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AMC MCQ > Cardio > Flashcards

Cardio Flashcards

1
Q

Pt with MS, on auscultation; opening snap indicate»>

A

NON-calcified mitral valve

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2
Q

Most common finding on cardiac examination in patient with miral valve disease?

A

atrial fibrillation

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3
Q

ejection systolic murmur radiate to carotid

A

AS

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4
Q

wide fixed splitting of S2

A

ASD

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5
Q

pansystolic murmur radiating to whole myocardium

A

VSD

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6
Q

continuous machinery murmur

A

PDA

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7
Q

Pt with well developed UL& underdeveloped LL. Exam shows delayed femoral pulsation»>

A

Coarctation of Aorta (COA)

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8
Q

COA murmur»>

A

at whole precordium radiating to back

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9
Q

MCC of cyanotic congenital heart disease?

A

TOF

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10
Q

Cyanotic spells in pt with TOF occur at childhood (not directly after birth)
1st step in management of cyanotic spells in TOF?

A

Squatting position

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11
Q

Cyanosis since birth (at 1st day of life)»>

A

TGVs

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12
Q

1st step in management TGV?

A

PG infusion (to maintain patency of PDA)

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13
Q

Heart failure symptoms few days after birth»>

A

hypo-plastic left heart $

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14
Q

Most imp drug for AR?

A

ACEI

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15
Q

Fixed split S2?

A

ASD

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16
Q

More common association with ASD?

A

RBBB

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17
Q

Most common cyanotic heart disease?

A

TOF

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18
Q

Most common complication of TOF?

A

cyanotic spells

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19
Q

3 day child with symptoms of HF and shock»>

A

hypoplastic ventricle

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20
Q

Systolic murmur over aortic area with syncope»>

A

AS

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21
Q

Cyanosis since birth»>

A

TOG

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22
Q

Cyanosis relieved by squatting»>

A

TOF

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23
Q

Systolic murmur radiating to the back»>

A

coarctation of aorta

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24
Q

Continuous machinery murmur?

A

PDA

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25
Q

Mid-diastolic rumbling murmur?

A

MS

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26
Q

Decrescendo early diastolic murmur?

A

AR

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27
Q

Systolic murmur over apex radiate to axilla?

A

MR

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28
Q

Systolic murmur over apex radiate to carotid?

A

AS

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29
Q

Most common drug addiction causing CHD?

A

Cocaine

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30
Q

Most common material causing CHD?

A

Alcohol

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31
Q

Most common CHD with down?

A

endocardial cushion

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32
Q

Most common CHD with DM?

A

VSD

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33
Q

Marked difference bet upper body pressure and lower body pressure (delayed femoral pulse)»>

A

Coarctation of aorta (COA)

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34
Q

Most common complication with MS?

A

AF

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35
Q

1st step in TOGV?

A

prostaglandin infusion

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36
Q

Pt with chest pain improve with setting & leaning forward»>

A

pericarditis

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37
Q

MCC of pericardutis

A

Viral infection (coxackie virus)

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38
Q

TTT of pericarduti

A

NSAIDs

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39
Q

TTT of uremic pericarditis?

A

Dialysis

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40
Q

Best inv of constrictive pericarditis?

A

CT (calcified pericardium)

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41
Q

TTT constructive pericarditis

A

pericardiectomy

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42
Q

Pt with distant heart sounds, ++ JVP, hypotension»>

A

Pericardial effusion and tamponade…….next step is chest x-ray

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43
Q

Main TTT of pericardial effusion?

A

Pericardiocentesis

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44
Q

Immigrant from Iraq/ Aboriginal with erythema marginatum. Lab shows ++ ASO titer. ECG shows prolonged PR interval»>

A

Rheumatic fever

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45
Q

Aboriginal with rash, migratory arthritis and H/O URTI»>

..next step

A

RHEUMATIC FEVER……..oral penicillin

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46
Q

Most imp ECG findings in rheumatic fever?

A

prolonged PR interval

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47
Q

Organisms causing Infective Endocrditis:

Most common over all?

A

strep viridians

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48
Q

Organisms causing Infective Endocrditis

After dental procedure?

A

strep. viridians

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49
Q

Organisms causing Infective Endocrditis

Drug addict?

A

.staph

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50
Q

Organisms causing Infective Endocrditis

After cardiac cath?

A

staph

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51
Q

Organisms causing Infective Endocrditis

After GIT or genitourinary procedure?

A

strep fecalis

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52
Q

Organisms causing Infective Endocrditis

Colon cancer»>

A

strep bovis… vvvvvvvvvvv imp

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53
Q

Pt with IE, Blood culture grows step bovis»>

Next step

A

: colonoscopy

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54
Q

MC affected valve in drug addict with IE»>

A

Tricuspid valve

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55
Q

MC valve lesion in drug addict with IE?

