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PANCE > Cardiology 16% > Flashcards

Cardiology 16% Flashcards

1
Q

Inotropes
Ex:
MOA:

A

Ex: dobutamine, dopamine, epinephrine, digoxin
MOA: increase CO by increasing contractility

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2
Q

Chronotropes
Ex:
MOA:

A

Positive: adrenaline
Negative: digoxin
MOA: alter heart rate

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3
Q

Pressors
Ex:
MOA:

A

Ex: Dopamine, phenylephrine
MOA: improve pressure by increasing vascular tone

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4
Q

Postural hypotension =

A

> 20 mmHg drop in SBP OR >10 mmHg drop in DBP b/w supine and sitting and/or standing

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5
Q

Metabolic syndrome =

A

3 or more of the following:

  1. Truncal obesity
  2. HDL < 40 (men) or <50 (women)
  3. Hypertriglyceridemia: >150
  4. Fasting glucose >110
  5. HTN
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6
Q 
Blood pressure for:
Normal =
PreHTN =
HTN stage 1 =
HTN stage 2 =
A

Normal = <120/<80
PreHTN = 120-139/80-90
HTN stage 1 = 140-159/90-99
HTN stage 2 = >160/>100

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7
Q

Hypertensive urgency =

Hypertensive emergency =

A

Increased BP w/ NO apparent acute end-organ damage

> 220 mmHg SBP or >125 mmHg DBP w/ acute target end-organ damage

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8
Q

ECG of HTN may reveal ____

A

left ventricular hypertrophy = deep S waves in V1 + V2, tall R waves in V5 + V6

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9
Q

Goal blood pressure in HTN

A

140/90

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10
Q

Goal blood pressure in diabetes or CKD

A

130/80

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11
Q

HCTZ, Chlorthalidone =
MOA:
SE:

A

Diuretic
MOA: prevent kidney Na/water reabsorption at DISTAL DILUTING TUBULE
SE: HypoNa, HypoK
hyperuricemia, hyperglycemia –> caution in pts w/ DM and gout

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12
Q

HTN medication that should be used w/ caution in pts w/ DM and gout

A

HCTZ, Chlorthalidone

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13
Q

Furosemide, bumetanide =
MOA:
SE:

A

Loop diuretics
MOA: inhibit water transport across Loop of Henle –> increased extretion of water, Na, Cl, K
SE: HypoK/Na/Cl, Hypochloremic metabolic alkalosis, hyperglycemia

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14
Q

HTN medication CI in pts w/ sulfa allergies.

A

Loop diuretics: Furosemide, bumetanide

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15
Q

Spironolactone, Amiloride, Eplerenone =
MOA:
SE:

A

K+ sparing diuretics
MOA: inhibit aldosterone-mediated Na/H2O absorption
SE: HyperK, gynecomastia

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16
Q

HTN medication that causes gynecomastia

A

K+ sparing diuretics: Spironolactone, Amiloride, Eplerenone

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17
Q

Nifedipine, amlodipine =
MOA:
Indication:

A

Dihydropyridines CCB
MOA: potent vasodilators (no effect on cardiac contractility/conduction)
Ind: HTN, Angina, Raynaud’s

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18
Q

Verapamil, Diltiazem =
MOA:
Indication:

A

Non-dihydropyridines CCB
MOA: cardiac contractility and conduction, potent vasodilators, reduce vascular permeability
Ind: HTN w/ A fib, Angina, Raynaud’s

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19
Q

HTN medication that causes constipation

A

verapamil

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20
Q

Cardioselective beta blockers: (3)

Non-cardioselective beta blockers: (1)

A

Cardioselective beta blockers (beta-1) : Atenolol, metoprolol, esmolol
Non-cardioselective beta blockers (beta-1 & beta-2): Propranolol

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21
Q

T/F: Beta blockers are used as 1st line monotherapy in HTN.

A

False. Thiazide diuretics (HTCZ) are tx of choice as initial therapy in uncomplicated HTN.

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22
Q

CI of beta blockers:

A

2nd/3rd heart block, decompensated heart failure

Nonselective beta blockers CI in asthma/COPD –> may worsen peripheral vascular disease/Raynaud’s phenomenon

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23
Q

CI of CCB:

A

pts taking beta blockers, CHF, 2nd/3rd heart block

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24
Q

Drug of choice for pts w/ HTN and BPH
Indications:
SE:

A

alpha-1 blockers: Prazosin, Terazosin, Doxazosin
Increased HDL, decrease LDL, improves insulin sensitivity
SE: 1st dose syncope, NOT 1st line

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25
Q

Tx of hypertensive urgencies/emergencies:

If MI also present:

A

Preferred: sodium nitroprusside
If MI present: nitroglycerin or beta-blocker

Others: nicardipine, enalaprilat, diazoxide, trimethaphan, loop diuretics

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26
Q

Tx of aortic dissection:

A

Nitroprusside + beta-blocker (labetalol, esmolol) + urgent surgery

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27
Q

Tx of hypertensive urgencies w/ acute renal failure:

A

Fenoldopam (dopamine-1 receptor agonist)

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28
Q

___-sided HF is most commonly caused by ___ -sided HF.

A

RIGHT-sided HF is most commonly caused by LEFT -sided HF.

