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Cardiology Flashcards

1
Q

Opening snap w/ low pitched diastolic rumble or w/ expiration

A

Mitral stenosis –> AFIB

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2
Q

Most common valve abnormality in RF?

A

Mitral stenosis –> LA dilation –> AFIB

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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

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4
Q

Mid-systolic click w/ Short systolic murmur over apex, dec w/ squatting, 5-10sec chest pain

A

MVP = myxomatous degeneration

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5
Q

High pitched, holosystolic blowing murmur at apex –> axilla, PMI displaced inferolaterally

A

Mitral regurgitation

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6
Q

Endocarditis or infarct, holosystolic murmur at apex

A

Mitral regurgitation –> replace

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7
Q

Inc w/ handgrip

A

MR (AS dec) & VSD & MVP (but NOT HOCM)

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8
Q

Holosystolic murmur INC w/ squatting

A

VSD

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9
Q

Calcification, old men, CP, syncope or CHF, crescendo-decrescendo systolic murmur

A

Aortic stenosis –> replace w/ gradient >50mmHg

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10
Q

Ejection click –> harsh, mid-systolic C-D, radiates to carotids

A

Aortic stenosis

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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

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12
Q

Pounding, racing heart, worse when supine or on left side, 150/55mmHg

A

Aortic regurg - widened pulse pressure, water hammer pulses

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13
Q

Blowing diastolic murmur at LSB, inc/ leaning forward w/ held expiration

A

Aortic regurg

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14
Q

Fixed splitting of 2nd heart sound

A

ASD

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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)

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16
Q

CP worse w/ exertion, better w/ rest, nitrates

A

STEMI, Trops w/ NSTEMI, only w/ stress test –> Cath

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17
Q

Cath: 1 vessel = stent + plavix, 3+ or includes LAD = CABG

A

Internal mammary for LAD, saphenous for all other vessels

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18
Q

Suspect re-infarct after previous CABG + MI, what enzymes?

A

CK-MB and myglobin, trops will remain high

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19
Q

PCWP after CABG 0-3; >20

A

More IVFs; ventricular failure

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20
Q

T-wave inversion, new RBBB, RVH/strain, acute dyspnea, CP

A

PE

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21
Q

Pulselessness, paresthesia, pallor, pain, paralysis of right hand

A

AFIB –> limb ischemia = vascular surgery

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22
Q

Torsades Tx

A

Mag sulfate

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23
Q

Peaked T waves, long PR, QRS

A

HyperK –> Ca-gluconate, B2 agonists, insulin, Nabicarb

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24
Q

Terminate SVT

A

Adenosine

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25
Q

Narrow complex tach, no P or buried in QRS or inverted

A

SVT —> Vagal or Adenosine

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26
Q

Young women, tachy b/w 160-220, no heart diease, cold water immersion helps

A

PSVT = Inc AV node re-entry/conductivity –> vagal & adenosine slow conduction

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27
Q

Dig toxicity arrhythmia

A

Atrial tachy w/ AV block (150-250)

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28
Q

Narrow complex tachy, BP 60/30 tx?

A

DC cardioversion

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29
Q

Pulmonary disease arrhythmia

A

Multifocal atrial tachy

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30
Q

Wide complex tachy tx

A

Amiodarone or Lidocaine

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31
Q

Wide complex tachy + 2 fusion beats or AV dissociation

A

Sustained monomorphic VT —> IV amiodarone

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32
Q

Tx of AFIB in unstable pt (common after CABG)

A

DC cardioversion

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33
Q

1 ectopic foci for AFIB

A

Pulmonary veins

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34
Q

Tx PEA

A

Compressions —> Epi q 3-5min

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35
Q

Premature atrial beats next step?

A

Observation - d/t anxiety, caffeine, CHF, electrolytes (BMP)

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36
Q

AFIB/flutter drug

A

Digoxin

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37
Q

Tx symptomatic bradycardia

A

IV atropine —> TCP —> pacemaker

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38
Q

Pt w/ WPW and new onset AFIB tx?

A

Cardioversion or anti-arrhythmic Procainamide

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39
Q

New onset AFIB next step?

A

Check TSH

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40
Q

Bradycardia with wide QRS “sine-wave” pattern, hyperK tx?

