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IPAP > PANCE Review > Flashcards

PANCE Review Flashcards

1
Q

MCC of Dilated Myopathy

MC infectious cause

? metabolic issue can cause this

A

Idiopathic

Enterovirus: Coxsackie

B1- Thiamine

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2
Q

? is the hallmark PE finding of Dilated Cardiomyopathy

? is the Dx test of choice

How is this condition managed

A

S3 gallop

Echo- LV dilation w/ EF <50% (systolic failure)

Loop ACEI BB; Inc contractility w/ Digitalis

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3
Q

When is an ICD indicated for Dilated Cardiomyopathy

MCC of Restrictive Cardiomopathy

MC c/c

A

EF <35%

Sarcoidosis

Dyspnea

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4
Q

What will be seen on PE of Restrictive Cardiomyopathy

What is the Dx test of choice

What is the definitive Dx test

A

Kussmaul Sign- inc JVP w/ inspiration

Echo: non-dilated ventricles w/ diastolic dysfunction
MRI if Dx still uncertain

Endomyocardial biopsy- amyloidosis appears apple-green birefringence w/ Congo-red stain

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5
Q

How is Restrictive Cardiomyopathy managed

What causes HOCM

What creates the obstruction

A

Chelation- hemochromatosis, GCCS- sarcoidosis

Autosomal dominant d/o of inappropriate hypertrophy

Sub-aortic outflow d/t septal hypertrophy and anterior motion of MV during systole

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6
Q

What makes HOCM murmur louder

What do Pts w/ HOCM die from

What may be found on PE

A

Inc contractility, Dec LV volume

V-Fib

S4, MR, Pulse bisferiens

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7
Q

How is HOCM managed

How is HOCM Tx

What is an alternative Tx

A

BB > CCBs

Momectomy- young Pt refractory to medical therapy

Septal ablation w/ alcohol

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8
Q

Define Myocarditis

What non-cardiac issue can Pts present w/

Classic Dx study finding

A

Inflammation of muscle d/t viral infection (Coxsackie) leading to systolic dysfunction/pericarditis

Toxic megacolon

Cardiomegaly on CXR
Sinus tach on EKG
Ventricular dysfunction on Echo

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9
Q

Gold standard to Dx Myocarditis

How are Pts Tx

LA/RA enlargement on EKG

A

Biopsy- lymphocyte infiltration and myocardial necrosis

Loop ACEI BBs

L: M-shape P-wave in Lead 2, Biphasic P-wave in V1 w/ large terminal part
R: tall Lead 2 P-wave, Biphasic P-wave in V1 w/ larger initial component

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10
Q

RVH criteria on EKG

LVH criteria on EKG

Normal QRS axis

A

V1 w/ R >7mm or is R>S

Sokolow-Lyon: V1-S + V5-R= >35mm/30mm (m/w)
Cornell: aVL-R + V3-S= >28/20mm (m/w)

-30 - 90

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11
Q

How is Sinus Tach Tx during AMIs

How is Sinus Brady Tx

How is SSS Tx if Sxs

A

Metoprolol

Atropine then Epi/Pacing

Atropine then Dopamine, Epi, Pacine
Pacemaker= definitive

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12
Q

Most helpful part of EKG to determine if AV block exists

All heart blocks are Tx first line w/ ? if Sxs exist

When is ICD indicated for Type 1 Block

A

PR interval

Atropine

Persistent Sxs/PRI >0.30sec

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13
Q

Adverse outcome from surviving inferior wall MI

What causes the ‘saw-tooth’ pattern of A-Flutter

How is AFlutter Tx

A

Wenckebach block

One irritable atrial site

Stable: Vagal Rate (BB>CCBs)
Unstable: conversion
Ablation- definitive

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14
Q

What are the 4 types of Afib

Define Ashermann Phenomenon

A

Paroxysmal: self terminates <7d
Persistent: fails to self terminate, lasts >7d
Permanent: >12mon or refractory to conversion
Lone: exists outside of heart dz

Short RR cycle followed by aberrant beat seen in Afib

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15
Q

How is Afib Tx in stable Pts

What is the name of the definitive Tx procedure

How long is anticoagulation needed

A

Rate: BB or Non-DHPs (Digoxin if BB/CCB c/i d/t CHF/HOTN)

Maze

3wks prior, 4wks after

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16
Q

Direct thrombin inhibitor

Factor Xa inhibitors

What are the two types of PSVTs

A

Dabigatran- binds/inhibits thrombin

Edo/Apix/Riva-roxaban

AVNRT- two paths w/in AV node (MC type)
AVRT- two paths outside of AV node

17
Q

How is stable, Narrow PSVT Tx

How is stable, Wide PSVT Tx

Define MAT/WAP

A

Vagal, Adenosine then CCB/BB/Digoxin

Amiodarone, Procainamide

MAT: >100 in COPD Pt (Tx: Verapamil/BB if LV preserved)
WAP: <100bpm

18
Q

Pathophysiology behind WPW

What are the 3 EKG components of this condition

How is Wide Complex WPW Tx and what is avoided

A

Accessory pathway through Bundle of Kent connect atria to ventricles, bypassing AV node= D-wave

Wave-delta PR-short Wide-QRS

Procainamide > Amiodarone; Avoid Adenosine, BB, CCB, Digoxin

19
Q

EKG finding for AV junctional rhythms

Define PVC

What other EKG abnormality will be seen

A

Inverted P-wave 1, 2, aVF

Premature beat from ventricle causing T-wave to travel opposite of QRS complex

Compensatory pause

20
Q

MCC of V-Tach

How is this Tx in order

How are refractory Torsades Tx

A

Ischemic heart dz

Amiodarone, Lidocaine, Procainamide

Isoproterenol, Transvenous overdrive pacing

21
Q

Anti-Arrhythmics

A

Na blockers, dec automaticity and stabilize membrane:
1A: Double Quarter Pounder; Dispyramide Quinidine Procainamide
1B: Lettuce Tomatoes; Lidocaine Tocainide
1C: Pickles Extra Fries; Propafenone Encainide Flecainide

2: BB, dec AV conduction
3: K blocker, Amiodarone Ibutilide Dofetilide Sotalol
4: Ca blocker
5: Digoxin

22
Q

? antiarrhythmic possesses Class 1-4 properties

Classes ? are more for rhythm while Classes ? are used for rate

MC innocent murmur and MC continuous murmur

A

Amiodarone

Rhythm: 1,3 Rate: 2,4

Innocent: Still- dec w/ stand/valsalva; inc w/ supine
Continuous: Venous- dec w/ supine, rotation; inc w/ sitting upright

23
Q

MC type of ASD

What does this sound like

What EKG sign may be seen

What size needs surgical correction

A

Ostium secundum

Wide, fixed split S2 w/out varying during respiration

Crochetage- notched peak of R-wave in inferior lead

> 1cm or Sxs

24
Q

Define PDA

What does this sound like on PE

How is this Tx

A

Connected Pulm Artery and descending aorta

Continuous, machinery murmur w/ bounding peripheral pulses and wide pulse pressures (BMW)

Indomethacin- dec prostaglandin production

25
Q

MC location for aortic coarctations

What are the two types

What do Pts need pre-op

A

Ductus arteriorsus insertion site distal to left subclavian vein

Post-duct: adults, Pre-ductal: infants

Alprostadil

26
Q

MC congenital heart dz of childhood

What phenomenon can develop w/ this MC

When is surgical closure needed and why

A

VSD- MC type being perimembranous near TV

Katz Wachtel- RVH+LVH

Recurrent infection, Delayed growth, CHF, Sx; Prevent P-HTN

27
Q

What is the worse and what is the most important RF for CADz

Anginal equivalents are more common in ? Pts

What two meds dec mortality of CADz

A

Worse: DM, Important: smoking

Obese Women Elderly DM

ASA+BBs

28
Q

PCI vs CABG determinations

Meds used for myocardial perfusion imaging

Meds used for Stress Echo

A

PCI: 1-2 vessel w/out L-main involvement and normal EF
CABG: L-main stenosis, 3 vessel dz (2 vessel diabetic) or EF <40%

Adenosine, Dipyridamole

Dopamine, Dobutamine

29
Q

Pentad for Inferior MI

EKG progression during STEMI

AMI time protocols

A

S4, Inc JVP, Clear lungs, Kussmaul

Hyper-acute T-waves, ST elevation, Q-waves

EKG: 10min, Thrombolytics: 30min, PCI: 90min

30
Q

Cocaine induced MIs are Tx w/ ? med of choice

A

CCBs

IPAP (212 decks)

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