FMED Flashcards
(91 cards)
1
Q
What is the definitive diagnosis for myocarditis?
A
Endomyocardial biopsy- will show infiltration of lymphocytes with myocardial tissue necrosis
2
Q
What gallop is heard with DCM?
A
S3
3
Q
What is the management of DCM?
A
- Treat underling issues
- Ace inhibitors first line (reduce afterload by vasocdilation)
**may cause diuretics, BBs, or digoxin
4
Q
On myocardial biopsy, there is myocyte hypertrophy and disarray with interstitial fibrosis. What is the diagnosis?
A
HCM
5
Q
What is the primary difference between non-obstructive and obstructive HCM?
A
In non-obstructive HCM, the hypertrophy is lower on the septum and does not block valves. In obstructive, the hypertrophy is higher and obstructs the aortic and mitral valve
6
Q
You hear a systolic ejection murmur that increases with valsalva and standing and decreases with squatting and isometric hand grip. What is the most likely cause?
A
HCM
7
Q
What are the 1st line options for symptomatic management of HCM?
A
Beta blockers or Non-dihydropyridine CCBs
8
Q
What is the most common cause of RCM?
A
Amyloidosis
9
Q
Periorbital purpura and heart failure is pathognomonic for what condition?
A
Cardiac Amyloidosis
10
Q
What should you consider if you see bi-atrial enlargement on echo?
A
RCM
11
Q
What is the treatment for stress cardiomyopathy?
A
- immediate similar to acute MI, resolve trigger
- At Dc, ASA, BB, and ACEI until LV fully recovers
- Anticoagulation minimum of 3 months
12
Q
How do you determine LVH on EKG?
A
- If S in V1/V2 + R V5/V6 >35
- R in aVL >11
- R in 1 + S in III >25
13
Q
How do you determine RVH on EKG?
A
- RAD
- R>S in V1
- S>R in V6
14
Q
What are the two shockable rhythms?
A
V fib and pulses Vtach
15
Q
In what lead in the P wave normally negative?
A
AVR
16
Q
What is the recommended treatment for persistent sinus tach in the setting of ACS?
A
Beta blockers
17
Q
What is sick sinus syndrome?
A
Dysfunction of the sinus node that leads to a combination of sinus arrest with alternating paroxysms of atrial tachyarrythmias and bradyarrhythmias
18
Q
What is the recommended treatment for sick sinus syndrome?
A
- If stable, nothing
- If unstable, atropine
- Long term therapy, permanent pacemaker or defibrillator
19
Q
What is first degree heart block?
A
- Often a normal variant, when atrial impulses are delayed
- Prolonged PR >.20 seconds and all P waves are followed by a QRS
20
Q
What is Wenckebach heart block?
A
- Second degree block type 1 (Mobitz 1)
- Progressive PR lengthening until a QRS is dropped
21
Q
What is the treatment for Mobitz 1?
A
- If asymptomatic, no treatment
- If symptomatic, atropine and pacemaker is definitive
22
Q
What is Mobitz II?
A
- Interruption of electrical impulses at the AV node resulting in occasional non-conducted impulses, commonly seen in structural heart disease
- Constant PR interval before and after non conducted beat
23
Q
What is the management for Mobitz II?
A
Initial: transcutaneous pacing or atropine if symptomatic
-Definitive: Pacemaker because it often progresses to 3rd degree heart block
24
Q
How do you determine RBBB on EKG?
A
- QRS >0.12
- M shaped RR’ in V1
- Wide S wave in lead 1 and V6
25
How do you determine LBBB on EKG?
- QRS >0.12 seconds
| - Wide R wave in Leads 1 and V6
26
What is the recommended treatment for atrial flutter?
Stable: Vagal maneuvers, beta blockers, or Non-DP CCBs
27
What criteria is used to determine if a patient with non-valvular atrial fibrillation needs to be on anticoagulation?
