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EOR: Family Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What condition?

a 50-year-old woman with a history of hyperlipidemia and diabetes type 2 complaining of “chest pain attacks.”

She says that these attacks tend to occur while walking up five flights of stairs to get to her apartment.

they last for 15-20 minutes and are relieved by rest.

She describes the pain as sharp and substernal.

A baseline EKG is unremarkable.

stress EKG and observe transient ST depressions in the anterolateral leads after significant exertion

A

Stable angina

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2
Q

Dx of stable/unstable angina…

A

EKG

Exercise stress test

Echo/stress echo

coronary angiography

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3
Q

Gold standard Dx of angina…

A

coronary angiography

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4
Q

Medical Tx of Stable angina… (6)

A

ASA, nitrates, Beta Blockers, CCBs, ACE Inhibitors, Statins

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5
Q

Invasive Tx for stable angina (2)

A

coronary angioplasty

CABG

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6
Q

What condition?

a 58-year-old man with a history of coronary artery disease, hypertension, and hyperlipidemia

dull left-sided chest discomfort while at rest at home that was not relieved with taking nitroglycerin.

His ECG shows no ST-segment changes; serum troponin is not elevated.

A

Unstable Angina

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7
Q

ST depression > 1mm indicates…

A

ischemia

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8
Q

Treatment for unstable angina…

A

antiplatelet drugs

Beta blockers

nitro/CCBs

Revascularization

ACE-I + Statins

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9
Q

Tx of prinzmetal angina

A

Nitrates

CCBs for prophylaxis

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10
Q

What is contraindicated for prinzmetal angina?

A

beta blockers

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11
Q

What is contraindicated for prinzmetal angina?

A

beta blockers

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12
Q

What arrythmia?

RFs: Elderly, excessive alcohol use

Symptoms range from syncope, dyspnea, palpitations

Irregularly irregular pulse

A

a fib/flutter

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13
Q

Tx for a-fib/flutter RATE

A

CCBs, Beta Blockers

diltiazem/verapamil or metoprolol

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14
Q

Tx for afib/flutter rhythm (2 categories)

A

< 48 hours: cardioversion, amiodarone)

> 48 hours: anticoags x 21 days then cardioversion

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15
Q

CHADS2VASc score > (x) = anticoagulation

A

2+

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16
Q

LBBB ECG findings…

A

bunny ears in V4-V6 (R and R’)

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17
Q

RBBB ECG findings…

A

bunny ears in V1-V3 (R and R’)

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18
Q

Medical tx progression for PSVTs…

A

valsalva –> adenosine –> radioablation

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19
Q

SVT with delta waves and longer QRS…

A

WPW

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20
Q

Etiology for torsades…

A

hypokalemia, hypomagnesemia

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21
Q

Tx for torsades…

A

IV magnesium sulfate

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22
Q

Stable wide complex VT Tx…

A

amiodarone, lidocaine,

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23
Q

8 DDx for CP

A

MI

Angina

Pericarditis

Aortic dissection

PE

Pulmonary HTN

Rheumatic fever

Costochondritis

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24
Q

CP relieved by sitting/leaning forward

CP worse supine and during inspiration

A

pericarditis

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25
Q

severe, tearing CP radiating to back…

A

aortic dissection

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26
Q

Dyspnea + pleuritic CP can’t miss DDx…

A

PE

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27
Q

Dyspnea on exertion

CP

Edema

Syncope

Loud S2/P2 + ejection click

A

Pulmonary HTN

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28
Q

Migratory joint pain knees, ankles, elbows

CP

(+) ASO Titers

A

Rheumatic fever

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29
Q

Pain with palpation of chest

Chest Pain with movement of the arm

A

costochondritis

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30
Q

What condition?

48 yo male hx of ESRD and DM.

Dyspnea, cough, CP worse with inspiration and laying flat

Relief leaning forward/sitting upright

CMP shows BUN > 60

A

pericarditis

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31
Q

pericardial friction rub

diffuse ST segment elevation

A

pericarditis

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32
Q

Dx of pericarditis

A

ECG

Echo

(+) Kussmaul’s sign (increased CVP during inspiration)

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33
Q

Tx of pericarditis

A

NSAIDs/ASA x 7-14 days

corticosteroids if sxs persist > 48 hours

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34
Q

Tx of pericardial effusion

A

pericardiocentesis/pericardial window

35
Q

Dx of AAA

A

Ultrasound, CT

Angiography gold standard

36
Q

Screening for AAA

A

ultrasound in men 65-75 who have ever smoked

37
Q

Aortic dissection Dx (2)

A

MRI Angiography

CXR showing widened mediastinum

38
Q

which tx for HTN?

concurrent angina pectoris…

A

CCBs

39
Q

which tx for HTN?

DM with proteinuria

A

ACE/ARB

40
Q

ACE-I contraindicated in…

A

pregnancy

41
Q

which tx for HTN? (2)

a/w hyperkalemia

A

ACE-I, spironolactone

42
Q

_______ HTN meds are contraindicated in asthma and may cause impotence

A

beta blockers

43
Q

____ HTN meds may cause leg edema

A

CCBs

44
Q

Which CCBs are for rate control?

