Day 7 - cardio Flashcards
(118 cards)
1
Q
cancer –> ascites what type?
A
Exudative (has cancer in the fluid)
2
Q
portal HTN –> ascites, what type?
A
Transudative (fluid pushing out)
3
Q
Serum-Ascites gradient is? tells?
A
Serum Albumin - Ascites Albumin = tells if exudative or transudative
exudative - >1
transudative
4
Q
“onion skinning” bile duct on u/s = think?
A
Primary sclerosing cholangitis
5
Q
“beads on a string” bile duct on U/S = think?
A
Primary sclerosing cholangitis
6
Q
bloody diarrhea = infx cause diff dx (7)?
A
“Bloody SSEECCY”
- Shigella
- Salmonella
- E.coli
- Entomeoba
- Campylobactor (infx anywhere small or large bowel)
- CMV (HIV, immuncompromised)
- Yersenia entercolitica (inflames RLQ [cecum])
7
Q
Pyloric stenosis workup?
A
1) Fix electrolyte imbalance
2) U/S
3) Myotemy
8
Q
distal duodenum or jejunal ulcer think?
A
GASTRINOMA! (Zollinger-Ellison Syndrome)
9
Q
liver disease + hyper pigmentation = think?
A
Hemochromatosis
10
Q
Hemochromatosis heart complication?
A
Restrictive cardiomyopathy (bc Iron depositing in wall of heart)
11
Q
Workup hemochromatosis?
A
Dx:
1) Genetic testing (initial)
2) Liver biopsy (gold standard/confirm dx)
Tx:
mild - Phlebotomy
severe - Chelation therapy w/ defuroxamine
12
Q
What do you use for chelation for hemochromatosis?
A
Defuroxamine
13
Q
hazy aortic know w/ a large medastinal width = think?
A
aortic dissection
14
Q
Initial treatment for aortic dissection?
A
Beta Blocker
15
Q
Workup of aortic dissection?
A
1) beta blocker!!!
2) stable - spiral CT WITH contrast or X-ray
unstable - transesophageal echo
16
Q
Cardiac Tamponade triad of symptoms?
A
- hypotension
- muffled heart sound
- JVD
17
Q
costochondritis treat?
A
NSAIDs and rest
18
Q
Pain at chostochondral junction = think?
A
costochondritis
19
Q
workup of non-emergent chest pain?
A
nL EKG and can exercise –> Exercise treadmill test
nL EKG, but canNOT exercise –> pharm stress test
abnl EKG, but CAN exercise
--> Exercise stress echo
--> Exercise thallium (nuc med)
abnl EKG, but canNOT exercise
--> pharm stress echo (dobutomine, adenosine, dyperimadole)
--> thallium stress test (nuc med)
Stress echo’s don’t utilize EKGs so you use them instead when EKG is abnl
20
Q
HTN + prostate problem = what drug use?
A
alpha 1 blocker!
- zosin
21
Q
-zosin = think?
A
alpha 1 blocker
22
Q
Multiple coronary vessels effected in coronary issues –> treat?
A
Coronary artery bypass (CABG)
23
Q
1 vessel effected in coronary issues –> treat?
A
Angioplasty and stenting
24
Q
Indications for Coronary Artery Bypass Grafting (CABG)?
A
- 3 coronary vessels effected
- 2 vessels + risk factors/comorbidities (esp DM)
- Left main coronary artery effected
25
Indications for angioplasty and stenting (rather than CABG)?
limited vessels effected
- 1 vessel
- 2 vessels w/o risk factors/comorbidities
26
How to determine coronary vessels are "effected"/bad?
70% or more occlusion
27
In CABG what vessels are best to replace bad vessels w/?
ARTERIES! so do a coronary artery bypass w/ ARTERIES!
28
malignant HTN tell and treatment?
- IV nitro (1stline)
- IV labetalol (2nd)
Tell by doubling shock value (ie 90/60 x2) - equal to or higher in 1 or both values is malignant
29
LV dysfunction - most likely cause?
HTN
30
carotid massage helps w/ SVTs by?
slowing the heart down by increasing AV conduction delay
31
narrow complex tachycardia - think?
supraventricular tachycardia
32
supraventricular tachycardia
mild - vagal maneuvar (ie carotid massage)
mod - adenosine
severe - shock
33
Acute MI discharge which would provide greatest mortality benefit?
Beta Blockers
34
severe aortic stenosis treatment?
valvular replacement
35
mild aortic stenosis treatment?
ACE inhibitors
36
crescendo-decresendo systolic murmur heard at 2nd R intercostal space radiating to the carotids - think?
Aortic Stenosis
37
Asymmetric hypertrophy of the the ventricular septum w/o left ventricular dilation = think?
Hypertrophic obstructive cardiomyopathy (HOCUM)
38
Hypertrophic cardiomyopathy pts die from?
arrythmia
39
Treatment of Hypertrophic obstructive cardiomyopathy (HOCUM)?
beta blockers
40
best way to dx hypertrophic cardiomyopathy?
```
Dec preload (ie valsalva) --> inc murmur intensity
Inc afterload (squeeze fist) --> dec murmur intensity
```
this is bc less blood in ventricle --> more the valve is covered --> inc murmur
and vice versa
41
Treatment of DVT?
admit pt
| start LMWH --> bridge to warfarin w/ INR of 2-3
42
Goal INR of DVT treatment?
2-3
43
handgrip maneuver causes what?
Inc AFTERLOAD --> more blood in LV
44
Which murmurs inc w/ inc afterload?
Inc afterload --> more blood in LV
- Mitral regurg
- Aortic regurg
- VSD
45
Which murmurs dec w/ inc afterload (handrip maneuver)?
Inc afterload --> more blood in LV
- Aortic stenosis
- Hypertrophic cardiomyopathy
46
Rapid squatting causes what?
inc SVR and Preload
47
Rapid squatting causes wht in HOCUM and AS?
HOCUM DEC in intensity
| AS INC intensity
48
What maneuvers inc HOCUM intensity (2)?
- Valsalva
| - Standing up
49
What manuevers dec HOCUm intensity (3)?
- Hand grip
- Rapid Squatting
- Lying down
50
Amiodarone can react w/ what drug?
Warfarin (can potentiate, so may need to dec dose)
51
Amiodarone effects what organs?
- thyroid
- liver
- lungs
52
the lower the ABI the what?
the worse the patient's PVD is
53
PVD workup?
1) Check pulses
2) ABI
3) U/S w/ doppler
54
slow rising carotid pulse w/ systolic thrill = think?
aortic stenosis
55
confirmatory test for valvular dysfuntion?
Catheterization and angiography
56
Systolic heart sounds? (6)
- AS
- PS
- MR
- TR
- VSD
- MVP
57
Diastolic heart sounds?
ARMS PRiTS
- AR
- MS
- PR
- TS
58
Pulsus parvus et tardus found w/ what heart murmur?
AS
59
Pulsus parvus et tardus means?
pulses are weak w/ a delayed peak
60
holosytolic high pitched blowing murmur - think (2)?
MR (radiates to axilla)
| TR (radiates to R sternal border)
61
How differentiate b/t TR and VSD?
- TR radiates to R sternal border
| - VSD does NOT radiate
62
holosystolic harsh sounding murmur at LLSB non-raidating?
VSD
63
management of acute pulmonary edema?
NOMAD
- Nitrates
- Oxygen (1st)
- Morphine
- Aspirin
- Diuretics
64
irregularly irregular - think?
AFib
65
rate or rhythm control most important for AFibg
RATE control better than rhythm control!
| (ie beta blockers better than amiodarone)
66
AFib cardioversion or defibrillate?
CARDIOVERSION
67
Ventricular fib cardioversion or defibrillate?
DEFIBRILLATE
68
thickened ventricular septum = think?
hypertrophic obstructive cardiomyopathy
69
Meds that cause color change in vision? (3)
- Digoxin (blurry yellow vision)
- Sildenafil
- Ethambutol
70
Digoxin toxicity test?
Electrolyte panel --> looking for hypOKalemia
Digoxin levels does NOT help bc its INTRACELLULAR
71
Associations w/ coarctation of aorta?
- Turner syndrome (also bicuspid aortic valve --> AS)
72
Turner syndrome most common heart anomaly?
Bicuspid aortic valve --> AS
73
Heart issues w/ turner syndrome?
- Bicuspid aortic valve --> AS
| - Coarctation of aortic valve
74
constrictive pericarditis likely to have what physical exam finding?
Pericardial knock
75
Pericardial knock = think?
constrictive pericarditis
76
Widely fixed S2 - think?
ASD
77
Opening snap and diastolic rumble = think?
MVP
78
Systolic anterior motion of mitral valve = think?
Hypertrophic cardiomyopathy --> MR (pushing on ant leaflet)
79
Primzmelts angina due to?
vasospasm
80
Primzmelts angina associated w/?
other vasospasm things:
- migraines
- Reynaud's Phenom
81
What drug associated w/ Primzmelts angina?
Cocaine
82
lipid studies at what age?
Men >35
| Women >45
83
best treatment for hot flashes?
Estrogen
84
best treatment for post-menopausal osteoperosis?
Raloxifene
| Tamoxifene (older med)
85
"pre-excitation syndrome" = ?
Wolf parkinson's white syndrome
86
Delta wave found in what?
Wolff parkinson's white syndrome
87
Drugs make Wolff parkinson white syndrome better?
1A and 1C drugs
88
Pt on PDE inhibitors (ie sildenafil) w/ malignant HTN, labetalol or nitro?
LABETALOL
| - nitro contraindicated (would lead to drastic dec in BP)
89
Asthma or COPD w/ malignant HTN, labetalol or nitro?
NITRO
| - beta blocker contraindicated
90
Leads II, III, AVF --> what wall?
Inferior Wall
91
Inferior of wall infarct is R or L dominant?
RIGHT dominant most commonly, but can be left occasionally
92
V4 lead is what side of the heart?
RIGHT SIDE
93
Elevation of lead V4 think?
RIGHT side infarct
94
slurred up slope of QRS - think?
Wolff parkinson white syndrome (describing delta wave)
95
Most common reason for old person w/ aortic stenosis?
Calcification of the aortic valve
96
Most common reason for young person w/ aortic stenosis?
Bicuspid aortic valve
97
Treatment of prinzmetal angina?
Ca Channel blocker
Nitrates
Smoking cessation
98
ECG findings in prinzmetal angina?
Transient ST elevation
99
"fine crepitations throughout the chest" = think?
Pulmonary edema
100
muffled heart sounds + varying blood pressures (not locations based) = think?
cardiac tamponade
101
treat cardiac tamponade?
pericardiocentesis
102
unstable w/ heart block treatment?
transvenous pacemaker
103
stable 1st degree or 2nd degree mobitz type 1 heart block pts treated initially w/?
atropine
104
2nd degree mobitz type 2 or 3rd degree heart block pts treated w/?
pacemaker
105
AV block 1st degree EKG findings?
prolonged PR interval (>200msec)
| P wave comes to early
106
AV block 2nd degree, Mobitz type 1 (wenckebach) EKG findings?
- Progressive lengthening of PR interval until a beat is dropped (P not followed by QRS)
- Variable RR interval w/ a regularly irregular pattern
107
AV block 2nd degree, Mobitz type 2 EKG findings?
PR length is normal, but will drop QRS occasionally (p wave w/o QRS)
108
AV block 3rd degree, EKG findings?
p wave and QRS complexes no relation (so many p's w/o QRS, can see p waves ON QRS complex/Twave)
- atria and vents are conducting independently
109
PR lengthening w/ QRS drops = think?
2nd degree heart block, mobitz type 1
110
QRS drops, nL PR length = think?
2nd degree heart block, mobitz type 2
111
2 most common causes of MS in USA?
1) Rheumatic fever
| 2) Atrial Myxoma
112
Atrial myxoma is what dependent?
POSITIONAL
113
management of premature atrial contraction?
reassurance
114
Pansystolic mumur post MI = think?
Mitral regurg from PAPILLARY MUSCLE RUPTURE
115
R side heart infarct treat initially w/?
Fluids
116
ST elevation in V1 and V2, most likely location and artery of infarct?
Anteroseptal
| LAD
117
ST elevation in V3 and V4, most likely location of infarct?
Anteroapical
| distal LAD
118
ST elevation in II,III, avF, most likely location of infarct?
InFerior
| RCA
