Board Exam Cardiology Old And New

Front 1

What is risk factor for CAD you should count?

Back 1

HTN

DM

male relative with <55

female relative with <65

high lipids

Front 2

What is first management of person with STEMI?

Back 2

asa--> PCI/thrombolytics--> Plavix if stended -> b-blockers(metop vs atenolol)/ CCB if pt has severe asthma--> Plavix instead of asa if asa not tolerated

Front 3

What is symptomatic relief for MI?

Back 3

morphine oxygen and nitrates

Front 4

STEMI vs MSTEMI vs unstable angina which ones get anticoagulation?

Back 4

STEMI gets TPA if needed + asa/plavix

NSTEMI gets heparin + asa + eptifibatide/abciximab/tirofiban

unstable angina can get eptifibitad, tirofiban, and abcixiban and heparin

Front 5

What are 4 causes of sudden drop in BP in post MI?

Back 5

RV infarct, tachycardia, ST elevation in II, III and AVF

tamponade - tachycardia loss of pulse suddenly

valvue rupture- tachycardia and murmur

septal rupture- tachycardia, murmur RA 45% O2 sats--> RV is 75%

Front 6

What is a cannon A wave?

Back 6

tricuspid closed and you have atrial systole and blood hits tricuspid and goes backward into JVD

Front 7

Bradycardia+ hypotension + cannon A waves

rare situation what is it?

Back 7

complete heart block ---> only one that causes this

Front 8

What is the most important thing to do if you have symptomatic bradycardia?

Back 8

try atropine first

pacemaker in longterm

awlways atropine over EKG

Front 9

How do you know you have stable vs unstable angina?

Back 9

SBP<90

chest pain

dyspnea

confusion

Front 10

What is mangement of Vfibb/ Vtach?

Back 10

amiodarone lidocaine procainamide if stable

else if unstable shock the patient.

Front 11

What are the side affects of amiodarone?

Back 11

hypo/hyperthyroid

pulm fibrosis

corneal depositis

blue skin

Front 12

Wjhat is Afibb treatment for rate control?

Back 12

Bblocker

- if CAD CHF or graves

CCB

if asthma or depression

digoxin

if hypotensive

start anticoagulation

coumadin

Front 13

How to treat SVT?

Back 13

vagal maneuvers ice water, valsalva

adenosine if that doesn't work

BB, CCB, digoxin if that doesn't work

Front 14

What are signs of cardiac tamponade in a patient?

Back 14

cardiac tamponade JVD, hypotension, diminished heart sounds

pulsus paradoxus SBP decrease

Front 15

what are EKg findings ffor cardiac tamponade?

Back 15

low voltage QRS and electrical alternans

Front 16

What are echo findings for cardiac tampnade?

Back 16

right atrial and right ventricular collapse during diastole

IVC is plethoric due to back up

Front 17

What are signs of cyanide toxicity after starting nitroprusside?

Back 17

seizures, coma, any flushing or cyanosis arryhtmias

tachypnea, depression

metabolic acidosis and renal failure

Front 18

What is the treatment for nutroprusside cyanide toxicity?

Back 18

sodium thiosulfate

Front 19

in what situation does baby gt CHF?

Back 19

when mom is diabetic, they get glycogen deposition in the septum and they get septal hypertrophy

Front 20

What is ebsteins anomaly?

Back 20

right atrium growing into right ventricle

Front 21

Who gets ebsteins anomaly?

Back 21

fetuses of moms taking lithium

may show up as tricuspid stenosis

Front 22

What is prognosis of baby with septal hypertrophy and CHF from diabetic mom?

Back 22

it will resolve on its own since septal deposition of glycogen will slow down after birth

Front 23

How does hypoplastic left ventricle present?

Back 23

normal birth

ductus arteriosus closes you get sudden CHF in the baby

(so its a cyanotic heart disease)

Front 24

When do you get sclerotherapy and when do you use surgical ligation for treatment for varicose veins?

