PANCE_cardiology 13% Flashcards
1
Q
(RR)
first-line treatment of hypOtension in setting of aortic dissection with aortic rupture or tamponade:
A
fluid resucitation
2
Q
(RR)
what is aortic dissection?
A
damage of intima –> entry of blood b/w intima and media, creating a false lumen
3
Q
(RR)
what does hypOtension indicate for aortic dissection?
A
poor prognostic indicator
likely indicates aortic rupture or cardiac tamponade
4
Q
(RR)
“A 45-year-old woman presents to clinic to discuss her recent diagnoses of diabetes mellitus and hypertriglyceridemia. [What is] true regarding her glucose and triglyceride control?”
A
optimizing glycemic control may improve hypertriglyceridemia
(vs. “her greatest risk is renal failure secondary to diabetes”, though DM IS one of the leading causes of renal failure, it’s not an immediate risk for this pt)
5
Q
(RR)
a pt aged 40-75 with an LDL >= 190 should probably get WHAT for primary prevention of CVD (according to 2019 AHA/ACC guidelines)?
A
high-intensity statin
6
Q
(RR)
a pt aged 40-75 with diabetes should probably get WHAT for primary prevention of CVD (according to 2019 AHA/ACC guidelines)?
A
moderate-intensity statin
7
Q
(RR)
Who should get ASCVD risk screening?
A
all adults ages 40-75
8
Q
(RR)
If there is a high suspicion of upper extremity DVT, what is the next step in evaluation?
A
duplex ultrasound
9
Q
(RR)
A pt w/ L ventricular EF <=35% and heart failure NYHA Functional Class II or III indicates what intervention for prevention of ventricular dysrhythmia and sudden cardiac death?
A
implantable cardioverter-defibrillator
10
Q
(RR)
What education should be given to pt with acute exacerbation of systolic CHF upon discharge to help prevent readmission?
A
MONITOR DAILY WEIGHTS
“instructing patients to monitor daily weights can ehlp prevent heart failure readmission”
11
Q
(RR)
most cases of mitral valve prolapse are _____
A
benign
12
Q
(RR)
Mitral Valve Prolapse (MVP) can lead to what serious problems?
A
ACUTE MITRAL REGURGITATION (MR)
sudden cardiac death
infectious endocarditis
stroke
13
Q
(RR)
patients with symptomatic MVP (Mitral Valve Prolapse) such as autonomic dysfunction are trialed on __________
A
BETA BLOCKERS
(also counseled on caffeine, ETOH and tobacco abstinence and given 24-hr cardiac monitor)
14
Q
(RR)
PE findings of MVP
A
midsystolic click
late systolic murmur
15
Q
(RR)
pts with symptoms of MVP may present with:
A
palpitations
dyspnea
nonexertional CP
fatigue
16
Q
(RR)
how to diagnose mitral valve prolapse (MVP)
A
clinical exam
CONFIRMED BY ECHO
17
Q
(RR)
name a guideline used for risk stratification to predict occurrence of adverse outcomes in the evaluation of UA (Unstable Angina) and NSTEMI:
A
TIMI
(Thrombolysis in Myocardial Infarction) risk tool
18
Q
(RR - Ischemic Heart Disease)
initial ECG changes observed in ischemic heart disease presentation
A
T wave prolongation and magnitude
(up to 50% of ECGs are normal or nonspecific)
19
Q
(RR)
what is the MC tachydysrhythmia associated with sinus node dysfunction (formally known as sick sinus syndrome)?
A
atrial fibrillation
20
Q
(RR)
50% of cases of sinus node dysfunction demonstrate
A
alternating bradycardia and an atrial tachydysrhythmia
21
Q
(RR)
diffuse ST segment elevation (except for aVR and V1 which will show reciprocal ST depression and PR elevation)
A
pericarditis
22
Q
(RR)
pain that DECREASES in intensity when pt leans forward is a distinct characteristic of what?
A
pericarditis
23
Q
(RR)
why does pericarditis pain decrease with leaning forward?
A
“sitting up and leaning forward reduces the pressure on the parietal pericardium and allows for diaphragm splinting”
24
Q
(RR)
first line treatment for acute pericarditis
A
NSAIDs
(but not if it’s a case of pericarditis after MI or uremic pericarditis)
25
(RR)
two MC causes of pericarditis, in order:
first - idiopathic
second - viral (coxsackie)
26
(RR)
how do VSDs present?
HOLOSYSTOLIC MURMUR, best heard at
L LOWER STERNAL BORDER
frequently accompanied by a thrill or a displaced PMI
27
(RR)
in terms of VSD, what is Eisenmenger syndrome?
it is the progression of the defect to RIGHT-TO-LEFT shunting
28
(RR)
in a pt presenting with pulmonary edema and hypertension and tachycardia, what underlying condition puts the pt at risk of developing nitrate-induced hypOtension?
aortic stenosis
(in preload-dependent states, in which cardiac output depends on adequate preload to the heart, admin of nitrates can result in critical hypOtension
preload-dependent states = aortic stenosis, volume depletion, R ventricular infarction, hypertrophic obstructive cardiomyopathy)
29
(RR)
acute decomp post acute anterior STEMI - what is most likely etiology of this acute decomp?
