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Clin Med > CV > Flashcards

CV Flashcards

1
Q

most common cause of non-ischemic cardiomyopathies

A

chronic alcoholism

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2
Q

most common type (95%) of cardiomyopathy

A

dilated

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3
Q

MCC of dilated cardiomyopathy

A

ischemia

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4
Q

the 6 Ds that cause dilated cardiomyopathy

A

6 Ds: don’t know, Doxorubicin (chemo), drinking (alcohol), drugs (cocaine), deficiency (vit B1), delivery (post-partum)

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5
Q

MCC of restrictive cardiomyopathy

A

amyloidosis

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6
Q

how to hear HCM murmur bettere

A

stand after squat, valsalva (L sternal border)

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7
Q

tx for symptomatic bradycardia

A

atropine

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8
Q

for suspected afib, besides HTN/heart dz/valve dz, should ask about hx of: (3)

A

stroke, hyperthyroidism, lung dz (COPD, PNA, PE, CA)

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9
Q

preferred anti-coags in Afib

A

DOACs

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10
Q

when to use warfarin instead of preferred anti-coags in Afib -3

A

if NOAC is too expensive, in valvular A.Fib, or GFR<30.

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11
Q

A fib 1st line for rate control

A

BB and non-diCCBs

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12
Q

most common congenital heart problem

A

VSD

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13
Q

ASD murmur best heard where

A

L 2nd-3rd ICS

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14
Q

VSD murmur best heard where

A

L sternal border

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15
Q

what Dx? classic sign: kid with higher blood pressure in the arms than in the legs and pulses that are bounding in the arms but decreased in the legs.

A

coarctation of the aorta

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16
Q

what congenital murmur usually disappears on its own w/in a day or so?

A

Patent ductus arteriosus

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17
Q

2 CXR findings for coarctation of the aorta

A

CXR: notching of posterior ribs; aortic shadow shows figure of 3 sign due to dilatation of proximal and distal segments surrounding coarctation.

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18
Q

4 features of tetrology of fallot

A

4 features (PROVe): 1) pulmonary stenosis, 2)RVH, 3) overriding aorta, 4) ventricular septal defect.

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19
Q

CXR finding for tetralogy of fallot

A

boot shaped heart

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20
Q

gold standard for dx of CAD

A

coronary angiography

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21
Q

Consider ________ test for CV risk assessment in asymptomatic adults >40 at intermediate risk

A

Coronary artery Ca scoring

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22
Q

tx for CAD (4)

A

Statin, aspirin, ACE-I/ ARB, BB

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23
Q

during MI, troponin onset happens b/w __ and __ hrs

A

4-8 hrs

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24
Q

what med is CI if MI from cocaine?

A

BB

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25
Q

ST elevation must be >1.5-2.5mm in which leads to count as STEMI (otherwise just >1mm in 2 consecutive)

A

V2-V3

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26
Q

2 tx for * Prinzmetal variant (aka vasospastic) angina

A

nitro, CCB

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27
Q

pt dx in ED is unstable angina. next step?

A

do Heart/TIMI and if high score (5+), do stress test. If low score (<3), discharge and have pt follow up w/ PCP/cardiology (they will do stress test). If neg stress test, \Give statin, aspirin, or BB based on risk factors.

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28
Q

HFrEF has a EF < ____

A

<40%
40 or less

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29
Q

4 pillars of HFrEF tx

A

ARNi (sacubitril + valsartan) or ACEi or ARB, BB (carvedilol, metoprolol, bisoprolol), Mineralcorticoid receptor antagonist (spironolactone / eplerenone), SGLT-2 inhibitors (dapagliflozin)

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30
Q

tell HF pts to avoid _____ (med) and limit intake of _____ (2)

A

avoid NSAIDs. limit fluid and Na intake

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31
Q

treat HTN if >____ and no comorbities

A

> 140/90

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32
Q

tx HTN if >130/80 + what conditions (3)

A

> 130/80 w/ hx of CVD/ DM or age 65-75 or ASVCD risk >10%

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33
Q

tx HTN in CKD if > _____

A

120

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34
Q

tx for HTN in CKD (in any race)

A

ACE/ARB

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35
Q

tx for black pts w/ HTN

A

long-acting dihydrophyridine Ca Channel Blocker (amlodipine) or a thiazide-like diuretic (chlorathaladone)

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36
Q

tx for non-black DM pts w/ HTN

A

ACE/ARB

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37
Q

tx for HTN in pregnancy

A

methyldopa, labetalol, procardia

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38
Q

what is the FROM JANE of endocarditis?

