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213 Cards in this Set
- Front
- Back
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Class ECG findings in atrial flutter
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"sawtooth" P waves
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definition of unstable angina
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angina is new, worsening or occurs at rest
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antihypertensive for diabetic patients with proteinuria
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ACEI
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Becks triad for cardiac tamponade
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hypotension, distant heart sounds, JVD
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drugs that slow AV node transmission
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B-blockers, digoxin, Ca-Channel blockers
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hypercholesterolemia treatment that leads to flushing pruritis
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niacin
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treatment for atrial fibrillation
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anticoagulation, rate control, cardioversion
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treatment for venticular fibrillation
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immediate cardioversion
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autoimmune complication occuring 2-4 weeks post-MI
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Dresslers syndrome; fever, pericarditis, increased ESR
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IV drug use with JVD, holosystolic murmur at the left sternal border. Treatment?
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treat existing heart failure and replace the tricuspid valve
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diagnostic test for HOCM
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echocardiogram (showing thickening left ventricular wall and outflow obstruction)
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a fall in systolic BP of 10mmHg with inspiration
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pulsus paradoxus (seen in cardiac tamponade)
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classic ECG findings in pericarditis
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low-voltage, diffuse ST-segment elevation
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definition of hypertension
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BP >140/90 on three separate occasion two weeks apart
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eight surgically correctable of hypertension
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1-renal artery stenosis; 2-coarctation of the aorta; 3-pheochromocytoma; 4-Conn's syndrome; 5-Cushings syndrome; 6-unilateral renal parenchymal disease; 7-hyperthyroidism; 8-hyperparathyroidism
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evaluation of a pulsatile abdominal mass and bruit
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abdominal ultrasound and CT
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indications for surgical repair of abdominal aortic aneurysm
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>5.5cm, rapidly enlarging, symptomatic or ruptured
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treatment for acute coronary syndrome
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morphine, O2, sublingual nitroglycerin, ASA, IV-B-blockers, heparin
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what is metabolic syndrome?
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abdominal obesity, high TGs, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states
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Name the appropriate diagnostic test: A 50 year old male with angina can exercise to 85% of maximum predicted heart rate
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exercise stress test with ECG
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Name the appropriate diagnostic test: A 65 year old woman with LBBB and severe osteoarthiritis has unstable angina
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pharmacological stress test (i.e. dobutamine echo)
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target LDL in a patient with diabetes
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<70
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signs of active ischemia during stress testing
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angina, ST-segment changes on ECG or decrease in BP
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ECG findings suggesting MI
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ST-segment elevation (depression means ischemia), flattened T waves, Q waves
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A young patient has angina at rest with ST-segment elevation. Cardiac enzymes are normal.
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Prinzmetals angina
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common symptoms associated with silent MIs
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CHF, shock, and altered mental status
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diagnostic test for pulmonary embolism
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V/Q scan
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an agent that reverses the effects of heparin
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protamine
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the coagulation parameter affected by warfarin
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PT
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A young patient with a family history of sudden death collapses and dies while exercising.
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HOCM
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endocarditis prophylaxis regimens
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oral surgery-amoxicillin; GI/GU procedures-ampicillin or gentamicin before and amoxicillin after
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the 6 Ps of ischemia due to peripheral vascular disease
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pain, pallor, pulselessness, paralysis, paresthesia, poikilothermia
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Virchow's triad
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stasis, hypercoaguability, endothelial damage
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the most common cause of hypertension in young women
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OCPs
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the most common cause of hypertension in men
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excessive EtOH
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which heart defects have the lowest risk of infective endocarditis?
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ASD
syphilitic aorta cardiac pacemakers |
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holosystolic murmur that is increased on inspiration is the result of what condition?
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tricuspid insufficiency
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neck vein distension with prominent V waves are symptomatic of what?
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right-sided heart failure
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what is the drug-class of choice for Prinzmetal's angina?
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calcium-channel blocker
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how can beta-blockers adversely affect lipids?
