MKSAP II

Question 1

Indications for aortic repair

Answer 1

• diameter 5.5cm or larger
• rapid expansion with greater than 0.5cm/year
• symptoms (abdominal or back pain/tenderness)

Open vs endovascular repair (EVAR) is determined by CTA which must be done prior to any intervention.

Question 2

How long do you have to quit smoking before CV risk decreases?

Answer 2

• substantial reduction in 2 years and returning to nonsmoker at 10 years

Question 3

What study do all people with WPW need to get to risk stratify for sudden cardiac death?

Answer 3

Electrophysiology study

Question 4

Cut off for aortic diameter for pregnancy in woman with Marfan syndrome

Answer 4

Generally pregnancy is considered safe if aortic diameter is smaller than 4.0 cm.

If the ascending aortic diameter is greater than 4.5 cm or have rapid dilation then may need aortic repair surgery

Question 5

What is a papillary fibroelastoma?

Answer 5

Small, independently mobile cardiac tumors that are typically attached to L-sided valvular endocardium by a stalk; may be assoc with stroke, TIA, angina, MI, and peripheral embolization

Question 6

When do you use thrombolytic therapy for STEMIs?

Answer 6

When symptom onset is within 12 hours and PCI is not available within 2 hours (120 minutes).

Question 7

How to calculate ABI?

Answer 7

Higher ankle pressure divided by higher brachial pressure. If 0.90 or lower, than has PAD.

Question 8

What does it mean if you have an ABI > 1.40?

Answer 8

Presence of calcified noncompressible artery in LE and considered uninterpretable -> must use toe-brachial index

Question 9

How do you tell restrictive cardiomyopathy from constrictive pericarditis?

Answer 9

1. elevated BNP
2. concordant rise and fall of L and R systolic pressures with respiration (opposite in constrictive pericarditis where there is an inverse relationship because of ventricular interdependence (i.e. RV systolic pressure rises during inspiration with decrease in LV pressure)

Question 10

Normal width of LV and pericardium on cardiac MRI

Answer 10

LV: less than 11mm
Pericardium: less than 2mm

Question 11

Ticagrelor side effect

Answer 11

Dyspnea

Question 12

When do you do balloon valvuloplasty for pulm valve stenosis?

Answer 12

1. Peak doppler gradient >50mmg or mean gradient >30mmg

2. Favorable valve (otherwise needs pulm valve replacement)

Question 13

Why should you be wary of doing adenosine SPECT in COPD patients?

Answer 13

Actually, you can but you shouldn’t in actively wheezing patients because of bronchospasm.