EXAM #2: REVIEW Flashcards by Jonathan Kallevang

List the four changes to heart sounds that can occur in the setting of an acute MI.

1) New S3
2) New S4
3) New Mitral Regurgitation
4) Paradoxically split S2

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List the medical therapy that should be initiated for patients post-MI.

1) ASA for life
2) P2Y12 inhibitor i.e. plavix for a year
3) Beta-blocker
4) ACE inhibitor and/or aldosterone antagonist if EF is less than 40%
5) High intensity statin therapy
6) PRN NTG

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List the absolute contraindications to thrombolytic therapy.

1) Prior ICH
2) Known cerebral vascular lesion
3) Known malignant intracranial neoplasm
4) Ischemic stroke in within 3 months
5) Active bleeding/bleeding diathesis
6) Head/facial trauma within 3 months
7) Intracranial or intraseptal surgery within 2 months
8) Severe uncontrolled HTN

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What is the best location to listen to a systolic ejection click in a neonate?

Apex of the heart

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List the four systolic ejection murmurs in kids.

1) Aortic stenosis
2) Pulmonary stenosis
3) Tetralogy of Fallot
4) Coarctation of the Aorta

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List the four systolic regurgitant murmurs.

1) Mitral regurgitation
2) Tricuspid regurgitation
3) VSD
4) ASD

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List the diastolic murmurs.

1) Aortic insufficiency
2) Pulmonary insufficiency
3) Mitral stenosis

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Outline the medical management for a VSD.

1) Digoxin
2) Diuretics
3) ACEIs

PLUS a high calorie diet

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What are the specific surgical indications for a VSD?

1) Growth/development failure

2) Failure to close within 6-12 months

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What are the sequelae of a large VSD?

1) Delayed growth and development
2) Decreased exercise tolerance
3) Frequent pulmonary infections
4) CHF

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List three signs of a PDA on physical exam not associated with the heart murmur.

1) Tachycardia
2) Hyperactive precordium
3) Bounding peripheral pulses and a wide pulse pressure

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If you see “atrioventricular septal defect” what associated should immediately come to mind?

Down’s Syndrome

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What are some signs and symptoms that would make you concerned about Coarctation of the Aorta, especially if they were paired with “higher upper extremity pulses than lower extremity?”

1) Poor feeding
2) Poor weight gain
3) Dyspnea
4) Pallor

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If Coarctation of the Aorta is NOT recognized, what sequelae follow?

1) CHF by 3 months of age

2) Renal impairment

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You receive a consult about a child with Trisomy 21 and left axis deviation noted on ECG. What should you be immediately suspicious for?

Atrioventricular Septal Defect

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What heart sounds could you expect to hear in a child with an ASD?

1) Ejection murmur at the pulmonary listening post
2) S2 that is widely split and fixed

Note that the ejection murmur is not due to the flow of blood through the ASD; rather, there is relative pulmonary stenosis b/c of the increased volume that needs to get through the pulmonary outflow tract per beat.

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What are the medical and surgical treatment options for Coarctation of the Aorta?

Medical:

PGE1
Anti-congestive meds
Balloon angioplasty

Surgical:
- Resection

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List the signs of a large VSD on physical exam.

1) Poor weight gain
2) CHF
3) Systolic thrill
4) Systolic regurgitant murmur
5) Possible diastolic rumble with large shunt

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How do the ECG findings in Coarctation of the Aorta differ between young and old children?

Young= RVH

Older= LVH

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What historical features would make you suspicious for TGA?

Cyanosis from birth, especially in a male, full-term baby

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What structures are connected in a BT shunt?

PA and brachiocephalic a.

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What are the signs associated with Truncus arteriosus?

1) Wide pulse pressure

2) Single S2

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Outline the initial steps in managing a patient with TGA.

1) PGE1
2) Correct acidosis
3) Balloon atrial septostomy

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What is the specific name of the operation to correct TGA?

Atrial switch operation

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How can you surgically treat TOF?

