EOM

Question 1

What polymyalgia Rheumatica ?

Answer 1

Inflammation disorder that causes muscle pain

Question 2

What are key sxs of Polymyalgia Rheumatica (PMR)?

Answer 2

morning stiffness lasting 48 hours. Aching/pain in neck, bilateral shoulders, low back, hips & thighs.
SXS MUST BE ONGOING FOR 2WKS

Question 3

What Dx finding will be seen in PMR?

Answer 3

Elevated ESR >100

Question 4

How do you tx PMR?

Answer 4

Prednisone 15 mg/day

Question 5

What is Giant Cell Arteritis or Temporal Arteritis ?

Answer 5

Immune Mediated damage to the carotid arteries. Damage lead to inflammation and thrombus formation + instability of the vessels walls prone to aneurysms.

Question 6

Which artery is most commonly affected in Giant Cell Arteritis or Temporal Arteritis?

Answer 6

Temporal artery is commonly affected

Question 7

SXS of Giant Cell Arteritis or Temporal Arteritis ?

Answer 7

New HA (unilateral in temporal area)
Pain when brushing hair.
·Vision loss (ophthalmic artery blockage) Pain/stiffness in hips & shoulders
Fever & weight loss
Pain w chewing food (jaw claudication)

Question 8

Dx for Giant Cell Arteritis or Temporal Arteritis?

Answer 8

Temporal Artery Biopsy
Elevated ESR >100
Bruit heard w temporal accusation

Question 9

Tx for Giant Cell Arteritis or Temporal Arteritis?

Answer 9

Vision intact-> prednisone -> 40-60mg/day
Vision loss-> methylprednisolone 500-1000 IV/day for 3 days

Question 10

What is Hypertrophic Cardiomyopathy ?

Answer 10

Asymmetric thickening of the myocardium. Septum thicker >3omm than the rest of the ventricle

Question 11

What causes Hypertrophic Cardiomyopathy ?

Answer 11

Autosomal dominant mutation of the protein that encodes sarcomere.
–> Beta-myosin heavy chain
–> myosin-bindin protein C

Question 12

Which pts with Hypertrophic Cardiomyopathy should get a ICD?

Answer 12

1) septal wall thickness >30mm
2)unexplained syncope
3) fail to increase or decrease BP by 20 mm Hg
4) LVEF is less than or equal to 35%

Question 13

SXS of Hypertrophic Cardiomyopathy

Answer 13

dyspnea on exertion, presyncope,syncope, fatigue, edema, orthopnea, paroxysmal nocturnal dyspnea

Question 14

Dx for Hypertrophic Cardiomyopathy?

Answer 14

ECG
Echocardiogram

Question 15

Tx Hypertrophic Cardiomyopathy?

Answer 15

B Blockers (avoid meds that decrease preload & afterload)
implantable cardioverter-defibrillator
abalation of septum
anticoag w A fib

Question 16

Hypertophic cardiomyopathy can cause which type of arrhythmia?

Answer 16

Ventricular arrhythmias

Question 17

What is Restrictive Cardiomyopathy ?

Answer 17

Restrictive filling & reduced diastolic volume of LV &/or RV
* Stiff heart-> diastolic dysfunction
Systole remains normal

Question 18

What are 4 major causes of Restrictive cardiomyopathy?

Answer 18

Endomyocardial fibrosis (collagen)
Amyloidosis (protein)
Sarcoidosis (granulomas)
Hemochromatosis (iron)

Question 19

What are SXS of Restrictive cardiomyopathy?

Answer 19

Kussmaul sign -> JVP increase w inspiration
Venous congestion, exterional dyspnea, paroxysmal noctural dyspnea
apical impluse not displaced-> S4 mitral & tricuspid reguritation murmur

Question 20

Dx Restrictive cardiomyopathy?

Answer 20

Biopsy & tissue analysis w fat pad, transrectal or myocardial
ECHO
ECG
Low voltage QRS complex

Question 21

What is Dilated cardiomyopathy?

Answer 21

Dilation of the LV (thin myocardium) -> ejection fraction <40. normal diastolic filling but impaired systolic

Question 22

What causes Dilated Cardiomyopathy

Answer 22

Chagas diease
drug (cocaine) or alcohol use
Doxorubicin (chemotherapy drug)
Thiamine deficieny (Ber Beri)-> vitamin B1 defincney

Question 23

Sxs of Dilated Cardiomyopathy

Answer 23

S3 gallop
cough & frothy sputum
anasarca (swelling of the whole body)
Abdominal distention
Cheyne-stokes breathing (gradually deeper and faster breathing until breathing stops)

Question 24

Dx of dilated cardiomyopathy?

Answer 24

Enlarged heart on CXR
LBBB pattern on ECG
decreased efection fraction

Question 25

Tx for dilated cardiomyopathy?

Answer 25

diuretics reduce afterload (ACE/ARBs) cardiac transplant

Question 26

What causes takotsubo cardiomyopathy and how do you tx it?

Answer 26

enlargement of ventricles triggered Intense emotional or physical stress sxs CP, dizziness, syncope, dyspnea, pulmoanry edema Tx nitrates, labatolol --------------------> aviod anticoag = risk for ventricular rupture

Question 27

What is unstable angina ?

Answer 27

Supply & demand mismatch-> myocardial ischemia but not infarction (cells has not died) -> no alleviation with rest No troponin elevation ->ST depression, T wave inversion or no changes Persistent for 20 mins & not relieved by nitroglycerin

Question 28

What is Stable Angina?

Answer 28

progressive narrowing of the vessel. Familiar chest pain on exertion. Alleviates w rest.

Question 29

What is Non ST elevation Myocardial Infraction (NSTEMI)

Answer 29

Supply & demand mismatch -> non-transmural subendocardial infract § ST depression & T-wave inversion § Elevated troponin

Question 30

What is ST Elevation Myocardial Infraction (STEMI)

Answer 30

Complete blockage to coronary artery -> transmural infract of wall supplied by artery ST elevation Elevated Troponin

Question 31

What does HEART stand for and when do you decided hospital admittance vs home w f/u?

Answer 31

History Ecg Age Risk Troponin Heart score greater than 4 = hospital stay Heart score less than 3 w neg work up -> home

Question 32

What medications do you give for an MI?

Answer 32

Asa, nitroglycerin antiplatelet-> clopidogrel, ticagrelor Heparin bollus send to cath lab where they receive IIb/IIIa inhibitor * Epitfibatide (preferred), Abcixamab

Question 33

What is Peripheral Arterial Diease ?

Answer 33

Claudication-> pain w excertion that resolves at rest

Question 34

In Peripheral Arterial Diease what are the 6 P's that indicate critical limb ischemia?

Answer 34

Pain Pulseless Poikilothermic Pallor Paresthesia Paralysis

Question 35

What is a major risk factor for Peripheral Arterial Diease?

Answer 35

Tobacco use. has CVD

Question 36

What is pseudoclaudication and how does it differ from Peripheral Arterial Diease claudication?

Answer 36

narrowing of spinal canal causing pain, numbness, weakness when standing. Allievated by leaning forward on a shopping cart (positional pain) Peripheral Arterial Diease claudication-> exertional pain that allivates with rest.

Question 37

What is a normal and abnormal pulse grade?

Answer 37

2= normal 3= abnormal 0 = absent

Question 38

Ankle brachial index measure?

Answer 38

Highest systolic BP at Brachial artery Highest systolic BP in PT or DP Calculate using valves from left leg & right leg 0.9 = abnormal normal = 1.0-1.4

Question 39

Tx for PAD

Answer 39

Asprin 81 mg Po qd -> CVD & amputation risk decrease High does statin (atorvastatin 80 mg & rosuvastatin 40 mg) Cilostazol -> suppress platelet aggreg Excercise program Quit smoking

Question 40

When is it recommended for men to be screened for abdominal aortic aneurysm?

Answer 40

Screen b/w aged 65-75 y/o 1 time

Question 41

When is AAA diagnosed via U/S

Answer 41

when the aorta has grown 5.0 cm surgery is indicated if growth is 5.5 cm or 1/2 cm growth in 6 months