Cardiology

Question 1

Treatments for unstable bradycardia

Answer 1

Atropine: decrease vagal tone, improve a/v conduction
Epinephrine or Dopamine infusion: Beta agonists
Transcutaneous Pacing

Question 2

Treatment for tachycardia
Unstable?
Wide QRS?
Narrow complex QRS?

Answer 2

Unstable: synchronized cardioversion (Adenosine if narrow)
Wide: Amiodarone, Lidocaine/Procainamide
Narrow: Vagal maneuvers, Adenosine, BB/CCB

Question 3

Artery that supplies inferior portion of heart

EKG leads?

Answer 3

Right coronary artery

II, III, avF

Question 4

Dresslers Syndrome

Answer 4

Post-MI pericarditis, fever, pulmonary infiltrates

Treat with ASA, cholchicine

Question 5

Systolic HF vs Diastolic HF

Answer 5

Systolic: LVEF decreased, s3 gallop, more common
Diastolic: Normal EF/ s4 gallop

Question 6

Medications that decrease mortality in HF

Answer 6

ACEI/ARBs, BB’s, nitrates + hydralazine, spironolactone

Question 7

Pericarditis signs and symptoms

Answer 7

persistent, pleuritic, postural pain and pericardial friction rub, +/- fever

Question 8

EKG finding with Pericardial effusion

Answer 8

low voltage QRS comples or electrical alternans

Question 9

Pericardial tamponade manifestations

Answer 9

Becks Triad: distant heart sounds, inc. JVP, hypotension
Pulsus paradoxus
Dyspnea, fatigue, edema

Question 10

Dyspnea, right sided HF, JVD during inspiration (Kussmauls), pericardial knock

Answer 10

Constrictive pericarditis

Question 11

Most common cause of pericarditis and myocarditis

Answer 11

Enteroviruses (coxsackie, echo)

Question 12

Cardiomyopathy with systolic dysfunction

Answer 12

Dilated Cardiomyopathy

Question 13

Most common cause of restrictive cardiomyopathy

Answer 13

Amyloidosis

Question 14

Echocardiogram findings of Restrictive cardiomyopathy, hypertrophic cardiomyopathy

Answer 14

Restrictive: Ventricles nondilated, normal wall thickness, dilation of both atria
Hypertrophic: Asymmetric wall thickness (septal)

Question 15

Most common complication of Rheumatic fever

Answer 15

Mitral valve disease (Mitral Stenosis)

Question 16

Jones Criteria

Answer 16

Rheumatic fever diagnosis
2 major or 1 major + 2 minor criteria
Major: Polyarthritis, carditis, sydenhams chorea, erythema marginatum, subQ nodules

Minor: fever, arthralgias, elevated ESR/CRP, prolong PR interval

Question 17

Ejection click

Answer 17

Mitral valve prolapse

Question 18

Opening snap

Answer 18

Mitral Stenosis

Question 19

Tetralogy of Fallot

Answer 19

1. RV outflow obstruction
2. RV hypertrophy
3. VSD
4. Overriding Aorta

Right to left shunt (cyanosis)

Bootshaped heart on CXR

Question 20

“egg on a string” CXR finding

Answer 20

Transposition of Great Vessels

Question 21

1st line treatment HTN in african americans

Answer 21

Diuretics or CCB

Question 22

Dihydrpyridines

Answer 22

amlodopine, nifedipine: vasodilators with no effect on contractility or conduction

Question 23

Hypertensive Emergency and management

Answer 23

> 220/120 + target organ damage

Decrease BP by 10% first hour, 15% next 2-3 hours (IV meds!)

Question 24

Hypertensive Urgency and management

Answer 24

Elevated BP, no target organ damage

Decrease BP by 25% in 1-2 days (PO meds!)

Question 25

Most effective agent for increasing HDL

Answer 25

Niacin

Question 26

Endocarditis: Most common valve involved in IVDA

Answer 26

Tricuspid valve (Mitral valve in other types)

Question 27

Most common cause of acute bacterial endocarditis?

Subacute? Treatment?

Answer 27

Acute: S. Aureus, Nafcillin + Gentamicin 4-6 weeks
Subacute: S. Viridians, PCN/Amp + Gentamicin

Question 28

Painless erythemateous macules on palms/soles

Answer 28

Janeway lesions

Question 29

Tender nodules on pads of digits

Answer 29

Oslers Nodes

Question 30

Diagnosis for Endocarditis

Answer 30

Modified Duke Criteria:
2 major or 1 major + 3 minor

Major: 2 + cultures with common organism, + echocardiogram or new AR, MR
Minor: Predisposing condition, fever, vascular phenomena, immunologic phenomena, + culture with uncommon organsim, + echocardiogram not meeting criteria

Question 31

Endocarditis prosthetic valve: organism and treatment

Answer 31

S. epidermis

Vanco + Gentamicin + Rifamipin

Question 32

Most common vessel involed in peripheral arterial disease

Answer 32

Femoral and popliteal (80-90%)

Question 33

Which vessel is involved if patient has buttock/thigh pain, impotence and decreased femoral pulses

Answer 33

Aortic bifurcation/common iliac

Question 34

Ankle brachial index score with PAD

Answer 34

<0.9

Question 35

Most common area for aortic dissection

Answer 35

Asecending (highest mortality)

Anterior chest pain, new onset AR

Question 36

Which disease is present in 50% of Giant cell arteritis cases

Answer 36

Polymyalgia rheumatica

Question 37

20-45 y/o male smoker with tender nodules along venous distruction, digit/toe ischemia, raynauds

Answer 37

Thromboangiitis obliterans (buerger disease)

Question 38

Most common location for VENOUS ulcers

Answer 38

Medial malleolus

Question 39

Widely split fixed splitting s2

Answer 39

ASD

Question 40

Causes of Obstructive shock

Answer 40

PE, pericardial tamponade, tension PTX, aortic dissection (proximal)

Question 41

Septic Shock definition

Answer 41

Sepsis (SIRS + infection focus) + refractory hypotension

SIRS= Elevated Temp, pulse, RR, WBC (2 of 4)

Question 42

Hallmark of Distributive Shock

Answer 42

Decrease CO, SVR, PCWP (early septic shock is elevated CO)

Question 43

Kussmauls sign

Answer 43

Increase in JVP with inspiration. Seen in Cardiac tamponade

Question 44

Greater/less saphenous vein is apart of which venous system

Answer 44

Superficial