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1
Q

Acute decompensated heart failure

A

Rad/chemo, management —> O2, furosemide, nitro if stable, pressors (NE) if unstable

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2
Q

PVCs tx

A

Bb/CCB, amiodarone 2nd line, only treat if symptomatic

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3
Q

Sick sinus syndrome tx

A

pacemaker THEN Bb

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4
Q

Vasovagal syncope etiology

A

Parasympathetic innervation—> SA arrest

Less common Sympathetic inactivated, vasodilation, drop in bp

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5
Q

Dropped beats after progressively longer PRs

A

Mobitz I

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6
Q

Complication of AAA repair

A

Bowel ischemia

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7
Q

Bounding pulses

A

Aortic regurg (also septic shock during hyperacute=hypotension, dec SVR, inc cap permeability, later have cold extremities), also PT feels pounding HR

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8
Q

Aortic stenosis physical exam findings

A

Pulsus parvis et tardis, soft S2, systolic cres-decresc murmur early peak = mild, mid-late peak = severe R upper sternal border

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9
Q

Pulsus paradoxus

A

Tamponade, COPD/asthma can also cause, DECREASED systolic BP by >10 during INSPIRATION

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10
Q

Indication for mitral valve repair in MR

A

Primary MR, LVEF<60

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11
Q

Complications of PCI

A

AV fistula (continuous bruit, thrill, can watch may spontaneously close, close w compression, close surgically)
pseudoaneurysm (pulsatile, systolic bruit)
aneurysm (limb ischemia)
retroperitoneal hematoma flank pain + hypotension 24 h

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12
Q

Marfans + sudden onset severe CP

A

Acute aortic dissection, AR, diastolic murmur

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13
Q

Acute aortic dissection management

A

Pain (morphine), pressure <120 IV esmolol, nitro 2nd line, NO HYDRAL, CXR pericardial effusion, mediastinal widening, dx CT if stable, TEE if unstable

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14
Q

Patient comes in w ACS

A

Aspirin (unless worried about aneurysm), oxygen

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15
Q

Pericarditis

A

Don’t forget about pts with CKD!!! Pericarditis hurts more when you MUVA (worse lying down) post-MI, uremia, viral, autoimmune, pulsus paradoxus, uremia dialysis DOESNT HAVE EKG STelev/PRdep, tx NSAIDs and colchicine

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16
Q

Pericardial effusion

A

Suspect in PT w blunt trauma
w/o tamponade PMI nonpalpable, muffled heart sounds
w/ tamponade becks triad JVD hypotension muffled heart sounds
mech dec RV filling, dec RV compliance, dec LV volume

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17
Q

Management of a fib

A

Unstable cardioversion, stable Rx (Bb, CCB, dig)

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18
Q

Pharmacologic stress test

A

Adenosine vasodilator, increases flow to show relative lower uptake (no inc in HR or BP), don’t use in pts with COPD

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19
Q

HFpEF

A

EF>50%

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20
Q

Supraventricular tachycardia

A

Unstable synch cardioversion, stable can try adenosine or vag maneuvers

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21
Q

Shock (hypovol, cardiogenic, septic)

A

Hypovolemic preload low, CO low, SVR high trying to compensate inc sympathetic tone

Cardiogenic heart is fucked so CO low, preload high b/c heart is fucked, SVR high trying to compensate

Septic everything is dilated cytokines etc so SVR and preload low, CO high trying sooooo hard to keep shit together

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22
Q

Tetralogy of fallot

A

Single S2 (P2 inaudible), crescendo decresc systolic murmur

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23
Q

HTN definition, w/u, tx

A

> 140 x 3 1w apart
UA, BMP, lipids, no w/u for secondary HTN unless fail >3 rx, sudden onset, <30 yo w no fam hx, severe
Tx: lifestyle all pts (diet/wt loss, exercise, alcohol)
Rx criteria: >140 OR >130 + ACS, DM, CKD, >65, 10y risk >10%

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24
Q

Angina

A

Typical loc/duration, worse w exercise/stress, better w rest/nitro, first step EKG stress test

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25
Q

Cyanotic infant <24 h old single S2 w no murmur

A

Transposition of the great vessels +- murmur (PFO=no murmur), also single S2 with tet (+ right outflow cresc-decresc systolic murmur)

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26
Q

Valvular abscess

A

Endocarditis + early diastolic murmur (AR) + conduction abnormalities

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27
Q

Rx that increases QRS with faster HR

A

Flecainide (class 1C)

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28
Q

Bb in pt w eczema

A

ASTHMA, will cause cough/wheezes

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29
Q

Hypertriglyceridemia treatment

A

Statin + <500 lifestyle modifications if >1,000 fibrates NO ALCOHOL niacin is NOT GOOD

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30
Q

Cardiac cath complications

A

Atherosclerotic emboli = TERR Blue Toes, end organ damage, retina, rash

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31
Q

Supravalvular aortic stenosis

A

Usually congenital, difference in BP r and l arm, systolic murmur heard higher up on R sternal border, palpable thrill suprasternal notch

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32
Q

Reproducible CP worse with movement

A

Costochondritis, double ChEck w CXR EKG, no stress test

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33
Q

Warfarin INDUCERS

A

NSAIDs, acetaminophen, antibiotics, amiodarone

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34
Q

LEFT AXIS DEVIATION IN A BABY STOP FUCKING FORGETTING THIS

A

Tricuspid atresia

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35
Q

Tachycardia-mediated cardiomyopathy

A

Rhythm and rate control (Bb) can be reversible act fast

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36
Q

Is PEA a shockable rhythm?

