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General Surgery > Cardiology PANCE 2 6/9/20 > Flashcards

Cardiology PANCE 2 6/9/20 Flashcards

1
Q

what artery for an anterior wall MI

A

LAD

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2
Q

what artery for a lateral wall MI

A

circumflex

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3
Q

what artery for an inferior wall MI

A

RCA

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4
Q

what leads are anterior

A

V1 - V4

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5
Q

what leads are lateral

A

I, AVL, V5, V6

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6
Q

what leads are inferior

A

II, III, AVF

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7
Q

what rates are sinus tach

A

100-150

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8
Q

how do you tx sinus tach

A

nothing

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9
Q

what rate is sinus brady

A

less than 60

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10
Q

how do you tx sinus brady

A

atropine

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11
Q

how do you tx sinus brady syndrome, sick sinus syndrome

A

pacemaker

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12
Q

describe 1at degree heart block

A

long PR interval

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13
Q

tx for 1st degree block

A

none

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14
Q

describe type II A block

A

progressive block with dropped beats

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15
Q

how do you tx II A block

A

atropine + Pace

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16
Q

describe type III AV block

A

pacemaker

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17
Q

what are the three options for a flutter Tx

  • stable:
  • Unstable
  • definitive
A
  • Stable: vagel, BB, CCB
  • Unstable: cardiovertion
  • Definative: ablation
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18
Q

what are three medication classes that will control the rate in A fibb patients

A

BB: metoprolol
CCB: diltiazam
digioxin

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19
Q

who with a fib can get cardioverted

A

AF < 48 hours

- 3/4 weeks of anticoag + TEE

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20
Q

how do you tx unstable A fib:

A

cardiovertion

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21
Q

what CHADs VAS gets anti coag

A

> 1

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22
Q

what are all the elements of the CHADs VAS

A 
CHF 
HTN 
Age > 75 
DM II 
Stroke: +2
Vascular disease 
age >65 
sex
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23
Q

what are the three primary pathologies that can cause a prologed QT

A

macrolides
TCA
electrolight abnormalities

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24
Q

How do you tx prolonged QT

A

AICD

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25
Q

How do you tx stable SVT (2)

A
  • vagal

- adenosine

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26
Q

How do you tx stable V tach

A

amiodrone

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27
Q

How do you tx unstable V tach or SVT

A

cardiovertion

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28
Q

what is the definitive dx of narrow or wide complex tachycardia

A
  • ablation
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29
Q

what is wide complex SVT

A

V tach

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30
Q

what is multifocal atrial tachycardia (MAT) a compliaction of

A

COPD

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31
Q

what do you tx MAT with (2)

A

BB

CCB

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32
Q

what do you tx WPW with

A

procainimide

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33
Q

a prolonged QT can lead to what

A

torsades

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34
Q

how do you tx torsades

A

IV Mag

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35
Q

How do you manage PEA

A

CPR + EPI + defib

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36
Q

what is another name for D fiv

A

unsynchronized cardivertion

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37
Q

Diffuse ST elevation- “what pathology”

A
  • acute pericarditis
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38
Q

LBB RsR in what leads

A

V5- V6

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39
Q

RBB RsR what leads

A

V1- v2

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40
Q

who cannot get a pharmacologic stress test

A

obstructive airway disease

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41
Q

who cannot get a tredmill stress test (2)

A
  • cant walk

- baseline abnormalities

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42
Q

what is the MCC of CAD

A

athersclerosis

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43
Q

what are 5 RF for CAD

A
  • DM
  • smoking
  • HTN
  • HLD
  • Family history
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44
Q

what is subsernal chest pain that is brought on by exertion

A

angina

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45
Q

how long can angina last for

A

< 30 min

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46
Q

what are the three anginal equivalents

A
  • Dyspnea
  • epigastic
  • shoulder pain
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47
Q

what is the first line test for angina

A
  • EKG
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48
Q

what is the medication used for a pharmachologic stress test

A
  • dobutamine
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49
Q

what is the gold standard for CAD

A

Cath

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50
Q

what are the 4 indications for CABG over CAD

A
  • > 3 vessles
  • > 70%
  • LAD
  • ED < 40%
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51
Q

what are the three groups that cannot get nitro

A
  • SBP < 90
  • RV infarct
  • Sildenophil
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52
Q

how do you tx prinzmental angina

A

CCB

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53
Q

what is the MC cause of MI

A

Atherosclerosis

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54
Q

Chest pain and brady may be what location MI

A

inferior wall

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55
Q

what are the three EKG progressions you will see in an MI

A
  • peaked T waves
  • ST elevation
  • T wave invertion
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56
Q

what are the three timelines for troponin

  • appear
  • peak
  • last
A
  • appear: 4-8 hours
  • peak:12-24 hours
  • last: 7-10 days
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57
Q

what type of medication is clopedogril (plavix)

