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Internal Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

[Diagnosis]

precipitated by exertion, cold, stress

lasting 2-10 minutes, tightness, squeezing, , heaviness,

retrosternal radiating to the neck, jaw, shoulders, arms, epigastric

A

Stable Angina

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2
Q

[Diagnosis]

Increasing patter or at rest

more than 30 mins

retrosternal radiating to the neck, jaw, shoulders, arms, epigastric

A

unstable anguna

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3
Q

[Diagnosis]

pleuritic, sharp, retrosternal pain toward the cardiac apex radiating to the left shoulder

relieved by sitting up or leaning forward

A

Pericarditis

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4
Q

[Diagnosis]

Sudden onset of unrelenting pain

tearing or ripping, knifelike

anterior chest radiating to the back between shoulder blades

loss of peripheral pulses, HPN

A

Acute Aortic Syndrome

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5
Q

[Diagnosis]

sudden onset pleuritic chest pain, lateral,

dyspnea, tachypnea, tachycardia, hypotension

A

Pulmonary Embolis,

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6
Q

[Diagnosis]

chest pain, characterized as pressure, substernally located

dyspnea, signs of increased venous pressure

A

Pulmonary hypertension

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7
Q

[Diagnosis]

sudden onset chest pain, pleuritic
dyspnea, decreased breath sound on one side

A

Spontaneous pneumothorax

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8
Q

[Diagnosis]

Burning chest pain lasting 10-60 mins, substernal epigastric,

worst by post prandial recumbency, relieved by antacids

A

GERD

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9
Q

[Diagnosis]

pressure/tightness/burning chest pain lasting 2-30mins, retrosterna

closely mimic angina

A

esophageal spasm

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10
Q

[Diagnosis]

burning chest pain, 60-90 mins after meals, prolonged, epigastric to substernal relieved with food or antacids

A

peptic ulcer

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11
Q

[Diagnosis]

aching, colicky, RUQ pain radiating to the back after a fatty meal

A

GB disease

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12
Q

Chest pain that decreases the likelihood of MI

A
  1. Pain that reaches it peak immediately
  2. Pleuritic
  3. Positional
  4. Tender of palpation
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13
Q

[Diagnosis]

53M hypertensive, heavy substernal chest pain on exertion, relieved by rest

radiating to the shoulder,

A

CSAP

Initial Test: ECG
Next: Stress test
First line: beta blocker and CCB

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14
Q

___ sign

heavy or squeezing, substernal or central

A

Levine Sign

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15
Q

[CCS Classification for angina]

Slight limitation, emotions, more than 2 blocks, more than 1 flight of stairs

A

CCS FC II

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16
Q

[CCS Classification for angina]

Marked limitation, 1-2 blocks, more than 1 flight of stairs

A

CCS FC III

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17
Q

In MI, ECG is needed to assess

A
  1. LV function
  2. Wall motion
  3. EF
  4. Thrombus
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18
Q

What drugs can be given for patients who cant exercise

A
  1. Dobutamine
  2. Adenosine
  3. Dipyridamole
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19
Q

What is the role of beta blockers in managing chronic angina

A
  1. Lowers HR, reducing myocardial demand, arterial pressure,
  2. Blocks catecholamine release
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20
Q

Nicorandil is a 2nd line drug for chronic angina. Its mechanism of action is due to

A

Dilating the vessels via ATP-sensitive K channels

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21
Q

____ is a drug used in MI that improves myocardial glucose utilization via inhibition of FA metabolism and increasing the availability of ATP

A

Trimetazidine

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22
Q

What are the indications for PCI?

A
  1. Persistent or symptom limiting angina pectoris despite medical management + evidence of ischemia during stress test
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23
Q

What are the indication for CABG

A
  1. 3 vessel CAD

2. 2 vessels involving the LAD and LCA

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24
Q

What are the indications for PCI?

A
  1. Persistent symptoms of angina despite medical management

2. Evidence of ischemia during stress test

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25
Q

What is the LDL goal in patients with CAD?

A

LDL <100

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26
Q

What is the LDL goal for patients with CAD and DM?

