MKSAP STOCK1 Flashcards
(152 cards)
1
Q
What is the frequency of echocardiographic surveillance for asymptomatic moderate aortic regurgitation?
A
Echo q 1-2 years
2
Q
At what CHA2DS2VASc score is PO anticoagulation recommended in NONVALVULAR Atrial Fibrillation patients?
A
>1
3
Q
What is the expected hematologic compensation in patients with cyanotic congenital heart disease?
A
Erythrocytosis
4
Q
Control of what TWO clinical parameters is recommended in patients with heart failure with preserved ejection fraction?
A
Blood pressure and volume!!! Paramount importance cf. to HFrEF (where goal-directed approach important)
5
Q
What procedures exist for which endocarditis ppx is indicated in high-risk patients?
A
Dental procedures involving manipulation of gingival tissue or the periapical region of teeth OR perforation of the oral mucosa
6
Q
What is the next best test to evaluate for peripheral arterial disease in a patient with an Ankle-Brachial Index >1.40
A
Great Toe systolic pressure measurement
7
Q
What is the diagnostic test for acute limb ischemia?
A
Angiography
8
Q
Indications for early surgical intervention in patients with Native Valve Infective Endocarditis
A
Valve Dysfxn with heart failure; Heart Block; L sided endocarditis caused by S. aureus, fungal or highly resistant bug; Annular or aortic abscess; Persistent bacteremia 5-7 days after abx; Recurrent emboli on abx; and mobile vegetations >10 mm in length
9
Q
What is the preferred method of imaging for surveillance of bicuspid AoV and associated aortopathy?
A
TTE
10
Q
What is the most common cardiac abnormality associated with aortic coarctation?
A
Aortic Stenosis (possibly related to Bicuspid AoV)
11
Q
What syndrome is characterized by elevated eosinophil count without a secondary cause and has evidence of organ involvement?
A
Hypereosinophilic Syndrome
12
Q
Cardiac Monitoring Device indicated for patients with SYNCOPE?
A
Implantable Loop Event Recorder
13
Q
What is defined as LOW risk for ASCVD by the Pooled Cohort Equations?
A
<5%
14
Q
This is the most common cause of reduced left ventricular function in heart transplant patients after the first year?
A
Allograft Vasculopathy
15
Q
What is the treatment for all asymptomatic patients with SEVERE pulmonary valve stenosis?
A
Valve Repair or Replacement
16
Q
What is the initial nonpharmacologic therapy for symptomatic PAD?
A
Supervised Exercise Program
17
Q
What are two hematologic findings consistent with aplastic anemia?
A
Pancytopenia and Severely hypocellular marrow
18
Q
What is the indicated mgmt strategy for multivessel coronary artery disease and depressed LV function associated with ACS?
A
CABG
19
Q
What is the indication for mitral valvuloplasty in an asymptomatic patient with severe mitral stenosis?
A
Pregnancy (as it will demand a higher cardiac output!)
20
Q
What form of atrial septal defect involves the mitral valve?
A
Ostium Primum ASD
21
Q
What is the treatment of PVC-related cardiomyopathy?
A
Catheter Ablation
22
Q
What is the recommended frequency of surveillance imaging for stable patients with Marfan Syndrome with aortic root dilation <4.5 cm?
A
6 months after diagnosis and then every 12 months after that
23
Q
What is the recommended evaluation for patients with new-onset heart failure and risk factors or symptoms of CAD?
A
Either stress testing or catheterization
24
Q
Therapy for patients with von Willebrand disease before major surgery
A
Factor VIII concentrates containing von Willebrand factor
25
At what level of 10 year Cardiovascular Risk from the Pooled Cohort Equations is statin therapy indicated?
\>7.5%
26
What are THREE indications for cardiac resynchronization therapy?
EF \<35%, NYHA functional class III-IV symptoms on guideline-directed medical therapy or LBBB with QRS duration \>150 ms
27
What are TWO diagnostic criteria for Brugada Syndrome?
\> 2 mm Coved precordial ST elevation and SYMPTOMS (i.e. syncope or ventricular arrhythmia)
28
What pulmonary vein complication is assoicated with catheter ablation for atrial fibrillation?
