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3rd Year (Step 2) > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Dysphagia. 3 add’l alarm Sx that indicate endoscopy to exclude cancer?

A

Weight loss — blood in stool — anemia

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2
Q

Dx? Young patient w/ progressive dysphagia to both solids & liquids @ same time

A

Achalasia

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3
Q

Dx? Older patient w/ dysphagia first to solids then to both solids & liquids

A

Esophageal cancer

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4
Q

What is “Dyspepsia”?

A

Any 1 of following 3 Sx - Postprandial fullness — Early satiation — Epigastric pain or burning

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5
Q

Most common cause of epigastric pain?

A

Non-ulcer dyspepsia (not a reason to admit to hospital)

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6
Q

Dx? Epigastric pain worse w/ food

A

Gastric ulcer

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7
Q

Dx? Epigastric pain better w/ food

A

Duodenal ulcer

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8
Q

Dx? Epigastric pain w/ weight loss

A

Cancer &/or gastric ulcer

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9
Q

Dx? Epigastric pain w/ tenderness

A

Pancreatitis

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10
Q

Dx? Epigastric pain w/ bad taste – cough – hoarse

A

Gastroesophageal reflux

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11
Q

Dx? Epigastric pain w/ Diabetes & bloating

A

Gastroparesis

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12
Q

What is an “Upper GI Series”?

A

Barium swallow w/ x-ray images of esophagus stomach & duodenum. Can detect ulcers, but CANNOT detect presence of cancers or H. pylori.

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13
Q

Most accurate test for PUD?

A

Upper endoscopy

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14
Q

H. pylori most accurate test? Test to confirm cure following antibiotic Tx?

A

Most accurate test = Endoscopy — Confirm cure = Stool Antigen or Breath Test

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15
Q

Best initial therapy for H. pylori?

A

PPI & Clarithromycin & Amoxicillin (2nd, try Metronidazole & Tetracycline as alternatives & bismuth to aid in resolution of Tx-resistant ulcers)

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16
Q

How is management different for Tx-resistant GU vs. DU?

A

Tx-resistant GU requires repeat endoscopy w/ biopsy to rule out cancer. Tx-resistant DU calls for urea breath test, stool antigen test, or repeat endoscopy to detect H. pylori in which case different antibiotics would be given.

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17
Q

How to treat RV infarction?

A

High volume fluid replacement. Avoid nitroglycerin as they markedly worsen cardiac filling

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18
Q

In what cardiac conditions are Thrombolytics useful?

A

ST elevation MI

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19
Q

In what cardiac conditions is Heparin useful?

A

non-ST elevation MI

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20
Q

70-yr old w/ crushing substernal chest pain – 1st step?

A

EKG

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21
Q

What is “acute coronary syndrome”?

A

Acute blockage of one or more coronary arteries. Typically causes crushing substernal CP that may radiate to jaw or arm, Nause, & Sweating

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22
Q

Acute Coronary Syndrome – ass’d w/ what type of murmur?

A

S4 gallop

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23
Q

What is Kussmaul sign ass’d with?

A

Constrictive Pericarditis or Restrictive Cardiomyopathy (Kussmaul sign = increase in jugulovenous pressure on inhalation)

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24
Q

Constrictive pericarditis – murmur heard?

A

Friction rub – triphasic “scratchy” sound

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25
Q

Pulsus Paradoxus is ass’d w/ what?

A 
Cardiac Tamponade    
(PP = decrease of BP greater than 10 mmHg on inspiration)

– Also COPD & Asthma

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26
Q

Statins - AEs?

A

Elevation of transaminases (LFTs) — Myositis

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27
Q

Niacin - AEs?

A

Elevation in glucose & uric acid level — Pruritis

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28
Q

Fibrates - AEs?

A

Myositis when combined w/ statins

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29
Q

Cholestyramine - AEs?

A

Flatus & Abdominal cramping

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30
Q

Ezetimibe - AEs?

A

Well tolerated but nearly useless

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31
Q

When are Verapamil & Diltiazem used in CAD?

A

In place of beta-blockers in patients w/ severe asthma — Prinzmetal angina — Cocaine-induced CP — Inability to control pain w/ maximal therapy

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32
Q

CCBs - AEs?

A

Edema — Constipation — Heart block (rare)

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33
Q

What does “revascularization” refer to?

A

Coronary bypass surgery or Angioplasty (angiography is indispensible in evaluating patients for this)

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34
Q

Best therapy in acute coronary syndromes, particularly those w/ ST elevation?

A

Angioplasty (also called PCI — percutaneous coronary intervention)

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35
Q

What does a PR interval greater that 200 milliseconds signify?

