Master the Boards: Cardiology 1

Question 1

Most common cause of death US

Answer 1

CAD

Question 2

8 CAD risk factors

Answer 2

• DM- most dangerous
• HTN
• Tobacco
• HLD
• PAD
• Obesity
• Inactivity
• Family Hx (female <65, male <55)

Question 3

Most common cause of chest pain

Answer 3

GERD

Question 4

3 Q’s to rule out CAD (only need 1)

Answer 4

• pleuritic-lung stuff
• positional- pericarditis
• tenderness- costochondritis

Question 5

Physiology behind S3

Answer 5

rapid ventricular refilling during diastole extra fluid

Question 6

Physiology behind s4

Answer 6

sound of arrival systole pushing blood into non compliant ventricle

Question 7

Most accurate test for ischemic type pain

Answer 7

Trop or CK-MB, but do EKG first

Question 8

What does troponin c bind to

Answer 8

Calcium to activate actin myosin interaction

Question 9

What does troponin T bind to

Answer 9

Tropomyosin

Question 10

What does troponin I bind to

Answer 10

blocks or inhibits actin myosin interaction

Question 11

When to do dipyriamole or adenosine or dobutamine echo

Answer 11

-when patient cannot exercise to 85% of Max HR, COPD, amputation, reconditioning, weakness from previous stroke, lower extremity ulcer, dementia, obesity

Question 12

When to do exercise thallium test or stress echo

Answer 12

-when EKG is unreadable for ischemia: LBBB, digoxin use, pacemaker, LV hypertrophy, any baseline abnormality of ST segment

Question 13

ACS tx

Answer 13

Aspirin
clopidogrel
prasugrel (if angioplasty  is done)
nitrates and morphine (don't lower mortality)
02
BB- lower mortality but timing is not critical
Acei
Statin

Question 14

Thrombolytics MOA

Answer 14

they activate plasminogen to plasmin which chops up fibrin into d dimers, this is why clots elevate levels of D-Dimer

Question 15

Most common cause of death in CHF and MI

Answer 15

Ventricular arrhythmia brought on by ischemia

Question 16

MOA of BB in MI

Answer 16

Slow❤️ to increase reprofusion time

also means more filling time and better SV

Question 17

What interventions always lower mortality in ACS(6)

Answer 17

Aspirin
Thrombolytics
Primary angioplasty
metop
statin
clopidogrel

Question 18

What meds lower mortality in ACS w low ejection fraction

Answer 18

ACEi/ARB

Question 19

What med lowers mortality in ACS with ST depression

Answer 19

heparin

Question 20

In ACS when should CCB be used instead of BB

Answer 20

intolerance of BB, severe asthma, cocaine induced, coronary vasospasms or peinzmetal angina

Question 21

When to do pace maker for acute MI

Answer 21

3rd degree AV block
Mobits 2
Bifasicular block
New LBBB 
Symptomatic Bradycardia

Question 22

lyte disturbance from ACEi/ARB

Answer 22

Hyper K

Question 23

4 Indications for cabage

Answer 23

1. Three Coronary vessels with >70% stenosis
2. Left main coronary artery stenosis >50-70%
3. Two Vessels in diabetics
4. two or three vessels with low ejection fraction

Question 24

What anti anginal can be added on if pain isn’t controlled

Answer 24

ranolazine

Question 25

Besides CAD who always needs a statin (4)

Answer 25

PAD
Aortic Dissection
Carotid dz
Cerebrovascular accident

Question 26

5 RF for to include in lipid managment

Answer 26

1. Tobacco use
2. BP >140/90 or on BP med
3. Low HDL
4. FH of early Heart dz female <65, male <55
5. Age male > 45, female >55

Question 27

What labs to check regularly statin

Answer 27

Transaminases 2% of patients have increase

Question 28

Do you need to check routine CPK for statins

Answer 28

no rhabdo can happen but don’t be checking CPK all the time.

Question 29

When do diabetic patients need statins

Answer 29

if LDL >100

Question 30

10 year score to need a statin

Answer 30

> 7.5% 10 year risk factor for ACS