Pulmonary vein stenosis
29
What is the diagnostic test for a patient with symptomatic stable angina that is no adequately controlled on optimal medical therapy?
Coronary Angiography
30
What is the first line treatment of acute pericarditis following myocardial infarction?
Aspirin
31
What physical exam finding is useful in distinguishing hepatopathy due to constrictive pericarditis from primary liver disease?
Elevated CVP will be seen in constrictive pericarditis
32
What is the recommended type of stress test for a patient with normal resting EKG?
Exercise Stress Testing
33
What is the diagnosis for an irregularly irregular rhythm with a right bundle branch block pattern?
Atrial Fibrillation with Aberrant Conduction
34
Complication presenting with a new holosystolic murmur and cardiac thrill 3-7 days following acute MI?
Ischemic VSD
35
What are 3 indications for TTE in asymptomatic patients with a murmur?
Systolic murmur \>3/6, Late or Holosystolic murmur, or diastolic and continuous murmurs
36
What are the two leading modifiable risk factors for myocardial infarction?
Dyslipidemia and Smoking
37
What is the mechanism of treatment indicated for low-output heart failure following correction of volume overload?
Afterload Reduction
38
What is the treatment of choice for pregnant women with thrombotic microangiopathy of pregnancy?
Immediate Delivery
39
What viral infection is associated with acquired pure red cell aplasia?
Parvovirus B19
40
What is an intervention to help stablize fluctuating INRs while taking warfarin
Daily Low dose PO vitamin K
41
What is the recommended duration of dual antiplatelet therapy following PCI with DES?
At least 1 year
42
What device is used to prevent intravenous line-associated paradoxical air embolism in patients with Eisenmenger Syndrome?
Intravenous Line Air Filter
43
What degree of mortality benefit has been shown for screening for CAD in asymptomatic patients with DM?
None (i.e. you don?t do stress or cath) but you should still do the Pooled Cohort equations
44
What is the diagnostic test if you suspect a macroangiopathic hemolytic anemia?
TEE
45
What is the initial treatment for hemodynamically stable supraventricular tachycardia?
Vagal Maneuvers
46
What are two criteria for implantable cardioverter-defibrillator placement in patients with heart failure?
LV EF \<35%; NYHA class II/III sx
47
What are three hematologic findings in patients with Paroxysmal Nocturnal Hemoglobinuria?
Hemolytic Anemia; Hypocellular Bone Marrow (hence assoc. with hypoplastic MDS), and lack of CD55 and CD59 surface proteins on cells (flow cytometry)
48
What controversial cardiac imaging study is useful for clarifying cardiovascular risk in INTERMEDIATE risk patients?
Coronary Calcium Scoring
49
What is the radiologic test indicated in patients with superficial venous thrombophlebitis?
Venous Duplex US
50
What is the most common cause of easy bruising and heavy menses with normal PT and aPTT
von Willebrand disease
51
What are two drug classes indicated for ALL patients with heart failure with reduced ejection fraction (HFrEF)
Beta Blockers and ACE inhibitors
52
What is the recommended next step in mgmt of pts with Pre-excitation (WPW) and syncope?
EP study for potential ablation
53
What is the preferred treatment for severe symptomatic mitral stenosis?
Percutaneous Balloon Mitral Valvulplasty; if pregnant and asymptomatic you do it because you expect an increased CO in pregnancy
54
What are three medications that should be continued indefinitely after acute coronary syndrome?
Aspirin, ACE inhibitor, and Statin
55
What drug class should be discontinued 24-48 hours before cardiac stress testing to diagnose coronary artery disease?
Beta Blockers
56
What therapy is indicated for patients with end stage heart failure who are not candidates for heart transplantation?
LVAD
57
What is the appropriate mgmt of asymptomatic first degree AV block accompanied by RBBB and Left posterior Fascicular block (i.e. Trifascicular block)
Clinical Observation
58
What is the cause of differential cyanosis and clubbing affecting the lower body?
Patent Ductus Arteriosus with Eisenmenger syndrome
59
What is the essential diagnostic test for implanted cardiac device infection?
Blood Cultures
60
What is the recommended frequency of US surveillance of an asymptomatic AAA \<5.5 cm in men and \<5.0 cm in women?
