Cardiology Flashcards
Correcting which risk factor for CAD will result in the most immediate benefit for the patient?
Smoking
T/F: Ischemic pain is not tender, positional, or pleuritic?
True
Dx: chest wall tenderness?
Costochondritis
Dx: radiation to back, unequal BP between arms?
Aortic dissection
Dx: pain worse with lying flat, better with sitting up?
Pericarditis
Dx: cough, sputum, hemoptysis?
Pneumonia
Dx: sudden-onset SOB, tachycardia, hypoxia?
PE
Dx: sharp pleuritic pain, tracheal deviation?
Pneumothorax
What can dipyrimadole, adenosine, or dobutamine be used for?
Non-exercise stress test
What do you need to stop before a stress test (2)?
- B-blockers
2. Caffeine
Who needs coronary angiography?
People with reversible ischemia on stress test
What diagnostic procedure determines if a patient needs surgery vs angioplasty?
Angiography
For a patient with chronic angina, which 2 drugs will lower mortality?
- Aspiring
2. B-blockers
What metabolic derangement can ACE inhibitors cause?
Hyperkalemia
What’s the first line therapy in patients with stable angina?
B-blockers
What level of intensity are Atorvastatin and Rosuvastatin?
High intensity
What level of intensity are Fluvastatin, Lovastatin, Pitavastatin, Pravastatin, and Simvastatin?
Low intensity
What’s the most common adverse effect of statin meds?
Liver dysfunction
In severe hyperlipidemia when the LDL isn’t controlled even on max dose of statin, what can you use?
PCSK9 inhibitors
Which lipid-lowering medication has the adverse effect of elevations of transaminases and myositis?
Statins
Which lipid-lowering medication has the adverse effect of elevation in glucose and uric acid, and priuritis?
Niacin
Which lipid-lowering medication has the adverse effect of increased risk of myositis when combined with statins?
Fibric acid derivatives
Which lipid-lowering medication has the adverse effect of flatus and abdominal cramping?
Cholestyramine
Which lipid-lowering medication has very few adverse effects but barely helps anything?
Ezetimibe
What are the 3 instances when you would use a calcium channel blocker in CAD?
- Asthma
- Prinzmetal angina
- Cocaine-induced chest pain
What are the 3 most common adverse effects of calcium channel blockers?
- Edema
- Constipation
- Heartblock
In which 3 instances does CABG benefit a patient?
- 3 vessel disease with at least 70% in each
- L main coronary artery occlusion
- Two vessel disease in patient with DM
Which lasts longer, internal mammary or saphenous grafts?
Internal mammary (10 vs 5 years)
What’s another word for angioplasty?
PCI
What is Dressler syndrome?
Pericarditis after MI
Which is associated with greater mortality: MI in inferior wall or anterior wall?
Anterior wall
When does myoglobin become abnormal after MI?
1-4 hours
When do troponin and CK-MB become abnormal after MI?
4-6 hours
When do myoglobin and CK-MB go back to normal after MI?
1-2 days
When does troponin go back to normal after MI?
10-14 days
What organ insufficiency can cause falsely elevated troponin?
Renal insufficiency
What are the first 2 steps to checking for re-infarction if a patient has new chest pain within a few days after an MI?
- EKG
2. CK-MB levels
What’s the best way to prevent restenosis of the coronary artery after PCI?
Drug eluting stent that inhibits local T cell response (paclitaxel or sirolimus)
The mortality benefit of thrombolytics extends out to ___ hours from the onset of chest pain?
12
If there is no ST segment elevation, is there a benefit to thrombolytics?
No; give heparin
Do you give an antiplatelet drug to a non-ST elevation coronary syndrome?
Yes
Which heparin to give: LMWH (enoxaparin) or unfractionated?
LMWH has better mortality benefit
Post-MI dx: bradycardia and cannon a waves?
Third degree AV block
Post-MI dx: sudden loss of pulse, JVD?
Tamponade/wall rupture
Post-MI dx: new murmur, rales/congestion?
Valve rupture
Post-MI dx: new murmur, increase in O2 sat on entering R ventricle?
Septal rupture
In what cases do you use spironolactone post-MI?
EF<40%
Do not use a rhythm controlling agent to prevent the development of an arhhythmia– don’t be fooled by “frequent PVC’s and ectopy”
Cool
How many months post-MI do you give P2Y12 inhibitor?
12 months
Do not combine nitrates with what drug?
Sildenafil
What’s the most-common cause of post-MI erectile dysfunction?
Anxiety; B-blockers
When should a patient wait to re-engage in sexual activity post-MI?
2-4 weeks
What heart sound is present in CHF and sounds like “I believe?”
