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CK > Cardio/Mix > Flashcards

Cardio/Mix Flashcards

(104 cards)

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1
Q

best initial management of BP 170/100 no end organ damage

A

2 drug therapy for BP >20/>10 above target (130/80)

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2
Q

secondary complications of OSA

A

*secondary HTN 2o catecholamine release during apnoeic episodes (not amenable to medication)
*pulmonary HTN
*Rt side heart failure
* inc risk of AF

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3
Q

Causes of Acute Limb Ischaemia

A

*cardiac/ arterial embolism ( AF, LV thrombus,
LV aneurysm, Infective endocarditis, prosthetic valve)
*arterial thrombosis with hx of PAD ( other limb affected pulse)
*iatrogenic, blunt force trauma

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4
Q

Vasovagal syncope management

A

reassurance and avoidance of triggers
counter pressure maneuver for recurrent episodes ( crossing legs, clenching hands)

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5
Q

management of tachyarrhythmia in an haemodynamicaly unstable adult

A

synchronised cardioversion

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6
Q

Management of symptomatic bradycardia

A

HR <50
Determine haemodynamic stability if stable —> find underlying cause
Unstable —> atropine 1mg IV
If no improvement —> pacing

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7
Q

SLE cardiovascular risk

A

Increased atherosclerosis —> increased risk of premature CAD

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8
Q

Defining feature of seizures

A

lateral tongue biting

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9
Q

EF indicative of HF

A

<40%

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10
Q

Pts with valvular heart disease having surgery assessment

A

symptoms +/-
surgical risk low / intermediate/high
cardiac function :- EF/ pulmonary HTN
if negative then proceed with surgery
if symptomatic or presence of valve specific criteria –> valve intervention before surgery

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11
Q

is h pylori testing part of the GERD workup

A

NO
H pylori testing indicated in dyspepsia workup not reflux

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12
Q

1st line mgx in pts with recurrent GERD

A

PPI

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13
Q

factors that can trigger AF

A

*hyperthyroidism
*drugs e.g. cocaine/ sympathomimetic
*excess alcohol
*increased sympathetic tone e.g. acute illness ( PE, MI, sepsis), cardiac surgery

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14
Q

young pt with new onset AF, normal echo. next diagnostic test?

A

serum TSH, free T4

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15
Q

differentiating feature between cardiac and liver cause of ascites, LL edema and spleenomegaly

A

positive hepatojugular reflex indicates cardiac cause. Highly specific for RT heart failure

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16
Q

management of AF

A

assess if haemodynamicaly stable or unstable
unstable –> synchronised cardioversion
stable –> rate control using B. blocker (metoprolol),
CCB (verapamil, diltiazem)

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17
Q

monomorphic ventricular tachycardia ecg findings

A

regular RR interval
no visible P wave
wider QRS complex
QRS complexes all look the same except for fusion beat which is pathognomic

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18
Q

management of monomorphic ventricular tachycardia

A

hemodynamically stable –> amiodarone, lidocaine, procainamide
haemodynamically unstable –> synchronised cardioversion

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19
Q

ischemic colitis presentation

A

*Lt sided abdominal pain and bloody diarrhoea
*fever, leucocytosis

( can occur as complicaton of infrarenal AAA repair)

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20
Q

initial medical mgx of acute aortic dissection

A

B blockers ( labetalol, esmolol)
*reduce BP
*reduce HR
*reduce rate of rise of BP

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21
Q

Chagas disease findings

A

Protozoal disease –> Trypansoma Cruzi
endemic to S America
*megacolon
*megaoesophgus
*cardiomegaly

