Rotations Uworld Im Cardiology

Front 1

ACS

1) When you suspect a possible coronary event that could be an MI (STEMI, NSTEMI - remember you must meet 2/3 criteria), you know that STEP 1 is to give MONAB. Which of the Rx in MONAB is the most impt to give first?

Back 1

1) ASA

Front 2

LYTES

1) Review and Draw our the cardiac A.P. w/ electrolyte mvt.

2) What is the MOA of furosemide?
a) TF it can have what effect ont the serum [ ] of which 2 electrolytes which can then lead to what?

Back 2

1)









2) Inhibs the Na-K-2Cl pump in the TAL of the LOH.
a) Hypokalemia & Hypomagnesemia -->
V-tach
&
Hypokelamia -->
Stim Digoxin -->
V-Tach
-Think, if you are hypokalemic, their will be more "motivation" for K+ out of cell during plateau phase -->
V-Tach

Front 3

SVT
1) What is SVT?

2) If a pt has stable SVT, how do you proceed?
a) MOA of adenosine?

3) If pt has unstable SVT, how do you proceed?

Back 3

1) Tachy w/ a narrow QRS complex

2) Vagal maneuvers -->
Adenosine & AV node blockers
a) Acts on A1 receptors -->
Slow conduction through AV node

3) DC Cardioversion

Front 4

Chronic Liver Dz

1) IVDU has an inc risk of what 2 infxns that effect liver?
a) Hep B --> Inc risk of what ES liver cond'n?
b) Cirrhosis --> Inc risk what?
c) Portal HTN is the MCC of what?
d) Cirrhosis can also -->
What 2 additional PE findings?

Back 4

1) Hep B &C
a) Cirrhosis
b) Portal HTN
c) Ascites
d) Hepatomegaly, Splenomegaly

Front 5

MI

1) RV infarct is characterized by what 4 things?

2) What should and should NOT be given to pt w/ R. ventric infarct?

3) Give 3 scenarios in which nitrates are CI?

4) Give 1 major PE sign that can differentiate R & L Ventricular Infarction?

Back 5

1) Inf wall MI;
JVD;
HYPO-TN;
CLEAR LUNG FIELDS

2) Should Give:
Fluids to incr preload -->
Maintain contractility and CO

Should NOT give:
Nitrates and Diuretics which Dec Preload (remember nitrates inc venous capacity)

3) Aortic stenosis;
Recent PDE Inhib use;
RV infarct

4) RV Infarction = Clear Lungs
LV Infarction = Pulm Edema --> NO CLEAR LUNGS

Front 6

Aortic Regurg

1) Clinical Picture of Aortic Regurg?

2) 2 MCC aortic regurg in US?

3) MCC of aortic regurg in countries without ABX?

Back 6

1) Wide pulse pressure;
Water hammer Pulse: Pounding heartbeat when lying supine or on L. side (BC brings heart closer to chest)

2) Aortic root dilation;
Bicuspid aortic valve (also a cause of aortic stenosis in pt < 30)

3) Rheumatic Fever

Front 7

Sinus Brady

1) Define Sinus brady?

2) If pt has sx-ic sinus brady, what's the tx approach?

3) MOA of atropine?

4) MOA of adenosine?

5) When would the use of epi be appropriate in sinus brady?

6) What is Amiodarone used for?

7) MOA of Amiodarone?

Back 7

1) EKG: HR < 60 w/ Reg Rhythm and Constant PR Interval

2) Atrpine -->
Transcutaneous pacing

3) Inhibs ACh receptors (anticholinergic)

4) Inhib A1R -->
Dec conduction through AV node

5) sinus brady + Hemodynamic instability (HAP)

6) SVT and Ventric Tachys

7) Class III Anti-Arrhythmic that blocks K + Channs in SA and AV nodes -->
Prolonged Repol

Front 8

Acute pericarditis

1) When does acute pericarditis usually occur?

2) Give the clinical picture of AP?

3) When does IV septum rupture and Pap Muscle rupture usually occur?
a) Present w/ what?

4) When does ventric FW Rupture usually occur?
a) s/s?

Back 8

1) 1st several days after a cardiac event (ie: MI)

2) Sharp, pleuritic pain -
Worse when supine -
Better when sitting up and leaning forward;
Friction Rub;
Diffuse ST elevations w/ PR depressions

3) 3-7 days after MI
a) New onset systolic murmur

4) 3-7 days after ANT WALL MI
a) Pericardial tamponade;
PEA

Front 9

Aortic Dissection
1) What will you see on CT for aortic dissection?

2) What is the elading RF for aortic dissection?
a) What EKG sign would indicate that the HTN is chronic?

3) What are teh 2 types of AD and how are they tx'ed?
a) MOA of Labetolol?
b) By inhibiting beta-1 it does what to heart?
c) By inhibiting beta-2 it does what to heart?

Back 9

1) False Lumen

2) HTN
a) EKG changes showing LVH

3) Stanford Type A:
Only Involves ASCENDING AORTA:
SURGERY + Labetolol

Stanford Type B:
Distal to Subclavian Art:
LABETALOL
a) Antags alpha-1;
Antags beta 1 & 2
b) Dec rate
c)

Front 10

A-Fib

1) What are the causes of A-fib? ( I SMART CHAP )

2) What are 4 drugs taht can lead to a-fib

Back 10

1) List here

















2) ETHOL
Cocaine
Amphetamines
Theophylline

Front 11

PVCs
1) How can you tell on EKG that someone is having PVCs?

2) what effect on survival does tx of PVCs w/ anti-arrhythmic have?

3) TX for asx-ic PVCs?

4) Tx for Sx-ic PVCs?

Back 11

1) Irreg Rhythm;
Wide QRSl;
Compensatory pause;
Bizarre QRS morphology

2) Worsens survival!!

3) No TX! Observe only

4) Beta-blocker

Front 12

Uremic pericarditis

1) What is uremic pericarditis?

2) What is the absolute TX for uremic pericarditis?

3) What will the BUN typically be in Uremic Pericaridits?

4) How will the CBC be effected in someone w/ Uremic Pericaridtis?

5) 4 Absolute Indications for Dialysis?

6) 2 CI for dialysis?

Back 12

1) Uremic (Inc BUN / Cr) + Pericarditis

2) Hemodialysis

3) BUN > 60 mh/dL

4) Anemia

5) Fluid overload NOT responsive to Med Tx;
Hyperkalemia NOT responsive to med tx;
Uremic pericaridtis;
Refractory Metabolic Acidosis

6) Debilitating chronic dz;
Severe irreversible dementia

Front 13

Atrial Flutter
1) What are teh EKG findings for Atrial Flutter?

Back 13

1) "Sawtooth" pattern of atrial impulses taht are larger than a normal p-wave

Front 14

MI w/ acute HF and Pulm congestion

1) If you have an MI w/ AHF and Pulm Congestion, what is a loop diuretic you can give?
a) Why beneficial?

Back 14

1) Furosemide
a) Decrease cardiac preload -->
Dec Pulmonary Edema

Front 15

Digitalis

1) MOA of digitalis?


2) Digitalis OD --> what?

3) What is the atrial rate of:
a) Atrial Tachy?
b) Atrial Flutter?
c) a-fib?

Back 15

1) Look this up!!!








