Cardiology Flashcards
1
Q
AS/PS Murmur (and radiation)
A
Crescendo/Decrescendo systolic murmur at RUSB Radiates to neck
2
Q
MR/TR Murmur (and radiation)
A
Blowing holosystolic heard best at Apex. Radiates to Axilla
3
Q
MS Murmur
A
Diastolic murmur heard best at Apex. Sometimes preceded by opening snap
4
Q
AR Murmur
A
Diastolic decrescendo heard best at LUSB. Sometime s accompanied by Austin Flint Murmur
5
Q
Austin Flint Murmur
A
Late diastolic rumble at apex
6
Q
Mitral Valve Prolapse
A
Systolic crescendo with Mid-systolic click heard best at Apex.
7
Q
ASD Murmur
A
Systolic ejection crescendo decrescendo @ pulmonic area (LUSB) Widely split S2
8
Q
PDA murmur
A
Continuous Machinery Murmur loudest at Pulm area (LUSB)
9
Q
Coarctation Murmur
A
Systolic murmur radiates to back/scapula/chest
10
Q
Coarctation CXR
A
3 sign Rib Notching
11
Q
Tetralogy of Fallot CXR
A
Boot shaped heart
12
Q
4 Parts to Tet of Fallot
A
- RV outflow obstruction (pulm stenosis) 2. RV Hypertrophy 3. VSD 4 Overriding aorta
13
Q
MC site of ASD
A
Ostium Secundum
14
Q
MC CHD
A
VSD
15
Q
VSD murmur
A
Harsh holosystolic at LSB
16
Q
All Diastolic murmurs are _________
A
Pathological
17
Q
If you hear Apex you think ___________
A
Mitral valve
18
Q
LUSB = ________ Area
A
Pulmonic
19
Q
RUSB = _________ Area
A
Aortic
20
Q
Base = _________ Area
A
Aortic
21
Q
LLSB = ________ Area
A
Tricuspid
22
Q
L Mid Axillary line = _______ Area
A
Mitral
23
Q
Aortic Stenosis Symptoms
A
(SAD) Syncope, Angina, Dyspnea
24
Q
When to refer pt w/ Aortic Stenosis
A
When they become symptomatic
25
Anytime they give you a big pulse w/ both a diastolic and systolic murmur think \_\_\_\_\_\_
Aortic regurg
26
Rheumatic Fever is the Most common Etiology of what murmur?
Mitral stenosis
27
Symptoms of Mitral Stenosis
DOE, Orthopnea/PND, Pulm Edema, Angina, Hemoptysis, Hoarsemness
28
If the mitral Valve is stenosed blood will back up into what structure?
L Atrium
29
If blood is backed up into the L atrium due to MS what major organ system will start to dysfunction?
Lungs --\> Pulmonary edema, orthopnea, DOE etc.
30
Most common innocent murmur of childhood
Still's Murmur
31
Musical, short systolic ejection murmur
Still's murmur
32
Acyanotic heart lesions of childhood
ASD VSD PDA Coarctation Aortic Stenosis
33
Disparity of pulses and blood pressure between arms and legs makes you think of which CHD?
Coarctation of the Aorta
34
Cyanotic heart lesions
Tetralogy of Fallot Transposition of the great vessels
35
Three different kinds of cardiomyopathies
Dilated Hypertrophic Restrictive
36
Define Dilated Cardiomyopathy
Dilated and impaired contraction of one or both ventricles -The balloon has lost elasticity
37
Etiologies of dilated cardiomyop.
Viral Genetic ETOH
38
Sx of Dilated Cardiomyop.
The heart can't pump enough out so it becomes congested. -CHF -JVD
39
Management of Dilated cardiomyop
Tx. CHF Eval for transplant
40
Define Hypertrophic Cardiomyopathy
Disorganized hypertrophy of L vent. and occasionally R vent
41
Etiology of Hypertrophic Cardiomyop.
Genetic mutations
42
You hear of a young athlete who falls down on the field and dies suddenly. You think of what?
Hypertrophic
43
EKG of hypertrophic cardiomyop
Prom Q waves P wave abnormalities LAD
44
Tx. of HOCM
B blockers CCB Pacer myectomy or ablation
45
Restrictive cardiomyopathic heart has _____ and _____ \_\_\_\_ Walls
Rigid and stiff ventricular walls
46
Restrictive c-myop. is Rare, or common in the us?
