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pance randos > Cardiology > Flashcards

Cardiology Flashcards

1
Q

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

A

thrill

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2
Q

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

A

cardiac tamponade, pericarditis and obstructive lung disease

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3
Q

On palpation, what size is normal for the aorta?

A

less than 3 cm

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4
Q

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

A

atrial septal defect

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5
Q

A pathologic S3 is most commonly associated with what diagnosis?

A

CHF

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6
Q

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

A

septal defect

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7
Q

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

A

pda

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8
Q

What is the gold standard for diagnosing coronary artery disease?

A

cardiac cath

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9
Q

Define stage 1 hypertension according to JNC 7.

A

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

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10
Q

goal for BP in diabetic

A

130/80

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11
Q

What is the most common cause of secondary hypertension?

A

chronic kidney disease

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12
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

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13
Q

List three signs or symptoms which will likely be included in a description of a patient with a pheochromocytoma?

A

thin, diaphoretic, tachycardic, agitated, hypertensive

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14
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 a pure beta blocker

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15
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

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16
Q

What is the most common cause of CHF?

A

coronary artery disease

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17
Q

What ejection fraction is typical for a patient with CHF?

A

35-40%

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18
Q

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

A

CHF

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19
Q

A beta natriuretic peptide below what level rules out CHF?

A

<100

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20
Q

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

A

2.5-3.5

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21
Q

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

A

dopamine

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22
Q

What diagnosis is most likely in an IV drug user with a new heart murmur and fever?

A

endocarditis

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23
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

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24
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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25
Q

What are the three major criteria for endocarditis?

A

2 positive blood cultures, a positive transesophageal echocardiography, new murmur

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26
Q

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

A

osler nodes

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27
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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28
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

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29
Q

What is the gold standard for diagnosing myocarditis?

A

myocardial biopsy

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30
Q

Where do most aortic dissections occur?

A

The ascending or descending thoracic aorta

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31
Q

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

A

pericarditis

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32
Q

What is the first line medical treatment for pericarditis?

A

aspirin and NSAIDS

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33
Q

What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?

A

dressler syndrome

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34
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

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35
Q

Define paradoxical pulse.

A

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

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36
Q

Define pulsus alternans.

A

EKG waveform changes from beat to beat

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37
Q

What is the definitive treatment for cardiac tamponade?

A

pericardiocentesis

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38
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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39
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 regurg

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40
Q

What two antibiotics are used for empiric treatment of endocarditis?

A

vanco and ceftriaxone

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41
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).

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42
Q

What are the two main causes of aortic stenosis?

A

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

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43
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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44
Q

On auscultation you hear a harsh, blowing,

pansystolic murmur at the apex. What is the most likely diagnosis?

A

mitral regurg

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45
Q

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

A

transesophageal echo

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46
Q

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

A

thin female

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47
Q

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

A

sitting up and leaning forward

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48
Q

What is Tietze syndrome?

A

costochondritis

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49
Q

Are most pulmonary valve problems congenital or acquired?

A

95% are congenital

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50
Q

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

A

2-3

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51
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

52
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

53
Q

A question about Prinzmetal’s angina will often contain what key thing in the patient’s history?

A

cocaine use

54
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

55
Q

Are ulcers from venous insufficiency painful or painless?

A

painless

56
Q

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

A

1 year

57
Q

Where is disease of the mitral valve best heard?

A

apex

58
Q

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

A

STEMI and new LBBB

59
Q

List three catastrophic complications of a myocardial infarction.

A

Papillary muscle rupture, myocardial wall rupture and left ventricular aneurysm

60
Q

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

A

SVT

61
Q

Acute endocarditis is most commonly caused by what organism?

A

staph aureus

62
Q

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

A

patent foramen ovale

63
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

64
Q

What is the appropriate treatment for a patent ductus arteriosus.

A

indomethacin

65
Q

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

A

tetralogy of Fallot

66
Q

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

A

ventricular septal defect

67
Q

Subacute endocarditis is most commonly caused by what organism?

A

strep viridans

68
Q

What is the most common place for an aortic aneurysm?

A

abdomen, below renal arteries

69
Q

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

A

Lown-Ganong-Levine syndrome

70
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)

71
Q

List two risk factors for an aortic dissection?

A

Hypertension, Marfan’s syndrome, bicuspid aortic valve, pregnancy

72
Q

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

A

widened mediastinum

73
Q

What is the best test to diagnose an aortic

dissection?

A

CT

74
Q

List the six P’s of an ischemic limb.

A

Pain, paresthesias, pallor, pulselessness, poikilothermia, paralysis

75
Q

You have a patient with pulsus paradoxus. What two diagnosis should you be thinking of?

A

pericarditis, pleural effusion, obstructive lung disease

76
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

77
Q

Giant cell arteritis is associated with what other disease?

A

polymyalgia rheumatica

78
Q

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

A

atrial flutter

79
Q

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

A

left atrial enlargement

80
Q

List the components of Virchow’s triad.

A

stasis, hypercoagulable state, vascular injury

81
Q

Where is disease of the tricuspid valve best heard?

A

Along the left lower sternal border

82
Q

What is the most common congenital heart

disease?

A

VSD

83
Q

Are ulcers from arterial insufficiency painful or painless?

A

painful

84
Q

Give two contraindications for using an ACEI.

A

bilateral renal artery stenosis, hx of angioedema, pregnancy

85
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

86
Q

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

A

RBBB

87
Q

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

A

potassium, they may have hyperkalemia

88
Q

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

A

digoxin

89
Q

A blockage of which artery causes an anterior wall MI?

A

LAD

90
Q

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

A

Loop. thiaides only work with GFR over 30

91
Q

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

A

V1, 2, 3

92
Q

Do loop diuretics cause hyperkalemia or hypokalemia?

A

hypokalemia

93
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.

94
Q

Which hyperlipidemia medication may cause flushing?

A

niacin

95
Q

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

A

statins, ezetimibe, niacin, nicotinic acid

96
Q

List three class 1a antiarrhythmics.

A

Disopyramide, quinidine, procainamide

97
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 counting boxes are 300, 150, 100, 75, 60.

98
Q

A U wave on EKG should make you think of what

diagnosis?

A

hypokalemia

99
Q

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

A

40-60 bpm

100
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

101
Q

Which cardiac medication has gynecomastia in its side effect profile?

A

spironolactone

102
Q

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

A

hypothermia

103
Q

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

A

atropine

104
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

105
Q

How do you treat polymyalgia rheumatica?

A

low dose prednisone

106
Q

What is the management of a patient in supraventricular tachycardia?

A

vagal maneuvers, carotid massage, adenosine

107
Q

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

A

adenosine

108
Q

The EKG shows irregularly irregular narrow QRS

waves. What diagnosis should you be thinking of?

A

A fib

109
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 rhythm

110
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

111
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.

112
Q

How do you define 1st degree AV block?

A

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

113
Q

What is the other term for Mobitz type I?

A

Wenckebach

114
Q

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

A

serum creatinine and serum K+

115
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.

116
Q

What is the treatment for a patient with a Mobitz II

AV block?

A

pacemeaker

117
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

118
Q

Name one aldosterone antagonist.

A

spironolactone, eplerenone

119
Q

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

A

WPW

120
Q

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

A

lead 1 and AVF

121
Q

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

A

LBBB

122
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.

123
Q

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

A

Right atrial enlargement

124
Q

What are the three inferior leads?

A

II, III and aVF

125
Q

A blockage of which artery causes a lateral wall MI?

A

left circumflex artery

126
Q

Which EKG leads are used to diagnose an anterolateral MI?

A

V5 and V6

pance randos (4 decks)

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