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FMED EOR > FMED > Flashcards

FMED Flashcards

1
Q

What is the definitive diagnosis for myocarditis?

A

Endomyocardial biopsy- will show infiltration of lymphocytes with myocardial tissue necrosis

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2
Q

What gallop is heard with DCM?

A

S3

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3
Q

What is the management of DCM?

A
  • Treat underling issues
  • Ace inhibitors first line (reduce afterload by vasocdilation)

**may cause diuretics, BBs, or digoxin

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4
Q

On myocardial biopsy, there is myocyte hypertrophy and disarray with interstitial fibrosis. What is the diagnosis?

A

HCM

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5
Q

What is the primary difference between non-obstructive and obstructive HCM?

A

In non-obstructive HCM, the hypertrophy is lower on the septum and does not block valves. In obstructive, the hypertrophy is higher and obstructs the aortic and mitral valve

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6
Q

You hear a systolic ejection murmur that increases with valsalva and standing and decreases with squatting and isometric hand grip. What is the most likely cause?

A

HCM

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7
Q

What are the 1st line options for symptomatic management of HCM?

A

Beta blockers or Non-dihydropyridine CCBs

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8
Q

What is the most common cause of RCM?

A

Amyloidosis

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9
Q

Periorbital purpura and heart failure is pathognomonic for what condition?

A

Cardiac Amyloidosis

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10
Q

What should you consider if you see bi-atrial enlargement on echo?

A

RCM

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11
Q

What is the treatment for stress cardiomyopathy?

A
  • immediate similar to acute MI, resolve trigger
  • At Dc, ASA, BB, and ACEI until LV fully recovers
  • Anticoagulation minimum of 3 months
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12
Q

How do you determine LVH on EKG?

A
  • If S in V1/V2 + R V5/V6 >35
  • R in aVL >11
  • R in 1 + S in III >25
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13
Q

How do you determine RVH on EKG?

A
  • RAD
  • R>S in V1
  • S>R in V6
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14
Q

What are the two shockable rhythms?

A

V fib and pulses Vtach

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15
Q

In what lead in the P wave normally negative?

A

AVR

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16
Q

What is the recommended treatment for persistent sinus tach in the setting of ACS?

A

Beta blockers

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17
Q

What is sick sinus syndrome?

A

Dysfunction of the sinus node that leads to a combination of sinus arrest with alternating paroxysms of atrial tachyarrythmias and bradyarrhythmias

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18
Q

What is the recommended treatment for sick sinus syndrome?

A
  • If stable, nothing
  • If unstable, atropine
  • Long term therapy, permanent pacemaker or defibrillator
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19
Q

What is first degree heart block?

A
  • Often a normal variant, when atrial impulses are delayed

- Prolonged PR >.20 seconds and all P waves are followed by a QRS

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20
Q

What is Wenckebach heart block?

A
  • Second degree block type 1 (Mobitz 1)

- Progressive PR lengthening until a QRS is dropped

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21
Q

What is the treatment for Mobitz 1?

A
  • If asymptomatic, no treatment

- If symptomatic, atropine and pacemaker is definitive

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22
Q

What is Mobitz II?

A
  • Interruption of electrical impulses at the AV node resulting in occasional non-conducted impulses, commonly seen in structural heart disease
  • Constant PR interval before and after non conducted beat
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23
Q

What is the management for Mobitz II?

A

Initial: transcutaneous pacing or atropine if symptomatic

-Definitive: Pacemaker because it often progresses to 3rd degree heart block

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24
Q

How do you determine RBBB on EKG?

A
  • QRS >0.12
  • M shaped RR’ in V1
  • Wide S wave in lead 1 and V6
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25
Q

How do you determine LBBB on EKG?

A
  • QRS >0.12 seconds

- Wide R wave in Leads 1 and V6

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26
Q

What is the recommended treatment for atrial flutter?

A

Stable: Vagal maneuvers, beta blockers, or Non-DP CCBs

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27
Q

What criteria is used to determine if a patient with non-valvular atrial fibrillation needs to be on anticoagulation?

A

CHA2DS2-VASc criteria

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28
Q

What is Wolff-Parkinson white syndrome?

