Cardiology

Question 1

S3 or S3/S4

Answer 1

CHF

Question 2

S4 alone

Answer 2

HTN

HFPEF

Question 3

Continuous murmur

Answer 3

Pulmonary AVM
PDA
Coarctation aorta

Question 4

Loud S1

Answer 4

Exercise
Short PR
MS/TS
ASD
PDA

Question 5

Soft S1

Answer 5

LBBB
Long PR
Severe MS
MR/AR

Question 6

Variable S1

Answer 6

AF
AV block
Tamponade

Question 7

Wide split S1

Answer 7

RBBB
ASD
Ebstein’s

Question 8

Loud S2

Answer 8

A2 - sev HTN, coarctation, aneurysm

P2 - pHTN, ASD

Question 9

Soft S2

Answer 9

A2 - sev AS, AR

P2 - PS

Question 10

Physiologic split S2

Answer 10

During inspiration

Question 11

Paradoxical split S2

Answer 11

Delayed closure of aortic valve
During expiration (not inspiration)
1. LBBB
2. WPW
3. AS
4. HOCM/LVOT

Question 12

Fixed split S2

Answer 12

Heard EQUALLY in both inspiration and expiration

ASD

Question 13

Persistent/wide split S2

Answer 13

Heard in inspiration and expiration but LOUDER in inspiration (inc venous return)
RBBB

Question 14

Rhythm control AF - CHF

Answer 14

EF>40% = amio or sotalol
EF<40% = amio

Question 15

Rhythm control AF - CAD

Answer 15

Amio
Sotalol (need QTc <440, not in renal)
Dronedarone

Question 16

Rhythm control AF - no CHF or CAD

Answer 16

Sotalol
Dronedarone (not perm AF or CHF, hepatotoxic)
Propafenone (not in CAD, CHF, liver, renal)
Flecainide (not in CAD, CHF, liver, renal)

Question 17

When to do rhythm control

Answer 17

1. Stable, <1 yr onset AF
2. Symptomatic/QOL
3. Paroxysmal recurrent episodes
4. CMO
5. Hard to rate control

Question 18

NYHA IV/LVAD Driving

Answer 18

None

Question 19

Non reversible VT/VF driving

Answer 19

6 mos/none

Question 20

Unexplained syncope

Answer 20

3 mos/12 mos symptom free

Question 21

ICD insertion

Answer 21

Primary - 1 month
Secondary - 6 mos
Commercial - none

Question 22

Familial hypercholesterolemia dx

Answer 22

LDL >5 plus

1. Tendon xanthoma
2. Family member LDL>5
3. Family early CVD M<55, F<65

Question 23

Familial DLD Tx

Answer 23

1. Statin
2. Ezetimibe
3. PCSK9 inhibitor
   Target LDL <2.5 (2 if CAD) and 50%

Question 24

POTS Definition

Answer 24

Sustained HR inc >30 bpm 10 mins standing

With no drop in BP >20/10

Question 25

POTS Tx

Answer 25

``` Na 10 g/d Water 3-4 L Compression stockings Exercise Midodrine, fludrocortisone Other: methyldopa, ivabradine, clonidine ```

Question 26

PAD Screening

Answer 26

``` Rule In 1. Femoral bruit 2. Pulse abnormality Rule out 1. No pulse abnormality ```

Question 27

PAD Symptoms

Answer 27

``` Rule In 1. Cool to touch 2. Bruit 3. Pulse abnormality 4. Discolouration Rule Out 1. No pulse abnormality ```

Question 28

PAD Tx

Answer 28

``` Stop smoking, exercise, foot care Pharm 1. Statin in all 2. ACEi in all 3. ASA/Plavix - definitely in symptomatic. Consider ASA+riva 2.5 4. T2DM management 5. PDE5 inhibitor - not in chf ```

Question 29

Diffuse T wave inversion

Answer 29

Increased ICP

Question 30

RV strain pattern

Answer 30

STD/T wave inversion V1-V3, inferior leads

Question 31

LVH Criteria

Answer 31

1. LV strain - STD, T wave inv V4-6 | 2. R I and S III >25 mm OR S V1 and tallest R V5/6 >35 mm

Question 32

Biphasic T waves V1/V2

Answer 32

Wellen's | Critical pLAD stenosis

Question 33

Persistent STE post MI

Answer 33

LV aneurysm Q waves Small T waves

Question 34

Posterior MI

Answer 34

STD V1-V3 Tall broad R waves Upright T Dominant R in V2

Question 35

Canon a waves

Answer 35

AV dissociation - AV block, VT

Question 36

Notched P wave

Answer 36

P mitrale | Mitral stenosis

Question 37

Peaked T waves

Answer 37

Hyperkalemia

Question 38

Hypokalemia

Answer 38

T wave inversion U wave STD Long PR

Question 39

Brugada

Answer 39

Type 1 - domed ST and negative T wave V1-3 Type 2 - saddle ST High risk SCD

Question 40

J waves

Answer 40

Hypothermia Deflection at J point (right after QRS) Also get Brady, ventricular ectopy, VT/VF

Question 41

Digoxin use ECG

Answer 41

Fast atrial arrhythmia AV block ST scooping Bidirectional VT

Question 42

LAFB

Answer 42

L axis deviation qR I/AVL rS II/III/AVF

Question 43

LPFB

Answer 43

R axis deviation rS I/AVL qR II/III/AVF