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22
Q

initial management of narrow complex QRS

A

adenosine
can aid in diagnosis AF/flutter
or terminate PSVT

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23
Q

Rt Ventricular infarction presentation

A

hypotension
raised JVP
clear lung fields
ST elevation II,III, aVF

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24
Q

Left ventricular aneurysm

A

occurs several months after MI esp LAD
2o to scar deposition

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25
Lt ventricular aneurysm presentation/findings
several months post MI *HF symptoms/ angina *ECG:- persistent ST elevation in previous MI leads deep Q waves *ECHO:- progressive Lt vent wall enlargement and dyskinetic wall
26
workup for new HTN diagnosis
FBC U&E LFT TSH HbA1C Lipids ECG ECHO urine analysis urine Albumin:creatinine uric acid
27
initial management acute viral pericarditis
NSAIDS + colchicine ( prevent recurrence) if issue with NSAIDs then prednisolone + colchicine
28
High output cardiac failure presentation
*wide pulse pressure *prominent apical impulse *signs of Rt and Lt heart failure
29
cardiac tamponade features
*raised JVP *muffled HS *hypotension *nonpalpable apical impulse *CXR cardiomegaly with clear lung fields
30
pulsus bisferiens indication of which condition
aortic regurgitation
31
Commonest cause of acute cardiac arrest in acute MI
Ventricular arrhythmia
32
Criteria for aortic valve replacement
*Symptomatic e.g dyspnoea, angina, syncope/presyncope *LVEF < 50% * undergoing other cardiac surgery
33
initial mgx of athlete with 1o HB or Mobitz type I
normal finding in athletes reassure
34
orthostatic hypotension diagnosis
>20mmHg drop SBP/ >10 mmHg DBP drop elevated BUN indicated dehydration --> possible cause
35
AVNRT features
*most common type of SVT * abnormal conduction through 2 distinct AV nodal pathways *ECG:- narrow complex QRS, regular RR interval, buried P waves
36
longitudinal tear in oesophagus refer to
Mallory Weiss tear c/o haematemesis, epigastric or back pain precipitated by vomiting and intense retching
37
CXR findings thoracic AA
*widened mediastinum *tracheal deviation * enlarged aortic knob
38
pathophysiology of thoracic AA
degenerative aortic disease
39
most likely cause of sudden death in pt with pmhx of MI and LVEF < 30%
ventricular arrhythmia
40
post cardiac injury syndrome
aka Dressler's syndrome *weeks to months after MI *C/O chest pain improves with leaning forward , increase on inspiration * ECG:- diffuse ST segment elevation with reciprocal depression in V1 and aVR
41
mgx of post cardiac injury syndrome
NSAIDs high dose aspirin
42
initial mgx of AF 2o hyperthyroidism
B Blockers ( will also help with anxiety and tremor) followed by methimazole and anticoagulation according to risk
43
S3 indicative of which type of HF
systolic HF
44
severe MR features
*LV overload and LV dilatation ( dyspnoea on exertion) *loud S3 indicates severity *holosystolic murmur
45
difference between cardiac tamponade and RV MI
both present with raised JVP, hypotension and clear lungs difference is RVMI has ST elevation II,III,aVF
46
initial mgx of hypotensive pt with RVMI
normal saline bolus hypotension is 2o decreased bld supply to Lt heart
47
initial mgx pf pt with STEMI and pulmonary oedema
iv furosemide
48
constrictive pericarditis features
*pericardial knock ( high pitched early diastolic sound) *heart border calcification *biatrial enlargement with normal ventricular wall thickness *Rt heart failure signs
49
reversible risk factors for PACs (premature atrial complexes)
*tobacco use *alcohol
50
hyperplasticity polyps screening
non neoplastic regular screening times
51
colorectal screening guidelines
*start age 45 *10 years or 40 yrs old for significant fhx *10 year interval for average risk *5 yr interval for pts with significant fhx ie hx of colorectal cancer <60 1o relative
52
initial mgx of pt with Tourettes
antidopaminergic --> 1. VMAT2 inhibitors (vesicular Mono Amino Transporter 2) --> tetrabenzine previously antipsychotic meds risperidone but have se tardive dyskinesia
