Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IM > Cardiology, Harrison > Flashcards

Cardiology, Harrison Flashcards

1
Q

Estimates risk of ischemic stroke in patients with non-rheumatic/non-valvular Afib

A

CHADS2 Score: 1) CHF 2) Htn 3) Age >75 4) DM 5) Previous stroke; Each corresponds to 1 point, except for previous stroke which corresponds to 2 points; A score >2 = oral anticoagulation advised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Estimates 10-year risk of coronary disease, cerebrovascular disease, peripheral vascular disease, and heart failure

A

Framingham Cardiovascular Risk: 1) Age 2) SBP 3) Total cholesterol 4) HDL 5) BP treatment 6) Smoking status 7) DM 8) Gender

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chest discomfort precipitated by emotion/exertion; rapidly resolves (within 5-10 mins) with resting/nitrates

A

Chronic stable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MCC of chronic stable angina

A

Atherosclerotic epicardial Hcoronary artery disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Accelerates coronary atherosclerosis in both sexes at all ages

A

Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Family history of coronary artery disease, significant ages within genders

A

Male less than 55; Female less than 65 (must be FIRST DEGREE relatives)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Chest pain of chronic stable angina lasts for

A

2-10 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Atypical chest discomfort of angina is common in

A

1) Elderly >75 2) Women 3) Diabetics; may present with anginal equivalents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

T/F Pain of chronic stable angina may radiate to the back/interscapular region

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Chest pain of chronic stable angina RARELY localises where

A

Below umbilicus or above mandible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Angina that occurs at rest is referred to as

A

Unstable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Angina at night while the patient is recumbent

A

Angina decubitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Symptoms of myocardial schema (MI) other than angina

A

Anginal equivalents: Dyspnea, nausea, fatigue, faintness, epigastric discomfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

MI without chest discomfort but detectable by continuous ECG (Holter monitoring) or during stress test

A

Silent ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Mitral regurgitation is best appreciated with the patient in ___ position

A

Left lateral decubitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

T/F Localization of chest discomfort with a single fingertip on the chest makes angina unlikely

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Unstable angina lasts for

A

10-20 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Angina of acute MI lasts for

A

> 30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Angina that cannot be relieved by nitroglycerin

A

Acute MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Late-peaking systolic murmur radiating to the carotid arteries

A

Aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Condition that can cause chest pain that closely mimics angina

A

Esophageal spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Simplest test for diagnosis and risk stratification of ischemic heart disease

A

Treadmill ECG (exercise stress test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Used to diagnose ischemic heart disease when resting ECG is abnormal

A

Stress myocardial perfusion imaging: Thallium or sestamini is infused IV during exercise/pharmacologic stress testing; imaged after cessation of exercise and 4 hours later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Substances that may be used for pharmacologic stress testing

A

1) Dobutamine 2) Adenosine 3) Dipyridamole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Definitive test for assessing severity of CAD

A

Coronary arteriography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Target heart rate in exercise stress testing

A

85% of maximal heart rate for age and gender

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Exercise stress testing is discontinued when

A

1) Chest discomfort 2) Severe shortness of breath 3) Dizziness 4) Severe fatigue 5) ST depression >0.2mV 6) Decrease in SBP by >10mmHg 7) Vtach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Baseline (0mV) in ECG

A

PR segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Contraindications to stress testing

A

1) Rest angina within 48 hours 2) Unstable rhythm 3) Severe aortic stenosis 4) Acute myocarditis 5) Uncontrolled heart failure 6) Severe pulmonary htn 7) Active infective endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Vitamins that improve outcomes of patients with IHD

A

Vitamin C and E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Indications for coronary artery bypass surgery (CABG)

A

1) Significant left main CAD 2) 3-vessel CAD 3) 2-vessel CAD that includes LAD 4) Require revascularization but vessels unsuitable for PCI 5) Angina refractory to medical therapy 6) Medical therapy not tolerated 7) Diabetic with at least 2-vessel disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Drugs that can be used to increase HDL and decrease TAG

A

1) Niacin (Vitamin B6) 2) Fibrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

T/F Unstable angina and NSTEMI have similar mechanisms, clinical presentations, and treatment strategies

A

T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Angina that occurs with a crescendo pattern

A

Unstable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Difference between NSTEMI and Unstable angina

A

NSTEMI: With evidence of myocardial necrosis (elevated cardiac markers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Age risk factors per gender

A

Male - 50 or older; Female - 60 or older

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Clinical hallmark of unstable angina

A

Chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Cardiac marker: First to elevate

A

Myoglobin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Myoglobin remains elevated up to

