Cardiology Flashcards
What side effect might make a patient stop taking an ACEI?
Cough
Define orthostatic hypotension
A drop in systolic BP of >20mmHg when standing up
You feel a pulse that seems to be vibrating. What term do you use to describe it?
Thrill
What are three things in your differential if you have a paradoxical pulse?
Cardiac tamponade, pericarditis, and obstructive lung disease
On palpation, what size is normal for the aorta?
Less than 3 cm
A fixed or consistent split S2 should make you think of what diagnosis?
Atrial Septal Defect
A pathologthic S3 is most commonly associated with what diagnossis?
CHF
If you hear a midsystolic click you should immediately be thinking about what diagnosis?
Mitral Valve Prolapse
An opening snap on auscultation of the heart should make you think of what diagnosis?
Mitral Stenosis
A continuous murmur most likely involves what area of the heart?
It is most likely a septal defect
septal area
You hear a continuous machine like murmur. What is the most likely diagnosis?
PDA
List three medications which may be used for a pharmacological stress test.
Adenosine, dobutamine, dipyridamole, and persantine.
What is the gold standard for diagnosing coronary artery disease?
Cardiac catheterization
Define stage 1 hypertension according to JNC 7
Systolic pressure of 140-159 and diastolic of 90-99
What is the treatment goal BP for a diabetic with hypertension?
130/80
What is the most common cause of secondary hypertension?
Chronic Kidney Disease
No matter what medications you use, you are having trouble keeping a patient’s blood pressure under control You also notice hyperpigmented skin and truncal obesity. What is the most likely diagnosis?
Cushing’s disease
List three signs or symptoms which will likely be included in a description of a patient with a pheochromocytoma?
Thin, diaphoretic, tachycardic, agitated, and hypertensive
You have a patient with the diagnosis of pheochromocytoma. While waiting for surgery should you use an alpha or a beta blocker?
Alpha blocker (you should never use a pure beta blocker)
A young boy comes into your office. He has elevated blood pressure when taken in his arm, but no palpable femoral pulse. What is the most likely diagnosis?
Coarctation of the aorta
According to the CDC, what is the range for a normal BMI?
18.5 - 24.9
What is the first line medical treatment for stage 1 hypertension?
A Thiazide Diuretic
After a thiazide diuretic, what medication should you start in a hypertensive patient who also has diabetes?
An ACE-Inhibitor or an ARB
Following a myocardial infarction, what medication should you be using to treat hypertension?
Beta blocker
Paroxysmal nocturnal dyspnea should make you think of what diagnosis?
CHF
What is the most common cause of CHF?
Coronary artery disease
What ejection fraction is typical for a patient with CHF?
35% - 40%
What is the most likely diagnosis for a young man who experiences sudden death while playing sports?
Hypertrophic cardiomyopathy
Batwing vessels or Kerley B lines on a chest x-ray should make you think of what diagnosis?
CHF
A beta natriuretic peptide below what levels rules our CHF?
< 100
What is the therapeutic range for INR following a mechanical valve replacement?
2.5 - 3.5
What is the first line IV inotropic agent when dealing with cardiogenic shock?
Dopamine
What diagnosis is most likely in an IV drug user with a new heart murmur and fever?
Endocarditis
List two diagnoses which require antibiotic prophylaxis for “dirty procedures?”
Prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congenital cyanotic heart defect.
Does a patient with mitral valve prolapse require prophylactic antibiotics for dental work?
No, a recent change moves mitral valve prolapse from high risk to moderate risk.
What are the three major criteria for endocarditis?
2 positive blood cultures, a positive TEE, new murmur.
Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?
Osler nodes
List the 4 minor criteria for diagnosing endocarditis?
Fever, embolic event (janeway lesions or petechiae, splinter hemorrhages), immunological event (osler nodes, glomerulonephritis), 1 positive blood culture
What are the five components of Tetralogy of Fallot
wait there’s 5?, according to brian wallace there is
- VSD
- Over-riding aorta
- Pulmonic stenosis
- Right ventricular hypertrophy
(5. Right sided aortic arch)
What is the gold standard for diagnosing myocarditis?
Myocardial biopsy
Where do most aortic dissections occur?
The ascending or descending thoracic aorta
A patient complains of severe pleuritic chest pain that is worse when leaning forward. What is the most likely diagnosis?
Pericarditis
What is the first line medical treatment for pericarditis?
NSAIDS and Aspirin
What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?
Dressler syndrome
A patient presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all of the leads. What is the most likely diagnosis?
Pericarditis
Define paradoxical pulse
There is a large difference in pulse pressure between inhalation and exhalation
Define pulsus alternans
EKG waveform changes from beat to beat
What is the difinitive treatment for cardiac tamponade?
Pericardiocentesis
On physical exam you hear a harsh systolic murmur along the right sternal border. What is the most likely diagnosis?
Aortic stenosis
A wide pulse pressure with a blowing diastolic decrescendo murmur at the right 2nd intercostal space should make you think of what diagnosis?
Aortic regurgitation
What is the best location to hear problems with the aortic valve?
2nd right intercostal space
Where is the disease of the pulmonary valve best heard?
2nd left intercostal space
What two antibiotics are used for empiric treatment of endocarditis?
Ceftriaxone + Vanco are 1st line empiric therapy
What two valvular issues do patients with Marfan’s syndrome often have?
Aortic regurgitation and MVP
What are the two main causes of aortic stenosis?
Congenital bicuspid valve and calcification of the valve secondary to coronary artery disease
An elderly patient presents with dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely diagnosis?
Aortic stenosis
On auscultation you hear a harsh blowing pansystolic murmur at the apex. What is most likely diagnosis?
Mitral regurgitation
You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis?
Transesophogeal echo
A patient with MVP will often have what physical characteristics? (gender and appearance)
Thin female
What is the best patient position to hear aortic regurgitation and aortic stenosis?
Sitting up and leaning forward
What is Tietze syndrome?
Costochondritis
Are most pulmonary valve problems congenital or acquired?
Congenital (95%)
What is the therapeutic range for INR following an organic valve replacement?
2 - 3
A 60 year old male presents to the ED with severe dizziness and back pain. His BP is dropping and you can feel an abdominal pulsatile mass on physical exam. What is the most likely diagnosis?
Ruptured aortic aneurysm
In a patient with aortic stenosis, will the PMI be medially displaced, normal, or laterally displaced?
It will be laterally displaced due to left ventricular hypertrophy
A patient complains of severe crushing chest pain. EKG shows ST segment elevations. All labs including troponins and CK-MB are negative. What is the most likely diagnosis?
Prinzmetal’s Angina
A question about Prinzmetals angina will often contain what key thing in the patient’s history?
Cocaine use
Name two things that would constitute a positive stress test?
A drop in blood pressure, a new arrhythmia, an increase in angina symptoms, ST depressions
Are ulcers from venous insufficiency painful or painless?
Painless
A patient has just recieved a cardiac stent. how long will he be on aspirin and clopidogrel?
One year