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UWORLD Q BANK review > Cardiology > Flashcards

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

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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

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3
Q

Woman on fluconazole and ondansetron develops palpitations. EKG shows TdP. Treatment?

A

IV Magnesium. If hemodynamically unstable- cardioversion

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4
Q

Anterior MI, next best step

A

Aspirin.

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5
Q

Treatment for ventricular fibrillation

A

Defibrillator.

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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

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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.

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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.

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9
Q

Becks triad cause

A

Decreased LV preload in cardiac tamponade

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10
Q

Type of syncope confirmed with upright tilt table test

A

Vasovagal syncope

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11
Q

Diagnosis in cerebrovascular disease causing syncope

A

Do arteriography and carotid USG

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12
Q

Diagnosis of Aortic dissection in hypotension patients

A

Do TEE. Ascending dissection requires urgent surgical repair

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13
Q

MCC of acute cardiac arrest post MI ?

A

V Fib

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14
Q

Which woman with cardiac conditions can’t get pregnant?

A

MAP- MS, AS, PAH.

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15
Q

New diastolic murmur after AV replacement. Next step?

A

Echo. To assess for AR

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16
Q

Asymptomatic newborn with 2/6 holosystolic murmur. Best next step?

A

Do echo. Large defects VSD have soft murmur

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17
Q

Congenital long QT syndrome treatment

A

Propranolol

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18
Q

MOA of beta blockers and CCB

A

Decreases myocardial contractility

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19
Q

Use of adenosine

A

AVNRT

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20
Q

Risk factors for Premature atrial complexes

A

Caffeine, smoking, stress. Please Avoid Caffeine and Smoking- PAC

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21
Q

Side effect of niacin given for hyperlipidemia

A

Cutaneous flushing and itching

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22
Q

WPW with Afib. Treatment?

A

Procainamide. If unstable cardioversion

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23
Q

Post catheterisation complication- hypotension, back pain, improves with NS. Next step

A

CT abd/ pelvis suspicious of retro peritoneal hematoma

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24
Q

Management of respiratory failure due to acute decompensated HF

A

Non invasive positive pressure ventilation

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25
Q

Prevention of acute limb ischemia secondary to left atrial thrombus

A

Apixaban, direct oral anticoagulant must be used

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26
Q

Treatment for aortic dissection

A

Beta blockers then nitroprusside, then surgical correction

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27
Q

Cyanotic newborn - ecg shows tall P waves and left axis deviation, decreased pulmonary markings on cxr. Diagnosis?

A

Tricuspid valve atresia.

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28
Q

Blunt thoracic aortic injury diagnosis by ?

A

CT angiography

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29
Q

BNP levels correlate with severity of which chamber?

A

LV systolic dysfunction.

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30
Q

Cardiac complications of sarcoidosis

A

Restrictive cardiomyopathy, AV block, dilated cardiomyopathy, MVP, AR, ventricular arrhythmias, HF

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31
Q

Surveillance method for <80% carotid stenosis with risk factors

A

Annual carotid duplex

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32
Q

Rx of sturge Weber syndrome

A

Laser therapy, anti epileptic, IOP reduction

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33
Q

Supply of SA, AV node

A

RCA

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34
Q

ECG finding when we are not supposed to shock

A

During relative refractory period- T wave (repolarization). Only shock in R wave- depolarization

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35
Q

Sudden chest, epigastric pain- sharp, deep, low BP, JVD, STEMI in inf leads. widened mediastinum

A

Aortic dissection- coronary ostial involvement-RCA occlusion- MI involving RV

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36
Q

Sharp localized ant chest pain, 6wks ago CABG, h/o DM, ESRD, temp-100, nonspecific ST, Cr- 1.5, small pericardial effusion

A

Acute pericarditis due to Post cardiac injury syndrome- immune mediated inflamm- NSAIDS+colchicine

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37
Q

Causes of post cardiac inj synd

A

MI, Cardiac sx, trauma, PCI

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38
Q

Complication of CABG- 2 weeks- incisional purulence, crepitus, fever, chest pain

A

Bacterial mediastinitis

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39
Q

CF of ruptured AAA

A

sudden severe abd/back pain, shock, umbilical/flank hematoma

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40
Q

ACS- NSTEMI mx

A

Nitrates, beta blocker, dual anti platelet, anticiag, statin, coronary reperfusion-angio within 24 hrs. STEMI- PCI, fibrinolytics

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41
Q

ALI immediate rx

A

anticoagulant- IV heparin

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42
Q

NSTEMI refused intervention, taking aspirin. NBS?

A

include P2Y12 inhibitor

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43
Q

Illicit drugs causing HTN

A

cocaine, amphetamines, MDMA/ecstacy, PCP, marijuana

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44
Q

MC comorbidity assoc with AFib

A

Chronic HTN

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45
Q

Meds causing QT prolongation

A

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)

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46
Q

Congenital causes of QT prolongation

A

Romano ward, Jervell and Lange nielsen syndrome (+SNHL)

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47
Q

Cardiac anomalies associated with trisomy 18

A

Edward- VSD, ASD, PDA

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48
Q

Cardiac anomaly assoc with Digeorge

A

Truncus arteriosus- single S2

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49
Q

Valve dysfunction based on types of prosthetic

A

Paravalvular leak- mechanical (regurgitation around valve), transvalvular regurg- bioprosthetic (regurg through valve), stenosis- due to thrombus

50
Q

What to consider while adding amiodarone in a HF pt

A

Digoxin toxicity, decrease dose by 25-50%. Monitor weekly

51
Q

Embolic sources that can cause ALI

A

LA, LV, IE, prosthetic valve thrombosis

52
Q

Primary mechanism of class 1C antiarrythmics causing SVT

A

Use dependence- in rapid rates, more number of channels blocked, progressive decrease in impulse conduction- widened QRS complex

53
Q

ECG findings in vasovagal syncope

A

Bradycardia, sinus arrest

54
Q

Cocaine induced NTEMI mx?

A

IV BZD, aspirin, GTN, CCB, if STEMI- catheterize

55
Q

WPW with pre excited AFib

A

Procainamide

56
Q

ECG in WPW

A

delta wave, short PR, wide QRS

57
Q

CF of Digeorge

A

CATCH- cardiac outflow anomaly, anomalous face, thymic hypoplasia, cleft palate, hypoparathyroidism

58
Q

Relation betw digoxin and potassium

A

compete to bind to myocardium at Na-K ATPase- hypokalemia increases digoxin toxicity

59
Q

Digoxin induced arrhythmias

A

Increased automaticity of myoc conduction or increased vagal tone- atrial tach with AV block

60
Q

CVC placed. NBS

A

Portable CXR- should be proximal to angle betw trachea and rigth main bronchus

61
Q

CVC complications

A

Inappropriate placements, lung puncture- pneumothorax, myocardial perforation- cardiac tamponade, arterial puncture

62
Q

PAD 1st line mx

A

Check ABI, supervised graded exercise program, stop smoking, DM, BP control. Start low dose aspirin + statin

63
Q

62F dyspnea, dry cough, orthopnea, JVD, pulm edema, HTN, AFib. NBS

A

NIPPV- reduces WOB and decreases intrapulmonary shunting by displacing edema from alveoli

64
Q

Mx of HCM

A

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
Q

Sensation of skipped beats, HTN, DM, irreg heart rhythm. ECG- showing reg RR, dropped QRS

A

Progressive prolongation of PR, narrow QRS- Mobitz type 1

66
Q

Vagal tone and mobitz type 1

A

increasing vagal tone worsens block and vice versa

67
Q

Mobitz type 2 ECG and vagal tone relation

A

Constant RR, randomly dropped QRS. Increasing vagal tone improves block

68
Q

1st degree AV block

A

Reg PP, RR, prolonged PR

69
Q

42F exertional dyspnea, harsh late peaking systolic murmur- 2nd R ICS radiating to carotids, S4+

A

AS- congenital valve malformation

70
Q

65M PAD, in 5 yrs increased risk in?

A

MI, start antiplatelet, statin, lifestyle modification

71
Q

Preop test for prev Inf wall MI going for rotator cuff sx

A

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
Q

Valve abn in williams syndr

A

Supravalvular AS

73
Q

HF signs, holosystolic murumu in left sternal border, prominent V wave, absent X descent

A

TR due to RHF- dilation of RV- Dil of TV annulus

74
Q

Prominent A, flat Y seen in

A

TS

75
Q

JVP wave in cardiac tamponade

A

flat y

76
Q

Prognosis of newborn with HCM

A

Spontaneous regression by 1 yr

77
Q

AFib pt on metoprolol and apixaban has frequent triggers. BMI high. NBS

A

Do sleep apnea testing

78
Q

Rx for amlodipine causing edema

A

ACEi

79
Q

67M exertional syncope, dyspnea, fatigue, cardiac RF+ additional finding?

A

weak slow rising carotid pulses- AS

80
Q

Greatest impact in reducing BP- non pharm

A

DASH diet

81
Q

24wks preg- HTN, 1+proteinuria. NBS

A

24 hr urine protein to diagnose preeclampsia

82
Q

Mechanism MR due to HF in dilated cardiomyopathy

A

LV papillary muscle detachment

83
Q

Hemodynamic changes in LVMI

A

Increased LV, RV preload, SVR

84
Q

Hemodynamic changes in RVMI

A

Increased RV preload, SVR decreased LV

85
Q

Murmur in ADE of ICD pacemaker

A

TR- can cause RHF. Confirm with Echo

86
Q

Young man exertional syncope, ecg- t inversion in ant leads. NBS

A

Echo- HCM, systolic ejection murmur, diastolic dysfunction + audible s4

87
Q

NBS if CHA2DS2-VASc score in Afib pt>1-2

A

Oral anticoag- M->2, F->3

88
Q

34M substernal chest pain radiating to neck, not relieved by rest, ECG-normal, exercise stress- N. BMI high

A

Esophageal disease, give antacid

89
Q

H/o URTI x 2 wks, syncope, dyspnea. ECG- electrical alterans

A

Acute pericarditis- cardiac tamponade- do pericardiocentesis

90
Q

Sudden low back pain, HTN, smokes Xray- prevertebral calcification

A

Unstable AAA- hemod stable- do CT abdomen, if unstable and not a known h/o- USG

91
Q

2 months old- holosystolic murmur-left sternal border, prominent S2, diastolic rumble at apex, no cyanosis

A

VSD- L-R, more flow to pulm art- PHTN- Loud S2, pulm over circulation, more blood through mitral valve- diastolic flow murmur

92
Q

Surgical indications in IE

A

Acute HF, extension of inf, persistent bacteremia ref to antibiotics, diff to eradicate organisms, large vege/persistent septic emboli

93
Q

Aortic dissection causing cardiac tamponade. NBS

A

Dont do pericardiocentesis-can worsen or extend the dissection, Do TEE

94
Q

Radiological signs in pulm embolism

A

Westermark, hampton hump, fleischner

95
Q

17M echo-LVH, early diastolic filling, mild LA enlargement

A

HCM- diastolic dysfuntn- decreases filling time, LV size decreased, thickness+

96
Q

Athlete’s heart adaptations in endurance and strength training

A

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
Q

Brugada synd involves mut of which channels, ecg abn?

A

Cardiac Na channels (AD). ST elevation in V1,V2. Risk of scd due to ventricular arryth

98
Q

62M PCI x 2wks, htn, smokes, underwent right femoral access. Swelling in right ing area + palpable thrill, continuous murmur

A

AV fistula

99
Q

38wks preg- dyspnea, grade 3 holosystolic murmur, S3. NBS?

A

Echo-peripartum cardiomyopathy- dil cardiomyopathy- secondary MR

100
Q

Causes of cardiac syncope

A

AS, HCM, VTACH, TDP, sick sinus, advanced AV block

101
Q

2hr old Resp distress 2/2 meconium aspiration syndrome, decreased RV output. Post ductal spo2<preductal spo2. NBS

A

Persistent pulm HTN of newborn- give O2, nitric oxide

102
Q

Vascular resistance changes in VSD

A

Birth- increased SVR, decreased PVR. If large defect- pulm over circulation

103
Q

AntiHTN choice in gout

A

Losartan, ACEi, CCB

104
Q

Old- dyspnea, edema, bruises easily, proteinuria. Smokes, drinks. JVD+ echo- concentric LVH + diastolic dysfunction, small pericardial effusion

A

Amyloidosis- restrictive cardiomyopathy. Confirm with endomyocardial biopsy

105
Q

Can digoxin be given in acute MI?

A

No, slows conduction through AV and increases contractility, worsens by increases o2 demand

106
Q

Can beta blockers be given in acute HF

A

No-negative chronotropic and inotropic effects, given for decreasing mortality in acute MI

107
Q

S3 heard in?

A

HFeRF, high output states, MR, AR

108
Q

S4 heard in?

A

Concentric LVH, restrictive cardiomyopathy, acute MI

109
Q

Hypovolemic shock, has esophageal cancer, ECG- sine wave pattern

A

Give calcium gluconate- for hyperkalemia 2/2 GI loss- hyperkalemic metabolic acidosis

110
Q

Echo findings in viral myocarditis causing cardiomyopathy

A

4 chamber dil with diffuse wall hypokinesis

111
Q

At what BUN will uremic pericarditis occur?

A

>

  1. Initiate hemodialysis
112
Q

32M dyspnea, cough, weakness, drug user. ECG-N, CXR- scattered lung lesions in the peripheral lungs b/l. Finding?

A

Systolic murmur increased on inspiration- TR due to IE- septic pulm emboli

113
Q

Paradoxical splitting of S2 seen in

A

AS, SHTN, LBBB, HCM

114
Q

Indications for AS valve replacement

A

Severe AS+ onset of symptoms, LVEF<50%, undergoing other cardiac sx (CABG)

115
Q

Direct thrombin inhibitors

A

Dabigatran

116
Q

Direct factor Xa inhibitor

A

apixaban, rivaroxaban, edoxaban

117
Q

Indication of cilostazol

A

PDE3 inhibitor for intermittent claudication, suppresses platelet aggregation

118
Q

Mx of coarctation of aorta

A

PGE1- increasing systemic blood flow from right to left shunting by keeping the PDA open

119
Q

Fatigue, diff conc, forgetful, constipation, weight gain. H/o htn, nonischemic cardiomyopathy, LV systolic dysfunctn, Afib, elevated ALP. Drug causing this?

A

Thyroid dysfunction due to amiodarone

120
Q

Co2 insufflation causing sinus brady and transient AV block . CAuse?

A

Peritoneal stretching- increases vagal tone. But can also cause increase in SVR- increased BP due to increased intra abd pressure

121
Q

Co2 gas embolization

A

End organ infarction- art embolism, hypotension, obstructive shock- venous embolism

122
Q
A

UWORLD Q BANK review (17 decks)

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