A

NO! Do chest compressions

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37
Q

Fibromuscular dysplasia

A

Consider as cause of secondary HTN, amarousis fugax, aldosterone/renin will be <20, ddx adrenal tumor aldosterone/renin will be >20, dx CTA or Doppler US

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38
Q

Rhythms can use a defibrillator

A

V fib, pulseless V tach, shock, epi q3-5 min if not responsive, amiodarone/lidocaine

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39
Q

Patient w SVT

A

Give adenosine for diagnostic

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40
Q

Peripartum cardiomyopathy

A

36 weeks

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41
Q

Constrictive pericarditis

A

Viral (TB), Radiation, idIOpathic Surgery, Kussmaul’s sign (INC JVP on inspiration), pericardial knock, CXR calcifications

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42
Q

PAD tx

A

Aspirin, statin, exercise, surgery

*** SENSORY/MOTOR, REST PAIN GIVE HEPARIN then other studies (TTE), bypass grafting ABI <0.4 or rest pain

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43
Q

Niacin

A

Flushing itching something with prostaglandins give with aspirin but really just don’t give not effective

44
Q

Drugs after DES

A

Aspirin + clopidogrel p2y12, ACEi, Bb, statin, spironolactone

44
Q

Isolated systolic HTN

A

Syst >140 diastolic <90, hardened arterial walls can’t dilate

44
Q

Cor pulmonale

A

NO CRACKLES in a lunger

45
Q

AAA

A

screening=65-75 men ever smoker
RF for rupture=cont smoking
Sx=can have hematuria w rupture! Prevertebral calcification
Tx=emergent surg (indications=>5.5cm OR symptomatic any size, contraindications=cancer, other comorbidity w/ high mortality risk)

46
Q

PE

A

Pleuritic (sharp) CP, normal lung sounds, normal CXR, LONG DISTANCE TRUCK DRIVER

3 pts—> Ddx, DVT
1.5 pts—> HR>100, Hx DVT/PE, Hx recent surg/immobilization
1 pt—>Coughing blood, Cancer

5+ pts= DVT likely, FIRST give O2, fluids, if no contraindication to anticoag (hemorrhage) give Hep THEN get CT, if contraindicated get CT first then IVC filter

ONLY unfractionated hep GFR <30 (no Xa inh or LMWH)

(In preg) V/Q pretest prob–> nl VQ r/o, low low r/o, high high r/i, other combo nd w/u CTA or LE US

47
Q

BNP

A

CHF CHF CHF AND NOTHING ELSE

48
Q

Polycystic kidney dz

A

Early onset HTN, B/L UPPER ABDOMINAL MASSES

49
Q

Inspiration

A

Decreases SBP, but >10 is not normal pulsus paradoxus

50
Q

Baby that’s fine but becomes cyanotic in a day or 2 of life

A

PDA closure!

51
Q

Young pt recent viral illness signs of CHF

A

Dilated cardiomyopathy

52
Q

Malignant HTN

A

HTN >=180/120 + hypertensive encephalopathy (retinal hemorrhage, exudate, papilledema, neuro probs, cerebral edema) +- end organ damage

53
Q

Long QT tx

A

Bb, pacer if h/o syncope

54
Q

RFs for APCs

A

Alcohol, smoking, caffeine, stress

55
Q

Amiodarone side effects

A

PHQ-TS pulm, hepatitis, long QT, thyroid, skin turns blue

Always get PFTs, TSH

56
Q

Sustained monomorphic VT

A

If stable amiodarone don’t need to shock

57
Q

Most common arrhythmia with acute MI (10-60 min)

A

Ventricular arrhythmia, V fib, reentrant

58
Q

Symptomatic sinus bradycardia w hypotension

A

Atropine —> if not responsive, dopamine/epi

59
Q

Dig + amiodarone

A

Nausea vomiting, vision color changes, Arrhythmias

60
Q

Nitroglycerin mech of action

A

Vasodilation —> dec preload, coronary arteries are already max dilated

61
Q

Pulmonic stenosis PE

A

Split S2 throughout widens w inspiration, systolic ejection click, L upper sternal border, congenital

62
Q

Most common complication of stent

A

Thrombosis, ST elev, 10 days after, usually med noncompliance

63
Q

Bb toxicity

A

Bradycardia, wheezing, AMS/arrhythmia, hypotension, hypoglycemia, sz
Give fluids, IV atropine, if still hypotensive GLUCAGON