A

antiplatelet

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58
Q

what low molecular weight hererin has a SE of thrombocytopenia

A

low molecular weight heperin

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59
Q

prinzmetal angina or cocaine MI’s do NOT get what meds

A
  • beta blockers
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60
Q

what is the most importnat part about an MI

A

PCI

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61
Q

alteplase is AKA

A

TPA

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62
Q

what does NSTEMI get in addition to MONA

A

heperin

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63
Q

what does STEMI get in addition to MONA

A
  • hererin
  • ACE
  • PCI
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64
Q

what do you do for R ventricle (interior wall MI)

A
  • No nito

- give fluids

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65
Q

what clinical decision rule is used in a MI

A
  • TIMI
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66
Q

what TIMI is high risk

A

> 3

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67
Q

what are three contrainidcatrions to TPA

A
  • hemorrhagic stroke 6 months
  • facial trauma 3 months
  • previous intracranial hemorrhage
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68
Q

what is the MC cause of CHF

A

CAD

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69
Q

what heart sound is best heard on diastolic HF

A

S4

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70
Q

what type of breathing do you see with CHF

A

Chayne stokes breathing

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71
Q

what is the MC symptom of L sided CHF

A

dyspnea

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72
Q

what type of HF has a good EF

A

diastolic

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73
Q

what are the 3 imaging / lab values in CHF

A
  • ECHO: best
  • CXR:
  • BNP: > 100
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74
Q

what are the 3 best medications for CHF

A
  1. Ace
  2. BB
  3. Diuretic
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75
Q

what metabolic distribution is caused by an ACE

A
  • hyperkalemia
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76
Q

where are ace metabolized

A

kidney

77
Q

what HF medication causes gout

A

Lopp diurtics (furosimide)

78
Q

what EF for defibrillator

A

< 35%

79
Q

what pathology is kerly B lines associated with

A

CHF

80
Q

what are the 2 main causes of acute pericarditis

A
  • Idiopathic

- (viral)coxackie

81
Q

do individuals with perdicaditis have fever

A

most often yes

82
Q

what position for pericarditis is better

A

fetal

83
Q

what might you hear on ascultation with pericarditis ina FORWARD position

A

friction rub

84
Q

low voltage EKG and muffles heart sounds think what

A

pericardial effusion

85
Q

what is the MC cause of a pericardial effusion

A

pericarditis

86
Q

what will you see on an EKG for pericardial effusion

A
  • Low voltage

- electrical alternates

87
Q

what will you see on CXR for pericardial effusion

A

cardiomegaly

88
Q

what is becks triad

A
  • muffled heart sounds
  • JVD
  • hypotesion
89
Q

what pathology is pulses paradoxus associated with

A

cardiac tampanode

90
Q

how do you tx cardiac tampanode

A

pericardiocentesis

91
Q

what is thickened pericardium that decreases filling

A
  • constrictive pericarditis
92
Q

what is Kussmals sign and what pathology is it associated with

A
  • Kussmals sign: increased JVD with inspiration

- constrictive pericarditis

93
Q

what is a “high pitched 3rd heart sound” and what is it associated with

A

high pitched 3rd heart sound: pericardial knock

Pathology: constrictive pericarditis

94
Q

what is the cause of rheumatic fever

A

-GABHS (strep pyogenys)

95
Q

what valve for rehumatic fever

  • 70%
  • 30%
A

mitral (70%)

aortic (30%)

