Cardiology Flashcards
1
Q
Opening snap w/ low pitched diastolic rumble or w/ expiration
A
Mitral stenosis –> AFIB
2
Q
Most common valve abnormality in RF?
A
Mitral stenosis –> LA dilation –> AFIB
3
Q
Rheumatic fever, diastolic rumble at apex, AFIB, PND, orthopnea, SOB from CHF, thin cachectic person
A
Mitral stenosis –> medical management, balloon valvotomy or replace b4 CHF
4
Q
Mid-systolic click w/ Short systolic murmur over apex, dec w/ squatting, 5-10sec chest pain
A
MVP = myxomatous degeneration
5
Q
High pitched, holosystolic blowing murmur at apex –> axilla, PMI displaced inferolaterally
A
Mitral regurgitation
6
Q
Endocarditis or infarct, holosystolic murmur at apex
A
Mitral regurgitation –> replace
7
Q
Inc w/ handgrip
A
MR (AS dec) & VSD & MVP (but NOT HOCM)
8
Q
Holosystolic murmur INC w/ squatting
A
VSD
9
Q
Calcification, old men, CP, syncope or CHF, crescendo-decrescendo systolic murmur
A
Aortic stenosis –> replace w/ gradient >50mmHg
10
Q
Ejection click –> harsh, mid-systolic C-D, radiates to carotids
A
Aortic stenosis
11
Q
D/T Infection, infarct, dissection, blowing decrescendo, widened pulse pressure, bounding pulse, head bob
A
Aortic regurg –> replace at 1st LV dilation w/ possible CABG
12
Q
Pounding, racing heart, worse when supine or on left side, 150/55mmHg
A
Aortic regurg - widened pulse pressure, water hammer pulses
13
Q
Blowing diastolic murmur at LSB, inc/ leaning forward w/ held expiration
A
Aortic regurg
14
Q
Fixed splitting of 2nd heart sound
A
ASD
15
Q
Young black male, C-D murmur LLSB, inc w/ valsalva murmur type and mitral valve abnormality
A
HOCM & systolic anterior motion (SAM) of mitral valve (valsalva dec VR)
16
Q
CP worse w/ exertion, better w/ rest, nitrates
A
STEMI, Trops w/ NSTEMI, only w/ stress test –> Cath
17
Q
Cath: 1 vessel = stent + plavix, 3+ or includes LAD = CABG
A
Internal mammary for LAD, saphenous for all other vessels
18
Q
Suspect re-infarct after previous CABG + MI, what enzymes?
A
CK-MB and myglobin, trops will remain high
19
Q
PCWP after CABG 0-3; >20
A
More IVFs; ventricular failure
20
Q
T-wave inversion, new RBBB, RVH/strain, acute dyspnea, CP
A
PE
21
Q
Pulselessness, paresthesia, pallor, pain, paralysis of right hand
A
AFIB –> limb ischemia = vascular surgery
22
Q
Torsades Tx
A
Mag sulfate
23
Q
Peaked T waves, long PR, QRS
A
HyperK –> Ca-gluconate, B2 agonists, insulin, Nabicarb
24
Q
Terminate SVT
A
Adenosine
25
Narrow complex tach, no P or buried in QRS or inverted
SVT ---> Vagal or Adenosine
26
Young women, tachy b/w 160-220, no heart diease, cold water immersion helps
PSVT = Inc AV node re-entry/conductivity --> vagal & adenosine slow conduction
27
Dig toxicity arrhythmia
Atrial tachy w/ AV block (150-250)
28
Narrow complex tachy, BP 60/30 tx?
DC cardioversion
29
Pulmonary disease arrhythmia
Multifocal atrial tachy
30
Wide complex tachy tx
Amiodarone or Lidocaine
31
Wide complex tachy + 2 fusion beats or AV dissociation
Sustained monomorphic VT ---> IV amiodarone
32
Tx of AFIB in unstable pt (common after CABG)
DC cardioversion
33
#1 ectopic foci for AFIB
Pulmonary veins
34
Tx PEA
Compressions ---> Epi q 3-5min
35
Premature atrial beats next step?
Observation - d/t anxiety, caffeine, CHF, electrolytes (BMP)
36
AFIB/flutter drug
Digoxin
37
Tx symptomatic bradycardia
IV atropine ---> TCP ---> pacemaker
38
Pt w/ WPW and new onset AFIB tx?
