Cardiology Flashcards
You feel a pulse that seems to be vibrating. What term do you use to describe it?
thrill
What are three things in your differential if you have a paradoxical pulse?
cardiac tamponade, pericarditis and obstructive lung disease
On palpation, what size is normal for the aorta?
less than 3 cm
A fixed or consistent split S2 should make you think of what diagnosis?
atrial septal defect
A pathologic S3 is most commonly associated with what diagnosis?
CHF
A continuous murmur most likely involves what area of the heart?
septal defect
You hear a continuous machine-like murmur. What is the most likely diagnosis?
pda
What is the gold standard for diagnosing coronary artery disease?
cardiac cath
Define stage 1 hypertension according to JNC 7.
Systolic pressure of 140-159 and diastolic of 90-99
goal for BP in diabetic
130/80
What is the most common cause of secondary hypertension?
chronic kidney disease
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?
Cushing’s disease
List three signs or symptoms which will likely be included in a description of a patient with a pheochromocytoma?
thin, diaphoretic, tachycardic, agitated, hypertensive
You have a patient with diagnosis of a pheochromocytoma. While waiting for surgery should you use an alpha blocker or a beta blocker?
alpha blocker. never a pure beta blocker
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?
coarctation of the aorta
What is the most common cause of CHF?
coronary artery disease
What ejection fraction is typical for a patient with CHF?
35-40%
Bat wing vessels or Kerley B lines on a CXR should make you think of what diagnosis?
CHF
A beta natriuretic peptide below what level rules out CHF?
<100
What is the therapeutic range for INR following a mechanical valve replacement?
2.5-3.5
What is the first line IV inotropic agent when dealing with cardiogenic shock?
dopamine
What diagnosis is most likely in an IV drug user with a new heart murmur and fever?
endocarditis
List two diagnoses which require antibiotic prophylaxis for “dirty procedures?”
Prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congential cyanotic heart defect
Does a patient with mitral valve prolapse require prophylactic antibiotics for dental work?
No, a recent change moves mitral valve prolapse from high risk to moderate risk.
What are the three major criteria for endocarditis?
2 positive blood cultures, a positive transesophageal echocardiography, new murmur
Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?
osler nodes
List the 4 minor criteria for diagnosing endocarditis.
Fever, embolic event (Janeway lesions or petechiae, splinter hemorrhages), immunological event (osler nodes, glomerulonephritis), 1 positive blood culture
What are the five components of tetralogy of Fallot?
Ventricular septal defect, right ventricular hypertrophy, right ventricular outflow obstruction (pulmonary valve stenosis), overriding aorta, right sided aortic arch
What is the gold standard for diagnosing myocarditis?
myocardial biopsy
Where do most aortic dissections occur?
The ascending or descending thoracic aorta
A patient complains of severe pleuritic chest pain that is worse when leaning forward. What is the most likely diagnosis?
pericarditis
What is the first line medical treatment for pericarditis?
aspirin and NSAIDS
What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?
dressler syndrome
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?
pericarditis
Define paradoxical pulse.
There is a large difference in pulse pressure between inhalation and exhalation.
Define pulsus alternans.
EKG waveform changes from beat to beat
What is the definitive treatment for cardiac tamponade?
pericardiocentesis
On physical exam you hear a harsh systolic murmur along the right sternal border. What is the most likely diagnosis?
aortic stenosis
A wide pulse pressure with a blowing diastolic decrescendo murmur at the right 2nd intercostal space should make you think of what diagnosis?
aortic regurg
What two antibiotics are used for empiric treatment of endocarditis?
vanco and ceftriaxone
What two valvular issues do patients with Marfan’s syndrome often have?
Aortic regurgitation and mitral valve prolapse (you can tell them apart by where they are heard).
What are the two main causes of aortic stenosis?
Congenital bicuspid valve and calcification of the valve secondary to coronary artery disease
An elderly patient presents with dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely diagnosis?
aortic stenosis
On auscultation you hear a harsh, blowing,
pansystolic murmur at the apex. What is the most likely diagnosis?
mitral regurg
You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis?
transesophageal echo
A patient with mitral valve prolapse will often have what physical characteristics?
thin female
What is the best patient position to hear aortic regurge and aortic stenosis?
sitting up and leaning forward
What is Tietze syndrome?
costochondritis
Are most pulmonary valve problems congenital or acquired?
95% are congenital
What is the therapeutic range for INR following an organic valve replacement?
2-3
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?
ruptured aortic aneurysm
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?
prinzmetal’s angina
A question about Prinzmetal’s angina will often contain what key thing in the patient’s history?
cocaine use
Name two things that would constitute a positive
stress test.
A drop in blood pressure, a new arrhythmia, an increase in angina symptoms, ST depressions
Are ulcers from venous insufficiency painful or painless?
painless
A patient has just received a cardiac stent. How long will he be on aspirin and clopidogrel?
1 year
Where is disease of the mitral valve best heard?
apex
Clot busting drugs should be used within 3 hours of which two cardiac events?
STEMI and new LBBB
List three catastrophic complications of a myocardial infarction.
Papillary muscle rupture, myocardial wall rupture and left ventricular aneurysm
An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely diagnosis?
SVT
Acute endocarditis is most commonly caused by what organism?
staph aureus
What is the most common cause of an atrial septal defect?
patent foramen ovale
Where on your patient should you listen for the murmur associated with an atrial septal defect?
At the left second or third interspace
What is the appropriate treatment for a patent ductus arteriosus.
indomethacin
A Blalock procedure is used to correct what congenital heart condition?
tetralogy of Fallot
you hear a loud, harsh pulmonary murmur along the left sternal border. What is the most likely diagnosis?
ventricular septal defect
Subacute endocarditis is most commonly caused by what organism?
strep viridans
What is the most common place for an aortic aneurysm?
abdomen, below renal arteries
The accessory pathway known as the James bundle should make you think of what syndrome?
Lown-Ganong-Levine syndrome
What imaging needs to be done before taking a patient to the OR with an aortic aneurysm?
CT (echo may be used as initial study, but CT is need for surgery)
List two risk factors for an aortic dissection?
Hypertension, Marfan’s syndrome, bicuspid aortic valve, pregnancy
What will a CXR show for a patient with an aortic dissection?
widened mediastinum
What is the best test to diagnose an aortic
dissection?
CT
List the six P’s of an ischemic limb.
Pain, paresthesias, pallor, pulselessness, poikilothermia, paralysis
You have a patient with pulsus paradoxus. What two diagnosis should you be thinking of?
pericarditis, pleural effusion, obstructive lung disease
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?
Intermittent claudication caused by peripheral arterial disease
Giant cell arteritis is associated with what other disease?
polymyalgia rheumatica
A sawtooth pattern on EKG should make you think of what diagnosis?
atrial flutter
A biphasic P wave should make you think of what diagnosis?
left atrial enlargement
List the components of Virchow’s triad.
stasis, hypercoagulable state, vascular injury
Where is disease of the tricuspid valve best heard?
Along the left lower sternal border
What is the most common congenital heart
disease?
VSD
Are ulcers from arterial insufficiency painful or painless?
painful
Give two contraindications for using an ACEI.
bilateral renal artery stenosis, hx of angioedema, pregnancy
Both lead I and AVF have positive QRS complexes. Does this represent normal axis, left axis deviation or right axis deviation?
normal axis
An RSR prime in leads V1 or V2 should make you think of what diagnosis?
RBBB
Which lab should be tightly monitored in a patient taking an aldosterone antagonist?
potassium, they may have hyperkalemia
Which cardiac medication is used to help with cardiac contractility after you have optimized most of the other cardiac medications?
digoxin
A blockage of which artery causes an anterior wall MI?
LAD
A patient has a GFR of 25 and HTN. Which class should you use, a loop or a thiazide diuretic?
Loop. thiaides only work with GFR over 30
Which EKG leads are used to diagnose an anterior wall MI?
V1, 2, 3
Do loop diuretics cause hyperkalemia or hypokalemia?
hypokalemia
A patient recently started taking Lipitor. He is now complaining of aches and pains. What test should you order?
Serum creatinine kinase, you’re looking for rhabdomyolysis.
Which hyperlipidemia medication may cause flushing?
niacin
Name three medication “classes” which are used to reduce LDL?
statins, ezetimibe, niacin, nicotinic acid
List three class 1a antiarrhythmics.
Disopyramide, quinidine, procainamide
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?
The answer is 100. The heart rates by counting boxes are 300, 150, 100, 75, 60.
A U wave on EKG should make you think of what
diagnosis?
hypokalemia
What will the heart rate be if the AV node is pacing the heart?
40-60 bpm
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?
left axis deviation
Which cardiac medication has gynecomastia in its side effect profile?
spironolactone
An Osborne or J wave on EKG should make you think of what diagnosis?
hypothermia
What is the first line medication for a patient with symptomatic bradycardia?
atropine
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?
premature atrial contraction
How do you treat polymyalgia rheumatica?
low dose prednisone
What is the management of a patient in supraventricular tachycardia?
vagal maneuvers, carotid massage, adenosine
What is the first medication you should give for atrial flutter?
adenosine
The EKG shows irregularly irregular narrow QRS
waves. What diagnosis should you be thinking of?
A fib
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?
junctional rhythm
An EKG shows two premature ventricular contractions. These two QRS waves look very different. What is the term for this?
Multifocal premature ventricular contractions
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?
He is in ventricular fibrillation. The treatment is defibrillation.
How do you define 1st degree AV block?
The PR interval is longer than 0.2 seconds or one block on EKG.
What is the other term for Mobitz type I?
Wenckebach
What two labs do you want to monitor in a patient on an ACEI?
serum creatinine and serum K+
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?
Count QRS waves in a six second strip and multiply by 10 to get beats per minute.
What is the treatment for a patient with a Mobitz II
AV block?
pacemeaker
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?
third degree AV block
Name one aldosterone antagonist.
spironolactone, eplerenone
You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?
WPW
What two leads do you use to determine the axis of the heart?
lead 1 and AVF
An RSR prime in leads V5 or V6 should make you think of what diagnosis?
LBBB
Which finding requires immediate attention, left bundle branch block or right bundle branch block?
New left bundle branch block is a STEMI equivalent. Right bundle branch block is usually not a problem.
Tall peaked P waves should make you think of what diagnosis?
Right atrial enlargement
What are the three inferior leads?
II, III and aVF
A blockage of which artery causes a lateral wall MI?
left circumflex artery
Which EKG leads are used to diagnose an anterolateral MI?
V5 and V6
