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Internal Medicine - MCCQE 1 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

what is ck-mb and troponin?

A

cardio markers
ck-mb - stays elevated x 1-2 days
troponin - stays elevated x 1-2 wks

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2
Q

when do i answer exercise thallium testing or stress echo?

A 
when ekg is unreadable for ischemia:
LBBB
digoxin use
pacemaker in place
LVH
any baseline abnormality of the ST segment of the EKG
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3
Q

next best diagnostic test to evaluate an abnormal stress test that shows “reversible” ischemia?

A

angiography

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4
Q

when is coronary bypass appropriate?

A

once angiogram has been done

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5
Q

name p2y12 receptor blockers and their moa?

A

clopidopgrel, prasugrel, ticagrelor

they block aggregation of platelets to each other by inhibiting ADP-induced activation of the p2y12 receptor.

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6
Q

prasugrel?

A

p2y12 antagonist added only for angioplasty!!!

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7
Q

when to give thrombolytics (alteplase)?

A

chest pain for <12 hrs and STEMI and PCI cannot be performed within 90 minutes of arrival the ED.

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8
Q

when to have urgent angioplasty or PCI?

A

within <12hr of chest pain and within 90 min since the time of first contact to PCI capable facility

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9
Q

when is lidocaine or amiodarone the answer for acute MI?

A

only when there is ventricular tachycardia or ventricular fibrillation

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10
Q

factor Xa inhibitors?

what inhibits them?

A

rivaroxaban, apixaban, edoxaban, betrixaban

inhibited by Andexanet alfa

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11
Q

indirect thrombin inhibitors?

A

heparin and LMWH

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12
Q

Direct thrombin inhibitors?

what inhibits them?

A

argatroban, bivalirudin, desirudin, dabigatran

inhibited by Idarucizumab

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13
Q

aortic stenosis?

A

syncope in old folks;
systolic, cres-decres murmur on R 2nd ICS, radiating to R carotids or R clavicle, Diminished A2, ejection click, paradoxical slitting of S2
Diagnose with TEE (best initial)
Tx with diuretics; balloon dilation if pt too sick to undergo surgery

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14
Q

difference btw bioprosthetic vs mechanical valves?

A

bioprosthetic lasts less and no anticoagulation required

mechanical lasts more but require warfarin (INR 2-3)

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15
Q

Aortic regurgitation?

A

SOB and fatigue
diastolic, decres at L sternal border
Diagnosis with TTE
Tx with ACEIs/ARBs and nifedipine

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16
Q

mitral stenosis?

A

rheumatic fever is most common cause (immigrant, pregnant)
dysphagia, hoarseness, a fib
diastolic rumble after an opening snap (OS)
MS worsens when OS closes to S2
Diagnose with TTE
Tx with diuretics and ballon valvuloplasty (most effective)

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17
Q

mitral regurgitation?

A

dyspnea on exertion
holosystolic murmur heard best at apex; radiates to axilla
diagnose with TTE
Tx with ACEIs/ARBs and nifedipine

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18
Q

pericarditis Tx?

A

NSAIDs; Ibuprofen with colchicine

If pain persists then add PO prednisone

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19
Q

pericardial tamponade?

A

SOB, Hypotension, JVD
pulsus paradoxus (bp drops >10mmhg with inhalation)
electrical alternans
Dx with echo; do EKG
Tx with Pericardiocentesis (best initial therapy)
Pericardial window placement (most effective long term)

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20
Q

most dangerous therapy for P temponade?

A

diuretics

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21
Q

constrictive pericarditis?

A

unique features:
kussmaul sign (increase in jvp on inhalation)
pericardial knock
Dx: CXR (calcification), EKG, CT/MRI
Tx: diuretics (best initial therapy)
surgical removal of pericardium (most effective therapy)

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22
Q

Aortic dissection?

A

severe sudden chest pain radiating to back btw scapula
difference in bp btw L and R arms
Dx: Best initial is CXR (widened mediastium)
Most accurate: CT angio = TEE (when CT angio is CI esp. during renal Insuff.) = MR angio
Tx: BBs immediately, ICU, nitroprusside for further bp control

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23
Q

when to screen for AAA?

A

ultrasound in men 60-75 who are current or former smokers

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24
Q

when to repair AAA?

A

> 5.5mm

<5.5mm; monitor it regularly with US q6months - 3years; lifestyle modifications

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25
Q

meds used in rate control of a fib?

A

atenelol, metroprolol

non dhp ccbs i.e verapamil and diltiazem

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26
Q

WPW syndrome patient should avoid?

A

warm bath -> causes peripheral vasodilation and rise in body temp -> drop in BP -> sympathetic system is activated -> further increase in HR and worsening sxs

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27
Q

“asymptomatic” severe aortic stenosis patient? next best step?

A

exercise testing to confirm symptomatic status; if yes then further management

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28
Q

when BBs are contraindicated in pts with ACS?

A
  • systolic bp <90 mmhg
  • severe bradycardia
  • 2nd or 3rd deg AV block
  • peripheral vascular diseases
  • uncompensated CHF
  • cardiogenic shock
  • asthma or emphysema that is sensitive to beta agonist
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29
Q

diastolic murmurs?

A

AR and MS

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30
Q

behcet’s syndrome?

A

recurring oral
genital ulcers
Eye lesions (uveitis; tx with Topical steriod)
Skin lesions (sterile pustule with erythematous margins within 48hrs after an aspetic needle prick)
vasculitis (unknown reasons)
seen in pt from korea, japan and easter Mediterranean

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31
Q

long term therapy for CONGENITAL torsades de pointes?

A

beta blockers

*contraindicated in acquired TdP because bradycardia may prolong QT interval further and worsen the sxs

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32
Q

drugs to avoid in HOCM?

A

diuretics, ACE/ARBs, nitrates (anything that reduces preload)

BBs are beneficial (increase vent contractility, increase vent volume and compliance)

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33
Q

what are Canadian HTN education program (CHEP) recommendations?

A

initial therapy for isolated HTN are:
Thiazide/Thiazide like diuretics, beta blockers(younger patient <60yrs), ACE inhibitors (non black pt), long acting CCBs, ARBs

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34
Q

treatment of post-thrombotic syndrome? what are signs and sxs?

A

Tx is Graduated compression (reducing underlying venous HTN)
Sxs - pain, cramps, heaviness, paresthesia, and pruritis
Sign - pretibial edema, skin induration, hyperpigmentation, redness, venous ectasia, and compression pain

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35
Q

heparin overdose?

A

Tx with Protamine sulfate

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36
Q

First line drugs to use in CKD?

A

ACE inhibitors/ARBs

Slight elevation in creatinine is acceptable and therapy should continue unless hyperkalemia develops

37
Q

what is the assessment of severe AS?

A

Mean gradient is >40 mmhg

Aortic valve area is <1.0 cm2

38
Q

Worsening of SVT after the use of CCBs or Digoxin?

A

WPW syndrome

Avoid the use of AV nodal blockers such as BBs, CCBs, digoxin or adenosine

39
Q

which thrombolytic therapy is preferred? Tissue plasminogen activator or streptokinase?

A

TPA > streptokinase

40
Q

when to use Amiodarone IV 300 mg in VF and pulseless VT?

A

after 3rd defibrillation, CPR and epinephrine

41
Q

following successful reversion of Vfib with defibrillation, what is next step?

A

amiodarone IV for 24 to 48 hrs

42
Q

ppx before dental procedure is required in pts with what valvular diseases?

A

hx of infective endocarditis;
prosthetic valves;
cardiac transplant patients with valvulopathy;
unrepaired cyanotic congenital heart disease

43
Q

what is normal PR interval?

A

120ms - 200ms

44
Q

what is normal QT interval?

A

400ms - 440ms

45
Q

what is normal qrs interval?

A

60ms - 100ms

46
Q

abnormal diastolic dysfunction with impaired ventricular filling and increased filling pressures?

A

Hypertrophic cardiomyopathy

Obstruction is caused by systolic anterior motion of the mitral valve against the hypertrophied septum

47
Q

what conditions can cause QT prolongation?

A

HypoKalemia
HypoCalcemia
HypoMagnesemia
Type 1a Antiarrhythmic (quinidine, procainamide)

48
Q

What is medical treatment of neurogenic orthostatic hypotension?

A

Midodrine (alpha 1 adrenergic agonist)
Fludrocortisone (mineralocorticoid)
Droxidopa (Norepinephrine precursor)

49
Q

Target BP in Diabetic pt with microalbuminuria?

What is best Initial therapy?

A

130/80
ACE inhibitors
(DHP CCBs are 2nd line)

50
Q

Range of Albumin to creatinine ratio in Men and Women that indicates microalbuminuria?

A

ACR in men: 2.0 - 20 mg/mmol

ACR in Women: 2.8 - 28 mg/mmol

51
Q

What receptors are responsible for dyspnea in pulmonary congestion?

A

Juxtacapillary (J) receptors

52
Q

What medication provides greatest mortality benefit in hypertensive patients with DM and ESRD?

A

ACE inhibitors

53
Q

When Inpatient management of DVT patients is needed?

A

Massive DVT (ileofemoral);
symptomatic PE;
High risk for bleeding with anticoagulants;
Presence of co morbid conditions

54
Q

Drugs to avoid in Raynaud’s phenomenon?

A

Beta Blockers
Cisplatin
Bleomycin

55
Q

Drug of choice for termination of SVT in hemodynamically stable pt?

A

IV adenosine

“Adore the SUV”

56
Q

Drug of choice to terminate stable pt with TdP?

A

IV Magnesium

“Twist da Magnet”

57
Q

Constantly prolonged PR interval and a P wave always followed by a QRS complex?

A

First degree Heart Block

58
Q

Progressive PR interval prolongation followed by a P wave with a dropped QRS complex?

A

Mobitz type 1 (second deg HB)

Also called Wanckebach

59
Q

Constant PR interval followed by a P wave with a dropped QRS complex?

A

Mobitz type 2 (Second deg HB)

60
Q

ECG shows complete AV node dissociation with no relationship between the P waves and QRS complexes?

A

Third deg heart block
Medical emergency
Initially tx with IV access, O2, bp monitoring, transcutaneous pacing
Then permanent pacemaker or ICD

61
Q

Drugs that decrease both preload and afterload? i.e venous and arterial vasodilator

A

ACE inhibitors, ARBs, Nitroprusside, Prazosin

62
Q

What is phlegmasia cerulea dolens?

A
63
Q

Acute treatment of cyanide toxicity?

A

Sodium Nitrate and Sodium Thiosulfate

64
Q

Murmurs increase with valsalva/standing (decrease in venous return) and decrease with leg raise/squatting (increase in venous return)

A

HOCM and MVP

65
Q

CHA2DS2-VASc score?

A 
Congestive heart failure (1)
hypertension (1)
Age >75 (2)
Diabetes Mellitus (1)
Stroke/TIA (2)
Vascular Disease (1)
Age 65-75 (1)
Sex Female (1)
66
Q

What are absolute contraindications for Thrombolytics?

A

Bleeding diathesis(tendency to bleed easily);
Head or facial injury within last 3 months;
GI bleeding within last 4 weeks;
Prior intracranial hemorrhage;
Ischemic Stroke within 3 months
Suspected Aortic dissection

67
Q

most common side effect of ASA?

A

Ringing in both ears!

68
Q

Tx for WPW in stable pts?

A

IV Procainamide or IV amiodarone

“Proclaim the Wolves”

69
Q

What is the most common cause of death within the 1st year of heart transplant?

A

Infection

70
Q

Patients intolerant to ACE inhibitors from hyperkalemia or renal insufficiency should take what?

A

Combination of hydralazine and oral nitrate

Isosorbide/hydralazine

71
Q

What is the most common cause of mitral stenosis?

A

Rheumatic Fever

72
Q

ST elevation in Lead II, III, AVF where lead II and III has equal ST elevation. V1-V3 has ST depression. Where is the most likely occlusion?

A

Left circumflex artery

73
Q

WPW syndrome plus Right atrium enlargement and reduced vascular markings on CXR?

A

Ebstein anomaly

74
Q

drugs with rebound HTN after abrupt discontinuation?

A

Clonidine and Guanfacine

75
Q

Best initial treatment for Multifocal Atrial Tachycardia?

A

First give O2 then Diltiazem

76
Q

What is multifocal atrial tachycardia (MAT) associated with?

A

COPD/Emphysema

77
Q

What to AVOID in multifocal atrial tachycardia?

A

Beta Blockers

78
Q

Best initial management for stable SVT pt?

A 
vagal maneuvers (carotid sinus massage, ice immersion of the face, valsalva)
If that fails, then IV adenosine
79
Q

Type of cardioversion required for unstable Vfib or pulsless VT?

A

Unsynchronized cardioversion (defibrillation)

80
Q

what is phytonadione?

A

vitamin K used in warfarin induced bleeding

81
Q

What wave on ECG is associated with hypothermia?

A

J wave or Osborn wave

82
Q

What meds are contraindicated during Aortic dissection?

A

Direct vasodilators like hydralazine diazoxide

83
Q

What are the ACLS guidelines for vfib/pVT?

A

cpr–>defib–>cpr–>defib–>epi –>cpr –>defib–>amiodarone

(120J - 200J) for biphasic defib or 360J for monophasic defib

84
Q

Best recommended antihypertensive medication in pts with CAD?

A

Beta Blockers

85
Q

What is the effect of Potassium on Digoxin?

A

Hypokalemia Worsens the Digoxin Toxicity.

Digoxin completes for Na-K ATPase channels with Potassium.

86
Q

What is the treatment for hyperkalemic emergency i.e Sine wave pattern on EKG?

A

Calcium gluconate and Insulin plus glucose

87
Q

What does a, c, v means in normal JVP waveform?

A

“a” wave is caused by right atrial contraction, closely followed by tricuspid valve closure;
“c” wave is caused by right ventricular contraction, against a closed tricuspid valve;
“v” wave, representing the peak of right atrial filling, just prior to reopening of the tricuspid valve

88
Q

What causes cannon a wave?

A

AV dissociation like Ventricular tachycardia, complete AV heart block

89
Q

What causes prominent v waves?

A

Tricuspid regurgitation; there is elevation of right atrial pressure throughout ventricular systole

Internal Medicine - MCCQE 1 (13 decks)

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