Mksap 08-26

Front 1

what drug given in pt with known CAD to reduce risk of MI/stroke?

Back 1

statins, esp pravastatin and simvastatin

Front 2

target LDL value

Back 2

0-1 RF: <160; 2+ RF: <130; CAD/DM/PAD/AAA: <100, maybe <70

Front 3

how to convert hba1c to average FSG

Back 3

HbA1c * 33 - 86

Front 4

causes of secondary hypertriglyceridemia (4)

Back 4

DM, Hypothyroidism, alcohol abuse, estrogen use

Hint 4

None

Front 5

tx for hypertriglyceridemia

Back 5

if secondary, treat 1' disorder; if 1', use NIACIN, fibric acid derivatives (?fibrates), or omega-3 fatty acids; also, lifestyle changes

Front 6

use of bile acid sequestrants in hyperTG

Back 6

contraindicated -- can actually increase TG

Front 7

what TG level confers risk for pancreatitis?

Back 7

>1000 (?>500)

Front 8

classification of TG levels

Back 8

<150: normal; 150-199: borderline; 200-499: high; >500: very high

Front 9

what is total chol the sum of?

Back 9

LDL + HDL + vLDL

Front 10

what is the non-HDL cholesterol goal?

Back 10

non-HDL chol = totalchol - HDL = vLDL + LDL; non-HDL cholesterol goals are LDL goals + 30;

Front 11

what risk with statin-fibrate combo?

Back 11

myositis

Front 12

what to do if LDL not adequately controlled on max dose statin?

Back 12

add bile acid sequestrant or ezetimibe (as long as no hTG)

Front 13

max dose simvastatin

Back 13

40mg/d

Front 14

criteria for metabolic syndrome

Back 14

>= 3 risk factors (ABCDeFG): 1) Abdominal obesity; 4) BP > 130/85; 3) Cholesterol -- HDL<50 in women; 2) TG>150; 5) fasting glucose > 110

Front 15

what drugs elevate HDL and decrease TG? Which to use with statin?

Back 15

niacin and fibrates; niacin-statin preferred b/c of fibrate-statin risk of myositis

Front 16

dosage of niacin

Back 16

titrate up to 1500-2000 mg/d, depending on tolerance

Front 17

ecg findings in pericarditis

Back 17

diffuse pr depression, st elevation

Front 18

mgmt of symptomatic aortic stenosis

Back 18

valve replacement (3-5yr prognosis is poor)

Front 19

symptoms of chronic pericarditis

Back 19

dyspnea, signs of R-sided HF; no chest pain

Front 20

PTCA vs CABG in diabetics

Back 20

CABG shown to have better long-term mortality

Front 21

which murmurs increase in intensity with valsalva?

Back 21

MVP and HOCM

Front 22

4 causes of CP that can quickly lead to death

Back 22

1) MI; 2) Aortic dissection; 3) Tension pneumothorax; 4) PE

Front 23

best rapid diagnostic test for aortic dissection

Back 23

TEE

Front 24

when to do echo/nuclear imaging vs electrocardiography in stress testing?

Back 24

if baseline ECG is abnormal, difficult to interpret ECG changes

Front 25

risk of thromboembolus with cardioversion in afib? how to avoid?

Back 25

if afib < 48hrs, cardioversion usu safe; else, need anticoag first; TEE if need to confirm absence of thrombus formation

Hint 25

None

Front 26

common causes of pleuritis in young people

Back 26

viral pleurisy; also autoimmune dzs (SLE, RA), drug-induced lupus

Front 27

VQ scan vs PECT for r/o PE

Back 27

according to MKSAP, VQ unless high risk pt (not sure this is still true)

Front 28

which drugs have mortality benefit in CAD?

Back 28

beta blockers and ACEi (independent of effects on BP and LV function)

Front 29

what change in heart sounds with WPW?

Back 29

paradoxically split S2

Front 30

P-P interval in mobitz I

Back 30

constant

Front 31

pathophys of mobitz II

Back 31

usu a/w L or R BBB; dropped beat when the remaining branch suffers intermittent block

Front 32

detecting MI in pt with LBBB

Back 32

cannot assess ST depression in presence of LBBB ==> need to do nuclear imaging

Front 33

use of class Ia antiarrythmics in pts with frequent PVCs

Back 33

contraindicated -- proarrythmic effects of class Ia drugs outweighs benefit

Front 34

in-hospital mortality of cardiogenic shock

Back 34

50%

Front 35

most important intervention in cardiogenic shock due to acute MI

Back 35

restore patency of vessel - angiography/angioplasty

Front 36

what immediate intervention in acute STEMI?

Back 36

angioplasty (not thrombolysis)

Front 37

what does persistent ST elevation very late after acute MI indicate? (3)

Back 37

1) persistent myocardial injury; 2) ventricular aneurysm formation; 3) localized MI-related pericarditis

Front 38

what is isosorbide mononitrate?

Back 38

venous and arterial vasodilator used to tx angina

Front 39

tx of choice for preventing post-MI remodeling

Back 39

ACEi (improves LV function, reduces short- and long-term mortality, reduces incidence of heart failure, reduces incidence of recurrent reinfarction)

Front 40

which cardiac pts benefit most from ACEi tx?

Back 40

anterior wall MI, systolic dysfunction, or clinical evidence of CHF

Front 41

when do most post-MI VSDs occur?

Back 41

2-7 days after infarction (same timing as post-MI papillary rupture)

Front 42

acute hypotension and bradycardia in setting of acute MI -- whats the cause?

Back 42

vagal reaction

Front 43

which vessels usu involved in RV infarction?

Back 43

right coronary artery proximal to RV marginal branch

Front 44

what can cause triad of hypotension, elevated JVP, and clear lung fields? (2)

Back 44

RV infarct or tamponade

Hint 44

None

Front 45

what kind of arrythmia a/w RV infarct?

Back 45

bradycardia (from SA or AV node ischemia)

Front 46

therapy for RV infarct

Back 46

standard MI tx + volume loading, avoid diuretics/venodilators (eg nitrates), ?pacing

Front 47

survival rate 24hrs after large VSD/papillary muscle rupture

Back 47

25% with medical therapy

Front 48

tx of post-MI VSD

Back 48

nitroprusside or intra-aortic balloon pump

Front 49

where does free wall rupture typically occur after MI?

Back 49

at juncture of infarcted myocardium with normal myocardium; less often in ccenter of infarct

Front 50

when does free wall rupture occure post MI?

Back 50

1-4d, rarely up to 3wks after MI

Front 51

coronary angiography before discharge for which patients?

Back 51

pts with angina or residual ischemia (at rest or with exertion) after successful thrombolysis; for pts w/o angina/ischemia, stress test sufficient for discharge

Front 52

what leads involved in lateral MI?

Back 52

I, aVL, V5, V6

Front 53

presentation of posterior MI on ecg

Back 53

prominent R waves + ST depression in precordial leads, often a/w inferior MI

Front 54

vtach vs vfib

Back 54

arbitrary distinction based on cycle length; both are fatal if not corrected