Cardiology Flashcards
(205 cards)
1
Q
Correcting which risk factor for CAD will result in the most immediate benefit for the patient?
A
Smoking
2
Q
T/F: Ischemic pain is not tender, positional, or pleuritic?
A
True
3
Q
Dx: chest wall tenderness?
A
Costochondritis
4
Q
Dx: radiation to back, unequal BP between arms?
A
Aortic dissection
5
Q
Dx: pain worse with lying flat, better with sitting up?
A
Pericarditis
6
Q
Dx: cough, sputum, hemoptysis?
A
Pneumonia
7
Q
Dx: sudden-onset SOB, tachycardia, hypoxia?
A
PE
8
Q
Dx: sharp pleuritic pain, tracheal deviation?
A
Pneumothorax
9
Q
What can dipyrimadole, adenosine, or dobutamine be used for?
A
Non-exercise stress test
10
Q
What do you need to stop before a stress test (2)?
A
- B-blockers
2. Caffeine
11
Q
Who needs coronary angiography?
A
People with reversible ischemia on stress test
12
Q
What diagnostic procedure determines if a patient needs surgery vs angioplasty?
A
Angiography
13
Q
For a patient with chronic angina, which 2 drugs will lower mortality?
A
- Aspiring
2. B-blockers
14
Q
What metabolic derangement can ACE inhibitors cause?
A
Hyperkalemia
15
Q
What’s the first line therapy in patients with stable angina?
A
B-blockers
16
Q
What level of intensity are Atorvastatin and Rosuvastatin?
A
High intensity
17
Q
What level of intensity are Fluvastatin, Lovastatin, Pitavastatin, Pravastatin, and Simvastatin?
A
Low intensity
18
Q
What’s the most common adverse effect of statin meds?
A
Liver dysfunction
19
Q
In severe hyperlipidemia when the LDL isn’t controlled even on max dose of statin, what can you use?
A
PCSK9 inhibitors
20
Q
Which lipid-lowering medication has the adverse effect of elevations of transaminases and myositis?
A
Statins
21
Q
Which lipid-lowering medication has the adverse effect of elevation in glucose and uric acid, and priuritis?
A
Niacin
22
Q
Which lipid-lowering medication has the adverse effect of increased risk of myositis when combined with statins?
A
Fibric acid derivatives
23
Q
Which lipid-lowering medication has the adverse effect of flatus and abdominal cramping?
A
Cholestyramine
24
Q
Which lipid-lowering medication has very few adverse effects but barely helps anything?
A
Ezetimibe
25
What are the 3 instances when you would use a calcium channel blocker in CAD?
1. Asthma
2. Prinzmetal angina
3. Cocaine-induced chest pain
26
What are the 3 most common adverse effects of calcium channel blockers?
1. Edema
2. Constipation
3. Heartblock
27
In which 3 instances does CABG benefit a patient?
1. 3 vessel disease with at least 70% in each
2. L main coronary artery occlusion
3. Two vessel disease in patient with DM
28
Which lasts longer, internal mammary or saphenous grafts?
Internal mammary (10 vs 5 years)
29
What's another word for angioplasty?
PCI
30
What is Dressler syndrome?
Pericarditis after MI
31
Which is associated with greater mortality: MI in inferior wall or anterior wall?
Anterior wall
32
When does myoglobin become abnormal after MI?
1-4 hours
33
When do troponin and CK-MB become abnormal after MI?
4-6 hours
34
When do myoglobin and CK-MB go back to normal after MI?
1-2 days
35
When does troponin go back to normal after MI?
10-14 days
36
What organ insufficiency can cause falsely elevated troponin?
Renal insufficiency
37
What are the first 2 steps to checking for re-infarction if a patient has new chest pain within a few days after an MI?
1. EKG
| 2. CK-MB levels
38
What's the best way to prevent restenosis of the coronary artery after PCI?
Drug eluting stent that inhibits local T cell response (paclitaxel or sirolimus)
39
The mortality benefit of thrombolytics extends out to ___ hours from the onset of chest pain?
