Cardio Flashcards
(167 cards)
1
Q
Pt with MS, on auscultation; opening snap indicate»>
A
NON-calcified mitral valve
2
Q
Most common finding on cardiac examination in patient with miral valve disease?
A
atrial fibrillation
3
Q
ejection systolic murmur radiate to carotid
A
AS
4
Q
wide fixed splitting of S2
A
ASD
5
Q
pansystolic murmur radiating to whole myocardium
A
VSD
6
Q
continuous machinery murmur
A
PDA
7
Q
Pt with well developed UL& underdeveloped LL. Exam shows delayed femoral pulsation»>
A
Coarctation of Aorta (COA)
8
Q
COA murmur»>
A
at whole precordium radiating to back
9
Q
MCC of cyanotic congenital heart disease?
A
TOF
10
Q
Cyanotic spells in pt with TOF occur at childhood (not directly after birth)
1st step in management of cyanotic spells in TOF?
A
Squatting position
11
Q
Cyanosis since birth (at 1st day of life)»>
A
TGVs
12
Q
1st step in management TGV?
A
PG infusion (to maintain patency of PDA)
13
Q
Heart failure symptoms few days after birth»>
A
hypo-plastic left heart $
14
Q
Most imp drug for AR?
A
ACEI
15
Q
Fixed split S2?
A
ASD
16
Q
More common association with ASD?
A
RBBB
17
Q
Most common cyanotic heart disease?
A
TOF
18
Q
Most common complication of TOF?
A
cyanotic spells
19
Q
3 day child with symptoms of HF and shock»>
A
hypoplastic ventricle
20
Q
Systolic murmur over aortic area with syncope»>
A
AS
21
Q
Cyanosis since birth»>
A
TOG
22
Q
Cyanosis relieved by squatting»>
A
TOF
23
Q
Systolic murmur radiating to the back»>
A
coarctation of aorta
24
Q
Continuous machinery murmur?
A
PDA
25
Mid-diastolic rumbling murmur?
MS
26
Decrescendo early diastolic murmur?
AR
27
Systolic murmur over apex radiate to axilla?
MR
28
Systolic murmur over apex radiate to carotid?
AS
29
Most common drug addiction causing CHD?
Cocaine
30
Most common material causing CHD?
Alcohol
31
Most common CHD with down?
endocardial cushion
32
Most common CHD with DM?
VSD
33
Marked difference bet upper body pressure and lower body pressure (delayed femoral pulse)>>>
Coarctation of aorta (COA)
34
Most common complication with MS?
AF
35
1st step in TOGV?
prostaglandin infusion
36
Pt with chest pain improve with setting & leaning forward>>>
pericarditis
37
MCC of pericardutis
Viral infection (coxackie virus)
38
TTT of pericarduti
NSAIDs
39
TTT of uremic pericarditis?
Dialysis
40
Best inv of constrictive pericarditis?
CT (calcified pericardium)
41
TTT constructive pericarditis
pericardiectomy
42
Pt with distant heart sounds, ++ JVP, hypotension>>>
Pericardial effusion and tamponade…….next step is chest x-ray
43
Main TTT of pericardial effusion?
Pericardiocentesis
44
Immigrant from Iraq/ Aboriginal with erythema marginatum. Lab shows ++ ASO titer. ECG shows prolonged PR interval>>>
Rheumatic fever
45
Aboriginal with rash, migratory arthritis and H/O URTI>>>
..next step
RHEUMATIC FEVER……..oral penicillin
46
Most imp ECG findings in rheumatic fever?
prolonged PR interval
47
Organisms causing Infective Endocrditis:
| Most common over all?
strep viridians
48
Organisms causing Infective Endocrditis
| After dental procedure?
strep. viridians
49
Organisms causing Infective Endocrditis
Drug addict?
.staph
50
Organisms causing Infective Endocrditis
| After cardiac cath?
staph
51
Organisms causing Infective Endocrditis
After GIT or genitourinary procedure?
strep fecalis
52
Organisms causing Infective Endocrditis
Colon cancer>>>
strep bovis… vvvvvvvvvvv imp
53
Pt with IE, Blood culture grows step bovis>>>
| Next step
: colonoscopy
54
MC affected valve in drug addict with IE>>>
Tricuspid valve
55
MC valve lesion in drug addict with IE?
