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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

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2
Q

(RR)
what is aortic dissection?

A

damage of intima –> entry of blood b/w intima and media, creating a false lumen

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3
Q

(RR)
what does hypOtension indicate for aortic dissection?

A

poor prognostic indicator
likely indicates aortic rupture or cardiac tamponade

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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)

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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

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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

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7
Q

(RR)
Who should get ASCVD risk screening?

A

all adults ages 40-75

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8
Q

(RR)
If there is a high suspicion of upper extremity DVT, what is the next step in evaluation?

A

duplex ultrasound

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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

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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”

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11
Q

(RR)
most cases of mitral valve prolapse are _____

A

benign

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12
Q

(RR)
Mitral Valve Prolapse (MVP) can lead to what serious problems?

A

ACUTE MITRAL REGURGITATION (MR)
sudden cardiac death
infectious endocarditis
stroke

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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)

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14
Q

(RR)
PE findings of MVP

A

midsystolic click
late systolic murmur

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15
Q

(RR)
pts with symptoms of MVP may present with:

A

palpitations
dyspnea
nonexertional CP
fatigue

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16
Q

(RR)
how to diagnose mitral valve prolapse (MVP)

A

clinical exam
CONFIRMED BY ECHO

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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

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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)

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19
Q

(RR)
what is the MC tachydysrhythmia associated with sinus node dysfunction (formally known as sick sinus syndrome)?

A

atrial fibrillation

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20
Q

(RR)
50% of cases of sinus node dysfunction demonstrate

A

alternating bradycardia and an atrial tachydysrhythmia

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21
Q

(RR)
diffuse ST segment elevation (except for aVR and V1 which will show reciprocal ST depression and PR elevation)

A

pericarditis

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22
Q

(RR)
pain that DECREASES in intensity when pt leans forward is a distinct characteristic of what?

A

pericarditis

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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”

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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)

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25
Q

(RR)
two MC causes of pericarditis, in order:

A

first - idiopathic
second - viral (coxsackie)

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26
Q

(RR)
how do VSDs present?

A

HOLOSYSTOLIC MURMUR, best heard at
L LOWER STERNAL BORDER

frequently accompanied by a thrill or a displaced PMI

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27
Q

(RR)
in terms of VSD, what is Eisenmenger syndrome?

A

it is the progression of the defect to RIGHT-TO-LEFT shunting

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28
Q

(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?

A

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)

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29
Q

(RR)
acute decomp post acute anterior STEMI - what is most likely etiology of this acute decomp?

A

L ventricular free wall rupture

post MI ventricular free wall rupture is the most common mechanical complication post MI

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30
Q

(RR)
Beck triad

A

pericardial tamponade

1 - muffled heart sounds
2 - JVD
3 - hypOtension

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31
Q

(RR)
ECG showing low-voltage QRS, electrical alternans

A

think pericardial tamponade

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32
Q

(RR)
treatment for pericardial tamponade

A

pericardiocentesis

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33
Q

(RR)
three EKG signs of hyperkalemia

A

peaked T waves
prolonged PR
wide QRS

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34
Q

(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?

A

observation with u/s every week for 2-4 weeks

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35
Q

(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

A

2 mm DOWNSLOPING ST-SEGMENT DEPRESSION IS THE MOST SPECIFIC FINDING FOR MYOCARDIAL ISCHEMIA DURING AN EXERCISE STRESS TEST

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36
Q

(RR)
first, second, third-line treatments for symptomatic or hemodynamically unstable bradycardia (and define bradycardia)

A

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

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37
Q

(RR)
first degree AV heart block ECG findings:

A

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

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38
Q

(RR)
drugs that slow nodal conduction

A

digoxin
BB
CCB

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39
Q

(RR)
asymptomatic L ventricular systolic dysfunction w/ LVEF <40% should consider what pharmaceutical intervention?

A

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.

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40
Q

(RR) BUZZWORDS
boot-shaped heart

A

Teratology of Fallot

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41
Q

(RR) BUZZWORDS
rib notching

A

think coarctation of the aorta

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42
Q

(RR)
EKG findings of coarctation of the aorta

A

LVH

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43
Q

(RR)
diagnosis of coarctation of the aorta is made by _____

A

echo

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44
Q

(RR)
coarctation of the aorta is assocated with what congenital syndrome?

