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1
Q

Worst risk factor for angina?

A

DM

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2
Q

Normal LVF

A

> 50%

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3
Q

Vessel assoc w/ I, aVL, V5/V6 (lateral)

A

Circumflex

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4
Q

Vessel assoc w/ II, III, aVF (inferior)

A

Right coronary

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5
Q

Vessel assoc w/ V1 and V2 (septal)

A

LAD

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6
Q

Vessel assoc w/ V3 and V4 (anterior)

A

LAD

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7
Q

Treating angina/CAD

A

ASA, BB (2: CCB), NTG

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8
Q

Definition of ACS

A

Clinical manifestions of plaque rupture and coronary occlusion
Includes USA, NSTEMI, STEMI

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9
Q

Treat USA

A

Admit, IV, O2

ASA, clopidogrel, BB, LMWH, nitrates

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10
Q

Atypical MI sx occur in what populations

A

Elderly, women, DM

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11
Q

EKG markers for cardiac ischemia

A

Peaked T waves, ST elevation, Q waves, T wave inversion, ST depression

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12
Q

Time frame of trops

A

Increase in 3-5 hours, normal in 5-14 days (peak 24-48 hours)

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13
Q

Post MI free wall rupture

A

Within 2 weeks (usually 1-4)

Hemopericardium and tamponade

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14
Q

Post MI IV septum rupture

A

Within 10 days

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15
Q

Post MI papillary muscle rupture

A

New mitral regurg

RCA (inferior MIs)

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16
Q

Post MI pseudoaneurysm

A

Incomplete free wall rupture

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17
Q

Dressler

A

Autoimmune pericarditis

6-8 weeks

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18
Q

Signs of left sided heart failure

A

Left PMI, S3, S4, crackles/rales at the bases

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19
Q

Signs of right sided heart failure

A

Edema, JVD, hepatomegaly/hepatojugular reflux,

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20
Q

Ddx for flash pulmonary edema

A

PE, asthma, pneumonia

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21
Q

Cardioversion vs defib

A

Cardioversion is synchronized (dont hit the T wave)

Defib vfib

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22
Q

Treat acute/unstable afib

A

BB for rate control
<48 hrs: shock
>48hrs or unknown: TEE or anticoagulate for 3 weeks, shock
Both get anticoagulation for 4 weeks after

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23
Q

Multifocal atrial tachycardia

A

Severe pulmonary disease

3 different P wave morphologies

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24
Q

Most common arrhythmia associated with dig toxicity

A

Paroxysmal atrial tachycardia with 2:1 block

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25
Q

WPW

A

Accessory conduction pathway

Narrow complex tachycardia, short PR interval and delta wave

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26
Q

Cannon A waves

A

When atria and ventricle contract together

Seen in 3rd AVB, pulmonary hypertension, VT

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27
Q

Sick SInus Syndrome

A

Spontaneous sinus bradycardia

Elderly

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28
Q

ECG changes seen in pericarditis

A
  1. Diffuse ST elevation and PR depression
  2. ST normal
  3. T wave inversion
  4. T wave normal
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29
Q

CP that improves with sitting up and leaning forward

A

Acute pericarditis

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30
Q

Kussmaul sign

A

JVD fails to decrease during inspiration

Right sided heart problems, PE, restrictive pericarditis

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31
Q

Pericardial knock

A

abrupt cessation of ventricular filling

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32
Q

When will a CXR show a pericardial effusion?

A

> 250mL of fluid

“water bottle” appearance

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33
Q

Cardiac tamponade fluid amounts

A

200mL quickly or 2L slowly

34
Q

Impairment in cardiac tamponade

A

Ventricular filling during diastole

35
Q

Clinical features of tamponade

A

Elevated JVP (prominent x with absent y)
Narrowed pulse pressure (decreased stroke volume)
Pulsus paradoxus (>10mm decrease in atrial pressure during inspiration)
Muffled heart sounds
Cardiogenic shock (tachypnea, tachycardia, hypotension)

36
Q

EKG of tamponade

A

Electrical alternans (not sensitive or specific)

37
Q

Cause of mitral stenosis

A

Almost all are rheumatic heart disease

38
Q

Sequela of long standing mitral stenosis

A

Asymptomatic until area is ~1.5cm2

Pulmonary HTN, right sided heart failure, afib

39
Q

Murmur of mitral stenosis

A

Opening snap followed by a diastolic rumble (murmur increases in length as stenosis worsens)
Distance between S2 and opening snap closer as stenosis worsens
Murmur followed by a loud S1

40
Q

Common life things that cause symptomatic mitral stenosis

A

Exercise and pregnancy

41
Q

Echo of mitral stenosis

A

Left atrial enlargement
Thick, calcified valve
“fish mouth” opening

42
Q

Sequela of long standing aortic stenosis

A

Cardiac output fails to increase with exertion when area falls below 0.7 (<0.8 considered severe)
LVH/LV dilation -> LV dysfunction -> pulling apart of mitral valve -> mitral regurg