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decrease HDL, increase TGs
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Virchow's triad
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1. endothelial damage
2. hypercoaguability 3. venous stasis |
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Trousseaus sign
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hypercoaguability due to malignancy
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which artery supplies the AV node?
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RCA
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which anti-arrhythmic drug can lead to confusion in the elderly?
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lidocaine
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what is the treatment of choice for Dresslers syndrome?
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anti-inflammatories
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what is the gold standard test for a pericardial fluid?
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echo
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what defines a hypertensive urgency?
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greater than 180/130
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side-effects of thiazines
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hyperglycemia
hyperlipidemia hyperuricemia hypercalcemia |
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what are the K+-sparring diuretics?
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spironolactone, triamterene, amiloride
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first-line treatment for HTN ugency
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orals (beta-blocker, clonidine, ACEI)
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PR-segment depression in precordial leads + diffuse ST-segment elevation = ??
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pericarditis
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Conn's syndrome is caused by what hormone?
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aldosterone-producing adrenal adenoma
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Cushings syndrome
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ACTH-producing pituitary tumor
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name Beck's triad for tamponade
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1. hypotension
2. distant heart sounds 3. distended neck veins |
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size cut-offs for surgical repair of aneuryms
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abdominal >5.5cm
thoracic >6.0cm |
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most common cause of aortic dissection
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HTN
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most common location of aortic dissection
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above the aortic valve distal to the left subclavian artery
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name the Debakey system for aortic dissection
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type I = both ascending and descending
type II = ascending only type III = descending only |
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name the Stanford classification for aortic dissection
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type A = ascending only
type B = all others |
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what is the most common dysrhythmia associated with COPD?
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RBBB
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treatment for second degree type II AV block?
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pace maker
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treatment for third degree AV block?
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pace maker
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delta wave before QRS is pathological for what?
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WPW
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most common type of cardiomyopathy
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dilated cardiomyopathy
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most common causes of dilated cardiomyopathy
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ischemia
long-standing HTN |
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most common cause of sudden death in young athletes
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HOCM
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most common cause of right-sided heart failure
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left-sided heart failure
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ST-segment depression is indicative of what?
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ischemia
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ST-segment elevation is indicative of what?
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dying myocardium
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what is the best predictor of post-MI survival?
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left ventricular EF
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name the area of MI these leads correspond to:
II, III, aVF |
inferior MI
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name the area of MI these leads correspond to:
V1-V4 |
anterior MI
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name the area of MI these leads correspond to:
I, aVL, V5-V6 |
lateral MI
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PTCA is not used for which vessel?
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left main
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most common cause of acute post-MI death?
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lethal arrhythmia
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autoimmune process, fever, pericarditis, pleural effusion, leukocytosis, increased ESR all occurring 2-4 weeks post-MI
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Dressler's syndrome
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blood pressure treatment goals
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uncomplicated <140/90
DM or renal disease <130/80 |
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what percent of OCP users will develop HTN?
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5%
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what is the first line therapy for HOCM? second line?
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first line = beta blockers
second line = calcium channel blockers (diltazem) |
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most common cause of death associated with an acute MI
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re-entry ventricular arrhythmia
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which beta-blocker is preferred for post-MI HTN?
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metaprolol is preferred over propanolol due to its higher beta-2 selectivity
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which heart condition can cause JVD, hepatosplenomegaly, ascites, peripheral edema?
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RV failure
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what drug should patients that have a-fib without any other risk factors be put on? "Lone A-fib"
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ASA, no warfarin necessary without other risk factors
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what do you do if you see an elevated CPK in patients that are on an statin?
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discontinue the statin
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what is the first and second line therapy for decompensated heart failure?
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nitro first then loop diuretics
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what is Conn's syndrome?
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hypertension + hypernatremia + hypokalemia + metabolic alkalosis
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what urinary tract infection can cystoscopy lead to?
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enterococcal bacturia
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what is the first line drug for v-tach?
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amiodarone or lidocaine
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what can causes pulsus pardoxus?
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cardiac tamponade, tension pneumo, severe asthma
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what is the most common cause of an aortic dissection?
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HTN
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what is a common side effect with anti-histamines?
