MTB 5

Question 1

What is Constrictive Pericarditis

Answer 1

Combination of physical findings + calcification on CXR

Calcification and fibrosis that prevents filling of right side of heart if chronic

Question 2

Physical findings of Constrictive Pericarditis

Answer 2

Right heart failure
- Edema
- Ascites
- HSM
- JVD
K's - Kussmaul sign, Knock

Question 3

Causes of Constrictive Pericarditis in the U.S.

Answer 3

Viruses
Cardiac Surgery
Chest Radiation
Idiopathic

Question 4

Causes of Constrictive Pericarditis in developing countries

Answer 4

TB

Question 5

What is Kussmaul sign

Answer 5

Increase in JVD on inhalation

Question 6

What is “knock” on PE

Answer 6

Extra heart sound in diastole from ventricular filling

Question 7

Best initial test for Constrictive Pericarditis

Answer 7

CXR shows calcification and fibrosis

Question 8

Most accurate test for Constrictive Pericarditis

Answer 8

MRI

CT

Question 9

TX for Constrictive Pericarditis

Answer 9

1. Diuretics - used first to decompress filing, relieve edema
2. Surgical removal of pericardium

Question 10

Peripheral Artery Disease Etiology

Answer 10

Stenosis of peripheral arteries

• DM
• HTN
• HLD
• Smoking

Question 11

Presentation of Peripheral Artery Disease

Answer 11

Leg pain in the calves on exertion = femoral popliteal
Pain relieved by rest
Pain when walking up or down hills
Severe
- Loss of hair follicles, sweat glands, sebaceous glands
- Smooth and shiny skin

Question 12

Presentation of spinal stenosis

Answer 12

Worse when walking down hills b/c leaning back

Question 13

Best initial test for Peripheral Artery Disease

Answer 13

ABI

> 10% difference or ABI < 0.9

Question 14

Most accurate test for Peripheral Artery Disease

Answer 14

Angiogram

Question 15

TX for Peripheral Artery Disease

Answer 15

1. ASA
2. Stop smoking
3. Cilostazol
4. Enroll pts in supervised exercise program, minimum of 12 weeks w 20-45 mins, 3X/week
5. Surgery if all else fails

Question 16

Presentation of Femoral Artery Aneurysm

Answer 16

Pulsatile Groin mass below inguinal ligament

Anterior thigh pain - nerve compression

Question 17

What is Popliteal Artery Aneurysm ass’d with

Answer 17

AAA

Question 18

What are the different types of bypasses done in PAD

Answer 18

1. Femoral - popliteal Bypass - if arteries above and below knee affected
2. Femoral-Tibial Bypass - arteries of lower legs/foot
3. Aorto-Femoral Bypass - major Abd Artery (Aorta) large arteries branching off affected

Question 19

Best initial test in suspected Aortic Dissection

Answer 19

CXR shows mediastinal widening

Question 20

Aortic Dissection Presentation

Answer 20

Pain in b/t scapula

Difference in BP b/t arms

Question 21

Most accurate test in suspected Aortic Dissection

Answer 21

Angiography

Question 22

TX for Aortic Dissection

Answer 22

1. Control BP
   - B-blocker - IV Labetolol BEFORE nitroprusside
   - Nitroprusside - reflex tach
   - Surgery

Question 23

MOA of Beta blockers on Aortic Dissection

Answer 23

Decreases shearing forces
Decrease HR
Decrease stress on aortic wall

Question 24

When do we repair AAA

Answer 24

If diameter > 5 cm

Rapidly enlarging

Question 25

Worst form of heart disease in pregnancy

Answer 25

1. Peripartum Cardiomyopathy w persistent ventricular dysfunction
2. Eisenmenger Syndrome

Question 26

Peripartum Cardiomyopathy

Answer 26

After delivery

Abs made against myocardium

Question 27

TX for Peripartum Cardiomyopathy

Answer 27

1. Drugs
ACEi/ARB
Beta blockers
Spironolactone
Diuretics
Digoxin
2. Cardiac Transplant

Question 28

What is Eisenmenger Syndrome

Answer 28

R to L shunt from Pulm. HTN

VSD –> L to R shunt –> Pulm HTN