A
  • Pre-excitation syndrome that is a type of AV reciprocating tachycardia (pSVT)
  • Accessory pathway is bundle of Kent
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29
Q

What is the treatment for stable Wolff-parkinson white?

A

Procainamide

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30
Q

What are some of the adverse effects of quinidine?

A
  • Increased QT and torsades
  • Diarrhea
  • Cinchonism (loss of hearing, angioedema, vertigo, tinnitus)
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31
Q

What is the DOC for acute ventricular arrhythmias?

A

Lidocaine

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32
Q

What is the treatment for Torsades?

A

IV mag sulfate

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33
Q

What are some of the side effects of amiodarone?

A
  • Pulmonary toxicity and fibrosis

- Neuro toxicities (tremor, ataxia, Blue/grey skin

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34
Q

What is the MOA of Amiodarone?

A

-Block potassium channels and prolong repolarization, widening the WRS and prolongin the Qt interval

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35
Q

What is the recommended outpatient regimen for stable angina?

A

Daily aspirin, BB, nitro, and daily statin

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36
Q

Which artery is typically associated with anterior infarctions?

A

LAD

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37
Q

Which artery is typically associated with inferior infarctions?

A

RCA

38
Q

Which artery is typically associated with lateral infarctions?

A

Circumflex

39
Q

What is the first line treatment for vasospastic angina?

A

CCBs

** avoid beta blockers, will lead to unopposed vasospasm

40
Q

Is DOE, PND, orthopnea, and fatigue typical of left or right HF?

A

Left

41
Q

What is a transudative pleural effusion?

A

Accumulation of fluid in a body cavity due to filtration fo blood serum across a physiology intake vascular wall

42
Q

What medications are recommended for hypertensive urgency?

A

Clonidine, captopril, Lasix, or Nicardipine

43
Q

What medications are recommended for HTN and Gout?

A

CCBs or Losartan

44
Q

What is the treatment for persistent orthostatic hypotension?

A

Fludrocortisone

45
Q

What physical exam findings are typical of endocarditis?

A
  • Fever, malaise
  • new onset murmur
  • Osler nodes on fingers, painful
  • Janeway lesions on palms, painless
  • Splinter hemorrhages
  • Roth spots
46
Q

What is the treatment of endocarditis of a native valve?

Prosthetic valve?

A

Native: Nafcillin plus either ceftriaxone or gentamicin
Prosthetic: Vanc + Gentamicin + rifampin

**duration is 4-6 weeks with aminoglycosides only for first 2 weeks

47
Q

What is constrictive pericarditis?

A

Loss of pericardial elasticity leading to restriction of ventricular diastolic filling

48
Q

What is a water hammer pulse?

A

Associated with aortic regurgitation, Swift upstroke and rapid fall in radial pulse accentuated with wrist elevation

49
Q

What is the most common cause of mitral stenosis?

A

Rheumatic heart disease

50
Q

On physical exam, you hear a diastolic murmur, S3 and S4 gallop, and bounding pulses. You also observe corrigans pulse (visible pulsation of the carotid). What diagnosis should you be considering?

A

Aortic regurgitation

51
Q

What is the treatment for symptomatic mitral valve prolapse?

A

Beta blockers

52
Q

What is carvallos sign?

A

Associated with tricuspid regurgitation, increased murmur intensity with inspiration

53
Q

What is an Austin flint murmur?

A

Low pitched rumbling diastolic heart murmur best heard at apex, associated with severe aortic regurgitation

54
Q

What will you see on CXR if there is aortic dissection?

A

Widened mediastinum

55
Q

What is the management of aortic dissection?

A
  • Acute proximal: surgery

- Descending distal: labetalol, SBP is rapidly lowered to a goal of 100-120 within 20 minutes

56
Q

What is Leriche syndrome?

A

PAD of the aortic bifurcation/common iliac, triad of claudication, impotence, and decreased femoral pulses

57
Q

What is the pharmacologic treatment for PAD?

A

Cilostazol (antiplatelet, PDE3 inhibitor), plavix, or aspirin

58
Q

What is Buergers disease?

A

Aka thromboangitis obliterans, nonatherosclerotic inflammatory small and medium vessel vasculitis
-strong correlation to smoking

59
Q

What is the treatment of Buergers disease?