CHA2DS2-VASc criteria
28
What is Wolff-Parkinson white syndrome?
- Pre-excitation syndrome that is a type of AV reciprocating tachycardia (pSVT)
- Accessory pathway is bundle of Kent
29
What is the treatment for stable Wolff-parkinson white?
Procainamide
30
What are some of the adverse effects of quinidine?
- Increased QT and torsades
- Diarrhea
- Cinchonism (loss of hearing, angioedema, vertigo, tinnitus)
31
What is the DOC for acute ventricular arrhythmias?
Lidocaine
32
What is the treatment for Torsades?
IV mag sulfate
33
What are some of the side effects of amiodarone?
- Pulmonary toxicity and fibrosis
| - Neuro toxicities (tremor, ataxia, Blue/grey skin
34
What is the MOA of Amiodarone?
-Block potassium channels and prolong repolarization, widening the WRS and prolongin the Qt interval
35
What is the recommended outpatient regimen for stable angina?
Daily aspirin, BB, nitro, and daily statin
36
Which artery is typically associated with anterior infarctions?
LAD
37
Which artery is typically associated with inferior infarctions?
RCA
38
Which artery is typically associated with lateral infarctions?
Circumflex
39
What is the first line treatment for vasospastic angina?
CCBs
** avoid beta blockers, will lead to unopposed vasospasm
40
Is DOE, PND, orthopnea, and fatigue typical of left or right HF?
Left
41
What is a transudative pleural effusion?
Accumulation of fluid in a body cavity due to filtration fo blood serum across a physiology intake vascular wall
42
What medications are recommended for hypertensive urgency?
Clonidine, captopril, Lasix, or Nicardipine
43
What medications are recommended for HTN and Gout?
CCBs or Losartan
44
What is the treatment for persistent orthostatic hypotension?
Fludrocortisone
45
What physical exam findings are typical of endocarditis?
- Fever, malaise
- new onset murmur
- Osler nodes on fingers, painful
- Janeway lesions on palms, painless
- Splinter hemorrhages
- Roth spots
46
What is the treatment of endocarditis of a native valve?
| Prosthetic valve?
Native: Nafcillin plus either ceftriaxone or gentamicin
Prosthetic: Vanc + Gentamicin + rifampin
**duration is 4-6 weeks with aminoglycosides only for first 2 weeks
47
What is constrictive pericarditis?
Loss of pericardial elasticity leading to restriction of ventricular diastolic filling
48
What is a water hammer pulse?
Associated with aortic regurgitation, Swift upstroke and rapid fall in radial pulse accentuated with wrist elevation
49
What is the most common cause of mitral stenosis?
Rheumatic heart disease
50
On physical exam, you hear a diastolic murmur, S3 and S4 gallop, and bounding pulses. You also observe corrigans pulse (visible pulsation of the carotid). What diagnosis should you be considering?
Aortic regurgitation
51
What is the treatment for symptomatic mitral valve prolapse?
Beta blockers
52
What is carvallos sign?
Associated with tricuspid regurgitation, increased murmur intensity with inspiration
53
What is an Austin flint murmur?
Low pitched rumbling diastolic heart murmur best heard at apex, associated with severe aortic regurgitation
54
What will you see on CXR if there is aortic dissection?
Widened mediastinum
55
What is the management of aortic dissection?
- Acute proximal: surgery
| - Descending distal: labetalol, SBP is rapidly lowered to a goal of 100-120 within 20 minutes
56
What is Leriche syndrome?
PAD of the aortic bifurcation/common iliac, triad of claudication, impotence, and decreased femoral pulses
57
What is the pharmacologic treatment for PAD?
Cilostazol (antiplatelet, PDE3 inhibitor), plavix, or aspirin
58
What is Buergers disease?
Aka thromboangitis obliterans, nonatherosclerotic inflammatory small and medium vessel vasculitis
-strong correlation to smoking
59
What is the treatment of Buergers disease?
