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Family Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is Dressler’s Syndrome?

What is the treatment?

What should be avoided to prevent pericardial wall thinning?

A

Pericarditis following a myocaridal infarction

ASA or Colchacine

NSAIDs and corticosteroids

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2
Q

What are the two most common symptoms associated with a pulmonary embolism?

What is the best initial test when working up a PE?

A

Dyspnea (m/c) and pleuritic chest pain

Spiral CT

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3
Q

The treatment for a pulmonary embolism is low molecular weight heparin plus warfarin. What are the low molecular weight agents?

A
  • Enoxaparin
  • Daltaparin
  • Tinzaparin
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4
Q

What are common signs and symptoms of congestive heart failure?

A
  • Exertional dyspnea (SOB), then with rest
  • Chronic nonproductive cough, worse in a recumbent position
  • Fatigue
  • Orthopnea (late), night cough, relieved by sitting up or sleeping with additional pillows
  • Paroxysmal nocturnal dyspnea
  • Nocturia
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5
Q

What are the pharmacological agents used to treat heart failure?

Hint: LMNOP

A
  • Loop Diuretics (don’t use in diastolic HF)
  • Morphine (reduces pre-load)
  • Nitrates (reduces pre-load)
  • Oxygen
  • Position

CCB for diastolic HF

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6
Q

What adventatous breath sound is associated with congestive heart failure?

What will be seen on CXR?

A

Rales

Kerley B Lines

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7
Q

What is the BEST test for working up congestive heart failure?

A

Echocardiogram

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8
Q

What is stable angina?

A
  • predictable; presents with a consistent amount of exertion
  • the patient can achieve relief with rest or nitroglycerin
  • indicative of a stable, flow-limiting plaque
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9
Q

What is the first line treatment for african american patients with essential hypertension?

A

CCB or Thiazide

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10
Q

A 71-year-old woman presents to the clinic due to a headache. Her vital signs are heart rate of 90 beats/minute, respirations of 18 per minute, temperature of 97.8°F, and blood pressure of 200/100 mm Hg in both arms. Findings on physical exam are within normal limits except for bilateral papilledema. At the previous three office visits, the patient’s blood pressure averaged 150/90 mm Hg. Her only medications are amlodipine 10 mg daily and simvastatin 40 mg daily, both of which she takes regularly.

What the most likely diagnosis?

A

Hypertensive Emergency where there are signs of end-organ damage (papilledema, headache)

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11
Q

What are the characteristics of pleuritic chest pain?

A

Sudden and intense pain that is sharp, stabbing, or burning and worse with inhaling, exhaling, deep breathing, coughing, sneezing, or laughing.

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12
Q

A 42-year-old man presents to the emergency department with pleuritic chest pain that worsens when taking deep breaths and lying on his back but is better with sitting up and leaning forward. He had similar symptoms about one year ago that resolved. Physical exam reveals a pericardial friction rub, and an electrocardiogram reveals widespread ST elevation in multiple leads. He is given ibuprofen. What drug can be used as adjunct therapy to prevent recurrent episodes of this condition in this patient?

A

Colchacine

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13
Q

What tick-borne disease is most likely to be associated with an atrioventricular heart block?

A

Lyme Disease

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14
Q

What psychiatric disorder has a high association with Burgada Syndrome?

A

Schizophrenia

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15
Q

A morbidly obese, 60-year-old woman presents to the emergency department with the complaint of left leg pain. On physical exam, an area of edema above the left medial malleolus that extends coronally is visible. The area is tender to palpation. A palpable cord is present. Bilateral varicose veins are visible. A duplex ultrasound reveals vein wall thickening, subcutaneous edema, and thrombus occluding the great saphenous vein. What is the most likely diagnosis for this condition?

A

Superficial Vein Thrombosis

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16
Q

Who should routinely get Aspirin for primary prevention of CVD?

A

USPSTF recommendations

  • Adults aged 40 to 59 years with a ≥10% 10-year CVD risk (grade C)
  • Adults 60 years or older – The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older
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17
Q

What are some common manifestations of endocarditis?

A
  • Osler Nodes: painful raised red lesions on the hands and feet
  • Janeway Lesions: non-tender, flat, small lesions on hands/feet
  • Petechiae: palate or conjunctiva
  • Clubbing
  • Roth Spots: retinal hemorrhages with pale centers
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18
Q

What is the USPSTF recommendation for high cholesterol screening?

