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Clinical Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Q001. most common congenital cyanotic lesion in newborn

A

A001. tetralogy of Fallow (later); transposition great arteries

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2
Q

Q002. cyanotic newborn or 2 week; heart failure; supracardiac shadow above enlarged heart increased pulmonary blood flow (snowman snowstorm); right heart enlargement

A

A002. total anomalous pulmonary venous return

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3
Q

Q003. straight narrow mediastium; globular heart (egg on string)

A

A003. transposition great arteries

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4
Q

Q004. severe cyanosis; heart failure once ductus closes; gray blue color; right side predominance

A

A004. hypoplastic left heart

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5
Q

Q005. In truncus arteriosis

A

A005. common trunk supplying pulmonary and systemic circulations. Ventricular septal defect. Loud systolic murmur with thrill; mild cyanosis. Severe heart failure.

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6
Q

Q006. tricuspid atresia

A

A006. right ventricle hypoplasia; no tricuspid valve; usually persistent foramen ovale or atrial septal defect; cyanotic and quite ill; severe reduction in pulmonary blood flow on x ray and left axis instead of right.

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7
Q

Q007. Innocent murmurs

A

A007. age 3 to 7; time increase cardiac output; soft vibratory or musical systolic ejections murmur at left lower midsternal boards <2/6 intensity

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8
Q

Q008. tall symmetric peaked T waves

A

A008. Hyper K

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9
Q

Q009. Widening of QRS complex

A

A009. hyper K

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10
Q

Q010. prolongation of P waves

A

A010. hyper K

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11
Q

Q011. Increased U wave

A

A011. Hypo K

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12
Q

Q012. ST segment depression and; T wave amplitude decreased

A

A012. Hypo K

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13
Q

Q013. Swelling of face after taking captopril or enalapril

A

A013. angioedema from angiotensin receptor blockers / ACE I (avoid prils and valsartan)

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14
Q

Q014. Premature atrial contraction

A

A014. occurs 78% healthy male aviators; if symptomatic b blocker

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15
Q

Q015. Theophylline

A

A015. toxicity: seizures, hypotension, arrhythmias; dimethylxanthine for COPD

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16
Q

Q016. Ipratropium

A

A016. headache dryness pulmonary symptoms; Atrovent for COPD

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17
Q

Q017. livedo reticularis (lacy erythematous rash) peripheral ischemia (blue toes) eosinophilia; post coronary catheterization

A

A017. Suggestive of cholesterol emboli

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18
Q

Q018. Causes of renal failure; post coronary catheterization

A

A018. cholesterol embolization (blue toes) vs; contarast nephropathy

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19
Q

Q019. Coxsackie s virus B and pregnancy

A

A019. mom ill, baby much more ill,; mechanical ventilation, shock hypotension, cardiogenic with ST ECG

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20
Q

Q020. Parvovirus and pregnancy

A

A020. 5ths disease and; hydrops early in pregnancy

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21
Q

Q021. Myocarditis

A

A021. infection, toxins, granulmatous disease. febrile, coxsackie,; ST wave abnormality; Hepatic transaminase elevated; cardiomegaly with pulmonary edema

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22
Q

Q022. Echo instead of ECG when

A

A022. Left bundle branch block old; previous MI; pacemaker; digoxin

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23
Q

Q023. Murmurs best heard on expiration

A

A023. left sided

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24
Q

Q024. Dressler syndrome

A

A024. post CABG post cardioectomy pericarditis; Worse lying down better sitting up, rub

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25
Q

Q025. left ventricular dysfunction and hypertension

A

A025. concentric hypertrophy; dyspnea on exertion; treat with b blocker to improve relaxation allow better filling

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26
Q

Q026. equivalent right atrium, right ventricle and pulmonary wedge pressure; low blood pressure; tachycardia

A

A026. cardiac tamponade

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27
Q

Q027. SVT

A

A027. 180 300 bpm; tolerated well in kids; suggest underlying anomaly; Epstein and WPW; revert by dunking head in cold water

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28
Q

Q028. infant with no murmur,; precordial hyperactivity; loud second heart sound; grey or cyanotic

A

A028. hypoplastic left heart; underdevelopment of left cardiac chamber; atresia or stenosis of aortic or mitral orifices; hypoplasia of aorta; left atrium and ventricle endocardial fibroelastosis. patent foramen ovale; dilated hypertrophic right ventricle

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29
Q

Q029. right ventricular infarct vs cardiac tamponade

A

A029. hypotension; tachycardia; clear lungs; absence of pulsus paradoxus in Right ventricular infarction

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30
Q

Q030. lupus, contraceptive use; headache; upper extremity weakness; CT with infarct of anterior and posterior frontal lobes; parietyal lobes extending to white matter

A

A030. dural sinus thrombosis; superior sagital sinus; test for anti phospholipid antibody; get cerebral venography

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31
Q

Q031. apical heave; thrill at second left intercostal space; loud systolic diastolic rasping murmur left sternal boarder; hyerdynamic left ventricle abnormal flow; prominence of pulmonary artery; increased pumonary vascular markings; wide pulse pressure; bounding arterial pulses; apical heave

A

A031. patent ductus arteriosus; failure of closure of the ductus arteriosis postnatally.

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32
Q

Q032. pulsus paradoxus,; hypotension; electrical alternans in pt with breast cancer; pericardial effusion; right ventricular collapse

A

A032. tamponade; treat pericardiocentesis

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33
Q

Q033. purpura, cytopenia, hemolytic anemia, neurologic signs, renal insufficiency, fever

A

A033. TTP

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34
Q

Q034. Angiomyolipoma

A

A034. Tuberous Sclerosis; Kidney Harmatoma: blood vessels, muscle, mature adipose tissue

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35
Q

Q035. Angiosarcoma

A

A035. Liver Angiosarcoma:; Polyvinyl chloride, arsenic, thorium dioxide

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36
Q

Q036. Bacillary angiomatosis

A

A036. Benign capillary proliferation involving skin and visceral organs in AIDs patients. Stimulates Kaposi Sarcoma in AIDS; Bartonella henselae, gram negative bacillus, causative agent

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37
Q

Q037. Capillary Hemangioma

A

A037. treatment: leave alone!; facial lesion in newborns, regresses with age

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38
Q

Q038. Cavernous hemangioma

A

A038. most common benign tumor of liver and spleen; may rupture if large

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39
Q

Q039. Cystic hygroma

A

A039. lymphangioma in neck; associated with Turner’s syndrome

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40
Q

Q040. Glomus tumor

A

A040. Derive arteriovenous shunts in glomus bodies; Painful red subungual nodual in digit

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41
Q

Q041. Hereditary telangiectasia

A

A041. Dilated vessels on skin and mucous membranes in mouth and GI tract

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42
Q

Q042. Kaposi Sarcoma

A

A042. malignant tumor arising from endothelial cells or primitive mesenchymal cells; HSV type 8; raised red purple discoloration that progresses from plat lesion to a plaque to nodule that ulcerates

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43
Q

Q043. Lymphangiosarcoma

A

A043. malignancy of lymphatic vessels; arises out of longstanding chronic lymphadema after modified radial masectomy

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44
Q

Q044. Pyogenic granuloma

A

A044. vascular, red pedunculated mass that ulcerates and bleeds easily; post traumatic and associated with pregnancy

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45
Q

Q045. Spider telangiectasia

A

A045. arteriovenous fistula (disappears when compressed); associated with hyperestrinism

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46
Q

Q046. Sturge Weber syndrome

A

A046. Nevus flammeus on face in distribution of opthalamic branch of cranial nerve V (trigeminal)

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47
Q

Q047. VHL syndrome

A

A047. cavernous hemangioma in cerebellum and retina; increased incidence of pheochromocytoma and bilateral renal cell carcinomas.

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48
Q

Q048. What does “irregularly irregular” mean on an ECG?

A

A048. Irregular RR intervals

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49
Q

Q049. Irregularly irregular rhythm without p waves prior to each QRS

A

A049. Atrial fibrillation

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50
Q

Q050. Etiologies of A Fib (10)

A

A050. PIRATES:; Pulmonary (COPD, PE), Pheochromocytoma, Pericarditis;; Ischemic heart disease, HTN;; Rheumatic heart disease;; Anemia;; Thyrotoxicosis;; Ethanol (& cocaine), Endocarditis;; Sepsis

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51
Q

Q051. Signs/symptoms of A Fib (5)

A

A051. A FL PT:; Asymptomatic patient;; Fatigue (most common);; Light headedness, syncope;; Palpitations, skipped beats;; Tachypnea, dyspnea

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52
Q

Q052. Complication of A Fib

A

A052. diffuse Embolization (often to brain, leading to TIA or stroke)

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53
Q

Q053. One of two possible Drugs given to A Fib to control rate in an emergent situation

A

A053. IV Calcium channel blocker: Diltiazem; (or); IV Beta blocker: Metoprolol

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54
Q

Q054. Drugs given to A Fib to control rate in a non emergent situation (2)

A

A054. oral Beta blocker:; Atenolol; (and); oral Calcium channel blockers:; Verapamil or Diltiazem

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55
Q

Q055. what are the (2) ways to cardiovert an A Fib rhythm?; when should you not cardiovert?; what would the Tx be then?

A

A055. Medical: Amiodarone; Electrical: start at 100 J Do not cardiovert if patient is in A Fib > 24 hours. Tx: Warfarin for 3 4 weeks before cardioversion

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56
Q

Q056. If cardioversion from A Fib to sinus rhythm does not occur, what should patient be treated with?

A

A056. Long term anticoagulants DOC:; Warfarin (1st); Aspirin (2nd)

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57
Q

Q057. how many seconds and boxes is a normal PR interval?

A

A057. 0.2 ms 5 small boxes

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58
Q

Q058. define:; Q wave; When is it pathologic?

A

A058. when initial part of ventricular depolarization is downward; Pathologic: greater then 1 small box

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59
Q

Q059. normal time and boxes for QRS interval?

A

A059. < 0.12 ms 3 small boxes

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60
Q

Q060. normal sinus rate

A

A060. 60 100 bpm

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61
Q

Q061. define:; Junctional rhythm

A

A061. rhythm originating in the AV node and causing narrow QRS without P waves

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62
Q

Q062. Dx:; no p waves; all complexes are wide; no changes in height (amplitude) with each complex; > 100bpm

A

A062. Ventricular tachycardia

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63
Q

Q063. Dx:; wide QRS complexes that vary in amplitude; (2 names)

A

A063. Ventricular Fibrillation; Torsades de Pointes

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64
Q

Q064. Dx:; normal sinus rhythm with PR interval > 0.2 ms (> 5 small boxes)

A

A064. First degree AV block

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65
Q

Q065. Dx:; PR interval elongates from beat to beat until it becomes so long that a beat drops

A

A065. Second degree AV block, type 1 (Wenckebach)

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66
Q

Q066. Dx:; PR interval is fixed but every so often there is a P wave without a QRS

A

A066. Second degree AV block, type 2 (Mobitz)

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67
Q

Q067. Dx:; no relationship b/t P waves and QRS complexes

A

A067. Third degree AV block

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68
Q

Q068. Dx:; QRS > 0.12 (> 3 small boxes) RSR’ in V1 + V2;; deep S wave in lateral leads (I, aVL, V5 + V6)

A

A068. RBBB

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69
Q

Q069. Dx:; QRS > 0.12 (> 3 small boxes);; RSR’ in V5 + V6; diffuse ST elevation

A

A069. LBBB

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70
Q

Q070. Dx:; Different shapes to 3 or more P waves; normal rhythm; (what is it called if it is tachycardic?)

