pain should always make you think of what diagnosis?
DVT
Where is disease of the tricuspid valve best heard?
Along the left lower sternal border
What is the most common congenital heart disease?
Ventricular septal defect
Are ulcers from arterial insufficiency painful or painless?
Painful
Give two contraindications for using an ACEI.
Bilateral renal artery stenosis, history of angioedema, pregnancy
Both lead I and AVF have positive QRS complexes. Does this represent normal axis, left axis deviation or right axis deviation?
Normal axis
What medication might you switch to if a patient develops an intolerable cough on an ACEI?
Angiotensin receptor blocker (ARBs)
What class of cardiac medications should be avoided in patients with asthma?
Beta blockers (Blocks receptors for bronchodilators)
A boot-shaped heart on CXR should make you think of what congenital heart condition?
Tetralogy of Fallot
An RSR prime in leads V1 or V2 should make you think of what diagnosis?
Right bundle branch block
Which lab should be tightly monitored in a patient taking an aldosterone antagonist?
Potassium, they may have hyperkalemia.
What is the best test for diagnosing CHF?
Echo
Which cardiac medication is used to help with cardiac contractility after you have optimized most of the other cardiac medications?
Digoxin
A blockage of which artery causes an anterior wall MI?
Left anterior descending artery
What lab result will increase the risk of digoxin toxicity?
Hypokalemia or hypercalcemia
A patient presents to the ER in acute CHF. What drug class will likely be the first choice?
Loop diuretics
A patient has a GFR of 25 and HTN. Which class should you use, a loop or a thiazide diuretic?
A loop will work no matter how low the GFR is. Thiazides will only work with a GFR over 30.
Which EKG leads are used to diagnose an anterior wall MI?
V1, V2, and V3
Do loop diuretics cause hyperkalemia or hypokalemia?
Hypokalemia
Statins are the drug of choice to treat what type of dyslipidemia?
Elevated LDL
A patient recently started taking Lipitor. He is now complaining of aches and pains. What test should you order?
Serum creatinine kinase, you’re looking for rhabdomyolysis.
How does ezetimibe work?
Decreases intestinal absorption of cholesterol.
Which hyperlipidemia medication may cause flushing?
Niacin
Name three medication “classes” which are used to reduce LDL?
Statins, ezetimibe niacin, and nicotinic acid
Name two fibric acid derivatives.
Fenofibrate and gemfibrozil
List three class 1a antiarrhythmics.
Disopyramide, quinidine, procainamide
You are counting boxes from the peak of a QRS wave on an EKG in order to determine the heart rate. What would the heart rate be if the next QRS wave peak were three boxes away? What numbers are associated with the first five boxes?
The answer is 100. The heart rates by counting boxes are 300, 150, 100, 75, 60
A U wave on EKG should make you think of what diagnosis?
Hypokalemia
What will the heart rate be if the AV node is pacing the heart?
40-60 beats per minute
Which cardiac medication has gynecomastia in its side effect profile?
Spironolactone
Lead I has a QRS that is up and the AVF lead has a QRS complex that is down. Does this represent normal axis, left axis deviation or right axis deviation?
Left axis deviation
An Osborn or J wave on EKG should make you think of what diagnosis?
Hypothermia
What is the first line medication for a patient with symptomatic bradycardia?
Atropine
What is the heart rate for tachycardia? How about bradycardia?
Tachycardia >100, bradycardia <60
On EKG there is an early but otherwise normal PQRS complex. After that beat there is a slight pause and then a normal rhythm continues. What is the term for this one beat?
Premature atrial contraction
How do you treat polymyalgia rheumatica?
Low dose prednisone
What is the management of a patient in supraventricular tachycardia?
Vagal maneuvers, carotid massage, adenosine
What is the definitive treatment for atrial flutter?
Radiofrequency catheter ablation
An 82 year old patient complains of headaches and jaw claudication. What is the most likely diagnosis?
Giant cell (temporal) arteritis
The EKG shows irregularly irregular narrow QRS, waves. What diagnosis should you be thinking of?
Atrial fibrillation
An EKG shows a regular rate of 50 beats per minute. The QRS is narrow and there is no visible P wave. What is the most likely diagnosis?
Junctional rythm
Name a common cause of a junctional rhythm.
Digitoxin toxicity
An EKG shows two premature ventricular contractions. These two QRS waves look very different. What is the term for this?
Multifocal premature ventricular contractions
What is the most common cause of sudden cardiac death?
Ventricular fibrillation
A patient in the ER has no pulse; but on EKG there are wide irregular “complexes” which are at an irregular rate. They all appear very different from one another. What is the treatment for this patient?
He is in ventricular fibrillation. The treatment is defibrillation.
Tall peaked T waves should make you think of what diagnosis?
Hyperkalemia
How do you define 1st degree AV block?
The PR interval is longer than 0.2 seconds or one block on EKG.
What is the other term for Mobitz type I?
Wenckebach
What is the most important complication of giant cell arteritis?
Blindness
What two labs do you want to monitor in a patient on an ACEI?
Serum creatinine and serum potassium
The heart rate is irregular so you can’t count boxes between QRS waves to determine heart rate. What is another method you can use to determine rate on an EKG?
Count QRS waves in a six second strip and multiply by 10 to get beats per minute.
What is the treatment for a patient with a Mobitz II AV block?
Pacemaker
You see regular P waves and regular QRS complexes, but they do not seem to have any correlation to each other. What is the diagnosis?
Third degree AV block
Name one aldosterone antagonist.
Spironolactone, eplerenone
You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?
Wolff-Parkinson-White syndrome
What two leads do you use to determine the axis of the heart?
Lead I and AVF
An RSR prime in leads V5 or V6 should make you think of what diagnosis?
Left bundle branch block
Which finding requires immediate attention: left bundle branch block or right bundle branch block?
New left bundle branch block is a STEMI equivalent. Right bundle branch block is usually not a problem.
What medication class is used to lower triglycerides?
Fibric acid derivatives
Tall peaked P waves should make you think of what diagnosis?
Right atrial enlargement
List two causes of right atrial enlargement.
Pulmonary HTN severe lung disease pulmonary valve stenosis
Which EKG leads are used to diagnose an anterolateral MI?
V5 and V6
What are the three inferior leads?
II, III, and aVF
A blockage of which artery causes a lateral wall MI?
Left circumflex artery
What is represented by ST segment depressions greater than 1mm on EKG?
Ischemia
Rheumatic fever most commonly affects which valve?
The mitral valve
What is the only cyanotic congenital heart disease on the NCCPA blueprint?
Tetralogy of Fallot
On EKG, there is an early wide QRS complex with no associated P wave. After that beat there is a slight pause and then a normal rhythm continues. What is the term for this one beat?
Premature ventricular contraction
What is the definitive treatment for a patient with recurrent ventricular tachycardia?
Implanted defibrillator
On an EKG, you notice a patient has a gradually lengthening PR interval and then a missed QRS complex. The pattern repeats again. What type of AV block is this?
Mobitz I or Wenckebach
List three side effects of digoxin.
Nausea/vomiting anorexia, confusion, arrhythmias (sinus brady, AV block) fatigue, vision disturbances etc.
What is the first line medical treatment for torsades de pointes?
Magnesium sulfate