A

FROM Jane: Fever, Roth’s spots, Osler nodes, Murmer, Janeway lesions, Anemia, Nail bed hemorrhage, Emoboli. Janeway lesions (small erythematous/hemorrhagic nonpainful macules on palms/soles caused by septic emboli); Osler’s nodes (painful pink palpable pea-sized nodules in fingers/toes); subungual splinter hemorrhages (linear in middle of nail)
Roth’s spots (white areas in retina surrounded by zone of hemorrhage).

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39
Q

endocarditis prophylaxis

A

Amox PO 2g 30-60min prior to procedure

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40
Q

pericarditis pain feels better when pt ____

A

leans forward

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41
Q

pulse abnormality poss present in pericarditis

A

paradoxical pulse (increased drop in SBP during inspiration). Would feel like pulse diminishes or disappears during inspiration

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42
Q

most specific finding for pericarditis

A

3 part fiction rub (highly specific; best heard w/ diapragm over L sternal border w/ pt upright and leaning forward and holding breath after expiration; triphasic; raspy, scratchy, grating, or squeaking

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43
Q

EKG finding in pericarditis

A

ST elevations and PR depressions in all leads; T wave elevation in most leads

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44
Q

tx for mild pericarditis

A

NSAIDs in anti-inflammatory dose + colchicine

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45
Q

tx for pericarditis secondary to dressler syndrome

A

aspirin + cochicine X 3 mo (not ibuprofen)

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46
Q

Beck’s triad in cardiac tamponade

A

Beck’s triad: JVD, muted heart sounds, hypotension. (in <50%).

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47
Q

order __ to dx tamponade

A

echo

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48
Q

what EKG finding is specific for pericardial effusion

A

electrical alternans (rhythm switching of QRS axis; specific but not sensitive for effusion)

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49
Q

MCC of aortic stenosis in <70

A

bicuspid aortic valve

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50
Q

MCC of aortic stenosis in >70

A

ddegenerative

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51
Q

R vs L sided murmurs: which increase w/ inspiration

A

R sided

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52
Q

MCC of S3

A

CHF

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53
Q

tx for aortic stenosis

A

valve replacement

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54
Q

how to make aortic stenosis murmur louder (2)

A

leaning forward with expiration and squatting

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55
Q

MCC of AR

A

weakening of vlaves due to aging.

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56
Q

aortic dissections can cause what murmur?

A

AR

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57
Q

tx for acute AR

A

early surgery w/in 24 hrs of diagnosis is best prognosis

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58
Q

MCC of mitral stenosis

A

rheumatic heart dz

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59
Q

MCC of chronic MR

A

Most common: MVP, then rheumatic heart dz, ischemia,, infectious endocarditis.

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60
Q

MR shows up how long after rheumatic fever

A

20-40 years

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61
Q

rumbling low pitch murmur with palpable S1 at apex and opening snap just after S2

A

MS

62
Q

blowing holosystolic murmur (ssssh dub) at apex w/ split S2, radiates to L axilla

A

MR

63
Q

tx for MVP w/ palpitations

A

BB

64
Q

consider what 3 consequences from MS and MR

A

CHF, afib / stroke

65
Q

only effective tx for MR

A

valve repair/replacement

66
Q

if CP + focal neuro deficit, think _____

A

aortic dissections

67
Q

MC focal neuro deficit in aortic dissections

A

cerebral ischemia

68
Q

MC location of AAA

A

below renal arteries

69
Q

who to screen for AAA

A

Screen all men 65-75 w/ hx of smoking 100+ cigs.

70
Q

what D dimer cutoff to help r/o aortic dissections

A

<500

71
Q

tx for symptomatic aortic dissections

A

surgery

72
Q

non-surgery tx for AAA — lifestyle + 3 meds

A

goal = prevent rupture. Quit smoking. Statin, BB, ACE-I / ARB

73
Q

when to do surgery for AAA

A

Surgery if acute rupture, rapidly growing, involves branching arteries, or >5.5cm.

74
Q

tx for arterial embolism in leg

A

Anticoag w/ IV heparin (bolus then constant). If not limb threatening, call vascular surgeon for angioplasty, graft, or endarterectomy. Goal is embolectomy w/in 4-6 hrs.

75
Q

pt c/o sudden onset leg pain. loss of distal pulse, cyanosis. dx?

A

arterial embolism

76
Q

giant cell arteritis is vasculitis of what size arteries?

A

medium to large

77
Q

suspect what dx if amaurosis fugax? (brief–only a few min–visual field loss upper and extends downward like a curtain).

