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103 Cards in this Set
- Front
- Back
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16 y.o. boy comes for routine physical, he had been in excellent health, on examination the blood pressure is 120/80, P 72, cardiac exam S2 widely split, does not change w/ respiration. Has grade 2 by 2/6 midsystolic murmur best heard in pulmonary area and a middiastolic murmur best heard over left sternal border. what's the diagnosis?
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atrial septal defect
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pt w/ middiastolic murmur w/ change of position, character and intensity of murmur changes.
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Atrial myxoma, due to the changing of the position.
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A pt w/ SOB, elevated JVP, hypotension, has paradoxical pulse of 20 mm Hg, EKG amplitude changes w/ each heart beat (electrical alternans). CXR has cardiomegaly. What's the diagnosis?
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cardiac tamponade?
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A pt w/ SOB, elevated JVP, hypotension, has paradoxical pulse of 20 mm Hg, EKG amplitude changes w/ each heart beat (electrical alternans). CXR has cardiomegaly. What will you do next?
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pericardiocentesis, to treat tamponade
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A pt w/ SOB, elevated JVP, hypotension, has paradoxical pulse of 20 mm Hg, EKG amplitude changes w/ each heart beat (electrical alternans). CXR has cardiomegaly. How will you confirm the diagnosis?
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Perform echocardiogram, for cardiac tamponande
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22 y.o. F in 3rd trimester of pregnancy came for routine check up, has grade 1 systolic murmur on left sternal border, which disappears on standing and valsava. what's the cause of this murmur?
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functional murmur due to increase cardiac output in late pregnancy and early postpartum.
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pt w/ increase JVP, enlarged liver, when palpate liver the JVP increases? what is this called and what is this a sign of?
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this is called hepatojugular reflex which is a sign of right sided heart failure.
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an asymptomatic patient w/ mitral valve prolapse, diagnosed accidently, what do you do?
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Reassurance, no treatment needed
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Pt w/ aortic regurgitation c/o exertional SOB, which of the following drugs will be helpful?
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ACE inhibitor, nifedipine, or hydralazline because they all decrease the afterload
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a patient w/ mechanical valve, has INR of 2, what do you do?
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Increase the dose of coumadin to maintain INR between 2.5 to 3.5 because of the mechanical valve.
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maternal rubella infection in early pregnancy can cause which congenital heart disease?
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PDA
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PDA is discovered in a premature infant, which medications can help in closure
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Indomethacin or Ibuprofen
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A child while playing became short of breath and cyanotic, and occasionally passes out. what's the most likely diagnosis?
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Tetralogy of Fallot
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a young female w/ coarctation of the aorta most likely has what genetic abnormality?
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Turner's syndrome
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A patient has hypertension, his femoral pulse is low, his lower extremities are very cold. systolic murmur heard on the bank. CXR shows notching of the ribs. what's the diagnosis?
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coarctation of the aorta.
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A patient has hypertension, his femoral pulse is low, his lower extremities are very cold. systolic murmur heard on the bank. CXR shows notching of the ribs. what's the diagnosis? how can you confirm?
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MRI, MRA, CT scan of the chest
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what disease are these EKG findings characteristic of?
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Wolff parkinson white, as noted by the shortened PR interval, wide QRS, and delta wave at the beginning of the QRS
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Diagnose this arrhythmia
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atrial fibrillation, look at the absence of P waves and the abnormal RR intervals
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pt comes w/ blood pressure 230/130 and c/o chest pain suggestive of ischemia. which antihypertensive is appropriate to use?
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IV nitroglycerin
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a patient is started of IV nitroglycerin and c/o headache. What do you do?
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reassure patient that it is a common side effect.
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pt on IV nitroglycerin starts to turn blue. pulse oximetry suggests that saturation is 98%. what's the diagnosis? and how do you treat them?
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methemoglobinemia, stop nitrates and give methylene blue.
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A pt w/ blood pressure greater 230/130 is started on IV nitroprusside. the nurse forgot to use the pump. patient becomes confused, develops seizure. what's the diagnosis?
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cyanide toxicity. stop the drug and give amyl nitrate which will create methemoglobinemia which will bind w/ the free cyanites.
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what is the most important life style change for hypertension
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weight loss
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what is the most important life style modification for coronary artery disease?
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smoking cessation
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what is the most important life style modification for coronary artery disease, if patient is not a smoker
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weight loss
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80 y.o. M, w/ BP 180/80, is taking amlodipine, which drug would you like to add?
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Diuretic is best drug for isolated systolic hypertension, which is what this patient has
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50 y.o. w/ h/o ashtma, BP 150/90, besides lifestyle modification, which drug would you like to start?
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Diuretic, b/c they are the first line drug. Beta blockers can be used as well, but they are contraindicated in patients w/ asthma.
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Patient has symptoms of angina and hypertension, what is the best drug.
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A beta blocker
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A patient has diabetes plus hypertension, what is the drug of choice??
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ACE inhibitor
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best treatment for a patient w/ CHF and hypertension?
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ACE inhibitor
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best treatment for patient w/ Polycystic Kidney Disease and hypertension
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ACE inhibitor to counteract high levels in renin
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a patient w/ h/o hypertension is started on an ACE inhibitor, what do you do?
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discontinue ACE inhibitor
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a 60 y.o. w/ h/o HTN is started on a calcium channel blocker. He comes w/ leg swelling and denies exertional SOB, on exam his lungs are clear. lower extremity edema is present. what do you do next?
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Discontinue calcium channel blocker as they can cause ankle edema.
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a patient w/ htn is taking verapamil c/o constipation. what do you do next?
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discontinue verapamil, b/c it can cause constipation.
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if a patient has hypertension and gout what medication should be avoided?
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diuretics
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if a patient has htn and benign prostatic hypertrophy, what do you treat him with
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alpha blocker, prazosin or terazosin
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pt w/ hypertension, sodium is 145, serum potassium is 2.8, what is the diagnosis?
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primary hyperaldosteronism, caused most likely by adrenal adenoma
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pt w/ hypertension, sodium is 145, serum potassium is 2.8, what is the diagnosis? how do you investigate it?
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send renin and aldosterone levels to investigate primary hyperaldosteronism.
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patient w/ hypertension has h/o recurrent attack of palpitations, diaphoresis, anxiety, headache. on examination he may have postural hypotension, what's the most likely diagnosis?
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pheochromocytoma, the catecholamines are secreted in pulses hence the recurrent nature of these attacks
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patient w/ hypertension has h/o recurrent attack of palpitations, diaphoresis, anxiety, headache. on examination he may have postural hypotension, what's the most likely diagnosis? what's the best test?
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24 hour urine for metanephrine, which is the most sensitive test. and then order a CT abdomen to look for adrenal adenoma.
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patient w/ hypertension has h/o recurrent attack of palpitations, diaphoresis, anxiety, headache. on examination he may have postural hypotension. CT abdomen reveals adrenal adenoma. surgery is indicated. what is the best antihypertensive before patient goest to surgery?
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alpha blocker (prazosin, terazosin,
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which drug is the best for treatment of hypertension in pregnancy?
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methyldopa (others: hydralazine, beta blockers (causes fetal growth retardation), and calcium channel blockers)
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which diseases have highest risk of coronary artery disease?
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1. diabetes 2. Vascular disease 3. chronic kidney disease
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pt w/ CAD, what medications have been found to be most beneficial??
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1. aspirin 2. statins
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In a patient w/ a recent MI when should an ACE inhibitor be given?
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if patient is NOT hypotensive w/in 24 hours, unless serum creatinine is high > 2.5
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In patients who have had an MI when should statins be given.
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should be started in all patients prior to hospital to discharge if the cholesterol is high.
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In a patient w/ a recent MI when should an aldosterone antagonist be given?
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recommended for post MI patient w/ left ventricular dysfunction and heart failure
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In a patient w/ a recent MI when should a calcium channel blocker be given?
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if patient is on short acting dihydropyridines, discontinue these medications
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while waiting to go to CCU in the ED, an MI patient develops bradycardia. what will you do? if first intervention doesn't work, what do you do next?
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Give the patient atropine. if that doesn't work give them a pacemaker.
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while waiting to go to CCU in the ED, an MI patient develop a-fib. what will you give?
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Give the patient IV beta blocker
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while waiting to go to CCU in the ED, an MI patient develops non-sustained V. Tach (<30 s). what do you do?
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Just observe the patient
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while waiting to go to CCU in the ED, an MI patient develops recurrent non-sustained V. Tach (<30 s)
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increase beta blocker or give them amiodarone
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while waiting to go to CCU in the ED, an MI patient develops V. Tach what do you do?
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Give them amiodarone. if not available give lidocaine.
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while waiting to go to CCU in the ED, an MI patient develops hemodynamic instability? what do you do?
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Synchronized cardioversion
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while waiting to go to CCU in the ED, an MI patient develops V. fibrillation. what do you do?
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defibrillate the patient. (monophasic 360 joulse, or biphasic 150-200 joules)
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while waiting to go to CCU in the ED, an MI patient develops V. fibrillation. what do you do? if patient still doesn't convert?
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give them epinephrine or vasopressin and then another shock
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while waiting to go to CCU in the ED, an MI patient develops V. fibrillation. what do you do? if patient still doesn't convert after epi, vasopressin, and the second shock, what do you do?
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amiodarone and then another shock
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a patient has asystole, what do you?
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check another lead, check the connections, make sure that it's not ventricular fibrillation. then give epinephrine and atropine. Don't defibrillate.
