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FM 2 Flashcards

1
Q

define cardiac chest pain that that occurs at rest and usually happens at night or early morning hours

A

printzmetal or vasospastic

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2
Q

gold standard to diagnose printzmetal angina

A

coronary angiography with the injection of provocative agents into the coronary artery.

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3
Q

tx for prinzmetal angina

A

nitro and CCB***

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4
Q

what medication is contraindicated for printzmetal angina

A

BB

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5
Q

Early wide “bizarre” QRS, no p wave seen

A

PVC

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6
Q

NSTEMI

A

ECG changes such as ST-segment depression, T-wave inversion, or both may be present, cardiac markers will be elevated

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7
Q

pericarditis cp is relieved with?

A

sitting and/or leaning forward

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8
Q

best initial test for PE

A

spiral CT

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9
Q

triangular or rounded pleural-based infiltrate usually located adjacent to the hilum

A

estermark sign or Hampton hump

**PE

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10
Q

gold standard definitive test for diagnosis of PE

A

Pulmonary angiography

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11
Q

S4 heart sounds

A

Diastolic HF (ejection fraction is usually normal)

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12
Q

S3 heart sound

A

Systolic HF (reduced EF) with volume overload - tachycardia, tachypnea. (Rapid ventricular filling during early diastole is the mechanism responsible for the S3)

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13
Q

best test to diagnose CHF

A

echo

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14
Q

Systolic left heart failure tx

A

ACEI + loop diuretic + BB

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15
Q

Diastolic heart failure tx

A

Ace inhibitor + β-blocker or CCB

(**(do not use diuretics in stable chronic diastolic failure)

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16
Q

what murmur do you MC hear with CAD

A

mitral regurg an S4

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17
Q

BP under what for prevention of CAD

A

<140/90

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18
Q

want LDL levels under?

A

<70

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19
Q

ASA allergy.. waht to prescribe for MI Prevention

A

clopidogrel

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20
Q

dental or medical procedures in the mouth, intestinal tract or urinary tract

want to think?

A

endocarditis

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21
Q

fever + new onset murmur

A

endocarditis

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22
Q

MCC of ndocarditis with intravenous drug users

A

staph aureus

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23
Q

MCC Of Endocarditis with prosthetic valve

A

staph epidermitis

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24
Q

emperic tx for endocarditis

-what if they have prosthetic vavle?

A

IV vancomycin or ampicillin/sulbactam PLUS aminoglycoside

prosthetic valve—– add rifampin

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25
Q

High-Risk patients endocarditis prophylaxis for procedures give?

A

Amoxicillin - 2 g 30-60 minutes before the procedure

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26
Q

SPSTF recommends screening for patients for hyperlipidemia with NO evidence of CVD and NO other risk factors should begin at _______years of age

A

35

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27
Q

NCEP recommends screening all adults for hyperlipidemia at age _____years regardless of risk factors

A

20

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28
Q

FOUR GROUPS MOST LIKELY TO BENEFIT FROM STATIN THERAPY

A
  1. Patients with any form of clinical atherosclerotic cardiovascular disease (ASCVD)
  2. Patients with primary LDL-C levels of 190 mg per dL or greater
  3. Patients WITH diabetes mellitus, 40 to 75 years of age, with LDL-C levels of 70 to 189 mg per dL
  4. patients WITHOUT diabetes, 40 to 75 years of age, with an estimated 10-year ASCVD risk ≥ 7.5%
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29
Q

HDL level of ___ is protective

A

> 60

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30
Q

list the high intensitty drugs given for hyperlipidemia

A

Atorvastatin 40-80 mg

Rosuvastatin 40 mg

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31
Q

Primary hypertension is defined as

A

resting systolic BP ≥ 130 or diastolic BP ≥ 80

  • on at least two readings
  • on at least two separate visits
  • with no identifiable cause
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32
Q