96
Q

what labs for rheumatic fever

A

ESR

CRP

97
Q

what is the jones criteria associated with

A

rheumatic fever

98
Q

how do you tx rheumatic fever

A

aspirin

Pen G

99
Q

Harsh / rumble sound

stenosis or regurg

A

stenosis

100
Q

Blowing sound

stenosis or regurg

A

regurg

101
Q

aortic regurg radiated where

A

L upper sternal boarder

102
Q

aortic stenosis radiates where

A

carotids

103
Q

Mitral regurg radiates where

A

axilla

104
Q

sitting up and leading forward makes what murmurs louder

A

aortic stenosis and aortic regurg

105
Q

what type of murmur is louder if you are lying on the left side

A

mitral regurg

106
Q

squatting
supine
leg raises
increases what murmurs

A

all but hypertrophic cardiomyopathy

107
Q

what 2 movements decrease the venous return

A
  • valsalva

- standing

108
Q

how does decreasing venous return AKA

Valsalva and standing influence murmurs

A

it decreases all murmurs with teh exception of HCOM

109
Q

how do you increase HCOM 2

A

valsalva and standing

110
Q

what are the three aortic stenosis complications

A

angina
syncope
CHF

111
Q

systolic crescendo de crescendo murmur that radiates to the neck

A

aortic stenosis

112
Q

treatment for severe Aortic stenosis

A

AVR

113
Q

RHD and endocarditis cause what type of murmur

A

aortic regurg

114
Q

“diastolic decrescendo blowing murmur”

bounding pulses

A

aortic regurg

115
Q

what murmur has a narrow pulse pressure

A
  • aortic stenosis
116
Q

what Murmur has a mise pulse pressure

A
  • aortic regurg
117
Q

How so you tx aoritc regurg

A

afterload reduction

118
Q

what is the MC cause of mitral stenosis

A
  • reheumatic heart disease
119
Q

“fish mouth valve”

A
  • mitral stenosis
120
Q

Diatolic rumble with opening snap

A

mitral stenosis

121
Q

“boundng pulse murmur”

A

aortic regurg

122
Q

“blowing holosystolic murmur”

A

Mitral regurg

123
Q

mitral regurg tx

A

Ace

124
Q

“mid to late ejection click”

A

Mitral vale prolapse

125
Q

how do you tx mitral valve prolapse

A
  • reassurance

- beta blockers

126
Q

what is the MCC of secondary HTN

A

renal artery stenosis

127
Q

what is the MCC of end stage renal disease in the US

A
  1. DM

2. HTN

128
Q

what are the 4 grades if HTN retinopatht

A
  1. arterial narrowing
  2. A-V nicking
  3. hemmorages + soft excudated
  4. papilledema
129
Q

JNC 8 what is the goal HTN

A
  1. <140/90

2. If > 60 yo: 150> 90

130
Q

with HCTZ what are the only 3 things that increase

A
  • Hypercalcemia
  • Hyperurecemia (Gout)
  • Hyperglycemia (DM)
131
Q

what is the only Duirertc that causes HYPERkalemia

A
  • K sparing (spironolactone)
132
Q

what is the main metabolic chnage that is involved with Ace

A

Hyperkalemia

133
Q

ace and arbs are containdicated in what population

A

pregnancy

134
Q

what is the one non cardioselective beta blocker

A

propanolol

135
Q

what 2 beta blockers are both cardioselective and non cardioselective

A

labetalol and carvedilol

136
Q

what CCB are non dihydropyidines and this are NON cardioselective 2

A
  • verapamil

- Diltiazem

137
Q

how much should you lower the BP by in an emergency

A
  • 25% in 48 hours hours
138
Q

what are the two primary medications used in HTN urgency

A
  • clonidine

- captopril

139
Q

what is a compliaction to clonidine

A

rebound HTN (will look liek pheo)

140
Q

Grade IV HTN retininopathy may presnet with what

A

blurred vision

141
Q

when someone is having an ishemic stroke at what level do you lower their BP

A

> 185/ 110

142
Q

what what age do you start checkling lipids

  • w/o FH
  • w/ FH
A
  • w/o: 35M, 45F

- with: 25M, 35F

143
Q

who are the 4 statin benifit groups

A
  • DM 40-75
  • 40-75 with 10 year risk > 7.5
  • > 21 yo with LDL > 190
  • CAD
144
Q

what meds lower TG

A

fibrates

145
Q

what meds inc HDL

A

niacin

146
Q

niacin is also B?

A

B3

147
Q

Gemfibrozil
fenofibrate

these are examples of

A

Fibrates to lower TG

148
Q

what is the MC value effected in endocarditis

A

mitral valve unless IVDU then tricuspid

149
Q

what is the difference between acute bacterial and subacute endocarditis

A

subacute is in abnormal valves

150
Q

what organism for acute bacterial endocarditis

A

staph aurues

151
Q

what organism for subacute endocarditis

A

step virdands

152
Q

what organisms for endocarditis in IVD

A

MRSA

153
Q

what is the Tx for subacute endocarditis

A

ampcillin + gent

154
Q

what is the Tx for acute endocarditis

A

nafcillin + gent

155
Q

what is the Tx for PV endocarditis

A

Vanc + Rifampin + Gent

156
Q

what murmur for infective endocarditis

A

new regueg murmur

157
Q

what are the 4 clnical manifestations ABE

A

Janeway lesions
roth sports
osler nodes
splinter hemorrhages

158
Q

what are the 4 endocarditis prophalaxis indications

A
  • Prosthetic valve
  • heart repairs with prosthetic material
  • prior endocarditis
  • congenital heart disease
159
Q

what are the two options for endocarditis prophalaxis

A

amoxicillin

clindamycin

160
Q

Pain
pallor
pulselessness
These are associated with what pathology

A
  • PAD
161
Q

what location for PAD ulcers

A
  • lateral malleolar
162
Q

how do you dx PAD

A

ABI < .9

163
Q

what are the three tx for PAD

A
  • cliostazole
  • aspirin
  • clopedogrel
164
Q

what are the 2 MC risk factors for AAA

A
  • athersclerosis

- smoking

165
Q
  • Syncope
  • hpotension
  • pulsitile mass

what pathology

A

AAA

166
Q

what is the qualification for a low dose CT of the chest

A
  • 15 pack years within the last 30 years

annual low dose CT

167
Q

what do you do with a AAA

  • 3.0cm - 4.0 cm
  • 4.0 -4.5 cm
  • > 4.5cm
A
  • 3.0cm - 4.0 cm: monitor every year
  • 4.0 -4.5 cm: monitor every 6 months
  • > 4.5cm: surgery
168
Q

what medication is included in the mamangemnt of a AAA because it lowers the sheering forces

A

beta blocker

169
Q

where is the worst location to have a aortic dissection

A

ascending

170
Q

what is the most importnat risk factor for an aortic dissection

A

hypertension

171
Q

sudden ripping tearing chest pain:

A
  • aortic dissection
172
Q

what is the classic finding on X ray for an aortic disection

A

widened mediastimum

173
Q

what is the gold standard for aortic dissection

A

MRI

174
Q

how do you manage aortic dissection

  • ascending:
  • Descending:
A
  • ascending: surgery

- Descending:labetalol

175
Q

what is burgers disease

A

non athersclerotic inflammatory disease of the small to medium vessels

176
Q

what is burgers disease associated with (RF)

A

smoking

177
Q

what is trousseau’s sign of malignancy

A
  • migratory thrombophilibitis associated with malignancy
178
Q

for superficial thrombophilibitis what do you see on ultrasound

A

non compressable vein

179
Q

superficial thrombophilibitis what is the MC cause

A

factor V leiden difficenecy

180
Q

superficial thrombophilibitis tx (3)

A

warm compress
elevation
NSAIDs

181
Q

how long for DVT treatment

A

3 months for inital life long after that

182
Q

what pathology “inadequate perfusion and tissue oxygenation”

A

shock

183
Q

what are the 4 types of shock and a little infor about each

A
  1. hypovolemic: reduced blood volume
  2. cardiogenic: reduced cardiac output
  3. obstructive: Obstruction to circulation
  4. disributive: maldistribution of blood flow
184
Q

what is the SVR and CO with hypovolemic shock

A
  1. SVR: increased

2. CO: decreased

185
Q

what is the SVR and CO with cardiogenic shock

A
  1. SVR: increased
  2. CO: decreased
  3. pulmonary capilary wedge pressure: increased
186
Q

what is the one type of shock you do not give fluids

A
  • cardiogenic
187
Q

what type of shock

  • CO: decreased
  • SVR: decreased
  • PCWP: decreased
A

distributive

188
Q

what are the 4 qualifications for SIRS

A
  • Temp: > 100.3
  • Pulse: > 90 BPM
  • respiratory rate: >20
  • WBC: >12,000
189
Q

what is the only type of shock that has
CO: increased
Skin: warm

A

septic

General Surgery (30 decks)

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