A

LDL <70

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27
Q

What accounts for the automaticity of the cardiac action?

A

SA and AV nodes

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28
Q

What determines the heart rate?

A

Slope of phase 4 in SA node

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29
Q

[Pacemaker Potential]

opening of hyperpolarization-activated channel permeable to Na and K

A

Phase 4

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30
Q

[Pacemaker Potential]

Rapid depolarization and overshoot; Ca-mediated action potential

A

Phase 0

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31
Q

[Pacemaker Potential]

Final repolarization, increase in K efflux

A

Phase 3

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32
Q

What is the major site of atherosclerotic disease?

A

Epicardial arteries

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33
Q

The main stimulus for vasomotion of epicardial arteries is?

A

Flow

Its role is for transport

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34
Q

The main stimulus for vasomotion of small arteries is?

A

Pressure

Its role is for regulation

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35
Q

The main stimulus for vasomotion of arterioles is

A

Metabolites

its role is for exchange

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36
Q

____% stenosis results in a limitation of the ability to increase flow to meet increased myocardial demand

A

50%

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37
Q

___% stenosis results in limitation of flow at rest

A

80%

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38
Q

[Pharma]

Irreversible cox1 inhibitor

A

Aspirin

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39
Q

[Pharma]

P2Y12 inhibitor decreasing platelet aggregation

A

Clopidogrel

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40
Q

[Pharma]

3-hydroxy-3-methytglutaryl CoA reductase inhibitor

A

Statins (HMG CoA reductase inhibitor)

SE: Rhabdomyolysis, myopathy, liver disease

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41
Q

[Pharma]

blocks RAAS; can cause hyperkalemia in solitary kidney

A

ACEI/ARB

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42
Q

[Pharma]

vasodilator of peripheral vessels + nodal inhibition

A

Verapamil/Diltiazem

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43
Q

[Pharma]

Reduction of peripheral vascular resistance

A

CCB

-dipines

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44
Q

[Pharma]

What drug is contraindicated in Hypertrophic Obstructive Cardiomyopathy

A

HOCM

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45
Q

[Pharma]

If channel inhibitor

A

Ivabradine

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46
Q

[Pharma]

Stimulates K+ adenosine triphosphate channel

A

Nicorandil

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47
Q

[Pharma]

Anti-ischemic metabolic modulator

A

Trimetazidine

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48
Q

What are the indications for CABG?

A
  1. Left main coronary artery disease
  2. 3 vessel disease + LVEF <50% or DM
  3. 2 vessel disease that includes proximal left descending coronary artery
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49
Q

[Diagnose]

52/M smoker HON, severe substernal chest pain radiating to the right arm, diaphoresis

chest pain persist despite sublingual nitrates; 130/90, 90 bpm

A

Dx: ACS
Initial: ECG
Used to distinguish unstable angina and NSTEMI: cardiac biomarkers

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50
Q

[Diagnose]

new-onset angina or worse in frequency, duration or intensity or at rest <30min

ECG: ST depression or TW inversion or flattening or normal ECG

Trop I: normal

A

Unstable angina

Tx: Medical + PCI before discharge

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51
Q

[Diagnose]

new-onset angina or worse in frequency, duration or intensity or at rest <30min

ECG: ST depression or TW inversion or flattening or normal ECG

Trop I: elevated

A

NSTEMI

Tx: Medical + PCI before discharge

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52
Q

[Diagnose]

Angina at rest >30 mins

ST Elevation

Every elevated troponins

A

STEMI

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53
Q

[Markers]

What cardiac biomarker will first rise in Acute MI?

A

Myoglobin

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54
Q

what cardiac biomarker is used to determine reinfarction?

A

CKMB

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55
Q

Dual antiplatelet therapy should last for at least ___ year

A

1 year

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56
Q

Nitrates cannot be given if the patient took vardenafil for ____ hours

A

24 hours

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57
Q

Patients cannot take nitrates is they took this PDE5 inhibitor in the past 48 hours

A

Tadalafil

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58
Q

What is the role of statins in anti ischemic therapy?