A

Calcium gluconate (faster than Kayexelate)

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41
Q

Hyperthyroidism, thyroxine induced arrhythmia

A

Sinus tach, PSVT, Atrial Fib

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42
Q

F/C, LUQ pain, fluid in spleen

A

Infective endocarditis (L) w/ septic emboli to spleen

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43
Q

Small petechiae on palate, murmur, microscopic hematuria, 1+ proteinuria

A

Endocarditis —> TEE —> vanco

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44
Q

1st step in infective endocarditis

A

3 blood cultures –> antibiotics, imaging

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45
Q

Holosystolic murmur inc w/ inspiration, IVDU

A

Endocarditis –> Vanco

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46
Q

Retrosternal CP worse w/ inspiration, better leaning forward, PR depression, MI 2 weeks ago

A

Pericarditis = Dressler syndrome (following MI) –> NSAIDs

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47
Q

Causes of pericarditis

A

Viral, SLE, uremia

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48
Q

DOE, edema, ascities, pericardial knock, calcified pericardium, prominent x and y waves

A

Constrictive pericarditis - TB, viral, surgery, radiation

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49
Q

Chest pain w/ BUN >60

A

Uremic pericarditis —> dialysis

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50
Q

Young person, no cardiac risk factors develops CHF sx = cause?

A

Myocarditis = Coxsackie B virus

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51
Q

Runny nose, congestion, RDS, fever, cardiomegaly CXR

A

Myocarditis = coxsackie B, adeno –> Bx –> diuretics

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52
Q

Sore throat, fever, pericarditis, chorea, subcutaneous nodules, arthritis

A

Rheumatic fever - GAS infection –> PCN G

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53
Q

New murmur, low diastolic rumble, 1 yr ago sore throat + arthralgia

A

Endocarditis –> IM benzathine PCN every 4wks

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54
Q

Endocarditis prophylaxis

A

5yrs or 21 (w/o carditis); 10yrs or 21 (w/ carditis); 10yrs or 40 (w/ valve disease)

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55
Q

S/P CABG day 3, pain, fever, leukocytosis, rapid AFIB, cloudy wound drainage, pericardial fluid

A

Acute mediastinitis –> drain, surgical debridement + abx; AFIB resolves w/in 24hrs

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56
Q

Sudden painful, pale, poikothermic, pulseless, paresthetic paralytic LE, AFIB

A

Arterial embolization –> doppler –> clot bust or embolectomty w/ Fogarty if complete

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57
Q

Tearing chest pain to back, unequal pulses, wide mediastinum

A

TAA –> EKG, troponins, CT –> surgery

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58
Q

Diseases assoc w/ aortic aneurysms

A

Behcet, Takayasu, Giant cell, anklylosing, RA, psoriatic and reactive arthritis

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59
Q

Complication of giant cell arteritis

A

Aortic aneurysm

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60
Q

Atherosclerosis, >65 man smoker, pulsatile mass

A

AAA –> US or CT –> if (+) repeat q6mo

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61
Q

Indications for AAA surgery

A

> 5.5cm, expanding >0.5-1cm/yr OR symptmatic/tender/new back pain = immediate

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62
Q

1 risk for expanding AAA

A

Smoking (Lower w/ DM, statins)

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63
Q

POD 1 from AAA, abd pain, bloody diarrhea, tenderness, fever, leukocytosis, intact pulses

A

Ischemia of bowel

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64
Q

Claudication of arm, dizziness, loss of balance

A

Subclavian steal syndrome –> duplex scan

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65
Q

Stridor, crowing resp w/ hyperextension, tracheal compression on bronch

A

Vascular rings

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66
Q

Causes of persistent pulm HTN

A

Perinatal ASPHYXIA, meconium aspiration –> O2

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67
Q

1 cause of secondary HTN, to-and-fro over CVA

A

Fibromuscular dysplasia

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68
Q

Soft palate injury –> stroke mechanism

A

Internal carotid artery dissection

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69
Q

Palpitations, SVT in healthy adolescent

A

WPW = accessory AV pathway –> sudden death

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70
Q

Congenital deafness, syncopal episodes, no confusion

A

Jarvell-Lange-Neilson syndrome = Congenital QT = Propanolol

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71
Q

Drug for familial HLD >2 y/o

A

Cholesteryl

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72
Q

Congenital heart block cause

A

Lupus

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73
Q

Timeframe for sildenafil and doxazosin dosing

A

4+ hr interval

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74
Q

Tachy, NV, HA, + antibiotic, COPD

A

Theophylline toxicity

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75
Q

Thickened ventricular walls, proteinuria, easily bruised

A

Amyloidosis

76
Q

DOE, weakness, fatigue –> CP, hoarseness, syncope, edema

77
Q

Thiazides SEs

A

HyperGLUC, hypoK, Na

78
Q

Insomnia, weight loss, fine tremor, AFIB tx?

