Cardiology

Question 1

ST depressions…

Answer 1

Signs of ischemia

Question 2

Q waves on leads II, III, aVF

Answer 2

Inferior wall infarct

Question 3

ECG shows diffuse ST segment elevation, with chest pain relieved by sitting forward

Answer 3

Pericarditis

Question 4

Most common cause of pericarditis?

Answer 4

Coxsackievirus

Question 5

Features of unstable angina.

Answer 5

• prolonged chest pain that presents at rest, does not respond to nitroglycerin
• ECG changes (ST depression)
• minimally elevated cardiac enzymes

Question 6

Treatment of Prinzmetal angina.

Answer 6

Calcium channel blockers

Question 7

Features of Prinzmetal angina.

Answer 7

• chest pain at rest
• ST-segment elevations on ECG
• Cardiac enzymes are normal

Question 8

Treatment of achalasia.

Answer 8

pneumatic dilatation or botulism toxin administration

Question 9

Mitral stenosis murmur characteristics.

Answer 9

Late diastolic blowing murmur (best heard at the apex), with an opening snap.

Question 10

Aortic stenosis murmur characteristics.

Answer 10

Crescendo - decrescendo systolic ejection murmur

• slow pulse upstroke
• radiates to carotids
• leads to syncope, angina, dyspnea on exertion

Question 11

Aortic regurgitation murmur characteristics.

Answer 11

Early diastolic decrescendo murmur

• widened pulse pressure
• LVH, LV dilatation

Question 12

Mitral prolapse murmur characteristics.

Answer 12

Midsystolic click, late systolic murmur

Question 13

Most common etiology of mitral stenosis.

Answer 13

Rheumatic fever.

Question 14

Etiologies for Aortic stenosis.

Answer 14

age-related calcification or early onset calcification from bicuspid aortic valve

Question 15

Etiologies for Aortic regurgitation.

Answer 15

Congenital Rheumatic damage
Endocarditis
Aortic dissection/aortic root dilatation
Marfan syndrome

Question 16

Virchow’s triad.

Answer 16

Endothelial damage
Venous stasis
Hyper-coagulable state

Question 17

Homan sign.

Answer 17

Dorsiflexion sign for DVT

Question 18

Trousseau sign.

Answer 18

Migratory superficial thrombophlebitis, classic marker for pancreatic cancer.

Question 19

How are the effects of ASA, heparin and warfarin monitored?

Answer 19

Heparin -> PTT
Warfarin -> PT
ASA -> bleeding time

Question 20

Reversal agent for Heparin and LMW heparin.

Answer 20

Protamine.

Question 21

Causes for vitamin K deficiency.

Answer 21

• Neonate who did not receive prophylactic vit K
• Malabsorption
• Alcoholism
• Prolonged antibiotic used (kills vit K producing bowel flora)

Question 22

Cause of cor pulmonale in young woman with no other medical history or risk factors.

Answer 22

Idiopathic pulmonary arterial hypertension.

Question 23

Treatment for Idiopathic pulmonary arterial hypertension.

Answer 23

Parenteral epoprostenol  (prostacyclin)
Antiendothilin (bosentan)
Heart-lung transplant

Question 24

Most common kind of cardiomyopathy.

Answer 24

Dilated cardiomyopathy.

Question 25

Etiologies of dilated cardiomyopathy.