L ventricular free wall rupture
post MI ventricular free wall rupture is the most common mechanical complication post MI
30
(RR)
Beck triad
pericardial tamponade
1 - muffled heart sounds
2 - JVD
3 - hypOtension
31
(RR)
ECG showing low-voltage QRS, electrical alternans
think pericardial tamponade
32
(RR)
treatment for pericardial tamponade
pericardiocentesis
33
(RR)
three EKG signs of hyperkalemia
peaked T waves
prolonged PR
wide QRS
34
(RR)
If a pt has an isolated distal DVT, is asymptomatic, has a negative D-dimer, is not at high risk for proximal thrombus extension, what is the acceptable treatment plan?
observation with u/s every week for 2-4 weeks
35
(RR)
A patient with an intermediate risk of coronary artery disease is undergoing an exercise stress test. Which of the following is the most specific finding for myocardial ischemia?
A) 2 mm downsloping ST-segment depression
B) 2 mm upsloping ST-segment depression
C) Increase of systolic blood pressure
D) Sporadic premature ventricular complexes
2 mm DOWNSLOPING ST-SEGMENT DEPRESSION IS THE MOST SPECIFIC FINDING FOR MYOCARDIAL ISCHEMIA DURING AN EXERCISE STRESS TEST
36
(RR)
first, second, third-line treatments for symptomatic or hemodynamically unstable bradycardia (and define bradycardia)
bradycardia = HR <59
first - atropine: 1 mg IV bolus, repeated q3-5 min for total of 3 mg
second - dopamine: infusion 5-20 mcg/kg/minute
third - transcutaneous pacing
37
(RR)
first degree AV heart block ECG findings:
PR interval >200 ms
this type of block is often a normal variant, w/o clinical significance, occurring in ~2% healthy young adults
requires no specific treatment
38
(RR)
drugs that slow nodal conduction
digoxin
BB
CCB
39
(RR)
asymptomatic L ventricular systolic dysfunction w/ LVEF <40% should consider what pharmaceutical intervention?
ACE-I like lisinopril
ACE-Is are beneficial in the prevention and treatment of HF b/c they reduce afterload and preload, prevent angiotensin II from triggering harmful cardiac remodeling, and reduce sympathetic activation.
40
(RR) BUZZWORDS
boot-shaped heart
Teratology of Fallot
41
(RR) BUZZWORDS
rib notching
think coarctation of the aorta
42
(RR)
EKG findings of coarctation of the aorta
LVH
43
(RR)
diagnosis of coarctation of the aorta is made by _____
echo
44
(RR)
coarctation of the aorta is assocated with what congenital syndrome?
Turner syndrome
45
(RR)
radiographic finding for most likely diagnosis for a 14 y/o boy with soft systolic murmur and femoral pulses delayed compared to radial pulses
RIB NOTCHING
these develop in response to increased collateral blood flow needed to bypass the congenital narrowing of the aorta
46
(RR)
MC type of coarctation of aorta
localized aortic coarctation
which occurs at or near junction of aortic arch and descending thoracic aorta, distal to origin of L subclavian artery
47
(RR)
EKG findings for coarctation of aorta
LVH
48
(RR)
"A continuous systolic-diastolic murmur is auscultated in a 3-week-old dyspneic infant. She is tachypneic and diaphoretic. Her mother reports weight loss and poor feeding. Doppler color-flow imaging reveals high velocity jets in the pulmonary artery." This patient will most likely undergo what corrective surgery?
LIGATION
this is PDA, ACYANOTIC congenital cardiac condition
ligation is referred method of closure
49
(RR)
what is PDA?
the fetal connection b/w the pulmonary artery and the aorta remains open
causes a continuous "machine-like" murmur heard in systole and diastole
50
(RR)
what does PDA sound like?
continuous
rough
machine-like murmur
best heard in 1st interspace of LSB
51
(RR)
management of PDA?
indomethacin
conservative observation
surgical ligation
percutaneous transcatheter occlusion
52
(RR)
"Which of the following is a cyanotic congenital heart disease?
a) ASD
b) coarctation of aorta
c) PDA
d) Tetralogy of Fallot"
D) TETRALOGY OF FALLOT
1 - R vent outflow tract obstruction
2 - R vent hypertrophy
3 - VSD
4 - overriding aorta
53
(RR)
"what is the survival benefit of ACE-Is in pts who have suffered rEF?"
PREVENTS VENTRICULAR REMODELING
54
(RR)
what is the benefit of an ACE-I for pts post-MI?
REDUCE MORTALITY in pts after a STEMI by PREVENTING VENTRICULAR REMODELING
55
(RR)
All pts who present with syncope get what study?
