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Step 2 CK (primary set) > cardiology > Flashcards

cardiology Flashcards

1
Q

<p>effect of valsalva early strain (2)</p>

A

<p>decrease venous return
decrease all murmurs except HCM and MVP
</p>

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2
Q

<p>effect of valsalva late release (2)</p>

A

<p>increase venous return

| increase right sided murmurs</p>

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3
Q

<p>effect of standing (2)</p>

A

<p>decrease venous return

| similar to the strain phase of valsalva</p>

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4
Q

<p>effect of squatting (3)</p>

A

<p>increase venous return
increase afterload by kinkingof femoral arteries
increase reverse flow</p>

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5
Q

<p>effect of handgrip (3)</p>

A

<p>increase afterload
increase blood pressure
increase reverse flow across valve</p>

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6
Q

<p>murmurs getting louder with valsalva (2)</p>

A

<p>HCM

| MVP</p>

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7
Q

<p>why during valsalva murmur get louder in MVP (2)</p>

A

<p>decrease left ventricular volume

| increase of leaflet prolapse</p>

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8
Q

<p>why during valsalva murmur get louder in HCM (2)</p>

A

<p>decrease left ventricular volume

| increase gradient</p>

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9
Q

<p>effect of standing resembles what other effect</p>

A

<p>valsalva</p>

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10
Q

<p>murmurs that get louder with squatting (3)</p>

A

<p>aortic regurgitation
mitral regurgitation
VSD</p>

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11
Q

<p>murmurs that get softer with squatting (2)</p>

A

<p>HCM

| MVP</p>

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12
Q

<p>why murmurs get softer with squatting in HCM (4)</p>

A

<p>more blood less murmur
increase preload
decrease gradient across outflow obstruction
decrease obstruction and decrease afterload</p>

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13
Q

<p>why murmurs get softer with squatting in MVP (2)</p>

A

<p>increase left ventricular size

| decrease mitral valve leaflets prolapse</p>

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14
Q

<p>murmurs getting louder with handgrip (3)</p>

A

<p>aortic regurgitation
mitral regurgitation
VSD</p>

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15
Q

<p>murmurs getting softer with handgrip (3)</p>

A

<p>HCM
increase gradient across outflow obstruction
decrease flow</p>

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16
Q

<p>auscultation in mitral valve prolapse (2)</p>

A

<p>single or multiple non ejection clicks
plus
mid to late systolic of mitral regurgitation</p>

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17
Q

<p>CHF with ejection fraction a 55 dx</p>

A

<p>diastolic dysfunction</p>

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18
Q

<p>number 1 cause of diastolic dysfunction</p>

A

<p>HTA</p>

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19
Q

<p>rx of diastolic dysfunction (2)</p>

A

<p>diuretics

| antihypertensives</p>

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20
Q

<p>physiopatho in diastolic dysfunction</p>

A

<p>impaired ventricular filling due to poor myocardial relaxation or diminished ventricular compliances</p>

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21
Q

<p>cause of AFIB in diastolic dysfunction (3)</p>

A

<p>left ventricular dilation
leads to left atrial dilation
which in turn causes atrial fibrillation</p>

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22
Q

<p>HTN in the setting of bilateral nontender masses</p>

A

<p>autosomal dominant polycystic kidney disease</p>

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23
Q

<p>HTN in the setting of bilateral nontender masses best test to do</p>

A

<p>abdomen ultrasonogram</p>

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24
Q

<p>clue for autosomal dominant polycystic kidney disease (5)</p>

A 
<p>HTN
Hematuria
proteinuria
palpable renal masses
progressive renal insufficiency</p>
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25
Q

<p>flank pain in autosomal polycystic kidney disease cause (3)</p>

A

<p>renal calculi
cyst rupture or hemmorrage
upper urinary tract infection</p>

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26
Q

<p>the early common finding in autosomal polycystic kidney disease</p>

A

<p>HTN</p>

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27
Q

<p>extra renal manif of autosomal polykidney disease (5)</p>

A 
<p>cerebral aneurysms
hepatic and pancreatic cysts
cardiac valve disorder
colonic diverticulosis
ventral and inguinal hernias</p>
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28
Q

<p>management of APKD (3)</p>

A

<p>follow blood pressure and renal function
aggressive control of cardiovascular risks factors
ACE inhibitor for HTN
</p>

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29
Q

<p>end stage renal diasease in APKD (2)</p>

A

<p>dialysis

| renal transplant</p>

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30
Q

<p>patient with HTA is seen in consultation in history , he exercices regularly an eats low salt diet .but he drinks 3-4 glasses of wine every day and 6-8 beers on week end .he quits smoking 3 years ago next step in management of HTN in this patient</p>

A

<p>counsel for reduction of alcohol</p>

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31
Q

<p>quid of excessive alcohol intake</p>

A

<p>> 2 drinks a day

| </p>

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32
Q

<p>quid of binge drinking</p>

A

<p>> 5 drinks in a row</p>

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33
Q

<p>lifestyle modification in HTN (6)</p>

A 
<p>low salt diet
diet rich in fruit and vegetables
low fat dairy products
regular aerobic exercices
lose weight
limit alcohol intake</p>
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34
Q

<p>patient with TA 160/85 while supine and 135/70 while standing dx</p>

A

<p>orthostatic hypotension</p>

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35
Q

<p>EKG for AFIB (3)</p>

A

<p>narrow qrs complex
no organized P waves
irregularly irregular rhythm</p>

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36
Q

<p>stable patient with afib Management</p>

A

<p>Rate control</p>

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37
Q

<p>medication used for rate control</p>

A

<p>Betablocker

| calcium blocker like Diltiazem</p>

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38
Q

<p>use of digoxin for rate control in AFIB (2)</p>

A

<p>AFIB due to heart failure

| patient unable to tolerate B blocker or Calcium channel blocker</p>

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39
Q

<p>indication of cardiversion in Patient with AFIB (4)</p>

A

<p>less than 48 h
patient with hypotension
pulmonary edema
ischemic heart disease</p>

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40
Q

<p>what to do before beginning cardioversion in AFIB more than 48h (2)</p>

A

<p>anticoagulation 3-4 weeks
plus
rate control</p>

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41
Q

<p>best test to see if AFIB is complicated with heart thrombus</p>

A

<p>TEE</p>

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42
Q

<p>patient with chest pain sus elevation of ST segment and ventricular premature beats administration of lidocaine will cause what in this patient</p>

A

<p>increase the risk in asystole</p>

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43
Q

<p>advantage and drawback of lidocaine in acute coronary syndrome (2)</p>

A

<p>decrease risk of VFIB

| increase the risk of asystole</p>

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44
Q

<p>patient with history of rhinitis and eczema in childhood is coming for chest pain .ekg shows st segment depression .he is placed on aspirin bblocker etc.2 days later he develops respiratory distress with wheezing and prolonged expiratory.cause of that</p>

A

<p>medication side effect Bblocker and Aspirin</p>

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45
Q

<p>causes of acute dyspnea in hospitalized patients (7)</p>

A 
<p>arrythmia
bronchoconstriction
CHF/hypervolemia
infection/pneumonia asppiration
pleural effusion
PE
anxiety</p>
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46
Q

<p>patient with cardiac disease or (electrolytes abnormalities) develops dizziness tachycardia(or bradycardia) during hospitalization dx</p>

A

<p>arrythmia</p>

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47
Q

<p>patient with history of asthma ,is placed on aspirin and Bblocker develops wheezing and pprolonged expiratory phase during hospilaisation Cause of that</p>

A

<p>bronchoconstriction</p>

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48
Q

<p>patient with cardiac disease develops crakles high jugular venous pressure>8 cm h2o lower extremity edema cause of that</p>

A

<p>CHF</p>

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49
Q

accidentally patient has received 2000 cc de liquid develops dyspnea, develops crackles DX

A

hypervolemia

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50
Q

characteristics clinic of pleural effusion in the context of acute dyspnea (2)

A

decreased breath sounds

dullness to percussion

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51
Q

clue for anxiety in the setting of acute dyspnea in hospitalized patient(4)

A

tachycardia
tachypnea
normal lung exam
normal oxygenation

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52
Q

<p>EG in anterolateral MI</p>

A

<p>st segment elevation in 1 avl,v1-v3</p>

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53
Q

what can happen in anterolateral MI (2)

A

muscle ischemia or rupture—>

mitral regurgitation

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54
Q

MI causing typically mitral regurg and why (2)

A

posteroseptal MI

a cause of solitary blood supply of of the post medial papillary muscle

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55
Q

consequence of mitral regurg in anterolateral MI or post septal MI (4)

A

increase left atrial pressure
but no changes in left atrium size
in left ventricular sizes
and no changes in left ventricular ejection fraction

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56
Q

patient with chest pain during exercice but normal baseline resting EKG, next step

A

exercice EKG

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57
Q

why patient with SLE are at risk for acute coronary syndrome (2)

A

most of the they are reiceiving prednisone

prednisone and Lupus cause acelarated coronary atherosclerosis

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58
Q

syncope during exercise (3)

A

aortic stenosis
HOC
VTAC

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59
Q

murmur in aortic stenosis (3)

A

2nd intercostal space
radiation in caritods
crescendo-decrescendo

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60
Q

<p>disease with pulsus parvus and tardus</p>

A

<p>aortic stenosis</p>

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61
Q

<p>quid of pulsus parvus and tardus</p>

A

<p>aotic stenosis</p>

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62
Q

<p>other finding in aortic stenosis</p>

A

<p>weak S2

| S4</p>

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63
Q

three possible symptoms in AS (3)

A

syncope during exercice
exertionnal angina
dyspnea

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64
Q

<p>definitive dx of AS</p>

A

<p>echocardiogram</p>

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65
Q

<p>rx of symptomatic AS</p>

A

<p>valve replacement</p>

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66
Q

patient with chest pain with normal QRS complex 80msec (n< 120) and PR interval 280 msec (normal

A

first degree heart block

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67
Q

clue for first degree heart block (2)

A

prolonged PR interval

P wave always follows QRS unlikely other heart block

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68
Q

rx of first degree heart block with normal QRS duration

A

observation

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69
Q

<p>First degree AV block with prolonged QRS </p>

A

<p>electrophysiologic testing to determine the nature of the delay of conduction below the AV node</p>

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70
Q

<p>patient with history of respiratory infection one week ago develops Ta =100/60 distended neck veins and heart sounds distant dx </p>

A

<p>pericardial effusion</p>

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71
Q

<p>xray in pericardial effusion</p>

A

<p>enlarged cardiac silhouette</p>

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72
Q

<p>ekg clue for pericardial effusion</p>

A

<p>electrical alternans</p>

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73
Q

<p>quid of electrical alternans</p>

A

<p>qrs complexes whose amplitude vary from beat to beat on ekg</p>

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74
Q

<p>definitive dx in pericardial effusion</p>

A

<p>echocardiogram</p>

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75
Q

quid hypertensive urgency (2)

A

severe HTN> 180/120

no symptoms, no end organ damage

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76
Q

two divisions for hypertensive emergency (2)

A

malignant HTN

Hypertensiive encephalopathy

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77
Q

clue for malignant HTN (2)

A

severe HTN
plus
papilledema and retinal hemorrage

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78
Q

clue for hypertensive encephalopathy (2)

A

severe HTN
plus
cerebral edema and non localizing neurologic symptoms and signs

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79
Q

symptom in cerebral edema (4)

A

headache
nausea
vomiting
plus non localizing neurologic symptoms

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80
Q

def of non localizing neurologic symptom (4)

A

restlessness
confusion
seizures
coma

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81
Q

organ affected in malignant HTN (2)

A

kidney

eye

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82
Q

renal problem in malignant HTN

A

nephrosclerosis

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83
Q

quid of manif of nephrosclerosis (3)