A

Propanolol (Grave’s disease)

79
Q

Nosocomial UTI –> IE bug

A

Enterococci

80
Q

Adjunct tx in MI w/ pulmonary edema

A

Furosemide

81
Q

Indicator of the severity of CHF

A

NypoNa & H2O retention –> high renin, aldo, ADH, NE

82
Q

Long-standing HTN, CHF, new PND, dyspnea - drug to relieve sx?

A

Nitro = dilates veins, red preload & diuretics

83
Q

Old man, awakes at night to pee, fainted while peeing type of syncope?

A

Situational

84
Q

Female, smoker, NOCTURNAL chest pain 15-20min, transient ST elevations

A

Prinzmetals angina = CCBs

85
Q

Drugs that prolong QRS

A

1C (flecainide),

86
Q

Post cardiac cath, intact pulses, blue toes, abd pain, inc Cr, low C3, WBC, eosinophilia

A

Cholesterol emboli

87
Q

Cardiac cath + blue toes, vision loss ex cause?

A

Cholesterol embolization

88
Q

Cardiac cath + hypotension, leg hematoma next steo?

A

CT abd, pelvis

89
Q

Meds to hold 48 hrs b4 cardiac stress test?

A

BBs, CCBs and Nitrates - they reduce severity of ischemia during test

90
Q

Drugs that improve mortality in CHF

A

BBs, ACE-I, Spironolactone

91
Q

60 w/ cough, peeing, dizzy, N, sweating

A

Vasovagal syncope —> tilt table test

92
Q

Enlarged cardiac shadow, “water-bottle,” recent URI, SOB, low voltage EKG, no palpable PMI

A

Pericardial effusion (malignancy, post-MI, uremia, auto-immune, hypothyroid)

93
Q

4th heart sound

94
Q

2 strong systolic peaks of aortic pulse w/ mid-systolic dip

A

Pulsus bisferins (Aortic regurg & HOCM)

95
Q

Chemical stress test w/ dipyramidole mechanism?

A

Coronary steal - dilated normal vessels steal BF from narrow coronaries

96
Q

CHF, 170/100, stiff left ventricle, EF 55%

A

Diastolic CHF –> LA dilation –> AFIB

97
Q

Warfarin + weakness, dizziness, anemia, tachycardia, back pain

A

Suspect bleeding - retroperitoneal hematoma

98
Q

3-7d post MI, new systolic murmur

A

IV wall rupture or papillary muscle rupture

99
Q

3-7d post MI, tamponade, PEA

A

Ventricular free wall rupture

100
Q

LAD MI, JVD, distant heart sounds, complication?

A

5d-2wks = free wall rutpure

101
Q

V1-6 elevation MI

A

Anterior = LAD

102
Q

II, III, aVF elevation MI

A

Inferior = RCA or LCX

103
Q

V1-3 depression + I & aVL elevation MI

A

Posterior = LCX

104
Q

V1-3 depression + I & aVL depression MI

A

Posterior = RCA

105
Q

Cold leg, no distal pulse post-MI

A

MI –> stasis –> emboli = get ECHO

106
Q

Cause of stroke w/ fluctuating sx, hx TIA, uncontrolled HTN, DM

A

Thrombotic (following a cath)

107
Q

Cause of stroke w/ abrupt, maximal sx from start, hx of AFIB, endocarditis, bruits

108
Q

Pain, Pulselessness, poikolothermic, paresthesia, pale

A

Aterial thrombo/embolism –> US doppler, ateriogram –> 6hrs to fix embolectomy or tPA

109
Q

Edema following limb ischemia revascularization, painful, tense

A

Compartment syndrome –> fasciotomy

110
Q

S/P femoral embolectomy, AFIB + bleeding ulcer, calf swollen, tender, painful, pulses intact

A

Ischemia-reperfusion injury = compartment syndrome

111
Q

Sudden transient loss of neuro fxn w/o HA

A

TIA = IC stenosis –> Duplex and surgery

112
Q

Sudden neuro deficits w/o HA, >24hrs

A

Ischemic stroke –> CT + tPA w/in 3hrs

113
Q

Sudden severe HA, HTN –> neuro deficits

A

Hemorrhagic stroke –> CT, control HTN

114
Q

Ischemic stroke best Tx for neurological recovery

A

tPA w/in 3-4.5hrs w/ BP <185/110 - NOT shown to dec mortality

115
Q

When can you start Warfarin after cardioembolic stroke?