Every 6 to 12 months
61
What are 4 potential complications associated with bicuspid aortic valve?
Aortic Stenosis, Aortic Regurgitation, Infective Endocarditis, and Aortopathy (dissection or aneurysm)
62
What is the recommended frequency of echocardiographic monitoring for patients with asymptomatic severe aortic stenosis?
Every 6 to 12 months
63
What is the treatment of choice for a hemodynamically stable patient with possible transient constrictive pericarditis?
Anti-Inflammatory agents
64
What phosphodiesterase inhibitor can be used for symptomatic PAD?
Cilostazol
65
What are three indications for aortic valve replacement in patients with aortic regurgitation?
Symptoms, LV dilation (LV end diastolic width), and LV EF \<50%
66
What are two drug classes indicated for ALL patients with PAD?
Antiplatelet Agent (Aspirin) and a Statin
67
What is the recommended mgmt of an incidentally discovered atrial septal aneurysm?
No further evaluation or intervention
68
What is the HALLMARK physical exam finding associated with upper extremity peripheral arterial disease?
Difference in the systolic blood pressures between the two arms
69
What is the clinical entity in which patients experience persistent symptoms and hemodynamic derangements after treatment of a symptomatic pericardial effusion?
Effusive Constrictive Pericarditis
70
What is a classic infection associated with increased risk of sepsis and eath in patients with hereditary hemochromatosis?
Vibrio vulnificus
71
What benign cardiac tumor associated with constitutional symptoms and neurologic sx due to systemic embolization?
L atrial myxoma
72
What are two treatment options for cardiogenic shock?
IV vasoactive medications vs. Device-Based hemodynamic support (IABP)
73
What is the preferred type of prosthesis in patients requiring valve replacement with a contraindication to anticoagulation?
Bioprosthesis
74
What is the first line treatment for a patient taking warfarin who has significant bleeding?
4 factor Prothrombin Complex Concentrate (PCC- Kcentra) and IV vitamin K
75
What is the most common structural valvular disorder associated with Tetralogy of Falot repair?
PR- Pulmonic Valve Regurgitation
76
Four Conditions in which transfusion is NO LONGER indicated in patients with Sickle Cell dz
Uncomplicated Pregnancy; Routine painful crises; Minor Surgery WITHOUT anesthesia; and asymptomatic anemia
77
What is the immediate therapy indicated for patients presenting with acute heart failure and volume overload?
Diuretic Therapy- preferably with a loop diuretic
78
What is the optimal time for first follow-up appointment following discharge for patients hospitalized for heart failure?
Within 7 days
79
What is the most common endocrine cause of reversible heart failure?
Hyperthyroidism (always check a TSH)
80
In addition to aspirin what are three drug classes indicated as long therapy for patients following MI?
Statins, Beta Blockers, and ACE inhibitor
81
What is the duration of anticoagulation therapy for patients with unprovoked proximal DVT or PE with low or moderate bleeding risk?
Longterm Anticoagulation
82
What are two angiographic indications for CABG in patients with angina who remain symptomatic despite optimal medical tx?
Left Main Disease; Multivessel disease with proximal LAD involvement
83
What pulmonary contraindication exists to pharmacologic vasodilator stress testing?
Active Bronchospasm
84
What length of corrected QT interval is associated with Torsades de Pointes?
\>500
85
What are two possible treatments for "low-pressure" cardiac tamponade?
Normal Saline (volume) and obviously and definitively, pericardiocentesis
86
What is the alternative therapy for patients with venous thromboembolism and recent bleeding?
IVC filter
87
What clinical parameter is associated with HIGH RISK for recurrent peripartum cardiomyopathy in subsequent pregnancies
Persistent LV dysfunction
88
What is the initial treatment indicated for patients with PFO and cryptogenic stroke?
Antiplatelet therapy with Aspirin
89
What abnormality is associated with fixed splitting of S2, midsystolic murmur and right ventricular heave?
Ostium Secundum Atrial Septal Defect
90
What is the preferred treatment for asymptomatic severe mitral regurgitation with reduced LV function and suitable valve anatomy?