Back 24

if failed 3-6 motnsh of compression stockings consider sclerotherapy

if failed multiple times sclerotherapy and compression stockings then try surgical ligation

Front 25

When to give bacterial endocarditis prophylaxis?

Back 25

Who: only pts with hx of endocarditis, pts with prosthetic valves, hx of congital heart disease, or having heart transplant

when you are doing dental procedures causing bleeding

when doing resp tract procedures/ biopsies

when doing GI and GU procedure in a patient who is known to have infection already

procedures with infected skin or muscles tissue

Front 26

What are drugs to start in flash pulm edema?

Back 26

nitroglycerine + nitroprusside for BP control also do IV Lasix

Front 27

What murmur do you see with young female?

Back 27

mitral valve prolapse

Front 28

What murmur do you see with immigrant populations?

Back 28

mitral stenosis

Front 29

What murmur do you see with turners syndrome

or with coarctation of the aorta?

Back 29

bicuspid aortic valve

Front 30

palpitations SOB atypical chest pain with out exertion what murmur?

Back 30

mitral valve prolapse

Front 31

What are all the systolic murmurs?

Back 31

aortic stenosis/pulmonic stenosis

mitral regurge/tricuspid regurge

mitral valprolapse

HOCM

Front 32

What are the diastolic murmurs?

Back 32

aortic/ pulmonic regurge

mitral and tricuspid stenosis

Front 33

What murmurs increase with inspiration?

Back 33

all right sided murmurs + stenosis and regurge of pulmonic and tricuspid valves

Front 34

What murmurs increase with exhalation?

Back 34

all left sided murmurs and mitral and aortic valve lesions

Front 35

What are the only two murmurs that decrease in intensity if you increase venous return?

Back 35

HOCM

and mitral valve prolapse

Front 36

What are ways to increase venous return to the heart? to decrease venous return?

Back 36

squatting and leg raise

to decrease venous return you need to do standing and valsalva

Front 37

What murmurs decrease with increased afterload?

Back 37

HOCM, Mitral Valve prolapse and aortic stenosis

Front 38

What are ways to increase afterload? decrease it?

Back 38

handgrip to increase

ace inhibitors and nitrates decrease afterload

Front 39

What is treatment if murmur improves on standing/ valsalva?

Back 39

this decrease in venous return that is imporving the murmur

so you need to get rid of excess volume coming to the heart

Front 40

What is treatment if ymurmur improves with nitrates?

Back 40

this is improvement with decrease in afterload

so you should give ace inhibitor for treatment

Front 41

What is description of aortic stenosis?

Back 41

2nd and right intercoastal space space radiating to the carotids

crescendo decrescendo murmur

Front 42

What murmur is heard in the left ;lower sternal border?

Back 42

aortic regurge

tricuspid murmurs

VSD

HOCM

and mitral valve prolapse to apex

Front 43

Whats VSD description?

Back 43

holosystolic murmurs in the left lower sternal border

Front 44

Whats ASD description?

Back 44

fixed splitting of S2

signs of right heart fialure

SOB

parasternal heave

Front 45

What's MR description?

Back 45

holosystolic murmur at the apex radiating to axilla

Front 46

When to do repair for mitral regurge?

Back 46

EF <60% or when ventricle is >40mm size

Front 47

When to repair aortic regurge?

Back 47

EF <55%

left ventricle size>55

Front 48

Who gets mitral stenosis?

Back 48

rheumatic diease immigrants

pregnant patients

Front 49

How to deal with MS in pregnant patients?

Back 49

always do surgery for MS repair even if currently pregnant

Front 50

What are the characteristics of tetralogy of fallot?

Back 50

right ventricle out flow tract obstruction

overriding aorta over the ventricular septum

right ventricular hypertrophy

VSD

Front 51

What is description of aortic regurgitation?

Back 51

diastolic decresndo murmur at lower left sternal bordr

Front 52

Where can you hear in the left upper sternal border?

Back 52

pulmonic murmurs

ASD

Front 53

What are toxicities of amniodarone?