1) BT shunt | 2) Full surgical repair

List the 5T's of cyanotic heart disease.

5T's: 1) Truncus Arteriosus 2) Transporition of Great Vessels 3) Tricuspid Atresia 4) Tetralogy of Fallot 5) Total anomalous pulmonary venous return

What is the immediate management plan for a child with left-sided heart obstruction?

1) PEG1 2) Inotropic support 3) Correct metabolic acidosis with IV fluid and sodium bicarbonate

What are the three general categories of drugs that you should consider for a critically ill child?

1) Inotropes 2) Antibiotics 3) Sodium bicarbonate

What predisposes a child to the development of a complete heart block?

1) Mom with SLE 2) Iatrogenic cause 3) Inflammatory and infectious diseases

Outline the treatment for a Chylothroax.

1) Pleurocentesis 2) NPO 3) IV diuretics 4) Octerotide

What are the three medical management options for post-acute CHF s/p MI?

1) Diuretics 2) ACEI 3) Aldosterone antagonists

What is an oxygen step up in the cath. lab pathognomonic for?

Acute VSD

Describe the murmur that may be heart with MI associated VSD.

New murmur at the lower left sternal border with thrill

What are the symptoms of an MI-associated VSD?

1) Chest pain 2) Dyspnea 3) Hypotension 4) Biventricular failure

How is HF managed in the acute phase of an MI?

1) NTG 2) Judicious morphine 3) BiPap

What are the three most important features of shock management?

1) Oxygen supplementation 2) ABGs to manage acid-base status 3) ICU level care

What are the consequences of shock in the various organ systems?

1) Multiorgan dysfunction 2) Acidemia 3) Myocardial dysfunction 4) ARDS 5) ATN 6) Hepatic injury/ intestinal ischemia 7) CNS disturbances

What is the most common form of target organ damage in SAH?

IHD

What is SAH a risk factor for?

1) ASCVD 2) MI 3) HF 4) Sudden cardiac death

List three sequelae of HTN involving the CNS.

1) Decreasing cognitive function 2) TIA 3) CVA

What phase of the cardiac cycle is initially impaired by HTN?

Increased LV mass leads to loss of compliance and diastolic dysfunction

What is the first line treatment for HTN in patients with CKD?

ACEI or ARB

List the labs that you should order for a patient with a new diagnosis of SAH.

1) Urine dipstick 2) Fasting glucose 3) Hematocrit 4) Serum creatinine 5) Serum Ca++ and K+ 6) Lipid panel PLUS an ECG

What is Virchow's triad?

1) Stasis 2) Vascular damage 3) Hypercoagulability

List the signs/symptoms of a PE.

1) Tachypnea 2) Coarse/diminished lung sounds 3) Chest pain/pleurisy 4) Hemoptysis

How is PAD treated pharmacologically?

1) Treatment of the underlying etiology 2) Ciloztazol 3) Petoxyfylline 4) Platelet inhibitors

What are the major risk factors for a PE?

1) HTN 2) Prior DVT 3) Prolonged anesthesia 4) Hypercoaguable state 5) Estrogen

What is the equation for blood pressure?

BP= TPR x CO

What causes HTN-induced end-organ damage?

1) Damage induced by the pressure itself 2) Cardiac remodeling 3) Vascular remodeling

List four comorbid conditions associated with HTN.

1) IHD 2) HF 3) A-fib 4) CVA

Specifically, what causes essential HTN?

1) Augmented SNS discharge 2) Abberant responses to peripheral signals 3) Vascular dysfunction 4) Renal dysfunction

List three physical exam findings associated with MR

1) Sharp/severe carotid pulse 2) Left/down and hyperdynamic apical impulse 3) LA thrust at the left parasternal area

Describe the murmur associated with MR.

Holosystolic with a level contour; radiates to the axilla/back

What is the pharmacologic treatment for MR?

Nitroprusside + Dobutamine

Outline the long-term medical treatment for MR.

1) Treat LV failure 2) Anticoagulate a-fib 3) Digitalis 4) Prophylaxis against infective endocarditis

Describe the murmur associated with MS.