A

24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

CK-MB and Troponin elevate when

A

3-12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

CK-MB remains elevated until

A

1.5-3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Cardiac marker: Last to decline

A

Troponin (remains elevated for 1-2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Cardiac marker: Assist with determination of coronary risk

A

1) High sensitivity C-reactive protein (hsCRP) 2) Homocysteine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Cardiac marker: Aids in diagnosis, management, prognosis, and monitoring therapy of congestive heart failure (CHF)

A

B-type natriuretic peptide (BNP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

A marker of long-term cardiac risk produced by all nucleated cells, unaffected by acute phase reactants, body or muscle mass, and diet

A

Cystatin C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

When is ambulation permitted in patients with UA and NSTEMI

A

1) No recurrence of schema 2) No elevation of cardiac biomarkers at 12-24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Pain reliever used in UA/NSTEMI in patients whose symptoms are not relieved after 3 serial sublingual nitroglycerin tablets

A

Morphine sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Antithrombin of choice for UA/NSTEMI; superior to unfractionated heparin in reducing recurrent cardiac events

A

Enoxaparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Drugs shown to have benefit for long-term therapy in UA/NSTEMI patients

A

1) Beta blockers (helps decrease triggers for MI) 2) Statins and ACEIs (long-term plaque stabilisation 3) Antiplatelet (prevents/reduces severity of thrombosis if a plaque ruptures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Tearing or ripping knife-like chest pain radiating to the back between the shoulder blades

A

Aortic dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Grading of heart murmurs

A

1-very faint; 2-faint; 3-moderately loud; 4-loud with thrill; 5-stethoscope lightly pressed on skin; 6-stethoscope slightly above chest wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Posterior calf pain on active dorsiflexion of foot against resistance

A

Homan’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Rise or lack of fall of JVP with inspiration

A

Kussmaul’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Venous pressure should fall by at least ___ mmHg with inspiration

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Abdominojugular reflex

A

Pressure over the RUQ for 10 seconds results in a sustained rise of >3 cm in JVP for at least 15 seconds after release of hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Uncontrolled htn with NO end-organ damage

A

Hypertensive urgency/hypertensive crisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Uncontrolled htn with end-organ damage

A

Hypertensive emergency/malignant hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Hypertensive urgency: Treatment

A

Oral drugs first; lower BP within 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Hypertensive emergency: Treatment

A

IV medications; lower BP by not >20-25% within the first hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Drug class that should be avoided in patients with congestive heart failure

A

Beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Criteria for white coat hypertension

A

1) At least 3 clinic measurements >140/90 2) At least 2 non-clinic measurements less than 140/90 3) No target organ damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Orthostatic hypotension is a fall in SBP by ___ mmHg or DBP by ___ mmHg from supine to upright within ___ minutes

A

> 20, >10, 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Leading cause of death and disability in the developed world

A

Atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Enzyme inhibited by statins

A

HMG-CoA reductase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Characteristic of LDL in diabetic dyslipidemia

A

Levels near average but smaller and denser particles thus more atherogenic

66
Q

Gravest complication of atherosclerosis

A

Acute thrombosis

67
Q

5 A’s of behavioural counselling framework in smoking cessation

A

Ask about tobacco use; Advise to quit; Assess willingness to quit; Assist to quit; Arrange follow-up and support

68
Q

BP goal for patients with diabetes or kidney disease

A

Less than 130/80 (140/90 for all others)

69
Q

Metabolic syndrome describes a constellation of metabolic derrangements that typically includes 3 or more of the following

A

1) Abdominal obesity (>102 cm in men, >88 cm in women) 2) TG 150 mg/dL or greater 3) HDL Less than or equal to 40 mg/dL in males and 50 mg/dL in females 4) BP 130/85 5) Fasting glucose 100 mg/dL or greater

70
Q

Fasting lipid profile should be done for all adults ___ of age; to be repeated every ___ years if values are acceptable

A

> 20, 5

71
Q

Components of lipid profile

A

1) Total cholesterol 2) TAG 3) LDL 4) HDL

72
Q

___ treatment has been shown to reduce risk of first MI in men

A

Low-dose aspirin

73
Q

Risk factors that modify LDL goals

A

1) Smoking 2) Htn 3) Low HDL 4) DM 5) Family history of premature CAD 6) Age >45 in males >55 in females 7) Emerging risk factors (e.g. homocysteine)

74
Q

Metabolic syndrome is aka

A

1) Insulin-resistance syndrome 2) Syndrome X

75
Q

Metabolic syndrome places the individual at increased risk for

A

1) Coronary artery disease 2) Stroke 3) Peripheral vascular disease 4) TIIDM 5) NASH

