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Casey: Panre > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What side effect might make a patient stop taking an ACEI?

A

Cough

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2
Q

Define orthostatic hypotension.

A

A drop in systolic pressure of >20mmHg when standing up.

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3
Q

You feel a pulse that seems to be vibrating. What term do you use to describe it?

A

Thrill

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4
Q

What are three things in your differential if you have a paradoxical pulse?

A

Cardiac tamponade
pericarditis
obstructive lung disease

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5
Q

What is a paradoxical pulse?

A

An abnormally large decrease in systolic BP during inspiration. Normal is less than 10mmHg. PP is more than 20mmHg.

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6
Q

On palpation, what size is normal for the aorta?

A

Less than 3cm

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7
Q

A fixed or consistent split S2 should make you think of what dx?

A

Atrial septal defect

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8
Q

A pathologic S3 is most commonly associated with what dx?

A

CHF

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9
Q

If you hear a mid systolic click you should immediately be thinking about what dx?

A

Mitral valve prolapse

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10
Q

An opening snap on auscultation of the hear should make you think of what dx?

A

Mitral stenosis

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11
Q

A continuous murmur most likely involves what area of the heart?

A

It is most likely a septal defect.

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12
Q

You hear a continuous machine-like murmur. What is the most likely dx?

A

Patent ductus arteriosus(PDA)

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13
Q

List 3 meds which may be used for a pharmacological stress test.

A

Adenosine
Dobutamine
Dipyridamole
Persantine

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14
Q

What is the gold standard for dx’ing coronary artery disease?

A

Cardiac catheterization

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15
Q

Define stage 1 hypertension acc to JNC7.

A

Systolic pressure of 140-159 and diastolic 90-99

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16
Q

What is the tx goal for a diabetic with HTN?

A

130/80

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17
Q

What is the most common cause of 2ndary HTN?

A

chronic kidney disease

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18
Q

No matter what meds you use, you are having trouble keeping a pt’s BP under control. You also notice hyper pigmented skin and truncal obesity. What is the most likely dx?

A

Cushing’s disease

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19
Q

List 3 s/s which will likely be included in the description of a pt with a pheochromocytoma.

A 
Thin
diaphoretic
tachycardic
agitated
hypertensive
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20
Q

What is a pheochromocytoma?

A

(benign) tumor that develops in an adrenal gland. Usually, this type of tumor affects one of your two adrenal glands, but it can affect both.

If you have a pheochromocytoma, the tumor releases hormones that cause either episodic or persistent high blood pressure. Untreated, a pheochromocytoma can result in severe or life-threatening damage to other body systems, especially the cardiovascular system.

Most people with a pheochromocytoma are between the ages of 20 and 50, but the tumor can develop at any age. Surgical treatment to remove a pheochromocytoma usually returns blood pressure to normal.

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21
Q

You have a pt with a dx of pheochromocytoma. While waiting for surgery, should you use an alpha or beta blocker?

A

Alpha blocker. You should never use a pure beta blocker.

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22
Q

A young boy comes into your office. He has elevated BP when taken in his arm, but no femoral pulses can be palpated. What is the most likely dx?

A

Coarctation of the aorta

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23
Q

According to the CDC, what is the range for a normal BMI?

A

18-5-24.9

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24
Q

What is the first line medical tx for stage 1 HTN?

A

Thiazide diuretic

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25
Q

After a thiazide diuretic, what medication should you start in a HTN pt who also has DM?

A

ACEI

ARB

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26
Q

Following an MI, what med should you be using to tx HTN?

A

beta blocker

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27
Q

Paroxysmal nocturnal dyspnea should make you think of what dx?

A

CHF

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28
Q

What is the most common cause of CHF?

A

Coronary artery disease

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29
Q

What ejection fraction is typical for a pt c CHF?

A

35-40%

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30
Q

What is the most likely dx for a young man who experiences sudden death while playing sports?

A

Hypertrophic cardiomyopathy

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31
Q

Bat wing vessels or Kerley B lines on CXR should make you think of what dx?

A

CHF

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32
Q

A beta natriuretic peptide below what level rules out CHF?

A

<100

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33
Q

What is the therapeutic range for INR following a mechanical valve replacement?

A

2.5-3.5

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34
Q

What is the first line IV inotropic agent when dealing with cardiogenic shock?

A

Dopamine

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35
Q

What dx is most likely in an IV drug user with a new heart murmur and fever?

A

Endocarditis

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36
Q

List 2 dx which require abx prophylaxis for “dirty procedures”?

