Cardiology

Question 1

Diastolic HF characteristics and treatment

Answer 1

LV stiffness, increased afterload, LVH
Due to systemic hypertension or Ao stenosis
Assoc with dyspnea
S4 gallop
Tx: diuretics, beta blockers, nondihydropyridine CCB (verapamil and diltiazem)

Question 2

Prinzmetal’s angina presentation and treatment

Answer 2

variant angina, common in women, worse in AM

Tx: CCB and nitrates

Question 3

EKG of variant angina vs ischemia

Answer 3

variant angina: ST elevation

ischemia: ST depression

Question 4

Treatment of MI due to cocaine/ephedrine containing substances

Answer 4

***NO Beta blockers***
benzos
asa
nitrates
CCB 
alpha blocker

Question 5

AFib meds

Answer 5

Digoxin (#1 if hypotensive or have systolic HF)
beta blocker
Nondihydropyridine CCB (#1 if COPD or PAD bc BB can make worse)

Question 6

Systolic HF treated with

Answer 6

beta blocker
loop diuretic
ACEI

Question 7

Superior vena cava syndrome presentation and causes

Answer 7

-facial and upper arm swelling (never in lower ext), cyanosis
-obstruction in SVC flow into right atrium:
small cell ca of the lung
NON hodgkin lymphoma
indwelling catheter thrombosis

Question 8

Causes of right HF

Answer 8

1 chronic left HF

pulm HTN
PE
pulm parenchymal dz (fibrosis or chronic bronchitis)

Question 9

Causes of constrictive pericarditis

Answer 9

1 prior chest radiation

cardiac sx
connective tissue dz
bacterial (tb)

Question 10

Preferred initial test for acute aortic dissection

Answer 10

*TEE
MRI
CT

Question 11

Risk factors for acute aortic dissection

Answer 11

collagen dz (marfan or ehlors-danlos)
chronic systemic HTN
vasculitis (giant cell arteritis and Takayasu)
cocaine
bicuspid Ao valve

Question 12

Acute pericarditis in any age female must consider

Answer 12

SLE

Question 13

Pericardial tamponade characteristics and treatment

Answer 13

• hypotension, tachycardia, elevated JVP, paradoxical pulse

- emergent pericardiocentesis followed by pericardiectomy

Question 14

Coarctation of aorta presentation

Answer 14

equal and bilateral upper ext HTN
low BP in legs
radial-femoral pulse lag
bicuspid Ao valve in 70%

Question 15

Aortic dissection treatment

Answer 15

• IV vasodilator AND Beta blocker (vasodilator alone can make worse)
• emergent surgical intervention

Question 16

Systolic HF presentation and manifestations

Answer 16

• fatigue, weakness, mental obtundation

- LV dilation, increased preload, reduced contraction, reduced EF, decreased CO

Question 17

Electrolytes associated with Digoxin toxicity

Answer 17

hypokalemia

hypomagnesemia

Question 18

Prolonged QT interval causes and manifestation

Answer 18

-hypomagnesemia
hypocalcemia induced meds (phenothiazines, haldol, risperidone, TCAs, terfenadine, astemizole
congenital
-Can lead to torsades de pointes

Question 19

Orthostatic hypotension findings

Answer 19

20-mm Hg systolic and 10-mm Hg diastolic drop with standing

**increased HR indicated hypovolemia whereas no compensatory increase in HR indicates autonomic insufficiency

Question 20

acute vs subacute endocarditis

Answer 20

acute: indwelling cath infection or IV drug user, staph aureus, tricuspid valve, acutely ill
subacute: strep viridans, more indolent

Question 21

endocarditis preferred testing

Answer 21

cultures, ECHO, TEE

Question 22

Coarctation of the aorta

Answer 22

40% w/biscupid valve
apical ejection click
risk of cerebral aneurysm

Question 23

Chronic HTN with orthostatic HYPOtension

Answer 23

pheochromocytoma

Question 24

Treatment of isolated systolic hypertension

Answer 24

long acting thiazide diuretic

long acting dihydropyridine CCB

Question 25

Afib in any patient but especially over 60

Answer 25

rule out hyperthyroidism

Question 26

Congenital long QT syndrome exam and complicatons

Answer 26

Exam WNL when asymptomatic
Can get torsades de pointes during sympathetic nervous system activation (exercise or emotional)
Increased risk of syncope and sudden cardiac death

Question 27

HOCM exam findings

Answer 27

apical lift due to LVH
systolic ejection murmur near apex
*bisferiens carotid pulse

Question 28

Initial monotherapy in healthy person with essential HT

Answer 28

Thiazide
CCB
ACEI
ARB

Question 29

Cor Pulmonale cause and presentation

Answer 29

Secondary to lung disease/pulmonary hypertension causing right vent HF
-signs: left parasternal lift, elevated JVP, congestive hepatomegaly, ascites, peripheral edema