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STEP 2 CK > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Where is the most common location of the ectopic foci that cause Atrial Fibrillation?

A

Pulmonary Veins

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2
Q

An accessory atrioventricular bypass tract is seen in what cardiac syndrome?

A

Wolff-Parkinson-White Syndrome

Delta waves are seen on EKG.

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3
Q

What is the most common cause of atrial flutter?

A

A re-entrant circuit around the tricuspid annulus.

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4
Q

Interventricular Septum Rupture

A

Seen 3-5 days post-MI involving the LAD.
Presents with acute cardiogenic shock, JVD, and hepatomegaly.
Harsh, holocystolic murmur with palpable thrill at the LSB.
Diagnosis: pulmonary artery catheterization with step up in oxygenation from the RA to RV or via TTE

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5
Q

Papillary Muscle Rupture

A

3-5 days post-MI of the RCA.
Presents with severe, acute mitral regurgitation, sudden-onset hypotension, dyspnea, and pulmonary edema.
Soft, holocystolic murmur without palpable thrill.

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6
Q

Tennessee

A

S4 heart sound

Indicates stiff LV and LV hypertrophy from long-standing hypertension or restrictive cardiomyopathy.

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7
Q

In an adenosine or dypiramidole stress-test that is positive for ischemia, what is the mechanism responsible for the changes seen.

A

Augmentation of blood flow in non-obstructed vessels. This is because adenosine and dypiramidole both cause dilation of the vessels that is most prominent in non-obstructed vessels.

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8
Q

What is the mechanism responsible for the changes seen in a dobutamine stress test?

A

Increase myocardial oxygen demand.

Dobutamine increases HR and myocardial contractility.

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9
Q

Kentucky

A

S3 heart sound
Heard in left-sided heart failure.
May be a normal finding in young adults and well-trained athletes without other symptoms.

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10
Q

Complete AV dissociation

A

Complete heart block

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11
Q

For A-Fib with RVR in a patient with WPW, what drug do you use to convert stable patients?

A

Procainamide (Ibutilide as well)

Electro-cardioversion for unstable patients

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12
Q

Acute Mitral Regurgitation

A

Can occur due to papillary muscle displacement secondary to acute MI.
Presents with acute pulmonary edema.
Increase left atrial and ventricular filling pressures.

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13
Q

Symptomatic Sinus Bradycardia

A

Initial - IV atropine
No response with atropine - IV epi or dopamine
No response with epi or dopamine - trancutaneous pacing

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14
Q

Screening for AAA

A

Men aged 65-75 who have smoked should receive a one-time screening ultrasound.

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15
Q

ST segment elevations in II, III, and aVF

A

Inferior wall MI
Reciprocal changes in I and aVL
Involves the RCA or the Left Circumflex (LCX), most commonly the RCA

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16
Q

ST segment depressions in V1 and V2

A

Posterior wall MI
RCA if depressions in I and aVL
LCX if elevations in I and aVL

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17
Q

ST segment depression in V1 and V2 and elevations in II, III, aVF

A

Occlusion of the right coronary artery (RCA)

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18
Q

Anterior MI

A

Occlusion of the LAD

Changes in some or all of V1 - V6

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19
Q

Lateral MI

A

Involvement of the LCX or diagonal
ST elevations in I, aVL, V5, and V6
ST depression in II, III, and aVF

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20
Q

Right Ventricle MI

A

Occurs in 1/2 of all inferior MI
Involves the RCA
ST elevations in V4-V6R

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21
Q

Occlusion of the Left Main Coronary Artery

A

Usually causes sudden death as this supplies the LAD and LCX

Elevations in anterior and lateral leads: I, aVL, V1-V6

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22
Q

Vasospastic Angina Treatment

A

CCBs for prevention

Sublingual Nitroglycerin for abortive therapy

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23
Q

Hyponatremia in Heart Failure

A

Poor prognostic factor

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24
Q

New conduction abnormalities in a patient with infective endocarditis:

A

Perivalvular abscess

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25
Q

Tricuspid Regurgitation

A

Holosystolic murmur

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26
Q

Left Ventricular Aneurysm

A

Etiology: scar tissue following transmural MI
Presentation: several months post-MI, heart failure and angina, Ventricular arrhythmia (V-tach), systemic embolization (stroke)
EKG: persistent ST elevation, deep Q waves
Echo: thin, dyskinetic myocardial wall - impaired EF

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27
Q

Cardiac Index =

A

Cardiac Output / Body Surface Area

Reduced in HF

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28
Q

Costochondritis

A

Chest wall tenderness

Most accurate test is physical exam

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29
Q

Pericarditis

A

Pain worse with lying flat and better sitting up in a young patient <40 years old
Most accurate test is EKG with ST elevations in all leads and PR depression

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30
Q

Aortic Dissection

A

Radiation to the back, unequal blood pressure between arms

Most accurate test is a CXR with widened mediastinum, chest CT, MRI, or TEE to confirm diagnosis

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31
Q

Duodenal Ulcer Disease

A

Epigastric discomfort, pain relieved with eating

Most accurate test is endoscopy

32
Q

GERD

A

Bad taste in mouth, cough, hoarseness

Most accurate test is response to PPIs, aluminum hydroxide, magnesium hydroxide, viscous lidocaine

33
Q

Pneumonia

A

Cough, sputum, hemoptysis, chest pain

Most accurate test is CXR

34
Q

Pulmonary Embolism

A

Sudden-onset SOB, tachycardia, hypoxia, chest pain

Most accurate test is spiral CT, V/Q scan

35
Q

Pneumothorax

A

Sharp, pleuritic chest pain, tracheal deviation

Most accurate test is CXR

36
Q

Exercise Tolerance Test

A

Used to determine the presence of ischemia

Shows ST segment depression if ischemia is detected

37
Q

Exercise thallium

A

Used if there is an inability to read the EKG or there are baseline ST segment abnormalities
Shows decreased uptake of nuclear isotope if ischemia is detected

38
Q

Exercise Echo

A

Used if there is an inability to read the EKG or there are baseline ST segment abnormalities
Shows wall motion abnormalities if there is ischemia

39
Q

Dipyridamole Thallium Test

A

Used if there is an inability to exercise to target heart rate
Showed decreased uptake of nuclear isotope if there is ischemia

40
Q

Dobutamine Echo Test

A

Used if there is an inability to exercise to target heart rate
Shows wall motion abnormalities if there is ischemia

41
Q

What is the time to becoming abnormal in the setting of an MI for an EKG? What is the duration of the abnormality?

A

Immediately at the onset of pain

Will show ST elevations that progress to Q waves over several days to a week

42
Q

What is the time to becoming abnormal in the setting of an MI for Myoglobin? What is the duration of the abnormality?

A

1-4 hours

Resolves in 1-2 days

43
Q

What is the time to becoming abnormal in the setting of an MI for CK-MB? What is the duration of the abnormality?

A

4-6 hours

Resolves in 1-2 days

44
Q

What is the time to becoming abnormal in the setting of an MI for Troponin? What is the duration of the abnormality?

A

4-6 hours

Resolves in 10-14 days

45
Q

Treatment indications in the setting of MI: ASPIRIN

A

Everyone, the best initial therapy

46
Q

Treatment indications in the setting of MI:

CLOPIDOGREL or PRASUGREL or TICAGRELOR

A

Those undergoing angioplasty or stenting, second antiplatelet drug with aspirin

47
Q

Treatment indications in the setting of MI:

BETA BLOCKERS

A

Everyone, effect is not dependent on time so can be started at any time during the admission

48
Q

Treatment indications in the setting of MI:

ACEI/ARB

A

Everyone, benefit best with an EF <40%

49
Q

Treatment indications in the setting of MI:

STATINS

A

Everyone, goal LDL <70 mg/dL

50
Q

Treatment indications in the setting of MI:

NITRATES

A

Everyone, no clear mortality benefit

51
Q

Treatment indications in the setting of MI:

HEPARIN

A

After thrombolytics/PCI to prevent restenosis, initial therapy with ST depression and other non-ST elevation events like unstable angina

52
Q

Treatment indications in the setting of MI:

CCB’s

A

If a patient can’t use B-blockers, in cocaine-induced pain, in Prinzmetal or vasospastic variant angina

53
Q

What are the absolute contraindications to thrombolytics?