A

Prosthetic valve
Valve repair with any prosthetic material
prior endocarditis
Congenital cyanotic heart defect

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37
Q

Does a patient with mitral valve prolapse require prophylactic abx for dental work?

A

No

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38
Q

What are 3 major criteria for endocarditis?

A

2 positive blood cultures
a positive transesophageal echocardiography
new murmur

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39
Q

Which are painful and found on the fingers and toes: Osler nodes or Janeway lesions?

A

Osler nodes (ouch!)

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40
Q

List 4 minor criteria for dx’ing endocarditis.

A

Fever
embolic event: Janeway lesions or petechiae, splinter hemorrhages
Immunological event (Osler nodes, glomerulonephritis)
1 positive blood culture

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41
Q

What are the 5 components of Tetralogy of Fallot?

A 
Ventricular septal defect
Right ventricular hypertrophy
right ventricular outflow obstruction (pulmonary valve stenosis)
Overriding aorta
right sided aortic arch
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42
Q

Sudden death in a young athlete associated with…

A

hypertrophic cardiomyopathy

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43
Q

Fixed wide splitting of S2

A

Atrial septal Defect (ASD)

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44
Q

How does coarctation of the aorta present?

A

Rib notching, absent or weak femoral pulses with a delay of palpable femoral pulse and HTN in arms but low or normal blood pressure in the legs

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45
Q

What disorder is associated with a machine like murmur?

A

patent ductus arteriosus

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46
Q

What dx would you think of in an infant who has cyanosis with crying or feeding?

A

tetralogy of ballot

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47
Q

A holosystolic murmur suggests…

A

VSD

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48
Q

A new mitral regurgitant murmur in a pt with a hx of iv drug abuse suggests…..

A

bacterial endocarditis

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49
Q

How is a pericardial friction rub heard best? Associated c what condition?

A

With the pt sitting up and leaning forward

acute pericarditis

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50
Q

What is the gold standard for diagnosing myocarditis?

A

Myocardial bx

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51
Q

Where do most aortic dissections occur?

A

The ascending or descending thoracic aorta

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52
Q

A pt c/o severe pleuritic chest pain that is relieved with sitting and leaning forward. What is the most likely dx?

A

pericarditis

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53
Q

What is the first line medical tx for pericarditis?

A

Aspirin and NSAIDS

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54
Q

What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?

A

Dressler syndrome

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55
Q

A pt presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all of the leads. What is the most likely dx?

A

Pericarditis

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56
Q

Define paradoxical pulse

A

There is a large difference in pulse pressure between inhalation and exhalation.

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57
Q

Define pulsus alternans.

A

EKG waveform changes from beat to beat.

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58
Q

What is the definitive treatment for cardiac tamponade.

A

Pericardiocentesis

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59
Q

On physical exam, you hear a harsh systolic murmur along the right sternal border. What is the most likely dx?

A

Aortic stenosis

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60
Q

A wide pulse pressure with a blowing diastolic decrescendo murmur at the right 2nd intercostal space should make you think of what dx?

A

Aortic regurgitation

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61
Q

What is the best location to hear problems with the aortic valve?

A

2nd right intercostal space

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62
Q

Where is disease of the pulmonary valve best heard?

A

2nd left intercostal space

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63
Q

What 2 abx are used for empiric treatment of endocarditis?

A

Vancomycin and ceftriaxone together are the first line empiric treatment

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64
Q

What 2 valvular issues do patients with Marfan’s syndrome often have?

A

Aortic regurgitation and mitral valve prolapse (you can tell them apart by where they are heard)

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65
Q

What are the 2 main causes of aortic stenosis?

A

congenital bicuspid valve

calcification of the valve secondary to coronary artery disease

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66
Q

An elderly pt presents c dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely dx?

A

aortic stenosis

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67
Q

On auscultation, you hear a harsh, blowing pan systolic murmur at the apex. What is the most likely dx?

A

Mitral regurgitation

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68
Q

You suspect mitral regurgitation. What is the most accurate way to prove your dx?

A

Transesophageal echo

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69
Q

A pt c mitral valve prolapse will often have what physical characteristics.

A

Often a thin female

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70
Q

What is the best pt position to hear aortic regorge and aortic stenosis?

A

Sitting up and leaning forward

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71
Q

What is Tietze syndrome?

A

Costochondritis

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72
Q

Are most pulmonary valve problems congenital or acquired?

