Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Step 3 > Internal Medicine > Flashcards

Internal Medicine Flashcards

1
Q

The best “initial” diagnostic test for for ischemic type pain is ?

Note : If the case is very very typical of chest pain or ischemic type pain

A

EKG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

If in ischemic type pain ( chest pain ) they give you to choose between EKG and treatment with aspirin , nitrates , oxygen and morphing , wha would you choose first ?

A

Treatment first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Answer :

Who Binds to calcium to activate actin/ myosin interaction

A

Troponin C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Binds to tropomyosin

A

Troponin T

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Blocks or inhibits actin / myosin interaction

A

Troponin i

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

In ischemic attack, which enzymes rise at 3-6 hours after the start of the chest pain ?

A

1- CK- MB ( stays elevated 1-2 days )

2- Troponin ( stays elevated 1-2 weeks )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Best enzyme to diagnose re-infarction is ?

A

CK-MB ( stays elevated only for 1-2 days )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The most “accurate “ test for ischemic type pain is ?

A

CK-MB and troponin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which enzyme rise first in ischemic attack ?

A

Myoglobin ( 1-4 hours after the chest pain starts )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The “stress “ test used in obese and big- breast patients with CAD is ?

A

Sestamibi nuclear stress test ( this radioisotope penetrates best the tissue )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The 3 “stress test” used for patients who can not exercise to a target heart rate of > 85 % of maximum are ??

A

1- Dypiridamol or 2- adenosine thallium or 3- dobutamine echo

Note : patients with
1- COPD 
2- Amputation 
3- Deconditioning 
4- weakness / previous stroke 
5- lower extremity ulcer 
6- dementia 
7- obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q 
Note : patients with the following conditions will benefit from the 3 “stress test “ called 
1- COPD 
2- Amputation 
3- Deconditioning 
4- weakness / previous stroke 
5- lower extremity ulcer 
6- dementia 
7- obesity
A

1- Dypiridamol or 2- adenosine thallium or 3- dobutamine echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If the stress test is unreadable for ischemia, what type of stress test (2) would you use ?

A

Exercise thallium stress test or stress echocardiography
Patients with:
1- left bundle branch block
2- digoxin use
3- pacemaker in place
4- left ventricular hypertrophy
5- any baseline abnormality of ST segment of the EKG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Patients with the following conditions will benefit from the “ stress tests “ called ?? ( 2 )
1- left bundle branch block
2- digoxin use
3- pacemaker in place
4- left ventricular hypertrophy
5- any baseline abnormality of ST segment of the EKG

A

Exercise thallium stress test or stress echocardiography ( used when EKG is unreadable )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Best initial test for evaluating valve function or ventricular wall motion is ?

A

Echocardiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Most accurate method to evaluate ejection fraction is ?

A

Nuclear ventriculogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If angiogram has already been done in a patient with positive CAD and still with symptoms, the next best step is ?

A

CABG ( coronary artery bypass graft )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The isotope that is used I stress tests when the EKG is unreadable is called ( blank ) ? And the mechanism of action is through ……..?

A

Thallium ( isotope ) . The mechanism of action is through:
Na/K/ ATPase of normal myocardium that picks the isotope when the tissue is alive ( because thallium looks like potassium )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Answer : Can you have an ACS with a normal EKG ?

A

Yes , because acute coronary syndrome is NOT based on enzyme levels , or angiography or stress test results or even EKG …… it is based on history of chest pain with features suggestive of ischemic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Mention the 3 medications added to anyone getting an angioplasty and stent ( they inhibit ADP activation of platelets )

A

1- Clopidogrel
2- Ticagrelor
3- Prasugrel ( causes more bleeding that is why is given only when angioplasty is done ) . The other 2 can be given with aspirin for patients with acute myocardial infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Mention (from the drugs inhibiting ADP activation of platelets ) which is the only one given during angioplasty ??

A

Prasugrel ( causes more bleeding that is why is given only when angioplasty is done ) . The other 2 can be given with aspirin for patients with acute myocardial infarction ( they are clopidogrel and ticagrelor )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Mention : P2Y12 Antagonists that block the aggregation of platelets by inhibiting ADP activation of the P2Y 12 receptor

A

Ticagrelor
Clopidogrel
Prasugrel
The last 2 are in thienopyridine class

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What treatment has the single greatest efficacy in lowering mortality in STEMI when thrombolytics are contraindicated ??