A

acute renal failure
hematuria
proteinuria

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84
Q

<p>auscultation finding in aptient with aortic stenosis</p>

A

<p>systolic murmur ejection radiating to the apex and carotid arteries</p>

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85
Q

<p>teens and early twenties with AS cause</p>

A

<p>bicuspid valve</p>

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86
Q

elderly with AS cause

A

calcification of the trileaflet valve

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87
Q

<p>muscle pain in patient taking statin </p>

A

<p>statin induced myopathy</p>

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88
Q

<p>mechanism of action of statin</p>

A

<p>inhibition of intracellular synthesis pathway</p>

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89
Q

action of station intracellularly (3)

A

inhibit HMG coA reductase enzyme
prevent conversion of HMG co A to mevalonic acid
increase the number of cell membrane LDL receptors

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90
Q

why statin can induce myopathy

A

by decreasing co enzyme synthesis Q10

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91
Q

<p>role of Q10 coenzyme</p>

A

<p>involve in muscle cell energy</p>

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92
Q

clue supraventricular tachycardia on EKG (4)

A

narrow QRS complex
tachycardia
no regular P waves as they are buried within QRS complex
retrograde P wave can occur

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93
Q

dx and management of supraventricular tachycardia (2)

A

adenosine

or vagal maneuvers

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94
Q

action of adenosine (3)

A

slows the sinus rate
increases AV nodal conduction delay
can cause a transient block in AV node conduction

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95
Q

role of adenosine in supraventricular tachycardia (2)

A

can help to identify P waves to clarify dx of atrial flutter or atrial tachycardia
terminate paroxysmal supraventricular tachycardia by interrupting the AV nodal reentry circuit

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96
Q

quid of vagal maneuvers (3)

A

carotid sinus massage
valsalva
eyeball pressure

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97
Q

<p>patient smoker complain of cramping pain in his right thigh after walking 2 blocks ,the pain goes away once he stops and rests for several minutes</p>

A

<p>PAD</p>

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98
Q

<p>best initial management in PAD intermittent claudication</p>

A

<p>exercice therapy</p>

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99
Q

<p>indication of cilostazole in PAD</p>

A

<p>persistent symptom despite adequate supervised exercice therapy</p>

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100
Q

<p>indication of surgery in PAD</p>

A

<p>persistent symptom despite adequate supervised exercice therapy and cylostazole</p>

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101
Q

<p>HTA basic testing(4)</p>

A

<p>urinalysis for occult hematuria and urine protein creatinine ratio
chemistry panel
lipid profile
baseline ECG</p>

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102
Q

<p>when to search for secondary HTA(4)</p>

A

<p>severe or malignant HTA
resistant HTA requiring > ou egal a 3 drugs
sudden blood pressure rise in patient with previosly controled HTA
age of onset < 30 without family history of HTA</p>

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103
Q

<p>patient with HTA ,hypokaliemia and hyperglycemia and weight gain dx </p>

A

<p>adrenal cortical disease

| (cushing disease)</p>

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104
Q

<p>cause of cushing syndrome(4)</p>

A

<p>adrenal cortical hyperplasia
acth producing pituitary adenoma (cushing disease)
ectopic ACTH production
exogenous steroids</p>

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105
Q

<p>clue for cushing(7)</p>

A 
<p>poximal muscle weaness
central adiposity
thinning of the skin
psychiatreic problem
hypokaliemia 
hypertension
hyperglycemia</p>
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106
Q

<p>psychiatric problem in cushing(3)</p>

A

<p>sleep disturbances
depression
psychosis</p>

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107
Q

<p>quid of preload measurement(2)</p>

A

<p>right atrial pressure

| pulmonary capillary wedge pressure</p>

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108
Q

<p>normal right atrial pressure</p>

A

<p>mean 4 mm of HG</p>

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109
Q

<p>normal pulmonary wedge pressure</p>

A

<p>mean of 9 mm de HG</p>

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110
Q

<p>quid of cardiac index</p>

A

<p>pump function measurement</p>

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111
Q

<p>normal cardiac index</p>

A

<p>2.8-4.2 l/mn/m2</p>

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112
Q

<p>quid of systemic vascular resistance</p>

A

<p>measure afterload</p>

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113
Q

<p>normal systemic vascular resistance</p>

A

<p>1150l/mn/m2</p>

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114
Q

<p>normal mixed venous oxygen saturation</p>

A

<p>60%-80%</p>

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115
Q

<p>the only parameter increase in Hypovolemic schock</p>

A

<p>everything is low except systemic vascular resistance</p>

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116
Q

<p>the only two parameters decrease in cardiogenic shock</p>

A

<p>everything is high except cardiac pump function

| mixed venous oxygen saturation</p>

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117
Q

<p>the only shock syndrome with low vascular resistance and increased mixed venous oxygen saturation</p>

A

<p>septic shock</p>

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118
Q

<p>patient with hypotension, normal Pulmonary wedge pressure and increased mixed venous saturation</p>

A

<p>septic shock</p>

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119
Q

<p>hwat's the underlying basic pathophysiology in septic shock</p>

A

<p>decrease systemic vascular resistance due to overall peripheral vasodilation</p>

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120
Q

<p>swanz ganz catether in septic shock(4)</p>

A

<p>low pulmonary wedge pressure
low systemic vascular resistance
increased cardiac output
high mixed venous oxygen saturation</p>

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121
Q

<p>origin of formation of AFIB focii</p>

A

<p>pulmonary veins</p>

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122
Q

<p>quid for atrial flutter origin</p>

A

<p>reentrant circuit that rotates around the tricuspid annulus</p>

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123
Q

<p>quid for paroxysmal supraventricular tachycardia origin</p>

A

<p>reentry circuit most commonly oinvolved the AV node or via accessory bypass tract</p>

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124
Q

<p>patient on digoxin and furosemide present with wide complex tachycardia what to check</p>

A

<p>serum electrolytes</p>

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125
Q

<p>effect of furosemide(2)</p>

A

<p>low K

| low MG++</p>

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126
Q

<p>effects of low K and low Mg++</p>

A

<p>ventricular tachycardia</p>

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127
Q

<p>risk factor for digoxin toxicity</p>

A

<p>low K</p>

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128
Q

<p>consequence of digoxin toxicity</p>

A

<p>ventricular tachycardia</p>

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129
Q

<p>side effect of thiazide (5)</p>

A 
<p>hyperglycemia
increased LDL cholesterol and plasma triglycerides
hyponatremia
hypokaliemia
hypercalcemia</p>
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130
Q

<p>hypergluc in thiazide(4)</p>

A

<p>G= glycemia
L=lipidemia
U=uricemia
C=Calcemia</p>

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131
Q

<p>in swanx ganz catheter clue for cardiogenic shock(2)</p>

A

<p>reduced cardiac index

| elevated pulmonary wedge pressure</p>

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132
Q

<p>how 's systemic vascular resistance in cardiogenic shock</p>

A

<p>high to maintain adequate perfusion of tissue</p>

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133
Q

<p>the most contributory factor in CHF edema</p>

A

<p>increased renal sodium retention</p>

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134
Q

<p>cause of increased renal sodium retention in CHF(2)</p>

A

<p>low renal perfusion----> stimulation of renin aldosterone system--->hypoperfusion renal secondary to cardiac output
renal arteries are constricted </p>

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135
Q

<p>patient with palpitations HR 160 suddenly with no history of haert problem.Symptoms improves when immersing face in cold water dx</p>

A

<p>paroxysmal supraventricular tachycardia</p>

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136
Q

<p>the cold therapy work s by affecting what</p>

A

<p>atrioventricular node conductivity</p>

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137
Q

<p>cause of supraventricular tachycardia</p>

A

<p>accessory conduction pathways</p>

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138
Q

<p>why you can have hepatomegaly,ascites, increased JVP in constrictive pericarditis</p>

A

<p>decreeased diastolic filling leafing to cardiac output impairment</p>

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139
Q

<p>common cause of constrictive pericarditis(4)</p>

A

<p>radiation therapy
viral pericarditis
cardiac surgery
idiopathic</p>

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140
Q

<p>kussmaul sign </p>

A

<p>failure of JVP to decrease during inspiration</p>

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141
Q

<p>other name of constrictive pericarditis</p>

A

<p>inelastic pericardium</p>

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142
Q

<p>dx of constrictive pericarditis(3)</p>

A

<p>calcified pericardium in xray
thickened pericardium on CT or MRI scanning
cardiac catheterisation</p>

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143
Q

<p>rx of constrictive percarditis(2)</p>

A

<p>diuretics
or
pericardiectomy</p>

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144
Q

<p>after anterior wall MI patient develops pleuritic chest pain improving when sitting and leaning forward.EKG shows diffuse ST segment elevation dx</p>

A

<p>acute pericarditis</p>

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145
Q

<p>laps de temps pour developper acute pericarditis post MI</p>

A

<p>within the first several days</p>

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146
Q

<p>EKG for acute pericarditis(2)</p>

A

<p>diffuse ST segment elevation
PR depressions
</p>

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147
Q

<p>quid of lone AFIB</p>

A

<p>presence of paroxysmal persistent or permanent AFIb with no evidence of cardiopulmonary or structural heart disease</p>

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148
Q

<p>rx of lone AFIB</p>

A

<p>nothing</p>

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149
Q

<p>paroxysmal AFIB</p>

A

<p>reccurrent > a 2 episodes that terminate spontaneously in < 7 days usually within 24 hours</p>

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150
Q

<p>persistent AFIB</p>

A

<p>episodes lasting more than 7 days</p>

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151
Q

<p>longstanding persistent AFIB</p>

A

<p>pesistent for more than 1 year duration</p>

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152
Q

<p>permanent AFIB</p>

A

<p>persistent with no further plans for ryhtm controls</p>

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153
Q

<p>CHADS 2 score 0(2)</p>

A

<p>no anticoagulation

| aspirin preferred</p>

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154
Q

<p>CHADS 2 score 1 (2)</p>

A

<p>anticoagulation preferred
or
aspirin</p>

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155
Q

<p>CHADS 2 score 2-6</p>

A

<p>anticoagulation</p>

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156
Q

<p>cause of restrictive cardiomyopathy(4)</p>

A

<p>sarcoidosis
amyloidosis
hemochromatosis
fibrosis endomyocardial</p>

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157
Q

<p>clue for restrictive cardiomyopathy in echo</p>

A

<p>symmetrical thickening of the left ventricular walls and slightly reduced systolic function</p>

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158
Q

<p>the only reversible cause of restrictive cardiomyopathy</p>

A

<p>hemochromatosis</p>

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159
Q

<p>echo with interventricular septum thickness</p>

A

<p>hypertrophic cardiomyopathy</p>

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160
Q

<p>primary rx of hemochromatosis</p>

A

<p>phlebotomy</p>

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161
Q

<p>quid of the anti-ischemic nitrate action</p>

A

<p>systemic vasodilation rather than coronary dilation
systemic venodilation lowers (ventricular)preload and left ventricular end diastolic volume reducing wall stress and myocardial oxygen demand
dilation of capacitance vessels</p>

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162
Q

<p>action of nitrate</p>

A

<p>reduced left ventricular volume</p>

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163
Q

<p>supraventricular tachycardia in patient hemodynamically unstable management</p>

A

<p>DC cardioversion</p>

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164
Q

<p>anterior wall myocardial infarction with pulmonary edema what medication to give and why</p>

A

<p>furosemide

| furosemide causes venodilation which further decreases the preload</p>

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165
Q

<p>anterior wall myocardial infarction with pulmonary edema what medication u cant give and why</p>

A

<p>betablocker

| can worsen acute heart failure</p>

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166
Q

<p>other medication can be used in pulmonary edema caused by anterior wall myocardial infarction and why</p>

A

<p>Morphine

| decrease prload and anxiolytic</p>

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167
Q

<p>patient with syncope with history of respiratotry infection 2 weeks ago EKG shows electrical alternans best next step in this patient</p>