S3
What condition might rales indicate?
CHF
Dyspnea dx: sudden onset dyspnea, clear lungs?
PE
Dyspnea dx: sudden onset dyspena, wheezing, increased expiratory phase?
Asthma
Dyspnea dx: slower onset, fever, sputum, unilateral rales/rhonchi
Pneumonia
Dyspnea dx: decreased breath sounds unilaterally, tracheal deviation?
Pneumothorax
Dyspnea dx: circumoral numbness, caffeine use, h/o anxiety?
Panic attack
Dyspnea dx: pallor, gradual over days to weeks?
Anemia
Dyspnea dx: pulsus paradoxus, decreased heart sounds, JVD?
Tamponade
Dyspnea dx: palpitations, syncope?
Arrhythmia of any kind
Dyspnea dx: dullness to percussion at bases?
Pleural effusion
Dyspnea dx: long smoking history, barrel chest?
COPD
Dyspnea dx: recent anesthetic use, brown blood not improved with oxygen, clear lungs on auscultation, cyanosis?
Methemoglobinemia
Dyspnea dx: burning building or car, wood-burning stove in winter, suicide attempt?
Carbon monoxide poisoning
Will any of those dyspnea dx questions have an S3 gallop?
No
When do you use digoxin?
Low EF (systolic HF)
What are the 3 proven B-blockers for systolic dysfunction?
- Metoprolol
- Carvedilol
- Bisoprolol
When are B-blockers contraindicated in HF?
When the patient is acutely decompensated
Do diuretics lower mortality in CHF?
No, they just control sx
Does digoxin lower mortality in CHF?
No, it just decreases the frequency of hospitalizations
Can lisinopril cause hyperkalemia?
Yes
If EF is under 35%, what’s a good treatment device?
Pacemaker or defibrillator
What are 2 treatments that are beneficial in diastolic HF?
- Spironolactone
2. Diuretics
Does pulmonary edema present with an S3 sound?
Yes
Does a normal BNP level exclude pulmonary edema?
Yes
Mitral stenosis presents during pregnancy because there is a 50% increase in _____ ______?
Plasma volume
Which valvular disease has: Dysphagia Hoarseness Afib Hemoptysis?
CHF associated with mitral stenosis
Why does hoarseness occur?
Laryngeal nerve compression from LA
The enlargement of which atrium causes elevation of the L mainstem bronchus?
Left atrium
Which atrium is enlarged in mitral stenosis?
L atrium
What congenital valvular abnormality can lead to aortic stenosis?
Bicuspid valve
What’s the most common presentation of aortic stenosis?
Angina, syncope, CHF
Which chamber of the heart gets enlarged with aortic stenosis?
L ventricle
Which valvular disorder is caused by HTN, endocarditis, MI with papillary muscle rupture, or any other reason that the heart dilates?
Mitral regurgitation
Which valvular disorder presents with a pansystolic (holosystolic) murmur that radiates to the axilla?
Mitral regurgitation
Which valvular disorder is caused by anything that makes the heart or aorta dilate in size?
Aortic regurgitation
Which valvular disorder has head bobbing and BP in legs as much as 40mmHg more than arm BP?
Aortic regurgitation
What’s often used in regurgitation disorders for vasodilation (3)?
ACEi/ARBs or nifedipine
What heart sound is the result of hypertrophy?
S4
What’s the best initial therapy for hypertrophic cardiomyopathy?
B-blockers
What’s a surgical option for HOCM?
Ablation of the septum
Can you use digoxin in hypertrophic cardiomyopathy?
No
In HOCM, do ACEi’s and diuretics help?
No! But in the other forms they are ok
Which 4 murmurs are increased by squatting/leg raising, and decreased by standing/valsalva?
AS, MS, AR, MR
Which 2 murmurs are decreased by squatting/leg raising, and increased by standing/valsalva?
HVP, HOCM
Standing and valsalva increase or decrease blood?
Decrease (like a diuretic)
Handgrip increases blood in which chamber?
L ventricle
Amyl nitrate decreases blood in which chamber?
L ventricle
Do steroids and IVIg help viral myocarditis?
No
What drug decreases recurrences of pericarditis?
Colchicine
What’s the best tx for acute pericarditis?
NSAIDs
Which condition has pulsus paradoxus?
Pericardial tamponade
What presents with acute pain between the scapulae and difference in blood pressure between the arms?
Aortic dissection
What’s the best test for aortic dissection?
Angiogram
What’s the most appropriate screening for the aortic aneurysm?
Men who ever smoked age >65 with ultrasound
When the width of the abdominal aortic aneurysm exceeds __cm in diameter, surgical or cath repair of lesion is indicated?