Mitral Valve Repair
91
What vaccination reduces the risk of furture cardiovascular events in patients with existing cardiovascular disease?
Annual Influenza vaccine
92
What is the recommended agent for treatment of acute, uncomplicated vaso-occlusive pain episodes in patients with sickle cell disease?
Opioids for pain, Hydroxyurea
93
What is the treatment of choice for most patients with symptomatic severe aortic stenosis?
Surgical Aortic Valve Replacement (SAVR)
94
What are the 4 risk groups with an indication for statins?
1) pts with clinical ASCVD 2) Pt with LDL \>190 3) Pt age 40-75 with DM 1 or 2 and 4) Pt age 40-75 with 10 yr ASCVD risk \>7.5%
95
Most common cause of secondary erythrocytosis?
Hypoxemia
96
What is the initial imaging of choice for patients with suspected mitral regurgitation?
Transthoracic Echocardiography
97
Name two diseases that have prolonged aPTT that correct fully with a mixing study
Hemophilia A (Factor VIII def) and Hemophilia B (Factor IX def, Christmas Dz)
98
What is the diagnostic test of choice for Chronic Thromboembolic Pulmonary HTN (CTEPH)
VQ scan
99
What adjunctive antiplatelet agent is indicated for patients undergoing thrombolysis for STEMI?
Clopidogrel
100
What is the most sensitive diagnostic test for suspected folate deficiency?
Homocysteine level
101
Recommended initial radiologic test for patients with Multiple Myeloma who are experiencing low back pain
Skeletal Survey
102
What is the prophylactic intervention for patients at high risk of sudden death from HOCM?
Implantable Cardioverter-Defibrillator
103
What is the recommended treatment for patients with liver disease and INR \>1.5 before undergoing CVC placement
None
104
What is the indication for immediate repeat echocardiogram for ALL patients with valvular heart disease?
Change in clinical status
105
What genetic mutation occurs in half of patients with idiopathic Budd-Chiari syndrome?
JAK2 V617F activating mutation
106
What congenital valvular abnormality is characterized by an aortic ejection sound with either a systolic or diastolic murumur?
Bicuspid Aortic Valve
107
What are two laboratory findings associated with Cold Agglutinin Disease
Erythrocyte clumping that disappears with warming; positive direct antiglobulin (Coombs) test
108
What is the recommended frequency of aortic imaging in patients with a bicuspid aortic valve and an aortic root diameter \>4.5 cm?
Every Year
109
What diagnosis is associated with chest pain, ST elevation, elevated cardiac biomarkers and wall motion abnormalities of mid-apical L ventricle but with normal angiography?
Stress Cardiomyopathy (Takotsubo CMO)
110
What is a possible definitive treatment for Mobitz Type I second degree AV block associated with acute coronary syndrome?
Reperfusion (lytics or PCI)
111
Peripheral Blood Smear finding in pseudothrombocytopenia
Platelet clumping
112
What is the physiologic impact of overdiuresis in patients with Hypertrophic Cardiomyopathy?
It will increase the dynamic left ventricular outflow tract obstruction
113
What is the duration of anticoagulation therapy in patients with a first provoked venous thromboembolism?
3 months
114
What is the first line therapy for a bleeding patient with acquired hemophilia and high titers of inhibitor?
Recombinant Activated Factor VIIa
115
These are the two first line antianginal therapies for stable angina pectoris
Beta-blockers and nitrates
116
Indications for testing offspring of a patient with factor V Leidin mutation
None
117
Three hematologic findings characteristic of B thalassemia
Hemolytic Anemia, Microcytosis (nl RDW) and target cells on smear
118
What is the mgmt of nonbleeding patients with ITP and a platelet count \>30 k?
Clinical Observation
119
What are the indications for thrombophilia testing in a patient with a first provoked thromboembolic event?
None
120
What are the thresholds for repair of abdominal aortic aneurysms in men and women?
5.5 cm in men and 5.0 cm in women
121
What is a congenital cardiac condition that may cause platypnea-orthodeoxia syndrome?
Patent Foramen Ovale
122
What is the diagnostic test for Hereditary Spherocytosis?