43
Q

Causes of aortic stenosis

A

Bicuspid aortic vale, calcification with age, rheumatic fever

44
Q

Murmur/Signs of aortic stenosis

A

Harsh crescendo-decrescendo murmur that radiates to carotids
Soft S2, S4
Parvus et bardus (delayed carotid upstroke)
Precordial thrill

45
Q

Murmur/Clinical features of aortic regurg

A

Diastolic decrescendo murmur at the left sternal border
Wide pulse pressure (increased systolic BP)
Corrigan/water hammer pulse (rapidly increasing pulse that collapses suddenly)
Austin Flint murmur (low pitched diastolic rumble)

46
Q

Clinical features of tricuspid regurg

A 
Looks like RVF (edema, hepatomegaly etc)
Pulsatile liver
Prominent V waves in JVP
Blowing, holosystolic murmur
Afib
47
Q

Classifying aortic dissection

A

A: proximal (even if as an extension from descending)
B: Distal; just descending (distal to subclavian)

48
Q

Manage aortic dissection

A

BB immediately (lower HR and force of EF), sodium nitroprusside to lower systolic BP
A: surgical
B: medical

49
Q

Sx of acute arterial occlusion

A

Pain, pallor, polar (cold), paralysis, paresthesias, pulselessness

50
Q

Venous ulcers

A

Not as painful as arterial, over medial malleolus

51
Q

Sx of peripheral vascular disease

A

(arterial insufficiency)
Claudication, pain at night (distal metatarsals; improves with foot over bed)
Diminished pulses, hairless, thick toenails

52
Q

Definition of cardiogenic shock

A

BP <90 with urine output <20mL/hr and adequate LV filling pressure

53
Q

Pathophys of chronic bronchitis

A

Excess mucous production -> inflammation and scarring, smooth muscle hyperplasia -> obstruction

54
Q

Pathophys of emphysema

A

Smoke increases activated PMNs and macrophages -> release protease/elastase (relative deficiency of antiprotease)

55
Q

LFTs in COPD

A

FEV1/FEV decreased
FEV1 decreased
TLC increased

56
Q

Esophageal perforation

A

Often seen with pedestrian vs vehicle trauma or instrumentation
Green discharge from tube
Dx with esophagography

57
Q

Fetal hydantoin syndrome

A

Cleft lip/palate
Distal phalangeal hypoplasia
Microcephaly

58
Q

Murmur most likely to be heart with infectious endocarditis from IVD use

A

Holosystolic murmur that increases with inspiration

59
Q

Friedreich Ataxia

A

GAA repeats; abnormal frataxin protein (highly expressed in brain, heat and pancreas)
Neurologic dysfunctions, cardiomyopathy, DM
Loss of dorsal spinal column -> decreased vibration and position
Kyphoscoliosis and pes cavus

60
Q

Acute cerebellar ataxia

A

Acute onset following infection

Ataxia, nystagmus and dysarthria

61
Q

Pancoast tumor

A

Shoulder pain, Horner Syndrome, C8-T2 problems, supraclavicular lymph nodes

62
Q

FAS

A

Short palpebral fissures, thin upper lip, smooth filtrum
Growth retardation
Occurs via inhibition of NMDA and over activation of GABA

63
Q

Post surgery fever, tremor, lid lag but no muscle rigidity

A

Thyroid storm (even if no known thyroid disease)

64
Q

Cupping of optic disc

A

Glaucoma
Close is acute
Open is chronic

65
Q

Acalculus cholecystiti

A

Seen in trauma, surgery, ICU patients, prolonged fasting
Fever, leukocytosis, elevated LFTs
Abdominal US

66
Q

Sickle cell can lead to what kind of kidney damage

A

Renal papillary necrosis (and renal medullary carcinoma)

67
Q

Sx of adrenal insufficiency

A

HyperK, hypoNa, hypotension

Hyperpigmentation, thinning hair

68
Q

Liver sequelae of polycythemia vera?

A

Budd Chiari syndrome due to venous thrombosis (abdominal US)

69
Q

New onset, drug resistant HTN

A

pheochromocytoma

70
Q

New dx pseudogout; next step?

A

R/O secondary causes: hyperparathyroidism, hypothyroidism, hemochromatosis

71
Q

Kidney issues with long term analgesic use

A

Tubulointersitial nephritis and papillary necrosis

72
Q

Most common anatomical location for ectopic foci causing afib

A

pulmonary veins

73
Q

Mediastinal mass with elevated bHCG and AFP

A

nonseminomatous germ cell tumor

74
Q

Associations predisposing to membranous nephropathy

A

SLE and HepB

75
Q

Associations predisposing to FSGS

A

HIV, heroin, sickle cell

76
Q

NT in Huntingtons

77
Q

Huntingtons

A

Chorea, delayed saccades, depression, loss of executive function

78
Q

Concerning sequela of prong longed seizure

A

Cortical necrosis

79
Q

Video vs esophageal motility in evaluating difficulting swallowing

A

Associated coughing/choking/difficulty initiating, do the video

80
Q

Medullary thyroid cancer is associated with

A

RET

cancer of parafollicular (calcitonin secreting) cells

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