A

Turner syndrome

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45
Q

(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

A

RIB NOTCHING

these develop in response to increased collateral blood flow needed to bypass the congenital narrowing of the aorta

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46
Q

(RR)
MC type of coarctation of aorta

A

localized aortic coarctation

which occurs at or near junction of aortic arch and descending thoracic aorta, distal to origin of L subclavian artery

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47
Q

(RR)
EKG findings for coarctation of aorta

A

LVH

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48
Q

(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?

A

LIGATION

this is PDA, ACYANOTIC congenital cardiac condition
ligation is referred method of closure

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49
Q

(RR)
what is PDA?

A

the fetal connection b/w the pulmonary artery and the aorta remains open

causes a continuous “machine-like” murmur heard in systole and diastole

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50
Q

(RR)
what does PDA sound like?

A

continuous
rough
machine-like murmur
best heard in 1st interspace of LSB

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51
Q

(RR)
management of PDA?

A

indomethacin
conservative observation
surgical ligation
percutaneous transcatheter occlusion

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52
Q

(RR)
“Which of the following is a cyanotic congenital heart disease?
a) ASD
b) coarctation of aorta
c) PDA
d) Tetralogy of Fallot”

A

D) TETRALOGY OF FALLOT

1 - R vent outflow tract obstruction
2 - R vent hypertrophy
3 - VSD
4 - overriding aorta

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53
Q

(RR)
“what is the survival benefit of ACE-Is in pts who have suffered rEF?”

A

PREVENTS VENTRICULAR REMODELING

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54
Q

(RR)
what is the benefit of an ACE-I for pts post-MI?

A

REDUCE MORTALITY in pts after a STEMI by PREVENTING VENTRICULAR REMODELING

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55
Q

(RR)
All pts who present with syncope get what study?

A

EKG

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56
Q

(RR)
what is the focus of management of aortic stenosis in acute setting?

A

restore preload, and get cardiology consult
(in other words, IVF and cardiology consult)

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57
Q

(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”

A

D) FLECAINIDE

contraindicated in the setting of coronary artery or structural heart disease b/c of increased risk of polymorphic ventricular tachycardia

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58
Q

(RR)
mnemonic for Class IC antiarrhythmics?

A

Can I have Fries, Please?
Class IC
Flecainide, Propafenone

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59
Q

(RR)
What is the MOA of Class IC Antiarrhythmics?

A

fast Na+ channel blockers

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60
Q

(RR)
if Class IC antiarrhythmics are fast Na+ channel blockers, what changes do they cause in the heart and on the EKG?

A

increase AV node refractory period

increase PR, QT, QRS

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61
Q

(RR)
what is the MC cause of aortic valve insufficiency IN INDUSTRIALIZED COUNTRES?

worldwide?

A

AORTIC ROOT DILATION

worldwide - rheumatic heart disease

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62
Q

(RR)
common hx findings of aortic insufficiency (regurgitation)

A

infectious endocarditis, dissection, Marfan syndrome

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63
Q

(RR)
After airway is secured, what is the most appropriate next step in management of PEA?

A

CHEST COMPRESSIONS

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64
Q

(RR)
Causes of PEA (8)

A

The H’s and T’s:
Hypovolemia
Hypoxia
Hypothermia
Hyperkalemia

Tension Pneumo
Thrombus (PE or MI)
Toxicology
Tamponade

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65
Q

(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

A

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

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66
Q

(RR)
first line agent for treatment of aortic dissection

A

IV BB: labetalol or esmolol

FOLLOWED BY VASODILATORS (they’re not first)
i.e. nicardipine or nitroprusside

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67
Q

(RR)
five mainstays of management of aortic dissection

A
  • 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
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68
Q

(RR)
if a pt presents with s/s of infectious endocarditis from IV drug use, what are most appropriate abx?

A

VANCOYMYCIN AND CEFTRIAXONE

you need to cover MRSA, staph, strep, enterocci

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69
Q

(RR)
what organisms are most commonly found in right-sided endocarditis?

A

Staph aureus
Strep pneumoniae
gram negative bac

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70
Q

(RR)
what organisms are most commonly responsible for bac endocarditis in the presence of a GI malignancy?

A

Strep bovis

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71
Q

(RR)
what two items are necessary for diagnosis of bac endocarditis?

A

DUKE CRITERIA
and echocardiography

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72
Q

(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?”

A

REPEAT DUPLEX ULTRASOUND

in pts w/ high pre-test probability, a repeat duplex u/s is indicated in pts with persistent symptoms

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73
Q

(RR)
major criteria for rheumatic fever

A

Jones Criteria - the majors
JONES - C

Joints (polyarthritis)
Oh no
Nodules
Erythema marginatum
Sydenham chorea
Carditis

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74
Q

(RR)
minor criteria for Rheumatic Fever

A

fever
arthralgia
previous rheumatic heart disease

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75
Q

(RR)
leading cause of valvular disease in the world

A

rheumatic fever (esp children 4-9 yrs)

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76
Q

(RR)
hx of infection from GAS….think

A

rheumatic fever

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77
Q

(RR)
initial approach to managing suspected white coat hypertension

A

ambulatory bp monitoring
(send them home w/ bp cuff)

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78
Q

(RR)
“what is first line medication for uncomplicated HTN according to ACC/AHA?”

A

thiazide diuretics

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79
Q

(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)?

A

warm compress
extremity elevation
compression stockings
pain management
remain ambulatory

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80
Q

(RR)
management of complicated superficial thrombophlebitis

A

anticoagulation

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81
Q

(RR)
what are the concerning axial leg veins that increase a pts risk of superficial thrombus extending into deep veins?

A

great saphenous vein
accessory saphenous vein
small saphenous vein

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82
Q

(RR)
What do inotropic drugs do (big picture)?

A

alters the force of myocardial contraction

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83
Q

(RR)
list nine positive inotropic drugs

A

(these increase myocardial contractility)
dopamine
dobutamine
epinephrine
norepinephrine
digoxin
phosphodiesterase inhibitors (Milrinone)
glucagon
insulin
amiodarone

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84
Q

(RR)
list four negative inotropic drugs

A

(these decrease myocardial contractility)
BB
CCB
class IA antiarrhythmics (quinidine, procainamide)
Class IC antiarrhythmics (flecainide)

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85
Q

(RR)
what is digoxin, in terms of contractility and rate effects?

A

positive inotrope
negative chronotrope

(“it augments pumping while decreasing heart rate”)

86
Q

(RR)
define pulsus paradoxus

A

fall in SBP >10 mm Hg during inspiration

87
Q

(RR)
define pulsus alternans

A

alternation of one strong beat followed by a beat of decreased amplitude during palpation of peripheral pulses

88
Q

(RR)
what might you see on an EKG of cardiac tamponade?

A

sinus tach
low voltage QRS complexes
ELECTRICAL ALTERNANS
PR segment depression

89
Q

(RR)
“which of the following is an independent cause of secondary hypertension?
a) Addison’s disease
b) A Fib
c) hypercholesterolemia
d) primary aldosteronism”

A

D) PRIMARY ALDOSTERONISM

“Primary aldosteronism typically causes hypOkalemia, mild hypernatremia, or drug-resistant HTN”

90
Q

(RR)
increased Na + decreased K + HTN

A

hyperaldosteronism

91
Q

(RR)
what is the most common cause of primary hyperaldosteronism?

A

adrenal adenoma is the most common cause

also, decreased renin

92
Q

(RR)
what medication is used to treat hyperaldosteronism?

A

spironolactone
(and surgery if primary)

93
Q

(RR)
how does acute mitral regurgitation usually present?

A

pts typically present in FULMINANT PULMONARY EDEMA RAPID IN ONSET

it is associated with a MID SYSTOLIC MURMUR

94
Q

(RR)
sudden onset and rapid progression of pulmonary edema, hypOtension, and s/s of cardiogenic shock

A

think acute mitral regurgitation
(often missed b/c clinical hx mimics an acute pulmonary process)

95
Q

(RR)
unique, harsh, midsystolic murmur best heard at apex that radiates to the base rather than the axilla

A

ACUTE mitral regurgitation

96
Q

(RR)
blowing holosystolic murmur best heard at apex with radiation to axilla

A

CHRONIC mitral regurgitation

97
Q

(RR)
treatment for acute mitral regurgitation

A

nitroprusside
dobutamine
intra aortic balloon pump
emergency sx

98
Q

(RR)
treatment for chronic mitral regurgitation

A

CHF Rx
valve repair or replacement

99
Q

(RR)
describe restrictive cardiomyopathy (RCM)

A

DECREASED MYOMETRIAL COMPLICANCE IN THE ABSENCE OF PERICARDIAL DISEASE

walls of ventricles become stiff, but not necessarily thickened

100
Q

(RR)
it is common for pts with RCM to fail ______ management of _________

A

DIURETIC MANAGEMENT OF PERIPHERAL EDEMA

101
Q

(RR)
restrictive cardiomyopathy may have what infiltrative disorder etiologies?

A

amyloidosis
sarcoidosis
hemochromatosis

102
Q

(RR)
three common signs of restrictive cardiomyopathy

A

peripheral edema
dyspnea
fatigue
(signs of R-sided heart failure)

103
Q

(RR)
echo findings for restrictive cardiomyopathy

A

impaired diastolic filling
preserved systolic function

104
Q

(RR)
MC cause of restrictive cardiomyopathy

A

amyloidosis

105
Q

(RR)
dilation and impaired contraction of one or both ventricles

A

dilated cardiomyopathy

106
Q

(RR)
six etiologies for dilated cardiomyopathy

A

ischemic
infectious (viral, Chagas, HIV, Lyme)
idiopathic

genetic
toxic (ETOH, cocaine, meth, chemotherapy)
valvular

107
Q

(RR)
leading cause of sudden cardiac death in young athletes

A

hypertrophic cardiomyopathy

108
Q

(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

A

PULMONIC STENOSIS

109
Q

(RR)
three tenants of treatment of non-ST elevation MI

A

dual antiplatelet therapy
anticoagulation
early coronary angiography with revascularization (in most pts)

110
Q

(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?

A

UNFRACTIONATED HEPARIN

111
Q

(RR)
what is the antiplatelet therapy for patients with non-ST elevation ACS (in absence of absolute contraindication)

A

ASA
P2Y12 receptor blocker (clopidogrel, ticlopidine)

112
Q

(RR)
“What cardiac complication is associated with hypERthyroidism?”

A

high-output cardiac failure

“Through beta-adrenergic stimulation, elevated thyroid hormone levels can produce high-output cardiac failure.”

113
Q

(RR)
what is the definitive intervention to correct mitral regurgitation caused by papillary m rupture?

A

MITRAL VALVE REPLACEMENT

114
Q

(RR)
acute MI may lead to the sudden rupture of ____________-

A

chorda tendinae or papillary m
…causing a sudden volume overload of both the L atrium and the L ventricle

115
Q

(RR)
what is the most important RF for aortic dissection?

116
Q

(RR)
what is a bicuspid aortic valve a risk for?

A

aortic dissection

117
Q

(RR)
contraindication for eplerenone, and what class of drug is it?

A

elevated serum potassium

mineralocorticoid receptor antagonist (as is spironolactone)

“eplerenone is contraindicated….b/c it has the potential to increase potassium”

118
Q

(RR)
antiplatelet choices for NSTEMI

A

ASA
clopidogrel
prasugrel
ticagrelor (these are three P2Y12 inhibitors)

119
Q

(RR)
where is the block in Second-Degree Heart Block, Type II?

A

below the AV node, generally in the His-Purkinje system

120
Q

(RR)
EKG findings for Second-Degree Heart Block, Type II (i.e Mobitz II)

A

P waves normal
QRS complexes usually wide
PR intervals are same duration
DROPPED BEATS

121
Q

(RR)
primary cause of PAD

A

atherosclerosis

122
Q

(RR)
how can patients with PAD relieve their pain?

A

hang the foot of the affected leg over the side of the bed

123
Q

(RR)
MC atypical presenting complaint in elderly pts with ACS

A

DYSPNEA

60-70% of pts older than 85 years presenting with an angina-equivalent complaint have atypical features, most commonly dyspnea

124
Q

(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?

