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Medicine > Uworld Cardiology > Flashcards

Uworld Cardiology Flashcards

0
Q

Patient with ST segment depression and T-wave inversion in leadsC4 through V6. Troponin T is normal, chest x-ray shows no acute abnormality. The pupils are dilated, nasal mucosa is atrophic, and patient is agitated and sweating. Next step in management? Contraindicated?

A

Acute cocaine intoxication. Give:

  1. benzodiazepines.
  2. Aspirin
  3. Nitroglycerin and calcium channel blockers

Beta blockers contraindicated.

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1
Q

Origin of

  1. paroxysmal supraventricular tachycardia?
  2. Of Wolff-Parkinson-White?
  3. Of atrial flutter?
  4. Of sinus tachycardia?
  5. Atrial fibrillation?
A
  1. AV node
  2. Bundle of Kent
  3. Tricuspid annulus
  4. SA node
  5. Pulmonary veins
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2
Q

Metabolic conditions that can lead to AFIB?

A

Catecholamine surges or hyperthyroidism

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3
Q

Drugs that can cause AFIB?

A

Caffeine, theophylline, digoxin

Cocaine, amphetamines, alcohol,

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4
Q

Patient post MI who presents with wide complex tachycardia and fusion beats. Treat with?

A

If stable IV amiodarone

If unstable (hypertension, respiratory distress) cardioversion

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5
Q

Patient presents with a regular, narrow complex tachycardia. Treat with?

A
  1. Esmolol (short-acting beta blocker for Rapid rate control)
  2. Adenosine
  3. Carotid massage
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6
Q

Hypertrophic cardiomyopathy: epidemiology? Carotid findings? murmur? Maneuver to increase murmur?

A
  1. Young, African-Americans
  2. Dual upstroke
  3. Systolic ejection type murmur
  4. Valsalva maneuver (decrease preload)
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7
Q

Drug that can increase QRS duration? Used to treat? Mechanism?

A

Flecainide. Ventricular or supraventricular tachycardia. Class 1C antiarrhythmic - Blocks sodium channels

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8
Q

Patient with swelling and hepatosplenomegaly. Physical exam to suggest cardiac problem?

A

Positive hepatojugular reflex (pressing on abdomen causes JVD)

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18
Q

CHF with proteinuria and easy bruisability – most likely diagnosis?

A

Amyloidosis

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19
Q

Drug to control essential hand tremor and hypertension?

A

Propranolol

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20
Q

70 percent of patients with mitral stenosis will develop? Why?

A

AFIB. left atrial dilation

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21
Q

Patient with Wolff-Parkinson-White syndrome goes into AFIB. Treatment?

A

Procainamide. (Beta blockers, calcium channel blockers, adenosine and digoxin should not be used for these patients because they increase AV node refractory period)

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22
Q

Effect of pericardial effusion On EKG?

A

Electrical alternans - QRS complexes whose amplitudes vary from beat to beat

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23
Q

Initial labs for hypertension work up ?

A
  1. Urinalysis (four hematuria)
  2. Chemistry and lipid profile (risk of coronary artery disease)
  3. EKG
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24
Q

Use this test to r/o hypertension caused by:

  1. Cushing’s syndrome
  2. Primary hyperaldosteronism
  3. Renal artery stenosis
  4. Pheochromocytoma
A
  1. 24 hour urine cortisol excretion
  2. Renin level
  3. Renal ultrasound
  4. Urine metanephrines
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25
Q

Type of vessels: arteries versus veins

A

Resistance vessels versus capacitance vessels?

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26
Q

Patient comes in with MI. Should leave with what drugs? If patient underwent PCI, will also leave with?

A
  1. Aspirin
  2. ACE inhibitors
  3. Beta blockers
  4. Statin

Clopidogrel

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27
Q

Effect of calcium channel blockers (amlodipine) in ACS?

A

Avoid. Increased mortality

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28
Q

Treatment for type I heart block?

Type II? Type III?

A
  1. Nothing
  2. Atropine if symptomatic
  3. Atropine if symptomatic
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29
Q

Chlorthalidone?

A

Thiazide diuretic

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30
Q

Medications to withhold prior to cardiac stress testing?

A
  1. Beta blockers
  2. calcium channel blockers
  3. nitrates
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31
Q

Dypridamole?

A
  1. PDE inhibitor
  2. Tromboxane inhibitor
  3. Increased adenosine (decreases reuptake and breakdown)
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32
Q

Heart side effect from thiazides?

A

Ventricular arrhythmia

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33
Q

Treatment of embolic artery occlusion?

A

Surgical embolectomy or percutaneous thrombolysis

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34
Q

HOCM - murmur from?

A
  1. Septal hypertrophy

2. Systolic anterior motion of mitral valve

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35
Q

PACs usually result in what arrhythmias?

A

Mostly supraventricular. Sometimes ventricular.

36
Q

Treatment of symptomatic PACs?

A

Beta blocker

37
Q

Mech of niacin induced flushing? Mitigate Sx by?

A

Increase in prostaglandins. Taking aspirin.

38
Q

Always investigate what type of murmur? How?

A

Diastolic continuous murmurs. ECHO.

39
Q

Digoxin used for?

A

Atrial tachycardias

40
Q

Algorithm for VF or VT?

A
  1. Defibrillation
  2. Epi (every 3 min)
  3. Defib
  4. Antiarrhythmics (lidocaine, amiodarone, Mg)
41
Q

Pulsus parvus et tardes observed with?