Osmotic Fragility Test
123
What is the preoperative function of an implantable cardioverter-defibrillator to prevent false detection of a tachyarrhythmia due to electrical interference (i.e. the Bovie)?
Disable the Shock Function
124
What is the type of transfusion for patients with platelet transfusion refractoriness?
HLA-matched platelets
125
What are the two recommended tests for men and non-menstruating women with Iron Deficiency Anemia
Colonoscopy and EGD
126
What is the recommended initial study for evaluating chest pain in patients with an intermediate risk of coronary artery disease and normal baseline EKG?
Exercise Stress test
127
What is the initial treatment indicated for uncomplicated Type B acute aortic injury
Medical therapy (Beta blockade and arterial vasodilator)
128
What pretransfusion erythrocyte treatment is used to reduce risk of transfustion associated GVHD?
Irradiation
129
What is the recommended treatment for patients aged 60 years or older with essential thrombocythemia or platelet count \> 1 million
Hydroxyurea + Aspirin
130
What is the recommended hemoglobin threshold for transfusion for hospitalized pt
\<7
131
What are FOUR FINDINGS on resting EKG that preclude exercise stress testing?
LBBB, Paced rhythm, Preexcitation (WPW), and ST depression \>1 mm at baseline
132
What is the indication for use of high-sensitivity CRP testing for cardiovascular risk stratification?
Intermediate Risk for CV disease
133
What is the cardiac monitoring device indicated for patients with infrequent episodes of palpitations not associated with syncope?
30 Day Event Monitor
134
What is the minimum duration of antiplatelet therapy following placement of a Bare Metal Stent?
At least 4 weeks
135
What is the congenital abnormality characterized by upper extremity hypertension and radial artery to femoral artery pulse delay?
Aortic Coarctation (assoc. with Turners 45 XO)
136
What is the diagnostic study of choice for evaluating perivalvular abscesses in patients with infective endocarditis?
Transesophageal Echocardiograpy TEE
137
This is the treatment of nonbleeding patients taking warfarin with INR \>9
Withold warfarin and give PO vitamin K
138
What is the threshold platelet transfusion in nonbleeding patients with chemotherapy induced thrombocytopenia?
\<10k
139
What is the characteristic murmur associated with aortic regurgitation?
Diastolic Decrescendo murmur
140
What is the diagnostic study indicated for evaluation of possible ischemic disease in pts with intermediate probability and normal ST segments on resting EKG?
Exercise Stress Testing
141
What are the three initial antithrombotic therapie sfor NSTEMI?
Aspirin, P2Y12 inhibitor (clopidogrel) and heparin
142
Common scoring system used to assess pretest probability for heparin-induced thrombocytopenia
The 4T score
143
What is the appropriate mgmt of patietn with high risk score on exercise stress testing?
Cardiac Catheterization
144
Which family members of patients with Hypertrophic Cardiomyopathy should undergo echocardiographic screening?
Alll first degree relatives
145
Preferred mgmt of nonbleeding pts who have supratherapeutic INR less than 9
Withold one or two doses of warfarin but not vitamin K
146
What is the mgmt of accelerated idioventricular rhythm occuring within 24 hours of reperfusion therapy?
None
147
Treatment indicated for acute dissection of the ascending aorta (Stanford Type A)
Surgical Repair
148
What are two medications shown to improve symptoms and reduce mortality in black patients with NYHA class III or IV heart failure sx ON MAXIMAL THERAPY?
Hydralazine and Isosorbide dinitrate (NOT a replacement to BB, ACE, and spironolactone but ADJUNCTIVE)
149
What is the preferred treatment for COMPLICATED type B aortic dissection
Immediate Aortic Repair (whereas medical mgmt indicated for uncomplicated type B aortic dissection)
150
What are the components of "Triple Therapy" for a patient with atrial fibrillation who just underwent PCI?
Anticoagulant (i.e. Warfarin for afib) + Aspirin + another antiplatelet agent (Clopidogrel or Prasugrel)
151
What is the MGMT of small membranous VSD without heart enlargement, pulmonary HTN, Hx of endocarditis, or valvular regurgitation?
Clinical Observation
152
What is the most common dose-limiting side effect of anthracycline drugs?
Cardiotoxicity