5cm
Which is the worst form of heart disease in pregnancy?
Peripartum cardiomyopathy (Eisenmenger is second)
Which direction of the shunt is Eisenmenger Syndrome?
R to L
What’s the most common cause of bronchiectasis?
CF
What condition presents with widening of the bronchi?
Bronchiectasis
What’s an inhaled med used to treat CF-associated bronchiectasis?
Dornase alfa
What dx might present as an asthmatic patient with recurrent episodes of brown-flecked sputum and transient infiltrates on CXR, eosinophilia, and cough, wheezing, and hemoptysis?
Allergic bronchopulmonary aspergillosis
Are inhaled steroids effective for allergic bronchopulmonary aspergillosis?
No
How do you treat allergic bronchopulmonary aspergillosis (acute, recurrent, and prevention)?
Acute: oral steroids
Recurrent: itraconazole
Prevention: Omalizumab
Does CF affect the endocrine or the exocrine glands?
Exocrine
Neutrophils in CF dump tons of ____ into airway secretions, clogging them up?
DNA
T/F: CF can lead to meconium ileus and biliary cirrhosis?
True
What’s the most accurate test for CF?
Sweat chloride test
What do PFTs show in CF (obstructive vs restrictive)?
Mixed obstructive and restrictive patterns
Which type of antibiotics are inhaled in CF patients?
Aminoglycosides
Which 2 vaccinations do CF patients need?
- Pneumococcal
2. Influenza
What does Ivacaftor combined with Lumacaftor do in CF patients?
Increases the activity of the CFTR in 5% of patients who have a specific mutation
Community acquired pneumonia is defined as pneumonia occurring __ hours before hospitalization or within __ hours of hospital admission?
48, 48
Which organism is the most common cause of community acquired pneumonia?
Strep pneumoniae
Which common CAP pathogen is associated with COPD?
Haemophilus influenzae
Which common CAP pathogen is associated with recent viral infection?
Staph aureus
Which common CAP pathogen is associated with alcoholism, diabetes?
Klebsiella pneumoniae
Which category of common CAP pathogen is associated with poor dentition, aspiration?
Anaerobes
Which common CAP pathogen is associated with young, healthy patients?
Mycoplasma pneumoniae
Which common CAP pathogen is associated with hoarseness?
Chlamydophila pneumoniae
Which common CAP pathogen is associated with contaminated water sources, air conditioning, and ventilation systems?
Legionella
Which common CAP pathogen is associated with birds?
Chlamydia psittaci
Which common CAP pathogen is associated with animal birth, veterinarians, farmers?
Coxiella burnetii
T/F: rales, rhonchi, and crepitus are findings from virtually any form of lung infex?
True
Which common CAP pathogen is associated with rotten egg sputum?
Anaerobes
Which common CAP pathogen is associated with dry cough, rarely severe, bullous myringitis (eardrum blisters)?
Mycoplasma pneumoniae
Which common CAP pathogen is associated with GI sx or CNS sx?
Legionella
Which common CAP pathogen is associated with AIDS <200 CD4?
Pneumocystis
Sputum gram stain is adequate if there are more than __ WBCs and less than __ epithelial cells?
25, 10
What is an empyema?
An infected pleural effusion
What’s the specific diagnostic test for Mycoplasma pneumoniae?
PCR, cold agglutinins
What’s the specific diagnostic test for Chlamydophila pneumoniae?
Rising serologic titers
What’s the specific diagnostic test for Legionella?
Urine antigen, culture on charcoal-yeast
What’s the specific diagnostic test for Chlamydia psittaci?
Rising serologic titers
What’s the specific diagnostic test for Coxiella burnetii?
Rising serologic titers
What’s the specific diagnostic test for Pneumocystis jiroveci?
Bronchoalveolar lavage
When do you hospitalize for pneumonia (11)?
- Hypotension systolic below 90
- RR above 30
- pH below 7.35
- BUN above 30
- Na less than 130
- Glucose above 250
- Pulse above 125/min
- Confusion
- Temp above 40C
- Age 65+
- COPD, CHF, RF, liver dz
Pleural effusion with pH <7.2 indicates what?
Empyema
LDH >60% of serum or protein >50% of serum suggest exudate or transudate?
Exudate
What’s CURB65?
Confusion Uremia Respiratory distress BP low Age >65
What are the 2 main initial CAP abx in the hospital?
- Ceftriaxone
2. Azithromycin
Hospital acquired pneumonia is almost always gram ___?
Negative
What’s the hospital acquired pneumonia treatment in the hospital?
Pip-tazo or Pip-Clav
Is sputum culture worthwhile in ventilator associated pneumonia?
