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Flashcards in Uworld Cardiology Deck (65):
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Origin of
1. paroxysmal supraventricular tachycardia?
2. Of Wolff-Parkinson-White?
3. Of atrial flutter?
4. Of sinus tachycardia?
5. Atrial fibrillation?

1. AV node
2. Bundle of Kent
3. Tricuspid annulus
4. SA node
5. Pulmonary veins

1

Patient with ST segment depression and T-wave inversion in leadsC4 through V6. Troponin T is normal, chest x-ray shows no acute abnormality. The pupils are dilated, nasal mucosa is atrophic, and patient is agitated and sweating. Next step in management? Contraindicated?

Acute cocaine intoxication. Give:
1.benzodiazepines.
2. Aspirin
3. Nitroglycerin and calcium channel blockers

Beta blockers contraindicated.

2

Metabolic conditions that can lead to AFIB?

Catecholamine surges or hyperthyroidism

3

Drugs that can cause AFIB?

Caffeine, theophylline, digoxin

Cocaine, amphetamines, alcohol,

4

Patient post MI who presents with wide complex tachycardia and fusion beats. Treat with?

If stable IV amiodarone

If unstable (hypertension, respiratory distress) cardioversion

5

Patient presents with a regular, narrow complex tachycardia. Treat with?

1. Esmolol (short-acting beta blocker for Rapid rate control)
2. Adenosine
3. Carotid massage

6

Hypertrophic cardiomyopathy: epidemiology? Carotid findings? murmur? Maneuver to increase murmur?

1. Young, African-Americans
2. Dual upstroke
3. Systolic ejection type murmur
4. Valsalva maneuver (decrease preload)

7

Drug that can increase QRS duration? Used to treat? Mechanism?

Flecainide. Ventricular or supraventricular tachycardia. Class 1C antiarrhythmic - Blocks sodium channels

8

Patient with swelling and hepatosplenomegaly. Physical exam to suggest cardiac problem?

Positive hepatojugular reflex (pressing on abdomen causes JVD)

18

CHF with proteinuria and easy bruisability – most likely diagnosis?

Amyloidosis

19

Drug to control essential hand tremor and hypertension?

Propranolol

20

70 percent of patients with mitral stenosis will develop? Why?

AFIB. left atrial dilation

21

Patient with Wolff-Parkinson-White syndrome goes into AFIB. Treatment?

Procainamide. (Beta blockers, calcium channel blockers, adenosine and digoxin should not be used for these patients because they increase AV node refractory period)

22

Effect of pericardial effusion On EKG?

Electrical alternans - QRS complexes whose amplitudes vary from beat to beat

23

Initial labs for hypertension work up ?

1. Urinalysis (four hematuria)
2. Chemistry and lipid profile (risk of coronary artery disease)
3. EKG

24

Use this test to r/o hypertension caused by:
1. Cushing's syndrome
2. Primary hyperaldosteronism
3. Renal artery stenosis
4. Pheochromocytoma

1. 24 hour urine cortisol excretion
2. Renin level
3. Renal ultrasound
4. Urine metanephrines

25

Type of vessels: arteries versus veins

Resistance vessels versus capacitance vessels?

26

Patient comes in with MI. Should leave with what drugs? If patient underwent PCI, will also leave with?

1. Aspirin
2. ACE inhibitors
3. Beta blockers
4. Statin

Clopidogrel

27

Effect of calcium channel blockers (amlodipine) in ACS?

Avoid. Increased mortality

28

Treatment for type I heart block?
Type II? Type III?

1. Nothing
2. Atropine if symptomatic
3. Atropine if symptomatic

29

Chlorthalidone?

Thiazide diuretic

30

Medications to withhold prior to cardiac stress testing?

1. Beta blockers
2. calcium channel blockers
3. nitrates

31

Dypridamole?

1. PDE inhibitor
2. Tromboxane inhibitor
3. Increased adenosine (decreases reuptake and breakdown)

32

Heart side effect from thiazides?

Ventricular arrhythmia

33

Treatment of embolic artery occlusion?

Surgical embolectomy or percutaneous thrombolysis

34

HOCM - murmur from?

1. Septal hypertrophy
2. Systolic anterior motion of mitral valve

35

PACs usually result in what arrhythmias?

Mostly supraventricular. Sometimes ventricular.

36

Treatment of symptomatic PACs?

Beta blocker

37

Mech of niacin induced flushing? Mitigate Sx by?

Increase in prostaglandins. Taking aspirin.

38

Always investigate what type of murmur? How?

Diastolic continuous murmurs. ECHO.

39

Digoxin used for?

Atrial tachycardias

40

Algorithm for VF or VT?

1. Defibrillation
2. Epi (every 3 min)
3. Defib
4. Antiarrhythmics (lidocaine, amiodarone, Mg)

41

Pulsus parvus et tardes observed with?

Aortic stenosis

42

Causes of increased capillary hydrostatic pressure?

1. Heart failure
2. Renal Na retention (kidney problems, pregnancy)
3. Venous obstruction (cirrhosis, venous insufficiency, pul HTN)

43

Causes of hypoalbuminemia?

1. Loss (GI or nephrotic)
2. Decreased production (cirrhosis and malnutrition)

44

Causes of increased capillary permeability?

Burns, allergies, ARDs, malignant ascities

45

Treatment of narrow complex tachycardia vs wide complex tachycardia?

Vegas maneuvers or adenosine

Vs

Amiodarone or lidocaine

46

Electrical alternans?

Cardiac tamponade

47

Use DC cardioversion for?

AFIB, A-flutter, and monomorphic ventricular tachycardia

48

Use Transvenous pacemaker if?

Sick sinus syndrome and 2nd/3rd degree heart block

49

EKG findings in PE?

Sinus tachycardia
New onset right bundle branch block
S1 Q3 T3

50

Posterior M – see on EKG?

ST depression in V1 – V3
ST elevation in I and aVL (LCX)
ST depression in I and aVL (RCA)

51

Prinzmetal angina presents with? Treatment?

Episodes at night
EKG shows ST elevations
Seen in smokers

Treat with nitrates and Ca channel blockers (do not treat with aspirin or beta blockers)

52

Diastolic dysfunction? Caused by?

HF with preserved EF. Hypertension.

53

Nitrates contraindicated with?

Aortic stenosis, PDE inhibitors, RV infarction

55

Non-pharmacologic ways to lower HTN?

Weight loss
Limit salt
Vegetables
Low fat
Decrease alcohol intake

56

SVT gets better with cold water because?

cold water increases Vegal tone -> slows AV node (SVT reentrant pathway that hits AV node)

SA node also affected by Vegal maneuvers, but not the main mech of SVT

57

Blood-pressure medications that cause lower extremity edema?

Dihydropyridines (amlodipine)

58

Signs of hemochromatosis?

Cardiac: dilated cardiomyopathy and conduction
Skin: bronze diabetes
Muscular: arthropathy
Gastrointestinal: hepatomegaly
Endo: diabetes, hypergonadism

59

Treatment for hypertrophic cardiomyopathy?

Beta blocker

60

Right ventricular failure: Time course? Coronary artery involved? Clinical findings? ECHO findings?

Acute, RCA,

hypertension clear lungs and kussmal sign

hypokinetic RV

61

Papillary muscle rupture: Time course? Coronary artery involved? Clinical findings? ECHO findings?

Acute or within 3 to 5 days, RCA

Pulmonary edema, new systolic murmur

Mitral regurg with flail leaflet

62

Intraventricular septum rupture: Time course? Coronary artery involved? Clinical findings? ECHO findings?

Acute or within 3 to 5 days

LAD (apical septum or RCA (basal septum)

Shock, chest pain, holosystolic murmur, biventricular failure

Left to right shunt at ventricle

63

Free wall rupture: Time course? Coronary artery involved? Clinical findings? ECHO findings?

Up to two weeks, LAD

Shock, chest pain, JVD, distant heart sounds

Pericardial effusion and tamponade

64

Never treat endocarditis with?

Oral antibiotics

65

Drug to use for:
1. Supraventricular tachycardia?
2. Ventricular tachycardia?
3. Atrial fibrillation?

1. Adenosine (to slow rate to determine exact type of supraventricular tachycardia)
2. Lidocaine, procainamide (WPW)
3. Amiodarone

66

Post MI: papillary muscle rupture vs septal wall rupture? In common?

In common: holosystolic murmur

Murmur at apex and radiates to axilla vs murmur at left eternal border with thrill

67

Pt with cardiomyopathy, nephropathy, hepatomegaly and neuropathy - test?

Fat pad biopsy for amyloidosis

69

Signs of an arteriovenous fistula?

1. Increased preload (LVH)
2. increase in cardiac output but decreased TPR (widened pulse pressure)
3. Brisk carotid upstroke
4. tachycardia and flushed extremities

70

S3 indicates (most of the time)?

CHF exacerbation

71

Avoid amiodarone in which patients?

Avoid metoprolol in which patients?

Those with existing lung disease

Those with obstructive lung disease (can give to pts with restrictive lung disease)

72

Pulsus paradoxus - Ddx?

1. Tamponade
2. COPD/asthma

73

Signs/Sx of AR?

Causes?

1. Exertional dyspnea
2. Pounding heart sensation
3. Widened pulse pressure

Developing world: rheumatic disease
Developed world: congenital bicuspid valve; aortic root dilitation

74

Water hammer pulse seen in? Mech? Associated Sx?

AR;

Increased SV and abrupt rise in systolic BP (quick peripheral distention) followed by abrupt drop in diastolic BP (quick peripheral artery collapse)

Headaches; bobbing head

75

Ventricular arrhythmias - treatment options?

1. Amiodarone
2. Lidocaine

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