Tricuspid regurge
56
1st most imp inv of IE?
Trans-esophageal Echo (detect vegetation)
57
2nd most imp inv of IE?
Blood culture (identify organism)
58
Prophylaxis against IE?
2 conditions MUST be met;
Significant cardiac defect (prosthetic valve, previous IE)
Dental procedure
59
Prophylaxis against IE?
Amoxicillin 1h before & ½ an hour after procedure
60
1st MCC of dilated CM?
Alcohol
61
2nd MCC of dilated CM
Viral (MC virus: coxackie virus)
62
Young pt with Syncope/ Arrhythmias or Sudden death during exercise with F/H of sudden death during exercise at young age>>>
HOCM
63
Genetics of HOCM?
AD
| Symptoms of HOMC are more severe with exercise, dehydration, valsalva or standing
64
MCC of death in HOCM?
Obstruction
65
2nd MCC of death in HOCM?
Arrhythmias
66
MC type of arrhythmias in HOCM?
V.tach and V.fib
67
Inv of choice of HOCM?
Echo
68
TTT of choice of HOCM?
1st line: BB & 2nd line: CCB
69
TTT of arrhythmias in HOCM?
Implantable defibrillator
70
1st MC RF of IHD?
HTN
71
2nd MC RF of IHD?
Smoking
72
Highest risk of MI in pt with IHD?
Angina (not HTN)
73
Young smoker with recurrent attacks of typical chest pain>>>
Variant angina
74
TTT of variant angina?
stop smoking, nitrates during attack
75
Pt with H/O typical chest pain, ECG is normal... Next step?>>>
Exercise ECG
76
?Relieve chest pain in IHD
Nitrates
77
Pt with DM, HTN, hyperlipidemia lose consciousness, lab shows serum glucose of <40… which medication is responsible?
BB
| BB mask the signs of hypoglycemia BUT it doesn’t cause it
78
Imp findings in ECG in MI?
ST segment elevation
79
ST elevation at II, III& aVF?
inferior wall infarction
80
The earliest cardiac enzyme to appear MI?
Myoglobin
81
The most accurate enzyme in MI?
Troponin
82
The best enzyme to detect Re-infarction?
CK-MB
83
Definitive TTT of MI?
Angioplasty
84
Best TTT in case of late presentation of MI?
Heparin
85
Late presentation of MI with significant chest pain?
Nitrates
86
Which medications decrease mortality in MI?
BB, ACE-Is& statin
87
Best inv/TTT of myocardial aneurysm?
Echo/ Surgery
88
What to avoid After MI?
No operation for 6 months
89
Emergent surgery (e.g. fracture femur) with H/O angioplasty & stent in the last 6 months>>>
Don’t stop clopidogrel (high risk of thrombosis)
90
Elective endoscpoy with H/O angioplasty & stent in the last 6 months >>>
Don’t stop clopidogrel (high risk of thrombosis)
91
Female on OCP develops HTN>>>
1st: stop OCP and 2nd: re-evaluate
92
Pt with BP > 140/90 for the 1st time>>>
Ask pt to come back in 1-2 Ws
93
Best inv for HTN?
ambulatory monitoring
94
Best inv for paroxysmal arrhythmia?
Holter monitor
95
Imp inv of arrhythmia?
TFT, CBC and electrolytes
96
1st life style modification in TTT of HTN?
Wt loss
97
2nd life style modification in TTT of HTN?
low Na diet
98
Best initial drug for HTN?
Thiazides
99
First drug for DM with HTN?
ACEI
100
First line for DM + Protenuria?
ACEI
101
HTN + unilateral renal artery stenosis?
ACEI
102
HTN + bilateral renal artery stenosis?
Angioplasty& stent
103
HTN + OSTEOPOROSIS?
THIAZIDES
104
HTN + Hyperthyroidism?
BB
105
HTN + BPH?
Alpha blockers
106
HTN + HF?
ACEI
107
HTN and pregnancy?
alpha methly dopa and labetalol
108
Hypertensive emergency?
