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0. PANCE Review > Cardiology > Flashcards

Cardiology Flashcards

1
Q

A sawtooth pattern on EKG should make you think of what diagnosis?

A

Atrial flutter

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2
Q

List the 4 minor criteria for diagnosing endocarditis.

A
  • Fever,
  • Embolic event (Janeway lesions or petechiae, splinter hemorrhages),
  • Immunological event (osler nodes, glomerulonephritis),
  • 1 positive blood culture
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3
Q

List three class 1A antiarrhythmics.

A
  • Disopyramide,
  • Quinidine,
  • Procainamide
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4
Q

An RSR prime in leads V5 or V6 should make you think of what diagnosis?

A

LBBB

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5
Q

What is the first line IV inotropic agent when dealing with cardiogenic shock?

A

Dopamine

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6
Q

A blockage of which artery causes an anterior wall MI?

A

Left anterior descending artery

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7
Q

Following a myocardial infarction what medication should you be using to treat hypertension?

A

Beta blocker

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8
Q

Tall peaked P waves should make you think of what diagnosis?

A

Right atrial enlargement

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9
Q

What is the best patient position to hear aortic regurge and aortic stenosis?

A

Sitting up and leaning forward

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10
Q

An elderly patient presents with dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely diagnosis?

A

Aortic stenosis

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11
Q

Name one aldosterone antagonist?

A
  • Spironolactone,

- Eplerenone

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12
Q

A patient has a GFR of 25 and HTN. Which class should you use, a loop or a thiazide diuretic?

A

A loop will work no matter how low the GFR is.

Thiazides will only work with a GFR over 30.

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13
Q

After a thiazide diuretic what medication should you start in a hypertensive patient who also has diabetes?

A

ACEI or ARB

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14
Q

Which EKG leads are used to diagnose an anterior wall MI?

A

V1, V2 and V3

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15
Q

Clot busting drugs should be used within 3 hours of which two cardiac events?

A

STEMI and new left bundle branch block

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16
Q

On an EKG you notice a patient has a gradually lengthening PR interval and then a missed QRS complex. The pattern repeats again. What type of AV block is this?

A

Mobitz I or Wenckebach

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17
Q

Which hyperlipidemia medication may cause flushing?

A

Niacin

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18
Q

Are ulcers from venous insufficiency painful or painless?

A

Painless

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19
Q

What is the therapeutic range for INR following a mechanical valve replacement?

A

2.5-3.5

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20
Q

Where do most aortic dissections occur?

A

The ascending or descending thoracic aorta

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21
Q

What two labs do you want to monitor in a patient on an ACEI?

A

Serum creatinine and serum potassium

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22
Q

What are the three major criteria for endocarditis?

A
  • 2 positive blood cultures,
  • A positive transesophageal echocardiography,
  • New murmur
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23
Q

Where is disease of the pulmonary valve best heard?

A

2nd left intercostal space

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24
Q

A continuous murmur most likely involves what area of the heart?

A

It is most likely a septal defect

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25
Q

Where on your patient should you listen for the

murmur associated with an atrial septal defect?

A

At the left second or third interspace

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26
Q

A patient recently started taking Lipitor. He is now complaining of aches and pains. What test should you order?

A

Serum creatinine kinase, you’re looking for rhabdomyolysis.

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27
Q

A patient complains of severe pleuritic chest pain that feels better when leaning forward. What is the most likely diagnosis?

A

Pericarditis

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28
Q

An EKG shows two premature ventricular contractions. These two QRS waves look very different. What is the term for this?

A

Multifocal premature ventricular contractions

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29
Q

On EKG there is an early but otherwise normal PQRS complex. After that beat there is a slight pause and then a normal rhythm continues. What is the term for this one beat?

A

Premature atrial contraction

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30
Q

What side effect might make a patient stop taking an ACEI?

A

Cough

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31
Q

On physical exam you hear a harsh systolic murmur along the right sternal border. What is the most likely diagnosis?

A

Aortic stenosis

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32
Q

An RSR prime in leads V1 or V2 should make you think of what diagnosis?

A

Right bundle branch block

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33
Q

Name two fibric acid derivatives.

A

Fenofibrate and gemfibrozil

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34
Q

A patient has just received a cardiac stent. How long will he be on aspirin and clopidogrel?

A

One year

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35
Q

A beta natriuretic peptide below what level rules out CHF?

A

<100

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36
Q

Define orthostatic hypotension.

A

A drop in systolic blood pressure of >20 mmhg when standing up.

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37
Q

Which EKG leads are used to diagnose an anterolateral MI?

A

V5 and V6

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38
Q

What two leads do you use to determine the axis of the heart?

A

Lead I and AVF

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39
Q

What medication might you switch to if a patient develops an intolerable cough on an ACEI?

A

Angiotensin receptor blocker (ARBs)

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40
Q

Bat wing vessels or Kerley B lines on a CXR should make you think of what diagnosis?

A

CHF

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41
Q

Both lead I and AVF have positive QRS complexes. Does this represent normal axis, left axis deviation or right axis deviation?

A

Normal axis

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42
Q

What is the first line medical treatment for torsades de pointes?

A

Magnesium sulfate

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43
Q

What is the first line medical treatment for pericarditis?

A

Aspirin and NSAIDS

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44
Q

What is the appropriate treatment for a patent ductus arteriosus.

A

Indomethacin

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45
Q

What is the first line medical treatment for stage 1 hypertension?

A

Thiazide diuretic

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46
Q

Does a patient with mitral valve prolapse require prophylactic antibiotics for dental work?

A

No, a recent change moves mitral valve prolapse from high risk to moderate risk.

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47
Q

What is the best test for diagnosing CHF?

A

Echo

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48
Q

Which lab should be tightly monitored in a patient taking an aldosterone antagonist?

A

Potassium, they may have hyperkalemia

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49
Q

In a patient with aortic stenosis, will the PMI be

medially displaced, normal or laterally displaced?

A

It will be laterally displaced due to left ventricular hypertrophy.

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50
Q

Statins are the drug of choice to treat what type of dyslipidemia?

A

Elevated LDL

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51
Q

Name two things that would constitute a positive stress test.

A
  • A drop in blood pressure,
  • A new arrhythmia,
  • An increase in angina symptoms,
  • ST depressions
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52
Q

A patient with mitral valve prolapse will often have what physical characteristics?

A

Often a thin female

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53
Q

An 82 year old patient complains of headaches and jaw claudication. What is the most likely diagnosis?

A

Giant cell (temporal) arteritis

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54
Q

What are the three inferior leads?

A

II, III and aVF

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55
Q

The EKG shows irregularly irregular narrow QRS waves. What is the most likely diagnosis?

A

Atrial fibrillation

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56
Q

How do you treat polymyalgia rheumatica?

A

Low dose prednisone

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57
Q

Which cardiac medication has gynecomastia in its side effect profile?

A

Spironolactone

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58
Q

Lead I has a QRS that is up and the AVF lead has a QRS complex that is down. Does this represent normal axis, left axis deviation or right axis deviation?

A

Left axis deviation

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59
Q

Are most pulmonary valve problems congenital or acquired?

A

95% are congenital

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60
Q

You feel a pulse that seems to be vibrating. What term do you use to describe it?

A

Thrill

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61
Q

Where is disease of the tricuspid valve best heard?

A

Along the left lower sternal border.

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62
Q

What is Tietze syndrome?

A

Costochondritis

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63
Q

What is the most important complication of giant cell arteritis?

A

Blindness

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64
Q

What is the most common congenital heart disease?

A

Ventricular septal defect

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65
Q

List three medications which may be used for pharmacological stress test.

A
  • Adenosine,
  • Dobutamine,
  • Dipyridamole &
  • Persantine
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66
Q

An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely diagnosis?

A

Supraventricular tachycardia

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67
Q

A U wave on EKG should make you think of what diagnosis?

A

Hypokalemia

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68
Q

Tall peaked T waves should make you think of what diagnosis?

A

Hyperkalemia

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69
Q

What is the best test to diagnose an aortic dissection?

A

CT

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70
Q

Rheumatic fever most commonly affects which valve?

A

The mitral valve

71
Q

A patient complains of pain in his legs when he walks. It goes away after sitting. What term comes to mind for this symptom? What diagnosis is it associated with?

A

Intermittent claudication caused by peripheral arterial disease.

72
Q

What is the treatment goal for a diabetic with hypertension?

73
Q

A question stem includes an IV drug user with a new heart murmur and fever. What is the most likely diagnosis?

