Cardio

Question 1

Systolic blood pressure of >180 mm Hg & a diastolic blood pressure of >110 mm Hg, with no evidence of end-organ damage?

Answer 1

Hypertensive
urgency

resuming the anti-HTN regimen with close follow-up is the best treatment.

Question 2

HTN emergency - goal to lower BP ?

Answer 2

No more than 25% in first 2-6 hours
160/100

Question 3

An examination
reveals a right lower leg that is cold at the midcalf and right foot without palpable or Doppler pedal
pulses.

Most appropriate next step in management?

Answer 3

This patient has acute limb ischemia (ALI), a medical emergency

emergent revascularization is recommended to salvage this patient’s limb. An emergent
referral to a vascular subspecialist

Question 4

Digoxin toxicity - very common in elderly even if therapeutic range. Treatment?

Visual disturbances, neuro and GI

Answer 4

Stop digoxin and start at lower dose

Question 5

What drug has greatest benefit in decreasing mortality in suspected MI e.g. NSTEMI

Answer 5

Aspirin

Question 6

Screen infants for congenital heart disease in how many hours of life?

Answer 6

Pulse Oximetry within first 24hrs of life

Question 7

What drug is known for reducing hospitalization and cardiovascular death in HFpEF?

Answer 7

Dapagliflozin - farxiga

Question 8

Afib requiring anti-coagulation with mitral stenosis or mechanical valve- what drug?

Answer 8

Warfarin preferred

Question 9

What high dose statin decreases risk for secondary stroke?

Answer 9

Atorvastatin

Question 10

In HOCM; murmur increases under what conditions?

Answer 10

Decreased preload (valsalva)
Decreased after load

Question 11

Discontinue Apixaban how many days prior to a procedure?

Answer 11

1-2 days

Question 12

A CHADSVASC score of ? in men and women to start anticoagulation?

Answer 12

2> men and 3> women

Question 13

Adverse effects of ACEI

Answer 13

C - cough
A - angioedema
T - teratogen
C - creatinine increased
H - hyperkalemia
H - hypotension

Question 14

Triptans due to vasoconstriction properties contraindicated in what disease?

Answer 14

Coronary artery disease
Peripheral vascular disease
Cerebrovascular disease

Question 15

If intermediate risk of ACS or pre-op assessment - cannot reach 4 mets (climbing stairs) do what test?

Answer 15

cardiac stress test

Question 16

Low dose colchicine causes a 30% risk reduction in?

Answer 16

cardiovascular deaths

Question 17

Coronary artery calcium score needed for those with intermediate predicted risk of?

Answer 17

5% -7.5% and 7.5% - 20%

Question 18

Sick sinus syndrome is diagnosed with?

Answer 18

Holter monitor

Question 19

SA node dysfunction (right atrium) first line treatment?

Answer 19

permanent pacemaker
Bradycardia <50 with sinus pauses
> 3 seconds, decreased tolerance physical activity,

Question 20

What NSAID is safest with history of MI?

Answer 20

Naproxen

Question 21

What diuretic slows cortical bone loss in post-menopausal females to decrease incidence osteoporosis + hip fractures

Answer 21

Thiazide

Question 22

Sudden painless vision loss in one eye w/PMH HTN, T2DM.

Answer 22

= retinal vein occlusion - Tortuous, dilated retinal veins on fundoscopy

Question 23

What drug decreases all cause mortality and decreased cardiac death when initiated after MI

Answer 23

Sprinolactone - aldosterone antagonist

Question 24

HXSTEMI with Afib what anticoagulation regimen?

Answer 24

DAPT (ASA+Plavix) + Vit K
antagonist (warfarin)

with a goal INR 2.0 - 3.0

Question 26

in left bundle branch block - what type of stress test

Answer 26

pharmacological stress test

Question 27

Acute pericarditis is relieved in what position?

Answer 27

Sitting / leaning forward - brings heart closer to chest wall Worse with inspiration/supine

Question 28

Most pericarditis caused by?

Answer 28

Viruses e.g, parvovirus , enterovirus, adenovirus

Question 29

Hemodynamically stable with SVT? first line?

Answer 29

Vagal manuevers first IV adenosine and verapamil

Question 30

Refractory SVT?

