ITE - Cardiology

Question 1

Chronic venous insufficiency: Clues, Dx

Answer 1

Dx: clinical diagnosis with/without venous duplex u/s
clues: edema, dilated veins, thin/hyperpigmented skin, ulceration.

Question 2

Hypertrophic cardiomyopathy: Clues, Dx.

Answer 2

Clues: ejection murmur at LSB (outflow obstruction), late systolic murmur at apex (MR), abnormal ECG
Dx: TT echo w/ asymmetric LVH and septal thickening

Question 3

Peripheral vascular disease: Dx.

Answer 3

Dx: resting ABI < 0.9 (1.0-1.4 is normal), exercise ABI with >30mmhg or 20% drop. ABI > 1.4 uninterpretable and needs toe ABI

Question 4

RIght ventricular infarction: Dx.

Answer 4

Sxs: hypotension, JVD, clear lungs
ECG: V1, V4R

Question 5

Torsades de Pointes, drug-induced: Dx

Answer 5

Dx: Use of QTc prolonging meds
Ex: ondansetron, amio, quinolones, antifungals, antipsychotics, triptans

Question 6

Wolff-Parkinson-White pre-excitation: Dx

Answer 6

Dx: symptomatic AVRT with preexcitation (delta wave)

Question 7

Resynchronization therapy: Indications

Answer 7

HF w/ EF < 35%, NYHA class II-IV despite GDMT, sinus rhythm, LBBB with QRS > 150

Question 8

AC for mechanical prosthetic valve

Answer 8

Lifelong AC and antiplatelet therapy. Goal INR 2.5, with risk factors or ball/cage valve INR 3.0, bioprosthesis INR 2.5

Question 9

Bradycardia: Tx

Answer 9

Pacemaker for symptomatic and asymptomatic with high risk conduction abnormalities or heart block

Question 10

Mitral stenosis: Ausculation

Answer 10

Loud S1, increased pulmonic component of S2, opening snap, diastolic rumble, low pitched murmur at apex

Question 11

STEMI + signs of heart failure or shock

Answer 11

Emergent PCI, temporize with IABP or LVAD, reduce afterload, avoid beta blockers

Question 12

STEMI + V-Fib

Answer 12

EP consult and ICD, predischarge

Question 13

Atrial myxoma: Tx

Answer 13

Surgical removal

Question 14

Cardiogenic shock: Tx

Answer 14

Early/Aggressive fluids with initial bolus of 30mL/kg

Question 15

ICD: indications

Answer 15

HF w/ EF<35%, NYHA class II-III despite GDMT

Question 16

PVCs: Tx

Answer 16

Reasurance

If high risk or > 10% of beats affected: Beta blocker or CC blocker, then antiarrhythmics, then ablation

Question 17

PVD: Tx

Answer 17

Tx: Similar to CAD. Smoking cessation, DM control, HLD control. Aspirin, supervised exercise training (most effective way to improve fxnl status)

Question 18

Claudication: Tx

Answer 18

cilostazol for claudication

Question 19

Unstable angina: Tx

Answer 19

Tx: relieve pain, early risk stratification (TIMI risk score), if high risk –> PCI, if low –> medical management

Question 20

NYHA class I

Answer 20

?

Question 21

NYHA class II

Answer 21

?

Question 22

NYHA class III

Answer 22

?

Question 23

NYHA class IV

Answer 23

?

Question 24

Risk factors ranked

Answer 24

?

Question 25

ECG abnormalities that contraindicate stress ECG:

Answer 25

ST segment changes, preexcitation, LBBB, VPCs, digitalis effect

Question 26

digitalis effect:

Answer 26

?

Question 27

Contra’s for adenosine (for single-photon emission CT)

Answer 27

reactive airway disease with active wheezing

Question 28

Red flag murmurs

Answer 28

???diastolic or continuous murmur, cardiac symptoms (chest pain, dyspnea, syncope), or abnormalities on examination (clicks, abnormal S2, abnormal pulses)

Question 29

Benign murmurs do what with standing

Answer 29

decrease

Question 30

HCM, hemodynamics that affect

Answer 30

increases with decreased venous return

Question 31

Maneuver to decrease venous return

Answer 31

standing

valsalva

Question 32

MV prolapse, hemodynamics that affect

Answer 32

decrease venous return will move earlier in systole, increase intensity