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29
Q

S4 gallop heard in ___ heart failure

A

diastolic heart failure

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30
Q

Indication of Implantable Cardioverter-defibrillator in CHF

A

Ejection fraction <35

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31
Q

Effect of ACE inhibitors in CHF

A

decreased left ventricular wall stress

slow myocardial remodeling and fibrosis

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32
Q

Effect of beta-blockers in CHF

A

improve ejection fraction
reduce left ventricular dilation
reduce incidence of dysrhythmia

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33
Q

3 patterns of unstable angina:

A
  1. angina at rest
  2. new onset of angina symptoms
  3. increasing pattern of pain in previously stable patients
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34
Q

Levine sign =

A

Clenched fist over sternum and clenched teeth when describing chest pain
Seen in pt w/ ischemia

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35
Q

Definitive diagnosis of ischemic heart disease

A

Coronary angiography

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36
Q

Most useful diagnosis of ischemic heart disease

A

Exercise stress testing –> ST segment depression of 1 mm = +

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37
Q

1st line therapy for chronic angina

A

beta-blockers

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38
Q

Primary treatment for acute anginal attacks

A

Sublingual NTG tab/spray

Sublingual isosorbide dinitrate

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39
Q

Dressler syndrome =

A

1-2 weeks post-MI

Pericarditis, fever, leukocytosis, pericardial/pleural effusion

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40
Q

Type of murmur that might be heard in Acute Coronary Syndrome

A

Mitral regurgitation

S4 gallop

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41
Q

ST elevatation >1mm in 2 contiguous leads =

A

STEMI

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42
Q

How to differentiate b/w UA and NSTEMI

A

Cardiac biomarkers become elevated during evaluation = NSTEMI
Both have ST-segment depression

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43
Q

Transient ST-segment changes of >0.5 mm =

A

acute ischemia and Coronary Artery DIsease

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44
Q

_____ on ECG is high suggestive of new MI.

A

New left BBB

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45
Q

Progression of ECG changes in STEMI

A

peaked T waves –> ST seg elevation –> Q waves–> T wave inversion

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46
Q

Inferior MI in which leads?

Artery involved?

A

II, III, aVF

Right coronary artery

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47
Q

Posterior MI in which leads?

Artery involved?

A

V1, V2 ST depressions

Right coronary artery, Circumflex

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48
Q

Anteroseptal MI in which leads?

Artery involved?

A

V1, V2

Proximal Left Anterior Descending

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49
Q

Anterior MI in which leads?

Artery involved?

A

V1, V2, V3

Left Anterior Descending

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50
Q

Anterolateral MI in which leads?

Artery involved?

A

V4, V5, V6

Circumflex

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51
Q 
Myoglobin
Initial elevation time: 
Peak elevation:
Return to normal:
When to draw:
A

Initial elevation time: 1-4 hrs
Peak elevation: 6-7 hrs
Return to normal: 24 hrs
When to draw: 1-2 hrs after onset of chest pain

52
Q 
Cardiac troponin I
Initial elevation time: 
Peak elevation:
Return to normal:
When to draw:
A

Initial elevation time: 3-12 hrs
Peak elevation: 24 hrs
Return to normal: 5-10 DAYS
When to draw: 12 hrs after onset of chest pain, repeat in 8-12 hrs

53
Q 
Cardiac troponin T
Initial elevation time: 
Peak elevation:
Return to normal:
When to draw:
A

Initial elevation time: 3-12 hrs
Peak elevation: 12-48 hrs
Return to normal: 5-14 DAYS
When to draw: 12 hrs after onset of chest pain

54
Q 
CK-MB 
Initial elevation time: 
Peak elevation:
Return to normal:
When to draw:
A

Initial elevation time: 3-12 hrs
Peak elevation: 24 hrs
Return to normal: 48-72 hrs
When to draw: At presentation, repeat in 8-12 hrs
Evaluating possible reinfarction: sample baseline when symptoms begin, repeat 6-12 hrs later

55
Q

Most specific cardiac biomarkers for myocardial damage

A

Troponin T and I

56
Q

Most sensitive test to quantify extent of MI

A

MRI w/ gadolinium contrast

57
Q

Absolute contraindications of thrombolytic therapy in STEMI (5)