53
serotonin toxicity mgx
*discontinue all serotogenic meds *esmolol for high BP *IV hydration, cooling with a fan *benzos *cyproheptadine if benzos don't work * intubation and sedation
54
dextrometorphan
antitussive works primarily on sigma opioid receptor also has serotogenic activity
55
serotonin toxicity triad
*altered mental state *autonomic instability ( hyperthermia, mydriasis tachycardia) *neuromuscular excitability ( clonus, hyperreflexia)
56
vasovagal syncope features
*prodrome ( warmth, pallor, diaphoresis) *rapid recovery 1-2 mins * ECG pre syncope :- sinus bradycardia and asystole 2o sinus arrest
57
cyclothymic disorder
>2 years of multiple episodes of hypomania and depressive mood that don't fit full criteria for hypomania or major depressive disorder
58
Dysthymia aka persistent depressive disorder
*> 2 yrs hx of depressive episodes lasting most days * 1 year in children/ adolescents * no symptom free period for > 2/12 *i.e. chronically depressed
59
Causes of acute pericarditis
*viral or idiopathic *autoimmune (SLE) *uraemia ( CRF or ARF) * post MI --> early :- peri-infarction pericarditis ( <4/7 post MI) Late :- Dressler's syndrome ( weeks post MI)
60
acute pericariditis features
*pleuritic chest pain better with sitting up radiates to LT shoulder / bilateral scapulae *pericardial friction rub * ECG:- diffuse ST elevation / PR depression *ECHO:- pericardial effusion
61
PiP - Pericardial infarction pericarditis
*occurs <4/7 post MI esp if there was a delay of >3 hrs to treatment *all pts must have an ECHO to rule out pericardial effusion and other post MI complications * mgx is supportive, NSAIDS avoided first 7/7 risk of free wall rupture
62
initial management of clinically suspected acute limb ischemia
anticoagulation with IV heparin THEN investigate
63
clinical features of cardiac myxoma
*position dependent mitral valve obstruction *middiastolic rumble/ murmur * dyspnoea, syncope, * embolisation of tumour fragments --> stroke * constitutional symptoms ( fever, wt loss)
64
mitral stenosis pre pregnancy management
if severe (<1.5cm2 valve area) / symptomatic (dyspnoea on exertion) --> percutatneous mitral valve repair prior to pregnancy
65
essential elements of informed consent
* pts diagnosis *risk and benefits of the treatment and any alternatives *risks of refusing treatment
66
Group A streptococcus pharyngitis criteria for diagnosis
*fever * tender ant cx lymphadenopathy *tonsillar exudates * no cough 2-3 --> rapid strep ag test and abx 4 --> emipricial abx
67
Delirium in hospitalised elderly mgx
* treat underlying cause * reduce unnecessary meds *inc activity in am * reduce nighttime noise and light *soft restraints if not responding ( although they can worsen condition)
68
best mgx for hoarding disorder
CBT
69
GLP-1 and SGLT (flozins) benefit
* decreases cardiovascular mortality * induces weight loss * decreases risk of hypoglycemia
70
constrictive pericarditis presentation
*can follow a hx of radiation * RT HF symptoms *raised JVP, * LL oedema *ascites *kussumal sign
71
DASH diet
Dietary approaches to stop HTN diet * can reduce BP by 11mmHg
72
PE presentation
*Dyspnoea, tachypnoea *tachycardia > 100 *hx of recent immobilisation or hospitalisation * reduced SpO2 *unilateral lower limb oedema
73
chronic venous insufficiency
*LL oedema *varicose veins *medial leg ulcers * Mgx conservative i.e leg raising, exercise, compression
74
Ehlers Danlos features
*hypermobility of joints *multiple joint dislocations *poor wound healing *tissue fragility *poor paper like scarring
75
screening for AAA
1 time abdominal u/s in men aged 65-75 with any hx of smoking or hx of 1o relative with AAA rupture
76
indications for LL amputation
*non-revascularisable limb ischemia *unsalvegable soft tissue damage *life threatening infection
77
CVS abnormalities/complications in Turner's syndrome
*bicuspid aortic valve *coarctation of the aorta *aortic dissection
78
Mobitz Type I
progressively prolonged PR followed by dropped QRS
79
Mobitz Type II
constant PR with randomly dropped QRS
80
