Clinical Medicine - EKG (Johnston) Flashcards
1
Q
What is the condition present with a patient bobbing back and forth with the pulse
A
Aka De musset sign
-Aortic regurgitation
2
Q
How and where is mitral stenosis best heard
A
Diastolic murmur in the apex region (lateral recumbent) with the bell
3
Q
Multifocal atrial tachycardia is assocaited with which conditions
A
Lung diseases
4
Q
What is the treatment for mitral stenosis
A
- Anticoagulant if in afib (risk of emboli)
- MV replacement
- Mitral commissotomy (percutaneous ballon valvuloplasty)
5
Q
Anterior wall infractions tend to have which portion of the ANS response
A
Sympathetic (higher HR and BP)
6
Q
What is ortner syndrome and which condition is it seen with
A
Hoarseness due to compression of the left recurrent laryngeal nerve due to the increased left atrial size seen with mitral stenosis
7
Q
Inferior wall MI are associated with which ANS response
A
Parasympathetic (lower BP/HR)
8
Q
What is usually given to patients with hypovolemic shock
A
Must be given fluids to replenish the lost ones
Crystalloids (sodium, NS) in renal, Gi sweat, burns)
Packed RBC for hemorrhage
9
Q
ST elevation is indicative of what
A
Injury to the tissue
10
Q
What is the relation of an S3 gallop with heart failure
A
11x more likely for Heart failure
11
Q
What is the most common cause of hypovolemic shock
A
Hemorrhage
12
Q
What is the NYHA classification for a patient with marked limitation on physical activity, less than ordinary activity causes symptoms, asymptomatic at rest
A
Class 3
13
Q
What is the NYHA classification for a patient with no limitation in physical activity, no symptoms with ordinary exertion
A
Class 1
14
Q
Dehydration will cause what kind of shock
A
Hypovolemic shock
15
Q
What is the NYHA classification for a patient with unable to carry out physical activities without discomfort, symptoms as rest
A
Class 4
16
Q
What are the acute causes of mitral regurgitation
A
- Rupture of the chordal tendinae
- Rupture of papillary muscle
- Papillary muscle dysfunction due to ischemic event
- Infective endocarditis
17
Q
What is the condition present with a bounding upstroke, but drops
A
Aka Corrigan’s pulse
-Aortic regurgitation
18
Q
Which conditions tend to predispose and increase the chances of hyperkalemia
A
Renal failure or kidney diseased patients , acidotic
19
Q
What is the treatment of an unstable patient with PVCs
A
-Amiofarone,lidocaine, or Procainamide
20
Q
What is the NYHA classification for a patient with slight limitation of physical activity, ordination activity causes symptoms
A
Class 2
21
Q
What is the effect of high calcium on the QT
A
Shortened QT
22
Q
What is the condition present with Capillary flushing in the nailbed
A
Aka Quincke’s pulse
-Aortic regurgitation
23
Q
Distributive septic shock will have which findings
A
- Warm, flushed due to vasodilation
- Fast HR
- Flat neck veins
24
Q
What is the most common cause of LV systolic dysfunction
A
Ischemic heart disease
25
What are the ECG findings of the P wave in left atrial enlargement
- M shaped P wave in lead 1
| - Biphasic or negative P wave in V1
26
What is the condition present with a pistol like sound
Aka traube’s sign
| -Aortic regurgitation
27
What is the treatment for a patient with PAC
Beta blocker (metoprolol)
28
What is the condition present with a murmur in the 2nd ICS LSB that radiates to the left shoulder
Pulmonary stenosis
29
What is the appearance of the extremities in the case of distributive or dissociative shock
Pink, warm with vasodilation
30
What are the common causes for low output cardiac failure
-Ischemic heart disease
31
Abnormal T waves are indicative of what
Ischemic pattern (especially inverted or tall peaked waves)
32
What is the presence of paroxysmal nocturnal dyspnea a sign for
Cardiac failure, with a 2x increase in risk
33
Persistent ST elevation for 2 weeks will lead to thought of which condition
Ventricular aneurysm
34
Which patient should never ever reviewed a beta blocker
Class 4 HF patient
35
What is the condition with the finding of a systolic murmur that is harsh and heard at the 2nd ICS RSB that radiates into the suprasternal notch
Aortic stenosis
36
What is usually the finding in the extremities that would lead and support the diagnosis of a Pulmonary emboli
-Unilateral edema and pain (not bilateral)
37
What is the most likely treatment for a patient with severe sinus bradycardia
Atropine
38
What is Kussmal sign and what is it indicative for
-Distention of the jugular vein on inspiration and indicative of RV infarction
39
Which condition is present if there is a opening snap after S2 and in the case of a short interval between the S2 and opening snap
