1. Cardiology Flashcards
(91 cards)
1
Q
Septic shock criteria 4 Criteria
A
SIRS criteria 2 or more positive
- Temp: 100.4<
- Heart rate: 90<
- WBC: 12000< or 4000> + 10% band
- Respiratory: 20
2
Q
Obstructive shock disease
4 types/Tx
A
4 types
- Cardiac temponade
- Tension, Pnuemothorax
- Aortic dissection
- PE
Tx: underlying cause
3
Q
General circulatory shock
Patho/Lab/Tx
A
Patho (lack of O2 in tissue and orgran )
- Autonomic - loss of O2 -> increase CO and SVR to maintain
- lack of O2 -> anareobic metabolic -> by product lactic acid
Lab: CBC, BMP, Lactate
Tx: ABCDE
Airway(intubation)
Breath (ventilation)
Circulation (IV fluid)
Delivary O2 check - lactate level
End (Urine output check 0.5ml/kg/hr)
4
Q
Temp >38 (100.4), pulse >90, Respi >20, WBC >12000, <4000, lactate >4mmol/l
Name/Tx (+ anaphylatic)
A
Name: Distribution shock (spetic shock)
Tx: broad spectrum IV
if anyphylactic shock - 1:1000 epi 0.3mg IM
if cardiac arrest, IV 1:10000 epi 1mg
observe at least 4-6 hours
5
Q
Significant loss of blood, pale cool dry skin/extremities, slow capillary refill >2sec
Name/def/Tx
A
Name: Hypovolumic shock
Patho: Loss of third space fluid
Tx: ABCDE
6
Q
Most commonly caused by complications of acute MI
Name/Patho/Tx
A
Name: Cardiogenic shock
Path: lack of blood supply -> cardiac output low
Tx: O2, IV (not aggressive small amount) + Dobutamin/Epi
7
Q
Dizziness occur when pt change position from siting to standing
Name/Dx/Tx
A
Name: Orthostatic hypotension
Dx: sitting vs standing BP change (sys - 20, Dia - 10 difference)
Tx: oral hydration preferred (fludrocortisone)
8
Q
BP elevation 2 reading 2 different visit
Name/MC cause(2type)/Risk(3type)/PE/Tx
A
Name: Hypertension
MC cause
- Primary HTN - Idiopathic
- Secondary HTN - MC renal stenosis
Risk:
- General predisposition - age, black
- Environment - salt, obesity
- Exacerbating - smoking, ETOH, lack of exercising
PE:
- Funduscopic - AV nicking, arterial narrowing
- Cardiac check - bruit, PMI(vulvar dz) or BP arm/femoral check r/o coarctation (children)
- Abdomen - check for mass
- BMI check
Tx: Goal <140/90, diabetic 150/90 Life style (1st), meds (2nd) most successful tx - DASH diet
9
Q
Syncope + healthy young man without any health problem + NO exp of post ictal status, bladder/bowel incontinence
Name/Patho/cause
A
Name: Vasovagal hypotension
Patho: due to systemic hypotension cause loss of conciousness
Cause: prolong standing, heat exhaust, fear, blood draw
Most of case not dangerous
10
Q
- HTN + DM =
- HTN + AA =
- HTN + BPH =
- HTN + Gout =
A
- ACEI or ARB
- Thiazide, CCB
- Alpha blocker (zosin meds)
- CCB (No diuretic)
11
Q
HTN grades 4 levels
A
Normal: 120/80
Elevated: 121-129/80
Stage 1: 130-139/80-90
Stage 2: 140/90 above
12
Q
BP 180/120 + papilledema
Name/Tx
A
Name: HTN Emergency
Tx: BP decrease by Esmolol, labetalol IV (reduce 25% in 1 hour)
13
Q
BP 160/100
Name/Tx
A
Name: HTN ugerncy
Tx: BP decrease by Clonidine (goal: 25% by 24-48 hr)
14
Q
Every P wave followed by QRST, regular rhythm, 60-100 bpm, no abnormality Name
A
Name: Normal sinus
15
Q
HR more than 100 bpm
Name/Cause/Tx
A
Name: Sinus tachycardia
Cause: infection, hemorrahge, anxiety, hypovolemia
Tx: underlying cause
16
Q
HR less than 60 bpm
Name/Cause/Tx
A
Name: Sinus bradycardia
Cause: meds - beta blocker, CCB Some well controlled athlete (normal)
Tx: Atropine
17
Q
HR changed by expiration and inspiration
Name/SC(3)/Tx
A
Name: Sinus arryhthmia
SC: Irregular rythm, heart rate increase = inspiration, heart rate decrease = expiration
Tx: none, watch
18
Q
hx of corrective cardiac surgery, brady-tachy heart rate
Name/Risk/Tx
A
SSS (sick sinus syndrome)
Risk: strong relationship with A Fib, corrective heart surgery
Tx: PPM
19
Q
EKG: Constant prolonged PRI
Name/Tx
A
Name: 1st degree block
Tx: Observe
20
Q
EKG: Progressive PRI lengthening, dropped QRS
Name/Patho/Tx
A
Name: 2nd degree block I (mobitz 1 = wenckerbach)
Patho: not all atria signal reach at ventricle
Tx
- sx - atropine
- Nonsx - observe
21
Q
EKG: Constant/ prolong PRI, dropped QRS
Name/Patho/SC/Tx
A
Name: 2nd degree block II (mobitz II)
Patho: not all atria signal reach at ventricle
SC: always involve secondary organ disease
Tx: PPM
22
Q
EKG: P wave no related with QRS
Name/Patho/Tx
A
Name: 3rd degree block
Patho: No communication with atria and ventricle
Tx: PPM
23
Q
EKG: Flutter “saw tooth” wave, regular rhythm (3:1, or 4:1 ratio)
Name/Tx
A
Name: AV flutter
Tx
- Stable: vagal (1st), BB or CCB
- Unstable: DCC (50J),
- Definitive: radiofrequency ablation
24
Q
hx of alcohol use, irregularly irregular rhythm with narrow QRS
Name/Tx
A
Name: AF
Tx
- Stable - BB, CCB, if pt with AF + CHF - better with digoxin
- Unstable: DCC
- anticoagulation: CHADS2 to check risk, 4-6 weeks of warfarin
25
CHADS2 list explain
CHF
HTN
Age75
DM
Stroke+TIA - 2\< warfarin
26
hx of using macrolide, TCA, recurrent syncope, palpitation
Name/Tx
Long QT syndrome
Tx
* Disc med
* **BB (control rate)**
* AICD for congenital prolong QT
27
Tachycardia, regular NARROW complex QRS, no P morphology
Name/Patho/Tx
Name: Orthodromic PSVT
Patho: goes normal AV node
Tx:
* Stable: Vagal (1st), adenosine, (2nd), BB CCB (3rd)
* Unstable: DCC
* **Definitive - Radiofrequency abalation**
28
Tachycardia, regular WIDE complex QRS, no P morphology
Name/Patho/Tx
Name: Antidromic PSVT
Patho: goes accessory pathway
Tx:
* procainamide
* Unstable: DCC
* **Definitive - Radiofrequency abalation**
29
Delta wave + wide QRS + Short PRI
Name/patho/Tx
Name: WPW (AVRT)
Patho: AV send signal to bundle of kent = accesory pathway cause pre-exite venticle
Tx:
* Vagal (1st)
* Procainamide
* Unstable: DCC
* **Definitive: ablation**
30
Meds need to avoid WPW (4)
ABCD - adenocine, BB, CCB, digoxin
31
2 type of PSVT
AVNRT - 2 pathway in AV node (MC type)
AVRT - 1 pathway in AV node + 1 accessory pathway (WPW)
32
HR 100\< + less 3 morpho P
Name/Tx
Name: WAP (wandering)
Tx: BB, CCB
33
HR 100\< + more 3 Morpho P + COPD
Name/Risk/Tx
Name: MAT (multifocal)
Risk: strong associated with COPD
Tx: BB, CCB
34
P wave inverted + narrow QRS
Name
AV junctional dysrhythmias
35
Wide Bizarre QRS less than 3
