Cardiology Flashcards
1
Q
Chest pain, worse with movement of left arm. Palpating of chest reproduces pain. Next best step?
A
Observation. Musculoskeletal in origin. Ischemia doesn’t reproduce pain
2
Q
Chest pain, crushing substernal pain radiating to left arm. Troponin- 0.4. Diagnosis?
A
MI. Troponin will be above 0.4. Cardiac enzymes not elevated in unstable/ prinzmetal angina
3
Q
Woman on fluconazole and ondansetron develops palpitations. EKG shows TdP. Treatment?
A
IV Magnesium. If hemodynamically unstable- cardioversion
4
Q
Anterior MI, next best step
A
Aspirin.
5
Q
Treatment for ventricular fibrillation
A
Defibrillator.
6
Q
Epigastric burning after playing. No relief with antacids. EKG normal. Next best step?
A
Exercise ekg. Should be done in those with suspected stable ischemic heart disease
7
Q
Inferior MI, 3 days later develops SOB, hypotension, bibasilar crackles, faint systolic murmur. Cause?
A
Papillary muscle rupture. Results in MR. Involves RCA.
8
Q
1 hour old baby with respiratory distress. H/o Gest DM in mom, echo shows small LV cavity and increased Iv septum thickness. Next best step?
A
Beta blocker therapy. Hypertrophic cardiomyopathy of infancy.
9
Q
Becks triad cause
A
Decreased LV preload in cardiac tamponade
10
Q
Type of syncope confirmed with upright tilt table test
A
Vasovagal syncope
11
Q
Diagnosis in cerebrovascular disease causing syncope
A
Do arteriography and carotid USG
12
Q
Diagnosis of Aortic dissection in hypotension patients
A
Do TEE. Ascending dissection requires urgent surgical repair
13
Q
MCC of acute cardiac arrest post MI ?
A
V Fib
14
Q
Which woman with cardiac conditions can’t get pregnant?
A
MAP- MS, AS, PAH.
15
Q
New diastolic murmur after AV replacement. Next step?
A
Echo. To assess for AR
16
Q
Asymptomatic newborn with 2/6 holosystolic murmur. Best next step?
A
Do echo. Large defects VSD have soft murmur
17
Q
Congenital long QT syndrome treatment
A
Propranolol
18
Q
MOA of beta blockers and CCB
A
Decreases myocardial contractility
19
Q
Use of adenosine
A
AVNRT
20
Q
Risk factors for Premature atrial complexes
A
Caffeine, smoking, stress. Please Avoid Caffeine and Smoking- PAC
21
Q
Side effect of niacin given for hyperlipidemia
A
Cutaneous flushing and itching
22
Q
WPW with Afib. Treatment?
A
Procainamide. If unstable cardioversion
23
Q
Post catheterisation complication- hypotension, back pain, improves with NS. Next step
A
CT abd/ pelvis suspicious of retro peritoneal hematoma
24
Q
Management of respiratory failure due to acute decompensated HF
A
Non invasive positive pressure ventilation
25
Prevention of acute limb ischemia secondary to left atrial thrombus
Apixaban, direct oral anticoagulant must be used
26
Treatment for aortic dissection
Beta blockers then nitroprusside, then surgical correction
27
Cyanotic newborn - ecg shows tall P waves and left axis deviation, decreased pulmonary markings on cxr. Diagnosis?
Tricuspid valve atresia.
28
Blunt thoracic aortic injury diagnosis by ?
CT angiography
29
BNP levels correlate with severity of which chamber?
LV systolic dysfunction.
