Misc

Question 1

DAPT + PPI

Answer 1

Patients at increased risk of GI bleeding, prior GI bleed biggest risk factor

Do not use prasugrel

Question 2

Prasugrel CI

Answer 2

> 75 years, a prior history of stroke, or with weight.

Question 3

Platinum based chemo adverse effect

Answer 3

Htn

Question 4

tyrosine kinase inhibitors such as nilotinib adverse effect

Answer 4

Arterial thrombosis

Question 5

Familial dilated cardiomyopathy

Answer 5

clinical diagnosis when idiopathic dilated cardiomyopathy occurs in at least two closely related family members. Known mutations only cause 40-50% of disease

Question 6

HIV drugs lipids

Answer 6

Protease inhibitors cause HLD-> simvastatin and lovastatin are CI

Use atorvastatin 10 mg daily or rosuvastatin 10 mg

Question 7

LQTS ICD indication

Answer 7

Cardiac arrest

Consider if syncope/VT on beta blockers

Question 8

late-presenting, LAD MI + new well-heard murmur

Answer 8

VSD

Question 9

Pregnant women with mechanical valves

Answer 9

Warfarin is okay if <5 in the first trimester
If >5-> use lovenox or heparin

Any dose of warfarin is fine in 2nd and 3rd trimesters
Switch to lovenox or heparin at 36 weeks. Monitor factor Xa

Question 10

Preggo physical exam

Answer 10

mildly elevated JVP, an S3, and trace lower extremity edema, mild tachy are normal in third trimester

Hypoxemia/pulm edema-more definitive signs of hypervolemia

Question 11

Preggo hypertension

Preexisting hypertension or organ issues

Answer 11

Goal <150/90, nifedipine/labetalol/alpha-methyldopa/furosemide

Goal 120-160/ 80-110

Question 12

Shockable (VT/VF) cardiac arrest treatment

Answer 12

Temp management if comatose

Cath if ST elevations

For every minute that defib is delayed, survival decreases by 7-10%

Question 13

Goal spO2 after cardiac arrest

PaCO2 goal

Answer 13

92-98% (Increase PEEP or FiO2)

35-45 mm Hg

Question 14

Pre op eval, think

Answer 14

CAD, valves, arrhythmia, heart failure

Question 15

P2Y12 non ACS
ACS
Prasugrel CI in

Answer 15

Clopidogrel
Ticagrelor/ prasugrel
>75 yo and h/o stroke

Question 16

Risk factors for OSA

Risk factors for central sleep apnea

Answer 16

Age and BMI

male sex, advanced age, atrial fibrillation, and hypocapnia.

Question 17

> 60% survival and favorable neuro outcomes after out of hospital arrest

Answer 17

Defibrillation

Question 18

Mitral valve area

Preggo with severe MS

Answer 18

220/pressure half time

Balloon valvuloplasty regardless of symptoms

Question 19

Sports eval for 12-25 years of age

Answer 19

Use questionnaires from AHA or AAP

Question 20

Cardiac arrest with ongoing chest compressions

Answer 20

Bagging is preferred for ventilation as compressions do not need to be stopped

Question 21

Bystander help for cardiac arrest

Answer 21

Chest compressions and call EMS

Question 22

Cheyne-Stokes (central sleep apnea, associated with heart failure)
Treatment

Answer 22

Optimize heart failure treatment-> CPAP, if intolerant-try oxygen

Question 23

Technetium pyrophosphate scan is for

LVH+ renal dysfunction

Answer 23

TTR amyloid

Fabry disease -> obtain genetic testing

Question 24

Congenital long QT syndrome

Beta blocker
ICD

Answer 24

Seizure after cold stimulus
Get genetic testing: KCNQ1, KCNH2, SCN5A

If QT>470 or symptomatic (propranolol and nadolol)
After SCD, or recurrent events on meds

Avoid swimming, remove loud alarm clocks in LQT2

Question 25

Refractory cardiogenic shock

Biventricular / need for pulmonary support

Answer 25

Differentiate between left vs biventricular with RA pressure

Venoarterial ECMO (venovenous only supports lung function)

Question 26

Decreased survival rate after cardiac arrest

Answer 26

older age (especially >85 years of age), a history of cancer, nonshockable rhythm, unwitnessed arrest, and a pH <7.2

Question 27

Preggo Marfan

Answer 27

Replace aortic root and ascending aorta if >4 cm

Question 28

VF/ VT arrest meds

Answer 28

epinephrine 1 mg IV every 3-5 min after the second shock

Amiodarone 300 mg or lidocaine 1-1.5 mg/kg IV or IO after the third shock.

Question 29

Azole antifungals drug interactions

Answer 29

Increase concentration of cyclosporine and tacro

When stopped-> rejection meds should be increased, otherwise organ will be rejected

When initiated-> decrease rejection meds

Phenytoin does the opposite

Question 30

Preggo hemodynamics

First trimester

Answer 30

Increased CO, decreased SVR

CO reached peak in early third trimester
SVR reaches nadir in mid second trimester

Question 31

Pressor choice for sepsis if tachycardic

Answer 31

vasopressin or phenylephrine

Question 32

Differentiate shock

Answer 32

Cardiogenic vs septic vs hypovolemic

RHC MVO2 <65%+ elevated pressures vs >65% vs low pressures

Question 33

> 140/90 + proteinuria or
hypertension + significant end-organ dysfunction
after 20 weeks of gestation or postpartum

Severe features

Answer 33

Preeclampsia

> 160/110 or end organ dysfunction

Need urgent vaginal delivery. Use IV labetalol or hydralazine

Question 34

Dilated cardiomyopathy

Answer 34

Likely nonischemic, obtain detailed family history

Question 35

Preggo related htn increases risk of

Answer 35

HTN, CAD and stroke twofold