A

<p>percardicenthesis</p>

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168
Q

<p>quid of electrical alternans</p>

A

<p>une onde qrs longue suivie d'une courte </p>

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169
Q

<p>EKG of pericardial effusion(3)</p>

A

<p>electrical alternans
sinus tachycardia
low QRS voltage in large pericardial effusion</p>

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170
Q

<p>quid of sinus tachycardia with electrical alternans</p>

A

<p>large pericardial effusion</p>

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171
Q

<p>problem in HIC(2)</p>

A 
<p>abnormal mitral leaflet motion= systolic anterior motion of the mitral valve
septal hypertrophy</p>
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172
Q

<p>cause of systolic dysfunction </p>

A

<p>MI

| ...</p>

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173
Q

<p>catetherisation during systolic heart failure(3)</p>

A

<p>CI decreased
left ventricular end diastolic volume increased
total peripheral resistance increased</p>

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174
Q

<p>how 's the left ventricular end diastolic heart failure</p>

A

<p>normal</p>

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175
Q

<p>patient with tachysystolic AFIB what to do to improve the left ventricular function in those patients</p>

A

<p>control the rate and the rythm</p>

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176
Q

<p>why tachysystolic AFIB causes significant left ventricular dialtion and depressed EF(4)</p>

A

<p>tachycardia
neurohumoral activation
absence of atrial kick
atrial ventricular desynchronisation</p>

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177
Q

<p>importance of atrial kick </p>

A

<p>it accounts for 25% of LV end diastolic volume</p>

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178
Q

<p>tachysystolic AFIB (3)</p>

A

<p>irregular irregualr rythm
tachycardia
no P waves ion EKG</p>

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179
Q

<p>cardiac problem in hemochromatosis(3)</p>

A

<p>cardiac conduction abnormalities
dialted cardiomyopathy
heart failure</p>

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180
Q

<p>the greatest risk factor for printzmetal angina</p>

A

<p>smoking</p>

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181
Q

<p>young female with nocturnal chest pain lasting 15-20 mn .EKG shows St segment elevation in lead 1 avl,v4-v6 during the episode rx</p>

A

<p>diltiazem
or
nitrate</p>

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182
Q

<p>why to not give bblocker or aspirin in printz metal angina</p>

A

<p>cause vasoconstriction</p>

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183
Q

<p>other name of printz metal</p>

A

<p>variant angina</p>

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184
Q

<p>after long trip to central asia female using OCP develops hemoptysis and pleuritic chest paincause of these symptoms</p>

A

<p>pulmonary infarction</p>

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185
Q

<p>number one cause of pleuritic chest pain</p>

A

<p>PE</p>

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186
Q

<p>gold standard Dx in PE</p>

A

<p>helical CT</p>

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187
Q

<p>patient with chest pain palpitations is seen in emergency .Physical exam reveals HTA ,dilated pupils ,small amount of blood at the external nares St segment elevation in V1-V4.explanation of the symptoms</p>

A

<p>drugs induced vasospasm

| cocaine abuse</p>

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188
Q

<p>why you cant give bblocker to patietn in cocaine abuse</p>

A

<p>unopposed alpha agonist will worsen vasospasm in cocaine abuse</p>

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189
Q

<p>cause of St segment elevation(4)</p>

A

<p>MI
Cocaine abuse
acute pericarditis
printzmetal</p>

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190
Q

<p>clue for aortic regurge</p>

A

<p>wide pulse pressure</p>

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191
Q

<p>manif of wide pulse pressure in reality</p>

A

<p>water hammer pulse

| =pounding heartbeat</p>

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192
Q

<p>way for the patient hear better the pounding heart(2)</p>

A

<p>lying supine and

| lying on the left</p>

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193
Q

<p>most common cause of aortic dilation in The US(2)</p>

A

<p>aortic root dialtion

| bicuspid aortic valve</p>

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194
Q

<p>the greater non pharmocologic rx with greatest impact on HTA and why(2)</p>

A

<p>weight loss

| reduce HTA of 5-20 per 10 kg loss</p>

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195
Q

<p>the second non pharmocologic rx with greatest impact on HTA and why(2)</p>

A

<p>DASH diet

| reduce HTA 8-14 mm de hG</p>

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196
Q

<p>thethird non pharmocologic rx with greatest impact on HTA and why(2)</p>

A

<p>exercice

| reduce HTA 4-9 mm de hg</p>

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197
Q

<p>the 4 e non pharmocologic rx with greatest impact on HTA and why(2)</p>

A

<p>dietary sodium

| reduce HTA 2-8 mm de hg</p>

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198
Q

<p>the 5 e non pharmocologic rx with greatest impact on HTA and why(2)</p>

A

<p>alcohol intake

| reduce HTA 2-4 mm de hg</p>

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199
Q

<p>quid of DASH diet(2)</p>

A

<p>Diet rich in fruits and vegetables

| and low saturated fat and total fat</p>

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200
Q

<p>time to work out in HTA(2)</p>

A

<p>30 min /day

| 5-6 days /semaine</p>

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201
Q

<p>dietary sodium restriction in HTA</p>

A

<p>< 3 g /day</p>

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202
Q

<p>alcohol intake restriction in HTA(2)</p>

A

<p>2 drinks /day in men

| 1 drink /day in women</p>

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203
Q

<p>first line rx for newly dx hypertension satge 1</p>

A

<p>lifestyle modification</p>

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204
Q

<p>patient with pedal edema ascite emigrating from china to come in the US.chest xray reveals decreased heart sound and an accentuated sound directly after the second heart sound in ear;y diastole .chest xray shows ring calcification around the heart and jugular venous pressure tracings show prominent x and y descents cause of the patient symptoms and Dx</p>

A

<p>tuberculosis

| constrictive pericarditis</p>

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205
Q

<p>clinical presentation of constrictive pericarditis(4)</p>

A

<p>fatigue and dyspnee on exertion
peripheral edema and ascites
high jugular venous pressure
pericardial knock</p>

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206
Q

<p>dx findings in constrictive pericarditis(2)</p>

A

<p>X and Y descents during jugular venous pulse tracing

| imagind shows pericardial thickening and calcification</p>

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207
Q

<p>pericardial knock</p>

A

<p>early heart sound after S2</p>

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208
Q

<p>heart dysfunction in constrictive pericarditis</p>

A

<p>diastolic</p>

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209
Q

<p>endemic areas for TB(3)</p>

A

<p>africa
india
china</p>

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210
Q

<p>EKG for Mobitz type 1(wenkeback)</p>

A

<p>PR interval growing slowly progressively leading up to a dropped beat</p>

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211
Q

<p>problem in mobitz one </p>

A

<p>impaired AV node conduction</p>

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212
Q

<p>sudden tearing chest pain in aptient with chest xray showing widened mediastinum dx and medical condition causing that</p>

A

<p>dissection aortic

| HTA</p>

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213
Q

<p>drugs increasing the riosk of bleeding when taking warfarin(9)</p>

A 
<p>acetaminophen 
NSAIDS
antibiotis/antifungal
amiodarone
canberry juice
ginkgo biloba viit E
omeprazole
thyroid hormone
selectice serotonin reuptake inhibitors</p>
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214
Q

<p>drugs decreasing the effect of warfarin(6)</p>

A 
<p>rifampin
carbamazepine
oral contraceptives
ginseng
st jhon's wort
green vegetables(spinach)</p>
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215
Q

<p>dose of acetaminophen to cause bleeding with warfarin ingestion</p>

A

<p>> 2 g /jour for 1 week</p>

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216
Q

<p>the most important factor for survival in out hospital sudden cardiac arrest</p>

A

<p>time to rythm analysis and defibrillation=elapse time to effective resuscitation
en d'autres mots:prompt effective resuscitation with adequate bystander CPR,prompt rythm analysis and defibrillation</p>

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217
Q

<p>number one cause of outhospital sudden cardiac arrest(2)</p>

A

<p>sustained VTAC
sustained VFIB
both cause by MI or ischemia</p>

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218
Q

<p>murmur in aortic dissection</p>

A

<p>diastolic murmur in left sternal border</p>

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219
Q

<p> 3 clinical findings in aortic dissection with 2 you make the DX</p>

A

<p>tearing chest pain radiating in the back
variation in pulse or blood pressure between the right and the left arm
widened mediastinum</p>

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220
Q

<p>complication of dissection aortic</p>

A

<p>extend to pericardium=tamponnade
extend to coronary arteries=stroke
extend to carotid arteries=stroke
</p>

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221
Q

<p>dissection aortic plus hemiplegia dx</p>

A

<p>stroke</p>

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222
Q

<p>incidence of aortic dissection when 2 clinical symptoms are present see question above</p>

A

<p>80 %</p>

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223
Q

<p>patient found with pulsatile mass above umbilicus creat 2.0 and TA:160/90 dx and best test to confirm the DX(2)</p>

A

<p>abdominal aneurism of aorta

| abdominal ultrasound</p>

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224
Q

<p>quid of BNP</p>

A

<p>release by dilated ventricle</p>

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225
Q

<p>value for BNP to Dx CHF(4)</p>

A

<p>> 100 pg /ml
specificity 76
sensitivity 90
predictive value 83</p>

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226
Q

<p>importance of BNP</p>

A

<p>helps to differentiate dyspnea of cardiac origin with any other origin</p>

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227
Q

<p>cause of right Heart failure in COPD</p>

A

<p>pulmonary artery systolic pressure</p>

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228
Q

<p>sequence of event causing right heart failure in COPD</p>

A

<p>hypoxemia causes constriction of the pulmonary artery and with time pulmonary hypertension---> will lead to right ventricular hypertrophy and right ventricular failure</p>

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229
Q

<p>does right ventricular failure cause pulmonary edema</p>

A

<p>it s not a common cause of pulmonary edema</p>

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230
Q

<p>management of STEMI(6)</p>

A 
<p>oxygen 
nitrates
antiplatelet therapy
anticoagulation
bblockers
prompt reperfusion with PCI</p>
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231
Q

<p>antiplatelet therapy used in STEMI</p>

A

<p>platelet P2y12 receptor inhibitor</p>

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232
Q

<p>anticoagulation used in STEMI</p>

A

<p>bivalirudin is preferred over heparin</p>

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233
Q

<p>ideal first rx for STEMI</p>

A

<p>prompt reperfusion with PCI</p>

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234
Q

<p>clue for benign essential tremor(3)</p>

A

<p>tremor worst with activity
improves with with alcohol
family inheritance autososmal dominant</p>

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235
Q

<p>HTA plus benign esential tremor Rx</p>

A

<p>propranolol</p>

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236
Q

<p>the most effective non pharmacological rx of HTA</p>

A

<p>weight loss</p>

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237
Q

<p>clue for venous insufficiency(4)</p>

A

<p>pedal edema
medial ankle ulcer
dilated and tortuous superficial veins
normal physical exam</p>

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238
Q

<p>initial rx of venous insufficiency(3)</p>

A

<p>leg elevation
exercice
compression stockings</p>

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239
Q

<p>method to hear aortic regurgitation murmur(4)</p>

A

<p>diastolic murmur
best heard along the left sternal border at the third and fourth interspaces
best heart when you apply firm pressure with the diaphragm of the sthetoscope while patient is sitting up leaning forward and holding the breath in full expiration</p>

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240
Q

<p>cause of aortic regurge in developed countries in young adults</p>

A

<p>bicuspid aortic valve</p>

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241
Q

<p>cause of aortic regurge in developing countries in young adults</p>

A

<p>rheumatic heart disease</p>

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242
Q

<p>common cause of aortic regurgitation involving the aortic valve leaflet(8)</p>

A 
<p>rheumatic heart disease
endocarditis
bicuspid aortic valve
trauma
myxomatous degeneration
ankylosing spondylitis
acromegaly
medications</p>
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243
Q