A

95% are congenital

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73
Q

What is the therapeutic range for INR following an organic valve replacement?

A

2 to 3

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74
Q

A 60 yo male presents to the ER with severe dizziness and back pain. His BP is dropping, and you can feel an abdominal pulsatile mass on PE. What is the most likely dx?

A

Ruptured aortic aneurysm

75
Q

In a pt c aortic stenosis, will the PMI be medially displaced, normal or laterally displaced?

A

It will be laterally displaced due to left ventricular hypertrophy.

76
Q

A pt c/o severe crushing chest pain. EKG shows ST segment elevations. All labs including troponin and CK-MB are negative. What is the most likely dx?

A

Prinzmetal’s angina

77
Q

A question about Prinzmetal’s angina will often contain what key thing in the pt’s hx?

A

cocaine use

78
Q

Name 2 things that would constitute a positive stress test.

A

A drop in BP.
a new arrhythmia
an increase in angina symptoms
ST depressions

79
Q

Are ulcers from venous insufficiency painful or painless?

A

Painless

80
Q

A pt has just received a cardiac stent. How long will he be on aspirin and clopidogrel?

A

one year

81
Q

Where is disease of the mitral valve best heard?

A

At the apex

82
Q

What is the initial tx for a myocardial infarction?

A

MONA: morphine, oxygen, nitroglycerin and aspirin

83
Q

Clot busting drugs should be used within 3 hrs of which 2 cardiac events?

A

STEMI & new left bundle brach block

84
Q

List 3 catastrophic complications of a myocardial infarction.

A

Papillary muscle rupture
myocardial wall rupture
left ventricular aneurysm

85
Q

An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely dx?

A

Supra ventricular tachycardia

86
Q

Acute endocarditis is most commonly caused by what organism?

A

Staph aureus

87
Q

List 3 congenital heart diseases.

A 
Atrial septal defect (ASD)
Ventricular septal defect (VSD)
coarctation of the aorta
patent ductus artertiosus (PDA)
tetralogy of ballot
88
Q

What is the most common cause of an atrial septal defect?

A

Patent foramen ovale

89
Q

Where on your pt should you listen for the murmur associated with an atrial septal defect?

A

At the left second or third interspace

90
Q

A CXR shows a “3” sign with notching of the ribs. What is the most likely dx?

A

coarctation of the aorta

91
Q

What is the appropriate tx for a patent ductus arteriosus?

A

Indomethacin

92
Q

A Blalock procedure is used to correct what congenital heart defect?

A

Tetralogy of Fallot

93
Q

You hear a loud, harsh pulmonary murmur along the left sternal border. What is the most likely dx?

A

Ventricular septal defect

94
Q

Subacute endocarditis is most commonly caused by what organism?

A

Strep viridans

95
Q

What is the most common place for an aortic aneurysm?

A

In the abdomen and below the renal arteries

96
Q

Who is more likely to have an aortic aneurysm: males or females?

A

Males are 8x more likely to have an aortic aneurysm.

97
Q

The accessory pathway known as the James bundle should make you think of what syndrome?

A

Lown-Ganong-Levine syndrome

98
Q

What imaging needs to be done before taking a patient to the OR with an aortic aneurysm?

A

CT (echo may be used as initial but CT is needed for surgery)

99
Q

List 2 risk factors for an aortic dissection.

A

Hypertension
Marfan’s syndrome
bicuspid aortic valve
pregnancy

100
Q

A pt presents to the ER with tearing chest pain radiating to his back. what is the most likely dx?

A

Aortic dissection

101
Q

What will a CXR show for a pt with an aortic dissection?

A

Widened mediastinum

102
Q

What is the best test to dx an aortic dissection?

A

CT

103
Q

List the six P’s of an ischemic limb.

A 
Pain
paresthesias
pallor
pulselessness
poikilothermic
paralysis
104
Q

You have a pt with pulsus paradoxus. What 2 dx should you be thinking of?

A

Pericarditis
pericardial effusion
obstructive lung disease

105
Q

A pt c/o pain in his legs when he walks. It goes away after sitting. What term comes to mind for this symptom? What dx is it associated with?

A

Intermittent claudication caused by peripheral arterial disease.

106
Q

Giant cell arteritis is associated with what other dx?

A

Polymyalgia rheumatica

107
Q

A sawtooth pattern on EKG should make you think of what dx?

A

Atrial flutter

108
Q

What is the accessory pathway associated with Wolff-Parkinson-White syndrome?