Name/Tx
Name: PVC (premature ventricular complexes)
Tx: no tx need observe
36
Wide bizarre QRS more than 3, regular, tachy
Name/Tx
Name: VT
Tx:
* Stabe: BB, CCB
* Unstable: DCC
* Pulseless VT: defib + CPR
37
hypomag, tachy, twisted around baseline
Name/Risk/Tx
Name: Torsades de point
Risk: **antipsychotic meds related**
Tx: IV mag + stop medication, if offending Recurrent -\> needs PPM
38
Coarse, fine, no visible PQRST
Name/Tx
Name: V Fib
Tx: Defib (1st) + CPR
39
Rhythm presents on machine but no palpable pulse
Name/Cause/Tx
Name: PEA (pulseless electrical activity)
Cause: MC hypovolemia
Tx: CPR (1st) + EPI(2nd) + Defib
40
1. ST depression or horizon means
2. Convex vs Concave
1. pathological
2. Convex(sad) - patho, Concave(smile) - benign
41
RBB pattern (bunny) + ST elevation w/ downsloping + Asian male
Name/Risk/Tx
Name: Brugada syndrome
Risk: asian male MC
Tx: AICD
42
1. In CAD what is worst factor?
2. In CAD what is most important modifiable risk factor?
3. In CAD what is most common cause?
1. DM
2. stop Smoking
3. atherosclerosis
43
Path plaque of CAD 3 steps
1. fatty streak formation - lipid enter to WBC
2. LDL enter endothelium bring macropage to ingest LDL becoming foam cell
3. mature plaque
44
Chest pain less than 30 mins + relieved with nitro or rest
Name/PE/DX/TX
Name: Angina pectoris
PE: often normal
Dx: ECG(1st), stress test (2nd if ok ECG)
Tx: Nitro(acute), BB(chronic)
**Classic outpatient: ASA + nitro (prn) + BB + statin**
45
PTCA vs CABG
PTCA - used when 1-2 vessel involve w/o left main coronary artery
CABG - 3 vessel or main coronary artery involve, EF less than 40%
46
New onset of chest pain more than 30 mins + not relieved with nitro + troponin Negative + pain at rest
Name/Patho/Dx/Tx
Name: UA
Patho: partial occulsion
Dx: ECG - ST depression or T wave inverted
Tx:
1. antithrombotic therapy - ASA, clopidogrel, enoxaprin (heparin)
2. adjuctive therapy - BB(start in 24hr), NGT
47
New onset of chest pain more than 30 mins + not relieved with nitro + troponin positive + pain at rest + ECG ST depression/T wave inverted
Name/Patho/Dx/Tx
Name: NSTEMI
Patho: partial occlusion
Dx
* ECG - ST depression or T wave inverted
* cardiomarker - troponin +
Tx
1. antithrombotic therapy - ASA, clopidogrel, enoxaprin (heparin)
2. adjuctive therapy - BB(start in 24hr), NTG
48
New onset of chest pain more than 30 mins + not relieved with nitro + troponin positive + pain at rest + ECG ST elevation
Name/Patho/Dx/Tx
Name: STEMI
Patho: 100% occluision
Dx:
* ECG - ST elevation
* Cardiomarker - troponin +
Tx:
1. PCI or thrombolytic (alteplase, tenectaplase, reteplase)
2. antithrombotic therapy - ASA, clopidogrel, enoxaprin (heparin)
3. adjuctive therapy - BB (start in 24hr), **ACEI** (start in 24hr) - slow progression on HF
49
Cardiomarker 3 type/ appear time/return time
1) myoglobin - 1-2 hr appear/ return in 24 hr
2) CK/CK-MB - 4-6 hr appear/ 3-4 day return to baseline
3) troponine - 4-8 hr appear/ 7-10day return to baseline (most specific/sensitive)
50
What are complication of MI?