A

USPSTF recommends screening for patients with NO evidence of CVD and NO other risk factors should begin at 35 years of age

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19
Q

What patient groups are most likely to benefit from statin therapy?

A
  1. Patients with any form of clinical atherosclerotic cardiovascular disease (ASCVD)
  2. Patients with primary LDL-C levels of 190 mg per dL or greater
  3. Patients WITH diabetes mellitus, 40 to 75 years of age, with LDL-C levels of 70 to 189 mg per dL
  4. Patients WITHOUT diabetes, 40 to 75 years of age, with an estimated 10-year ASCVD risk ≥ 7.5%
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20
Q

What is the targeted LDL in a patient with diabetes?

A

LDL < 70; anything above 70 should be treated with statin therapy

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21
Q

A 35-year-old female presents for her annual wellness exam. Her BP in the office today is 128/78. Her previous visit also showed an elevated BP of 128/80. You diagnose her with elevated blood pressure. What should your recommendation be for treatment?

A

Educate and endorce lifestyle modifications (diet and exercise) and see back for a BP check in 3-6 months

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22
Q

What are some side effects of ACE inhibitors?

A

Ace inhibitors are associated with cough, angioedema, and can cause hyperkalemia.

They are contraindicated in pregnancy

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23
Q

In what patients are beta-blockers contraindicated as antihypertensive therapy?

A

Asthmatics

24
Q

What are the rate controlling calcium channel blockers?

A

Verapamil and Diltiazam

25
Q

What is the drug of choice in treating hypertensive urgency?

What is the drug of choice in treating hypertension emergency?

A

Clonidine

sodium nitroprusside

26
Q

What medication class should be used to treat high triglycerides?

A

Fibrates (Fenofibrate and Gemfibrizil)

27
Q

What are the diagnostic tests for leg claudication?

A
  • An ankle-brachial index (ABI), which uses Doppler measurements to compare the BP in the upper and lower extremities, is a highly sensitive and specific test
  • An ABI of ≤ 0.9 indicates significant disease

Angiography remains the gold standard study

28
Q

You are examining a patient who has been following up for several months. You notice that his head is bobbing; in addition, his carotid pulses have a rapid upstroke with a rapid fall. His BP is 120/60 mm Hg (right arm) and 145/60 mm Hg (right leg). What is the most likely diagnosis?

What is the definitive treatment?

What can be used prior to definitive treatment?

A

Aortic Regurgitation

Surgical therapy

Medical therapy to reduce afterload (ACE inhibitors, ARBs, Nifedipine)

29
Q

Which of the following medical conditions is most likely to increase the risk of multifocal atrial tachycardia?

A. Acute pancreatitis
B. Chronic obstructive pulmonary disease
C. Hyperlipidemia
D. Hypothyroidism

A

COPD or Other Pulmonary Diseases

Common examples of pulmonary diseases provoking multifocal atrial tachycardia are COPD and pneumonia. These pulmonary conditions can cause hypoxia, hypercapnia, and acidosis, which are all triggers of ectopic atrial activity.

30
Q

A 5-year-old girl presents for a routine physical examination. Her past medical history is unremarkable. She is on no medications and has no known allergies. Her development is normal. On her cardiac exam, you note a continuous murmur at the upper right sternal border; it is grade II/VI in intensity. The murmur radiates into the right neck region. Upon rotation of the child’s head to the left, the murmur’s intensity practically disappears. Her blood pressure is normal for her age, as is her heart rate and respiratory rate. Peripheral pulses are palpated in all extremities and are equal in strength. What is the most appropriate next step?

A

The child has a hum murmur which is a benign pediatric murmur. It occurs due to the turbulence created by venous return from the head and neck into the jugular vein. It is found mostly at the right upper sternal border and can radiate to the upper left sternal border or into the right lower neck.

The most appropriate next step is to reassure parents and provide education

31
Q

What is the goal LDL for patients with diabetes and coronary artery disease?

A

LDL < 100 mg/dL

32
Q

What is the number one independent risk factor for an acute MI?

A

Diabetes

33
Q

What are xanthomas?

