Cardiology

Question 1

If patient has chest pain and the etiology is not likely cardiac, most likely cause us?

Answer 1

GI disorder

Question 2

Common GI disorders a/w chest pain?

Answer 2

GERD, ulcer disease, cholelithiasis, duodenitis, gastritis.

Question 3

When a woman Is what age, rates of CAD will at least equal rates of men. Why?

Answer 3

55-60. By this time, protective effects of menstruation and naturally occurring estrogen have worn off. MENTSTRUATING WOMEN ALMOST NEVER HAVE MIs.

Question 4

Estrogen replace DOES OR DOES NOT help CAD?

Answer 4

Administrating estrogen replacement does NOT translate beneficial effect on CAD. May improve LDLs but does not help CAD.

Question 5

Overall, more men or women will die of heart disease?

Answer 5

Women

Question 6

What are the most clearly agreed upon risk factors for CAD?

Answer 6

Diabetes, htn, tobacco smoking, hyperlipidemia, first degree family hx of premature (impt) CAD - premature means men below 55 and women below 65, age above 45 in men and above 55 in women.

Question 7

What is the worst risk factor for CAD?

Answer 7

Diabetes mellitus

Question 8

What is the most COMMON risk for CAD?

Answer 8

HTN

Question 9

What is the most dangerous lipid profile feature for risk for CAD?

Answer 9

High LDL (vs. elevated TGs, elevated cholesterol, decreased HDL and obesity).

Question 10

PET scanning and elevated calcium scores on CT scan are what kind of risk factors for CAD?

Answer 10

Less reliable but probably risk factors. Calcium scores - experimental.

Question 11

What is Tako-Tusbo cardiomyopathy?

Answer 11

Acute myocardial damage usually occuring in postmenopausal women immediately after an overwhelming, emotional, stressful event. Leads to left ventricular dyskinesis. Like ischemic disease, manage with beta blockers and ACE inhibitors.

Question 12

What does re-vascularization do in Tako-Tsubo cardiomyopathy?

Answer 12

Nothing since coronary arteries are normal.

Question 13

What are unreliable, unproven risk factors for CAD?

Answer 13

Chlamydia infection, elevated CRP, elevated homocystein levels. NOT benefit to measuring these or trying to therapeutically intervene. WRONG ANSWERS. Knowing these just as important.

Question 14

Correction of which risk ractor will result in most immediate benefit to the patient?

Answer 14

Cessation of tobacco smoking. Within a year after stopping, CAD risk decreases by 50%. Within 2 year, decreases by 90%

Question 15

What is the ppt of ischemic pain? What qualities of pain go against ischemic pain?

Answer 15

Dull/Sore, squeezing or pressure like. Qualities that go AGAINST: sharp/knife-life, lasts for a few seconds.

Question 16

What features of chest pain rule out ischemia with a 95% NPP?

Answer 16

1) Pleuritic chest pain (changes with respiration) 2) positional 3) tenderness (changes with touch of chest wall)

Question 17

If case describes chest wall tenderness, answer to “what is most likely dx / most accurate test”?

Answer 17

Chostocondritis, physical exam

Question 18

If case describes radiation to back, unequal BP between arms, answer to “what is most likely dx / most accurate test”?

Answer 18

Aortic dissection, chest x ray with widened mediastinum, chest CT, MRI or Transesophageal exam confirms disease

Question 19

If case describes pain worse with lying flat, better when sitting up in a young (?

Answer 19

Pericarditis, ECG with ST elevation everywhere, PR depression

Question 20

If case describes epigastric discomfort, pain better when eating, , answer to “what is most likely dx / most accurate test”?

Answer 20

Duodenal ulcer disease, endoscopy

Question 21

If case describes bad taste, cough, hoarseness, answer to “what is most likely dx / most accurate test”?

Answer 21

GE reflux, response to PPI’s; aluminum and magnesium hydroxide; viscous lidocaine

Question 22

If case describes cough, sputum, hemoptysis, answer to “what is most likely dx / most accurate test”?

Answer 22

Pneumonia, chest x-ray

Question 23

If case describes sudden onset SOB, tachycardia, hypoxia answer to “what is most likely dx / most accurate test”?

Answer 23

PE, spiral CT, V/Q scan

Question 24

If case describes sharp, pleuritic pain, tracheal deviation answer to “what is most likely dx / most accurate test”?

Answer 24

Pneumothorax, chest x-ray