A

“Urgent “ angioplasty or PCI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Chest pain for < 12 hours and ST segment elevation in 2 or more leads or a new LBBB . What is the next step in management ????

A

Thombolytics ( should be given within 30 minutes of patient arrival in ED with pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Mention who can :

Activate plasminogen into plasmin so plasmin can chop up fresh or newly formed fibrin strands into D-dimers

A

Thrombolytics ( that is why clots elevate D- dimers )

Note : when fibrin clots are stabilized by factor XIII then plasmin will not cleave fibrin anymore

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What groups ( 2 ) of medication should be given to anyone with ACS , but they only lower mortality when there is “ left ventricular dysfunction “ or systolic dysfunction “ ( ejection fraction is low )

A

ACE inhibitors and ARBs ( angiotensin receptor blockers )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the most common cause of death in CHF and MI ?

What medication group lower mortality if given ( no need to give “urgent” as aspirin ) to the ischemic patient ??

A

1- “ventricular “ arrhythmia

2- Beta blockers because they are both anti- ischemic and anti- arrhythmic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

The Platelet inhibitor ( or antagonist ) that is associated with neutropenia is called ??

A

Ticlopidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When is pacemaker the answer for acute MI ? ( mention the 5 main causes )

A 
1- Complete heart block ( 3rd degree) 
2- Mobitz ll second degree AV- block 
3- BIFASCICULAR BLOCK 
4- New LBBB 
5- Symptomatic bradycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When is lidocaine or amiodarone the answer for acute MI ?

A

Ventricular tachycardia or ventricular fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Mention the 2 main diagnostic tests for cardiogenic shock

A

Echocardiogram and Swan- Ganz ( right heart ) catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Mention the 2 best options of treatment is a patient with cardiogenic shock

A

ACE inhibitors and urgent revascularization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Best diagnostic test in a patient with valve rupture

A

Echocardiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Mention the Best 3 treatment choices “before surgery” in a patient with valve rupture

A

ACE inhibitors,
Nitroprusside
Intra-aortic balloon pump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Best diagnostic tests ( 2 ) in a patient with septal rupture

A

1-Echo and
2- right heart catheter ( or Swan- Ganz ) catheter ( shows a step up in saturation from the right atrium to the right ventricle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Best treatment choices ( 2 ) in a patient with a septal rupture “before URGENT surgery “

A

ACE inhibitors

Nitroprusside

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Best diagnostic test for myocardial wall rupture

A

Echocardiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Best treatment choice (2 ) in a patient with myocardial wall rupture . Mention the 2 consecutive way of action

A

Pericardiocentesis and urgent cardiac repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Best treatment choice in a patient with right ventricular infarction

A

Fluid loading ( first diagnose with EKG showing right ventricular leads )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

For how long is the waiting “to have sex “ after a myocardial infarction ?

A

2-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Mention the 3 best treatment choices that “Lower mortality in NSTEMI “

A

1-Heparin ( Better is low molecular weight )
2- GP llb / llla inhibitors ( eptifibatide , tirofiban , abciximab )
3- angioplasty/ PCI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Mention the 3 drugs belonging to the group : GP llb / llla inhibitors

A

GP llb / llla inhibitors ( eptifibatide , tirofiban , abciximab )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

The single greatest benefit from : GP llb / llla inhibitors in a patient with ACS , comes with their association with :

A

Angioplasty and stent placement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What medication potentiates the effect of antithrombin which is in charge of the inhibition of almost every step of the clotting cascade ?

A

Heparin ( prevents new clots from forming ) . Does not work in patients with “ antithrombin “ deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

If chest pain persist after adding nitrates in a patient with ACS , you most add ??

A

Ranolazine ( anti-angina medication added if other can’t control pain )
or ivabradine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

The 4 indications for CABG are ??

A

1- three coronary vessels with > 70 % stenosis
2- left main coronary artery stenosis > 50-70 percent
3- two vessels in a diabetic patient
4- 2 or 3 vessels with low ejection fraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Indications for CABG are (4 ) ?

A
  • 3 coronary vessels with > 70 % stenosis
  • left main coronary artery stenosis > 50-70 %
  • 2 vessels in a diabetic
  • 2 or 3 vessels with low ejection fraction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Goal of therapy with statins in CAD is an LDL less than ??

