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cardiology mksap 15 > mksap related questions > Flashcards

mksap related questions Flashcards

1
Q

What are the indications for CABG

A

Left main disease + severe 3-vessel disease w/reduced EF, severe 3-vessel disease with reduced LV systolic function, severe 3 vessel disease with proximal LAD involvement. Also patients w/DM + multivessel disease may benefit

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2
Q

What is an option for patients with refractory angina, severe disease and poor op candidate

A

EECP- enhanced external counterpulsation

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3
Q

What are indications for valvuloplasty in mitral valve stenosis

A

indications of severe MS with symptoms present. Severe MS- transmitral pressure gradients over 10mmg Hg, LA enlargement, mitral valve area less than 1.5, pulmonary pressures over 50. excellent outcomes with >80% at 10 years. once symptoms present survival is less than 15% in 10 yrs

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4
Q

valvuloplasty vs surgical intervention in MS

A

perc valvuloplasty is less invasive, no anticoagulation. surgical- lifelong anticoagulation. If mod to severe MR present, cant perform valvuloplasty. also must rule out LA thrombus first

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5
Q

holosystolic murmur at apex radiation to axilla

A

mitral regurge

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6
Q

low pitched middiastolic murmur following opening snap accentuates presystole

A

Mitral stenosis

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7
Q

peripartum cardiomyopathy timing and risk factors

A

EF <45% 3 months prior or 6 months after pregnancy. risk factors- age over 30, African American, gestational hypertension. 10% mortality. if ef under 35% rec anticoagulation

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8
Q

faint distal LE pulses, hypertension, rib notching

A

coarctation of the aorta

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9
Q

indications for biventricular pacemaker

A

qrs over 120, EF 35%, NYHA III- helps with mechanical resynchronization vs jus defibrillator (fatigue, exercise tolerance, dyspnea all worse)

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10
Q

prominent a wave in JVP, parasternal impulse, ejection click, systolic thrill, early systolic murmur INCREASING with inspiration

A

pulm valve stenosis

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11
Q

exertional syncope, late peaking systolic murmur at 2nd RIC
sustained apical impulse
no split S2
radiation to carotids

A

aortic valve stenosis

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12
Q

Fixed split S2, equal a and v waves of JV, RV impulse, ejection clic

A

asd

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13
Q

holosystolic murmur at left sternal border
increases with inspiration
RVH/ RA deviation
prominent v wave

A

TR

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14
Q

increasing intensity with moving from squat to stand and decreases with valsalva

A

MR

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15
Q

midsystolic murmur at LLSB increasing with valsalva
decreases with hand-grip
S3 gallop

A

HCOM

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16
Q

symptoms/signs of biventricular heart failure

TTE with diastolic dysfunction, septal hypertrophy, outflow tract obstruction

A

HCOM

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17
Q

treatment for HCOM

A

maximize negative ionotropes

surgical septal myectomy if NYHA III or IV symptoms and refractory to medical management

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18
Q

treatment of unstable angina

A

coronary angiography
calculate TIMI risk score to assess short-term risk- uses 4 historical and 3 presentation characteristics - age, troponin, ST deviation, recent h/o angina, recent h/o asa, + traditional cardiac risk factors: family hx, DM, htn- high number = high risk of fatal MI over the next 14 days

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19
Q

post cardiac transplant patient with atypical symptoms-

new onset heart failure, decreased exercise tolerance, syncope, cardiac arrest

A

transplant vasculopathy or CAD- present in ~ 1/2 patients within 5 yrs post-transplant
- usually atypical or asymptomatic –> routine Coronary angiography

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20
Q

atypical symptoms or asymptomatic findings 1 -2 years post cardiac transplant

A

cardiac transplant rejection

not seen ~10 yrs post- more likely transplant vasculopathy at that point

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21
Q

B cell lymphoma and symptoms c/w abdominal or central nervous system mass, nonspecific flu-like illness

A

posttransplant lymphoproliferative disease

treat by decreasing immunosuppression

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22
Q

side effects of cyclosporin

A

hypertension, nephrotoxicity, hypertriglycerides, hirsutism, gingival hyperplasia, tremor

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23
Q

primary prevention indication for ICD

A 
NYHA class II or III + ischemic or non-I cardiomyopathy, EF 35% or less
SCDHeFT trial - 23% reduction in risk of death over 5 years compared to amio or placebo
24
Q

for worsening symptoms of NYHA III or IV despite ACEI and BB, can add

A

spironolactone –> further 35% reduction in mortality

25
Q

all patients with systolic heart failure, regardless of symptoms or functional status including asymptomatic, should receive

A

ACEI, BB
don’t start BB in decompensated state (should be euvolumic) tolerate low BP
note additional benefits when combined

26
Q

treatment of sCHF at pregnancy

A

metoprolol
no ACEI
all BB cross placenta and are in breast milk–>monitor fetal HR and glucose
atenolol–> early delivery, low birth weight
dig is ok- indicated if class III HF
diuretics ok if symptoms of volume overload
hydralazine OK if needed

27
Q

treatment of SVT in pregnancy

A

if hemodynamically stable- DOC is adenosine
try to avoid amio
DIg wont help with SVT

28
Q

AAA 4.0 - 5.4 cm in dia

A

follow via ultrasound every 6 months

29
Q

asymptomatic patient with AAA 5.5cm or larger

expanding AAA by 0.5cm/yr

A

surgical repair

30
Q

NSTEMI with ongoing pain despite therapy with Asa, IV nitroglycerine, LMWH, metoprolol, statin
(ST depression, T wave inversion)

A

start glycoprotein IIb/IIIa inhibitor
indicated in dynamic ECG changes, DM or CHF history. consider if TIMI is really high
increased bleeding risk

31
Q

medical management in NSTEMI

A

asa, BB, nitrates, anticoagulants

anticoagulants: full dose LMWH is better than unfractionated heparin- unless RF

32
Q

systemic emboli + fever, night sweats, weight loss, + LA mass attached to atrial septum or transmitral valve obstruction with elevated mean gradient

A

LA myxoma

usually without mets

33
Q

treatment of myxoma

A

surgical resection

34
Q

high pitched diastolic sounds
diastolic decrescendo murmur
(vs low-pitched diastolic sound)

A

mitral stenosis

35
Q

late presenting STEMI (over 12 hours)

A

no thrombolytics

coronary angiography and PCI

36
Q

IVDA

fever, hypotension, tachycardia, elevated JVD, b/l LE edema, leukocytosis

A

suspect endocarditis

37
Q

indications for emergent AVR in atrial endocarditis

A 
paravalvular extension (can see conduction abnormalities)
valvular destruction
hemodynamic instability
early intervention if heart failure, veg >1cm, distal emboli or resistant infection
38
Q

goal LDL if 2 more cardiac risk factors and intermediate 10 year risk (10-20% risk)

A

10 yr risk based on Framingham risk equation

LDL below 130 (3.4 mmol)

39
Q

goal LDL 2 more risk factors + high risk of CAD

A

below 100 (2.6 mmol)

40
Q

cholesterol reduction amount by bile acids

A

colestipol

10-15%

41
Q

patient with chest pain, normal ECG and normal cardiac enzymes

A

determine pre-test probability
If intermediate risk–> stress test , does not nec require hosp admission
even w/symptoms of GERD, consider atypical and get stress test
high pre-test prob–> coronary angio

42
Q

patient with sickle cell disese, heart failure, DOE, PND, inspiratory increase in JVD

A

consider hemochromatosis- endomyocardial biopsy

43
Q

TTE with restrictive LV filling, biatrial enlargement, normal systolic function, normal LV wall thickness, normal ventricular cavity size
restrictive LV filling without resp variation in peak filling velosity

A

restrictive cardiomyopathy

- dif dx- hemochromatosis

44
Q

treatment of hemochromatosis (non-hereditary type)

A

iron chelation (vs phlebotomy if inherited)

45
Q

c/o “palpitations” or “skipped beats” 2/6 midsystolic murmur at 2nd IC, no radiation, no syncope, active at baseline

A

no further intervention - innocent murmur- AS is most common in pts over 65
consider TTE if louder (3/6)

46
Q

pleuretic chest pain, fever, myalgia, may have ST elevation with concave up, rub, may have distant heart sounds, possible chest wall tenderness

A

pericarditis

47
Q

post MI follow up guidelines. TTE in hospital with anteroseptal hypokinesis, EF 30-35%, lungs clear, normal JVD. pt already on asa, aceI, statin, BB, plavix

A

suspect myocardial stunning. sugesst repeat TTE at follow up

ICD must be 40 days post-MI

48
Q

burning chest pain (atypical) x 4 weeks, rest and exertion, walks with a cane, h/o htn, BMI 28, LDL 140, neg troponin, ekg with LVH, no ST-T changes

A

nuclear perfusion stress test-
exercise stress test requires 85% maximal heart rate- pt has a cane, needs pharmacologic stress test
BMI is ok, so don’t need the PET

49
Q

CAC score

A

intermediate risk CAD to better risk stratisfy

50
Q

medically refractory angina, already on ranolazine

not a candidate for revascularization

A

EECP- similar to intra-aortic balloon pump
contraindications-severe aortic regurge, peripheral vascular disease
spinal cord stimulation is also an option

51
Q

medical management of chronic angina

A

Beta blocker
then add CCP or replace the BB with CCB
BB- unless heart block, symptomatic heart failure, SSS (absolute contraindications)
asthma, bad COPD relative contraindications
clopidogrel

52
Q

ranolazine MOA

A

anti Na channels in myocytes

53
Q

recurrent arrhythmia/atrial flutter s/p cardioversion, on BB, continued worsening fatigue, DOE. ECG with flutter 6:1, rate 50/min
rate controlled, yet symptomatic

A

radiofrequency ablation preferred to amiodarone or flecamide- 90% effective
flutter caused by counterclockwise rotation near the tricuspid valve

54
Q

CT with distal intramural hematoma

treatment- (crescent density)

A

IV nitroprusside- vasodilator- goal MAP 60-75
also tx with BB- goal HR 60-80
endovascular repair is for dissection only
urgent surgical repair if type A (

55
Q

findings in aortic disease - dissection or hematoma

A 
unequal pulses in legs
Unequal BP in arms
pulse deficit
diastolic murmur (crescendo)
normal neuro
56
Q

syncopal episode- did have LOC and no preceeding symptoms
occurred twice in last 3 years
no chest pain etc
occasional lightheadedness
active
normal ECG, normal HR, neg tilt vitals, normal carotid Doppler, exercise stress test with no ischemic changes and reached maximal heart rate

A

next step- loop recorder- implantable- infrequent and a structurally normal heart. if diseased heart, needs EP study

cardiology mksap 15 (1 decks)

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