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anti-cholinergic side-effects
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what is the most common EKG finding with a PE?
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sinus tachycardia
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most common cause of mitral stenosis
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rheumatic fever
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gold standard for diagnosing an aortic dissection
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TEE or CTA
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what is the treatment for PAC's?
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nothing, they are benign
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systolic murmur at LLSB + decrease in sound with squatting?
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HOCM
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how is HOCM conferred?
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autosomal dominant
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wide pulse pressure that worsens when supine or left recumbant?
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aortic regurgitation (water hammer pulse)
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treatment for uremic pericarditis?
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hemodialysis
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major side-effect of amiodarone?
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pulmonary fibrosis
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first line treatment for aortic dissection
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HTN control
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what drug must be given for post-MI patients <30 days since event prior to anesthesia?
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beta blocker
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does the Valsalva maneuver increase or decrease preload?
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decreases preload
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what is the only heart condition with a murmur that increases as preload decreases?
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HOCM
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most common cause of ascites
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portal HTN
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what is the first and second line therapy for WPW?
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anti-arrhythmic or synchronized cardioversion first; calcium channel blockers, dig, adenosine second; never give beta-blockers
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what does lidocaine treat?
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ventricular arrhythmias only
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which MI do you not give nitrates with?
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inferior-wall MI
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what is the treatment goal with aortic stenosis?
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decrease afterload with calcium channel blockers or ACEI
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what HTN drugs make aortic regurg worse?
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beta-blockers
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does cardiac tamponade increase or decrease preload?
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decrease preload
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what is the most common cause of a ventricular free wall rupture?
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usually post-anteior wall MI
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what is the most common cause of myocarditis?
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coxsackie B
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pansystolic murmur at LLSB + diastolic rumble at apex... ?
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VSD
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what is the drug of choice for a patient with HTN and BPH?
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alpha-blocker
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what is the treatment of choice for aortic stenosis?
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valve replacement
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what endocrine problem can amiodarone cause?
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hypothyroidism
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what anti-HTN drug can decrease both preload and afterload?
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ACEI
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what are the 5 P's of acute limb ischemia?
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pain, pulselessness, pallor, paresthesia, paralysis
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when does CK-MB normalize post-MI?
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1-2 days
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when does troponin normalize post-MI?
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~10 days
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treatment for LE edema
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elevation, compression stockings, ICDs
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treatment for first degree heart block
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nothing, it is benign
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most common chronic arrhythmia in adults
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A-fib
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recent URI + sudden onset cardiac failure = ??
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dilated cardiomyopathy due to coxsackie B
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what metabolic state can high volume licorice induce?
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metabolic alkalosis
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isolated systolic HTN is due to what??
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decreased elasticity of the arterial wall
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what are electrical alternans and what are they indicative of?
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they are a variation of QRS complex heights from beat to beat; caused by pericardial effusion
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an exercise EKG is best for patients of which pre-test probability?
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intermediate pre-test probability
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what drug will help limit post-MI ventricular remodeling?
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ACEI
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prolonged A-fib can lead to what cardiomyopathy?
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LV dilation
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what percent of patients with mitral stenosis will develop LA dilation?
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70%
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what are the features of hypovolemic shock? i.e. CO, SVR, blood pressure, heart rate, CVP
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decreased CO, increased SVR, decreased blood pressure, tachycardia, decreased CVP
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what is the treatment of choice for symptomatic PVCs?
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beta-blocker
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what lab test is best for hydration status?
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BUN/Cr ratio
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post-MI + persistent ST elevations = ??
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think ventricular aneurysm
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what are the causes of a widened mediastinum?
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aortic dissection, mediastinal mass, esophageal rupture, SVC syndrome, anthrax exposure, mediastinal mass
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what is the drug of choice for paroxysmal SVT?
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IV adenosine
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how do nitrates work?
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venodilation mostly; reduces cardiac preload
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BUN/Cr >20 = ??
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pre-renal azotemia
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which drugs have been shown to reduce mortality in post-MI patients?
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ACEI, beta-blockers
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inferior wall MIs involve what part of the heart 1/3 of the time?
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right ventricle
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what drug is contraindicated with RV-infarcts? what do you give?
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do not give nitrates; give fluids to maintain volume
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what diuretics are contraindicated with gout?
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thiazides
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what drug must you pre-treat with and for how long with A-fib present >48 hours?
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treat with warfarin for 3 weeks prior to cardioversion
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what cholesterol meds are known to cause a horrible taste?
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bile acid resins, i.e. cholestyramine, colestipol
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what is the murmur and what do you do with it:
mid-systolic click followed by later systolic murmur over apex |
mitral regurgitation; likely benign, check with echo to rule out valve pathology
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widened pulse pressure + diastolic murmur over RSB = ?
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aortic regurg
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why is WPW unlikely to develop an AV block?
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due to its accessory pathway; bundle of Kent
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what is the treatment for A-fib with a hx of WPW?
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stable - IV procainamide
unstable - cardioversion |
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what is the New York Heart Association classifications?
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Class I - no limitations
Class II - slight limitation with exertion, no symptoms at rest Class III - marked limitation with exertion, no symptoms at rest Class IV - symptoms at rest |
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name the Debakey aortic dissection classifications and which one is most likely with syphilis versus HTN?
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Type I - ascending and descending
Type II - ascending only (syphilis) Type III - descending only (HTN) |
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thiazide diuretics affect the calcium, sodium and potassium in what way?
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increase calcium
decrease sodium decrease potassium |
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what is the first line treatment for new onset HTN with an hx of DM?
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ACEI
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treatment for acute onset aortic regurgitation
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treat with positve inotrope (dopamine) and a vasodilator (nitroprusside)
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what will you see in terms of changes to CO, PCWP and PVR for hypovolemia, cardiogenic and septic shock
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hypovolemic shock = decreased CO, decreased PCWP, increased PVR
cardiogenic = decreased CO, increased PCWP, increased PVR septic = increased CO, decreased PCWP, decreased PVR |
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treatment of choice for HTN in a post-MI patient with normal EF
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beta-blockers
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target BP for DM patients
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<130/80
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first line drug therapy for hypercholesterolemia
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statins
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treatment of choice for high triglycerides
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fibrates
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name some criteria in the Framingham criteria for CHF
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basilar rales, S3 gallop, evidence of cardiomegaly, JDV, +hepatojugular reflux
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what electrolyte change is the most useful for predicting outcome with a digoxin toxicity?
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hyperkalemia
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treatment for digoxin toxicity
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treat with Digibind (digoxin-Fab)
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what drug is contraindicated with a digoxin toxicity?
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calcium channel blockers, i.e. diltiazem
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what type of heart disease are alcoholics prone to and what should you advise them to do to stop progression?
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dilated cardiomyopathy; tell them to stop drinking
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what is the treatment for varient/Prinzmetals angina?
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nitrates and calcium channel blockers
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what artery feeds the SA and AV nodes?
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RCA
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who is at highest risk for a silent MI?
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diabetics and elderly
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treatment for Raynauds
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dihydropyrmidine calcium channel blockers; i.e. nifedipine
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most common EKG finding with Prinzmetals angina
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transient ST segment elevation
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harsh, blowing, holosystolic murmur radiating from apex to axilla with a loud S1, S3, widely split S2 and a midsystolic click
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mitral regurg
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opening snap murmur after S2 with a loud S1 and diastolic rumble
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mitral stenosis
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wide-pulse pressure, diastolic descrendo murmur at right 2nd intercostal space with bounding pulses
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aortic regurg
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weak, prolonged pulse, crescendo/decresendo murmur radiating to the carotids, weak S2, decrease in murmur sound with valsalva
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aortic stenosis
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what cardiomyopathy does chronic alcohol abuse lead to?
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dilated cardiomyopathy leading to systolic dysfunction CHF
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occlusion of which artery leads to an anterior wall MI?
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anterior descending branch of the LCA
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first line therapy for isolated hyptension
|
thiazides or calcium channel blocker
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what is Osbournes sign?
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aka J-wave; it is an extra positive deflection on ECG between the terminal portion of the QRS complex and beginning of ST-segment due to hypothermia
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how do you diagnose Prinzmetals angina?
|
coronary angiography
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what do you give to patients that present with stable angina that has become unstable?
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IV heparin
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list the most common causes of post-op fever in order of time
|
1. wind (atelectasis) - day 1
2. water (UTI) - day 3 3. walking (DVT) - day 5 4. wound - day 7 5. wonder drugs?? |
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where does lung adenocarcioma usually occur? what type of cells? how do you identify it?
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usually peripheral, arises from mucuin-producing glandular tissue, identified by PAS staining
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foeign bodies usually go where
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right main stem brochus
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"mill wheel" murmur + sudden onset dyspnea = ??
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venous air embolism; often from central line cannulation
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treatment for tension pneumo
|
needle thoracotomy
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what bug type is usually involved with aspiration pneumonia and what drug do you treat it with (IV)?
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likely anaerobes, tx with clindamycin
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what drug type has the most profound effect on FEV1?
|
inhaled beta-2 agonists
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what chemo drug often leads to pulmonary fibrosis?
|
bleomycin
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how does iptratropium bromide work?
|
aka Atrovent; works as a muscarinic receptor antagonist
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how does theophylline work and what is it often used in adjunct for?
|
increases catecholamine activity; good for prevention of nocturnal symptoms
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erytema nodosum + uveitis + pulmontary fibrosis + increased ACE levels = ??
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sarcoidosis
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what lung disease does amiodarone cause and how does it present?
|
pulmonary fibrosis; may present as community-acquired pneumonia that does not respond to antibiotics
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with emphysema, is increased PaCO2, pulmonary HTN and right heart failure an early or late finding?
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late
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with chronic bronchtis, is increased PaCO2, pulmonary HTN and right heart failure an early or late finding?
|
early
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smoking history, hypercalemia, PTH-like peptide, centrally located, cavitary lesion, "keratin pearls"
|
squamous cell carcinoma
|
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most aggressive lung cancer, smoking history, hyponatremic
|
small cell ca, aka oat cell carcinoma
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non-smokers, peripheral location, linked to asbestos, pleural effusions show increased hyaluronidase levels
|
adenocarcinoma
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subtype of adenocarcinoma, due to proliferation of aveloar walls without invasion, CXR may resemble community-acquired pneumonia
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bronchioalveloar carcinoma
|
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rare lung cancer, often metastasizes to brain, histology shows large, undiffernetiated cells
|
large cell carcinoma
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how do you rule out barotrauma to the lungs?
|
CXR
|
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bilateral hilar/paratracheal lymphadenopathy = ??
|
sarcoidosis
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what is the DLCO like in chronic bronchitis versus emphysema?
|
chronic bronchitis - increased
emphysema - decreased |
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first line test for suspected TB in the ED
|
sputum stain for acid-fast bacilli and CXR
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how does Cromolyn work?
|
stabilizes the mast cells; aka Intal
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what do you see histologically with asbestos and what stain do you use to identify?
|
ferruginous bodies that stain with Prussian blue
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"thumb-print" sign on x-ray?
|
acute epiglottitis
|
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how does allergic bronchopulmonary aspergillosis present?
|
presents as poorly controlled asthmatic patient or CF patient that cannot be weaned from steroids; cavitary lesion
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radon gas puts you at highest risk for what carcinoma?
|
lung ca
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most common cause of pneumonia in CF patients
|
pseudomonas
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how does ASA induce asthma attacks?
|
blocks the action of COX-2 thus increasing the leukotriene synthesis pathway
|
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DVT from which vein has the highest risk for embolus?
|
common femoral
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what are the typical causes of exudative pleural effusions? what is the pleural:serum LDH ratio?
|
usually due to infection, neoplasm; pleural:serum LDH >0.6
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what are the typical causes of transudative pleural effusions?
|
due to changes in hydrostatic pressure or oncotic pressure; i.e. CHF, liver failure, etc.
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