Rare
47
CXR of Dilated cardiomyop
Cardiomegaly
48
CXR of Hypertrophic CM
Normal heart size
49
Deep squats will (Increase or Decrease) HOCM murmur?
Decrease
50
Valsalva will (Increase or Decrease) HOCM murmur?
Increase
51
What is the most common sustained arrhythmia?
Afib
52
Greatest risk of Afib
Stroke (thromboembolism)
53
If patient w/ Afib is asymptomatic, how do we tx?
Anticoagulation Rate control (CCB's, or BB)
54
Name this Rhythm
Describe
Treat
First Degree AV Block
Lengthened PR interval beyond .20
Tx reversible cause such as Ischemia, or meds
55
Name This Rhythm and Treat
Normal Sinus Rhythm
Do Nothing
56
Name This Rhythm
Describe
Treat
2nd degree block; Wenckeback (Mobitz 1)
Progressive PR Prolongation then a drop
Pacemaker if sx bradycardia
57
Name This Rhythm
Describe
Treat
2nd Degree; Mobitz 2
PR intervals are unchanged prior to a nonconducting P wave
Most pt's will require pacing
58
Name this Rhythm
Describe
Treat
Third Degree Block
P Waves dont correlate to QRS
Pacing
59
Name This Rhythm
Describe
Treat
V Tach
Can remain stable or go into torsades or sudden cardiac death
Cardiovert if pt remains unstable, for Torsades Anti-arrhythmics
60
Name this Rhythm
Treat
V Fib
Defibrillate
61
A pt presents with ST elevation in I, aVL, V5 and V6
Where is the STEMI?
Lateral
62
A pt presents with ST Elevation in II, III, and aVF
Where is the STEMI?
Inferior
63
A patient presents with ST Elevation in V1-V4
Where is the STEMI?
Anterior
64
Unless contraindicated all patients with CHF should be on ____ and \_\_\_\_
An ACEI & Diuretic
65
Ace Inhibitors End with
Pril
66
Loop diuretics end with
Mide, or Nide
67
BP = ___ X \_\_\_\_
CO X TPR
68
JNC 8 Goals for BP for Pt \> 60 years old
\< 150/90
69
JNC 8 BP Goal pt \<60 yo
140/90
70
JNC 8 BP goal pt w/ DM and CKD
140/90
71
First line options for HTN w/o comorbid conditions
Thiazides, CCB, ACEI, ARB (all equal choice)
72
First line options for HTN w/ DM or CKD
ACE-I, or ARB (JNC 8 says don't use together)
73
First line adjunct option for pt w/ HTN and Cardiac Hx
BBlocker
74
Where do Thiazide Diurectics work
Distal Tubule
75
When are loop diuretics the preferred diuretic of choice
with CHF and Edema
76
Which kind of diuretic has the risk of gynecomastia associated with it?
Spironolactone
77
What side effect of Ace Inhibitors is most concerning
Angioedema
78
Up to 20% of pts experience this side effect with ACEI's
Cough
79
What do ARB's End with?
Sartan
80
MC cause of heart failure
CAD
81
CHF appearance on CXR
Cardiomegaly
Kerley B lines
Pleural effusions
Pulmonary edema
82
BNP \> ____ means CHF is likely
100
83
Management of acute pulmonary edema/CHF
LMNOP:
Lasix
Morphine
Nitrates
Oxygen
Position
84
Define Hypertensive emergency
Increase BP (\>220/120)
WITH acute target organ damage such as Neuro damage (stroke), Cardiac damage (ACS, aortic diss), Renal damage (AKI), or Retinal Damage (Papilledema)
85
Management of hypertensive emergency
Dec MAP by 10% in first hour and additional 15% next 2-3 hrs using IV agents
86
Define hypertensive Urgency
Inc BP
W/O end organ damage
87
Management of HTN urgency
dec MAP 25% in 24-48hrs using PO agents
88
Drug of choice for PO use in HTN urgency
Clonidine
89
Drug of choice for IV use in HTN emergency
Sodium Nitroprusside
90
Drug of choice for HTN Emergency in Pregnant PT
Methyldopa
91
P's of Pericarditis
Persistent
Pleuritic
Postural pain
Pericardial friction rub
92
MC cause of pericarditis
Viral
93
Pericarditis 2-5 days s/p MI is called
Dressler's Syndrome
94
Managment of acute pericarditis
NSAIDs
Colchicine 2nd line management
Corticosteroids if sx \>48 h and refractiory to 1st line meds
95
Physical exam notes "distant heart sounds" you think of
Pericardial effusion
96
Electrical Alterans on EKG makes you think
Pericardial effusion
97
Beck's Triad
1. Distant (muffled) heart sounds
2. Inc JVP
3. Systemic hypotension
98
Beck's Triad is indicative of
Pericardial tamponade
99
Management of Pericardial tamponade
Immediate pericardiocentesis (window drainage if recurrent)
100
MC valve involved in infective endocarditis (in non-IVDA)
Mitral
101
Valve mc invloved in infective endocarditis in an IVDA
Tricuspid
102
MC pathogen in IVDA endocarditis
MRSA
103
MC pathogen in acute bacterial endocarditis
S. aureus
104
MC organism in subacute bacterial endocarditis
S. viridans
105
Peripheral manifestations of Infective endocarditis
Janeway lesions: erythematous macules on palms and soles
Roth spots: Petechiae on conjunctiva and plate
Osler Nodes: Tender nodules on pads of digits
Splinter hemorrhages
106
Empiric Tx of Native valve ABE
Nafcillin + Gentamycin x 4-6wks
OR
Vanco (if MRSA suspect)
107
Management of native valve SBE
Penicillin/ampicillin + Gent.