30
Cardiac complications of sarcoidosis
Restrictive cardiomyopathy, AV block, dilated cardiomyopathy, MVP, AR, ventricular arrhythmias, HF
31
Surveillance method for <80% carotid stenosis with risk factors
Annual carotid duplex
32
Rx of sturge Weber syndrome
Laser therapy, anti epileptic, IOP reduction
33
Supply of SA, AV node
RCA
34
ECG finding when we are not supposed to shock
During relative refractory period- T wave (repolarization). Only shock in R wave- depolarization
35
Sudden chest, epigastric pain- sharp, deep, low BP, JVD, STEMI in inf leads. widened mediastinum
Aortic dissection- coronary ostial involvement-RCA occlusion- MI involving RV
36
Sharp localized ant chest pain, 6wks ago CABG, h/o DM, ESRD, temp-100, nonspecific ST, Cr- 1.5, small pericardial effusion
Acute pericarditis due to Post cardiac injury syndrome- immune mediated inflamm- NSAIDS+colchicine
37
Causes of post cardiac inj synd
MI, Cardiac sx, trauma, PCI
38
Complication of CABG- 2 weeks- incisional purulence, crepitus, fever, chest pain
Bacterial mediastinitis
39
CF of ruptured AAA
sudden severe abd/back pain, shock, umbilical/flank hematoma
40
ACS- NSTEMI mx
Nitrates, beta blocker, dual anti platelet, anticiag, statin, coronary reperfusion-angio within 24 hrs. STEMI- PCI, fibrinolytics
41
ALI immediate rx
anticoagulant- IV heparin
42
NSTEMI refused intervention, taking aspirin. NBS?
include P2Y12 inhibitor
43
Illicit drugs causing HTN
cocaine, amphetamines, MDMA/ecstacy, PCP, marijuana
44
MC comorbidity assoc with AFib
Chronic HTN
45
Meds causing QT prolongation
Macrolides & fluoroquinolones
Antiemetics (eg, ondansetron)
Azoles (eg, fluconazole)
Antipsychotics, TCAs & SSRIs
Some opioids (eg, methadone, oxycodone)
Class Ia antiarrhythmics (eg, quinidine)
Class III antiarrhythmics (eg, dofetilide, sotalol)
46
Congenital causes of QT prolongation
Romano ward, Jervell and Lange nielsen syndrome (+SNHL)
47
Cardiac anomalies associated with trisomy 18
Edward- VSD, ASD, PDA
48
Cardiac anomaly assoc with Digeorge
Truncus arteriosus- single S2
49
Valve dysfunction based on types of prosthetic
Paravalvular leak- mechanical (regurgitation around valve), transvalvular regurg- bioprosthetic (regurg through valve), stenosis- due to thrombus
50
What to consider while adding amiodarone in a HF pt
Digoxin toxicity, decrease dose by 25-50%. Monitor weekly
51
Embolic sources that can cause ALI
LA, LV, IE, prosthetic valve thrombosis
52
Primary mechanism of class 1C antiarrythmics causing SVT
Use dependence- in rapid rates, more number of channels blocked, progressive decrease in impulse conduction- widened QRS complex
53
ECG findings in vasovagal syncope
Bradycardia, sinus arrest
54
Cocaine induced NTEMI mx?
IV BZD, aspirin, GTN, CCB, if STEMI- catheterize
55
WPW with pre excited AFib
Procainamide
56
ECG in WPW
delta wave, short PR, wide QRS
57
CF of Digeorge
CATCH- cardiac outflow anomaly, anomalous face, thymic hypoplasia, cleft palate, hypoparathyroidism
58
Relation betw digoxin and potassium
compete to bind to myocardium at Na-K ATPase- hypokalemia increases digoxin toxicity
59
Digoxin induced arrhythmias
Increased automaticity of myoc conduction or increased vagal tone- atrial tach with AV block
60
CVC placed. NBS
Portable CXR- should be proximal to angle betw trachea and rigth main bronchus
61
CVC complications
Inappropriate placements, lung puncture- pneumothorax, myocardial perforation- cardiac tamponade, arterial puncture
62
PAD 1st line mx
Check ABI, supervised graded exercise program, stop smoking, DM, BP control. Start low dose aspirin + statin
63
62F dyspnea, dry cough, orthopnea, JVD, pulm edema, HTN, AFib. NBS
NIPPV- reduces WOB and decreases intrapulmonary shunting by displacing edema from alveoli
64
Mx of HCM
Increase preload- maintain high LV EDV with hydration, low HR, beta blocker. High LVESV encouraged by low SV by low contractility or increased afterload
65
Sensation of skipped beats, HTN, DM, irreg heart rhythm. ECG- showing reg RR, dropped QRS
Progressive prolongation of PR, narrow QRS- Mobitz type 1
66
Vagal tone and mobitz type 1
increasing vagal tone worsens block and vice versa
67
Mobitz type 2 ECG and vagal tone relation
Constant RR, randomly dropped QRS. Increasing vagal tone improves block
68
1st degree AV block
Reg PP, RR, prolonged PR
69
42F exertional dyspnea, harsh late peaking systolic murmur- 2nd R ICS radiating to carotids, S4+
AS- congenital valve malformation
70
65M PAD, in 5 yrs increased risk in?
MI, start antiplatelet, statin, lifestyle modification
71
Preop test for prev Inf wall MI going for rotator cuff sx
None (According to RCRI- 6 predictors- high risk sx, ischemic heart disease, h/o chf, h/o TIA/stroke, DM+insulin, preop cr>2) 0-1- low risk, >2- increased risk of cardiac death/arrest/MI
72
Valve abn in williams syndr
Supravalvular AS
73
HF signs, holosystolic murumu in left sternal border, prominent V wave, absent X descent
TR due to RHF- dilation of RV- Dil of TV annulus
74
Prominent A, flat Y seen in
TS
75
JVP wave in cardiac tamponade
flat y
76
Prognosis of newborn with HCM
Spontaneous regression by 1 yr
77
AFib pt on metoprolol and apixaban has frequent triggers. BMI high. NBS
Do sleep apnea testing
78
Rx for amlodipine causing edema
ACEi
79
67M exertional syncope, dyspnea, fatigue, cardiac RF+ additional finding?
weak slow rising carotid pulses- AS
80
Greatest impact in reducing BP- non pharm
DASH diet
81
24wks preg- HTN, 1+proteinuria. NBS
24 hr urine protein to diagnose preeclampsia
82
Mechanism MR due to HF in dilated cardiomyopathy
LV papillary muscle detachment
83
Hemodynamic changes in LVMI
Increased LV, RV preload, SVR
84
Hemodynamic changes in RVMI
Increased RV preload, SVR decreased LV
85
Murmur in ADE of ICD pacemaker
TR- can cause RHF. Confirm with Echo
86
Young man exertional syncope, ecg- t inversion in ant leads. NBS
Echo- HCM, systolic ejection murmur, diastolic dysfunction + audible s4
87
NBS if CHA2DS2-VASc score in Afib pt>1-2
Oral anticoag- M->2, F->3
88
34M substernal chest pain radiating to neck, not relieved by rest, ECG-normal, exercise stress- N. BMI high
Esophageal disease, give antacid
89
H/o URTI x 2 wks, syncope, dyspnea. ECG- electrical alterans
Acute pericarditis- cardiac tamponade- do pericardiocentesis
90
Sudden low back pain, HTN, smokes Xray- prevertebral calcification
Unstable AAA- hemod stable- do CT abdomen, if unstable and not a known h/o- USG
91
2 months old- holosystolic murmur-left sternal border, prominent S2, diastolic rumble at apex, no cyanosis
VSD- L-R, more flow to pulm art- PHTN- Loud S2, pulm over circulation, more blood through mitral valve- diastolic flow murmur
92
Surgical indications in IE
Acute HF, extension of inf, persistent bacteremia ref to antibiotics, diff to eradicate organisms, large vege/persistent septic emboli
93
Aortic dissection causing cardiac tamponade. NBS
Dont do pericardiocentesis-can worsen or extend the dissection, Do TEE
94
Radiological signs in pulm embolism
Westermark, hampton hump, fleischner
95
17M echo-LVH, early diastolic filling, mild LA enlargement
HCM- diastolic dysfuntn- decreases filling time, LV size decreased, thickness+
96
Athlete's heart adaptations in endurance and strength training
Endurance- Eccentric hypertrophy- increased LV, RV size, diastolic filling, SV, EF-no change
Strength- Concentric hypertrophy- LV wall thickness, no RV change, no change in diastolic change, EF-no change/slight increase
97
Brugada synd involves mut of which channels, ecg abn?