Mitral stenosis, with severe forms having a shorter interval
40
What is the heart rate usually following an acute inferior MI
Sinus bradycardia
41
Tricuspid stenosis is often assocaited with which condition
Rheumatic heart
42
What is the most common cause of noncardiogenic shock
Septic or non-septic/anaphylaxis (vasodilation) shock aka distributive shock
43
Which patients are ACE inhibitors contraindicated
- Pregnancy
- Angioadema
- Bilateral renal artery stenosis
44
What is the cause of a patient going into shock, yet are still warm and pink in the extremities
Cyanide poisoning
45
Multifocal atrial tachycardia (MAT) is commonly seen in which patients
Late stage COPD
46
What is the effect of low calcium on the QT
Prolonged (leading to torsades)
47
How does lactate relate to mortality
The higher the lactate levels, the higher mortality rates
48
Paroxysmal atrial tachycardia with an AV block is associated with which condition
Digitalis toxicity
49
What is the order of treatment for a patient with sinus bradycardia
- Atropine
- Epi
- Isoproterenol
- Pacemaker
50
What are the values that are considered to be cardiogenic shock
-Decrease in BP, C and urine output
51
Which patients should ACE inhibitors be watched/ given cautiously
-Patients with renal insufficiency or potassium >5mEq
52
Wht are the major Jones criteria for rheumatic heart disease
- Inflammation of the heart (endocarditis, pericarditis etc)
- Migratory polyarthritis of large joints
- Painless subcutaneous nodules over bones and tendons
- Sydenham’s chorea (rapids, purposeless movement of the hands and arms)
- Erythema marginatum (distinct borders of raised erythematous lesions)
53
What test can be ran as a diagnostic when an ultrasound can not be run
D-Dimer
54
What condition is present if there is a loud S1, with an increased sound on the second heart sound
Mitral stenosis with some pulmonary hypertension
55
J waves are seen in which conditions.
Hypothermia
56
What side effect of ACE inhibitors is not seen in Angiotensin receptor blockers
The cough, but both classes work the same
57
What stage is ACC/AHA scale for CAD that has the risk factor, no symptoms, LVH or other LV structural defects
Class B
58
Anterior wall MI tend to lead to which complication
LV wall rupture and cardiac tamponade
| LV aneurysm
59
How does the loudness of the mitral regurgitation murmur correlate with severity
They are correlated
60
STEMI is usually caused by which event
Thrombus leading to a transmural infarction
61
What stage is ACC/AHA scale for CAD that has the risk factor, refractory Heart failure, eligible for specialized treatments such as mechanical support or transplantation
Class D
62
What is the ejection fraction in diastolic heart failure
The Ejection fraction will remain normal
63
What are the conditions that can cause high output hardback failure
High CO despite a low EF:
- Hyperthyroidism
- Anemia
- Pregnancy
- AV fistula
- Beriberi
- Paget’s
64
What are the findings of the ST elevation amounts in a STEMI
2 mm at J point in V2, V3 or 1 mm or greater in 2 contiguous chest leads
65
What are the findings and classification for higher amounts of blood loss
- Increased class
- Increased HR
- Decreased BP
- Increased RR
- Decreased urinary output
66
In a patient with malignancy, which electrolyte imbalance should first be thought to check
Calcium (tends to go up)
67
What stage is ACC/AHA scale for CAD that has the risk factor, no symptoms, no structural defects
Class A
68
What are the criteria for a sepsis
SIRS-systemic inflammatory response syndrome
- Fever
- Tachycardia (>90)
- Tachypnea (>20)
- Increased WBC (>12,000)
69
Why is an ace inhibitor beneficial in an MI
Prevents the remodeling process
70
Patients with mitral stenosis develop which symptoms
Cough, pulmonary edema, hemoptysis, Atrial emboli, A fib,
71
What are the signs of accelerated idioventricular rhythm (AIVR)
- Looks like Vtach, but at a rate of 60-100 bpm
| - Is benign and signs of reperfusion
72
What is the EKG finding with hypokalemia
Prominent U wave with flat T wave
73
What is the most common cause of a pause in the EKC
Nonconducted premature atrial contraction (PAC)
74
What are the chronic causes of mitral regurgitation
- Mitral valve prolapse
| - Mitral annular calcification
75
What non-MI conditions can have a ST elevation
- Pericarditis
- LVH with a J point elevation
- Normal variant of early repolarization
76
What condition is present if there is a Decreased S1, with a click
Mitral regurgitation, with the systolic click due to MVP
77
Heart failure can usually result in which change to sodium levels
Hyponatremia due to the increased in water consumption and decreased output as a result of decreased renal perfusion.