BP

  • normal
  • elevated
  • stage 1
  • stage 2
A

NORMAL: <120/80 and <80
ELEVATED: 120-129 and <80
STAGE 1: 130-139 OR 8-89
STAGE 2: >140 OR >90

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33
Q

target BP

A

<130/80

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34
Q

treatment guidelines for BP of:

  • normal
  • elev
  • stage 1
  • stage 2
A

NORMAL: eveal in 1 year, encourge healthy lifestyle

ELEV: Recommend healthy lifestyle changes and reassess in 3-6 months

STAGE 1:

  • assess 10 yr risk
  • *If risk < 10% start healthy lifestyle management and reassess in 3-6 months
  • *If risk > 10% or CVD, DM, CKD - lifestyle mod + 1 medication - reassess in 1 month
  • —->If goal met after 1 month - reassess in 3-6 months
  • —-> if goal not met after 1 MO— diff med or titrate current med

STAGE 2: healthy lifestyle + 2 BP meds

  • *If goal met after 1 month - reassess in 3-6 months
  • *If goal not met after 1 month, consider different med or titrate
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35
Q

HTN

For NON-BLACK patients, including those with diabetes: Initial treatment should be with either:

A

ACEI Or ARB

or
Long-acting calcium channel blockers (most often a dihydropyridine such as amlodipine)

or a thiazide-like diuretic (chlorthalidone or indapamide)

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36
Q

two meds that are most effective for HTN in black pt

A

thiazides and CCB

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37
Q

HTN MEDS FOR THE DISEASE

1. angina pectoris

A
  1. CCB

2.

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38
Q

tx for acute coronary syndrome

A 
M
O
N
A 
ACEI
39
Q

what is malignant HTN

-tx? **

A

Diastolic reading > 140 associated with papilledema (stage iv emergency) and either encephalopathy or nephropathy

TX
1. hydralazine IV

40
Q

-prils

41
Q

-sartans

42
Q

Nifedipine

A

Dihydroperidine CCB

43
Q

Amlodipine

A

Dihydroperidine CCB

44
Q

-pines

A

Dihydroperidine CCB

45
Q

Diltiazem

A

non Dihydroperidine CCB

46
Q

Verapamil

A

non

Dihydroperidine CCB

47
Q

-zosins

A

alpha blockers

48
Q

A-M BBs are?

A

cardioselective— act only on B1

  • atenolol
  • metoprool
  • Esmolol
  • bismolol
49
Q

N-Z BBs are?

A 
non cardio selective --act on B1 and B2 
*Nadolol 
*Propranolol 
*Timolol 
*Sotalol 
(pindolol
50
Q

list alpha and beta BBs

A

Labetalol

Carvediolol

51
Q

HTN in pregnancy tx?

A

Hydralazine*
labetalol
nicardipine
Methyldopa

52
Q

HTN + AFIB tx?

A

BB or CCB (non dihydroperidne … verap or diltizame)

53
Q

Angina + HTN tx

54
Q

POST MI + HTN tx

A

BB or ACEI

55
Q

Systolic HF + HTN tx

A

ACEI, BB, ARB, Diuretics

56
Q

DM/CKD + HTN tx

57
Q

Osteoporosis + HTN

58
Q

AA + HTN

A

CCB or diuretics thiazides

59
Q

first line tx for intermittent claudication aka periph arterial disease

A

smoking cessation

60
Q

other lines of tx for intermttent claudication

A

graduated exerise—walk to the point of claudication, then rest, then continue etc

control HTN DM weight

ASA + clopidogrel

Cilostazol (vasodilator)

61
Q

tx for asymptomatic PAD

A

preventative measures:

  • ASA
  • lipid lowering agents
  • bp control
62
Q

tx for PAD

A
  • prevention of atherosclerosis—control HLD, HTN, weight, DM
  • manage hyperlipidemia—statins, diet, exercise

graduated exercise

reduce BP

stop smoking

  • **MEDICAL INTERVENTION MOST IMP
    1. ASA + ticlopidine or clopidogrel—- symptomatic relief
    2. Cilostazol (PDE inhib aka vasodilator)    ***
63
Q

diagnosis for PAD

A

ABI <0.9

-definitive=arteriography

64
Q

first line tx for PVD

A

elevation and use of compression stockings

65
Q

S4, LVH,

young male who passes out during sports

66
Q

Medium-pitched, mid-systolic murmur that decreases with squatting and increases with straining or valsalva

67
Q

mcc CHF

A

CAD
HTN
MI
DM

68
Q

left sided HF s/s

A

pulmonary symps—- dyspna MC, orthopnea (LATE finding), pulm congestion/rales, pink frothy sputum, transudative effusions**

69
Q

right sided HF s/s

A 
backs up into periphery 
*periph edema, pitting edema 
hepatic congestion, fatigue
abd bloating
anorexia
70
Q

cxr findings for chf

A

kerley b lines–white markings in periphery

butterly or batwing apperance–pulm wedge pressure 12-18 hhmg

pulm edema and or plerual effusion–perihilar congestion

peri bronchial cuffing

cardiomegaly

71
Q

meds that a pt with CAD need to be on/discharged on from hosptial

A

ASA
SL nitro prn
dialy BB
high intensity statin

+/- ACEI (if LV function impaired)

72
Q

what valve is MC invovled in endocarditis

73
Q

mc bug causing acute bacterial endocarditis with normal valves

A

streph aureus

74
Q

MC valves invovled in bac endocarditis

in order of mc to least mc

A

mitral–mc

arotic 2nd mc

tricuspid 3rd mc

pulmonic 4th mc

75
Q

subacute bac endocarditis mc bug

A

strep viridans— less virulent why its subacute and is an indolent infection
MC from oral infection**

76
Q

IV drug user endocarditis mc bugs

A

MRSA
staph aureus
pseudomonas
candidida

77
Q

prosthetic valvues endocarditis mc bugs

A

staph epidermidis

78
Q

mc bug to cause endocarditis after valve surgery

79
Q

MCC OVERALL of endocarditis

A

streptococcus viridans

80
Q

acute endocarditis with native valve and not IVDU

A

ampicillin + Nafcillin + gentamicin
or
Vancomycin + gentamycin for mRSA

81
Q

pt with prosthetic valve who have endocarditis tx

A

vanco + gentamicin + rifampin

82
Q

IVDU endocarditis

A

nafcillin or vanco

83
Q

subacute endocarditis with native valve tx

A

pencillin or ampicillin + gentamycin

84
Q

fungal ednocarditis tx

A

amphotericin B and usually surgery

85
Q

indications for abx prophylaxis b4 oral procedures

and DOC and alternatives

A

cardiac

  • prosthetic valve or any prosthetic inserts like stents
  • prior hx of endocarditis
  • congen heart dz
  • cardio valvuloplasty in transplanted heart

DOC= 2g amoxicillin 30-60 min b4

Clindamycin is allergic

86
Q

ACEI and pregnancy

A

CONTRAINDICATED

SE: cough, angioedema, hyperK

87
Q

list rate control CCBs

A

verpamil and diltiazem

88
Q

hydralazine can cause

A

lupus like syndrome and pericarditis

89
Q

tx

  • htn emergency
  • htn urgency
  • malig htn
A

emergency= sodium nitroprusside DOC
urgency= clonidine DOC
malignant=hydralazine

90
Q

tx for isolated hypertriglyceridiemia

A

Fibrates—- Gemfibrozil and Fenofibrate
and
Niacin

***statins not used alone for this

91
Q

se of niacin

A

hyperglycemia— caution with DM

flushing

incr in LFTs

92
Q

SE of fibrates

A

rhabdo–esp with Gemfibrozil + statin combo

93
Q

SE of statins

A

myopathy
rhabdo
incr in LFTs

EORs (15 decks)

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