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PANCE study guide > Cardiology > Flashcards

Cardiology Flashcards

1
Q

AS/PS Murmur (and radiation)

A

Crescendo/Decrescendo systolic murmur at RUSB Radiates to neck

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2
Q

MR/TR Murmur (and radiation)

A

Blowing holosystolic heard best at Apex. Radiates to Axilla

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3
Q

MS Murmur

A

Diastolic murmur heard best at Apex. Sometimes preceded by opening snap

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4
Q

AR Murmur

A

Diastolic decrescendo heard best at LUSB. Sometime s accompanied by Austin Flint Murmur

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5
Q

Austin Flint Murmur

A

Late diastolic rumble at apex

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6
Q

Mitral Valve Prolapse

A

Systolic crescendo with Mid-systolic click heard best at Apex.

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7
Q

ASD Murmur

A

Systolic ejection crescendo decrescendo @ pulmonic area (LUSB) Widely split S2

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8
Q

PDA murmur

A

Continuous Machinery Murmur loudest at Pulm area (LUSB)

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9
Q

Coarctation Murmur

A

Systolic murmur radiates to back/scapula/chest

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10
Q

Coarctation CXR

A

3 sign Rib Notching

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11
Q

Tetralogy of Fallot CXR

A

Boot shaped heart

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12
Q

4 Parts to Tet of Fallot

A
  1. RV outflow obstruction (pulm stenosis) 2. RV Hypertrophy 3. VSD 4 Overriding aorta
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13
Q

MC site of ASD

A

Ostium Secundum

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14
Q

MC CHD

A

VSD

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15
Q

VSD murmur

A

Harsh holosystolic at LSB

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16
Q

All Diastolic murmurs are _________

A

Pathological

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17
Q

If you hear Apex you think ___________

A

Mitral valve

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18
Q

LUSB = ________ Area

A

Pulmonic

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19
Q

RUSB = _________ Area

A

Aortic

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20
Q

Base = _________ Area

A

Aortic

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21
Q

LLSB = ________ Area

A

Tricuspid

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22
Q

L Mid Axillary line = _______ Area

A

Mitral

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23
Q

Aortic Stenosis Symptoms

A

(SAD) Syncope, Angina, Dyspnea

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24
Q

When to refer pt w/ Aortic Stenosis

A

When they become symptomatic

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25
Q

Anytime they give you a big pulse w/ both a diastolic and systolic murmur think ______

A

Aortic regurg

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26
Q

Rheumatic Fever is the Most common Etiology of what murmur?

A

Mitral stenosis

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27
Q

Symptoms of Mitral Stenosis

A

DOE, Orthopnea/PND, Pulm Edema, Angina, Hemoptysis, Hoarsemness

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28
Q

If the mitral Valve is stenosed blood will back up into what structure?

A

L Atrium

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29
Q

If blood is backed up into the L atrium due to MS what major organ system will start to dysfunction?

A

Lungs –> Pulmonary edema, orthopnea, DOE etc.

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30
Q

Most common innocent murmur of childhood

A

Still’s Murmur

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31
Q

Musical, short systolic ejection murmur

A

Still’s murmur

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32
Q

Acyanotic heart lesions of childhood

A

ASD VSD PDA Coarctation Aortic Stenosis

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33
Q

Disparity of pulses and blood pressure between arms and legs makes you think of which CHD?

A

Coarctation of the Aorta

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34
Q

Cyanotic heart lesions

A

Tetralogy of Fallot Transposition of the great vessels

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35
Q

Three different kinds of cardiomyopathies

A

Dilated Hypertrophic Restrictive

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36
Q

Define Dilated Cardiomyopathy

A

Dilated and impaired contraction of one or both ventricles -The balloon has lost elasticity

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37
Q

Etiologies of dilated cardiomyop.

A

Viral Genetic ETOH

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38
Q

Sx of Dilated Cardiomyop.

A

The heart can’t pump enough out so it becomes congested. -CHF -JVD

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39
Q

Management of Dilated cardiomyop

A

Tx. CHF Eval for transplant

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40
Q

Define Hypertrophic Cardiomyopathy

A

Disorganized hypertrophy of L vent. and occasionally R vent

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41
Q

Etiology of Hypertrophic Cardiomyop.

A

Genetic mutations

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42
Q

You hear of a young athlete who falls down on the field and dies suddenly. You think of what?

A

Hypertrophic

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43
Q

EKG of hypertrophic cardiomyop

A

Prom Q waves P wave abnormalities LAD

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44
Q

Tx. of HOCM

A

B blockers CCB Pacer myectomy or ablation

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45
Q

Restrictive cardiomyopathic heart has _____ and _____ ____ Walls

A

Rigid and stiff ventricular walls

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46
Q

Restrictive c-myop. is Rare, or common in the us?

