Cardiology

Question 1

what are the indications for hemodialysis

Answer 1

AEIOU:

• metabolic Acidosis w/ pH 6.5 refractory to medication
• Ingestion: methanol, ethylene glycol, salicylates, lithium, valproate, carbamazepine
• Overload of volume refractory to diuretics
• Uremia causing pericarditis, encephalopathy or bleeding (platelet dysfunction)

Question 2

symptoms of amyloidosis

Answer 2

• proteinuria/ nephrotic syndrome
• restrictive cardiomyopathy
• hepatomegaly
• peripheral/ autonomic neuropathy
• bleeding diatheses
• macroglossia
• waxy thickening and easy bruising of skin

Question 3

most sensitive indicator of dehydration or orthostatic hypotension is

Answer 3

BUN/Cr ratio due to decreased GFR and increased urea reabsorption in volume depleted states

Question 4

major side effects of amiodarone

Answer 4

interstitial pneumonitis,

Question 5

list lifestyle interventions for hypertension in order of effectiveness

Answer 5

weight loss, DASH diet (high fruits/veggies, low saturated fats), exercise, low sodium (

Question 6

when can clonic jerks be seen in syncope

Answer 6

prolonged syncope in which there is brain hypoxia (therefore clonic jerks do not necessarily mean seizure)

Question 7

what does valsalva do to and what murmurs does it accentuate

Answer 7

valsalva decreases preload during strain (increases during release phase); accentuates HCM and MVP murmurs

Question 8

what does squatting do and what murmurs does it accentuate

Answer 8

squatting increases preload and increases afterload to accentuate AR, MR and VSD murmurs

Question 9

what does standing do to cardiac hemodynamics

Answer 9

decreases preload; accentuates HCM and MVP murmurs

Question 10

what does handgrip do to cardiac hemodynamics

Answer 10

increases afterload; accentuates AR, MR and VSD murmurs

Question 11

name the paroxysymal (abrupt onset and offset) supraventricular tachycardias and how would you manage them in hemodynamically stable patients

Answer 11

AVNRT, AVRT, atrial tachycardia, junctional tachyardia;
in hemodynamically stable patients use vagal maneuvers (carotid massage, eye pressure) or IV adenosine to slow AV conduction to unmask P waves and wave morphology as well as to resolve the tachycardia

Question 12

if your patient’s EKG shows tachycardia and QRS complexes with varying amplitudes he/she will likely need what treatment

Answer 12

pericardiocentesis (for pericardial effusion/ tamponade)

Question 13

a hemodynamically stable patient with sustained monomorphic ventricular tachycardia should be treated with…

Answer 13

a ventricular antiarrhythmic (i.e. amiodarone)

Question 14

treatment for patient with cocaine-associated chest pain; what drug is contraindicated

Answer 14

treat with benzos for lowering BP and anxiety;

beta-blockers contraindicated due to unopposed alpha activitity

Question 15

what symptoms do you get with cholesterol emboli

Answer 15

livedo reticularis, AKI, GI sx (nausea, abd pain); often seen after vascular procedures

Question 16

what lab findings suggest cholesterol embolus

Answer 16

eosinophilia (or eosinophiluria), hypocomplementemia, elevated Cr (AKI)

Question 17

in a patient on alpha1 blockers who wants to take sildenafil for ED, what precaution do you have to take

Answer 17

must take sildenafil and alpha1 blockers at least 4 hours apart to prevent hypotension

Question 18

does glycemic control improve erectile dysfunction

Answer 18

no

Question 19

symptoms of Adult Still’s disease

Answer 19

recurrent high fevers (> or =39), maculopapular rash, arthritis

Question 20

symptoms of infective endocarditis

Answer 20

fever, Osler’s nodes (painful, purple nodules on finger and toes), glomerulonephritis, arthritis

Question 21

what condition or lab abnormality is associated with breath-holding spells

Answer 21

iron-deficiency anemia (order a CBC and serum ferritin)

Question 22

diastolic decrescendo murmur at left sternal border is

Answer 22

aortic insufficiency

Question 23

what are all of the drugs/interventions that should be given for a STEMI

Answer 23

PCI within 90 minutes of arrival, oxygen, nitrates (unless RCA MI), platelet inhibitor, beta blockers (unless hypotensive/bradycardic), full-dose ASA, anticoagulation, statin as soon as possible

Question 24

what causes pruritus after hot baths in patients with polycythemia vera

Answer 24

increased number of circulating basophils release high levels of histamine

Question 25

what is the recommended screening for AAA

Answer 25

active or former smokers age 65-75 get a one time abdominal ultrasound

Question 26

a neonate with cyanotic heart disease and left axis deviation and decreased pulmonary vascular markings on x-ray should make you think of what condition

Answer 26

tricuspid atresia: lack of communication between RA and RV leads to hypoplastic RV (hence left axis deviation), blood flow to the lungs is decreased resulting in underdevelopment of lung vasculature

Question 27

what risk factor is associated with the highest rate of expansion and rupture of AAA

Answer 27

active smoking

Question 28

what cardiac defects are associated with hemochromatosis

Answer 28

dilated or restrictive cardiomyopathy (due to iron deposition in myocardial tissue) and conduction abnormalities (due to iron deposition in conduction pathways)

Question 29

explain the cause and significance of hyponatremia in CHF

Answer 29

hyponatremia occurs due to poor EF leading to increased ADH, renin and norepinephrine promoting water reabsorption and dilutional hyponatremia
hyponatremia is an indicator of CHF disease severity and predicts adverse outcomes

Question 30

ischemia and chronic hypertension cause what kind cardiomyopathy

Answer 30

dilated cardiomyopathy

Question 31

patients with what conditions should get prophylactic antibiotics prior to dental surgery

Answer 31

1. prosthetic valves
2. prior history of infective endocarditis
3. unrepaired congenital heart disease

Question 32

what two imaging modalities could you use in a patient presenting with widened mediastinum on CXR and back pain

Answer 32

chest CT or TEE

note: you cannot use TTE as it does not adequately visualize thoracic aorta

Question 33

first line for chronic stable angina

Answer 33

beta blockers

then CCB’s, then long-acting nitrates (short acting for acute events)

Question 34

persistent ST elevations and deep Q waves months out from an MI suggest what complication

Answer 34

ventricular aneurysm

Question 35

what 3 drugs can you use to treat a hypertensive emergency

Answer 35

labetolol, nitroprusside, nicardipine

Question 36

signs of constrictive pericarditis

Answer 36

right heart failure (JVD, ascites, hepatomegaly, peripheral edema), pericardial knock (mid diastolic sound), calcifications on heart border, Kussmal’s sign, pulsus paradoxus

Question 37

a patient with Parkinson’s presents with orthostatic hypotension, impotence, and other autonomic deficits; what is the diagnosis and how do you treat?

Answer 37

Shy-Drager (multisystem atrophy)

fludrocortisone for intravascular expansion, salt, compression stockings, alpha adrenergic agonists

Question 38

alcohol withdrawl vs. hepatic encephalopathy

Answer 38

both present with agitation and tremor/asterixis; for alcohol withdrawl look for other signs such as fever, tachycardia, HTN
for hepatic encephalopathy check LFT’s and BUN or other signs of decompensated liver failure

Question 39

blood pressure differential between arms can be what two conditions

Answer 39

aortic dissection, coarctation or subclavian atherosclerosis

Question 40

at what hemoglobin A1c should you consider starting insulin

Answer 40

Hgb A1c > 8.5%