V fib, dressler syndrome (pericarditis)
51
Emergency ACS protocol (3step)
1. ECG in 10 min
2. thrombolytics in 30 min or PCI in 90 min
3. MONA
52
Recent hx of MI + chest pain
Dressler syndrome = pericarditis
53
ACS important 3 'NO' meds
1. cocain induced MI - NO BB (unopposed alpha 1 constriction)
2. Right ventricular MI - NO nitrate or morphine due to preload decrease
3. hx of use viagra - NO nitrate
54
Early morning chest pain + transient ST elevation on EKG
Name/Patho/Dx/Tx
Name: Variant (Prinzmetal) angina Patho: vasospasm in the morning (if emotional - takasubo)
Dx:
* ECG - transient ST elevation
* Echo - if takasubo - LV apical balloon
Tx: CCB
55
useful tool to assess the risk of death & ischemic event
TIMI score
56
Thrombolytic absolute vs relative contraindication
Absolute: active bleeding, hx of ICH, stroke in 6month, aortic dissection
Relative: BP 180, internal bleeding 2 week ago
57
1. I, V5, V6, AVL
2. II, III, AVF
3. ST depression V1, V2
4. V1-V4
5. I, aVL, V4-6
1. lateral - CFX
2. inferior - RCA
3. posterior - RCA, CFX
4. anterior - LAD
5. anterolateral - LAD or CFX
58
In heart failure,
1. Right side MC/SS
2, Left side MC/SS
3. Systolic vs diastolic
1. left HF (Edema, JVD, hepatic congestion)
2. CAD, HTN (congest pulmonary, cough, fatigue)
3. systolic - thin wall + EF low + S3 Diastolic - thick wall + EF normal/high + S4
59
Dyspnea + rale + S3 gallop
Name/Dx/Tx
Name: HF (systolic)
Dx: Echo (1st), BNP
Tx: **ACEI (1st)** + diuretic (out patient)
Acute: LMNOP (lasix/morphine/nitrate/O2/postion)
60
CXR finding of CHF progress
cephalization -\> kerley B line-\>butterfly pattern -\> CHF sign -\> pulmonary edema
61
diffuse ST elevation with PR depression, sharp & acute pleuritic chest pain (sharp), leaning forward feel better
Name/Cause/Dx/Tx
Name: Acute Pericarditis
Cause: MC idiopathic, virus (2nd, coxsackie), **dresslar = hx of MI**
Dx: ECG - diffuse ST elevation, PR depression, Echo (find 2nd problem like effusion)
Tx: ASA or NSAID, 2nd colchicine
62
Muffled heart sound + low voltage QRS complex + electran alternan + waterbottle heart
Name/Dx/Tx
Name: Pericardia effusion
Dx: ECG (low voltage QRS/alternan), Echo
Tx: Obsevation
63
Muffled heart sound, JVD, hypotension
Name/Dx/Tx
Name: Cardiac temponade (WORST Form effusion)
Dx: Echo
Tx: Pericardiocentesis
64
Dypsnea + pericardial knock (high pitched 3rd heart sound) + kassumaul's sign
Name/Patho/Dx/Tx
Name: Constrictive pericarditis
Patho: stiff or thickened pericardium
Dx: Echo
Tx: pericardiectomy
65
Dyspnea + fever + myalgia + chest pain + rales + S3
Name/Patho/Cause/Risk/Dx/Tx
Name: Myocarditis
Patho: heart musle inflammed
Cause: MC coxsakie B
Risk: MC children
Dx: Echo, biopsy is gold
Tx: Supportive tx (same as HF)
66
hx of alcohol use + pregnancy + dyspnea
Name/Cause/Dx/Tx
Name: DCM (systolic)
Cause: MC idiopathic, alcohol, pregnancy
Dx: echo - thin ventricle, dilated heart, EF low
Tx: HF tx
67
hx of amyloidosis + kussmaul sign
Name/Risk/Dx/Tx
Name: RCM (diastole)
Risk: hx of amyloidosis(1st), sarcoidosis
Dx: Echo - normal/large ventricle, atria dialated
Tx: no specific tx
68
Sudden cardiac death during sports + fm hx of sudden death in young age
Name/Patho/PE/Dx/Tx
Name: HCM
Patho: septum is enlarged