65
Q

HOCM

65
Q

Nitroprusside infusion in PT w renal failure

A

Cyanide tox, AMS, seizure, lactic acidosis

66
Q

Vascular ring

A

BIPHASIC or EXPIRATORY stridor

67
Q

Indication for statin

A

ACS
40-75 yo w DM
10-y risk > 7.5%
LDL > 190

68
Q

Laryngomalacia

A

INSPIRATORY stridor collapse of upper airway (like snoring) 4-8mo, flex laryngoscopy

69
Q

PERICARDITIS + HIGH CR

A

UREMIC OMG OMG DIALYSIS STOP FORGETTING THIS

70
Q

Cardiac myxoma

A

MC cardiac tumor
Systemic sx, emboli, obstruction/cardiac sx, diastolic murmur
Dx echo
Tx surgery

71
Q

Ventricular aneurysm

A

Several mo after MI, deep Qs + ST elev, CHF/angina, thrombus, arrhythmia

72
Q

AV fistula

A

Trauma, iatrogenic, high OP heart failure, warm/flushed extremity, inc carotid upstroke, dx doppler tx surg

73
Q

HMGCOA reductase

A

Intracellular

74
Q

Normal JVP

A

< 3 cm @45*

75
Q

Who is low risk for CAD and doesn’t need any further testing?

A

Women < 50, men < 40, atypical chest pain, no risk factors

76
Q

Most common post-MI complication

A

Thrombus in LA—> get echo in PT w stroke, peripheral thrombus, etc etc

77
Q

Chronic venous insufficiency tx

A

Lifestyle (Leg raise, ex, comp stockings), duplex US

78
Q

Septic shock

A

SVR decreases (vasodilation), CO increases, PCWP/LA pressure decreases, lactate (dec perfusion) metabolic acidosis

79
Q

RAAS system

A 
SNS B1—>inc renin (Bb)
Angiotensinogen—>ATI (renin inh aliskiren)
ATI—>ATII (ACEi)
ATII—>vasoconstriction, inc aldo (ARB)
Aldo—>Na H2O retention (spironolactone)
80
Q

Mediastinitis

A

2 weeks after CABG

81
Q

Which direction of shunt is the bad one

A

RIGHT TO LEFT (not in alphabetical order, fucked uppppp)

82
Q

TCA toxicity

A

Tachycardic, Long QT (hypoCa), altered, Get EKG! Give bicarb to minimized effects on QRS

83
Q

Cocaine

A

Same as ACS (O2, ASA, nitro) BUT NO BB, give benzo

84
Q

Hypothermia

A

<28 severe
<32 moderate
<35 mild

85
Q

Transposition of great vessels

A

MC cyanosis neonatal pd, DOES NOT RESPOND TO SUPPLEMENTAL O2, PDA, VSD or PFO give PGE
DiGeorge (George is trans)

87
Q

Superficial thrombophlebitis

A

RF varicose veins, red tender warm, +/- cord (if thrombus present), nl pulses, tx supportive

88
Q

TIA

A

Carotid US

90
Q

Amaurosis fugax causes

A

TIA (carotid US), GCA (ESR, bx), OPHTHALMIC ARTERY IS A BRANCH OF THE INTERNAL CAROTID

91
Q

Fat embolism

A

24-48 h after ortho surg, may look like PE + RASH

92
Q

CENTRAL cyanosis

A

lips tongue nails, cong heart dz NOT PHYSIOLOGIC

93
Q

Blunt thoracic aortic injury

A

MVC, stable CT angiogram or TEE, unstable surgery

94
Q

Long QT–>Torsades du pointe

A

> 0.44M, 0.46F, Give Mg

95
Q

Aortic regurgitation

A

Asyx LV eccentric (thicker and bigger) inc compliance –> CHF

96
Q

Upper extremity DVT

A

Central line, young male wt lifter or b-ball

97
Q

Carotid endarterectomy

A

> 70% stenosis + SX

98
Q

Acute coronary ischemia

A

Ventricular arrhythmia

99
Q

Digoxin

A

ACUTE toxicity hyperK

CHRONIC toxicity hypoK, hypoMg –> PVCs

100
Q

PAD pain in calves

A

femoropopliteal arteries

101
Q

Skin probs PAD vs venous stasis

A

CHF=venous stasis

102
Q

Mitral stenosis

A

Opening snap S2, diastolic murmur apex, rheumatic fever hx, LV OK until progresses to regurg–> will have s/s R heart probs

103
Q

VSD prenatal/postnatal

A

prenatal RVP=LVP, postnatal fall in pulm vasc resistance causes L–>R shunt = murmur 10days old

104
Q

Statin indications

A

ACS, DM 40-75, 10y risk 7.5%, LDL>190

105
Q

Giant cell arteritis

A

Polymyalgia rheumatica, aortic aneurysm

STEP 2 AG (16 decks)

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