Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

My Step 2 CK > Cardiology > Flashcards

Cardiology Flashcards

1
Q

… is a diastolic decrescendo murmur heard best at the LLSB

A

aortic regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

…. is a triphasic scratchy sound on cardiac auscultation

A

Pericardial friction rub

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

…. murmur is a pansystolic (holosystolic) murmur obscuring S1 and S2 sounds that is heard best at the apex and radiates to the axilla

A

mitral regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

….. is a decrease of blood pressure of greater than 10 mmHg on inspiration

A

Pulsus Paradoxus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

….. murmur is a harsh crescendo-decrescendo systolic murmur best heard at 2nd right intercostal space and radiates to the carotid arteries.

A

aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

…… is an increase in jugulovenous pressure (JVP) on inhalation.

A

Kussmaul sign

normal decreases b/c inhalation causes blood to be pulled into heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

…… is bounding of jugulovenous wave bouncing up to neck because atrial contraction against closed tricuspid valve

A

Cannon A waves

associated with RV infarction and third degree AV block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

…… murmur is an opening snap followed by a low-pitched diastolic rumble heard best with patient in lateral decubitus position

A

mitral stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is periodical splitting of S2 and what does is signify?

A

P2 before A2

LBBB, HTN, aortic stenosis, LVH

(left ventricular contraction time increases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What results in widening of S2 splitting (A2 before P2)?

A

RBBB, pulmonary HTN, pulmonic stenosis, RVH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the only cardiac abnormality that results in fixed in splitting of S2?

A

Atrial septal defect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

A pt present with substernal chest pressure/ heaviness, with normal EKG and normal CIPs most likely suffer from …

A

Unstable Angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

A pt presenting with substernal chest pressure/heaviness, with normal EKG but elevated CIPs most likely suffers from ….

A

Non-ST elevation MI (NSTEMI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are features of unstable angina and NSTEMI that suggests progression to STEMI? (5)
(need catherterization)

A
  1. repetitive/ prolonged pain
  2. elevated CIPs
  3. persistent EKG changes
  4. Hemodynamically unstable
  5. Sustained V-tach
  6. syncope
  7. LVEF < 40%
  8. prior CABG/ PCI
  9. diabetes
  10. chronic renal disase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is treatment for unstable angina?

A
  1. aspirin
  2. beta blocker
  3. heparin
  4. nitrates, morphine, oxygen (don’t lower mortality)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is treament for NSTEMI?

A
  1. aspirin
  2. beta blocker
  3. heparin
  4. nitrates, morphine, oxygen (don’t lower mortality)
  5. statin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is treatment for STEMI?

A
  1. tPA (w/in 30 mins)
  2. aspirin
  3. beta blockers
  4. nitrates, morphine, oxygen (don’t lower mortality)
  5. statin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does an S4 suggest?

A

atrial systole into stiff left ventricle

LVH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does an S3 suggest?

A

atrial systole into filled ventricle

CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the best initial test for chest pain?

A

EKG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What leads represent inferior wall MI?

A

leads II, III, and avf

right coronary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the preferred markers for diagnosis of myocardial injury?

A

troponins (T and I)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

A pt presents with pleuritic chest pain with chest wall tenderness in which palpation of chest wall reproduces chest pain most likely suffers from …

A

Musculoskeletal chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

A pt presenting with epigastric pain worse 3 hours after eating most likely suffers from …

A

peptic ulcer disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What leads represent anterior wall MI?

A

V2-V4

left anterior descending artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What leads represent lateral wall MI?

A

I, aVL, V4-V6

left anterior descending artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What leads represent septal wall MI?

A

V1-V3

left anterior descending

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

A pt presents with pleuritic, sharp chest pain that is worse with lying down and relieved by sitting up most likely suffers from …

A

pericarditis

diffuse ST elevations; chest pain is positional and pleuritic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

A pt presents with sharp tearing chest pain that radiates to back between the scapula most likely suffers from …

A

dissecting aortic aneursym

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are contraindications for tPA use in STEMI? (7)

A
  1. recent surgery
  2. bleeding
  3. hypertension (>180/100)
  4. suspected aortic dissection
  5. hx of hemorrhagic stroke
  6. head trauma
  7. ischemic stroke w/in 3 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

A pt (young female) presents with transient chest pain with midsystolic click murmur most likely suffers from …

A

Mitral Valve Prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

A pt presents with sudden onset of chest pain and SOB with tracheal deviation on CXR and decreased breath sounds most likely suffers from …

A

pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Which thormbolytic should not be given repeated?

