MKSAP STOCK1 Flashcards
What is the frequency of echocardiographic surveillance for asymptomatic moderate aortic regurgitation?
Echo q 1-2 years
At what CHA2DS2VASc score is PO anticoagulation recommended in NONVALVULAR Atrial Fibrillation patients?
>1
What is the expected hematologic compensation in patients with cyanotic congenital heart disease?
Erythrocytosis
Control of what TWO clinical parameters is recommended in patients with heart failure with preserved ejection fraction?
Blood pressure and volume!!! Paramount importance cf. to HFrEF (where goal-directed approach important)
What procedures exist for which endocarditis ppx is indicated in high-risk patients?
Dental procedures involving manipulation of gingival tissue or the periapical region of teeth OR perforation of the oral mucosa
What is the next best test to evaluate for peripheral arterial disease in a patient with an Ankle-Brachial Index >1.40
Great Toe systolic pressure measurement
What is the diagnostic test for acute limb ischemia?
Angiography
Indications for early surgical intervention in patients with Native Valve Infective Endocarditis
Valve Dysfxn with heart failure; Heart Block; L sided endocarditis caused by S. aureus, fungal or highly resistant bug; Annular or aortic abscess; Persistent bacteremia 5-7 days after abx; Recurrent emboli on abx; and mobile vegetations >10 mm in length
What is the preferred method of imaging for surveillance of bicuspid AoV and associated aortopathy?
TTE
What is the most common cardiac abnormality associated with aortic coarctation?
Aortic Stenosis (possibly related to Bicuspid AoV)
What syndrome is characterized by elevated eosinophil count without a secondary cause and has evidence of organ involvement?
Hypereosinophilic Syndrome
Cardiac Monitoring Device indicated for patients with SYNCOPE?
Implantable Loop Event Recorder
What is defined as LOW risk for ASCVD by the Pooled Cohort Equations?
<5%
This is the most common cause of reduced left ventricular function in heart transplant patients after the first year?
Allograft Vasculopathy
What is the treatment for all asymptomatic patients with SEVERE pulmonary valve stenosis?
Valve Repair or Replacement
What is the initial nonpharmacologic therapy for symptomatic PAD?
Supervised Exercise Program
What are two hematologic findings consistent with aplastic anemia?
Pancytopenia and Severely hypocellular marrow
What is the indicated mgmt strategy for multivessel coronary artery disease and depressed LV function associated with ACS?
CABG
What is the indication for mitral valvuloplasty in an asymptomatic patient with severe mitral stenosis?
Pregnancy (as it will demand a higher cardiac output!)
What form of atrial septal defect involves the mitral valve?
Ostium Primum ASD
What is the treatment of PVC-related cardiomyopathy?
Catheter Ablation
What is the recommended frequency of surveillance imaging for stable patients with Marfan Syndrome with aortic root dilation <4.5 cm?
6 months after diagnosis and then every 12 months after that
What is the recommended evaluation for patients with new-onset heart failure and risk factors or symptoms of CAD?
Either stress testing or catheterization
Therapy for patients with von Willebrand disease before major surgery
Factor VIII concentrates containing von Willebrand factor
At what level of 10 year Cardiovascular Risk from the Pooled Cohort Equations is statin therapy indicated?
>7.5%
What are THREE indications for cardiac resynchronization therapy?
EF <35%, NYHA functional class III-IV symptoms on guideline-directed medical therapy or LBBB with QRS duration >150 ms
What are TWO diagnostic criteria for Brugada Syndrome?
> 2 mm Coved precordial ST elevation and SYMPTOMS (i.e. syncope or ventricular arrhythmia)
What pulmonary vein complication is assoicated with catheter ablation for atrial fibrillation?
Pulmonary vein stenosis
What is the diagnostic test for a patient with symptomatic stable angina that is no adequately controlled on optimal medical therapy?
Coronary Angiography
What is the first line treatment of acute pericarditis following myocardial infarction?