No
What’s the antibiotic treatment for ventilator associated pneumonia (3)?
- Pip/tazo
- Gentamicin
- Vanc
Which antibiotic can cause seizures?
Imipenem
Everyone over age __ should get the pneumococcal vaccine: first the __ then the __ 6-12 mos later?
65; 13, 23
What antibiotic covers lung abscesses?
Penicillin
What is always elevated in PCP (jiroveci)?
LDH
What’s the best tx and prophylaxis for PCP?
TMP-SMX
When do you start PCP prophylaxis?
CD4 count <200
If the CD4 count is maintained above 200 for several months, can AIDS patients go off prophylactic abx?
Yes!
What tx is used for atypical mycobacteria prophylaxis when CD4 count <50?
Azithromycin
What’s the mnemonic for TB treatment drugs?
RIPE
What does RIPE stand for?
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
How long do you give the RIPE drugs?
- All for 2 months
- Then just RI for 4 more months
Can you use pyrazinamide during pregnancy?
No, so you need to extend tx to >6 mos total for TB
What’s Rifampin’s toxicity?
Red color to body secretions
What’s Isoniazid’s toxicity?
Peripheral neuropathy
How do you prevent Izoniazid-related peripheral neuropathy?
Pyridoxine
What’s Pyrazinamide’s toxicity?
Hyperuricemia
What’s Ethambutol’s toxicity?
Optic neuritis/color vision loss
T/F: erythema and induration count towards a positive PPD test?
False; just induration counts
What are the two mm cutoff points for the PPD results?
5, 10, and 15mm
5 for people with immunosuppression or sx, 10 for people at high risk, 15 for no risk factors
When do you need 2 PPD tests?
When it’s the patient’s first time getting one and the first one results negative
If a patient is IGRA positive of PPD positive, how do you treat?
9 months of Isoniazid
T/F: 12 doses of INH and rifapentine treats positive IGRA or PPD?
True
What dx presents with skin and soft tissue infex, grows in 5-10 days, lives in water and soil, and the question stem may describe a colonized water line in a dental unit?
Mycobacteria abscessus and fortuitum
What dx presents with a cough/sputum in an older person with COPD?
Mycobacteria avium-intracellulaire
What’s the antibiotic tx for Mycobacteria avium-intracellulaire?
Aithromycin, rifampin, and ethambutol
When many features of malignancy are present for a lung lesion, what’s the right answer usually?
Resect
What are the lung cancer screening indications for chest CT?
Age 55 with 30 pack-year history (including if quit within past 15 years)
What kind of pneumoconiosis can coal exposure lead to?
Coal worker’s pneumoconiosis
What kind of pneumoconiosis can sandblasting, rock mining, tunneling lead to?
Silicosis
What kind of pneumoconiosis can shipyard workers, pipe fitting, and insulators lead to?
Asbestosis
What kind of pneumoconiosis can cotton lead to?
Byssinosis
What kind of pneumoconiosis can electronic manufacture lead to?
Berylliosis
What kind of pneumoconiosis can moldy sugar cane lead to?
Bagassosis
What dx presents with dyspnea, fine rales or crackles, loud P2 heart sound, and finger clubbing?
Pulmonary fibrosis
What does MTX cause in terms of lungs?
Pulmonary fibrosis
What will the PFTs show in restrictive lung disease?
FEV1/FVC will be normal (both will be decreased)
Biopsy shows what in berylliosis?
Granulomas
If there is a response to steroids in interstitial lung disease, what should you switch the patient to long-term?
Azathioprine
How do you differentiate between interstitial lung disease and hypersensitivity pneumonitis?
Hypersensitivity pneumonitis has fevers, chills, myalgia and there is an exposure
What dx presents in a young African American female with fine rales on lung exam without wheezing of asthma, and also presents with parotid gland enlargement, facial palsy, heart block and restrictive cardiomyopathy, CNS involvement, and iritis and uveitis?
Sarcoidosis
What dx presents with CXR showing hilar adenopathy in a generally healthy African American woman?
Sarcoidosis
Are the granulomas in sarcoidosis caseating or no?
Non-caseating
How does calcium sometimes change in sarcoidosis (less often than expected)?
Hypercalcemia and hypercalciuria
When should you do a V/Q scan instead of a CT angiogram for suspected PE?
When patients have renal failure
When is it appropriate to check D-dimer?
To rule out PE when the pretest probability is very low anyway
When are direct-acting thrombin inhibitors (eg: argatroban) or fondaparinux the answer?
In HIT
What dx presents with dyspnea and fatigue, syncope, CP, wide splitting of S2?
Pulmonary HTN
How is ideopathic pulmonary HTN treated?
Prostacyclin analogues