Cardiac Na channels (AD). ST elevation in V1,V2. Risk of scd due to ventricular arryth
98
62M PCI x 2wks, htn, smokes, underwent right femoral access. Swelling in right ing area + palpable thrill, continuous murmur
AV fistula
99
38wks preg- dyspnea, grade 3 holosystolic murmur, S3. NBS?
Echo-peripartum cardiomyopathy- dil cardiomyopathy- secondary MR
100
Causes of cardiac syncope
AS, HCM, VTACH, TDP, sick sinus, advanced AV block
101
2hr old Resp distress 2/2 meconium aspiration syndrome, decreased RV output. Post ductal spo2
Persistent pulm HTN of newborn- give O2, nitric oxide
102
Vascular resistance changes in VSD
Birth- increased SVR, decreased PVR. If large defect- pulm over circulation
103
AntiHTN choice in gout
Losartan, ACEi, CCB
104
Old- dyspnea, edema, bruises easily, proteinuria. Smokes, drinks. JVD+ echo- concentric LVH + diastolic dysfunction, small pericardial effusion
Amyloidosis- restrictive cardiomyopathy. Confirm with endomyocardial biopsy
105
Can digoxin be given in acute MI?
No, slows conduction through AV and increases contractility, worsens by increases o2 demand
106
Can beta blockers be given in acute HF
No-negative chronotropic and inotropic effects, given for decreasing mortality in acute MI
107
S3 heard in?
HFeRF, high output states, MR, AR
108
S4 heard in?
Concentric LVH, restrictive cardiomyopathy, acute MI
109
Hypovolemic shock, has esophageal cancer, ECG- sine wave pattern
Give calcium gluconate- for hyperkalemia 2/2 GI loss- hyperkalemic metabolic acidosis
110
Echo findings in viral myocarditis causing cardiomyopathy
4 chamber dil with diffuse wall hypokinesis
111
At what BUN will uremic pericarditis occur?
>60. Initiate hemodialysis
112
32M dyspnea, cough, weakness, drug user. ECG-N, CXR- scattered lung lesions in the peripheral lungs b/l. Finding?
Systolic murmur increased on inspiration- TR due to IE- septic pulm emboli
113
Paradoxical splitting of S2 seen in
AS, SHTN, LBBB, HCM
114
Indications for AS valve replacement
Severe AS+ onset of symptoms, LVEF<50%, undergoing other cardiac sx (CABG)
115
Direct thrombin inhibitors
Dabigatran
116
Direct factor Xa inhibitor
apixaban, rivaroxaban, edoxaban
117
Indication of cilostazol
PDE3 inhibitor for intermittent claudication, suppresses platelet aggregation
118
Mx of coarctation of aorta
PGE1- increasing systemic blood flow from right to left shunting by keeping the PDA open
119
Fatigue, diff conc, forgetful, constipation, weight gain. H/o htn, nonischemic cardiomyopathy, LV systolic dysfunctn, Afib, elevated ALP. Drug causing this?
Thyroid dysfunction due to amiodarone
120
Co2 insufflation causing sinus brady and transient AV block . CAuse?
Peritoneal stretching- increases vagal tone. But can also cause increase in SVR- increased BP due to increased intra abd pressure
121
Co2 gas embolization
End organ infarction- art embolism, hypotension, obstructive shock- venous embolism
122
