CR IV MEDI Cardio

Question 1

What are causes of hypertonic hyponatremia?

Answer 1

Hyperglycemia or hypertonic infusion

Question 2

How is isotonic hyponatremia similar to hypertonic hyponatremia

Answer 2

Similar to hypertonic hyponatremia but slow onset time so body has time to adjust

Question 3

What are non-renal and renal causes of hypovolemic hypotonic hyponatremia?

Answer 3

Non-renal - GI (UNa <20)

Renal - Thiazide diuretics, low aldosterone (UNa >20)

Question 4

What are two causes of euvolemic hypotonic hyponatremia? How can you tell them apart?

Answer 4

SIADH and Psychogenic polydipsia
SIADH - Urine concentrated
Psychogenic polydipsia - urine dilute

Question 5

If Na is increased too quickly, what is caused?

Answer 5

Osmotic Demylination Syndrome

Question 6

What three labs are needed for hyponatremia?

Answer 6

Urine Na
Urine Osmolarity
Plasma osmolarity

Question 7

How is the water deprivation test performed? What does each point tell you?

Answer 7

Restrict water - if urine osm improves = polydipsia
Give ADH - if urine osm improves = neurogenic
If ADH does not improve = nephrogenic

Question 8

What diuretics do you use to treat hypervolemic hyponatremia? Hypervolemia hypernatremia?

Answer 8

Loop diuretics - hyponatremia

Thiazide diuretics - hypernatremia

Question 9

What should be ordered immediately when K >5.5?

Answer 9

EKG

Question 10

What ECG abnormalities can be seen with hyperkalemia?

Answer 10

High T-wave, widened QRS

Question 11

What should be given immediately to stabilize a patient with hyperkalemia if symptomatic?

Answer 11

IV calcium gluconate

Question 12

What should be given to treat someone with hyperkalemia?

Answer 12

Insulin and glucose

Question 13

If a patient is hyperkalemic and in metabolic acidosis, what should be given?

Answer 13

IV bicarb

Question 14

What should be checked when a person is truly hypokalemic?

Answer 14

Magnesium

Question 15

What is the most common cause of hypercalcemia?

Answer 15

Hyperparathyroidism

Question 16

What three things should be given to treat hypercalcemia?

Answer 16

Saline
Loop diuretics
IV bisphosphanates

Question 17

What is the treatment for hyperphosphatemia?

Answer 17

Oral phosphate binders

Question 18

What regulates the movement of calcium into SMC?

Answer 18

MAgnesium

Question 19

What helps stabilize hypermagnesia? What is the treatment of choice?

Answer 19

Stabilize - IV calcium gluconate

Hemodialysis - treatment of choice

Question 20

What test is good at showing myocardial viability, better than eCHO and stress EKG?

Answer 20

Nuclear scintigraphy - MPI

Question 21

What test is still used in oncology and is useful for identifying EF?

Answer 21

MUGA scan

Question 22

What is the best test for congenital heart disease?

Answer 22

MRI with gadolinium contrast

Question 23

What is the most popular drug for cardiac stress testing? What can be used if BMI > 50?

Answer 23

Lexiscan

Adenosine - if BMI > 50

Question 24

What is the first goal of treatment for Afib? Second goal? Long term use?

Answer 24

Rate
Rhythm
Amiodarone - lone term use

Question 25

What is the most common symptom of LHF?

Answer 25

Orthopnea

Question 26

What is a major cause for Afib, not procedure related?

Answer 26

Obstructive Sleep Apnea

Question 27

What is hypokensis? Akinesis? Diskinesis?

Answer 27

Hypokenesis - ischemia, low oxygen, can be reversed Akinesis - dead tissue thins wall Dyskinesis - anneurysm

Question 28

What is the angiographic hallmark of prinzmetal's angina?

Answer 28

Coronary spasm w/ ST elevating during chest pain, goes away when pain goes away

Question 29

What is the treatment order for angina?

Answer 29

``` Aspirin 1st BB 2nd long-acting nitrate CCB Statin ```

Question 30

What should be used for IHD in a hypotensive patient?

Answer 30

Ranolazine

Question 31

What did the Courage trial show?

Answer 31

Medical treatment vs PCI no different in long term for asymptomatic patient PCI still wins when symptoms present

Question 32

What does 3rd heart sound indicate? 4th heart sound?

Answer 32

3rd - dilation because of ischemia | 4th - diastolic dysfunction because of ischemia

Question 33

What is the cornerstone of treatment for a person with Acute coronary syndrome?

Answer 33

BB and Nitrates

Question 34

What score is used to evaluate chest pain in the ER?

Answer 34

HEART score

Question 35

What is the gold standard enzyme for diagnosing MI?

Answer 35

Troponin

Question 36

What is mandatory treatment after PCI?

Answer 36

P2Y12 inhibitor/ASA dual treatment

Question 37

Is treatment for STEMI and nonSTEMI different?

Answer 37

No

Question 38

What complication has occured if you hear a loud harsh systolic murmur?

Answer 38

Interventricular septal rupture

Question 39

If a person keels over after lifting or straining after an MI, what most likely has happened?

Answer 39

Free wall rupture

Question 40

What should be done if Right ventricular infarction occurs?

Answer 40

Volume expansion

Question 41

What should not be given in Dressler's Syndome?

Answer 41

Steroids

Question 42

What is the most important diagnostic measure for HF?

Answer 42

ECHO

Question 43

What is the corner stone of treatment for HF? What should be added if EF <35?

Answer 43

ACEI or ARB | Spironolactone

Question 44

What BB is great for HF, particular diabetes?

Answer 44

Carvedilol

Question 45

What is an a-wave mean? V-wave? Cannon a-waves? Large V-waves?

Answer 45

A-wave - pressure in atria during atrial contraction V-wave - pressure in atria during ventricular systole Cannon a-wave - atrial contraction against closed tricuspid (v.tach, junctional rhythms) Large v-waves (tricuspid regurg)

Question 46

What two things are required for diagnosis of pulmonary hypertension?

Answer 46

Righ heart cath | PA resting pressure > 25 mmhg

Question 47

What calculator is used for risk of serious complication before/after surgery?

Answer 47

NSQIP calculator

Question 48

What is 1 MET? 4 MET? >10 MET?

Answer 48

1 MET - eat, dress, use toilet 4 MET - can walk up 1 flight of stiars >10 - can do physical exercise

Question 49

When is resynchronization therapy (biventricular pacer used)?

Answer 49

QRS >120 Symptomatic (NYHA III or IV) EF < 35

Question 50

What is a defibrilator used?

Answer 50

Class II or III with reduced EF | Already on max therapy