- Smoking cessation in mainstay
| - Iloprost is a PG analog that may help with critical limb ischemia while smoking cessation is in progress
60
What is atrial myxoma?
-Most common primary cardiac cancer, most commonly in LA and can mimic mitral stenosis (loud S1, diastolic murmur)
61
What is felty syndrome?
RA+ Splenomegaly+ neutropenia
62
What is the treatment for mild hidradenitis suppurativa?
Lifestyle changes and topical Clindamycin
63
What is hidradenitis suppurativa?
Chronic follicular hair follicle obstruction, follicular rupture, and associated inflammatory response. Characterized by inflammatory nodules, abscesses, draining sinus tracts, and hypertrophic scarring
64
What is the first line treatment for psoriasis?
High potency topical corticosteroids
65
What is the typical outpatient management of angina pectoris (stable angina)?
Daily aspirin, beta blockers, nitro, and daily statin
66
What is the definitive diagnostic test for angina pectoris?
Coronary angiography
67
What is the most common cause of MI?
Atherosclerosis
68
What is the most important treatment for a STEMI?
Repercussion within 90 minutes of arrival
69
What is the medical management of a STEMI?
Beta blockers, NTG, Aspirin, Heparin, ACEI, and REPERFUSION
70
Patient presets with angina that is new in onset, occurring at rests, and has been ongoing for more than an hour. On EKG, they ave ST depressions and T wave inversions. What should ou be concerned about?
Unstable angina or NSTEMI
***cardiac enzymes negative in UA
71
Does an NSTEMI need reperfusion?
NO
72
What is the first line treatment for vasospastic angina?
CCBs
Nitro is second line
73
What kind of medication should be avoided in vasospastic angina?
Beta blockers because it can lead to unopposed vasospasm
74
What is the difference between myocardial injury and myocardial infarction?
Myocardial injury results if ischemia progresses unresolved or untreated, but does not result in cell death. There will be ST changes.
Infarction is death of myocardial cells. Cardiac enzymes will be elevated, Q waves on EKG
75
What are the characteristics of Myocardial ischemia on EKG?
- Inverted T wave
- Tall, peaked symmetrical T wave
- Depressed ST segment
76
What are the common side effects of contraindications to ACE inhibitors?
Side effects: Hyperkalemia, cough, angioedema
Contraindications: Pregnancy, bilateral renal artery stenosis, hypotension
77
What is the first line medication for systolic heart failure and is the most effective medication for reducing mortality?
ACEI
78
What is the first line medication management for orthostatic hypotension?
Fludrocortisone
79
What is the first line medication for allergic rhinitis?
Intravascular glucocorticoids
80
What is the most common type of esophageal cancer in the US and what are the main risk factors?
Adenocarcinoma
| Main risk factors are Barrett’s esophagus, smoking, and increased BMI
81
Which antiviral medications are only effective against flu A?
Adamantane and rimantadine
Oseltamivir and zanamivir are effective for A and B
82
What is the most common cause of acute infective endocarditis?
S. Aureus
83
What valve is most commonly affected in endocarditis?
Mitral, except tricuspid if it is drug related
84
What is the treatment for Kawasaki disease?
IVIG and aspirin
85
What is the most common murmur associated with marfans syndrome?
Mitral valve prolapse
86
What is the most common valvular lesion in the elderly?
Aortic stenosis
87
What is the first recommended intervention for a stable patient with Orthodromic atrioventricular reentrant tachycardia, common in WPW?
Vagal maneuvers
88
Which antihypertensive agent is preferable for hypertensive emergency caused by pheochromocytoma?
Intravenous phentolamine
89
What will you hear on auscultation of mitral valve prolapse?
Midsystolic click
90
What is the treatment for beta blocker toxicity?
Glucagon
91
What is eisenmenger syndrome?
When an unrestricted large VSD develops into a right to left shunt
