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hammer18 Flashcards

1
Q

What are key features of third degree AV block?

A

Bradycardia, cannon A waves

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2
Q

What are key features of tamponade/free wall rupture?

A

Sudden loss of pulse, JVD

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3
Q

What are key features of RV infarction?

A

Inferior wall MI in history, clear lungs, tachycardia, hypotension with nitroglycerin

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4
Q

What are key features of valve rupture?

A

New murmur, rales/congestion

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5
Q

What are key features of septal rupture?

A

new murmur, increase in O2 saturation on entering the right ventricle

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6
Q

What are key features of ventricular fibrillation?

A

Loss of pulse

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7
Q

What 6 post infarction medications should everyone go home with?

A

Apirin, betablockers, statins, ACE inhibitors, clopidogrel or prasugrel or ticagrelor if they are intolerant of aspirin, ARBs if they have cough on ACE inhibitor

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8
Q

What medications are good for anterior wall MI? What medications cause erectile dysfunction commonly?

A

ACEi. Betablockers.

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9
Q

What is the essential feature of CHF? What are CI, SVR and LVEDV values? What are other features of CHF? What is one test that is essential for CHF?

A

Dyspnea. CI is decreased, SVR and LVEDV is increased. Orthopnea, rales, JVD, paroxysmal nocturnal dyspnea, S3 gallop rhythm. Echocardiography.

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10
Q

What is the most accurate test for ejection fraction? WHen do you use it?

A

Nuclear ventriculography or Meultiple gated acquisition scan to check for cardiotoxicity during doxyrubicine treatment

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11
Q

What is the management of a patietn with severe CHF who develops gynecomastia?

A

Switch spirnolactone to eplerenone since it doesnt have antiandrogenic effects

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12
Q

What devices do you use for CHF treatment and what are the indications?

A

Implantable defibrillator - Ischemic cardiomyopathy and EF below 35%.
Biventricular pacemaker - EF below 35% and wide QRD above 120 milliseconds with persistent symptoms

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13
Q

What medications provide mortality benefit in Systolic dysfunction?

A

ACEi/ARBS, betablockers, spirnolactone or eplerenone, Hydraliazine/nitrates, implantable defibrilator

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14
Q

What medications are beneficial for CHF with preserved EF (diastolic dysfunction)?

A

Beta blockers and diuretics. Don’t use diuretics in HOCM.

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15
Q

What is the most important test to do in acute Pulmonary edema?

A

EKG because it can lead to cardio version if the cause of the pulmonary edema is afib, aflutter or ventricular tachycardia.

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16
Q

What are the symptoms of acute pulmonary edema dn what is the first initial step?

A

Acute onset of shortenss of breath plus rales, JVD, S3 gallop, edema, orthopnae

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17
Q

What is the treatmetn of patients with acute pulmonary edema?

A

Oxygen, loop diuretics, morphine, nitrates. Dobutamine, amrinone and milrinone can be used in an acute setting as they increase contractablity and decrease afterload.

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18
Q

What causes increase in murmurs on teh right side? left side?

A

Right side inhalation which brings back blood through the right heart. Left side exhalation which releases blood into the left side.

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19
Q

What is the best initial test in valvular heart disease? Most accurate test?

A

Echocardiogram. Catherization

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20
Q

What are unique presentations of Mitral stenosis?

A

Dysphagia from LA compressing esophagus
Hoarseness from LA pressing laryngeal nerve
Atrial fibrillation and stroke from enormous LA
Hemoptysis. Opening snap murmur

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21
Q

What are EKG findings in Mitrial stenosis?

A

Biphasic pwaves in V1 and V2

22
Q

What are CXR findings in mitral stenosis?

A

Straightening of the left heart border, elevation of the left main-stem bronchus, second “bubble” behind the heart

23
Q

What is the treatment for Mitral stenosis?

A
  1. Diuretics and sodium restriction 2. Balloon valvuloplasty 3. Valve replacement only when a catheter procedure cannot be done, or fails 4. Warfarin for atrial fibrillation to an INR of 2 to 3 5. Rate control of afib with digoxin, BB or CCBs
24
Q

What is the presentation of aortic stenosis? Diagnostic tests?

A

Angina, syncope ,CHF - poorest prognosis. TTE, then TEE, then catherization

25
Q

What are EKG findings in aortic stenosis? Treatment?