Back 53

thyroid dysfxn, hepatotoxicity, cardiac bradyarrthmias, chronic interstitial pneumonitis,

ataxia

visual disturbances

peripheral neuropathy

Front 54

What are EKG and Xray findings of pericarditis?

Back 54

xray can show calcifications

ekg will show low voltage QRS complexes

Front 55

How to decide which antiarryhtmic to use in atrial fibrillation?

Back 55

no valvular disease= felcanide

CHF : use amniodarone and dofelitidie

CAD but no CHF= sotalol and drondarone

LVH= dronedarone and amniodarone

Front 56

What is ibutilide used for ?

Back 56

cardioversion for atrial fibrillation

Front 57

What is narrow complex tachycardia differential?

Back 57

Sinus tachycardia

-pwaves present regular >100bpm

sinus nodal reentrant tachycardia

100-150bpm

normal pwaves

AVNRT(most common)

narrow QRS HR 180

Pwaves are missing

pseudo R wave in V1 and II

AVRT

either absent Twaves, or pwave occurs right after Twave

(this category inclused slurred Delata waves of wolf Parkinson white)

Atrial Tachycardia

Pwaves are upside down in leads I and II

and PR interval is short

Atrial Flutter

beats 2:1 block regular

pwaves at 300 bpm

Front 58

What is differential for irregular narrow complex tachycardia?

Back 58

atrial fibrillation

aflutter around 140-160

MAT

Front 59

What is irregular wide complex tachycardia?

Back 59

a fibb

aflutter

bundle branch block

Front 60

What is wide regular complex tachycardia?

Back 60

vtach

RBB/LBBB

atrial tachycardia

Front 61

Which ones are the SVTS?

Back 61

AVNRT

AVRT

atrial tachycardia

Front 62

What are the charactersitiscs of wolf Parkinson white syndrome?

Back 62

PR<0.12

slurred QRS delta wave

episdoes of tachycardia >120 or 140

Front 63

What is peripartum tachycardia? what is treatment?

Back 63

chf during last month of prengnacy or after 5 months of delviery

if LVEF recovers after pregnancy your okay

if it doesn't don't get get pregnant, its gonna be bad for mom and shell need treatment

Front 64

what is PR normal length?

Back 64

4 boxes

Front 65

What is QRS normal length

Back 65

2 boxes

Front 66

What is QT normal length

Back 66

10 boxes

Front 67

What is treatment for wolf Parkinson white?

Back 67

they can die of afibb then vfibb, so get immediate catheter ablation for them

Front 68

When to use a tilt table test?

Back 68

cardiac electrolytes have been ruled out for causing syncope ===> now use tilt table for investiagtion

Front 69

What is considered severe aortic stenosis?

Back 69

area <1.0cm2

+ onset of any stmptoms

Front 70

What is common congenital heart problems that down syndrome pts develop?

Back 70

endocardial cushion defects aka ASD and VSD

Front 71

What long term problems do downs syndrome pts develop?

Back 71

acute leukemia

alzheimers

autism

ADHD

depressive disorder

seizure disorder

Front 72

What to do when INR high during Coumadin anticoag?

Back 72

>9= hold Coumadin and give oral vitamin K

if having a life threatening bleed give Propthrombin complex concentrate factor 8a, FFP,

5-9 hold Coumadin and resume when therapeutic

Front 73

What is ASD description?

Back 73

wide and fixed splitting of second heart sound

mid systolic ejection murmur heard in left upper sternal border

mid diastolic rumble @ left lower

Front 74

What is HOCM murmur?

Back 74

harsh crescendo decrescendo systolic murmur @ apex

in left lower sternal border

Front 75

What to do if a person is struck by lightning?

Back 75

autonomic dysfnxn causing signs of death liked fixed pupils

keep doing CPR until all causes of asystole can be ruled out.

Front 76

What kind of a murmur does an atrial myxoma cause?

Back 76

low pitched diastolic murmur over apex

Front 77

What is two murmurs over the apex?

Back 77

HOCM, atrial myxoma, mitral regurgitation

Front 78

What are the common complications of myxoma?

Back 78

CHF

Afibb

clots in the heart and major arteries

Front 79

What kind of clots does factor V leiden mutation cause?

Back 79

venous clots like DVT PE and portal vein cerebral veins mesenteric

Front 80

What is the cause of clotting when ppl are estrogen replacement?

Back 80

it promotes active protein C resistance

Front 81

How long to continue Coumadin on first DVT that is provoked?

Back 81

3-6 months after initial bridging with lovenox

Front 82

What is most common causes of multifocal atrial tachycardia?

Back 82

low mag and low k+ and hypoxia are most common

Front 83

What is 2nd line treatment for MAT?

Back 83

Bblockers and verapamil or disopyramide

Front 84

What is the most immediate test to do for compart syndrome? and how to interpret?

Back 84

always check for compartment pressure for >30 then do a fasciotomy

then calculate delta pressure diastolic BP- compartment pressure = normal is 20-30

if lower than that, you need to do fasciotomy

Front 85

What are the most common causes of sudden cardiac death in young ppl?

Back 85

ventricular tachycarrythmias

anomalos cornonary artery

other structural heart disease

Front 86

substernal chest pain in young ppl?

Back 86

ischemic disease in 20 yrs old is more likely due to anomalous coronary artery return .

Front 87

What is characteristic brugada syndrome?

Back 87

right bundle branch block and ST segement elevation in V1 and V3

not related to exercise

Front 88

What is the treatment for mobitz I and mobitz II AV block?

Back 88

only if they are symptomatic, they will get a permanent pacemaker

Front 89

B-blockers, calcium channel blockers, clonidine can be continued during surgery?

Back 89

yes they can be continued

Front 90

How far ahead to take off raloxifene before surgery?

Back 90

4 weeks before surgery

Front 91

when should you do high senstivity CRP testing?

Back 91

bascially when patients have 5-7.5 % scores with minimal symptoms on their ascvd scoring you should check this value multiple times to make sure their heart is not inflammed.

1.0 is considered low and 3.0 is considered high.

Front 92

which asymptomatic patients get echos when you hear what murmurs?

Back 92

diastolic, late holosystolic, continuous, and systolic 3/6

Front 93

what is the treatment for post ablative atrial fibrillation, do they need anticoagulation or not?

Back 93

they need anti coagulation based on their chads score whether they had ablation or not.

Front 94

when is it priority to repair abdominal aortic aneurysm/ ulcer? else wht to do if not urgent?

Back 94

you should check to see if all limbs have good perfusion, if not then, you should go for immediate open chest repair, else if you have just high BP , treat with b-blockade then lower BP with ggt, then take for endovascular repair( cath type)

Front 95

who gets moderate statin therapy?

Back 95

ascvd score<7.5% or higher and LDL is <190 and is nondiabetic

Front 96

what is considered high intensity statins?

Back 96

atorvastatin, rosuvastatin, and simvastatin 80mg ( not preferred since it causes the most rhabdo)

Front 97

does swtiching to an ARB releive the cough that is caused by an ace ?

Back 97

yes you get less cough

Front 98

if patient has CAD, and is on beta blockers, gets angina, gets stress test and passes it successfully, but still having symptoms what drug can u add to help with angina symptoms?

Back 98

add isosorbide monoitrate, it helps crease afterload and improve symptoms

Front 99

what is the complications of bicuspid aortic valve?

Back 99

you get regurge, aortic aneurysm, and risk for infective endocarditis

Front 100

what lifestyle factors are the most important in order of what changes risk of getting heart attack?

Back 100

they are

dyslipidemia, smoking, psychosocial stressors, diabetes mellitus, hypertension, obesity, alcohol consumption, physical inactivity, and diet low in fruits and vegetables

Front 101

what are indications for aortic stenosis surgical repair?

Back 101

you gotta have <1cm valve area + symtpoms

or

<1cm and going for cabg or heart procedure

or <1cm and no symptoms but has EF<50%