Cardiovascular

Question 1

Definition of unstable angina

Answer 1

Angina is new, is worsening, or occurs at rest

Question 2

Anti-HTNsive for a diabetic pt with proteinuria

Answer 2

ACEI

Question 3

Beck’s triad for cardiac tamponade

Answer 3

Hypotension, distant heart sounds, and JVD

Question 4

Drugs that slow AVN transmission

Answer 4

ß-blockers, digoxin, CCBs

Question 5

Hypercholesterolemia tx that leads to flushing and pruritus

Answer 5

Niacin

Question 6

Murmur: hypertrophic obstructive cardiomyopathy (HCM)

Answer 6

• SEM heard along the lateral sternal border

- INCREASES with Valsalva maneuver and standing

Question 7

Murmur: aortic insufficiency (AI)

Answer 7

• Diastolic, decrescendo, high-pitched, blowing murmur
• Best heard sitting up
• INCREASES with decreased preload (handgrip maneuver)

Question 8

Murmur: aortic stenosis (AS)

Answer 8

• Systolic crescendo/decrescendo murmur
• Radiates to the neck
• INCREASES with increased preload (Valsalva maneuver)

Question 9

Murmur: mitral regurgitation (MR)

Answer 9

• HSM

- Radiates to the axillae or carotids

Question 10

Murmur: mitral stenosis (MS)

Answer 10

Mid to late diastolic, low-pitched murmur

Question 11

Tx for AFib and AFlutter

Answer 11

• If unstable: cardiovert

- If stable or chronic: rate control with CCBs or ß-blockers

Question 12

Tx for VFib

Answer 12

Immediate cardioversion

Question 13

AutoI complication occurring 2-4 weeks post-MI

Answer 13

Dressler’s syndrome: fever, pericarditis, increased ESR

Question 14

IVDU with JVD and HSM at the left sternal border. Tx?

Answer 14

Tx existing heart failure and replace the tricuspid valve

Question 15

Dxic test for HCM

Answer 15

Echo (showing thickened left ventricular wall and outflow obstruction)

Question 16

A fall in SBP of >10 mmHg with inspiration

Answer 16

Pulsus paradoxus (seen in cardiac tamponade)

Question 17

Classic ECG findings in pericarditis

Answer 17

Low-voltage, diffuse ST elevation

Question 18

Definition of HTN

Answer 18

BP >140/90 on 3 separation occasions 2 weeks apart

Question 19

8 surgically correctable causes of HTN

Answer 19

1) Renal a. stenosis. 2) Coarct. 3) Pheo. 4) Conn’s syndrome. 5) Cushing’s syndrome. 6) U/l renal parenchymal dz. 7) Hyperthyroidism. 8) Hyperparathyroidism.

Question 20

Eval of a pulsatile abdominal mass and bruit

Answer 20

Abdominal U/S and CT

Question 21

Indications for surgical repair of abdominal ao aneurysm (AAA)

Answer 21

> 5.5 cm, rapidly enlarging, sxic, or ruptured

Question 22

Tx for acute coronary syndrome (ACS)

Answer 22

MONA-BH: Morphine, O2, SL nitroglycerin, ASA, IV ß-blockers, heparin

Question 23

What is metabolic syndrome?

Answer 23

Abdominal obesity, high TGs, low HDL, HTN, insulin resistance, prothrombotic or proinflammatory states

Question 24

Appropriate dxic test:

1. 50 yo M with angina can exercise to 85% of max predicted HR
2. 65 yo F with LBBB and severe OA has unstable angina

Answer 24

1. Exercise stress treadmill with ECG

2. Pharmacologic stress test (ex: dobutamine echo)

Question 25

Signs of active ischemia during stress testing

Answer 25

Angina, ST-segment ∆s on ECG, or decreased BP

Question 26

ECG findings suggesting MI

Answer 26

ST elevation (depression means ischemia), flattened T waves, and Q waves

Question 27

Coronary territories in MI

Answer 27

• Anterior wall: LAD/diagonal
• Inferior: PDA
• Posterior: LCX/oblique, RCA/marginal
• Septum: LAD/diagonal

Question 28

Young pt has angina at rest with ST elevation. Cardiac enzymes are nl.

Answer 28

Prinzmetal angina

Question 29

Common sxs a/w silent MIs

Answer 29

CHF, shock, and AMS

Question 30

Dxic test for pulmonary embolism (PE)

Answer 30

V/Q scan

Question 31

Agent that reverses the effects of heparin

Answer 31

Protamine

Question 32

Coagulation parameter affected by warfarin

Answer 32

PT

Question 33

Young pt with FHx of sudden death collapses and dies while exercising

Answer 33

HCM

Question 34

Endocarditis prophylaxis regimen and indications

Answer 34

Surgery/dental: amox 2g 30-60 mins before
-prosthetic valves, h/o IE, some congenital heart dz, heart transplant pts with valvulopathy

*changed from FA (not for GI/GU procedures, not for RHD)

Question 35

6 P’s of ischemia d/t peripheral vascular dz (PVD)

Answer 35

Pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia

Question 36

Virchow’s triad

Answer 36

Stasis, hypercoagulability, endothelial damage

Question 37

MCC of HTN in young F

Answer 37

OCPs

Question 38

MCC of HTN in young M

Answer 38

Excessive EtOH

Question 39

Classic ECG finding in atrial flutter

Answer 39

“Sawtooth” P waves