A

temporal arteritis

78
Q

tx for temporal arteritis

A

high dose corticosteroids and refer for biopsy w/in 1 wk to decrease chance of blindness

79
Q

skin findings in PAD

A

thin shiny skin, hair loss, poss ulcers/gangrene. pallor on elevation, cool to touch.

80
Q

test for PAD and results

A

Ankle Brachial Index–ankle will be low in comparison to arm (PAD is <1; normal is 1.0-1.4).

81
Q

look for what other dz if PAD?

A

CAD

82
Q

what is more common? DVT or superficial thrombophlebitis?

A

superficial thrombophlebitis

83
Q

tx for superficial thrombophlebitis

A

warm compresses, compression, LE elevation, normal activities, NSAIDs (8-12 days)

84
Q

6 causes of hypercoagulability

A

estrogen therapy, pregnancy, inflammation, dehydration, cancer, thrombophilia

85
Q

most common vascular dz after ACS and stroke.

A

Venous thromboemboism

86
Q

gold standard test for PE

A

chest angiography

87
Q

SVT Stable, NARROW complex QRS acute treatment

A

Vagal maneuvers (valsalva, carotid massage). If that doesn’t work - fast bolus Adenosine (6mg fast bolus; repeat w/ 12 mg after 1-2 min if not effective; can repeat 12mg once more) , AV nodal blocking agents (BB, CCB–diltiazem)

88
Q

tx for WPW

A

procainamide. no BB or n-dCCB.

89
Q

PE finding for premature contraction.

A

Bigeminal pulse (normal beat followed by premature beat)

90
Q

what dx? three or more consecutive “PVCs”. Rates typically 120-250bpm

A

VT

91
Q

Med tx for Stable, Sustained VT (acute)

A

Antiarrhythmics via IV such as Procainamide, Amiodarone

92
Q

tx for unstable VT

A

DCCV (shock)

93
Q

pt w/ V fib will present _____

A

pulseless, unresponsive

94
Q

MCC of Torsades de pointes

A

hypoMg

95
Q

tx for TdP

A

IV Mg 1-2g IV over 15 min. defib, discontinue QT prolonging drugs.

96
Q

bradycardia w/ pauses >3 sec

A

SSS

97
Q

SSS tx

A

pacemaker

98
Q

Constant, prolonged PR interval >200ms (one square on EKG) that stays same length. dx?

A

1st degree heart block

99
Q

Progressive PR interval lengthening leading to dropped QRS. dx?

A

Second Degree AV block Type I (Wenckeback/Mobtiz I)

100
Q

Constant, prolonged PR interval with dropped QRS (some P waves don’t conduct

A

Second Degree AV block Type II (Mobtiz II)

101
Q

tx for 2nd degree heart block type 1

A

atropine

102
Q

tx for 2nd degree heart block type 2

A

beta adrenergic agent (dopamine, dobutamine). AVOID Atropine. Temporary pacing.

103
Q

regular P-P intervals unrelated to R-R intervals

A

3rd degree heart block aka complete

104
Q

5 Hs of H and Ts that cause cardiac arrest

A

Hypoxia - MC
Hypovolemia - 2nd MC
Hydrogen ion /acidosis
Hypo/hyperK
Hypothermia

105
Q

5 Ts of H and Ts that can cause cardiac arrest

A

Tension PTX
Tamponade
Toxins
Thrombosis, pulm
Thrombosis, coronary

106
Q

multifocal atrial tachycardia is ASW what comorbitity

A

COPD

107
Q

Which of the following antiarrhythmic drugs can be associated with hyper- or hypothyroidism following long-term use?

Quinidine

Amiodarone

Digoxin

Verapamil

A

Amiodarone is structurally related to thyroxine and contains iodine, which can induce a hyper- or hypothyroid state.

108
Q

Contraindications to beta blockade following an acute myocardial infarction include which of the following?

Third degree A-V block

Sinus tachycardia

Hypertension

Rapid ventricular response to Atrial fibrillation/flutter

A

Beta blockade is contraindicated in second and third heart block.

109
Q

A 74 year-old male is diagnosed with pneumonia. The physician assistant should ensure the patient is not on which of the following before starting therapy with clarithromycin (Biaxin)?

Dipyridamole (Persantine)
simvastatin
Lasix
lisinopril

A

Statins are known to interact with the macrolides as they may cause prolonged QT interval, myopathy and rhabdomyolysis.

110
Q

In congestive heart failure the mechanism responsible for the production of an S3 gallop is

contraction of atria in late diastole against a stiffened ventricle.

rapid ventricular filling during early diastole.

vibration of a partially closed mitral valve during mid to late diastole.

secondary to closure of the mitral valve leaflets during systole.

A

Rapid ventricular filling during early diastole is the mechanism responsible for the S3.