12
40
If there is no ST segment elevation, is there a benefit to thrombolytics?
No; give heparin
41
Do you give an antiplatelet drug to a non-ST elevation coronary syndrome?
Yes
42
Which heparin to give: LMWH (enoxaparin) or unfractionated?
LMWH has better mortality benefit
43
Post-MI dx: bradycardia and cannon a waves?
Third degree AV block
44
Post-MI dx: sudden loss of pulse, JVD?
Tamponade/wall rupture
45
Post-MI dx: new murmur, rales/congestion?
Valve rupture
46
Post-MI dx: new murmur, increase in O2 sat on entering R ventricle?
Septal rupture
47
In what cases do you use spironolactone post-MI?
EF<40%
48
Do not use a rhythm controlling agent to prevent the development of an arhhythmia-- don't be fooled by "frequent PVC's and ectopy"
Cool
49
How many months post-MI do you give P2Y12 inhibitor?
12 months
50
Do not combine nitrates with what drug?
Sildenafil
51
What's the most-common cause of post-MI erectile dysfunction?
Anxiety; B-blockers
52
When should a patient wait to re-engage in sexual activity post-MI?
2-4 weeks
53
What heart sound is present in CHF and sounds like "I believe?"
S3
54
What condition might rales indicate?
CHF
55
Dyspnea dx: sudden onset dyspnea, clear lungs?
PE
56
Dyspnea dx: sudden onset dyspena, wheezing, increased expiratory phase?
Asthma
57
Dyspnea dx: slower onset, fever, sputum, unilateral rales/rhonchi
Pneumonia
58
Dyspnea dx: decreased breath sounds unilaterally, tracheal deviation?
Pneumothorax
59
Dyspnea dx: circumoral numbness, caffeine use, h/o anxiety?
Panic attack
60
Dyspnea dx: pallor, gradual over days to weeks?
Anemia
61
Dyspnea dx: pulsus paradoxus, decreased heart sounds, JVD?
Tamponade
62
Dyspnea dx: palpitations, syncope?
Arrhythmia of any kind
63
Dyspnea dx: dullness to percussion at bases?
Pleural effusion
64
Dyspnea dx: long smoking history, barrel chest?
COPD
65
Dyspnea dx: recent anesthetic use, brown blood not improved with oxygen, clear lungs on auscultation, cyanosis?
Methemoglobinemia
66
Dyspnea dx: burning building or car, wood-burning stove in winter, suicide attempt?
Carbon monoxide poisoning
67
Will any of those dyspnea dx questions have an S3 gallop?
No
68
When do you use digoxin?
Low EF (systolic HF)
69
What are the 3 proven B-blockers for systolic dysfunction?
1. Metoprolol
2. Carvedilol
3. Bisoprolol
70
When are B-blockers contraindicated in HF?
When the patient is acutely decompensated
71
Do diuretics lower mortality in CHF?
No, they just control sx
72
Does digoxin lower mortality in CHF?
No, it just decreases the frequency of hospitalizations
73
Can lisinopril cause hyperkalemia?
Yes
74
If EF is under 35%, what's a good treatment device?
Pacemaker or defibrillator
75
What are 2 treatments that are beneficial in diastolic HF?
1. Spironolactone
| 2. Diuretics
76
Does pulmonary edema present with an S3 sound?
Yes
77
Does a normal BNP level exclude pulmonary edema?
Yes
78
Mitral stenosis presents during pregnancy because there is a 50% increase in _____ ______?
Plasma volume
79
```
Which valvular disease has:
Dysphagia
Hoarseness
Afib
Hemoptysis?
```
CHF associated with mitral stenosis
80
Why does hoarseness occur?
Laryngeal nerve compression from LA
81
The enlargement of which atrium causes elevation of the L mainstem bronchus?
Left atrium
82
Which atrium is enlarged in mitral stenosis?
L atrium
83
What congenital valvular abnormality can lead to aortic stenosis?
Bicuspid valve
84
What's the most common presentation of aortic stenosis?