A
  • Smoking cessation in mainstay

- Iloprost is a PG analog that may help with critical limb ischemia while smoking cessation is in progress

60
Q

What is atrial myxoma?

A

-Most common primary cardiac cancer, most commonly in LA and can mimic mitral stenosis (loud S1, diastolic murmur)

61
Q

What is felty syndrome?

A

RA+ Splenomegaly+ neutropenia

62
Q

What is the treatment for mild hidradenitis suppurativa?

A

Lifestyle changes and topical Clindamycin

63
Q

What is hidradenitis suppurativa?

A

Chronic follicular hair follicle obstruction, follicular rupture, and associated inflammatory response. Characterized by inflammatory nodules, abscesses, draining sinus tracts, and hypertrophic scarring

64
Q

What is the first line treatment for psoriasis?

A

High potency topical corticosteroids

65
Q

What is the typical outpatient management of angina pectoris (stable angina)?

A

Daily aspirin, beta blockers, nitro, and daily statin

66
Q

What is the definitive diagnostic test for angina pectoris?

A

Coronary angiography

67
Q

What is the most common cause of MI?

A

Atherosclerosis

68
Q

What is the most important treatment for a STEMI?

A

Repercussion within 90 minutes of arrival

69
Q

What is the medical management of a STEMI?

A

Beta blockers, NTG, Aspirin, Heparin, ACEI, and REPERFUSION

70
Q

Patient presets with angina that is new in onset, occurring at rests, and has been ongoing for more than an hour. On EKG, they ave ST depressions and T wave inversions. What should ou be concerned about?

A

Unstable angina or NSTEMI

***cardiac enzymes negative in UA

71
Q

Does an NSTEMI need reperfusion?

A

NO

72
Q

What is the first line treatment for vasospastic angina?

A

CCBs

Nitro is second line

73
Q

What kind of medication should be avoided in vasospastic angina?

A

Beta blockers because it can lead to unopposed vasospasm

74
Q

What is the difference between myocardial injury and myocardial infarction?

A

Myocardial injury results if ischemia progresses unresolved or untreated, but does not result in cell death. There will be ST changes.

Infarction is death of myocardial cells. Cardiac enzymes will be elevated, Q waves on EKG

75
Q

What are the characteristics of Myocardial ischemia on EKG?

A
  • Inverted T wave
  • Tall, peaked symmetrical T wave
  • Depressed ST segment
76
Q

What are the common side effects of contraindications to ACE inhibitors?

A

Side effects: Hyperkalemia, cough, angioedema

Contraindications: Pregnancy, bilateral renal artery stenosis, hypotension

77
Q

What is the first line medication for systolic heart failure and is the most effective medication for reducing mortality?

A

ACEI

78
Q

What is the first line medication management for orthostatic hypotension?

A

Fludrocortisone

79
Q

What is the first line medication for allergic rhinitis?

A

Intravascular glucocorticoids

80
Q

What is the most common type of esophageal cancer in the US and what are the main risk factors?

A

Adenocarcinoma

Main risk factors are Barrett’s esophagus, smoking, and increased BMI

81
Q

Which antiviral medications are only effective against flu A?

A

Adamantane and rimantadine

Oseltamivir and zanamivir are effective for A and B

82
Q

What is the most common cause of acute infective endocarditis?

A

S. Aureus

83
Q

What valve is most commonly affected in endocarditis?

A

Mitral, except tricuspid if it is drug related

84
Q

What is the treatment for Kawasaki disease?

A

IVIG and aspirin

85
Q

What is the most common murmur associated with marfans syndrome?

A

Mitral valve prolapse

86
Q

What is the most common valvular lesion in the elderly?

A

Aortic stenosis

87
Q

What is the first recommended intervention for a stable patient with Orthodromic atrioventricular reentrant tachycardia, common in WPW?

A

Vagal maneuvers

88
Q

Which antihypertensive agent is preferable for hypertensive emergency caused by pheochromocytoma?

A

Intravenous phentolamine

89
Q

What will you hear on auscultation of mitral valve prolapse?

A

Midsystolic click

90
Q

What is the treatment for beta blocker toxicity?

A

Glucagon

91
Q

What is eisenmenger syndrome?

A

When an unrestricted large VSD develops into a right to left shunt

FMED EOR (1 decks)

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