111
Q

During an inferior wall myocardial infarction the signs and symptoms of nausea and vomiting, weakness and sinus bradycardia are a result of what mechanism?

Increased sympathetic tone

Increased vagal tone

Activation of the renin-angiotensin system

Activation of the inflammatory and complement cascade system

A

Increased vagal tone is common in inferior wall MI; if the SA node is involved, bradycardia may develop.

112
Q

Of the following, which is the most common cause of secondary hypertension?

Hyperthyroidism

Hypothyroidism

Obstructive sleep apnea

Aortic coarctation

A

OSA. Although the vast majority of patients have primary or essential hypertension, secondary hypertension is identified in approximately 10% of adult patients. Common causes of secondary hypertension include the following:

Renovascular disease
Obstructive sleep apnea
Renal parenchymal disease
Primary aldosteronism
Drug- or alcohol-induced
113
Q

holosystolic murmur is caused by what 3 valvular / septal conditions?

A

A holosystolic murmur is caused by Mitral Regurgitation, Tricuspid Regurgitation, or a Ventricular Septal Defect.

114
Q

Which of the following physical exam findings is consistent with Aortic Stenosis?

A: Narrow pulse pressure
B: Systolic murmur best heard at the apex
C: Diastolic murmur heard best at the right 2nd intercostal space
D: Systolic murmur and a sternal heave
E: The murmur gets louder during inspiration

A

A: Narrow pulse pressure (systolic minus diastolic blood pressure < 30 mmHg).

115
Q

Which one of the following cardiac dysrhythmias is associated with antipsychotic use?

A Atrial fibrillation
B Third degree heart block 
C Torsades de pointes
D Wolff-Parkinson-White syndrome
A

TdP

116
Q

According to guidelines from the Eighth Report of the Joint National Committee (JNC 8), patients older than age 60 years with hypertension and no other medical history should be treated to which of the following blood pressure goals?

A    < 120/80 mm Hg
B  < 130/85 mm Hg
C  < 140/85 mm Hg
D  < 150/90 mm Hg
A

D < 150/90 mm Hg

117
Q

Which of the following medications has the greatest impact on reducing mortality in patients presenting with acute coronary syndrome?

A  Aspirin
B  Metoprolol
C  Morphine
D  Nitroglycerin
A

ASA

118
Q

Which of the following is commonly the first reported symptom of aortic stenosis?

A  Chest pain
B  Dyspnea
C  Syncope
D  Vomiting
A

dyspnea

119
Q

What is the most common cause of tricuspid valve stenosis?

A  Bacterial endocarditis
B  Dilation and dissection of the aortic root
C  Marfan syndrome
D  Rheumatic heart disease
A

D Rheumatic heart disease

120
Q

What is the recommended anticoagulant for a pregnant patient diagnosed with a deep vein thrombosis?

A

Low-molecular-weight heparin.

121
Q

for PAD tx, rx ASA/plavix + statin + ______ (class)

A

cilostazol or pentoxifylline (phosphodiasterase inhibitor),

122
Q

EKG shows inferior ST elevation. next step?

A

ECG findings suggestive of this include ST segment elevation in leads II, III, and aVF with the elevation in lead III greater than that of lead II or associated elevation in lead V1. Any ST segment elevation in the inferior leads should prompt a right-sided electrocardiogram. ST segment elevation in leads V4R, V5R and V6R is diagnostic of a right ventricular infarct

123
Q

Which of the following laboratory studies should be ordered in a patient being evaluated for hypertriglyceridemia?

A Antinuclear antibody
B Complete blood count
C Thyroid-stimulating hormone
D Troponin I
A

TSH. can be caused by hypothyroidism

124
Q

Which of the following best describes the physiologic process responsible for the fourth heart sound heard in patients with advanced aortic stenosis?

AAtrial contraction against a noncompliant left ventricle
BBlood striking a dilated left ventricle during diastole
CDelayed closure of the aortic valve in relation to the pulmonic valve
DTurbulent blood flow across a calcified aortic valve
A

AAtrial contraction against a noncompliant left ventricle

125
Q

long term rx for incident of sustained monomorphic VT

A

BB

126
Q

ABCDE of causes of 1st degree AV block

A

adenosine
BB
n-hCCB
digoxin
exercisers

127
Q

BLOCK of causes of 2nd degree AV block type 1

A

BB
lyme
ordinary (normal variant)
CCB
K - hyperK

128
Q

MC chronic arrhythmia

A

afib

129
Q

tx for stable WIDE complex SVT

A

IV procainamide or amiodarone

130
Q

definitive tx for SVT

A

radiofreqency catheter ablation

131
Q

tx for symptomatic PVCs

A

BB (alt non-dCCB)

132
Q

worst RF for angina/CAD

A

DM

133
Q

4 meds that pt with CAD/angina should be on

A

statin
ASA
BB
nitro

134
Q

most effective med class to improve mortality in HFrEF

A

ACe inhiitors

135
Q

MCC (virus) of myocarditis

A

coxsackie B

136
Q

2 most important orders to put in for suspected infective endocarditis

A

blood cultures and echo

137
Q

is AS ASW S3 or S4

A

S4

138
Q

if pt develops myalgias on a statin, switch to one of which 2 statins?

A

pravastatin or fluvastatin

139
Q

3 AE of statins that require lab monitoring

A

liver dysfunction
kidney disfunction
hyperglycemia

140
Q

bile acid sequestrants (cholestyramine) are used to lower LDLs, but can increase ________

A

triglycerides

141
Q

aortic dissection SBP goal is ______ - _____ after _____ minutes

A

100-120
20 min

142
Q

nonatherosclerotic inflammatory small and medium vessel vasculitis, leading to vaso-occlusive phenomena
Pt will be young smoker with claudication or ischemic ulcers on LE

A

thromboangiitis obliterans aka Buerger’s dz

143
Q

is an innocent murmur systolic or diastolic?

A

systolic

144
Q

Which of the following is the mechanism of action of Class III antiarrhythmic drugs?

Na+ channel blocker

K+ channel blocker

Beta adrenoreceptor blocker

Ca++ channel blocker

A

K+ channel blocker

think 3k

145
Q

MC arrhythmia in MS

A

afib

146
Q

A 46 year-old male with no past medical history presents complaining of chest pain for four hours. The patient admits to feeling very poorly over the past two weeks with fever and upper respiratory symptoms. The patient denies shortness of breath or diaphoresis. On examination the patient appears fatigued. Vital signs reveal a BP of 130/80, HR 90 and regular, RR 14. The patient is afebrile. Labs reveal a Troponin I of 10.33 ug/L (0-0.4ug/L). Cardiac catheterization shows normal coronary arteries and an ejection fraction of 40% with global hypokinesis. Which of the following is the most likely diagnosis?

myocarditis

pericarditis

hypertrophic cardiomyopathy

coronary artery disease

A

myocarditis

147
Q

A hospitalized patient is found with confirmed pulseless ventricular tachycardia. IV access is obtained following the second shock given. Which medication is to be administered immediately?

A

epi

148
Q

The drug of choice for treating hypertensive encephalopathy in the nonpregnant patient is

sodium nitroprusside

labetalol

esmolol

IV nitroglycerin

hydralazine

A

sodium nitroprusside
Most of the medications listed are a good option for hypertensive emergencies . Sodium nitroprusside is the most widely used/ available, is a rapidly acting arterial and venous dilator, and is the drug of choice for most hypertensive emergences unless there is severe kidney disease.

149
Q

ST segment elevation that is present beyond 4-8 weeks after the acute infarct and a scar that bulges paradoxically during systole on echocardiogram. dx?

A

ventricular aneurysm

150
Q

Which of the following medication classes is the recommended treatment for patients who have an anterior wall myocardial infarction with poor left ventricular function?

Beta blockers

Calcium channel blockers

Potassium sparing diuretics

ACE inhibitors

A

ACE inhibitors. ACE inhibitors have been proven to be effective in the therapy of heart failure, especially in the setting of left ventricular dysfunction. They are considered first-line therapy in patients with symptomatic left ventricular systolic function

Beta blockers need to be used with caution in a patient with severe left ventricular dysfunction as they will worsen left ventricular contractility and may make this dysfunction worse. They are used, however, in the early stages of chronic heart failure.

151
Q

Which of the following is the most common complication that occurs in the setting of acute pericarditis?

Pericardial effusion

Left ventricular failure

Superior vena cava syndrome

Subclavian steal syndrome

A

Pericardial effusion. Accumulation of transudate, exudate or blood in the pericardial sac can occur due to pericardial inflammation.

152
Q

A patient presents to the office following a syncopal episode. The patient claims that the syncope occurs when he changes position such as rolling over in bed or when he bends over to tie his shoes. Which of the following is the most likely explanation for this presentation?

Carotid sinus hypersensitivity

Vasovagal episode

Subclavian steal syndrome

Atrial myxoma

A

Atrial myxoma most commonly presents with sudden onset of symptoms that are typically positional in nature due to the effect that gravity has on the tumor. Myxomas are the most common type of primary cardiac tumor in all age groups and are most commonly found in the atria.

Clin Med (14 decks)

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