Cardioversion or anti-arrhythmic Procainamide
39
New onset AFIB next step?
Check TSH
40
Bradycardia with wide QRS "sine-wave" pattern, hyperK tx?
Calcium gluconate (faster than Kayexelate)
41
Hyperthyroidism, thyroxine induced arrhythmia
Sinus tach, PSVT, Atrial Fib
42
F/C, LUQ pain, fluid in spleen
Infective endocarditis (L) w/ septic emboli to spleen
43
Small petechiae on palate, murmur, microscopic hematuria, 1+ proteinuria
Endocarditis ---> TEE ---> vanco
44
1st step in infective endocarditis
3 blood cultures --> antibiotics, imaging
45
Holosystolic murmur inc w/ inspiration, IVDU
Endocarditis --> Vanco
46
Retrosternal CP worse w/ inspiration, better leaning forward, PR depression, MI 2 weeks ago
Pericarditis = Dressler syndrome (following MI) --> NSAIDs
47
Causes of pericarditis
Viral, SLE, uremia
48
DOE, edema, ascities, pericardial knock, calcified pericardium, prominent x and y waves
Constrictive pericarditis - TB, viral, surgery, radiation
49
Chest pain w/ BUN >60
Uremic pericarditis ---> dialysis
50
Young person, no cardiac risk factors develops CHF sx = cause?
Myocarditis = Coxsackie B virus
51
Runny nose, congestion, RDS, fever, cardiomegaly CXR
Myocarditis = coxsackie B, adeno --> Bx --> diuretics
52
Sore throat, fever, pericarditis, chorea, subcutaneous nodules, arthritis
Rheumatic fever - GAS infection --> PCN G
53
New murmur, low diastolic rumble, 1 yr ago sore throat + arthralgia
Endocarditis --> IM benzathine PCN every 4wks
54
Endocarditis prophylaxis
5yrs or 21 (w/o carditis); 10yrs or 21 (w/ carditis); 10yrs or 40 (w/ valve disease)
55
S/P CABG day 3, pain, fever, leukocytosis, rapid AFIB, cloudy wound drainage, pericardial fluid
Acute mediastinitis --> drain, surgical debridement + abx; AFIB resolves w/in 24hrs
56
Sudden painful, pale, poikothermic, pulseless, paresthetic paralytic LE, AFIB
Arterial embolization --> doppler --> clot bust or embolectomty w/ Fogarty if complete
57
Tearing chest pain to back, unequal pulses, wide mediastinum
TAA --> EKG, troponins, CT --> surgery
58
Diseases assoc w/ aortic aneurysms
Behcet, Takayasu, Giant cell, anklylosing, RA, psoriatic and reactive arthritis
59
Complication of giant cell arteritis
Aortic aneurysm
60
Atherosclerosis, >65 man smoker, pulsatile mass
AAA --> US or CT --> if (+) repeat q6mo
61
Indications for AAA surgery
>5.5cm, expanding >0.5-1cm/yr OR symptmatic/tender/new back pain = immediate
62
#1 risk for expanding AAA
Smoking (Lower w/ DM, statins)
63
POD 1 from AAA, abd pain, bloody diarrhea, tenderness, fever, leukocytosis, intact pulses
Ischemia of bowel
64
Claudication of arm, dizziness, loss of balance
Subclavian steal syndrome --> duplex scan
65
Stridor, crowing resp w/ hyperextension, tracheal compression on bronch
Vascular rings
66
Causes of persistent pulm HTN
Perinatal ASPHYXIA, meconium aspiration --> O2
67
#1 cause of secondary HTN, to-and-fro over CVA
Fibromuscular dysplasia
68
Soft palate injury --> stroke mechanism
Internal carotid artery dissection
69
Palpitations, SVT in healthy adolescent
WPW = accessory AV pathway --> sudden death
70
Congenital deafness, syncopal episodes, no confusion
Jarvell-Lange-Neilson syndrome = Congenital QT = Propanolol
71
Drug for familial HLD >2 y/o
Cholesteryl
72
Congenital heart block cause
Lupus
73
Timeframe for sildenafil and doxazosin dosing
4+ hr interval
74
Tachy, NV, HA, + antibiotic, COPD
Theophylline toxicity
75
Thickened ventricular walls, proteinuria, easily bruised
Amyloidosis
76
DOE, weakness, fatigue --> CP, hoarseness, syncope, edema
Pul HTN
77
Thiazides SEs
HyperGLUC, hypoK, Na
78
Insomnia, weight loss, fine tremor, AFIB tx?