A

First degree AV block, which has little pathologic potential & requires no intervention

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36
Q

What does ST depression in leads V1 & V2 signify?

A

Posterior wall myocardial infarction (these leads are read in opposite direction as the rest of the leads, so depression here is comparable to elevation in the other leads)

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37
Q

What is first step in patient w/ acute coronary syndrome & ST elevation?

A

Aspirin

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38
Q

When do you substitute Clopidogrel for Aspirin in Tx of CP + ST elevation?

A

When patient is intolerant of Aspirin or has undergone angioplasty w/ stenting

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39
Q

What do you give to a patient w/ CP & ST elevation that is intolerant of Aspirin?

A

Clopidogrel

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40
Q

CP w/ ST elevation (V2-V4) – give Aspirin then what’s next step?

A

Angioplasty lowers mortality (w/in 90 min of pt arriving to ED w/ CP). Also immediately should give Morphine & oxygen & nitrates but these don’t lower mortality

41
Q

MC cause of death in first several days post-MI?

A

Ventricular arrhythmia

42
Q

How do you decrease risk of restenosis following angioplasty?

A

Placement of a drug-eluting stent (paclitaxel or sirolimus) & Heparin Tx

43
Q

4 contraindications for Thrombolytics?

A

Major bleeding into bowel (melena) or any bleeding into brain/CNS — Recent surgery (w/in 2wks) — HTN above 180/110 — Nonhemorrhagic stroke w/in last 6 months

44
Q

With Thrombolytics the sooner the better but how long does their mortality benefit extend following CP?

A

up until 12 hours after CP they are considered beneficial

45
Q

in ACS, when are ACEi/ARBs most beneficial?

A

When EF is < 40%

46
Q

CP w/ ST depression — Aspirin is given what’s best next step?

A

Heparin (as quickly as possible following Aspirin)

47
Q

Name 3 GP IIb/IIIa inhibitors

A

Abciximab — Tirofiban — Eptifibitide

48
Q

When do GPIIb/IIIa inhibitors have a mortality benefit?

A

non-ST elevation MI & for those undergoing PCI & stenting

49
Q

When is Heparin most useful?

A

non-ST elevation MI

50
Q

When do Thrombolytics have a mortality benefit?

A

ONLY w/ ST elevation MI

51
Q

Third-degree block means what?

A

Atria & ventricles are out of coordination w/ each other & are contracting separately

52
Q

How are symptomatic bradycardias treated?

A

First w/ Atropine then w/ pacemaker if Atropine is ineffective

53
Q

the RCA supplies what 3 major structures?

A

AV node — Right ventricle — Inferior wall of the heart

54
Q

Post-MI – what are some signs of Tamponade / free wall rupture?

A

“Sudden loss of pulse” a few days after MI — Dx w/ emergent echocardiography

55
Q

Post-MI – what are some signs of valve or septal rupture?

A

New onset of a murmer & pulmonary congestion (Mitral regurg - apex w/ radiation to axilla — Vent septal rupture - lower left sternal border)

56
Q

Dx? Greater O2 saturation in right ventricle than right atrium.

A

Septal rupture (post-MI)

57
Q

How are mural thrombi detected & treated?

A

Detected w/ echocardiography — Treated w/ Heparin followed by Warfarin

58
Q

How are aneurysms detected?

A

Echocardiography

59
Q

Dx post-MI? Bradycardia w/ cannon A waves

A

3rd degree AV block

60
Q

Dx post-MI? Bradycardia w/ no cannon A waves

A

Sinus bradycardia

61
Q

Dx post-MI? Sudden loss of pulse & jugulovenous distension

A

Tamponade / wall rupture

62
Q

Dx post-MI? IWMI in history — clear lungs — tachycardia — hypotension w/ nitroglycerin

A

RV infarction

63
Q

Dx post-MI? New murmur & rales/congestion

A

Valve rupture

64
Q

Dx post-MI? New murmur — inc in O2 conc on entering RV

A

Septal rupture

65
Q

Dx post-MI? Loss of pulse & need EKG

A

Ventricular fibrillation

66
Q

Purpose of stress test?

A

Determines if angiography is needed (angiography determines need for revascularization such as angioplasty or bypass surgery)

67
Q

4 meds all postinfarction patients should go home on?

A

Aspirin — Beta-blockers — Statins — Ace inhibitors

68
Q

What type of dysfunction can cause CHF w/ preserved EF?

A

Diastolic dysfunction (heart cannot properly relax & fill)

69
Q

Medication that may cause CHF?

A

Adriamycin (Doxorubicin)

70
Q

Sx of CHF?