A

Aortic stenosis

42
Q

Causes of increased capillary hydrostatic pressure?

A
  1. Heart failure
  2. Renal Na retention (kidney problems, pregnancy)
  3. Venous obstruction (cirrhosis, venous insufficiency, pul HTN)
43
Q

Causes of hypoalbuminemia?

A
  1. Loss (GI or nephrotic)

2. Decreased production (cirrhosis and malnutrition)

44
Q

Causes of increased capillary permeability?

A

Burns, allergies, ARDs, malignant ascities

45
Q

Treatment of narrow complex tachycardia vs wide complex tachycardia?

A

Vegas maneuvers or adenosine

Vs

Amiodarone or lidocaine

46
Q

Electrical alternans?

A

Cardiac tamponade

47
Q

Use DC cardioversion for?

A

AFIB, A-flutter, and monomorphic ventricular tachycardia

48
Q

Use Transvenous pacemaker if?

A

Sick sinus syndrome and 2nd/3rd degree heart block

49
Q

EKG findings in PE?

A

Sinus tachycardia
New onset right bundle branch block
S1 Q3 T3

50
Q

Posterior M – see on EKG?

A

ST depression in V1 – V3
ST elevation in I and aVL (LCX)
ST depression in I and aVL (RCA)

51
Q

Prinzmetal angina presents with? Treatment?

A

Episodes at night
EKG shows ST elevations
Seen in smokers

Treat with nitrates and Ca channel blockers (do not treat with aspirin or beta blockers)

52
Q

Diastolic dysfunction? Caused by?

A

HF with preserved EF. Hypertension.

53
Q

Nitrates contraindicated with?

A

Aortic stenosis, PDE inhibitors, RV infarction

55
Q

Non-pharmacologic ways to lower HTN?

A 
Weight loss
Limit salt
Vegetables
Low fat
Decrease alcohol intake
56
Q

SVT gets better with cold water because?

A

cold water increases Vegal tone -> slows AV node (SVT reentrant pathway that hits AV node)

SA node also affected by Vegal maneuvers, but not the main mech of SVT

57
Q

Blood-pressure medications that cause lower extremity edema?

A

Dihydropyridines (amlodipine)

58
Q

Signs of hemochromatosis?

A 
Cardiac: dilated cardiomyopathy and conduction
Skin: bronze diabetes
Muscular: arthropathy
Gastrointestinal: hepatomegaly
Endo: diabetes, hypergonadism
59
Q

Treatment for hypertrophic cardiomyopathy?

A

Beta blocker

60
Q

Right ventricular failure: Time course? Coronary artery involved? Clinical findings? ECHO findings?

A

Acute, RCA,

hypertension clear lungs and kussmal sign

hypokinetic RV

61
Q

Papillary muscle rupture: Time course? Coronary artery involved? Clinical findings? ECHO findings?

A

Acute or within 3 to 5 days, RCA

Pulmonary edema, new systolic murmur

Mitral regurg with flail leaflet

62
Q

Intraventricular septum rupture: Time course? Coronary artery involved? Clinical findings? ECHO findings?

A

Acute or within 3 to 5 days

LAD (apical septum or RCA (basal septum)

Shock, chest pain, holosystolic murmur, biventricular failure

Left to right shunt at ventricle

63
Q

Free wall rupture: Time course? Coronary artery involved? Clinical findings? ECHO findings?

A

Up to two weeks, LAD

Shock, chest pain, JVD, distant heart sounds

Pericardial effusion and tamponade

64
Q

Never treat endocarditis with?

A

Oral antibiotics

65
Q

Drug to use for:

  1. Supraventricular tachycardia?
  2. Ventricular tachycardia?
  3. Atrial fibrillation?
A
  1. Adenosine (to slow rate to determine exact type of supraventricular tachycardia)
  2. Lidocaine, procainamide (WPW)
  3. Amiodarone
66
Q

Post MI: papillary muscle rupture vs septal wall rupture? In common?

A

In common: holosystolic murmur

Murmur at apex and radiates to axilla vs murmur at left eternal border with thrill

67
Q

Pt with cardiomyopathy, nephropathy, hepatomegaly and neuropathy - test?

A

Fat pad biopsy for amyloidosis

69
Q

Signs of an arteriovenous fistula?

A
  1. Increased preload (LVH)
  2. increase in cardiac output but decreased TPR (widened pulse pressure)
  3. Brisk carotid upstroke
  4. tachycardia and flushed extremities
70
Q

S3 indicates (most of the time)?

A

CHF exacerbation

71
Q

Avoid amiodarone in which patients?

Avoid metoprolol in which patients?

A

Those with existing lung disease

Those with obstructive lung disease (can give to pts with restrictive lung disease)

72
Q

Pulsus paradoxus - Ddx?

A
  1. Tamponade

2. COPD/asthma

73
Q

Signs/Sx of AR?

Causes?

A
  1. Exertional dyspnea
  2. Pounding heart sensation
  3. Widened pulse pressure

Developing world: rheumatic disease
Developed world: congenital bicuspid valve; aortic root dilitation

74
Q

Water hammer pulse seen in? Mech? Associated Sx?

A

AR;

Increased SV and abrupt rise in systolic BP (quick peripheral distention) followed by abrupt drop in diastolic BP (quick peripheral artery collapse)

Headaches; bobbing head

75
Q

Ventricular arrhythmias - treatment options?

A
  1. Amiodarone

2. Lidocaine

Medicine (106 decks)

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