A

Plaque stabilization

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59
Q

[Diagnose]

chest pain heavy, squeezing, crushing, occuring at rest, more severe and lasts longer

sweating, nausea, anxiety, restlessness, sense of impending doom

ST elevation or LBBB or pathologic Q wave

A

STEMI

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60
Q

The most frequent location of chest pain is beneath ___

A

xiphoid and epigastrium

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61
Q

[Classification of MI]

spontaneous MI

A

Type 1

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62
Q

[Classification of MI]

MI secondary to ischemic imbalance

A

Type 2

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63
Q

[Classification of MI]

MI resulting in death when biomarker values are unavailable

A

Type 3

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64
Q

[Classification of MI]

MI related to PCI

A

Type 4a

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65
Q

[Classification of MI]

MI related to Stent thrombosis

A

Type 4b

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66
Q

[Classification of MI]

MI related to CABG

A

Type 5

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67
Q

What is the recommended door-to-balloon time to conduct PCI?

A

within 90 minutes

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68
Q

If you are unable to do PCI in a patient with STEMI within 90 minutes, what is your next step?

A

administer fibrinolytic therapy within 30 mins of presentation

then transfer for angiography

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69
Q

What are the absolute contraindications in to fibrinolytic therapy?

A
  1. Hemorrhage of the brain
  2. Other CVD within past year
  3. Marked hypertension (>180/>110)
  4. Bleeding internally (exclude menses)
  5. Aortic dissection is suspected

HOMBA

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70
Q

What are the relative contraindications for fibrinolytic therapy?

A
  1. INR >/ 2
  2. <2 weeks surgery
  3. > 10 mins CPR
  4. Bleeding diathesis
  5. Pregnancy
  6. Hemorrhagic ophthalmic condition
  7. Active peptic ulcer disease
  8. Severe HPN that is controlled
  9. Streptokinase <50 days to 2 years
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71
Q

What is the most common cause of out-of-hospital death from STEMI?

A

VFib

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72
Q

What is the most common cause of in-hospital death from STEMI?

A

Pump failure

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73
Q

[Diagnosis]

29M with PTB, sharp chest pain aggravated by lying relieved by sitting, high pitched rasping sound on cardiac auscultation.

ECG: ST segment elevation with PR-segment depression

A

Dx: Acute pericarditis

Tx: anti-inflammatory with aspirin

Avoid anticoagulants since it can cause tamponade

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74
Q

What is the pathognomonic character of pericarditis?

A

pericardial friction rub

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75
Q

What are the SSx of pericarditis?

A
  1. Chest pain
  2. Rub, pericardial
  3. Effusion
    4 ST Elevation
  4. Tamponade
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76
Q

Aside from the diffuse ST segment elevation seen in V2 to V6, what other ECG finding is suggestive of acute pericarditis?

A

PR-segment depression

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77
Q

What are the ECG changes in acute pericarditis

A

Stage 1 - widespread elevation of ST segment

Stage 2 - ST segment normal

Stage 3 - T wave inversion

Stage 4 - ECG normal

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78
Q

What antirheumatic drugs can be given to patients with pericarditis?

A
  1. Colchicine
  2. Prednisone

Given 3 months
Colchicine is CI in hepatic and renal dysfunction

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79
Q

[Heart murmur]

Next step for:

Diastolic or continuous murmur

A

Echocardiography

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80
Q

[Heart murmur]

Next step for:

Grade I + II, midsystolic, asymptomatic murmur

Normal ECG, Normal CXR

A

No further workup

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81
Q

[Heart murmur]

Next step for:

Grade III murmur

or holosystolic or late systolic

A

Echocardiography

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82
Q

[Grading or murmur]

Murmur + thrill

A

Grade IV

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83
Q

[Grading or murmur]

Murmur heard with stethoscope lightly pressed on skin

A

Grade V

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84
Q

[Grading or murmur]

Murmur heard with stethoscope slightly above the chest

A

Grade VI

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85
Q

[ECG Changes: Wall involved]

I, aVL, V1-V6

A

Large anterior wall

Proximal LAD

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86
Q

[ECG Changes: Wall involved]

II, III, aVF

A

Inferior wall

Distal LAD

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87
Q

[ECG Changes: Wall involved]

