Flashcards in Cardiology/BW Deck (172):
What side effect might make a patient stop taking an ACEI?
Define orthostatic hypotension
A drop in systolic BP of >20mmHg when standing up
You feel a pulse that seems to be vibrating. What term do you use to describe it?
What are three things in your differential if you have a paradoxical pulse?
Cardiac tamponade, pericarditis, and obstructive lung disease
On palpation, what size is normal for the aorta?
Less than 3 cm
A fixed or consistent split S2 should make you think of what diagnosis?
Atrial Septal Defect
A pathologthic S3 is most commonly associated with what diagnossis?
If you hear a midsystolic click you should immediately be thinking about what diagnosis?
Mitral Valve Prolapse
An opening snap on auscultation of the heart should make you think of what diagnosis?
A continuous murmur most likely involves what area of the heart?
It is most likely a septal defect
You hear a continuous machine like murmur. What is the most likely diagnosis?
List three medications which may be used for a pharmacological stress test.
Adenosine, dobutamine, dipyridamole, and persantine.
What is the gold standard for diagnosing coronary artery disease?
Define stage 1 hypertension according to JNC 7
Systolic pressure of 140-159 and diastolic of 90-99
What is the treatment goal BP for a diabetic with hypertension?
What is the most common cause of secondary hypertension?
Chronic Kidney Disease
No matter what medications you use, you are having trouble keeping a patient's blood pressure under control You also notice hyperpigmented skin and truncal obesity. What is the most likely diagnosis?
List three signs or symptoms which will likely be included in a description of a patient with a pheochromocytoma?
Thin, diaphoretic, tachycardic, agitated, and hypertensive
You have a patient with the diagnosis of pheochromocytoma. While waiting for surgery should you use an alpha or a beta blocker?
Alpha blocker (you should never use a pure beta blocker)
A young boy comes into your office. He has elevated blood pressure when taken in his arm, but no palpable femoral pulse. What is the most likely diagnosis?
Coarctation of the aorta
According to the CDC, what is the range for a normal BMI?
18.5 - 24.9
What is the first line medical treatment for stage 1 hypertension?
A Thiazide Diuretic
After a thiazide diuretic, what medication should you start in a hypertensive patient who also has diabetes?
An ACE-Inhibitor or an ARB
Following a myocardial infarction, what medication should you be using to treat hypertension?
Paroxysmal nocturnal dyspnea should make you think of what diagnosis?
What is the most common cause of CHF?
Coronary artery disease
What ejection fraction is typical for a patient with CHF?
35% - 40%
What is the most likely diagnosis for a young man who experiences sudden death while playing sports?
Batwing vessels or Kerley B lines on a chest x-ray should make you think of what diagnosis?
A beta natriuretic peptide below what levels rules our CHF?
What is the therapeutic range for INR following a mechanical valve replacement?
2.5 - 3.5
What is the first line IV inotropic agent when dealing with cardiogenic shock?
What diagnosis is most likely in an IV drug user with a new heart murmur and fever?
List two diagnoses which require antibiotic prophylaxis for "dirty procedures?"
Prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congenital cyanotic heart defect.
Does a patient with mitral valve prolapse require prophylactic antibiotics for dental work?
No, a recent change moves mitral valve prolapse from high risk to moderate risk.
What are the three major criteria for endocarditis?
2 positive blood cultures, a positive TEE, new murmur.
Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?
List the 4 minor criteria for diagnosing endocarditis?
Fever, embolic event (janeway lesions or petechiae, splinter hemorrhages), immunological event (osler nodes, glomerulonephritis), 1 positive blood culture
What are the five components of Tetralogy of Fallot
(wait there's 5?, according to brian wallace there is)
2. Over-riding aorta
3. Pulmonic stenosis
4. Right ventricular hypertrophy
(5. Right sided aortic arch)
What is the gold standard for diagnosing myocarditis?
Where do most aortic dissections occur?
The ascending or descending thoracic aorta
A patient complains of severe pleuritic chest pain that is worse when leaning forward. What is the most likely diagnosis?
What is the first line medical treatment for pericarditis?
NSAIDS and Aspirin
What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?
A patient presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all of the leads. What is the most likely diagnosis?
Define paradoxical pulse
There is a large difference in pulse pressure between inhalation and exhalation
Define pulsus alternans
EKG waveform changes from beat to beat
What is the difinitive treatment for cardiac tamponade?
On physical exam you hear a harsh systolic murmur along the right sternal border. What is the most likely diagnosis?
A wide pulse pressure with a blowing diastolic decrescendo murmur at the right 2nd intercostal space should make you think of what diagnosis?
What is the best location to hear problems with the aortic valve?
2nd right intercostal space
Where is the disease of the pulmonary valve best heard?
2nd left intercostal space
What two antibiotics are used for empiric treatment of endocarditis?
Ceftriaxone + Vanco are 1st line empiric therapy
What two valvular issues do patients with Marfan's syndrome often have?