A

> 70 ( statins are used for any CAD or equivalent like diabetes with LDL > 100 )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Use statins is the 10 year risk of CAD is > of ????

A

> 7.5 %

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

The 4 CAD equivalents are ??

A
  • Diabetes
  • PAD
  • Aortic disease
  • Carotid disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

The most common adverse effects of statins therapy is ??

A

Liver toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Mention 2 PCSK9 inhibitors ?

This drugs inhibit PCSK9 which blocks the clearance of LDL by the liver from the blood. This drugs can bring down enormous amounts of LDL in familial hypercholesterolemia . Are injectable . Are the answer when statins are used at maximum doses and still LDL is not controlled

A

Evolocumab and alirocumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Every patient with CAD and stroke should be on ?

A

Statins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Most patient with diabetes should be on ??

A

Statins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Patients with > than 10% ten-year risk of CAD or > 7.5% as well should be on ??

A

Statins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

The 4 pilars of treatment in a patient with pulmonary edema are ?

A

Oxygen , furosemide , nitrates and morphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

The sound on S3 gallop is ?

A

Splash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

The sound on a S4 gallop is ??

A

Bang !

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Mention the 4 Pilars in tests in a patient with pulmonary edema .

This tests are indicated at the same time that treatment with nitrates -morphine- oxygen and furosemide ( in CCS)

A
  • CXR
  • EKG
  • Oximeter / consider also ABG
  • Echocardiogram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What agent ( drug group ) is given in pulmonary edema when preload reduction fails to suppress the SOB ? ( that is when clock is moved forward for 30-60 minutes and still there is SOB )

A

Positive inotropes ( dobutamine , milrinone , inamrinone )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Mention 3 drugs used for sustained ventricular tachycardia that is hemodynamically stable ….

A

Amiodarone , procainamide and

Lidocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Mention a synthetic version of atrial natriuretic peptide used in acute pulmonary edema as part of preload reduction

A

Nesiritide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

A normal ( blank ) level excludes CHF . Fill the blank

A

BNP ( is indicated when the diagnosis is not clear ….. can distinguish from pulmonary embolism, pneumonia , asthma and CHF )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Fill the blank by using “ decrease “ and increase “ in the following patient with : pulmonary edema “””that has a right heart catheter placed “””

  • cardiac output
  • systemic vascular resistance
  • wedge pressure
  • right atrial pressure
A
  • decreased
  • increased
  • increased
  • increased
65
Q

Fill the blank by using “ decrease “ and increase “ in the following patient with : hypovolemic shock “ “””that has a right heart catheter placed “””

  • cardiac output
  • systemic vascular resistance
  • wedge pressure
  • right atrial pressure
A
  • decreased
  • increased
  • decreased
  • decreased
66
Q

Fill the blank by using “ decrease “ and increase “ in the following patient with : septic shock “””that has a right heart catheter placed “””

  • cardiac output
  • systemic vascular resistance
  • wedge pressure
  • right atrial pressure
A
  • increased
  • decreased
  • decreased
  • decreased
67
Q

Fill the blank by using “ decrease “ and increase “ in the following patient with : pulmonary hypertension “””that has a right heart catheter placed “””

  • cardiac output
  • systemic vascular resistance
  • wedge pressure
  • right atrial pressure
A
  • decreased
  • increased
  • decreased
  • increased
68
Q

Wedge pressure is the same as ….?

A

Left atrial pressure ( increased with left ventricular failure)

69
Q

All patients after stabilized from acute pulmonary edema should have a ( blank ) to check for systolic with low ejection fraction or diastolic dysfunction with normal ejection fraction

Fill the blank

A

Echocardiogram

70
Q

The beta blockers with evidence of lowering mortality are ( 3 )

A

Metoprolol
Carvedilol
Bisoprolol

71
Q

In CHF with systolic dysfunction, when ACE inhibitors or ARBs can’t be used then we must use the combination of …..?