A

A070. Wandering pacemaker; MFAT: Multifocal Atrial Tachycardia

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71
Q

Q071. Dx:; short PR interval; slurring delta wave connecting P wave to QRS complex

A

A071. Wolff Parkinson White syndrome

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72
Q

Q072. Dx:; diffuse ST elevation that slopes in a concave manner back to baseline + diffuse PR segment depression in all leads except PR elevation in aVR

A

A072. Pericarditis

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73
Q

Q073. drug Tx of wandering pacemaker and MFAT?

A

A073. Verapamil (Ca channel block)

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74
Q

Q074. what Tx breaks SVT (superventricular tachy) in > 90%?

A

A074. Adenosine (failure to break r/o SVT)

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75
Q

Q075. Tx for V tach with hypotension or no pulse

A

A075. Emergency defibrillation @ 200 360 J

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76
Q

Q076. Tx of asymptomatic V tach; (2 meds)

A

A076. Amiodarone; or; Lidocaine

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77
Q

Q077. Tx of V Fib

A

A077. Emergent electroshock @ 200 360 J

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78
Q

Q078. how do you distinguish Paroxysmal Nocturnal Dyspnea from asthma?

A

A078. no improvement with bronchodilators

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79
Q

Q079. Dx:; SVT with AV block + yellow skin

A

A079. Digoxin toxicity

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80
Q

Q080. How do you diagnose LVH from a ECG? (2)

A

A080. 1. S wave in V1 + R wave in V5 or V6 > 7 large boxes (35 small); 2. R wave in V5 or V6 > 25 small boxes; OR; R wave in lead aVL > 11 small boxes

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81
Q

Q081. Causes of prolonged QT (8)

A

A081. QT WIDTH:; QT: Prolonged QT syndrome; W: WPW; I: Infarction; D: Drugs; T: Torsades de pointes; H: HypoK, HypoC, Hypomagnesium

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82
Q

Q082. What electrolyte disorder causes short QT segments?

A

A082. HyperC

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83
Q

Q083. Causes of Torsades de Pointes (7)*

A

A083. POINTES:; Phenothiazines; Other meds (TCAs); Intracranial bleed; No known cause (idiopathic); Type 1 Anti arrhythmics; Electrolyte abnormalities; Syndrome of prolonged QT

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84
Q

Q084. What can be given to a patient to temporarily slow a rapid supraventricular rhythm in order for you to be able to identify it?

A

A084. Adenosine

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85
Q

Q085. What drugs should not be given to someone with Wolff Parkinson White syndrome?; (4); What is the DOC?

A

A085. ABCD:; Adenosine; Beta blockers; Calcium channel blockers; Digoxin; DOC: Procainamide

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86
Q

Q086. Causes of Mobitz I (3); Causes of Mobitz II (2)

A

A086. Mobitz I:; Inferior wall MI;; Digitalis toxicity;; Inc Vagal tone Mobitz II:; Inferior or septal wall MI;; Conduction system disease

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87
Q

Q087. Tx for Mobitz I & II; (2)

A

A087. Both:; Atropine & temporary pacing; (Mobitz II should have pacemaker)

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88
Q

Q088. Causes of third degree heart block (3)

A

A088. Digitalis toxicity;; Inferior wall MI;; Conduction system disease

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89
Q

Q089. Causes of Bradycardia (6)

A

A089. if R R is longer then “One INCH”:; Overmedication;; Inferior MI / Inc intracranial Pressure;; Normal variant (athletes);; Carotid sinus hypersensitivity;; Hypoparathyroidism

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90
Q

Q090. Tx for bradycardia (3)

A

A090. 1. Atropine; 2. pacing; 3. pressors for hypotension

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91
Q

Q091. a 24 years old woman with preeclampsia Tx with IV drip of magnesium complains of difficulty breathing and has diminished reflexes. Next step? (2 together)

A

A091. 1. Stop magnesium; 2. give IV calcium

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92
Q

Q092. equation for Mean Arterial Pressure

A

A092. MAP = (2dBP + sBP)/3

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93
Q

Q093. Dilation of which heart chamber is a major cause of A fib?

A

A093. Left atrium

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94
Q

Q094. (5)* deadly causes of chest pain

A

A094. TAPUM:; Tension pneumothorax;; Aortic Dissection;; PE;; Unstable Angina;; MI

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95
Q

Q095. how is the maximum HR determined?

A

A095. 220 patient’s age = Max HR

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96
Q

Q096. (6) Major risk factors for CAD which is most preventable?; which is the greatest risk?

A

A096. Diabetes (greatest);; Smoking (most preventable);; HTN;; Hypercholesterolemia;; Family History;; Age

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97
Q

Q097. Dx:; Chest pain that has an established character, timing and duration; pain is transient, reproducible and predictable. What is cause?; What is Tx? (2 together)

A

A097. Dx: Stable Angina; Cause: Reduced coronary blood flow through fixed atherosclerotic plaque in vessel of heart; Tx: rest + Nitroglycerin

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98
Q

Q098. Exertional substernal (precordial) chest pressure and pain radiating to left arm, jaw or back. N/V, diaphoresis, dyspnea, HTN and tachycardia can accompany it. Name the types

A

A098. Angina:; Stable; Unstable; Variant (Prinzmetal’s)

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99
Q

Q099. Angina type that is also considered an Acute Coronary Syndrome (ACS). What (3) factors must it have for diagnosis?

A

A099. Unstable Angina; 1) New onset; 2) angina that changes or accelerates in pattern, location or severity; 3) Occurs at REST

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100
Q

Q100. Dx:; Similar characteristics of stable angina, but due to vasospasm instead of atherosclerosis. Tx? (2 drugs together)

A

A100. Variant (Prinzmetal’s) Angina; Tx:; 1. Calcium Channel blockers +; 2. Nitrates

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101
Q

Q101. what (2) groups of patients may not show the classic signs pain seen in stable angina?; Why?

A

A101. Elderly and diabetics (b/c: neuropathies)

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102
Q

Q102. What does the EKG look like for the (3) angina types?

A

A102. Stable + Unstable:; ST Depression; T wave Inversion; Variant: ST elevation

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103
Q

Q103. 62 years old smoker with 3 episodes of severe heavy chest pain in the morning. Each lasted 3 5 minutes, but he has no pain now. He has never had this before. What is it?

A

A103. Unstable Angina

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104
Q

Q104. 62 years old man with frequent episodes of chest pain on and off for 8 months. He says the pain wakes him from sleep at night. What is it?

A

A104. Variant (Prinzmetal’s) Angina

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105
Q

Q105. what is the alternative to an exercise Stress Test if the patient cannot get on a treadmill?

A

A105. IV Dobutamine is given to stimulate myocardial function

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106
Q

Q106. What is the criteria for a “positive” Stress Test? (5)

A

A106. either:; ST elevation; ST depression >1 mm in multiple leads; Dec BP; failure to go more than 2 minutes; failure to complete for reason other then cardiac symptoms (i.e. arthritis)

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107
Q

Q107. what does Myocardial Perfusion Imaging detect? (3)

A

A107. Myocardial perfusion; Ventricular volume; Ejection Fraction

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108
Q

Q108. An ultrasound of the heart revealing abnormal wall motion due to ischemia or infarction. It also assesses left ventricular function and EF

A

A108. Echocardiography

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109
Q

Q109. What are (5) Dx that need a cardiac catheterization?; Describe procedure for each

A

A109. 1) MI / Unstable angina: stent or angiography; 2) Valvular disease: valvuloplasty; 3) Arrhythmias: mapping bypass tracts; 4) Myocardial disease Bx: glycogen storage disease or cardiomyopathies; 5) Congenital heart disease identification: angiography and closure of defects

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110
Q

Q110. (4) serum markers for MI

A

A110. Myoglobin;; Troponin T/I;; CK;; Lactate Dehydrogenase

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111
Q

Q111. How is the right heart accessed in a cardiac catheterization? (2); Left heart? (2)

A

A111. Right:; Femoral or Internal Jugular; Left:; Femoral or Radial artery (from right heart)

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112
Q

Q112. what is the wave morphology changes sequence in a MI ECG? (6)

A

A112. 1. peaked T waves; 2. T wave inversion; 3. ST elevation; 4. Q waves; 5. ST normalization; 6. T waves return upright

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113
Q

Q113. which cardiac enzyme is the most sensitive and specific for acute MI?

A

A113. Troponin I/T

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114
Q

Q114. which cardiac enzyme remains increased (peaked) the longest?

A

A114. LDH

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115
Q

Q115. what does ST depression mean?

A

A115. ST goes in the opposite direction of the QRS

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116
Q

Q116. what does a Q wave on an EKG in the presence of an infarction indicate?

A

A116. Transmural infarction; (extends through full thickness of the myocardial wall)

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117
Q

Q117. Time of onset for the (4) serum markers for MI

A

A117. Myoglobin (1 4 hrs); Troponin I/T (3 12); CK MB (3 12); LDH (6 12)

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118
Q

Q118. which cardiac enzyme has the shortest duration?; Longest?

A

A118. Myoglobin (1 day); Troponin I/T (7 10 days)

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119
Q

Q119. ST elevation in II, III & aVF

A

A119. Inferior wall MI

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120
Q

Q120. ST depression in II, III & aVF

A

A120. Cor Pulmonale; (right sided heart failure)

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121
Q

Q121. ST elevation in V1, V2, V3

A

A121. Anterior/septal MI

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122
Q

Q122. ST elevation in V4, V5, V6

A

A122. Lateral wall MI

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123
Q

Q123. ST depression in V1, V2

A

A123. Posterior wall MI

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124
Q

Q124. difference b/t unstable angina & non ST elevation MI? (2)

A

A124. non ST elevation MI has:; 1. more severe lack of Oxygen (more severe myocardial damage); 2. Enzyme leakage (Unstable angina has none)

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125
Q

Q125. Tx for Unstable angina & MI (6)

A

A125. MONA has HEP B:; Morphine; Oxygen; Nitrates; Aspirin; HEParin; Beta blockers

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126
Q

Q126. primary Tx (2) for the acute MI w/in 6 hours of infarct; (name 3 other drugs)

A

A126. Throbolytics:; 1. tPA + 2. Heparin (DOC); Urokinase; streptokinase; Alteplase

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127
Q

Q127. At what level should LDL be in person with MI history?; What is given to lower it?

