Cardiology Flashcards
(184 cards)
1
Q
What side effect might make a patient stop taking an ACEI?
A
Cough
2
Q
Define orthostatic hypotension.
A
A drop in systolic pressure of >20mmHg when standing up.
3
Q
You feel a pulse that seems to be vibrating. What term do you use to describe it?
A
Thrill
4
Q
What are three things in your differential if you have a paradoxical pulse?
A
Cardiac tamponade
pericarditis
obstructive lung disease
5
Q
What is a paradoxical pulse?
A
An abnormally large decrease in systolic BP during inspiration. Normal is less than 10mmHg. PP is more than 20mmHg.
6
Q
On palpation, what size is normal for the aorta?
A
Less than 3cm
7
Q
A fixed or consistent split S2 should make you think of what dx?
A
Atrial septal defect
8
Q
A pathologic S3 is most commonly associated with what dx?
A
CHF
9
Q
If you hear a mid systolic click you should immediately be thinking about what dx?
A
Mitral valve prolapse
10
Q
An opening snap on auscultation of the hear should make you think of what dx?
A
Mitral stenosis
11
Q
A continuous murmur most likely involves what area of the heart?
A
It is most likely a septal defect.
12
Q
You hear a continuous machine-like murmur. What is the most likely dx?
A
Patent ductus arteriosus(PDA)
13
Q
List 3 meds which may be used for a pharmacological stress test.
A
Adenosine
Dobutamine
Dipyridamole
Persantine
14
Q
What is the gold standard for dx’ing coronary artery disease?
A
Cardiac catheterization
15
Q
Define stage 1 hypertension acc to JNC7.
A
Systolic pressure of 140-159 and diastolic 90-99
16
Q
What is the tx goal for a diabetic with HTN?
A
130/80
17
Q
What is the most common cause of 2ndary HTN?
A
chronic kidney disease
18
Q
No matter what meds you use, you are having trouble keeping a pt’s BP under control. You also notice hyper pigmented skin and truncal obesity. What is the most likely dx?
A
Cushing’s disease
19
Q
List 3 s/s which will likely be included in the description of a pt with a pheochromocytoma.
A
Thin diaphoretic tachycardic agitated hypertensive
20
Q
What is a pheochromocytoma?
A
(benign) tumor that develops in an adrenal gland. Usually, this type of tumor affects one of your two adrenal glands, but it can affect both.
If you have a pheochromocytoma, the tumor releases hormones that cause either episodic or persistent high blood pressure. Untreated, a pheochromocytoma can result in severe or life-threatening damage to other body systems, especially the cardiovascular system.
Most people with a pheochromocytoma are between the ages of 20 and 50, but the tumor can develop at any age. Surgical treatment to remove a pheochromocytoma usually returns blood pressure to normal.
21
Q
You have a pt with a dx of pheochromocytoma. While waiting for surgery, should you use an alpha or beta blocker?
A
Alpha blocker. You should never use a pure beta blocker.
22
Q
A young boy comes into your office. He has elevated BP when taken in his arm, but no femoral pulses can be palpated. What is the most likely dx?
A
Coarctation of the aorta
23
Q
According to the CDC, what is the range for a normal BMI?
A
18-5-24.9
24
Q
What is the first line medical tx for stage 1 HTN?
A
Thiazide diuretic
25
After a thiazide diuretic, what medication should you start in a HTN pt who also has DM?
ACEI
| ARB
26
Following an MI, what med should you be using to tx HTN?
beta blocker
27
Paroxysmal nocturnal dyspnea should make you think of what dx?
CHF
28
What is the most common cause of CHF?
Coronary artery disease
29
What ejection fraction is typical for a pt c CHF?
35-40%
30
What is the most likely dx for a young man who experiences sudden death while playing sports?
Hypertrophic cardiomyopathy
31
Bat wing vessels or Kerley B lines on CXR should make you think of what dx?
CHF
32
A beta natriuretic peptide below what level rules out CHF?
<100
33
What is the therapeutic range for INR following a mechanical valve replacement?
2.5-3.5
34
What is the first line IV inotropic agent when dealing with cardiogenic shock?
Dopamine
35
What dx is most likely in an IV drug user with a new heart murmur and fever?
Endocarditis
36
List 2 dx which require abx prophylaxis for "dirty procedures"?
Prosthetic valve
Valve repair with any prosthetic material
prior endocarditis
Congenital cyanotic heart defect
37
Does a patient with mitral valve prolapse require prophylactic abx for dental work?
No
38
What are 3 major criteria for endocarditis?
2 positive blood cultures
a positive transesophageal echocardiography
new murmur
39
Which are painful and found on the fingers and toes: Osler nodes or Janeway lesions?
Osler nodes (ouch!)
40
List 4 minor criteria for dx'ing endocarditis.
Fever
embolic event: Janeway lesions or petechiae, splinter hemorrhages
Immunological event (Osler nodes, glomerulonephritis)
1 positive blood culture
41
What are the 5 components of Tetralogy of Fallot?
```
Ventricular septal defect
Right ventricular hypertrophy
right ventricular outflow obstruction (pulmonary valve stenosis)
Overriding aorta
right sided aortic arch
```
42
Sudden death in a young athlete associated with...
hypertrophic cardiomyopathy
43
Fixed wide splitting of S2
Atrial septal Defect (ASD)
44
How does coarctation of the aorta present?
Rib notching, absent or weak femoral pulses with a delay of palpable femoral pulse and HTN in arms but low or normal blood pressure in the legs
45
What disorder is associated with a machine like murmur?
patent ductus arteriosus
46
What dx would you think of in an infant who has cyanosis with crying or feeding?
tetralogy of ballot
47
A holosystolic murmur suggests...
VSD
48
A new mitral regurgitant murmur in a pt with a hx of iv drug abuse suggests.....
bacterial endocarditis
49
How is a pericardial friction rub heard best? Associated c what condition?
With the pt sitting up and leaning forward
| acute pericarditis
50
What is the gold standard for diagnosing myocarditis?
Myocardial bx
51
Where do most aortic dissections occur?
The ascending or descending thoracic aorta
52
A pt c/o severe pleuritic chest pain that is relieved with sitting and leaning forward. What is the most likely dx?
pericarditis
53
What is the first line medical tx for pericarditis?
Aspirin and NSAIDS
54
What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?
Dressler syndrome
55
A pt presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all of the leads. What is the most likely dx?
Pericarditis
56
Define paradoxical pulse
There is a large difference in pulse pressure between inhalation and exhalation.
57
Define pulsus alternans.
EKG waveform changes from beat to beat.
58
What is the definitive treatment for cardiac tamponade.
Pericardiocentesis
59
On physical exam, you hear a harsh systolic murmur along the right sternal border. What is the most likely dx?
Aortic stenosis
60
A wide pulse pressure with a blowing diastolic decrescendo murmur at the right 2nd intercostal space should make you think of what dx?
Aortic regurgitation
61
What is the best location to hear problems with the aortic valve?
2nd right intercostal space
62
Where is disease of the pulmonary valve best heard?
2nd left intercostal space
63
What 2 abx are used for empiric treatment of endocarditis?
Vancomycin and ceftriaxone together are the first line empiric treatment
64
What 2 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)
65
What are the 2 main causes of aortic stenosis?
congenital bicuspid valve
| calcification of the valve secondary to coronary artery disease
66
An elderly pt presents c dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely dx?
aortic stenosis
67
On auscultation, you hear a harsh, blowing pan systolic murmur at the apex. What is the most likely dx?
Mitral regurgitation
68
You suspect mitral regurgitation. What is the most accurate way to prove your dx?
Transesophageal echo
69
A pt c mitral valve prolapse will often have what physical characteristics.
Often a thin female
70
What is the best pt position to hear aortic regorge and aortic stenosis?
Sitting up and leaning forward
71
What is Tietze syndrome?
Costochondritis
72
Are most pulmonary valve problems congenital or acquired?
95% are congenital
73
What is the therapeutic range for INR following an organic valve replacement?
2 to 3
74
A 60 yo male presents to the ER with severe dizziness and back pain. His BP is dropping, and you can feel an abdominal pulsatile mass on PE. What is the most likely dx?
Ruptured aortic aneurysm
75
In a pt c aortic stenosis, will the PMI be medially displaced, normal or laterally displaced?
It will be laterally displaced due to left ventricular hypertrophy.
76
A pt c/o severe crushing chest pain. EKG shows ST segment elevations. All labs including troponin and CK-MB are negative. What is the most likely dx?
Prinzmetal's angina
77
A question about Prinzmetal's angina will often contain what key thing in the pt's hx?
cocaine use
78
Name 2 things that would constitute a positive stress test.
A drop in BP.
a new arrhythmia
an increase in angina symptoms
ST depressions
79
Are ulcers from venous insufficiency painful or painless?
Painless
80
A pt has just received a cardiac stent. How long will he be on aspirin and clopidogrel?
one year
81
Where is disease of the mitral valve best heard?
At the apex
82
What is the initial tx for a myocardial infarction?
MONA: morphine, oxygen, nitroglycerin and aspirin
83
Clot busting drugs should be used within 3 hrs of which 2 cardiac events?
STEMI & new left bundle brach block
84
List 3 catastrophic complications of a myocardial infarction.
Papillary muscle rupture
myocardial wall rupture
left ventricular aneurysm
85
An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely dx?
Supra ventricular tachycardia
86
Acute endocarditis is most commonly caused by what organism?
Staph aureus
87
List 3 congenital heart diseases.
```
Atrial septal defect (ASD)
Ventricular septal defect (VSD)
coarctation of the aorta
patent ductus artertiosus (PDA)
tetralogy of ballot
```
88
What is the most common cause of an atrial septal defect?
Patent foramen ovale
89
Where on your pt should you listen for the murmur associated with an atrial septal defect?
At the left second or third interspace
90
A CXR shows a "3" sign with notching of the ribs. What is the most likely dx?
coarctation of the aorta
91
What is the appropriate tx for a patent ductus arteriosus?
Indomethacin
92
A Blalock procedure is used to correct what congenital heart defect?
Tetralogy of Fallot
93
You hear a loud, harsh pulmonary murmur along the left sternal border. What is the most likely dx?
Ventricular septal defect
94
Subacute endocarditis is most commonly caused by what organism?
Strep viridans
95
What is the most common place for an aortic aneurysm?
In the abdomen and below the renal arteries
96
Who is more likely to have an aortic aneurysm: males or females?
Males are 8x more likely to have an aortic aneurysm.
97
The accessory pathway known as the James bundle should make you think of what syndrome?
Lown-Ganong-Levine syndrome
98
What imaging needs to be done before taking a patient to the OR with an aortic aneurysm?
CT (echo may be used as initial but CT is needed for surgery)
99
List 2 risk factors for an aortic dissection.
Hypertension
Marfan's syndrome
bicuspid aortic valve
pregnancy
100
A pt presents to the ER with tearing chest pain radiating to his back. what is the most likely dx?
Aortic dissection
101
What will a CXR show for a pt with an aortic dissection?
Widened mediastinum
102
What is the best test to dx an aortic dissection?
CT
103
List the six P's of an ischemic limb.
```
Pain
paresthesias
pallor
pulselessness
poikilothermic
paralysis
```
104
You have a pt with pulsus paradoxus. What 2 dx should you be thinking of?
Pericarditis
pericardial effusion
obstructive lung disease
105
A pt c/o pain in his legs when he walks. It goes away after sitting. What term comes to mind for this symptom? What dx is it associated with?
Intermittent claudication caused by peripheral arterial disease.
106
Giant cell arteritis is associated with what other dx?
Polymyalgia rheumatica
107
A sawtooth pattern on EKG should make you think of what dx?
Atrial flutter
108
What is the accessory pathway associated with Wolff-Parkinson-White syndrome?
the bundle of Kent
109
A biphasic P wave should make you think of what dx?
Left atrial enlargement
110
What is the gold standard for the diagnosis of giant cell arteritis?
biopsy of the temporal artery
111
What is the treatment for giant cell arteritis?
High dose prednisone
112
List the components of Virchow's triad.
Stasis
vascular injury
hypercoagulability
113
Calf pain should always make you think of what dx?
DVT
114
Where is disease of the tricuspid valve best heard?
Along the left lower sternal border
115
What is the most common congenital heart disease?
Ventricular septal defect
116
Are ulcers from arterial insufficiency painful or painless?
Painful
117
Give 2 contraindications for using an ACEI.
Bilateral renal artery stenosis
hx of angioedema
pregnancy
118
Both lead I and AVF have positive QRF complexes. Does this represent normal axis, left axis deviation or right axis deviation?
Normal axis
119
What med might you switch to if a pt develops an intolerable cough on an ACEI?
Angiotensin receptor blocker (ARBs)
120
What class of cardiac medications should be avoided in pts c asthma?
Beta blockers (blocks receptors for bronchodilators)
121
A boot shaped heart on CXR should make you think of what congenital heart condition?
Tetralogy of ballot
122
An RSR prime in leads V1 or V2 should make you think of what dx?
Right bundle branch block
123
Which lab should be tightly monitored in a patient taking an aldosterone antagonist?
Potassium, they may have hyperkalemia
124
What is the best test for dx'ing CHF?
Echo
125
Which cardiac medication is used to help cardiac contractility after you have optimized most of the other cardiac meds?
Digoxin
126
A blockage of which artery causes an anterior wall MI?
left anterior descending artery
127
Which lab result will increase the risk of digoxin toxicity?
Hypokalemia or hypercalcemia
128
A patient presents to the ER in acute CHF. What drug class will likely be the first choice?
Loop diuretics
129
A pt has a GFR of 25 and HTN. Which class should you use--a loop or thiazide diuretic?
a loop will work no matter how long the GFR is. thiazides will only work with a GFR>30.
130
Which EKG leads are used to dx anterior wall MI?
V1, V2, V3
131
Do loop diuretics cause hyperkalemia or hypokalemia?
hypokalemia
132
Statins are the drug of choice to tx what type of dyslipidemia?
Elevated LDL
133
A pt recently started taking Lipitor. He is now c/o aches and pains. What test should you order?
Serum creatinine kinase: you are looking for rhabdomyolysis
134
How does ezetimibe work?
Decreases intestinal absorption of cholesterol
135
Which hyperlipidemia med may cause flossing?
Niacin
136
Name 3 medication "classes" which are used to reduce LDL?
Statins
ezetimibe
niacin
nicotinic acid
137
Name 2 fibric acid derivatives.
Fenofibrate
| gemfibrozil
138
List 3 class 1a antiarrhythmics.
Disopyramide
quinidine
procainamide
139
You are counting boxes from the peak of a QRS wave on an EKG IOT determine the heart rate. What would the heart rate be if the next QRS were 3 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.
140
An U wave on EKG should make you think of what dx?
Hypokalemia
141
What will the heart rate be if the AV node is pacing the heart?
40-60 beats per minute
142
Which cardiac medication has gynecomastia in its side effect profile?
spironolactone
143
Lead I has a QRS that is up and the AVF lead has a QRF complex that is down. Does this represent normal axis, left axis deviation or right axis deviation?
Left axis deviation
144
An Osborn or J wave on EKG should make you think of what dx?
Hypothermia
145
What is the first line medication for a pt c symptomatic bradycardia?
Atropine
146
What is the heart rate for tachycardia? How about bradycardia?
Tachy >100
| Brady<60
147
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
148
How do you treat polymyalgia rheumatica?
Low dose prednisone
149
What is the management of a patient in supra ventricular tachycardia?
Vagal maneuvers
carotid massage
adenosine
150
What is the definitive treatment for atrial flutter?
Radio frequency catheter ablation
151
An 82 yo pt c/o HA and jaw claudication. What is the most likely diagnosis?
Giant cell (temporal) arteritis
152
The EKG shows irregularly irregular narrow QRS waves. What dx should you be thinking of?
Atrial fibrillation
153
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 dx?
Junctional rhythm
154
Name a common cause of a junctional rhythm.
Digoxin toxicity
155
An EKG shows two premature ventricular contractions. These 2 QRS waves look very different. What is the term for this?
Multifocal premature ventricular contractions
156
What is the most common cause of sudden cardiac death?
Ventricular fibrillation
157
A pt 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 tx of this pt?
He is in ventricular fibrillation. The tx is defibrillation.
158
Tall peaked T waves should make you think of what diagnosis?
Hyperkalemia
159
How do you define 1st degree AV block?
the PR interval is longer than 0.2 seconds or one block on EKG
160
What is the other term for Mobitz type I?
Wenckebach
161
What is the most important complication of giant cell arteritis?
Blindness
162
What 2 labs do you want to monitor in a pt on an ACEI?
Serum creatinine
| serum potassium
163
The HR 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.
164
What is the treatment for a patient with a Mobitz II AV block?
pacemaker
165
You see regular P waves and regular QRS complexes, but they do not seem to have any correlation to each other. What is the dx?
Third degree AV block
166
Name one aldosterone antagonist.
Spironolactone, eplenerone
167
You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?
Wolff-Parkinson-White syndrome
168
What two leads do you use to determine the axis of the heart?
Lead I and AVF
169
An RSR prime in leads V5 or V6 should make you think of what dx?
left bundle branch block
170
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.
171
What medication is used to lower triglycerides?
Fibric acid derivatives
172
Tall peaked P waves should make you think of what dx?
Right atrial enlargement
173
List 2 causes of right atrial enlargement.
Pulmonary HTN
severe lung disease
pulmonary valve stenosis
174
Which EKG leads are used to dx an anterolateral MI?
V5 and V6
175
What are the 3 inferior leads?
II, III, aVF
176
A blockage of which artery causes a lateral wall MI?
left circumflex artery
177
What is represented by ST segment depressions greater than 1mm on EKG?
Ischemia
178
Rheumatic fever most commonly affects which valve?
The mitral valve
179
What is the only cyanotic congenital heart disease on the NCCPA blueprint?
Tetralogy of ballot
180
On EKG, there is an early wide QRS complex with no associated P wave. After that beat, there is a slight pause, and then a normal rhythm continues. What is the term for this one beat?
premature ventricular contraction
181
What is the definitive treatment for a patient c recurrent ventricular tachycardia?
Implanted defibrillator
182
On an EKG, you notice a pt has a gradually lengthening PR interval and then a missed QRS complex. The pattern repeats again. What type of AV block is this?
Mobitz I or Wenckebach
183
List 3 SE of digoxin.
```
Nausea/vomiting
anorexia
confusion
arrhythmia (sinus brady, AV block)
fatigue
vision disturbances
```
184
What is the first line medical tx for torsades de pointes?
Magnesium sulfate
