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UWorld step 2 > cardiology uworld > Flashcards

cardiology uworld Flashcards

1
Q

CHADVASC score > 2, what drug do you give to reduce systemic embolic risk?
moa?
why is it better than warfarin?

A

apixiban or dabiGATRan – long term
direct inhibits factor X (Xiban)
direct thrombin inhibitor (gator)
less risk of hemorrhagic bleeding like warfarin–

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2
Q

indirect causes of QT prolongation?

A

antipsychotics: haloperidol

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3
Q

atrial fibrillation management that ONLY causes QRS prolongation

A

Flecainide class 1C

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4
Q

CHA2DS2VASc scoring?

A

CHF
HTN
Age >75 gets 2, 64-75 gets 1
DM
Stroke or TIA gets. 2
Vascular Dx (PAD, past MI)
Sex Category : FEMALES

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5
Q

Most common comorbidity with A-fib?
effect on the heart?

A

chronic HTN
atrial remodeling –> atrial fibrosis & dilation
*will see atrial enlargement, concentric LV hypertrophy
*if paroxysmal you won’t see anything on EKG

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6
Q

rapid and irregular pulse with no p waves ?
management?

A

atrial fibrillation with RVR (>100bpm)
rate and rhythm control

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7
Q

no p-waves where does it originate ?

A

atrial fibrillation
pulmonary veins

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8
Q

atrial fibrillation management if greater than ___ >bpm

A

if greater than 150>bpm –> synchronized cardio version

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9
Q
A
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10
Q

atrial fibrillation guidelines for hemodynamically stable patients (<150bpm)

A

rate control: non-dihydropyridines(diltiazam or verapamil) or b-blockers (metoprolol)

for long term : check CHA2DS2VASc FOR anti-coagulation tx (usually need it)

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11
Q

Low BP + sinus bradycardia –> next best step?

A

Atropine

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12
Q

what causes atrial tachycardia with second degree av block

A

digoxin )can also cause lots of other arrhythmias

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13
Q

progressively lengthening of PR interval followed by a drop in QRS ?
next best step?

A

Mobitz type 1 weinkeback

no further intervention

*also seen in long distance athletes

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14
Q

what is this? and what’s next best step?

A

complete AV block, dissociation between P waves and QRS
leads to decreased cardiac output, (thus sxms fatigue, weakness)

next best step cardiac pacing followed by pacemaker

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15
Q

who do you see this in?
what’s usual sxms?
what’s next step?

A

mobitz type 1
P-R gets longer longer then drops.

AV node delayed conduction
asymptomatic
can see it in athletes, b-blockers, or structural heart changes

–> observation

vs mobitz 2 constant P-R then sudden drop

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16
Q

what is this d/t?
what is the best next step and why? (2)

A

sine wave d/t hyperkalemia

tx with calcium gluconate to stabilize cardiac membranes
and then with insulin and glucose to drive the K back into cells

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17
Q

young male syncope episode
T-wave inversion on EKG
d/t?
will likely see (2)?
dx?
tx?

cause of death?

A

HOCM
AD - sarcomere (myosin binding) protein
1) LVOT
2) ischemia induced ventricular tachycardia: O2 supply mismatch (increase in O2 demand d/t more muscle mass & decrease in O2 supply due to myocardial disarray with microvascular dysfunction)
dx: echocardiography
tx: b-blockers or non-di’s (verapamil/diltiazam) to get more LV blood volume

cause of death: ventricular arrhythmia

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18
Q

syncope vs seizure – tongue biting?

A

syncope: frontal tongue biting

seizure: lateral tongue biting

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19
Q

elderly patient
bradycardia or w/ a-fib
ekg: sinus bradycardia, sinus pauses (delayed p waves), sinoatrial nodal exit block ( dropped p waves)
what is it ?
what is it due to?

A

sick sinus syndrome
age related degeneration of cardiac conduction system w/ fibrosis of sinus node

cardiac conduction system degeneration

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20
Q

young patient with rapid heart beat and regular**

tx?

A

AVNRT: (paroxysmal supraventricular tachycardia)
TWO distinct conduction pathways in the atrioventricular node

accessory pathways avoiding AV node: WPW

p waves buried in the complex
narrow QRS

tx: adenosine – interrupts the AV nodal reentry circuit

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21
Q

any patient with NARROW QRS complex and tachycardia what to give them?

A

supraventricular tachycardia:
give ADENOSINE

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22
Q

hemodynamically NOT stable + tachycardia
management?

A

SYNCHRONIZED CARDIOVERSION

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23
Q

What is this?
next step?

A

Ventricular fibrillation

next step: DEFIBRILLATION**

only defibrillation if its in V-fib or pulseLESS v-tachy

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24
Q

Sudden cardiac death with pt hx of MI or EF <30% is?

A

VENTRICULAR ARRHYTHMIA

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25
Q

what is this ?
next best step?

A

QT prolongation –> torsades de pointes

next step: MAGNESIUM SULFATE

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26
Q

what is this?
next best step in Hemostable vs hemoUnstable?

A

monomorphic ventricular tachycardia
regular wide complex tachycardia

stable: amiodarone

unstable WITH pulse : synchronized cardio version

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27
Q

intermittent, prominent A waves with high JVP

A

canon A waves
d/t atrioventricular dissociation

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28
Q

WPW
hemo unstable
hemo stable

A

unstable: electrical cardio version

stable: ibutilide or procainamide

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29
Q

cocaine induced MI
next best step?

A

give benzodiazepines: for agitation anxiety

then aspiring for platelet aggregation
nitroglycerin and CCB for vasoconstrictive pain

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30
Q

nitrates:
____ preload
____ left ventricular end-diastolic volume
____ myocardial oxygen demand

A

lowers preload
lowers ventricular end diastolic volume
lowers myocardial oxygen demand by reducing wall stress

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31
Q

stable angina
first line therapy

A

B-blockers – decrease myocardial contractility

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32
Q

pt with atypical angina (suspecting stable ischemic heart disease) what is the initial best step?

A

Exercise EKG

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33
Q

pt <50yo, smoker, recurrent chest pain at rest or sleep, with spontaneous resolution

ekg: ST elevation
Coronary angio: negative

what is it ?
best preventative tx?
best abortive tx?

A

vasospastic angina
d/t: hyperactivity of intimal smooth muscle causing coronary artery vasospasm

tx: prev- Calcium Channel Blocker (diltiazam, verapamil)
abortive: sublingual nitroglycerin

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34
Q

acsvd ___ % >
start on :

A

7.5%

statin

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35
Q

leads ii, iii, aVF st elevation
_____ MI
involves the ___ ventricle
____ CONFIRMS R ventricular MI
____ RV preload
_____ LV preload
____ SVR

A

inferior wall MI
effects R ventricle
V4R confirms RVMI – right sided precordial EKG

increase in RV Preload
decrease in LV Preload
increase in SVR

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36
Q

pt with MI (ST elevation) with bibasilar crackles in lungs
next best step?

A

pulmonary edema with MI

emergency PCI
loop diuretic Furosemide (but not with hypotension)

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37
Q

medication management for MI

A
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38
Q

diffuse ST segment elevation after an MI episode (1mo ago)

A

post cardiac injury
dressler syndrome

tx: NSAID in form of high dose aspirin +/- colchicine

39
Q

what S_ do you hear in acute phase of MI

A

S 4 d/t left ventricular stiffening and impaired relaxation induced by MI

40
Q

MI then bibasilar lung sounds with deep Q waves

A

left ventricular aneurysm

41
Q

pleuritic chest pain

A

costochondritis, pericarditis, malignancy, pneumonia, pulmonary embolism

42
Q

poor heart failure prognosis ?

A

hyponatremia
volume overload + low cardiac output –> decreased renal perfusion –> kidneys think low perfusion is hypovolemia –> activate RAAS –> CAUSING HYPONATREMIA

43
Q

progressive dyspnea
hypoxemia
diffuse pulmonary crackles
S3 (low pitched, early diastolic sound)

A

decompensated heart failure

44
Q

decompensated heart failure + symptoms of cardiogenic shock :
medication:
effect:

A

dobutamine B1>b2

positive ionotropic effect: increases contractility –> higher left ventricular stroke volume –> DECREASED LEFT VENTRICULAR END-SYSTOLIC VOLUME–> increase in EF
positive chronotropic effect: increases heart rate

45
Q

heart failure medication: furosemide’s effect on renal

A

reduces central venous and renal venous pressure
improving cardiac output
increases GFR

46
Q

initial management of acute decompensated heart failure:

A

1) clinical stability
2) reduce preload
3) investigate precipitating factors

47
Q

what sound do you hear with CHF?