EKG
56
(RR)
what is the focus of management of aortic stenosis in acute setting?
restore preload, and get cardiology consult
(in other words, IVF and cardiology consult)
57
(RR)
"Which of the following antiarrhythmic medications is contraindicated in the setting of coronary artery or structural heart disease?
a) amiodarone
b) dofetilide
c) dronedarone
d) flecainide"
D) FLECAINIDE
contraindicated in the setting of coronary artery or structural heart disease b/c of increased risk of polymorphic ventricular tachycardia
58
(RR)
mnemonic for Class IC antiarrhythmics?
Can I have Fries, Please?
Class IC
Flecainide, Propafenone
59
(RR)
What is the MOA of Class IC Antiarrhythmics?
fast Na+ channel blockers
60
(RR)
if Class IC antiarrhythmics are fast Na+ channel blockers, what changes do they cause in the heart and on the EKG?
increase AV node refractory period
increase PR, QT, QRS
61
(RR)
what is the MC cause of aortic valve insufficiency IN INDUSTRIALIZED COUNTRES?
worldwide?
AORTIC ROOT DILATION
worldwide - rheumatic heart disease
62
(RR)
common hx findings of aortic insufficiency (regurgitation)
infectious endocarditis, dissection, Marfan syndrome
63
(RR)
After airway is secured, what is the most appropriate next step in management of PEA?
CHEST COMPRESSIONS
64
(RR)
Causes of PEA (8)
The H's and T's:
Hypovolemia
Hypoxia
Hypothermia
Hyperkalemia
Tension Pneumo
Thrombus (PE or MI)
Toxicology
Tamponade
65
(RR)
which of the following RF is most likely cause of a patient's hypertriglyceridemia?
a) age
b) genetic disorder
c) HTN
d) increased consumption of ETOH
e) smoking
D) INCREASED CONSUMPTION OF ETOH
MC RF for hypertriglyceridemia:
obesity
metabolic syndrome
DM II
other RF for hypertriglyceridemia
ETOH
lack of exercise
meds
genetic disorders
66
(RR)
first line agent for treatment of aortic dissection
IV BB: labetalol or esmolol
FOLLOWED BY VASODILATORS (they're not first)
i.e. nicardipine or nitroprusside
67
(RR)
five mainstays of management of aortic dissection
- reduce BP to lowest tolerable level (SBP 100-120's)
- reduce HR <60bpm
- IV BB (esmolol, labetaolol, propanolol)
- nitroprusside (ONLY AFTER HR is controlled)
- pain control
68
(RR)
if a pt presents with s/s of infectious endocarditis from IV drug use, what are most appropriate abx?
VANCOYMYCIN AND CEFTRIAXONE
you need to cover MRSA, staph, strep, enterocci
69
(RR)
what organisms are most commonly found in right-sided endocarditis?
Staph aureus
Strep pneumoniae
gram negative bac
70
(RR)
what organisms are most commonly responsible for bac endocarditis in the presence of a GI malignancy?
Strep bovis
71
(RR)
what two items are necessary for diagnosis of bac endocarditis?
DUKE CRITERIA
and echocardiography
72
(RR)
"A 35-year-old woman with no past medical history and who is taking oral contraceptives, presents for evaluation of thigh pain and swelling of her entire leg. Her right calf is 3.5cm larger than her left and there is pitting edema. She was seen six days ago for the same complaint and had a negative ultrasound. {What} is the most appropriate plan?"
REPEAT DUPLEX ULTRASOUND
in pts w/ high pre-test probability, a repeat duplex u/s is indicated in pts with persistent symptoms
73
(RR)
major criteria for rheumatic fever
Jones Criteria - the majors
JONES - C
Joints (polyarthritis)
Oh no
Nodules
Erythema marginatum
Sydenham chorea
Carditis
74
(RR)
minor criteria for Rheumatic Fever
fever
arthralgia
previous rheumatic heart disease
75
(RR)
leading cause of valvular disease in the world
rheumatic fever (esp children 4-9 yrs)
76
(RR)
hx of infection from GAS....think
rheumatic fever
77
(RR)
initial approach to managing suspected white coat hypertension
ambulatory bp monitoring
(send them home w/ bp cuff)
78
(RR)
"what is first line medication for uncomplicated HTN according to ACC/AHA?"
thiazide diuretics
79
(RR)
pt gets a duplex u/s and finds a R small saphenous vein thrombophlebitis and has no other complaints or complications....what is the immediate correct management for this pt's symptoms (four things)?
warm compress
extremity elevation
compression stockings
pain management
remain ambulatory
80
(RR)
management of complicated superficial thrombophlebitis
anticoagulation
81
(RR)
what are the concerning axial leg veins that increase a pts risk of superficial thrombus extending into deep veins?
great saphenous vein
accessory saphenous vein
small saphenous vein
82
(RR)
What do inotropic drugs do (big picture)?
alters the force of myocardial contraction
83
(RR)
list nine positive inotropic drugs
(these increase myocardial contractility)
dopamine
dobutamine
epinephrine
norepinephrine
digoxin
phosphodiesterase inhibitors (Milrinone)
glucagon
insulin
amiodarone
84
(RR)
list four negative inotropic drugs
(these decrease myocardial contractility)
BB
CCB
class IA antiarrhythmics (quinidine, procainamide)
Class IC antiarrhythmics (flecainide)
85
(RR)
what is digoxin, in terms of contractility and rate effects?
positive inotrope
negative chronotrope
("it augments pumping while decreasing heart rate")
86
(RR)
define pulsus paradoxus
fall in SBP >10 mm Hg during inspiration
87
(RR)
define pulsus alternans
alternation of one strong beat followed by a beat of decreased amplitude during palpation of peripheral pulses
88
(RR)
what might you see on an EKG of cardiac tamponade?
sinus tach
low voltage QRS complexes
ELECTRICAL ALTERNANS
PR segment depression
89
(RR)
"which of the following is an independent cause of secondary hypertension?
a) Addison's disease
b) A Fib
c) hypercholesterolemia
d) primary aldosteronism”
D) PRIMARY ALDOSTERONISM
"Primary aldosteronism typically causes hypOkalemia, mild hypernatremia, or drug-resistant HTN"
90
(RR)
increased Na + decreased K + HTN
hyperaldosteronism
91
(RR)
what is the most common cause of primary hyperaldosteronism?
adrenal adenoma is the most common cause
also, decreased renin
92
(RR)
what medication is used to treat hyperaldosteronism?
spironolactone
(and surgery if primary)
93
(RR)
how does acute mitral regurgitation usually present?
pts typically present in FULMINANT PULMONARY EDEMA RAPID IN ONSET
it is associated with a MID SYSTOLIC MURMUR
94
(RR)
sudden onset and rapid progression of pulmonary edema, hypOtension, and s/s of cardiogenic shock
think acute mitral regurgitation
(often missed b/c clinical hx mimics an acute pulmonary process)
95
(RR)
unique, harsh, midsystolic murmur best heard at apex that radiates to the base rather than the axilla
ACUTE mitral regurgitation
96
(RR)
blowing holosystolic murmur best heard at apex with radiation to axilla
CHRONIC mitral regurgitation
97
(RR)
treatment for acute mitral regurgitation
nitroprusside
dobutamine
intra aortic balloon pump
emergency sx
98
(RR)
treatment for chronic mitral regurgitation
CHF Rx
valve repair or replacement
99
(RR)
describe restrictive cardiomyopathy (RCM)
DECREASED MYOMETRIAL COMPLICANCE IN THE ABSENCE OF PERICARDIAL DISEASE
walls of ventricles become stiff, but not necessarily thickened
100
(RR)
it is common for pts with RCM to fail ______ management of _________
DIURETIC MANAGEMENT OF PERIPHERAL EDEMA
101
(RR)
restrictive cardiomyopathy may have what infiltrative disorder etiologies?
amyloidosis
sarcoidosis
hemochromatosis
102
(RR)
three common signs of restrictive cardiomyopathy
peripheral edema
dyspnea
fatigue
(signs of R-sided heart failure)
103
(RR)
echo findings for restrictive cardiomyopathy
impaired diastolic filling
preserved systolic function
104
(RR)
MC cause of restrictive cardiomyopathy
amyloidosis
105
(RR)
dilation and impaired contraction of one or both ventricles
dilated cardiomyopathy
106
(RR)
six etiologies for dilated cardiomyopathy
ischemic
infectious (viral, Chagas, HIV, Lyme)
idiopathic
genetic
toxic (ETOH, cocaine, meth, chemotherapy)
valvular
107
(RR)
leading cause of sudden cardiac death in young athletes
hypertrophic cardiomyopathy
108
(RR)
systolic ejection murmur most notable at LUSB with clicking sound during systole (which decreases when pt inspires)
Pt c/o several months of worsening intermittent chest pain, dyspnea, fatigue w/ exercise
PULMONIC STENOSIS
109
(RR)
three tenants of treatment of non-ST elevation MI
dual antiplatelet therapy
anticoagulation
early coronary angiography with revascularization (in most pts)
110
(RR)
what is the preferred anticoagulant in pts with NSTEMI in whom coronary angiography and possibly revascularization are going to be performed w/in 48 hrs?
UNFRACTIONATED HEPARIN
111
(RR)
what is the antiplatelet therapy for patients with non-ST elevation ACS (in absence of absolute contraindication)
ASA
P2Y12 receptor blocker (clopidogrel, ticlopidine)
112
(RR)
"What cardiac complication is associated with hypERthyroidism?"
high-output cardiac failure
"Through beta-adrenergic stimulation, elevated thyroid hormone levels can produce high-output cardiac failure."
113
(RR)
what is the definitive intervention to correct mitral regurgitation caused by papillary m rupture?
MITRAL VALVE REPLACEMENT
114
(RR)
acute MI may lead to the sudden rupture of ____________-
chorda tendinae or papillary m
...causing a sudden volume overload of both the L atrium and the L ventricle
115
(RR)
what is the most important RF for aortic dissection?
HTN
116
(RR)
what is a bicuspid aortic valve a risk for?
aortic dissection
117
(RR)
contraindication for eplerenone, and what class of drug is it?
elevated serum potassium
mineralocorticoid receptor antagonist (as is spironolactone)
"eplerenone is contraindicated....b/c it has the potential to increase potassium"
118
(RR)
antiplatelet choices for NSTEMI
ASA
clopidogrel
prasugrel
ticagrelor (these are three P2Y12 inhibitors)
119
(RR)
where is the block in Second-Degree Heart Block, Type II?
below the AV node, generally in the His-Purkinje system
120
(RR)
EKG findings for Second-Degree Heart Block, Type II (i.e Mobitz II)
P waves normal
QRS complexes usually wide
PR intervals are same duration
DROPPED BEATS
121
(RR)
primary cause of PAD
atherosclerosis
122
(RR)
how can patients with PAD relieve their pain?
hang the foot of the affected leg over the side of the bed
123
(RR)
MC atypical presenting complaint in elderly pts with ACS
DYSPNEA
60-70% of pts older than 85 years presenting with an angina-equivalent complaint have atypical features, most commonly dyspnea
124
(RR)
pts who undergo cardioversion with AFib lasting more than 48 hrs (or for an unknown duration of time) should get anticoagulation for at least how long?
FOUR WEEKS
"Although electrical atrial activity is normalized following cardioversion, atrial mechanical stunning and a higher risk of stroke may persist for up to four weeks, and warfarin w/ a goal of INR 2.0 - 3.0 must be continued during this time"
125
"What is the classic auscultatory feature of mitral valve prolapse?"
MIDSYSTOLIC CLICK
126
(RR)
"Mitral valve prolapse is often associated with what conditions?"
Marfan syndrome
Ehlers-Danlos syndrome
127
(RR)
Long-term prophylaxis to reduce Prinzmetal angina attacks is best accomplished with what meds?
CCB (namely NIFEDIPINE)
LONG-ACTING NITRATES (like ISOSORBIDE DINITRATE)
128
(RR)
EKG shows transient ST segment elevations and cardiac enzymes are normal
Prinzmetal Angina
129
(RR)
pts who have cocaine-induced ACS cannot receive what drugs, and why?
BB (such as labetalol)
this may lead to UNOPPOSED ALPHA-ADRENERGIC STIMULATION which could result in CORONARY ARTERY VASOCONSTRICTION and systemic HYPERTENSION
130
(RR)
absolute contraindications to fibrolytic therapies
hx of intracranial hemorrhage
cerebral vascular structural lesions
intracranial neoplasm
ischemic stroke or head/facial trauma w/in past 3 months
active bleeding
131
(RR)
relative contraindications for fibrolytic therapies
SBP >= 180
DBP >= 110
uncontrolled HTN
pregnancy
anticoagulant use
132
(RR)
when do men determined to be low risk for heart disease start screening for lipid abnomalities?
age 35
133
(RR)
name thiazide diuretic SEs
HYPERGLYCEMIA
hypokalemia
hyponatremia
magnesium depletion
hypercalcemia
hyperuricemia
134
(RR)
Pt with a 10-year ASCVD event risk score of 9% should have what initial therapy?
moderate-intensity statin therapy, which may include lovastatin, simvastatin, fluvastatin, pitavastatin
135
(RR)
Which of the following qualities reassures that a murmur is innocent in nature?
a) blowing quality
b) decreased intensity in a sitting position vs a supine position
c) grade >=3 intensity
d) holosystolic in timing
e) increased intensity in a sitting position vs a supine position
B) DECREASED INTENSITY IN A SITTING POSITION VS A SUPINE POSITION
Innocent murmurs have a softer intensity when pt is sitting
(also, Grade <= 2, short systolic duration, minimal radiation, and musical or vibratory quality)
136
(RR)
"how many days after surgery does a postoperative DVT typically occur?"
7-10 days
137
(CME)
"A pt who just had a small MI has a LDL of 150. What LDL number is this pt's goal?"
reduce by 50% or more
138
(CME)
"Which heart disease is often associated w/ a beta myosin heavy chain gene mutation on chromosome 14 and can be treated with verapamil?
hypertrophic cardiomyopathy
139
(CME)
"According to current guidelines, what should a diabetic patient's blood pressure be less than?
a) 140/90
b) 140/80
c) 130/90
d) 130/80
e) 120/80"
D) 130/80
140
(CME)
"Which medication is the preferred treatment for a pt in Torsades?
f) amiodarone
g) lidocaine
h) atropine
i) magnesium
j) calcium"
I) MAGNESIUM
141
(CME)
"A patient with significant lateral wall MI should have ST elevations in which leads?
a) V1 & V2
b) V3 & V4
c) II, III and aVF
d) I, aVL, V5 - V6
e) aVR, V1"
D) I, aVL, V5 - V6
142
(CME)
"Which antihypertensive class frequently causes constipation and/or peripheral edema?
f) alpha blockers
g) beta blockers
h) calcium channel blockers
i) diuretics
j) ACE-I"
H) CALCIUM CHANNEL BLOCKERS
143
(CME)
"Which systolic murmur is the most likely myocardial infarction complication?
a) aortic stenosis
b) aortic regurgitation
c) mitral stenosis
d) atrial septal defect
e) ventricular septal defect"
E) VENTRICULAR SEPTAL DEFECT
144
(CME)
"Which skin condition is a myocardial infarction independent risk factor?
f) eczema
g) psoriasis
h) seborrheic dermatitis
i) vitiligo
j) rosacea"
G) PSORIASIS
145
(CME)
"which of the following is an anti-ischemic agent that does not reduce blood pressure?
a) ranolazine
b) eplerenone
c) bumetanide
d) ramipril
e) ivabradine"
A) RANOLAZINE
146
(CME)
which medication is contraindicated with ACE-I in diabetic patients?
f) linezolid
g) metformin
h) digoxin
i) spironolactone
j) aliskiren
J) ALISKIREN
147
(CME)
which medication should be avoided in patients with significant coronary artery disease?
a) streptokinase
b) phenobarbital
c) hydroxyzine
d) sumatriptan
e) lorazepam
D) SUMATRIPTAN
148
(CME)
What will a pt with Prinzmetal angina most likely have on their EKG?
f) ST depression
g) ST elevation
h) Q waves
i) tall T waves
j) U waves
G) ST ELEVATION
149
(CME)
what is the aortic area for hearing a murmur?
2nd R intercostal space
150
(CME)
what is the pulmonic area for hearing murmurs?
2nd L intercostal space
151
(CME)
What is the tricuspid area for murmur listening?
4th L intercostal space (aka LLSB)
152
(CME)
what is the mitral area for listening to a murmur?
apex, or 5th L intercostal space (midclavicular line)
153
(CME)
just for fun...what is Erb's point in terms of heart anatomy?
3rd L intercostal space along the L sternal border
154
(CME)
what grade murmurs have a thrill?
grades IV to VI
155
(CME)
what is the only murmur that increases with inspiration?
tricuspid regurgitation
"a holosystolic murmur w/ R-sided signs"
156
(NCCPA Practice Exam)
If a pt has gout, what cholesterol treatment should be avoided?
NIACIN
Niacin SE include
flushing
PUD
gout
hyperglycemia
hepatotoxicity
157
(CME)
"Which of the following is most likely to occur as a SE of taking too much niacin for hypercholesterolemia?
a) hypoglycemia
b) gout
c) hyperthyroidism
d) diarrhea"
"GOUT"
158
(CME)
"which of the following is a continuous murmur?
a) mitral regurgitation
b) atrial septal defect
c) ventricular septal defect
d) coarctation of the aorta
e) venous hum"
VENOUS HUM
159
(CME)
"Which of the following is considered a crescendo-decrescendo murmur?
a) mitral regurgitation
b) mitral stenosis
c) aortic regurgitation
d) aortic stenosis"
AORTIC STENOSIS
160
(RR)
what should be monitored for pts taking amiodarone?
annual CXR
eye exams
monitor thyroid fxn
monitor liver fxn
161
(RR)
"What type of heart block is consistent with acute rheumatic fever?"
"First degree heart block (prolonged PR interval)"
162
(RR)
common hx finding of rheumatic fever
GAS infection!
163
(NCCPA practice exam)
"Which of the following physical findings is most suggestive of pericardial tamponade?
a) auscultatory gap in the Korotkoff sounds
b) bigeminal pulse
c) blowing, diastolic heart murmur
d) delayed femoral pulse
e) paradoxical pulse"
E) PARADOXICAL PULSE
"Pulsus paradoxus is a classic finding (drop 10 mmHg in systolic pressure on inspiration), narrow pulse pressure." (SmartyPance)
164
(RR)
long term tx of Vasospastic Angina
aka Prinzmetal Angina - CCB and long-acting nitrates
i.e. nifedipine and isosorbide dinitrate
"long term management of the anginal attacks include calcium channel blockers, namely nifedipine, and long-acting nitrates like isosorbide dinitrate."
165
(RR)
"What is the diagnostic murmur auscultated in aortic stenosis?"
crescendo-decrescendo systolic murmur
...that radiates to the carotids, paradoxically split S2,S4 gallop, and murmur decreases with Valsalva
166
(RR)
How do patients with acute mitral regurgitation typically present?
FULMINANT PULMONARY EDEMA RAPID IN ONSET
associated with MIDSYSTOLIC MURMUR
CAN OCCUR AS A DELAYED CONSEQUENCE OF ACUTE MI (2 to 7 days post event)
167
(RR)
"A patient with which one of the following congenital heart diseases would benefit from palivizumab administration?
a) cyanotic congenital heart disease
b) PDA
c) pulmonic stenosis
d) secundum atrial septal defect"
A) CYANOTIC CONGENITAL HEART DISEASE
this is the mab administered to prevent RSV infections
(think of Onyx)
168
(RR)
four ACYANOTIC congenital heart diseases
ASD
VSD
PDA
CoA
169
(RR)
describe third degree heart block
"P waves march through the QRS-T complexes"
it's complete heart block
SA node and AV node (or Purkinje fibers) are acting independently of each other
slow rate
170
(RR)
"Which peripheral arteries are most commonly affected by arterial thrombosis?"
"femoral and popliteal arteries"
171
(RR)
"A 23 yo F delivers her first child. Her FH is positive for three uncles who needed early-in-life surgery for “heart defects.” You are asked to assess her 1-day-old infant, who does not appear well. During your examination, which of the following findings most suggests the presence of congenital heart disease?
a) basilar crackles and peripheral edema
b) fever
c) symmetric brachial and femoral pulses
d) systolic murmur"
A) BASILAR CRACKLES AND PERIPHERAL EDEMA
...."80% of infants presenting with congestive heart failure (pulmonary or peripheral edema or both)"
172
(RR)
58 y/o M w/ AFib with RVR
What is appropriate anticoagulation?
Dabigatran
NOAC (direct thrombin inhibitor and oral factor Xa inhibitors)
173
(RR)
INR range for pts taking warfarin for AFib?
INR 2-3
174
(RR)
"Which of the following is an indication for permanent pacemaker placement?
a) asymptomatic Mobitz I
b) asymptomatic Mobitz II
c) asymptomatic sinus brady w/ HR of 40bpm
d) asymptomatic 3-second sinus pauses"
B) ASYMPTOMATIC MOBITZ TYPE II SECOND DEGREE HEART BLOCK
"This block has a high risk of progressing to complete heart block and should be treated with pacemaker placement, regardless of symptoms."
175
(RR)
"What drug can be administered to reopen a recently closed ductous arteriosus?"
Prostaglandin E1 (PEG1)
176
(RR)
"What medication (and dose) can be used to temporarily preserve patency of the ductus arteriosus?"
alprostadil (PEG1)
0.05 - 0.1 mcg/kg/min IV
177
(RR)
"A 5-week-old infant presents with dyspnea and fluid overload but not cyanosis. Auscultation reveals a loud, holosystolic murmur at the LLSB. Echocardiography would most likely show [which] abnormalities?
a) aorta is connected to R ventricle
b) pulm artery is connected to L ventricle
c) vent septal defect in membranous portion
d) vent septal defect in muscular portion"
"VENTRICULAR SEPTAL DEFECT IN THE MEMBRANOUS PORTION"
"The majority of clinically significant VSDs occur in the membranous part, near the atrioventricular node."
178
(RR)
"Which of the following is a contraindication for the use of gemfibrozil in patients with hypertriglyceridemia?
a) active PUD
b) biliary disease
c) myoapthy
d) severe asthma"
B) BILIARY DISEASE
"Gemfibrozil use is contraindicated in patients with biliary disease. Gemfibrozil is a fibric acid derivative..." "...gemfibrozil can reduce serum triglyceride concentration by 70%"
179
(RR)
"Which of the following conditions is most suggestive of an asymptomatic abdominal aortic aneurysm?
a) abd bruit
b) abd mass
c) HTN
d) hypOtension"
B) ABD MASS
180
(CME)
name the three continuous murmurs (systolic and diastolic)
pericardial friction rub
PDA
venous hum (loudest in diastole)
181
(RR)
who gets combination anti-hypertensive treatment, and what's the key to combination treatment?
"SBP that is 20 mm Hg over goal or a diastolic pressure that is 10 mm Hg over goal"
"combo therapy should include antihypertensives of two different classes, such as amlodipine (a calcium channel blocker) and lisinopril (an angiotensin-converting enzyme inhibitor)"
182
(RR)
MC locations for venous stasis ulcers
medial and lateral malleoli
183
(RR)
what is MOA for first line treatment for paroxysmal supraventricular tachycardia?
inhibits atrioventricular nodal conduction
(it's adenosine)
184
(RR)
"What is the treatment for a patient who is hemodynamically unstable with a regular, narrow complex tachycardia?"
"cardioversion"
185
(RR)
hypertensive emergency vs hypertensive urgency
urgency = >180/120
emergency = elevated bp w/ evidence of end-organ damage
186
(RR)
"what is the MC SE following administration of IV amiodarone?"
"hypotension"
187
(RR)
MOA of amiodarone
"inhibition of outward potassium channels which prolongs the duration of the action potential"
188
(RR)
"What SE is responsible for the greatest number of deaths associated with amiodarone?"
"pulmonary toxicity, the MC of which is chronic interstitial pneumonitis"
189
(RR)
two common presenting signs of infectious endocarditis for a pt with a hx of IV drug use
septic emboli (found on CXR?)
and
"significant illness" (RR)
190
(RR)
if a pt is hypotensive and unstable, and showing wide complex tachycardia, what intervention is indicated?
synchronized cardioversion at 200 joules
(NOT adenosine, which is not recommended in hypotensive pts with a wide complex tachy)
191
(RR)
"what is the MC cause of ventricular tachycardia?"
"myocardial ischemia or infarct"
192
(RR)
three treatment options for Vtach
procainamide
amiodarone
synchronized cardioversion (refractory)
193
(RR)
if hyperthyroidism is causing a tachycardia, what is the likely presentation?
sinus tachycardia or AFib
hypertension
these are the more likely presentations of hyperthyroidism-caused tachycardia
194
(RR)
important distinction between cardiac tamponade and pericardial effusion
Tamponade = "fluid filling the pericardial sac accumulates faster than the rate of stretch in the parietal pericardium." They present with Beck's Triad of hypOtension, JVD, muffled heart sounds, or maybe also tachycardia and impaired diastolic filling.
pericardial effusions "are often asymptomatic and are due to a variety of diseases such as malignancy, renal failure, uremia, trauma, and radiation therapy"
195
(RR)
memory aid for L and R BBB
William Morrow
L BBB = "W" in V1 and "M" in V6
R BBB = "M" in V1 and "W in V6
196
(RR)
"A bicuspid aortic valve is often associated with which of the following findings?
a) AAA
b) dilation of the ascending aorta
c) L atrial dilation
d) patent foramen ovale"
B) DILATION OF THE ASCENDING AORTA
197
(RR)
bicuspid aortic valve has increased prevalence assoc'd w/ what three things?
coarctation of the aorta
Turner syndrome
DILATION OF THE ASCENDING AORTA
198
(RR)
"Pts with bicuspid aortic valve more frequently develop what aortic valvular abnormality?"
"aortic stenosis occurs much more frequently than aortic regurgitation"
199
(RR)
mainstay of therapy in hypertensive emergency that has lead to hypertensive pulmonary edema
vasodilators and diuretics
(nitroglycerine is preferred antihypertensive in setting of pulm edema)
200
(RR)
What is intermediate risk category for 10 year ASCVD event risk guidelines?
"Those who have a 10-year ASCVD event risk between 7.5% and 20% are considered to be at intermediate risk and are recommended to initate moderate-intensity statin therapy. "
201
(RR)
treatment differences b/w obstructive hypertrophic cardiomyopathy vs nonobstructive hypertrophic cardiomyopathy
nonobstructive = cardiac transplant (only viable solution)
obstructive = cardiac pacing, surgical myectomy or septal ablation
202
(RR)
when do you consider bridging anticoagulation for AFib pts facing surgery/procedures?
CHADS VASc score calculations (?)
and
if interruption is<1 week, no bridging needed
if interruption is > 1 wk, consider bridging
(you can stop warfarin 5 days before the procedure w/ no bridging and just pick it up again 12-24 hrs after procedure)
203
(RR)
medical tx for congenital long QT syndrome
propanolol
204
(RR)
tx for Torsades de pointes
magnesium sulfate
205
(RR) BUZZWORDS
palpable nodular cord
superficial thrombophlebitis
(RF = pregnancy, varicose veins, hx of localized trauma, IV therapy)
206
(RR)
MOA of ACE-inhibitors
block conversion of angiotensin I to angiotensin II
which causes a modest reduction in renal blood flow
207
(RR)
when are ACE-inhibitors useful?
in HTN and DM II
they are renoproctective
208
(RR)
"by what mechanism do ACE inhibitors cause hyperkalemia?"
"reduction of aldosterone secretion"
209
(RR)
what is the treatment of choice in hemodynamically stable wide complex tachydysrhythmias in WPW?
procainamide
210
(RR)
TWO possible reasons for systolic crescendo-decrescendo murmur
HYPERTROPHIC CARDIOMYOPATHY
and aortic stenosis
211
(RR)
congenital abnormality risk for a fetus if mom takes lithium during first trimester
Ebstein anomaly
( = "failure of the tricuspid valve to form properly, resulting in downward displacement of the leaflets and incompetency of the valve. This leads to a relatively small functional right ventricle, tricuspid regurgitation, and eventually symptoms of heart failure")
212
(RR)
three common Factor Xa inhibitor oral anticoagulants
name two other common oral anticoagulants and their MOA
Factor Xa Inhibitor =
apixaban
rivaroxaban
edoxaban
also ~
warfarin --inhibits Vit K synthesis
dabigatran - direct thrombin inhibitor