A

streptokinase (b/c provokes allergic reaction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are modifiable risk factors of ischemic heart disease?

A
  1. LDL
  2. smoking
  3. HTN
  4. inactivity
  5. obesity
  6. diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the next best step in the management of a patient with classic ischemic cardiac symptoms that are chronic with a normal EKG?

A

Stress test (detect ST depression > 2mm suggest inducible ischemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are requirements of pt that are going to undergo exercise stress test?

A

reach 85% max heart (220-age)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

If stress test post MI is positive, what is the next best step in management?

A

catherization

if negative, treat with medical treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What treatment are patients with acute coronary sent home on?

A
  1. aspirin
  2. plavix
  3. beta blocker
  4. ACE inhibitors (stop at 6 weeks if EF normal)
  5. statins (stop if LDL low)
  6. nitrates (pain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are contraindications to exercise stress test?

A
  1. active symptoms
  2. cant exercise (then do pharmacologic stress test)
  3. baseline abnormality (do nuclear stress test)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

When should a pt have a CABG rather than angioplasty for treatment of reversible ischemia?

A
  1. 3 vessel disease
  2. left main disease
  3. 2 vessel disease in diabetic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How do you differentiate septal wall rupture compared to mitral valve rupture prior to echo?

A

septal has step up increase in saturation when going from right atrium to right ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the treatment for Dressler syndrome? (pericarditis post MI)

A
  1. asprin and NSAIDs

2. steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

A pt with chest pain at rest with ST segment elevation but the stress test and angiogram are normal most likely suffers from …

A

Prinzmetal Angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the most accurate test for Prinzmetal Angina?

A

ergonovine (triggers spasm) on angiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the most common cause of death post MI?

A

V-tach or V-fib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the treatment for right ventricular infarction?

A

fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is treatment for Prinzmetal angina?

A

calcium channel blockers or nitrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What percent of cardiac output is based on atrial contribution?

A

10-20% in normal pt

increased if heart condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

A pt presents with tachypnea, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue and weakness most likely suggests …

A

congestive heart failure

pulmonary rales, peripheral edema, ascites, JVD, displaced apical impulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is class 1 heart failure?

A

no limitations of activity; no symptoms from ordinary activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is class 2 heart failure?

A

mild limitation of activity; no symptoms at rest or w/ mild exertion

52
Q

What is class 3 heart failure?

A

marked limitation of activity; no symptoms at rest

53
Q

What is class 4 heart failure?

A

confined to bed/chair; symptoms at rest

54
Q

A chest x-ray showing cardiomegaly, vascular redistribution, kerley B-lines, and interstitial edema suggests…

A

Pulmonary edema secondary to ventricular dysfunction (CHF)

55
Q

How is BNP used for diagnosis of cause of dyspnea?

A

if normal, excludes congestive heart failure

if elevated, suggests congestive heart failure

56
Q

What is treatment of systolic CHF?

A
  1. diuretics (furosemide)
  2. beta blocker (metoprolol, carvedilol)
  3. ACE inhibitors
  4. spironolactone
  5. Digoxin
57
Q

What are the effects of potassium on digoxin?

A

hyperkalemia: deceased digoxin activity
hypokalemia: increased digoxin activity

58
Q

What are the most common side effects of digoxin toxicity?

A
  1. GI (most common)
  2. hyperkalemia
  3. gynecomastia
  4. blurry vision w/ yellow halos
  5. arrhythmias
59
Q

What is used for digoxin toxicity involving CNS symptoms or arrhythmias?

A

stop digoxin and give digiband

60
Q

What is treatment of diastolic heart failure?

A
  1. correct underlying disease
  2. diuretics (symptom relief)
  3. beta blockers/ calcium channel blockers (slow heart to increase filling)
61
Q

When should a patient receive an automatic implantable cardioverter/defibrillator (AICD)?

A

pt with dilated cardiomyopathy with ejection fraction< 35%

62
Q

When should a patient receive a biventricular pacemaker?

A

pt with dilated cardiomyopathy with QRS wider than 120 ms

63
Q

What is the most common cause of mitral stenosis?

A

rheumatic fever

immigrant, pregnant pt

64
Q

What is the treatment for mitral stenosis?

A
  1. preload reduction (Na reduction and diuretics)

2. balloon valvulotomy (in pt who remains symptomatic despite medical therapy)

65
Q

What are common complications of mitral stenosis? (4)

A
  1. systemic embolism (due to stagnate blood in enlarged LA)
  2. hoarsenss (dilated LA compressing recurrent laryngeal nerve)
  3. dysphagia (dilated LA compressing esophagus)
  4. a-fib
66
Q

What happens to opening snap of mitral stenosis when the stenosis gets worse?