A

LVH. S wave in V1 plus an R wave in V5 greater than 35 mm . Valve replacement

26
Q

What is the murmur in mitral regurgitation and treatment?

A

Pansystolic murmur. ACEIs or ARBs are best. Can add Digoxin and diuretics.

27
Q

What are unique presentations of aortic regurgitation?

A

Wide pulse pressure, water hammer (wide-bounding) pulse, Quincke pulse (pulsations in nail bed), Hill sign (BP in legs as much as 40mm Hg above arm BP), head bobbing (de Musset sign)

28
Q

What is the treatment for aortic regurgitation?

A

ACEi/ARBs or nifedipine as vasodilators will increase forward flow of blood and delay progression

29
Q

What is the presentation of MVP? What is the best initial treatment?

A

Atypical chest pain, palpitations, panic attack. Beta blockers.

30
Q

What murmurs do not increase with expiration?

A

MVP and HOCM

31
Q

What medications lower mortality in dilated cardiomyopathy?

A

ACEi, ARBs and BB

32
Q

What makes hypertrophic obstructive cardiomyopathy worse? Best initial test?

A

Anything that decreases left ventricular chamber size (e.g. ACEi, ARBs, digoxin, hydralazine, Valsalva and udeenly standing. Echo

33
Q

What is the treatment for HOCM?

A

Beta blockers, Negative inotropes like Verapamil and disopyramide. NO DIURETICS.NO SPIRNOLACTONE Implantable defibriallotrs if syncope and ablation of septum. Surgical myomectomy if therapy fails.

34
Q

What contributes to obstruction i HOCM?

A

Systolic anterior motion of mitral valve

35
Q

What does valsalva do for MVP and HOCM? handgrip?

A

Increases the murmurs. Decreases murmurs.

36
Q

What is the difference between handgrip and amyl nitrate?

A

Handgrip increaseas afterload thereby decreasing ventricular emptying. Amylnitrate increases emptying making HOCM and MVP worse.

37
Q

What is a specific finding on EKG for pericarditis? What drug decreases recurrence?

A

PR depression. St is elevated in all leads.Colchicine

38
Q

What are EKG and echo findings in pericardial tamponade?

A

Electrical alterans (different heights of QRS complexes between beats). Echo shows right atrial and ventricular diastolic collapse.

39
Q

Which findings are associated with constricitve pericarditis and what is best initial test? Treatment?

A

Kussmaul sign - increase in JVD on inhalaition and pericardial knock. CXR. Diuretics and surgical removal.

40
Q

What is the diagnostic test for Peripheral artery disease?

A

ABI less than 0.9. Aspirin, smoking cessation, cilostazol is most effective medication.

41
Q

What is the best initial test for acute aortic dissection? What is the most accurate?

A

CXR. CT angiogram.

42
Q

What is the management of aortic dissection?

A

Control BP. Give BB first, then nitroprusside then surgical correction.

43
Q

What is the worst cardiac defect in pregrnant women?

A

Peripartum cardiomyopathy.

44
Q

What organisms does Amoxicillin cover?

A

H. influenza, E. coli, listeria, proteus, salmonella

45
Q

What are some penicilinase resistant penicillins and what do they treat?

A

Oxacillin, cloxacillin, dicloxacillin. Skin infections like impetigo, erysipelas, endocarditis, meningitis, bacteremia f, osteomyelitis and septic arthritis

46
Q

What are pip tazo used to treat?

A

Cholecystitis, ascending cholangitis, pyelonephritis, bacteremia, Hospital acquired and Ventilator associated PNA, Neutropenia and fever

47
Q

Which cephalosporins cover anerobes? What do they treat and what is the contraindication?

A

Only cefotetan and cefoxitin. PID combined with doxycycline. Increase risk of bleeding and disulfram reaction with alcohol.

48
Q

Which cephalosporin covers MRSA? Pseudomonas?

A

Ceftaroline. Ceftazidime

49
Q

What is the adverse effect of cephalosporins?

A

Cefoxitin and cefotetan deplete prothrombin and increase risk of bleeding. Ceftriaxone has inadequate biliary metabolism.

50
Q

What is the purpose of aztreonam?

A

Monobactam that only treats gram negative bacilli including pseudomonas and has no cross reaction with penicillin

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