step 3 5

Question 1

what is EPS

Answer 1

dystonia, akathisia, or parkinsonism

Question 2

by far leading cause of death in our country

Answer 2

coronary artery disease

Question 3

biggest RF for CAD

Answer 3

diabetes

Question 4

most common cause of chest pain that is not cardiac in etiology

Answer 4

GERD

Question 5

best test for evaluating EF

Answer 5

nuclear ventriculogram

Question 6

mortality affect of ACEis/ARBs in ACS

Answer 6

only with LV dysfunction or systolic dysfunction

Question 7

ACS interventions that lower mortality

Answer 7

aspirin, thrombolytics, primary angioplasty, metoprolol, statins, clopidogrel, ACE/ARBs ( if EF low)

Question 8

NSTEMI vs. STEMI

Answer 8

No lytics in NSTEMI, and anticoagulation is used

Question 9

cardioselective betablockers

Answer 9

metoprolol, atenolol

Question 10

how to determine if someone needs a CABG

Answer 10

significant changes on stress testing → coronary angiography → determine if candidate for CABG

Question 11

better graft for CABG

Answer 11

internal mammary artery (10 yrs) vs saphenous vein (5 yrs)

Question 12

CABG indications

Answer 12

• 3 coronary vessels with 70 percent stenosis
• left main coronary artery stenosis 50-70 percent
• 2 vessels in a diabetic
• 2 or 3 vessels with low EF

Question 13

CAD management

Answer 13

ASA
Metoprolol
Statin with LDL goal <70

Question 14

ACSVD cut-off for statin

Answer 14

7.5%

Question 15

why do we use statins?

Answer 15

proven mortality benefit

Question 16

PCSK9 inhibitors

Answer 16

evolocumab, alirocumab

Question 17

use of PCSK9 inhibitors

Answer 17

severe hyperlipidemia (familial hypercolesterolemia) not responsive to statins

Question 18

new cardiac drugs

Answer 18

Ivabradine
Sacubitril/valsartan
both shown to have mortality benefit.

Question 19

HFpEF management

Answer 19

beta blockers and diuretics (verify)

Question 20

meds with mortality benefit in CHF

Answer 20

ACE/ARB, betablocker, spironolactone

Question 21

severe HFrEF management

Answer 21

IF EF <35% → ICD
IF EF <35% + QRS > 120 → biventricular pacemaker (IE cardiac resynchronization therapy)
consider life vest
→ think about discontinuing betablocker (may be exacerbating fluid overload/pulmonary edema).

Question 22

absolute contraindication to beta blocker

Answer 22

symptomatic bradycardia