Alpa-MKSAP

Question 1

If patient has intermediate risk of cardiovascular disease, which test can be done to further risk stratify in high or low risk?

Answer 1

High sensitivity C-reactive protein
(hsCRP)
3.0 mg/L is HIGH risk

OR
Coronary Artery Calcium Scoring
> 400 is HIGH Risk

Question 2

Which are high intensity statins?

Answer 2

Atorvastatin 40-80 mg
Simvastatin 80 mg (Black Box Warning) .
Rosuvastatin 20-40 mg

Question 3

Biggest modifiable risk factor for acute MI

Answer 3

Dyslipidemia

INTERHEART study

Question 4

What ages (male and female) to give ASA 81 mg as primary prevention?

Answer 4

Men 45-79 ys

Women 55-79 yrs

Question 5

What percentage in 10 year ASCVD scoring is considered HIGH Risk?

Answer 5

> 7.5%

Question 6

How much Left Main Disease is needed for CABG?

Answer 6

Symptomatic and 50% stenosis

Asymptomatic and 70% stenosis

Question 7

How to calculate TIMI score?

Answer 7

1. ASA use in 7 days
2. Two angina episodes in 24 hours
3. ST- T wave changes
4. (+) Biomarkers
5. Known >50% coronary artery disease
6. More than 3 Risk Factors (HTN, DLD, DM, Family Hx, Smoking)
7. Age > 65

Question 8

Most common arrhythmia after reperfusion?

Answer 8

AIVR- Acclerated Idioventricular Rhythm

Question 9

Most Common Valvular Disease after Tetralogy of Fallot repair?

Answer 9

Pulmonary valve regurgitation

Question 10

50% of patients with Aortic Coarctation will have this aortic valve abnormality

Answer 10

Bicuspid Aortic Valve

Question 11

Which Chemotherapy agents associated with Cardiotoxicity?

Which are reversible?

Answer 11

Doxorubicin, daunorubicin, Mitozantrone and Trastuzumab

Anthracyclines are dose dependent and nonreversible
Trastuzumab is reversible

Question 12

When is anticoagulation indicated for peripartum cardiomyopathy?

Answer 12

If LVEF less than 35% with peripartum cardiomyopathy due to risk of VTE

Question 13

If Pregnant woman having ventricular arrhythmia, what medication?

Answer 13

Lidocaine, although Quinidine is preferred

Question 14

Fetal Arrhythmia, what medication?

Answer 14

Procainamide

Question 15

Antihypertensives in Pregnant Women?

Answer 15

Labetalol and Hydralazine

Question 16

What anticoagulation is given to pregnant women with mechanical valves?

Answer 16

Warfarin

Can switch to heparin right before delivery due to warfarin’s AE of fetal intracranial hemorrhage

Question 17

What ABI value diagnoses Peripheral Arterial Disease?

Answer 17

0.90

Question 18

If ABI > 1.4, what’s the next step?

Answer 18

Toe-Brachial Index

Question 19

Cilostazol is contraindicated in which patients?

Answer 19

Heart Failure! or LVEF

Question 20

What is pseudoclaudication?

Answer 20

Lumbar Spinal Stenosis

Improves with waist flexion and can be uncomfortable while standing still

Question 21

When to screen for Abdominal Aortic Aneurysm?

Answer 21

Men who smoked/still smoke btwn 65-75 yo

Question 22

When to surgically intervene Abdominal Aortic Aneurysm?

Answer 22

> 5.5 cm maximal aortic diameter in MEN, more than 0.5 cm growth in 1 year, symptomatic
OR
5.0 cm maximal aortic diameter in WOMEN

Question 23

What is Stanford type A? Type B?

Answer 23

Type A: aortic arch and ascending aorta

Type B: descending aorta (distal to left subclavian a.)

Question 24

When do you surgically intervene on type B Acute Aortic Syndrome?

Answer 24

Complications:

1. Occlusion of a major aortic branch leading to end-organ ischemia
2. Persistent severe hypertension
3. Persistent pain
4. Propagation of the dissection (which may be manifested by persistent or recurrent pain
5. Aneurysmal expansion
6. Rupture

Question 25

What specific ACE-I will treat Thoracic Aortic Aneurysm?