Aortic regurgitation and MVP
What are the two main causes of aortic stenosis?
Congenital bicuspid valve and calcification of the valve secondary to coronary artery disease
An elderly patient presents with dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely diagnosis?
On auscultation you hear a harsh blowing pansystolic murmur at the apex. What is most likely diagnosis?
You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis?
A patient with MVP will often have what physical characteristics? (gender and appearance)
What is the best patient position to hear aortic regurgitation and aortic stenosis?
Sitting up and leaning forward
What is Tietze syndrome?
Are most pulmonary valve problems congenital or acquired?
What is the therapeutic range for INR following an organic valve replacement?
2 - 3
A 60 year old male presents to the ED with severe dizziness and back pain. His BP is dropping and you can feel an abdominal pulsatile mass on physical exam. What is the most likely diagnosis?
Ruptured aortic aneurysm
In a patient with aortic stenosis, will the PMI be medially displaced, normal, or laterally displaced?
It will be laterally displaced due to left ventricular hypertrophy
A patient complains of severe crushing chest pain. EKG shows ST segment elevations. All labs including troponins and CK-MB are negative. What is the most likely diagnosis?
A question about Prinzmetals angina will often contain what key thing in the patient's history?
Name two things that would constitute a positive stress test?
A drop in blood pressure, a new arrhythmia, an increase in angina symptoms, ST depressions
Are ulcers from venous insufficiency painful or painless?
A patient has just recieved a cardiac stent. how long will he be on aspirin and clopidogrel?
Where is disease of the mitral valve best heard?
At the apex
What is the initial treatment for a myocardial infarction?
MONA - Morphine, Oxygen, Nitro, Asprin
Clot busting drugs should be used within 3 hours of which two cardiac events?
STEMI and new left bundle branch block
List three catastrophic complications of an MI?
Papillary muscle rupture, myocardial wall rupture, and left ventricular aneurysm.
An EKG shows a regular heart rate of 200 bmps. QRS is narrow. What is the most likely diagnosis?
What is the most common cause of sudden death?
Acute endocarditis is most commonly caused by what organism?
List three congenital heart diseases
ASD, VSD, Coarctation, PDA, TOF
What is the most common cause of an atrial septal defect?
Where on your patient should you listen for the murmur associated with an atrial septal defect?
At the left 2nd or 3rd interspace
A chest x-ray shows a "3" sign with notching of the ribs. What is the most likely diagnosis?
Coarctation of the aorta
What is the appropriate treatment to close a patent ductus arteriosus?
A Blalock procedure is used to correct what congenital heart condition?
Tetralogy of Fallot
You hear a loud, harsh pulmonary murmur along the left sternal border. What is the most likely diagnosis?
Subacute endocarditis is most commonly caused by what organism?
What is the most common place for an aortic aneurysm?
In the abdomen and below the renal arteries
Who is more likely to have an aortic aneurysm males or females?
Males are 8 times more likely to have an aortic aneurysm.
The accessory pathway known as the James bundle should make you think of what syndrome?
What imaging needs to be done before taking a patient tot he OR with an aortic aneurysm?
CT (echo may be used as initial study, but CT is needed for surgery)
List two risk factors for an aortic dissection?
HTN, Marfan's, Bicuspid aortic valve, pregnancy
A patient presents to the ED with tearing chest pain radiating to his back. What is the most likely diagnosis?
What will a chest x-ray show for a patient with an aortic dissection?
What is the best test to diagnose an aortic dissection?
List the 6 P's of an ischemic limb.
Pain, parasthesias, pallor, pulselessness, poikilothermia, paralysis.
You have a patient with pulsus alternans. What two diagnosis should you be thinking of?
Pericarditis, pericardial effusion, and obstructive lung tissue.
A patient complains of pain in his leg when he walks. It goes away after sitting. What term comes to mind for his symptom? What diagnosis is it associated with?
Intermittent claudication. Peripheral arterial disease.
Giant cell arteritis is associated with what other disease?
A sawtooth pattern on EKG should make you think of what diagnosis?
What is the accessory pathway associated with Wolff-Parkinson-White syndrome?
The bundle of Kent
A biphasic P wave should make you think of what diagnosis?
Left atrial enlargement
What is the gold standard for diagnosis of giant cell arteritis?
Biopsy of the temporal artery
What is the treatment for giant cell arteritis?
High dose prednisone (one time, 60mg)
List the components of Virchow's triad?
Stasis, vascular injury, hypercoagulability.
Calf pain should always make you think of what diagnosis?
Where is disease of the tricuspid valve best heard?
Along the left lower sternal border.
What is the most common congenital heart disease?
Are ulcers from arterial insufficiency painful or painless?
Give two contraindications for using an ACE-Inhibitor
Bilateral renal artery stenosis, history of angioedema, pregnancy.
Both lead I and avF have positive QRS complexes. Does this represent normal axis, left axis deviation or right axis deviation?
What medication might you switch to if a patient develops an intolerable cough on an ACE-I?
What class of cardiac medications should be avoided in patients with asthma?
A boot shaped heart on chest x-ray should make you think of what congenital heart condition?
Tetralogy of Fallot
An RSR prime in leads V1 or V2 should make you think of what diagnosis?
Right bundle branch block
Which lab should be tightly monitored in a patient taking an aldosterone antagonist?
Potassium (they may have hyperkalemia)
What is the best test for diagnosing CHF?
Which cardiac medication is used to help with cardiac contractility after you have optimized most of the other cardiac medications?
(lookup dig toxicity symptoms)
A blockage of which artery causes an anterior wall MI?
Left anterior descending artery
What lab result will increase the risk of Digoxin toxicity?
Hypokalemia or hypercalcemia
A patient presents to the ER in acute CHF. What drug class will likely be the first choice?
A patient has a GFR of 25 and HTN. Which class should you use, a loop or a thiazide diuretic?
A loop will work no matter how low the GFR is (Zero order kinetics?). Thiazides will only work with a GFR over 30.
Which EKG leads are used to diagnose an anterior wall MI?
V1, V2, V3
Do loop diuretics cause hyperkalemia or hypokalemia?
Statins are the drug of choice to treat what type of dyslipidemia?
A patient recently started taking Lipitor. He is now c/o aches and pains. What test should you order.
Serum Creatinine Kinase
(looking for Rhabdomyolysis)
How does ezetimibe work?
Decreases intenstinal absorption of cholesterol.
Which hyperlipidemia medication may cause flushing?
Name three medications "classes" which are indicated for reduction in LDL.
Statins, ezetimibe, niacin, and nicotinic acid
Name two fibric acid derivatives
Fenofibrate and Gemfibrozil
List the three class 1a antiarrhythmics
Disopyamide, quinidine, procainamide.
You are counting boxes from the peak of a QRS wave on an EKG in order to determine the heart rate. What would the heart rate be if the next QRS wave peak were three 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.
A U wave on EKG should make you think of what diagnosis?
What will the heart rate be if the AV node is pacing the heart?
40-60 beats per minute
Which cardiac medication has gynecomastia in its side effect profile?
Lead I has a QRS that is up and the acF lead has a QRS complex that is down. Does this represent normal axis, left axis deviation, or right axis deviation?
Left axis deviation
An Osborne of J wave on EKG should make you think of what diagnosis?
What is the first line medication for a patient with symptomatic bradycardia?
What is the heart rate for tachycardia? How about bradycardia?
60 & 100
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
How do you treat polymyalgia rheumatica
Low dose prednisone
What is the management of a patient in supreventricular tachycardia?
Vagal maneuvers, carotid massage, adenosine
What is the first medication you should give for atrial flutter?
An 82 year old patient c/o headaches and jaw claudication. What is the most likely diagnosis?
Giant cell (temporal) arteritis
The 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 diagnosis?
Name a common cause of a junctional rhythm
An EKG shows two premature ventricular contractions. These two QRS waves look very different. What is the term for this?
Multifocal premature ventricular contractions
What is the most common cause of sudden cardiac death?
Tall peaked T waves should make you think of what diagnosis?
How do you define 1st degree AV block?
The PR interval is longer than .2 seconds (or one block on the EKG)
What is the other term for Mobitz type I?
What is the most important complication of giant cell arteritis?
What two labs do you want to monitor in a patient on an ACEI?
Serum Creatinin and potassium
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 heart rate on an EKG?
Count QRS waves in a 6 strip and multiple by 10.
What is the treatment for a patient with a Mobitz II AV block?
You see regular P waves and regular QRS complexes, but they do not seem to have any correlation to each other. What is the diagnosis?
3rd degree AV block
Name on aldosterone antagonist
You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?
What two leads do you use to determine the axis of the heart?
Lead I and avF
An RSR prime in leads V5 or V6 should make you think of what diagnosis?
Left bundle branch block
Which finding requires immediate attention, left bundle branch block or right bundle branch block?
New left bundle block is a STEMI equivalent. RIght bundle branch block is usually not a problem.
What medication class is used to lower triglycerides?
Fibric acid derivatives
Tall peaked P waves should make you think of what diagnosis?
Right atrial enlargement
List two causes of right atrial enlargement?
Pulmonary HTN, severe lung disease, pulmonary valve stenosis.
Which EKG leads are used to diagnose an anterolateral MI?
V5 and V6
Which are the three inferior leads?
II, III, avF
A blockage of which artery causes a lateral wall MI?
Left circumflex artery
What is represented by ST segment depressions greater than 1mm on EKG?
Rheumatic fever most commonly affects which valve?
The mitral valve
What is the only cyanotic congenital heart disease on the NCCPA blueprint?
Tetralogy of Fallot
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?
On an EKG you notice a patient 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
List three side effects of Digoxin
Nausea/vomiting, anorexia, confusion, arrythmias (sinus brady, AV block), fatigue, vision disturbances, etc.