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MTB STEP 2 (R) > MTB 2 CK - Cardio > Flashcards

MTB 2 CK - Cardio Flashcards

1
Q

Normal splitting

A 
S1 A2|P2
during inhalation (drop in intrathoracic pressure, increased venous return, longer pulmonary ejection time)
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2
Q

Wide splitting

A

S1 A2| |P2
Conditions that delay RV emptying (pulmonic stenosis, RBBB)
Exaggeration of normal

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3
Q

Fixed splitting

A

S1 A2| |P2

Seen in ASD (increased RV filling). Always there, similar to wide splitting…

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4
Q

Paradoxical splitting

A

S1 P2| |A2
Delayed LV emptying (aortic stenosis, LBBB)
P2 occurs before A2 which is abnormal.
On inhalation, P2 is prolonged, moves closer to A2, can be no splitting

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5
Q

(Maneuver and effect)

  • Inhalation
  • Exhalation
  • Hand grip
  • Valsalva
  • Rapid squatting
A
  • Increased right heart sounds
  • Increased left heart sounds
  • (increased SVR) Increased intensity of MR, AR, VSD, MVP murmurs (all things where flow is going backwards); decreases intensity of AS, HCOM (less fluid moving forwards to make a big sound)
  • (decreased venous return/preload increases LV outflow obstruction) increases intensity of MVP and HCOM
  • (increases venous return/preload) decreases HCOM
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6
Q

GI disorders associated with chest pain (4)

A

Ulcer disease
Cholelithiasis
Duodenitis
Gastritis

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7
Q

Around what age do the protective effects of estrogen wear off for women?

A

55-60yo

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8
Q

Pro ischemic pain qualities

A

soreness, dullness, squeezing, pressure-like pain

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9
Q

Anti-ischemic pain qualities

A

sharp, knifelike, lasting a few seconds

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10
Q

Fever + chest pain suggests

A

PE or pneumonia

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11
Q

Office chest pain days to weeks. Cardiac enzymes?

A

No

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12
Q

Office chest pain minutes to hours. Cardiac enzymes?

A

Yes

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13
Q

maximum HR equation

A

220-age

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14
Q

What if you can’t read the EKG? What test do you order

A

Thallium or sestamibi uptake scan.

Echo

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15
Q

Remember the difference in ischemia and infarction!

A

!

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16
Q

Holter monitor does not detect

A

ischemia (don’t do it for chest pain!!)

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17
Q

Holter monitor does detect

A

arrhythmia

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18
Q

Chronic angina meds (3)

A

Aspirin
B-blocker
Nitroglycerin

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19
Q

When to give Clopidogrel (CAD)

A

if aspirin intolerant (allergy)

w/ recent angioplasty w/ stenting

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20
Q

Prasugrel: don’t give to patients >75yo due to

A

risk of hemorrhagic stroke

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21
Q

Give ticlopidine if (CAD)

A

allergic to aspirin and clopidogrel (but not bc of bleeding!)

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22
Q

Ticlopidine adverse effects

A

neutropenia, TTP

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23
Q

When to give statins for CAD

A

LDL >100

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24
Q

What do you need to check regularly in a patient on a statin?

A

AST/ALT

Liver dysfunction MC adverse effect

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25
Q

Niacin adverse effects

A

glucose, uric acid, itchy

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26
Q

fibric acid adverse effects

A

myositis with statins

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27
Q

ezetimibe adverse effects

A

well tolerated but useless

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28
Q

CCB in CAD

A

may increase mortality by raising HR

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29
Q

When to use CCB in CAD

A
  1. Severe asthma
  2. Prinzmetal angina
  3. Cocaine-induced angina (B-blocker CI)
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30
Q

Adverse effects of CCB

A
  1. Edema
  2. Constipation
  3. Heart block (rare)
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31
Q

PCI vs. med mgmt in chronic angina

A

medical mgmt is better

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32
Q

Don’t use PCI for…

A

stable patients

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33
Q

Heart sound associated with acute coronary syndrome

A

S4

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34
Q

Kussmaul sign

A

increase in JVP on inhalation

–constrictive pericarditis, restrictive cardiomyopathy

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35
Q

continuous machine like murmur

A

PDA

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36
Q

Which is worse MI in V2-V4 or MI in II, III, aVF?

A

V2-V4–this is anterior wall. Higher mortality than inferior wall (II, III, aVF)

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37
Q

Pathologic potential of first degree AV block?

A

Very little

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38
Q

Should you treat PVCs?

A

Nope

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39
Q

Leads V1 and V2 should be read…

A

backwards (ST elevation is actually depression and depression is actually elevation) because they are posterior leads

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40
Q

O2, NG, aspirin, morphine–which to give first in acute MI?

A

Aspirin. The only one that lowers mortality

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41
Q

What is the earliest cardiac enzymes become elevated?

A

4hr

42
Q

Myoglobin onset

A

1-4hr

43
Q

Myoglobin duration

A

1-2d

44
Q

CK-MB onset

A

4-6hr

45
Q

CK-MB duration

A

1-2d

46
Q

Troponin onset

A

4-6hr

47
Q

Troponin duration

A

10-14d

48
Q

2 problems with troponin levels

A
  1. cannot detect reinfarction during window of elevation

2. if patient has renal insufficiency can have false positive troponins (renally excreted)

49
Q

How do we detect reinfarction w/in a few days of first?

A

CK-MB

50
Q

MCC of death after recent MI

A

ventricular arrhythmia

51
Q

PCI vs thrombolytics in ACS

A

PCI

52
Q

Warfarin in ACS

A

NOT USED. used for clots in venous side of circulation. no use in coronary disease

53
Q

Heparin in ACS

A

usually given at the time of PCI but discontinued long term

54
Q

Which is better, immediate thrombolytics or delayed angioplasty?

A

Immediate thrombolytics

55
Q

1, 2 tx for ST segment depression

A
  1. Aspirin

2. Heparin

56
Q

Thrombolytics for ST depression ACS

A

No. no clot.

57
Q

Utility of GP2B3A inhibitors

A
  • -Not helpful in STEMI alone
  • -Helpful in STEMI/ACS with angioplasty or stenting
  • -Helpful in NSTEMI
58
Q

Stable angina meds

A

…

59
Q

Weight loss affects

A

BP

60
Q

Exercise affects

A

HDL

61
Q

Smoking affects

A

HDL

62
Q

when is the only time tPA is beneficial?

A

STEMI

63
Q

What is Heparin best for?

A

non-STEMI

64
Q

All of the complications of MI can have this symptom

A

Hypotension.

Will not lead you towards one diagnosis

65
Q

MI complication w/ cannon A wave

A

Third degree heart block

66
Q

TX of bradycardia after MI

A

Atropine

Pacemaker prn

67
Q

RV infarction–artery?

A

Right coronary artery

68
Q

RV infarction exam finding

A

clear lungs

69
Q

RV infarction, wall?

A

inferior

70
Q

RV infarction dx

A

flip EKG leads, elevation in RV4

71
Q

Right coronary artery supplies (3)

A

RIght ventricle
Inferior wall
AV node

72
Q

TX of RVI

A

high-volume fluid replacement

73
Q

Tx to avoid in RVI

A

nitroglycerin

74
Q

Presentation of free wall rupture

A

tamponade
sudden loss of pulse/pulseless electrical activity
clear lungs

75
Q

Vtach/Vfib tx

A

cardioversion/defibrillation

76
Q

Valve/septal rupture presentation

A

New onset murmur

New onset pulmonary congestion

77
Q

After MI if you have an increase in O2 sat between RA and RV

A

Septal rupture

78
Q

Intraaortic balloon pump

A

Never a permanent device
Bridge to surgery for valve replacement or transplant for 24-48hr

For acute pump failure or anatomic problem that can be fixed in OR

79
Q

Ventricular aneurysm tx

A

none needed

80
Q

Ventricular mural thrombus tx

A

heparin then warfarin

81
Q

Post-MI stress test

A

to determine residual ischemia, need for revascularization (angina)

Would do angiography next if +

82
Q

Post-MI angiography

A

to determine need for revascularization w/ angioplasty or CABG
(don’t do if infarcted w/ dead myocardium, only if reversible)

83
Q

Prophylactic anti-arrhythmics

A

DO NOT USE. INCREASE MORTALITY

84
Q

Transthoracic vs transesophageal echo for CHF

A

Transthoracic

85
Q

Utility of TEE

A

most accurate test to evaluate valve function and diameter

86
Q

When is nuclear ventriculography the best test for CHF?

A

Rarely. When giving chemo (doxorubicin)

87
Q

bNP

A

if normal, rules out CHF.

Do this if w/ acute SOA the etiology is not clear and can’t wait for an echo

88
Q

Tests to determine ETIOLOGY (not diagnosis of) CHF

A

EKG–MI, heart block
CXR–dilated cardiomyopathy
Holter monitor–paroxysmal arrhythmias
Cardiac cath–Precise valve diameters, septal defects
CBC–Anemia
TSH–high and low levels can cause CHF
Endomyocardial biopsy–rarely done; sarcoid, amyloid, infections
Swan-Ganz catheter–distinguishes CHF from ARDS; not routinely done

89
Q

Drugs that lower CHF mortality

A

ACE-I, B-blocker, Spironolactone
Hydralazine + Nitroglycerin
Implantable defibrillators

90
Q

Tx of systolic CHF

A

ACE-I–everyone gets this
B-blocker–metoprolol, bisoprolol, carvedilol only
spironolactone–class III, IV
diuretics–loop, to control symptoms
digoxin–to control symptoms and decrease hospitalizations
hydralazine + NG–in substitution for ACE-I

91
Q

CCB in systolic CHF

A

no benefit

92
Q

+ inotropes in systolic CHF

A

no benefit

93
Q

Routine anticoagulation w/ warfarin in CHF

A

never a right answer is there is no clot

94
Q

TX of diastolic CHF

A

B-blockers–definitely
Diuretics–definitely
DO NOT USE–digoxin, spironolactone
Uncertain: ACE-I, ARB, hydralazine

95
Q

Diuretics in HCOM?

A

No! will increase obstruction

96
Q

Tests for pulmonary edema

A

BNP, CXR, ABG, EKG, Echo

These will help determine ETIOLOGY of pulmonary edema

97
Q

most important acute test for pulmonary edema and why

A

EKG–an arrhythmia could be the etiology

98
Q

Best initial therapy in pulmonary edema

A
  1. Diuretics

O2, morphine, nitrates, ACE-I

99
Q

3 approaches of treating pulmonary edema

A

preload reduction, positive inotropes, afterload reduction

100
Q

preload reduction therapy in pulmonary edema

A

diuretics, nitrates

101
Q

+ inotropes in PEd

A

dobutamine, amnirone/milrinone

Used in acute setting (ICU) when unresponsive to preload reduction

102
Q

afterload reduction in PEd

A

nitroprusside, hydralazine acutely

ACE-I long term if systolic dysfunction

MTB STEP 2 (R) (12 decks)

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