Hospitalization & 1st line: Labetolol/ 2nd line: Na nitroprusside
109
MC RF of digitalis toxicity?
hypokalemia
110
Presentation of digital is toxicity
Vomiting, abd pain, colored vision& arrhythmia in ECG
111
Most imp ECG finding in digitalis toxicity?
down sloping ST segment with sagging appearance
112
TTT of digital toxicity
Digitalis antibodies
113
Patient on digoxin develop arrhythmia, what to do?
stop digoxin and give potassium
114
MCC of Lt sided HF (LHF)?
MI
115
MCC of Rt sided HF (RHF)
Left sided HF
116
Most imp sign of LHF?
Bilateral basal lung crepitation
117
Most imp sign of RHF?
Systemic congestion
118
Inv of choice of HF?
Echo
119
Hepato- jugular reflux>>>
| +ve in hepatomegaly due to
congestive HF
120
Hepato- jugular reflux>>>
| -ve in hepatomegaly DT
liver pathology
121
Medications MUST be given in HF>>>
ACE-Is, BB and aldosterone antagonist
122
Most dangerous type of lipids?
LDL
123
Most imp in exam to say familial?
tendon xanthoma (NOT xanthelasma)
124
DOC for hyperlipidemia>>>
Statin
125
Mechanism of action statins
HMG-COA reductase inhibitor
126
Pt on statin, BB, ACE-I, aspirin develop myopathy… Cause?
Statin
127
Inv of choice in suspected statin- induced myopathy?
CK
128
Imp SE of statin? (2)
myopathy (check CK)
| Hepatitis (check AST, ALT)
129
Imp forbidden combinations:
Statin and gemfibrizol?
Will cause
Severe rhabdomyolysis
130
Nitrates and sildenafil cause
Severe hypotension
131
Allopurinol and azathioprine?cause
severe toxicity
132
Pt with severe chest pain radiating to the back>>>
Aortic dissection
133
MC RF of aortic dissection>>>
HTN
134
X-ray of aortic dissection>>>
Wide mediastinum
135
Aortic dissection and stable patient>>>
CT angio
136
Aortic dissection and unstable patient>>>
Trans-esophageal echo
137
1st step in TTT of aortic dissection?
Lower BP (BB is the best to start with)
138
MC medication causing orthostatic hypotension?
Diuretics
139
1st line of TTT orthostatic hypotension?
IV fluid
140
2nd line orthostatic hypotension?
Stop the offending drug
141
Inv of choice orthostatic hypotension?
Upright tilt table test
142
Pt with BPH loses conscious while micturating>>>
Situational syncope
143
quick recovery
| HOCM vs AS??
VVVVVVV IMP
144
Both of them?
young age
145
Both of them?
sudden syncope
146
Both of them?
risky with exercise
147
Both of them?
sudden death
148
HOCM…
positive family history
149
HOCM...
systolic murmur over sternal border
150
HOCM murmur....
noooo radiation
151
AS?
systolic murmur over aortic area radiate to carotid
152
Chest pain>>>
more with Aortic stenosis
153
MI and surgery:
No operation before 6 months
154
Stent and urgent operation:
Do not stop clopidogrel…..risk of thrombosis
155
Target lipid profile????
| Total Cholesterol...
less than 4 mmol/l
156
LDL target
less than 2 mmol/l
157
HDL?target target
more than 1 mmol/l
158
TG?target target
less than 2 mmol/l
159
Drug of choice of hypercholssterol
statin to maximum tolerated dose
160
Sudden tearing chest pain referred to the back and HTN>>>
aortic dissection
| Next step………CXR……..wide mediastinum
161
47 yrs male patient HTN, DM and smoker next best step?
CVS risk assessment
162
Best assessment for obesity causing CVS disease?
waist hip ratio
163
DM type 2 with any CVS risk factor ?
add statin regardless lipid profile
164
How long to take clopidogrel for after STE MI?
| after NSTEMI
4 weeks
| 12 months
165
Meds > 4 weeks post MI?
```
SABA
Statin
Aspirin
Beta Blockers
ACEI
```
166
Meds for Pulmonary edema?
```
MONaD
Morphine
Oxygen
Nitrates
Diuretics
```
167
Afib Pt with HF, what meds to avoid
CCB such as VD
verapamil
diltiazam
