Circulation

Question 1

Surgical embolectomy is only for massive PE.

Answer 1

If AC is CI, get IVC filter.

Question 2

CTEPH treatment

Answer 2

surgical or percutaneous pulmonary endarterectomy. If high surgical risk, balloon angioplasty and/or medical therapy with pulmonary vasodilators (Riociguat). Should be on AC.

Question 3

Bone morphogenetic protein receptor type II (BMP2) gene

Answer 3

familial pulmonary htn

Question 4

Intermediate or High Wells score.

Answer 4

Start AC before imaging

Question 5

If suspecting pulmonary hypertension due to CTEPH

Answer 5

V/Q scan before RHC

Question 6

Poor PE prognosis

Answer 6

RV:LV diameter > 0.9, new RBBB, S1Q3T3

Question 7

Most common hypercoag cause of CTEPH

Answer 7

antiphospholipid antibodies. Can also see anticardiolipin antibodies, and lupus anticoagulant. Splenectomy increases risk. All CTEPH patients should undergo hypercoag workup.

Question 8

PH TR jet

Answer 8

> 3.4. Also early diastolic pulmonary regurgitation velocity of >2.2 m/sec, an IVC diameter >2.1 cm with <50% inspiratory collapse, or a pulmonary artery diameter >25 mm

Question 9

RHC for PH timing

Answer 9

After it is diagnosed on echo. IF pcwp tracing is unreliable, directly measure LVEDP.

Question 10

Pulmonary arterial htn treatment

Answer 10

Test for vasoreactivity: ≥10 mm Hg reduction in mPAP to a value of <40 mm Hg and without a reduction in CO. If positive-> CCBs. If negative, Pulmonary vasodilators such as PDE-5i.

Question 11

Massive PE.

Answer 11

hypotension, cardiogenic shock, or cardiac arrest.
Systemic thrombolytics if acceptable bleeding risk. CI in structural intracranial disease, previous intracranial hemorrhage, ischemic stroke within 3 months, active bleeding, recent brain or spinal surgery, recent head trauma with fracture or brain injury, and bleeding diathesis

Question 12

Precapillary pulmonary htn without evidence of lung disease on PFTs/CT chest, consider

Answer 12

CTEPH

Question 13

CTPA kidney CI

Answer 13

AKI or chronic kidney disease with GFR <30

Question 14

Undifferentiated shock

Answer 14

Consider adrenal crisis (hyperkalemia, hyponatremia). central obesity, abdominal striae, and bruises= cushing.

Question 15

angiotensin-converting enzyme (ACE) inhibitor–induced angioedema diagnosis

Answer 15

no lab testing, clinical diagnosis, due to the inhibition of bradykinin degradation.
if there were family history of angioedema, personal history of malignancy, or prior angioedema event-> suspect rare angioedema disorder and get complement protein 4 level.

Question 16

Orthostatic syncope on chronic steroids

Answer 16

due to adrenal insufficiency, can be unmasked by illness

Question 17

Nicotine w/drawal in setting of ACS

Answer 17

Nicotine patch. NRT on discharge/varenicline.

avoid bupropion in anyone at risk for seizures

Question 18

lightheadedness, gradual vision, and nausea before syncope

Answer 18

vasovagal syncope

Question 19

best biomarker of tobacco smoke exposure.

Answer 19

cotinine

Question 20

markers of immune-mediated anaphylaxis.
sepsis.

Answer 20

histamine and tryptase.
endotoxin.

Question 21

DM fasting Glucose level

Answer 21

> 125

Question 22

Pre thrombolytics for stroke tests

Answer 22

CT Head and glucose

Question 23

elevated calcium and low-normal phosphorus and low-normal magnesium

Answer 23

Primary hyperparathyroidism

Question 24

hydrochlorothiazide electrolyte abnormality

Answer 24

hypercalcemia

Question 25

Best treatment of metabolic syndrome

Answer 25

aggressive lifestyle modification

Question 26

acute physiologic effects of nicotine

Answer 26

stimulation of the sympathetic nervous system to increase BP and HR

Question 27

Cigarettes vs smokeless tobacco effects

Answer 27

MI, HF, insulin resistance, afib, vasoconstriction vs no afib

Question 28

Metabolic syndrome diagnosis

Answer 28

3 of 5: waist circumference in men ≥102 cm or ≥88 cm in women), triglycerides (>175 mg/dL), HDL (<40 mg/dL in men or <50 mg/dL in women), BP ≥130/85 mm Hg, and elevated fasting plasma glucose (≥100 mg/dL).

Question 29

Allergy epi

Answer 29

1:1000 IM, 0.2-0.5 mg

Question 30

primary hyperaldo workup

Answer 30

ARR> 30: positive Then, confirm with oral sodium loading test, saline infusion test, fludrocortisone suppression, or captopril challenge. -> adrenal CT-> adrenal vein sampling

Question 31

Cardiac fibromas

Answer 31

Benign, associated with polyposis syndromes, distinct, well-demarcated, non-contractile and solid, highly echogenic mass within the myocardium" with central calcification possible

Question 32

Goal BP before giving IV thrombolytics for stroke

Answer 32

<185/110