V1 to V3

A

Anteroseptal wall

Distal LAD

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88
Q

[ECG Changes: Wall involved]

V2 to V4

A

Anteroapical

Distal LAD

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89
Q

[ECG Changes: Wall involved]

V4 to V6

A

Posterolateral

CircumPlex

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90
Q

[Auscultation]

Atrial septal defect is best heard at ____

A

pulmonic area

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91
Q

[Auscultation]

Ventricular septal defect is best seen at

A

tricuspid area

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92
Q

[Murmurs]

Crescendo, midsystolic murmur

A

Aortic stenosis

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93
Q

[Murmurs]

early diastolic murmur

A

Aortic regurgitation

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94
Q

[Murmurs]

holosystolic

A

Mitral regurgitation

Tricuspid regurgitation

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95
Q

[Murmurs]

diastolic murmur after the opening snal

A

MS

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96
Q

In patients with HOCM, what is the effect of squatting or leg raising to the murmur?

A

Decreases murmur

Same with MVP

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97
Q

In patients with VSD, what is the effect of squatting or leg raising to the murmur?

A

increases murmur

same with AS, AR, MS, MR

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98
Q

What is the effect of standing or valsalva in the murmur of HOCM?

A

Increases

same with MVP

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99
Q

What is the effect of standing or valsalva to the murmur of mitral regurgitation?

A

decreases murmur

Same with AS, AR, MS, VSD

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100
Q

[Diagnose]

70/M chest pain, exertional syncope 3/6 mid-systolic murmur at 2nd ICS, weak and narrow pulse

A

Dx: AS

Initial test: Transthoracic echocardiogram

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101
Q

___ effect

murmur transmitted downward confusing with MR

A

Gallavardin effect

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102
Q

[Diagnosis]

Paradoxical splitting of S2, pulsus parvus et tardus. narrow pulse pressure

A

AS

103
Q

What is the echocardiographic finding in AS?

A
  1. reduced systolic opening of the valve leaflet with thickening
  2. LV hypertrophy
104
Q

What is the role of statins in Aortic stenosis?

A

Slow down leaflet calcification

105
Q

[Diagnosis]

62M, HPN

Diastolic murmur, high pitched, blowing, on the left sternal border, wide pulse pressure

murmur heard over femoral artery

A

Dx: AR
Initial tes: transthoraci echocardiogram

Drug that should not be given in acute condition: beta blocker

106
Q

____ sign murmur heard over the femoral artery. Can be suggestive of AR.

A

Duroziez sign

107
Q

What is the associated murmur in syphilis?

A

AR

108
Q

What is the associated murmur in patients with ankylosing spondylitis?

A

AR

109
Q

____ murmur heard in severe AR; early diastolic rumbling murmur

A

austin flint

AT

110
Q

____ sign

bobbing motion of the head

A

De musset sign

AR

111
Q

___ sign

bounding and forceful pulse, rapidly increasing and subsequently collapsing

A

Water-Hammer sign or Corrigan’s pulse

AR

112
Q

___ sign

pulsation at the root of the nail

A

Quicke pulse

AR

113
Q

___ sign

booming pistol shoot sound over the femoral arteries

A

Traube sign

114
Q

___ sign

pulsating popliteal artery

A

Lincoln sign

115
Q

What is the treatment of choice for AR with an EF <55%

A

Surgery within 24 hours

Also if the Left ventricular end systolic diameter goes above 55mm

116
Q

[Diagnosis]

30M with RHD

opening snap, low-pitched, tumbling, diastolic murmur at the apex

A

Dx: mitral stenosis

Treatment of choice: percutaneous transmitral commisurotomy

117
Q

What is the earliest CXR finding of mitral stenosis

A

straightening of the upper left border of the cardiac silhouette

118
Q

What is the cut-off value to say that there is critical valve narrowing in mitral stenosis?

A

Valve surface area <1cm2

119
Q

The opening snap right after S2 in patients with mitral stenosis is best heard upon?

A

Upon expiration

the opening snap is due to high LA pressure

120
Q

What is the hemodynamic hallmark of mitral regurgitation?

