Cardiology

Question 1

What is 1st line mgmt of orthostatic hypotension?

Answer 1

Remove medications that cause it

Ex: Doxazosin (BPH med): alpha adrenergic antagonist

anti-HTN meds, nitrates, antidepressants

Question 2

What are some additional things to know about medications regarding Orthostatic hypotension?

Answer 2

• In patients that continue to be symptomatic despite non-pharmacologic measures, fludrocortisone can be used as monotherapy.
• Patients with both anemia and orthostatic hypotension should begin a trial of erythropoietin.

Question 3

What confirms orthostatic hypotension?

Answer 3

Decrease in systolic BP 20

Decrease in diastolic BP 10

Question 4

What are the 6 Ps of Acute Arterial Occlusion?

Answer 4

1. Paresthesia
2. Pallor
3. Pulselessness
4. Poikilothermia (unable to regulate body temperature)
5. Paralysis
6. Pain out of proportion to exam

Question 5

What is the recommended imaging modality for Acute Arterial Occlusion?

Answer 5

CTA of the pelvis with runoff

Question 6

What are late findings of acute arterial occlusion?

Answer 6

paralysis

gangrene

loss of sensation

Question 7

What is the primary risk associated with CTA?

Answer 7

contrast nephropathy

Question 8

What is the gold standard of diagnosing arterial occlusion?

Answer 8

Digital subtraction angiography because has the additional benefit of potential treatment at the time of assessment

Question 9

What is the most common limb artery to be affected by acute arterial occlusion?

Answer 9

The superficial femoral artery

Question 10

What PMH will you see in pt who presents with thromboembolsim?

Answer 10

hx of recent MI or a-fib

Question 11

What is the MC sirte of an acute arterial occlusion?

Answer 11

femoral artery bifurcation

Question 12

What are treatments for acute arterial occlusion/thromboembolism?

Answer 12

thrombolysis

stenting

thrombectomy

surgery (bypass)

Question 13

What is 1st line treatment for varicose veins?

Answer 13

Conservative measures: leg elevation, compression stockings, and exercise

Question 14

If conservative measures faily to treat varicose veins, what is the next step?

Answer 14

vein ablation:

• sclerotherapy
• laser therapy

Question 15

Subcutaneous dilated, tortuous veins

Answer 15

varicose veins

Question 16

Pt is complaining of a dull ache in her legs after prolonged standing.

What dz?

Answer 16

varicose veins

Question 17

Will pt with gastric cancer present with dysphagia?

Answer 17

They can if the cancer is at the proximal stomach

Question 18

What are signs of metastatic disease in gastric cancer?

Answer 18

left supraclavicular node (Virchow’s node)

left axillary node (Irish node)

periumbilical node (Sister Mary Joseph’s node)

Question 19

What is the diagnostic test of choice in patients with suspected deep vein thrombosis?

Answer 19

Doppler US

Question 20

What will PE for DVT show?

Answer 20

dilated superficial veins, with unilateral edema, warmth, tenderness, and erythema

+ Homan sign (

Question 21

What will Doppler US show for DVT?

Answer 21

Demonstrates noncompressibility of imaged vein, indicating a thrombus.

Question 22

What is the gold standard for DVT?

Answer 22

venography

Question 23

What is the triad that causes DVT?

Answer 23

Virchow triad

1. stasis
2. hypercoaguable state
3. trauma

Question 24

What will PE for PAD show?

Answer 24

loss of hair

skin atrophy/shiny skin

cool temperature

pale color

ulceration

weal lower extremity pulses

decreased sensation

Question 25

How is dx of PAD made?

Answer 25

ankle-brachial index (ABI) value of **≤0.9** **systolic** BP of **ankle**/**systolic** BP of **brachial artery**

Question 26

1st line tx of PAD

Answer 26

anti-platelet agents such as **aspirin or clopidogrel** (use for all patients) aggresive risk factor modifications: complete **tobacco cessation**, **exercise, antihypertensives, statin, and diabetes management**

Question 27

When is **carotid endarterectomy** recommended?

Answer 27

If pt has symptomatic carotid artery disease and **\>70 occlusion** whose **perioperative morbidity and mortality risk is \< 6%**

Question 28

How can symptomatic carotid artery disease manifest?

Answer 28

**transient ischemic attacks** **cerebrovascular accidents**

Question 29

What is the gold standard dx for carotid artery disease?

Answer 29

cerebral angiography

Question 30

What medical mgmt should be started following a carotid endarterectomy?

Answer 30

antiplatelet therapy and statin therapy

Question 31

Cardiac Functional Status Level 1

Answer 31

Can take care of self, such as eat, dress or use toilet

Question 32

Cardiac Functional Level Status 3-4

Answer 32

can walk up a flight of steps or a hill or walk on ground level at 3-4 mph

Question 33

Cardiac Functional Status 4-10

Answer 33

can do heavy work around the house, such as scrubbing floors or lifting or moving heavy furniture, or climb 2 flights of stairs

Question 34

Cardiac Functional Status \> 10

Answer 34

can participate in strenuous sports such as swimming, singles tennis, football, basketball and skiing

Question 35

What is bilirubin?

Answer 35

Bilirubin is a **byproduct of heme metabolism**, which occurs in three phases: **prehepatic, intrahepatic, and posthepatic**.

Question 36

Prehepatic processes result in what form of bilirubin?

Answer 36

Prehepatic processes, such as **red cell breakdown, hemolysis,** **erythropoiesis, hematoma resorption, and myoglobin breakdown**, often result in **unconjugated bilirubin or indirect bilirubin**

Question 37

What is unconjugated bilirubin?

Answer 37

Unconjugated bilirubin is **fat soluble**, however, the **majority is bound to albumin in plasma**, which **prevents diffusion across the blood-brain barrier** and **kernicterus** (bilirubin encephalopathy) in newborns.

Question 38

In what phase is direct bilirubin formed?

Answer 38

In the **hepatic phase** of bilirubin metabolism, **conjugated bilirubin, or direct bilirubin, is formed** by enzymatic binding to a sugar making it water soluble.

Question 39

Another word for direct bilirubin is?

Answer 39

conjugated bilirubin

Question 40

What are common intrahepatic causes of hyperbilirubinemia?

Answer 40

autoimmune, infectious (hepatitis), genetic defects involving conjugation (Gilbert syndrome, Crigler-Najjar syndrome), or pharmacologic

Question 41

What happens during the posthepatic phase of bilirubin?

Answer 41

The posthepatic phase involves excretion of conjugated bilirubin into bile.

Question 42

What are posthepatic causes of hyperbilirubinemia related to?

Answer 42

**biliary obstruction** (cholelithiasis, choledocholithiasis, Mirizzi syndrome) **infectious** (cholecystitis, cholangitis) secondary to **neoplasm** in or around the biliary tract