A

Hydralazine and nitrates

72
Q

In CHF , the diuretic ( blank ) lowers mortality only in advance symptomatic disease

Fill the blank

A

Spironolactone ( any patient originally presenting with pulmonary edema should spironolactone )

73
Q

The diuretic ( blank ) causes gynecomastia and erectile dysfunction in men so you must switch to ( blank )

A

Spironolactone….. switch to eplerenone ( mineralocorticoid antagonist that lowers mortality….without androgenic side effects of spironolactone )

74
Q

In CHF with systolic dysfunction after using : ACE inhibitors, beta blockers , diuretics , digoxin and mineralocorticoids inhibitors ; the patient is still dysgenic ……. what drug would you use now ??
Mention 1 drug and 1 combination of drugs

A

1- drug ( Ivabradine ) . Used if Pulse > 70 or beta blockers can’t be used in systolic dysfunction . Is a SA nodal inhibitor of “ funny channels “ that slows the HR

2- combination ( Sacubitril / Valsartan ). Used instead of ACE inhibitors. Sacubitril is only added to an ARBs as for example : valsartan

75
Q

Mention the 6 groups of medication or combinations used in CHF with systolic dysfunction

A 
1- ACE inhibitors or ARBs 
2- Metoprolol , carvedilol or bisoprolol 
3- spironolactone or esplerenone 
4- Diuretics 
5- Digoxin 
6- Hydralazine / Nitrates
76
Q

Mention the 2 groups of medication used in CHF with diastolic dysfunction

A
  • metoprolol, carvedilol and bisoprolol

- diuretic

77
Q

A patient with CHF that feels good but has a EF of 23% in “ the last 6 months “ may benefit from …?

A

Implantable cardioverter / defibrillators ( indicated in dilated cardiomyopathy because the most common cause of death in CHF patients is sudden death from arrhythmia. Those with EF below 35 “”that persist “” are candidates for implantable defibrillators

78
Q

If a patient with CHF is still SOB and has a wide QRS ( > 120 ) you must resynchronize him with a ……?

A

Biventricular pacemaker ( used in a those with severe CHF because in them lowers mortality) . To use when EF < 35 and QRS > 120 . This is called : “ Cardiac resynchronization therapy “”

79
Q

Wide QRS means the ventricles are not beating together so there is inefficient forward flow ….. so you must use ( like in a patient with CHF ) a ???????

A

Biventricular pacemaker . The effect is instant

80
Q

The most common causes of valvular heart disease in young patients are ?? ( 4)

A

Mitral valve prolapse
HOCM
Mitral stenosis
Bicuspid aortic valve

81
Q

Must common valvular disease in a patient with :

Turner’s syndrome and Coartation of the aorta is ??

A

Bicuspid aortic valve

82
Q

A young female with palpitations and atypical chest pain NOT with exertion probably has ?

A

Mitral valve prolapse

83
Q

In CCS in a patient with valvular disease , what exams would you check on the physical exam ?? ( 3 )

A

Cardiovascular
Chest
Extremities

84
Q

Mention the 4 most common causes of systolic murmurs

A

Aortic stenosis
Mitral regurgitation
Mitral valve prolapse
HOCM

85
Q

Mention the 2 most common causes of diastolic murmurs

A

Aortic regurgitation

Mitral stenosis

86
Q

Fill the blank

All right- sided murmurs increase in intensity when you order the patient to perform ( blank ) ?

A

Inhalation

87
Q

Fill the blank

All left- sided murmurs increase in intensity when you order the patient to perform ( blank ) ?

A

Exhalation

88
Q

In the 4 groups of maneuvers for valvular diseases the ones (2) that increase the venous return and so increase the “murmurs “ in the following entities is called ????
- aortic and mitral STENOSIS
- aortic and mitral REGURGITATION
- VSD
Note: The exemption to the rule are 2 conditions called ( blank and blank ) ????

A
  • Maneuvers : squatting and leg raising
  • HOCM and mitral valve prolapse ( decrease the murmur because ventricles receive much blood and this conditions improve when ventricles are ingurgitated with blood )
89
Q

In the 4 groups of maneuvers for valvular diseases the ones (2) that decrease the venous return and so decrease the “murmurs “ in the following entities is called ????
- aortic and mitral STENOSIS
- aortic and mitral REGURGITATION
- VSD
Note: The exemption to the rule are 2 conditions called ( blank and blank ) ????

A
  • standing and Valsalva maneuvers
  • HOCM and Mitral valve prolapse ( increase the murmur because ventricles receive less blood and this entities get worse when ventricles are thinner or not full with blood )
90
Q

In the 4 groups of maneuvers for valvular diseases the “one “ that increases afterload and behaves as the OPPOSITE from ACE inhibitors worsening the murmur of conditions that would get better with ACE inhibitors ( like MR , AR and VSD ) is called ( blank ) ??