PE: squatting, lying supine - murmur decreased, standing & valsalva - murmur increase
Dx: Echo - thick septum
Tx: **Early detection and ICD placement is key** BB (1st),
Definitive: Myodectomy
**Avoid extreme sport and dehydration**
69
Join pain + chest pain + erythema marginatum
Name/SC/Risk/Cause/Dx/Tx
Name: Rheumatic fever
SC: MC mitral valve involve
Risk: children \*(5-15)
Cause: GAS bacteria
Dx: Jones major, fever minor (joint/oh my carditis/nodule/erythema marginatum/sydeham's chorea)
Tx: ASA + PEN G (if allergic - erythro)
70
Trigriceride 200\< + LDL 100
Name/Cause/Dx/Screen/Tx
Name: Hyperlipidemia
Cause: Hypercholestrolemia, hypertriglyceridemia
Dx: 10year CVD risk screening
Screen: initial normal person age 35 male, 45 female
* Statin guideline -
* 1. DM
* 2. LDL \>190, \>21 yo,
* 3. ASCVD score \>7.5,
* 4. hx of CVD
Tx: LDL lower - statins, HDL higher - niacin, Trigly lower - fibrates \*Weight loss/exercise\*
71
fever + roth spot + osler node + murmur + Janeway + anemia + nail hemorrage
Name/Cause/SC/Dx/Tx
Name: Infective endocarditis
Cause: Acute - staph A, subacute - strep viridin (relate with dental disease), Enterococci - Man in 50y with hx of GI/GU procedures
SC: MC valve - mitral (Staphy A, strep viridin), IV drug - tricuspid (staphy A)
Dx: 3 sets of blood draw before abx 1 hr apart, ECHO(TTE)
* DUKE criteria - Blood 2 set +, Echo (major), Fever (minor)
Tx:
* acute: Naf + genta
* subacute: pen/amx + genta,
* IF IVDA - VANCO
72
Dental procedure prophylaxis of infective endocarditis meds
3 case/Tx
Only recommended for
1. prosthetic heart valves
2. previous bacterial endocarditis
3. congenital heart defects
Tx: 2g amox 30-60 min (clinda if allergy)
73
Uni-vision impairment + temporal pain
Name/Related dx/Dx/Tx
Name: Giant cell arthritis
Related Dz: Polymyalgia rheumatica
Dx: ESR first/biopsy definitive
Tx: **before diagnosis must start prednisone (no vision loss)**
**If vision loss - methylprednisolone**
74
Decreased/absent pulse + atropic skin change + worse with walking/better with rest + pale, dusky red
Name/Dx/Tx
Name: PAD
Dx: ABI (1st) - \<0.9, Arteriography (gold)
Tx: **Cilostazol** + ASA + clopidogrel, Surgical: PTA
75
hx of smoking, atherosclerosis, pulsatile abd mass, bruit heard on abd, hypotension/syncope
Name/Cause/Dx/Tx/Screen
Name: AAA
Cause: **MC risk factor Artherosclerosis**, Strongest factor SMOKING
Dx: US (1st), test of choice CT scan w/ contrast
Tx:
* surgical repair - \>**5.5cm or 0.5 cm every in 6month**
* 4.5cm - referral for surgery
* 4-4.5cm - Q6Mo monitor
* 3-4cm Q1yr monitor
Screen: Task force: recommanded screen who **ever smoked before 65 year old**
76
hx of HTN, severe tearing (ripping knife-like) chest pain (10/10), R/L arm BP different 20 or more
Name/Dx/Tx/Caution
Name: Aortic dissection (intimal wall tearing)
Dx: CT, CXR - widening of the mediastinum
Tx:
* Surgical - standford A/debakey I/II
* Medical - Esmolo, labetalol (1st) + nitroprusside (negative inotrope)
Caution: vasodilator will cause tachycardia rebound
77
IV catherization has done, redness, swollen
Name/Cause/Dx/Tx
Name: Superficial thrombophlebitis
Cause: MC IV cath, trauma, pregnancy
Dx: duplex US
Tx: supportive
78
Long Smoking hx + finger toes claudication
Name/Cause/PE/Dx/Tx