A

Endocarditis

74
Q

How does ezetimibe work?

A

Decreases intestinal absorption of cholesterol.

75
Q

A question about Prinzmetal’s angina will often

contain what key thing in the patient’s history?

A

Cocaine use

76
Q

Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?

A

Osler nodes

77
Q

What is the definitive treatment for a patient with recurrent ventricular tachycardia?

A

Implanted defibrillator

78
Q

Who is more likely to have an aortic aneurysm males or females?

A

Males are eight times as likely to have an aortic aneurysm.

79
Q

No matter what medications you use you are having trouble keeping a patient’s blood pressure under control. You also notice hyperpigmented skin and truncal obesity. What is the most likely diagnosis?

A

Cushing’s disease

80
Q

What is the only cyanotic congenital heart disease on the NCCPA blueprint?

A

Tetralogy of Fallot

81
Q

A young boy comes into your office. He has elevated blood pressure when taken in his arm, but no palpable femoral pulse. What is the most likely diagnosis?

A

Coarctation of the aorta

82
Q

What is the most common cause of sudden death?

A

Ventricular fibrillation

83
Q

How do you define 1st degree AV block?

A

The PR interval is longer than 0.2 seconds or one block on EKG.

84
Q

List three congential heart diseases.

A
  • Atrial septal defect (ASD),
  • Ventricular septal defect (VSD),
  • Coarctation of the aorta,
  • Patent ductus arteriosus (PDA),
  • Tetralogy of Fallot
85
Q

A blockage of which artery causes a lateral wall MI?

A

Left circumflex artery

86
Q

List the six P’s of an ischemic limb?

A
  • Pain,
  • Paresthesias,
  • Pallor,
  • Pulselessness,
  • Poikilothermia,
  • Paralysis
87
Q

What ejection fraction is typical for a patient with CHF?

88
Q

The accessory pathway known as the James bundle should make you think of what syndrome?

A

Lown-Ganong-Levine syndrome

89
Q

What will a CXR show for a patient with an aortic dissection?

A

Widened mediastinum

90
Q

A 60 year old male presents to the ER with severe dizziness and back pain. His blood pressure is dropping and you can feel an abdominal pulsatile mass on physical exam. What is the most likely diagnosis?

A

Ruptured aortic aneurysm

91
Q

What medication class is used to lower triglycerides?

A

Fibric acid derivatives

92
Q

On EKG there is an early wide QRS complex with no associated P wave. After that beat there is a slight pause and then a normal rhythm continues. What is the term for this one beat?

A

Premature ventricular contraction

93
Q

List three side effects of digoxin.

A
  • Nausea/vomiting,
  • Anorexia,
  • Confusion,
  • Arrhythmias(sinus brady, AV block),
  • Fatigue,
  • Vision disturbances etc.
94
Q

You hear a loud, harsh pulmonary murmur along the left sternal border. What is the most likely diagnosis?

A

Ventricular septal defect

95
Q

You are counting boxes from the peak of a QRS wave on an EKG in order to determine the heart rate. What would the heart rate be if the next QRS wave peak were three boxes away? What numbers are associated with the first five boxes?

A

The answer is 100. The heart rates by conting boxes are 300, 150, 100, 75, 60.

96
Q

What is the treatment for giant cell arteritis?

A

High dose prednisone

97
Q

What is the most common cause of secondary hypertension?

A

Chronic kidney disease

98
Q

What is the initial treatment for a myocardial infarction?

A

MONA

- Morphine, 
- Oxygen, 
- Nitroglycerin
- Aspirin
99
Q

What is the first line medication for a patient with symptomatic bradycardia?

100
Q

You see regular P waves and regular QRS complexes, but they do not seem to have any correlation to each other. What is the diagnosis?

A

Third degree AV block

101
Q

What is the best location to hear problems with the aortic valve?

A

2nd right intercostal space

102
Q

What is the gold standard for diagnosis of giant cell arteritis?

A

Biopsy of the temporal artery

103
Q

If you hear a midsystolic click you should immediately be thinking about what diagnosis?

A

Mitral valve prolapse

104
Q

A wide pulse pressure with a blowing diastolic decrescendo murmur at the right 2nd intercostal space should make you think of what diagnosis?

A

Aortic regurgitation

105
Q

What terms will likely be include in a description of a patient with a pheochromocytoma?

