Cardiology

Question 1

MC diagnosis of chest discomfort at the ER

Answer 1

GI causes

Question 2

pleuritic, KNIFE-LIKE pain radiation to trapezius

Answer 2

pain in acute pericarditis

Question 3

severe sudden TEARING pain radiating to the INTERSCAPULAR AREA

Answer 3

Aortic Dissection

Question 4

MC presentation of pulmonary embolism

Answer 4

dyspnea

Question 5

clenching of FIST held against the sternum

Answer 5

Levine sign

Question 6

50/M, smoker, HTN, heavy complaining substernal chest pain during exertion lasting 5 minutes and relieve by rest

Answer 6

Chronic stable angina pectoris

Question 7

first line of treatment to reduce angina (Chronic CS)

Answer 7

Beta blocker/CCB

Question 8

Canadian CVS FC of Angina: Emotional stress in cold, few hours from after awakening, slight limitation

Answer 8

CCS II

Question 9

CCS FC of angina: MARKED limitation

Answer 9

CCS III

I - ordinary physical activity
IV - inability to carry on any physical activity without discomfort

Question 10

Definitive test for CAD

Answer 10

Coronary angiography

Question 11

Drugs rescued for patient who cannot stress test

Answer 11

Dobutamine
Adenosine
Dipyridamole

Question 12

Goal LDL for proven CAD:

Answer 12

LDL: <100mg/dl
if with DM: <70mg/dl

Question 13

most important determinant of Pulse pressure

Answer 13

Stroke volume

Question 14

Indications for CABG`

Answer 14

Left main coronary artery disease
3 vessels dse + LVEF <50% or DM
2 vessel dse that includes proximal left descending coronary artery

Question 15

what is MCC of IN-HOSPITAL death among patients suffering from ACS

Answer 15

Pump failure

Question 16

Classification of MI: MI related to percutaneous Coronary Intervention

Answer 16

Type 4a

Question 17

Classification of MI: MI resulting in death when biomarkers are unavailable

Answer 17

type 3

Question 18

Classification of MI: MI related to CABG

Answer 18

Type 5

Question 19

Class of MI: spontaneous MI, Severe CAD but on occasion non obstructive CAD

Answer 19

Type 1

Question 20

Classification of MI: MI secondary to an ischemic balance, coronary artery spasm, arrhythmia, anemia, respiratory failure, hypotension and hypertension with or without left ventricular hypertrophy

Answer 20

type 2

Question 21

Classification of MI: related to Stent thrombosis

Answer 21

type 4b

Question 22

Reflex: Anterior wall involvement, tachycardia, hypertensive

Answer 22

James-Reflex

Question 23

Reflex: inferior wall affected, bradycardia, hypotension

Answer 23

Bezold- Jarisch Reflex

Question 24

first cardiomarker to rise in N-STEMI ACS

Answer 24

Myoglobin

Question 25

best test to detect a REINFARCTION a few days after the initial infarction

Answer 25

CK-MB - rise in 3-6hrs, sustain till 1-2 days

Question 26

cardio marker that rise 3-6 hrs and sustain till 1-2 weeks

Answer 26

Troponin

Question 27

Kilip scoring with Severe heart failure, mid basal rales and pulmonary edema, S3 and S4, Normal BP

Answer 27

Class III

Question 28

Kilip scoring of Mod HF, bibasal rales, Normal BP, S3 gallop, tachypnea

Answer 28

Kilip score of 2

Question 29

MCC of OUT-hospital death from STEMI

Answer 29

Vfib

Question 30

Compromise the first heart sound

Answer 30

mitral and tricuspid valve closure

Question 31

Compromised by the 2nd heart sound

Answer 31

Aortic and pulmonic valve closure

Question 32

ECG changes of Hypokalema

Answer 32

Flat/inverted T waves prominent U wave ST depression QT prolongation

Question 33

ECG changes of Hyperkalemia

Answer 33

Low p waves Tall T wave

Question 34

ECG changes in HypoCalcemia

Answer 34

Prolong QT -- associated with long QT syndrome, Torsade de pointes Hypercalcemica - shortened QT interval

Question 35

Drug that can cause Torsades de pointes (prolong QT)