Angina, syncope, CHF
85
Which chamber of the heart gets enlarged with aortic stenosis?
L ventricle
86
Which valvular disorder is caused by HTN, endocarditis, MI with papillary muscle rupture, or any other reason that the heart dilates?
Mitral regurgitation
87
Which valvular disorder presents with a pansystolic (holosystolic) murmur that radiates to the axilla?
Mitral regurgitation
88
Which valvular disorder is caused by anything that makes the heart or aorta dilate in size?
Aortic regurgitation
89
Which valvular disorder has head bobbing and BP in legs as much as 40mmHg more than arm BP?
Aortic regurgitation
90
What's often used in regurgitation disorders for vasodilation (3)?
ACEi/ARBs or nifedipine
91
What heart sound is the result of hypertrophy?
S4
92
What's the best initial therapy for hypertrophic cardiomyopathy?
B-blockers
93
What's a surgical option for HOCM?
Ablation of the septum
94
Can you use digoxin in hypertrophic cardiomyopathy?
No
95
In HOCM, do ACEi's and diuretics help?
No! But in the other forms they are ok
96
Which 4 murmurs are increased by squatting/leg raising, and decreased by standing/valsalva?
AS, MS, AR, MR
97
Which 2 murmurs are decreased by squatting/leg raising, and increased by standing/valsalva?
HVP, HOCM
98
Standing and valsalva increase or decrease blood?
Decrease (like a diuretic)
99
Handgrip increases blood in which chamber?
L ventricle
100
Amyl nitrate decreases blood in which chamber?
L ventricle
101
Do steroids and IVIg help viral myocarditis?
No
102
What drug decreases recurrences of pericarditis?
Colchicine
103
What's the best tx for acute pericarditis?
NSAIDs
104
Which condition has pulsus paradoxus?
Pericardial tamponade
105
What presents with acute pain between the scapulae and difference in blood pressure between the arms?
Aortic dissection
106
What's the best test for aortic dissection?
Angiogram
107
What's the most appropriate screening for the aortic aneurysm?
Men who ever smoked age >65 with ultrasound
108
When the width of the abdominal aortic aneurysm exceeds __cm in diameter, surgical or cath repair of lesion is indicated?
5cm
109
Which is the worst form of heart disease in pregnancy?
Peripartum cardiomyopathy (Eisenmenger is second)
110
Which direction of the shunt is Eisenmenger Syndrome?
R to L
111
What's the most common cause of bronchiectasis?
CF
112
What condition presents with widening of the bronchi?
Bronchiectasis
113
What's an inhaled med used to treat CF-associated bronchiectasis?
Dornase alfa
114
What dx might present as an asthmatic patient with recurrent episodes of brown-flecked sputum and transient infiltrates on CXR, eosinophilia, and cough, wheezing, and hemoptysis?
Allergic bronchopulmonary aspergillosis
115
Are inhaled steroids effective for allergic bronchopulmonary aspergillosis?
No
116
How do you treat allergic bronchopulmonary aspergillosis (acute, recurrent, and prevention)?
Acute: oral steroids
Recurrent: itraconazole
Prevention: Omalizumab
117
Does CF affect the endocrine or the exocrine glands?
Exocrine
118
Neutrophils in CF dump tons of ____ into airway secretions, clogging them up?
DNA
119
T/F: CF can lead to meconium ileus and biliary cirrhosis?
True
120
What's the most accurate test for CF?
Sweat chloride test
121
What do PFTs show in CF (obstructive vs restrictive)?
Mixed obstructive and restrictive patterns
122
Which type of antibiotics are inhaled in CF patients?
Aminoglycosides
123
Which 2 vaccinations do CF patients need?
1. Pneumococcal
| 2. Influenza
124
What does Ivacaftor combined with Lumacaftor do in CF patients?
Increases the activity of the CFTR in 5% of patients who have a specific mutation
125
Community acquired pneumonia is defined as pneumonia occurring __ hours before hospitalization or within __ hours of hospital admission?
48, 48
126
Which organism is the most common cause of community acquired pneumonia?
Strep pneumoniae
127
Which common CAP pathogen is associated with COPD?
Haemophilus influenzae
128
Which common CAP pathogen is associated with recent viral infection?
Staph aureus
129
Which common CAP pathogen is associated with alcoholism, diabetes?
Klebsiella pneumoniae
130
Which category of common CAP pathogen is associated with poor dentition, aspiration?
Anaerobes
131
Which common CAP pathogen is associated with young, healthy patients?
Mycoplasma pneumoniae
132
Which common CAP pathogen is associated with hoarseness?
Chlamydophila pneumoniae
133
Which common CAP pathogen is associated with contaminated water sources, air conditioning, and ventilation systems?
Legionella
134
Which common CAP pathogen is associated with birds?
Chlamydia psittaci
135
Which common CAP pathogen is associated with animal birth, veterinarians, farmers?
Coxiella burnetii
136
T/F: rales, rhonchi, and crepitus are findings from virtually any form of lung infex?
True
137
Which common CAP pathogen is associated with rotten egg sputum?
Anaerobes
138
Which common CAP pathogen is associated with dry cough, rarely severe, bullous myringitis (eardrum blisters)?
Mycoplasma pneumoniae
139
Which common CAP pathogen is associated with GI sx or CNS sx?
Legionella
140
Which common CAP pathogen is associated with AIDS <200 CD4?
Pneumocystis
141
Sputum gram stain is adequate if there are more than __ WBCs and less than __ epithelial cells?
25, 10
142
What is an empyema?
An infected pleural effusion
143
What's the specific diagnostic test for Mycoplasma pneumoniae?
PCR, cold agglutinins
144
What's the specific diagnostic test for Chlamydophila pneumoniae?
Rising serologic titers
145
What's the specific diagnostic test for Legionella?
Urine antigen, culture on charcoal-yeast
146
What's the specific diagnostic test for Chlamydia psittaci?
Rising serologic titers
147
What's the specific diagnostic test for Coxiella burnetii?
Rising serologic titers
148
What's the specific diagnostic test for Pneumocystis jiroveci?
Bronchoalveolar lavage
149
When do you hospitalize for pneumonia (11)?
1. Hypotension systolic below 90
2. RR above 30
3. pH below 7.35
4. BUN above 30
5. Na less than 130
6. Glucose above 250
7. Pulse above 125/min
8. Confusion
9. Temp above 40C
10. Age 65+
11. COPD, CHF, RF, liver dz
150
Pleural effusion with pH <7.2 indicates what?
Empyema
151
LDH >60% of serum or protein >50% of serum suggest exudate or transudate?
Exudate
152
What's CURB65?
```
Confusion
Uremia
Respiratory distress
BP low
Age >65
```
153
What are the 2 main initial CAP abx in the hospital?
1. Ceftriaxone
| 2. Azithromycin
154
Hospital acquired pneumonia is almost always gram ___?
Negative
155
What's the hospital acquired pneumonia treatment in the hospital?
Pip-tazo or Pip-Clav
156
Is sputum culture worthwhile in ventilator associated pneumonia?
No
157
What's the antibiotic treatment for ventilator associated pneumonia (3)?
1. Pip/tazo
2. Gentamicin
3. Vanc
158
Which antibiotic can cause seizures?
Imipenem
159
Everyone over age __ should get the pneumococcal vaccine: first the __ then the __ 6-12 mos later?
65; 13, 23
160
What antibiotic covers lung abscesses?
Penicillin
161
What is always elevated in PCP (jiroveci)?
LDH
162
What's the best tx and prophylaxis for PCP?
TMP-SMX
163
When do you start PCP prophylaxis?
CD4 count <200
164
If the CD4 count is maintained above 200 for several months, can AIDS patients go off prophylactic abx?
Yes!
165
What tx is used for atypical mycobacteria prophylaxis when CD4 count <50?
Azithromycin
166
What's the mnemonic for TB treatment drugs?
RIPE
167
What does RIPE stand for?
Rifampin
Isoniazid
Pyrazinamide
Ethambutol
168
How long do you give the RIPE drugs?