A

elevated left atrioventricular pressure gradient

121
Q

___ sign

high functional tricuspid murmur

A

carvallo sign

122
Q

Aside from SOB and heart failure, patients with MS also present with ___

A
  1. Dysphagia
  2. Hoarseness
  3. AFib and stroke
123
Q

What are the DOC for patients with MS?

A
  1. Beta blockers, digoxin, NDHP CCB to slow down HR

2. Warfarin if with AF (INR 2-3

124
Q

What is the best initial therapy for MS?

A

Diuretics

125
Q

What is the most effective treatment for MS?

A

Percutaneous mitral balloon valvotomy or valvuloplasty

126
Q

[Heart Failure]

What is the EF for HFrEF?

A

<40%

due to decreased pumping ability

127
Q

[Heart Failure]

What is the EF for HFpEF

A

> 40-50%

due to decreased ventricular compliance/relaxation

128
Q

___ respiration signifies advanced HF

A

Cheyne-stokes

129
Q

[Right/Left CHF]

bibasal rales
pleural effusions
pulmonary edema
orthopnea, PND

Dyspnea

A

LSHF

130
Q

[Right/Left CHF]

Fluid retention
Hepatojugular reflux, peripheral edema
hepatomegaly
ascites

A

RSHF

131
Q

[HFrEF vs HFpEF]

displaced PMI, S3 gallop

Q waves, decreased EF

A

HFrEF

132
Q

[HFrEF vs HFpEF]

sustained PMI, S4 gallop

LVH, normal preserved

EF (>55%) abnormal LV diastolic indices

A

HFpEF

133
Q

[NYHA]

Symptoms with ordinary activity

2 flights of stairs

A

Stage II

134
Q

[NYHA]

marked limitation in less than ordinary activity

<1 flight of stairs

A

Stage III

135
Q

[Stage of heart failure]

Structural heart disease with no symptoms

A

Stage B

136
Q

[Stage of heart failure]

Structural heart disease with prior or current symptoms

A

Stage C

137
Q

[Stage of heart failure]

Refractory HF; occurs at rest

A

Stage D

138
Q

Drug class with mortality benefit in HF

A
  1. ACEi in HFrEF

2. Beta blockers - Carvedilol, Bisoprolol, Metoprolol succinate

139
Q

[Pharma for HF]

angiotensin receptor-neprilysin inhibitor

A

Sacubitril/Valsartan

140
Q

[Diagnosis]

Dyspnea, orthopnea, cyanosis, elevated JVP, Hepatomegaly

ECG: tall p-waves, RAD, RVH

CXR: enlarged pulmonary artery

Echo: RA/RV enlargement

A

Cor pulmonale

141
Q

What is the best initial test for cases of cardiomyopathy?

A

Echocardiography

142
Q

What is the best initial therapy for HOCM?

A

beta blockers

143
Q

[Types of cardiomyopathy]

Impaired systolic function

EF <30%
Dilated LV wall

A

Dilated CM

144
Q

[Types of cardiomyopathy]

Impaired ventricular filling

EF 25 to 50%

normal to decreased LV wall dimension

+ RH failure

A

Restrictive CM

145
Q

[Types of cardiomyopathy]

Septum hypertrophy

EF >60%

Decreased LV wall dimension, LV is thick

+ angina, syncope

A

Hypertrophic CM

146
Q

What is the leading cause of sudden death in young healthy athletes

A

hypertrophic CMP

147
Q

[Diagnosis]

septal hypertrophy + systolic anterior motion of the mitral valve

A

HOCM

148
Q

[Diagnosis]

chest pain, progressive dyspnea, distended jugular veins, muffled heart sounds, pulsus paradoxus, bp 70/50

A

Dx: Cardiac tamponade

149
Q

How will you say that it is a paradoxical pulse?

A

> 10mmHg inspiratory decline in systolic arterial pressure

150
Q

Pathognomonic CXR for cardiac tamponade?

A

Water bottle sign

151
Q

ECG finding in cardiac tamponade?