A

the bundle of Kent

109
Q

A biphasic P wave should make you think of what dx?

A

Left atrial enlargement

110
Q

What is the gold standard for the diagnosis of giant cell arteritis?

A

biopsy of the temporal artery

111
Q

What is the treatment for giant cell arteritis?

A

High dose prednisone

112
Q

List the components of Virchow’s triad.

A

Stasis
vascular injury
hypercoagulability

113
Q

Calf pain should always make you think of what dx?

A

DVT

114
Q

Where is disease of the tricuspid valve best heard?

A

Along the left lower sternal border

115
Q

What is the most common congenital heart disease?

A

Ventricular septal defect

116
Q

Are ulcers from arterial insufficiency painful or painless?

A

Painful

117
Q

Give 2 contraindications for using an ACEI.

A

Bilateral renal artery stenosis
hx of angioedema
pregnancy

118
Q

Both lead I and AVF have positive QRF complexes. Does this represent normal axis, left axis deviation or right axis deviation?

A

Normal axis

119
Q

What med might you switch to if a pt develops an intolerable cough on an ACEI?

A

Angiotensin receptor blocker (ARBs)

120
Q

What class of cardiac medications should be avoided in pts c asthma?

A

Beta blockers (blocks receptors for bronchodilators)

121
Q

A boot shaped heart on CXR should make you think of what congenital heart condition?

A

Tetralogy of ballot

122
Q

An RSR prime in leads V1 or V2 should make you think of what dx?

A

Right bundle branch block

123
Q

Which lab should be tightly monitored in a patient taking an aldosterone antagonist?

A

Potassium, they may have hyperkalemia

124
Q

What is the best test for dx’ing CHF?

A

Echo

125
Q

Which cardiac medication is used to help cardiac contractility after you have optimized most of the other cardiac meds?

A

Digoxin

126
Q

A blockage of which artery causes an anterior wall MI?

A

left anterior descending artery

127
Q

Which lab result will increase the risk of digoxin toxicity?

A

Hypokalemia or hypercalcemia

128
Q

A patient presents to the ER in acute CHF. What drug class will likely be the first choice?

A

Loop diuretics

129
Q

A pt has a GFR of 25 and HTN. Which class should you use–a loop or thiazide diuretic?

A

a loop will work no matter how long the GFR is. thiazides will only work with a GFR>30.

130
Q

Which EKG leads are used to dx anterior wall MI?

A

V1, V2, V3

131
Q

Do loop diuretics cause hyperkalemia or hypokalemia?

A

hypokalemia

132
Q

Statins are the drug of choice to tx what type of dyslipidemia?

A

Elevated LDL

133
Q

A pt recently started taking Lipitor. He is now c/o aches and pains. What test should you order?

A

Serum creatinine kinase: you are looking for rhabdomyolysis

134
Q

How does ezetimibe work?

A

Decreases intestinal absorption of cholesterol

135
Q

Which hyperlipidemia med may cause flossing?

A

Niacin

136
Q

Name 3 medication “classes” which are used to reduce LDL?

A

Statins
ezetimibe
niacin
nicotinic acid

137
Q

Name 2 fibric acid derivatives.

A

Fenofibrate

gemfibrozil

138
Q

List 3 class 1a antiarrhythmics.

A

Disopyramide
quinidine
procainamide

139
Q

You are counting boxes from the peak of a QRS wave on an EKG IOT determine the heart rate. What would the heart rate be if the next QRS were 3 boxes away? What numbers are associated with the first five boxes?

A

The answer is 100. The heart rates by counting boxes are 300, 150, 100, 75, 60.

140
Q

An U wave on EKG should make you think of what dx?

A

Hypokalemia

141
Q

What will the heart rate be if the AV node is pacing the heart?

A

40-60 beats per minute

142
Q

Which cardiac medication has gynecomastia in its side effect profile?

A

spironolactone

143
Q

Lead I has a QRS that is up and the AVF lead has a QRF complex that is down. Does this represent normal axis, left axis deviation or right axis deviation?

A

Left axis deviation

144
Q

An Osborn or J wave on EKG should make you think of what dx?

A

Hypothermia

145
Q

What is the first line medication for a pt c symptomatic bradycardia?

A

Atropine

146
Q

What is the heart rate for tachycardia? How about bradycardia?

A

Tachy >100

Brady<60

147
Q

On EKG there is an early but otherwise normal PQRS complex. After that beat there is a slight pause and then a normal rhythm continues. What is the term for this one beat?

A

Premature atrial contraction

148
Q

How do you treat polymyalgia rheumatica?

A

Low dose prednisone

149
Q

What is the management of a patient in supra ventricular tachycardia?

A

Vagal maneuvers
carotid massage
adenosine

150
Q

What is the definitive treatment for atrial flutter?

A

Radio frequency catheter ablation

151
Q

An 82 yo pt c/o HA and jaw claudication. What is the most likely diagnosis?

A

Giant cell (temporal) arteritis

152
Q

The EKG shows irregularly irregular narrow QRS waves. What dx should you be thinking of?

A

Atrial fibrillation

153
Q

An EKG shows a regular rate of 50 beats per minute. The QRS is narrow and there is no visible P wave. What is the most likely dx?

A

Junctional rhythm

154
Q

Name a common cause of a junctional rhythm.

A

Digoxin toxicity

155
Q

An EKG shows two premature ventricular contractions. These 2 QRS waves look very different. What is the term for this?

A

Multifocal premature ventricular contractions

156
Q

What is the most common cause of sudden cardiac death?

A

Ventricular fibrillation

157
Q

A pt in the ER has no pulse; but on EKG, there are wide irregular “complexes” which are at an irregular rate. they all appear very different from one another. What is the tx of this pt?

A

He is in ventricular fibrillation. The tx is defibrillation.

158
Q

Tall peaked T waves should make you think of what diagnosis?

A

Hyperkalemia

159
Q

How do you define 1st degree AV block?

A

the PR interval is longer than 0.2 seconds or one block on EKG

160
Q

What is the other term for Mobitz type I?

A

Wenckebach

161
Q

What is the most important complication of giant cell arteritis?

A

Blindness

162
Q

What 2 labs do you want to monitor in a pt on an ACEI?

A

Serum creatinine

serum potassium

163
Q

The HR is irregular, so you can’t count boxes between QRS waves to determine heart rate. What is another method you can use to determine rate on an EKG?

A

Count QRS waves in a six second strip and multiply by 10 to get beats per minute.

164
Q

What is the treatment for a patient with a Mobitz II AV block?

A

pacemaker

165
Q

You see regular P waves and regular QRS complexes, but they do not seem to have any correlation to each other. What is the dx?

A

Third degree AV block

166
Q

Name one aldosterone antagonist.

A

Spironolactone, eplenerone

167
Q

You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?

A

Wolff-Parkinson-White syndrome

168
Q

What two leads do you use to determine the axis of the heart?

A

Lead I and AVF

169
Q

An RSR prime in leads V5 or V6 should make you think of what dx?

A

left bundle branch block

170
Q

Which finding requires immediate attention: left bundle branch block or right bundle branch block?

A

New left bundle branch block is a STEMI equivalent. right bundle branch block is usually not a problem.

171
Q

What medication is used to lower triglycerides?

A

Fibric acid derivatives

172
Q

Tall peaked P waves should make you think of what dx?

A

Right atrial enlargement

173
Q

List 2 causes of right atrial enlargement.

A

Pulmonary HTN
severe lung disease
pulmonary valve stenosis

174
Q

Which EKG leads are used to dx an anterolateral MI?

A

V5 and V6

175
Q

What are the 3 inferior leads?

A

II, III, aVF

176
Q

A blockage of which artery causes a lateral wall MI?

A

left circumflex artery

177
Q

What is represented by ST segment depressions greater than 1mm on EKG?

A

Ischemia

178
Q

Rheumatic fever most commonly affects which valve?

A

The mitral valve

179
Q

What is the only cyanotic congenital heart disease on the NCCPA blueprint?

A

Tetralogy of ballot

180
Q

On EKG, there is an early wide QRS complex with no associated P wave. After that beat, there is a slight pause, and then a normal rhythm continues. What is the term for this one beat?

A

premature ventricular contraction

181
Q

What is the definitive treatment for a patient c recurrent ventricular tachycardia?

A

Implanted defibrillator

182
Q

On an EKG, you notice a pt has a gradually lengthening PR interval and then a missed QRS complex. The pattern repeats again. What type of AV block is this?

A

Mobitz I or Wenckebach

183
Q

List 3 SE of digoxin.

A 
Nausea/vomiting
anorexia
confusion
arrhythmia (sinus brady, AV block)
fatigue
vision disturbances
184
Q

What is the first line medical tx for torsades de pointes?

A

Magnesium sulfate

Casey: Panre (12 decks)

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