A

A127. less then 100; statins

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128
Q

Q128. When are throbolytics indicated in MI? (3)

A

A128. patients < 80 years old; within 6 12 hrs of chest pain; evidence of infarct on ECG

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129
Q

Q129. Contra indications of Throbolytics (9)

A

A129. Having Some Breaks A Blood Clot In Small Pieces:; History of intracranial bleed; stroke < 1 year BP > 180/110; active internal bleed; bleeding disorder; CPR; Intracranial tumor; suspected aortic dissection; Peptic ulcer

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130
Q

Q130. drug class that is used to break up clots

A

A130. thrombolytics

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131
Q

Q131. name a specific drug that prevents future clots from forming

A

A131. heparin

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132
Q

Q132. procedure Tx of choice for MI if there is a high risk of ST elevation (cardiogenic shock) or it has been 3 hours since initial symptoms presented?

A

A132. PTCA; (Percutaneous Transluminal Coronary Angioplasty)

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133
Q

Q133. which thrombolytic is highly immunogenic and cannot be used in the same patient twice in a 6 month period?

A

A133. streptokinase

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134
Q

Q134. what should be given 48 hours post infarct if tPA was used?

A

A134. heparin

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135
Q

Q135. drug class that is excellent for late and long term therapy for acute MI to decrease afterload and prevent remodeling?

A

A135. ACEi

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136
Q

Q136. 58 years old man discharged from hospital after MI 2 weeks ago presents with fever, chest pain and malaise. EKG shows diffuse ST T wave changes. What is Dx?; What is Tx?; (2 possible meds)

A

A136. Dressler’s syndrome; Tx:; 1. NSAIDs or 2. Corticosteroids

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137
Q

Q137. Medication orders with discharge of an ACS (post MI) patient? (5)

A

A137. easy AS ABC:; Aspirin (indefinitely); Statin to lower LDL < 100; ACE inh (if EF <40%); Beta blocker (indefinitely); Clopidogrel for 1 12 mo depending on stent placement

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138
Q

Q138. Dx:; fever, pericarditis and possible pericardial or pleural effusions post cardiac surgery

A

A138. Dressler’s syndrome

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139
Q

Q139. Most common infectious cause of Myocarditis

A

A139. Coxsackie B

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140
Q

Q140. (4) systemic diseases that causes Myocarditis

A

A140. KISS:; Kawasaki’s; Inflammatory conditions; SLE; Sarcoidosis

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141
Q

Q141. (4) Parasites that cause Myocarditis

A

A141. Trypanosoma Cruzi (Chagas);; Toxoplasmosis;; Trichinella;; Echinococcus

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142
Q

Q142. (5) Bacterial causes of Myocarditis

A

A142. women Trick Corny Men to Strip and Lie down:; Group A beta hemolytic Strep (rheumatic fever);; Corynebacterium;; Meningococcus;; Lyme (B. burgdorferi);; Trichinella

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143
Q

Q143. (8) viral causes of myocarditis

A

A143. Coxsackie A or B;; HIV;; Echovirus;; EBV:; CMV;; HBV;; Influenza;; Adenovirus

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144
Q

Q144. (3) drugs that cause pericarditis

A

A144. It Hurts Pericardium:; Isoniazid;; Hydralazine;; Procainamide

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145
Q

Q145. Etiology of Pericarditis (5)

A

A145. Bacterial, viral or fungal infections;; Post MI (Dressler’s);; Uremia;; Serositis from: RA or SLE; Scleroderma;

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146
Q

Q146. Tx for pericarditis if:; infection; pain/inflammation; Dressler’s; Recurrent cases

A

A146. Infection Abx;; Relieve pain + reduce inflammation NSAIDs;; Dressler’s Steroids;; Recurrent Cases Pericardectomy; (only of recurrent cases)

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147
Q

Q147. Dx:; Transient fall in BP > 10 mmHg during inspiration

A

A147. Pulsus Paradoxus

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148
Q

Q148. Dx:; Physiologic result of rapid accumulation of fluid in the pericardial sac; impairs cardiac filling and reduces cardiac output

A

A148. Pericardial Tamponade

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149
Q

Q149. Etiology of Pericardial Tamponade (3)

A

A149. Aortic dissection or ventricular rupture into pericardium; Pericarditis; Trauma

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150
Q

Q150. Beck’s triad of the pericardial tamponade; (4) other signs/Sx

A

A150. Beck’s triad:; JVD; Muffled heart sounds; Hypotension; Other Sx:; Tachycardia; Pulsus Paradoxus*;; Dyspnea;; Narrow Pulse Pressure

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151
Q

Q151. Tx for Pericardial Tamponade for:; 1. unstable; 2. stable; 3. both

A

A151. Unstable:; Immediate Pericardiocentesis;; Stable:; Pericardial window; Both:; Infuse fluids to expand volume

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152
Q

Q152. Failure of venous pressure to fall during inspiration

A

A152. Kussmaul’s sign

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153
Q

Q153. If pericardiocentesis has clots, what is likely source of blood?

A

A153. Right Ventricle

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154
Q

Q154. Dx:; Patient has chest pain with inspiration that radiates to the left trapezial ridge; Pain is relieved by sitting up and leaning forward; does not respond to nitroglycerine

A

A154. Pericarditis

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155
Q

Q155. additional signs/Sx for Constrictive pericarditis (versus pericarditis); (4)

A

A155. Extra fluid:; JVD; Kussmaul’s sign; peripheral edema; LV failure

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156
Q

Q156. When a patient has VHD or previous endocarditis, what (3) procedure types must they obtain endocarditis prophylaxis medications?

A

A156. Dental procedures; Urologic procedures; GI procedures

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157
Q

Q157. Dx:; acute onset of fever, chills and rigors; new cardiac murmur, possible associated meningitis or pneumonia

A

A157. Acute Bacterial Endocarditis (ABE)

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158
Q

Q158. Infection of healthy heart valves by high virulence organisms; MCC?; Prognosis if not treated?

A

A158. ABE; S. Aureus; Prognosis: fatal if not Tx w/i 6 weeks

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159
Q

Q159. Dx:; seeding of previously damaged heart valves by rheumatic fever, mitral prolapse, etc by low virulence organisms; MCC?; What valve is affected the most?

A

A159. Subacute Bacterial Endocarditis; Strep Viridans; Mitral valve

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160
Q

Q160. What valve is most commonly affected with IV drug users?; What bug?

A

A160. Tricuspid; S. Aureus

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161
Q

Q161. what endocarditis bug is associated with colonic neoplasms?

A

A161. Strep Bovis

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162
Q

Q162. Dx:; gradual onset of fever, sweats, weakness, anorexia, new murmur, splenomegaly, Osler’s nodes, splinter hemorrhages, Janeway lesions, Roth spots

A

A162. Subacute Bacterial Endocarditis (SBE)

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163
Q

Q163. Name sign:; Tender violaceous subcutaneous nodules on fingers & toes

A

A163. Osler’s nodes (SBE)

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164
Q

Q164. Name sign:; fine linear hemorrhages in the middle of nailbeds

A

A164. Splinter Hemorrhages

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165
Q

Q165. Name sign:; multiple hemorrhagic nontender macules or nodules on palms & soles

A

A165. Janeway Lesions

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166
Q

Q166. Name sign:; retinal hemorrhages with clear central areas seen on fundoscopy (with new murmur)

A

A166. Roth’s spots (SBE)

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167
Q

Q167. What is considered Major criteria in the Duke’s criteria for endocarditis?; (2)

A

A167. 1. Two positive blood cultures; 2. Echo showing vegetations

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168
Q

Q168. What are the (6) Minor criteria in the Duke’s criteria for endocarditis?

A

A168. 1. Fever; 2. Predisposing heart abnormality; 3. Arterial emboli (Janeway); 4. Osler nodes or Roth’s spots; 5. positive blood culture not meeting major criteria; 6. Echo suspicious of endocarditis, but not meeting major criteria

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169
Q

Q169. For the Duke’s criteria of Endocarditis, what are the (3) ways to dx with major and minor signs?

A

A169. 1. (2) major criteria; 2. (1) major + (3) minor; 3. (5) minor criteria

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170
Q

Q170. Tx for endocarditis that cultures:; 1. Strep; 2. Staph; 3. MRSA

A

A170. 1. Ceftriaxone or Penicillin G (4 weeks); 2. Naficillin (4 weeks); 3. Vancomycin (4 weeks)

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171
Q

Q171. What is the Tx for patients with Valular abnormalities if they are having dental procedures, GI or GU surgery? (2 possible)

A

A171. Prophylactic:; 1. Amoxicillin; or; 2. Clarithromycin

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172
Q

Q172. Valvular dysfunction requiring surgery is common with which type of organism?

A

A172. Fungi (Candida or Aspergillus)

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173
Q

Q173. Endocarditis type:; due to cancer seeding heart valves during metastasis what can it lead to?

A

A173. Marantic endocarditis; leads to cerebral infarcts

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174
Q

Q174. Endocarditis type:; may be due to autoantibody damage of valves by SLE

A

A174. Libman Sacks endocarditis

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175
Q

Q175. MC valve affected by RHD

A

A175. Mitral

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176
Q

Q176. Cause of Rheumatic fever?; What does it lead to?

A

A176. Group A Strep leads to Rheumatic Heart Disease (RHD); immune complex deposits on valves

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177
Q

Q177. Major criteria (JONES criteria) for Dx Rheumatic fever (5)

A

A177. JCNES:; Joints (arthritis); Carditis (myo , endo or peri ); Nodules (sub Q); Erythema marginatum rash; Sydenham’s chorea (face, tongue, upper limb)

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178
Q

Q178. Minor criteria for Dx Rheumatic fever (5)

A

A178. Pump FEAR:; Prolonged PR interval;; Fever;; Elevated ESR;; Arthralgias;; Recent Strep infection;

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179
Q

Q179. Tx for Rheumatic fever due to:; 1. Strep; 2. Arthritis; 3. Carditis

A

A179. Penicillin for strep;; ASA for arthritis;; Steroids for carditis

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180
Q

Q180. Etiology of Dilated Cardiomyopathy; (6)*

A

A180. TIMED:; Toxic (EtOH, heavy metals); Infectious / Ischemic; Metabolic / Mechanical (arrhythmia, valve disease); Endocrine; Drugs

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181
Q

Q181. what are the Reversible and Irreversible(2) toxic causes of Dilated Cardiomyopathy?

A

A181. Reversible:; prolonged EtOH use; Irreversible:; Cocaine;; heavy metal toxicity

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182
Q

Q182. what are the Reversible and Irreversible(2) endocrine causes of Dilated Cardiomyopathy?

A

A182. Reversible:; Thyroid disease; (hypo or hyper); Irreversible:; Acromegaly;; Pheochromocytoma

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183
Q

Q183. Reversible metabolic deficiencies that cause Dilated Cardiomyopathy? (4)

A

A183. HypoC;; HypoP;; Thiamine deficiency (wet beri beri);; Selenium deficiency

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184
Q

Q184. Infections that cause Dilated Cardiomyopathy; (3)

A

A184. HIV;; Coxsackie virus;; Chagas disease

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185
Q

Q185. Drugs that cause Dilated Cardiomyopathy (2)

A

A185. Doxorubicin (Adriamycin);; AZT

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186
Q

Q186. Dx:; Cardiomyopathy with R + L Heart failure; A fib; Mitral regurgitation; S 3 Gallop

A

A186. Dilated Cardiomyopathy

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187
Q

Q187. Diastolic or Systolic Disease Cardiomyopathy:; 1. Dilated; 2. Restrictive; 3. Hypertrophic

A

A187. Systolic:; Dilated; Diastolic:; Restrictive & Hypertrophic

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188
Q

Q188. Diagnostic results of Dilated cardiomyopathy; auscultation; EKG (3); CXR (2); Echo (2)

A

A188. Auscultation: S 3;; EKG: Vent Hypertrophy, BBB and/or A fib;; CXR: Inc heart size; pulm congestion; Echo: low EF, large ventricles

189
Q

Q189. Tx Dilated Cardiomyopathy; (3)

A

A189. stop any toxic agents;; Anticoagulation with coumadin (even without evidence of thrombus);; Heart transplant

190
Q

Q190. Dx:; Right or left ventricular enlargement with loss of contractile function causing CHF, arrhythmia, or thrombus formation.

A

A190. Dilated Cardiomyopathy

191
Q

Q191. Definition:; Scarring and infiltration of the myocardium causing decreased right or left ventricular filling

A

A191. Restrictive Cardiomyopathy

192
Q

Q192. Etiology of Restrictive Cardiomyopathy; (7)*

A

A192. ACHES:; Amyloidosis;; Carcinoid heart disease / Congenital;; Hemochromatosis;; Endomyocardial fibrosis; Sarcoidosis / Scleroderma

193
Q

Q193. Dx:; Pulmonary HTN (right CHF); S 4 gallop; Low QRS voltage on EKG; Exercise intolerance; Diastolic disease

A

A193. Restrictive Cardiomyopathy

194
Q

Q194. *Aside from the normal cardiac work up, what is the gold standard Dx test for Restrictive CM?

A

A194. Endomyocardial Bx

195
Q

Q195. Definition:; Increase in the size of the interventricular septum causing narrowing of the LV outflow tract leading to anterior mitral valve outflow obstruction

A

A195. Hypertrophic Cardiomyopathy

196
Q

Q196. another name for Hypertrophic Cardiomyopathy

A

A196. IHSS; (Idiopathic Hypertrophic Subaortic Stenosis)

197
Q

Q197. (3) causes of paradoxical splitting of S 2

A

A197. Hypertrophic cardiomyopathy (IHSS);; Aortic stenosis;; LBBB

198
Q

Q198. murmur that decrease with squatting (and increases when returning to standing position)

A

A198. Hypertrophic CM (IHSS)

199
Q

Q199. Etiology of Hypertrophic Cardiomyopathy; (2)

A

A199. 50% idiopathic; 50% familial (autosomal dominant, with variable penetrance)

200
Q

Q200. Dx:; Angina (at rest or exercise); Syncope; Arrhythmias; CHF

A

A200. Hypertrophic Cardiomyopathy

201
Q

Q201. sudden death from Hypertrophic CM is usually due to what?

A

A201. Arrhythmias

202
Q

Q202. Dx:; 25 years old man becomes severly dyspneic and collapses while running laps, His father died suddenly at an early age.

A

A202. Hypertrophic CM (IHSS)

203
Q

Q203. Diagnostic results to Dx Hypertrophic CM; Auscultation (2); EKG (4); Echo (2)

A

A203. Auscultation Systolic ejection murmur, Paradoxical splitting of S2;; EKG LVH, PVCs, A fib, ST + Q abnormalities;; Echo septal hypertrophy, LVH with small LV

204
Q

Q204. Tx for Hypertrophic CM; (2 together); if becomes more severe?

A

A204. 1. No exercise; 2. Beta blocker; More severe: implantable Cardiac Defibrillator

205
Q

Q205. What is the BP limit for Malignant HTN?; Difference b/t HTN Urgency vs Emergency?

A

A205. Systolic >210 or diastolic >110; Hypertensive URGENCY:; WITHOUT evidence of end organ damage; Hypertensive EMERGENCY:; Severe HTN with evidence of end organ damage (encephalopathy, renal failure, CHF, etc)

206
Q

Q206. what is important to remember about treating a hypertensive emergency?; What meds can be given for Tx? (3 possible)

A

A206. Do NOT lower BP by more then 1/4 at first, or patient can have a stroke; Meds:; IV drip w/; 1. Nitroprusside; 2. Nitroglyerin; 3. Beta blocker

207
Q

Q207. DOC for HTN without any comorbid disease

A

A207. Thiazide

208
Q

Q208. DOC for HTN with CHF; (choice of 3)

A

A208. 1. ACEI / ARBs; 2. B blocker; 3. Spirolactone (K sparing)

209
Q

Q209. DOC for HTN with MI; (2 together)

A

A209. B blocker + ACEI

210
Q

Q210. DOC for HTN with osteoporosis

A

A210. Thiazide (dec. calcium excretion)

211
Q

Q211. DOC for HTN with BPH

A

A211. Terazosin (Alpha blocker)

212
Q

Q212. DOC for HTN with pregnancy

A

A212. alpha methyldopa

213
Q

Q213. (3) contraindications for Beta blockers

A

A213. 1. COPD; 2. Diabetes; 3. HyperK

214
Q

Q214. (3) contraindications for ACEI

A

A214. 1. Pregnancy; 2. Renal artery stenosis; 3. Renal Failure (creatinine >1.5)

215
Q

Q215. contraindication of all diuretics

A

A215. Gout

216
Q

Q216. (2) hypersteroidism syndromes that cause HTN with hyperK

A

A216. Cushing’s; Conn’s

217
Q

Q217. endocrine system abnormality that can lead to HTN due to episiodic autonomic bursts of epinepherine

A

A217. Pheochomocytoma

218
Q

Q218. congenital cause of HTN that leads to HTN in arms and low BP in legs

A

A218. Coartation of the Aorta

219
Q

Q219. renal artery stenosis that causes HTN in:; 1) older men; 2) younger women

A

A219. 1) Atherosclerosis; 2) Fibromuscular dysplasia

220
Q

Q220. Dx:; valvular problem that causes HTN with a wide PP; Physiologic cause?

A

A220. Aortic Regurgitation; cause: Inc SV

221
Q

Q221. Dx:; congenital problem that causes HTN with a wide PP; Physiologic cause for HTN?

A

A221. Patent Ductus Arteriosus; cause: Inc SV

222
Q

Q222. (3) drug classes that cause HTN; What metal poisoning?

A

A222. makes vessels like COAL:; Corticosteroids; Oral contraceptives; Amphetamines; Lead poisoning

223
Q

Q223. (5) deadly causes of chest pain

A

A223. TAPUM:; Tension pneumothorax; Aortic Dissection; PE; Unstable Angina; MI

224
Q

Q224. heart medication that can cause cyanide toxicity

A

A224. Nitroprusside

225
Q

Q225. First Rx Tx for Hypertensive emergency due to pheochromocytoma

A

A225. Phentolamine

226
Q

Q226. (2) possible Tx for a preclampsia related hypertensive emergency

A

A226. Hydralazine or Magnesium

227
Q

Q227. What is the most commonly seen early sign of right CHF, which is not seen in early left CHF?

A

A227. JVD

228
Q

Q228. What are the systolic dysfunctions of CHF? (EF, Preload, LVEDP, contractility)

A

A228. Ejection Fraction < 40%; Preload and LVEDP: Inc; Contractility: Dec; (leads to LV hypertrophy)

229
Q

Q229. What causes CHF exacerbation in previously stable patients? (10)

A

A229. FAILURE:; Forgot medication;; Arrhythmia, Anemia;; Ischemia, Infection;; Lifestyle (Inc sodium);; Upregulation (Inc cardiac output pregnancy or hyperthyroidism);; Renal failure with fluid overload;; Emboli (pulmonary); Endocarditis

230
Q

Q230. What are the diastolic dysfunctions of CHF? (compliance, contraction, recoil, stiffness, LVEDP, CO, EF)

A

A230. Compliance: Decreased; Contraction: Normal; Recoil: Decreased; Stiffness: Increased; LVEDP: Increased; CO: Normal; EF: normal to high

231
Q

Q231. Which type of CHF dysfunction systolic or diastolic has a normal ejection fraction and is more common in women?

A

A231. diastolic

232
Q

Q232. What related heart conditions are seen in the systolic dysfunction of CHF that deals with decreased contractility? (4)

A

A232. Ischemia (most common);; Dilated Cardiomyopathy;; HTN;; Valvular disease

233
Q

Q233. What related conditions are seen in the systolic dysfunction of CHF that deals with Inc afterload? (3)

A

A233. Hypertension;; Aortic stenosis;; Aortic regurgitation

234
Q

Q234. What related conditions are seen in the diastolic dysfunction of CHF that deals with abnormal active relaxation? (2)

A

A234. Ischemia;; Hypertrophic cardiomyopathy; (from disorders causing LVH)

235
Q

Q235. What related conditions are seen in the diastolic dysfunction of CHF that deals with abnormal passive filling? (2)

A

A235. Restrictive cardiomyopathy;; Concentric hypertrophy from HTN

236
Q

Q236. What are the early signs of Left sided CHF? (2)

A

A236. Dyspnea on exertion;; Dec exercise tolerance

237
Q

Q237. What are the late sx of Left sided CHF? (8)

A

A237. PORNS DD Tits:; Paroxysmal Nocturnal Dyspnea;; Orthopnea;; Rales and crackles;; Nocturia;; S 3 gallop;; Diaphoresis;; Displaced PMI (laterally);; Tachycardia

238
Q

Q238. What are the early signs of Right sided CHF? (6)

A

A238. A Juicy CHERry:; Anorexia; JVD*; Cyanosis; Hepatomegaly; Edema in periphery; RUQ pain

239
Q

Q239. What are the late sx of Right sided CHF? (2)

A

A239. abnormal Hepatojugular reflex;; Ascites

240
Q

Q240. What force causes the pulmonary congestion in diastolic dysfunction?

A

A240. Increased hydrostatic pressure

241
Q

Q241. what (3) ways can CHF be diagnosed by a CXR?

A

A241. Enlargement of cardiac silhouette;; Pulmonary vascular congestion;; Kerley B lines

242
Q

Q242. (3) lab methods of diagnosing CHF

A

A242. CXR;; Echocardiogram (function of ventricles);; Basic Natriuretic Peptide (BNP elevation)

243
Q

Q243. AHA staging guidelines for CHF (stages A D)

A

A243. A: at risk but without structural heart disorder; B: no sx, with structural disorder; C: prior or current sx + structure disorder; D: end stage disease

244
Q

Q244. NY Heart Assoc Functional Classes of Heart Failure (I IV); [measures pt activity limitation]

A

A244. I: No limitation; II: slight limitation; III: Sx with minimal effort, ok at rest; IV: Sx at rest

245
Q

Q245. SOB while lying flat

A

A245. Orthopnea

246
Q

Q246. What drug classes are good versus CHF? (3); Which ones are only helpful if patient has a diastolic dysfunction? (2)

A

A246. Systolic or Diastolic dysfunction:; ACEIs/ARBs; Beta blockers; diuretics; Diastolic dysfunction only:; Calcium channel blockers; Nitroglycerin

247
Q

Q247. Name the diuretic used for mild CHF and the 2 for significant CHF

A

A247. Mild:; Thiazides; Significant CHF:; Loop diuretics; Spirolactone

248
Q

Q248. What is the difference in the signs/sx of people with right CHF and cirrhosis? (2)

A

A248. Right CHF also has:; 1. JVD; 2. Orthopnea

249
Q

Q249. what are the (5) Tx for Acute Pulmonary Edema and Paroxysmal Nocturnal Dyspnea?

A

A249. NOMAD:; Nitroglycerin; Oxygen; Morphine; Aspirin; Diuretic

250
Q

Q250. What is the rule for prescribing beta blockers for CHF?

A

A250. never give during active CHF add beta blockers once the patient is diuresed to dry weight and on stable doses of other medications

251
Q

Q251. Heart valve disease almost always due to Rheumatic Fever

A

A251. Mitral Stenosis

252
Q

Q252. Murmur type:; Dyspnea on Exertion; Cough, rales; signs of RV failure; RV precordial thrust; Hoarse voice

A

A252. Mitral Stenosis; (Hoarse voice is from enlarged LA on recurrent laryngeal nerve)

253
Q

Q253. Diagnostic results for Mitral Stenosis; Auscultation; CXR (2); EKG (3); Echo

A

A253. Auscultation: mid diastolic low pitched rumble with opening snap;; CXR: large Left atrium and Kerely B lines; EKG: LA enlargement; RV hypertrophy; A fib; Echo: abnormal valve

254
Q

Q254. Tx for mitral stenosis with each grade:; I (4);; II (2);; III/IV (1); What should always be avoided with mitral stenosis tx?

A

A254. Grade:; I: Diuretics; B Blockers; Anticoagulants; Digitalis; II: Drugs from I + Balloon valvuloplasty (if drugs dont work); III/IV: Balloon Valvuloplasty; Avoid: Inotropic Agents!

255
Q

Q255. Etiology of Acute Mitral Regurgitation; (2)

A

A255. MI with papillary muscle rupture;; Endocarditis

256
Q

Q256. Etiology of Chronic Mitral Regurgitation; (3)

A

A256. Rheumatic fever;; Mitral Prolapse;; LV dilation

257
Q

Q257. Diagnostic tests for Mitral Regurgitation; Auscultation; EKG; Echo

A

A257. Auscultation: Loud, holosystolic apical murmur radiating to axilla; EKG: large LA; Echo: valve problem

258
Q

Q258. Tx for Mitral Regurgitation (6)*

A

A258. DAVES Deal:; Diuretics;; ACEi;; Vasodilators;; Endocarditis prophylaxis;; Surgery if severe;; Digitalis

259
Q

Q259. Most common valvular disorder

A

A259. Mitral prolapse

260
Q

Q260. Asymptomatic murmur with genetic predisposition, seen most commonly in women

A

A260. Mitral Prolapse

261
Q

Q261. What (2) murmurs are seen in Marfan’s syndrome?

A

A261. Mitral prolapse; Aortic Regurgitation

262
Q

Q262. Tx for mitral prolapse?

A

A262. not necessary to tx unless symptomatic

263
Q

Q263. Mean survival rate for patients with Aortic Stenosis and:; 1. Angina; 2. Syncope; 3. Heart failure

A

A263. 1. 5 years; 2. 2 3 years; 3. 1 2 years

264
Q

Q264. Etiology of Aortic Stenosis (2)

A

A264. Calcific disease with age; Bicuspid valve (around age 40)

265
Q

Q265. Conditions with a wide Pulse Pressure; (6)*

A

A265. WAH HA H ide pulse pressure:; Wet beri beri;; Aortic Regurgitation;; Hyperthyroidism;; HTN;; Anemia;; Hypertrophic Subaortic Stenosis (IHSS)

266
Q

Q266. What (2) valve disorders result in severe decompensation to CHF due to the absence of hemodynamic compensation?; How are they treated?

A

A266. Mitral Regurgitation; Aortic Regurgitation; Tx: Emergent surgery

267
Q

Q267. Classic triad* of Sx for Aortic Stenosis; (4) other signs

A

A267. SAD:; Syncope;; Angina;; Dyspnea on Exertion; Others:; Forceful apex beat; narrow Pulse Pressure; Paradoxical S2 split; heard in carotids

268
Q

Q268. Diagnostic test results for Aortic Stenosis; Auscultation; EKG; Echo; CXR

A

A268. Auscultation: Loud systolic crescendo decrescendo murmur;; EKG: LV strain; CXR: calcifications on valve; Echo: diseased valve

269
Q

Q269. What is the EKG LV strain pattern seen in aortic stenosis?; (hint: affects 4 leads)

A

A269. ST depression + T wave inversion in I, aVL, V5 and V6

270
Q

Q270. Tx for aortic stenosis; What should be avoided?; (2)

A

A270. Valve replacement; AVOID Afterload reducers (ACEi & beta blockers)

271
Q

Q271. (2) main etiologies for Aortic Regurgitation

A

A271. Aortic root dilatation or dissection;; Valvular disease;

272
Q

Q272. (3)* causes of Aortic root dilatation thereby causing Aortic Regurgitation

A

A272. Marfan’s;; Idiopathic (but inc with HTN);; Collagen vascular disease

273
Q

Q273. (2) causes of Valvular disease thereby causing Aortic Regurgitation

A

A273. Rheumatic heart disease;; Endocarditis

274
Q

Q274. (6)* causes of proximal Aortic root dissection thereby causing Aortic Regurgitation

A

A274. “THE MTS”:; Third Trimester Pregnancy;; HTN;; Ehlers Danlos;; Marphans (Cystic medial necrosis);; Turner’s syndrome;; Syphilis;; (Aortic arch is shaped like a mountain)

275
Q

Q275. Names of the unique signs of Aortic regurgitation; (7)*

A

A275. Tap Water Quickly Complicates De Murmur Designs:; 1. Traube’s sign; 2. Water Hammer pulse; 3. Quincke’s sign; 4. Corrigan’s pulse; 5. de Musset’s sign; 6. Muller’s sign; 7. Duroziez’s sign

276
Q

Q276. Aortic regurgitation sign:; wide pulse pressure presenting w/forceful arterial pulse upswing with rapid falloff

A

A276. Water Hammer pulse

277
Q

Q277. Aortic regurgitation sign:; pistol shot bruit over femoral pulse

A

A277. Traube’s sign

278
Q

Q278. Aortic regurgitation sign:; unusually large carotid pulsations

A

A278. Corrigan’s pulse

279
Q

Q279. murmur sign:; pulsatile blanching & reddening of fingernails upon light pressure; What murmur?

A

A279. Quincke’s sign; (Aortic Regurgitation)

280
Q

Q280. Aortic regurgitation sign:; head bobbing caused by carotid pulsation

A

A280. de Musset’s sign; (head bobs like listening to “De Mussic”)

281
Q

Q281. Aortic regurgitation sign:; pulsatile bobbing of the uvula

A

A281. Muller’s sign

282
Q

Q282. Aortic regurgitation sign:; to and fro murmur over femoral artery (heard best with mild pressure applied to artery)

A

A282. Duroziez’s sign

283
Q

Q283. Murmur presentation:; dyspnea, orthopnea, paroxysmal nocturnal dyspnea, angina, LV failure, wide pulse pressure

A

A283. Aortic regurgitation

284
Q

Q284. Murmur presentation:; starts asymptomatic, then dyspnea, angina, syncope, heart failure

A

A284. Aortic stenosis

285
Q

Q285. Murmur presentation:; mostly asymptomatic, atypical chest pain, SOB, fatigue

A

A285. Mitral Prolapse

286
Q

Q286. Murmur presentation:; dyspnea, fatigue, weakness, cough, A fib, systemic emboli

A

A286. Mitral Regurgitation

287
Q

Q287. Murmur presentation:; DOE, rales, cough, hemoptysis, systemic emboli, RV precordial thrust, RV failure, Hoarse voice

A

A287. Mitral stenosis

288
Q

Q288. What is heard on Auscultation for Aortic regurgitation?; (3)

A

A288. 1. High pitched, blowing decrescendo diastolic murmur; 2. Apical diastolic rumble; (mitral stenosis without snap); 3. Midsystolic flow murmur at base

289
Q

Q289. Tx for Aortic regurgitation problems; (3)

A

A289. Tx LV heart failure;; Endocarditis prophylaxis;; Valve replacement

290
Q

Q290. Etiology of Tricuspid stenosis (3)*

A

A290. CCR:; Congenital;; Carcinoid;; Rheumatic heart disease

291
Q

Q291. Murmur presentation:; peripheral edema, JVD, hepatomegaly, ascites, jaundice; (2)

A

A291. Tricuspid stenosis; or; Tricuspid Regurgitation

292
Q

Q292. Auscultation results for Tricuspid stenosis?; Tx?

A

A292. Diastolic, rumbling low pitched heard with Inspiration; Tx: Repair valve

293
Q

Q293. Dx:; Patient with DVT has a stroke. He has a fixed S2 split

A

A293. Atrial Septal Defect; (with right to left emboli)

294
Q

Q294. Etiology of Tricuspid Regurgitation (4)

A

A294. Increased pulmonary artery Pressure; (from L CHF or Mitral stenosis/regurgitation);; R CHF;; Right papillary muscle rupture with MI;; Tricuspid valve lesions; (rheumatic heart or bacterial endocarditis)

295
Q

Q295. Holosystolic murmurs; (3)*

A

A295. MTV; Mitral Regurgitation;; Tricuspid regurgitation;; Ventricular Septal Defect

296
Q

Q296. Number 1 cause of death in CHF patients

A

A296. Arrhythmia

297
Q

Q297. Diagnostic results for Tricuspid Regurgitation:; Auscultation; EKG (2); Echo

A

A297. Auscultation: Holosystolic murmur increasing with inspiration; EKG: RV enlargement; A fib; Echo: diseased valve

298
Q

Q298. Tx for Tricuspid Regurgitation; (3)*

A

A298. Tricuspid Dying Slowly:; Tx heart failure;; Diuresis;; Surgical repair of valve

299
Q

Q299. What is done first if a patient has hyperK and peaked T waves? Why?

A

A299. give Calcium to stabilize cardiac membrane

300
Q

Q300. Murmur:; Diastolic apical rumble and opening snap

A

A300. Mitral stenosis

301
Q

Q301. Murmur:; Late systolic murmur with midsystolic click; What is confirming test?

A

A301. Mitral Prolapse; Valsalva click starts earlier, murmur prolonged

302
Q

Q302. Murmur:; High pitched apical blowing holosystolic murmur; where does it radiate?

A

A302. Mitral Regurgitation; radiates: Axillae

303
Q

Q303. Murmur:; Diastolic rumble louder with inspiration

A

A303. Tricuspid stenosis

304
Q

Q304. Murmur:; High pitched blowing holosystolic murmur heard better with inspiration; Where is it heard?; Where are pulsations seen?

A

A304. Tricuspid Regurgitation; heard at left sternal border; Jugular pulsations

305
Q

Q305. Name sign:; Peripheral pulses that are weak and late compared to heart sounds; What murmur?

A

A305. Pulsus Parvus et Tardus; Aortic Stenosis

306
Q

Q306. Murmur:; midsystolic crescendo decrescendo murmur; Where does it radiate? (2); What heart sound is also heard?

A

A306. Aortic stenosis; radiates to: Carotids and Apex; S4 also heard

307
Q

Q307. Name sign:; Double peaked arterial pulse; what murmur?

A

A307. Pulsus Bisferiens; Aortic regurgitation

308
Q

Q308. Murmur:; Blowing early diastolic, apical diastolic rumble, midsystolic flow murmurs

A

A308. Aortic Regurgitation

309
Q

Q309. Dx that causes Murmur:; Systolic murmur at apex and left sternal boarder not transmitted to carotids; How is it heard better?

A

A309. IHSS; heard better with standing after squat

310
Q

Q310. When during S1 S2 do you hear the “flow murmur” (murmur heard with any high flow state)?; What is differential dx? (5)*

A

A310. Midsystolic:; Aortic Regurgitation; Atrial Septal defect (fixed split S2); Anemia; Adolescence; Pregnancy

311
Q

Q311. difference b/t Type A and Type B Aortic Dissections

A

A311. Type A: involves the ascending aorta and can extend into the descending aorta; Type B: descending aorta only

312
Q

Q312. Debakey Classification of Aortic Dissection Types I III Which is most common?

A

A312. I: Ascending plus part of distal aorta (most common); II: Ascending only; III: Descending only

313
Q

Q313. What is infected on the aorta when the aortic dissection is due to syphilis?

A

A313. Vasa Vasorum

314
Q

Q314. Etiology of Aortic Dissection (7)

A

A314. PATC3H:; Pregnancy (3rd trimester);; Aortic Coarctation (Turners or idiopathic);; Trauma;; Congenital heart disease / CT disease (Marfans and E D syndromes) / Cocaine;; HTN

315
Q

Q315. Dx:; Severe tearing chest pain that radiates to the back, HTN, possible unequal pulses distally, possible aortic regurgitation murmur

A

A315. Aortic Dissection

316
Q

Q316. (3) tests to confirm Dx of aortic dissection

A

A316. Angiogram (gold standard);; CXR wide mediastinum;; CT with contrast

317
Q

Q317. Drug Tx for Aortic dissection to stabilize BP; (2); What is the next step for Type A vs. Type B?

A

A317. Rx: Beta blocker + nitroprusside to keep BP < 120; Type A: Immediate surgery; Type B: medical stabilization

318
Q

Q318. Etiologies of Syncope (7)

A

A318. SVNCOPE:; Situational (valsalva, tight collar);; Vasovagal response (common faint);; Neurogenic;; Cardiac;; Orthostatic hypotension;; Psychiatric (faking it);; Everything else (idiopathic)

319
Q

Q319. At what level is HDL cardioprotective?

A

A319. > 60

320
Q

Q320. What “type” is all isolated hypercholesterolemia?

A

A320. Type IIa

321
Q

Q321. What transports cholesterol from the gut to the bloodstream?

A

A321. Chylomicrons

322
Q

Q322. What is left over after lipoprotein lipase liberates FFA from chylomicrons for use in tissues?

A

A322. Chylomicron remnants

323
Q

Q323. What is secreted from the liver and carries endogenous cholesterol?

A

A323. VLDL

324
Q

Q324. What is metabolized from VLDL?

A

A324. Intermediate Density Lipoproteins (IDL)

325
Q

Q325. What is metabolized from IDL and carries cholesterol in the bloodstream to the tissues?

A

A325. LDL

326
Q

Q326. What takes up free cholesterol secreted by the tissues and transports it to the liver?

A

A326. HDL

327
Q

Q327. What is the name for the (3) Type IIa Isolated Hypercholesterolemias?; What is abnormal with all of them?; What is the total cholesterol range?

A

A327. Familial Hypercholesterolemia;; Familial defective apo B100;; Polygenic Hypercholesterolemia; High LDL; total cholesterol from 240 500

328
Q

Q328. What are the (3) isolated Hypertriglyceridemias and each “Type”?; What is elevated with each?

A

A328. 1. familial Hypertriglyeridemia Type IV high VLDL; 2. familial Apo CII deficiency; 3. familial Lipoprotein Lipase deficiency; (2 and 3 are both Type I + V high chylomicrons)

329
Q

Q329. Class of drugs that that reduce LDL by binding bile acids in the gut. name (2) drugs

A

A329. Bile Acid Sequestrants; Cholestyramine; Colestipol

330
Q

Q330. which drug class is best for reducing triglycerides in VLDL and chylomicrons?

A

A330. Fibrinates

331
Q

Q331. Etiologies of A Fib; (10)

A

A331. PIRATES:; Pulmonary (COPD, PE), Pheochromocytoma, Pericarditis;; Ischemic heart disease & HTN;; Rheumatic heart disease; Anemia;; Thyrotoxicosis;; Ethanol & cocaine;; Sepsis

332
Q

Q332. Signs/symptoms of A Fib; (5)

A

A332. A FL PT:; Asymptomatic patient;; Fatigue (most common);; Light headedness, syncope;; Palpitations, skipped beats;; Tachypnea, dyspnea

333
Q

Q333. Drugs given to A Fib to control rate in a non emergent situation; (2)

A

A333. oral Beta blocker:; Atenolol; (and); oral Calcium channel blockers:; Verapamil or Diltiazem

334
Q

Q334. what are the (2) ways to cardiovert an A Fib rhythm?; when should you not cardiovert?; what would the Tx be then?

A

A334. Medical: Amiodarone; Electrical: start @ 100 J; Do not cardiovert if patient is in A Fib > 24 hours. Tx: Warfarin for 3 4 weeks before cardioversion

335
Q

Q335. Dx:; when the heart is unable to pump sufficient amounts of blood to meet the O2 requirement of the body causing blood to backup

A

A335. Congestive Heart Failure; (CHF)

336
Q

Q336. What are the systolic dysfunctions of CHF?; (EF, Preload, LVEDP, contractility)

A

A336. Ejection Fraction < 40%; leading to Inc preload & LVEDP,; which leads to Dec contractility and Inc cardiac hypertrophy

337
Q

Q337. What causes CHF exacerbation in previously stable patients?; (10)

A

A337. FAILURE:; Forgot medication;; Arrhythmia, Anemia;; Ischemia, Infection;; Lifestyle (Inc sodium);; Upregulation (Inc cardiac output pregnancy or hyperthyroidism);; Renal failure with fluid overload;; Emboli (pulmonary); Endocarditis

338
Q

Q338. What are the diastolic dysfunctions of CHF?; (compliance, contraction, recoil, LVEDP, CO, EF)

A

A338. Decreased compliance with normal contractile function; (ventricle either cant relax or fill properly); leading to Inc stiffness, Dec recoil & coencentric hypertrophy. LVEDP is Inc,; CO is nml,; EF is nml to high

339
Q

Q339. What related heart conditions are seen in the systolic dysfunction of CHF that deals with decreased contractility?; (4)

A

A339. Ischemia(most common);; Dilated Cardiomyopathy;; Hypertensive burnout;; Valvular disease

340
Q

Q340. What related conditions are seen in the systolic dysfunction of CHF that deals with Inc afterload?; (3)

A

A340. Hypertension;; Aortic stenosis;; Aortic regurgitation

341
Q

Q341. What related conditions are seen in the diastolic dysfunction of CHF that deals with abnormal active relaxation?; (2)

A

A341. Ischemia;; Hypertrophic cardiomyopathy; (from disorders causing LVH)

342
Q

Q342. What related conditions are seen in the diastolic dysfunction of CHF that deals with abnormal passive filling?; (2)

A

A342. Restrictive cardiomyopathy;; Concentric hypertrophy from HTN

343
Q

Q343. What are the early signs of Left sided CHF?; (2)

A

A343. Dyspnea on exertion;; Dec exercise tolerance

344
Q

Q344. What are the late sx of Left sided CHF?; (8)

A

A344. PORNS DD Tits:; Paroxysmal Nocturnal Dyspnea;; Orthopnea;; Rales & crackles;; Nocturia;; S 3 gallop;; Diaphoresis;; Displaced PMI (laterally);; Tachycardia

345
Q

Q345. What are the early signs of Right sided CHF?; (6)

A

A345. A Juicy CHERry:; Anorexia; JVD*; Cyanosis; Hepatomegaly; Edema in periphery; RUQ pain

346
Q

Q346. What are the late sx of Right sided CHF?; (2)

A

A346. abnormal Hepatojugular reflex;; Ascites

347
Q

Q347. NY Heart Assoc Functional Classes of Heart Failure (I IV); [measures pt activity]

A

A347. I: No limitation; II: slight limitation; III: Sx with minimal effort, ok at rest; IV: Sx at rest

348
Q

Q348. What drug classes are good versus CHF? Which ones are only helpful if patient has a diastolic dysfunction?

A

A348. Systolic or Diastolic dysfunction:; ACEIs/ARBs; Beta blockers; diuretics; Diastolic dysfunction only:; Calcium channel blockers; Nitroglycerin

349
Q

Q349. What diuretics are used for mild CHF and (2 for) significant CHF?

A

A349. Mild:; Thiazides; Significant CHF:; Loop diuretics; Spirolactone

350
Q

Q350. What is the difference in the signs/sx of people with right CHF and cirrhosis?; (2)

A

A350. Same sx, except right CHF patients have trouble lying flat & have JVD

351
Q

Q351. what are the (5) Tx for Acute Pulmonary Edema & Paroxysmal Nocturnal Dyspnea?

A

A351. NOMAD:; Nitroglycerin; Oxygen; Morphine; Aspirin; Diuretic

352
Q

Q352. Describe (2) types of Malignant HTN; (+ BP limits)

A

A352. Hypertensive URGENCY:; systolic >200 or diastolic >110; WITHOUT evidence of end organ damage; Hypertensive EMERGENCY:; Severe HTN with evidence of end organ damage; (encephalopathy, renal failure, CHF, etc)

353
Q

Q353. what is important to remember about treating a hypertensive emergency?; (2)

A

A353. 1) Immediate therapy is needed; 2) IV drip with Nitroprusside or Nitroglyerin, but do not lower BP by more then 1/4 at first, or patient can have a stroke

354
Q

Q354. DOC for HTN with CHF; (3)

A

A354. ACEI / ARBs; B blocker,; K sparing diuretic

355
Q

Q355. DOC for HTN with MI; (2)

A

A355. B blocker & ACEI

356
Q

Q356. renal artery stenosis that causes HTN in:; 1) older men; 2) younger women

A

A356. 1) atherosclerosis; 2) fibromuscular dysplasia

357
Q

Q357. valvular problem that causes HTN with a wide PP due to Inc SV

A

A357. Aortic Regurgitation

358
Q

Q358. congenital problem that causes HTN with a wide PP due to Inc SV

A

A358. Patent Ductus Arteriosus

359
Q

Q359. (3) drug classes that cause HTN; What metal poisoning?