This maneuver only makes improvement in the 2 conditions called ( blank and blank ) ??

A

Handgrip maneuver ( only improves the murmur of HOCM and MVP because allows the ventricles be more filled out with blood and so this makes these conditions better and their murmurs softens )

91
Q

In the 4 groups of maneuvers for valvular diseases the “one “ that decreases afterload and behaves like ACE inhibitors improving the murmur of conditions that would get better with ACE inhibitors ( like MR , AR and VSD ) is called ( blank ) ??

This maneuver only worsens two conditions called ?

A

Amyl nitrate ( is the opposite from handgrip maneuver ) . This maneuver worsens the murmur in HOCM and MVP because ventricles are less fill out with blood and so this worsens these specific conditions

92
Q

What does handgrip do to the murmur of aortic stenosis ??

Softens or louder the murmur ??

A

Softens the murmur because prevents the blood from leaving the ventricles . Is like covering up a trumpet so the air won’t go out . This happens because the gradient goes down with the increased afterload ( gradient between the left ventricle and the aorta ) , so less gradient less murmur and viceversa

93
Q

What does Amyl nitrate do to the murmur of aortic stenosis ??

Softens or louder the murmur ??

A

Harden the murmur because decreases afterload because is a vasodilator and by doing this increase the gradient between the left ventricle and the aorta so the murmur is louder

94
Q

The effect of handgrip and Amyl nitrate in “ mitral stenosis “ is ??

A

None …. or negligible

95
Q

The best initial diagnostic test for valvular lesions on single best answer questions is ?

A

Echocardiogram ( order TTE first in CCS, then order TEE second if still no diagnosis )

Note : on CCS cases you should also add
EKG , and CXR ( looking for hypertrophy due to the valvular lesion )

96
Q

The most accurate diagnostic test for valvular lesions is ?

A

Left heart catheterization

97
Q

In “CCS “ cases in valvular lesions, besides the TTE , TEE and left heart catheterization , what other 2 tests you must order ??

A

EKG and CXR

98
Q

What is the best choice of treatment for regurgitant valvular lesions ?

A

Vasodilators such as ACE inhibitors, ARBs and nifedipine ( because they cause afterload reduction )
Note : when vasodilation is not enough then use surgery

99
Q

Stenotic valvular lesions are best treated with ….( blank ) but in some cases like mitral stenosis a patient should undergo ( blank , blank ) even if the patient is pregnant

A 
Anatomic repair ( surgery ) 
Balloon valvuloplasty ( even if the patient is pregnant )
100
Q

answer yes or no the following question :
In valvular lesions where “valsalva and standing maneuvers “ improve the murmur :
“ diuretics are or aren’t indicated “

A

Are indicated ( yes ) . This lesions are :
1- Aortic stenosis
2- Aortic regurgitation
3- Mitral stenosis
4- Mitral regurgitation
5- VSD
Note : in mitral stenosis balloon valvuloplasty is better than diuretics …… and in aortic stenosis valvular replacement is better than diuretics
Note : valsalva maneuvers decrease venous return so murmur softens ( less blood less murmur )

101
Q

In the following lesions mention “yes or no “ if diuretics are or aren’t indicated

1- Aortic stenosis 
2- Aortic regurgitation 
3- Mitral stenosis
4- Mitral regurgitation 
5- VSD
A

Yes ( these lesion’s murmur gets better with valsalva and standing maneuver so in this lesions diuretics are indicated )
See page # 47 of master the boards

102
Q

Mention “yes or no” if in the following lesions diuretics are or aren’t indicated :

HOCM and MVP

A

No indicated because this lesions get better when the ventricles are more full of blood so if you use diuretics…….. you know baby

103
Q

In valvular lesions where Amyl nitrate is indicated mention “yes or no “ if you consider ACE inhibitors could be used

A

Yes because Amyl nitrate is a vasodilator as ACE inhibitors so ….. they make better valvular lesions like :
1- AR 2- MR 3- VSD

104
Q

Mention “yes or no “
In the following valvular lesions is ok to use ACE inhibitors and ARBs ??
1- AR 2- MR 3- VSD

A

Yes because they are vasodilators which improve regurgitant lesions

105
Q

What does “ leg raising - squatting and Amyl nitrate “ do to the murmur of AORTIC STENOSIS ???
“ Softens or make it louder and worse “????