Answer 25

Losartan

Question 26

What is the difference between Acute Aortic Dissection and Acute Intramural Hematoma?

Answer 26

Dissection has interruption of intima with intimal flap and false lumen within media Hematoma has crescent shaped hematoma within media but no interruption of intima

Question 27

After diagnosing Marfan Syndrome, how often should you perform Echo to check for aortic root dilation/aneurysm?

Answer 27

Echo 6 months after Dx and then annually

Question 28

Which types of Congenital Heart Disease cause Eisemengers Syndrome? How to manage Eisemengers Syndrome?

Answer 28

Severe PAH--> PDA, VSD, ASD Iron deficiency increases symptoms, so treat it (Increased Hgb/Hct is physiologic/normal, no phlebotomy) Avoid dehydration, high altitude, and air emboli in IV lines

Question 29

50% of Bicuspid Aortic Valve patients have this other CHD?

Answer 29

Aortic Coarctation

Question 30

What are XRAY findings of Aortic Coarctation?

Answer 30

figure 3 sign OR rib notching- dilation of intercostal arteries

Question 31

If patient has cryptogenic stroke and patent foramen ovale, how do you manage?

Answer 31

Antiplatelet

Question 32

What type of valvular heart disease is a late complication of Tetralogy of Fallot repair?

Answer 32

Pulmonary Valve Regurgitation

Question 33

What Congenital Heart Disease is associated with fixed splitting and right ventricular heave?

Answer 33

Atrial Septal Defect

Question 34

What Congenital Heart Disease is associated with upper extremity hypertension and radial to femoral artery pulse delay?

Answer 34

Aortic Coarctation

Question 35

Noonan syndrome is associated with which congential heart disease?

Answer 35

Pulmonary Valve Stenosis

Question 36

For Pulmonary Valve Stenosis, at which peak gradient is considered SEVERE?

Answer 36

Peak gradient > 60 mm Hg

Question 37

Target INR for mechanical aortic valve? | Target INR for mechanical mitral valve?

Answer 37

Mechanical Aortic Valve INR: 2.5 | Mechanical Mitral Valve INR: 3.5

Question 38

How long do you anticoagulate bioprosthetic valve?

Answer 38

3 months

Question 39

When to check TTE for valvular heart disease? | first presentation

Answer 39

systolic murmur 3/6, diastolic murmur OR symptoms

Question 40

Surgical indication for Aortic Valve Replacement with AS?

Answer 40

1. Symptomatic patients with severe aortic stenosis | 2. Asymptomatic patients with severe aortic stenosis LV ejection fraction

Question 41

What Aortic Valve Area (AVA) in Aortic Stenosis is considered SEVERE?

Question 42

What type of murmur is associated with Bicuspid Aortic Valve....?

Answer 42

Diastolic OR Systolic murmur, with an ejection

Question 43

Surgical Indication for Mitral Regurgitation?

Answer 43

1. Symptomatic acute severe mitral regurgitation 2. Symptomatic chronic severe mitral regurgitation with LV EF > 30% 3. Asymptomatic chronic severe mitral regurgitation and mild to moderate LV dysfunction

Question 44

Triad seen with Cardiac Tamponade?

Answer 44

JVD Hypotension Pulsus Paradoxus Sinus tachycardia/Electrical Alternans

Question 45

Name 5 causes of Acute Pericarditis?

Answer 45

Viral, tuberculosis, HIV, neoplasm, trauma, uremia, radiation, hydralazine penicillin, chemotherapy, autoimmune causes

Question 46

How to treat frequent Premature Ventricular Contractions? | What is considered frequent PVCs?

Answer 46

Symptomatic or frequent PVCs (>10,000 PVCs/24 hours or >10% of all beats) First-line therapy: β-blocker or calcium channel blocker therapy 2nd line therapy: catheter ablation

Question 47

What valvular disease is common after atrial fibrillation ablation?

Answer 47

Pulmonary Valve Stenosis