A

A359. Oral contraceptives; Corticosteroids; Amphetamines; Lead poisoning

360
Q

Q360. (6) Major risk factors for CAD; which is most prevetable?; which is the greatest risk?

A

A360. Diabetes (greatest); Smoking (most preventable); HTN; Hypercholesterolemia; Family History; Age

361
Q

Q361. Chest pain that has an established character, timing and duration; pain is transient, reproducible and predictable. What is cause?; What is Tx? (2)

A

A361. Stable Angina; Reduced coronary blood flow through fixed atherosclerotic plaque in vessel of heart; rest & nitroglycerin

362
Q

Q362. exertional substernal (precordial) chest pressure and pain radiating to left arm, jaw or back. N/V, diaphoresis, dyspnea, HTN and tachycardia can accompany it. Name the types

A

A362. Angina:; Stable; Unstable; Variant (Prinzmetal’s)

363
Q

Q363. Angina type that is also considered an Acute Coronary Syndrome (ACS). What (3) factors must it have for diagnosis?

A

A363. Unstable Angina; 1) New onset; 2) angina that changes or accelerates in pattern, location or severity; 3) Occurs at REST

364
Q

Q364. Similar characteristics of stable angina, but due to vasospasm instead of atherosclerosis. (2) Tx?

A

A364. Variant (Prinzmetal’s) Angina; Nitrates & Calcium Channel blockers

365
Q

Q365. what (2) groups of patients may not show the classic signs pain seen in stable angina?; Why?

A

A365. Elderly & diabetics; (b/c: neuropathies)

366
Q

Q366. 62 years old smoker with 3 episodes of severe heavy chest pain in the morning. Each lasted 3 5 minutes, but he has no pain now. He has never had this before. What is it?

A

A366. Unstable Angina

367
Q

Q367. 62 years old man with frequent episodes of chest pain on and off for 8 months. He says the pain wakes him from sleep at night. What is it?

A

A367. Variant (Prinzmetal’s) Angina

368
Q

Q368. What is the criteria for a “positive” Stress Test?; (5)

A

A368. either:; ST elevation; ST depression >1 mm in multiple leads; Dec BP; failure to go more than 2 minutes; failure to complete for reason other then cardiac symptoms (i.e. arthritis)

369
Q

Q369. what does Myocardial Perfusion Imaging detect?; (3)

A

A369. Myocardial perfusion; Ventricular volume; Ejection Fraction

370
Q

Q370. (5) uses for a cardiac catherization

A

A370. 1) MI / Unstable angina: stent or angiography; 2) Valvular disease: valvuloplasty; 3) Arrhythmias: mapping bypass tracts; 4) Myocardial disease Bx: glycogen storage disease or cardiomyopathies; 5) Congenital heart disease identification: angiography & closure of defects

371
Q

Q371. How is the right heart accessed in a cardiac catheterization? (2); Left heart? (2)

A

A371. Right:; Femoral or Internal Jugular; Left:; Femoral or Radial artery (from right heart)

372
Q

Q372. what is the wave morphology changes sequence in a MI ECG?; (6)

A

A372. 1. peaked T waves; 2. T wave inversion; 3. ST elevation; 4. Q waves; 5. ST normalization; 6. T waves return upright

373
Q

Q373. which cardiac enzyme has the shortest duration?; Longest?

A

A373. Myoglobin (1 day); Troponin I/T (7 10 days)

374
Q

Q374. difference b/t unstable angina & non ST elevation MI?; (2)

A

A374. non ST elevation MI has:; 1. more severe lack of Oxygen (more severe myocardial damage); 2. Enzyme leakage (Unstable angina has none)

375
Q

Q375. Tx for Unstable angina & MI; (6)

A

A375. MONA has HEP B:; Morphine; Oxygen; Nitrates; Aspirin; HEParin; Beta blockers

376
Q

Q376. primary Tx (2) for the acute MI w/in 6 hours of infarct; (name 4 drugs)

A

A376. Thrombolytics:; tPA + Heparin (DOC); Urokinase; strptokinase; Alteplase

377
Q

Q377. At what level should LDL be in person with MI history?; What is given to lower it?

A

A377. less then 100; statins

378
Q

Q378. When are thrombolytics indicated in MI?; (3)

A

A378. patients < 80 yo; within 6 12 hrs of chest pain; evidence of infarct on ECG

379
Q

Q379. Contra indications of Thrombolytics; (9)

A

A379. Having Some Breaks A Blood Clot In Small Pieces:; History of intracranial bleed; stroke < 1 year; BP > 180/110; active internal bleed; bleeding disorder; CPR; Intracranial tumor; suspected aortic dissection; Peptic ulcer

380
Q

Q380. drug that prevents future clots from forming

A

A380. heparin

381
Q

Q381. Tx of choice for MI if there is a high risk of ST elevation (cardiogenic shock) or it has been 3 hours since initial symptoms presented?

A

A381. PTCA; (Percutaneous Transluminal Coronary Angioplasty)

382
Q

Q382. which throbolytic is highly immunogenic and cannot be used in the same patient twice in a 6 month period?

A

A382. streptokinase

383
Q

Q383. drug class that is excellent for late & long term therapy for acute MI to decrease afterload and prevent remodeling?

A

A383. ACEi

384
Q

Q384. how many seconds & boxes is a normal PR interval?

A

A384. 0.2 ms; 5 small boxes

385
Q

Q385. define:; Q wave; When is it pathologic?

A

A385. when initial part of ventricular depolarization is downward; Pathologic: greater then 1 small box

386
Q

Q386. normal time & boxes for QRS interval?

A

A386. < 0.12 ms; 3 small boxes

387
Q

Q387. define:; Junctional rhythm

A

A387. rhythm originating in the AV node & causing narrow QRS without P waves

388
Q

Q388. no p waves;; all complexes are wide;; no changes in height (amplitude) with each complex;; > 100bpm

A

A388. Ventricular tachycardia

389
Q

Q389. wide QRS complexes that vary in amplitude; (2 names)

A

A389. Ventricular Fibrillation; Torsades de Pointes

390
Q

Q390. normal sinus rhythm with PR interval > 0.2 ms (> 5 small boxes)

A

A390. First degree AV block

391
Q

Q391. PR interval elongates from beat to beat until it becomes so long that a beat drops

A

A391. Second degree AV block, type 1; (Wenckebach)

392
Q

Q392. PR interval is fixed but every so often there is a P wave without a QRS

A

A392. Second degree AV block, type 2; (Mobitz)

393
Q

Q393. no relationship b/t P waves and QRS complexes

A

A393. Third degree AV block

394
Q

Q394. QRS > 0.12 (> 3 small boxes); RSR’ in V1 & V2;; deep S wave in lateral leads (I, aVL, V5 & V6)

A

A394. RBBB

395
Q

Q395. QRS > 0.12 (> 3 small boxes);; RSR’ in V5 & V6;; diffuse ST elevation

A

A395. LBBB

396
Q

Q396. Different shapes to 3 or more P waves;; normal rhythm; (what is it called if it is tachycardic?)

A

A396. Wandering pacemaker; MFAT:; Multifocal Atrial Tachycardia

397
Q

Q397. short PR interval;; slurring delta wave connecting P wave to QRS complex

A

A397. Wolff Parkinson White syndrome

398
Q

Q398. diffuse ST elevation that slopes in a concave manner back to baseline + diffuse PR segment depression in all leads except PR elevation in aVR

A

A398. Pericarditis

399
Q

Q399. Tx of wandering pacemaker & MFAT?; (1 drug / 1 “other”)

A

A399. Verapamil (Ca channel block); &; Tx underlying condition

400
Q

Q400. what Tx breaks SVT (supraventricular tach) in > 90%?

A

A400. Adenosine; (failure to break r/o SVT)

401
Q

Q401. Tx of asymptomatic V tach; (2)

A

A401. Amiodarone; Lidocaine

402
Q

Q402. 58 years old man discharged from hospital after MI 2 weeks ago presents with fever, chest pain & malaise. EKG shows diffuse ST T wave changes. What is Dx?; What is Tx?

A

A402. Dressler’s syndrome; NSAIDs

403
Q

Q403. Medication orders with dischsrge of an ACS (post MI) patient?; (5)

A

A403. easy AS ABC:; Aspirin (indefinitely); Statin to lower LDL < 100; ACE inh (if EF <40%); Beta blocker (indefinitely); Clopidogrel for 1 12 mo depending on stent placement

404
Q

Q404. Dx:; fever, pericarditis & possible pericardial or pleural effusions post cardiac surgery

A

A404. Dressler’s syndrome

405
Q

Q405. SVT with AV block & yellow skin

A

A405. Digoxin toxicity

406
Q

Q406. Etiology of Dilated Cardiomyopathy; (6)

A

A406. TIMED:; Toxic (EtOH, heavy metals); Infectious / Ischemic; Metabolic / Mechanical (arrhythmia, valve disease); Endocrine; Drugs

407
Q

Q407. what is the Reversible & Irreversible(2) toxic causes of Dilated Cardiomyopathy?

A

A407. Reversible:; prolonged EtOH use; Irreversible:; Cocaine;; heavy metal toxicity

408
Q

Q408. what is the Reversible & Irreversible(2) endocrine causes of Dilated Cardiomyopathy?

A

A408. Reversible:; Thyroid disease (hypo or hyper); Irreversible:; Acromegaly;; Pheochromocytoma

409
Q

Q409. Reversible metabolic causes of Dilated Cardiomyopathy?; (4)

A

A409. HypoC;; HypoP;; Thiamine deficiency (wet beri beri);; Selenium deficiency

410
Q

Q410. Infections that cause Dilated Cardiomyopathy; (3)

A

A410. HIV;; Coxsackie virus;; Chagas disease

411
Q

Q411. Drugs that cause Dilated Cardiomyopathy; (2)

A

A411. Doxorubicin (Adriamycin);; AZT

412
Q

Q412. Signs/Sx of Dilated Cardiomyopathy

A

A412. RAMS:; R & L Heart failure;; A fib;; Mitral regurgitation;; S 3 Gallop

413
Q

Q413. Diastolic or Systolic Disease Cardiomyopathy:; 1. Dilated; 2. Restrictive; 3. Hypertrophic

A

A413. Systolic:; Dilated; Diastolic:; Restrictive &; Hypertrophic

414
Q

Q414. Diagnostic results of Dilated cardiomyopathy; auscultation; EKG (3); CXR (2); Echo (2)

A

A414. Auscultation: S 3;; EKG: Vent Hypertrophy, BBB &/or A fib;; CXR: Inc heart size; pulm congestion; Echo: low EF, large ventricles

415
Q

Q415. Tx Dilated Cardiomyopathy; (3)

A

A415. stop any toxic agents; anticoagulation with coumadin (even without evidence of thrombus); heart transplant

416
Q

Q416. Right or left ventricular enlargement with loss of contractile function causing CHF, arrhythmia, or throbus formation.

