Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Internal Medicine > Step Up To Medicine - Cardio > Flashcards

Step Up To Medicine - Cardio Flashcards

(102 cards)

Start Studying
1
Q

CAD have have what clinical presentation?

A 
Asymptomatic
Stable angina pectoris
USA pectoris
MI (NSTEMI, STEMI)
Sudden cardiac death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

LDL goal in pts w CAD?

A

<100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe typical anginal chest pain?

A

Substernal
Worse w exertion
Better w rest/nitro

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Best test for chest pain

A

ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When should you use a stress test (stable angina)

A

Confirm dx of angina
Eval response of therapy
ID high risk pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When is a stress test considered positive?

A

ST depression
Chest pain
HOTN
Arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Standard of care for stable angina?

A

ASA
B-blocker
Nitrates (chest pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

SE of nitrates?

A

HA
Orthostatic HOTN
Tolerance
Syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

COURAGE trial?

A

No difference between PCI (bare metal) or max medical management for stable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PCI sciency name

A

Angioplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is acute coronary syndrome?

A

Clnical manafestation of athersclerotic plaque rupture and coronary occlusion

Usually refers to USA, NSTEMI, STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does stress test identify?

  • hint this is a limitation
A

Flow limiting high-grade lesions

- thus can miss an MI (its an acute rupture of plaque)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How to differentiate USA and MI?

A

Presentation is the same, you must look at cardiac markers and EKG findings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Essence trial?

A

Found that enoxaparin was greater than heparin for

  • risk of death
  • recurrent angina
  • less need for PCI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is fibrinolysis useful?

A

Only in STEMI when you cant get to PCI

- not used for USA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CARE trial?

A

Pt w hx of MI who took statin

  • death reduced 24%
  • stroke reduced 31%
  • CABAGE reduced 27%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Suspect MI if combination of?

A

Substernal chest pain >30 min and Diaphoresis strongly suggest MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Who doesnt get Nitro?

A

Right ventricular infarct

  • inferior ECG changes
  • HOTN
  • elevated JVP
  • hepatomegaly
  • clear lungs

Its preload dependent - they will experience cardiovascular collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which is worse STEMI or NSTEMI?

A 
STEMI = infact 75% of time
NSTEMI = infarct 25% of time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How are troponins monitored?

A

Q 8 hrs x 3 samples

  • higher peak and longer enzymes are high more sever the myocardial injury is
  • worse prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Only agents shown to reduce mortality in MI pts?

A

ASA
B-blocker
ACEI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

CAPRICORN trial?

A

The b-blocker carvediol reduces risk of death in post MI LV dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Meds indicated for MI?

A 
O2
Nitro
B-blocker
ASA
Morphine
ACEI 
IV heparin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Best test if pt developes recurrent chest pain while in the hospital (for their MI)

