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Flashcards in Cardiology Review Deck (175):
1

What side effect might make a patient stop taking an ACEI?

Cough

2

Define orthostatic hypotension.

A drop in systolic blood pressure of >20 mmhg when standing up.

3

You feel a pulse that seems to be vibrating. What term do you use to describe it?

Thrill

4

What are three things in your differential if you have a paradoxical pulse?

Cardiac tamponade, pericarditis and obstructive lung disease

5

On palpation, what size is normal for the aorta?

Less than 3 cm

6

A fixed or consistent split S2 should make you think of what diagnosis?

Atrial septal defect

7

A pathologic S3 is most commonly associated with what diagnosis?

CHF

8

If you hear a midsystolic click you should immediately be thinking about what diagnosis?

Mitral valve prolapse

9

An opening snap on auscultation of the heart should make you think of what diagnosis?

Mitral stenosis

10

A continuous murmur most likely involves what area of the heart?

It is most likely a septal defect.

11

You hear a continuous machine like murmur. What is the most likely diagnosis?

Patent ductus arteriosus (PDA)

12

List three medications which may be used for pharmacological stress test.

Adenosine, dobutamine, dipyridamole and persantine.

13

What is the gold standard for diagnosing coronary artery disease?

Cardiac catheterization

14

Define stage 1 hypertension according to JNC 7.

Systolic pressure of 140-159 and diastolic of 90-99.

15

What is the treatment goal for a diabetic with hypertension?

130/80

16

What is the most common cause of secondary hypertension?

Chronic kidney disease

17

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?

Cushing's disease

18

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

19

You have a patient with diagnosis of pheochromocytoma. While waiting for surgery should you use an alpha blocker or a beta blocker?

Alpha blocker. You should never use a pure beta blocker.

20

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

21

According to the CDC what is the range for a normal BMI?

18.5-24.9

22

What is the first line medical treatment for stage 1 hypertension?

Thiazide diuretic

23

After a thiazide diuretic what medication should you start in a hypertensive patient who also has diabetes?

An ACEI or an ARB

24

Following a myocardial infarction what medication should you be using to treat hypertension?

Beta blocker

25

Paroxysmal nocturnal dyspnea should make you think of what diagnosis?

CHF

26

What is the most common cause of CHF?

Coronary artery disease

27

What ejection fraction is typical for a patient with CHF?

35-40%

28

What is the most likely diagnosis for a young man who experiences sudden death while playing sports?

Hypertrophic cardiomyopathy

29

Batwing vessels or Kerley B lines on a chest x-ray should make you think of what diagnosis?

CHF

30

A beta natriuretic peptide below what level rules out CHF?

< 100

31

What is the therapeutic range for INR following a mechanical valve replacement?

2.5-3.5

32

What is the first line IV inotropic agent when dealing with cardiogenic shock?

Dopamine

33

What diagnosis is most likely in an IV drug user with a new heart murmur and fever?

Endocarditis

34

List two diagnoses which require antibiotic prophylaxis for "dirty procedures?"

Prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congential cyanotic heart defect.

35

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.

36

What are the three major criteria for endocarditis?

2 positive blood cultures, a positive transesophageal echocardiography, new murmur.

37

Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?

Osler nodes

38

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.

39

What are the five components of Tetralogy of Fallot?

Ventricular septal defect, right ventricular hypertrophy, right ventricular outflow obstruction (pulmonary valve stenosis), overriding aorta, right sided aortic arch.

40

What is the gold standard for diagnosing myocarditis?

Myocardial biopsy

41

Where do most aortic dissections occur?

The ascending or descending thoracic aorta.

42

A patient complains of severe pleuritic chest pain that is worse when leaning forward. What is the most likely diagnosis?

Pericarditis

43

What is the first line medical treatment for pericarditis?

Aspirin and NSAIDS

44

What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?

Dressler syndrome

45

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?

Pericarditis

46

Define paradoxical pulse.

There is a large difference in pulse pressure between inhalation and exhalation.

47

Define pulsus alternans.

EKG waveform changes from beat to beat.

48

What is the definitive treatment for cardiac tamponade?