- All for 2 months
| - Then just RI for 4 more months
169
Can you use pyrazinamide during pregnancy?
No, so you need to extend tx to >6 mos total for TB
170
What's Rifampin's toxicity?
Red color to body secretions
171
What's Isoniazid's toxicity?
Peripheral neuropathy
172
How do you prevent Izoniazid-related peripheral neuropathy?
Pyridoxine
173
What's Pyrazinamide's toxicity?
Hyperuricemia
174
What's Ethambutol's toxicity?
Optic neuritis/color vision loss
175
T/F: erythema and induration count towards a positive PPD test?
False; just induration counts
176
What are the two mm cutoff points for the PPD results?
5, 10, and 15mm
| 5 for people with immunosuppression or sx, 10 for people at high risk, 15 for no risk factors
177
When do you need 2 PPD tests?
When it's the patient's first time getting one and the first one results negative
178
If a patient is IGRA positive of PPD positive, how do you treat?
9 months of Isoniazid
179
T/F: 12 doses of INH and rifapentine treats positive IGRA or PPD?
True
180
What dx presents with skin and soft tissue infex, grows in 5-10 days, lives in water and soil, and the question stem may describe a colonized water line in a dental unit?
Mycobacteria abscessus and fortuitum
181
What dx presents with a cough/sputum in an older person with COPD?
Mycobacteria avium-intracellulaire
182
What's the antibiotic tx for Mycobacteria avium-intracellulaire?
Aithromycin, rifampin, and ethambutol
183
When many features of malignancy are present for a lung lesion, what's the right answer usually?
Resect
184
What are the lung cancer screening indications for chest CT?
Age 55 with 30 pack-year history (including if quit within past 15 years)
185
What kind of pneumoconiosis can coal exposure lead to?
Coal worker's pneumoconiosis
186
What kind of pneumoconiosis can sandblasting, rock mining, tunneling lead to?
Silicosis
187
What kind of pneumoconiosis can shipyard workers, pipe fitting, and insulators lead to?
Asbestosis
188
What kind of pneumoconiosis can cotton lead to?
Byssinosis
189
What kind of pneumoconiosis can electronic manufacture lead to?
Berylliosis
190
What kind of pneumoconiosis can moldy sugar cane lead to?
Bagassosis
191
What dx presents with dyspnea, fine rales or crackles, loud P2 heart sound, and finger clubbing?
Pulmonary fibrosis
192
What does MTX cause in terms of lungs?
Pulmonary fibrosis
193
What will the PFTs show in restrictive lung disease?
FEV1/FVC will be normal (both will be decreased)
194
Biopsy shows what in berylliosis?
Granulomas
195
If there is a response to steroids in interstitial lung disease, what should you switch the patient to long-term?
Azathioprine
196
How do you differentiate between interstitial lung disease and hypersensitivity pneumonitis?
Hypersensitivity pneumonitis has fevers, chills, myalgia and there is an exposure
197
What dx presents in a young African American female with fine rales on lung exam without wheezing of asthma, and also presents with parotid gland enlargement, facial palsy, heart block and restrictive cardiomyopathy, CNS involvement, and iritis and uveitis?
Sarcoidosis
198
What dx presents with CXR showing hilar adenopathy in a generally healthy African American woman?
Sarcoidosis
199
Are the granulomas in sarcoidosis caseating or no?
Non-caseating
200
How does calcium sometimes change in sarcoidosis (less often than expected)?
Hypercalcemia and hypercalciuria
201
When should you do a V/Q scan instead of a CT angiogram for suspected PE?
When patients have renal failure
202
When is it appropriate to check D-dimer?
To rule out PE when the pretest probability is very low anyway
203
When are direct-acting thrombin inhibitors (eg: argatroban) or fondaparinux the answer?
In HIT
204
What dx presents with dyspnea and fatigue, syncope, CP, wide splitting of S2?
Pulmonary HTN
205
How is ideopathic pulmonary HTN treated?
Prostacyclin analogues
