Cardiology #4

Question 1

Best initial test for AAA

Answer 1

CT scan with IV contrast

(For those who are symptomatic, hemodynamically stable) to get size, presence, and extent

Question 2

What is the recommendation for screening for AAA?

Answer 2

One-time screening via abdominal US in men 65-75 years of age who have ever smoked

Question 3

What is the pathophysiology of AAA?

Answer 3

Proteolytic degeneration of aortic wall and connective tissue inflammation

Question 4

Risk Factors for AAA

Answer 4

• Smoking
• Age > 60
• Men
• Caucasians
• Connective tissue disorder (Marfan)
• Hypertension
• Syphilis

Question 5

If a patient has DM or CKD and hypertension, what medications are recommended?

Answer 5

ACEi, ARB

Question 6

Hypertensive medications to use in AA?

Answer 6

Thiazides, CCB

Question 7

Name some CCBs

Answer 7

• Amlodipine
• Diltiazem
• Verapamil
• Nicardipine
• Nifedipine

Question 8

Name some ARBs

Answer 8

• Losartan
• Olmesartan
• Valsartan
• Telmisartan

Question 9

With gout, what medications should be used in hypertension?

Answer 9

CCB

-Losartan is the only ARB that doesn’t cause hyperuricemia

Question 10

If a patient has Raynaud’s, what hypertensive medication should also be used?

Answer 10

CCB

Question 11

What hypertensive medications are likely to help A-fib?

Answer 11

BB, CCB

Question 12

If a patient has hypertension and depression, what medications should be avoided?

Answer 12

BB

Question 13

What is the treatment for a hypertensive urgency?

Answer 13

Clonidine

Captopril

Question 14

However, with Clonidine, what is an adverse effect?

Answer 14

Rebound hypertension if discontinued abruptly (mimics Pheochromocytoma)

Question 15

What are some examples of end-organ damage with hypertensive emergency?

Answer 15

• General: headache, dyspnea, AMS, n/v
• Neurologic: stroke, seizure
• Cardiac: Aortic dissection, acute heart failure
• Renal: acute kidney injury, hematuria
• Retinal: malignant hypertension, retinopathy

Question 16

Adenosine MOA

Answer 16

-Slows AV node conduction time and blocks AV nodal reentry pathways

Question 17

Amiodarone MOA

Answer 17

• Class III anti arrhythmic (K+ channel blocker) with class I through IV properties
• Prolongs action potential

Question 18

Common side effect of Loop Diuretics (Furosemide)

Answer 18

Ototoxicity

Question 19

What loop diuretic do you use in sulfa allergy or history of gout?

Answer 19

Ethacrynic Acid

Question 20

What is one common side effect of Spironolactone?

Answer 20

Gynecomastia

Question 21

What two drug classes should you NOT use in pregnancy?

Answer 21

ACE and ARB

Question 22

Regarding CCB, what three endings should you look for to determine if a medication belongs to this class?

Answer 22

ZEM, PINE, MIL

Question 23

Regarding CCB, what two drugs are NON-dihydropyridines and what is the MOA?

Answer 23

Verapamil, Diltiazem

Vasodilation and slow conduction through AV node leading to decreased cardiac conduction and contractility

Question 24

Two major adverse reactions to CCB

Answer 24

Peripheral edema
Constipation
Headache

Question 25

When should you NOT use CCB?

Answer 25

- Patients with LV dysfunction and CHF - Patients with 2nd or 3rd degree heart block - Patients taking BB (do not double up on decreasing contractility of the heart)

Question 26

What are the cardio selective BB? (They only affect Beta-1 receptors)

Answer 26

BEAM Bispoprolol Esmolol Atenolol Metoprolol

Question 27

What is true about Nonselective BB?

Answer 27

They affect Beta-2 receptors in the lungs and should be avoided in patients with COPD, asthma, etc.

Question 28

Side effects of BB

Answer 28

- Can make the symptoms of hyperglycemia | - Fatigue, Impotence, Depression

Question 29

What is Eisenmenger Syndrome?

Answer 29

Pulmonary HTN and cyanotic heart disease occurring when a left-to-right shunt switches and becomes a right-to-left shunt (cyanotic). -Patients develop cyanotic lower extremities, cyanosis and clubbing of the feet

Question 30

What is the MC innocent physiologic murmur?

Answer 30

Still Murmur

Question 31

Describe a Still Murmur

Answer 31

Musical, vibratory, noisy, twanging best heard in inferior aspect of the LLSB and apex

Question 32

What is Tricuspid Atresia?

Answer 32

Absence of tricuspid valve leads to hypoplastic right ventricle -A PDA or VSD is necessary for pulmonary blood flow and survival

Question 33

What does a CXR show with tricuspid atresia?

Answer 33

Normal or enlarged cardiac silhouette with DECREASED pulmonary flow

Question 34

Treatment for Tricuspid Atresia

Answer 34

- Maintain patency of ductus arteriosus (prostaglandin E1 Alprostadil) to stabilize initially - Surgical repair is definitive

Question 35

MCC of subacute endocarditis

Answer 35

Strep Viridans