Pericardiocentesis

49

On physical exam you hear a harsh systolic murmur along the right sternal border. What is the most likely diagnosis?

Aortic stenosis

50

A wide pulse pressures with a blowing diastolic decrescendo murmur at the right 2nd intercostal space should make you think of what diagnosis?

Aortic regurgitation

51

What is the best location to hear problems with the aortic valve?

2nd right intercostal space

52

Where is disease of the pulmonary valve best heard?

2nd left intercostal space

53

What two antibiotics are used for empiric treatment of endocarditis?

Vancomycin and ceftriaxone together are first line empiric treatment.

54

What two valvular issues do patients with Marfan's syndrome often have?

Aortic regurgitation and mitral valve prolapse (you can tell them apart by where they are heard).

55

What are the two main causes of aortic stenosis?

Congenital bicuspid valve and calcification of the valve secondary to coronary artery disease.

56

An elderly patient presents with dyspnea, angina and syncope on exertion. The EKG is normal. What is the most likely diagnosis?

Aortic stenosis

57

On auscultation you hear a harsh blowing pansystolic murmur at the apex. What is the most likely diagnosis?

Mitral regurgitation

58

You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis?

Transesophageal echo

59

A patient with mitral valve prolapse will often have what physical characteristics?

Thin female

60

What is the best patient position to hear aortic regurge and aortic stenosis?

Sitting up and leaning forward.

61

What is Tietze syndrome?

Costochondritis

62

Are most pulmonary valve problems congenital or acquired?

95% are congenital

63

What is the therapeutic range for INR following an organic valve replacement?

2 to 3

64

A 60 year old male presents to the ED with severe dizziness and back pain. His blood pressure is dropping and you can feel an abdominal pulsatile mass on physical exam. What is the most likely diagnosis?

Ruptured aortic aneurysm

65

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.

66

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?

Prinzmetal's angina

67

A question about Prinzmetal's angina will often contain what key thing in the patient's history?

Cocaine use

68

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

69

Are ulcers from venous insufficiency painful or painless?

Painless

70

A patient has just received a cardiac stent. How long will he be on aspirin and clopidogrel?

One year

71

Where is disease of the mitral valve best heard?

At the apex

72

What is the initial treatment for a myocardial infarction?

MONA - Morphine, oxygen, nitroglycerin and aspirin

73

Clot busting drugs should be used within 3 hours of which two cardiac events?

STEMI and new left bundle branch block.

74

List three catastrophic complications of a myocardial infarction.

Papillary muscle rupture, myocardial wall rupture and left ventricular aneurysm.

75

An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely diagnosis?

Supraventricular tachycardia

76

What is the most common cause of sudden death?

Ventricular fibrillation

77

Acute endocarditis is most commonly caused by what organism?

Staph Aureus

78

List three congential heart diseases.

Atrial septal defect (ASD), ventricular septal defect (VSD), coarctation of the aorta, patent ductus arteriosus (PDA), tetralogy of Fallot.

79

What is the most common cause of an atrial septal defect?

Patent foramen ovale

80

Where on your patient should you listen for the murmur associated with an atrial septal defect?

At the left second or third interspace.

81

A chest x-ray shows a "3" sign with notching of the ribs. What is the most likely diagnosis?

Coarctation of the aorta.

82

What is the appropriate treatment for a patent ductus arteriosus.

Indomethacin

83

A Blalock procedure is used to correct what congenital heart condition?

Tetralogy of Fallot

84

You hear a loud, harsh pulmonary murmur along the left sternal border. What is the most likely diagnosis?

Ventricular septal defect

85

Subacute endocarditis is most commonly caused by what organism?

Strep Viridans

86

What is the most common place for an aortic aneurysm?

In the abdomen and below the renal arteries.

87

Who is more likely to have an aortic aneurysm males or females?

Males are eight times as likely to have an aortic aneurysm.

88

The accessory pathway known as the James bundle should make you think of what syndrome?

Lown-Ganong-Levine syndrome

89

What imaging needs to be done before taking a patient to the OR with an aortic aneurysm?

CT (echo may be used as initial study, but CT is need for surgery).

90

List two risk factors for an aortic dissection?

Hypertension, Marfan's syndrome, bicuspid aortic valve, pregnancy.

91

A patient presents to the ED with tearing chest pain radiating to his back. What is the most likely diagnosis?

Aortic dissection

92

What will a chest x-ray show for a patient with an aortic dissection?

Widened mediastinum

93

What is the best test to diagnose an aortic dissection?

CT

94

List the six P's of an ischemic limb.

Pain, paresthesias, pallor, pulselessness, poikilothermia, paralysis.

95

You have a patient with pulsus alternans. What two diagnosis should you be thinking of?

Pericarditis, pericardial effusion and an obstructive lung issue.

96

A patient complains of pain in his legs when he walks. It goes away after sitting. What term comes to mind for this symptom? What diagnosis is it associated with?

Intermittent claudication. Peripheral arterial disease.

97

Giant cell arteritis is associated with what other disease?

Polymyalgia rheumatica

98

A sawtooth pattern on EKG should make you think of what diagnosis?

Atrial flutter

99

What is the accessory pathway associated with Wolff-Parkinson-White syndrome?

The bundle of Kent

100

A biphasic P wave should make you think of what diagnosis?

Left atrial enlargement

101

What is the gold standard for diagnosis of giant cell arteritis?

Biopsy of the temporal artery

102

What is the treatment for giant cell arteritis?

High dose prednisone

103

List the components of Virchow's triad.

Stasis, vascular injury, hypercoagulability.

104

Calf pain should always make you think of what diagnosis?

DVT

105

Where is disease of the tricuspid valve best heard?

Along the left lower sternal border.

106

What is the most common congenital heart disease?

Ventricular septal defect

107

Are ulcers from arterial insufficiency painful or painless?

Painful

108

Give two contraindications for using an ACEI.

Bilateral renal artery stenosis, history of angioedema, pregnancy.

109

Both lead I and AVF have positive QRS complexes. Does this represent normal axis, left axis deviation or right axis deviation?

Normal axis

110

What medication might you switch to if a patient develops an intolerable cough on an ACEI?

Angiotensin receptor blocker (ARBs)

111

What class of cardiac medications should be avoided in patients with asthma?

Beta blockers (Blocks receptors for bronchodilators).

112

A boot shaped heart on chest x-ray should make you think of what congenital heart condition?

Tetralogy of Fallot

113

An RSR prime in leads V1 or V2 should make you think of what diagnosis?

Right bundle branch block

114

Which lab should be tightly monitored in a patient taking an aldosterone antagonist?

Potassium, they may have hyperkalemia.

115

What is the best test for diagnosing CHF?

Echo

116

Which cardiac medication is used to help with cardiac contractility after you have optimized most of the other cardiac medications?

Digoxin

117

A blockage of which artery causes an anterior wall MI?

Left anterior descending artery

118

What lab result will increase the risk of digoxin toxicity?

Hypokalemia or hypercalcemia

119

A patient presents to the ER in acute CHF. What drug class will likely be the first choice?

Loop diuretics

120

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. Thiazides will only work with a GFR over 30.

121

Which EKG leads are used to diagnose an anterior wall MI?

V1, V2 and V3

122

Do loop diuretics cause hyperkalemia or hypokalemia?

Hypokalemia

123

Statins are the drug of choice to treat what type of dyslipidemia?

Elevated LDL

124

A patient recently started taking lipitor. He is now complaining of aches and pains. What test should you order?

Serum creatinine kinase, you're looking for rhabdomyolysis.

125

How does ezetimibe work?

Decreases intestinal absorption of cholesterol.

126

Which hyperlipidemia medication may cause flushing?

Niacin

127

Name three medication "classes" which are indicated for reduction in LDL?

Statins, ezetimibe, niacin and nicotinic acid.

128

Name two fibric acid derivatives.

Fenofibrate and Gemfibrozil

129

List three class 1a antiarrhythmics.

Disopyramide, quinidine, procainamide.

130

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.

131

A U wave on EKG should make you think of what diagnosis?

Hypokalemia

132

What will the heart rate be if the AV node is pacing the heart?

40-60 beats per minute

133

Which cardiac medication has gynecomastia in its side effect profile?

Spironolactone

134

Lead I has a QRS that is up and the AVF lead has a QRS complex that is down. Does this represent normal axis, left axis deviation or right axis deviation?

Left axis deviation

135

An Osborne or J wave on EKG should make you think of what diagnosis?

Hypothermia

136

What is the first line medication for a patient with symptomatic bradycardia?

Atropine

137

What is the heart rate for tachycardia? How about bradycardia?

Tachycardia >100, bradycardia <60

138

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

139

How do you treat polymyalgia rheumatica?

Low dose prednisone

140

What is the management of a patient in supraventricular tachycardia?

Vagal maneuvers, carotid massage, adenosine

141

What is the first medication you should give for atrial flutter?

Adenosine

142

An eighty two year old patient complains of headaches and jaw claudication. What is the most likely diagnosis?

Giant cell (temporal) arteritis

143

The EKG shows irregularly irregular narrow QRS waves. What diagnosis should you be thinking of?

Atrial fibrillation

144

An EKG shows a regular rate of fifty beats per minute. The QRS is narrow and there is no visible P wave. What is the most likely diagnosis?

Junctional rythm

145

Name a common cause of a junctional rhythm.

Digitoxin toxicity

146

An EKG shows two premature ventricular contractions. These two QRS waves look very different. What is the term for this?

Multifocal premature ventricular contractions.

147

What is the most common cause of sudden cardiac death?

Ventricular fibrillation

148

A patient in the ED has no pulse, but on EKG there are wide irregular "complexes" which are at an irregular rate. They all appear very different from one another. What is the treatment for this patient?

He is in ventricular fibrillation. The treatment is defibrillation.

149

Tall peaked T waves should make you think of what diagnosis?

Hyperkalemia

150

How do you define 1st degree AV block?

The PR interval is longer than 0.2 seconds or one block on EKG.

151

What is the other term for Mobitz type I?

Wenckebach

152

What is the most important complication of giant cell arteritis?

Blindness

153

What two labs do you want to monitor in a patient on an ACEI?

Serum creatinine and serum potassium.

154

The heart rate is irregular so you can't count boxes between QRS waves to determine heart rate. What is another method you can use to determine rate on an EKG?

Count QRS waves in a six second strip and multiply by 10 to get beats per minute.

155

What is the treatment for a patient with a Mobitz II AV block?

Pacemaker

156

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?

Third degree AV block

157

Name one aldosterone antagonist.

Spironolactone, eplerenone

158

You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?

Wolff-Parkinson-White syndrome

159

What two leads do you use to determine the axis of the heart?

Lead I and AVF

160

An RSR prime in leads V5 or V6 should make you think of what diagnosis?

Left bundle branch block

161

Which finding requires immediate attention, left bundle branch block or right bundle branch block?

New left bundle branch block is a STEMI equivalent. Right bundle branch block is usually not a problem.

162

What medication class is used to lower triglycerides?

Fibric acid derivatives

163

Tall peaked P waves should make you think of what diagnosis?

Right atrial enlargement

164

List two causes of right atrial enlargement?

Pulmonary HTN, severe lung disease, pulmonary valve stenosis.

165

Which EKG leads are used to diagnose an anterolateral MI?

V5 and V6

166

What are the three inferior leads?

II, III and aVF

167

A blockage of which artery causes a lateral wall MI?

Left circumflex artery

168

What is represented by ST segment depressions greater than 1mm on EKG?

Ischemia

169

Rheumatic fever most commonly affects which valve?

The mitral valve

170

What is the only cyanotic congenital heart disease on the NCCPA blueprint?

Tetralogy of Fallot

171

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?

Premature ventricular contraction

172

What is the definitive treatment for a patient with recurrent ventricular tachycardia?

Implanted defibrillator

173

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

174

List three side effects of digoxin.

Nausea/vomiting, anorexia, confusion, arrhythmias (sinus brady, AV block), fatigue, vision disturbances etc.

175

What is the first line medical treatment for Torsades de pointes?

Magnesium sulfate