Cardiology Internal Med Board Review

Front 1

How do you diagnose PAD?

Back 1

1. Claudication
2. Brachial and Ankle blood pressure before and after exercise is best test for functional impairment.
3. Angiography is the best test for defining location of disease. CT And MR angiography very good at this.

Front 2

What do you use to treat PAD?

Back 2

1. Stop Smoking
2. Excercise > 30 min daily
3. Cilostazol- a PDE inhibitor that increases cAMP in plts which results in decreased plt aggregation. Only treats sxs!
4. Pentoxifylline

Front 3

When should you not use cilostazol

Back 3

LV dysfunction- causes salt water retention.

Front 4

If patients have PAD what is their risk of MI and death?

Back 4

at least double for asx PAD. more than double for sx PAD.

Front 5

List the causes of PAD

Back 5

1. arteriosclerosis (smoking and DM)
2. arteritis (CTD, takayasu)
3. Buerger disease (aka thromboangiitis obliterans)
4. Popliteal Artery Entrapment
5. Trauma (jackhammer hands)

Front 6

What is Popliteal Artery Entrapment?

Back 6

popliteal artery entrapment is arterial compression caused by congenital abnl in poplitieal muscles which causes claudication in young men when walking but not running.

Front 7

What is pseudoclaudication?

Back 7

Lumbar spinal stenosis
relieved by sitting down (flexing spine) but not by standing still.
Exacerbated by anything that extends spine (walking downhill)

Front 8

What are preventative treatments associated with PAD?

Back 8

lipid control with statins
consider ASA, plavix as well for cardiac prevention.

Front 9

What are surgical treatments for PAD?

Back 9

percutaneous angioplasty and stents.

Front 10

What should you do with acute peripheral arterial occlusion?

Back 10

IV heparin protects the collateral circulation.
(many arterial emboli to the lower extremities comes from the heart or aterhomatous emboli from diseased aorta, also possible from aneurysm)
Surgical thrombectom/embolectomy is Treatment of Choice.

Front 11

What is Buerger's Disease?

Back 11

Thrombooangitis Obliterans
affects young males <30
associated with smoking
involves medium and small arteries and affects arteries of wrists and hands.

Front 12

what is PVD?

Back 12

peripheral vascular disease is the old name for peripheral arterial disease. PAD = PVD

Front 13

Surgical options for PAD?

Back 13

aortoiliac/aortofemoral reconstruction, etc
but lots of surgical risk, so percutaneous intervention much preferred

Front 14

What is raynaud's disease?

Back 14

constriction of small arteries and arterioles leading to acrocyanosis when cold. usually involves small arteries and arterioles in digits and skin.

Front 15

what do you use to treat raynaud's disease?

Back 15

calcium channel blockers, biofeedback, perhaps ntg but that is not first line rx

Front 16

combination of gangrene and thrombophelbitis makes you think about?

Back 16

buerger's disease

Front 17

If you have atherosclerotic carotid disease are you more likely to have MI or TIA?

Back 17

MI

Front 18

If TIA symptoms, how should you screen for carotid disease?

Back 18

Carotid US, or use MRA

Front 19

At what level of stenosis is CEA indicated?

Back 19

>70%

Front 20

Unilateral headache, with TIA sxs or dilated pupil

Back 20

suspect internal carotid artery dissection
(can also be unilateral neck pain with htn pt)
look for cholesterol emboli on fundoscopic exam

Front 21

treatment for internal carotid artery dissection which was spontaneous

Back 21

no treatment, prognosis is excellent.

Front 22

HTN, Blood Pressure in Arms higher than in legs, young patient, normal CO, LVH on EKG

Back 22

Coarctation of Aorta

Front 23

If you meet voltage criteria on EKG, what is your specificity?

Back 23

95%
You cannot use EKG as screening tool because sensitivity is not high.

Front 24

What is significant of LVH in terms of prognosis?

Back 24

LVH Is independent risk factor for early cardiac death based on framingham study.

Front 25

Complications of Aortic Aneurysms

Back 25

rupture
atheroembolic disease

(but remember that most emboli originate from heart itself!)

Front 26

How large does AAA have to be to require surgery?

Back 26

expanding >0.5cm in 6 months.
any aneurysm larger than 5cm
any aneurysm pressing on surrounding structures

Front 27

what is peri-operative morbidity and mortality for AAA?

Back 27

Acute MI and other CAD related problems.
can do preop screening with nuclear stress test if pt has >2 CAD risk factors

Front 28

what can happened to BP if abdominal aortic aneurysm is not treated?

Back 28

HTN

Front 29

Causes of Aortic Dissection

Back 29

1. HTN
2. Cystic medial necrosis (marfan's)
3. Bicuspid Aortic Valve
3. Coarctation of Aorta
4. 3rd Trimester of Preganancy

Front 30

DeBakey Classification of Aortic Dissection

Back 30

I) in ascending and descending aorta
II) proximal to ascending
III) descending aorta alone (after subclavian

Front 31

Stanford Classification of Aortic Dissection

Back 31

A) anthing involving ascending aorta
B) Limited to descending aorta

Front 32

Treatment for Aortic Dissection

Back 32

decrease the elevated BP by using beta blockers and nitroprusside if necessary.
Ascending dissection - surgery
Descending dissection- medical managment

Front 33

Diagnose Aortic Dissection

Back 33

CT and MRI
TEE can accurately diagnose descending dissections

Front 34

Thoracic Aortic Aneurysms, when to do surgery?

Back 34

5.5 cm ascending
6.5 descending
if enlarging or pressing on nearby organs

Front 35

What are the main organisms for subacute IE?

Back 35

1. Strep Virdians
2. Strep Bovis
3. Staph Epidermidis
4. Enterococcus
5. Fungal
*if strep bovis, must do colonoscopy to rule out cancer

Front 36

What organisisms cause acute IE?

Back 36

1. s. aureus
2. group B strep
3. Gram Neg organisism

Front 37

What do you see in IV drug abusers and pts with prosthetic valves?

Back 37

staph epidermidis
gram neg endocarditis
staph aureus

Front 38

Right sided endocarditis makes you wonder about

Back 38

IV drug abuse
-look for septic embolization
-look for RV enlargement
- onset of RV enlargement is a bad sign

Front 39

Physical findings in IE?

Back 39

1. osler nodes (tender, pads of digits)
2. janeway lesions (nontender macules on palms and soles)
3. splinter hemorrhages
4. roth spots- retinal hemorrhage

Front 40

Endocarditis prophylaxis?

Back 40

only highest risk patients
1 . prosthetic cardiac valve
2. previous IE
3. congential heart disease, esp with prosthetic device
4. cardiac transplant pts with valvuopathy

Front 41

endocarditis within 2 months of valvular surgery

Back 41

seeded during placement, harder to treat, must replace valve if no response to one round of antibx