<p>common cause of aortic regurgitation involving trhe ascending aorta or aortic root disease (8)</p>

A 
<p>hta
aortitis syphilitic
ankylosing spondylitis
dissection aortic
ehlers danlos
IBD
reactve arthritis
Marfan syndrome</p>
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244
Q

<p>Medication to hold for 48 h prior to cardiac testing(3)</p>

A

<p>Bblocker
calcium blocker
nitrates</p>

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245
Q

<p>medication to hold 48 h prior to vasodilator stress test</p>

A

<p>dipyridamole</p>

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246
Q

<p>medication to hold 12 h prior to vasodilator stress test</p>

A

<p>caffeine containing food or drinks</p>

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247
Q

<p>medication you can continue prior to to cardiac stress testing(5)</p>

A 
<p>ACE inhibitor
ARBs
digoxin
statins
diuretics</p>
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248
Q

<p>gold standard Dx of CAD</p>

A

<p>coronary angiography</p>

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249
Q

<p>indication of amiodarone(3)</p>

A

<p>ventricular arythmias
rythm control in AFIB
left ventricular systolic dysfuction</p>

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250
Q

<p>toxicity of amiodarone(7)</p>

A 
<p>hypo or hyper thyroidism
hepatotoxicity
bradycardia
heart block
pneumonitis
neurologic symptoms
visual disturbances</p>
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251
Q

<p>visual probelm associated with amiodarone(2)</p>

A

<p>corneal microdeposits

| optic neuropathy</p>

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252
Q

<p>heart problem with amiodarone(2)</p>

A

<p>Qt prolongation

| risk de torsades de pointes</p>

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253
Q

<p>dermatologic problem associated with amiodarone</p>

A

<p>blue gray skin discoloration</p>

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254
Q

<p>neurologic problem associated with amiodarone</p>

A

<p>peripheral neuropathy</p>

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255
Q

<p>gastrointestinal and hepatic problem associated with amiodarone(2)</p>

A

<p>elevated transaminases

| hepatitis</p>

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256
Q

<p>mark for IV drug user in USMLE</p>

A

<p>needle tracks on arms</p>

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257
Q

<p>IV drug user with fever andround lesions in lungs and sinus tachycardia.what accompanying finding is expected </p>

A

<p>systolic murmur that increases with inspiration</p>

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258
Q

<p>bug in infective endocarditris in IV drug user</p>

A

<p>staph aureus</p>

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259
Q

<p>what increases the risk of infective endocarditis in IV drug user</p>

A

<p>HIV infection</p>

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260
Q

<p>holosystolic murmur increasing with inspiration quid of that</p>

A

<p>tricuspid involvement</p>

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261
Q

<p>IE with round lung opacity</p>

A

<p>septic pulmonary emboli</p>

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262
Q

<p>what must be done in young patient with systemic HTA</p>

A

<p>evaluation for coarctation of aorta</p>

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263
Q

<p>assessment of coarctation of aorta in physical exam(3)</p>

A

<p>search for brachio femoral delay
upper extremity hypertension lower extremity hypotension
continuous cardiac murmur from large collaterals</p>

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264
Q

<p>acqiured cause of coarctation of aorta </p>

A

<p>maladue de takayasu</p>

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265
Q

<p>chest xray for aaortic coarctation</p>

A

<p>notching of the 3 th-8th ribs from enlarged intercostal arteries</p>

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266
Q

<p>confirmatory dx for aortic coarctation</p>

A

<p>echocardiography</p>

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267
Q

<p>rx of aortic coarctation(2)</p>

A

<p>balloon angioplasty
plus or minus
stent</p>

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268
Q

<p>complication of CABG</p>

A

<p>AFIB</p>

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269
Q

<p>AFIB in hemodynamically unstable patient rx</p>

A

<p>DC cardioversion</p>

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270
Q

<p>EKG of AFIB(3)</p>

A

<p>absent P waes
an irregularly irregylar rate
narrow QRS complex</p>

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271
Q

<p>clinical features for cocaine abuse(4)</p>

A

<p>sympathetic activity
chest pain
psychomotor agitation
seizures</p>

272
Q

<p>sympathetic activity in cocaine abuse(3)</p>

A

<p>tachycardia
HTA
dilated pupils</p>

273
Q

<p>why chest pain in cocaine abuse</p>

A

<p>coronary vasodilation</p>

274
Q

<p>complication of cocaine abuse(3)</p>

A

<p>acute MI
aortic dissection
intracranial hemorrage</p>

275
Q

<p>clue in USmle for cocaine abuse</p>

A

<p>nasal mucosa is atrophic</p>

276
Q

<p>chest pain management in cocaine abuse(5)</p>

A 
<p>benzodiazepines
aspirin
Nitrate and calcium blocker
no Bblocker
immediate cardiac catheterisation with reperfusion when indicated</p>
277
Q

<p>why you ccant use fibrinolytics in the management of chest pain caused by cocaine abuse</p>

A

<p>increased risk of intracranial hemorrage</p>

278
Q

<p>patient with infective endocarditis is started on vancomycin .Days later culture grows streptococcus mutans highly sensitive to PNC next step</p>

A

<p>switch antibiotics to IV ceftriaxone</p>

279
Q

<p>rx of infective endocarditis caude by step mutans(3)</p>

A

<p>IV pNC
IV ceftriaxone
for 4 weeks</p>

280
Q

<p>what intervention in STEMI will improve the long term prognosis of patient</p>

A

<p>restore coronary blood flow</p>

281
Q

<p>inferior MI</p>

A

<p>2 ,3 avf</p>

282
Q

<p>two primary options to restore coronary blood flow(2)</p>

A

<p>PTCA

| fibrinolysis</p>

283
Q

<p>when to do exercice EKG or pharmacologic stress testing in patient with chest pain </p>

A

<p>when you have intermediate risk of CAD</p>

284
Q

<p>quid of intermediate risk of CAD(3)</p>

A

<p>atypical angina in men of all ages
atypical angina in women > ou egal 50
typical angina in women age 30-50</p>

285
Q

<p>high risk for CAD(2)</p>

A

<p>typical angina in men > ou egal a 40 ans

| typical angina in women age > ou egal a 60 ans</p>

286
Q

<p>low risk for CAD(2)</p>

A

<p>atypical chest pain in women age < 50 ans

| asymptomatic people of all ages</p>

287
Q

<p>high risk for CAD CAT(2)</p>

A

<p>start Rx

| coronary angiography if unstable angina</p>

288
Q

<p>patient with ant.hypertension with hypotension tachycardia,distended neck veins pulsus paradoxus with teraing chest pain dx</p>

A

<p>pericardial tamponnade due to dissection aortique</p>

289
Q

<p>USMLE pulsus paradoxus</p>

A

<p>respiratory variation in systolic blood pressure or

| decrease > 10mm de hg drop in systolic pressureduring inspiration</p>

290
Q

<p>why syncope and hypotension in tamponnade(4)</p>

A

<p>compression of cardiac chambers by fluid in pericardium
limit diastolic filling of trhe right sided chambers
decreases preload
reduces cardiac out put</p>

291
Q

<p>young age under 70 patient with aortic stenosis cause </p>

A

<p>bicuspid aortic valve</p>

292
Q

<p>elderly 70 patient with aortic stenosis cause </p>

A

<p>calcification of aorta</p>

293
Q

<p>tearing cehst pain in thew context of hypotension with respiratory variation in systolic blood pressure hypotension ,distended jugular veins dx</p>

A

<p>dissection aortique</p>

294
Q

<p>dissection aortic wuth Ta higher in right arm than the left arm why</p>

A

<p>extension of the dissection into the great vessels feeding the left arm</p>

295
Q

<p>after myocardial infarction patient develops develops widened QRS complex with compensatory pause next step but patietn is asymptomatic</p>

A

<p>observation</p>

296
Q

<p>PVC in symptomatic patient rx </p>

A

<p>Bblocker</p>

297
Q

<p>when you cant use nitrates in in MI</p>

A

<p>right ventricular MI</p>

298
Q

<p>when to suspect right ventricular MI</p>

A

<p>often accompany post MI</p>

299
Q

<p>when to suspect right ventricular MI(5)</p>

A

<p>hypotension
with clear lung fields
high JVP
Kussmaul's sign positif</p>

300
Q

<p>Left ventricular infarct(2)</p>

A

<p>hypotension

| pulmonary edema</p>

301
Q

<p>correction of hypotension in right ventricular infarct(2)</p>

A

<p>administer normal saline bolus

| don't give nitro</p>

302
Q

<p>patient developping dyspnea after stab wound to the right thigh 10 months ago .In EP,right leg is warmer and apperas flushed compared to his left leg cause of the patient symptom</p>

A

<p>increased cardiac preload</p>

303
Q

<p>patient developping dyspnea after stab wound to the right thigh 10 months ago .In EP,right leg is warmer and apperas flushed compared to his left leg cause of the patient symptom dx</p>

A

<p>AV fistula</p>

304
Q

<p>congenital cause of AV fistula(4)</p>

A

<p>PDA
angiomas
pulmonary AVF
CNS AVF</p>

305
Q

<p>acquired cause of AVF(4)</p>

A

<p>trauma
iatrogenic ( femoral catheterisation)
atherosclerosis(aortocava fistula)
cancer</p>

306
Q

<p>why heart failure in AVF</p>

A

<p>the circulation is unable to meet the oxygen demand of the peripheral tissues</p>

307
Q

<p>patietn with dyspnes and elevate BNP what you expect to find in this patient</p>

A

<p>S3</p>

308
Q

<p>meaning of S3 and elevated BNP</p>

A

<p>increased cardiac filling pressures</p>

309
Q

<p>patinet with left sided chest pain improving with leaning forward and creat 5.1 dx and rx(2)</p>

A

<p>pericarditis

| hemodyalisis</p>

310
Q

<p>most common cause of pericarditis</p>

A

<p>viral infection</p>

311
Q

<p>rx of viral pericarditis</p>

A

<p>NSAID</p>

312
Q

<p>cause of pericarditis(5)</p>

A 
<p>iatrogenic
connective tissue disease
cardiac
uremic
malignancy</p>
313
Q

<p>iatrogenic cause of pericarditis(4)</p>

A

<p>surgery
trauma
radiation
drug related/chemo</p>

314
Q

<p>connective tissue causing pericarditis(2)</p>

A

<p>RA

| SLE</p>

315
Q

<p>cardiac problem causing pericarditis</p>

A

<p>dressler syndrome</p>

316
Q

<p>quid of dressler syndrome(2)</p>

A

<p>post MI infarction

| usually 1 -6 weeks after MI</p>

317
Q

<p>when you will have uremic pericarditis</p>

A

<p>whrn BUN> 60 mg/dl</p>

318
Q

<p>CHADS 2 score(5)</p>

A 
<p>C=CHF =1 pt
H=hypertension=1
A=age . ou egal a 75=1
D=diabetes=1
S=prior stroke =2</p>
319
Q

<p>CHF apres recent cold</p>

A

<p>dilated cardiomyopathy</p>

320
Q

<p>finding on echo in dilated cardiomyopathy(2)</p>

A

<p>dilated ventricles with diffuse hypokinesia

| low ejection fraction</p>

321
Q

<p>viral myocarditis cause #1</p>

A

<p>coxsackievirus B</p>

322
Q

<p>viral myocarditis other cause(4)</p>

A

<p>parvovirus B19
human herpes virus 6
adenovirus
enterovirus</p>

323
Q

<p>tracing of arterial line and BP </p>

A

<p>compare pick lors de l'inspiration and pic in systolic presure to understand the graphics</p>

324
Q

<p>quid of pulsus paradoxus</p>

A

<p>decrease of ten mm de hg of systolic pressure during inspiration</p>

325
Q

<p>explanation of pulsus paradoxus</p>

A

<p>in inspiration the intrathoracic pressure is negative
incresase venous return to the right heart
interventricular septum shifs into the left ventricular cavity reducing the left ventricular and diastolic volume
d'ou decreasd systolic blood pressure in the case of tamponnade</p>

326
Q

<p>other cause of pulsus paradoxus(2)</p>

A

<p>severe asthma

| COPD</p>

327
Q

<p>why isolated systolic hypertension in elderly </p>

A

<p>rigidity of the arterial wall</p>

328
Q

<p>rx of isolated systolic hypertension in elderly</p>

A

<p>monotherapy with thiazide
or ACE inhibitor
or
long acting calcium channel blocker</p>

329
Q

<p>heart problem in Marfan(3)</p>

A

<p>aortic dilation
regurge
aortic dissection</p>

330
Q

<p>murmur in Marfan</p>

A

<p>early diastolic murmur</p>

331
Q

<p>skeletal problem in Marfan(5)</p>

A 
<p>arachnodactyly
pectus deformity
joint hypermobility
increase arm to height ratio
decrease upper to lower body segment ratio</p>
332
Q

<p>ocular problem in marfan</p>

A

<p>ectopia lentis</p>

333
Q

<p>why marfan patient tend to have spontaneous pneumothorax</p>

A

<p>rupture of apical blebs</p>

334
Q

<p>skin finding in Marfan(2)</p>

A

<p>reccurrent or incisionnal hernia

| skin striae</p>

335
Q

<p>Marfan patient with acute chest pain</p>

A

<p>acute aortic dissection</p>

336
Q

<p>syncope provoked by strong emotion</p>

A

<p>vasovagal syncope</p>

337
Q

<p>inciting event of vasovagal syncope in patient < 60 ans(2)</p>

A

<p>emotionnal stress(venipuncture)
orthostatic stress(prolonged standing)
</p>

338
Q

<p>inciting event of vasovagal syncope in patient > 60 ans(3)</p>

A

<p>micturition
cough
defecation</p>

339
Q

<p>dx of uncertain vasovagal syncope</p>

A

<p>upright tilt table testing</p>

340
Q

<p>dx of vasovagal syncope</p>

A

<p>clinical</p>

341
Q

<p>what medication should be given to all patient with MI within 24 hours</p>

A

<p>ACE inhibitor</p>

342
Q

<p>why ACE inhibitor in post MI(2)</p>

A

<p>to prevent remodelling of the ventricle and

| possible dilation of the ventricle leading to CHF</p>

343
Q

<p>military recruit with body temperature > 40 during exercice with central nervous system dx</p>

A

<p>heat stroke</p>

344
Q

<p>common symptom in heat stroke(3)</p>

A

<p>dehydration
hypotension
tachycardia</p>

345
Q

<p>systemic effects of heat stroke(4)</p>

A

<p>seizures
acute respiratory distress syndrome
DIC
hepatic and renal failure</p>

346
Q

<p>rx of heat stroke(4)</p>

A

<p>rapid cooling with ice water immersion
fluid resuscitation
electrolyte correction
management of end organ damage</p>

347
Q

<p>antipyretic in heat stroke </p>

A

<p>any role</p>

348
Q

<p>risk factors for heat stroke(6)</p>

A 
<p>strenuous activity during hot and humid weather
dehydration
poor acclimatisation
lack of physical fittness
obesity
medications </p>
349
Q

<p>medication involved in heat stroke(4)</p>

A

<p>anticholinergics
antihistamines
phenothiazines
tricyclics</p>

350
Q

<p>murmur on right sternal border increased with expiration </p>

A

<p>left side heart murmurs</p>

351
Q

<p>symptom of aorti stenosis(3)</p>

A

<p>S=Syncope
A=angine
D=Dyspnea</p>

352
Q

<p>indication of surgery in Aortic stenosis(3)</p>

A

<p>symptomatic patient
patients with severe AS undergoing CABG or other valvular surgery
asymptomatic patient with severe AS and poor LV systolic function=LV hypertrophy >15 mm
valve area <0,6 cm2 or abnormal response to exercice</p>

353
Q

<p>cause of anginal pain in aortic stenosis</p>

A

<p>increased myocardial oxygen demand</p>

354
Q

<p>medication with decreased mortality following MI(4)</p>

A

<p>aspirin
B blockers
ACE inhibitor
lipid lowering statins</p>

355
Q

<p>indication of clopidogrel in MI(3)</p>

A

<p>intolerance to aspirin
post US/NSTEMI
following PCI</p>

356
Q

<p>duration of taking of aspirin and clopidogrel after UA/NSTEMI</p>

A

<p>12 months for clopidogrel

| definitely for aspirin</p>

357
Q

<p>role of clopidogrel and aspirin inn post PCI</p>

A

<p>prevent stent thrombosis</p>

358
Q

<p>AFIB with cardiac arrest next step</p>

A

<p>chest compression</p>

359
Q

<p>quid of pulseless electrical activity</p>

A

<p>the presence of organized rythm on cardiac monitoring without a measurable BP or palpable pulse in a cardiac arrest patient</p>

360
Q

<p>wht to do in pulseless electrical activity(2)</p>

A

<p>chest compression
no defibrillator
nosynchronised cardioversion</p>

361
Q

<p>AFIB with cardiac arrest Dx</p>

A

<p>pulseless electrical activity</p>

362
Q

<p>reversible causes of asystole/pulselkess electrical activity 5H(5)</p>

A 
<p>hypovolemia
hypoxia
hydrogen nions( acidosis)
hypo or hyperkaliemia
hypothermia</p>
363
Q

<p>reversible causes of asystole/pulselkess electrical activity 5T(5)</p>

A 
<p>tension pneumothorax
tamponnade
toxins
thrombosis(pulmonary or coronary)
trauma</p>
364
Q

<p>elderly with diarrhea develops orthostatic hypotension,mucosal dryness, what's the most sensitive indicator to see if elder is dehydrated</p>

A

<p>increase BUN/CREAT ratio</p>

365
Q

<p>after MI patient develops leg Pain dx</p>

A

<p>occlusion of popliteal artery</p>

366
Q

<p>5 P in occlusion artery</p>

A 
<p>Pain
pulselessness
paresthesia
poikilothermia
pallor</p>
367
Q

<p>tr of occlusion artery(2)</p>

A

<p>embolectomy
or
intra arterial fibrinolysis/mechanical embolectomy via interventionnal radiology</p>

368
Q

<p>pleuritic chest pain normal cardiac exam, tenderness to palpation over the sternum</p>

A

<p>costochondritis</p>

369
Q

<p>clue for pain from musculoskeletal origin</p>

A

<p>reproducible with palpation</p>

370
Q

<p>papiltaion with AFIB in patient with lid lag retraction and tremor dx</p>

A

<p>graves disease</p>

371
Q

<p>rx of hyperthyroidism related tachysystolic AFIB</p>

A

<p>propranol</p>

372
Q

<p>patient with HTA is receiving a drug whicn enhances natriuresis,decreases serum angiotensin 2 concentration and decreases aldosterone production action of that drug</p>

A

<p>direct renin inhibitor</p>

373
Q

<p>example of direct renin inhibitor</p>

A

<p>aliskiren</p>

374
Q

<p>drugs affecting the renin angiotensin aldosterone axis(3)</p>

A

<p>ACE inhibitors
angiotensin receptor blockers
direct renin inhibitor</p>

375
Q

<p>MI plus flash pulmonary edema management</p>

A

<p>furosemide</p>

376
Q

<p>initial stabilisation of acute ST segment elevation MI(7)</p>

A 
<p>02 if sao2 < 90% or dyspnea
aspirin 325 mg
P2y12 inhibitor(clopidogrel)
nitrates
beta blocker
high dose statin (atorvastatin 80 Mg)
anticoagulation</p>
377
Q

<p>ST segment elevation plus unstable sinus bradycardia management</p>

A

<p>IV atropine</p>

378
Q

<p>ST segment elevation plus persistent severe pain ,management</p>

A

<p>IV morphine</p>

379
Q

<p>ST segment elevation plus persistent

| pain,hypertension or heart failure ,management</p>

A

<p>IV nitroglycerine</p>

380
Q

<p>when you cant use nitro in MI(3)</p>

A

<p>hypotension
right ventricular infarct
severe aortic stenosis</p>

381
Q

<p>when you cant use b blockers in MI(2)</p>

A

<p>CHF

| bradycardia</p>

382
Q

<p>laps of time to perform percutaneous transluminal coronary angioplasty following MI</p>

A

<p>within 90 mn preferred</p>

383
Q

<p>if PTCA within 120 mn not available in case of acute ST segment elevation next step</p>

A

<p>thrombolysis </p>

384
Q

<p>patient is receiving a medication for palpitation ,he undergoes a stres test for chest pain durinfg the test his heart rate increases form 65 to 175 and qrs duration from 0,09 to 0.13 seconds .which medication was used for palpitation in thsis patient</p>

A

<p>flecainide</p>

385
Q

<p>why during stress test if you are taking flecainide heart rate will increase and QRS complex prolonged</p>

A

<p>the medication has a use dependance prperty
more effective at higher heart rates because there is not as much time between heartbeats for the medication to dissociate from its receptor</p>

386
Q

<p>action of flecainide </p>

A

<p>block sodium channel </p>

387
Q

<p>indication of flecainide(2)</p>

A

<p>ventricular arythmias

| supraventricular tavhycardia as AFIB</p>

388
Q

<p>class of antiarrythmic involved in use dependence phenomenon</p>

A 
<p>class 1c
class iV</p>
389
Q

<p>does class IV prolong QRS complex</p>

A

<p>no</p>

390
Q

<p>patient with MI under rx 4 days later develops chest pain .the best marker to be useful in this patient</p>

A

<p>CK MB</p>

391
Q

<p>the most specific and sensitive test for MI(2)</p>

A

<p>troponin T

| return to normal in 10 days post MI</p>

392
Q

<p>wy CKMB is the best test in reocclsuion following a previous recent one</p>

A

<p>it takes 1-2 days to become normal after MI</p>

393
Q

<p>murmur in mitral regurge</p>

A

<p>holosystolic murmur</p>

394
Q

<p>features for mitral regurgitation(4)</p>

A

<p>exertional dyspnea
fatigue
AFIB
heart failure signs</p>

395
Q

<p>aortic stenosis in elderly cause</p>

A

<p>sclerocalcific changes</p>

396
Q

<p>you perform myocardial perfusion scanning for a patient,it reveals uniform distribution at rest but inhomogenesity of the distribution after dipyridamole injection.waht effect of dipyridamole helps in making the dx of ischemic heart disease</p>

A

<p>coronary steal phenomenon</p>

397
Q

<p>indication of myocardial perfusion scanning with dipyridamole</p>

A

<p>amputated patient</p>

398
Q

<p>quid of coronary steal </p>

A

<p>redistribution of coronary blood flow to non diseases segments</p>

399
Q

<p>whta other substance can be used in myocardial perfusion scanning</p>

A

<p>adenosine</p>

400
Q

<p>risk of mitral stenosis</p>

A

<p>left atrial dilation
AFIB
cardiac emboli</p>

401
Q

<p>consequence of pressure transmitted to pulmonary vasculature inmitral stenosis(3)</p>

A

<p>dyspnea
cough
hemoptysis</p>

402
Q

<p>patient with right sided weakness cough hemoptyis dyspnes from cambogia dx</p>

A

<p>stroke caused by cardiac emboli inthe setting of mitral stenosis</p>

403
Q

<p>quid of mallory weiss(2)</p>

A

<p>upper gastrointestinal mucosal tear

| caused by forceful retching</p>

404
Q

<p>quid of boerhave syndrome(3)</p>

A

<p>esophageal transmural tear
caused by forcefu retching
esophageal air and fluid leakage in nearby areas</p>

405
Q

<p>chest xray in boerhave syndrome(3)</p>

A 
<p>unilateral pleural effusion
with or without pneumothorax
subcutaneous or mediastinal emphysema
widened mediastinum
</p>
406
Q

<p>pleurl fluid analysis in boerhave syndrome(2)</p>

A

<p>high amylase > 2500 UI

| food particles</p>

407
Q

<p>dx of boerhave syndrome(*2)</p>

A

<p>CT

| contrast esophagography with gastrographin</p>

408
Q

<p>confirnatory dx in mallory weiss</p>

A

<p>endoscopy gastro digestive </p>

409
Q

<p>risk factor for variant angina</p>

A

<p>smoking</p>

410
Q

<p>EKG in variant angina</p>

A

<p>ST segment elevation</p>

411
Q

<p>condition associated with printzmetal angina(2)</p>

A

<p>migraine

| raynauds phenomenon</p>

412
Q

<p>pain characteristic in prntzmetal</p>

A

<p>occurs at night

| goes spontaneously after 15-20 mn</p>

413
Q

<p>hypertension in the setting of hypercalcemia</p>

A

<p>parathyroid gland disease</p>

414
Q

<p>secondary HTA caused by renal parenchymal disease(2)</p>

A 
<p>elevated serum creat
abnormal urinalysis (proteinuria,red blood cell casts)</p>
415
Q

<p>secondary HTA caused by reno vacular disease(4)</p>

A

<p>severe HTA > ou egal 180/120 after 55
abdominal bruit
flash pulmonary edema
unexplained rise in creat</p>

416
Q

<p>secondary HTA caused by primary aldosteronism(3)</p>

A

<p>hypokaliemia
slight hypernatremia
adrenal incidentaloma</p>

417
Q

<p>secondary HTA caused by pheochromocytoma (3)</p>

A

<p>paroxysmal elevated BP with tachycardia
pounding headaches papiltations and diaphoresis
adrenal incidentaloma</p>

418
Q

<p>secondary HTA caused by hypothyroidism(5)</p>

A 
<p>constipation
weight gain
bradycardia
cold intolerance
dry skin</p>
419
Q

<p>secondary HTA caused by primary hyperparathyroidism(3)</p>

A

<p>hypercalcemia
kidney stones
neuropsychiatric disease</p>

420
Q

<p>secondary HTA caused by coarctation of aorta</p>

A

<p>differential HTA with brachio femoral pulse delay</p>

421
Q

<p>xray findingds in pericardial effusion</p>

A

<p>water bottle cardiac silhouette</p>

422
Q

<p>how 's the jugular venous pressure in viral pericarditis </p>

A

<p>could be normal</p>

423
Q

<p>how 's the point of maximal impulse in viral pericarditis </p>

A

<p>non palpable</p>

424
Q

<p>first test to do in a setting of syncope</p>

A

<p>EKG</p>

425
Q

<p>syncope occuring during prolonged standing position distress or painful stimuli dx</p>

A

<p>vasovagal or neurally mediated syncope</p>

426
Q

<p>syncope occuring during postural changes with changes in heart rate and blood pressure</p>

A

<p>orthostatic hypotension</p>

427
Q

<p>syncope during exercice or with exertion(4)</p>

A

<p>aortic stenosis
HOC
anomalous coronary arteries
VTAC</p>

428
Q

<p>syncope with sinus pauses on monitor prolonged PR interval or QRS duration(3)</p>

A

<p>sick sinus syndrome
bradyarythmiasd
av block</p>

429
Q

<p>syncope with hypokaliemia or hypomg++ or any medication causing prolonged QT interval</p>

A

<p>torsades de pointes

| (acquired long QT syndrome)</p>

430
Q

<p>syncope with triggers ( swimming,during sleep sudden noice) family history of sudden daerth prolonged qt interval on ECG</p>

A

<p>congenital long Qt syndrome</p>

431
Q

<p>ECG findings suggesting arrythmia as the cause of syncope(6)</p>

A 
<p>innaproppriate sinus bradycardia
sino atrial block
sinus pauses
AV block
nonsustained VTAC
short or long QTC interval</p>
432
Q

<p>murmur in aortic regurge(2)</p>

A

<p>early diastolic murmur

| left sternal border</p>

433
Q

<p>bounding pulse or water hammer peripheral pulse</p>

A

<p>aortic regurgitation</p>

434
Q

<p>aortic murmur in regurgitation localisation in valvular disease</p>

A

<p>diastolic murmur in left sternal border 3 e 4 e espace intercostal</p>

435
Q

<p>aortic murmur in regurgitation localisation in aortic root disease</p>

A

<p>diastolic murmur in right sternal border</p>

436
Q

<p>conduction abnormality in the setting of infective endocarditis</p>

A

<p>perivalvular abcess</p>

437
Q

<p>risk in acute endocarditis involving the aortic valve in IV drug user</p>

A

<p>periannular extension of endocarditis</p>

438
Q

<p>peripheral edema with normal physical exam in a patient taking calcium blocker cause of edema</p>

A

<p>dihydropyridine Ca channel antagonist</p>

439
Q

<p>sudden death in young athlete</p>

A

<p>hypertrophic cardiomyopathy</p>

440
Q

<p>risk factor for coroanry syndrome(3)</p>

A

<p>smoking
family history
estrogen therapy</p>

441
Q

<p>patientin EB with chest pain and suspected coronary syndrome .what drug should be administered first</p>

A

<p>aspirin</p>

442
Q

<p>why aspirin is so important in acute coronary syndrome(2)</p>

A

<p>reeudces risk of MI

| decrease mortality overall</p>

443
Q

<p>apical holosystolic murmur</p>

A

<p>mitral rergurgitation</p>

444
Q

<p>apical mid late systolic murmur</p>

A

<p>mitral valve prolapse</p>

445
Q

<p>apical mid late diastolic murmur</p>

A

<p>mitral stenosis</p>

446
Q

<p>left sternal border systolic ejection murmur</p>

A

<p>Hypertrophic cardiomyopathy</p>

447
Q

<p>left sternal border early diastolic murmur(2)3 e espace intercostal</p>

A

<p>aortic regurgitation

| pulmonic regurgitation</p>

448
Q

<p>quid of pulomonic area</p>

A

<p>2 espace intercostal G</p>

449
Q

<p>systolic ejection murmur in pulmonic area</p>

A

<p>pulmonic stenosis
flow murmur
ASD</p>

450
Q

<p>systolic ejection click in pulmonic area</p>

A

<p>pulmonic stenosis</p>

451
Q

<p>quid aortic area</p>

A

<p>2 e espace intercostal droit</p>

452
Q

<p>systolic ejection murmur in aortic area</p>

A

<p>aortic stenosis</p>

453
Q

<p>holosystolic murmur in tricuspid area</p>

A

<p>tricuspid regurge

| VCD</p>

454
Q

<p>quid of tricuspid area </p>

A

<p>4 e espace intercostal in the left close to sternum</p>

455
Q

<p>mid late diastolic murmur(2)</p>

A

<p>tricuspid stenosis

| ASD</p>

456
Q

<p>cause of mitral regurgitation in developed countries</p>

A

<p>mitral valve prolapse=myxomatous degeneration of the valve</p>

457
Q

<p>complication of severe chronic Mitral regurgitation(3)</p>

A

<p>AFIB
left ventricular dysfunction
CHF</p>

458
Q

<p>most common benign tumor in heart</p>

A

<p>Myxoma</p>

459
Q

<p>Symptom for atrial myxoma(3)</p>

A

<p>systemic embolization
cardiovascular symptoms simulating mitral valve disease
constitutioonnal symptoms</p>

460
Q

<p>most sensitive test to Dx atrial myxoma</p>

A

<p>transesophageal echocardiography</p>

461
Q

<p>complication of myxoma</p>

A

<p>sudden death</p>

462
Q

<p>murmur in myxoma</p>

A

<p>early diastolic sound=tumor flop</p>

463
Q

<p>why constitutionnal symptoms in myxoma</p>

A

<p>overproduction of interleukin 6</p>

464
Q

<p>anterior wall MI</p>

A

<p>V1- V6</p>

465
Q

<p>hemodynamic hypotension compromises 3 a 7 jours after anterior MI(3)</p>

A

<p>paillary muscle rupture
left ventricle free wall rupture
interventricular septum rupture</p>

466
Q

<p>hypotension with pansystolic murmur apical after anterior wall MI</p>

A

<p>acute mitral regurgitation caused by papillary muscle dysfunction</p>

467
Q

<p>normal heart rate at rest</p>

A

<p>60-100</p>

468
Q

<p>symptomatic sinus bradycardia(dizziness) rx</p>

A

<p>iV atropine</p>

469
Q

<p>symptomatic sinus bradycardia unresponsive to atropine</p>

A

<p>permanent pace maker</p>

470
Q

<p>cause of sinus bradycardia(4)</p>

A

<p>sick sinus syndrome
hypoglycemia
medication
exagerated vagal activity</p>

471
Q

<p>medication involved in sinus bradicardia(3)</p>

A

<p>digitalis
B blocker
Calcium channel blocker</p>

472
Q

<p>first line antianginal rx used in stabe chronic angina</p>

A

<p>B blocker</p>

473
Q

<p>antianginal drug(3)</p>

A

<p>bblocker
calcium channel blocker
nitrates</p>

474
Q

<p>action of BBlocker as antianginal drug</p>

A

<p>decrease myocardial contractility and heart</p>

475
Q

<p>action of calcium channel blocker as antianginal drug</p>

A

<p>peripheral and coronary vasodilation</p>

476
Q

<p>can you combine Bblocker and calcium blocker as antianginal</p>

A

<p>yes

| in persisting angina</p>

477
Q

<p>preventive rx in stable chronic angina(5)</p>

A 
<p>aspirin
statin
smoking cessation
regular exercices and weight loss
control of BP and diabetes</p>
478
Q

<p>when to use nitrate in stable chronic angina</p>

A

<p>when B blocker and calcium blocker are contindicated</p>

479
Q

<p>medication which has not been shown to improve survival in patients with CHF(2)</p>

A

<p>digoxin

| furosemide</p>

480
Q

<p>medication which has been shown to improve survival in patients with CHF(5)</p>

A 
<p>ace inhibitor
ARB's
bblocker
aspirin
spironolactone</p>
481
Q

<p>S4 meaning</p>

A

<p>diastolic disfunction</p>

482
Q

<p>why S4 in MI</p>

A

<p>ischemic damage may lead to diastolic dysfuction and stiffened ventricle</p>

483
Q

<p>rx of dressler syndrome</p>

A

<p>NSAIDS</p>

484
Q

<p>indication of corticosteroids in dressler syndrome(2)</p>

A

<p>refractory cases

| contrindication of NSAIDS</p>

485
Q

<p>why you should avoid anticoagulation if you suspect dressler syndrome</p>

A

<p>risk of hemorragic pericardial effusion</p>

486
Q

<p>bad prognosis factor in heart failure</p>

A

<p>hyponatremia</p>

487
Q

<p>why hyponatremia is a factro of bad prognosis in heart failure(2)</p>

A

<p>it indicates sever heart failure

| high level of neurohumoral activation</p>

488
Q

<p>cause of hypo or hyperkaliemia in CHF(2)</p>

A

<p>drugs induced

| reflection of renin angiotensin aldosterone system activity</p>

489
Q

<p>CHF with echo finding of concentric thickening of the ventricular walls ,normal ventricular chamber dimensions and diastolic dysfunction cause of that</p>

A

<p>amyloidosis</p>

490
Q

<p>type of amyloidosis(2)</p>

A

<p>primary=AL

| secondary=AA</p>

491
Q

<p>cause of amyloidosis</p>

A

<p>any chronic inflammator conditions</p>

492
Q

<p>some examples of chronic inflammatory disease(5)</p>

A 
<p>inflammatory arthritis
chronic infections
IBD
Malignancy
vasculitis</p>
493
Q

<p>CHF in amyloidosis</p>

A

<p>restrictive</p>

494
Q

<p>dx of amyloidosis</p>

A

<p>tissue biopsy(abdominal fat pad biopsy)</p>

495
Q

<p>inthe USMLE clue for syncope caused by arrythmia(4)</p>

A

<p>syncope without warning
presence of structural disease(post infarction)
frequent ectipic beats
thiazide is taking by teh patient</p>

496
Q

<p>patient after MI develops cold leg next step and why(2)</p>

A

<p>echo cardiography

| search for intraventricular thrombus</p>

497
Q

<p>patietn presenting with left chestpain 5 days ago he was diagnosed for ant MI with complete occlsuion of LAD 2 miniutes later he is unresponsive with no pulse palpated and death(possible)dx</p>

A

<p>ventricular free wall rupture</p>

498
Q

<p>mechanical complication of MI(4)</p>

A

<p>right ventricular failure
papillary muscle rupture
interventricular sseptum rupture
free wall rupture</p>

499
Q

<p>artery involved in right ventricular failure</p>

A

<p>RCA</p>

500
Q

<p>time course for right ventricular failure</p>

A

<p>acute</p>

501
Q

<p>finding in right ventricular failure(2)</p>

A

<p>hypotension with clear lungs

| kussmaul sign</p>

502
Q

<p>echo finding in right ventricular failure</p>

A

<p>hypokinetic RV</p>

503
Q

<p>artery involved in papillary mx rupture</p>

A

<p>RCA</p>

504
Q

<p>time course for papillary mx rupture</p>

A

<p>acute and within 3 -5 days</p>

505
Q

<p>finding in papillary mx rupture</p>

A

<p>acute severe pulmonary edema

| new holosystolic murmur</p>

506
Q

<p>echo finding in papillary mx rupture</p>

A

<p>severe mitral regurge with flail leaflet</p>

507
Q

<p>artery involved in interventricular septum rupture or defect(2)</p>

A

<p>LAD for apical rupture

| RCA for basal rupture</p>

508
Q

<p>time course in interventricular septum rupture or defect</p>

A

<p>acute and within 3 -5 days</p>

509
Q

<p>finding in interventricular septum rupture or defect(4)</p>

A

<p>shock
chest pain
new hollow systiolic murmur
biventricular failure</p>

510
Q

<p>echo finding in interventricular septum rupture or defect(2)</p>

A

<p>left to right shunt level of ventricle

| step up oxygen between right atrium and ventricle</p>

511
Q

<p>artery involved in free wall rupture</p>

A

<p>LAD</p>

512
Q

<p>time course in free wall rupture</p>

A

<p>within first 2 days - 2 weeks</p>

513
Q

<p>finding in free wall rupture(3)</p>

A

<p>shock and chest pain
jugular venous distension
distant heart sounds</p>

514
Q

<p>echo finding in free wall rupture</p>

A

<p>pericardial effucion with tamponnade</p>

515
Q

<p>SMVT</p>

A

<p>sustained monomorphic ventricular tachycardia</p>

516
Q

<p>cause of SMVT</p>

A

<p>post MI complication 6 a 48 h apres MI</p>

517
Q

<p>EKG of SMVT</p>

A

<p>wide complex tachycardia with 2 fusion beats</p>

518
Q

<p>rx of hemodynamic stable SMVT(3)</p>

A

<p>IV amiodarone
lidocaine
procainamide</p>

519
Q

<p>rx of hemodynamic unstable SMVT</p>

A

<p>electrical cardioversion</p>

520
Q

<p>heart and alcohol</p>

A

<p>dilated cardiomyopathy</p>

521
Q

<p>measures most likely to reverse heart failure in alcoholic CHF</p>

A

<p>total abstinence from alcohol</p>

522
Q

<p>mainstay of rx of alcoholic CHF</p>

A

<p>total abstinence from alcohol</p>

523
Q

<p>what disease patient with intermittent claudication will have over the next 5 years</p>

A

<p>MI</p>

524
Q

<p>major cause of mortality in patient with PAD</p>

A

<p>cardiovascular disease</p>

525
Q

<p>probability of non fatal MI and stroke in patient with intermittent claudication</p>

A

<p>20% 5 year risk</p>

526
Q

<p>probability of death to cardiovascular causes in patient with intermittent claudication</p>

A

<p>15 a 30 %</p>

527
Q

<p>probability of critical limb ischemia with risk of limb amputation in patient with intermittent claudication</p>

A

<p>1 a 2 %</p>

528
Q

<p>stanford classification of dissection aortic (2)</p>

A

<p>type A

| B</p>

529
Q

<p>rx of type A aortic dissection(2)</p>

A

<p>Labetalol

| surgery</p>

530
Q

<p>rx of type A aortic dissection</p>

A

<p>Labetalol</p>

531
Q

<p>quid of type A aortic dissection</p>

A

<p>ascending aorta is involved</p>

532
Q

<p>quid of type B aortic dissection</p>

A

<p>descending aorta</p>

533
Q

<p>CT for aortic dissection</p>

A

<p>descending aorta with false and true lumen separated by an intimal flap</p>

534
Q

<p>aortic mur murmur caused by aortic dissection</p>

A

<p>right sternal border compared to primary aortic valvular disease ,murmur is herad to the left</p>

535
Q

<p>best test to Dx aortic dissection</p>

A

<p>TEE

| CT with contrast</p>

536
Q

<p>when to use CT with contrast in the Dx of aortic dissection</p>

A

<p>when renal function is normal</p>

537
Q

<p>artery and lead in anterior MI(2)</p>

A

<p>LAD

| v1 a V6</p>

538
Q

<p>artery and lead in inferior MI(2)</p>

A

<p>RCA or left circumflex artery 9LCX)

| ST elevation 2,3 avf</p>

539
Q

<p>artery and lead in post MI(4)</p>

A 
<p>RCA or left circumflex artery
ST depression in leads V1-V3
ST elevation in 1 and AVL(LCX)
ST depression in leads 1 and AVL (RCA)
</p>
540
Q

<p>artery and lead in lat MI(3)</p>

A

<p>LCX/diagonal
St elevation in leads 1 avl v5 v6
St depression in leads 2, 3 avf</p>

541
Q

<p>right ventricular MI when it occurs</p>

A

<p>in inferior MI</p>

542
Q

<p>artery in right ventricular MI(2)</p>

A

<p>RCA

| St segment elevation in leads V4-V6R</p>

543
Q

<p>MI plus hypotension plus clear lung </p>

A

<p>right ventricular failure</p>

544
Q

<p>MI with sinus bradycardia </p>

A

<p>inferior MI</p>

545
Q

<p>why inferior MI cangive bradycardia(2)</p>

A

<p>increased vagal tone

| RCA supply blood to sinoatrial node</p>

546
Q

<p>complication of RCA occlusion and why</p>

A

<p>AV block

| RCA supply AV node through AV nodal artery </p>

547
Q

<p>ST segment elevations in 2,3 avf and ST segment depression in V1 V2</p>

A

<p>inferior MI with posterior MI associated</p>

548
Q

<p>hypotension AV block and bradycardia in the setting of MI</p>

A

<p>inferior MI</p>

549
Q

<p>clue for MI inferior involving right heart(2)</p>

A

<p>ST segment elevation ,2,3 AVL

| St segment depression in i and AVL</p>

550
Q

<p>EKG in atrial premature beats</p>

A

<p>early P wave</p>

551
Q

<p>risk factor for atrial premature beats(4)</p>

A

<p>tobacco
alcohol
caffeine
stress</p>

552
Q

<p>symptomatic patient with atrial premature beats rx</p>

A

<p>B blocker</p>

553
Q

<p>xray in thoracic aorta aneurism(3)</p>

A

<p>widened mediastinum
increased aortic knob
tracheal deviation
</p>

554
Q

<p>cause of ascending aorta aneurism(2)</p>

A

<p>cystic medial necrasis

| connective tissue disorders</p>

555
Q

<p>cause of descending aorta aneurism</p>

A

<p>atherosclerosis</p>

556
Q

<p>enlarged aorta in xray </p>

A

<p>aneurism</p>

557
Q

<p>patient with low grade fevers exertionnal dyspnea

| fingerttip pain and dark and cloudy urine.In physical exam proximal and distal interphalangeal joints are swollen</p>

A

<p>infective endocarditis</p>

558
Q

<p>quid of osler nodes</p>

A

<p>painful fingertip</p>

559
Q

<p>dark and cloudy urine(2)</p>

A

<p>proteinuria

| hematuria</p>

560
Q

<p>swollen interphalangeal joints</p>

A

<p>arthritis</p>

561
Q

<p>vascular phenomoenon in infective endocarditis(5)</p>

A 
<p>systemic arterial emboli
septic pulmonary infarcts
mycotic aneurism
conjonctival hemorrage
janeway lesions </p>
562
Q

<p>quid of Janeway lesions</p>

A

<p>macular erythematous nontender lesions on the palms and soles</p>

563
Q

<p>systemic emboli manifestation(3)</p>

A

<p>focal neurologic deficits
renal infarcts
splenic infarcts</p>

564
Q

<p>definitice dx or infective endocarditis</p>

A

<p>DUKE criteria</p>

565
Q

<p>inheritance of hypertrophic cardiomyopathy</p>

A

<p>autosomal dominant</p>

566
Q

<p>quid of masive pulmonary embolism(2)</p>

A

<p>PE complicated by hypotension

| and acute right strain</p>

567
Q

<p>sign of right heart strain in PE(2)</p>

A

<p>high JVP

| RBBB</p>

568
Q

<p>complication of right heart strain in PE(6)</p>

A 
<p>right ventriculr dysfunction
decreasde to the left side of the heart
decreased cardiac output
left heart pump failure
bradycardia
cardiogenic shock</p>
569
Q

<p>fibrinolysis in PE in the setting of post op</p>

A

<p>can't be given within the past 10 days of surgery</p>

570
Q

<p>CHF with normal TA or elevated TA(3)</p>

A

<p>supplement o2
IV loops diuretics
consider IV vasodilators as nitroglycerin or nitroprusside</p>

571
Q

<p>CHF plus sign de shock(3)</p>

A

<p>supplement o2
IV loops diuretics
IV vasopressors as norepinephrine</p>

572
Q

<p>side effect of digoxin(5)</p>

A 
<p>nausea 
vomiting 
diarrhea
vision changes 
arythmias</p>
573
Q

<p>patient is taking digoxin develops diarrhea what to do</p>

A

<p>measure digoxin levels</p>

574
Q

<p>patient taking an anti arrythmic in teh setting of VTAC develops fibrose pulmonaire .what drug was used to rx the patient</p>

A

<p>amiodarone</p>

575
Q

<p>patient with diatolic and continuous murmur at left sternal border next step</p>

A

<p>echocardiography</p>

576
Q

<p>rule for diastolic and continuous murmur as well as loud systolic murmurs next step</p>

A

<p>investigate with transthoracic echodopler</p>

577
Q

<p>midsystolic murmur grade 1-2 /6 in young patient next step(2)</p>

A

<p>nothing

| benign</p>

578
Q

<p>medication reducing overall mortality in CHF(4)</p>

A

<p>ACE inhibitor
b blocker
ARBs
spironolactone</p>

579
Q

<p>complication of niacin(2)</p>

A

<p>pruritis

| flushing</p>

580
Q

<p>how to explain niacin complication</p>

A

<p>prostaglandin related vasodilation </p>

581
Q

<p>rx of niacin induced pruritis and flushing</p>

A

<p>low dose of aspirin</p>

582
Q

<p>patient with medical history of wolt parkinson white develops palpitations and AFIB rx</p>

A

<p>procainamide</p>

583
Q

<p>rx of AFIB normally</p>

A

<p>AV nodal blockers</p>

584
Q

<p>quid AV nodal blocker(4)</p>

A

<p>b blocker
calcium channel blocker
digoxin
adenosine</p>

585
Q

<p>middle aged or older male loses consciuousness immediately after urination or during coughing fits</p>

A

<p>situationnal syncope</p>

586
Q

<p>cause of situationnal syncope</p>

A

<p>autonomic dysregulation</p>

587
Q

<p>beck triad in tamponnade(3)</p>

A

<p>hypotension
muffled heart sound
distended neck veins</p>

588
Q

<p>hypotension in tamponnade(3)</p>

A

<p>shift of interventricular septum toward the left ventricular cavity
reduces left ventricular preload
stroke volume and cardiac output</p>

589
Q

<p>clue for GERD(3)</p>

A

<p>retrosternal burning sensation after eating and with lying down
hoarseness
chronic cough</p>

590
Q

<p>initial rx of GERD(2)</p>

A

<p>proton pump inhibitor

| H2 receptor antagonist</p>

591
Q

<p>quid of resistant HTA</p>

A

<p>persistent HTA persistent despite using > ou egal a 3 antihypertensive agents</p>

592
Q

<p>what to do in front of all resistant HTA</p>

A

<p>check secondary HTA</p>

593
Q

<p>when to suspect renovascular HTA in case of secondary HTA(6)</p>

A

<p>severe HTA with recurrent flash pulmonary edema
severe HTA with diffuse atherosclerosis
onset of severe HTA after 55
HTA with asymetric kidney size or small atrophic kidney unilateral
presence of abdominal bruit
elevation of serun creat > 30 % from baseline after starting ACE inhibitor or ARbs</p>

594
Q

<p>clue for renovascular HTA</p>

A

<p>continuous abdominal bruit</p>

595
Q

<p>young patient with CHF first dx</p>

A

<p>viral myocarditis </p>

596
Q

<p>trap to avoid in viral myocarditis </p>

A

<p>most of hte time you can have no preceding symptom</p>

597
Q

<p>clue for cardiac cause of pedal edema </p>

A

<p>hepatojugular refux</p>

598
Q

<p>importance of reflux hepatojugular</p>

A

<p>helps to differentiate cadiac from other causes(hepatic) of edema</p>

599
Q

<p>clue for ventricular aneurism following MI(2)</p>

A

<p>persistent ST segment elevation after a recent MI

| deep q waves in the same leads</p>

600
Q

<p>complication of ventricular aneurism(5)</p>

A 
<p>CHF
refractory angina
ventricular arythmias
mural thrombus
mitral regurgitation</p>
601
Q

<p>dx of ventricular aneurism </p>

A

<p>echocardiography</p>

602
Q

<p>echo in ventricular aneurism </p>

A

<p>dyskinetic wall motion of a portion of the left ventricle</p>

603
Q

<p>laps of time to have ventricular aneurism</p>

A

<p>5 days or 3 months following MI</p>

604
Q

<p>which type of MI can cause ventricular aneurism(2)</p>

A

<p>transmural MI

| acute ST segment elevation MI</p>

605
Q

<p>complication of MI acute hours to 2 days</p>

A

<p>reinfarction</p>

606
Q

<p>laps of time to have ventricular septum rupture following MI</p>

A

<p>hours - 1 week</p>

607
Q

<p>laps of time to have free wall rupture following MI</p>

A

<p>hours - 2 weeks</p>

608
Q

<p>laps of time to have free wall rupture following MI</p>

A

<p>hours - 1 month</p>

609
Q

<p>laps of time to have papillary muscle rupture following MI</p>

A

<p>2 days--1 week</p>

610
Q

<p>laps of time to have pericarditis following MI</p>

A

<p>1 day-3 months</p>

611
Q

<p>laps of time to haveleft ventricular aneurism following MI</p>

A

<p>5 days to 3 months</p>

612
Q

<p>most following arythmias for digitalis toxicity</p>

A

<p>atrial tachycardia with AV block</p>

613
Q

<p>why digitalis causes atrial tachycardia with AV block(2)</p>

A

<p>increased ectopy

| increased vagal tone</p>

614
Q

<p>most common findings in pulmonary embolism</p>

A

<p>sinus tachycardia</p>

615
Q

<p>westermak sign in xray thorax in PE</p>

A

<p>dilation of the pulmonary proximal to the clot</p>

616
Q

<p>hampton's hump </p>

A

<p>pleural infiltrates corresponding to pulmonary infarction</p>

617
Q

<p>murmur in hypertrophic cardiomyopathy</p>

A

<p>systolic ejection murmur alomg the left sternal border</p>

618
Q

<p>rx of VFIB and pulseless VTAC </p>

A

<p> defibrillation</p>

619
Q

<p>energy used to defibrillate VFIB or pulseles VTAC</p>

A

<p>200-360 joules</p>

620
Q

<p>3 degree heart block or complete atrioventricular block(2)</p>

A

<p>conastant R-R interval

| P wave activity unrelated to qrs</p>

621
Q

<p>symptomatic third degree block rx</p>

A

<p>temporary pacemaker(cardiac pacing)</p>

622
Q

<p>risk factor in aortic dissection(3)</p>

A

<p>HTA
Marfan
cocaine use</p>

623
Q

<p>blood pressure in Aortic dissection</p>

A

<p>> 20 mm de hg variation in systolic blood pressure btween arms</p>

624
Q

<p>complictaion of aortic dissection(8)</p>

A 
<p>stroke
acute aortic regurgitation
horner's syndrome
acute MI 
pericardial effusion or tamponnade
hemothorax
lower extremity weakness or ischemia
abdominal pain</p>
625
Q

<p>lower extremity weakness in aortic dissection</p>

A

<p>spinal illliac artery involved in the process</p>

626
Q

<p>abdominal pain in aortic dissection</p>

A

<p>mesenteric artery</p>

627
Q

<p>patietn with restrictive lung diseaseby rheumatoid lung disease comes with AFIB with a rapid ventricular response what drug toavoid in this patient</p>

A

<p>amiodarone</p>

628
Q

<p>ECG findings in MOBITZ one second degree AV block</p>

A

<p>progressive prolonged PR interval leads to a non conducted P wave ( group beating)</p>

629
Q

<p>ECG findings in MOBITZ 2 second degree AV block</p>

A

<p>PR interval remains constant with intermittent non conducted P waves</p>

630
Q

<p>level of block in Mobtz 1</p>

A

<p>usually AV nodal</p>

631
Q

<p>level of block in Mobtz 2</p>

A

<p>below the level of AV node</p>

632
Q

<p>QRS complex in Mobitz 1</p>

A

<p>narrow</p>

633
Q

<p>QRS complex in Mobitz 2</p>

A

<p>narrow or wide</p>

634
Q

<p>what happen with execice or atropin in MOBITZ one</p>

A

<p>improves type 1 AV block</p>

635
Q

<p>what happen with execice or atropin in MOBITZ 2 </p>

A

<p>worsens type 2 block</p>

636
Q

<p>what happen with vagal maneuver in MOBITZ 2</p>

A

<p>improves it</p>

637
Q

<p>what happen with vagal maneuver in MOBITZ 1</p>

A

<p>worsens it</p>

638
Q

<p>risk of complete heart in MOBITZ one</p>

A

<p>low risk</p>

639
Q

<p>risk of complete heart in MOBITZ 2(2)</p>

A

<p>high risk

| indictaion of pace maker</p>

640
Q

<p>drug causing AV block mobitz 1(3)</p>

A

<p>digoxin
B blocker
calcium blocker</p>

641
Q

<p>group beating</p>

A

<p>after 3 PQRS complexes you have one drop</p>

642
Q

<p>cause of Mobitz one(4)</p>

A

<p>healthy people
athletes
heart problem
drugs</p>

643
Q

<p>muscle pain with high CPK in patient taking statin</p>

A

<p>stop simvastatin</p>

644
Q

<p>muscle pain in aptient taking statin first step</p>

A

<p>check CPK level</p>

645
Q

<p>syncope in post MI</p>

A

<p>ventricular arrythmias</p>

646
Q

<p>quid of ventricular arrythmia(3)</p>

A

<p>ventricular premature beats
nonsustained and sustained VTAC
VFIB</p>

647
Q

<p>most common cause of sudden cardiac death in the setting of acute MI</p>

A

<p>VFIB</p>

648
Q

<p>laps of time for cardiac sudden arrest in the setting of MI</p>

A

<p>first hour</p>

649
Q

<p>predominant mechanism for ventricular arythmia</p>

A

<p>reentry</p>

650
Q

<p>mechanism of arhytmia in post MI occuring within 10 mn of MI and name of that process in arythmia </p>

A

<p>reentrant arythmias

| immediate or phase 1 a ventricular arrhytmias</p>

651
Q

<p>mechanism of arhytmia in post MI occuring 10 a 60 mn after MI and name of that process in arythmia (2)</p>

A

<p>abnormal automaticity

| delayed or phase 1b arrhytmias</p>

652
Q

<p>most common cause of sudden cardiac arrest death in the immediate post MI</p>

A

<p>reentrant ventricular arrythmias</p>

653
Q

<p>CHF in patient from brazil with history of megacolon bug causing that</p>

A

<p>chagas disease

| protozoal disease</p>

654
Q

Manif of chagas disease (3)

A

Megaesophagus
megacolon
cardiac dysfunction

655
Q

bug in chagas

A

Tripanosoma cruzi in latin america

656
Q

trick to know S4

A

TENessee first syllable S4

657
Q

when do you hear S4 (2)

A

just before s1

its a diatolic sound

658
Q

<p>meaning of S4 and cause of S4(2)</p>

A

<p>ventricular hypertrophy

| HTA</p>

659
Q

clue for anaphylactic shock (2)

A

hypotension

diffuse rash

660
Q

<p>medical cause of anaphylaxis</p>

A

<p>latex containing products like gloves</p>

661
Q

first line tx of Hypertrophic cardiomyopathy (2)

A 
B blocker 
calcium blocker(diltiazem)
662
Q

<p>why Bblocker or calcium blocker are good in the treatment of HOC</p>

A

<p>they promote diastolic relaxation</p>

663
Q

<p>trick to know S3</p>

A

<p>kentucKY third syllable is S3</p>

664
Q

<p>when you hear S3</p>

A

<p>just after S2</p>

665
Q

<p>meaning of S3</p>

A

<p>left ventricular failure </p>

666
Q

best drug to use initially in patient with S3 & shortness of breath

A

IV diuretics

667
Q

parameter in hemorrhagic shock

A 
Cardiac ouput (CO) decreased
PCWP decreases (pulmonary capillary wedge pressure)
SVR increases( peripheral resistance)
BP decreases
Heart rate increases
668
Q

HTN plus systolic diastolic abdominal bruit

A

renal artery stenosis

669
Q

syncope in HOCM (4)

A

outflow obstruction
arrythmia
ischemia
ventricular baroreceptors response

670
Q

diagnosis of orthostatic hypotension

A

drop in systolic pressure greater than 20mm when moving from lying down to standing

671
Q

risk for orthostatic hypotension (5)

A 
prolonged recumbence
diuretics
adrenergic blocking agent
vasodilators
elderly hypovolemic and/or with autonomic  neuropathy
672
Q

blue hands and feet following administration of vasopressor in the setting of an accident

A

norepinephrine induced vasospasm

673
Q

risk in the development of AAA (4)

A

cigarette smoking
family history of AAA
white race
atherosclerosis

674
Q

strongest predictor of abdominal aortic aneurysm expansion and rupture (3)

A

large aneurism diameter
rapid rate of expansion
current cigarette smoking

675
Q

current indication for surgery in aneurism

A

<5.5 cm
rapid rate of expansion 0.5 cm in 6 months or 1 cm per year
presence of symptoms

676
Q

symptomatic AAA (2)

A

abdominal back flank pain

limb ischemia

Step 2 CK (primary set) (22 decks)

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