2) Inc atrial or ventricular ectopic beats --> Atrial Tachy;
Inc vagal tone --> AV block
a) 150-250
b) 250-350
c) ?

Front 16

Aortic Stenosis
1) Look up in other notes the 3 categories for MCC aortic stenosis

2) Look up and write down the clinical picture of aortic stenosis from other ntoes

3) What gallop can be heard in aortic stenosis?
a) How does S4 "Atrial Kick" develop?

Back 16

1)











2)












3) S4 "Atrial Kick"
a) AS -->
Concentric hypertrophy of L. Vent -->
Stiff L. Vent -->
Diastolic Dysfnctn

Front 17

Statins

1) 2 Major AE of statins?

2) Give MOA of Myopathy from Statins?

Back 17

1) Inc Liver Enz, Myopathy

2) Statins inhib HMG-COA Reductase -->
Dec synthesis of CoQ10 -->
Myopathy

Front 18

Costochondritis

How do you differentiate costochondritis pain from the pain of cardiac / pulmonary origin?

Back 18

CC pain is reproducible w/ palpation

Front 19

Hemochromatosis

1) What is hemochromatosis?

2) Major s/s of hemochromatosis?

Back 19

1) In Fe in the blood

2) Hypogonadotropic Hypogonadism from hemosiderin deposition in the pituitary;
Male hypogonadism
(Dec testosterone --> Testicular atrophy and dec sexual drive);
Arthropathy (Hemosiderin in Jts);
Bronze Diabetes
(Bronze from Hemosiderin deposition -->
Inc skin pigmentation.
Diabetics from Endocrine Dysfnctn);
Hepatomegaly & Cirrhosis;
Dilated Restrictive Cardiomyopathy -->
Heart failure adn various conduction abnormalities

Front 20

Amiodarone
1) What is one of the major metabolic SE of amiodarone?
a) TF pts on amiodarone must have f/u w/ what lab test?

2) 2 other Non-Metabolic SE of Amiodarone?

Back 20

1) Hypothyroidism
a) TSH

2) Lung Fibrosis, Liver toxicity

Front 21

Infective Endocarditis

1) s/s?

2) Duke criteria?

Back 21

1) Look up in first aid!

2) Look up and mem

Front 22

PACs

1) What are 2 reversible RF for PAC on EKG?

2) If a pt is sx-ic w/ PAC, what is the next step in managemetn?

3) Where to PACs originate?

Back 22

1) ETHOL and Tobacco

2) beta-blockers

3) In a foci separate from the SA node

Front 23

MI

1) What additional heart sound is often heard in pts w/ MI?
a) Mech of development of S4 in MI?

Back 23

1) S4 "Atrial Kick"
a) MI -->
Ischemic damage -->
Stiff vents -->
Diastolic dysfnctn -->
S4 "Atrial kick"

Front 24

S4 Atrial Kick

1) An S4 "atrial kick" heart sound sounds like what word?

2) Now we know that an S4 "atrial kick" is an indicator of a stiff L. vent. 2 things --> stiff L. vent --> S4 "atrial kick"

Back 24

1) "ten - Ne- ssee

2) Restrictive cardiomyopathy;
Prolonged HTN --> L. Ventricular Hypertrophy

Front 25

Marfan's
1) List PE findings and risks of Marfan's

2) Describe the presentation of aortic dissection

Back 25

1) Hyperextendable joints
Long limbs and digits
Frail blood vessels --> Aor Dissection
Spontaneous pneumo
Pectus excavatum
MVP and regurg
Retinal detachment

2) Severe CP that radiates to the back and neck;
Widened mediastinum;
Early diastolic murmur of aortic regurg

Front 26

Diastolic Dysfnctn

1) DD is a filling defect ususally d/t "stiff ventricles." Give the pathogenesis of DD, including sequelae
a) 2 possible tx?
b) If DD -->
Heart Failure, will contractility and TF ejection fraction be maintained? CO?

2) What is high output cardiac failure?

Back 26

1) HTN -->
LVH / "Stiff Vents" -->
L. atrial dilation -->
A-fib
a) Diuretics & Anti-HTN Meds
b) Yes. No! (BC low filling volume)

2) Supranormal ventricular fnctning that still cannot meet body's O2 demands

Front 27

Malignant HTN

1) What 2 criteria must be met to make a dx of maglignant HTN?

2) Malignant HTN leads to end organ damage via what pathological change?

Back 27

1) HTN (> or = to 200 / 140)
Papilledema

2) Fibrinoid necrosis of small arterioles

Front 28

Rheumatic Fever --> Rheumatic Heart Dz

1) What is the MC valvular manifestation of RF?
a) Describe auscultative findings?
b) Describe the chain of events that can cause Mitral Stenosis -->
AF -->
Lung Congestion

Back 28

1) Mitral stenosis
a) Loud S1;
Mid-diastolic rumbling murmur @ apex
b) Mitral stenosis -->
Inc L. atrial pressure -->
L. atrial dilation -->
A-fib -->
Dec S4 "Atrial kick" -->
Dec flow through mitral valve -->
Inc lung congestion -->
Dyspnea

Front 29

MI associated Arrhythmia
1) What type of arrhythmia in a Post-MI pt will most commonly --> death?
a) Give pathophys of Re-entrant ventricular arrhythmia?

Back 29

1) Re-entrant Ventricular Arrhythmia (V-fib)
a) Ischemia -->
Heterogeneity of conduction in myocardium
(Scattered areas of conduction block) -->
Re-entry arrhytmia

Front 30

PEA

1) What is PEA
a) 1st step?

2) What are the only 2 shockable rhythms?

3) Give the 6 Hs & 6Ts of PEA Ets?

Back 30

1) when there is electrical activity of heart without mechanical contraction
a) Compressions

2) VF / VT

3) Ques # 402 680

Front 31

Caan's Syndrome (Primary Hyperaldosteronism)

1) Give the lab findings of Caan's Syndrome?

Back 31

1) HTN
Hypernatremia
Hypokalemia
Metabolic acidosis
Inc HCO3-
Dec renin (Feedback Inhib from inc aldosterone)

Front 32

Acute onset CHF (Several Days)

1) Give the typical pathogenesis of acute onset CHF?

2) Why would you NOT see eccentric or concentric hypertrophy in AO CHF?

Back 32

1) Viral Infxns (Coxsackie B, Parvovirus B-19, HHV-6, Adenovirus, Enterovirus)
-->
Myocarditis -->
Dilated cardiomyopathy w/ diffuse hypokinesia -->
Systolic dysfnctn (dec EF)

2) BC Eccentric and Concentric hypertrophy are the result of chronic stress on the heart and they develop slowly over time

Front 33

S3 Heart Sound

1) What word does an S3 sound resemble?
a) Give physiology of S3 heart sound?

2) S3 is normal in who?

3) S3 in Middle aged --> elderly ppl?

4) #1 tx for ventricular failure?

Back 33

1) "Ken-tu-ky"
a) When blood from L. atrium strikes blood that is already in L. ventricle --.
Vibration of blood b/t ventric walls

2) Younger individuals and athletes

3) Ventricular failure

4) IV diuretics (for real!)

Front 34

A-fib tx

1) What is the major risk / prob that can occur in pts w/ A-fib?