A

opening snap happens earlier

67
Q

What are the signs of large left atrium?

A
  1. straightening of left heart border

2. elevation of left mainstem bronchus

68
Q

When should surgery be performed for mitral regurgitation?

A
  1. symptoms persistent despite optimal meds
  2. EF < 60%
  3. LV ESD > 40 mm
69
Q

What is the best inital test for valvular disease?

A

ECHO

70
Q

What is the most accurate test for valvular disease?

A

Catheterization

71
Q

What is the medical treatment for mitral regurgitation?

A

arteriolar vasodilators (ACE inhibitors, ARBs, hydralazine)

72
Q

What are the symptoms of mitral valve prolapse? (4 P’s)

A
  1. pain
  2. palpitations
  3. panic attacks
  4. passing out

(in young women)

73
Q

… is a mid systolic click and late systolic murmur at apex that worsens with valsalva/ standing and improves with squatting/ leg raise

A

Mitral Valve Prolapse

74
Q

What are the hemodynamic effects of valsalva and standing?

A

decrease return to heart

left sided murmurs: decreased

(except for MVP and HOCM which increase)

75
Q

What is the hemodynamic effect of squatting and leg raise?

A

increase return to heart

left sided murmurs: increased

(except for MVP and HOCM which decreases)

76
Q

What are the causes of aortic stenosis? (3)

A
  1. calcification in aging
  2. bicuspid aortic valve (young onset)
  3. rheumatic
77
Q

What is the treatment for aortic stenosis?

A
  1. valve replacement

2. balloon valvuloplasty (if pt too ill for surgery)

78
Q

What is the most common presentation of aortic stenosis? What is the worse presentation of aortic stenosis?

A

angina; CHF

79
Q

When should a pt undergo surgery for aortic regurgitation?

A
  1. ejection fraction < 55%

2. left ventricular end systolic diameter > 55mm

80
Q

What is Duroziez sign and what is it associated with?

A

systolic or diastolic thrill/murmur heard over the femoral arteries; aortic regurgitation

81
Q

What is the best medical treatment for aortic regurgitation?

A

vasodilators (ACE inhibitors, ARBs, nifedipine)

82
Q

What is the medical treatment for hypertrophic obstructive cardiomyopathy?

A

Beta blockers

83
Q

What is the medical treatment for mitral valve prolapse?

A

Beta blockers

84
Q

What is the hemodynamic effect of handgrip on the heart?

A

increases afterload

regurgitations: increases murmur
stenosis: decreases murmur

85
Q

What is the most common cause of hypertrophic cardiomyopathy?

A

hypertension

86
Q

What is the hemodynamic effect of amyl nitrate on the heart?

A

decreases afterload

regurgitations: decreases murmur
stenosis: increases murmur

87
Q

What are the 2 most common causes of dilated cardiomyopathy?

A
  1. ischemic heart disease
  2. alcoholics

(peripartum, doxorubicin, chagas disease)

88
Q

What is the treatment for dilated cardiomyopathy?

A
  1. ACE inhibitors
  2. beta blockers
  3. spironolactone
  4. diuretics, digoxin

(like systolic HF)

89
Q

A young pt presents with SOB and syncopal episodes while participating in athletic event most likely suffers from …

A

hypertrophic obstructive cardiomyopathy (LV size smaller –> need increased fluid to prevent outflow blockages)

90
Q

What is treatment for hypertrophic obstructive cardiomyopathy?

A
  1. beta blockers or calcium channel blockers (increase filling)
  2. septoplasty (surgery if severe)
91
Q

What are causes of restrictive cardiomyopathy?

systolic & diastolic

A
  1. sarcoidosis
  2. amyloidosis
  3. hemochromatosis
  4. cancer
  5. fibrosis (scleroderma, radiation)
92
Q

An EKG showing diffuse ST segment elevation with PR segment depression is suggestive of …

A

Pericarditis

93
Q

What are the 2 diseases that are associated with kussmaul sign?

A
  1. restrictive cardiomyopathy

2. constrictive pericarditis

94
Q

What is treatment for pericarditis?

A
  1. NSAIDs

2. steroids

95
Q

What is the treatment for pericardial effusion?

A

fluid aspiration

96
Q

…. is a life threatening condition in which a pericardial effusion has developed so rapidly or become so large that it compresses heart

A

Cardiac tamponade

97
Q

A pt presents with pulsus paradoxus, JVD, hypotension and decreased/ muffled heart sounds most likely suffers from …

A

Cardiac tamponade

98
Q

What is the most accurate diagnosis for cardiac tamponade?