Answer 35

Macrolides

Question 36

Associated condition with Opening snap at Diastole

Answer 36

Mitral stenosis

Question 37

Associated condition with Tumor Plop at Diastole

Answer 37

Atrial Myxoma

Question 38

Associated condition with Pericardial Knock at Diastole

Answer 38

Constrictive pericarditis

Question 39

sign where the murmur heard over femoral artery

Answer 39

Duroziez sign

Question 40

Sign of jarring of the entire body and bobbing motion of the head, due to AR

Answer 40

De musset sign

Question 41

sign: bounding and forceful pulse, rapidly increasing and subsequently collpasing

Answer 41

Water-hammer/Corigan pulse - AR

Question 42

capillary pulsation at the root of the nail due AR

Answer 42

Quinke's pulse

Question 43

Booming "pistol shot" sound over femoral arteries due to AR

Answer 43

Traube sign

Question 44

Treatment of choice for acute AR:

Answer 44

Surgery and usually necessary within 24hrs of diagnosis

Question 45

best initial treatment for symptomatic mitral stenosis

Answer 45

Diuretics - relieved of dyspnea from pulmonary congestion

Question 46

most effective treatment for MS

Answer 46

Percutaneous mitral balloon valvotomy or valvuloplasty

Question 47

Cardinal sx of HF

Answer 47

fatigue and shortness of breath

Question 48

MC systolic HF or HFrEF?

Answer 48

HFrEF: depressed <40% MC: CAD

Question 49

MC diastolic HF or HF with preserved EF?

Answer 49

preserved >40-50% MC: HTN

Question 50

In ACS, time period if NOT re-perfused --> IRREVERSIBLE INJURY

Answer 50

20 minutes

Question 51

Medical Management you can give to Chronic HF, but NOT in acute HF?

Answer 51

Chronic HF: Beta blockers (Bisoprolol, Carvedilol, Metoprolol) if given in ACS --> depresses everything

Question 52

MCC of chronic cosntrictive pericardutis in develiping nations

Answer 52

TB

Question 53

Becks triad

Answer 53

Hypotension Soft or absent heart sounds Jugulae venous distention

Question 54

Fluid to consider acute or chronic tamponade?

Answer 54

Acute - 200mL Chronic - >2000mL

Question 55

Decrease in at least 10mmhg os systolic blood pressure

Answer 55

Pulsus paradoxus

Question 56

BP ,190/80, taken Enalapril 50mg OD, Creatinine 2.1mg/dL. Consider Dx if there is detoriation of renal function assoc wit ACEI

Answer 56

Renal artery stenosis

Question 57

Differentiate Urgency from emergency

Answer 57

Presence of target organ damage

Question 58

Drug that raises the HDL cholesterol

Answer 58

Niacin

Question 59

First line tx for severe hypertriglyceridemia

Answer 59

Fibrates

Question 60

This prevets pancreatitis in px with severe hypertruglyceredemia

Answer 60

Omega 3 FA (fish oils)

Question 61

Decreases LDL, and safe for pregnant and lactating women

Answer 61

Bile acid sequestrants

Question 62

MC A/E of statin

Answer 62

Liver toxicity

Question 63

How to diagnose Infective Endocarditis

Answer 63

2 major 1 major & 3 minor 5 minor

Question 64

Best emperic therapy for IE

Answer 64

Vancomycin and Gentamicin

Question 65

What is the caused of Brugada syndrome

Answer 65

Loss of function mutation in SCN5a -- decrease sodium channel that affect the Phase 0 and Phase 1 of cardiac AP

Question 66

ECG findings in Brugada syndrome

Answer 66

Pseudo Right bundle branch block Persistemt ST segment elevation in leads V1 to V2

Question 67

Medication to avoid in Brugada syndrome

Answer 67

Class I antiarrhythmic drugs

Question 68

ABI ratio diagnostic

Answer 68

N - 1-1.40 ABI <0.9 Noncompressible arteries due to vasculad calcification >1.40

Question 69

6P's of Acute Limb ischemia

Answer 69

pain Pallor Paresthesia Paralysis Pulseleness Poikilothermia

Question 70

First line for symptom improvement for PAD

Answer 70

Cilostazol CI: CHF

Question 71

Most appropriate diagnostic exam in Pulmonary embolism

Answer 71

Chest CT with contrast

Question 72

Virchows Triad

Answer 72

Endothelial injury Venous statis Hypercoagulable stats

Question 73

Gold standard exam for pulmonary embolism

Answer 73

Invasive pulmonary angiogram

Question 74

Known as the great masquerader

Answer 74

Pulmonary embolism

Question 75

MC ECG abnormality in PE

Answer 75

T wave inversion