116
Q

When are aspirin and clopidogrel NOT ok w/ use of tPA

A

1st 24hrs after tPA is given

117
Q

Stroke antiplatelet therapy to reduce risk of recurrence

A

Aspirin - give ASAP in 1st 24hrs (clopidogrel if ASA intolerant)

118
Q

Stroke + already on aspirin –> tx?

A

Aspirin + dipyrimadole or clopidogrel

119
Q

Stroke + AFIB –> tx?

A

LT anti-cogaluation (warfarin, dabigitran, rivaroxaban)

120
Q

Cause of stroke w/ focal neuro, HA, N/V, brady, AMS, slow progression, HTN, drug use, coagulopathy

A

Intracranial hemorrhage

121
Q

Cause of stroke w/ pure motor, pure sensory, mix, dysarthria w/ clumsy hand, no speech problems

A

Lacunar = HTN –> small vessel hyalinosis

122
Q

UL motor, dysarthria, no sensory loss

A

Lacunar - posterior internal capsule

123
Q

UL sensory loss of face, arm, leg, trunk

A

Lacunar - VPL of thalamus

124
Q

> LE weakness + IL arm & leg incoordination

A

Lacunar - anterior internal capsule

125
Q

Hand weakness, mild motor aphasia, no sensory loss

A

Lacunar - pontine base

126
Q

C/L sensory & motor, eye deviation TO side, homonymous hemianopsia, aphasia, hemineglect

127
Q

C/L LE sensory & motor, emotional, urinary incontinence, lack of will

128
Q

C/L hemiplegia & IL CN involvement, ataxia

A

Vertebrobasilar

129
Q

Occipital HA, gaze palsy, facial weakness

A

Cerebellar hemorrhage

130
Q

Hemiparesis, sensory, Upgaze, non-reactive pinpoint, eye Toward lesion

131
Q

1 cause B/L LE swelling

A

Venous insufficiency

132
Q

Tenderness + swelling DDx

A

DVT, lipidema

133
Q

Pitting edema DDx

A

Venous, DVT, CHF, early lymphedema

134
Q

Brown hemosiderin, dry dermatitis, skin ulceration Dx

A

Venous insufficiency

135
Q

Warm tender moist skin Dx

A

Complex regional pain syndrome/reflex sympathetic dystrophy

136
Q

S/P 2mo crush injury, burning, agonizing pain, cold, moist cyanotic extremity

A

Reflex sympathetic dystrophy (Causalgia) –> symp block dx + sympathectomy

137
Q

Brawny induration, warty texture w/ papillomatosis, can’t pinch skin of dorsum 2nd toe

A

Lymphedema (malignancy, surgery, infection)(Kaposi-Stemmer sign)

138
Q

Edema + jaundice, spider hemangioma, ascites

A

Liver disease

139
Q

Edema + JVD, lung crackles Dx

140
Q

Labs if etiology unclear

A

CBC< BMP, albumin, UA, TSH, EKG, BNP, CXR, D-dimer, sleep study (pul HTN)

141
Q

Morning weight gain >0.7kg Dx

A

Idiopahic edema - 65% recumbent, assoc w/ obesity, depression

142
Q

Tumors assoc w/ edema

A

Prostate, ovarian, lymphoma = CT scan

143
Q

Tx idiopathic edema

A

Intermittent laying, avoid heat, low Na, dec fluid intake, weight loss, spironolactone

144
Q

Tx venous insufficiency

A

Compression socks, horse chestnut seed, loop diuretics ST use

145
Q

Tx lymphedema

A

Exercise, elevation, pneumatic device, manual drainage, surgery, Abx for cellulitis

146
Q

Tx DVT

A

LMWH or warfarin –> INR 2-3, IVC filter

147
Q

Dermal edema secondary to inc CT/mucopolysaccharides

A

Myxedema = thyroid disease

148
Q

JVP, hepatomegaly, ascities, edema, no pulmonary edema

A

R heart failure = Cor pulmonale - #1 is COPD > pul fibrosis,

149
Q

Leg pain w/ walking, relieved by rest

A

Ateriosclerosis/Caludication –> stop smoking, exercise, Cilostazol

150
Q

Disabling claudication work-up

A

Doppler –> sig pressure gradient –> angiogram –> angioplasty or bypass grafts

151
Q

B/L hip, thigh, buttock pain w/ walking, smoker, poor LE pulses

A

Leriche syndrome/claudication –> impotence

152
Q

Patient can’t sleep d/t leg pain, better sitting and dangling legs –> pale –> purple, atophic skin

A

Claudication soon –> ulceration and gangrene

153
Q

Peripheral vascular disease precipitant?