A

Dyspnea (#1) — Orthopnea (worse when lying flat) — peripheral edema — Rales — JVD — PND (sudden worsening @ night) — S3 gallop rhythm

71
Q

Dx? Dyspnea — sudden onset — clear lungs

A

Pulmonary embolus

also p/w:

  • PLEURITIC chest pain
  • Tachypnea, tachycardia, & low grade fever are present in 70, 30, 15 % of cases respectively
72
Q

Dx? Dyspnea — sudden onset — wheezing — increased expiratory phase

A

Asthma

73
Q

Dx? Dyspnea — Slower onset — fever - sputum - unilateral rales/rhonchi

A

Pneumonia

74
Q

Dx? Dyspnea — dec’d breath sounds unilaterally — tracheal deviation

A

Pneumothorax (spontaneous deviates to side — tension deviates away)

75
Q

Dx? Dyspnea — circumoral numbness — caffeine use — history of anxiety

A

Panic attack

76
Q

Dx? Dyspnea — Pallor — gradual over days to weeks

A

Anemia

77
Q

Dx? Dyspnea — Pulsus paradoxus — decreased heart sounds — JVD

A

Tamponade

78
Q

Dx? Dyspnea — Palpitations - Syncope

A

Arrhythmia of almost any kind

79
Q

Dx? Dyspnea — Dullness to percussion at bases

A

Pleural effusion

80
Q

Dx? Dyspnea — Long smoking history — barrel chest

A

COPD

81
Q

Dx? Dyspnea — Recent anesthetic use — brown blood not improved w/ oxygen — clear lungs on auscultation — cyanosis

A

Methemoglobinemia (Tx = IV methylene blue which reduces iron back to 2+)

82
Q

Dx? Dyspnea — Burning bulding or car — wood-burning stove in winter — suicide attempt

A

Carbon monoxide poisoning

83
Q

Most important test w/ CHF?

A

TransThoracic Echocardiography
(ALL pts w/ CHF must undergo to determine EF & distinguish diastolic vs. systolic)

(TEE is better for evaluating heart valve function & diameter)

84
Q

Most common cause of death from CHF?

A

Arrhythmia / sudden death

85
Q

Spironolactone AEs?

A

Hyperkalemia & Gynecomastia

86
Q

Does Digoxin lower mortality in CHF?

A

No — it controls Sx & lowers frequency of hospitalizations

87
Q

How to handle patient w/ dilated cardiomyopathy secondary to MI taking lisinopril, furosemide, metoprolol, aspirin, & digoxin that has persistent hyperkalemia?

A

Switch Lisinopril to Hydralazine & Nitroglycerin (this regimen also has mortality benefit & addresses hyperkalemia)

88
Q

How do Troponin levels & EKG findings differ in Unstable Angina vs. NSTEMI?

A

UA is considered to be present in patients with ischemic symptoms suggestive of an ACS and no elevation in troponins, with or without electrocardiogram (ECG) changes indicative of ischemia (eg, ST segment depression or transient elevation or new T wave inversion).

NSTEMI is considered to be present in patients having the same manifestations as those in UA, but in whom an elevation in troponins is present.

89
Q

In a patient w/ non-STEMI ACS, the presence of any 1 of what 5 other characteristics would indicate the use of angiography & revascularization?

A
  • Hemodynamic instability or cardiogenic shock
  • Severe left ventricular dysfunction or heart failure
  • Recurrent or persistent rest angina despite intensive medical therapy
  • New or worsening mitral regurgitation or new ventricular septal defect
  • Sustained ventricular arrhythmias
90
Q

Fixed splitting of S2 is found in what Dx?

A

Atrial or ventricular septal defect

91
Q

Acute ischemia or MI — what type of murmur is classically seen?

A

S4 (atrial gallop)

  • ischemic damage may lead to diastolic dysfunction & stiffened LV, resulting in atrial gallop (S4)
92
Q

EKG would determine which etiologies of CHF?

A
  • MI

- Heart block

93
Q

Chest x-ray would determine which etiologies of CHF?

A

Dilated Cardiomyopathy

94
Q

Holter Monitor would determine which etiologies of CHF?

A

Paroxysmal Arrhythmias

95
Q

Cardiac Catheterization would determine which etiologies of CHF?

A
  • Precise valve diameters

- Septal defects

96
Q

CBC would determine which etiologies of CHF?

A

Anemia

97
Q

Thyroid Function (TSH/T4) would determine which etiologies of CHF?

A

Both high & low Thyroid levels cause CHF

98
Q

Swan-Ganz right heart catheterization would determine which etiologies of CHF?

A

Distinguishes CHF from ARDS; not routine

3rd Year (Step 2) (44 decks)

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