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Medical > Core Lecture Series > Flashcards

Core Lecture Series Flashcards

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USMLE® Step 1 flashcards
1
Q

Describe the image

A

RAO Caudal

  • LAD (on top)
  • CFx (coming towards front)
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2
Q

Describe the image

A

LAO Cranial

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3
Q

Describe the findings

A
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4
Q

Describe the findings

A

LAO Straight

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5
Q

Describe the findings

A

LAO Cranial

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6
Q

Describe the findings

A

RAO Straight

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7
Q

What are the branches of the SMA?

A
  • inferior pancreaticoduodenal
  • intestinal
  • ileocolic
  • right colic
  • middle colic
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8
Q

What are the branches of the celiac trunk?

A
  • Left gastric
  • Common hepatic
  • Splenic
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9
Q

Describe the views and imaging of the left coronary system

A
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10
Q

Describe the image

A
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11
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12
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13
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14
Q

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15
Q

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16
Q

Describe the image

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17
Q

Describe the views and imaging of the right coronary system

A
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18
Q

Describe the image

A
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19
Q

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20
Q

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21
Q

Describe the findings of the LV gram

A
22
Q

What is the most common challenge in regards to radial access?

A

vasospasm

23
Q

What tests should be performed before attempting radial access?

Why?

A
  • Barbeau or Allen’s Test
  • To assess ulnar and radial flow in the superficial palmar arch
24
Q

What is the best treatment for radial artery vasospasm during cath?

A
  • Intra-arterial vasodilators
    • verapamil, Nitrates
  • Sedation
  • Minimizing catheter manipulation and catheter exchanges
25
Q

What is a dreaded complication or transradial access?

A

compartment syndrome

26
Q

What is one way to treat suspected compartment syndrome related to cardiac catheterization?

A

early recognition and tamponade

  • often using a sphygmomanometer cuff to apply direct pressure to the forearm
27
Q

What percentage of patients following transradial access will develop arterial thrombosis?

A

up to 10%

28
Q

What is the optimal projection for visualizing:

  • LMCA
A
  • Proximal and mid-LM
    • RAO caudal (shallow)
    • AP caudal
  • Distal LM
    • LAO Caudal
29
Q

What is the optimal projection for visualizing:

  • LAD
A
  • Proximal
    • LAO caudal
    • LAO cranial (if foreshetening occurs with LAO caudal)
    • RAO cranial
      • eliminates foreshortening seen with LAO cranial/caudal views but overlap with CFx may occur in proximal LAD
  • Mid
    • AP cranial or
    • RAO cranial
30
Q

What is the optimal projection for visualizing:

  • CFx
A
  • AP caudal
  • LAO caudal (shallow)
  • RAO caudal
  • Proximal
    • RAO caudal (shallow)
      • may be compromised by foreshortening
  • Ostium of RI
    • LAO caudal (steep)
31
Q

What is the optimal projection for visualizing:

  • RCA
A
  • Proximal
    • LAO straight
  • Mid
    • left lateral projection
  • Distal RCA, PDA, PLB bifuraction
    • LAO cranial
  • Proximal and mid PDA
    • RAO
32
Q

What is the optimal projection for visualizing:

  • LIMA
A

Lateral projection

33
Q

What study demonstrated the noninferiority of Edoxaban over Warfarin in nonvalvular A-fib?

A

Engage AF-TIMI 48

  • Primary Outcome - systemic or embolic event (Modified intention to treat) - p < 0.001
    • Warfarin - 1.5% / year
    • High dose (60mg) - 1.18% / year
    • Los dose (30mg) - 1.61% / year
  • Major Bleeding - p < 0.001
    • Warfarin - 3.43% / year
    • High dose (60mg) - 2.75% / year
    • Los dose (30mg) - 1.61% / year
34
Q

What did the RE-VERSE AD trial show?

A
  • Clinical Question
    • Among patients receiving dabigatran who develop serious bleeding or need an urgent invasive procedure, does idarucizumab reverse the anticoagulatnt effects of dabigatran?
  • Bottom Line
    • Among patients receiving dabigatran who develop serious bleedin or need an urgent invasive procedure, idarucizumab reverses the anticoagulant effects of dabigatran within minutes of administration
35
Q

What is the reversal agent for Dabigatran?

A

Idarucizumab (Praxbind)

  • monoclonal antibody fragment that binds dabigatran
  • rapidly normalizes hemostasis and reduces levels of circulating dabigatran in patients who had serious bleeding or required urgent procedure (RE-VERSE AD)
  • Class I recommendation
36
Q

What is the reversal agent for Rivaroxaban and Apixaban?

A

Andexanet alfa (Andexxa)

  • coagulation factor Xa [recombinant], inactivated-zhzo
  • bioengineered, recombinant modified protein designed to serve as an antidote against direct factor Xa inhibitors
    *
37
Q

Which NOAC is able to be removed with Hemodialysis?

A

Dabigatran

38
Q

What did the AFFIRM trial show?

A
  • Clinical Question:
    • Among patients with A-fib and a high risk of stroke or death, what are the effects of rate control versus rhythm control on mortality?
  • Bottom Line:
    • In patients with nonvalvular AF, there is no survival benefit between rate and rhythm control, but rhythm trends toward increased mortality
39
Q

What were the AFFIRM study outcomes:

  • Primary
A

5 year mortality

  • Rate control - 25.9%
  • Rhythm control - 26.7%
  • P = 0.08
40
Q

What were the AFFIRM study outcomes:

  • Secondary (notable)
A
  • Hospitalization:
    • 73% vs. 80% - p < 0.001
  • ​Ischemic strokes
    • ​5.5% vs. 7.1% (p = 0.79)
      • mostly in patients whom warfarin had been stopped or INR subtherapeutic
  • Torsades, PEA, Bradycardia
    • ​all in favor of rate control
41
Q

Which NOAC has the greatest degree of renal excretion?

A

Dabigatran (Pradaxa)

  • 80% renal excretion
42
Q

What is the recommended dose reduction for Apixaban (Eliquis)?

Dose?

A
  • Age > 80 years
  • Body weight < 60 kg
  • Serum Cr > 1.5 mg/dl
  • 2.5mg BID
43
Q

What is the recommended dose reduction for Rivaroxaban in renal impairment?

Renal function cutoff?

A
  • Rivaroxaban 15mg daily
  • CrCl 15-50 ml/min
44
Q

What is the mechanism of action of edoxaban?

A

factor Xa inhibitor

45
Q

What is the recommended renal function cutoff/dose reduction for Edoxaban?

A
  • CrCl 51-95 mL/min –> 60 mg daily
  • CrCl 15-50 mL/min –> 30mg daily
  • CrCl < 15 or > 95 mL/min –> not recommended
46
Q

Define supraventricular tachycardia (SVT)

A

arrhythmia that requires the nonventricular cardiac tissues for maintenance of tachycardia

47
Q

What are the most common SVT’s?

A
  • AVNRT (60%)
  • AVRT (30%)
  • AT (10%)
48
Q

What is the best way to differentiate:

  • regular, narrow complex tachycardia
A
  • Long RP (RP > PR)
    • Sinus tachycardia
    • Atrial tachycardia
  • Short RP (RP < PR)
    • AVNRT
    • AVRT (Accessory pathway)
49
Q

What is the best way to dist

A
50
Q

What clinical features can help distinguish between SVT’s?

A

character of symptom onset

  • AVNRT or AVRT
    • sudden, abrupt onset and termination without any clear inciting factor
  • AT
    • gradual onset and resolution
    • possible trigger (such as exercise)

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