76
Q

Common key underlying abnormality in metabolic syndrome

A

Insulin resistance

77
Q

Antihypertensive regimen for patients with metabolic syndrome should include

A

ACEI and ARBs

78
Q

ATP III recommends at least ___ minutes of moderate-intensity physical activity on a daily basis for weight reduction

A

30

79
Q

First-line drug for LDL reduction in metabolic syndrome

A

Statin

80
Q

Inability of ventricle to contract normally, with symptoms resulting from inadequate cardiac output; depressed EF

A

Systolic failure (EF less than 40%)

81
Q

Inability of the ventricle to relax and fill normally, with symptoms from elevated filling pressures; preserved EF

A

Diastolic failure (EF >50%)

82
Q

High- vs low-output heart failure: After MI, htn, dilated cardiomyopathy, valvular or pericardial disease

A

Low-output

83
Q

High- vs low-output heart failure: Hyperthyroidism, anemia, pregnancy, AV fistula, beriberi, Paget disease

A

High-output

84
Q

T/F Low-output heart failure is often accompanied by vasoconstriction and cold extremities

A

F, vasodilation and warm extremities

85
Q

Systolic vs diastolic heart failure: More common in women and seen especially in elderly women with hypertension

A

Diastolic

86
Q

Hypertrophy brought about by PRESSURE overload

A

Concentric

87
Q

Hypertrophy brought about by VOLUME overload

A

Eccentric/dilated

88
Q

Ascites is most commonly seen in what etiology of heart failure

A

1) Constrictive pericarditis 2) Tricuspid valve disease

89
Q

Abdominojugular reflex is positive in

A

Congestive hepatomegaly

90
Q

Criteria to establish a clinical diagnosis of CHF

A

Framingham criteria

91
Q

At least ___ major and ___ minor Framingham criteria are required to establish a diagnosis of CHF

A

1 major, 2 minor

92
Q

Major Framingham criteria

A

1) Cardiomegaly 2) S3 gallop 3) Acute pulmonary edema 4) Rales 5) PNDn 6) Neck vein distention 7) (+) hepatojugular reflex 8) Increased venous pressure

93
Q

Minor Framingham criteria

A

1) Extremity edema 2) Night cough 3) Dyspnea on exertion 4) Hepatomegaly 5) Pleural effusion 6) Vital capacity reduced by 1/3 from normal 7) Tachycardia of 120 or greater

94
Q

Major or minor Framingham criterion

A

Weight loss of 4.5 kg or greater over 5 days of treatment

95
Q

Cardiac marker that helps in differentiating between cardiac and pulmonary causes of dyspnea

A

BNP

96
Q

CHF Stage: At high risk of HF but no evident structural heart disease or symptoms of HF

A

A

97
Q

CHF Stage: Structural heart disease without symptoms of HF

A

B

98
Q

CHF Stage: Structural heart disease with prior or current symptoms of HF

A

C

99
Q

CHF Stage: Refractory HF requiring specialized interventions

A

D

100
Q

Sudden death in CHF is most commonly due to

A

Vfib

101
Q

Suspect ___ in middle-aged or elderly who develop asthma for the first time

A

Heart failure (HF)

102
Q

Cornerstone of modern HF treatment

A

ACEI and beta blockers

103
Q

Cor pulmonale is caused by ___ in >50% of cases

A

COPD

104
Q

RV heave is characteristic of

A

Cor pulmonale

105
Q

JVP waves prominent in for pulmonale

A

a and v

106
Q

MC symptom of for pulmonale

A

Dyspnea

107
Q

This is the increased intensity if holosystolic murmur of tricuspid regurgitation with inspiration

A

Carvallo’s sign

108
Q

The main premise in the treatment of for pulmonale is

A

Treat the underlying disorder

109
Q

Hand placed over sternum with a clenched fist to indicate a squeezing, central, substernal discomfort

A

Levine’s sign

110
Q

Form of angina pectoris caused by intermittent focal spasm of a major epicardial coronary artery

A

Prinzmetal/variant angina

111
Q

T/F Prinzmetal angina is more severe than classic angina and occurs typically at rest but usually not increased by exercise

A

T

112
Q

T/F Prinzmetal angina is associated with ST elevation

A

T, transient

113
Q

Substances that places a person at high risk for prinzmetal angina

A

1) Alcohol 2) Cocaine 3) 5-FU 4) Sumatriptan

114
Q

T/F Prinzmetal angina promptly responds to sublingual nitrates

A

T

115
Q

Most common artery involved in prinzmetal angina

A

Right coronary artery

116
Q

Spasm of coronary artery usually occurs within __ cm of luminal obstruction

A

1

117
Q

Cardiac marker: Taken only once, at least 12 hours after chest pain

A

Trop I or T

118
Q

Cardiac marker: Increased sensitivity with serial sampling (q6-8)

