Cardiology

Question 1

S1

Answer 1

Closure of Mitral and tricuspid valves

Question 2

S2

Answer 2

closure of Aortic and Pulmonic valves

Question 3

Systolic

Answer 3

between S1 -> S2

Question 4

Diastolic

Answer 4

Between S2 -> S1

Question 5

S3 (not normal)

Answer 5

Rapid Ventricular filling because of HFrEF momken besabb el MR

Question 6

S4 (Pathologic Always

Answer 6

Atrial Click with Normal Sinus Rhythm Because the ventricle does not relax

Question 7

S4 Causes

Answer 7

1) Hypertrophic Cardiomyopathy
2) Restrictive Cardiomyopathy Like : A) Sarcoidosis
B) AL
C) Hemochromatosis

Question 8

s1-> s2 (Systolic) Problem

Answer 8

1) Aortic Stenosis
2)Mitral Regu

Question 9

S2 -> S1 (Dia)

Answer 9

1) Aortic Reg
2) Mitral St

Question 10

Pulsus Alternans

Answer 10

Weak then strong pulse (Change in the strength)
Cause of this is : Cardiac Tamponade

Question 11

Reversed Splitting in S2 Heart Sound

Answer 11

A2 + P2 Paradoxical Splitting we see A2 before P2

Question 12

Causes for S2 Splitting

Answer 12

1) LBBB
2) Aortic Stenosis
3) HOCM

Question 13

Jugular vein Elevated DD :

Answer 13

1)HF
2) Cirrhosis (Portal HTN)
3) Nephrotic Syn (protein UREA)

Question 14

Kussmaul Sign

Answer 14

Pressure elevated in JV during inspiration .
Causes for this Kussmaul sign: Constictive Percarditis

Question 15

Pulsus Paradoxus

Answer 15

BP Lower in insoiration more than 10mmhg in systolic

Question 16

Cardiac Tamponade Triad

Answer 16

hypotension, jugular venous distension, and muffled heart sounds

Question 17

Ischemic Heart Disease

Answer 17

Unstable Angina -> Acute Coronary Syndrome
Pain describes as pressure

Question 18

Aortic Dissection

Answer 18

paid described as : Sharp Pain radiates to back between the scapules .
Dx: CT Angio
Tx: Meical / Surjucal

Question 19

Pneumothrax

Answer 19

Pleurtic Pain change with Position
BP lowers becuase of Pressure on the heart

Question 20

PE :

Answer 20

Sharp pain - Pleuritic chest pain change with breath

Question 21

Stable Angina

Answer 21

Not Life threatining .
TX is symptomatic:
1) Aspirin
2) Statins
3) Nitrates ( Lowers the pain and cause vasodilation)
4) Beta blockers( Lower the demand)

Question 22

Acute Coronary Synd.

Answer 22

1) New Onset Angina <14 days
2) Cresendo Pat. ( waja3 bzed m3 johod ha2al ya3ni makanesh 3endo )
3) Pain at rest

Question 23

ST Elevation MI

Answer 23

Door to baloon 90 mins - Pain described as chest pain radiates to right arm or shoulder

Question 24

non ST-elevation
momken Normal ST
Momken ST Depression
momken T wave inversion

Answer 24

mno5od Cardia Markers if + -> MI (NSTEMI)
if - -> Unstable Angina

Question 25

Anterior Wall (Left anterior descending artery)

Answer 25

V1-V4

Question 26

Lateral Wall Left circumflex

Answer 26

I , aVL , V5, V6

Question 27

Inferor Wall (Right Coronary artery

Answer 27

II, III, aVF

Question 28

STEMI Treatment

Answer 28

1) Aspirin 2) Plavix (Clopidogrel) 3) heparin (short half life 3ashan ne3malo PCI) 4) Beta Blockers 5) Statins

Question 29

Mona is additional treatment not lower mortality

Answer 29

M- morphine O - O2 N Nitrates A Aspirin

Question 30

NSTEMI

Answer 30

TX : 1) Aspirin + plavix 2) Heparin (LMWH) 3) Beta blockers 4) Statins PCI During 48hours if stemi for sure . but if unstable angina fe sha3'lat tani non invasive kaman . if refractory chest pain - PCI

Question 31

Thrombolytics When to give ?

Answer 31

1)Patient with STEMI can't do PCI within 120 mins 2) Massive PE and more

Question 32

CABG when ?

Answer 32

at least one PCI Other indication 1) Left main coronary art 2) Three vessels disease 3) Two vessel disease of diabetic Pat.

Question 33

Discharged patient

Answer 33

TX 1) ACE-I ( No remodling of the heart) 2) Dual APT( Aspirin + plavix 2) Statins 2) Beta blockers kolhen mne3tehen for life ma3da el dapt mnwa2ef wa7ad mnhen after 1 year

Question 34

Prinzmetal's Angina (Variant Angina)

Answer 34

Young middle age woman PCI - We see normal artery - Spasm reversible fa eza 3ena STEMI + Normal coronart Artery -> Prinzmetal's angina Don't give aspirin because in make it more difficcult Treatment : Vasodilation (CCB+Nitrates)

Question 35

Congestive Heart Failure

Answer 35

1) Dyspnea 2) Lower Exrimity Edema 3) JVP Distention 4) Apical Impulse ya3ni el apex bekon zaye7

Question 36

HFrEF Dilated Cardiomyopathy

Answer 36

1) Most common Ischemia 2) Familial (genetic) 3) Toxic 4) Infection

Question 37

HFpEF

Answer 37

1) Restrictive Cardiomyopathy : A) AL B) Sarcoidosis C) Hemochromatosis 2) Hypertrophic Cardiomyopathy A) Aortic Stenosis B) HTN C) HOCM

Question 38

c-pap and bi-pap contraindacted

Answer 38

hypotension and more but this is the most important

Question 39

c-pap indication

Answer 39

Pulmonary edema Obstructive sleep apnea

Question 40

Bi-pap Indications

Answer 40

COPD Severe Asthma attack

Question 41

MBC Drugs

Answer 41

Metoprolol bisoprolol carvidilol

Question 42

in HF DO NOT USE

Answer 42

CCBS (NONDYH - Verapamil / deltiazem T2D Fluid retntion Anti TNF

Question 43

Sprinolactone SE

Answer 43

RF HyperK Gnecomastia

Question 44

Entresto SE

Answer 44

Hypotension RF HyperK

Question 45

Stages of management of HF

Answer 45

Stage 1 : BBs / ACEI, ARBs/ Fusid Stage 2 Sprinolactone Stage 3 Entresto but stop ACEI / ARBs If still sympotomatic - Devices

Question 46

CRTD

Answer 46

Indication 1) LBBB 2) LVEF <= 35% 3) NYHA (2-4) 4)Failure of medical treatment

Question 47

ICD Indication

Answer 47

1) NYHA 2-4 2) EF <= 35% 3)Failure of medical treatment Fe eshe mohem hon eza Ischemic HD ya3ni fe pasi MI wel EF<=30 hay indication la ICD fesh 7aji ykon el sha3'lat el ba2i Kaman sha3'li : HOCM + Syncome or history of familian sudden cardical death indication la ICD aw eza brugada symptomatic

Question 48

Brugada

Answer 48

RBBB + ST-elevation howe el shakel el 3adi taba3hen

Question 49

ICD Another indication

Answer 49

VT or VF

Question 50

Asymptomatic Patient with Wide S2 Splitting :

Answer 50

Atrial Septal Defect

Question 51

pulsus parvus et tardus

Answer 51

aortic stenosis - bensama3 el pulse ba3ed da2et el 2aleb