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MTB Flashcards

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1
Q

What is the worst risk factor for CAD

A

Diabetes mellitus

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2
Q

What is the most common risk factor for CAD

A

HTN

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3
Q

Risk factors for CAD

A 
Diabetes mellitus
Tobacco smoking
HTN
Hyperlipidemia
FHX - Premature CAD in first degree (M  45, Females >55
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4
Q

Correcting which risk factor has greatest immediate improvement

A

Stoping smoking

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5
Q

Most dangerous component of lipid profile for CAD

A

Elevated LDL

Low HDL = poor long-term prognosis

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6
Q

Presentation of Tako-Tsubo Cardiomyopathy

A 
Acute myocardial damage
Postmenopausal women
Follows stressful event
Ballooning and LV dyskinesis
Massive catecholamine discharge
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7
Q

TX for Tako-Tsubo Cardiomyopathy

A

Beta blockers

ACE-I

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8
Q

Unreliable risk factors for CAD

Wrong answers

A

Elevated homocysteine, CRP

Chlamydia Infxn

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9
Q

Presentation of Inferior Wall ischemia

A 
Vagal reflexes
Bradycardia
HypoTN
Dizziness
Fainting
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10
Q

Presentation of ischemic pain

A 
Dull/sore
Squeezing/pressure-like
Substernal
Lasts 20-30 mins
Can radiate to neck/arm
Sometimes w exertion
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11
Q

Chest pain that is NOT ischemic presentation

A 
Sharp/Pointlike
Lasts a few seconds
Right or left sided
Pleuritic 
Positional 
Tender
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12
Q

Chest pain w chest wall tenderness

Most accurate next test?

A

Costochondritis

PE

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13
Q

Chest pain radiating to back + unequal BP in arms

Most accurate next test?

A

Aortic Dissection
- Can also present as tearing, sharp pain, radiating to in b/t scapula
CXR shows widened mediastinum
CT, MRI, TEE = confirm

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14
Q

Chest pain worse w lying flat, better sitting up

Most accurate next test?

A

Pericarditis

EKG shows ST elevation all leads, PR depression

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15
Q

Chest pain worse w inspiration?

A

Costochondritis

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16
Q

Epigastric discomfort + pain relieved with eating

Test?

A

Duodenal Ulcer Dz

Endoscopy

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17
Q

Bad taste, cough, hoarseness

Test?

A

GERD

Response to PPI’s, Al OH, Mg OH

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18
Q

Cough, sputum, hemoptysis

Test?

A

Pneumonia

CXR

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19
Q

Sudden onset SOB, tachycardia, hypoxia

Test?

A

PE
Spiral CT
V/Q scan for pregnant women

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20
Q

Sharp, pleuritic pain, tracheal deviation

Test?

A

Pneumothorax

CXR

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21
Q

How does aortic stenosis present?

Worst prognosis

A

Angina
Syncope
CHF = worst prognosis

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22
Q

Causes of Pleuritic pain

A 
PE
Pneumonia
Pericarditis
Pneumothorax (PTX) 
Pleuritis
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23
Q

CKMB

Begin? Peak? Normalizes?

A

Begins @ 4 hours
Peaks @ 12 hours
Normalizes 3-4 days

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24
Q

Best cardiac enzyme reinfarction

25
Troponin Accumulates in what pts? Normalizes?
Pts with renal failure and seizures | 2 weeks to normalize
26
What factors must be present to do a stress test?
1. Can read the EKG | 2. Pt can exercise = HR > 80% of maximum
27
Which drugs impact validity of stress test
Beta blockers | Digoxin
28
High False Positive rates seen in who with stress tests
Asymptomatic young females
29
High False Negative rates seen in who with stress tests
Pts with known CAD
30
Workup if positive stress test
Angiogram - If 3 Vessel DZ or Left Main -> CABG - If 1 or 2 Vessel dz -> Angioplasty
31
How to differentiate ischemia v. infarction
Reperfusion images at rest | - Ischemia detected by reversal of decrease in thallium uptake or wall motion returning to normal after rest
32
Testing for pt that cannot exercise in CAD
Persantine (dipyridamole) OR adenosine with nuclear isotopes (thallium, sestamibi) Dobutamine Echo
33
When do we do angiography | What is done
Detect location of CAD | Radiopaque contrast dye injected into blood vessels - imaging w X-ray
34
Most accurate method to detect CAD
Angiography
35
When do we use Holter
Rhythm disorders | A fib, A flutter, ectopy - PVCs, V tach
36
Drugs that lower mortality in chronic Angina
ASA Beta blockers Nitroglycerin
37
Which drugs lower mortality in CAD
``` ASA Beta blockers Angioplasty TPA Clopidogrel Statins IF LDL > 100 ACE-Inhibitors IF decreased EF ```
38
Route of admin of nitroglycerin in chronic Angina
Oral | Transdermal patch
39
Route of admin of nitroglycerin in acute coronary syndromes
Sublingual Paste IV
40
When is Clopidogrel used
ASA intolerance | Recent angioplasty w stenting
41
AEs of Prasugrel
Hemorrhagic stroke
42
AEs of Ticlopidine
Neutropenia
43
When to use Ticlopidine
Pt allergic to ASA and Clopidogrel
44
Do ACE I or ARBs cause hyperkalemia
Both b/c they inhibit Aldosterone, which excretes K+ from distal tubule
45
MOA of Hydralazine Impact on afterload/preload Mortality benefit?
Direct acting arterial vasodilator Decreases Afterload Mortality benefit in Systolic dysfunction Used w nitrates to dilate coronary arteries
46
What is goal LDL in CAD pts?
Less than 100 mg/dL
47
Which lipid do lifestyle modifications improve the most
HDL
48
Impact of weight loss on BP
For every kg lost = 1 mmHg Reduction
49
What are CAD equivalents
PAD Aortic disease Diabetes mellitus Carotid dz
50
MC AE of statins
Liver Dysfunction - Test all pts AST and ALT Rhabdomyolysis = much less common
51
Statins MOA - 2
1. Inhibit HMG-Co A Reductase (RLE in cholesterol synthesis) | 2. Antioxidant effect on endothelial ling of coronary arteries
52
Niacin ass'd with
Glucose intolerance Elevation of uric acid Histamine release = itching
53
Gemfibrozil, Fibric Acid Derivatives | AE
Lower TGs | Myositis
54
Cholestyramine | AE
GI AE's
55
Which drug is NOT used in CAD
DHP CCB's (Nifedipine, Amlodipine) - Raise HR = increase myocardial O2 demand - Reflex tachycardia
56
When are NDHP CCB's used in CAD? | Which ones are they?
Severe Asthma Prinzmetal Angina Cocaine-induced chest pain Verapamil, Diltiazem
57
AE's of CCBs
Edema Constipation Heart block
58
Indications for CABG
1. Three vessel disease 2. Left main Coronary occlusion 3. Two vessel disease + Diabetes 4. Persistent Sx's despite maximal medical management
59
Best therapy in acute coronary syndrome
PCI/Angioplasty

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