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1
Q

effect of valsalva early strain(2)

A

decrease venous return

decrease all murmurs except HCM and MVP

2
Q

effect of valsalva late release(2)

A

increase venous return

increase right sided murmurs

3
Q

effect of standing(2)

A

decrease venous return

similar to the strain phase of valsalva

4
Q

effect of squatting(3)

A

increase venous return
increase afterload by kinkingof femoral arteries
increase reverse flow

5
Q

effect of handgrip(3)

A

increase afterload
increase blood pressure
increase reverse flow across valve

6
Q

murmurs getting louder with valsalva(2)

A

HCM

MVP

7
Q

why during valsalva murmur get louder in MVP (2)

A

decrease left ventricular volume

increase of leaflet prolapse

8
Q

why during valsalva murmur get louder in HCM (2)

A

decrease left ventricular volume

increase gradient

9
Q

effect of standing resembles what other effect

A

valsalva

10
Q

murmurs that get louder with squatting(3)

A

aortic regurgitation
mitrel regurgitation
VSD

11
Q

murmurs that get softer with squatting(2)

A

HCM

MVP

12
Q

why murmurs get softer with squatting in HCM (4)

A

more blood less murmur
increase preload
decrease gradient across outflow obstruction
decrease obstruction and decrease afterload

13
Q

why murmurs get softer with squatting in MVP(2)

A

increase left ventricular size

decrease mitral valve leaflets prolapse

14
Q

murmurs getting louder with handgrip(3)

A

aortic regurgitation
mital regurgitation
VSD

15
Q

murmurs getting softer with handgrip(3)

A

HCM
increase gradient across outflow obstruction
decrease flow

16
Q

auscultation in mitral valve prolapse(2)

A

single or multiple non ejection clicks
plus
mid to late systolic of mitral regurgitation

17
Q

CHF with ejection fraction a 55 dx

A

diastolic dysfunction

18
Q

number 1 cause of diastolic dysfunction

A

HTA

19
Q

rx of diastolic dysfunction(2)

A

diuretics

antihypertensives

20
Q

physiopatho in diastolic dysfunction

A

impaired ventricular filling due to poor myocardial relaxation or diminished ventricular compliances

21
Q

cause of AFIB in diastolic dysfunction(3)

A

left ventricular dilation
leads to left atrial dilation
which in turn causes atrial fibrillation

22
Q

HTA in the setting of bilateral nontender masses

A

autosomal dominant polycystic kidney disease

23
Q

HTA in the setting of bilateral nontender masses best test to do

A

abdomen ultrasonogram

24
Q

clue for autosomal dominant polycystic kidney disease(5)

A
HTA
Hematuria
proteinuria
palpable renal masses
progressive renal insufficiency
25
Q

flank pain in autosomal polycystic kidney disease cause(3)

A

renal calculi
cyst rupture or hemmorrage
upper urinary tract infection

26
Q

the early common finding in autosomal polycystic kidney disease

A

HTA

27
Q

extra renal manif of autosomal polykidney disease(5)

A
cerebral aneurisms
hepatic and pancreatic cysts
cardiac valve disorder
colonic diverticulosis
ventral and inguinal hernias
28
Q

management of APKD(3)

A

follow blood pressure and renal function
aggressive control of cardiovascular risks factors
ACE inhibitor for HTA

29
Q

end stage renal diasease in APKD(2)

A

dyalisis

renal transplant

30
Q

patient with HTA is seen in consultation in history , he exercices regularly an eats low salt diet .but he drinks 3-4 glasses of wine every day and 6-8 beers on week end .he quits smoking 3 years ago next step in management of HTA in this patient

A

counsel for reduction of alcohol

31
Q

quid of excessive alcohol intake

A

> 2 drinks a day

32
Q

quid of binge drinking

A

> 5 drinks in a row

33
Q

lifestyle modification in HTA(6)

A
low salt diet
diet rich in fruit and vegetables
low fat dairy products
regular aerobic exercices
lose weight
limit alcohol intake
34
Q

patient with TA 160/85 while supine and 135/70 while standing dx

A

orthostatic hypotension

35
Q

EKG for AFIB(3)

A

narrow qrs complex
no organised P waves
irregularly irregular rythm

36
Q

stable patient with afib Management

A

Rate control

37
Q

medication used for rate control

A

Betablocker

calcium blocker like Diltiazem

38
Q

use of digoxin for rate control in AFIB(2)

A

AFIB due to heart failure

patient unable to tolerate B blocker or Calcium channel blocker

39
Q

indication of cardiversion in Patient with AFIB(4)

A

less than 48 h
patient with hypotension
pulmonary edema
ischemic heart disease

40
Q

what to do before beginning cardioversion in AFIB more than 48 h(2)

A

anticoagulation 3-4 weeks
plus
rate control

41
Q

best test to see if AFIB is complicated with heart thrombus

A

TEE

42
Q

patient with chest pain sus elevation of ST segment and ventricular premature beats administration of lidocaine will cause what in this patient

A

increase the risk in asystole

43
Q

advantage and drawback of lidocaine in acute coronary syndrome(2)

A

decrease risk of VFIB

increase the risk of asystole

44
Q

patient with history of rhinitis and eczema in childhood is coming for chest pain .ekg shows st segment depression .he is placed on aspirin bblocker etc.2 days later he develops respiratory distress with wheezing and prolonged expiratory.cause of that

A

medication side effect Bblocker and Aspirin

45
Q

causes of acute dyspnee in hospitalized patients(7)

A
arrythmia
bronchoconstriction
CHF/hypervolemia
infection/pneumonia asppiration
pleural effusion
PE
anxiety
46
Q

patient with cardiac disease or (electrolytes abnormalities) develops dizziness tachycardia(or braadycardia) during hospitalisation dx

A

arrythmia

47
Q

patient with history of asthma ,is placed on aspirin and Bblocker develops wheezing and pprolonged expiratory phase during hospilaisation Cause of that

A

bronchoconstriction

48
Q

patient with cardiac disease develops crakles high jugular venous pressure>8 cm h2o lower extremity edema cause of that

A

CHF

49
Q

accidentaly patient has received 2000 cc de liquide develops dyspnea,develops crackles DX

A

hypervolemia

50
Q

characteristics clinique of pleural effusion in tyhe context of acute dyspnee (2)

A

decreased breath sounds

dullness to percussion

51
Q

clue for anxiety in the setting of acute dyspnea in hospitalised patient(4)

A

tachycardia
tachypnee
normal lung exam
normal oxygenation

52
Q

EG in anterolateral MI

A

st segment elevation in 1 avl,v1-v3

53
Q

what can happen in anterolateral MI(2)

A

muscle ischemia or rupture—>

mitral regurgitation

54
Q

MI causing typically mitral regurge and why(2)

A

posteroseptal MI

a cause of solitary blood supply of of the post medial papillary muscle

55
Q

consequence of lmitral regurge in anterolateral MI or post septal MI(4)

A

increase left atrial pressure
but no changes in left atrium size
in left ventricular sizes
and no changes in left ventricular ejection fraction

56
Q

patient with chest pain during exercice but normal baseline resting EKG ,next step

A

exercice EKG

57
Q

why patient with SLE are at risk for acute coronary syndrome(2)

A

most of the they are reiceiving prednisone

prednisone and Lupus cause acelarated coronary atherosclerosis

58
Q

syncope during exercice(3)

A

aortic stenosis
HOC
VTAC

59
Q

murmur in aortic stenosis(3)

A

2 nd intercostal space
radiation in caritids
crescendo-decrescendo

60
Q

disease with pulsus parvus and tardus

A

aortic stenosis

61
Q

quid of pulsus parvus and tardus

A

aotic stenosis

62
Q

other finding in aortic stenosis

A

weak S2

S4

63
Q

three possible symptoms in AS(3)

A

syncope during exercice
exertionnal angina
dyspnea

64
Q

definitive dx of AS

A

echocardiogram

65
Q

rx of symptomatic AS

A

valve replacement

66
Q

patient with chest pain with normal QRS complex 80msec(n

A

first degree heart block

67
Q

clue for first degree heart block(2)

A

prolonged PR interval

P wave always follows QRS unlikely other heart block

68
Q

rx of first degree heart block with normal QRS duration

A

abservation

69
Q

First degree AV block with prolonged QRS

A

electrophysiologic testing to determine the nature of the delay of conduction below the AV node

70
Q

patient with history of respiratory infection one week ago develops Ta =100/60 distended neck veins and heart sounds distant dx

A

pericardial effusion

71
Q

xray in pericardial effusion

A

enlarged cardiac silhouette

72
Q

ekg clue for pericardial effusion

A

electrical alternans

73
Q

quid of electrical alternans

A

qrs complexes whose amplitude vary from beat to beat on ekg

74
Q

definitive dx in pericardial effusion

A

echocardiogram

75
Q

quid hypertensive urgency(2)

A

severe HTA > ou egal 180/120

no symptoms ,no end organ damage

76
Q

two divisions for hypertensive emergency(2)

A

malignant HTA

Hypertensiive encephalopathy

77
Q

clue for malignant HTA(2)

A

severe HTA
plus
papilledema and retinal hemorrage

78
Q

clue for hypertensive encephalopathy(2)

A

severe HTA
plus
cerebral edema and non localizing neurologic symptoms and signs

79
Q

symptom in cerabral edema(4)

A

headache
nausea
vomiting
plus non localizing neurologic symptoms

80
Q

quid of non localizing neurologic symptom(4)

A

restlessness
confusion
seizures
coma

81
Q

organ atteint in malignat HTA(2)

A

rein

eye

82
Q

rein problem in malignant HTA

A

nephrosclerosis

83
Q

quid of manif of nephrosclerosis(3)

A

acute renal failure
hematuria
proteinuria

84
Q

auscultation finding in aptient with aortic stenosis

A

systolic murmur ejection radiating to the apex and carotid arteries

85
Q

teens and early twenties with AS cause

A

bicuspid valve

86
Q

elderly with AS cause

A

Calcification of the trileaflet valve

87
Q

muscle pain in patient taking statin

A

statin induced myopathy

88
Q

mechanism of action of statin

A

inhibition of intracellular synthesis pathway

89
Q

action of station intracellularly(3)

A

inhibit HMG co A reductase enzyme
prevent conversion of HMG co A to mevalonic acid
increase the number of cell membrane LDL receptors

90
Q

why statin can induce myopathy

A

by decreasing co enzyme synthesis Q 10

91
Q

role of Q10 coenzyme

A

involve in muscle cell energy

92
Q

clue supraventricular tachycardia on EKG(4)

A

narrow QRS complex
tachycardia
no regular P waves as they are buried within QRS complex
retrograde P wave can occur

93
Q

dx and management of supraventricular tachycardia(2)

A

adenosine

or vagal maneuvers

94
Q

action of adenosine(3)

A

slows the sinus rate
increases AV nodal conduction delay
can cause a transient block in AV node conduction

95
Q

role of adenosine in supraventricular tachycardia(2)

A

can help to identify P waves to clarify dx of atrial flutter or atrial tachycardia
terminate paroxysmal supraventricular tachycardia by interrupting the AV nodal reentry circuit

96
Q

quid of vagal maneuvers(3)

A

carotid sinus massage
valsalva
eyeball pressure

97
Q

patient smoker complain of cramping pain in his right thigh after walking 2 blocks ,the pain goes away once he stops and rests for several minutes

A

PAD

98
Q

best initial management in PAD intermittent claudication

A

exercice therapy

99
Q

indication of cilostazole in PAD

A

persistent symptom despite adequate supervised exercice therapy

100
Q

indication of surgery in PAD

A

persistent symptom despite adequate supervised exercice therapy and cylostazole

101
Q

HTA basic testing(4)

A

urinalysis for occult hematuria and urine protein creatinine ratio
chemistry panel
lipid profile
baseline ECG

102
Q

when to search for secondary HTA(4)

A

severe or malignant HTA
resistant HTA requiring > ou egal a 3 drugs
sudden blood pressure rise in patient with previosly controled HTA
age of onset

103
Q

patient with HTA ,hypokaliemia and hyperglycemia and weight gain dx

A

adrenal cortical disease

cushing disease

104
Q

cause of cushing syndrome(4)

A

adrenal cortical hyperplasia
acth producing pituitary adenoma (cushing disease)
ectopic ACTH production
exogenous steroids

105
Q

clue for cushing(7)

A
poximal muscle weaness
central adiposity
thinning of the skin
psychiatreic problem
hypokaliemia 
hypertension
hyperglycemia
106
Q

psychiatric problem in cushing(3)

A

sleep disturbances
depression
psychosis

107
Q

quid of preload measurement(2)

A

right atrial pressure

pulmonary capillary wedge pressure

108
Q

normal right atrial pressure

A

mean 4 mm of HG

109
Q

normal pulmonary wedge pressure

A

mean of 9 mm de HG

110
Q

quid of cardiac index

A

pump function measurement

111
Q

normal cardiac index

A

2.8-4.2 l/mn/m2

112
Q

quid of systemic vascular resistance

A

measure afterload

113
Q

normal systemic vascular resistance

A

1150l/mn/m2

114
Q

normal mixed venous oxygen saturation

A

60%-80%

115
Q

the only parameter increase in Hypovolemic schock

A

everything is low except systemic vascular resistance

116
Q

the only two parameters decrease in cardiogenic shock

A

everything is high except cardiac pump function

mixed venous oxygen saturation

117
Q

the only shock syndrome with low vascular resistance and increased mixed venous oxygen saturation

A

septic shock

118
Q

patient with hypotension, normal Pulmonary wedge pressure and increased mixed venous saturation

A

septic shock

119
Q

hwat’s the underlying basic pathophysiology in septic shock

A

decrease systemic vascular resistance due to overall peripheral vasodilation

120
Q

swanz ganz catether in septic shock(4)

A

low pulmonary wedge pressure
low systemic vascular resistance
increased cardiac output
high mixed venous oxygen saturation

121
Q

origin of formation of AFIB focii

A

pulmonary veins

122
Q

quid for atrial flutter origin

A

reentrant circuit that rotates around the tricuspid annulus

123
Q

quid for paroxysmal supraventricular tachycardia origin

A

reentry circuit most commonly oinvolved the AV node or via accessory bypass tract

124
Q

patient on digoxin and furosemide present with wide complex tachycardia what to check

A

serum electrolytes

125
Q

effect of furosemide(2)

A

low K

low MG++

126
Q

effects of low K and low Mg++

A

ventricular tachycardia

127
Q

risk factor for digoxin toxicity

A

low K

128
Q

consequence of digoxin toxicity

A

ventricular tachycardia

129
Q

side effect of thiazide (5)

A
hyperglycemia
increased LDL cholesterol and plasma triglycerides
hyponatremia
hypokaliemia
hypercalcemia
130
Q

hypergluc in thiazide(4)

A

G= glycemia
L=lipidemia
U=uricemia
C=Calcemia

131
Q

in swanx ganz catheter clue for cardiogenic shock(2)

A

reduced cardiac index

elevated pulmonary wedge pressure

132
Q

how ‘s systemic vascular resistance in cardiogenic shock

A

high to maintain adequate perfusion of tissue

133
Q

the most contributory factor in CHF edema

A

increased renal sodium retention

134
Q

cause of increased renal sodium retention in CHF(2)

A

low renal perfusion—-> stimulation of renin aldosterone system—>hypoperfusion renal secondary to cardiac output
renal arteries are constricted

135
Q

patient with palpitations HR 160 suddenly with no history of haert problem.Symptoms improves when immersing face in cold water dx

A

paroxysmal supraventricular tachycardia

136
Q

the cold therapy work s by affecting what

A

atrioventricular node conductivity

137
Q

cause of supraventricular tachycardia

A

accessory conduction pathways

138
Q

why you can have hepatomegaly,ascites, increased JVP in constrictive pericarditis

A

decreeased diastolic filling leafing to cardiac output impairment

139
Q

common cause of constrictive pericarditis(4)

A

radiation therapy
viral pericarditis
cardiac surgery
idiopathic

140
Q

kussmaul sign

A

failure of JVP to decrease during inspiration

141
Q

other name of constrictive pericarditis

A

inelastic pericardium

142
Q

dx of constrictive pericarditis(3)

A

calcified pericardium in xray
thickened pericardium on CT or MRI scanning
cardiac catheterisation

143
Q

rx of constrictive percarditis(2)

A

diuretics
or
pericardiectomy

144
Q

after anterior wall MI patient develops pleuritic chest pain improving when sitting and leaning forward.EKG shows diffuse ST segment elevation dx

A

acute pericarditis

145
Q

laps de temps pour developper acute pericarditis post MI

A

within the first several days

146
Q

EKG for acute pericarditis(2)

A

diffuse ST segment elevation

PR depressions

147
Q

quid of lone AFIB

A

presence of paroxysmal persistent or permanent AFIb with no evidence of cardiopulmonary or structural heart disease

148
Q

rx of lone AFIB

A

nothing

149
Q

paroxysmal AFIB

A

reccurrent > a 2 episodes that terminate spontaneously in

150
Q

persistent AFIB

A

episodes lasting more than 7 days

151
Q

longstanding persistent AFIB

A

pesistent for more than 1 year duration

152
Q

permanent AFIB

A

persistent with no further plans for ryhtm controls

153
Q

CHADS 2 score 0(2)

A

no anticoagulation

aspirin preferred

154
Q

CHADS 2 score 1 (2)

A

anticoagulation preferred
or
aspirin

155
Q

CHADS 2 score 2-6

A

anticoagulation

156
Q

cause of restrictive cardiomyopathy(4)

A

sarcoidosis
amyloidosis
hemochromatosis
fibrosis endomyocardial

157
Q

clue for restrictive cardiomyopathy in echo

A

symmetrical thickening of the left ventricular walls and slightly reduced systolic function

158
Q

the only reversible cause of restrictive cardiomyopathy

A

hemochromatosis

159
Q

echo with interventricular septum thickness

A

hypertrophic cardiomyopathy

160
Q

primary rx of hemochromatosis

A

phlebotomy

161
Q

quid of the anti-ischemic nitrate action

A

systemic vasodilation rather than coronary dilation
systemic venodilation lowers (ventricular)preload and left ventricular end diastolic volume reducing wall stress and myocardial oxygen demand
dilation of capacitance vessels

162
Q

action of nitrate

A

reduced left ventricular volume

163
Q

supraventricular tachycardia in patient hemodynamically unstable management

A

DC cardioversion

164
Q

anterior wall myocardial infarction with pulmonary edema what medication to give and why

A

furosemide

furosemide causes venodilation which further decreases the preload

165
Q

anterior wall myocardial infarction with pulmonary edema what medication u cant give and why

A

betablocker

can worsen acute heart failure

166
Q

other medication can be used in pulmonary edema caused by anterior wall myocardial infarction and why

A

Morphine

decrease prload and anxiolytic

167
Q

patient with syncope with history of respiratotry infection 2 weeks ago EKG shows electrical alternans best next step in this patient

A

percardicenthesis

168
Q

quid of electrical alternans

A

une onde qrs longue suivie d’une courte

169
Q

EKG of pericardial effusion(3)

A

electrical alternans
sinus tachycardia
low QRS voltage in large pericardial effusion

170
Q

quid of sinus tachycardia with electrical alternans

A

large pericardial effusion

171
Q

problem in HIC(2)

A
abnormal mitral leaflet motion= systolic anterior motion of the mitral valve
septal hypertrophy
172
Q

cause of systolic dysfunction

A

MI

173
Q

catetherisation during systolic heart failure(3)

A

CI decreased
left ventricular end diastolic volume increased
total peripheral resistance increased

174
Q

how ‘s the left ventricular end diastolic heart failure

A

normal

175
Q

patient with tachysystolic AFIB what to do to improve the left ventricular function in those patients

A

control the rate and the rythm

176
Q

why tachysystolic AFIB causes significant left ventricular dialtion and depressed EF(4)

A

tachycardia
neurohumoral activation
absence of atrial kick
atrial ventricular desynchronisation

177
Q

importance of atrial kick

A

it accounts for 25% of LV end diastolic volume

178
Q

tachysystolic AFIB (3)

A

irregular irregualr rythm
tachycardia
no P waves ion EKG

179
Q

cardiac problem in hemochromatosis(3)

A

cardiac conduction abnormalities
dialted cardiomyopathy
heart failure

180
Q

the greatest risk factor for printzmetal angina

A

smoking

181
Q

young female with nocturnal chest pain lasting 15-20 mn .EKG shows St segment elevation in lead 1 avl,v4-v6 during the episode rx

A

diltiazem
or
nitrate

182
Q

why to not give bblocker or aspirin in printz metal angina

A

cause vasoconstriction

183
Q

other name of printz metal

A

variant angina

184
Q

after long trip to central asia female using OCP develops hemoptysis and pleuritic chest paincause of these symptoms

A

pulmonary infarction

185
Q

number one cause of pleuritic chest pain

A

PE

186
Q

gold standard Dx in PE

A

helical CT

187
Q

patient with chest pain palpitations is seen in emergency .Physical exam reveals HTA ,dilated pupils ,small amount of blood at the external nares St segment elevation in V1-V4.explanation of the symptoms

A

drugs induced vasospasm

cocaine abuse

188
Q

why you cant give bblocker to patietn in cocaine abuse

A

unopposed alpha agonist will worsen vasospasm in cocaine abuse

189
Q

cause of St segment elevation(4)

A

MI
Cocaine abuse
acute pericarditis
printzmetal

190
Q

clue for aortic regurge

A

wide pulse pressure

191
Q

manif of wide pulse pressure in reality

A

water hammer pulse

=pounding heartbeat

192
Q

way for the patient hear better the pounding heart(2)

A

lying supine and

lying on the left

193
Q

most common cause of aortic dilation in The US(2)

A

aortic root dialtion

bicuspid aortic valve

194
Q

the greater non pharmocologic rx with greatest impact on HTA and why(2)

A

weight loss

reduce HTA of 5-20 per 10 kg loss

195
Q

the second non pharmocologic rx with greatest impact on HTA and why(2)

A

DASH diet

reduce HTA 8-14 mm de hG

196
Q

thethird non pharmocologic rx with greatest impact on HTA and why(2)

A

exercice

reduce HTA 4-9 mm de hg

197
Q

the 4 e non pharmocologic rx with greatest impact on HTA and why(2)

A

dietary sodium

reduce HTA 2-8 mm de hg

198
Q

the 5 e non pharmocologic rx with greatest impact on HTA and why(2)

A

alcohol intake

reduce HTA 2-4 mm de hg

199
Q

quid of DASH diet(2)

A

Diet rich in fruits and vegetables

and low saturated fat and total fat

200
Q

time to work out in HTA(2)

A

30 min /day

5-6 days /semaine

201
Q

dietary sodium restriction in HTA

A
202
Q

alcohol intake restriction in HTA(2)

A

2 drinks /day in men

1 drink /day in women

203
Q

first line rx for newly dx hypertension satge 1

A

lifestyle modification

204
Q

patient with pedal edema ascite emigrating from china to come in the US.chest xray reveals decreased heart sound and an accentuated sound directly after the second heart sound in ear;y diastole .chest xray shows ring calcification around the heart and jugular venous pressure tracings show prominent x and y descents cause of the patient symptoms and Dx

A

tuberculosis

constrictive pericarditis

205
Q

clinical presentation of constrictive pericarditis(4)

A

fatigue and dyspnee on exertion
peripheral edema and ascites
high jugular venous pressure
pericardial knock

206
Q

dx findings in constrictive pericarditis(2)

A

X and Y descents during jugular venous pulse tracing

imagind shows pericardial thickening and calcification

207
Q

pericardial knock

A

early heart sound after S2

208
Q

heart dysfunction in constrictive pericarditis

A

diastolic

209
Q

endemic areas for TB(3)

A

africa
india
china

210
Q

EKG for Mobitz type 1(wenkeback)

A

PR interval growing slowly progressively leading up to a dropped beat

211
Q

problem in mobitz one

A

impaired AV node conduction

212
Q

sudden tearing chest pain in aptient with chest xray showing widened mediastinum dx and medical condition causing that

A

dissection aortic

HTA

213
Q

drugs increasing the riosk of bleeding when taking warfarin(9)

A
acetaminophen 
NSAIDS
antibiotis/antifungal
amiodarone
canberry juice
ginkgo biloba viit E
omeprazole
thyroid hormone
selectice serotonin reuptake inhibitors
214
Q

drugs decreasing the effect of warfarin(6)

A
rifampin
carbamazepine
oral contraceptives
ginseng
st jhon's wort
green vegetables(spinach)
215
Q

dose of acetaminophen to cause bleeding with warfarin ingestion

A

> 2 g /jour for 1 week

216
Q

the most important factor for survival in out hospital sudden cardiac arrest

A

time to rythm analysis and defibrillation=elapse time to effective resuscitation
en d’autres mots:prompt effective resuscitation with adequate bystander CPR,prompt rythm analysis and defibrillation

217
Q

number one cause of outhospital sudden cardiac arrest(2)

A

sustained VTAC
sustained VFIB
both cause by MI or ischemia

218
Q

murmur in aortic dissection

A

diastolic murmur in left sternal border

219
Q

3 clinical findings in aortic dissection with 2 you make the DX

A

tearing chest pain radiating in the back
variation in pulse or blood pressure between the right and the left arm
widened mediastinum

220
Q

complication of dissection aortic

A

extend to pericardium=tamponnade
extend to coronary arteries=stroke
extend to carotid arteries=stroke

221
Q

dissection aortic plus hemiplegia dx

A

stroke

222
Q

incidence of aortic dissection when 2 clinical symptoms are present see question above

A

80 %

223
Q

patient found with pulsatile mass above umbilicus creat 2.0 and TA:160/90 dx and best test to confirm the DX(2)

A

abdominal aneurism of aorta

abdominal ultrasound

224
Q

quid of BNP

A

release by dilated ventricle

225
Q

value for BNP to Dx CHF(4)

A

> 100 pg /ml
specificity 76
sensitivity 90
predictive value 83

226
Q

importance of BNP

A

helps to differentiate dyspnea of cardiac origin with any other origin

227
Q

cause of right Heart failure in COPD

A

pulmonary artery systolic pressure

228
Q

sequence of event causing right heart failure in COPD

A

hypoxemia causes constriction of the pulmonary artery and with time pulmonary hypertension—> will lead to right ventricular hypertrophy and right ventricular failure

229
Q

does right ventricular failure cause pulmonary edema

A

it s not a common cause of pulmonary edema

230
Q

management of STEMI(6)

A
oxygen 
nitrates
antiplatelet therapy
anticoagulation
bblockers
prompt reperfusion with PCI
231
Q

antiplatelet therapy used in STEMI

A

platelet P2y12 receptor inhibitor

232
Q

anticoagulation used in STEMI

A

bivalirudin is preferred over heparin

233
Q

ideal first rx for STEMI

A

prompt reperfusion with PCI

234
Q

clue for benign essential tremor(3)

A

tremor worst with activity
improves with with alcohol
family inheritance autososmal dominant

235
Q

HTA plus benign esential tremor Rx

A

propranolol

236
Q

the most effective non pharmacological rx of HTA

A

weight loss

237
Q

clue for venous insufficiency(4)

A

pedal edema
medial ankle ulcer
dilated and tortuous superficial veins
normal physical exam

238
Q

initial rx of venous insufficiency(3)

A

leg elevation
exercice
compression stockings

239
Q

method to hear aortic regurgitation murmur(4)

A

diastolic murmur
best heard along the left sternal border at the third and fourth interspaces
best heart when you apply firm pressure with the diaphragm of the sthetoscope while patient is sitting up leaning forward and holding the breath in full expiration

240
Q

cause of aortic regurge in developed countries in young adults

A

bicuspid aortic valve

241
Q

cause of aortic regurge in developing countries in young adults

A

rheumatic heart disease

242
Q

common cause of aortic regurgitation involving the aortic valve leaflet(8)

A
rheumatic heart disease
endocarditis
bicuspid aortic valve
trauma
myxomatous degeneration
ankylosing spondylitis
acromegaly
medications
243
Q

common cause of aortic regurgitation involving trhe ascending aorta or aortic root disease (8)

A
hta
aortitis syphilitic
ankylosing spondylitis
dissection aortic
ehlers danlos
IBD
reactve arthritis
Marfan syndrome
244
Q

Medication to hold for 48 h prior to cardiac testing(3)

A

Bblocker
calcium blocker
nitrates

245
Q

medication to hold 48 h prior to vasodilator stress test

A

dipyridamole

246
Q

medication to hold 12 h prior to vasodilator stress test

A

caffeine containing food or drinks

247
Q

medication you can continue prior to to cardiac stress testing(5)

A
ACE inhibitor
ARBs
digoxin
statins
diuretics
248
Q

gold standard Dx of CAD

A

coronary angiography

249
Q

indication of amiodarone(3)

A

ventricular arythmias
rythm control in AFIB
left ventricular systolic dysfuction

250
Q

toxicity of amiodarone(7)

A
hypo or hyper thyroidism
hepatotoxicity
bradycardia
heart block
pneumonitis
neurologic symptoms
visual disturbances
251
Q

visual probelm associated with amiodarone(2)

A

corneal microdeposits

optic neuropathy

252
Q

heart problem with amiodarone(2)

A

Qt prolongation

risk de torsades de pointes

253
Q

dermatologic problem associated with amiodarone

A

blue gray skin discoloration

254
Q

neurologic problem associated with amiodarone

A

peripheral neuropathy

255
Q

gastrointestinal and hepatic problem associated with amiodarone(2)

A

elevated transaminases

hepatitis

256
Q

mark for IV drug user in USMLE

A

needle tracks on arms

257
Q

IV drug user with fever andround lesions in lungs and sinus tachycardia.what accompanying finding is expected

A

systolic murmur that increases with inspiration

258
Q

bug in infective endocarditris in IV drug user

A

staph aureus

259
Q

what increases the risk of infective endocarditis in IV drug user

A

HIV infection

260
Q

holosystolic murmur increasing with inspiration quid of that

A

tricuspid involvement

261
Q

IE with round lung opacity

A

septic pulmonary emboli

262
Q

what must be done in young patient with systemic HTA

A

evaluation for coarctation of aorta

263
Q

assessment of coarctation of aorta in physical exam(3)

A

search for brachio femoral delay
upper extremity hypertension lower extremity hypotension
continuous cardiac murmur from large collaterals

264
Q

acqiured cause of coarctation of aorta

A

maladue de takayasu

265
Q

chest xray for aaortic coarctation

A

notching of the 3 th-8th ribs from enlarged intercostal arteries

266
Q

confirmatory dx for aortic coarctation

A

echocardiography

267
Q

rx of aortic coarctation(2)

A

balloon angioplasty
plus or minus
stent

268
Q

complication of CABG

A

AFIB

269
Q

AFIB in hemodynamically unstable patient rx

A

DC cardioversion

270
Q

EKG of AFIB(3)

A

absent P waes
an irregularly irregylar rate
narrow QRS complex

271
Q

clinical features for cocaine abuse(4)

A

sympathetic activity
chest pain
psychomotor agitation
seizures

272
Q

sympathetic activity in cocaine abuse(3)

A

tachycardia
HTA
dilated pupils

273
Q

why chest pain in cocaine abuse

A

coronary vasodilation

274
Q

complication of cocaine abuse(3)

A

acute MI
aortic dissection
intracranial hemorrage

275
Q

clue in USmle for cocaine abuse

A

nasal mucosa is atrophic

276
Q

chest pain management in cocaine abuse(5)

A
benzodiazepines
aspirin
Nitrate and calcium blocker
no Bblocker
immediate cardiac catheterisation with reperfusion when indicated
277
Q

why you ccant use fibrinolytics in the management of chest pain caused by cocaine abuse

A

increased risk of intracranial hemorrage

278
Q

patient with infective endocarditis is started on vancomycin .Days later culture grows streptococcus mutans highly sensitive to PNC next step

A

switch antibiotics to IV ceftriaxone

279
Q

rx of infective endocarditis caude by step mutans(3)

A

IV pNC
IV ceftriaxone
for 4 weeks

280
Q

what intervention in STEMI will improve the long term prognosis of patient

A

restore coronary blood flow

281
Q

inferior MI

A

2 ,3 avf

282
Q

two primary options to restore coronary blood flow(2)

A

PTCA

fibrinolysis

283
Q

when to do exercice EKG or pharmacologic stress testing in patient with chest pain

A

when you have intermediate risk of CAD

284
Q

quid of intermediate risk of CAD(3)

A

atypical angina in men of all ages
atypical angina in women > ou egal 50
typical angina in women age 30-50

285
Q

high risk for CAD(2)

A

typical angina in men > ou egal a 40 ans

typical angina in women age > ou egal a 60 ans

286
Q

low risk for CAD(2)

A

atypical chest pain in women age

287
Q

high risk for CAD CAT(2)

A

start Rx

coronary angiography if unstable angina

288
Q

patient with ant.hypertension with hypotension tachycardia,distended neck veins pulsus paradoxus with teraing chest pain dx

A

pericardial tamponnade due to dissection aortique

289
Q

USMLE pulsus paradoxus

A

respiratory variation in systolic blood pressure or

decrease > 10mm de hg drop in systolic pressureduring inspiration

290
Q

why syncope and hypotension in tamponnade(4)

A

compression of cardiac chambers by fluid in pericardium
limit diastolic filling of trhe right sided chambers
decreases preload
reduces cardiac out put

291
Q

young age under 70 patient with aortic stenosis cause

A

bicuspid aortic valve

292
Q

elderly 70 patient with aortic stenosis cause

A

calcification of aorta

293
Q

tearing cehst pain in thew context of hypotension with respiratory variation in systolic blood pressure hypotension ,distended jugular veins dx

A

dissection aortique

294
Q

dissection aortic wuth Ta higher in right arm than the left arm why

A

extension of the dissection into the great vessels feeding the left arm

295
Q

after myocardial infarction patient develops develops widened QRS complex with compensatory pause next step but patietn is asymptomatic

A

observation

296
Q

PVC in symptomatic patient rx

A

Bblocker

297
Q

when you cant use nitrates in in MI

A

right ventricular MI

298
Q

when to suspect right ventricular MI

A

often accompany post MI

299
Q

when to suspect right ventricular MI(5)

A

hypotension
with clear lung fields
high JVP
Kussmaul’s sign positif

300
Q

Left ventricular infarct(2)

A

hypotension

pulmonary edema

301
Q

correction of hypotension in right ventricular infarct(2)

A

administer normal saline bolus

don’t give nitro

302
Q

patient developping dyspnea after stab wound to the right thigh 10 months ago .In EP,right leg is warmer and apperas flushed compared to his left leg cause of the patient symptom

A

increased cardiac preload

303
Q

patient developping dyspnea after stab wound to the right thigh 10 months ago .In EP,right leg is warmer and apperas flushed compared to his left leg cause of the patient symptom dx

A

AV fistula

304
Q

congenital cause of AV fistula(4)

A

PDA
angiomas
pulmonary AVF
CNS AVF

305
Q

acquired cause of AVF(4)

A

trauma
iatrogenic ( femoral catheterisation)
atherosclerosis(aortocava fistula)
cancer

306
Q

why heart failure in AVF

A

the circulation is unable to meet the oxygen demand of the peripheral tissues

307
Q

patietn with dyspnes and elevate BNP what you expect to find in this patient

A

S3

308
Q

meaning of S3 and elevated BNP

A

increased cardiac filling pressures

309
Q

patinet with left sided chest pain improving with leaning forward and creat 5.1 dx and rx(2)

A

pericarditis

hemodyalisis

310
Q

most common cause of pericarditis

A

viral infection

311
Q

rx of viral pericarditis

A

NSAID

312
Q

cause of pericarditis(5)

A
iatrogenic
connective tissue disease
cardiac
uremic
malignancy
313
Q

iatrogenic cause of pericarditis(4)

A

surgery
trauma
radiation
drug related/chemo

314
Q

connective tissue causing pericarditis(2)

A

RA

SLE

315
Q

cardiac problem causing pericarditis

A

dressler syndrome

316
Q

quid of dressler syndrome(2)

A

post MI infarction

usually 1 -6 weeks after MI

317
Q

when you will have uremic pericarditis

A

whrn BUN> 60 mg/dl

318
Q

CHADS 2 score(5)

A
C=CHF =1 pt
H=hypertension=1
A=age . ou egal a 75=1
D=diabetes=1
S=prior stroke =2
319
Q

CHF apres recent cold

A

dilated cardiomyopathy

320
Q

finding on echo in dilated cardiomyopathy(2)

A

dilated ventricles with diffuse hypokinesia

low ejection fraction

321
Q

viral myocarditis cause #1

A

coxsackievirus B

322
Q

viral myocarditis other cause(4)

A

parvovirus B19
human herpes virus 6
adenovirus
enterovirus

323
Q

tracing of arterial line and BP

A

compare pick lors de l’inspiration and pic in systolic presure to understand the graphics

324
Q

quid of pulsus paradoxus

A

decrease of ten mm de hg of systolic pressure during inspiration

325
Q

explanation of pulsus paradoxus

A

in inspiration the intrathoracic pressure is negative
incresase venous return to the right heart
interventricular septum shifs into the left ventricular cavity reducing the left ventricular and diastolic volume
d’ou decreasd systolic blood pressure in the case of tamponnade

326
Q

other cause of pulsus paradoxus(2)

A

severe asthma

COPD

327
Q

why isolated systolic hypertension in elderly

A

rigidity of the arterial wall

328
Q

rx of isolated systolic hypertension in elderly

A

monotherapy with thiazide
or ACE inhibitor
or
long acting calcium channel blocker

329
Q

heart problem in Marfan(3)

A

aortic dilation
regurge
aortic dissection

330
Q

murmur in Marfan

A

early diastolic murmur

331
Q

skeletal problem in Marfan(5)

A
arachnodactyly
pectus deformity
joint hypermobility
increase arm to height ratio
decrease upper to lower body segment ratio
332
Q

ocular problem in marfan

A

ectopia lentis

333
Q

why marfan patient tend to have spontaneous pneumothorax

A

rupture of apical blebs

334
Q

skin finding in Marfan(2)

A

reccurrent or incisionnal hernia

skin striae

335
Q

Marfan patient with acute chest pain

A

acute aortic dissection

336
Q

syncope provoked by strong emotion

A

vasovagal syncope

337
Q

inciting event of vasovagal syncope in patient

A
emotionnal stress(venipuncture)
orthostatic stress(prolonged standing)
338
Q

inciting event of vasovagal syncope in patient > 60 ans(3)

A

micturition
cough
defecation

339
Q

dx of uncertain vasovagal syncope

A

upright tilt table testing

340
Q

dx of vasovagal syncope

A

clinical

341
Q

what medication should be given to all patient with MI within 24 hours

A

ACE inhibitor

342
Q

why ACE inhibitor in post MI(2)

A

to prevent remodelling of the ventricle and

possible dilation of the ventricle leading to CHF

343
Q

military recruit with body temperature > 40 during exercice with central nervous system dx

A

heat stroke

344
Q

common symptom in heat stroke(3)

A

dehydration
hypotension
tachycardia

345
Q

systemic effects of heat stroke(4)

A

seizures
acute respiratory distress syndrome
DIC
hepatic and renal failure

346
Q

rx of heat stroke(4)

A

rapid cooling with ice water immersion
fluid resuscitation
electrolyte correction
management of end organ damage

347
Q

antipyretic in heat stroke

A

any role

348
Q

risk factors for heat stroke(6)

A
strenuous activity during hot and humid weather
dehydration
poor acclimatisation
lack of physical fittness
obesity
medications
349
Q

medication involved in heat stroke(4)

A

anticholinergics
antihistamines
phenothiazines
tricyclics

350
Q

murmur on right sternal border increased with expiration

A

left side heart murmurs

351
Q

symptom of aorti stenosis(3)

A

S=Syncope
A=angine
D=Dyspnea

352
Q

indication of surgery in Aortic stenosis(3)

A

symptomatic patient
patients with severe AS undergoing CABG or other valvular surgery
asymptomatic patient with severe AS and poor LV systolic function=LV hypertrophy >15 mm
valve area

353
Q

cause of anginal pain in aortic stenosis

A

increased myocardial oxygen demand

354
Q

medication with decreased mortality following MI(4)

A

aspirin
B blockers
ACE inhibitor
lipid lowering statins

355
Q

indication of clopidogrel in MI(3)

A

intolerance to aspirin
post US/NSTEMI
following PCI

356
Q

duration of taking of aspirin and clopidogrel after UA/NSTEMI

A

12 months for clopidogrel

definitely for aspirin

357
Q

role of clopidogrel and aspirin inn post PCI

A

prevent stent thrombosis

358
Q

AFIB with cardiac arrest next step

A

chest compression

359
Q

quid of pulseless electrical activity

A

the presence of organized rythm on cardiac monitoring without a measurable BP or palpable pulse in a cardiac arrest patient

360
Q

wht to do in pulseless electrical activity(2)

A

chest compression
no defibrillator
nosynchronised cardioversion

361
Q

AFIB with cardiac arrest Dx

A

pulseless electrical activity

362
Q

reversible causes of asystole/pulselkess electrical activity 5H(5)

A
hypovolemia
hypoxia
hydrogen nions( acidosis)
hypo or hyperkaliemia
hypothermia
363
Q

reversible causes of asystole/pulselkess electrical activity 5T(5)

A
tension pneumothorax
tamponnade
toxins
thrombosis(pulmonary or coronary)
trauma
364
Q

elderly with diarrhea develops orthostatic hypotension,mucosal dryness, what’s the most sensitive indicator to see if elder is dehydrated

A

increase BUN/CREAT ratio

365
Q

after MI patient develops leg Pain dx

A

occlusion of popliteal artery

366
Q

5 P in occlusion artery

A
Pain
pulselessness
paresthesia
poikilothermia
pallor
367
Q

tr of occlusion artery(2)

A

embolectomy
or
intra arterial fibrinolysis/mechanical embolectomy via interventionnal radiology

368
Q

pleuritic chest pain normal cardiac exam, tenderness to palpation over the sternum

A

costochondritis

369
Q

clue for pain from musculoskeletal origin

A

reproducible with palpation

370
Q

papiltaion with AFIB in patient with lid lag retraction and tremor dx

A

graves disease

371
Q

rx of hyperthyroidism related tachysystolic AFIB

A

propranol

372
Q

patient with HTA is receiving a drug whicn enhances natriuresis,decreases serum angiotensin 2 concentration and decreases aldosterone production action of that drug

A

direct renin inhibitor

373
Q

example of direct renin inhibitor

A

aliskiren

374
Q

drugs affecting the renin angiotensin aldosterone axis(3)

A

ACE inhibitors
angiotensin receptor blockers
direct renin inhibitor

375
Q

MI plus flash pulmonary edema management

A

furosemide

376
Q

initial stabilisation of acute ST segment elevation MI(7)

A

02 if sao2

377
Q

ST segment elevation plus unstable sinus bradycardia management

A

IV atropine

378
Q

ST segment elevation plus persistent severe pain ,management

A

IV morphine

379
Q

ST segment elevation plus persistent

pain,hypertension or heart failure ,management

A

IV nitroglycerine

380
Q

when you cant use nitro in MI(3)

A

hypotension
right ventricular infarct
severe aortic stenosis

381
Q

when you cant use b blockers in MI(2)

A

CHF

bradycardia

382
Q

laps of time to perform percutaneous transluminal coronary angioplasty following MI

A

within 90 mn preferred

383
Q

if PTCA within 120 mn not available in case of acute ST segment elevation next step

A

thrombolysis

384
Q

patient is receiving a medication for palpitation ,he undergoes a stres test for chest pain durinfg the test his heart rate increases form 65 to 175 and qrs duration from 0,09 to 0.13 seconds .which medication was used for palpitation in thsis patient

A

flecainide

385
Q

why during stress test if you are taking flecainide heart rate will increase and QRS complex prolonged

A

the medication has a use dependance prperty
more effective at higher heart rates because there is not as much time between heartbeats for the medication to dissociate from its receptor

386
Q

action of flecainide

A

block sodium channel

387
Q

indication of flecainide(2)

A

ventricular arythmias

supraventricular tavhycardia as AFIB

388
Q

class of antiarrythmic involved in use dependence phenomenon

A
class 1c
class iV
389
Q

does class IV prolong QRS complex

A

no

390
Q

patient with MI under rx 4 days later develops chest pain .the best marker to be useful in this patient

A

CK MB

391
Q

the most specific and sensitive test for MI(2)

A

troponin T

return to normal in 10 days post MI

392
Q

wy CKMB is the best test in reocclsuion following a previous recent one

A

it takes 1-2 days to become normal after MI

393
Q

murmur in mitral regurge

A

holosystolic murmur

394
Q

features for mitral regurgitation(4)

A

exertional dyspnea
fatigue
AFIB
heart failure signs

395
Q

aortic stenosis in elderly cause

A

sclerocalcific changes

396
Q

you perform myocardial perfusion scanning for a patient,it reveals uniform distribution at rest but inhomogenesity of the distribution after dipyridamole injection.waht effect of dipyridamole helps in making the dx of ischemic heart disease

A

coronary steal phenomenon

397
Q

indication of myocardial perfusion scanning with dipyridamole

A

amputated patient

398
Q

quid of coronary steal

A

redistribution of coronary blood flow to non diseases segments

399
Q

whta other substance can be used in myocardial perfusion scanning

A

adenosine

400
Q

risk of mitral stenosis

A

left atrial dilation
AFIB
cardiac emboli

401
Q

consequence of pressure transmitted to pulmonary vasculature inmitral stenosis(3)

A

dyspnea
cough
hemoptysis

402
Q

patient with right sided weakness cough hemoptyis dyspnes from cambogia dx

A

stroke caused by cardiac emboli inthe setting of mitral stenosis

403
Q

quid of mallory weiss(2)

A

upper gastrointestinal mucosal tear

caused by forceful retching

404
Q

quid of boerhave syndrome(3)

A

esophageal transmural tear
caused by forcefu retching
esophageal air and fluid leakage in nearby areas

405
Q

chest xray in boerhave syndrome(3)

A

unilateral pleural effusion
with or without pneumothorax
subcutaneous or mediastinal emphysema
widened mediastinum

406
Q

pleurl fluid analysis in boerhave syndrome(2)

A

high amylase > 2500 UI

food particles

407
Q

dx of boerhave syndrome(*2)

A

CT

contrast esophagography with gastrographin

408
Q

confirnatory dx in mallory weiss

A

endoscopy gastro digestive

409
Q

risk factor for variant angina

A

smoking

410
Q

EKG in variant angina

A

ST segment elevation

411
Q

condition associated with printzmetal angina(2)

A

migraine

raynauds phenomenon

412
Q

pain characteristic in prntzmetal

A

occurs at night

goes spontaneously after 15-20 mn

413
Q

hypertension in the setting of hypercalcemia

A

parathyroid gland disease

414
Q

secondary HTA caused by renal parenchymal disease(2)

A
elevated serum creat
abnormal urinalysis (proteinuria,red blood cell casts)
415
Q

secondary HTA caused by reno vacular disease(4)

A

severe HTA > ou egal 180/120 after 55
abdominal bruit
flash pulmonary edema
unexplained rise in creat

416
Q

secondary HTA caused by primary aldosteronism(3)

A

hypokaliemia
slight hypernatremia
adrenal incidentaloma

417
Q

secondary HTA caused by pheochromocytoma (3)

A

paroxysmal elevated BP with tachycardia
pounding headaches papiltations and diaphoresis
adrenal incidentaloma

418
Q

secondary HTA caused by hypothyroidism(5)

A
constipation
weight gain
bradycardia
cold intolerance
dry skin
419
Q

secondary HTA caused by primary hyperparathyroidism(3)

A

hypercalcemia
kidney stones
neuropsychiatric disease

420
Q

secondary HTA caused by coarctation of aorta

A

differential HTA with brachio femoral pulse delay

421
Q

xray findingds in pericardial effusion

A

water bottle cardiac silhouette

422
Q

how ‘s the jugular venous pressure in viral pericarditis

A

could be normal

423
Q

how ‘s the point of maximal impulse in viral pericarditis

A

non palpable

424
Q

first test to do in a setting of syncope

A

EKG

425
Q

syncope occuring during prolonged standing position distress or painful stimuli dx

A

vasovagal or neurally mediated syncope

426
Q

syncope occuring during postural changes with changes in heart rate and blood pressure

A

orthostatic hypotension

427
Q

syncope during exercice or with exertion(4)

A

aortic stenosis
HOC
anomalous coronary arteries
VTAC

428
Q

syncope with sinus pauses on monitor prolonged PR interval or QRS duration(3)

A

sick sinus syndrome
bradyarythmiasd
av block

429
Q

syncope with hypokaliemia or hypomg++ or any medication causing prolonged QT interval

A

torsades de pointes

acquired long QT syndrome

430
Q

syncope with triggers ( swimming,during sleep sudden noice) family history of sudden daerth prolonged qt interval on ECG

A

congenital long Qt syndrome

431
Q

ECG findings suggesting arrythmia as the cause of syncope(6)

A
innaproppriate sinus bradycardia
sino atrial block
sinus pauses
AV block
nonsustained VTAC
short or long QTC interval
432
Q

murmur in aortic regurge(2)

A

early diastolic murmur

left sternal border

433
Q

bounding pulse or water hammer peripheral pulse

A

aortic regurgitation

434
Q

aortic murmur in regurgitation localisation in valvular disease

A

diastolic murmur in left sternal border 3 e 4 e espace intercostal

435
Q

aortic murmur in regurgitation localisation in aortic root disease

A

diastolic murmur in right sternal border

436
Q

conduction abnormality in the setting of infective endocarditis

A

perivalvular abcess

437
Q

risk in acute endocarditis involving the aortic valve in IV drug user

A

periannular extension of endocarditis

438
Q

peripheral edema with normal physical exam in a patient taking calcium blocker cause of edema

A

dihydropyridine Ca channel antagonist

439
Q

sudden death in young athlete

A

hypertrophic cardiomyopathy

440
Q

risk factor for coroanry syndrome(3)

A

smoking
family history
estrogen therapy

441
Q

patientin EB with chest pain and suspected coronary syndrome .what drug should be administered first

A

aspirin

442
Q

why aspirin is so important in acute coronary syndrome(2)

A

reeudces risk of MI

decrease mortality overall

443
Q

apical holosystolic murmur

A

mitral rergurgitation

444
Q

apical mid late systolic murmur

A

mitral valve prolapse

445
Q

apical mid late diastolic murmur

A

mitral stenosis

446
Q

left sternal border systolic ejection murmur

A

Hypertrophic cardiomyopathy

447
Q

left sternal border early diastolic murmur(2)3 e espace intercostal

A

aortic regurgitation

pulmonic regurgitation

448
Q

quid of pulomonic area

A

2 espace intercostal G

449
Q

systolic ejection murmur in pulmonic area

A

pulmonic stenosis
flow murmur
ASD

450
Q

systolic ejection click in pulmonic area

A

pulmonic stenosis

451
Q

quid aortic area

A

2 e espace intercostal droit

452
Q

systolic ejection murmur in aortic area

A

aortic stenosis

453
Q

holosystolic murmur in tricuspid area

A

tricuspid regurge

VCD

454
Q

quid of tricuspid area

A

4 e espace intercostal in the left close to sternum

455
Q

mid late diastolic murmur(2)

A

tricuspid stenosis

ASD

456
Q

cause of mitral regurgitation in developed countries

A

mitral valve prolapse=myxomatous degeneration of the valve

457
Q

complication of severe chronic Mitral regurgitation(3)

A

AFIB
left ventricular dysfunction
CHF

458
Q

most common benign tumor in heart

A

Myxoma

459
Q

Symptom for atrial myxoma(3)

A

systemic embolization
cardiovascular symptoms simulating mitral valve disease
constitutioonnal symptoms

460
Q

most sensitive test to Dx atrial myxoma

A

transesophageal echocardiography

461
Q

complication of myxoma

A

sudden death

462
Q

murmur in myxoma

A

early diastolic sound=tumor flop

463
Q

why constitutionnal symptoms in myxoma

A

overproduction of interleukin 6

464
Q

anterior wall MI

A

V1- V6

465
Q

hemodynamic hypotension compromises 3 a 7 jours after anterior MI(3)

A

paillary muscle rupture
left ventricle free wall rupture
interventricular septum rupture

466
Q

hypotension with pansystolic murmur apical after anterior wall MI

A

acute mitral regurgitation caused by papillary muscle dysfunction

467
Q

normal heart rate at rest

A

60-100

468
Q

symptomatic sinus bradycardia(dizziness) rx

A

iV atropine

469
Q

symptomatic sinus bradycardia unresponsive to atropine

A

permanent pace maker

470
Q

cause of sinus bradycardia(4)

A

sick sinus syndrome
hypoglycemia
medication
exagerated vagal activity

471
Q

medication involved in sinus bradicardia(3)

A

digitalis
B blocker
Calcium channel blocker

472
Q

first line antianginal rx used in stabe chronic angina

A

B blocker

473
Q

antianginal drug(3)

A

bblocker
calcium channel blocker
nitrates

474
Q

action of BBlocker as antianginal drug

A

decrease myocardial contractility and heart

475
Q

action of calcium channel blocker as antianginal drug

A

peripheral and coronary vasodilation

476
Q

can you combine Bblocker and calcium blocker as antianginal

A

yes

in persisting angina

477
Q

preventive rx in stable chronic angina(5)

A
aspirin
statin
smoking cessation
regular exercices and weight loss
control of BP and diabetes
478
Q

when to use nitrate in stable chronic angina

A

when B blocker and calcium blocker are contindicated

479
Q

medication which has not been shown to improve survival in patients with CHF(2)

A

digoxin

furosemide

480
Q

medication which has been shown to improve survival in patients with CHF(5)

A
ace inhibitor
ARB's
bblocker
aspirin
spironolactone
481
Q

S4 meaning

A

diastolic disfunction

482
Q

why S4 in MI

A

ischemic damage may lead to diastolic dysfuction and stiffened ventricle

483
Q

rx of dressler syndrome

A

NSAIDS

484
Q

indication of corticosteroids in dressler syndrome(2)

A

refractory cases

contrindication of NSAIDS

485
Q

why you should avoid anticoagulation if you suspect dressler syndrome

A

risk of hemorragic pericardial effusion

486
Q

bad prognosis factor in heart failure

A

hyponatremia

487
Q

why hyponatremia is a factro of bad prognosis in heart failure(2)

A

it indicates sever heart failure

high level of neurohumoral activation

488
Q

cause of hypo or hyperkaliemia in CHF(2)

A

drugs induced

reflection of renin angiotensin aldosterone system activity

489
Q

CHF with echo finding of concentric thickening of the ventricular walls ,normal ventricular chamber dimensions and diastolic dysfunction cause of that

A

amyloidosis

490
Q

type of amyloidosis(2)

A

primary=AL

secondary=AA

491
Q

cause of amyloidosis

A

any chronic inflammator conditions

492
Q

some examples of chronic inflammatory disease(5)

A
inflammatory arthritis
chronic infections
IBD
Malignancy
vasculitis
493
Q

CHF in amyloidosis

A

restrictive

494
Q

dx of amyloidosis

A

tissue biopsy(abdominal fat pad biopsy)

495
Q

inthe USMLE clue for syncope caused by arrythmia(4)

A

syncope without warning
presence of structural disease(post infarction)
frequent ectipic beats
thiazide is taking by teh patient

496
Q

patient after MI develops cold leg next step and why(2)

A

echo cardiography

search for intraventricular thrombus

497
Q

patietn presenting with left chestpain 5 days ago he was diagnosed for ant MI with complete occlsuion of LAD 2 miniutes later he is unresponsive with no pulse palpated and death(possible)dx

A

ventricular free wall rupture

498
Q

mechanical complication of MI(4)

A

right ventricular failure
papillary muscle rupture
interventricular sseptum rupture
free wall rupture

499
Q

artery involved in right ventricular failure

A

RCA

500
Q

time course for right ventricular failure

A

acute

501
Q

finding in right ventricular failure(2)

A

hypotension with clear lungs

kussmaul sign

502
Q

echo finding in right ventricular failure

A

hypokinetic RV

503
Q

artery involved in papillary mx rupture

A

RCA

504
Q

time course for papillary mx rupture

A

acute and within 3 -5 days

505
Q

finding in papillary mx rupture

A

acute severe pulmonary edema

new holosystolic murmur

506
Q

echo finding in papillary mx rupture

A

severe mitral regurge with flail leaflet

507
Q

artery involved in interventricular septum rupture or defect(2)

A

LAD for apical rupture

RCA for basal rupture

508
Q

time course in interventricular septum rupture or defect

A

acute and within 3 -5 days

509
Q

finding in interventricular septum rupture or defect(4)

A

shock
chest pain
new hollow systiolic murmur
biventricular failure

510
Q

echo finding in interventricular septum rupture or defect(2)

A

left to right shunt level of ventricle

step up oxygen between right atrium and ventricle

511
Q

artery involved in free wall rupture

A

LAD

512
Q

time course in free wall rupture

A

within first 2 days - 2 weeks

513
Q

finding in free wall rupture(3)

A

shock and chest pain
jugular venous distension
distant heart sounds

514
Q

echo finding in free wall rupture

A

pericardial effucion with tamponnade

515
Q

SMVT

A

sustained monomorphic ventricular tachycardia

516
Q

cause of SMVT

A

post MI complication 6 a 48 h apres MI

517
Q

EKG of SMVT

A

wide complex tachycardia with 2 fusion beats

518
Q

rx of hemodynamic stable SMVT(3)

A

IV amiodarone
lidocaine
procainamide

519
Q

rx of hemodynamic unstable SMVT

A

electrical cardioversion

520
Q

heart and alcohol

A

dilated cardiomyopathy

521
Q

measures most likely to reverse heart failure in alcoholic CHF

A

total abstinence from alcohol

522
Q

mainstay of rx of alcoholic CHF

A

total abstinence from alcohol

523
Q

what disease patient with intermittent claudication will have over the next 5 years

A

MI

524
Q

major cause of mortality in patient with PAD

A

cardiovascular disease

525
Q

probability of non fatal MI and stroke in patient with intermittent claudication

A

20% 5 year risk

526
Q

probability of death to cardiovascular causes in patient with intermittent claudication

A

15 a 30 %

527
Q

probability of critical limb ischemia with risk of limb amputation in patient with intermittent claudication

A

1 a 2 %

528
Q

stanford classification of dissection aortic (2)

A

type A

B

529
Q

rx of type A aortic dissection(2)

A

Labetalol

surgery

530
Q

rx of type A aortic dissection

A

Labetalol

531
Q

quid of type A aortic dissection

A

ascending aorta is involved

532
Q

quid of type B aortic dissection

A

descending aorta

533
Q

CT for aortic dissection

A

descending aorta with false and true lumen separated by an intimal flap

534
Q

aortic mur murmur caused by aortic dissection

A

right sternal border compared to primary aortic valvular disease ,murmur is herad to the left

535
Q

best test to Dx aortic dissection

A

TEE

CT with contrast

536
Q

when to use CT with contrast in the Dx of aortic dissection

A

when renal function is normal

537
Q

artery and lead in anterior MI(2)

A

LAD

v1 a V6

538
Q

artery and lead in inferior MI(2)

A

RCA or left circumflex artery 9LCX)

ST elevation 2,3 avf

539
Q

artery and lead in post MI(4)

A

RCA or left circumflex artery
ST depression in leads V1-V3
ST elevation in 1 and AVL(LCX)
ST depression in leads 1 and AVL (RCA)

540
Q

artery and lead in lat MI(3)

A

LCX/diagonal
St elevation in leads 1 avl v5 v6
St depression in leads 2, 3 avf

541
Q

right ventricular MI when it occurs

A

in inferior MI

542
Q

artery in right ventricular MI(2)

A

RCA

St segment elevation in leads V4-V6R

543
Q

MI plus hypotension plus clear lung

A

right ventricular failure

544
Q

MI with sinus bradycardia

A

inferior MI

545
Q

why inferior MI cangive bradycardia(2)

A

increased vagal tone

RCA supply blood to sinoatrial node

546
Q

complication of RCA occlusion and why

A

AV block

RCA supply AV node through AV nodal artery

547
Q

ST segment elevations in 2,3 avf and ST segment depression in V1 V2

A

inferior MI with posterior MI associated

548
Q

hypotension AV block and bradycardia in the setting of MI

A

inferior MI

549
Q

clue for MI inferior involving right heart(2)

A

ST segment elevation ,2,3 AVL

St segment depression in i and AVL

550
Q

EKG in atrial premature beats

A

early P wave

551
Q

risk factor for atrial premature beats(4)

A

tobacco
alcohol
caffeine
stress

552
Q

symptomatic patient with atrial premature beats rx

A

B blocker

553
Q

xray in thoracic aorta aneurism(3)

A

widened mediastinum
increased aortic knob
tracheal deviation

554
Q

cause of ascending aorta aneurism(2)

A

cystic medial necrasis

connective tissue disorders

555
Q

cause of descending aorta aneurism

A

atherosclerosis

556
Q

enlarged aorta in xray

A

aneurism

557
Q

patient with low grade fevers exertionnal dyspnea

fingerttip pain and dark and cloudy urine.In physical exam proximal and distal interphalangeal joints are swollen

A

infective endocarditis

558
Q

quid of osler nodes

A

painful fingertip

559
Q

dark and cloudy urine(2)

A

proteinuria

hematuria

560
Q

swollen interphalangeal joints

A

arthritis

561
Q

vascular phenomoenon in infective endocarditis(5)

A
systemic arterial emboli
septic pulmonary infarcts
mycotic aneurism
conjonctival hemorrage
janeway lesions
562
Q

quid of Janeway lesions

A

macular erythematous nontender lesions on the palms and soles

563
Q

systemic emboli manifestation(3)

A

focal neurologic deficits
renal infarcts
splenic infarcts

564
Q

definitice dx or infective endocarditis

A

DUKE criteria

565
Q

inheritance of hypertrophic cardiomyopathy

A

autosomal dominant

566
Q

quid of masive pulmonary embolism(2)

A

PE complicated by hypotension

and acute right strain

567
Q

sign of right heart strain in PE(2)

A

high JVP

RBBB

568
Q

complication of right heart strain in PE(6)

A
right ventriculr dysfunction
decreasde to the left side of the heart
decreased cardiac output
left heart pump failure
bradycardia
cardiogenic shock
569
Q

fibrinolysis in PE in the setting of post op

A

can’t be given within the past 10 days of surgery

570
Q

CHF with normal TA or elevated TA(3)

A

supplement o2
IV loops diuretics
consider IV vasodilators as nitroglycerin or nitroprusside

571
Q

CHF plus sign de shock(3)

A

supplement o2
IV loops diuretics
IV vasopressors as norepinephrine

572
Q

side effect of digoxin(5)

A
nausea 
vomiting 
diarrhea
vision changes 
arythmias
573
Q

patient is taking digoxin develops diarrhea what to do

A

measure digoxin levels

574
Q

patient taking an anti arrythmic in teh setting of VTAC develops fibrose pulmonaire .what drug was used to rx the patient

A

amiodarone

575
Q

patient with diatolic and continuous murmur at left sternal border next step

A

echocardiography

576
Q

rule for diastolic and continuous murmur as well as loud systolic murmurs next step

A

investigate with transthoracic echodopler

577
Q

midsystolic murmur grade 1-2 /6 in young patient next step(2)

A

nothing

benign

578
Q

medication reducing overall mortality in CHF(4)

A

ACE inhibitor
b blocker
ARBs
spironolactone

579
Q

complication of niacin(2)

A

pruritis

flushing

580
Q

how to explain niacin complication

A

prostaglandin related vasodilation

581
Q

rx of niacin induced pruritis and flushing

A

low dose of aspirin

582
Q

patient with medical history of wolt parkinson white develops palpitations and AFIB rx

A

procainamide

583
Q

rx of AFIB normally

A

AV nodal blockers

584
Q

quid AV nodal blocker(4)

A

b blocker
calcium channel blocker
digoxin
adenosine

585
Q

middle aged or older male loses consciuousness immediately after urination or during coughing fits

A

situationnal syncope

586
Q

cause of situationnal syncope

A

autonomic dysregulation

587
Q

beck triad in tamponnade(3)

A

hypotension
muffled heart sound
distended neck veins

588
Q

hypotension in tamponnade(3)

A

shift of interventricular septum toward the left ventricular cavity
reduces left ventricular preload
stroke volume and cardiac output

589
Q

clue for GERD(3)

A

retrosternal burning sensation after eating and with lying down
hoarseness
chronic cough

590
Q

initial rx of GERD(2)

A

proton pump inhibitor

H2 receptor antagonist

591
Q

quid of resistant HTA

A

persistent HTA persistent despite using > ou egal a 3 antihypertensive agents

592
Q

what to do in front of all resistant HTA

A

check secondary HTA

593
Q

when to suspect renovascular HTA in case of secondary HTA(6)

A

severe HTA with recurrent flash pulmonary edema
severe HTA with diffuse atherosclerosis
onset of severe HTA after 55
HTA with asymetric kidney size or small atrophic kidney unilateral
presence of abdominal bruit
elevation of serun creat > 30 % from baseline after starting ACE inhibitor or ARbs

594
Q

clue for renovascular HTA

A

continuous abdominal bruit

595
Q

young patient with CHF first dx

A