A

CK-MB is the most helpful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Heparin is for STEMI and NSTEMI, when do you not use it?
Stable angina
26
If pt is treated conservatively for UA/NSTEMI, then need what before discharge?
stress test to see if they need angiography (cath)
27
MI pts have elevated risk for?
Stroke (during the next 5 yrs) | - the lower the EF and older thept - Higher risk of stroke
28
MCC of death following MI?
Ventricular arrhythmia - Vtach - VFib
29
Post MI all pts need to go home with?
ASA B-blocker statin ACEI
30
If you suspect cardiac pain you should give?
Nytro and asa
31
MCC of noncardiac chest pain?
GI d/o
32
Non cardiac pain that may respond to nitro?
Esophagela spasm | - still unlikely
33
If pain changes w respiration rate (pleuritic), body position, or TTP to chest wall?
cardiac cause is highly unlikely
34
Pt has chronic stable angina and presents w symptoms of USA you should?
ECG and troponin Give ASA IV heparin
35
Which presents first, systolic or diastolic dysfunction?
Usually its simultaneous
36
Tests to order for new CHF?
``` cxr ECG Troponin - r/o MI CBC - anemia Echo - r/o pericardial effusion ```
37
Common treatable cause of CHF?
HTN - goal is to reduce preload and afterload
38
RALES trial?
``` Showed spironolactone reduces morbidity and mortality in pts w class III, IV HF - CI in renal failure ```
39
Things to monitor in CHF pt?
``` Weight (water gain) Exercise tolerance Lab values: - electrolytes - potassium - BUN - creatinine - serum digoxin ```
40
Standard tx for CHF?
Loop diuretic ACEI B-blocker Maybes: - digoxin - hydralazine/nitrate - spironolactone
41
MCC of death in CHF?
Sudden death from ventricular arrhythmias | - ischemia provokes ventricular arrhythmias
42
COMET trial?
Carvediol best B-blocker for CHF
43
Meds that do and do not lower mortality in systolic HF’?
Do reduce mortality - ACEI/ARB - B-blocker - Spironolactone (aldosterone agonists) - Hydralazine+nitrate do not (symptoms only)q - loop diuretics - digoxin
44
Signs of digoxin toxicity?
GI: N/V, anorexia Cardiac: ectropic (ventricular) beats, AV block, AFib CNS: visual disturbances, disorientation
45
What drug plays no role in CHF?
CCB - may rause mortality However i f you need more control of other shit (HTN) you can use - amlodipine - felodipine
46
5 yr mortality for CHF pts?
50%
47
CAST I and CAST II trial?
Antiarrhythmic drugs to suppress PVCs after MI increase death
48
Types of PVC’s?
couplet - 2 in a row Bigeminy - sinus beat followed by PVC Trigeminy - 2 sinus beats followed by PVC
49
Pts in Afib w underlying heart disease have?
High risk of embolization and hemodynamic compromise (death)
50
Treatment of Afib and Aflutter?
Control ventricular rate Restore NSR Assess need for anticoagulation
51
AFFIRM trial?
Rate control is superior to rhythm control in treatment of Afib
52
differentiating source of arrhythmias by QRS?A
Narrow QRS: above level of AV node Wide QRS: outside normal conduction system - Supraventricular - HIS-purkinge systems
53
S/e of adenosine?
- HA - Flushing - SOB - Chest pressure - Nausea
54
What causes 75% of cardiac arrest?
Vtac | VFib
55
Torsades de points?
Rapid polymorphic VT Causes - prolonged QT interval - congenital QT - TCA - anticholinergics - electrolytes - ischemia Tx: iv magnesium and fix prob
56
When is PVC and VT especially worrisome?
Pt w underlying heart disease - LV dysfunction Risk of Sudden Death
57
If a pt has wide QRS tachycardia you should suspect?
VT
58
Best treatment for pt w underlying heart disease and non sustained VT?
Implantable defibrillator
59
Difference between cardiac arrest and SCD?
Cardiac arrest - sudden loss of cardiac output, - potentially reversible Sudden cardiac death - unexpected death w/in 1 hr of symptom onset
60
Can drugs convert VFib?
Not alone | - need defib, CPR and epi
61
Does defib work for asystole?
Nope they need CPR and Epi
62
What is PEA?
Pulseless electrical activity | - monitor shows stuff but no pulse found
63
Which heart blocks requrie pacemaker?
Second degree mobitz type II | Third degree
64
Standing, valsalva and leg raise diminish all murmurs except?
``` MVP Hypertrophic cardiomyopathy (HCM) ```
65
Cardinal manifestations of acute pericarditis?
``` Chest pain Pericardial friction rub ECG changes - ST elevation - PR depression Pericardial effusion ```
66
Constrictive pericarditis causes what diastolic dysfunction?
Early diastole - rapid filling | Late diastole - halted filling
67
If a pt has signs of cirrhosis- ascities, hepatomegaly and distended neck veins you should r/o what?
Constrictive pericarditis
68
Untreated pericarditis progresses to?
Worsening Co and hepatic and/or renal failure They need surgery
69
TOC for pericardial effusion and cardiac tamponade?
Echo
70
Rapid pericardial effusion can lead to?
Cardiac tamponade
71
What does cardiac tamponade do to cardiac pressures?
All 4 chambers pressure equalize during diastole
72
Beck triad is a sign of?
Cardiac tamponad
73
What is beck triad?
HOTN Muffled heart sounds JVD
74
Symptomatic AS pts need?
Valve replacement | - 1/4 die in 3 yrs w/o surgery
75
Management of AS?
Asymptomatic - nothing | Symptomatic - surgery
76
Physical findings of aortic insufficiency? (Weird ones)
De Musset sign: head bobbing Muller sign: uvula bobs Duroziez sign: Pistol shot sound heard over femoral arteries
77
Key signs of mitral valve prolapse?
Systolic click Mid systolic rumbling murmur - increase w standing and valsalva - decreases w squatting
78
Always suspect endocarditis in pts w?
New heart murmur and Unexplained fever/bacteriema
79
Best test for diagnosis of endocarditis?
TEE - better than trans thoracic
80
Prognosis for infective endocarditis?
Almost always fatal
81
Coarctation of the aorta in women is often associated w?
Turner syndrome
82
Leading cause of death in adults w PDA?
Heart failure | Infective endocarditis
83
Pulmonary pressures in adults w PDA?
Usually normal
84
Short active BP lowering med?
Hydralazine
85
Types of meds for Hypertensive emergency vs urgency?
Emergency - IV drugs | Urgency - PO drugs
86
Types of aortic dissection and treatments
Type A - involves the ascending - surgery | Type B - descending only - medical
87
Why is it important to r/o aortic dissection in suspected MI pts?
Because thrombolytics used to treat MI are often fatal for aortic dissection pts
88
Preferred tests for acute aortic dissection?
TEE - unstable pts | CT - stable pts
89
What is leriche syndrome?
Atheromatous occlusion of distal aorta just above the bifurcation - Bilateral claudication, impotence and absent/diminished femoral pulses
90
How to differentate location of peripheral vascular disease?
Femoral or popliteal - calf claudication | Aortic - buttock and hip claudication
91
When are ABI not accurate?
DM pts - often have calcified incompressible vessels
92
Why do only 1/2 of DVT pts have classic findings?
Superficial venous system is patent the classic findings (erythema, pain, cords) dont occur b/c the blood drains from those patent veins
93
Of those pts w classic DVT findings how many have DVT?
50%
94
Preferred heparin?
LMWH - longer 1/2 life - given outpatient - no need for PTT levels - more $$$
95
many pts w DVT develop what?
CVI - 80%
96
If you see superficial thrombophlebitis in different locations over a short time you need to worry about?
Migratory superficial thrombophlebitis | - trousseau syndrome
97
S/s common in all forms of shock?
HOTN Oliguria Tachycardia AMS
98
Only shock with elevated jugular venous pulse?
Cardiogenic shock
99
W hypovolemic shock, when do the compensatory measures start to fail?
20-25% blood loss
100
Best method for monitor shock treatment?
Urine output
101
Skin finding w septic shock and hypovolemic shock?
septic: Severe peripheral vasodilation (flushing, warm skin) Hypovolemic: peripheral vasoconstriction (cool, clammy skin)
102
MCC of death in ICU?
Septic shock

Internal Medicine (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions