cardiology

Question 1

most frequent cause of diastolic heart failure

Answer 1

LVH

Question 2

NYHA class 1 HF

Answer 2

asymptomatic

Question 3

NYHA class 2 HF

Answer 3

symptomatic with mod activity

Question 4

NYHA class 3 HF

Answer 4

symptomatic with mild activity

Question 5

NYHA class 4 HF

Answer 5

symptomatic at rest

Question 6

most predominant symptoms of L HF

Answer 6

dyspnea

Question 7

most predominant symptoms of R HF

Answer 7

signs of fluid retention (edema, hepatic congestion, ascites, loss of appetite)

Question 8

labs to order for HF

Answer 8

CBC, BNP, CXR, ECG, echo

Question 9

initial pharm treatment of HF

Answer 9

diuretic and ACE (mild use HCTZ, severe use lasix. remember GFR must be above 30 to use HCTZ)

Question 10

side effects of ACE

Answer 10

cough, dizziness, hypotension

Question 11

what do beta blockers do to EF?

Answer 11

decrease due to decreasing catecholemines

Question 12

when is digitalis used for HF?

Answer 12

in patients who remain symptomatic when taking diuretics and ACE or in HF and Afib and need rate control

Question 13

signs of digitalis toxicity

Answer 13

anorexia, nausea, HA, blurring or yellowing of vision

Question 14

what HTN med can accelerate CHF progression?

Answer 14

CCB–if have to use one, amplodipine DOC

Question 15

causes of acute pulmonary edema

Answer 15

acute MI, valvular regurg, mitral stenosis, noncardiac causes such as opioids, increased ICP, sepsis, shock, DIC

Question 16

sxs of pulmonary edema

Answer 16

severe dyspnea, pink frothy sputum, diaphoresis, cyanosis. wheezing rales and rhonchi

Question 17

butterfly pattern of alveolar edema

Answer 17

acute pulmonary edema

Question 18

tx pulmonary edema

Answer 18

put in sitting position, oxygen, may need to intubate…morphine 2-8mg IV, IV lasix,

Question 19

symptoms of paroxysmal SVT

Answer 19

may be asymptomatic. rapid heart beat, mild chest pain or SOB.
EKG findings? HR 140-240, regular, P wave can be buried in QRS

Question 20

causes of Afib

Answer 20

pericarditis, chest trauma, cardiac surgery, thyroid disorders, acute alcohol withdrawal, older age

Question 21

tx of Afib

Answer 21

if stable, rate control with BB and anticoagulation. if unstable (shock, hypotension), cardioversion. if fails, give IV ibutilide and try again

Question 22

BB unsuccessful at rate control for Afib. now what?

Answer 22

try CCB (diltiazem)

Question 23

sawtooth baseline on EKG

Answer 23

a flutter

Question 24

tx a flutter

Answer 24

rate control. Amiodarone and dofetilide DOC

Question 25

premature ventricular beats

Answer 25

isolated beats originating from ventricular tissue, sudden death occurs when these are in presence of organic heart disease

Question 26

tx premature ventricular beats

Answer 26

no tx if asymptomatic. bb for symptomatic

Question 27

v tach

Answer 27

defined as run of 3 or more consecutive ventricular premature beats

Question 28

lab findings in torsades

Answer 28

hypokalemia and hypomagnesmia

Question 29

tx v tach

Answer 29

synchronized cardioversion if hypotension, HF, or myocardial ischemia. if patient is tolerating rhythm, use amiodarone or lidocaine

Question 30

V fib treatment

Answer 30

cardiover-defibrillator

Question 31

tx first degree AV block

Answer 31

none

Question 32

2nd degree AV block AKA mobitz 1

Answer 32

progressively lengthening PR interval until beat drops. no tx

Question 33

3rd degree AV block aka mobitz 2

Answer 33

multiple P waves per QRS then bradycardia. tx is pacemaker because can turn in to complete block

Question 34

most common cause of secondary htn

Answer 34

renal parenchymal disease. others are cushings, genetics, kidney diseases, hyperaldosteronism, pheos, renal artery stenosis

Question 35

JNC 7 HTN category 1

Answer 35

bp over 140/90

Question 36

JNC 7 HTN category 2

Answer 36

bp over 160/100

Question 37

action of beta blockers

Answer 37

decrease HR and CO, decrease renin release

Question 38

BB side effects

Answer 38

bronchospasm, AV node depression, raynauds, fatigue, can mask sxs of hypoglycemia

Question 39

CCB action

Answer 39

peripheral vasodilation with less reflex tachycardia and fluid retention

Question 40

who are ccb best for?

Answer 40

blacks and elderly

Question 41

MOA of alpha antagonists (sins)

Answer 41

relax smooth muscle and reduce bp by lowering PVR

Question 42

side effects of alpha antagonists

Answer 42

hypotension, palpitations, HA, nervousness

Question 43

what can hydralazine cause?

Answer 43

lupus

Question 44

what are good drug combos?

Answer 44

Ace and BB, CCB and diuretic. never use CCB and BB together.

Question 45

hypertensive urgencies

Answer 45

bp over 220/110

Question 46

tx HTN emergency

Answer 46

reduce pressure by no more than 25% then to a level of 160/100 over 2-6 hours using labetalol or nicardipine

Question 47

if HTN caused by pheo or cocaine, what HTN drug needs to be avoided?

Answer 47

BB

Question 48

classic sxs of chronic stable angina

Answer 48

lasts less than 3 minutes, brought on by exertion and leaves with rest, can be brought on by heavy meal. tightness, squeezing, burning pressing or aching pain

Question 49

management of coronary artery disease

Answer 49

LDL goal of

Question 50

symptoms of PVD

Answer 50

intermittent claudication (pain on exertion). severe cramping of calf muscles, relieved with rest.

Question 51

workup of PVD

Answer 51

doppler, ABI (less than 1 is abnormal), CT angiography

Question 52

pallor, paresthesia, paralysis, pulses, pain

Answer 52

acute arterial occlusion

Question 53

systolic ejection murmur that ratiates to the carotids

Answer 53

AS

Question 54

AS treatment

Answer 54

INR maintained between 2 and 3

Question 55

aortic insufficiency symptoms

Answer 55

exertional dyspnea and fatigue, PND or pulmonary edema

Question 56

watter hammer pulse, quincke pulses, head bobbing, high pitched decrescendo murmur

Answer 56

aortic regurg

Question 57

AR treatment

Answer 57

serially monitor by echo. surgery indicated when LV dysfunction is less than 55%

Question 58

pansystolic murmur heard best at apex and radiates to axilla

Answer 58

mitral regurg

Question 59

mid systolic click

Answer 59

mitral valve prolapse

Question 60

most likely causative organism of endocarditis

Answer 60

subacute--s viridans. staph aureus. late prosthetic valve usually due to strep

Question 61

physical exam findings of endocarditis

Answer 61

splinter hemorrhages, petechiae, osler nodes (painful), janeway lesions, roth spots on retina

Question 62

duke criteria for endocarditis

Answer 62

2 positive blood cultures, echo showing endocardial involvement, development of murmur

Question 63

complications of endocarditis

Answer 63

stroke, myocardial abscesses, peripheral emboli

Question 64

tx of endocarditis

Answer 64

vanco plus ceftriaxone. replacement may be required, and anticoagulation is contraindicative in native valve endocarditis b/c of increased risk of intracerebral hemorrhage

Question 65

CI of statin

Answer 65

pregnancy, liver disease

Question 66

drug interactions of statins

Answer 66

diltiazem and verapamil

Question 67

what do bile acid sequestrants do to LDL and TG?

Answer 67

decrease LDL, increase TG

Question 68

what is ezetimibe?

Answer 68

cholesterol absorption inhibitor that decreases LDL

Question 69

drugs for hypertriglyceridemia

Answer 69

Niacin and fibric acid

Question 70

side effect of fibric acid

Answer 70

choleylithiasis, myopathy and liver tox

Question 71

side effects of niacin

Answer 71

hyperglycemia and hyperuricemia (avoid in DM and gout) can also cause flushing