A

A416. Dilated Cardiomyopathy

417
Q

Q417. Scarring & infiltration of the myocardium causing decreased right or left ventricular filling

A

A417. Restrictive Cardiomyopathy

418
Q

Q418. Etiology of Restrictive Cardiomyopathy; (7)

A

A418. ACHES:; Amyloidosis;; Carcinoid heart disease / Congenital;; Hemochromatosis;; Endomyocardial fibrosis; Sarcoidosis / Scleroderma

419
Q

Q419. Dx:; Pulmonary HTN (right CHF);; S 4 gallop; Low QRS voltage on EKG; Exercise intolerance;; Diastolic disease

A

A419. Restrictive Cardiomyopathy

420
Q

Q420. (5) tests used to assist in the Dx of Restrictive Cardiomyopathy

A

A420. Auscultation;; EKG;; CXR;; Echo;; Endomyocardial Bx*

421
Q

Q421. Increase in the size of the interventricular septum causing narrowing of the LV outflow tract leading to anterior mitral valve outflow obstruction

A

A421. Hypertrophic Cardiomyopathy

422
Q

Q422. etiology of Hypertrophic Cardiomyopathy

A

A422. 50% idiopathic; 50% familial (autosomal dominant, with variable penetrance)

423
Q

Q423. Dx:; Angina (at rest or exercise); Syncope; Arrhythmias; CHF

A

A423. Hypertrophic Cardiomyopathy

424
Q

Q424. 25 years old man becomes severely dyspneic & collapses while running laps, His father died suddenly at an early age.

A

A424. Hypertrophic CM (IHSS)

425
Q

Q425. Diagnostic results to Dx Hypertrophic CM; Auscultation (2); EKG (4); Echo (2)

A

A425. Auscultation Systolic ejection murmur;; Paradoxical splitting of S2;; EKG LVH, PVCs, A fib, ST & Q abnormalities;; Echo septal hypertrophy, LVH with small LV

426
Q

Q426. Tx for Hypertrophic CM; (3)

A

A426. No exercise; Beta blocker; implantable cardiac defibrillator

427
Q

Q427. Etiology of Pericarditis; (6)

A

A427. Bacterial, viral or fungal infections;; Serositis from:; RA;; SLE;; Scleroderma;; Uremia;; post MI (Dressler’s syndrome)

428
Q

Q428. Tx for pericarditis if:; infection; pain/inflammation; Dressler’s; Recurrent cases

A

A428. Tx infection with Abx;; NSAIDs to relieve pain & reduce inflammation;; Steroids for Dressler’s;; Pericardectomy only with recurrent cases

429
Q

Q429. Transient fall in BP > 10 mmHg during inspiration

A

A429. Pulsus Paradoxus

430
Q

Q430. Physiologic result of rapid accumulation of fluid in the pericardial sac; impairs cardiac filling & reduces cardiac output

A

A430. Pericardial Tamponade

431
Q

Q431. Etiology of Pericardial Tamponade; (3)

A

A431. Pericarditis; Trauma; Aortic dissection or ventricular rupture into pericardium

432
Q

Q432. Beck’s triad of the pericardial tamponade; (4) other signs/Sx

A

A432. Beck’s triad:; Hypotension; Muffled heart sounds; JVD; Other Sx:; Dyspnea;; Tachycardia;; Pulsus Paradoxus*; narrow Pulse Pressure

433
Q

Q433. Tx for Pericardial Tamponade for:; 1. unstable; 2. stable; 3. both

A

A433. Unstable: Immediate Pericardiocentesis;; Stable: Pericardial window; Both: Infuse fluids to expand volume

434
Q

Q434. Patient has chest pain with inspiration that radiates to the left trapezial ridge;; Pain is relieved by sitting up and leaning forward; does not respond to nitroglycerine

A

A434. Pericarditis

435
Q

Q435. Murmur type:; Dyspnea on Exertion; Cough, rales; signs of RV failure;; RV precordial thrust; Hoarse voice (from enlarged LA on recurrent laryngeal nerve)

A

A435. Mitral Stenosis

436
Q

Q436. Diagnostic results for Mitral Stenosis; Auscultation; CXR; EKG

A

A436. Auscultation: mid diastolic opening snap;; CXR: large Left atrium & Kerely B lines; EKG: LA enlargement; RV hypertrophy; A fib

437
Q

Q437. Tx for mitral stenosis with each grade (I IV); What should always be avoided with mitral stenosis tx?

A

A437. Grade:; I: Diuretics; B Blockers; Anticoagulants; Digitalis; II: Drugs from I + Balloon valvuloplasty (if drugs dont work); III/IV: Balloon Valvuloplasty; Avoid: Inotropic Agents!

438
Q

Q438. Acute etiology of Mitral Regurgitation; (2)

A

A438. MI with papillary muscle rupture;; Endocarditis

439
Q

Q439. Chronic etiology of Mitral Regurgitation; (3)

A

A439. Rheumatic fever;; Mitral Prolapse;; LV dilation

440
Q

Q440. Diagnostic tests for Mitral Regurgitation; Auscultation; EKG; Echo

A

A440. Auscultation: Loud, holosystolic apical murmur radiating to axilla; EKG: large LA; Echo: valve problem

441
Q

Q441. Tx for Mitral Regurgitation; (6)

A

A441. ACEinh;; Diuretics;; Vasodilators;; Digitalis;; Endocarditis prophylaxis;; Surgery if severe

442
Q

Q442. What murmur is seen in Marfan’s syndrome?

A

A442. Mitral prolapse

443
Q

Q443. Mean survival rate for patients with Aortic Stenosis and:; 1. Angina; 2. Syncope; 3. Heart failure

A

A443. 1. 5 years; 2. 2 3 years; 3. 1 2 years

444
Q

Q444. Etiology of Aortic Stenosis; (2)

A

A444. Calcific disease with age; Bicuspid valve (around age 40)

445
Q

Q445. Conditions with a wide Pulse Pressure; (6)

A

A445. WAH HAH ide pulse pressure:; Wet beri beri; Aortic Regurgitation;; Hyperthyroidism;; Hypertension;; Anemia;; Hypertrophic Subaortic Stenosis (IHSS)

446
Q

Q446. WHat (2) valve disorders result in severe decompensation to CHF due to the absence of hemodynamic compensation. How is it treated?

A

A446. Mitral Regurgitation; Aortic Regurgitation; Tx: Emergent surgery

447
Q

Q447. Classic triad of Sx for Aortic Stenosis; (4) other signs

A

A447. SAD:; Syncope;; Angina;; Dyspna on Exertion; Others:; Forceful apex beat; narrow Pulse Pressure; Paradoxical S2 split; heard in carotids

448
Q

Q448. Diagnostic test results for Aortic Stenosis; Auscultation; EKG; Echo; CXR

A

A448. Auscultation: Loud systolic crescendo decrescendo murmur;; EKG: LV strain; CXR: calcifications on valve; Echo: diseased valve

449
Q

Q449. What is the EKG LV strain pattern seen in aortic stenosis?

A

A449. ST depression & T wave inversion in I, aVL, V5 & V6

450
Q

Q450. Tx for aortic stenosis; (2)

A

A450. avoid Afterload reducers (ACEinh & beta blockers); Valve replacement

451
Q

Q451. (3) main etiologies for Aortic Regurgitation

A

A451. Aortic root dilatation;; Valvular disease;; Proximal Aortic root dissection

452
Q

Q452. (3) causes of Aortic root dilatation thereby causing Aortic Regurgitation

A

A452. Marfan’s;; Idiopathic (but inc with HTN);; Collagen vascular disease

453
Q

Q453. (6) causes of proximal Aortic root dissection thereby causing Aortic Regurgitation

A

A453. “C 3 SHET”:; Cystic medial necrosis (Marfans);; 3rd trimester pregnancy;; Syphilis;; HTN;; Ehlers Danlos;; Turner’s syndrome

454
Q

Q454. Names of the 7 unique signs of Aortic regurgitation

A

A454. 1. Water Hammer pulse; 2. Traube’s sign; 3. Corrigan’s pulse; 4. Quincke’s sign; 5. de Musset’s sign; 6. Muller’s sign; 7. Duroziez’s sign

455
Q

Q455. Aortic regurgitation sign:; wide pulse pressure presenting w/forceful arterial pulse upswing with rapid falloff

A

A455. Water Hammer pulse

456
Q

Q456. Aortic regurgitation sign:; pistol shot bruit over femoral pulse

A

A456. Traube’s sign

457
Q

Q457. Aortic regurgitation sign:; unusually large carotid pulsations

A

A457. Corrigan’s pulse

458
Q

Q458. Aortic regurgitation sign:; pulsatile blanching & reddening of fingernails upon light pressure

A

A458. Quincke’s sign

459
Q

Q459. Aortic regurgitation sign:; head bobbing caused by carotid pulsation

A

A459. de Musset’s sign

460
Q

Q460. Aortic regurgitation sign:; pulsatile bobbing of the uvula

A

A460. Muller’s sign

461
Q

Q461. Aortic regurgitation sign:; to & fro murmur over femoral artery (heard best with mild pressure applied to artery)

A

A461. Duroziez’s sign

462
Q

Q462. Murmur presentation:; dyspnea, orthopnea, paroxysmal noctournal dyspnea, angina, LV failure,; wide pulse pressure

A

A462. Aortic regurgitation

463
Q

Q463. Murmur presentation:; starts asymptomatic, then dyspnea, angina, syncope, heart failure

A

A463. Aortic stenosis

464
Q

Q464. Murmur presentation:; mostly asymptomatic, atypical chest pain, SOB, fatigue

A

A464. Mitral Prolapse

465
Q

Q465. Murmur presentation:; dyspnea, fatigue, weakness, cough, A fib, systemic emboli

A

A465. Mitral Regurgitation

466
Q

Q466. Murmur presentation:; DOE, rales, cough, hemoptysis, systemic emboli, RV precordial thrust, RV failure, Hoarse voice

A

A466. Mitral stenosis

467
Q

Q467. How do you diagnose LVH from a ECG?; (2)

A

A467. 1. S wave in V1 + R wave in V5 or V6 > 7 large boxes (35 small); 2. R wave in V5 or V6 > 25 small boxes OR R wave in lead aVL > 11 small boxes

468
Q

Q468. Diagnostic tests for Aortic Regurgitation; Auscultation (3); EKG

A

A468. Auscultation:; 1. Holosystolic, blowing decrescendo diastolic murmur; 2. Apical diastolic rumble (mitral stenosis without snap); 3. Midsystolic flow murmur at base; EKG: LVH; Echo: regurgitant valve

Clinical Medicine (7 decks)

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