Coronary Artery Disease

Question 1

statistical tests
sens
spec
ppv, npb, accuracy

Answer 1

pos dz no dz
pos test true + false+ (type 1 error) PPV= tp/testp
neg test false- type 2 true neg NPV= tn/testn
sens. tp/dzp spec tn/dzneg accur=tn+t+/
alltests

Question 2

appropriate test

Answer 2

test when test changes answer

Question 3

classification of chest pain

Answer 3

typical angina: sssdiscomfort, exertional or stress provoked, relieved by rest/ntg

atypical: only 2 of above
noncardiac: meets <1 above

Question 4

Duke treadmill score:

Answer 4

duration, symptoms, shift
exercise time- 5xmm shift- 4x angina index
(angina index: 0 no cp, 1 cp, 2 cp stops test)
low >5 intermed 4 to -10 high < -11

Question 5

stress imaging by guidelines:

Answer 5

only if ecg not interpretable

Question 6

atropine contrindications

Answer 6

narrow angle glaucoma
pyloric stenosis
myasthenia gravis

Question 7

DM revasc

Answer 7

if prox lad involved, cabg

Question 8

CT angio

Answer 8

low pretest or intermediate pretest probablility

Question 9

intermediate cardiac risk?

Answer 9

1-5% range

Question 10

risk of surgery

Answer 10

high: aortic/vascular >5% cardiac risk
intermediate: 1-5% carotid, ent, ortho, prostate
low: breast, endoscopic,cataract <1%

Question 11

nonemergent low risk surgery

Answer 11

no stress
stress if < 4 mets and if no risk proceed
risk factors: q waves, hx mi/ DM/ renal insuff/ hx cerebrovasc dz/ hz chf

Question 12

intermediate risk

Answer 12

intermediate treadmill score
moderate perfusion defect
stress echo with defect at high doses

Question 13

noninvasive highest risk

Answer 13

high risk >3% annual mortality
high risk treadmill score
resting EF/exercise 2 seg at low dose

Question 14

CARP study

Answer 14

randomized to revasc prior to surgery
also DECREASE V
delay surgery for procedure increases events

Question 15

abx prophylaxis

xplant pt

Answer 15

if regurg lesion

Question 16

coumadin bridging

Answer 16

risk factors: afib, prior thrombo, lv dysfunction, older valves,

low risk: bileaf avr with no rf
high risk: any mech mvr or avr with rf: bridge ufh iv

Question 17

reversing warfarin

Answer 17

ffp> vit k

vit k may cause hypercoag state, so use ffp

Question 18

surgery and devices

Answer 18

most probs with monopolar electrosurgery- bipolar electrosurgery does not cause emi

Question 19

Abciximab acute coronary setting

Answer 19

Not for upstream use in ACS

Question 20

Pulmonary htn- syncope relevance

Answer 20

Puts into class 4

Question 21

Duke treadmill score

Answer 21

> 5 low risk
Intermed -10 to 4
High <10