Propanolol (Grave's disease)
79
Nosocomial UTI --> IE bug
Enterococci
80
Adjunct tx in MI w/ pulmonary edema
Furosemide
81
Indicator of the severity of CHF
NypoNa & H2O retention --> high renin, aldo, ADH, NE
82
Long-standing HTN, CHF, new PND, dyspnea - drug to relieve sx?
Nitro = dilates veins, red preload & diuretics
83
Old man, awakes at night to pee, fainted while peeing type of syncope?
Situational
84
Female, smoker, NOCTURNAL chest pain 15-20min, transient ST elevations
Prinzmetals angina = CCBs
85
Drugs that prolong QRS
1C (flecainide),
86
Post cardiac cath, intact pulses, blue toes, abd pain, inc Cr, low C3, WBC, eosinophilia
Cholesterol emboli
87
Cardiac cath + blue toes, vision loss ex cause?
Cholesterol embolization
88
Cardiac cath + hypotension, leg hematoma next steo?
CT abd, pelvis
89
Meds to hold 48 hrs b4 cardiac stress test?
BBs, CCBs and Nitrates - they reduce severity of ischemia during test
90
Drugs that improve mortality in CHF
BBs, ACE-I, Spironolactone
91
60 w/ cough, peeing, dizzy, N, sweating
Vasovagal syncope ---> tilt table test
92
Enlarged cardiac shadow, "water-bottle," recent URI, SOB, low voltage EKG, no palpable PMI
Pericardial effusion (malignancy, post-MI, uremia, auto-immune, hypothyroid)
93
4th heart sound
LVH
94
2 strong systolic peaks of aortic pulse w/ mid-systolic dip
Pulsus bisferins (Aortic regurg & HOCM)
95
Chemical stress test w/ dipyramidole mechanism?
Coronary steal - dilated normal vessels steal BF from narrow coronaries
96
CHF, 170/100, stiff left ventricle, EF 55%
Diastolic CHF --> LA dilation --> AFIB
97
Warfarin + weakness, dizziness, anemia, tachycardia, back pain
Suspect bleeding - retroperitoneal hematoma
98
3-7d post MI, new systolic murmur
IV wall rupture or papillary muscle rupture
99
3-7d post MI, tamponade, PEA
Ventricular free wall rupture
100
LAD MI, JVD, distant heart sounds, complication?
5d-2wks = free wall rutpure
101
V1-6 elevation MI
Anterior = LAD
102
II, III, aVF elevation MI
Inferior = RCA or LCX
103
V1-3 depression + I & aVL elevation MI
Posterior = LCX
104
V1-3 depression + I & aVL depression MI
Posterior = RCA
105
Cold leg, no distal pulse post-MI
MI --> stasis --> emboli = get ECHO
106
Cause of stroke w/ fluctuating sx, hx TIA, uncontrolled HTN, DM
Thrombotic (following a cath)
107
Cause of stroke w/ abrupt, maximal sx from start, hx of AFIB, endocarditis, bruits
Embolic
108
Pain, Pulselessness, poikolothermic, paresthesia, pale
Aterial thrombo/embolism --> US doppler, ateriogram --> 6hrs to fix embolectomy or tPA
109
Edema following limb ischemia revascularization, painful, tense
Compartment syndrome --> fasciotomy
110
S/P femoral embolectomy, AFIB + bleeding ulcer, calf swollen, tender, painful, pulses intact
Ischemia-reperfusion injury = compartment syndrome
111
Sudden transient loss of neuro fxn w/o HA
TIA = IC stenosis --> Duplex and surgery
112
Sudden neuro deficits w/o HA, >24hrs
Ischemic stroke --> CT + tPA w/in 3hrs
113
Sudden severe HA, HTN --> neuro deficits
Hemorrhagic stroke --> CT, control HTN
114
Ischemic stroke best Tx for neurological recovery
tPA w/in 3-4.5hrs w/ BP <185/110 - NOT shown to dec mortality
115
When can you start Warfarin after cardioembolic stroke?