A

electrical alternans

152
Q

[Diagnosis]

65/M smoker, pain on both calves after walking a few blocks, resolves with rest.

femoral and dorsalis pedis are diminished bilaterally, cool to touch, shiny

A

Dx: PAD
Initial test: ABI

Pain + pallor + pulselessness = arterial occlusion

153
Q

What is the ABI cut off value in duplex UTZ to say its PAD?

A

<0.9

Severe ischemia - <0.5

154
Q

What is the most accurate test to diagnose PAD?

A

Arteriography

155
Q

What is the first line drug for symptom improvement in PAD?

A

Cilostazol

Second line - pentoxifylline

156
Q

[Diagnosis]

50F, leg swelling and sudden onset dyspnea with pain on inspiration. previous surgery < 2 weeks,

110/70 110 bpm RR 30

A

Dx: Pulmonary Embolism

Most appropriate test: chest CT with contrast

157
Q

Virchow’s triad is composed of ___

A
  1. Endothelial Injury
  2. Venous stasis
  3. Hypercoacuable state
158
Q

What are the variables in Well’s score for PE?

A
  1. DVT SSx
  2. Alternative dx less likely PE
  3. HR > 100
  4. Immobilization 3 days, surgeru withint 4 weeks
  5. Prior PE or DVT
  6. Hemoptysis
  7. Cancer
159
Q

What are the variables in Well’s score for DVT?

A
  1. Active CA
  2. Paralysis
  3. Bedridden > 3 days; major surgery <12 weeks
  4. Tenderness along deep veins
  5. Entire leg swelling
  6. Unilateral calf swelling >3cm
160
Q

What is the rule out test in PE?

A

D-dimer

161
Q

[CXR Finding in PE]

Focal oliemia

A

Westermark sign

162
Q

[CXR Finding in PE]

enlarged RDPA

A

Palla sign

163
Q

[CXR Finding in PE]

wedge-shape opacity at lung periphery

A

Hampton hump

164
Q

What are the ECG findings in PE?

A
  1. Sinus tachycardia
  2. S1Q3T3
  3. T wave inversion in V1 to V4
165
Q

McConnell sign in 2DE for PE means there is

A

Hypokinesis of the RV free wall

166
Q

[Pharma: Dyslipidemia]

Cholesterol absorption inhibitor

A

Ezetimibe

167
Q

[Pharma: Dyslipidemia]

Bile acid sequesteran

A

Cholestyramine

168
Q

[Pharma: Dyslipidemia]

upregulates lipoprotein lipase to increase breakdown of VLDL and chylomicrons

A

Fibrates (gemfibrozil, fenofibrate)

169
Q

[Pharma: Dyslipidemia]

CPK levels must be checked in patients taking this drug combination due to rhabdomyolysis as most common adverse effect

A

Rhabdomyolysis

Statin + fibric acid derivative (Gemfibrozil)

170
Q

What are the 4 statin benefit groups

A
  1. Clinical ASCVD
  2. LDL-C > 190mg/dL without secondary cause
  3. Primary prevention with DM
  4. Primary prevention without DM by ASCVD risk >/ 7.5%
171
Q

[Pharma: Dyslipidemia]

PCSK9-inhibitor

A

Evolocumab

172
Q

[Pharma: Dyslipidemia]

CETP-inhibitor

A

Torcetrapib

173
Q

[Pharma: Dyslipidemia]

first line treatment for severe hypertriglyceridemia

A

Fibrates

174
Q

[Pharma: Dyslipidemia]

What is the contraindication for cholestyramine

A

TG > 500

175
Q

[Hypertension]

What medications should be avoided in patients with gout?