2) 2 tx options in a-fib pts to dec risk of stroke in pts who ARE sx-ic?
a) Which is preferred in most pts?

3) What is the Tx for A-fib pts to dec risk of stroke in pts who are NOT sx-ic?

4) The CHADS2 score will determine the choice of anti-coag. Give the scoring system and approved anti-coag tx?

Back 34

1) stroke

2) Anti-coag + Rate CTL
OR
Anti-coag + Rhythm CTL
a) Rate CTL + Anti-Coags

3) Anti-coags alone

4) 1 pt: CHF, HTN, > or = 75 y/o, DM
2 pts: Prior stroke

0 pts = ASA alone
1-2 pts = ASA or Warfarin
3+ pts = Warfarin

Front 35

Leg Edema in CHF

1) Give the mechanism of Leg Edema formation in CHF

Back 35

1) CHF -->
Renal Hypoperfusion -->
Stim RAA system -->
Inc Aldost -->
Inc NA & H2O retention -->
Inc Hydrostatic pressrue in legs -->
BL pitting Leg edema

Front 36

VF / Pulseless V-tach

1) What is the initial tx of someone w/ VF / pulseless V-tach?

2) How can you recognize VF on EKG?

Back 36

1) Defibrillation

2) Fibrillatory waves and absence of reg QRS complexes

Front 37

Variant (Prinzmental's) Angina

1) What is it?

2) When does it usually occur?

3) Biggest RF?

4) EKG findings?

5) TX?

6) What Rx should be AVOIDED in Prinzmetal's Angina?

Back 37

1) Transient coronary vasospasm

2) Night (midnight - 8 am)

3) Smoking

4) Transient ST elevation on EKG

5) Ca chann blocker or Nitrate

6) Non-selective beta-blocker
&
ASA

Front 38

MI --> Ventric Remodeling

1) Ventric remodeling often follow MI. In what ways does a L. ventric remodel?
a) Ventric remodeling can --> what?

What RX should be indicated w/in 24 hrs to P-lax ventricular remodeling?

Back 38

1) L. vent dilation; Thinning of ventricular walls
a) CHF

ACE I

Front 39

AAA

1) What is teh imaging test of choice?

Back 39

1) ABD US

Front 40

Thiazide diuretics

1) 3 metabolic SE of thiazide diuretics

2) 3 electrolyte SE of TD?

Back 40

1) Hyperglycemia, Inc LDL, Inc TGs

2) Dec Na, Dec K, Inc Ca

Front 41

Leg Edema

1) What is the underlying cause of BL Leg edema in a malnourished pt?

2) What causes non-pitting edema?

3) What causes Pitting edema?

Back 41

1) Low plasma oncotic pressure from low amt of PRO

2) Lymphatic obstruction (lymphedema);
Interstiti accum of albumin w/ low to normal lymphatic flow
(ie: Myxedema w/ hypothyroidism)

3) low hydrostatic pressure
(hypovol from dehydration)
OR
Low oncotic pressure (malnutrition)
-->
Fluid mvt from vascular to interstitial space

Front 42

Aor Sten

1) You suspect aortic stenosis in a pt. What is the next step?
a) What specific echo findings are consistent w/ AS?
b) Tx for sx-ic AS?

Back 42

1) Echo
a) Aortic valve abnorms;
LVH;
Inc LV-Aortic Pressure Gradient
b) Valve replacement

Front 43

Amiodarone

6 potential negative SE of Amiodarone?

Back 43

-Pulmonary Fibrosis ("It's hard to BLAB")
-Hypo-Hyperthyroidism
-Hepatotoxicity --> Inc aminotransferase levels
-Corneal deposits
-Bue-gray skin discoloration

Front 44

Aor Ste
1) It is NOT unusual for a person w/ aort sten to experience anginal chest pain. Why does this occur?

Back 44

1) AS -->
LVH -->
Inc Myocardial O2 Demand

Front 45

Aortic Aneurysms

1) What is the MC site of Thoracic AA?
a) Thoracic AA usually the result of what?

2) 2nd MC site for Thoracic AA?
a) Usually the result of what?

Back 45

1) Ascending aorta
a) Cystic medial necrosis

2) Descending aorta just distal to origin of subclavian artery
a) Atherosclerosis

Front 46

Caridac Tamponade
1) 3 PE signs of cardiac tamponade?

2) EKG findings?

3) Tx?

Back 46

1) HYPO-TN;
Tachy;
JVD (R. Heart Failure)

2) Eletrical alternans

3) Volume replacement;
Pericardiocentesis

Front 47

1) Pt presents w/ a hx of recent MI and cold leg. dx?
a) Give pathogenesis of thrombus formation?

2) How to confirm Dx?

Back 47

1) Thrombus from L. ventric
a) MI -->
Hypo/akinetic portion fo heart -->
blood stasis -->
Thrombus formation

2) Echocardiogram

Front 48

Stable Angina and HTN
1) Best tx?

Back 48

1) beta-blocker

Front 49

Aortic Dissection
1) What is the MCC of Aortic Dissection?

2) Give 3 less common causes / associations w/ AD?

Back 49

1) HTN

2) Marfan's;
Ehlers Danlos;
Atherosclerosis ( --> AA --> Dissection)

Front 50

SCD

1) Sudden cardiac death MC'ly occurs in who?

2) What is the MC underlying et of SCD?

Back 50

1) Young AA during exertion

2) Hypertrophic cardiomyopathy -->
VT / VF

Front 51

AAA
1) What are 3 indications for surgical repair of AAA?

2) What is the #1 medical management / intervention approach that can dec rate of AAA enlargement?

3) Even though smoking cessation is teh #1 way to slow growth of AAA, what is the underlying Et of AAA formation?

Back 51

1) Diameter > 5 cm;
cm;
Rapid growth rate

2) Stop smoking

3) Atherosclerosis

Front 52

Dyspnea

1) What are 2 major pulmonary causes dyspnea?
a) What are the major features / sx of CHF?
b) Which cause of pulmonary edema will most likely cause an inc in BNP?
1. What should the level be to dx CHF?

c) Both ANP & BNP are released from heart in response to volume overload. Where specifically are they released from?

Back 52

1) CHf;
COPD
a) Orthopnea,
LE edema,
S3,
Bibasilar crackles,
JVD,
Hepatosplenomegaly

b) CHF
1. > 100 pg / ml

c) ANP = Atria
BNP = Ventricles

Front 53

Chagas Dz

1) What protozoan causes Chagas dz?

2) 3 Major manifestations of Cardiac Dz?
a) Give the pathogenesis of megaesophagus / megacolon?
b) How does chagas dz cause cadiac damage?

3) chagas dz is endemic to ppl from what region?

Back 53

1) Trypanosoma cruzi

2) Megaesophagus;
Megacolon;
Cardiac Dz
a) Destruction of nerves CTL-ing GI smooth muscle
b) Trypanosoma cruzi -->
prolonged myocarditis

3) Latin America

Front 54

Right Ventricle Infarction

1) When should you be on alert for a R. Ventric Infarction?
a) How often will a pt w/ an inferior infarct also have a R. ventricular infarction?
b) Now obviously you need to be suspicious when you see ST elevation in II, III and aVF, but what other EKG sign can clue you into a possible R. sided infarct?