A

Lesions on the skin containing cholesterol and fats. They are often associated with inherited disorders of lipid metabolism.

Xanthomas are raised, waxy-appearing, frequently yellowish-colored skin lesions.

34
Q

What is the first line therapy for hypertriglyceridemia?

A

Fibrates (Fenofibrate) are the most potent medications to decrease trigylcerides - can reduce TG level as much as 50% or greater

35
Q

Which protein is found in the urine of a patient with rhabdomyolysis?

A

Myoglobin

36
Q

What is the MOA of nitroglycerin?

What are some associated side effects?

A

Increased myocardial blood supply - increases coronary artery blood flow and collateral circulation as wellas reduces coronary artery vasospasm.

Vasodilation occurs due to stimulation of guanylate cyclase, which increases cGMP

HA, flushing, tolerance (tachyphylaxis), hypotension, peripheral edema

37
Q

What is the typical presentation of aortic stenosis?

A
38
Q

What manuvers can be done to increase venous return?

Does increase venous return increase most murmur intenstities?

A
  • Supine Position
  • Squatting
  • Leg elevation

Yes, except hypertrophic cardiomyopathy and the click of mitral prolapse

39
Q

What is the most common valvular disease and what are the two etiologies?

A

Aortic Stenosis

Degenerative: calcifications, wear and tear, especially in patients > 70 years
Congenital and Bicuspid Valve: common in patients < 70 years

40
Q

Describe the murmur associated with aortic stenosis?

What is the first symptom of aortic stenosis?

A

Harsh, low-pitched, mid-late peaking, systolic, crescendo-decrescendo murmur best heard a the right upper sternal border

Will increase with increased venous return (squatting, supine, and leg raise)

Exertional dyspnea

41
Q

A 35-year-old man presents to the clinic with a chief concern of dyspnea on exertion and chest pain. He has no significant medical history and takes no medications. He has had increasing shortness of breath and is becoming tired more quickly with exercise over the past 4 months. He also notes a few episodes of lightheadedness. He has not changed his workout routine or diet. He drinks 60 fluid ounces of water daily. He has no symptoms with normal daily activities or at rest. Vital signs include HR of 80 bpm, oxygen saturation of 95%, BP of 120/80 mm Hg, and T of 98°F. The cardiac exam reveals a systolic ejection murmur at the right upper sternal border. His carotid pulse is weak and delayed. Bilateral radial and posterior tibialis pulses are 2+ and equal. His lungs are clear to auscultation in all fields. The abdomen is soft with no hepatosplenomegaly. What is the most likely etiology of the suspected murmur for this patient?

A

Aortic Stenosis - calcification of a bicuspid aortic valve due to patients young age

42
Q

What is the most commonly occluded artery in acute coronary syndromes?

A

Left Anterior Descending Artery

43
Q

What drug class are “Statins” and what is their MOA?

What are some adverse effects?

A

HMG-CoA Reductase Inhibitors
* Lovastatin, Pravastain, Simvastatin, Rosuvastatin, Atorvastatin, Fluvastatin, Pitavastatin

MOA: prevent synthesis of mevalonate, a cholesterol precursor, by inhibiting HMG-CoA reductase, the first and rate limiting step in helpatic cholesterol synthesis

Myopathy, hepatic dysfunction, hyperglycemia

High intensity Statins (Rosuvastatin and Simvastatin) can cause proteinuria and hematuria

44
Q

A 64-year-old man with a medical history of hypertension on hydrochlorothiazide 25 mg daily presents to the urgent care with chest pain since this morning. He describes the pain as sharp, constant, and worse with inspiration. He reports the chest pain happens at rest and does not worsen with exertion. He reports the pain radiates to his left shoulder. Vital signs today include HR of 100 bpm, BP of 132/81 mm Hg, RR of 16/min, oxygen saturation of 98% on room air, and T of 98.4°F. On physical exam, a pericardial friction rub is heard at the end of expiration. The chest wall is symmetric, without deformity, and atraumatic in appearance. No tenderness to palpation of the chest wall is noted. What should be ordered to determine if this is pericarditis vs. and pericardial effusion due to friction rub on exam?

A

Echocardiogram

45
Q

What are the EKG changes associated with pericarditis?

A
  • PR elevation in aVR
  • PR depression
  • Diffuse concave ST elevation
46
Q

In which ECG leads can a myocardial infarction in the anteroseptal portion of the heart be seen?

A

Leads V1-V3

47
Q

Which part of the aorta do abdominal aortic aneurysms occur at most often?

A

Below the renal arteries (infrarenal)

48
Q

A 65-year-old man with a medical history of hypertension and hyperlipidemia, for which he takes amlodipine and atorvastatin, presents to the clinic for an annual wellness examination. He has smoked a pack of cigarettes per day for 44 years. Vital signs include a HR of 80 bpm, BP of 130/80 mm Hg, RR of 20/minute, SpO2 of 99% on room air, and T of 98.6°F. Physical examination findings include a regular rate and rhythm, lungs clear to auscultation bilaterally, no carotid bruits, an abdominal bruit at the umbilicus, 2+ distal pulses in all extremities, and a soft and nontender abdomen with bowel sounds present in all four quadrants and no pulsatile masses. What is the most likely diagnosis?

A

AAA

49
Q

A 66-year-old woman with hypertension controlled by lisinopril and hyperlipidemia controlled by atorvastatin presents to the urgent care clinic with pain in her left calf that started 2 hours ago. She notes that her left calf is warm to the touch and swollen. Her vital signs are a BP of 122/86 mm Hg, HR of 80 bpm, RR of 16/min, SpO2 of 93% on room air, T of 99.1°F, and a BMI of 36 kg/m2. Upon physical examination, tenderness is noted in the left calf and the area is erythematous and edematous. Cardiac examination is within normal limits, and lung exam is unremarkable. An ultrasound of the left lower extremity is obtained and reveals noncompressibility of the left posterior tibial vein. What is the best next step in the management of this patient’s condition?

A. No anticoagulation indicated
B. Placement of an inferior vena cava filter
C. Rivaroxaban for 12 weeks
D. Warfarin for 12 weeks

A

Rivaroxaban for 12 weeks

50
Q

The ACC has an atherosclerotic cardiovascular disease (ASCVD) risk calculator that determines a patient’s 10-year risk of a cardiovascular disease event. At what percentage risk level is prescription of a moderate-intensity statin recommended?

A

> 7.5%

Clinically, most use > 10% risk with a grey zone between 5-10%

51
Q

In patients with heart failure with reduced ejection fraction (HFrEF) what medication classes can improve mortality?

A
  • angiotensin-converting enzyme (ACE) inhibitors
  • angiotensin II receptor blockers (ARBs)
  • beta-blockers
  • mineralocorticoid receptor antagonists
  • sodium-glucose cotransporter 2 (SGLT2) inhibitors

ACE inhibitors are usually introduced first

52
Q

What patient cohorts should receive antibiotic prophylaxis for infective endocarditis?

What is the antibiotic used for prophylaxis?

A

1) those with prosthetic cardiac valves or implanted material
2) those with previous, relapse, or recurrent IE
3) those with congenital heart disease
4) cardiac transplant recipients

Amoxicillin (if allergic or can’t take pcn a macrolide should be used)

Azithromycin is preferred

53
Q

Describe the murmur associated with hypertrophic cardiomyopathy?

A

Harsh systolic cresendo-decresendo murmur heard best at left sternal border, may have a loud S4

Murmur will increase in intensity with decreased venous return (Valsalva, standing) – this is different than aortic stenosis that will decrease in intensity

54
Q

What ankle-brachial index (ABI) ratio suggests a degree of arterial obstruction often associated with claudication?

What is a normal ABI?

A

ABI of 0.4-0.9

0.9 - 1.4

55
Q

What is a helpful physical exam finding that can differentiate peripheral artery disease from chronic venous insufficiency?

A

Leg swelling/edema; PAD does not have leg swelling

56
Q

What is Pancoast Syndrome and what type of lung cancer is it associated with?

A

Pancoast syndrome involves a lung malignancy in the superior sulcus. These tumors can cause nerve impingement that leads to arm or shoulder pain and hand muscle atrophy. They can also disrupt the sympathetic nerve chain, which innervates the eye, leading to ptosis, miosis, and anhidrosis of the ipsilateral side (Horner syndrome).

Non-Small Cell Lung Cancer

57
Q
A

Family Medicine (14 decks)

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