A

cardiac catheterization shows equal left and right atrial pressures

99
Q

What is the treatment for cardiac tamponade?

A
  1. pericardiocentesis (followed by pericardial window)

2. subxiphoid surgical drainage

100
Q

What can be seen on EKG in the setting of cardiac tamponade?

A

electrical alternans (small complexes alternating with large complexes)

101
Q

A pt presenting with exertional dyspnea, pericardial knock, signs/ symptoms of right heart failure, kussmaul sign, distant heart sounds most likely suffers from …

A

Constrictive pericarditis

102
Q

What is the most accurate diagnostic test for constrictive pericarditis?

A

Chest CT/MRI show thickened/ calcified pericardium

103
Q

What is the treatment for constrictive pericarditis?

A

pericardiectomy (remove pericardium)

104
Q

What is the treatment for symptomatic sinus bradycardia?

A
  1. atropine (acute)

2. pacemaker (chronic)

105
Q

…. is constant, prolonged PR interval (>.2 sec)

A

First Degree AV block

no tx

106
Q

… is progressively prolongation of PR interval until dropped ventricular beat

A

Second Degree AV block type 1 (Wenckebach)

no tx

107
Q

…. is normal PR interval or fixed prolonged PR interval associated with dropped ventricular beat

A

Second Degree AV block type 2 (Mobitz)

108
Q

What is treatment for second degree AV block type 2 (Mobitz) and why do we treat?

A

pacemaker; prevent progression to third degree AV block

109
Q

…. is atrial and ventricular beating separately without correlation

A

Third degree AV block

110
Q

What is treatment for symptomatic third AV block (Adams-Stoke attacks -> sudden loss of consciousness)?

A
  1. atropine (acute)

2. pacemaker

111
Q

What is the treatment for supraventricular tachycardia?

A
  1. carotid sinus massage (increase vagal tone)
  2. adenosine/ verapamil
  3. synchronized external conversion (if unstable)
112
Q

… is an EKG with 3 different P waves from beat to beat followed by normal QRS

A

Multifocal atrial tachycardia

113
Q

What disease is associated with multifocal atrial tachycardia?

A

COPD (chronic lung disease)

114
Q

… is characterized as saw-tooth wave on EKG in which atrial rate is 250-300 and ventricular rate is (125-150) resulting in 2:1 or 3:1 ration

A

Atrial flutter

115
Q

What is the treatment for multifocal atrial tachycardia?

A
  1. diltiazem/ verapamil
  2. digoxin

(avoid beta blockers)

116
Q

… is characterized by no P-wave and irregularly irregular ventricular contraction on EKG

A

atrial fibrillation

117
Q

What is the treatment for atrial flutter?

A
  1. beta blockers
  2. calcium channel blockers
  3. digoxin
118
Q

What characterizes unstable arrhythmia?

A
  1. confusion
  2. chest pain
  3. SOB
  4. hypertension
    (synchronized cardioversion is all but )
119
Q

What is CHADS score and what is it used for?

A 
score system to determine stroke risk in pts with a-fib and need for anticoagulation
CHF (1)
HTN (1)
Age > 75 y/o (1)
Diabetes (1)
Stroke/TIA prior (2)
if 0: no tx
if 1: aspirin or warfarin
if 2 or more: warfarin
120
Q

What is treatment for a-fib?

A

rate control

  1. beta blocker
  2. calcium channel blockers
  3. digoxin

(rhythm conversion:
amiodarone)

121
Q

What should you do before synchronized cardioversion in a pt with a-fib?

A

anticoagulation to be sure not to dislodge clot when shocked

122
Q

… is characterized by short PR interval and delta wave (slurred initial deflection of QRS) on EKG

A

Wolff Parkison White Syndrome

aberrant electrical pathway around AV node

123
Q

What is treatment for WPW?

A
  1. radiofrequency catheterization ablation (long-term)
  2. synchronized cardioversion (unstable)
  3. procainamide (stable)
124
Q

What is treatment for pulseless V-tach and V-fib?

A

asynchronized cardioversion

125
Q

What tests should be done in pt on amiodarone?

A
  1. PFTs
  2. LFTs
  3. TFTs (thyroid)
126
Q

What are common side effects of amiodarone?

A
  1. pulmonary fibrosis
  2. blue-gray discoloration of skin
  3. blurry vision with halo
  4. hypothyroid
  5. hepatotoxicity

My Step 2 CK (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions