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Day 7 - cardio Flashcards

1
Q

cancer –> ascites what type?

A

Exudative (has cancer in the fluid)

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2
Q

portal HTN –> ascites, what type?

A

Transudative (fluid pushing out)

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3
Q

Serum-Ascites gradient is? tells?

A

Serum Albumin - Ascites Albumin = tells if exudative or transudative

exudative - >1
transudative

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4
Q

“onion skinning” bile duct on u/s = think?

A

Primary sclerosing cholangitis

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5
Q

“beads on a string” bile duct on U/S = think?

A

Primary sclerosing cholangitis

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6
Q

bloody diarrhea = infx cause diff dx (7)?

A

“Bloody SSEECCY”

  • Shigella
  • Salmonella
  • E.coli
  • Entomeoba
  • Campylobactor (infx anywhere small or large bowel)
  • CMV (HIV, immuncompromised)
  • Yersenia entercolitica (inflames RLQ [cecum])
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7
Q

Pyloric stenosis workup?

A

1) Fix electrolyte imbalance
2) U/S
3) Myotemy

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8
Q

distal duodenum or jejunal ulcer think?

A

GASTRINOMA! (Zollinger-Ellison Syndrome)

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9
Q

liver disease + hyper pigmentation = think?

A

Hemochromatosis

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10
Q

Hemochromatosis heart complication?

A

Restrictive cardiomyopathy (bc Iron depositing in wall of heart)

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11
Q

Workup hemochromatosis?

A

Dx:

1) Genetic testing (initial)
2) Liver biopsy (gold standard/confirm dx)

Tx:
mild - Phlebotomy
severe - Chelation therapy w/ defuroxamine

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12
Q

What do you use for chelation for hemochromatosis?

A

Defuroxamine

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13
Q

hazy aortic know w/ a large medastinal width = think?

A

aortic dissection

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14
Q

Initial treatment for aortic dissection?

A

Beta Blocker

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15
Q

Workup of aortic dissection?

A

1) beta blocker!!!
2) stable - spiral CT WITH contrast or X-ray
unstable - transesophageal echo

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16
Q

Cardiac Tamponade triad of symptoms?

A
  • hypotension
  • muffled heart sound
  • JVD
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17
Q

costochondritis treat?

A

NSAIDs and rest

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18
Q

Pain at chostochondral junction = think?

A

costochondritis

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19
Q

workup of non-emergent chest pain?

A

nL EKG and can exercise –> Exercise treadmill test
nL EKG, but canNOT exercise –> pharm stress test

abnl EKG, but CAN exercise 
       --> Exercise stress echo
       --> Exercise thallium (nuc med)
abnl EKG, but canNOT exercise 
     --> pharm stress echo (dobutomine, adenosine, dyperimadole)
     --> thallium stress test (nuc med)

Stress echo’s don’t utilize EKGs so you use them instead when EKG is abnl

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20
Q

HTN + prostate problem = what drug use?

A

alpha 1 blocker!

  • zosin
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21
Q

-zosin = think?

A

alpha 1 blocker

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22
Q

Multiple coronary vessels effected in coronary issues –> treat?

A

Coronary artery bypass (CABG)

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23
Q

1 vessel effected in coronary issues –> treat?

A

Angioplasty and stenting

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24
Q

Indications for Coronary Artery Bypass Grafting (CABG)?

A
  • 3 coronary vessels effected
  • 2 vessels + risk factors/comorbidities (esp DM)
  • Left main coronary artery effected
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25
Q

Indications for angioplasty and stenting (rather than CABG)?

A

limited vessels effected

  • 1 vessel
  • 2 vessels w/o risk factors/comorbidities
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26
Q

How to determine coronary vessels are “effected”/bad?

A

70% or more occlusion

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27
Q

In CABG what vessels are best to replace bad vessels w/?

A

ARTERIES! so do a coronary artery bypass w/ ARTERIES!

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28
Q

malignant HTN tell and treatment?

A
  • IV nitro (1stline)
  • IV labetalol (2nd)

Tell by doubling shock value (ie 90/60 x2) - equal to or higher in 1 or both values is malignant

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29
Q

LV dysfunction - most likely cause?

A

HTN

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30
Q

carotid massage helps w/ SVTs by?

A

slowing the heart down by increasing AV conduction delay

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31
Q

narrow complex tachycardia - think?

A

supraventricular tachycardia

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32
Q

supraventricular tachycardia

A

mild - vagal maneuvar (ie carotid massage)
mod - adenosine
severe - shock

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33
Q

Acute MI discharge which would provide greatest mortality benefit?

A

Beta Blockers

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34
Q

severe aortic stenosis treatment?

A

valvular replacement

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35
Q

mild aortic stenosis treatment?

A

ACE inhibitors

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36
Q

crescendo-decresendo systolic murmur heard at 2nd R intercostal space radiating to the carotids - think?

A

Aortic Stenosis

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37
Q

Asymmetric hypertrophy of the the ventricular septum w/o left ventricular dilation = think?

A

Hypertrophic obstructive cardiomyopathy (HOCUM)

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38
Q

Hypertrophic cardiomyopathy pts die from?

A

arrythmia

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39
Q

Treatment of Hypertrophic obstructive cardiomyopathy (HOCUM)?

A

beta blockers

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40
Q

best way to dx hypertrophic cardiomyopathy?

A 
Dec preload (ie valsalva) --> inc murmur intensity 
Inc afterload (squeeze fist) --> dec murmur intensity

this is bc less blood in ventricle –> more the valve is covered –> inc murmur
and vice versa

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41
Q

Treatment of DVT?

A

admit pt

start LMWH –> bridge to warfarin w/ INR of 2-3

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42
Q

Goal INR of DVT treatment?

A

2-3

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43
Q

handgrip maneuver causes what?

A

Inc AFTERLOAD –> more blood in LV

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44
Q

Which murmurs inc w/ inc afterload?

A

Inc afterload –> more blood in LV

  • Mitral regurg
  • Aortic regurg
  • VSD
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45
Q

Which murmurs dec w/ inc afterload (handrip maneuver)?

A

Inc afterload –> more blood in LV

  • Aortic stenosis
  • Hypertrophic cardiomyopathy
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46
Q

Rapid squatting causes what?

A

inc SVR and Preload

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47
Q

Rapid squatting causes wht in HOCUM and AS?

A

HOCUM DEC in intensity

AS INC intensity

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48
Q

What maneuvers inc HOCUM intensity (2)?

A
  • Valsalva

- Standing up

49
Q

What manuevers dec HOCUm intensity (3)?

A
  • Hand grip
  • Rapid Squatting
  • Lying down
50
Q

Amiodarone can react w/ what drug?

A

Warfarin (can potentiate, so may need to dec dose)

51
Q

Amiodarone effects what organs?

A
  • thyroid
  • liver
  • lungs
52
Q

the lower the ABI the what?

A

the worse the patient’s PVD is

53
Q

PVD workup?

A

1) Check pulses
2) ABI
3) U/S w/ doppler

54
Q

slow rising carotid pulse w/ systolic thrill = think?

A

aortic stenosis

55
Q

confirmatory test for valvular dysfuntion?

A

Catheterization and angiography

56
Q

Systolic heart sounds? (6)

A
  • AS
  • PS
  • MR
  • TR
  • VSD
  • MVP
57
Q

Diastolic heart sounds?

A

ARMS PRiTS

  • AR
  • MS
  • PR
  • TS
58
Q

Pulsus parvus et tardus found w/ what heart murmur?

59
Q

Pulsus parvus et tardus means?

A

pulses are weak w/ a delayed peak

60
Q

holosytolic high pitched blowing murmur - think (2)?

A

MR (radiates to axilla)

TR (radiates to R sternal border)

61
Q

How differentiate b/t TR and VSD?

A
  • TR radiates to R sternal border

- VSD does NOT radiate

62
Q

holosystolic harsh sounding murmur at LLSB non-raidating?

63
Q

management of acute pulmonary edema?

A

NOMAD

  • Nitrates
  • Oxygen (1st)
  • Morphine
  • Aspirin
  • Diuretics
64
Q

irregularly irregular - think?

65
Q

rate or rhythm control most important for AFibg

A

RATE control better than rhythm control!

(ie beta blockers better than amiodarone)

66
Q

AFib cardioversion or defibrillate?

A

CARDIOVERSION

67
Q

Ventricular fib cardioversion or defibrillate?

A

DEFIBRILLATE

68
Q

thickened ventricular septum = think?

A

hypertrophic obstructive cardiomyopathy

69
Q

Meds that cause color change in vision? (3)

A
  • Digoxin (blurry yellow vision)
  • Sildenafil
  • Ethambutol
70
Q

Digoxin toxicity test?

A

Electrolyte panel –> looking for hypOKalemia

Digoxin levels does NOT help bc its INTRACELLULAR

71
Q

Associations w/ coarctation of aorta?

A
  • Turner syndrome (also bicuspid aortic valve –> AS)
72
Q

Turner syndrome most common heart anomaly?

A

Bicuspid aortic valve –> AS

73
Q

Heart issues w/ turner syndrome?

A
  • Bicuspid aortic valve –> AS

- Coarctation of aortic valve

74
Q

constrictive pericarditis likely to have what physical exam finding?

A

Pericardial knock

75
Q

Pericardial knock = think?

A

constrictive pericarditis

76
Q

Widely fixed S2 - think?

77
Q

Opening snap and diastolic rumble = think?

78
Q

Systolic anterior motion of mitral valve = think?

A

Hypertrophic cardiomyopathy –> MR (pushing on ant leaflet)

79
Q

Primzmelts angina due to?

80
Q

Primzmelts angina associated w/?

A

other vasospasm things:

  • migraines
  • Reynaud’s Phenom
81
Q

What drug associated w/ Primzmelts angina?

82
Q

lipid studies at what age?

A

Men >35

Women >45

83
Q

best treatment for hot flashes?

84
Q

best treatment for post-menopausal osteoperosis?

A

Raloxifene

Tamoxifene (older med)

85
Q

“pre-excitation syndrome” = ?

A

Wolf parkinson’s white syndrome

86
Q

Delta wave found in what?

A

Wolff parkinson’s white syndrome

87
Q

Drugs make Wolff parkinson white syndrome better?

A

1A and 1C drugs

88
Q

Pt on PDE inhibitors (ie sildenafil) w/ malignant HTN, labetalol or nitro?

A

LABETALOL

- nitro contraindicated (would lead to drastic dec in BP)

89
Q

Asthma or COPD w/ malignant HTN, labetalol or nitro?

A

NITRO

- beta blocker contraindicated

90
Q

Leads II, III, AVF –> what wall?

A

Inferior Wall

91
Q

Inferior of wall infarct is R or L dominant?

A

RIGHT dominant most commonly, but can be left occasionally

92
Q

V4 lead is what side of the heart?

A

RIGHT SIDE

93
Q

Elevation of lead V4 think?

A

RIGHT side infarct

94
Q

slurred up slope of QRS - think?

A

Wolff parkinson white syndrome (describing delta wave)

95
Q

Most common reason for old person w/ aortic stenosis?

A

Calcification of the aortic valve

96
Q

Most common reason for young person w/ aortic stenosis?

A

Bicuspid aortic valve

97
Q

Treatment of prinzmetal angina?

A

Ca Channel blocker
Nitrates
Smoking cessation

98
Q

ECG findings in prinzmetal angina?

A

Transient ST elevation

99
Q

“fine crepitations throughout the chest” = think?

A

Pulmonary edema

100
Q

muffled heart sounds + varying blood pressures (not locations based) = think?

A

cardiac tamponade

101
Q

treat cardiac tamponade?

A

pericardiocentesis

102
Q

unstable w/ heart block treatment?

A

transvenous pacemaker

103
Q

stable 1st degree or 2nd degree mobitz type 1 heart block pts treated initially w/?

104
Q

2nd degree mobitz type 2 or 3rd degree heart block pts treated w/?

105
Q

AV block 1st degree EKG findings?

A

prolonged PR interval (>200msec)

P wave comes to early

106
Q

AV block 2nd degree, Mobitz type 1 (wenckebach) EKG findings?

A
  • Progressive lengthening of PR interval until a beat is dropped (P not followed by QRS)
  • Variable RR interval w/ a regularly irregular pattern
107
Q

AV block 2nd degree, Mobitz type 2 EKG findings?

A

PR length is normal, but will drop QRS occasionally (p wave w/o QRS)

108
Q

AV block 3rd degree, EKG findings?

A

p wave and QRS complexes no relation (so many p’s w/o QRS, can see p waves ON QRS complex/Twave)

  • atria and vents are conducting independently
109
Q

PR lengthening w/ QRS drops = think?

A

2nd degree heart block, mobitz type 1

110
Q

QRS drops, nL PR length = think?

A

2nd degree heart block, mobitz type 2

111
Q

2 most common causes of MS in USA?

A

1) Rheumatic fever

2) Atrial Myxoma

112
Q

Atrial myxoma is what dependent?

A

POSITIONAL

113
Q

management of premature atrial contraction?

A

reassurance

114
Q

Pansystolic mumur post MI = think?

A

Mitral regurg from PAPILLARY MUSCLE RUPTURE

115
Q

R side heart infarct treat initially w/?

116
Q

ST elevation in V1 and V2, most likely location and artery of infarct?

A

Anteroseptal

LAD

117
Q

ST elevation in V3 and V4, most likely location of infarct?

A

Anteroapical

distal LAD

118
Q

ST elevation in II,III, avF, most likely location of infarct?

A

InFerior

RCA

Sicular (9 decks)

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