A

Make it louder and worse because with Aortic stenosis something very interesting happens and that is : the bigger the gradient between the left ventricle and the aorta the louder and worse is the murmur so this maneuver put more blood into the left ventricle and the aorta he murmur is louder …. and Amyl nitrate is a vasodilator so makes it easy to the left ventricle push blood forward so this increases the gradient and the murmur is heard louder

106
Q

What does Amyl nitrate do to the murmur of aortic stenosis ??
“ makes it better or softer or makes it louder or worse “
Explain !!

A

Louder or worse because :
Make it louder and worse because with Aortic stenosis something very interesting happens and that is : the bigger the gradient between the left ventricle and the aorta the louder and worse is the murmur so Amyl nitrate is a vasodilator so makes it easy to the left ventricle push blood forward so this increases the gradient and the murmur is heard louder

107
Q

What does “ handgrip maneuver “ do to the murmur of aortic stenosis ??
“ makes it better or softer or makes it louder or worse “
Explain !!

A

Better or softer because : with Aortic stenosis something very interesting happens and that is : the bigger the gradient between the left ventricle and the aorta the louder and worse is the murmur so with handgrip the afterload is bigger and the gradient between the left ventricle and the aorta is less or smaller …. the left ventricle needs to push harder against the aorta and the murmur is softer

108
Q

What does valsalva and standing maneuvers do to the murmur of aortic stenosis ??
“ softens or make it louder and worse “??

A

Softens because these maneuvers decrease the venous return and less blood passes through the Left ventricle al this makes the murmur softer . That is why diuretics are used in aortic stenosis before surgery is performed

109
Q

Aortic stenosis is considered mild when the gradient is less than ( blank mm Hg ) , is moderate when the gradient is between ( blank and blank mm Hg ) , and is severe when the gradient is more than ( blank mm Hg )
Fill the blank

A

Mild ( < 30 mm Hg )
Moderate ( 30 - 70 mmHg )
Severe ( > 70 mm Hg )

110
Q

The main advantage of using Bioprosthetic valve replacement over mechanic valves is ….?

A

They don’t need anticoagulation with warfarin ( bioprosthetic ) . Is true that they last less time ( only 10 years ) and mechanical last 15 -20 years but anticoagulation sometimes brings a lot of complications

111
Q

Cystic medical necrosis can cause a valvular condition called ??

A

Aortic regurgitation . Other rarer causes are :

Marfan’s syndrome , ankylosis spondylitis syphilis and reactive arthritis

112
Q

Diastolic decrescendo murmur heard best at the left eternal border refers to …..?

A

Aortic regurgitation

113
Q

Corrigan’s pulse also known as water hammer pulse belongs to the valvular disease called ??

A

Aortic regurgitation

114
Q

Capillary pulsations in the finger nails known as Quincke pulse belongs to a valvular disease called ?

A

Aortic regurgitation

115
Q

Musset’s sign ( head bobbing with each pulse ) belongs to a valvular condition called ?

A

Aortic regurgitation

116
Q

Duroziez ‘s sign ( murmur heard over femoral artery ) belongs to a valvular disease called ?

A

Aortic regurgitation

117
Q

Hill sign ( blood pressure gradient much higher in the lower extremities ) belongs to a valvular disease called ?

A

Aortic regurgitation

118
Q

The 3 groups of medication that are the best initial therapy for Aortic regurgitation are ??

A

ACE inhibitors
ARBs
Nifedipine
Note : for CCS you should add a loop diuretic such as furosemide

119
Q

Surgery is the answer in Aortic regurgitation when ejection fraction drops below ( blank % ) or the left ventricular end systolic diameter goes above ( blank mm ) even if patients are asymptomatic
Fill the blank !!

A

< 55 % ejection fraction

> 55 mm of the left ventricular end systolic diameter

120
Q

Diastolic rumble after an opening snap ( can be described as an extra sound in diastole ) ; refers to ??

A

Mitral stenosis

121
Q

As the mitral stenosis worsens , the opening snap moves ( blank ) to ( blank )

A

(Closer) to (S2 ) because mitral opens when LA pressure > LV pressure so as MS worsens = higher LA pressure and the valve is pushed to open earlier
Note : the murmur increases with leg raising , squatting and expiration

122
Q

On CXR is seen “straightening of the left heart border and elevation of the left mainstem bronchus “ . This refers to the valvular disease called ??

