Cvs, Aortic Dis, Heart Dis In Px

Question 1

The worst cardiac dis in px?

Answer 1

Peripartum CMP

The next is eisenmeger syndrome

Question 2

A pt with hx of smocking n htn came to the ER with sudden onset chest pain and pain between his scapula. Dx?
Clues to the dx are?

Answer 2

Aortic dissection.

Pain between scapula is a clue. Another clue is BP difference between rt n lt

Question 3

Best initial test in PAD?

Interpretation

Answer 3

Ankle brachial index. Ratio of BP in the ankle to brachial aa
<0.9 is diagnostic

Question 4

Best initial test, most accurate test and most frequently used diagnostic tests in aortic dissection

Answer 4

• best initial- CXR showing mediastinal widening
• most accurate- angiography but invasive
• CT angiography, MRA, TEE have equal accuracy but CT angio is performed most often because it’s the easiest.

Question 5

A 56 yr old comes with sxs of ACS , his sxs improved after ASA n nitroglycerin given by paramedics on the way to the hospital. ECG shows T wave inversion in leads V1-V4. Troponin level is normal. What drug should immediately be added?

Answer 5

IV heparin
- pts sxs n ECG findings- ACS due to either unstable angina or NSTEMI which will b defferentiated later (6-12hours) by significant elevation in troponin
But acute mx is the same.
➡️antiplatelets, antithrombotics, b blockers, nitrates, statins r given; PCI within 24 hrs.
- Fibrinolytic therapy is not used

Question 6

Drug therapy in PAD

Answer 6

ASA, statins, cilostazole

Question 7

Rx of aortic dissection

Answer 7

Controlling the BP is the most important step - in type B dissection

• B blockers followed by nitroprusside
• surgical correction is the most appropriate Rx in type A dissection

Question 8

1st line drug for diabetic erectile dysfunction

Timing of drug administration if combining them with alpha blockers

Answer 8

Phosphodiesterase inhibitors like sildenafil

At least 4hr interval should be there

Question 9

Pt presented with severe symptomatic htn with headache epistaxis LV hypertrophy on EKG. CXR shows rib notching. What physical examination do u use to evaluate this pts cause of hypertension?

Answer 9

Simultaneous palpation of the brachial n femoral pulses( brachio femoral delay)
Coarctation of the aorta

Question 10

The next step after IJV catheterization should be?

Answer 10

CXR to confirm proper placement of catheter tip n absence of complication before administering drugs

Question 11

Bilateral lower extremity pitting edema, varicose veins, and ulcer suggest the dx of?

Answer 11

Venous insufficiency

Question 12

Screening for aortic aneurysm

Answer 12

• Men who ever smoked
• age>65
  With ultrasound

Question 13

The most useful intervention to improve functional capacity n reduce sxs in PAD

Answer 13

A supervised graded exercise program

Question 14

Pleuritic chest pain, dyspnea, tachypnea in a long distance truck driver is most consistent with?

Answer 14

Pulmonary embolism

Question 15

Patient diagnosed with hypertension for the first time , what investigations should be done ?

Answer 15

Urinalysis, chemistry, lipid profile, EKG