Cardiology

Question 1

left anterior wall aneurysm (post MI) on EKG

Answer 1

QS waves with persistent ST elevation in leads V2–V4

Question 2

Thoracentesis diagnosis of empyema

Answer 2

aspiration of grossly purulent material or one of the following:

• positive Gram stain or culture
• pleural glucose less than 60 mg/dL
• pH less than 7.2
• LDH greater than 1,000 IU/L

Question 3

When to give thrombolytics in STEMI

Answer 3

If PCI >120 minutes for transfer from first medical contact (90 minutes if no transfer)

Question 4

Posterior wall MI on EKG

Answer 4

• ST- depressions in V1, V2, and V3

- Can see tall, broad R waves in V2-V3 and a dominant R wave in V2 (R/S ratio > 1)

Question 5

Most common cause of ventricular arrhythmias

Answer 5

Ischemic heart disease

Question 6

What dysrhythmia can be triggered by PVCs

Answer 6

V-tach

Question 7

Sick Sinus SYndrome

Answer 7

Tachy-brady
Due to disease of SA node
Worse with increased vagal tone
Usually require pacemaker

Question 8

Arrhythmogenic right ventricular cardiomyopathy on EKG

Answer 8

Epsilon wave: a positive electrocardiographic deflection after the QRS segment in leads V1–V3
Fibrofatty infiltration of ventricles
Syncope or sudden cardiac arrest

Question 9

Cause and treatment of arrhythmogenic right ventricular cardiomyopathy

Answer 9

Fibrofatty replacement of right ventricular muscle

Beta-blockers and implantable cardioverter-defibrillator device

Question 10

Brugada cause and EKG findings

Answer 10

Sodium channelopathy that presents with syncope
RBBB with ST segment elevation followed by a downsloping inverted T wave in leads V1 and V2
ICD

Question 11

Wolff-Parkinson-White on EKG

Answer 11

Short PR interval followed by a slurred QR segment (delta wave)
Accessory conduction pathway, bypasses AV node

Question 12

Differentiate between the orthodromic and antidromic WPW

Answer 12

Orthodromic: regular narrow complex tachydysrhythmia
Antidromic: regular wide complex tachydysrhythmia

Question 13

EKG changes in order in hyperkalemia

Answer 13

Starts at 5.5-6.5
Peaked T waves, p wave wide and flat, PR interval prolongation, p wave disappears
At 7-9
QRS prolongation, escape beats, AV block, eventual sine wave morphology

Question 14

Treatment for chest pain after cocaine use

Answer 14

ASA, benzos, trops

Question 15

EKG changes in hypercalcemia

Answer 15

Short QT interval

Will causes decreased reflexes

Question 16

First step to evaluate a patient with LVAD

Answer 16

Auscultate precordium - whirr

Question 17

Most anterior part of heart

Answer 17

Right ventricle

Question 18

MAT vs wandering pacemaker

Answer 18

Both has 3+ atrial morphologies
Wandering PM: 60-100 bpm
MAT: 100-180 bpm

Question 19

Blunt cardiac trauma clearance

Answer 19

Normal EKG and trops

Question 20

Location of venous cutdown of great saphenous vein

Answer 20

Anterior and superior to medial malleolus

Question 21

RVH on EKG

Answer 21

RAD
Dominant r wave in V1
Dominant S wave in V5/6

Question 22

Umbilical cath

Answer 22

2 arteries, 1 vein
Cannulating vein is easier
Vein is thin walled

Question 23

Shock index

Answer 23

HR/SBP
>.7 indicates shock
Normal is 0.5-0.7

Question 24

Spontaneous carotid artery dissection

Answer 24

Caused by innocuous movements
HA, neck pain, pulsatile tinnitus, retinal ischemia
Horner Syndrome
Thrombolytic therapy

Question 25

Prolonged QT syndrome

Answer 25

>460, notched T waves or T wave alternates on EKG Leads to ventricular tachys Presents with syncope K ion channel mutations

Question 26

Most common cause of tricuspid valve stenosis

Answer 26

Rheumatic heart disease

Question 27

Post MI ventricular aneurysm

Answer 27

Persistent ST elevation with no signs of ACS, usually in precordial leads Q or QS waves

Question 28

MAP goal in neurogenic shock

Answer 28

85

Question 29

Takayasu arteritis

Answer 29

Large vessel (aortic arch and carotids)

Question 30

Most specific finding for acute decompensated heart failure

Answer 30

S3

Question 31

Hypertrophic cardiomyopathy on EKG

Answer 31

Large amplitude QRS Dagger Q inferior and/or lateral Tall R in V1-V2 Give BB or CCB

Question 32

1st line for stable v-tach

Answer 32

Procanimide

Question 33

Treat acute chest syndrome in SCA

Answer 33

Exchange transfusion

Question 34

Calculate MAP

Answer 34

MAP = DBP + 1/3(SBP-DBP)

Question 35

Bidirectional ventricular tachycardia most often caused by

Answer 35

Digoxin toxicity

Question 36

Poor prognostic indicators in CHF

Answer 36

HypoNa, bad kidneys, low albumin, elevated LFTS

Question 37

Medication do and don’t in aortic stenosis

Answer 37

Do: ACE-I | Don’t: BB and CCB

Question 38

Pericardial knock indiciates

Answer 38

Restrictive pericarditis

Question 39

RCA supplies what

Answer 39

RV free wall, SA nodes, papillary muscles | 2, 3, avf

Question 40

CV collapse during labor

Answer 40

Mitral stenosis - high output leading to LA enlargement -> afib and arrhythmia

Question 41

Lown-Ganong-Levine syndrome

Answer 41

Paroxysmal tachycardia | PR < .12 and normal QRS

Question 42

Renal artery stenosis

Answer 42

Increased AT2 and aldosterone -> increased Na and Bicarb resorption, K and H lost in urine Hypokalemia and metabolic alkalosis

Question 43

High output heart failure

Answer 43

Causes: sepsis, hyperthyroid, beriberi, AV fistula Decreased SVR, increased CO and venous congestion Sx: HF but w/ warm, well perfumed extremities, water hammer pulse, hyperdynamic precordium

Question 44

Treat hypotension, bradycardia in heart transplant patient

Answer 44

Dopamine or dobutamine

Question 45

HOCM

Answer 45

Holosystolic | Decreased with increased cardiac load: squatting/Trendelenburg

Question 46

Most common SE of IV amio

Answer 46

Hypotension

Question 47

Nerve that runs along left lateral border of heart

Answer 47

Phrenic

Question 48

Nerve that runs along left lateral border of heart

Answer 48

Phrenic