78
What is the treatment of a stable PVC
Metoprolol
79
What is the condition present with diastolic, decrescendo murmur heard in the 3rd ICS LSB
Aortic regurgitation
80
How does the prognosis of the patient correlated with ST depression
The further the ST depression, the more likely the patient is to die
81
What is the initial medical management of a pt with an MI
MONA-B:
- Morphine
- Oxygen
- Nitroglycerin
- Aspirin
- betablocker
82
How does treatment of a STEMI and an NSTEMI differs
Everything is the same except the thrombolytics dont work
83
What is the treatment of RV infarction leading to heart failure
-Fluids to help prime the RV
84
What stage is ACC/AHA scale for CAD that has the risk factor,previous MI, Heart failure, structural defects, decreased exercise tolerance
Class C
85
QRS complex changes are indicative of which condition
Pattern of necrosis or infarction
86
What is the definition of shock and what are the causes
Tissue hypoperfusion and cellular hypoxia caused by:
- Decreased oxygen delivery or utilization
- Increased oxygen consumption
- hypotension<80-90 mmHg or 40 below baseline
- MAP <60-65
87
Where is a mitral regurgitation best heard
Over the apex, radiating to the axilla
88
What is the condition present with a wide pulse pressure
Aortic regurgitation
89
If a pt presents with a malar rash similar to lupus, what condition is suspected
Mitral stenosis with some pulmonary edema
90
Which MI tends to lead to a second degree AV block and which type is it typically
Inferior wall MI, usually leading to Wenchebach
91
What is the condition if the physical finding is narrow pulse pressure with a decreased systolic volume and pressure
Aortic stenosis
92
Which condition is present if there are parvis (weak) and tarsus (late) pulses
Aortic stenosis
93
What is the condition present with frothing sound heard when compressing the stethoscope of the femoral artery
Aka Durozrey’s sign
| -Aortic regurgitation
94
What is are the characteristics of the ventricles during diastolic heart failure
They can not relax, so there is the tendency to become fibrotic
95
How does septic shock result in vasodilation
- Endothelial damage leading to the release of Nitric oxide
- Cytokines
- Increased lactate leads to hypoxia
96
What is the treatment for a mitral valve prolapse
Beta blocker for hyperadrenergic state
97
What is the most common cause of mitral regurgitation
Mitral valve prolapse due to floppy valve syndrome
98
Which patients are beta blockers contraindicated in
- Class 4 heart failure
- Anything higher than a class 2 AV block
- Patients on something causing hypotension
99
If there is a patient older than 65 years old with A fib, what should be checked
Thyroid (Free T4, TSH)
100
What is the condition present with the pressure is higher in the legs than the upper extremities
Aka Hill’s sign
| -Aortic regurgitation
101
What is gallavardin phenomenon and what condition is it found
Murmur that radiates to the apex, like mitral stenosis, except it is in aortic stenosis
102
How do you treat Supraventricular tachycardia
Adenosine
103
How do you treat multifocal atrial tachycardia (MAT)
IV verapamil or diltiazem (calcium channel blocker)
104
What is the usual appearance and state of the extremities in the cause of shock
Blue, cold, clammy, due to decreases perfusion and vasoconstriction
105
What is the appearance in the cause of hypovolemic, cardiogenic, or obstructive shock
Cool, clammy, pallor, extremities with vasoconstriction
106
What is the most common cause of cardiogenic shock
Cardiac pump failure caused by cardiac failure due to an MI
107
Which patients should not be given a beta blocker
- Hypotension
- Decompensated heart
- Advanced AV block
108
In the treatment of heart failure, when should fluid be restricted
< 126