2 weeks
116
When are aspirin and clopidogrel NOT ok w/ use of tPA
1st 24hrs after tPA is given
117
Stroke antiplatelet therapy to reduce risk of recurrence
Aspirin - give ASAP in 1st 24hrs (clopidogrel if ASA intolerant)
118
Stroke + already on aspirin --> tx?
Aspirin + dipyrimadole or clopidogrel
119
Stroke + AFIB --> tx?
LT anti-cogaluation (warfarin, dabigitran, rivaroxaban)
120
Cause of stroke w/ focal neuro, HA, N/V, brady, AMS, slow progression, HTN, drug use, coagulopathy
Intracranial hemorrhage
121
Cause of stroke w/ pure motor, pure sensory, mix, dysarthria w/ clumsy hand, no speech problems
Lacunar = HTN --> small vessel hyalinosis
122
UL motor, dysarthria, no sensory loss
Lacunar - posterior internal capsule
123
UL sensory loss of face, arm, leg, trunk
Lacunar - VPL of thalamus
124
> LE weakness + IL arm & leg incoordination
Lacunar - anterior internal capsule
125
Hand weakness, mild motor aphasia, no sensory loss
Lacunar - pontine base
126
C/L sensory & motor, eye deviation TO side, homonymous hemianopsia, aphasia, hemineglect
MCA
127
C/L LE sensory & motor, emotional, urinary incontinence, lack of will
ACA
128
C/L hemiplegia & IL CN involvement, ataxia
Vertebrobasilar
129
Occipital HA, gaze palsy, facial weakness
Cerebellar hemorrhage
130
Hemiparesis, sensory, Upgaze, non-reactive pinpoint, eye Toward lesion
Thalamus
131
#1 cause B/L LE swelling
Venous insufficiency
132
Tenderness + swelling DDx
DVT, lipidema
133
Pitting edema DDx
Venous, DVT, CHF, early lymphedema
134
Brown hemosiderin, dry dermatitis, skin ulceration Dx
Venous insufficiency
135
Warm tender moist skin Dx
Complex regional pain syndrome/reflex sympathetic dystrophy
136
S/P 2mo crush injury, burning, agonizing pain, cold, moist cyanotic extremity
Reflex sympathetic dystrophy (Causalgia) --> symp block dx + sympathectomy
137
Brawny induration, warty texture w/ papillomatosis, can't pinch skin of dorsum 2nd toe
Lymphedema (malignancy, surgery, infection)(Kaposi-Stemmer sign)
138
Edema + jaundice, spider hemangioma, ascites
Liver disease
139
Edema + JVD, lung crackles Dx
CHF
140
Labs if etiology unclear
CBC< BMP, albumin, UA, TSH, EKG, BNP, CXR, D-dimer, sleep study (pul HTN)
141
Morning weight gain >0.7kg Dx
Idiopahic edema - 65% recumbent, assoc w/ obesity, depression
142
Tumors assoc w/ edema
Prostate, ovarian, lymphoma = CT scan
143
Tx idiopathic edema
Intermittent laying, avoid heat, low Na, dec fluid intake, weight loss, spironolactone
144
Tx venous insufficiency
Compression socks, horse chestnut seed, loop diuretics ST use
145
Tx lymphedema
Exercise, elevation, pneumatic device, manual drainage, surgery, Abx for cellulitis
146
Tx DVT
LMWH or warfarin --> INR 2-3, IVC filter
147
Dermal edema secondary to inc CT/mucopolysaccharides
Myxedema = thyroid disease
148
JVP, hepatomegaly, ascities, edema, no pulmonary edema
R heart failure = Cor pulmonale - #1 is COPD > pul fibrosis,
149
Leg pain w/ walking, relieved by rest
Ateriosclerosis/Caludication --> stop smoking, exercise, Cilostazol
150
Disabling claudication work-up
Doppler --> sig pressure gradient --> angiogram --> angioplasty or bypass grafts
151
B/L hip, thigh, buttock pain w/ walking, smoker, poor LE pulses
Leriche syndrome/claudication --> impotence
152
Patient can't sleep d/t leg pain, better sitting and dangling legs --> pale --> purple, atophic skin
Claudication soon --> ulceration and gangrene
153
Peripheral vascular disease precipitant?
Smoking --> inc atherosclerosis
154
Atherosclerosis, smoking, calf pain w/ walking interferes w/ life
PAD --> ABI --> US doppler --> ateriogram
155
Calf pain at rest, scaly skin, shiny, no hair, purple and improve w/ legs down
PAD --> single lesion = angioplasty w/ stent or fem-fem or fem-pop bypass
156
ABI index
0.9-1.2 normal; 0.8-0.9 mild; 0.5-0.8 mod; <0.5 severe
157
PVD diffuse disease tx
Anti-platelets like clopidogrel + cilostazol --> amputation as last resort
158
Persistent HTN, inc Cr w/ ACE, recurrent pul edema, >55 y/o, abdominal bruit
Renovascular HTN
159
Persistent HTN, hypoK, hyperNa, aldo:renin >20:1
Primary hyperaldosteronism
160
Persistent HTN, inc urine cortisol, central obesity, proximal muscle weakness, ED
Cushing syndrome
161
Persistent HTN, rib-notcing, delayed femoral pulse, UL SBP > LL, machine murmur over back
Coarctation of aorta
162
CP radiating to back, severe HTN, early diastolic decrescendo murmur RSB, widened mediastinum
Aortic dissection ---> TEE, CT - cause = HTN
163
Asymmetric BP Left:Right, HTN, tall, long fingers, syphilis
Aortic dissection ---> CXR, CTA --> MRI, TEE, TTE
164
Tx ascending dissection = surgery, TEE for aortic replacement?
Tx descedning dissection = control BP
165
#1 risk factor for stroke
HTN
166
HTN cause w/ inc Cr, proteinuria, RBC casts
Renal parenchymal
167
HTN cause w/ pounding HA, tachy, diaphoresis
Pheo
168
HTN cause w/ kidney stones, hyper Ca, depression, fatigue, confusion, psychosis
Parathyroid - (80% adenoma)
169
Cyanosis, harsh systolic murmur, breathe fast after feeding
Tetrology of fallot --> knee-chest, O2--> surgery b4 6mo
170
Knee-to-chest mechanism
Inc systemic vascular resistance --> dec R-->L shunt
171
DiGeorge, tetrology, recurrent sinusitis, fever, morning HA + seizures cause?
Tetrology --> brain abscess
172
Left axis dev, absent R waves in precordium, peaked t-waves, cyanotic
Tricuspid valve atresia
173
Cyanotic at birth, PaO2 38 no improvement with 100% O2
Cyanotic heart defect --> PGE1 to maintain PDA
174
Cyanosis, NO MURMUR, loud single S2, no improvement with O2
Transposition --> PGE1 to maintain PDA
175
Cardiac vs. Resp cyanosis
100% O2, <10-15mmHg Inc PaO2 = tetrology, 15-20 = Truncus
176
#1 congenital heart defect
VSD --> L-->R = dyspnea HF
177
Dyspnea, holosystolic LLSB and at apex, FTT
VSD --> ECHO w/ bubble study OR surveillance as most close spontaneously
178
Split fixed S2, Hx frequent colds
ASD
179
Inc femoral pulses, continuous "machinery murmur"
PDA --> Indo "Ends"
180
Dec femoral pulses, murmur b/w scapulae
Coarctation
181
*COPD*, OSA --> DOE, syncope, tricuspid regurg, JVD, peripheral edema, hepatomegaly, ascities, distant heart sounds, RBBB, RVH, no pulmonary congestion
Cor pulmonale (RHF d/t pulm HTN)
- R heart cath --> pulm artery pressure >25
- --> O2, diuretics
182
2months s/p MI --> DOE, fatigue, crackles, holosystolic murmur at apex --> axilla, unchanged ST elevation and deep Q waves on EKG
Ventricular aneurysm --> LVH --> MR
183
When to do dobutamine stress test
Underlying EKG abn, pacemaker
| Physically unable
184
When to do exercise EKG stress test
Pt w/ exertional chest pain
1mm depression = +
2mm = severe
185
When to do stress ECHO
Valvular, HOCM, pulm HTN, EKG abn
186
When to do myocardial perfusion imaging
Active chest pain w/o EKG abn
| Wall motion abn during echo
