Cardiology Flashcards
(126 cards)
1
Q
You feel a pulse that seems to be vibrating. What term do you use to describe it?
A
thrill
2
Q
What are three things in your differential if you have a paradoxical pulse?
A
cardiac tamponade, pericarditis and obstructive lung disease
3
Q
On palpation, what size is normal for the aorta?
A
less than 3 cm
4
Q
A fixed or consistent split S2 should make you think of what diagnosis?
A
atrial septal defect
5
Q
A pathologic S3 is most commonly associated with what diagnosis?
A
CHF
6
Q
A continuous murmur most likely involves what area of the heart?
A
septal defect
7
Q
You hear a continuous machine-like murmur. What is the most likely diagnosis?
A
pda
8
Q
What is the gold standard for diagnosing coronary artery disease?
A
cardiac cath
9
Q
Define stage 1 hypertension according to JNC 7.
A
Systolic pressure of 140-159 and diastolic of 90-99
10
Q
goal for BP in diabetic
A
130/80
11
Q
What is the most common cause of secondary hypertension?
A
chronic kidney disease
12
Q
No matter what medications you use you are having trouble keeping a patient’s blood pressure under control. You also notice hyperpigmented skin and truncal obesity. What is the most likely diagnosis?
A
Cushing’s disease
13
Q
List three signs or symptoms which will likely be included in a description of a patient with a pheochromocytoma?
A
thin, diaphoretic, tachycardic, agitated, hypertensive
14
Q
You have a patient with diagnosis of a pheochromocytoma. While waiting for surgery should you use an alpha blocker or a beta blocker?
A
alpha blocker. never a pure beta blocker
15
Q
A young boy comes into your office. He has elevated blood pressure when taken in his arm, but no palpable femoral pulse. What is the most likely diagnosis?
A
coarctation of the aorta
16
Q
What is the most common cause of CHF?
A
coronary artery disease
17
Q
What ejection fraction is typical for a patient with CHF?
A
35-40%
18
Q
Bat wing vessels or Kerley B lines on a CXR should make you think of what diagnosis?
A
CHF
19
Q
A beta natriuretic peptide below what level rules out CHF?
A
<100
20
Q
What is the therapeutic range for INR following a mechanical valve replacement?
A
2.5-3.5
21
Q
What is the first line IV inotropic agent when dealing with cardiogenic shock?
A
dopamine
22
Q
What diagnosis is most likely in an IV drug user with a new heart murmur and fever?
A
endocarditis
23
Q
List two diagnoses which require antibiotic prophylaxis for “dirty procedures?”
A
Prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congential cyanotic heart defect
24
Q
Does a patient with mitral valve prolapse require prophylactic antibiotics for dental work?
A
No, a recent change moves mitral valve prolapse from high risk to moderate risk.
25
What are the three major criteria for endocarditis?
2 positive blood cultures, a positive transesophageal echocardiography, new murmur
26
Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?
osler nodes
27
List the 4 minor criteria for diagnosing endocarditis.
Fever, embolic event (Janeway lesions or petechiae, splinter hemorrhages), immunological event (osler nodes, glomerulonephritis), 1 positive blood culture
28
What are the five components of tetralogy of Fallot?
Ventricular septal defect, right ventricular hypertrophy, right ventricular outflow obstruction (pulmonary valve stenosis), overriding aorta, right sided aortic arch
29
What is the gold standard for diagnosing myocarditis?
myocardial biopsy
30
Where do most aortic dissections occur?
The ascending or descending thoracic aorta
31
A patient complains of severe pleuritic chest pain that is worse when leaning forward. What is the most likely diagnosis?
pericarditis
32
What is the first line medical treatment for pericarditis?
aspirin and NSAIDS
33
What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?
dressler syndrome
34
A patient presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all of the leads. What is the most likely diagnosis?
pericarditis
35
Define paradoxical pulse.
There is a large difference in pulse pressure between inhalation and exhalation.
36
Define pulsus alternans.
EKG waveform changes from beat to beat
37
What is the definitive treatment for cardiac tamponade?
pericardiocentesis
38
On physical exam you hear a harsh systolic murmur along the right sternal border. What is the most likely diagnosis?
aortic stenosis
39
A wide pulse pressure with a blowing diastolic decrescendo murmur at the right 2nd intercostal space should make you think of what diagnosis?
aortic regurg
40
What two antibiotics are used for empiric treatment of endocarditis?
vanco and ceftriaxone
41
What two valvular issues do patients with Marfan's syndrome often have?
Aortic regurgitation and mitral valve prolapse (you can tell them apart by where they are heard).
42
What are the two main causes of aortic stenosis?
Congenital bicuspid valve and calcification of the valve secondary to coronary artery disease
43
An elderly patient presents with dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely diagnosis?
aortic stenosis
44
On auscultation you hear a harsh, blowing,
| pansystolic murmur at the apex. What is the most likely diagnosis?
mitral regurg
45
You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis?
transesophageal echo
46
A patient with mitral valve prolapse will often have what physical characteristics?
thin female
47
What is the best patient position to hear aortic regurge and aortic stenosis?
sitting up and leaning forward
48
What is Tietze syndrome?
costochondritis
49
Are most pulmonary valve problems congenital or acquired?
95% are congenital
50
What is the therapeutic range for INR following an organic valve replacement?
2-3
51
A 60 year old male presents to the ER with severe dizziness and back pain. His blood pressure is dropping and you can feel an abdominal pulsatile mass on physical exam. What is the most likely diagnosis?
ruptured aortic aneurysm
52
A patient complains of severe crushing chest
pain. EKG shows ST segment elevations. All labs including troponins and CK-MB are negative. What is the most likely diagnosis?
prinzmetal's angina
53
A question about Prinzmetal's angina will often contain what key thing in the patient's history?
cocaine use
54
Name two things that would constitute a positive
| stress test.
A drop in blood pressure, a new arrhythmia, an increase in angina symptoms, ST depressions
55
Are ulcers from venous insufficiency painful or painless?
painless
56
A patient has just received a cardiac stent. How long will he be on aspirin and clopidogrel?
1 year
57
Where is disease of the mitral valve best heard?
apex
58
Clot busting drugs should be used within 3 hours of which two cardiac events?
STEMI and new LBBB
59
List three catastrophic complications of a myocardial infarction.
Papillary muscle rupture, myocardial wall rupture and left ventricular aneurysm
60
An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely diagnosis?
SVT
61
Acute endocarditis is most commonly caused by what organism?
staph aureus
62
What is the most common cause of an atrial septal defect?
patent foramen ovale
63
Where on your patient should you listen for the murmur associated with an atrial septal defect?
At the left second or third interspace
64
What is the appropriate treatment for a patent ductus arteriosus.
indomethacin
65
A Blalock procedure is used to correct what congenital heart condition?
tetralogy of Fallot
66
you hear a loud, harsh pulmonary murmur along the left sternal border. What is the most likely diagnosis?
ventricular septal defect
67
Subacute endocarditis is most commonly caused by what organism?
strep viridans
68
What is the most common place for an aortic aneurysm?
abdomen, below renal arteries
69
The accessory pathway known as the James bundle should make you think of what syndrome?
Lown-Ganong-Levine syndrome
70
What imaging needs to be done before taking a patient to the OR with an aortic aneurysm?
CT (echo may be used as initial study, but CT is need for surgery)
71
List two risk factors for an aortic dissection?
Hypertension, Marfan's syndrome, bicuspid aortic valve, pregnancy
72
What will a CXR show for a patient with an aortic dissection?
widened mediastinum
73
What is the best test to diagnose an aortic
| dissection?
CT
74
List the six P's of an ischemic limb.
Pain, paresthesias, pallor, pulselessness, poikilothermia, paralysis
75
You have a patient with pulsus paradoxus. What two diagnosis should you be thinking of?
pericarditis, pleural effusion, obstructive lung disease
76
A patient complains of pain in his legs when he walks. It goes away after sitting. What term comes to mind for this symptom? What diagnosis is it associated with?
Intermittent claudication caused by peripheral arterial disease
77
Giant cell arteritis is associated with what other disease?
polymyalgia rheumatica
78
A sawtooth pattern on EKG should make you think of what diagnosis?
atrial flutter
79
A biphasic P wave should make you think of what diagnosis?
left atrial enlargement
80
List the components of Virchow's triad.
stasis, hypercoagulable state, vascular injury
81
Where is disease of the tricuspid valve best heard?
Along the left lower sternal border
82
What is the most common congenital heart
| disease?
VSD
83
Are ulcers from arterial insufficiency painful or painless?
painful
84
Give two contraindications for using an ACEI.
bilateral renal artery stenosis, hx of angioedema, pregnancy
85
Both lead I and AVF have positive QRS complexes. Does this represent normal axis, left axis deviation or right axis deviation?
normal axis
86
An RSR prime in leads V1 or V2 should make you think of what diagnosis?
