CV: Endocarditis, Congenital Heart Dz, Arterial and Venous Dz, Shock, Cardiac Neoplasms

Question 1

Rheumatic fever is a type __ hypersensitivity

Symptoms =

Answer 1

2

FEVERSS:
fever, erythema marginatum, valvular damage, ↑ESR, red-hot joints (migratory polyarthritis), subcutaneous nodules, Sydenham chorea

Question 2

Etiology of multifocal atrial tachycardia?

tx?

Answer 2

end-stage COPD

improve oxygenation

Question 3

Rheumatic fever :
dx?
MC murmur?

Answer 3

ASO titers

mitral regurg

Question 4

Rheumatic heart disease:

MC murmur?

Answer 4

mitral stenosis (then regurg when busts)

Question 5

endocarditis:
organism if acute?
organism if subacute?
a/w IVDA?
on prosthetic valves?

Answer 5

Acute: S. aureus
**on normal valves → rapid onset

Subacute:

1. dental procedures → S. viridans
2. GU/GI procedures → enterococcus
   * *on damaged valves → insidious onset

IVDA: S. aureus on tricuspid valve&raquo_space; Pseudomonas, Candida

Prosthetic valves: S. epidermidis

Question 6

low-grade diastolic rumble murmur w/ fixed split S2

Answer 6

ASD, think paradoxical emboli

Question 7

holosystolic murmur at mid-LSB

Answer 7

VSD

Question 8

continuous, machinery-like murmur

MCC death?

Answer 8

PDA

heart failure, infectious endocarditis

Question 9

Aortic dissection:
type A vs B?
tx?

etiology?

Answer 9

A = acute-onset tearing chest pain --> asc aorta
B = interscapular back pain --> desc aorta

type A → Tx β-blockers + surgery
type B → Tx β-blockers

HTN and CT diseases

Question 10

AAA:
dx?
tx?
MC location?

Answer 10

abdominal U/S

5 cm or sx → Tx synthetic graft

below the renal arteries

Question 11

small herald bleed followed by massive UGIB s/p aortic graft placement

Answer 11

Aortoenteric fistula

Question 12

Ruptured AAA:
presentation?
tx?
signs of impending rupture?

Answer 12

triad of tearing abdominal pain, hypotension, pulsatile mass

emergency laparotomy (don’t waste time • on dx tests)

1. Cullen sign (umbilical ecchymoses)
2. Grey-Turner sign (flank ecchymoses)

Question 13

Peripheral vascular dz:
dx?
management of mild vs severe?

Answer 13

arteriogram (gold standard)
or ABI (normal is >/= 1)

mild (ABI <0.4) → bypass graft vs. angioplasty

Question 14

Peripheral vascular dz:
MC site?
risk factors?

Answer 14

superficial femoral artery

diabetes, smoking

Question 15

Leriche syndrome:

symptoms?

Answer 15

PVD of distal aorta above bifurcation → bilateral claudication, impotence, ↓femoral pulses

Question 16

Acute arterial occlusion:
symptoms?
dx?
tx?

Answer 16

emboli → arterial occlusion → 6 Ps – pain, pallor, paralysis, parasthesias, poikilothermia, pulselessness

arteriogram

IV heparin + surgical embolectomy (if < 6 hrs)
if > 6 hrs, amputation

*** cholesterol embolization syndrome is similar except it presents after surgical or radiographic procedure (disruption of artherosclerotic plaque)

Question 17

Acute arterial occlusion:
MCC?
MC site?

Answer 17

AFib

common femoral artery

Question 18

Mycotic aneurysm:

management?

Answer 18

bacterial (not fungal) infx → aortic aneurysm

IV abx + surgical excision

Question 19

Luetic heart:
etiology?
presentation?
tx?

Answer 19

tertiary syphilis

aortic aneurysm + aortic regurg + coronary artery stenosis

IV PCN G + surgical repair

Question 20

Heparin vs. enoxaparin?

Answer 20

enoxaparin (Lovenox) and dalteparin (Fragmin) have longer T1⁄2 for qday dosing, more $$$

Question 21

Superficial venous thrombus:
presentation?
management of mild/severe/septic?

Answer 21

painful, palpable venous cord w/ local erythema and edema

• mild → Tx aspirin
• severe → Tx aspirin + warm compresses
• septic → remove IV cath + give IV abx

Question 22

Migratory SVT is a/w…

Answer 22

pancreatic cancer (Trousseau phenomenon)

Question 23

PE on EKG:

Answer 23

sinus tachycardia is more common than S1Q3T3

Question 24

Phlegmasia cerulea dolens =
dx?
tx?

Answer 24

severe form of deep venous thrombosis which results from extensive thrombotic occlusion of the major and the collateral veins of an extremityvenous → acute onset leg edema with pain and cyanosis
**high risk for massive PE

US or pelvic CT

heparin + venous thrombectomy

Question 25

Post-thrombotic syndrome (chronic venous insufficiency):
etiology?
presentation?
tx?

Answer 25

DVT damages valves → chronic venous HTN

severe leg edema and ulceration around ankle area

compression stockings + leg elevation; wet-to-dry TID for ulcers

Question 26

general initial tx of shock?

Answer 26

IV fluids –> pressors (epi > dopamine) then fix root cause)

Question 27

Axis on EKG:
normal –>
left-axis deviation –>
right-axis deviation –>

Answer 27

I+/II+: normal

I+/II–: left-axis deviation

I–/II+: right-axis deviation

Question 28

What are Dukes Criteria?

Answer 28

Makes diagnosis of infectious endocarditis
Major criteria:
> + blood culcture/sustained bacteremia
> endocardial involvment (mass, abcess, regurg)

Minor:
> fever
> predisposing heart condition or IVDU
> vascular phenomena: major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, and Janeway lesions
> Immunologic phenomena: glomerulonephritis, Osler’s nodes, Roth spots, and rheumatoid factor
> + echo

*to dx 2 major or 1 major and 3 minor or 5 minor

Question 29

metastatic cancer → hypercoagulable
state → clots form
on valves → can embolize

Tx?

Answer 29

Marantic endocarditis

tx Heparin (controversial)

Question 30

valve commonly affected in libman-sacks endocarditis

Answer 30

mitral (regurg > stenosis)

**vegetations on BOTH sides of valve

Question 31

HTNive urgency vs emergency

Answer 31

urgency = >220/120

emergency = >220/120 + endo organ damage (HA, renal failure, pulm edema)

Question 32

treatment of HTNive urgency vs emergency

Answer 32

urgency = lower BP graduallt over 24 hrs with PO meds

emergency = lower BP by 25% in 1-2 hrs with IV nitroprusside
**if have severe HA then get heat CT to r/o intercranial bleeding, get LP if CT neg

Question 33

Class I vs II vs II vs IV types of hypovolemic shock

Answer 33

Class I: 40% + ∆MS, anuria

Question 34

Sirs vs sepsis vs septic shock vs MODS

Answer 34

SIRS: 2+ of the following – ↑/↓T,
↑RR, ↑HR, ↑/↓WBC
Sepsis: SIRS + positive blood cx
Septic shock: sepsis + ↓BP
MODS: multiple organ dysfxn

Question 35

MCC ARDS

Answer 35

septic shock

Question 36

Tx unique to neurogenic shock

Answer 36

supine or T berg positioning to maintian BF to brain

Question 37

pedunculated, benign mass that
presents like intermittent mitral
stenosis

Answer 37

atrial myxoma

Question 38

MC heart tumor in kids

Answer 38

cardiac rhabdosarcoma

assc with tuberous sclerosis