The Final Step CV chapter Flashcards
1
Q
What side effect might make a patient stop taking an ACE-I?
A
cough
2
Q
define orthostatic hyptoension
A
a drop in systolice BP of > 20 mmHg or diastolic BP of > 10 mmHg
3
Q
You feel a pulse that seems to be vibrating. What term do you use to describe it?
A
Thrill
4
Q
What are three things in your differential diagnosis if you have a paradoxical pulse?
A
Cardiac tamponade
pericarditis
obstructive lung disease
5
Q
on palpation, what size is normal for the aorta?
A
< 3 cm
6
Q
A fixed or consistent split S2 should make you think of what diagnosis?
A
Atrial septal defect
7
Q
A pathologic S3 is most commonly associated with what diagnosis?
A
CHF
8
Q
If you hear a midsystolic click you should immediately be thinking about what diagnosis?
A
Mitral Valve Prolapse
9
Q
An opening snap on auscultation of the heart should make you think of what diagnosis?
A
mitral stenosis
10
Q
A continuous murmur most likely involves what area of the heart?
A
It is most likely a septal defect
11
Q
You hear a continuous machine-like murmur. What is most likely
A
Patent ductus arteriosus (PDA)
12
Q
list three medications which may be used for pharmacological stress test.
A
Adenosine
dobutamine
dipyridamole
persantine
13
Q
what is the gold standard for diagnosing coronary artery disease?
A
cardiac catheterization
14
Q
define stage one HTN according to JNC 8.
A
systolc BP 140-159 mmHg or diastolic BP 90-99 mmHg
15
Q
What is the treatment goal for a diabetic w/ hypertension?
A
<140/90 mmHg
16
Q
What is the most common cause of secondary hypertension?
A
Chronic kidney disease
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
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
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????)
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
21
Q
According to the CDC, what is the range for a normal BMI?
A
18.5-24.9
22
Q
What is the first line medical treatment for stage 1 hypertension?
A
Thiazide diuretic
23
Q
After a thiazide diuretic, what medication should you start in a hypertensive patient who also has diabetes?
A
An ACEI or ARB
24
Q
following a MI, what medication should you be using to treat HTN?
A
beta blocker
25
Paroxysmal nocturnal dyspnea should make you think of what diagnosis?
CHF (left sided)
26
What is the most common cause of CHF?
coronary artery disease (CAD)
27
What ejection fraction is typical for a patient with CHF?
35-40%
28
What is the most likely diagnosis for a young man who experiences sudden death while playing sports?
hypertrophic cardiomyopathy
29
Bat wing vessels or Kerley B lines on a CXR should make you think of what Dx?
CHF
30
a beta natriuretic peptide below what level rules out CHF?
< 100
31
What is the therapeutic range for INR following a mechanical valve replacement?
2.5-3.5
32
What is the first line IV inotropic agent when dealing with cardiogenic shock?
Dopamine
33
What diagnosis is most likely in an IV drug user with a new heart murmur and fever?
endocarditis
34
List two diagnoses which require antibiotic prophylaxis for "dirty procedures?"
prosthetic valve, valve repair w/ any prosthetic material, prior endocarditis diagnosis, congenital cyanotic heart defect
35
Does a patient with mitral valve prolapse require prophylactic ABx for dental work?
No. a recent change moves mitral vavle prolapse from high risk to moderate risk
36
What are the three major criteria for endocarditis?
1. 2 positive blood cultures
2. a positive transesophageal echocardiography
3. new murmur
37
Which are painful and found on the fingers and toes--Osler nodes or Janeway lesions?
Osler nodes
38
LIst the 4 minor criteria for diagnosing endocarditis
1. fever
2. embolic event (Janeway lesions or petechiae, splinter hemorrhages)
3. immunological event (osler nodes, glomerulonephritis)
4. one positive blood culture
39
What are the five components of tetralogy of Fallot?
1. ventricular septal defect
2. RT vent. hypertrophy
3. RT vent. outflow obstruction (pulmonary valve stenosis)
4. overriding aorta
5. RT sided aortic arch
40
What is the gold standard for diagnosing myocarditis?
myocardial biopsy
41
Where do most aortic dissections occur?
The ascending or descending thoracic aorta
42
A pt complains of severe pleuritic chest pain that is relieved with sitting and learning forward. What is the most likely diagnosis?
Pericarditis
43
What is the first line medical treatment for pericarditis?
Aspirin and NSAIDs
44
What is the name of the syndrome that involves percarditis several days after a myocardial infarction?
Dressler syndrome
45
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?
pericarditis
46
Define paradoxical pulse.
There is a large difference in pulse pressure between inhalation and exhalation
47
Define pulsus alternans
EKG waveform changes from beat to beat
48
What is the definitive treatment for cardiac tamponade?
pericardiocentesis
49
On physical exam, you hear a harsh systolic murmur along the RT sternal border. What is the most likely diagnosis?
Aortic stenosis
50
A wide pulse pressure with a blowing diastolic decrescendo murmur at teh RT second intercostal space should make you think of what diagnosis?
Aortic regurgitation
51
What is the best location to hear problems with the aortic valve?
2nd RT intercostal space
52
Where is disease of the pulmonary valve best heard?
2nd LT intercostal space
53
What two antibiotics are used for empiric treatment of endocarditis?
Vancomycin and ceftriaxone (3rd gen cephalosporin; excellent CNS/CFS penetration; gram -) together are first line empiric treatment
54
What two valvular issues do patients with Marfan's syndrome often have?
Aortic regurgitation and mitral valve prolapse (you tell them apart by where they are heard)
55
What are the two main causes of aortic stenosis?
Congenital bicuspid valve and calcification of the valve secondary to coronary artery disease.
56
An elderly patient presents with dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely diagnosis?
Aortic stenosis
57
on auscultation, you hear a harsh, blowing, pansystolic murmur at the apex. What is the most likely diagnosis?
Mitral regurgitation
58
You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis?
Transesophageal echo
59
A patient with mitral valve prolapse will often have what physical characteristic?
often a thin female
60
What is the best patient position to hear aortic regurge and aortic stenosis
Sitting up and leaning forward
61
What is Tietze syndrome?
Costochondritis
62
Are most pulmonary valve problems congenital or acquired?
95% are congenital
63
What is the therapeutic range for INR following an organic valve replacement?
2-3
64
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?
Ruptured aortic aneurysm
65
In a pt w/ aortic stenosis, will the PMI be medially displaced, normal, or laterally displaced?
laterally displaced due to left ventricular hypertrophy
66
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?
Prinzmetal's angina
67
A question about Prinzmetal's angina will often contain whay key thing in the patient's Hx?
Cocaine use
68
Name two things that would constitute a positive stress test.
1. a drop in BP
2. a new arrhythmia
3. an increase in angina symptoms
4. ST depressions
69
Are ulcers from venous insufficiency painful or painless?
Painless
70
A pt has just received a cardiac stent. How long wil he be on aspirin and clopidogrel?
One year
71
Where is the disease of the mitral valve best heard?
Apex
72
What is the initial treatment for a myocardial infarction?
MONA--morphine, oxygen, nitroglycerin, and aspirin
73
Clot busting drugs should be used within three hours of which two cardiac events?
STEMI and new left bundle branch block
74
List three catastrophic complications of an MI
1. papillary muscle rupture
2. Myocardial wall rupture
3. left ventricular aneurysm
75
An EKG shows a regular heart rate of 200bpm. QRS is narrow what is the most likely diagnosis?
Supraventricular tachycardia
76
Acute endocarditis is most commonly caused by what organism?
staph aureus
77
list three congenital heart diseases
1. Atrial septal defect (ASD)
2. Ventricular septal defect (VSD)
3. Coarctation of the aorta
4. patent ductus arteriosus
5. Tetralogy of Fallot
78
What is the most common cause of an atrial septal defect?
Patent foramen ovale
79
Where on your patient should you listen for the murmur associated with and atrial septal defect?
LT 2nd or 3rd intercostal space
80
A CXR shows a "3" sign with notching of the ribs. What is the most likely diagnosis?
coarctation of the aorta
81
What is the appropriate treatment for a patent ductus arteriosus?
indomethacin
82
A blalock procedure is used to correct what congenital heart condition?
Tetralolgy of Fallot
83
You hear a loud, harsh pulmonary murmur along the left sternal border. What is the most likely diagnosis?
Ventricular septal defect
84
Subacute endocarditis is most commonly caused by what organism?
Strep viridans
85
What is the most common place for an aortic aneurysm?
In the abdomen and below the renal arteries
86
Who is more likely to have an aortic aneurysm males or females?
males are 8 times as likely to have an aortic aneurysm
87
The accessory pathway known as the James bundle should make you think of what syndrome?
Lown-Ganong-Levine syndrome
88
What imaging needs to be done before taking a pt to the OR with an aortic aneurysm
CT (echo may be used as initial study, but CT is needed for surgery)
89
List two risk factors for an aortic dissection?
1. HTN
2. Marfan's syndrome
3. bicuspid aortic valve
4. pregnancy
90
A pt presents to the ER with tearing chest pain radiating to his back. What is the most likely diagnosis?
Aortic dissection
91
What will a CXR show for a pt with an aortic dissection?
Widened mediastinum
92
What is the best test to diagnose an aortic dissection?
CT
93
List the six P's of an ischemic limb
1. pain
2. paresthesias
3. Pallor
4. Pulselessness
5. poikilothemia
6. paralysis
94
You have a pt w/ pulsus paradoxus. What two diagnoses should you be thinking of?
1. Pericarditis
2. pericardial effusion
3. obstructive lung issue
95
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?
Intermittent claudication caused by peripheral arterial disease
96
Giant cell arteritis is associated with what disease?
Polymyalgia rheumatica
97
A sawtooth pattern on EKG should make you think of what diagnosis
Atrial flutter
98
What is the accessory pathway associated with Wolff-Parkinson-White syndrome
The bundle of Kent
99
a biphasic P wave should make you think of what diagnosis?
LT atrial enlargement (I disagree with this answer, but I did double check it. I think it should be right atrial enlargement)
100
What is the gold standard for diagnosis of giant cell arteritis
Biopsy of the temporal artery
101
What is the treatment for giant cell arteritis?
High dose prednisone
102
List the components of Virchow's triad
1. Stasis
2. Vascular injury
3. hypercoagulability
103
Calf pain should always make you think of what diagnosis?
DVT
104
where is disease of the tricuspid valve best heard?
Along the left lower sternal border
105
What is the most common congenital heart disease?
Ventricular septal defect
106
Are ulcers from arterial insufficiency painful or painless?
Painful
107
Give two contraindications for using and ACEI
1. bilateral renal artery stenosis
2. Hx of angioedema
3. Pregnancy
108
Both lead I and aVF have positive QRS complexes. Does this represent normal, left, or right axis deviation?
Normal
109
What medication might you switch to if a patient develops an intolerable cough on an ACEI
ARB ("-sartans)
110
What class of cardiac medication should be avoided in patients w/ asthma?
Beta blockers (block receptors for bronchodilators)
111
A boot-shaped heart on CXR should make you think of what congenital heart condition?
Tetralogy of Fallot
112
an RSR' in leads V1 or V2 should make you think of what diagnosis?
RT bundle branch block
113
Which lab should be tightly monitored in a patient taking an aldosterone antagonist?
Potassium (hyperkalemia)
114
What is the best test for diagnosing CHF?
Echo
115
Which cardiac medication is used to help w/ cardiac contractility after you have optimized most of the other cardiac medications?
Digoxin
116
A blockage of which artery causes and anterior wall MI
LAD (LT ant. descending)
117
What lab result will increase the risk of digoxin toxicity?
Hypokalemia or hypercalcemia
118
A pt presents to the ER in acute CHF. What drug class will likely be the first choice?
Loop diuretics
119
A pt has a GFR of 25 and HTN. Which class should you use, a loop or a thiazide diuretic?
a loop will work no matter how low the GFR is. Thiazides only work with a GFR over 30.
120
Which EKG leads are used to diagnose an anterior wall MI?
according to Sean: V3 & V4. According to this book: V1, V2 (septal leads), and V3
121
Do loop diuretics cause hyperkalemia or hypokalemia?
Hypokalemia
122
Statins are the drug of choice to treat what type of dyslipidemia?
Elevated LDL
123
A patient recently started taking Lipitor. He is now complaining of aches and pains. What test should you order?
Serum creatinine kinase, you're looking for rhabdo
124
How does ezetimibe work?
Decreases intestinal absorption of cholesterol
125
Which hyperlipidemia medication may cause flushing?
Niacin
126
Name three medication "classes" which are used to reduce LDL?
1. Statins
2. ezetimibe
3. Niacin
4. Nicotinic acid
127
Name two fibrit acid derivatives?
Fenofibrate
| Gemgibrozil
128
List three class 1a antiarrhythmics.
1. quinidine
2. disopyramide
3. procainamide
129
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?
100. HR by counting boxes = 300, 150, 100, 75, 60
130
A U wave on EKG should make you think of what diagnosis?
hypokalemia
131
What will the heart rate be if the AV node is pacing the heart?
40-60 bpm
132
Which cardiac medication has gynecomastia in its side effect profile?
spironolactone
133
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?
LT axis deviation
134
an Osborn or J wave on EKG should make you think of what Dx?
hypothermia
135
What is the first line medication for a patient w/ symptomatic bradycardia?
Atropine
136
What is the heart rate for tachycardia? How about bradycardia?
tachycardia > 100
| bradtcardia < 60
137
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?
premature atrial contraction
138
How do you treat polymalgia rheumatica?
low dose prednisone
139
What is the management of a patient in SVT?
vagal maneuvers
carotid massage
adenosine
140
What is the definitive treatment for atrial flutter
RF catheter ablation
141
an 82 year old patient complains of HA and jaw claudication. What is the most likely Dx?
giant cell (temporal) arteritis
142
The EKG show irregulary irregular narrow QRS waves. What Dx should you be thinking of?
Atrial fibrillation
143
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?
Junctional rythm
144
Name a common cause of junctional rythm.
Digoxin toxicity
145
An EKG shows premature ventricular contractions. These two QRS waves look very different. What is the term for this?
Multifocal premature ventricular contractions
146
What is the most common cause of sudden cardiac death?
Ventricular fibrillation
147
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?
defibrillation b/c he is in V-fib
148
tall, peaked T waves should make you think of what diagnosis?
hyperkalemia
149
how do you define 1st degree AV block?
The PR interval is longer than 0.2 seconds
150
What is the other term for Mobitz type I
Wenckenback
151
What is the most important complication of giant cell arteritis?
blindness
152
What two labs do you want to monitor in a patient on ACEIs?
potassium and SCr
153
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?
Count QRS waves in a six second strip and multiply by 10 (add a zero)
154
What is the treatment for a pt w/ a Mobitz II AV block?
pacemaker
155
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?
Third degree AV block
156
Name on aldosterone antagonist
Spironolactone
| eplerenone
157
you see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?
Wolff-Parkinson-White
158
What two leads do you use to determine the axis of the heart?
Lead I and aVF
159
an RSR' in leads V5 or V6 should make you think of what diagnosis?
Left bundle branch block
160
Which finding requires immediate attention: left bundle branh block or right bundle branch block?
new LBBB is a STEMI equivalent. RBBB is usually not a problem
161
What medication class is used to lower triglycerides?
Fibric acid derivatives
162
Tall peaked P waves should make you think of what diagnosis
RT atrial enlargement
163
List two causes of RT atrial enlargement
Pulmonary HTN
severe lung disease
pulmonary valve stenosis
164
Which EKG leads are used to diagnose anterolateral MI?
V5 and V6
165
What are the three inferior leads?
II, III, and aVF
166
a blockage of which artery causes a lateral wall MI?
LT circumflex artery
167
What is represented by ST segment depressions greater than 1 mm on EKG?
ischemia
168
rheumatic fever most commonly affects which valve?
Mitral valve
169
what is the only cyanotic congenital heart disease on the NCCPA blueprint?
Tetralogy of Fallot
170
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?
premature ventricular contraction
171
What is the definitive treatment for a patient with recurrent ventricular tachycardia
implanted defibrillator
172
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?
Mobitz I or Wenckebach
173
List three side effects of digoxin
1. N/V
2. anorexia
3. confusion
4. arrhythmias (sinus brady, AV block)
5. fatigue
6. vision desturbances
174
What is the first line medical treatment for torsades de pointes?
Magnesium sulfate