RBBB
87
Which lab should be tightly monitored in a patient taking an aldosterone antagonist?
potassium, they may have hyperkalemia
88
Which cardiac medication is used to help with cardiac contractility after you have optimized most of the other cardiac medications?
digoxin
89
A blockage of which artery causes an anterior wall MI?
LAD
90
A patient has a GFR of 25 and HTN. Which class should you use, a loop or a thiazide diuretic?
Loop. thiaides only work with GFR over 30
91
Which EKG leads are used to diagnose an anterior wall MI?
V1, 2, 3
92
Do loop diuretics cause hyperkalemia or hypokalemia?
hypokalemia
93
A patient recently started taking Lipitor. He is now complaining of aches and pains. What test should you order?
Serum creatinine kinase, you're looking for rhabdomyolysis.
94
Which hyperlipidemia medication may cause flushing?
niacin
95
Name three medication “classes” which are used to reduce LDL?
statins, ezetimibe, niacin, nicotinic acid
96
List three class 1a antiarrhythmics.
Disopyramide, quinidine, procainamide
97
You are counting boxes from the peak of a QRS wave on an EKG in order to determine the heart rate. What would the heart rate be if the next QRS wave peak were three boxes away? What numbers are associated with the first five boxes?
The answer is 100. The heart rates by counting boxes are 300, 150, 100, 75, 60.
98
A U wave on EKG should make you think of what
| diagnosis?
hypokalemia
99
What will the heart rate be if the AV node is pacing the heart?
40-60 bpm
100
Lead I has a QRS that is up and the AVF lead has a QRS complex that is down. Does this represent normal axis, left axis deviation or right axis deviation?
left axis deviation
101
Which cardiac medication has gynecomastia in its side effect profile?
spironolactone
102
An Osborne or J wave on EKG should make you think of what diagnosis?
hypothermia
103
What is the first line medication for a patient with symptomatic bradycardia?
atropine
104
On EKG there is an early but otherwise normal PQRS complex. After that beat there is a slight pause and then a normal rhythm continues. What is the term for this one beat?
premature atrial contraction
105
How do you treat polymyalgia rheumatica?
low dose prednisone
106
What is the management of a patient in supraventricular tachycardia?
vagal maneuvers, carotid massage, adenosine
107
What is the first medication you should give for atrial flutter?
adenosine
108
The EKG shows irregularly irregular narrow QRS
| waves. What diagnosis should you be thinking of?
A fib
109
An EKG shows a regular rate of 50 beats per minute. The QRS is narrow and there is no visible P wave. What is the most likely diagnosis?
junctional rhythm
110
An EKG shows two premature ventricular contractions. These two QRS waves look very different. What is the term for this?
Multifocal premature ventricular contractions
111
A patient in the ER has no pulse, but on EKG there are wide irregular "complexes" which are at an irregular rate. They all appear very different from one another. What is the treatment for this patient?
He is in ventricular fibrillation. The treatment is defibrillation.
112
How do you define 1st degree AV block?
The PR interval is longer than 0.2 seconds or one block on EKG.
113
What is the other term for Mobitz type I?
Wenckebach
114
What two labs do you want to monitor in a patient on an ACEI?
serum creatinine and serum K+
115
The heart rate is irregular so you can't count boxes between QRS waves to determine heart rate. What is another method you can use to determine rate on an EKG?
Count QRS waves in a six second strip and multiply by 10 to get beats per minute.
116
What is the treatment for a patient with a Mobitz II
| AV block?
pacemeaker
117
You see regular P waves and regular QRS complexes, but they do not seem to have any correlation to each other. What is the diagnosis?
third degree AV block
118
Name one aldosterone antagonist.
spironolactone, eplerenone
119
You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?
WPW
120
What two leads do you use to determine the axis of the heart?
lead 1 and AVF
121
An RSR prime in leads V5 or V6 should make you think of what diagnosis?
LBBB
122
Which finding requires immediate attention, left bundle branch block or right bundle branch block?
New left bundle branch block is a STEMI equivalent. Right bundle branch block is usually not a problem.
123
Tall peaked P waves should make you think of what diagnosis?
Right atrial enlargement
124
What are the three inferior leads?
II, III and aVF
125
A blockage of which artery causes a lateral wall MI?
left circumflex artery
126
Which EKG leads are used to diagnose an anterolateral MI?
V5 and V6
