deck 10

Question 1

learn murmurs

Answer 1

…

Question 2

most common cause of mitral regurg

Answer 2

mitral valve prolapse

- occurs due to myxomatous degeneration of the mitral valve leaflets and chordae

Question 3

new term for variant angina

Answer 3

vasospastic angina

Question 4

cause of vasospastic angina

Answer 4

vascular smooth muscle hyperreactivity

Question 5

RF’s for vasospastic angina

Answer 5

cigarette smoking

Question 6

ECG for vasospastic angina

Answer 6

contiguous ST elevation during episodes of chest discomfort

Question 7

hemodynamic features of septic shock

Answer 7

• Low SVR (and thus after load)
• low normal or decreased pulmonary capillary wedge pressure
• increased CO
• high mixed venous O2 saturation

Question 8

chest pain algorithm for stable patient

Answer 8

1) Obtain ECG + CXR
2) Administer aspirin ASAP if risk for aortic dissection is low
3) O2, IV access

Question 9

mgmt of patient with chest pain + ECG findings of ACS

Answer 9

heparin

Question 10

features of venous stasis

Answer 10

• pain worse in evening or following prolonged standing

Question 11

initial treatment of chronic venous insufficiency

Answer 11

Leg elevation, exercise, compression stockings

Question 12

main RF’s of aneurysm expansion and rupture

Answer 12

• large diameter
• rate of expansion
• CURRENT cigarette smoking (unknown mechanism but thought to be associated with degeneration of connective tissue in the aortic wall)

Question 13

med all patients with MI should be discharged home with

Answer 13

ACE inhibitors within 24 hours of MI. Following MI, ventricles of heart undergo remodeling, causing dilation of LV + thinning of ventricular was, resulting in CHF.

Question 14

most common focus of afib

Answer 14

pulmonary veins

Question 15

STEMI management

Answer 15

• full-dose aspirin + cath lab
• PCI recommended within 90 minutes.
• additional stabilization measures = 02, platelet receptor blockers, nitroglycerin for pain control, beta-blockers, anticoagulation

Question 16

treatment of choice for Dressler’s syndrome

Answer 16

NSAIDs

Question 17

alcohol and cardiovascular disesae

Answer 17

• excessive alcohol intake is associated with increased incidence of HTN
• moderate alcohol intake is associated with decreased incidence of coronary heart disease

Question 18

meds that can reduce response to antihypertensive agents

Answer 18

• NSAIDs, decongestants, glucocorticoids

Question 19

presentation of septic emboli

Answer 19

cough + chest pain + hemoptysis

Question 20

atypical angina can present as

Answer 20

• epigastric burning provoked by exercise

Question 21

other sequela of lupus

Answer 21

known RF for accelerated atherosclerosis and premature coronary heart disease

Question 22

recommended test for patients with suspected stable ischemic heart disease

Answer 22

exercise ECG

Question 23

hyponatremia and CHF

Answer 23

• hyponatremia parallels severity of HF + is an independent predictor of adverse clinical outcomes.

Question 24

treatment of hyponatremia in CHF

Answer 24

• fluid restriction, ACEi’s, loop diuretics

Question 25

protein/gamma gap

Answer 25

- gap between total protein and albumin

Question 26

causes of gamma gap

Answer 26

MM, HIV, autoimmune inflammation (due to acute-phase proteins), amyloidosis

Question 27

advair

Answer 27

salmeterol + fluticasone

Question 28

CHADS-VAS cutoff for managing with anticoagulation

Answer 28

greater than 2

Question 29

NOAC's used reduce systemic embolization in patients with AFib/eg at high risk of thromboembolic events

Answer 29

apixaban, dabigatran, rivaroxaban, edoxaban

Question 30

clopidogrel is...

Answer 30

antiplatelet therapy

Question 31

clinical presentation of constrictive pericarditis

Answer 31

- fatigue + dyspnea on exertion - peripheral edema and ascites - increased JVP - pericardial knock - pulsus paradoxus - kussmaul's sign - pericardial calcifications on CXR

Question 32

Causes of clubbing

Answer 32

1) lung malignancies 2) CF 3) Right to left cardiac shunts * hypoxemia in COPD alone does not cause clubbing.

Question 33

problem with LMWH (enoxaparin) and Xa inhibitors (fondaparinux, rivaroxaban)

Answer 33

reduce renal clearance

Question 34

PE presentation

Answer 34

sudden-onset chest pain + dyspnea + tachycardia

Question 35

common finding associated with PE

Answer 35

Small pleural effusions due to hemorrhage or inflammation | - effusions tend to be exudative and grossly bloody, and can be associated with PAIN due to pleural irritation.

Question 36

treatment for hypersensitivity pneumonitis from birds

Answer 36

avoid responsible antigen (eg birds)

Question 37

pleural effusion management

Answer 37

- if CHF, nothing. If no CHF, US for mass, then thoracentesis to determine if transudate or exudate.

Question 38

How to test for c-spine radiculopathy

Answer 38

spurning's test - turns the patient's head to the affected side while extending and applying downward pressure to the top of the patient's head.

Question 39

shoulder exam special tests

Answer 39

Neers --> Hawkins --> cross arm --> biceps

Question 40

first step in workup of chronic cough in smoker

Answer 40

CXR. Always need to rule out malignancy.

Question 41

only treatment hasn't been shown to decrease mortality

Answer 41

CPAP, O2, tobacco cessation

Question 42

meds that can exacerbate asthma/COPD

Answer 42

beta-blockers, NSAIDs

Question 43

asthma mimis

Answer 43

**vocal cord dysfunction Chung-Strauss Allergic bronchopulmonary aspergillosis

Question 44

asthma step up from SABA + low-dose ICS

Answer 44

* uptitrate steroid before starting LABA. | - anyone on LABA, must always be on corticosteroid. LABA can mask symptoms.

Question 45

DLCO is not reduced in...

Answer 45

asthma It is in emphysema, ILD, and anemia (think about as carrying blood out). You have destruction of lung parenchyma in these conditions.

Question 46

chronic cough defined as

Answer 46

8 weeks

Question 47

most common causes of chronic cough

Answer 47

RAD (usually young w/ allergies) GERD Postnasal drip

Question 48

percentage of people who get cough on ACEI's

Answer 48

20%

Question 49

bicarb in COPD patients

Answer 49

elevated due to chronic compensation.