Cardiology

Question 1

What is first indicator for hypovolemia?

Answer 1

Pulse

Question 2

What is caused by tachyarrhythmia

Answer 2

Tachycardia-mediated cardiopathy

• Chronic tachy –> LV dilation & myocardial dysfunction
• Palpitations and/or CHF
• Tx: rate or rhythm control

Question 3

How do I diagnose tachycardia-mediated cardiomyopathy?

Answer 3

EKG, echo

Question 4

What is the MCC of LE edema?

Answer 4

Venous insufficiency

- Causes venous HTN

Question 5

What diseases do you see pulsus paradoxus in?

Answer 5

Tamponade, COPD, asthma, pericarditis, croup

Question 6

What murmurs can Marfan’s have?

Answer 6

MVP and aortic regurg

Question 7

What occurs 5 days - 3 months after MI with persistent ST elevation after MI and deep q waves in same lead?

Answer 7

Ventricular aneurysms

• progressive LV enlargement –> HF, arrhythmia, mural thrombosis, miral regurg

Question 8

What causes premature atrial complexes?

Answer 8

Activation of atria from site other than SA

• Benign
• Can cause skipped beats
• Eliminate etoh, alcohol, caffeine, stress

Question 9

What do you think of with BUN >60?

Answer 9

Uremic pericarditis

Question 10

How do you treat uremic pericarditis?

Answer 10

Hemodialysis

Question 11

What is MC location of ectopic foci that cause Afib?

Answer 11

Pulmonary veins

Question 12

How do you treat Afib with RVR

Answer 12

Beta blockers, dilitazem, digoxin

Rhythm control for those with recurrent episodes

Question 13

What artery is affected with inferior wall MI?

Answer 13

RCA

Question 14

What causes flash pulmonary edema?

Answer 14

Secondary to Acute MI

Question 15

Tx for flash pulm edema

Answer 15

loop diuretic (not if hypovolemic)

Question 16

What is most frequent arrhythmia causing Sudden cardiac arrest?

Answer 16

Vfib

Question 17

What is wide complex tachycardia with 2 fusion beats?

Answer 17

Sustained monomorphic ventricular tachycardia

Question 18

Risk factors for SMVT

Answer 18

CAD, left ventricular systolic dysfunction

Question 19

Tx for SMVT?

Answer 19

Amiodarone

Question 20

What to think of if right heart strain seen as RBBB on EKG + hypotension?

Answer 20

PE

Question 21

Mixed venous O2 sat in septic shock?

Answer 21

High

Question 22

What to do if lone afib (one episode)?

Answer 22

No treatment

Question 23

What to do if right ventricular MI?

Answer 23

High flow IVF (if hypotensive)

Question 24

What causes N/V, dec appetite, confusion, weakness?

Answer 24

Digoxin toxicity

• can have scotoma and blurry vision

Question 25

What increases digoxin toxicity?

Answer 25

Hypokalemia

Question 26

What causes PVT?

Answer 26

Re-entry into AV node

Question 27

Tx for PVT?

Answer 27

Cold water immersion, carotid sinus massage, valsalva, inc vagal tone , dec conduction through AV node - Adenosine

Question 28

Who generally gets PVT?

Answer 28

PPl w/ no strctural heart disease

Question 29

Tx for WPW?

Answer 29

Unstable: cardiovert Stable: IV ibutilide or procainamide

Question 30

What causes stent thrombosis?

Answer 30

Premature d/c of antiplatelet therapy

Question 31

What is key for prerenal azotemia?

Answer 31

BUN/Cr >20

Question 32

Indications for carotid endardectomy?

Answer 32

symtpomatic 70-99% stenosis | Asymptomatic 60-99%

Question 33

Which antiarrhythmics have use dependence?

Answer 33

Class IC: flecainide and propafone? - Fast HR → less time to dissociate → higher # blocked Na channels → dec impulse conduction → widening of QRS complex

Question 34

Causes of aortic aneurysms?

Answer 34

Ascending: cystic medial necrosis Descending: atherosclerosis

Question 35

Young women with random chest pain, worse at night, smoker

Answer 35

Prinzmetal angina

Question 36

What is prinzmetal aw/

Answer 36

Raynauds

Question 37

Tx for prinzmetal?

Answer 37

CCB or nitrates

Question 38

What to do if large STEMI at risk for LV thrombus and anteroapical aeurysm formatioN?

Answer 38

- Use TTE to asesss | - Immediate anticaog (risk for embolization)

Question 39

How does NE induced vasospasm work?

Answer 39

If dec bloof flow in patient, NE can cause vasoconstriction resulting in ischemia and necrosis of distal fingers & toes

Question 40

What is a common complication of CABG?

Answer 40

Afib

Question 41

What pw/ strong peripheral artieral pulse (brisk carotid upstroke), systolic flow murmur, flushed extremities, left ventricular hypertrophy?

Answer 41

AVF - shunting dec SVR, inc preload and output

Question 42

What is dressler?

Answer 42

Malaise, fever, inc ESR, autoimmune

Question 43

Tx for dressler

Answer 43

NSAIDs

Question 44

Tx for pulseless electrical activity ?

Answer 44

CPR + vasopressor

Question 45

Tx for PAD

Answer 45

Aspirin + statin + exercise

Question 46

BNP level in CHF?

Answer 46

>100

Question 47

What lab abnormality parallels severity of HF?

Answer 47

Hyponatremia

Question 48

Disease? | Blue toe syndrome, livedo reticualris, bright yellow plaques in retinal artery (hollenhorst plaques) after cardiac cath

Answer 48

Cholesterol embolism Tx: supportive - can go to brain, intestine, pancreas, kidneys

Question 49

Dx? Hepatomegaly, kussmaul, ascites, inc JVP, X&Y descents, hepatojugular reflex, pericardial knock, pericardial calcifications?

Answer 49

Constrictive pericarditis

Question 50

What cause constrictive pericarditis?

Answer 50

Radiation, TB

Question 51

Tx for constrictive pericarditis

Answer 51

Diuretics temporarily, pericardiectomy

Question 52

Medication that causes bradycardia, AV block, hypotension, diffuse wheezing?

Answer 52

Beta blockers

Question 53

Physiology behind MI w/ papillary muscle displacement?

Answer 53

Leads to MR → excessive diastolic volume overload → elevated LVEDP → reflected back in left atrium and pulm circulation → CHF & pulm edema

Question 54

What is a known complication of AAA?

Answer 54

Bowel ischemia - from inadequate colonic collateral arterial perfusion to left and sigmoid colon after loss of IMA - Fever & leukocystosis

Question 55

How to Dx for bowel ischemia?

Answer 55

Abdominal US

Question 56

All patients with systemic HTN should be evaluated for?

Answer 56

Coarctation of aorta

Question 57

What is a reversible cause of restrictive cardiomyopathy?

Answer 57

Hemochromatosis

Question 58

What pw/ dyspnea, epigastric pain, N/V?

Answer 58

Atypical ACS

Question 59

What drug increases digoxin levels?

Answer 59

Amiodarone, verapamil, quinidine

Question 60

Dx? CXR: enlarged, water bottle shaped cardiac silhouette Diminished heart sounds, nonpalpable apical impulse

Answer 60

Pericardial effusion

Question 61

What do you see a dual upstroke to midsystolic obstruction during contraction?

Answer 61

HCM

Question 62

Tx for HCM?

Answer 62

Beta blockers

Question 63

Murmur in aortic dissection?

Answer 63

Aortic regurg: descrescendo diastolic murmur

Question 64

MC risk factor for aortic dissection?

Answer 64

HTN

Question 65

Dx for aortic dissection?

Answer 65

urgent TEE

Question 66

Tx for aortic dissection?

Answer 66

IV labetalol

Question 67

Tx for type A vs B aortic dissection?

Answer 67

A: surgery B: medically

Question 68

What tx for left ventricular systolic dysfunction?

Answer 68

Beta blockers, ACE/ARB, spironolactone African Americans: also hydralazine and nitrates

Question 69

What is resistant HTN?

Answer 69

Persistent despite >3 antihypertensive

Question 70

What disease to think ofwith resistant HTN?

Answer 70

Renal artery stenosis Will hear abdominal bruits

Question 71

How do nitrates cause anti-ischemic effect?

Answer 71

Systemic vasodilation & dec in cardial preload --> less wall stress on left ventricular wall

Question 72

Most effect non-med way to dec BP?

Answer 72

Weight loss

Question 73

What is malignant HTN?

Answer 73

Severe HTN with retinal hemorrhages, exudates, papilledema

Question 74

What has alternating amplitude of QRS complex/

Answer 74

Electrical alternans - pericarditis

Question 75

What bug if endocarditis and nosocomial UTI?

Answer 75

Enterococci

Question 76

Periodontal infection + endocarditis. What bug?

Answer 76

Eikenella

Question 77

Endocarditis + round lesions in peripheral lung fields?

Answer 77

Septic emboli from valvular vegetations

Question 78

Holosystolic murmur that inc with inspiration in endocarditis?

Answer 78

Tricuspid regurg in IVDU

Question 79

Cause of new conduction abnormality in patients with endocarditis?

Answer 79

Perivalvular abscess

Question 80

IVDU + HIV. What do you think?

Answer 80

Endocarditis. HIV increases risk. - May not have tricuspid murmur - Septic pulm emboli - caused by S. aureus

Question 81

How do dx endocarditis?

Answer 81

Serial blood culture (3 from 3 venipuncture sites)

Question 82

Tx for s. aueus endocarditis?

Answer 82

Empiric vanc

Question 83

Tx for HACEK endocarditis?

Answer 83

Ampicillin- sulbactam

Question 84

Tx for viridans endocarditis?

Answer 84

PCN G or ceftriaxone IV

Question 85

What causes S4 gallop during acute phase of MI?

Answer 85

L ventricular wal stiffening and dysfunction

Question 86

What has fibrillatory waves and absence of QRS?

Answer 86

Vfib

Question 87

Tx for Vfib?

Answer 87

Early defib until CPR ongoing then antiarrhythmic

Question 88

Harsh crescendo descresendo murmur at LLSB

Answer 88

HCM

Question 89

MCC of isolated aortic regurg in young adults?

Answer 89

Bicuspid aortic valve

Question 90

What has "pounding heart", widened pulse pressure?

Answer 90

Aortic regurg

Question 91

Early diastolic murmur that is high pitched and sustained or descrendo

Answer 91

Aortic regurg