A 
Major bleeding (bowel or brain)
Recent surgery (<2 weeks)
Severe HTN (>180/110)
Nonhemorrhagic stroke (<6 months)
54
Q

What medications should every patient be started on after an MI?

A

Aspirin
Beta Blocker
Statin
ACEI/ARB

55
Q

What is the most likely diagnosis in the setting of post-MI?

Bradycardia, cannon A waves

A

Third-degree AV block

56
Q

What is the most likely diagnosis in the setting of post-MI?

Bradycardia without cannon A waves

A

Sinus Bradycardia

57
Q

What is the most likely diagnosis in the setting of post-MI?

Sudden loss of pulse, jugulovenous distention

A

Tamponade/Wall Rupture

58
Q

What is the most likely diagnosis in the setting of post-MI?

IWMI in history, clear lungs, tachycardia, hypotension with nitroglycerin

A

RV infarction

59
Q

What is the most likely diagnosis in the setting of post-MI?

New murmur, rales/congestion

A

Valve rupture

60
Q

What is the most likely diagnosis in the setting of post-MI?

New murmur, increase is oxygen saturation on entering the right ventricle (step-up)

A

Septal Rupture

61
Q

What is the most likely diagnosis in the setting of post-MI?

Loss of pulse, need EKG in order to answer this question

A

Ventricular fibrillation

62
Q

What is the most likely diagnosis in the setting of Dyspnea?

Sudden onset dyspnea with clear lungs on exam

A

PE

63
Q

What is the most likely diagnosis in the setting of Dyspnea?

Sudden onset, wheezing, increased expiratory phase

A

Asthma

64
Q

What is the most likely diagnosis in the setting of Dyspnea?

Slow onset dyspnea, fever, sputum, unilateral rales/rhonchi

A

Pneumonia

65
Q

What is the most likely diagnosis in the setting of Dyspnea?

Decreased breath sounds unilaterally, tracheal deviation

A

PTX

66
Q

What is the most likely diagnosis in the setting of Dyspnea?

Circumoral numbness, caffeine use, hx of anxiety

A

Panic attack

67
Q

What is the most likely diagnosis in the setting of Dyspnea?

Pallor, gradual over days to weeks

A

Anemia

68
Q

What is the most likely diagnosis in the setting of Dyspnea?

Pulsus paradoxus, decreased heart sounds, JVD

A

Tamponade

69
Q

What is the most likely diagnosis in the setting of Dyspnea?

Palpitations, syncope

A

Arrhythmia of any kind

70
Q

What is the most likely diagnosis in the setting of Dyspnea?

Dullness to percussion at the bases

A

Pleural effusion

71
Q

What is the most likely diagnosis in the setting of Dyspnea?

Long smoking history, barrel chest

A

COPD

72
Q

What is the most likely diagnosis in the setting of Dyspnea?

Recent anesthetic use, brown blood, not improved with oxygen, clear lungs, cyanosis

A

Methemoglobinemia

73
Q

What is the most likely diagnosis in the setting of Dyspnea?

In a burning building or car, wood-burning stove in the winter, suicide attempt

A

Carbon monoxide poisoning

74
Q

Effects of Maneuvers on:

MS and AS

A 
Squatting = increase
Standing/Valsalva = decrease
75
Q

Effects of Maneuvers on:

MR and AR

A 
Squatting = increase
Standing/Valsalva = decrease
76
Q

Effects of Maneuvers on:

MVP

A 
Squatting = decrease
Standing/Valsalva = increase
77
Q

Effects of Maneuvers on:

HOCM

A 
Squatting = decrease
Standing/Valsalva = increase

STEP 2 CK (5 decks)

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