A

Smoking –> inc atherosclerosis

154
Q

Atherosclerosis, smoking, calf pain w/ walking interferes w/ life

A

PAD –> ABI –> US doppler –> ateriogram

155
Q

Calf pain at rest, scaly skin, shiny, no hair, purple and improve w/ legs down

A

PAD –> single lesion = angioplasty w/ stent or fem-fem or fem-pop bypass

156
Q

ABI index

A

0.9-1.2 normal; 0.8-0.9 mild; 0.5-0.8 mod; <0.5 severe

157
Q

PVD diffuse disease tx

A

Anti-platelets like clopidogrel + cilostazol –> amputation as last resort

158
Q

Persistent HTN, inc Cr w/ ACE, recurrent pul edema, >55 y/o, abdominal bruit

A

Renovascular HTN

159
Q

Persistent HTN, hypoK, hyperNa, aldo:renin >20:1

A

Primary hyperaldosteronism

160
Q

Persistent HTN, inc urine cortisol, central obesity, proximal muscle weakness, ED

A

Cushing syndrome

161
Q

Persistent HTN, rib-notcing, delayed femoral pulse, UL SBP > LL, machine murmur over back

A

Coarctation of aorta

162
Q

CP radiating to back, severe HTN, early diastolic decrescendo murmur RSB, widened mediastinum

A

Aortic dissection —> TEE, CT - cause = HTN

163
Q

Asymmetric BP Left:Right, HTN, tall, long fingers, syphilis

A

Aortic dissection —> CXR, CTA –> MRI, TEE, TTE

164
Q

Tx ascending dissection = surgery, TEE for aortic replacement?

A

Tx descedning dissection = control BP

165
Q

1 risk factor for stroke

166
Q

HTN cause w/ inc Cr, proteinuria, RBC casts

A

Renal parenchymal

167
Q

HTN cause w/ pounding HA, tachy, diaphoresis

168
Q

HTN cause w/ kidney stones, hyper Ca, depression, fatigue, confusion, psychosis

A

Parathyroid - (80% adenoma)

169
Q

Cyanosis, harsh systolic murmur, breathe fast after feeding

A

Tetrology of fallot –> knee-chest, O2–> surgery b4 6mo

170
Q

Knee-to-chest mechanism

A

Inc systemic vascular resistance –> dec R–>L shunt

171
Q

DiGeorge, tetrology, recurrent sinusitis, fever, morning HA + seizures cause?

A

Tetrology –> brain abscess

172
Q

Left axis dev, absent R waves in precordium, peaked t-waves, cyanotic

A

Tricuspid valve atresia

173
Q

Cyanotic at birth, PaO2 38 no improvement with 100% O2

A

Cyanotic heart defect –> PGE1 to maintain PDA

174
Q

Cyanosis, NO MURMUR, loud single S2, no improvement with O2

A

Transposition –> PGE1 to maintain PDA

175
Q

Cardiac vs. Resp cyanosis

A

100% O2, <10-15mmHg Inc PaO2 = tetrology, 15-20 = Truncus

176
Q

1 congenital heart defect

A

VSD –> L–>R = dyspnea HF

177
Q

Dyspnea, holosystolic LLSB and at apex, FTT

A

VSD –> ECHO w/ bubble study OR surveillance as most close spontaneously

178
Q

Split fixed S2, Hx frequent colds

179
Q

Inc femoral pulses, continuous “machinery murmur”

A

PDA –> Indo “Ends”

180
Q

Dec femoral pulses, murmur b/w scapulae

A

Coarctation

181
Q

COPD, OSA –> DOE, syncope, tricuspid regurg, JVD, peripheral edema, hepatomegaly, ascities, distant heart sounds, RBBB, RVH, no pulmonary congestion

A

Cor pulmonale (RHF d/t pulm HTN)

  • R heart cath –> pulm artery pressure >25
  • –> O2, diuretics
182
Q

2months s/p MI –> DOE, fatigue, crackles, holosystolic murmur at apex –> axilla, unchanged ST elevation and deep Q waves on EKG

A

Ventricular aneurysm –> LVH –> MR

183
Q

When to do dobutamine stress test

A

Underlying EKG abn, pacemaker

Physically unable

184
Q

When to do exercise EKG stress test

A

Pt w/ exertional chest pain
1mm depression = +
2mm = severe

185
Q

When to do stress ECHO

A

Valvular, HOCM, pulm HTN, EKG abn

186
Q

When to do myocardial perfusion imaging

A

Active chest pain w/o EKG abn

Wall motion abn during echo

Step 2 (20 decks)

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