A

CK-MB

119
Q

Generally occurs when coronary blood flow decreases abruptly after a thrombotic occlusion of a coronary artery previously affected by atherosclerosis

A

STEMI

120
Q

Prohibited drug implicated in STEMI

A

Cocaine

121
Q

Mc etiology of STEMI

A

Atherosclerotic plaque rupture > formation of a mural thrombus at site of rupture > occlusion

122
Q

Coronary plaques that are prone to rupture

A

Rich lipid core and fibrous cap

123
Q

Circadian variations of STEMI have been reported with clusters seen ___

A

In the morning, within a few hours of awakening

124
Q

MC presenting symptom of STEMI

A

Chest pain

125
Q

~___% of MIs are clinically silent

A

25

126
Q

Anterior vs inferior infarction: Sympathetic hyperactivity (tachycardia or hypertension)

A

Anterior

127
Q

Anterior vs inferior infarction: PSY hyperactivity (bradycardia or hypotension)

A

Inferior

128
Q

Heart disease that may present with radiation of discomfort to trapezius

A

Acute pericarditis

129
Q

When to request for cardiac markers

A

At presentation, 6-9 hours later, 12-24 hours later if diagnosis remains uncertain

130
Q

T/F Echo can distinguish acute STEMI from old myocardial scar

A

F, cannot

131
Q

Sequence of ECG changes in typical STEMI

A

ST elevation > T wave depression > Q wave development

132
Q

T/F Absence of Q wave = no STEMI

A

F, STEMI may be present in the absence of Q waves

133
Q

Initial therapy for STEMI

A

Aspirin, chewed

134
Q

In the absence of ___, fibrinolysis is not helpful and may be harmful in patients with MI

A

ST elevation

135
Q

Preferable symptoms-to-needle (PCI) time

A

Less than 2-3 hours

136
Q

Door-to-needle time for maximum benefit

A

Less than 30 minutes

137
Q

Patients who suffered from MI should be placed on bed rest for how long

A

First 12 hours; ambulate in room by 2nd to 3rd day in the absence of complications

138
Q

Correlates CHF mortality with severity of pump failure

A

Killip class

139
Q

Killip class: No signs of pulmonary or venous congestion

A

I

140
Q

Killip class: Moderate heart failure; R-sided heart failure

A

II

141
Q

Killip class: Severe heart failure; pulmonary edema

A

III

142
Q

Killip class: Shock with systolic pressure less than 90 mmHg

A

IV

143
Q

MCC complication of STEMI developed during hospitalization

A

Cardiogenic shock

144
Q

MC complication associated with transmural STEMI

A

Pericarditis

145
Q

Most out-of-hospital deaths from STEMI are due to

A

Sudden ventricular fibrillation

146
Q

Fibrinolysis is preferred over PCI in STEMI if patient presents ___ from onset

A

Less than 3 hours

147
Q

PCI is preferred over fibrinolysis in STEMI if patient presents ___ from onset

A

> 3 hours

148
Q

Resumption of work and sexual activity in post STEMI patients

A

2 weeks

149
Q

T/F Acute rheumatic fever (ARF) commonly develops in patients after untreated group A streptococcal infection

A

F, only ~3% develop ARF

150
Q

T/F ARF is more common after a GABHS pharyngitis than after a GABHS skin infection

A

T

151
Q

Used to detect GABHS after a throat infection

A

ASO

152
Q

Used to detect GABHS that is more sensitive to streptococcal pyoderma

A

Anti-DNAse-B

153
Q

Peak age of ARF

A

5-15 yo

154
Q

Most initial attacks of ARF in ADULTS occur at

A

End of second and beginning of 3rd decades of life

155
Q

Valve most often affected in ARF

A

Mitral

156
Q

Criteria for diagnosis of rheumatic fever

A

Jones criteria

157
Q

To fulfil the Jones criteria, either ___ OR ___ must be fulfilled

A

2 major; 1 major and 2 minor; + supporting evidence of a recent GABHS infection

158
Q

[USMLE] Order of affectation of heart valves in RF

A

Mitral > aortic&raquo_space; tricuspid

159
Q

Early cardiac lesion of RF

A

MR

160
Q

Late cardiac lesion of RF

A

MS

161
Q

RHD is what type of hypersensitivity reaction

A

II

162
Q

Carditis in RF involves what layer of the wall of the heart

A

All 3 (peri-, myo-, and endocardium); it is a pancarditis

IM (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions