Cards

Question 1

CC: Chest pain
PE: Chest wall tenderness

Diagnosis?
Accurate test?

Answer 1

Costochondritis

No additional testing

Question 2

CC: Chest pain w/ radiation to back
PE: Unequal blood pressure between arms

Diagnosis?
Accurate test?

Answer 2

Aortic Dissection
CXR: Widened mediastinum
Confirmatory: CT/MRI/TEE

Question 3

CC: Chest pain in person under 40yo
PE: Replicate pain with lying flat, improve with sitting up

Diagnosis?
Accurate test?

Answer 3

Pericarditis

ECG: ST elevations everywhere with PR depressions

Question 4

CC: Chest pain sudden onset with SOB
PE: tachycardic, hypoxic

Diagnosis?
Accurate test?

Answer 4

Pulmonary embolism

Spiral CT or VQ scan

Question 5

Niacin- effect and adverse effects

Answer 5

Excellent at adding to Statin for lipid control, increase HDL

AE: elevation in glucose and uric acid, pruritus

Question 6

Statin- effect and adverse effects

Answer 6

HMG-CoA reductase inhibitor, lowers LDL

Antioxidant effect on endothelial lining

AE: elevations in LFTs (monitor), myositis

Question 7

Gemfibrozil- effect and adverse effects

Answer 7

Fibric acid derivative, lowers TG. No mortality benefit.

AE: Enhances statins myositis

Question 8

Cholestryamine- effect and adverse effects

Answer 8

Bile acid sequester ant

AE: GI discomfort- flatus and cramps
Reduces absorption of other medications from gut

Question 9

Ezetimibe- effect and adverse effects

Answer 9

Lowers LDL, no effect on anything

Essentially useless

Well tolerated

Question 10

Dihydropyridine CCB (all the ones that end in -dipine)- effect

Answer 10

Decrease vascular resistance, negative inotrope

Causes reflex tachycardia- increasing myocardial oxygen demand

**increase mortality in CAD

Question 11

Non-dihydropyridine CCB (verapamil and diltiazem) - effect

Answer 11

Cardiac specific- reduce myocardial oxygen demand and vasospasm.

Used in with CAD when:
Severe asthma limits use of BB
Pinzmetal variant angina 
Cocaine induced chest pain 
Inability to control pain despite max medical management 

***Does NOT lower mortality risk

Question 12

Side effects of CCB

Answer 12

Edema
Constipation
Heart block
Increased prolactin (only verapamil)

Question 13

Extra heart sound right before S1

Answer 13

S4- indicated atrium contracting against stiffen ventricle

May be present during infarction or ventricular hypertrophy

Question 14

Extra heart sound right after S2

Answer 14

S3- turbulent flow into ventricles

May be present in diastolic heart failure

Question 15

> 10mmHg decrease in BP on inhalation

Answer 15

Pulsus paradoxus

Associated with cardiac tamponade

Question 16

Triphasic scratchy sound on auscultation

Answer 16

Pericardial friction rub

Associated with pericarditis

Question 17

Contraindications to thrombolytics

Answer 17

Major bleeding: Melena or Any brain bleed
Surgery in last 2 weeks
BP >180/110
Nonhemorrhagic stroke in last 6mo

***If thrombolytics contraindicated- transfer to facility that performs PCI

Question 18

ACS- Aspirin

Answer 18

Every patient prior to revascularization

***Improves mortality

Question 19

ACS-Clopidigrel

Answer 19

If aspirin is not tolerated

Always if patient undergoes stenting or angioplasty

Question 20

ACS- Beta blockers

Answer 20

Every patient- improves mortality

Not time sensitive-just start any time after admission

Question 21

ACS- ACE/ARB

Answer 21

Every patient- improves mortality

Best results if EF<40%, not time sensitive

Question 22

ACS- Statins

Answer 22

Every patient

Best benefit with LDL >100

Question 23

ACS- Heparin

Answer 23

After thrombolytic/PCI to prevent restenosis

Initial therapy with NSTEMI/UA (give immediately after ASA)

Question 24

ACS- Glycoprotein IIb/IIIa inhibitors, abciximab, tirofiban, eptifibitide

Answer 24

Redue mortality in those who are going to undergo angioplasty and stenting who have ACS (NOT STEMI)

Question 25

CC: Dyspnea, sudden onset PE: clear lungs Diagnosis?

Answer 25

PE

Question 26

CC: Dyspnea, sudden onset PE: wheezing, increased expiratory phase Diagnosis?

Answer 26

Asthma

Question 27

CC: Dyspnea with circumoral numbness, caffeine use, and history of anxiety Diagnosis?

Answer 27

Panic attack

Question 28

CC: Dyspnea PE: fever, sputum, unilateral rales/rhonci Diagnosis?

Answer 28

Pneumonia

Question 29

CC: Dyspnea, gradual PE: Pallor Diagnosis?

Answer 29

Anemia

Question 30

CC: Dyspnea with palpitations or syncope Diagnosis?

Answer 30

Arrythmia

Question 31

CC: Dyspnea, long history of smoking PE: Barrel chest Diagnosis?

Answer 31

COPD

Question 32

CC: Dyspnea with recent anesthetic use Pe: Brown blood, clear lungs, cyanosis Diagnosis?

Answer 32

Methemoglobinemia

Question 33

CC: Dyspnea after fire, wood burning stove exposure, suicidal

Answer 33

CO poisoning

Question 34

Which murmurs always increase with inspiration?

Answer 34

Right sided lesions

Question 35

Best initial test for heart murmurs?

Answer 35

Echo | Transesophageal echo is more specific

Question 36

Most accurate test for murmur?

Answer 36

Cardiac cath

Question 37

Most common etiology of mitral stenosis?

Answer 37

Rheumatic fever

Question 38

Indications for treatment of MS

Answer 38

Symptoms | Valve surface area less than 1cm2

Question 39

``` CHF Hoarseness Dysphagia A. fib Hemoptysis ```

Answer 39

MS- symptoms from LA dilitation

Question 40

Diastolic murmur | Increased intensity with squatting and leg raise

Answer 40

MS- increased venous return to heart causes increase in murmur

Question 41

Treatment for mitral stenosis

Answer 41

1. Diuretics and sodium restriction | 2. Balloon valvuloplasty

Question 42

Etiology of AS

Answer 42

Congenital bicuspid aortic valve | Calcified aortic valve

Question 43

CHF Angina Syncope

Answer 43

AS

Question 44

Systolic crescendo-decrescendo murmur Radiates to carotids Improve with valsalva and standing and hand grip

Answer 44

AS Decreased venous return to heart decreases murmur (val and stand) Decrease after load softens murmur (hand)

Question 45

Treatment for AS

Answer 45

Valve replacement

Question 46

Etiology of mitral regurg

Answer 46

``` HTN endocarditis MI Papillary muscle rupture and anything that dilates the heart ```

Question 47

Holosystolic murmur that radiates to axilla | Worsens with handgrip, squatting, and leg raise

Answer 47

MR Decrease after load worsens murmur Decreased venous return worsens

Question 48

Treatment for MR

Answer 48

1. Vasodilators (ARB/ACE) decrease progression of regurgatant lesion 2. Valve replacement is indicated when heart starts to dilate: LVESD >40 and EF drops below 60%

Question 49

Etiology of AR

Answer 49

``` MI HTN Endocarditis Marfans/cystic medical necrosis Inflammatory disorders such as ankylosing spondylitis and Reiter's Syphyllis Congenital bicuspid aortic valve ```

Question 50

``` CHF Wide pulse pressure Water hammer pulses Pulsations in finger nail beds BP much higher in legs Head bobbing ```

Answer 50

AR

Question 51

Diastolic decrescendo murmur Improve with valsalva and standing Worsens with handgrip

Answer 51

AR Decrease venous flow improves murmur Increased afterload worsens murmur

Question 52

Treat AR

Answer 52

1. ACE/ARB, nifedipine as vasodilators increase forward flow and decrease progression 2. surgical valve replacement- replace before: EF less than 55% or LVESD

Question 53

MVP etiology

Answer 53

Normal physiologic variant

Question 54

Atypical chest pain Palpitations Panic Attacks

Answer 54

MVP

Question 55

Midsystolic click valsalva and standing worsen Handgrip improves murmur

Answer 55

MVP

Question 56

MVP Treatment

Answer 56

1. BB with symptoms | 2. Valve repair via catheter with clip placement, or open with sutures