A
  • Thin,
  • Diaphoretic,
  • Tachycardic,
  • Agitated
106
Q

Do loop diuretics cause hyperkalemia or hypokalemia?

A

Hypokalemia

107
Q

A boot-shaped heart on CXR should make you think of what congenital heart condition?

A

Tetralogy of Fallot

108
Q

A patient presents to the ER in acute CHF. What drug class will likely be the first choice?

A

Loop diuretics

109
Q

On auscultation you hear a harsh blowing pansystolic murmur at the apex. What is the most likely diagnosis?

A

Mitral regurgitation

110
Q

Define pulsus alternans?

A

EKG waveform changes from beat to beat.

111
Q

What is the treatment for a patient with a Mobitz II AV block?

112
Q

List two risk factors for an aortic dissection?

A
  • Hypertension,
  • Marfan’s syndrome,
  • Bicuspid aortic valve,
  • Pregnancy
113
Q

You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?

A

Wolff-Parkinson-White syndrome

114
Q

Which finding requires immediate attention, left bundle branch block or right bundle branch block?

A

New left bundle branch block is a STEMI equivalent. Right bundle branch block is usually not a problem.

115
Q

What is represented by ST segment depressions greater than 1mm on EKG?

116
Q

What is the gold standard for diagnosing myocarditis?

A

Myocardial biopsy

117
Q

What is the therapeutic range for INR following an organic valve replacement?

118
Q

Name a common cause of a junctional rhythm.

A

Digitoxin toxicity

119
Q

Calf pain should always make you think of what diagnosis?

120
Q

What are three things in your differential if you have a paradoxical pulse?

A
  • Cardiac tamponade,
  • Pericarditis and
  • Pulmonary obstructive lung diseases (think COPD)
121
Q

What is the name of the syndrome that involves

pericarditis several days after a myocardial infarction?

A

Dressler syndrome

122
Q

What is the most common cause of CHF?

A

Coronary artery disease

123
Q

A patient in the ER has no pulse, but on EKG there are wide irregular “complexes” which are at an irregular rate. They all appear very different from one another. What is the treatment for this patient?

A

He is in ventricular fibrillation. The treatment is defibrillation.

124
Q

A biphasic P wave should make you think of what diagnosis?

A

Left atrial enlargement

125
Q

What is the management of a patient in supraventricular tachycardia?

A
  • Vagal maneuvers,
  • Carotid massage,
  • Adenosine
126
Q

What class of cardiac medications should be avoided in patients with asthma?

A

Beta blockers (Blocks receptors for bronchodilators)

127
Q

What is the most common cause of sudden cardiac death?

A

Ventricular fibrillation

128
Q

What is the other term for Mobitz type I?

A

Wenckebach

129
Q

Giant cell arteritis is associated with what other disease?

A

Polymyalgia rheumatica

130
Q

Subacute endocarditis is most commonly caused by what organism?

A

Strep Viridans

131
Q

An Osborne or J wave on EKG should make you think of what diagnosis?

A

Hypothermia

132
Q

What is the most common cause of an atrial septal defect?

A

Patent foramen ovale

133
Q

What is the definitive treatment for cardiac tamponade?

A

Pericardiocentesis

134
Q

List the components of Virchow’s triad.

A
  • Stasis,
  • Vascular injury,
  • Hypercoagulability
135
Q

On palpation, what size is normal for the aorta?

A

Less than 3 cm

136
Q

A CXR shows a “3” sign with notching of the ribs. What is the most likely diagnosis?

A

Coarctation of the aorta

137
Q

What will the heart rate be if the AV node is pacing the heart?

A

40-60 beats per minute

138
Q

What lab result will increase the risk of digoxin toxicity?

A

Hypokalemia or hypercalcemia

139
Q

The heart rate is irregular so you can’t count boxes between QRS waves to determine heart rate. What is another method you can use to determine rate on an EKG?

A

Count QRS waves in a six second strip and multiply by 10 to get beats per minute.

140
Q

Give two contraindications for using an ACEI.

A

Bilateral renal artery stenosis, history of angioedema, pregnancy

141
Q

A patient presents to the ER with tearing chest pain radiating to his back. What is the most likely diagnosis?

A

Aortic dissection

142
Q

What is the accessory pathway associated with Wolff-Parkinson-White syndrome?

A

The bundle of Kent

143
Q

What is the most likely diagnosis for a young man who experiences sudden death while playing sports?

A

Hypertrophic cardiomyopathy

144
Q

Paroxysmal nocturnal dyspnea should make you think of what diagnosis?

145
Q

List three catastrophic complications of a myocardial infarction.

A
  • Papillary muscle rupture,
  • Myocardial wall rupture and
  • Left ventricular aneurysm
146
Q

Acute endocarditis is most commonly caused by

what organism?

A

Staph aureus

147
Q

An opening snap on auscultation of the heart should make you think of what diagnosis?

A

Mitral stenosis

148
Q

You have a patient with diagnosis of a pheochromocytoma. While waiting for surgery should you use an alpha blocker or a beta blocker?

A

Alpha blocker. Never use a pure beta blocker.

149
Q

What is the most common place for an aortic aneurysm?

A

In the abdomen and below the renal arteries

150
Q

You hear a continuous machine-like murmur. What is the most likely diagnosis?

A

Patent ductus arteriosus (PDA)

151
Q

A patient complains of severe crushing chest
pain. EKG shows ST segment elevations. All labs including troponins and CK-MB are negative. What is the most likely diagnosis?

A

Prinzmetal’s angina

152
Q

Define paradoxical pulse.

A

There is a large difference in pulse pressure between inhalation and exhalation.

153
Q

You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis?

A

Transesophageal echo

154
Q

Which cardiac medication is used to help with cardiac contractility after you have optimized most of the other cardiac medications?

155
Q

What is the gold standard for diagnosing coronary artery disease?

A

Cardiac catheterization

156
Q

Are ulcers from arterial insufficiency painful or painless?

157
Q

What are the five components of tetralogy of

Fallot?

A
  • Ventricular septal defect,
  • Right ventricular hypertrophy,
  • Right ventricular outflow obstruction (pulmonary valve stenosis),
  • Overriding aorta,
  • Right sided aortic arch
158
Q

List two diagnoses which require antibiotic prophylaxis for “dirty procedures?”

A
  • Prosthetic valve,
  • Valve repair with any prosthetic material,
  • Prior endocarditis diagnosis,
  • Congential cyanotic heart defect
159
Q

What are the two main causes of aortic stenosis?

A

Congenital bicuspid valve and calcification of the valve secondary to coronary artery disease

160
Q

An EKG shows a regular rate of 50 beats per minute. The QRS is narrow and there is no visible P wave. What is the most likely diagnosis?

A

Junctional rythm

161
Q

Where is disease of the mitral valve best heard?

A

At the apex

162
Q

What is the first medication you should give for atrial flutter?

163
Q

A patient presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all of the leads. What is the most likely diagnosis?

A

Pericarditis

164
Q

List two causes of right atrial enlargement?

A
  • Pulmonary HTN,
  • Severe lung disease,
  • Pulmonary valve stenosis
165
Q

A pathologic S3 is most commonly associated with what diagnosis?

166
Q

According to the CDC what is the range for a normal BMI?

167
Q

You have a patient with pulsus paradoxus. What

two diagnosis should you be thinking of?

A
  • Cardiac tamponade,
  • Pericarditis and
  • Pulmonary obstructive lung diseases (think COPD)
168
Q

A fixed or consistent split S2 should make you think of what diagnosis?

A

Atrial septal defect

169
Q

What two antibiotics are used for empiric treatment of endocarditis?

A

Vancomycin and ceftriaxone together are first line empiric treatment

170
Q

A Blalock procedure is used to correct what congenital heart condition?

A

Tetralogy of Fallot

171
Q

What imaging needs to be done before taking a patient to the OR with an aortic aneurysm?

A

CT (echo may be used as initial study, but CT is need for surgery)

172
Q

What two valvular issues do patients with Marfan’s syndrome often have?

A

Aortic regurgitation and mitral valve prolapse (you can tell them apart by where they are heard).

173
Q

Name three medication “classes” which are used to reduce LDL?

A
  • Statins,
  • Ezetimibe,
  • Niacin and
  • Nicotinic acid
174
Q

Define stage 1 hypertension according to JNC 7.

A

Systolic pressure of 140-159 and diastolic of 90-99

0. PANCE Review (15 decks)

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