A

Mitral stenosis

123
Q

Answer which are :
1- the main initial therapy and the
2- most effective therapy for mistral stenosis

A

1- diuretics

2- Balloon valvuloplasty

124
Q

Aortic stenosis is due to ( blank ) of the valve , and mitral stenosis is due to ( blank ) of the valve . That is why balloon is used in mitral stenosis and no in aortic stenosis

A

( calcification )
( Fibrosis )
Note : that is why mitral stenosis can be stretched by balloon because fibrosis can be stretched opposite to calcification which is better treated by removing or replacing the valve

125
Q

Th murmur from mitral regurgitation ( blank ) in intensity with leg raising , squatting and handgrip . This murmur ( blank ) in intensity with valsalva and Amyl nitrate

A

( increases)

decreases

126
Q

The best initial therapy for mitral regurgitation is with 3 groups of drugs called ?

A 
ACE inhibitors 
ARBs 
Nifedipine ( anticalcics ) 
Because they are vasodilators 
Note : for CCS cases you should add furosemide
127
Q

In mitral regurgitation you should add surgery as treatment when ejection fraction is below (blank ) percent or left ventricular end systolic diameter goes above ( blank ) mm

A

Below 60 %
Above 40 mm
Note : repair is preferred to replacement

128
Q

Fill the blank related to the criteria for surgery in:
1- aortic regurgitation :
-ejection fraction less than ( blank %)
- left ventricular end systolic diameter above ( blank mm )
2- Mitral regurgitation :
-ejection fraction less than ( blank %)
- left ventricular end systolic diameter above ( blank mm )

A

1- < 55 % and LVESD > 55 mm

2- < 60 % and LVESD > 40 mm

129
Q

What happens ( louder or smaller ) with the murmur of VSD with : squatting , exhalation and leg raise ??

A

Louder ( worsen ) . More blood more murmur . Exhalation worsen the murmur because is a systolic murmur and those worsen with exhalation

130
Q

ASD is a hole in the heart that is associated with ( blank blank ) of the S2
Fill the blank !

A

Fixed splitting

131
Q

ASD should be repaired when the shunt ratio exceeds ( blank ) to ( blank ) . Fill the blank with numbers !!

A

1.5 to 1

132
Q

The best initial test in Dilated cardiomyopathy is ( blank ) also known as ( blank ) . It is used to determine ejection fraction and look for wall motion activity . The most accurate test is ( blank ) which is the most accurate method to determine ejection fraction . Fill the blank !!

A
  • Echocardiography

- MUGA or nuclear ventriculography

133
Q

Ischemia , alcohol , adriamycin , radiation and Chagas’ disease are causes of ( blank ) ??

A

Dilated cardiomyopathy

134
Q

The treatment for : Dilated cardiomyopathy is with 4 groups of drugs which are ??

Other medications used are digoxin and Ivabradine . The last one is used if after the use of ( blank blank ) if the heart rate is > 70 / min

A

1-ACE inhibitors
2-ARBs
3-Beta blockers
4-Spironolactone

After the use of : Beta blockers use
Ivabradine ( a sodium funny channel blocker ) if heart rate is > 70

135
Q

( blank ) is a test for Hypertrophic cardiomyopathy where you can see that the ejection fraction is normal

A

Echocardiography

136
Q

The mainstay of therapy for Hypertrophic cardiomyopathy is with ( blank blank and blank) . ACE inhibitors can be use but their benefit is not as clear
Fill the blank !!

A

Beta blockers and diuretics

137
Q

There is a unique sign belonging to 2 heart conditions called : Restrictive Cardiomyopathy and Constrictive pericarditis . This sign happens due to an increase in jugular venous pressure on inhalation . This sign is called ??

A

Kussmaul’s sign

138
Q

In Restrictive Cardiomyopathy ( blank ) is the mainstay of diagnosis and ( blank blank ) is the single most accurate diagnostic test of the ETIOLOGY
Fill the blank !!

A

Echocardiography ( mainstay )

Endomyocardial biopsy

139
Q

In Restrictive Cardiomyopathy, cardiac catheterization shows ??
… and EKG shows ??

A

Rapid x and y descents

EKG shows low voltage

140
Q

In Restrictive Cardiomyopathy, the bet treatments is with ( blank ) and correcting the underlying cause . Fill the blank !

A

Diuretics

141
Q

A sudden systolic dysfunction in a postmenopausal woman with sudden psychological stress that looks like a myocardial infarction with ventricular dysfunction refers to a rare disease called ??

A

Takotsubo Cardiomyopathy
Treatment is with : ACE inhibitors, diuretics and beta blockers. If the patient doesn’t die he/she will recover in a few weeks

142
Q

Takotsubo Cardiomyopathy is treated with 3 groups of drugs which are ??

A 
Treatment is with : 
ACE inhibitors, 
diuretics and 
beta blockers. 
Note : If the patient doesn’t die he/she  will recover in a few weeks
143
Q

Pleuritic, positional , sharp and brief chest pain refers to ??

A 
Pericardial disease : has positive “ friction rub” and NEGATIVE : 
1- pulsus paradoxus 
2- Kussmaul sign 
3- tenderness or edema 
4- blood pressure 
5- jugular venous distention
144
Q

Best initial test for pericardial disease is ??

A

EKG ( ST elevation everywhere and PR depression in lead II is pathognomonic )

145
Q

Management ( treatment ) of pericardial disease is with ( blank ) combined with ( blank ) ??

A

NSAIDs combined with colchicine

Note : advance the clock 1-2 days and have the patient visit the office … if still in pain give prednisone orally and advance the clock 1-2 days more to see result

146
Q

Patient presents with :

SOB , hypotension and jugular venous distention ( with clear lungs ) ….. the patient has ??

A

Pericardial tamponade

Note : unique features are
1- Pulsus paradoxus
2- electrical alternans

147
Q

Note : unique features are
1- Pulsus paradoxus
2- electrical alternans

This refers to ??

A

Pericardial tamponade

148
Q

What does inhalation do on venous return ?

A

Increases

149
Q

The most accurate diagnostic test for Pericardial Tamponade is ??

A

Echocardiography ( the earliest finding is diastolic collapse of the right atrium and right ventricle )

150
Q

When and Echocardiography is done the earliest finding is diastolic collapse of the right atrium and right ventricle . This refers to the emergent condition called ??

A

Cardiac Tamponade

151
Q

EKG will show : low voltage and electrical alternans …… this refers to ??

A

Cardiac tamponade

152
Q

Right heart catheterization will show “equalization “ of all the pressure in the heart during diastole …… is his refers to ?

A

Cardiac tamponade

153
Q

The wedge pressure will be the same as the right atrial pressure and pulmonary artery diastolic pressure ….. this refers to ?

A

Cardiac tamponade

154
Q

Answer the following regarding Cardiac tamponade :
The best initial therapy is ( blank )
The most effective long-term therapy is ( blank )
The most dangerous therapy is ( blank )

A

Pericardiocentesis
Pericardial window placement
Diuretics ( dangerous )

155
Q

A patient presents with SOB, and signs of chronic Right heart failure ( edema , jugular venous distention, heptosplenomegaly and ascites ) and also with :
-Kussmaul sign
- Pericadial knock
This patient has ?????????????

A

Constrictive pericarditis

156
Q

Extra diastolic sound from the heart hitting a calcified , thickened pericardium refers to the sign called ( blank ) ….. this is related to the disease called ( blank ) ?

A

Pericardial knock …. related to Constrictive pericarditis

157
Q

According to Constrictive pericarditis mention the 3 groups of testing that you will order and what do you expect to find

A

CXR ( shows calcification )
EKG ( shows low voltage )
CT and MRI ( shows thickening of the pericardium )

158
Q

Mention the :
1- best initial therapy and
2- most effective therapy
For Constrictive Pericarditis

A

1- Diuretics

2- Surgical removal of the pericardium ( ex : pericardial stripping )

159
Q

According to the following heart conditions , mention for which of them the therapy with “diuretics “ is “ The most dangerous therapy “ and “ The best initial therapy “
1- Pericardial Tamponade
2- Constrictive Pericarditis

A

1- Pericardial Tamponade ( NEVER give diuretics )
2- Constrictive Pericarditis ( Diuretics are best initial therapy ) …. most effective therapy is surgical removal of the pericardium ( that is : Pericardial stripping )

Step 3 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions