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Cardiovascular > The Final Step CV chapter > Flashcards

The Final Step CV chapter Flashcards

1
Q

What side effect might make a patient stop taking an ACE-I?

A

cough

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2
Q

define orthostatic hyptoension

A

a drop in systolice BP of > 20 mmHg or diastolic BP of > 10 mmHg

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3
Q

You feel a pulse that seems to be vibrating. What term do you use to describe it?

A

Thrill

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4
Q

What are three things in your differential diagnosis if you have a paradoxical pulse?

A

Cardiac tamponade
pericarditis
obstructive lung disease

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5
Q

on palpation, what size is normal for the aorta?

A

< 3 cm

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6
Q

A fixed or consistent split S2 should make you think of what diagnosis?

A

Atrial septal defect

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7
Q

A pathologic S3 is most commonly associated with what diagnosis?

A

CHF

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8
Q

If you hear a midsystolic click you should immediately be thinking about what diagnosis?

A

Mitral Valve Prolapse

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9
Q

An opening snap on auscultation of the heart should make you think of what diagnosis?

A

mitral stenosis

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10
Q

A continuous murmur most likely involves what area of the heart?

A

It is most likely a septal defect

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11
Q

You hear a continuous machine-like murmur. What is most likely

A

Patent ductus arteriosus (PDA)

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12
Q

list three medications which may be used for pharmacological stress test.

A

Adenosine
dobutamine
dipyridamole
persantine

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13
Q

what is the gold standard for diagnosing coronary artery disease?

A

cardiac catheterization

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14
Q

define stage one HTN according to JNC 8.

A

systolc BP 140-159 mmHg or diastolic BP 90-99 mmHg

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15
Q

What is the treatment goal for a diabetic w/ hypertension?

A

<140/90 mmHg

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16
Q

What is the most common cause of secondary hypertension?

A

Chronic kidney disease

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17
Q

No matter what medications you use you are having trouble keeping a patient’s blood pressure under control. You also notice hyperpigmented skin and truncal obesity. What is the most likely diagnosis?

A

Cushing’s disease

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18
Q

List three signs or symptoms which will likely be included in a description of a patient with a pheochromocytoma?

A

Thin, diaphoretic, tachycardic, agitated, and hypertensive

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19
Q

You have a patient with a diagnosis of a pheochromocytoma. While waiting for surgery, should you use an alpha blocker or a beta blocker

A

Alpha blocker. You should never use a pure beta blocker (WHY????)

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20
Q

A young boy comes into your office. He has elevated blood pressure when taken in his arm, but no femoral pulses can be palpated. What is the most likely diagnosis?

A

Coarctation of the aorta

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21
Q

According to the CDC, what is the range for a normal BMI?

A

18.5-24.9

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22
Q

What is the first line medical treatment for stage 1 hypertension?

A

Thiazide diuretic

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23
Q

After a thiazide diuretic, what medication should you start in a hypertensive patient who also has diabetes?

A

An ACEI or ARB

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24
Q

following a MI, what medication should you be using to treat HTN?

A

beta blocker

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25
Q

Paroxysmal nocturnal dyspnea should make you think of what diagnosis?

A

CHF (left sided)

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26
Q

What is the most common cause of CHF?

A

coronary artery disease (CAD)

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27
Q

What ejection fraction is typical for a patient with CHF?

A

35-40%

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28
Q

What is the most likely diagnosis for a young man who experiences sudden death while playing sports?

A

hypertrophic cardiomyopathy

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29
Q

Bat wing vessels or Kerley B lines on a CXR should make you think of what Dx?

A

CHF

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30
Q

a beta natriuretic peptide below what level rules out CHF?

A

< 100

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31
Q

What is the therapeutic range for INR following a mechanical valve replacement?

A

2.5-3.5

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32
Q

What is the first line IV inotropic agent when dealing with cardiogenic shock?

A

Dopamine

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33
Q

What diagnosis is most likely in an IV drug user with a new heart murmur and fever?

A

endocarditis

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34
Q

List two diagnoses which require antibiotic prophylaxis for “dirty procedures?”

A

prosthetic valve, valve repair w/ any prosthetic material, prior endocarditis diagnosis, congenital cyanotic heart defect

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35
Q

Does a patient with mitral valve prolapse require prophylactic ABx for dental work?

A

No. a recent change moves mitral vavle prolapse from high risk to moderate risk

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36
Q

What are the three major criteria for endocarditis?

A
  1. 2 positive blood cultures
  2. a positive transesophageal echocardiography
  3. new murmur
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37
Q

Which are painful and found on the fingers and toes–Osler nodes or Janeway lesions?

A

Osler nodes

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38
Q

LIst the 4 minor criteria for diagnosing endocarditis

A
  1. fever
  2. embolic event (Janeway lesions or petechiae, splinter hemorrhages)
  3. immunological event (osler nodes, glomerulonephritis)
  4. one positive blood culture
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39
Q

What are the five components of tetralogy of Fallot?

A
  1. ventricular septal defect
  2. RT vent. hypertrophy
  3. RT vent. outflow obstruction (pulmonary valve stenosis)
  4. overriding aorta
  5. RT sided aortic arch
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40
Q

What is the gold standard for diagnosing myocarditis?

A

myocardial biopsy

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41
Q

Where do most aortic dissections occur?

A

The ascending or descending thoracic aorta

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42
Q

A pt complains of severe pleuritic chest pain that is relieved with sitting and learning forward. What is the most likely diagnosis?

A

Pericarditis

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43
Q

What is the first line medical treatment for pericarditis?

A

Aspirin and NSAIDs

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44
Q

What is the name of the syndrome that involves percarditis several days after a myocardial infarction?

A

Dressler syndrome

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45
Q

A pt presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all of the leads. What is the most likely diagnosis?

A

pericarditis

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46
Q

Define paradoxical pulse.

A

There is a large difference in pulse pressure between inhalation and exhalation

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47
Q

Define pulsus alternans

A

EKG waveform changes from beat to beat

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48
Q

What is the definitive treatment for cardiac tamponade?

A

pericardiocentesis

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49
Q

On physical exam, you hear a harsh systolic murmur along the RT sternal border. What is the most likely diagnosis?

A

Aortic stenosis

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50
Q

A wide pulse pressure with a blowing diastolic decrescendo murmur at teh RT second intercostal space should make you think of what diagnosis?

A

Aortic regurgitation

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51
Q

What is the best location to hear problems with the aortic valve?

A

2nd RT intercostal space

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52
Q

Where is disease of the pulmonary valve best heard?

A

2nd LT intercostal space

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53
Q

What two antibiotics are used for empiric treatment of endocarditis?

A

Vancomycin and ceftriaxone (3rd gen cephalosporin; excellent CNS/CFS penetration; gram -) together are first line empiric treatment

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54
Q

What two valvular issues do patients with Marfan’s syndrome often have?

A

Aortic regurgitation and mitral valve prolapse (you tell them apart by where they are heard)

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55
Q

What are the two main causes of aortic stenosis?

A

Congenital bicuspid valve and calcification of the valve secondary to coronary artery disease.

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56
Q

An elderly patient presents with dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely diagnosis?

A

Aortic stenosis

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57
Q

on auscultation, you hear a harsh, blowing, pansystolic murmur at the apex. What is the most likely diagnosis?

A

Mitral regurgitation

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58
Q

You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis?

A

Transesophageal echo

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59
Q

A patient with mitral valve prolapse will often have what physical characteristic?

A

often a thin female

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60
Q

What is the best patient position to hear aortic regurge and aortic stenosis

A

Sitting up and leaning forward

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61
Q

What is Tietze syndrome?

A

Costochondritis

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62
Q

Are most pulmonary valve problems congenital or acquired?

A

95% are congenital

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63
Q

What is the therapeutic range for INR following an organic valve replacement?

A

2-3

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64
Q

A 60 yo male presents to the ER w/ severe dizziness and back pain. His blood pressure is dropping, and you can feel an abdominal pulsatile mass on physical exam. What is the most likely diagnosis?

A

Ruptured aortic aneurysm

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65
Q

In a pt w/ aortic stenosis, will the PMI be medially displaced, normal, or laterally displaced?

A

laterally displaced due to left ventricular hypertrophy

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66
Q

A pt c/o severe crushing chest pain. EKG shows ST segment elevations. All labs including troponins and CK-MB are negative. What is the most likely diagnosis?

A

Prinzmetal’s angina

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67
Q

A question about Prinzmetal’s angina will often contain whay key thing in the patient’s Hx?

A

Cocaine use

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68
Q

Name two things that would constitute a positive stress test.

A
  1. a drop in BP
  2. a new arrhythmia
  3. an increase in angina symptoms
  4. ST depressions
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69
Q

Are ulcers from venous insufficiency painful or painless?

A

Painless

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70
Q

A pt has just received a cardiac stent. How long wil he be on aspirin and clopidogrel?

A

One year

71
Q

Where is the disease of the mitral valve best heard?

A

Apex

72
Q

What is the initial treatment for a myocardial infarction?

A

MONA–morphine, oxygen, nitroglycerin, and aspirin

73
Q

Clot busting drugs should be used within three hours of which two cardiac events?

A

STEMI and new left bundle branch block

74
Q

List three catastrophic complications of an MI

A
  1. papillary muscle rupture
  2. Myocardial wall rupture
  3. left ventricular aneurysm
75
Q

An EKG shows a regular heart rate of 200bpm. QRS is narrow what is the most likely diagnosis?

A

Supraventricular tachycardia

76
Q

Acute endocarditis is most commonly caused by what organism?

A

staph aureus

77
Q

list three congenital heart diseases

A
  1. Atrial septal defect (ASD)
  2. Ventricular septal defect (VSD)
  3. Coarctation of the aorta
  4. patent ductus arteriosus
  5. Tetralogy of Fallot
78
Q

What is the most common cause of an atrial septal defect?

A

Patent foramen ovale

79
Q

Where on your patient should you listen for the murmur associated with and atrial septal defect?

A

LT 2nd or 3rd intercostal space

80
Q

A CXR shows a “3” sign with notching of the ribs. What is the most likely diagnosis?

A

coarctation of the aorta

81
Q

What is the appropriate treatment for a patent ductus arteriosus?

A

indomethacin

82
Q

A blalock procedure is used to correct what congenital heart condition?

A

Tetralolgy of Fallot

83
Q

You hear a loud, harsh pulmonary murmur along the left sternal border. What is the most likely diagnosis?

A

Ventricular septal defect

84
Q

Subacute endocarditis is most commonly caused by what organism?

A

Strep viridans

85
Q

What is the most common place for an aortic aneurysm?

A

In the abdomen and below the renal arteries

86
Q

Who is more likely to have an aortic aneurysm males or females?

A

males are 8 times as likely to have an aortic aneurysm

87
Q

The accessory pathway known as the James bundle should make you think of what syndrome?

A

Lown-Ganong-Levine syndrome

88
Q

What imaging needs to be done before taking a pt to the OR with an aortic aneurysm

A

CT (echo may be used as initial study, but CT is needed for surgery)

89
Q

List two risk factors for an aortic dissection?

A
  1. HTN
  2. Marfan’s syndrome
  3. bicuspid aortic valve
  4. pregnancy
90
Q

A pt presents to the ER with tearing chest pain radiating to his back. What is the most likely diagnosis?

A

Aortic dissection

91
Q

What will a CXR show for a pt with an aortic dissection?

A

Widened mediastinum

92
Q

What is the best test to diagnose an aortic dissection?

A

CT

93
Q

List the six P’s of an ischemic limb

A
  1. pain
  2. paresthesias
  3. Pallor
  4. Pulselessness
  5. poikilothemia
  6. paralysis
94
Q

You have a pt w/ pulsus paradoxus. What two diagnoses should you be thinking of?

A
  1. Pericarditis
  2. pericardial effusion
  3. obstructive lung issue
95
Q

A pt complains of pain in his legs when he walks. It goes away after sitting. What term comes to mind for this symptom? What diagnosis is it associated with?

A

Intermittent claudication caused by peripheral arterial disease

96
Q

Giant cell arteritis is associated with what disease?

A

Polymyalgia rheumatica

97
Q

A sawtooth pattern on EKG should make you think of what diagnosis

A

Atrial flutter

98
Q

What is the accessory pathway associated with Wolff-Parkinson-White syndrome

A

The bundle of Kent

99
Q

a biphasic P wave should make you think of what diagnosis?

A

LT atrial enlargement (I disagree with this answer, but I did double check it. I think it should be right atrial enlargement)

100
Q

What is the gold standard for diagnosis of giant cell arteritis

A

Biopsy of the temporal artery

101
Q

What is the treatment for giant cell arteritis?

A

High dose prednisone

102
Q

List the components of Virchow’s triad

A
  1. Stasis
  2. Vascular injury
  3. hypercoagulability
103
Q

Calf pain should always make you think of what diagnosis?

A

DVT

104
Q

where is disease of the tricuspid valve best heard?

A

Along the left lower sternal border

105
Q

What is the most common congenital heart disease?

A

Ventricular septal defect

106
Q

Are ulcers from arterial insufficiency painful or painless?

A

Painful

107
Q

Give two contraindications for using and ACEI

A
  1. bilateral renal artery stenosis
  2. Hx of angioedema
  3. Pregnancy
108
Q

Both lead I and aVF have positive QRS complexes. Does this represent normal, left, or right axis deviation?

A

Normal

109
Q

What medication might you switch to if a patient develops an intolerable cough on an ACEI

A

ARB (“-sartans)

110
Q

What class of cardiac medication should be avoided in patients w/ asthma?

A

Beta blockers (block receptors for bronchodilators)

111
Q

A boot-shaped heart on CXR should make you think of what congenital heart condition?

A

Tetralogy of Fallot

112
Q

an RSR’ in leads V1 or V2 should make you think of what diagnosis?

A

RT bundle branch block

113
Q

Which lab should be tightly monitored in a patient taking an aldosterone antagonist?

A

Potassium (hyperkalemia)

114
Q

What is the best test for diagnosing CHF?

A

Echo

115
Q

Which cardiac medication is used to help w/ cardiac contractility after you have optimized most of the other cardiac medications?

A

Digoxin

116
Q

A blockage of which artery causes and anterior wall MI

A

LAD (LT ant. descending)

117
Q

What lab result will increase the risk of digoxin toxicity?

A

Hypokalemia or hypercalcemia

118
Q

A pt presents to the ER in acute CHF. What drug class will likely be the first choice?

A

Loop diuretics

119
Q

A pt has a GFR of 25 and HTN. Which class should you use, a loop or a thiazide diuretic?

A

a loop will work no matter how low the GFR is. Thiazides only work with a GFR over 30.

120
Q

Which EKG leads are used to diagnose an anterior wall MI?

A

according to Sean: V3 & V4. According to this book: V1, V2 (septal leads), and V3

121
Q

Do loop diuretics cause hyperkalemia or hypokalemia?

A

Hypokalemia

122
Q

Statins are the drug of choice to treat what type of dyslipidemia?

A

Elevated LDL

123
Q

A patient recently started taking Lipitor. He is now complaining of aches and pains. What test should you order?

A

Serum creatinine kinase, you’re looking for rhabdo

124
Q

How does ezetimibe work?

A

Decreases intestinal absorption of cholesterol

125
Q

Which hyperlipidemia medication may cause flushing?

A

Niacin

126
Q

Name three medication “classes” which are used to reduce LDL?

A
  1. Statins
  2. ezetimibe
  3. Niacin
  4. Nicotinic acid
127
Q

Name two fibrit acid derivatives?

A

Fenofibrate

Gemgibrozil

128
Q

List three class 1a antiarrhythmics.

A
  1. quinidine
  2. disopyramide
  3. procainamide
129
Q

You are counting boxes from the peak of a QRS wave on an EKG in order to determine the heart rate. What would the heart rate be if the next QRS wave peak were three boxes away? What numbers are associated with the first five boxes?

A
  1. HR by counting boxes = 300, 150, 100, 75, 60
130
Q

A U wave on EKG should make you think of what diagnosis?

A

hypokalemia

131
Q

What will the heart rate be if the AV node is pacing the heart?

A

40-60 bpm

132
Q

Which cardiac medication has gynecomastia in its side effect profile?

A

spironolactone

133
Q

Lead I has a QRS that is up and the aVF lead has a QRS that is down. Does the represent RT, LT, or normal axis?

A

LT axis deviation

134
Q

an Osborn or J wave on EKG should make you think of what Dx?

A

hypothermia

135
Q

What is the first line medication for a patient w/ symptomatic bradycardia?

A

Atropine

136
Q

What is the heart rate for tachycardia? How about bradycardia?

A

tachycardia > 100

bradtcardia < 60

137
Q

On EKG there is an early but otherwise normal PQRS complex. After that beat there is a slight pause and then a normal rhythm contintues. What is the term for this one beat?

A

premature atrial contraction

138
Q

How do you treat polymalgia rheumatica?

A

low dose prednisone

139
Q

What is the management of a patient in SVT?

A

vagal maneuvers
carotid massage
adenosine

140
Q

What is the definitive treatment for atrial flutter

A

RF catheter ablation

141
Q

an 82 year old patient complains of HA and jaw claudication. What is the most likely Dx?

A

giant cell (temporal) arteritis

142
Q

The EKG show irregulary irregular narrow QRS waves. What Dx should you be thinking of?

A

Atrial fibrillation

143
Q

an EKG shows a regular rate of 50 bpm. The QRS is narrow and there is no visible P wave. What is the most likely diagnosis?

A

Junctional rythm

144
Q

Name a common cause of junctional rythm.

A

Digoxin toxicity

145
Q

An EKG shows premature ventricular contractions. These two QRS waves look very different. What is the term for this?

A

Multifocal premature ventricular contractions

146
Q

What is the most common cause of sudden cardiac death?

A

Ventricular fibrillation

147
Q

a pt in the ER has no pulse, but on EKG, there are wide, irregular “complexes” which are at an irregular rate. They all appear very different from one another. What is the treatment for this patient?

A

defibrillation b/c he is in V-fib

148
Q

tall, peaked T waves should make you think of what diagnosis?

A

hyperkalemia

149
Q

how do you define 1st degree AV block?

A

The PR interval is longer than 0.2 seconds

150
Q

What is the other term for Mobitz type I

A

Wenckenback

151
Q

What is the most important complication of giant cell arteritis?

A

blindness

152
Q

What two labs do you want to monitor in a patient on ACEIs?

A

potassium and SCr

153
Q

The heart rate is irregular, so you can’t count boxes between QRS waves to determine heart rate. What is another method you can use to determine rate on an EKG?

A

Count QRS waves in a six second strip and multiply by 10 (add a zero)

154
Q

What is the treatment for a pt w/ a Mobitz II AV block?

A

pacemaker

155
Q

You see regular P waves and regular QRS complexes, but they do not seem to have any correlation to each other. What is the diagnosis?

A

Third degree AV block

156
Q

Name on aldosterone antagonist

A

Spironolactone

eplerenone

157
Q

you see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?

A

Wolff-Parkinson-White

158
Q

What two leads do you use to determine the axis of the heart?

A

Lead I and aVF

159
Q

an RSR’ in leads V5 or V6 should make you think of what diagnosis?

A

Left bundle branch block

160
Q

Which finding requires immediate attention: left bundle branh block or right bundle branch block?

A

new LBBB is a STEMI equivalent. RBBB is usually not a problem

161
Q

What medication class is used to lower triglycerides?

A

Fibric acid derivatives

162
Q

Tall peaked P waves should make you think of what diagnosis

A

RT atrial enlargement

163
Q

List two causes of RT atrial enlargement

A

Pulmonary HTN
severe lung disease
pulmonary valve stenosis

164
Q

Which EKG leads are used to diagnose anterolateral MI?

A

V5 and V6

165
Q

What are the three inferior leads?

A

II, III, and aVF

166
Q

a blockage of which artery causes a lateral wall MI?

A

LT circumflex artery

167
Q

What is represented by ST segment depressions greater than 1 mm on EKG?

A

ischemia

168
Q

rheumatic fever most commonly affects which valve?

A

Mitral valve

169
Q

what is the only cyanotic congenital heart disease on the NCCPA blueprint?

A

Tetralogy of Fallot

170
Q

on EKG, there is an early, wide QRS complex with no associated P wave. After that beat, there is a sligh pause and then a normal rhythm continues. What is the term for this one beat?

A

premature ventricular contraction

171
Q

What is the definitive treatment for a patient with recurrent ventricular tachycardia

A

implanted defibrillator

172
Q

on an EKG, you notice a pt has .a gradually lengthening PR interval, and then a missed QRS complex. The pattern repeats again. What type of AV block is this?

A

Mobitz I or Wenckebach

173
Q

List three side effects of digoxin

A
  1. N/V
  2. anorexia
  3. confusion
  4. arrhythmias (sinus brady, AV block)
  5. fatigue
  6. vision desturbances
174
Q

What is the first line medical treatment for torsades de pointes?

A

Magnesium sulfate

Cardiovascular (7 decks)

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