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patient has Pulselles Electrical Activity, what do you do?
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manage like asystole, so epinephrine and atropine
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a patient has ventricular premature beats, how do you manage them?
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No treatment needed
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A patient has first degree AV block what do you do?
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nothing
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a patient has 2nd degree av block?
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for mobitz I-asymp-no treatment
symptomatic-give atropine and then pacemaker if needed. Mobitz type II-give pacemaker |
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treatment of 3rd degree av block?
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pacemaker
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MI patient admitted to CCU after 5 days the patient c/o sudden onset of SOB, on examination bilateral crackles are present, and a new systolic murmur best heard at apex, radiating to the axilla. what's the diagnosis? and treatment?
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mitral regurgitation, go to surgery
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MI patient admitted to CCU after 5 days the patient c/o sudden onset of SOB, on examination bilateral crackles are present, and a new systolic murmur at lower left sternal border, swan gange catheter shows increased oxygen saturation from r atrium to right ventricle. what's the diagnosis? and treatment?
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VSD which develops post MI. treat w/ surgery
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a post MI pt has persistent ST elevation after 4-8 weeks. what's the diagnosis?
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Left ventricle aneurysm following an MI
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post MI pt c/o CP, worse w/ inspiration, supine relieved by sitting up. what's the diagnosis? what do you do next?
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pericarditis, give aspirin or NSAIDS. don't do an echocardiogram unless the question asks you to confirm.
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4 weeks after an MI, patient comes w/ fever and chest pain, characteristic of pericarditis, labs show increased WBCs. what's the diagnosis? what's the treatment? what if fever and leukocytosis persists despite the first intervention?
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Dressler syndrome-b/c of late presentation and fever. an autoimmun disease, give aspirin or NSAIDS. use prednisone for refractory cases?
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post MI patient planned for discharge, echocardiogram suggests ejection fraction <40%, what meds will be helpful.
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ACE inhibitor?
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post-MI pt being discharged asks when can he resume sexual activity?
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2-4 weeks
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35 y.o. smoker came w/ CP, has ST depression, T inversion, cardiac enzymes negative. started on nitroglycerin, heparin, aspirin, beta blocker. after 24 hours has no chest pain. all cardiac enzymes are negative. EKG still has ST depression and T wave inversion. what do you do next?
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Send the patient for cardiac catheterization.
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60 y.o. comes w/ substernal chest pain while shoveling snow, CP relieved w/ S/L NTG, EKG nl, what do you do?
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admit to CCU, manage like unstable angina, b/c it is new onset angina.
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Pt w/ h/o angina on nitrates and aspirin. he still c/o exertional chest pain?
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add a beta blocker, b/c the pt's medical management has not been optimized.
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young pt comes w/ CP, you suspect cocaine use, EKG shows ST elevation. what's the treatment?
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treat w/ S/L NTG. avoid beta blocker and thrombolytic therapy. give prophylactic calcium channel blocker.
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patient needs resuscitation, can't get IV line, what do you do?
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put in an intraosseous needle and give IV fluids, medications, and everything.
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pt w/ hyperthermia has Ventricular fibirllation or cardiac arrest. is unresponsive to resuscitation. what do you do?
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Continue CPR until the patient has been rewarmed to 32 C, preferably more than 35 C.
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best treatment for hypothermia.
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internal core rewarming is more important than external rewarming, by extrcorporeal blood warming
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what's the worse prognostic indicator for hypothermia
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severe metabolic acidosis, ph <6.6
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An IV drug abuser comes w/ fever, cough, hemoptysis, CP, CXR shows multiple nodular densities, diagnosed w/ endocarditis. started on vancomycin plus gentamicin. after 7 days. he is still febrile, repeat blood culture shows MRSA sensitive to vancomycin. what do you do next?
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surgery consult for valve replacement
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pt on treatment for endocarditis, develops complete heart block, what's the diagnosis? what do you do?
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myocardial abscess which leads to conduction disturbance? call surgical consult to replace valve?
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A patient w/ blood culture is growing clostridium septicum or streptococcus bovis, besides treating these infections what is the next evaluation?
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colonoscopy
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End stage renal disease pt on hemodialysis, via tunnel dialysis catheter in left internal jugular vein, came w/ complaint of fever chills, on examination, exit site of catheter has erythema and tenderness. after sending blood culture, what else will you do?
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start vancomycin plus gentamicin, don't remove catheter unless pt is in septic shock or there is evidence of infection inside the tunnel (warm tender, pustular tunnel) or in the case of pseudomonas bacteremia, on fungus is growing in the blood.
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patient comes w/ h/o hypertension, worsening exertional SOB, paroxysmal nocturnal dyspnea, cough. O/E b/l crackles are present, lower extremity edema may or may not be there. JVP may or may not be elevated. CXR shows bilateral congestion. cardiomegaly is present. what's the diagnosis?
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congestive heart failure.
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A patient w/ end stage renal disease on hemodialysis came w/ shortness of breath, on examination he is fluid overloaded (edema, crackles, elevated JVP, he missed his last dialysis treatment, BP is 230/130. What is the most important thing to do?
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Arrange emergency dialysis
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50 y.o. man c/o passing out, has easy bruisability, constipation, diarrhea, diarrhea, recently diagnosed w/ carpal tunnel syndrome, found to have restrictive cardiomyopathy. urine analysis shows proteinuria. what's the diagnosis?
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Amyloidosis due to multiple systems involved
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30 y.o. F, came w/ c/o progressive edema, recently started having dull r. upper quandrant abdominal pain, weakness, easy fatiguability, lungs are clear on examination, lower extremity edema is present, JVP is elevated, hepatojugular reflex is present. What's the most likely diagnosis?
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Primary pulmonary hypertension.
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A young female w/ signs of right-sided heart failure. what is the diagnosis?
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primary pulmonary HTN or idiopathic pulmonary artery HTN.
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pt w/ increased JVP on inspiration, the JVP further increases. what is this called and what is it a sign of?
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Called Kussmaul's sign see in constrictive pericarditis and r. ventricular infart
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A patient w/ breast ca, s/p radiation therapy c/o SOB, CP, what's the diagnosis?
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constrictive pericarditis or pericardial effusion (any malignancy can cause pericardial effusion)
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pt w/ breast ca p/w SOB, O/E: feeble heart sounds, accentuated fall in systolic blood pressure during inspiration. what's the diagnosis?
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pericardial tamponade
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40 y.o. M, c/o SOB on exertion, heavy smoker, EtOH abuse, O/E: basal crackles are present, CXR: cardiomegaly, EKG sinus tachycardia, echo cardiogram suggests L. ventricle is dilated. coronary arteries are normal. what's the diagnosis? what advice would you give this patient?
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Dilated cardiomyopathy. stop drinking alcohol.
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40 y.o. M, c/o SOB on exertion, heavy smoker, patient is postpartum or on chemotherapy getting adriamycin, O/E: basal crackles are present, CXR: cardiomegaly, EKG sinus tachycardia, echo cardiogram suggests L. ventricle is dilated. coronary arteries are normal. what's the diagnosis?
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dilated cardiomyopathy
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20 y.o. M while playing football passes out for 2 minutes. On examination has sustained apical impulse. systolic murmur which increases w/ valsava and standing decreases w/ squatting.
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hypertrophic obstructive cardiomyopathy
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20 y.o. M while playing football passes out for 2 minutes. On examination has sustained apical impulse. systolic murmur which increases w/ valsava and standing decreases w/ squatting. how do you confirm this diagnosis? what's the treatment?
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confirm HOCM w/ echocardiogram. beta blockers and dual chamber pacemaker if needed.
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20 y.o. M while playing football passes out for 2 minutes. On examination has sustained apical impulse. systolic murmur which increases w/ valsava and standing decreases w/ squatting. if this pt has malignant ventricular arrhthymia or positive family h/o sudden death, what do you do?
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put in an implantable defibrillator
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pt diagnosed w/ HOCM, wants to play football and baseball.
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No, cannot participate in most competitive sports
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a young pt has a h/o syncope while playing football. the patient has h/o of deafness or hearing problems. O/E: not suggestive of hypertrophic cardiomyopathy. what's the diagnosis?
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congenital long QT syndrome
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a young pt has a h/o syncope while playing football. the patient has h/o of deafness or hearing problems. O/E: not suggestive of hypertrophic cardiomyopathy. what's the diagnosis? what's the treatment?
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congenital long QT syndrome, treat same as HOCM beta blocker, dual chamber pacemaker, implantable defibrillator if needed
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20 y.o. M while playing football passes out for 2 minutes. On examination has sustained apical impulse. systolic murmur which increases w/ valsava and standing decreases w/ squatting. if this pt has malignant ventricular arrhthymia or positive family h/o sudden death, what do you do?
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put in an implantable defibrillator
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pt diagnosed w/ HOCM, wants to play football and baseball.
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No, cannot participate in most competitive sports
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a young pt has a h/o syncope while playing football. the patient has h/o of deafness or hearing problems. O/E: not suggestive of hypertrophic cardiomyopathy. what's the diagnosis?
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congenital long QT syndrome
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a young pt has a h/o syncope while playing football. the patient has h/o of deafness or hearing problems. O/E: not suggestive of hypertrophic cardiomyopathy. what's the diagnosis? what's the treatment?
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congenital long QT syndrome, treat same as HOCM beta blocker, dual chamber pacemaker, implantable defibrillator if needed
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name this EKG finding and what toxicity it is associated with.
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premature ventricular beat associated w/ digitalis toxicity
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