Random Cardio Pathophys HY

Question 1

Which form of AV block may be physiologic?

Answer 1

mobitz I Wenckebach

Question 2

a fib tx

Answer 2

• anti-coagulation to prevent stroke(CHADS)
• rate control: AV blockers, slow ventricular rate (BB, NDCCBS)
• rhythm control (IA, IC, III)
• Ablation

Question 3

Vtachy/fib tx

Answer 3

acute: if hemodynamically stable –> III or IB
defibrillation/cardioversion

chronic: implantable cardioverter defibrillator (ICD)

anti-arrhythmia med therapy for reducing freq of ICD

Question 4

comes from one pt of ventricle - likely prior scar

Answer 4

monomorphic VT

reentrant arrhythmia

Question 5

_____ prevents conduction through bypass tract in WPW

Answer 5

procaniamide

IA: Na/K blockade, intermediate binding/dissociation properties

Question 6

_______ is used to tx ventricular tachycardia

Answer 6

lidocaine

IB: rapid binding/dissociation

Question 7

_______ used to tx Afib (w/ normal heart structure)

Answer 7

Flecanide

IC: slow binding and dissociation

Question 8

Class III

Answer 8

reverse-use dependence, greater effects at slower HR

use: a fib/flutter w/ structure abnormal heart, vfib/tachy to reduce freq of ICD discharge

Question 9

NDCCBs

Answer 9

block AV node, SVTs, - ionotrope

Question 10

DCCBS

Answer 10

purely vasodilators, vascular smc

HTN/chronic stable angina

Question 11

aspirin MOA

Answer 11

blocks COX1/2 to reduce prostaglandin metabolic –> reduced thromboxane-mediated platelet aggregation

Question 12

P2Y12 receptor blockers

Answer 12

prevent ADP-mediated platelet aggregation

can be given w/ aspirin to prevent stent thrombosis

Question 13

nitrates + _______ = extreme vasodilation/hypotension

Answer 13

nitrates (PROD cAMP) + PDE-5 (prevent degradation of cAMP) = extreme vasodilation/hypotension

CONTRAINDICATED

Question 14

type I infarct

Answer 14

acute thrombotic occlusion of coronary a.

Question 15

type II infarct

Answer 15

inadequate O2 supply bc of inc O2 demand in setting of “fixed coronary blockage”

Question 16

____ blockers worsen bundle branch blocks

Answer 16

Na chan blockers

Question 17

HMG-CoA reductase inhibitors

morbidity or mortality benefit in ASCVD?

Answer 17

both morbidity and mortality benefits in ASCVD

Question 18

statins primary prevention when 10-yr ASVCD risk >

Answer 18

statins primary prevention when 10-yr ASVCD risk >7.5%

Question 19

CHL drugs lowering LDL as much as possible in pts w/ established ASCVD

Answer 19

PCSK9 inhibitors

Ezetmibe

Question 20

early afterdepolarization (EAD)

Answer 20

QT prolonging meds

class III anti-arrhythmics

Question 21

delayed afterdepolarization (DAD)

Answer 21

digoxin toxicity

Question 22

ST-elevation MI

EKG changes

Answer 22

acute: ST elevation
hrs: ST elevation, dec R wave, Q wave begins

days 1-2: T wave inversion, Q wave deeper

days later: ST normalizes, T wave inverted

weeks later: ST & T normal, Q wave persists

Question 23

Inferior STEMI

Answer 23

GI sx
nitroglycerin induced hypOtension
AV node block if AV node ischemic
proximal RCA occlusion –> RV infarction

Question 24

tx for possible VT/VF post-MI

Answer 24

defibrillator

Question 25

tx for chronic claudication

Answer 25

``` smoking cessation m. training PDEi (Pletal) statin surgery ```

Question 26

aortoiliac occlusion

Answer 26

rare presentation: limb ischemia, acute abd pain tx: revascularization poor prognosis

Question 27

infrainguinal occlusion

Answer 27

more common often embolic (fib) tx: remove emboli, bypass obstruction good prognosis

Question 28

aneurysm: __+% increase in diameter or vessel

Answer 28

50+%

Question 29

repair aneurysm if

Answer 29

asymptomatic >5-5.5cm or triad of abd/back pain, hypOtension, pulsatile abd mass

Question 30

type B aortic dissection tx

Answer 30

medical therapy | surgery only for critical tissue loss

Question 31

type A aortic dissection tx

Answer 31

urgent surgical repair | high risk rupture/death in 48 hr

Question 32

primary aortic root dilatation

Answer 32

Marfan's, cystic medial necrosis, hypertension --> aortic regurgitation

Question 33

tx of which valvular disease includes afterload reduction and diuretics

Answer 33

mitral regurgitation

Question 34

amyloid CM comm produces ___ HF bc compliant __ is affected more strongly

Answer 34

amyloid CM comm produces RIGHT HF bc compliant RV is affected more strongly than LV

Question 35

gradient between PA diastolic P and wedge

Answer 35

``` obstructive shock (PE) ```

Question 36

harsh systolic murmur and palpable thrill

Answer 36

VSD

Question 37

ASD more commonly affect M or F?

Answer 37

F

Question 38

VSD more commonly membranous or muscular?

Answer 38

membranous

Question 39

PDA murmur

Answer 39

continuous during systole and diastole

Question 40

maternal Li use

Answer 40

PDA | Ebstein's Anomaly

Question 41

maternal rubella

Answer 41

PDA | pulmonary a. stenosis

Question 42

Eisenmenger's syndrome

Answer 42

ASD/PDA/VSD --> inc pulm BF damaging vasculature --> arterial remodeling that inc resistance to flow as pulm vascular R inc, Qp:Qs dec Qp L) ``` cyanosis, high risk of death reactive polycythemia and hyperviscosity paradoxical embolus: brain abscess arrhythmia, HF hemoptysis Hypertrophic osteoarthropathy (clubbing) ```

Question 43

TOF tx

Answer 43

Black-Taussing Shunt | full surgical correction

Question 44

coarctation of aorta more common in M or F?

Answer 44

males

Question 45

coarctation of aorta is associated w/

Answer 45

bicuspid aortic valve | PDA

Question 46

Pericarditis CP

Answer 46

CP sharp/positional, improves w/ leaning fwd, worse w/ inspiration

Question 47

pericarditis ECG

Answer 47

diffuse ST elevation not explained on basis of occluded coronary a. PR depression

Question 48

pericarditis tx

Answer 48

NSAIDS, colchicine

Question 49

earliest stage of passive ventricular filling

Answer 49

y-descent

Question 50

blunted y-descent

Answer 50

tamponade

Question 51

prominent Y-descent

Answer 51

constrictive pericarditis

Question 52

AA for normal heart struc

Answer 52

IA, IC

Question 53

AA for abnormal heart struc

Answer 53

III

Question 54

Ablation in AVNRT

Answer 54

ablate SLOW pathway

Question 55

development of Q wave

Answer 55

infarct

Question 56

NSTEMI ekg

Answer 56

ST depression or T wave inversion

Question 57

proven clinical benefit for HF

Answer 57

ACEi ARB bblockers mineral/aldo blockers

Question 58

polymorphic VT

Answer 58

wide complex tachy - likely from more widespread sources - acute ischemia, meds that prolong QT interval - TDP

Question 59

type B aortic dissection most commonly occur

Answer 59

just beyond L subclavian origin

Question 60

when to repair asymptomatic carotid blockage

Answer 60

when stenosis progresses >75%

Question 61

HCM leads to which type of HF

Answer 61

HF w/ preserved EF

Question 62

EF in amyloid induced restrictive CM

Answer 62

mildly dec contractility --> EF ~ 40-50%

Question 63

VSD more commonly affect M or F?

Answer 63

1:1

Question 64

PDA more commonly affect M or F?

Answer 64

F

Question 65

equal diastolic filling pressures

Answer 65

tamponade