Cardiology

Question 1

The physical responses to shock are mediated by:

Answer 1

Catecholamines
Renin, Antidiuretic hormone
Glucagon, Cortisol, and Growth hormone

Question 2

MC type of distributive shock:

Answer 2

Septic shock

Question 3

MC etiology of septic shock:

Answer 3

Gram-negative sepsis

Question 4

MC epidemiology of septic shock:

Answer 4

Extremes of age
Diabetics and immunosuppresed
Recent invasive procedure

Question 5

Shock tx: Inotropes

Answer 5

increase CO by increasing contractility

dobutamine, dopamine, epinephrine

Question 6

Shock tx: Chronotropes

Answer 6

alter heart rate

positive - adrenaline; negative - digoxin

Question 7

Shock tx: Pressors

Answer 7

improve pressure by increasing vascular tone

dopamine, phenylephrine

Question 8

Orthostatic/Postural Hypotension Defintion:

Answer 8

Drop of 20mmgHG systolic or 10mmHg diastolic between supine and sitting/standing measurements

Question 9

Orthostatic hypotension:

If increase in pulse of 15bpm or more, what’s the most likely cause?

Answer 9

Depleted circulating blood volume

Question 10

Orthostatic hypotension:

In no change in pulse, what are possible causes?

Answer 10

Meds, autonomic dz (Parkinson, Shy-Drager), peripheral neuropathies

Question 11

Orthostatic hypotension:

Diagnostic studies

Answer 11

CBC, BMP, EKG

Tilt test if necessary

Question 12

Metabolic syndrome is composed of:

Answer 12

Truncal obesity
Hyperinsulinemia and insulin resistance
Hypertryglyceridemia
HTN

Question 13

Define hypertensive urgency

Answer 13

Systolic > 220 or diastolic > 125.

Persistently elevated…must be lowered within hours

Question 14

Define hypertensive emergency

Answer 14

Must be lowered within 1 hour to prevent progression of end-organ damage. In the presence of strikingly elevated BP

Question 15

Define malignant hypertension

Answer 15

Elevated BP associated with papilledema and either encephalopathy or nephropathy.
If untreated, progressive renal failure occurs.

Question 16

MC symptom of mild to moderate HTN:

Answer 16

Nonspecific headache

Question 17

PE components to look for end-organ damage or secondary cause of HTN

Answer 17

BMI, waist circumference
BP in both arms, compare radial and femoral pulses (R/O coarctation)
Look for displaced PMI or new murmur
Listen for bruits/palpate for abdominal aortic mass
Fundoscopic exam

Question 18

ECG findings for LVH:

Answer 18

Deep S waves in V1, V2
Tall R waves in V5, V6

(May see LVH on CXR also)

Question 19

Goal BP:

Answer 19

JNC 8 - everyone 60 (<150/90)