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MS3 Year > Cardiology > Flashcards

Cardiology Flashcards

1
Q

You want a stress test, but the pt has heart failure, so what kind of stress test do you do?

A

Nuclear

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2
Q

Wide pulse pressure, water-hammer pulses (bounding), quincke pulse (nailbeds), head bobbing, dx?

A

aortic regurgiation

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3
Q

Name 4 categories of etiologies of pericardial disease

A

Infxn (viral, bacterial, fungal, TB); autoimmune (RA, SLE, Dressler’s, Uremia); Trauma (penetrating, blunt, aortic dissection); Cancer (breast, lung, esophageal, lymphoma)

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4
Q

What hypertension meds can cause peripheral edema?

A

CCBs

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5
Q

How do you treat a restrictive cardiomyopathy?

A

Beta blockers (diastolic heart failure)

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6
Q

Which cause of syncope presents with prodrome?

A

Vasovagal

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7
Q

What’s the magic time where you give tPA rather than transport for PCI in STEMI?

A

60 minutes

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8
Q

ST segment elevation everywhere indicates? (other finding?)

A

pericarditis; PR depressions

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9
Q

How can you prevent vasovagal?

A

beta blockers (controversial) - counter pressure techniques are better

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10
Q

A cath is perforemd and there’s 3 vessel disease. What’s the next step?

A

CABG

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11
Q

Teenager who gets profound dyspnea while playing a sport, dx?

A

HOCM

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12
Q

What are the four medications everyone with CAD should be on?

A

Aspirin, statin, ace-inhibitor, and beta blocker (ABAS)

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13
Q

Treatment for HOCM?

A

Beta blockers (avoid exercise and dehydration)

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14
Q

What test do you do before replacing aortic valve?

A

Left heart cath (you may need a CABG)

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15
Q

How do you check for statin hepatitis?

A

LFTs

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16
Q

A pregnant woman has a rumbling systolic murmur with an opening snap. Dx?

A

Mitral valve prolapse (sounds like mitral regurg, but maneuvers are different - more blood in heart decreases MVP murmur)

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17
Q

What can you use to correct orthostatic hypotension if rehydration/transfusion fails?

A

Steroids

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18
Q

What is the additional tx in stage 4 HF?

A

Pressors (stage IV = severe limitaitons, pt is dyspneic at rest)

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19
Q

Treatment for pericarditis with renal failure and diarrhea?

A

prednisone

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20
Q

Name 4 causes of dilated cardiomyopathy

A

virus, EtOH, ischemia, chemo

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21
Q

You want a stress test, but the pt has a history of a CABG, so what kind of stress test do you do?

A

Nuclear (done in pts with CABG, baseline wall defects, LBB)

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22
Q

Peristernal knock with restrictive physiology indicates?

A

Constrictive pericarditis

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23
Q

How do you diagnose pericardial effusion, tamponade, and constrictive pericardiits?

A

Echo

pericarditis with EKG or MRI

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24
Q

Treatment for pericarditis?

A

NSAIDs (+ colchicine) (avoid steroids b/c it increases recurrence)

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25
Q

How do you tx a symptomatic sinus bradycardia?

A

atropine (stable), pace (unstable), and fix underlying cause

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26
Q

Squat makes which murmurs louder?

A

Squat increases blood in heart

MS, MR, AR, and AS are all louder (MVP and HOCM are quieter)

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27
Q

Describe the chest pain in pericarditis (2)

A

pleurtic and positional

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28
Q

A pt is in 3rd degree block, what do you do?

A

pace (not shock)

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29
Q

Name 5 causes of restrictive cardiomyopathy?

A

Amyloid, sarcoid, hemochromatosis, cancer, and fibrosis

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30
Q

A person comes into the ED with chest pain; what do you give them first?

A

aspirin (not nitro)

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31
Q

What side effects do statins cause?

A

myositis, hepatitis

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32
Q

Pulsus paradoxus greater than 10 mmHg, is most likely?

A

Cardiac tamponade

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33
Q

Septic shock from aortic insufficiency gets?

A

intra aortic balloon pump

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34
Q

Aside from clinically, how can vasovagal be diagnosed?

A

tilt-table test

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35
Q

How do you treat SVT?

A

adenosine (stable), cardioversion (unstable)

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36
Q

You want a stress test, but the person has a reason they can’t walk. What kind of stress test do you do?

A

Pharmacologic stress test (dobutamine or adenosine)

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37
Q

Aside from volume down, what is another cause of orthostatic hypotension?

A

Autonomic nervous system dysfunction (due to age, diabetes, Shy-Drager (Parkinsons))

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38
Q

Ezetimibe side effects?

A

Diarrhea

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39
Q

Guy passes out while shoveling snow. What’s the cause of his syncope?

A

Aortic stenosis

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40
Q

A person calls EMS with chest pain and known coronary artery disease; what’s the first step?

A

Nitro (not aspirin)

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41
Q

What defines orthostatic hypotension?

A

change in systolic of greater than 20, diastolic of 10, HR of 15

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42
Q

You suspect CHF; what blood test do you get?

A

BNP (brain natriuretic peptide)

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43
Q

Systolic BP greater than 180 sytolic, but no end organ damage = ? How do you treat?

A

Hypertensive urgency; oral medications

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44
Q

You come upon an unresponsive pt, what is the FIRST thing you do?

A

check a pulse (not airway, not arousal)

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45
Q

Passing out after a long coughing fit, lung cancer - what’s the diagnosis?

A

vasovagal syncope

46
Q

How long do you keep patient on clopidogrel for a bare-metal stent? Drug-eluding stent?

A

1 month bare metal; 1 year for drug eluting (not needed in angioplasty)

47
Q

What hypertension medication can cause hyperkalemia?

A

ACE-i, ARB

48
Q

What is the difference btwn a grade III murmur and grade IV?

A

III: S1, S2 are quieter than murmur
IV: there’s a palpable thrill
(grade V: can still hear with 1/2 stethoscope off chest)

49
Q

What is Beck’s triad and what does it indicate?

A

JVD + hypotension + decreased heart sounds = cardiac tamponade

50
Q

Which cholesterol drug decreases LDL and TG?

51
Q

What is the JNC-8 recommendation for BP levels?

A

Gt 60 with no disease BP under 150/90; everyone else under 140/90

52
Q

Name 5 causes of syncope

A

vasovagal, orthostatic, mechanical cardiac (HOCM, AS, saddle embolus, left atrial myxoma), arrythmia, neurogenic (poor perfusion to the brain)

53
Q

Old man passes out while shoveling snow; what’s the most likely murmur?

A

Aortic stenosis

54
Q

You diagnose mitral valve regurgitation; what’s the most likely cause?

A

Papillary muscle rupture

55
Q

What is the first test you get when considereing CHF? What is the next? What is the best?

A

BNP; Echo; Angiogram (LVgram - invasive and generally not needed)

56
Q

How do you treat dilated cardiomyopathy?

A

beta blockers, ace-inhibitors, and diuretics (treat it like systolic dysfunction)

57
Q

How do you treat vtach?

A

amiodarone (stable), cardioversion (unstable)

58
Q

What’s the next step if you find someone who is orthostatic?

59
Q

What earns you the title of stage I hypertension? Stage II? Urgency? Emergency?

A

greater than 140/90; gt 160/100; gt 180/110; end organ damage

60
Q

What are the three presentations of typical angina?

A

Substernal, worse w/exertion, and relieved by NTG (2/3 = atypical; 0-1/3 = non-anginal)

61
Q

Treatment for pericarditis with renal failure?

A

Colchicine

62
Q

What drugs does patient get when having MI (8)?

A

MONA BASH
morphine, oxygen, nitrates, aspirin
Beta-blocker, ace-inhibitor, statin, heparin
(there are exceptions!)

63
Q

PR segment depression indicates?

A

pericarditis

64
Q

SV is determined by __ and __

A

contractility and preload

65
Q

Tx in stage 2 HF?

A

BB + ACE + loop diuretic

66
Q

Pt has diabetes and hypertension, what type of statin does he need?

A

High potency statin (atorva/rosuva)

67
Q

Cresendo-decrescendo murmur right sternal border?

A

Aortic stenosis

68
Q

What hypertension med can cause hypokalemia?

A

Thiazide diuretics

69
Q

How do you tx CHF exacerbation?

A

LMNOP

lasix (IV), morphine, nitrates (last two are venodilators, can help with dyspnea), oxygen, position (upright)

70
Q

What is the treatment for everyone with HF?

71
Q

Valsalva maneuver makes which murmurs louder?

A

valsalva decreases blood in heart

MVP and HOCM are louder

72
Q

A cath is perforemd and the LAD and left circumflex are blocked. What’s the next step?

A

CABG (do CABG instead of stent when multi-vessels or left mainstem equivalent is blocked)

73
Q

What is the door to balloon time?

A

90 minutes

74
Q

Which syncopes present with sudden onset and no prodrome?

A

Arrythmia and neurogenic

75
Q

Treatment for constrictive pericarditis?

A

Pericardiectomy

76
Q

Dyspnea on exertion, worsening orthopnea, paroxysmal nocturnal dyspnea - diagnosis?

A

Congestive heart failure

77
Q

Which rhythms can you NOT shock in a code?

