Cardiology

Question 1

What is a “significant” family history for CAD?

Answer 1

MI in female relative less than 65

Male relative less than 55

Question 2

How long does angina d/t ischemia typically last?

Answer 2

15-30 minutes

Question 3

S3 gallop signifies?

Answer 3

Dilated left ventricle

Question 4

S4 gallop signifies?

Answer 4

Left ventricular hypertropy

Question 5

How quickly does CK-MB rise and stay elevated?

Answer 5

Rises in 3-6 hrs, the same as Troponin, but stays elevated only 1-2 days. That’s why CK-MB is the best test to detect reinfarction a few days after an initial infarct.

Question 6

How quickly does Troponin rise and stay elevated?

Answer 6

Rises in 3-6 hrs, same as CK-MB, but stays elevated for 1-2 weeks.

Question 7

What is “low” “intermediate” and “high” risk Framingham scores?

Answer 7

Low is 0-9% 10 year CAD risk
Intermediate is 10-20%
High is >20%

Question 8

What are the expected annual rates of CAD death or MI for “low”, “intermediate”, and “high” risk Framingham scores?

Answer 8

Low - 2%

Question 9

Which patient should receive pharmacologic stress test instead of exercise stress?

Answer 9

Those who cannot exercise to target heart rate of >85% of maximum

Question 10

Which patient should receive cardiac radionuclide stress testing? (ECHO, Cardiac CT, MRI)

Answer 10

Patients whose EKGs are unreadable for ischemia:

• LBBB
• Digoxin use
• Pacemaker
• Left ventricular hypertrophy
• Baseline abnormality of the ST segments on EKG

Question 11

What instance does an ACEi or ARB lower mortality in acute coronary syndromes?

Answer 11

If their is low EF or systolic dysfunction

Question 12

What are examples of GPII/IIIa inhibitors?

Answer 12

Eptifibatide, Tirofiban, or Abciximab

Question 13

When is GPII/IIIa inhibitors shown to be beneficial in ACS?

Answer 13

In the setting of NSTEMI, especially when combined with angioplasty and stenting.

Question 14

When should thrombolytics be used in STEMI?

Answer 14

When PCI cannot be performed within 90 minutes of presentation AND

• chest pain has been for less than 12 hrs
• ST segment elevation in 2 or more leads or new onset LBBB

Question 15

Indications for CABG?

Answer 15

3 coronary vessels with >70%

Left main disease with >70%

Question 16

Patient with CHF and pulmonary edema, is Wedge pressure increased or decreased?

Answer 16

Increased, because there is increased L atrial pressure.

Question 17

Drugs used to treat diastolic dysfunction CHF?

Answer 17

Beta blockers and diuretics

• Spironolactone and Digoxin not shown to be beneficial
• ACE-i not definite if it helps.

Question 18

CHF patient with maximal medical therapy and still symptomatic, QRS duration >120 msec, what do you do next?

Answer 18

Place biventricular pacemaker, aka “cardiac resynchronization therapy”

Question 19

Valvular disease associated with Turner syndrome?

Answer 19

Bicuspid aortic valve

Question 20

Valsalva and standing up do what to venous return to the heart?

Answer 20

Decrease venous return to the heart

Question 21

Squatting and lifting legs in the air do what?

Answer 21

Increase venous return to the heart.

Question 22

Most murmurs increase with squatting and leg raise, which are the only two murmurs to decrease with that?

Answer 22

Mitral Valve Prolapse and HOCM

Question 23

Murmur in second right intercostal space that radiates to carotids, crescendo-decrescendo?

Answer 23

Aortic stenosis

Question 24

Murmur in apex that radiates to axilla?

Answer 24

Mitral regurgitation

Question 25

Best treatment for aortic stenosis?

Answer 25

initial therapy, but not long-term and doesn't alter prognosis. Best tx valve replacement

Question 26

Normal gradient for aortic valve?

Answer 26

70 severe aortic stenosis

Question 27

Pulse that is bounding and forceful, rapidly increasing and subsequently collapsing is called? What does it signify?

Answer 27

Water-hammer or Corrigan's pulse. | Signifies aortic regurgitation

Question 28

Treatment for aortic regurgitation?

Answer 28

ACEs, ARBs, nifedipine or loop diuretics. | Surgery when EF is <55% or LV end systolic diameter goes above 55mm.

Question 29

Diastolic rumble after an opening snap, what murmur is this?

Answer 29

Mitral Stenosis

Question 30

Treatment for Mitral Stenosis?

Answer 30

Diuretics best initial therapy. Balloon valvuloplasty is most effective therapy.

Question 31

Criteria for surgery for mitral regurgitation?

Answer 31

If LVEF 40%

Question 32

Holosystolic murmur at LLSB?

Answer 32

Ventricular Septal Defect

Question 33

Fixed splitting of S2?

Answer 33

ASD

Question 34

Causes for dilated cardiomyopathy?

Answer 34

Ischemia, alcohol, radiation, adriamycin, Chagas' disease

Question 35

Causes of restrictive cardiomyopathy?

Answer 35

Sarcoidosis, amyloidosis, hemochromatosis, cancer, myocardial fibrosis, glycogen storage diseases

Question 36

Pleuritic chest pain relieved by leaning forward and ST-segment elevation in all leads?

Answer 36

Pericarditis

Question 37

Treatment for pericarditis?

Answer 37

NSAIDs. If that doesn't work add oral Prednisone. Give it a couple days and if that doesn't work add Colchicine.

Question 38

What is pulsus paradoxus?

Answer 38

A drop of 10 mmHg with inspiration

Question 39

Diastolic collapse of the R atrium and R ventricle signifies?

Answer 39

One of the earliest findings of cardiac tamponade

Question 40

Do NOT give this medicine if a patient is in tamponade?

Answer 40

Diuretics

Question 41

Kussmaul's sign?

Answer 41

Increase in JVD during inspiration. It is a sign of constrictive pericarditis or restrictive cardiomyopathy.

Question 42

Treatment for constrictive pericarditis?

Answer 42

Diuretics and surgical removal of the pericardium

Question 43

Chest pain radiating to the back between the scapula, ripping type pain, and difference in BP between right and left arms. Diagnosis?

Answer 43

Thoracic aortic dissection.

Question 44

Who should be screened for AAA and when should surgery be performed?

Answer 44

Screen men 65-75 who smoked. Surgery for >5cm.

Question 45

Normal Ankle-Brachial index?

Answer 45

greater than or equal to 0.9

Question 46

Cilostazol, mechanism of action and what is it used for?

Answer 46

PDE 3 inhibitor, reduces platelet aggregation. Used for intermittent claudication in PVD

Question 47

CHADS2, what does it stand for, what's the scoring, who needs medicines?

Answer 47

CHF, HTN, Age>75, DM2, Stroke/TIA (2 points) | Score 0-1 give aspirin, 2 or more anticoagulate

Question 48

Multifocal Atrial Tachycardia associated with what other disease? Which medicine is contraindicated in MAT?

Answer 48

Associated with COPD. | Beta-blockers are contraindicated

Question 49

Management of unstable patient in SVT?

Answer 49

Synchronized cardioversion

Question 50

Stable patient in SVT, first step and then second step if refractory?

Answer 50

Vagal maneuvers, if that doesn't work, adenosine IV

Question 51

Best long term management for SVTs?

Answer 51

Radiofrequency catheter ablation

Question 52

What are some types of vagal maneuvers?

Answer 52

Valsalva, ice immersion of the face, carotid sinus massage,

Question 53

Patient with SVT given Cardizem and suddenly worsens, diagnosis?

Answer 53

WPW

Question 54

Most accurate study to diagnose WPW?

Answer 54

Electrophysiologic studies

Question 55

Best treatment if patient is in SVT or Vtach from WPW?

Answer 55

Procainamide

Question 56

Best long term treatment?

Answer 56

Radiofrequency catheter ablation

Question 57

Drugs you can use for vtach if patient stable or in conjunction with cardioversion if patient unstable?

Answer 57

Amiodarone, Lidocaine, Procainamide, Magnesium

Question 58

4 most common causes of acute heart failure?

Answer 58

Papillary muscle rupture Infective endocarditis Chordae tendinae rupture chest wall trauma with compromise of valvular apparatus

Question 59

Most common cause of severe acute mitral regurgitation?

Answer 59

Rupture of chordae tendinae