A

Thiazide diuretics

176
Q

[Hypertension]

What is the most common cause of secondary hypertension

A

primary renal disease

177
Q

[Hypertension]

In BP measurement, the length and width of the cuff should be _____ of the arms circumference

A

80%, 40%

released at a rate of 2-3mmHg

inflate to 30mmHg above expected SBP

178
Q

[Pharma: Hypertension]

Can cause sexual impotence, diabetes, gout, hyperuricemia

A

Thiazide diuretics

can cause hypokalemia

179
Q

[Pharma: Hypertension]

Can cause hypokalemia, hypocalcemia, hypomagnesemia, metalbolic alkalosis

A

Loop diuretics

180
Q

[Pharma: Hypertension]

can cause gynecomastia

A

Spironolactone

181
Q

[Pharma: Hypertension]

contraindicated in sick sinus syndrome

A

beta blocers

182
Q

[Pharma: Hypertension]

beta blocker with NO potentiating effect

A

Nebivolol

183
Q

[Pharma: Hypertension]

can cause sedation, xerostomia, CNS side effects

rebound HPN on withdrawal

A

Clonidine
Methydopa
Reserpine

184
Q

[Diagnosis]

Hematuria, urinary symptoms, elevated crea, cast on UA,

abdominal mass

A

Renal parenchymal disease

185
Q

[Diagnose]

Abrupt onset hypertension or worsening or difficult to control

flash pulmonary edema, early onset HPN

abdominal bruits

A

renovascular disease

186
Q

[Diagnose]

hypertension with spontaneous hypokalemia; adrenal mass

A

primary hyperaldosteronism

187
Q

[Diagnose]

Resistant HPN, snoring, apnea, day-time sleepiness, obesity

A

OSA

188
Q

[Hypertension]

SBP > 180
DBP >120

No TOD

A

Hypertensive Urgency

189
Q

[Hypertension]

SBP >180
DBP >120

With TOD

A

Hypertensive emergency

Admit to ICU

190
Q

What is the target SBP for patients with Hypertensive emergency + aortic dissection?

A

<120

191
Q

What is the target SBP for patients with hypertensive emergency + compelling condition

A

<140

192
Q

What is the target DBP for patients without compelling condition

A
  1. Not more than 25% in the 1st hour, then if stable
  2. 160/100 mmHg in the next 2 to 6 hours
  3. Then to normal following 24 to 48 hours
193
Q

What is the most common sustained arrythmia

A

AF

194
Q

What is the ECG finding in AF?

A
  1. Absence of discrete P wave

2. Irregularly irregular ventricular contraction

195
Q

What are the components of the CHA2DS2-VASc risk score?

A 
CHF - 1
HPN - 1
Age >/75 -2
DM - 1
Stroke or TIA - 2
Vascular disease - 1
Age 65 to 75 - 1
Sex - Female -1
196
Q

What is the estimated annual stroke score in CHA2DS2VASc 2?

A

2.2%

197
Q

What is the estimated annual stroke score in CHA2DS2VASc 4?

A

4.0%

198
Q

What is the estimated annual stroke score in CHA2DS2VASc 4?

A

3.2%

199
Q

What is the DOC for pharmacologic cardioversion in patients with AF and with structural heart disease?

A

Amiodarone

200
Q

What is the DOC for pharmacologic cardioversion in patients with AF without structural heart disease?

A
  1. Flecainide
  2. Ibutilide
  3. Propafenone
201
Q

When will you do an electrical cardioversion in patients with AF?

A

Recent onset AF (<48 hours)

202
Q

What is the antidote of Dabigatran?

A

Idarucizumab

203
Q

What is the most important step in the diagnosis of endocarditis?

A

Serial blood cultures

204
Q

What are the components of Duke’s Criteria?

A
  1. Fever
  2. Roth Spot
  3. Osler node
  4. Murmur
  5. Janeway lesions
  6. Anemia
  7. Nail-bed hemorrhage
  8. Emboli
205
Q

Based on Duke’s criteria, how will you say that the patient has endocarditis?

A
  1. 2 major
  2. 1 major + 3 minor
  3. 5 minor
206
Q

What are the major criteria in Duke’s?

A
  1. Sustained bacteremia
  2. Endocardial involvement
  3. New valvular regurgitation
207
Q

What are the minor criteria in Duke’s?

A
  1. Abnormal valve/risk of bacteremia
  2. fever
  3. Vascular phenomena
  4. Immune phenomena
  5. Positive blood culture not meeting the major criteria
  6. Positive echocardiogram
208
Q

What is the best empiric therapy for endocarditis?

A

vancomycin and gentamicin

209
Q

Serial blood cultures to diagnose endocarditis should be taken ___

A
  1. 3 two bottle blood set
  2. Separated by at least 2 hours
  3. Different sites
210
Q

[Most commons]

myocardial perfusion occurs during this time

A

Diastole

211
Q

[Most commons]

anterior chest MSK pain

A

costochondral and chondrosternal syndrome

212
Q

[Most commons]

presenting complaint of aortic dissection

A

Sudden onset of severe sharp pain

213
Q

[Most commons]

preventable cause of death among hospitalized patients

A

PE

214
Q

[Most commons]

most severe form of postphlebitic syndrome

A

Skin ulceration

215
Q

[Most commons]

autosomal dominant genetic mutations for prothrombotic states

A
  1. Factor V Leiden

2. Prothrombin gene mutation

216
Q

[Most commons]

acquired cause of thrombophilia and associated with venous/arterial thrombosis

A

APAS

217
Q

[Most commons]

gas exchange abnormality in PE

A

arterial hypoxemia and increased A-a gradient

218
Q

[Most commons]

usual cause of death from PE

A

Progressive right heart failure

219
Q

[Most commons]

symptom of DVT

A

charley horse or cramp

220
Q

[Most commons]

most common symptom for PE

A

Unexplained breathlessness

221
Q

sudden, severe calf discomfort suggests

A

Ruptured Bakers cyst

222
Q

[Most commons]

frequent symptom of PE

A

dyspnea

223
Q

[Most commons]

sign of PE

A

tachypnea

224
Q

leg pain, fever, chills

A

Cellulitis

225
Q

Tachycardia, low grade fever, neck vein distention

A

PE

226
Q

Dyspnea, syncope, hypotension

A

massive PE

227
Q

[Most commons]

frequently cited ECG abnormality in PE

A

S1Q3T3 sign

228
Q

[Most commons]

abnormality in PE on ECG

A

T wave inversion in leads V1 to V4

229
Q

principal imaging test for the diagnosis of PE

A

CT with IV contrast

230
Q

second-line diagnostic test for PE

A

lung scanning

231
Q

Best known indirect sign of PE

A

mcConnell sign

232
Q

Definitive diagnosis of PE

A

Pulmonary angiography

233
Q

Foundation for successful treatment of DVT and PE

A

anticoagulatin

234
Q

Major advantage of UFH

A

short half life

235
Q

Warfarin embryopathy most common exposure during ___ AOG

A

6th to 12th week AOG

236
Q

Two principal indications for IVC filters

A
  1. Active bleeding that precludes anticoagulation

2. Recurrent venous thrombosis despote anticoagulation

237
Q

Two determinants of arterial pressure

A
  1. Cardiac output

2. Peripheral resistance

238
Q

Strongest risk factor for stroke

A

elevated BP

239
Q

Indicative of primary renal disease

A

Proteinuria > 1000 mg/day

active urine sediment

240
Q

Gold standard for evaluation and identification of renal artery lesions

A

Contrast arteriography

241
Q

most common congenital cardiovascular cause of hypertension

A

CoA

242
Q

what is the definition of resistant hypertension?

A

BP >140/90 despite more than 3 antihypertensive agents

243
Q

Prototypic lesions in IE

A

vegetation

244
Q

IE in drug users usually affect ____ valve

A

tricuspid valve

245
Q

Optimal method for diagnosis of prosthetic valve endocarditis, valve perforation or fistula

A

transesophageal echocardiography

246
Q

Test of choice to detect perivalvular abscess

A

TEE with color doppler

247
Q

Most common valve affected in perivalvular infection

A

aortic valve infection

248
Q

most common tumor of the pericardium

A

malignant neoplasm from the mediastinum

249
Q

Most common primary malignant pericardial tumor

A

mesothelioma

250
Q

most common primary cardiac tumor in age groups

A

myxoma

251
Q

most common clinical presentation of myxoma

A

mimic MV disease

252
Q

most common cardiac tumors in infants and children?

A

rhabdomyoma and fibroma

253
Q

Most often involved in metastasis to the heart

A

pericardium > myocardium> endocardium or valves

Internal Medicine (10 decks)

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