Cardiology

Question 1

PCI within how many minutes of arriving in the ED with chest pain

Answer 1

90 minutes

Question 2

Major bleeding
Recent surgery (within past two weeks)
Severe HTN (>180/110)
Nonhemorrhagic stroke within the last 6 months

Answer 2

Absolute contraindications to thrombolytics

Question 3

Common complication of Acute MI

Answer 3

Sinus bradycardia

Question 4

Complications of Acute MI

Answer 4

Third degree AV block

Cannon “a” waves

Question 5

Treated first with atropine
Then place pacemaker if the atropine is not effective
Pace all permanent 3rd degree blocks

Answer 5

Symptomatic bradycardia

Question 6

New inferior wall MI and clear lungs on auscultation
ST elevation in right lead 4
Treated with high volume fluid
Avoid nitroglycerin

Answer 6

RV infarction

Question 7

Sudden loss of pulse
Clear lungs 
Complication of acute MI/tachycardia
Occurs several days after infarction
Best test Echo
Treated by pericardiocentesis

Answer 7

Tamponade/ Free wall rupture

Question 8

New onset murmur and pulmonary congestion
Complication of acute MI/Tachycardia
Mitral regurgitation best heard at apex with radiation to the axilla
Ventricular septal rupture best heard at LL sternal border
Look for step up in oxygen sat as you go from RA to RV for septal rupture

Answer 8

Valve or Septal rupture

Question 9

The following may be present in what cardiac event:

Recurrence of pain
New rales
Bump up in CK-MB
sudden onset pulmonary edema

Answer 9

Reinfarction

Question 10

What is the next best step in management for re-infarction

Answer 10

Repeat EKG
Retreat with angioplasty or thrombolytics
Continue aspirin, metoprolol, nitrates, ACE, statin

Question 11

Complication of acute MI
Bradycardia
Cannon A waves

Answer 11

Third degree AV block

Question 12

Complication of acute MI

No cannon A wave

Answer 12

Sinus bradycardia

Question 13

Complication of acute MI

Sudden loss of pulse, JV distension

Answer 13

Tamponade/wall rupture

Question 14

complication of acute MI
IWMI in history, clear lungs
Tachycardia
Hypotension with nitroglycerin

Answer 14

RV infarction

Question 15

Complication of acute MI

New murmur, rales/congestion

Answer 15

Valve rupture

Question 16

Complication of acute MI

New murmur, increase in oxygen saturation on entering the RV

Answer 16

Septal rupture

Question 17

Complication of acute MI

Loss of pulse, need EKG to answer question

Answer 17

Ventricular fibrillation

Question 18

Dyspnea
Pulsus paradoxus
Decreased heart sounds
JVD

Answer 18

Tamponade

Question 19

Dyspnea
Palpitations
Syncope

Answer 19

Arrhythmia

Question 20

Dyspnea
Long smoking history
Barrel chest

Answer 20

COPD

Question 21

Dyspnea
Recent anesthetic use
Brown blood not improved with oxygen
Clear lungs on auscultation
Cyanosis

Answer 21

Methemoglobinemia

Question 22

Dyspnea
Burning building or car
Wood burning stove in winter
Suicide attempt

Answer 22

Carbon monoxide poisoning

Question 23

Dyspnea
Sudden onset
Clear lungs

Answer 23

Pulmonary Embolus

Question 24

Dyspnea
Sudden onset
Wheezing
Increased expiratory phase

Answer 24

Asthma

Question 25

``` Dyspnea Slower Fever Sputum Unilateral rales/rhonci ```

Answer 25

Pneumonia

Question 26

Dyspnea Decreased breath sounds Unilateral Tracheal deviation

Answer 26

Pneumothorax

Question 27

Dyspnea Circumoral numbness Caffeine use History of anxiety

Answer 27

Panic attack

Question 28

Dyspnea Pallor Gradual over days to weeks

Answer 28

Anemia

Question 29

What is the best initial test in CHF

Answer 29

TTE

Question 30

What’s the most accurate test in CHF

Answer 30

MUGA or multiple gated acquisition scan or nuclear ventriculography

Question 31

When is BNP the most appropriate next step in management?

Answer 31

Acute SOB | Etiology unclear

Question 32

CHF treatment in systolic dysfunction

Answer 32

``` ACEi or ARBs BB Spironolactone, Eplerenone Diuretics Digoxin ```

Question 33

What is the next best step in management is a pt with CHF is still dyspneic after using an ACEi, BB, diuretic, digoxin and mineralcorticoid inhibitor?

Answer 33

Ivabradine Sacubitril/valsartan Hydralazine/nitrates

Question 34

Drugs that provide mortality benefit in systolic dysfunction

Answer 34

``` ACEi BB Spironolactone Hydralazine/nitrates Implantable defibrillator ```

Question 35

Most accurate test in Valvular heart disease

Answer 35

Catheterization

Question 36

Best initial test for Valvular heart disease?

Answer 36

Echocardiogram TEE more sensitive and specific than TTE

Question 37

``` SOB CHF Dysphasia Hoarseness A fib and stroke Hemoptysis ```

Answer 37

Mitral Stenosis

Question 38

Murmur that increases with squatting and leg raises

Answer 38

Mitral stenosis

Question 39

Best initial test in MS?

Answer 39

TTE

Question 40

Most accurate test in MS?

Answer 40

Catherization

Question 41

Triad of Aortic Stenosis

Answer 41

Angina Syncope CHF

Question 42

Valsalva and standing decrease intensity of murmur | Hand grip soften murmur

Answer 42

Aortic Stenosis

Question 43

Squatting and leg raising worsens murmur

Answer 43

MR

Question 44

All left sided murmurs except - and - will increase with expiration

Answer 44

MVP | HOCM

Question 45

Treatment of MR

Answer 45

ACEi or ARBs best

Question 46

Handgrip worsens this murmur while valsalva and standing soften this murmur

Answer 46

AR

Question 47

``` Wide pulse pressure Water hammer pulse Quincke pulse Hill sign (BP in legs as much as 40mmHg above arm BP) Head bobbing (de Musset sign) ```

Answer 47

AR

Question 48

Atypical Chest Palpitations Panic attack

Answer 48

Most common presentation of MVP

Question 49

Valsalva and standing worsen this murmur while squatting and handgrip improve

Answer 49

MVP

Question 50

Treatment for MVP

Answer 50

B Blocker when symptomatic

Question 51

QRS>120 Biventricular pacemaker Automated implantable cardioverter/defibrillator has mortality benefit

Answer 51

Dilated cardiomyopathy treatment

Question 52

Best initial therapy in both HOCM and HCM

Answer 52

B blockers

Question 53

Most accurate test in diagnosing Restrictive Cardiomyopathy

Answer 53

Endomyocardial biopsy

Question 54

What disease process causes equalization of pressures in diastole on R heart catheterization

Answer 54

Pericardial tamponade

Question 55

Best initial test in constrictive pericarditis

Answer 55

Chest x Ray: calcification and fibrosis