A
  1. Previous hemorrhagic stroke
  2. Any stroke within past 1 year
  3. Known intracranial neoplasm
  4. Active internal bleeding
  5. Suspected aortic dissection
58
Q 
Which of the following is NOT a cyanotic anomaly?
A. Tetralogy of Fallot
B. Pulmonary atresia 
C. Transposition of great vessels
D. Hypoplastic left heart syndrome
E. Atrial septal defect
A

E. ASD is non-cyanotic (Left to Right shunt). All others are cyanotic (Right to Left shunt)

59
Q

Tetralogy of Fallot =

A
  1. RV outflow obstruction (pulmonary artery stenosis)
  2. RV hypertrophy
  3. VSD
  4. Overriding aorta
60
Q

MC type of atrial septal defect

A

Ostium secundum

Non-cyanotic

61
Q

What type of congenital anomaly?

Crescendo-decrescendo holosystolic at LSB, radiating to back

A

Tetralogy of Fallot

Cyanotic

62
Q

What type of congenital anomaly?

Systolic ejection murmur at 2nd left intercostal space. Early to middle systolic rumble

A

ASD

Non-cyanotic

63
Q

What type of congenital anomaly?

Systolic murmur at LLSB

A

VSD

Non-cyanotic

64
Q

What type of congenital anomaly?

Continuous machinery murmur

A

PDA

Non-cyanotic

65
Q

What type of congenital anomaly?

Systolic, LUSB and left inter-scapular area

A

Coarctation of aorta

Non-cyanotic

66
Q

What type of congenital anomaly?

Common in Down syndrome

A

Atrioventricular canal defect

67
Q

Electrical alternans is pathognomonic for ___

A

Pericaridal effusion

68
Q

IVDU w/ infective endocarditis MC pathogen ____

___ valve frequently involved.

A

Staph aureus

Tricuspid valve

69
Q

what is an indication for cilostazol therapy?

A

Peripheral arterial disease

70
Q

Do venous ulcers or arterial ulcers appear on the medial aspect of the ankle?

A

venous.

Arterial are more common on the lateral side

71
Q

where is the most common site for an aortic aneurysm?

A

Infrarenal Aorta

72
Q

Endocarditis prophylaxis of choice:

A

Amoxicillin

Clindamycin if PCN allergy

73
Q

When is surgery indicated for abdominal aneurysm?

A

> 5cm aneurysm

must be > 3 cm to be called an aneurysm

74
Q

Treatment for acutely ill pts w/ HF pending blood cultures w/ Infective endocarditis

A

Gentamicin, vancomycin + cefepime (4th gen ceph)

75
Q

MC involved valve in rheumatic heart disease

76
Q

Criteria for Rheumatic fever:
___ major OR ___ major + ___ minor
Major (5)
Minor (5)

A

Jones criteria: 2 major OR 1 major + 2 minor

Major: carditis, erythema marginatum, subcutaneous nodues, chorea, polyarthritis

Minor: fever, polyarthralgias, reversible prolong PRI, increased ESR, increase C-reactive protein

77
Q

Abx tx of Rheumatic Fever

A

Penicillin G

Erythromycin if PCN allergy

78
Q

Leriche syndrome

A

Erectile dysfunction w/ iliac artery disease in peripheral arterial disease

79
Q

Endocarditis prophylaxis of choice:

A

Amoxicillin

Clindamycin if PCN allergy

80
Q

patient with bilateral conjunctivitis, edema and erythema of palms and soles, cracked lips, strawberry tongue. What complication can occur with this disease?

A

Coronary artery aneurysm (Kawasaki Disease)

81
Q

Elevated ____ has strong association w/ incidence and progression of PAD

A

homocysteine

82
Q

Brodie-Trendelenburg test

A

Differentiates saphenofemoral valve incompetence from perforator vein incompetence in Varicose Veins

83
Q

Sensitive/specific test for peripheral arterial disease

A

Ankle-brachial index <0.9

84
Q

Gold standard for dx of Peripheral Arterial Disease

A

Angiography

85
Q 
All of the following are features of Giant Cell Arteritis EXCEPT:
A. Polymyalgia rheumatica 
B. Diplopia 
C. Normochromic microcytic anemia
D. Thrombocytopenia 
E. Elevated ESR and CRP
A

C, D: Normochromic normocytic anemia, thrombocytosis

Polymyalgia rheumatica = pain and stiffness of shoulder and pelvic girdle; present in 50% of pts w/ GCA

86
Q

Management of AAA based on size

A

3-4 cm: US Q yearly
4-4.5 cm: US Q 6 months
>4.5 cm: Vascular surgeon referral
>5.5 cm or >0.5 cm expansion in 6 months: Immediate surgical repair

87
Q

Dx of choice for:
AAA:
Thoracic aneurysm:

A

AAA: Abdominal US

Thoracic aneurysm: CT scan

88
Q

Nonartherosclerotic, inflammatory vascular disease most associated with young (less than 40 y/o) smokers

A

Thromboangiitis obliterans

Small-medium vessels

89
Q

U waves

A

Hypokalemia

90
Q

J waves

A

Hypothermia

Aka Osborn waves

91
Q

Regimen that improves morbidity and mortality in Acute Coronary Syndrome

A

Aspirin, beta blocker, enoxaparin (Lovenox)

92
Q

Tx of variant (Prinzmetal) angina

93
Q

What electrolyte abnormalities increase risk of digoxin toxicity

A

HYPOmagnesemia
HYPOkalemia
HYPERcalcemia

94
Q 
Define:
Dromotropy =
Chronotropy =
Inotropy =
Lusitropy =
A 
Dromotropy = conduction velocity of AV node
Chronotropy = heart rate
Inotropy = cardiac contractility
Lusitropy = relaxation
95
Q

EKG of ASD shows ___

96
Q

EKG of ventriculoseptal defect shows ___

97
Q

EKG of Tetralogy of Fallot shows ___

A

RVH and right axis deviation

98
Q

CCB recommended for rate control for A fib in what kind of patient?

A

COPD

BB can cause severe respiratory distress

99
Q

Rib notching

A

Coarctation of aorta

100
Q

Cardiac tamponade pulse

A

Paradoxical pulse (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration)

101
Q

Tx of DVT in:

  1. idiopathic, 1st episode
  2. recurrent idiopathic OR continuing risk factors
  3. 1st epsiode w/ reversible/time-limiting risk factor (immobilization, trauma, post-sx)
A 
Initiation of heparin w/ warfarin in all 3 senarios
1. Warfarin for 6-12 months
2. Warfarin for 12 months
3. Warfarin for 3-6 months
Target INR: 2-3
102
Q

Tx of atrial fibrillation

A

CCB (verapamil) or BB

103
Q

Venous insufficiency: (lateral/medial) malleolus

104
Q

1st line tx for stable angina

105
Q

1st line tx for cardiogenic shock

A

Dobutamine

106
Q

pulsus paradoxus found in ____

A

pericardial effusion

107
Q

Abx that should be avoided in Long QT syndrome

A

macrolides

fluoroquinolones

108
Q

Wide QRS complex w/ broad slurred R wave in V5 and V6 w/ deep S wave in V1

109
Q

M shaped P wave in lead II, biphasic P wave in lead V1

A

Left atrial enlargement

110
Q

R wave larger than S wave in V1 w/ R wave measuring >7mm

A

Right ventricular hypertrophy

111
Q

Deep S wave in lead I, isolated Q wave in lead III, inverted T wave in lead III

A

Right heart strain

S1Q3T3 –> PE

112
Q

Wide QRS complexes w/ RsR’ pattern in leads V1 and V2. Wide S wave in V6.

A

Right bundle branch block

113
Q

Antidote for Heparin

A

Protamine sulfate

114
Q

Medications that cause acute pericarditis (5)

A 
Isoniazid
Procainamide
Phenoytoin 
Hydralazine
Penicillins
115
Q

Orthostatic hypotension seen in hypovolemia etiology (Chronic adrenal insufficiency, blood loss) is associated (with/without) compensatory increase in heart rate.

116
Q

Orthostatic hypotension seen in autonomic etiology (Diabetic autonomic insufficiency) is associated (with/without) compensatory increase in heart rate.

117
Q

C-reactive protein is a potent predictor of ____

A

future coronary events (Unstable angina, acute MI) and ischemic stroke

118
Q

What HTN medication may increase serum lithium levels?

A

Thiazide diuretics

NOT loop diuretics

119
Q

Best at lowering LDL

A

HMGcoA Reductase Inhibitors (statins)

120
Q

Best at raising HDL

A

Niacin (Vit B3)

121
Q

Best at decreasing Triglycerides

A

Fibrates (Gemfibrozil, fenofibrates)

122
Q

Only lipid lowering agent thats safe in pregnancy

A

Bile Acid Sequestrates (Cholestryamine, Colestipol, Colesevelam)

123
Q

Marfan’s Syndrome is caused by genetic deletion of ___

A

Fibrillin-1 (FBN-1)

124
Q

Polyarteritis Nodosa is highly associated with ___.

MOA

A

Hepatitis B

Antigen-antibody complexes

125
Q

Churg-Strauss syndrome is a ____ (small/medium/large) vessel vasculitis that is characterized by ___ (3)

A

ANCA-associated (p-ANCA)

small

eosinophilia, asthma, and vasculitis

126
Q

Pericardial effusions present with ____

A

exertional dyspnea
pulmonary edema
JVD

PANCE (20 decks)

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