Opening snap followed by a low-pitched rumbling--heard best at the apex

What ECG changes are seen with MS?

1) LAE 2) RVH 3) A-fib *Note that this is the same as MR?

Outline the medical treatment for MS.

1) Avoid strenuous exercise 2) Reduce salt and water intake 3) Attempt to achieve NSR 4) Anticoagulate a-fib 5) Prophylaxis against infective endocarditis

List six etiologies of MR.

1) Rheumatic Heart Disease 2) Infective endocarditis 3) Collagen-vascular disease 4) Cardiomyopathy 5) IHD 6) MVP

List three signs of MS on physical exam.

1) Mitral facies 2) Low-normal arterial pulses 3) Apical impulse inconspicuous to absent

List five etiologies of a-fib.

1) LAE 2) IHD 3) Toxin i.e. alcohol 4) Metabolic disease 5) Hemodynamic impairment

List factors that predispose a patient to CVA with a-fib.

1) Older than 65 2) HTN 3) Rheumatic Heart Disease 4) Prior TIA or CVA 5) DM 6) CHF

List the conditions that require urgent DC cardioversion with a-fib.

1) MI 2) Evidence of shock 3) Severe HF 4) Pre-excitation

What is Class III HF?

HF with marked activity limitation i.e. symptoms with less than ordinary symptoms

What happens when there is increased adrenergic stimulation in the neurohormonal model of HF?

1) Increased SNS tone 2) Beta-1 increase in HR and contractility 3) Alpha-1 increase in peripheral vasoconstriction

List six factors associated with a worse prognosis in HF.

1) Male 2) IHD 3) S3 4) Low pulse pressure 5) High functional class i.e. III or IV 6) Reduced exercise capacity

What physical exam finding is highly associated with LV failure?

Pulmonary rales

What is stage D HF?

Refractory HF

What are the "agents of choice" to treat HF?

ACEIs

List the five most common causes of HF.

1) Ischemia/infarction 2) HTN 3) Arrhythmia 4) Infection/inflammatory disease 5) PE

List three causes of RAAS activation in the neurohormonal model of HF.

1) Decreased RBF 2) Decreased Na+ in the distal tubule 3) SNS increases renin release

What are the consequences of the neurohormonal model of HF?

1) Peripheral arterial constriction 2) Na+ and water retention 3) Activation of inflammatory mediators that induce cardiac remodeling

List four physical exam signs associated with HF.

1) Apical impulse is displaced left and down 2) S3 3) Pulsus alternans 4) Murmurs

List three non-medical interventions for HF.

1) Intra-aortic balloon bump 2) LVAD 3) Transplant

What are five consequences of the LV remodeling that occurs in HF?

1) Hypertrophy 2) APD increases 3) Contractile/ regulatory proteins are altered 4) Increased myocardial wall tension 5) MV regurgitation

How does the exercise echo differ from a simple treadmill stress test?

1) More specific 2) Able to localize the involvement 3) Determine the EF

List the three qualities of typical chest pain.

1) Location 2) Exertional 3) Relieved with NTG or rest

List the contraindications to a vasodilator stress test.

1) Asthma 2) COPD 3) Hypotension 4) HR less than 40 5) Xanthines within 24 hrs 6) High degree AV block 7) Less than 2 days post MI

What are the contraindications to a dobutamine stress test?

1) Recent MI 2) Hypotension 3) Arrhythmia 4) Aortic stenosis 5) HCM 6) Aortic dissection

What is the risk of rupture if an aneurysm is less than 4cm?

0.3%

What is the risk of rupture if an aneurysm is between 5.0 and 5.9cm?

6.5%

What is the risk of rupture if an aneurysm is between 4.0 and 4.9cm?

1.5%

List the medical treatment for a stable aneurysm.

1) Smoking cessation 2) Lipid control 3) BP and dP/dt control 4) ASA 5) Beta-blocker 6) ACEI

EXAM #2: REVIEW Flashcards

(83 cards)