Cardiology Flashcards
Define pulsus alternans.
EKG waveform changes from beat to beat
If you suspect temporal arteritis what test gives a definitive diagnosis?
Biopsy of the temporal artery
You have a patient with paradoxical pulsus. What two diagnosis should you be thinking of?
Pericarditis and pericardial effusion
Define paradoxical pulse.
There is a large difference in pulse pressure between inhalation and exhalation
You hear a murmur with a fixed split S2 over the left 2nd intercostal space. What diagnosis should you be thinking of?
Atrial septal defect
Kerley B lines should make you think of what diagnosis?
CHF
At what size aortic aneurysm would you consider doing an elective surgical repair?
> 5.5cm
Patient arrives in acute distress. Chest x-ray shows a wide mediastinum. What diagnosis should you be thinking of?
Aortic dissection
In a subacute case of endocarditis what is the most common pathogen?
Strep viridans
You have a patient with pulsus alternans. What two diagnosis should you be thinking of?
Pericarditis and pericardial effusion
In Cushing’s syndrome is the serum corticosteroid elevated or low?
Elevated
In an acute case of endocarditis what is the most common pathogen?
Staph aureus
Where is disease of the pulmonary valve best heard?
2nd left intercostal space
What is the treatment for polymyalgia rheumatica?
low dose prednisone
You hear a midsystolic click. What diagnosis should you be thinking of?
Mitral valve prolapse
A BNP below what value will allow you to rule out CHF?
<100
Where is disease of the tricuspid valve best heard?
Along the left lower sternal border
What are the three major criteria for endocarditis?
2 positive blood cultures, a positive transesophageal echocardiography, new murmur
What is the most common cause of an atrial septal defect?
Patent foramen ovale
What is the first line medical treatment for an a pheochromocytoma?
Alpha blockers. Do not give Beta blockers
What is the therapeutic range for INR following an organic valve replacement?
2 to 3
What is the best patient position to hear aortic regurge and aortic stenosis?
Sitting up and leaning forward
What is the one contraindication for pharmacological stress testing?
Aortic stenosis
Which EKG leads are used to diagnose an anterolateral MI?
V5 and V6
Jaw claudication should make you think of what diagnosis?
Temporal arteritis
On physical exam you hear a harsh systolic murmur along the right sternal border. What diagnosis should you be thinking of?
Aortic stenosis
The EKG shows ST elevations in all leads. What diagnosis should you be thinking of?
Pericarditis
What it the medical treatment of temporal arteritis?
High dose prednisone
Which EKG leads are used to diagnose an anterior wall MI?
V1, V2 and V3
A boot shaped heart on CXR should make you think of what diagnosis?
Tetralogy of Fallot
What is the first line medical treatment for an aortic dissection?
Beta blocker - labetalol
What are the three components of Virchow’s triad?
DVT risk - Stasis, vascular injury, hypercoagulability
Where is disease of the mitral valve best heard?
At the apex
What is the therapeutic range for INR following a mechanical valve replacement?
2.5-3.5
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.
Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?
Osler nodes = Ouch
You have diagnosed a patient with high blood pressure. If he is otherwise healthy, what is the target blood pressure you’re shooting for?
less than 140/90
You hear a story about a young boy who recently died during a basketball game. What diagnosis should you be thinking of?
Hypertrophic cardiomyopathy
On physical exam you hear a loud harsh holosystolic murmur at the left sternal border. What diagnosis should you be thinking of?
Ventral septal defect
What causes an S4 sound?
A stiff left ventricle
You notice a machine like murmur heard best over the left second intercostal space. What diagnosis should you be thinking of?
Patent ductus
Wide pulse pressures with a decrescendo murmur at the left 3rd intercostal space should make you think of what diagnosis?
Aortic regurgitation
On physical exam where are aortic issues best auscultated?
2nd right intercostal space
What are the three inferior leads?
II, III and aVF
On physical exam you hear a blowing murmur at the apex which is pansystolic. There is also a brisk carotid upstroke. What diagnosis should you be thinking of?
Mitral valve regurge
On physical exam you hear an opening snap & low pitched murmur at the apex. What diagnosis should you be thinking of?
Mitral stenosis
What is the target blood pressure in a patient with diabetes or renal disease?
less than 130/80
List three medications which may be used for pharmacological stress test.
Adenosine, dobutamine, dipyridamole
What is Tietze syndrome?
Costochondritis
Child comes into the office with notable HTN but a weak femoral pulses. What diagnosis should you be thinking of?
Coarctation of the aorta
What is the initial treatment for an MI?
MONA - Morphine, oxygen, nitroglycerin and aspirin