syncope 2o arrhythmia presentation
*usually no prodromal symptoms *occurs at rest * hx of heart disease
81
WPW ECG findings
* short PR interval *delta wave upstroke of QRS *wide QRS complex
82
Diagnostic investigation in acute aortic dissection
*CT angiography * if hypotensive --> rupture likely --> then TEE
83
chostochondritis
*MSK chest pain * sharp, localised and reproducible *mgx:- reassurance and symptomatic treatment
84
pulmonary HTN presentation
*progressive SOB *tricupid regurgitation *raised pulmonary arterial pressure (N<35) *RT ventricular dilatation
85
diastolic dysfunction
* aka HF with preserved EF *1o cause is concentric LV hypertrophy 2o chronic HTN *AF, obesity, sedentary lifestyle assoc *c/o HF symptoms with EF >50%
86
cardiac chest pain with normal ECG next best step
serial ECGs every 15-30 mins in pts with persistent symptoms
87
pulmonary stenosis
* wide splitting of S2 > during inspiration * ejection click high pitched sound after S1 *crescendo decrescendo systolic murmur over Lt upper sternal border
88
PCI for STEMI criteria
*within 12hrs of symptoms onset *within 90mins of presentation to PCI facility *within 120mins of presentation to non PCI capable facility
89
adenosine moa
*reduces influx of Ca --> vasodilation + slows conduction through AV node
90
pharmacologic stress test
*administer adenosine or dobutamine *for pts what can't reach target HR, LBBB, pacemaker *adenosine > coronary bld flow highlighting areas that supplied by stenosed arteries
91
atrial flutter
*saw tooth pattern on ECG *can be regular irregular *require anticoagulation
92
Brugada Syndrome
*AD condition can predispose to V Tach *episodes occur at night and can be triggered by fever
93
next step after placing a CVC
portable CXR to confirm catheter tip placement rule out pneumothorax
94
next screening in pts with popliteal artery aneurysm
U/S of the contralateral popliteal artery and abdominal aorta
95
criteria for initiating statins
secondary prevention:- presence of atherosclerotic CVD Primary prevention :- LDL >190mg/dl, age >40+DM, estimated 10 yr CVD risk of >7.5%-10%
96
CVP levels and shock
* low CVP in hypovolemic shock and distributive shock ( e.g. anaphylaxis, neurogenic, sepsis) *high CVP in cariogenic and obstructive shock
97
indications for surgical intervention in infective endocarditis
*acute heart failure 2o AV/MV regurgitation *hard to treat organisms - failure of abx ( fungi etc) *vegetation >1cm in size *extension of infection e.g fistula, abscess, heart block
98
pt with prosthetic valve and signs of infective endocarditis with normal echo next step in mgx
TOE high false negative of transthoracic echo need to find source of vegetation as dictates length of abx course
99
sternal dehiscence
*complication of cardiac surgery * pt c/o clicking or rocking of the chest *O/e palpable rocking or clicking of sternum *Ix:- imaging shows displaced sternal wire * surgical emergency--> mgx:- exploration and fixation
100
persistent tachycardia or new arrhythmia with hx of blunt chest trauma. Investigations
*admit for continuous ECG monitoring *ECHO
101
haemodynamic changes (preload, after load and CO) in AV fistula
*decreased systemic vascular resistance --> decreased after load *faster return of bld to rt atrium --> increased preload *increased C.O
102
management of malignant pericardial effusion
*initial pericardiocentesis to relieve symptoms and provide cytological evaluation * prevent reaccumulation :--> pericardial window or prolonged cardiac catheter drainage
103
acute aortic dissection suspected + pleural fluid presentation
*acute chest pain radiating to back *asymmetric pulses *cocaine use increases risk *if complicated by haemothroax --> fluid in pleural space, hypotension. Ix of choice CT aortography
104
acute compartment syndrome
*increase pressure in enclosed fascial space --> decreased perfusion *tense swelling and pain which increases with passive movement *sensory and motor loss 8peripheral pulses remain intact *mgx:- fasciotomy

CK (12 decks)

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