Cardio

Question 1

risks assc with right sided endocarditis vs left sided

Answer 1

Right: (IV drug use) –> PE

Left: roth spots, splinter hemor (not specific), janeway lesions (asymptomatic lesions of palms and soles), ossler nodes (not seen in acute IE)

Question 2

most common endocarditis bugs

Answer 2

predamaged valve (ie bicuspid)= S. sanguinis, viridans
IV drug user: staph a

prostethic valve: staph epi

another way to think of it:

• ACUTE= staph A
• Subacute= S. Sanguinis

Question 3

explain pulsus paradoxus

Answer 3

inhale –> inc venous return in RA –> RV bulges with blood, pushes IV septum into LV –> decrease systolic BP

Question 4

new onset murmur in post op patient with shock like vitals?

Answer 4

consider post op MI with subsequent papillary muscle rupture

Question 5

how do you manage acute rheumatic fever recurrence?

Answer 5

with carditis: IM pen G benz for 10 years or until age 21

without carditis= 5 years

Question 6

first line PSVT?

Answer 6

vagal maneuvers

next: IV adenosine

Question 7

what type of valve in young persn (<65) for AR?

Answer 7

mechanical

Question 8

“plop” on auscultation with orthostatic signs

Answer 8

cardiac myxoma

Question 9

pulse control goal in chronic stable angina with Beta blockers?

Answer 9

<70 bpm

Question 10

first line dx for chronic venous stasis

Answer 10

duplex ultrasound

Question 11

true vs false aneurysm

Answer 11

true: involves all three layers of vessel wall
false: break in vessel wall with extravascular hematoma

Question 12

treatment of post catheter pseudoaneurysms?

Answer 12

ultrasound guided thrombin injection

Question 13

abi

Answer 13

1-1.3 is normal

.4-.9= borderline
>1.3= medial sclerosis

Question 14

how does an AV fistula create high output heart failure

Answer 14

dec peripheral vascular resistance –> dec SVR–> dec CO –> inc RAAS –>

Question 15

strongest risk factor for development/ rupture of AAA

Answer 15

smoking

Question 16

cause of polycythemia in VSD?

Answer 16

eisinmengers

PVR inc as inc blood flow through R side –> shunt reversal –> dec O2 sats –>body responds with EPO

Question 17

a murmur found in kids that goes away with neck compression?

Answer 17

venous hum –> turbulence in internal jugular

continuous murmur in supraclavicular region

Question 18

digeorge

Answer 18

CATCH22
Cleft palate
Abnormal facies –> short philthrum, low set ears
Thymic aplasia –> recurrent infx
Cardiac defects –> TOF, truncus arteriousos
Hypocalcemia –> no parathyroids

Question 19

what determines the degree of cyanosis in TOF

Answer 19

R ventricular outflow obstruction

Question 20

transposition of great vessels assoc with?

Answer 20

maternal diabetes

Question 21

findings in coarctation

Answer 21

rib notching –> doesn’t happen until 5-10 yo

arm diff in BP –> only if proximal to subclavian

Question 22

tricuspid atresia

Answer 22

blood moves from RA through ASD –> LA/LV –> systemic circ (hypoxic blood) and through VSD into RA –> into lungs

hypertrphied LV –> left axis dev

Question 23

mech/ prevention of flushing with niacin?

Answer 23

niacin upregulates prostaglandin synth –> take an NSAID 30 mins before

Question 24

approach to premature atrial beats

Answer 24

1) avoid triggers

2) sx–> flecanaide, metop

Question 25

timing of Trop vs CKMB

Answer 25

CKMB: peak 12-24h, fall 2-3 days Trop: normalize in 6-14 days --> BUT 20% rise 3-6 hours after initial suggests reinfarction

Question 26

beta blocker CI in cocaine induced ischemia

Answer 26

selective beta blockade --> can cause unopposed alpha blockage ***use CCB

Question 27

hereditary angioedema

Answer 27

AD, C1 inhibitor deficiency episodes are self limiting, resolve 2-4 days triggers: trauma (dental procedures), stress

Question 28

describe a WPW EKG and moa

Answer 28

- shortened PR intervals during preexcitation - slurred to wide QRS complex - delta waves AV reentrant pathway

Question 29

``` describe PR interval: first degree second degree -----> mobitz I ----->mobitz II ```

Answer 29

first degree= prlonged > 200ms mobitz I= prolonging followed by drop mobitz II= constant!! single or intermittent non conducted P waves

Question 30

name the three HOLOSYSTOLIC murmurs

Answer 30

mitral regurg tricuspid regug VSD

Question 31

open PDA is required for survival in.....

Answer 31

transposition of great vessels | hypoplastic left heart

Question 32

presentation of hypoplastic left heart

Answer 32

absent pulses with single S2 R axid dev grayish cyanosis ******truncus art also has single S2 (bc only one valve) but will have bounding pulses

Question 33

infant who is otherwise health, with holosystolic murmur, developing sx of FTT

Answer 33

VSD with rvh

Question 34

pda anatomy

Answer 34

connects pulmonary artery to aorta *machinery like murmur is pathologic 24 hours after birth PGE keeeeeps the pda open --> NSAIDS (indomethacin) closes it

Question 35

presentation of long QT syndrome. Tx?

Answer 35

Jervell and Leing Nielson syndrome: syncope, hearing loss, fam hx of sudden death The AD form has no deafness beta blockers

Question 36

as far as lifestyle factors, what will result in most immediate decrease in CAD risk

Answer 36

smoking cessation

Question 37

reasons for baseline EKG abnormality in which you have to do nuc stress test or echo

Answer 37

LBBB LVH pacemaker dig

Question 38

drugs that lower mortality in CAD

Answer 38

aspirin, beta blockers CCBs DO NOT!!

Question 39

antiplatelet therpay in CAD

Answer 39

stable= 1 agent= aspirin ACS= 2 agents= aspirin + clopidogrel, prasugrel, ticagrelor

Question 40

prasugrel is CI in... | ticlopidine causes....

Answer 40

patients > 75 --> inc risk of hemorragic stroke neutropenia, ttp

Question 41

fibrates vs statins

Answer 41

fibrates are better for tris when combined, inc risk for myositis

Question 42

how is an S4 related to ACS

Answer 42

ischemia --> non compliant, stiff ventricle

Question 43

other EKG findings in inferior MI (II, III, avF)

Answer 43

ST dep in I, avL --> reciprocal depression or elevation in V2,V3 --> this means POSTERIOR inferior RV

Question 44

someone has STEMI in ambulance, you give them ASA and sublingual nitrogen bc you're a good EMT, and then they're pressures tank. What happened?

Answer 44

RV MI! decreased preload --> give ICF

Question 45

ST depression in V1, V2

Answer 45

posterior wall MI (read these leads backwards)

Question 46

distinguish third degree AV block from bradyardia

Answer 46

cannon A wave

Question 47

first line meds for vasospastic angina

Answer 47

CCB

Question 48

pulsus parvus et tardus

Answer 48

delayed pulse in AS

Question 49

aliskiren

Answer 49

direct renin inhibitor

Question 50

leriche's syndrome triad

Answer 50

triad of 1. hip/thigh/buttock pain 2. impotence 3. absent/diminished distal pulses, generally symetrically *cause by arterial occlusion at aortoiliac jx

Question 51

best test for suspected thoracic aortic an rupture?

Answer 51

CT with contrast vs TEE if poor renal function

Question 52

presentation of adult with coarctation

Answer 52

high blood pressure continuous murmur --> collaterals --> rib notching S4 --> hypertrophied LV from HTN