A

all rhythms that are not vtach, vfib

78
Q

What are the JNC-8 guidelines for which medications to use in HTN (4)?

A
  • CCB (dipines), thiazide, ACEI/ARBs
  • but if old (gt 75) or black no ACE/ARB
  • unless you have CKD then you get an ACE/ARB
  • No beta blockers!
79
Q

What’s the difference btwn HOCM and concentric hypertorphic cardiomyopathy on echo?

A 
HOCM = asymmetric hypertrophy of the septum
Concentric = concentric hypertrophy
80
Q

How do you tx pericarditis? effusion? tamponade? constrictive?

A

anti-inflammatories (hemodialysis for uremia); pericardial window; pericardiocentesis, pericardiectomy

81
Q

How do you check for statin myositits?

82
Q

CO = __ x ___

83
Q

Patient comes in with chest pain and EKG is negative, troponins are negative, what is next step?

A

Stress test (could have some degree of myocardial ischemia due to unstable angina and may still need to go to cath lab electively)

84
Q

Name 8 causes of secondary hypertension

A

HH HARP CO
Hypercalcemia, Hyperthryoid, Hyperaldost (Conn’s), Aortic coarctation, Renovascular (2ndary), Pheocromocytoma, Cushings, OSA

85
Q

How do you definitevely diagnose a heart murmur?

86
Q

Patient comes in with chest pain and EKG is negative, next step?

A

Troponins (could be NSTEMI)

87
Q

You suspect CHF exacerbation, what’s the first step? ANd the next 3?

A

ECG (to rule out arrythmia and infarction); troponins, BNP, and CXR (to look for volume overload)

88
Q

Which murmurs need to be investigated?

A

Any diastolic murmur, and any systolic murmur greater than 3/6

89
Q

Name the main cause of concentric hypertrophic cardiomyopathy?

90
Q

Pericardial knock, dx?

A

constrictive pericarditis

91
Q

What class of medication prevents death in the first 24 hours post MI?

A

beta blockers

92
Q

MAP = __ x ___

93
Q

Bile-acid resins side effect?

94
Q

What medications do you give if there’s volume overload in a CHF patient?

A

Loop diuretics (IV in exacerbation, PO if not exacerbated)

95
Q

Echo shows restrictive cardiomyopathy, what step do you take to diagnose amyloid? sarcoid? hemachromatosis?

A

amyloid: fat pad biopsy (or gingival bx)
sarcoid: cardiac MRI then endomyocardial bx
hemachromatosis: ferritin level, then genetics

96
Q

Really high blood pressure with chest pain and an elevated creatinine get?

A

IV meds - hypertensive emergency (IV nitrates, CCBs, or BBs)

97
Q

At what ejection fraction should someone be considered for AICD placement?

A

EF less than 35% (and not in stage IV HF)

98
Q

Most common causes of pericarditis in US (2)?

A

viral, uremia

99
Q

?You suspect CHF; which imaging should you order?

A

2D Echo (aka Echocardiogram)

100
Q

In a question about a code, there’s always one answer that’s right every time. What is it?

A

compressions

101
Q

How do you get rid of niacin induced flush? What is niacin’s good effects?

A

aspirin; increases HDL and lowers LDL

102
Q

Absence of these 3 physical signs help point to CAD induced chest pain

A

nonpositional, nonpleuritic, nontender

103
Q

If your LDL is between 70-189, you have no vascular disease (CVA, PVD, CAD), and you are 40-75, name two things that would put you on a statin

A

diabetes; calculated 10 year risk greater than 7.5% (based on HTN, smoking, obesity, age)

104
Q

A patient is in afib and in shock, what do you do?

A

shock them (even not anticoagulated)

105
Q

Tx in stage 3 HF?

A

BB + ACE + loops + hydralazine/isosorbide dinitrate and spirinolactone or eplerenone

106
Q

Diastolic murmur with opening snap?

A

Mitral stenosis

107
Q

What hypertension med can cause a slow heart rate?

A

beta blockers

108
Q

If you diagnose pericardial tamponade you should do what? What can you do while waiting to relieve symptoms?

A

Pericardiocentesis; IVF (increase preload to open up right ventricle)

109
Q

Recurrent pericardial effusion gets what?

A

pericardial window (cut a piece of pericardium out so fluid can drain) (to tx pericardial effusion normally, tx the pericarditis)

110
Q

Which cholesterol drugs increase HDL? Increase TG?

A

fibrates and niacin; bile acid resin

111
Q

First line tx for mitral stenosis?

A

Balloon valvotomy

112
Q

Which rhythms can you shock in a code?

A

pulseless vtach, vfib

MS3 Year (18 decks)

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