Vanco in IVDA
108
Define intermittent claudication:
Reproducible pain/discomfort in LE brought on by exercise/walking and relieved w/ rest
109
Normal ABI
1-1.2
110
PAD if ABI \< \_\_\_?
.90
111
Severe PAD if ABI \_\_\_\_
0.50
112
GOLD standard for diagnosis of PAD
arteriography
113
Mainstay of tx for PAD
Cilostazole
114
What measurement of a AAA is considered aneurysmal?
\>3.0cm
115
MC location of AAA
Infrarenal
116
Gold standard test for AAA
Angiography
117
When do we operate on AAA?
\>5.5cm OR \>0.5 expansion in 6mo OR symptomatic
118
When do we refer to Vasc. Surgery for AAA
\>4.5cm
119
What do we do with a 4-4.5 cm AAA?
Monitor by US q6mo
120
What do we do with a 3-4cm AAA?
Monitor by US q1yr.
121
MC site for aortic dissection
ascending aorta
122
A pt presents w/ sudden onset of severe, tearing chest and uppoer back pain, you think \_\_\_\_\_
Aortic dissection
123
CXR of Aortic Dissection
Widening of mediastium
But 10% are normal so doesn't rule out
124
Gold standard test for Aortic Dissection
MRI Angiography
125
Name the Debakey Type and Stanford class of this AD
What is the recommended management
Debakey I
Stanford A
Surgical managment ASAP
126
Name Debakey Type and Stanford Class
What is the recommended managment
Debakey II
Stanford A
Surgical Management
127
Name Debakey type and Stanford Class of pictured AD
Recommended Management?
Debakey III
Stanford B
If no complications med management w/ BB (non-selective Labetalol), and sodium nitroprusside if needed
If complications - surgical management
128
Pt presents w/ HA, scalp tenderness, jaw claudication, fever, and vision loss, and a thick rope like temporal artery. What do you think of?
Giant Cell Arteritis
129
Managment of GCA
High dose corticosteroids w/ gradual tapering based on sx and ESR.
130
Virchow's Triad
1. Venous stasis (car ride \>4hr, bed rest)
2. Endothelial damage (low leg injury)
3. Hypercoagulability (Malignancy, pregnancy, OCP)
131
Gold standard diagnostic test for DVT
Venography:
132
First line Imaging test for DVT
Duplex ultrasound
133
Tx of DVT
1. Heparin, LMWH
2. Warfarin x 3-6mos for first event.
Consider lifelong Warfarin for pt/s w/ recurrent
134
Inferior Wall (RCA) infarct seen on EKG
II, III, aVF
135
Septal Wall (LAD) EKG Correlation w/ MI
V1 (+/- V2)
136
Anterior Wall (LAD) ECG correlation w/ MI
V2-V4
137
Lateral wall (Circ usually) ECG Correlation w/ MI
I, aVL (+/- V5, V6)
138
When to use Thrombolytics w/ MI
ONLY W/ STEMI!!!
Contraindicated in anyone that bleeds
139
Most effective managment of MI is
PCI
140
When must PCI be initiated
w/ in 90 minutes