A

verapamil, diltiazem

45
Q

_____ HTN meds treat HTN and BPH

A

alpha blockers

46
Q

____ HTN med may cause lupus-like syndrome or pericarditis

A

hydralazine

47
Q

DOC for hypertensive urgency

A

clonidine

48
Q

DOC for hypertensive emergency

A

sodium nitroprusside

49
Q

DOC for malignant hypertension

A

clevidipine/sodium nitroprusside

50
Q

Pt. p/w:

heart murmur with one week increasing fatigue/low fever

hx of dental cleaning/surgery

Grade III holosystolic murmur at apex

A

infectious endocarditis

51
Q

Roth spots

janeway lesions

splinter hemorrhages

painful osler nodes

digital clubbing

A

infectious endocarditis

52
Q

Stroke + fever… can’t miss DDx…

A

infectious endocarditis

53
Q

MC pathogen for endocarditis…

A

strep. viridans

54
Q

Dx of endocarditis (4)

A

Blood Cx x 3 1 hour apart

EKG

CBC/ESR/RF

TEE

55
Q

Tx of endocarditis with no IVDU and native heart valves…

A

ampicillin 500mg/hr IV

Nafcillin 2g IV q 4 hours

Gentamicin 1 mg/kg IV q 8 hours

56
Q

Tx of endocarditis with prosthetic valve

A

vancomycin 15mg/kg IV q 12 hours

nafcillin 2g IV q 4 hours

Gentamycin 1 mg/kg IV q 8 hours

57
Q

Tx of endocarditis for IVDU

A

nafcillin 2 g IV q 4 hours (covers MSSA)

58
Q

endocarditidis abx prophylaxis

A

2g amoxicillin 30-60 min before procedure

59
Q

Labs for CHF

A

BNP (low in obese)

EKG

CXR showing kerley B lines

Echocardiogram (most useful)

60
Q

NY Heart Failure Classifications: 4

A

1: no limitation
2: slight limitation of activity, comfortable at rest
3: marked limitation of activity, comfortable at rest
4: no physical activity, angina at rest

61
Q

Tx for systolic left heart failure…

A

Loop Diuretic + ACE-I + beta blocker

62
Q

Tx for diastolic HF

A

ACE + Beta Blocker or CCB

63
Q

3 meds for intermittent claudication

A

ASA + clopidogrel

cilostazol (PDE inhibitor)

64
Q

High intensity statin therapy

A

Atorvastatin 40-80 mg

Rosuvastatin 20mg

65
Q

Which HLD drug class?

TGs: down 20-40%
LDL: down 18-55%
HDL: 5-15 pt increase

SFx: myopathy, rhabdo, increased LFTs

A

Statins

66
Q

Which HLD drug class?

TGs: 40-60%
LDL: 5-30% increase
HDL: 15-25
SFx: rhabdo

A

Fibrates

67
Q

Which HLD drug class?

TGs: 30-50%
LDL: 5-10% increase
HDL: 5-10
SFx: flushing, poor glycemic control increased LFTs

A

niacin

68
Q

Which HLD drug class?

TGs: 30-50%
LDL: 5-10 increase
HDL: 5-10
SFx: GI upset

A

fish oil

69
Q

gold standard for PVD

A

angiography

70
Q

surgical interventions for PAD/PVD

A

angioplasty

bypass graft

71
Q

MC site for PAD/PVD

A

superficial femoral artery

72
Q

Pt. p/w:

pain in one or more LE muscle groups

diminished/absent distal pulses

hair loss

thick toenails

pallor

A

PAD/PVD

73
Q

Diastolic murmur usually indicates…

A

heart disease

74
Q

Which murmur?

Soft HIGH PITCHED, BLOWING DIASTOLIC murmur along LSB with the patient sitting, leaning forward after exhaling

A

Aortic regurgitation

75
Q

Which murmur?

DIASTOLIC low-pitched DECRESCENDO and rumbling with OPENING SNAP at the APEX

best heart at apex

A

mitral stenosis

76
Q

Which murmur?

High pitch, decrescendo murmur at LUSB, increases with inspiration

Best heard at LUSB

A

pulmonary regurgitation

77
Q

Which murmur?

MID DIASTOLIC RUMBLING at LLSB with OPENING SNAP

A

tricuspid stenosis

78
Q

Which murmur?

Systolic ejection crescendo-decrescendo RUSB

Best heard when sitting

A

aortic stenosis

79
Q

Which murmur?

HARSH MIDSYSTOLIC EJECTION CRESCENDO-DECRESCENDO murmur with WIDELY SPLIT S2 at LSB that RADIATES TO THE LEFT SHOULDER & NECK

best heard supine

A

pulmonic stenosis

80
Q

Which murmur?

Medium-pitched, mid-systolic murmur that decreases with squatting and increases with straining

S4 gallop and apical lift with a thick, stiff left ventricle

A

hypertrophic cardiomyopathy

81
Q

Which murmur?

MIDSYSTOLIC EJECTION CLICK at APEX

A

mitral valve prolapse

82
Q

Which murmur?

best heard supine

BLOWING HOLOSYSTOLIC murmur at APEX with a SPLIT S2

A

Mitral regurgitation

83
Q

Which murmur?

HIGH PITCHED HOLOSYSTOLIC murmur at mid LSB

A

tricuspid regurgitation

84
Q

Which murmur?

HARSH HOLOSYSTOLIC murmur heard best at the LLSB with WIDE RADIATION and a fixed, split S2

A

VSD

EOR: Family Medicine (14 decks)

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