Answer 25

``` Alcohol abuse Wet Beriberi Coxsackie B virus myocarditis Chronic cocaine use Chagas disease Doxorubicin toxicity Hemochromatosis Sarcoidosis Peripartum cardiomyopathy ```

Question 26

What endocrine disorder causes atrial fibrillation?

Answer 26

Hypothyroidism.

Question 27

Triad for WPW.

Answer 27

- Wide QRS complex - Short PR interval - Delta waves

Question 28

In fetal circulation, highest oxygen content found in:

Answer 28

Umbilical vein (brings blood from mother to baby)

Question 29

In fetal circulation, lowest oxygen content found in:

Answer 29

Umbilical arteries (brings blood away from baby and back to mom)

Question 30

"2 measurement rule" of HTN:

Answer 30

BP should be measured 2 times on each of 2 separate office visits before the diagnosis and pharmacologic treatment of HTN

Question 31

Medications to improve mortality in congestive heart failure:

Answer 31

- ACEI - dose-dependent (limit ventricular remodeling and reduced progression) - Beta blockers (reduce risk of sudden death/arrhythmia/remodeling) - ARBS - Spironolactone (improves survival for Class 3 and 4)

Question 32

Diabetes and ACEIs

Answer 32

ACE inhibitors reduce progression of nephropathy and neuropathy

Question 33

Which drugs are used for pregnant woman with HTN?

Answer 33

Labetolol Hydralazine alpha-Methyldopa (Mg2+ sulfate also lowers BP in Preclampsia)

Question 34

HTN urgency

Answer 34

Severe HTN, SBP >180, DBP >120 WITHOUT sxs.

Question 35

HTN emergency

Answer 35

1) Malignant HTN: HTN urgency + retinal hemorrhages, exudates or papilledema, or evidence of End-organ-damage 2) HTN encephalopathy: HTN urgency + cerebral edema & non-focal neuro sxs Tx: IV nitroprusside

Question 36

Secondary HTN in a young man... most likely cause?

Answer 36

Excessive alcohol intake

Question 37

Secondary HTN in a young woman... most likely cause?

Answer 37

Birth control pills or renal artery stenosis from Fibromuscular dysplasia (p/w bruit and should be treated with balloon angioplasty)

Question 38

Screening test for pheochromocytoma:

Answer 38

24-hr urine collection to assess catecholamine products, metephrines, vanillylmandelic acid, homovanillic acid

Question 39

Older patient with renal artery stenosis, most likely 2/2?

Answer 39

Atherosclerosis | DO NOT give them ACEIs since it precipitates them to acute renal failure

Question 40

Conn syndrome + HTN

Answer 40

Aldosterone-secreting adrenal neoplasm | Labs: high aldosterone, low renin, hypernatremia, hypokalemia, metabolic alkalosis

Question 41

Screening test for Conn syndrome (Hyperaldosteronism)?

Answer 41

Plasma aldosterone to Plasma renin activity ratio; ratio greater >30 is indicative of primary hyperaldosteronism

Question 42

Leriche syndrome

Answer 42

Combination of claudication of buttocks, buttock atrophy, and impotence in men cause by aortoilliac occlusive disease, requiring aortoiliac bypass graft

Question 43

Management of claudication?

Answer 43

Conservative FIRST cessation of smoking, exercise (develops collateral circulation), weight loss, good control of cholesterol, diabetes and HTN, ASA (or clopidogrel if can't tolerate ASA)

Question 44

Features of chronic mesenteric ischemia

Answer 44

Postprandial abdominal pain Fear of food w/ weight loss Extensive h/o of atherosclerotic disease Abdominal bruit Heme-occult-positive stool LACK OF JAUNDICE (r/o pancreatic cancer) CT abdomen is NEGATIVE (raising suspicion for ischemia) Dx: Angiography of superior mesenteric artery

Question 45

Features of venous insufficiency

Answer 45

- Deep vein thrombosis - Varicose veins - Swelling in the extremity with pain, fatigability or heaviness - Increased skin pigmentation around the ankles with possible skin breakdown and ulceration

Question 46

Superficial thrombophlebitis

Answer 46

Pt has a h/o varicose veins, c/o localized leg pain with superficial cordlike induration, reddish discoloration and mild fever. - NOT A RISK FACTOR for PE - NO NEED for anticoagulation Tx: conservative with NSAIDs and warm compresses

Question 47

Subclavian steal syndrome

Answer 47

Caused by left subclavian artery obstruction proximal to the vertebral artery, particularly when exercising their upper extremity t/f p/w: -CNS sxs (syncope, vertigo, confusion, ataxia, dysarthria) 2/2 blood being stolen from vertebrobasilar system -Upper extremity claudication during exercise Tx: surgical bypass

Question 48

Thoracic outlet syndrome

Answer 48

Caused by obstruction of nerves or blood vessels that serve the arm as the neurvascular bundle passes from the thoracocervical region to the axilla by CERVICAL RIBS or MUSCULAR HYPERTROPHY (classic is young male weight lifters). P/w: - Upper extremity paresthesia (nerve impingement) - Weakness - Cold extremities (arterial compromise) - Edema and or venous distention (venous compromise)