Cardiology

Question 1

Preferred treatment of antidromic tachydysrhythmia in WPW syndrome

Answer 1

Procainamide

Question 2

ACLS meds that can be given via ETT

Answer 2

Naloxone, atropine, vasopressin, epinephrine & lidocaine (NAVEL)

Question 3

ACLS defibrillation dose

Answer 3

200 J

Question 4

De Winter ECG Pattern

Answer 4

Tall prominent symmetric T waves in precordials + upsloping STD >1 mm in precordials +/- upsloping STE in aVR

2% of acute proximal LAD occlusions

Question 5

Left main coronary occlusion ECG pattern

Answer 5

STE in aVR > V1, + STD in I, II & V4-6

Question 6

What is Eisenmenger syndrome?

Answer 6

Acquired pHTN 2/2 L—>R cardiac shunt leading to cyanosis 2/2 shunt reversal

Question 7

Wellens Syndrome presentation

Answer 7

• History of anginal chest pain without troponemia
• Biphasic (type A) or deeply inverted (type B) T waves in precordials (mainly V2 & V3)

Highly specific for a critical stenosis of proximal LAD.

Question 8

Hypertrophic cardiomyopathy murmur and maneuvers

Answer 8

• Harsh midsystolic crescendo-decrescendo
• Increase: Valsalva, standing up (decreases preload)
• Decrease: Squatting, Trendelenburg (increases preload)

Question 9

Arrhythmogenic Right Ventricular Cardiomyopathy pathophysiology & EKG

Answer 9

• Pathophysiology: Autosomal dominant inheritance; fibrofatty replacement of RV myocardium leads to ventricular dysrhythmias resulting in syncope or sudden death (exercise-related)
• EKG: small positive deflection buried in terminal QRS complex (Epsilon wave)

Question 10

What is Dressler syndrome?

Answer 10

• postmyocardial infarction syndrome
• pericarditis occurring in setting of injury to heart or pericardium
• develops 2-10 weeks after MI
• persistent low-grade fever, CP & friction rub
• resolves spontaneously

Question 11

JNC 8 recommendations for initial HTN therapy by population

Answer 11

Non-black general: Thiazide, CCB, ACEi, ARB

Black general: Thiazide, CCB

Non-black CKD & DM: ACEi or ARB

High CAD risk or post-MI: BB

Question 12

JNC 8 recommendations for target BP by patient subgroups

Answer 12

• > =60 y: <150/<90

- <60 y: <140/90

Question 13

EKG features that increase likelihood of VT (9 total)

Answer 13

1. QRS >160 ms
2. Absence of BBB morphology
3. Extreme axis deviation (+ in aVR; - in I & aVF)
4. AV dissociation
5. Capture & fusion beats
6. Positive/negative concordance across precordials
7. Brugada’s sign (distance from onset of QRS complex to nadir of S wave >100 ms)
8. Josephson’s sign (notching near nadir of S wave)
9. RSR’ complexes with taller L rabbit ear (most specific for VT)

Question 14

How far away from AICD should sternal pad be placed when defibrillating?

Answer 14

10 cm

Question 15

Most common cause of pericarditis

Answer 15

Idiopathic followed by viral (coxsackie)