A

Tricuspid regurge

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56
Q

1st most imp inv of IE?

A

Trans-esophageal Echo (detect vegetation)

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57
Q

2nd most imp inv of IE?

A

Blood culture (identify organism)

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58
Q

Prophylaxis against IE?

A

2 conditions MUST be met;
Significant cardiac defect (prosthetic valve, previous IE)
Dental procedure

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59
Q

Prophylaxis against IE?

A

Amoxicillin 1h before & ½ an hour after procedure

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60
Q

1st MCC of dilated CM?

A

Alcohol

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61
Q

2nd MCC of dilated CM

A

Viral (MC virus: coxackie virus)

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62
Q

Young pt with Syncope/ Arrhythmias or Sudden death during exercise with F/H of sudden death during exercise at young age»>

A

HOCM

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63
Q

Genetics of HOCM?

A

AD

Symptoms of HOMC are more severe with exercise, dehydration, valsalva or standing

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64
Q

MCC of death in HOCM?

A

Obstruction

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65
Q

2nd MCC of death in HOCM?

A

Arrhythmias

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66
Q

MC type of arrhythmias in HOCM?

A

V.tach and V.fib

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67
Q

Inv of choice of HOCM?

A

Echo

68
Q

TTT of choice of HOCM?

A

1st line: BB & 2nd line: CCB

69
Q

TTT of arrhythmias in HOCM?

A

Implantable defibrillator

70
Q

1st MC RF of IHD?

A

HTN

71
Q

2nd MC RF of IHD?

A

Smoking

72
Q

Highest risk of MI in pt with IHD?

A

Angina (not HTN)

73
Q

Young smoker with recurrent attacks of typical chest pain»>

A

Variant angina

74
Q

TTT of variant angina?

A

stop smoking, nitrates during attack

75
Q

Pt with H/O typical chest pain, ECG is normal… Next step?»>

A

Exercise ECG

76
Q

?Relieve chest pain in IHD

A

Nitrates

77
Q

Pt with DM, HTN, hyperlipidemia lose consciousness, lab shows serum glucose of <40… which medication is responsible?

A

BB

BB mask the signs of hypoglycemia BUT it doesn’t cause it

78
Q

Imp findings in ECG in MI?

A

ST segment elevation

79
Q

ST elevation at II, III& aVF?

A

inferior wall infarction

80
Q

The earliest cardiac enzyme to appear MI?

A

Myoglobin

81
Q

The most accurate enzyme in MI?

A

Troponin

82
Q

The best enzyme to detect Re-infarction?

A

CK-MB

83
Q

Definitive TTT of MI?

A

Angioplasty

84
Q

Best TTT in case of late presentation of MI?

A

Heparin

85
Q

Late presentation of MI with significant chest pain?

A

Nitrates

86
Q

Which medications decrease mortality in MI?

A

BB, ACE-Is& statin

87
Q

Best inv/TTT of myocardial aneurysm?

A

Echo/ Surgery

88
Q

What to avoid After MI?

A

No operation for 6 months

89
Q

Emergent surgery (e.g. fracture femur) with H/O angioplasty & stent in the last 6 months»>

A

Don’t stop clopidogrel (high risk of thrombosis)

90
Q

Elective endoscpoy with H/O angioplasty & stent in the last 6 months&raquo_space;>

A

Don’t stop clopidogrel (high risk of thrombosis)

91
Q

Female on OCP develops HTN»>

A

1st: stop OCP and 2nd: re-evaluate

92
Q

Pt with BP > 140/90 for the 1st time»>

A

Ask pt to come back in 1-2 Ws

93
Q

Best inv for HTN?

A

ambulatory monitoring

94
Q

Best inv for paroxysmal arrhythmia?

A

Holter monitor

95
Q

Imp inv of arrhythmia?

A

TFT, CBC and electrolytes

96
Q

1st life style modification in TTT of HTN?

A

Wt loss

97
Q

2nd life style modification in TTT of HTN?

A

low Na diet

98
Q

Best initial drug for HTN?

A

Thiazides

99
Q

First drug for DM with HTN?

A

ACEI

100
Q

First line for DM + Protenuria?

A

ACEI

101
Q

HTN + unilateral renal artery stenosis?

A

ACEI

102
Q

HTN + bilateral renal artery stenosis?

A

Angioplasty& stent

103
Q

HTN + OSTEOPOROSIS?

A

THIAZIDES

104
Q

HTN + Hyperthyroidism?

A

BB

105
Q

HTN + BPH?

A

Alpha blockers

106
Q

HTN + HF?

A

ACEI

107
Q

HTN and pregnancy?

A

alpha methly dopa and labetalol

108
Q

Hypertensive emergency?

A

Hospitalization & 1st line: Labetolol/ 2nd line: Na nitroprusside

109
Q

MC RF of digitalis toxicity?

A

hypokalemia

110
Q

Presentation of digital is toxicity

A

Vomiting, abd pain, colored vision& arrhythmia in ECG

111
Q

Most imp ECG finding in digitalis toxicity?

A

down sloping ST segment with sagging appearance

112
Q

TTT of digital toxicity

A

Digitalis antibodies

113
Q

Patient on digoxin develop arrhythmia, what to do?

A

stop digoxin and give potassium

114
Q

MCC of Lt sided HF (LHF)?

A

MI

115
Q

MCC of Rt sided HF (RHF)

A

Left sided HF

116
Q

Most imp sign of LHF?

A

Bilateral basal lung crepitation

117
Q

Most imp sign of RHF?

A

Systemic congestion

118
Q

Inv of choice of HF?

A

Echo

119
Q

Hepato- jugular reflux»>

+ve in hepatomegaly due to

A

congestive HF

120
Q

Hepato- jugular reflux»>

-ve in hepatomegaly DT

A

liver pathology

121
Q

Medications MUST be given in HF»>

A

ACE-Is, BB and aldosterone antagonist

122
Q

Most dangerous type of lipids?

A

LDL

123
Q

Most imp in exam to say familial?

A

tendon xanthoma (NOT xanthelasma)

124
Q

DOC for hyperlipidemia»>

A

Statin

125
Q

Mechanism of action statins

A

HMG-COA reductase inhibitor

126
Q

Pt on statin, BB, ACE-I, aspirin develop myopathy… Cause?

A

Statin

127
Q

Inv of choice in suspected statin- induced myopathy?

A

CK

128
Q

Imp SE of statin? (2)

A

myopathy (check CK)

Hepatitis (check AST, ALT)

129
Q

Imp forbidden combinations:
Statin and gemfibrizol?
Will cause

A

Severe rhabdomyolysis

130
Q

Nitrates and sildenafil cause

A

Severe hypotension

131
Q

Allopurinol and azathioprine?cause

A

severe toxicity

132
Q

Pt with severe chest pain radiating to the back»>

A

Aortic dissection

133
Q

MC RF of aortic dissection»>

A

HTN

134
Q

X-ray of aortic dissection»>

A

Wide mediastinum

135
Q

Aortic dissection and stable patient»>

A

CT angio

136
Q

Aortic dissection and unstable patient»>

A

Trans-esophageal echo

137
Q

1st step in TTT of aortic dissection?

A

Lower BP (BB is the best to start with)

138
Q

MC medication causing orthostatic hypotension?

A

Diuretics

139
Q

1st line of TTT orthostatic hypotension?

A

IV fluid

140
Q

2nd line orthostatic hypotension?

A

Stop the offending drug

141
Q

Inv of choice orthostatic hypotension?

A

Upright tilt table test

142
Q

Pt with BPH loses conscious while micturating»>

A

Situational syncope

143
Q

quick recovery

HOCM vs AS??

A

VVVVVVV IMP

144
Q

Both of them?

A

young age

145
Q

Both of them?

A

sudden syncope

146
Q

Both of them?

A

risky with exercise

147
Q

Both of them?

A

sudden death

148
Q

HOCM…

A

positive family history

149
Q

HOCM…

A

systolic murmur over sternal border

150
Q

HOCM murmur….

A

noooo radiation

151
Q

AS?

A

systolic murmur over aortic area radiate to carotid

152
Q

Chest pain»>

A

more with Aortic stenosis

153
Q

MI and surgery:

A

No operation before 6 months

154
Q

Stent and urgent operation:

A

Do not stop clopidogrel…..risk of thrombosis

155
Q

Target lipid profile????

Total Cholesterol…

A

less than 4 mmol/l

156
Q

LDL target

A

less than 2 mmol/l

157
Q

HDL?target target

A

more than 1 mmol/l

158
Q

TG?target target

A

less than 2 mmol/l

159
Q

Drug of choice of hypercholssterol

A

statin to maximum tolerated dose

160
Q

Sudden tearing chest pain referred to the back and HTN»>

A

aortic dissection

Next step………CXR……..wide mediastinum

161
Q

47 yrs male patient HTN, DM and smoker next best step?

A

CVS risk assessment

162
Q

Best assessment for obesity causing CVS disease?

A

waist hip ratio

163
Q

DM type 2 with any CVS risk factor ?

A

add statin regardless lipid profile

164
Q

How long to take clopidogrel for after STE MI?

after NSTEMI

A

4 weeks

12 months

165
Q

Meds > 4 weeks post MI?

A 
SABA
Statin
Aspirin
Beta Blockers
ACEI
166
Q

Meds for Pulmonary edema?

A 
MONaD
Morphine
Oxygen
Nitrates
Diuretics
167
Q

Afib Pt with HF, what meds to avoid

A

CCB such as VD
verapamil
diltiazam

AMC MCQ (14 decks)

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