Section 2: Angina, Lipid Mgnt and Sex and the Heart Flashcards Preview

Cardiology USMLE Step 3 > Section 2: Angina, Lipid Mgnt and Sex and the Heart > Flashcards

Flashcards in Section 2: Angina, Lipid Mgnt and Sex and the Heart Deck (56)
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1

Give the definition of Acute Coronary Syndrome (ACS)

  • Causes acute chest pain
  • Can be with exercise or at rest
  • Can have ST segment elevation, depression, or even a normal EKG
  • Not based on enzyme levels, angiography, or stress test results
  • Based on a history of chest pain with features suggestive of ischemic disease

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1652-1654).  . Kindle Edition.

2

What is the best initial Rx for all cases of ACS?

Aspirin

3

Aspirin can be administered ------ or ------ and absorbed under the tongue. It has an instant effect on inhibiting platelets.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1657-1658).  . Kindle Edition.

Orally or chewed

4

Aspirin alone reduces mortality by --- percent for acute myocardial infarction and by --- percent for “unstable angina,” which may become a non-ST segment elevation myocardial infarction (NSTEMI).

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1660).  . Kindle Edition.

 

25%

50%

5

--- (1) --- and --- (2) --- should also be administered in acute coronary syndromes, but they do not lower mortality. --- (3) --- has no benefit if the patient is not hypoxic.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1660-1662).  . Kindle Edition.

  1. Nitrates
  2. Morphine
  3. Oxygen

6

--- (1) --- or --- (2) --- is added to aspirin for all patients with an acute myocardial infarction.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1662-1664).  . Kindle Edition.

  1. Prasugrel
  2. Clopidogrel

7

How soon must percutaneous coronary intervention (PCI) be perfomed in a patient with ACS?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1671).  . Kindle Edition.

Within 90 minutes

8

True or False

Angiography is superior to medical therapy (aspirin, beta blockers, statins) for patients with stable angina?

False

9

If PCI cannot be performed within 90 minutes of arrival in the emergency department, what should the patient receive?

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1678-1679).  . Kindle Edition.

Thrombolytics

10

List the indications for thrombolytics

  • Chest pain for < 12 hours and has ST segment elevation in 2 or more leads
  • A new left bundle branch block (LBBB)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1681-1682).  . Kindle Edition.

11

------- lower mortality, but the timing of their administration is not critical.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1686-1687).  . Kindle Edition.

Beta blockers

12

Should ACE inhibitors or angiotensin receptor blockers be given to all patients with ACS?

Yes

13

A 72-year-old man comes to the emergency department having had chest pain for the last hour. His initial EKG shows ST segment elevation in leads V2– V4. Aspirin has been given. Which of the following will most likely benefit this patient?

a. CK-MB

b. Stress test

c. Angioplasty

d. Metoprolol

e. Diltiazem

f. Atorvastatin

g. Digoxin

h. Amiodarone

i. Oxygen, morphine, and nitrates

j. Thrombolytics

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1695-1705).  . Kindle Edition.

 

C. Angioplasty will lower the risk of mortality most for this patient. If it can be obtained within 90 minutes, angioplasty is the best therapy. Metoprolol lowers mortality but is not dependent on how soon you give it, as long as the patient receives it before going home.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1706-1708).  . Kindle Edition.

14

What has the single greatest efficacy? in lowering mortality in STEMI.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1711).  . Kindle Edition.

Urgent angioplasty or

PCI

15

True or False

Statin medications, such as atorvastatin, should be given to all patients with an acute coronary syndrome, regardless of what the EKG shows or troponin or CK-MB levels.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1715-1717).  . Kindle Edition.

True

16

List the therapies used in Acute Coronary Syndromes that always lower mortality

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1718-1719).  . Kindle Edition.

  1. Aspirin
  2. Thrombolytics
  3. Primary angioplasty
  4. Metoprolol
  5. Statins
  6. Clopidogrel or prasugrel

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1724-1729).  . Kindle Edition.

17

List the therapies used in Acute Coronary Syndromes that lower mortality when there is low ejection fraction

  • ACE inhibitors OR
  • ARBs

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1730-1732).  . Kindle Edition.

18

List the therapies used in Acute Coronary Syndromes that do not lower mortality

  • Oxygen
  • Morphine
  • Nitrates
  • Calcium channel blockers
  • Lidocaine
  • Amiodarone

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1733-1738).  . Kindle Edition.

19

Indications for Prasugrel or clopidogrel in ACS

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1745-1749).  . Kindle Edition.

  1. There is aspirin allergy
  2. The patient undergoes angioplasty and stenting
  3. There is acute MI

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1745-1749).  . Kindle Edition.

20

Indications for calcium channel blockers (verepamil, diltiazem) in ACS

  1. The patient has an intolerance to beta blockers, such as severe reactive airway disease (asthma)
  2. There is cocaine-induced chest pain

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1753-1756).  . Kindle Edition.

21

Indications for a pacemaker in acute MI

  1. Third-degree AV block
  2. Mobitz II, second-degree AV block
  3. Bifascicular block
  4. New left bundle branch block
  5. Symptomatic bradycardia

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1759-1765).  . Kindle Edition.

22

Indications for lidnocaine or amiodarone in acute MI

  1. Only when there is ventricular tachycardia or ventricular fibrillation
  2. Do not give antiarrhythmic medications to prevent ventricular arrhythmias.

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1768-1771).  . Kindle Edition.

23

True or False

All the complications of myocardial infarction result in hypotension.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Location 1773).  . Kindle Edition.

True

24

Cardiogenic shock following an MI:

  1. What is the diagnostic test
  2. What is the Rx

  1. Echo, Swan-Ganz (right heart) catheter
  2. ACEI, urgent revascularization

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1779-1781).  . Kindle Edition.

25

Valvular rupture following an MI: 

  1. What is the diagnostic test
  2. What is the Rx

  1. Echo
  2. ACEI, nitroprusside, intra-aortic balloon pump as a bridge to surgery

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1783-1785).  . Kindle Edition.

26

Septal rupture following an MI:

  1.     What is the diagnostic test?
  2.     What is the Rx?

  1. Echo, right heart catheter showing a step up in saturation from the right atrium to right ventricle
  2. ACEI, nitroprusside, and urgent surgery

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1787-1788).  . Kindle Edition.

27

Myocardial wall rupture following an MI:

  1. What is the diagnostic test?
  2. What is the Rx?

  1. Echo
  2. Pericardiocentesis, urgent cardiac repair

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1790-1792).  . Kindle Edition.

28

Sinus bradycardia following an MI:

  1. What is the diagnostic test?
  2. What is the Rx?

  1. EKG
  2. Atropine, followed by pacemaker if there are still symptoms

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1794-1795).  . Kindle Edition.

29

    Third degree (complete) heart block following an MI:

  1. What is the diagnostic test?
  2.     What is the Rx?

  1. EKG, canon “a” waves
  2. Atropine and a pacemaker even if symptoms resolve

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1797-1799).  . Kindle Edition.

30

Right ventricular infarction following an MI:

  1. What is the diagnostic test?
  2. What is the Rx?

  1. EKG showing right ventricular leads
  2. Fluid loading

 

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 1800-1802).  . Kindle Edition.