Clin Med

Question 1

which syndromes = assoc w/ ASD vs VSD vs PDA vs AV canal vs coarct of aorta?

Answer 1

Down, FAS vs Down, FAS, maternal DM vs congen rubella vs Down vs bicuspid & aortic valve, Turner

Question 2

how to tx coarct of aorta? what’s its late finding?

Answer 2

PG, diuretic, Surg, cardiac cath/balloon/Stent. rib notch on CXR b/c dil intercostal aa

Question 3

Cardiac transplant indic vs complications

Answer 3

adults w/ repaired CHD now w/ progressive heart fail vs peds w/ severe CHD vs immunosuppress/infxn; DM, HLD, HTN; Cardiac allograft vasculopathy (CAV) – form of aggressive atherosclerosis -> concentric hypertrophy -> silent MI

Question 4

causes of pulm HTN. tx?

Answer 4

pulm over-circ -> inc pulm arterial pressure, pulm vasocontrict, pulm vasc dz. corrective surgery at young age if high morbidity; tx underlying dz, O2, PDE5-I (Viagra)

Question 5

Eisenmenger. tx?

Answer 5

untxed L/R shunt -> pulm HTN -> pulm obstructive dz -> RAP > LAP -> bidirectional shunt -> cyanosis, clubbing, endocarditis, CHF. endothelin receptor antagonist (bosentan) or PDE-I (sildenafil); Lung transplant + repair cardiac defect (or heart transplant)

Question 6

cyanosis sequelae: hyperviscosity vs hyperosteoarthropathy (and bleeding, PLT dysfxn). tx?

Answer 6

HA/faint/dizzy/fatigue, altered mentation; visual disturbance/tinnitus, paresthesia/myalgias vs Clubbing: Schamroth’s sign -> no diamond window when dorsal hands meet; Periostitis: subperiosteal new bone formation of long/tubular bone; OA, gout. O2, treat underlying

Question 7

clinical steps for infective endocarditis? indic for abx before dentist?

Answer 7

unexplained fever? -> blood cx before abx; Transthoracic or transesophageal echo for vegetation. previous IE, palliative shunts, unrepaired cyanotic lesion; prosthetic valve, prosthetic material or transcath device in past 6mo

Question 8

risk factors vs causes of neurodevelopmental disability

Answer 8

syndromes, severity of lesion, open heart surg vs open heart surg -> cerebral macro/micro emboli to CNS -> global cerebral ischemia

Question 9

CHD recs for preg vs ocp vs exer vs travel

Answer 9

consult w/ specialist -> anticoag or genetics vs don’t do estrogen ocp in cyanosis w/ intracardiac shunt, pulm HTN, Fontan vs >6mo post repair, w/o pulm HTN/arrhythmia/myocardial dysfxn = good; low/mod, avoid strain/lift; high pulm resistance –> no heavy; Eisenmenger –> no exer vs avoid dehydration & long sitting, give O2 to cyanotic pts in long flights

Question 10

MI type 1 vs 2

Answer 10

rise or fall in troponin, sxs of myocardial ischemia, ischemic changes on EKG like pathological Q waves, coronary thrombus on angio, plaque rupture. either N/STEMI vs mismatch b/w O2 supply & demand, stable plaque

Question 11

pt is having MI. what’s the goal time from door to EKG vs balloon/cath vs needle/lytics?

Answer 11

10min vs 90min (if sTEMI) vs 30min (if sTEMI)

Question 12

STEMI vs NSTEMI criteria & tx

Answer 12

complete coronary a occlusion. 2mm for men/1.5mm for women elev in leads V2/3 + 1mm elev in chest or limb leads –> immediate perfusion, PTCA, thrombolytics, fibrinolytics vs ST elev or new LBBB –> noninvasive coronary angio, early invasive cath, immediate invasive if refractory/hemodynam/electric instability; HIGH BIOMARKERS like CKMB & troponin I&T, otherwise unstable angina.

Question 13

nitroglycerin for ACS: pathophysio vs indic vs CI

Answer 13

converts to nitric oxide -> activate guanylate cyclase -> inc cGMP -> deP myosin light chain -> vasodil smooth mm; dil vv -> dec venous return & CO -> dec angina sxs; dil aa -> inc blood flow & perfusion vs CP, HTN, heart fail vs RV infarct, HoTN <90mmHg sbp, <48h PDE5-I use (sildena/tadala/vardenafil)

Question 14

ASA for ACS: pathophysio vs dosage. when to give supplemental O2 for ACS?

Answer 14

irreversible inhib of COX -> no thromboxane A2 -> no PLT aggreg vs 81mg daily for life. <90& arterial O2 or resp distress; don’t give routine anymore b/c inc vasc resistance

Question 15

morphine for ACS: indic vs CI

Answer 15

analgesic & anxietolytic effects. cont CP w/ anti-ischemic meds Class IIb vs Lethargy or altered mental status, HoTN, bradycardia, hypersensitivity

Question 16

Beta blockers for ACS: pathophysio vs indic vs CI

Answer 16

inc perfusion to ischemic myocardium; dec HR/bp & O2 demand; early admin -> long term survival; dec magnitude of infarct, re-infarct, & life threatening arrhythmia vs oral w/in first 24h, IV at time of STEMI if HTN or ongoing ischemia vs HR<60, sbp<90, heart fail, shock, asthma/COPD

Question 17

criteria for metab syndrome

Answer 17

waist circumference >35in women, >40in men; bp >130/85; HDL<50 women, <40 men; TG >150, fasting glu >100

Question 18

how to tx CHF? risk factors?

Answer 18

tx underlying cause w/ diuretics, ACE-I, beta blockers vs L/R, arrhythmia, hyperthyroid

Question 19

post MI criteria

Answer 19

RCA or distal circumflex occluded -> sT dep in V1-3 -> get V7-9

Question 20

where to insert bioptome cath. what are they used for?

Answer 20

jug or fem v into RV. monitor heart transplants & differentiate b/w cardiomyopathies

Question 21

when to give exer stress vs myocardial perfusion imging for intermediate probability?

Answer 21

RBBB, <1mm sT dep at rest vs LBBB, LVH, electrically paced ventricular rhythm, pre-excite, digoxin

Question 22

CI for adenosine vs dobutamine

Answer 22

bronchospasm, <90mmHg, >1st degree AV block, methylxanthine vs <1wk MI, unstable angina, cardiomyopathy, a/vtach, unctrlled HTN, LBBB, thoracic aortic aneurysm