Answer 30

Cardioversion

Question 31

Long term management recurrent SVT

Answer 31

radiofrequency ablation

Question 32

DM and found to have multi vessel CAD - what intervention superior?

Answer 32

CABG superior to PCI ad decreased rates death/MI

Question 33

78M on ASA+ Plavix for recent stroke scheduled for CABG in 5 days - what to d/c?

Answer 33

Stop clopidogrel 5 days before d/t increased bleeding risk. Can continue ASA

Question 34

Low renin, elevated aldosterone in a patient with resistant HTN

Answer 34

Primary hyperaldosteronism

Question 35

16F w/ arm span>height, myopia needs what test?

Answer 35

Echocardiogram to screen for cardiac complications

Question 36

8 year old with HTN needs what test to screen for end organ damage?

Answer 36

Echocardiogram for LVH

Question 37

Discontinue warfarin how many days prior to surgery in patients taking for Afib for stroke prevention

Answer 37

5 days prior to surgery without bridging

Question 38

Primary prevention for CVD in ages 40-75 with 7.5%- 10% 10 year risk of ASCVD with 1 or more CVD risk factors ( DM, HTN, HLD, smoking)

Answer 38

Moderate intensity statin Atorvastatin 10–20 mg Rosuvastatin 5–10 mg Simvastatin 20–40 mg

Question 39

Primary prevention for CVD in ages less than 40?

Answer 39

Behavioral intervention - diet/exercising

Question 40

ABI >1.4 = non compressible arteries - calcified vessels what imaging?

Answer 40

MR/CT angio to confirm vascular disease

Question 41

Age-related cardiovascular change?

Answer 41

Decreased maximal HR with exercise

Question 42

What medications decrease mortality in symptomatic HF?

Answer 42

ACEI, B-blockers, sprinolactone

Question 43

What medication is contraindicated in heart failure

Answer 43

non-dihydropyridine CCB as is it a negative ionotrope

Question 44

what psychiatric medication lengthen QTC

Answer 44

SSRI - d/c as can lead to life threatening tornadoes

Question 45

What lab do you need when calculating ASCVD

Answer 45

lipid panel, provides total cholesterol and HDL both needed for ASCVD score

Question 46

Periop management of anticoagulation? High risk?

Answer 46

High risk? stroke, TIA, VTE in last 3 months, coronary stent in last 12 months Bridge warfarin with LMWH

Question 47

Periop management of anticoagulation? Low risk?

Answer 47

D/c warfarin 5 days prior and restart 12-24hrs

Question 48

What medication decreases perioperative mortality

Answer 48

Statin

Question 49

First line pulseless ventricular tachycardia or ventricular fibrillation

Answer 49

Defibrillation

Question 50

Which anti-HTN med decreases severity of OSA?

Answer 50

Sprinolactone

Question 51

Patients with MI most likely to have what murmur?

Answer 51

Chronic mitral regurgitation due to LV remodeling. - loudest at apex, radiates to axilla

Question 52

What first line medication to use in septic shock

Answer 52

Norepinephrine - vasoconstrictor and ionotrope

Question 53

AAA that is 4-5cm? next step

Answer 53

Repeat U/S in 6-12 months

Question 54

21F with resistant HTN cause?

Answer 54

Fibromuscular dysplasia do MR or CT angiogram of renal arteries

Question 55

Treat venous stasis ulcer with? Shallow/irregular ulcer on medial lower leg with burning

Answer 55

Compression therapy with 30-40mmg HG

Question 56

AAA>5.5 men and 5.0 women

Answer 56

Surgery

Question 57

60M recent PCI for persistent angina what is best for secondary prevention of CVD?

Answer 57

Statin

Question 58

CAD and angina without heart failure treatment? Short term long term

Answer 58

Short term = nitroglycerin long term = B-blocker

Question 59

Afib first line to get HR <80 with COPD ?

Answer 59

non-dihydropyridine CCB e.g. verapamil or diltiazem

Question 60

This patient has diastolic heart failure, also called heart failure with preserved ejection fraction (HFpEF). Patients who have HFpEF with active fluid overload should be treated with ?

Answer 60

Diuretics such as furosemide (SOR B).