Aspirin
What physical exam finding is useful in distinguishing hepatopathy due to constrictive pericarditis from primary liver disease?
Elevated CVP will be seen in constrictive pericarditis
What is the recommended type of stress test for a patient with normal resting EKG?
Exercise Stress Testing
What is the diagnosis for an irregularly irregular rhythm with a right bundle branch block pattern?
Atrial Fibrillation with Aberrant Conduction
Complication presenting with a new holosystolic murmur and cardiac thrill 3-7 days following acute MI?
Ischemic VSD
What are 3 indications for TTE in asymptomatic patients with a murmur?
Systolic murmur >3/6, Late or Holosystolic murmur, or diastolic and continuous murmurs
What are the two leading modifiable risk factors for myocardial infarction?
Dyslipidemia and Smoking
What is the mechanism of treatment indicated for low-output heart failure following correction of volume overload?
Afterload Reduction
What is the treatment of choice for pregnant women with thrombotic microangiopathy of pregnancy?
Immediate Delivery
What viral infection is associated with acquired pure red cell aplasia?
Parvovirus B19
What is an intervention to help stablize fluctuating INRs while taking warfarin
Daily Low dose PO vitamin K
What is the recommended duration of dual antiplatelet therapy following PCI with DES?
At least 1 year
What device is used to prevent intravenous line-associated paradoxical air embolism in patients with Eisenmenger Syndrome?
Intravenous Line Air Filter
What degree of mortality benefit has been shown for screening for CAD in asymptomatic patients with DM?
None (i.e. you don?t do stress or cath) but you should still do the Pooled Cohort equations
What is the diagnostic test if you suspect a macroangiopathic hemolytic anemia?
TEE
What is the initial treatment for hemodynamically stable supraventricular tachycardia?
Vagal Maneuvers
What are two criteria for implantable cardioverter-defibrillator placement in patients with heart failure?
LV EF <35%; NYHA class II/III sx
What are three hematologic findings in patients with Paroxysmal Nocturnal Hemoglobinuria?
Hemolytic Anemia; Hypocellular Bone Marrow (hence assoc. with hypoplastic MDS), and lack of CD55 and CD59 surface proteins on cells (flow cytometry)
What controversial cardiac imaging study is useful for clarifying cardiovascular risk in INTERMEDIATE risk patients?
Coronary Calcium Scoring
What is the radiologic test indicated in patients with superficial venous thrombophlebitis?
Venous Duplex US
What is the most common cause of easy bruising and heavy menses with normal PT and aPTT
von Willebrand disease
What are two drug classes indicated for ALL patients with heart failure with reduced ejection fraction (HFrEF)
Beta Blockers and ACE inhibitors
What is the recommended next step in mgmt of pts with Pre-excitation (WPW) and syncope?
EP study for potential ablation
What is the preferred treatment for severe symptomatic mitral stenosis?
Percutaneous Balloon Mitral Valvulplasty; if pregnant and asymptomatic you do it because you expect an increased CO in pregnancy
What are three medications that should be continued indefinitely after acute coronary syndrome?
Aspirin, ACE inhibitor, and Statin
What drug class should be discontinued 24-48 hours before cardiac stress testing to diagnose coronary artery disease?
Beta Blockers
What therapy is indicated for patients with end stage heart failure who are not candidates for heart transplantation?
LVAD
What is the appropriate mgmt of asymptomatic first degree AV block accompanied by RBBB and Left posterior Fascicular block (i.e. Trifascicular block)
Clinical Observation
What is the cause of differential cyanosis and clubbing affecting the lower body?
Patent Ductus Arteriosus with Eisenmenger syndrome
What is the essential diagnostic test for implanted cardiac device infection?
Blood Cultures
What is the recommended frequency of US surveillance of an asymptomatic AAA <5.5 cm in men and <5.0 cm in women?
Every 6 to 12 months
What are 4 potential complications associated with bicuspid aortic valve?
Aortic Stenosis, Aortic Regurgitation, Infective Endocarditis, and Aortopathy (dissection or aneurysm)
What is the recommended frequency of echocardiographic monitoring for patients with asymptomatic severe aortic stenosis?
Every 6 to 12 months
What is the treatment of choice for a hemodynamically stable patient with possible transient constrictive pericarditis?
Anti-Inflammatory agents
What phosphodiesterase inhibitor can be used for symptomatic PAD?
Cilostazol
What are three indications for aortic valve replacement in patients with aortic regurgitation?
Symptoms, LV dilation (LV end diastolic width), and LV EF <50%
What are two drug classes indicated for ALL patients with PAD?
Antiplatelet Agent (Aspirin) and a Statin
What is the recommended mgmt of an incidentally discovered atrial septal aneurysm?
No further evaluation or intervention
What is the HALLMARK physical exam finding associated with upper extremity peripheral arterial disease?
Difference in the systolic blood pressures between the two arms
What is the clinical entity in which patients experience persistent symptoms and hemodynamic derangements after treatment of a symptomatic pericardial effusion?
Effusive Constrictive Pericarditis
What is a classic infection associated with increased risk of sepsis and eath in patients with hereditary hemochromatosis?
Vibrio vulnificus
What benign cardiac tumor associated with constitutional symptoms and neurologic sx due to systemic embolization?
L atrial myxoma
What are two treatment options for cardiogenic shock?
IV vasoactive medications vs. Device-Based hemodynamic support (IABP)
What is the preferred type of prosthesis in patients requiring valve replacement with a contraindication to anticoagulation?
Bioprosthesis
What is the first line treatment for a patient taking warfarin who has significant bleeding?
4 factor Prothrombin Complex Concentrate (PCC- Kcentra) and IV vitamin K
What is the most common structural valvular disorder associated with Tetralogy of Falot repair?
PR- Pulmonic Valve Regurgitation
Four Conditions in which transfusion is NO LONGER indicated in patients with Sickle Cell dz
Uncomplicated Pregnancy; Routine painful crises; Minor Surgery WITHOUT anesthesia; and asymptomatic anemia
What is the immediate therapy indicated for patients presenting with acute heart failure and volume overload?
Diuretic Therapy- preferably with a loop diuretic
What is the optimal time for first follow-up appointment following discharge for patients hospitalized for heart failure?
Within 7 days
What is the most common endocrine cause of reversible heart failure?
Hyperthyroidism (always check a TSH)
In addition to aspirin what are three drug classes indicated as long therapy for patients following MI?
Statins, Beta Blockers, and ACE inhibitor
What is the duration of anticoagulation therapy for patients with unprovoked proximal DVT or PE with low or moderate bleeding risk?
Longterm Anticoagulation
What are two angiographic indications for CABG in patients with angina who remain symptomatic despite optimal medical tx?
Left Main Disease; Multivessel disease with proximal LAD involvement
What pulmonary contraindication exists to pharmacologic vasodilator stress testing?
Active Bronchospasm
What length of corrected QT interval is associated with Torsades de Pointes?
>500
What are two possible treatments for “low-pressure” cardiac tamponade?
Normal Saline (volume) and obviously and definitively, pericardiocentesis
What is the alternative therapy for patients with venous thromboembolism and recent bleeding?
IVC filter
What clinical parameter is associated with HIGH RISK for recurrent peripartum cardiomyopathy in subsequent pregnancies
Persistent LV dysfunction
What is the initial treatment indicated for patients with PFO and cryptogenic stroke?
Antiplatelet therapy with Aspirin
What abnormality is associated with fixed splitting of S2, midsystolic murmur and right ventricular heave?
Ostium Secundum Atrial Septal Defect
What is the preferred treatment for asymptomatic severe mitral regurgitation with reduced LV function and suitable valve anatomy?
Mitral Valve Repair
What vaccination reduces the risk of furture cardiovascular events in patients with existing cardiovascular disease?
Annual Influenza vaccine
What is the recommended agent for treatment of acute, uncomplicated vaso-occlusive pain episodes in patients with sickle cell disease?
Opioids for pain, Hydroxyurea
What is the treatment of choice for most patients with symptomatic severe aortic stenosis?
Surgical Aortic Valve Replacement (SAVR)
What are the 4 risk groups with an indication for statins?
1) pts with clinical ASCVD 2) Pt with LDL >190 3) Pt age 40-75 with DM 1 or 2 and 4) Pt age 40-75 with 10 yr ASCVD risk >7.5%
Most common cause of secondary erythrocytosis?
Hypoxemia
What is the initial imaging of choice for patients with suspected mitral regurgitation?
Transthoracic Echocardiography
Name two diseases that have prolonged aPTT that correct fully with a mixing study
Hemophilia A (Factor VIII def) and Hemophilia B (Factor IX def, Christmas Dz)
What is the diagnostic test of choice for Chronic Thromboembolic Pulmonary HTN (CTEPH)
VQ scan
What adjunctive antiplatelet agent is indicated for patients undergoing thrombolysis for STEMI?
Clopidogrel
What is the most sensitive diagnostic test for suspected folate deficiency?
Homocysteine level
Recommended initial radiologic test for patients with Multiple Myeloma who are experiencing low back pain
Skeletal Survey
What is the prophylactic intervention for patients at high risk of sudden death from HOCM?
Implantable Cardioverter-Defibrillator
What is the recommended treatment for patients with liver disease and INR >1.5 before undergoing CVC placement
None
What is the indication for immediate repeat echocardiogram for ALL patients with valvular heart disease?
Change in clinical status
What genetic mutation occurs in half of patients with idiopathic Budd-Chiari syndrome?
JAK2 V617F activating mutation
What congenital valvular abnormality is characterized by an aortic ejection sound with either a systolic or diastolic murumur?
Bicuspid Aortic Valve
What are two laboratory findings associated with Cold Agglutinin Disease
Erythrocyte clumping that disappears with warming; positive direct antiglobulin (Coombs) test
What is the recommended frequency of aortic imaging in patients with a bicuspid aortic valve and an aortic root diameter >4.5 cm?
Every Year
What diagnosis is associated with chest pain, ST elevation, elevated cardiac biomarkers and wall motion abnormalities of mid-apical L ventricle but with normal angiography?
Stress Cardiomyopathy (Takotsubo CMO)
What is a possible definitive treatment for Mobitz Type I second degree AV block associated with acute coronary syndrome?
Reperfusion (lytics or PCI)
Peripheral Blood Smear finding in pseudothrombocytopenia
Platelet clumping
What is the physiologic impact of overdiuresis in patients with Hypertrophic Cardiomyopathy?
It will increase the dynamic left ventricular outflow tract obstruction
What is the duration of anticoagulation therapy in patients with a first provoked venous thromboembolism?
3 months
What is the first line therapy for a bleeding patient with acquired hemophilia and high titers of inhibitor?
Recombinant Activated Factor VIIa
These are the two first line antianginal therapies for stable angina pectoris
Beta-blockers and nitrates
Indications for testing offspring of a patient with factor V Leidin mutation
None
Three hematologic findings characteristic of B thalassemia
Hemolytic Anemia, Microcytosis (nl RDW) and target cells on smear
What is the mgmt of nonbleeding patients with ITP and a platelet count >30 k?
Clinical Observation
What are the indications for thrombophilia testing in a patient with a first provoked thromboembolic event?
None
What are the thresholds for repair of abdominal aortic aneurysms in men and women?
5.5 cm in men and 5.0 cm in women
What is a congenital cardiac condition that may cause platypnea-orthodeoxia syndrome?
Patent Foramen Ovale
What is the diagnostic test for Hereditary Spherocytosis?
Osmotic Fragility Test
What is the preoperative function of an implantable cardioverter-defibrillator to prevent false detection of a tachyarrhythmia due to electrical interference (i.e. the Bovie)?
Disable the Shock Function
What is the type of transfusion for patients with platelet transfusion refractoriness?
HLA-matched platelets
What are the two recommended tests for men and non-menstruating women with Iron Deficiency Anemia
Colonoscopy and EGD
What is the recommended initial study for evaluating chest pain in patients with an intermediate risk of coronary artery disease and normal baseline EKG?
Exercise Stress test
What is the initial treatment indicated for uncomplicated Type B acute aortic injury
Medical therapy (Beta blockade and arterial vasodilator)
What pretransfusion erythrocyte treatment is used to reduce risk of transfustion associated GVHD?
Irradiation
What is the recommended treatment for patients aged 60 years or older with essential thrombocythemia or platelet count > 1 million
Hydroxyurea + Aspirin
What is the recommended hemoglobin threshold for transfusion for hospitalized pt
<7
What are FOUR FINDINGS on resting EKG that preclude exercise stress testing?
LBBB, Paced rhythm, Preexcitation (WPW), and ST depression >1 mm at baseline
What is the indication for use of high-sensitivity CRP testing for cardiovascular risk stratification?
Intermediate Risk for CV disease
What is the cardiac monitoring device indicated for patients with infrequent episodes of palpitations not associated with syncope?
30 Day Event Monitor
What is the minimum duration of antiplatelet therapy following placement of a Bare Metal Stent?
At least 4 weeks
What is the congenital abnormality characterized by upper extremity hypertension and radial artery to femoral artery pulse delay?
Aortic Coarctation (assoc. with Turners 45 XO)
What is the diagnostic study of choice for evaluating perivalvular abscesses in patients with infective endocarditis?
Transesophageal Echocardiograpy TEE
This is the treatment of nonbleeding patients taking warfarin with INR >9
Withold warfarin and give PO vitamin K
What is the threshold platelet transfusion in nonbleeding patients with chemotherapy induced thrombocytopenia?
<10k
What is the characteristic murmur associated with aortic regurgitation?
Diastolic Decrescendo murmur
What is the diagnostic study indicated for evaluation of possible ischemic disease in pts with intermediate probability and normal ST segments on resting EKG?
Exercise Stress Testing
What are the three initial antithrombotic therapie sfor NSTEMI?
Aspirin, P2Y12 inhibitor (clopidogrel) and heparin
Common scoring system used to assess pretest probability for heparin-induced thrombocytopenia
The 4T score
What is the appropriate mgmt of patietn with high risk score on exercise stress testing?
Cardiac Catheterization
Which family members of patients with Hypertrophic Cardiomyopathy should undergo echocardiographic screening?
Alll first degree relatives
Preferred mgmt of nonbleeding pts who have supratherapeutic INR less than 9
Withold one or two doses of warfarin but not vitamin K
What is the mgmt of accelerated idioventricular rhythm occuring within 24 hours of reperfusion therapy?
None
Treatment indicated for acute dissection of the ascending aorta (Stanford Type A)
Surgical Repair
What are two medications shown to improve symptoms and reduce mortality in black patients with NYHA class III or IV heart failure sx ON MAXIMAL THERAPY?
Hydralazine and Isosorbide dinitrate (NOT a replacement to BB, ACE, and spironolactone but ADJUNCTIVE)
What is the preferred treatment for COMPLICATED type B aortic dissection
Immediate Aortic Repair (whereas medical mgmt indicated for uncomplicated type B aortic dissection)
What are the components of “Triple Therapy” for a patient with atrial fibrillation who just underwent PCI?
Anticoagulant (i.e. Warfarin for afib) + Aspirin + another antiplatelet agent (Clopidogrel or Prasugrel)
What is the MGMT of small membranous VSD without heart enlargement, pulmonary HTN, Hx of endocarditis, or valvular regurgitation?
Clinical Observation
What is the most common dose-limiting side effect of anthracycline drugs?
Cardiotoxicity