A

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
Q

“What is the classic auscultatory feature of mitral valve prolapse?”

A

MIDSYSTOLIC CLICK

126
Q

(RR)
“Mitral valve prolapse is often associated with what conditions?”

A

Marfan syndrome
Ehlers-Danlos syndrome

127
Q

(RR)
Long-term prophylaxis to reduce Prinzmetal angina attacks is best accomplished with what meds?

A

CCB (namely NIFEDIPINE)
LONG-ACTING NITRATES (like ISOSORBIDE DINITRATE)

128
Q

(RR)
EKG shows transient ST segment elevations and cardiac enzymes are normal

A

Prinzmetal Angina

129
Q

(RR)
pts who have cocaine-induced ACS cannot receive what drugs, and why?

A

BB (such as labetalol)
this may lead to UNOPPOSED ALPHA-ADRENERGIC STIMULATION which could result in CORONARY ARTERY VASOCONSTRICTION and systemic HYPERTENSION

130
Q

(RR)
absolute contraindications to fibrolytic therapies

A

hx of intracranial hemorrhage
cerebral vascular structural lesions
intracranial neoplasm
ischemic stroke or head/facial trauma w/in past 3 months
active bleeding

131
Q

(RR)
relative contraindications for fibrolytic therapies

A

SBP >= 180
DBP >= 110

uncontrolled HTN
pregnancy
anticoagulant use

132
Q

(RR)
when do men determined to be low risk for heart disease start screening for lipid abnomalities?

133
Q

(RR)
name thiazide diuretic SEs

A

HYPERGLYCEMIA
hypokalemia
hyponatremia
magnesium depletion

hypercalcemia
hyperuricemia

134
Q

(RR)
Pt with a 10-year ASCVD event risk score of 9% should have what initial therapy?

A

moderate-intensity statin therapy, which may include lovastatin, simvastatin, fluvastatin, pitavastatin

135
Q

(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

A

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
Q

(RR)
“how many days after surgery does a postoperative DVT typically occur?”

137
Q

(CME)
“A pt who just had a small MI has a LDL of 150. What LDL number is this pt’s goal?”

A

reduce by 50% or more

138
Q

(CME)
“Which heart disease is often associated w/ a beta myosin heavy chain gene mutation on chromosome 14 and can be treated with verapamil?

A

hypertrophic cardiomyopathy

139
Q

(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”

140
Q

(CME)
“Which medication is the preferred treatment for a pt in Torsades?
f) amiodarone
g) lidocaine
h) atropine
i) magnesium
j) calcium”

A

I) MAGNESIUM

141
Q

(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”

A

D) I, aVL, V5 - V6

142
Q

(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”

A

H) CALCIUM CHANNEL BLOCKERS

143
Q

(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”

A

E) VENTRICULAR SEPTAL DEFECT

144
Q

(CME)
“Which skin condition is a myocardial infarction independent risk factor?
f) eczema
g) psoriasis
h) seborrheic dermatitis
i) vitiligo
j) rosacea”

A

G) PSORIASIS

145
Q

(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

A) RANOLAZINE

146
Q

(CME)
which medication is contraindicated with ACE-I in diabetic patients?
f) linezolid
g) metformin
h) digoxin
i) spironolactone
j) aliskiren

A

J) ALISKIREN

147
Q

(CME)
which medication should be avoided in patients with significant coronary artery disease?
a) streptokinase
b) phenobarbital
c) hydroxyzine
d) sumatriptan
e) lorazepam

A

D) SUMATRIPTAN

148
Q

(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

A

G) ST ELEVATION

149
Q

(CME)
what is the aortic area for hearing a murmur?

A

2nd R intercostal space

150
Q

(CME)
what is the pulmonic area for hearing murmurs?

A

2nd L intercostal space

151
Q

(CME)
What is the tricuspid area for murmur listening?

A

4th L intercostal space (aka LLSB)

152
Q

(CME)
what is the mitral area for listening to a murmur?

A

apex, or 5th L intercostal space (midclavicular line)

153
Q

(CME)
just for fun…what is Erb’s point in terms of heart anatomy?

A

3rd L intercostal space along the L sternal border

154
Q

(CME)
what grade murmurs have a thrill?

A

grades IV to VI

155
Q

(CME)
what is the only murmur that increases with inspiration?

A

tricuspid regurgitation

“a holosystolic murmur w/ R-sided signs”

156
Q

(NCCPA Practice Exam)
If a pt has gout, what cholesterol treatment should be avoided?

A

NIACIN

Niacin SE include
flushing
PUD
gout
hyperglycemia
hepatotoxicity

157
Q

(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”

A

“GOUT”

158
Q

(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”

A

VENOUS HUM

159
Q

(CME)
“Which of the following is considered a crescendo-decrescendo murmur?
a) mitral regurgitation
b) mitral stenosis
c) aortic regurgitation
d) aortic stenosis”

A

AORTIC STENOSIS

160
Q

(RR)
what should be monitored for pts taking amiodarone?

A

annual CXR
eye exams
monitor thyroid fxn
monitor liver fxn

161
Q

(RR)
“What type of heart block is consistent with acute rheumatic fever?”

A

“First degree heart block (prolonged PR interval)”

162
Q

(RR)
common hx finding of rheumatic fever

A

GAS infection!

163
Q

(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”

A

E) PARADOXICAL PULSE

“Pulsus paradoxus is a classic finding (drop 10 mmHg in systolic pressure on inspiration), narrow pulse pressure.” (SmartyPance)

164
Q

(RR)
long term tx of Vasospastic Angina

A

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
Q

(RR)
“What is the diagnostic murmur auscultated in aortic stenosis?”

A

crescendo-decrescendo systolic murmur

…that radiates to the carotids, paradoxically split S2,S4 gallop, and murmur decreases with Valsalva

166
Q

(RR)
How do patients with acute mitral regurgitation typically present?

A

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
Q

(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

A) CYANOTIC CONGENITAL HEART DISEASE

this is the mab administered to prevent RSV infections

(think of Onyx)

168
Q

(RR)
four ACYANOTIC congenital heart diseases

A

ASD
VSD
PDA
CoA

169
Q

(RR)
describe third degree heart block

A

“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
Q

(RR)
“Which peripheral arteries are most commonly affected by arterial thrombosis?”

A

“femoral and popliteal arteries”

171
Q

(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

A) BASILAR CRACKLES AND PERIPHERAL EDEMA

….”80% of infants presenting with congestive heart failure (pulmonary or peripheral edema or both)”

172
Q

(RR)
58 y/o M w/ AFib with RVR

What is appropriate anticoagulation?

A

Dabigatran

NOAC (direct thrombin inhibitor and oral factor Xa inhibitors)

173
Q

(RR)
INR range for pts taking warfarin for AFib?

174
Q

(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”

A

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
Q

(RR)
“What drug can be administered to reopen a recently closed ductous arteriosus?”

A

Prostaglandin E1 (PEG1)

176
Q

(RR)
“What medication (and dose) can be used to temporarily preserve patency of the ductus arteriosus?”

A

alprostadil (PEG1)

0.05 - 0.1 mcg/kg/min IV

177
Q

(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”

A

“VENTRICULAR SEPTAL DEFECT IN THE MEMBRANOUS PORTION”

“The majority of clinically significant VSDs occur in the membranous part, near the atrioventricular node.”

178
Q

(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”

A

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
Q

(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”

A

B) ABD MASS

180
Q

(CME)
name the three continuous murmurs (systolic and diastolic)

A

pericardial friction rub

PDA

venous hum (loudest in diastole)

181
Q

(RR)
who gets combination anti-hypertensive treatment, and what’s the key to combination treatment?

A

“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
Q

(RR)
MC locations for venous stasis ulcers

A

medial and lateral malleoli

183
Q

(RR)
what is MOA for first line treatment for paroxysmal supraventricular tachycardia?

A

inhibits atrioventricular nodal conduction

(it’s adenosine)

184
Q

(RR)
“What is the treatment for a patient who is hemodynamically unstable with a regular, narrow complex tachycardia?”

A

“cardioversion”

185
Q

(RR)
hypertensive emergency vs hypertensive urgency

A

urgency = >180/120

emergency = elevated bp w/ evidence of end-organ damage

186
Q

(RR)
“what is the MC SE following administration of IV amiodarone?”

A

“hypotension”

187
Q

(RR)
MOA of amiodarone

A

“inhibition of outward potassium channels which prolongs the duration of the action potential”

188
Q

(RR)
“What SE is responsible for the greatest number of deaths associated with amiodarone?”

A

“pulmonary toxicity, the MC of which is chronic interstitial pneumonitis”

189
Q

(RR)
two common presenting signs of infectious endocarditis for a pt with a hx of IV drug use

A

septic emboli (found on CXR?)
and
“significant illness” (RR)

190
Q

(RR)
if a pt is hypotensive and unstable, and showing wide complex tachycardia, what intervention is indicated?

A

synchronized cardioversion at 200 joules

(NOT adenosine, which is not recommended in hypotensive pts with a wide complex tachy)

191
Q

(RR)
“what is the MC cause of ventricular tachycardia?”

A

“myocardial ischemia or infarct”

192
Q

(RR)
three treatment options for Vtach

A

procainamide
amiodarone
synchronized cardioversion (refractory)

193
Q

(RR)
if hyperthyroidism is causing a tachycardia, what is the likely presentation?

A

sinus tachycardia or AFib
hypertension

these are the more likely presentations of hyperthyroidism-caused tachycardia

194
Q

(RR)
important distinction between cardiac tamponade and pericardial effusion

A

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
Q

(RR)
memory aid for L and R BBB

A

William Morrow

L BBB = “W” in V1 and “M” in V6

R BBB = “M” in V1 and “W in V6

196
Q

(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”

A

B) DILATION OF THE ASCENDING AORTA

197
Q

(RR)
bicuspid aortic valve has increased prevalence assoc’d w/ what three things?

A

coarctation of the aorta
Turner syndrome
DILATION OF THE ASCENDING AORTA

198
Q

(RR)
“Pts with bicuspid aortic valve more frequently develop what aortic valvular abnormality?”

A

“aortic stenosis occurs much more frequently than aortic regurgitation”

199
Q

(RR)
mainstay of therapy in hypertensive emergency that has lead to hypertensive pulmonary edema

A

vasodilators and diuretics

(nitroglycerine is preferred antihypertensive in setting of pulm edema)

200
Q

(RR)
What is intermediate risk category for 10 year ASCVD event risk guidelines?

A

“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
Q

(RR)
treatment differences b/w obstructive hypertrophic cardiomyopathy vs nonobstructive hypertrophic cardiomyopathy

A

nonobstructive = cardiac transplant (only viable solution)

obstructive = cardiac pacing, surgical myectomy or septal ablation

202
Q

(RR)
when do you consider bridging anticoagulation for AFib pts facing surgery/procedures?

A

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
Q

(RR)
medical tx for congenital long QT syndrome

A

propanolol

204
Q

(RR)
tx for Torsades de pointes

A

magnesium sulfate

205
Q

(RR) BUZZWORDS
palpable nodular cord

A

superficial thrombophlebitis

(RF = pregnancy, varicose veins, hx of localized trauma, IV therapy)

206
Q

(RR)
MOA of ACE-inhibitors

A

block conversion of angiotensin I to angiotensin II

which causes a modest reduction in renal blood flow

207
Q

(RR)
when are ACE-inhibitors useful?

A

in HTN and DM II

they are renoproctective

208
Q

(RR)
“by what mechanism do ACE inhibitors cause hyperkalemia?”

A

“reduction of aldosterone secretion”

209
Q

(RR)
what is the treatment of choice in hemodynamically stable wide complex tachydysrhythmias in WPW?

A

procainamide

210
Q

(RR)
TWO possible reasons for systolic crescendo-decrescendo murmur

A

HYPERTROPHIC CARDIOMYOPATHY

and aortic stenosis

211
Q

(RR)
congenital abnormality risk for a fetus if mom takes lithium during first trimester

A

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
Q

(RR)
three common Factor Xa inhibitor oral anticoagulants

name two other common oral anticoagulants and their MOA

A

Factor Xa Inhibitor =
apixaban
rivaroxaban
edoxaban

also ~
warfarin –inhibits Vit K synthesis
dabigatran - direct thrombin inhibitor

PANCE (13 decks)

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