Name: Thromboangiitis obliterans (buerger's disease)
Cause: strong relationship with smoking
PE: allen test
Dx: Aortography
Tx: **Stop smoking definitive tx**, CCB for raynaud
79
PVD vs PAD explain
PAD - better with rest, lateral malleolus, atrophic
PVD - worse with rest, medial malleolus, brownish hyperpigment
80
Unilateral calf pain + homan sign
Name/Risk/MC site/Dx/Tx
Name: DVT
Risk: car ride/plan flight \>4 hours, OCP, pregnancy, malignancy
MC site: calf MC -\> lung PE
Dx: duplex US (1s), venography (gold)
Tx: LMWH -\> warfarin for 3month (1st), IV filter if failed coagulation
**LMWH is initial tx for pregnancy and malignancy**
**2 or more thrombophillic warfarin for 12 month** (deficiencies of antithrombin, protein C, or protein S; factor V Leiden; prothrombin; hyperhomocysteinemia; or high factor VIII)
81
Obesity, Dilated tortuous vein, worsening with long standing
Name/Dx/Tx
Name: Varicouse vein
Dx: Clinical, duplex US
Tx: stocking, leg elevation
82
Brownish pigmentation/medial malleoulus + pain/color improves with leg evelation
Name/Cause/Dx/Tx
Name: Chronic Venous Insufficiency
Cause: MC occurs after superficial thrombophlebitis or after DVT
Dx: trendelenburg test, US
Tx: stocking, leg elevation If ulcer tx - wet to dry dressing, Unna boot
83
MC cardiac tumor in adults
Name/Patho/Dx/Tx
Name: Atrial Myxoma,
Patho: ball valve obstruction at mitral valve (atria 40-50%, **Benign**)
Dx: Echo
Tx: Surgical remove
84
Harsh holosystolic murmur at lower left sternal border
Name/SC/Dx/Tx
Name: VSD
SC: MC type of congenital murmur, MC type membrane
Dx: Echo
Tx: close its own in 10 year, Growth disruptive or sx - surgical correction
85
Rib notching, BP difference top and bottom
Name/Dx/Tx
Name: Coarctation of the arota
Dx: Echo
Tx: balloon angioplasty (open up the narrow spot)
86
Machinery murmur (continue murmur)
Name/Patho/Dx/Tx
Name: PDA
Patho: bradykin increase and PGE1 decrease to close
Dx: Echo
Tx: indomethacin
**Sometimes requires PGE1 to keep it open due to other congenital effect**
87
"Boot-shaped" heart on x-ray, tet-spells
Name/Patho/SC/Dx/Tx
Name: Tetralogy of Fallot
Patho: PROV - pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta, VSD
SC: **Cyanotic**
Dx: Echo
Tx: initially squatting knee to chest, ultimately surgical correction, **May requires PDA continue open**
88
Wide fixed split S2
Name/MC site/Dx/Tx
Name: ASD
MC site: ostium secundum
Dx: Echo
Tx: close its own before 1 year, sx - surgical repair (2-4 yrs)
89
headache + siezure + bleeding
Name/MC site/Patho/Dx/Tx
Name: Arteriovenous malformation
MC site: MC brain, spine
Patho: tangled aterior + venos
Dx: CT
Tx: Surgery
90
metabolic syndrome criteria (5)
3 out of 5
1) waistline (\>35 inches for women, \>40 inches for men)
2) triglyceride levels (\>150 mg/dL)
3) low HDL cholesterol level (\<50 mg/dL for women, \<40 mg/dL for men)
4) hypertension (\>130/85 mmHg)
5) hyperglycemia (fasting blood glucose \>100 mg/dL)
91
dyspnea, non-exertional CP + fatigue + Mid systolic Click
Name/Related dz/PE/Dx/Tx
Name: MVP
Related Dz: Marfan, ehler-danlos
PE: midsystolic click + later systolic murmur
* Murmur louder = preload low (standing), Murmur sound decrease = preload high (squatting)
Dx: Echo
Tx: Observation