A

S3 gallop

48
Q

highly SENSITIVE for heart failure ?

A

serum BNP > 100

49
Q

pericardial friction rub s/p MI 3 days ago

what could prevent it ?

tx?

A

acute pericarditis

can also be due to uremic pericarditis bun> 60

early coronary repercussion

NSAID and colchicine

50
Q

fatigue, exertion dyspnea, lower extremity swelling with no pulmonary edema:

concentric thickened ventricular walls and diastolic dysfunction

A

R- sided heart failure

restrictive cardiomyopathy

can be d/t insoluble protein fibrils amyloid

50
Q

fatigue, exertion dyspnea, lower extremity swelling with no pulmonary edema:

concentric thickened ventricular walls and diastolic dysfunction

A

R- sided heart failure

restrictive cardiomyopathy

can be d/t insoluble protein fibrils amyloid

51
Q

high PCWP
low CI

low PCWP
low CI

A

cariogenic shock: MI

obstructive: pulmonary embolism

52
Q

causes of high output heart failure

how does it effect cardiac output

A

1) peripheral vasodilation d/t unmet metabolic demand
2) increased # of peripheral vessels
3) bypass of systemic arteriolar resistance d/t enlarged av fistula

decrease in SVR leads to Increase in cardiac output and increase in venous return thus increase in preload

53
Q

difference between R ventricular failure and liver cirrhosis

A
54
Q

right ventricular failure resulting FROM pulmonary pathology (COPD, PE)

elevate pulmonary artery systolic pressure greater than >____

what do you hear?

A

cor pulmonale

> 25 mmHg pulmonary artery systolic pressure

loud P2

55
Q

dyspnea, orthropnea, bibasilar lung crackles, and lower extremity edema with normal EF

A

heart failure with preserved ejection fraction from DIASTOLIC DYSFUNCITON (impaired relaxation with decreased compliance)

concentric hypertrophy d/t chronic hypertension or obesity

56
Q

pt with Hodgkin’s lymphoma, received chemo, now has biatrial enlargement, normal ventricular wall and cavity size

A

constrictive pericarditis

57
Q

young pt with viral prodrome
dilated ventricles with diffuse hypokinesis

A

dilated cardiomyopathy (viral myocarditis )

58
Q

young pt 30s with HTN and bilateral contender upper abdominal masses palpable

what is it?

next step?

A

AD polycystic kidney disease

abdominal ultrasound

59
Q

HTN medication in pt with gout

A

losartan
avoid diuretics

60
Q

HTN medication in pt with osteoporoisis

A

chlorthalidone
or any other thiazide

61
Q

Pt with SOB, tricuspid regurgitation (systolic murmur at lower sternal boarder increases with inspiration), right ventricular dilation
+
LV dysfunction (ef 30%) and crackles (volume overload)
suggestive of :
management:

A

Pulmonary HTN
d/t left sided heart failure

management: HF combination drug therapy (renin-angiotensin inhibitor, b-blocker, diuretic)

62
Q

67M with onset of HTN, upper abdominal systolic diastolic bruit
dx:

A

Renal Artery stenosis
Doppler U/S, CT-A, MR-A

63
Q

25F with transient vision loss, onset of HTN, bruit at mandibular angle, renin high, aldosterone:renin high

next step:

A

Fibromuscular dysplasia FMD
amauris fugax

  • either CT-A of abdomen
    or ultrasound
64
Q

pounding heart
worse with laying on side
waterhammer pulse

A

aortic regurgitation

pounding pulse d/t larger left ventricle

65
Q

diastolic and continuous murmur

early gradually decreasing (decrescendo) diastolic murmur that begins immediately after A2

high pitched blowing along the left sternal border at 3/4th intercostal space sitting up leaning forward with full expiration

A

aortic regurgitation

66
Q

harsh systolic, crescendo-decrescendo murmur at R upper sternal border with radiation to carotid arteries

if young: bicuspid aortic valve

if >70y/o senile calcific aortic valve

A

aortic stenosis

67
Q

diminished delayed carotid pulses: pulsus parvus et trades

late peaking, crescendo-decrescendo systolic murmur

soft and single S2 during inspiration

A

severe aortic stenosis

68
Q

diminished delayed carotid pulses: pulsus parvus et trades

late peaking, crescendo-decrescendo systolic murmur

soft and single S2 during inspiration

weak and slow rising carotid pulse

A

severe aortic stenosis

69
Q

wide splitting of A2 to P2

vs

narrow splitting of A2 to P2

A

pulmonic stenosis
pulmonary HTN
RBBB, ASD

aortic stenosis
systemic HTN
LBBB, HCM

70
Q

73M with episodes of dyspnea on exertion, syncope, pre-syncope, LV hypertrophy on EKG

what is this?

d/t?

next step?

A

aortic stenosis

d/t calcific disease

do an echocardiography

USUALLY d/t coronary artery disease

71
Q

what indicates severe aortic stenosis

A

valve area <1cm2

72
Q

pt with prosthetic heart valve:

dental procedure prophylactic abx:

A

30-60 min prior to procedure

oral amoxicillin to reduce strep viridian’s

if undergoing surgery skin soft tissue: give IV vancomycin for staph bacteremia

73
Q

holoSYSTOLIC murmur that INCREASES on inspiration

A

tricuspid regurgitation in infective endocarditis with possible emboli to the lungs s/p IV DRUG USE

multiple round nodular opacities w/ or w/o cavitation

74
Q
A
75
Q

Loud S3

A

Mitral regurgitation
dilated heart

76
Q

S4

A

concentric LV hypertrophy d/t systemic HTN or aortic stenosis

77
Q

opening snap with mid diastolic rumble at apex

early diastolic sound followed by mid diastolic murmur

A

mitral stenosis

78
Q

holosystolic murmur loudest at apex radiates to axilla

A

mitral regurgitation

-myxomatous degeneration of mitral valve can cause MR

79
Q

ascending aorta dissection and now have bibasilar crackles, S1 is soft, P2 loud, and S3 gallop

A

d/t aortic valve insufficiency
AR

80
Q

ascending aortic dissection vs descending aortic dissection treatment ?

A

ascending –> TEE OR CT-A to confirm –> surgery

descending –> labetolol and/or nitroprusside if SBP>120

81
Q

bradycardia, hypotension leading to cariogenic shock (cold/clammy) + hypoglycemia, bronchospasm/wheezing

refractory to atropine

what next?

A

b-blocker overdose
CCB, digoxin, or cholinergic similar presentation but no wheezing

give glucagon (increases cAMP)

82
Q

AE: weight gain and worsening glucose tolerance (leading to higher insulin secretion from pancreas)

A

b-blockers

83
Q

AE: peripheral edema

A

calcium channel blockers
vasodilatory effects leading to increased pressure and capillary permeability

84
Q

cyanide toxicity (nitroprusside) treatment

A
85
Q

management of HOCM

A
86
Q

AE: pulmonary infiltrates, or hepatocellular damage

A
87
Q

day 4 post MI, pt has harsh loud holosystolic murmur along Left sternal border with palpable thrill

A

inter ventricular septum rupture

88
Q

ST elevated in aVF & II III

A

inferior wall STEMI: RCA

89
Q

ST elevated aVL & v’s

A

LAD infarct

90
Q

hypovolemic shock
CVP
PVWP
CI
SVR
SvO2

A

CVP – LOW
PVWP – LOW
CI – LOW
SVR – hiiiiiiighhh*
SvO2 – low

91
Q

cardiogenic shock

A

CVP – HIGH
PVWP – HIGH
CI – LOOOWW*
SVR – HIGH
SvO2– low

92
Q

biatrial enlargement

A

constrictive pericarditis
– inelastic pericardium

UWorld step 2 (16 decks)

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