A

Rare

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47
Q

CXR of Dilated cardiomyop

A

Cardiomegaly

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48
Q

CXR of Hypertrophic CM

A

Normal heart size

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49
Q

Deep squats will (Increase or Decrease) HOCM murmur?

A

Decrease

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50
Q

Valsalva will (Increase or Decrease) HOCM murmur?

A

Increase

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51
Q

What is the most common sustained arrhythmia?

A

Afib

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52
Q

Greatest risk of Afib

A

Stroke (thromboembolism)

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53
Q

If patient w/ Afib is asymptomatic, how do we tx?

A

Anticoagulation Rate control (CCB’s, or BB)

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54
Q

Name this Rhythm

Describe

Treat

A

First Degree AV Block

Lengthened PR interval beyond .20

Tx reversible cause such as Ischemia, or meds

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55
Q

Name This Rhythm and Treat

A

Normal Sinus Rhythm

Do Nothing

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56
Q

Name This Rhythm

Describe

Treat

A

2nd degree block; Wenckeback (Mobitz 1)

Progressive PR Prolongation then a drop

Pacemaker if sx bradycardia

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57
Q

Name This Rhythm

Describe

Treat

A

2nd Degree; Mobitz 2

PR intervals are unchanged prior to a nonconducting P wave

Most pt’s will require pacing

58
Q

Name this Rhythm

Describe

Treat

A

Third Degree Block

P Waves dont correlate to QRS

Pacing

59
Q

Name This Rhythm

Describe

Treat

A

V Tach

Can remain stable or go into torsades or sudden cardiac death

Cardiovert if pt remains unstable, for Torsades Anti-arrhythmics

60
Q

Name this Rhythm

Treat

A

V Fib

Defibrillate

61
Q

A pt presents with ST elevation in I, aVL, V5 and V6

Where is the STEMI?

A

Lateral

62
Q

A pt presents with ST Elevation in II, III, and aVF

Where is the STEMI?

A

Inferior

63
Q

A patient presents with ST Elevation in V1-V4

Where is the STEMI?

A

Anterior

64
Q

Unless contraindicated all patients with CHF should be on ____ and ____

A

An ACEI & Diuretic

65
Q

Ace Inhibitors End with

A

Pril

66
Q

Loop diuretics end with

A

Mide, or Nide

67
Q

BP = ___ X ____

A

CO X TPR

68
Q

JNC 8 Goals for BP for Pt > 60 years old

A

< 150/90

69
Q

JNC 8 BP Goal pt <60 yo

A

140/90

70
Q

JNC 8 BP goal pt w/ DM and CKD

A

140/90

71
Q

First line options for HTN w/o comorbid conditions

A

Thiazides, CCB, ACEI, ARB (all equal choice)

72
Q

First line options for HTN w/ DM or CKD

A

ACE-I, or ARB (JNC 8 says don’t use together)

73
Q

First line adjunct option for pt w/ HTN and Cardiac Hx

A

BBlocker

74
Q

Where do Thiazide Diurectics work

A

Distal Tubule

75
Q

When are loop diuretics the preferred diuretic of choice

A

with CHF and Edema

76
Q

Which kind of diuretic has the risk of gynecomastia associated with it?

A

Spironolactone

77
Q

What side effect of Ace Inhibitors is most concerning

A

Angioedema

78
Q

Up to 20% of pts experience this side effect with ACEI’s

A

Cough

79
Q

What do ARB’s End with?

A

Sartan

80
Q

MC cause of heart failure

A

CAD

81
Q

CHF appearance on CXR

A

Cardiomegaly

Kerley B lines

Pleural effusions

Pulmonary edema

82
Q

BNP > ____ means CHF is likely

A

100

83
Q

Management of acute pulmonary edema/CHF

A

LMNOP:

Lasix

Morphine

Nitrates

Oxygen

Position

84
Q

Define Hypertensive emergency

A

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
Q

Management of hypertensive emergency

A

Dec MAP by 10% in first hour and additional 15% next 2-3 hrs using IV agents

86
Q

Define hypertensive Urgency

A

Inc BP

W/O end organ damage

87
Q

Management of HTN urgency

A

dec MAP 25% in 24-48hrs using PO agents

88
Q

Drug of choice for PO use in HTN urgency

A

Clonidine

89
Q

Drug of choice for IV use in HTN emergency

A

Sodium Nitroprusside

90
Q

Drug of choice for HTN Emergency in Pregnant PT

A

Methyldopa

91
Q

P’s of Pericarditis

A

Persistent

Pleuritic

Postural pain

Pericardial friction rub

92
Q

MC cause of pericarditis

A

Viral

93
Q

Pericarditis 2-5 days s/p MI is called

A

Dressler’s Syndrome

94
Q

Managment of acute pericarditis

A

NSAIDs

Colchicine 2nd line management

Corticosteroids if sx >48 h and refractiory to 1st line meds

95
Q

Physical exam notes “distant heart sounds” you think of

A

Pericardial effusion

96
Q

Electrical Alterans on EKG makes you think

A

Pericardial effusion

97
Q

Beck’s Triad

A
  1. Distant (muffled) heart sounds
  2. Inc JVP
  3. Systemic hypotension
98
Q

Beck’s Triad is indicative of

A

Pericardial tamponade

99
Q

Management of Pericardial tamponade

A

Immediate pericardiocentesis (window drainage if recurrent)

100
Q

MC valve involved in infective endocarditis (in non-IVDA)

A

Mitral

101
Q

Valve mc invloved in infective endocarditis in an IVDA

A

Tricuspid

102
Q

MC pathogen in IVDA endocarditis

A

MRSA

103
Q

MC pathogen in acute bacterial endocarditis

A

S. aureus

104
Q

MC organism in subacute bacterial endocarditis

A

S. viridans

105
Q

Peripheral manifestations of Infective endocarditis

A

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
Q

Empiric Tx of Native valve ABE

A

Nafcillin + Gentamycin x 4-6wks

OR

Vanco (if MRSA suspect)

107
Q

Management of native valve SBE

A

Penicillin/ampicillin + Gent.

Vanco in IVDA

108
Q

Define intermittent claudication:

A

Reproducible pain/discomfort in LE brought on by exercise/walking and relieved w/ rest

109
Q

Normal ABI

A

1-1.2

110
Q

PAD if ABI < ___?

A

.90

111
Q

Severe PAD if ABI ____

A

0.50

112
Q

GOLD standard for diagnosis of PAD

A

arteriography

113
Q

Mainstay of tx for PAD

A

Cilostazole

114
Q

What measurement of a AAA is considered aneurysmal?

A

>3.0cm

115
Q

MC location of AAA

A

Infrarenal

116
Q

Gold standard test for AAA

A

Angiography

117
Q

When do we operate on AAA?

A

>5.5cm OR >0.5 expansion in 6mo OR symptomatic

118
Q

When do we refer to Vasc. Surgery for AAA

A

>4.5cm

119
Q

What do we do with a 4-4.5 cm AAA?

A

Monitor by US q6mo

120
Q

What do we do with a 3-4cm AAA?

A

Monitor by US q1yr.

121
Q

MC site for aortic dissection

A

ascending aorta

122
Q

A pt presents w/ sudden onset of severe, tearing chest and uppoer back pain, you think _____

A

Aortic dissection

123
Q

CXR of Aortic Dissection

A

Widening of mediastium

But 10% are normal so doesn’t rule out

124
Q

Gold standard test for Aortic Dissection

A

MRI Angiography

125
Q

Name the Debakey Type and Stanford class of this AD

What is the recommended management

A

Debakey I

Stanford A

Surgical managment ASAP

126
Q

Name Debakey Type and Stanford Class

What is the recommended managment

A

Debakey II

Stanford A

Surgical Management

127
Q

Name Debakey type and Stanford Class of pictured AD

Recommended Management?

A

Debakey III

Stanford B

If no complications med management w/ BB (non-selective Labetalol), and sodium nitroprusside if needed

If complications - surgical management

128
Q

Pt presents w/ HA, scalp tenderness, jaw claudication, fever, and vision loss, and a thick rope like temporal artery. What do you think of?

A

Giant Cell Arteritis

129
Q

Managment of GCA

A

High dose corticosteroids w/ gradual tapering based on sx and ESR.

130
Q

Virchow’s Triad

A
  1. Venous stasis (car ride >4hr, bed rest)
  2. Endothelial damage (low leg injury)
  3. Hypercoagulability (Malignancy, pregnancy, OCP)
131
Q

Gold standard diagnostic test for DVT

A

Venography:

132
Q

First line Imaging test for DVT

A

Duplex ultrasound

133
Q

Tx of DVT

A
  1. Heparin, LMWH
  2. Warfarin x 3-6mos for first event.

Consider lifelong Warfarin for pt/s w/ recurrent

134
Q

Inferior Wall (RCA) infarct seen on EKG

A

II, III, aVF

135
Q

Septal Wall (LAD) EKG Correlation w/ MI

A

V1 (+/- V2)

136
Q

Anterior Wall (LAD) ECG correlation w/ MI

A

V2-V4

137
Q

Lateral wall (Circ usually) ECG Correlation w/ MI

A

I, aVL (+/- V5, V6)

138
Q

When to use Thrombolytics w/ MI

A

ONLY W/ STEMI!!!

Contraindicated in anyone that bleeds

139
Q

Most effective managment of MI is

A

PCI

140
Q

When must PCI be initiated

A

w/ in 90 minutes

PANCE study guide (14 decks)

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