2) What 4 aspects of PE should raise suspicion for R. sided infarction and TF R. ventric failure?

3) R. ventricular failure -->
Dec L. Ventricualr ____
a) TF what is teh Tx for R. ventric failure?

Back 54

1) When pt has an inferior infarct
a) 1/3 of the time
b) ST depression in I & avl may reflect STEMI on R. side (mirror effect)

2) HYPO-TN;
JVD;
Clear Lung Fields;
Kussmaul's Sign (Inc JVD w/ Inspiration)

3) Dec L. ventric Pre-load -->
Dec CO & HYPO-TN
a) Inc preload w/ IV fluids
&
d/c anything that decreases prelaod:
Nitroglycerin & diuretics

Front 55

Pulm Embolism

1) PE present w/ what sort of chest pain?
a) What is pleuritic chest pain?
b) 5 other causes of pleuritic CP?

2) What is the dx-ic test of choice for suspected PE?

Back 55

1) Pleuritic chest pain
a) CP upon inspiration that occurs when teh visceral and parietal pleura bcome irritated and inflammed
b) Pneumonia;
Pneumothorax;
Collagen vascular dz;
Viral pleuritis;
Radiation pneumonitis

2) Spiral CT of chest

Front 56

Constrictive Pericarditis

1) Constrictive pericarditis results in what 2 things?

2) Constrictive pericarditis impairs ventricular filling during diastole --> what?

3) Describe common findings in atrial pressure?

4) MCC of constrictive pericarditis in:
a) Developing countries?
b) US?

Back 56

1) Pericardial fibrosis;
Diastolic dysfnctn

2) Sx of low CO
(Fatigue, Dyspnea on exertion, Muscle wasting)
&
Sx of venous overload
(Inc JVP, Ascites, pos kussmaul's, pedal edema)

3) Sharp 'x' & 'y' descents

4)
a) TB
b) Viruses,
Cardiotherapy,
Cardiac Surg,
CT disorders

Front 57

Metoprolol

1) MOA?

2) However, if given @ HIGH doses it can do what?

Back 57

1) beta-1 SELECTIVE adrenertic antag

2) block beta-2 receptors in bronchial tree -->
CAN'T bronchodilate -->
wheeze, cough, prolonged expiration

Front 58

Post-MI Popliteal (or other leg) artery cont'd

1) After a pt sustains an MI, he/she may have a hypokinetic L. ventricle -->
Clot formation that may go to a leg artery. Give the 6 P's of acute limb ischemia

2) First step in tx?
a) 2nd step if limb is still viable?
b) 2nd step if limb is NOT still viable?

Back 58

1) Leg: LOOK UP the 6 p's in case files notes

2) Immediate heparin
a) Percutaneous thrombolysis
OR
Surgical / mechanical embolectomy
b) Surgery

Front 59

STEMI: LOOK @ YOUR FLOW CHART FOR ACS

1) What has the most significant effect on LT prognosis following a STEMI?
a) Whta are 2 mechs to restore coronary blood flow?
b) "Door-to-baloon" time should be what?
c) "Door - to - needle" time should be what?

Back 59

1) Amt of time that passes before coronary blood flow is restored
a) PTCA or fibrinolysis
b) 90 mins
c) 30 mins

Front 60

Aortic Dissection

1) What are 2 impt clues for aortic dissection?
a) What are the 2 dx-ic studies of choice for aortic dissection?

Back 60

1) Tearing chest pain w/ radiation to back;
Diff in BP > 30 mm hg b/t arms
a) TEE (NOT Transthoracic)
OR
CT w/out contrast

Front 61

RAS

1) What 3 things are highly suggestive of RAS?

2) What is teh leading cause of secondary HTN?

3) Give the physiology of a bruit?

Back 61

1) Systolic-diastolic ABD Bruit
HTN
Atherosclerosis

2) RAS (BC kidney sees less volume -> Stim of RAAS)

3) Turbulent blood flow in a vessel -->
Often resulting from luminal irregularities

Front 62

Aortic Stenosis

1) What are 3 classic sx of aortic stenosis?
a) Describe the classic murmur of aortic stenosis?
b) 2 PE signs of aortic stenosis?

2) What are the 2 major causes of exertional syncope?

Back 62

1) Exertional dyspnea;
Exertional Syncope;
Exertional Angina
a) Systolic ejection murmur radiating to apex and carotids
b) Pulsus parvus et tardus
Prolonged cardiac impulse palpated @ the apex

2) V Tach
LV outflow obstruction (Aort Sten; HOCM)

Front 63

Cocaine Abuse
1) Give the clinical picture of cocaine abuse?

2) Tx for cocaine induced STEMI?
a) 4 other appropriate drugs?
b) What class of Rx must be avoided and why?

Back 63

1) Pupil dilation;
Vasospasm -> Chest pain & STEMI;
Blood @ external nares

2) Same as classic STEMI-
PTCA or Thrombolysis
a) ASA, Nitrates, CCB, alpha-blocker
b) beta-blockers!:
BC it allows unopposed alpha-agonist activity that -->
Worsening Vasospasm
(Remember, beta blockers also CI in pheo, unless you give alpha blockers first!)

Front 64

Mitral Regurg

1) What is the MCC of mitral regurg?

2) Describe what mitral regug sounds like?

3) Describe the sequelae of MV prolapse?

Back 64

1) MV prolapse

2) Pansystolic (holosytolic) murmur that radiates to the axilla and is sometimes accompanied by a mid-systolic click

3) MVP -->
Mitral Regurg -->
LA dilation -->
A-fib

Front 65

Orthostatic HYPO-TN

1) What is orthostatic HYPO-TN? (definition)

2) OH often leads to what even?

3) Gie the populaions who are @ risk of OH?

Back 65

1) Drop in SBP > 20 mm Hg when moving from lyving down to standing

2) Syncope

3) Elderly;
Hypovolemic;
Autonomic Neuropathy (Diabetes, Parkinsons)
OR
PTs taking Diuretics, VAsodilators, Adrenergic Antags

Front 66

Dressler's Syndrome

1) What is DS?

2) What in a pt's history is a buzz word for pericarditis?

3) What are teh classic EKG findigns of Pericarditis?

4) What lab value will be increased in pericarditis?

5) Tx for pericarditis?

Back 66

1) Post-MI Autoimmune Pericarditis

2) Pain that is worse w/ deep inspiration
Pain that improves w/ leaning forward

3) Diffuse ST elevation EXCEPT for Reciprocal Depression in aVR;
PR depressions

4) ESR

5) 1st Line: NSAIDS
Refractory Pericarditis OR when NSAIDS are CI: Corticosteoids

Front 67

Syncope

1) What is the MCC of syncope?

2) How is the dx of vasovagal syncope confirmed?

Back 67

1) Vasovagal syncope

2) Tilt table test w/ or w/out pharmacologic provocation (Isoproterenol)

Front 68

Latex Allergy

1) MAy cause rash AND either hyper-hypoTN?

2) Latex allergy is particular coon in what population?

Back 68

1) Hypo-TN

2) Spina bifida

Front 69

Isolated systolic HTN

1) What is ISH?

2) Tx?

Back 69

1) Dec elasticity of arterial wall (usually w/ age) -->
Inc SBP WITHOUT chagne in DBP -->
Inc pulse pressure

2) Monotherapy w/:
1) Low dose thiazide
2) ACE I
3) Long acting CCB

Front 70

A-fib from WPW

1) Pts w/ WPW are @ an increased risk for dev what type of arrhytmia?
a) Now what is the normal tx for a-fib NOT resulting from WPW?
b) Why are teh above AV node blocking RX CI'ed in Afibr resulting from WPW?
-Why is the above dangerous?

c) TF whta is teh best tx or a pt w/ a-fib resulting from WPW?

Back 70

1) A-fib
a) AVV node blockers:
beta-blockers, CCB, Digoxin, Adenosine
b) BC by blocing the pathway of conduction from atria to vens via AV node, you will consequently INC conduction from Atrial to vents via the accesory Bundle of Kent!
-BC if you INC conduction fro atrial to vents via accesory bundle of kent you can get an inc risk of A-fib

c) DC cardioversion
OR
Anti-arrhythmics like Procainamide

Front 71

Aor Dissection

1) What are 3 clinical findings that are highly suggestive of Aor Dissection?
a) How many of the above 3 clinical findings must be present for the risk of Aortic Dissection to be > 80%?

Back 71

1) "Tearing" chest pain that radiates to back ;
Diff pulse or BP in L or R arms;
wideneded mediastinum on CXR
a) @ least 2

Front 72

MVP

1) Describ auscultation of MVP?

2) What will dec the prolapse and the pain assoc w/ MVP?
a) HOW?

Back 72

1) Mid systolic click over cardiac apex,
Short systolic murmur (If mitral regurg is present)

2) Squatting
a) Squatting -->
Inc Venous REturn -->
Dec or eliminates prolapse

Front 73

Paroxysmal Supraventricular Tachy

1) What is the MC MEchanism underlying PSVT?

2) All TX are aimed @ what goal?
a) Give these TX?

Back 73

1) Electrical conduction re-entry into the AV node

2) Dec AV node conductivity
a) Vagal maneuvers that inc vagal tone:
-VAlsalva Maneuver
-Carotid Sinus MAssage
-Immersion in Cold H2O

OR

Adenosine

Front 74

Prinzmetal's Angina (Variant Angina)

1) Underlying pathophys of prinzmetal's angina?
a) What rheumatological disorder is also te result of arterial vasospasm?

2) Greatest RF for PA?

3) What pops are @ greatest risk PA?

4) When do episodes of prinzmetal's Angina usually occur?

5) Episodes may be precipitated by what 5 things?

6) EKG findings in prinzmetal's angina?

7) Medical tx for PA?

Back 74

1) Temporary spasm of coronary arteries
a) Raynaud's Phenomenon

2) Smoking

3) Women who have other vasospastic disorders (Raynaud's or migraine HA)

4) Middle of night (12 midnight to 8 AM)

5) Exercise;
Hyperventilation;
Emotional stress;
Cold exposure;
Cocaine use

6) Transient ST elevations w/ return of ST segment of baseline upon resolutino of sx

7) CCB,
Nitrates

Front 75

Amlodipine

1) Amlodipine is what type of CCB?
a) What FX do DHP CCB have on blood vessels?
b) FX of this vasodilation?

Back 75

1) Dihydropyridine CCB
a) Vasodilation
b) Periphreal edema

Front 76

Situational Syncope
1) What is situational syncope?
a) 2 situations that often -->
a situational syncope episode
b) What is the pathophysiologic mechanism underlying situational syncoe?

2) How is SS different from postural HYPO-TN (orthostatic Hypo-TN)

Back 76

1) When a person has a syncopal episode in specific situations
a) Straining when having a BM
OR
Rapid bladder emptying (micturtition)
b) Autonomic dysregulation

2) BC someone w/ PH has syncopal episodes when standing d/t dec BP-
NOT bc of a certain situation

Front 77

Hypertrophic Cardiomyopathy

1) What is a classic heart murmur finding in hypertrophc cardiomyopathy?
a) Hoiw doe sn Inc Preload obliterate the heart murmur?

b) What type of inheritance pattern is hypertrophic cardiomyopathy?

Back 77

1) Murmmur @ left lower sternal border that dec w/ an inc preload
(NOTE: you can inc preload w/ squatting)
a) Inc PL -->
Distension of myocardium -->
Dec outflow obstruction from hypertrophied mocardium

b) Autosoal dominant

Front 78

Pericardial Effusion

1) Classic EKG finding?

2) Pericardial Effusion is often 2/2 what?

3) Pericardial effusion are often accompanied by what?

4) What 3 signs indicate a developing cardiac tamponade?

5) What imaging test confirms presence of a pericardial effusion?
a) A CXR is less definitie in its ability to dx pericaridal effusion. But what will you see on CXR?

Back 78

1) Electrical alternans

2) Viral Infxns (like a URI) -->
Viral pericarditis

3) Pleural effusions!

4) BECK'S TRIAD:
JVD,
Hypo-TN,
Muffled heart soudns

5) Echo
a) Enlargement of cardiac silhouette

Front 79

***Learn diff types of shock***

***Learn SIRS Criteria***

***Look up grading on JV pulse***

Back 79

***Learn diff types of shock***

***Learn SIRS Criteria***

***Look up grading on JV pulse***

Front 80

Constrictive Pericarditis

1) What is constrictive pericarditis?

2) What sign will be positive in pts w/ constrictive pericarditis?

3) 3 MCC of constrictive pericarditis?

4) How to make dx of CP?

5) Tx of constrictive pericarditis?

Back 80

1) Cond'n where the pericardium is thickened or scarred -->
Diastolic dysfnctn (dec filling) -->
Dec CO
AND
Dec Venous pressures -->
-Inc JVP
-Ascites
-Hepatic congestion (Hepatomegaly)
-Dyspnea
-Weakness

2) Kussmaull's sign -
Failure of JVP to decrease w/ inspiration

3) Cardiac surgery;
Viral pericarditis;
Radiation therapy

4) CXR shows calcified pericardium;
MRI / CT shows thickened pericardium;
Mearsuring pressures during cardiac cath

5) Diuretics or pericardiectomy

Front 81

Digoxin

1) Class?

2) MOA?

3) CU?

4) How is it cleared?

5) Give the run-down of dig toxicity sx?

6) What are the 4 things / events that can acutely inc dig levels?

7) Loop diuretics -->
___ --->
Inc risk dig toxicity?

Back 81

1) Cardiac Glycoside

2) Inhib Na/K ATPase

3) A-fib and heart failure

4) Renally

5) n/v,
dec appetitem
confusion,
weakness,
visual sx: scotoma, blurry vision, color changes, blindness

6) Viral illnesss,
Excessive diuretic use,
Volume depletion,
Renal injury

7) HYPOkalemia

Front 82

Acute limb ischemia

1) What is acute limb ischemia?
a) What are the sx of ALI?

2) 3 causes of ALI?
a) 2 major events that can lead to embolus formation in the eart -->
ALI?

3) What med can prevent ALI embolus?

Back 82

1) What a pt presents w/in 2 wks of onset of sx resulting from a sudden decrease in perfusion that threatens limb viability
a) 6 P's: LOOK THEM UP IN YOUR CASE FILES NOTES

2) Embolism, Trauma, Thrombossi
a) A-fib
Recent MI

3) Warfarin (Coumadin)

Front 83

Sequelae of COPD

1) Give the clinical picture of COPD?

2) COPD has what effect on O2 Sat?
a) Give the sequelae of this COPD induced hypoxemia?

3) Will R. ventricular failure cause Pulmonary Edema?
a) What will cause pulmonary Edema?

Back 83

1) Recurrent pulm infxn;
Chronic cough;
Smoking Hx;
Inc AP diameter;
Wheezing

2) Dec O2 Sat (hypoxemia)
a) COPD -->
Hypoxemia -->
Constriction of pulm arterial system -->
Pulm HTN -->
RVH -->
-Inc JVP
-Congestive Hepatosplenomegaly
-Ascites
-Peripheral (LE) edema
-Hepatojugular reflex

3) NO!
a) L. Ventricular Failure

Front 84

HCtosis --> REstrictive Cardiomyopathy --> CHF

1) 3 types of cardiomyopathy?
a) 4 major causes of restrictive cardiomyopathy?
b) Restrictive CM --> Wha type dysfncnt?
c) Describe L. Vent wall thickness in Restrictive Cardiomyopathy?

2) What is one way to differentiate b/t restrictive and hypertrophic CM?

3) Will their be more signs of R or L Heart Failure?

4) But can their also be some signs of L. heart failure?
a) ex?

5) Give tx for RCM from hemochromatosis?

Back 84

1) Restrictive,
Dilated (eccentric),
Hypertrophic (Concentric)
a) Infiltrative dz (Sarcoid, AMyloid)
Storage dz (HCTOsis)
Endomyocardial Fibrosis
Scleroderma
b) Diastolic dysfnctn
c) normal
OR
SYMMETRICALLY thickened
(Thick IV Setptum AND Lat Wall)

2) RC: Symetrically thickeened
HC: IV septum is thickened

3) R. heart failure

4) YES
a) Rales, Pleural effusion

5) Phlebotomy

Front 85

***Look up grading system of murmurs - like II / VI, etc...

Back 85

***Look up grading system of murmurs - like II / VI, etc...

Front 86

Boerhaave's Syndrome

1) what?

2) 2 common s/s?

3) Is hematemesis a promnent feature?

4) Radiologic studies can show what 3 things?

5) Fluid from pleural effusion will have a high [ ] of what?
a) ph?

Back 86

1) Esophageal perforation following severe retching

2) Fever and dyspnea

3) NO!

4) Unllateral Pleural Effusion (Left);
Mediastinal emphysema (widened mediastinum);
Contrast extravasation from esophagus

5) Amylase!
a) Low!

Front 87

AMI & Mitral Regurg

1) Lets review some of the leads and corresponding coronary arts?

2) W/ an anterior MI their may be _____ -->
what type of murmur?
a) However, pap muscle rupture mor commonly occurs w/ what type of MI?
b) Tx for papillary muscle rupture?

3) Acute (not chronic) MR-->
Inc in what?

Back 87

1) Inf surface;
Leads II, III, aVF;
RCA

Ant surface;
Leads V2-V4;
LAD

Lat surface of heart;
Leads I, aVL, V5, V6;
LCX

2) Papillary muscle ischemia / rupture -->
Mitral regurg
a) Postero-septal MI
b) Emergent Surgery

3) LA pressure, but not LA size

Front 88

Aortic Stenosis

1) Give 3 PE findings of aortic stenosis?

2) 1 possible stand out feature of pts w/ aortic stenosis?

3) MCC of aortic stenosis in elderly?

Back 88

1) Inc apical impulse;
Narrow pulse pressure;
Systolic murmur

2) exertional syncope

3) Calcification of aortic valve

Front 89

Bradycardiac Induced Syncope

1) What are 2 "Conduction" causes of bradycardia?

2) What are 2 signs of bradyarrhytmia on EKG?

3) What is 1 sign of tachyarrhytmia on EKG?

Back 89

1) Dz of sinus node (SSS);
Dz of conduction system

2) Prolonged PR,
Prolonged QRS

3) Prolonged QT interval

Front 90

GERD

1) Apart from a retrosternal burning sensation after eating or lying down, what are 2 other sx of GERD?

2) 2 medical tx for GERD?

3) 2 LT consequences of GERD?

Back 90

1) Hoarseness,
Chronic cough

2) H2 Receptor Antag (Ranitidine);
PPI (Omeprazole)

3) Barrett's Esophagus;
Esophageal carcinoma

Front 91

Hypertrophic Cardiomyopathy

1) HCM (young AA males) can be an inherited trait w/ what inheritance pattern?

2) W/ HCM you will get hypertrophy of what part of heart?

3) Their are 2 resons why a person w/ HCM will have outflow obstruction. Name them.

4) Describe the murmur seen in HCM?
a) This murmur increases w/ what?
why?
b) Murmur decreaes w/ what? why?

Back 91

1) Aut Dom

2) IV septum

3) Hypertrophied IV septum,
SAM (Systolic Anterior Motion: Abnormality in motion of mitral valve leaflets)

4) Crescendo-Decrescendog murmur @ lower sternal border
a) Murmur increases w/ DEC preload.
You can dec PL w/ 1 maneuvers:
Valsalva -
BC dec PL -->
Dec size of ventricular cavity and TF -->
Inc outflow obstruction
b) Squatting bc this INC PL

Front 92

Lidocaine in Pts w/ ACS
1) What class of anti-arrhytmics is Lidocaine?

2) Technically Lidocaine could be used to dec what?
a) Does lidocaine help overall prognosis?

3) Lidocaine can inc risk of what in pts?
a) TF should lidocaine be used prophylactically in pts w/ ACS?

Back 92

1) Class IB AA

2) dec Frequency of PVCs
&
Dec risk of VF in MI pt
a) NO!

3) Inc risk of asystole in ACS pts
a) NO!

Front 93

HTN

1)Give the cut-offs for BP

2) Give te lifestyle mods to dec BP and how much they dec BP by:

Back 93

1) N < 120 / 180
PRE-HTN 120-139 / 80-89
S I HTN: 140-159 / 90-99
S II HTN: > or = 160 / 100

2) Wt loss
BMI < 25
5-20 mm Hg

DASH diet
inc fruits and veggies, low salt and total fat
8-14 mm Hg

Low na intake
Na < 3 g / day
2-8 mm Hg

Exercise
30 mins / day, 5-6 days / wk
2-8 mm Hg

ETHOL
2 drink / day MEN; 1 drink / day women
2-4 mm Hg

Front 94

Aortic Dissection
1) Give 5 RF for aor dissection?
a) Biggest RF for aor dissection?

2) 2 interesting PE findings w/ AD?

3) 2 MC sites of AD?
a) If the aortic valve is involved, you may hear what?
b) If y ou have a proximal aortic dissection the coronary ostia may be involved, --> what?

4) What is teh 1st step in management of pt who may had AD w/ HTN?
a) This is done even before when?

Back 94

1) Pregnant,
Bicuspid Aortic Valve,
Coarctation of Aorta,
Marfan's,
HTN
a) HTN

2) Assymetric pulses & BP measurements

3) Above aortic valve,
Distal to L. Subclavian Art
a) Murmur of aortic regurg
b) Obstruction of ostia -
MClt obstruction of ostia --> RCA -->
Inf wall ischemia and ST changes in II, III, aVF

4) Tx HTN
a) Even before the dx-ic studies are performed

Front 95

Seizure vx. Syncope

1) What is a major way to diff b/t a seizure and a syncopal event?

2) What are 2 common seizure triggers?
a)) 2 other indicators of a seizure?

3) How to eval someone w/ new onset seizures?

Back 95

1) Syncope --> Return to baseline mental status immediately after regaining consciousness
Seizure --> Post-ictal stae of clouded sensorium

2) Stress and low sleep
a) Tongue biting and sore muscles

3) CBC, CMO, Drug screen, EEG, Brain MRI

Front 96

Pericardial Effusions

1) Give 6 possible causes of pericardial effusion?

2) How does Pericardial effusion appear on a CXR?

3) EKG?

4) PE?

5) When a pericardium can no longer stretch to accomodate the effusion, this is known as what?

Back 96

1) Viral illness,
Malignancy
Post-MI,
Uremia,
AI dz,
HYPOthyroidism

2) "Water-bottle' shaped heart

3) Low voltage

4) Distant heart souhnds, Difffuse PMI

5) Cardiac tamponade

Front 97

PE

1) Sx of moderate and severe pulmonary embolism?

2) What is a major sx of massive PE? Definition of massive PE?

3) PE can cause R. heart strain -->
What s/s?

4) Give the potential sequelae of R. Heart Strain?

5) What is teh tx of choice in massive PE?
a) 1 CI to fibrinolysis in MAssive PE?

Back 97

1) Dyspnea and Pleuritic chest pain

2) Syncope.
Def: PE complicated by HYPOTN and/or acute R> HEART STRAIN

3) JVD and RBBB on EKG

4) R. heart strain -->
R. ventricular dysfnctn -->
Dec flow to L. side of heart -->
Low CO -->
L. Heart pump failure -->
Bradycardia -->
Cardiogentic shock and CNS FX
(Dilated Pupils, Unresponsive Mental status)

5) Fibrinolysis
a) Surgery in past 10 days

Front 98

Amyloidosis

1) What is amyloidosis?
a) What are 2 CC of amyloidosis?

2) Give some organs that amyloid can deposit in and the potential defects that can occcur in those organs?

3) Give 3 characteristics of restrictie CM?

Back 98

1) Deposition of amyloid PRO in various organs -->
Organ dysfnctn
a) Multiple myeloma,
Chronic Inflamm Dz'es (RA)

2) Kidney --> PROuria
Liver --> Inhib syntehsis of coag factors (TF --> Easy bruisability)

3) Symetrical thickening of ventricular walls;
Diastolic Dysfnctn;
No change in ventricular dimensions!

Front 99

A-Fib

1) 3 characteristics of A-fib on EKG?

2) It is a common complication of what?

3) What are 3 signs of hemodynamic instability in an A-fib pt?
a) Tx fo A-fib of hemodynamic instability

Back 99

1) Irregularly irregular R-R Intervals;
NO discernable P-waves;
Narrow QRS

2) CABG or
CABG + Aortic Valve Replacement

3) HYPO-TN,
Altered mental status,
Lung sounds indicating fluid on lungs
a) Immediate cardioversion
(DC prefereable to pharmacologic)

Front 100

Some post-MI complications
1) IV septum Rupture: When occur?
a) What is a complication of IV septum rupture?

2) Ventricular free wall rupture: When occur?
a) What is a complication fo VFWR?
b) Usually in what type of MI?
c) 1st Tx?

3) PE
a) What is a complication of PE?

4) Ventricular Aneurysm
a) What type of MI can most often --> VA?
b) Clinical picture of VA?

Back 100

1) ~ 5 Days post-MI
a) VSD! --> Holosystolic murmur

2) Peak incidence is 3-7 days post anti wall MI
a) Acute decompensation; Tamponade --> PEA
b) Ant WAll MI
c) Pericardiocentesis

3) PE
a) PEA

4) Ventric aneurysm
a) Ant wall MI
b) Akinesis of involved portion;
Ventricular arrhythmia;
Systemic embolization

Front 101

Orthostatic HYPO-TN in elderly

1) Define orthostatic HYPO-TN

2) What is the cause / pathophysiology of most cases of OH?

3) What is the major reason for OH in the elderly?
a) Causes of low baroreceptor sensitivity in the elderly?

Back 101

1) Decrease in SBP by @ least 20 mm Hg
OR
DBP by @ least 10 mm Hg
when moving from lying position to a statnding position

2) Autonomic dysregulation,
Dec Intravascular tone,
Medications
-->
Insufficient Vasoconstriction of Leg Vessels

3) Loss of baroreceptor sensitivity
a) Arterial stiffness,
Dec NE @ SNS nerve endings,
Dec sensitivty of heart to SNS

Front 102

AV Fistula --> High Output Cardiac Failure

1) If a pt has high output, how can they be in HF?

2) Give 4 congenital causes of HO CF?

3) Give 4 acquired causes of HO cardiac failure?

4) What will happen once an AV fistula is formed?

5) What are some of the clinical sigs of HOCF from AV fistula?

6) 2 Other causes of HOCF besides AV fistula?

7) Dx of AVF in extremitiy using what?

8) BC you will have high CO, what will happen to the L. vent?
a) What happens when the L. ventricle hypertrophies?

Back 102

1) BC very little of that blood actually makes it to tissues. It is shunted back to veous circulation

2) PDA,
Angiomas,
Pulmonary AVF,
CNS AVF

3) Trauma,
Iatrogenic (Femoral Cath),
Atherosclerossi (Aortocaval fistula)
CA

4) Large amts of blood will be shunted through fistula -->
1. Dec SVR
2. Inc Cardial PReload
3. High CO (that's why it's HO cardiac failure)

5) Wide pulse pressure,
Strong peripheral pulses (ie: brisk carotid upstroke),
Systolic flow murmur,
Tachy,
Flushed extremitieis

6) Thyrotoxicosis, Paget's dz, Anemia, Thiamine defic

7) US

8) Hypertrophies
a) PMI becoes displaced to the left

Front 103

An Alternative to Exercise Stress Testing

1) Adenosine: 2 FX?

2) Dipyridamole: 2 FX?

3) What is another optioni to view myocardial perfusion defects in a person who cannot perform exercise testing?
a) Explain how MPS works?
b) This effect by dipyridamole is called what?

Back 103

1) Vasodilates,
Ihibs av node conduction

2) Vasodilator,
Inhibs PLT aggregation

3) Myocardial perfusion scanning w/ dipyridamole
a) Inject Dipyridamole -->
Vasodilation and subsequent inc blood flow
BUT
in vessels w/ CAD, dilation and TF perfusion is already maximal,
TF blood flow will be re-distributed to non-diseased areas -->
Dec perfusion to diseased areas
b) Coronary steal!

Front 104

HCM

1) Hypertrophic cardiomyopathy is more common in who?

2) Inheritance pattern of HCM?

3) PE findings that suggest HCM?

4) Describe murmur of HCM?
a) What are 2 maneuvers that will dec PL and TF inc murmur of HCM?
b) What 3 maneuvers will inc PL and TF dec murmur of HCM?

Back 104

1) Young AA males

2) Aut Dom

3) Carotid pulse w/ dual upstroke
(From mid-systolic obstructio as heart contracts);
Systolic ejection type murmur @ L. sternal border;
Strong apical impulse

4) Murmur increases when preload decreases-
BC low PL = low size of cavity =
High outflow obstruction for large IV septum
a) Valsalva maneuver and standing
b) Squatting, Recumbency (lying flat),
Leg raising

Front 105

Post-MI Complications

1) What are the 3 major MECHANICAL complications / Sequelae of MI?
a) Hemodynamic instability is usually the indicator that their is a complication from an MI. What is the time period durin which hemodynamic instability occurs which willmake you consider that the underlying cause is one of the 3 "mechanical" complications of MI?
b) What are teh classic auscultation findigns of mitral regurg?

Back 105

1) Papillary muscle rupture -->
MVP -->
Mitrral Regurg;
LV free wall rupture;
IV septum rupture
a) 3-7 days post MI bc thi is the point during the healing process in which the infarcted myocardium is softest and TF most prone to rupture
b) Pansystolic murmur that is loudest @ apex w/ radiatio to the axilla;
Soft S1 (bc of MVP)

Front 106

HOCM
1) Describe the hypertrophy of HOCM?

2) Althoguh we usually think of HCM affecting young AA males, it does NOT always have to. What is one event that can occur as a result of HOCM?

3) Describe the murmur of HOCM?

Back 106

1) IV septum hypertrophy

2) Syncope

3) Crescendo-Decrescendo systolic murmur along L. sternal border WITHOUT carotid radiation

Front 107

Cardiac Enzymes

1) What is the most sensitive and specifci cardiac enz for dx-ing 1st MI?
a) How long does it take for the TnT leads to return to baseline?
b) TF what is a better enz to dx re-infarction after a recent MI?
c) How long does CKMB take to return to baseline?

Back 107

1) TnT
a) up to 10 days
b) CKMB
c) 1-2 days

Front 108

CHF Mortality
1) List 4 RX that improve mortality in CHF pts?
a) Which of the above has actually been shown to prolong life?

2) Give mech by which ACE I improve mortality?

Back 108

1) ACE I;
ARBs;
beta-blockers;
Spirinolactone
a) ACE I

2) Hemodynamic FX (Dec prelaod and afterload);
Inhibs FX of the RAA system

Front 109

Some Measurements

1) What is cardiac index?

2) In systolic heart failure, what will the:
a) CI be?
b) TPR be?
c) LVEDV be?

3) Why is TPR inc in systolic heart failure?

4) LVEDV may be normal in what type of HF?

Back 109

1) A measure of CO (L/min) / Body surface area (m2)

2)
a) Decreased
b) Increased
c) Increased

3) BC activation fo SNS and RAAS system

4) Diastolic HF

Front 110

Aortic Dissection

1) What is the typical pt presentation of a person w/ aortic dissection?

2) A person w/ aortic dissection will have what EKG changes?

3) Dissection of what part of the aorta may --> ___ --> ____

4) Tell me something unique about BP in each arm in someone w/ AD?

5) 1st step in mngmnt of AD?!?!!??

6) Best dx-ic study?

Back 110

1) Acute retrosternal CP radiating to the back

2) NONE!!

3) Aortic regurg --> Early diastolic murmur

4) BP MAY be diff in each arm

5) CTL HTN

6) TEE

Front 111

Central Lines
1) TPN via a central line in the subclavian vein can --> Inc risk of what?
a) How will a pt w/ this sort of thrombosis present?
b) What's the most impt step in mngmnt of pt?

Back 111

1) Thrombosis
a) Pale, swollen arm, w/ distal pulses present
b) Remove the catheter

Front 112

Aortic Dissection
1) Describe 4 palces that aortic dissectio ncan extend into and subsequent sequelae?

2) What is some clinical evidence for cardiac tamponade?

Back 112

1) Carotid Arts --> stroke
Renal arts --> Acute renal failure
Aortic Valve --> Aortic Regurg
Pericardium --> cardiac tamponade

2) HYPO-TN
Inc JVP
Pulsus Paradoxus
Pericardial Effusion on Echo

Front 113

Diff Types Pulses

1) Pulsus Paradoxus:
a) What?
b) Indicates what?

2) Pulsus Alternans:
a) What?
b) Indicates what?

3) Pulsus Parvus et Tardus
a) What?
b) Indicates what?

Back 113

1)
a) Dec Systolic BP w/ inspration
b) Pericardial tamponade,
Asthma,
COPD,
Tension Pneumo,
Foreign body in airway

2)
a) Alternatinv weak and strong pulses
b) Cardiac Tamponade,
Impaired LV Systolic Fnctn

3)
a) Weak and delaed pulse
b) Aortic Stenosis

Front 114

Syncope

1) Give the 9 presentations of Syncope?

a) When resulting from seizures, ou could expect to see what?
b) If a pt has syncope w/ clonic jerks, does that automatically mean that the pt has had a seizure?

Back 114

1) "SUCH DROPS"
Seizures
Unexplained (50%)
Cardiac (Arrhythmias, Stenossi, MI)
Hypoglycemia
Drugs
Reflex Mechs (Vasovagal)
Orthostasis
Psychogenic
Stroke

a) Post-ictal sensorium / sleepiness
b) NO! Clonic jerks may occur in syncope of any kind since their is dec O2 to brain

Front 115

A-Fib

1) In A-fib, what mngmnt approach is preferred,
Rate CTL + Anti-coag
OR
Rhythm CTL _ Anti-coag?

2) What scoring system is used to determine which anti-coag to give?

Back 115

1) Rate CTL + Anti-coag

2) CHADS2 Score

Front 116

Misc

1) What cardiac Rx hould be avoided in pts w/ a pre-existing lung dz?

Back 116

1) Amiodarone

Front 117

HTN & Tremor

1) What is an essential tremor?

2) What is a resting tremor?

3) Which of the above is usually improved w/ ETHOL?

4) Pt presents w/ HTN and Benign Essential Tremor, what RX can tx both?

Back 117

1) A postural tremor
(Tremor that occurs when maintaining a particular posture)

2) A tremor @ rest (Parkinson's dz)

3) Essential Tremor

4) Non-selective beta-blocker (Propranolol)

2

Front 118

Mitral Stenosis

1) What ID can often lead to Mitral Stenosis?

2) Give a pathogenesis of other sequelae of mitral stenosis?

Back 118

1) Rheumatic Fever

2) MS -->
Inc Left Atrial Pressure -->
1. Inc pressure of pulmonary vascular bed -->
Pulmonary Congestion -->
Dyspnea,
Cough,
Hemoptysis
2. L. atrial enlargement -->
A-fib -->
Clot formation -->
Stroke

Front 119

Aor Regurg

1) What kind of murmur in mild Aor Regurg?

2) What kind of murmur in severe aor regurg?

3) Describe pulse in person w/ Aortic Regurg?

Back 119

1) Early Diastolic Murmur

2) Holosystolic murmur

3) "Waterhammer Pulse" -
AR -- Inc SV =
Abrupt rise in SBP & Distension of periph arts

Dec DBP and collapse of periph arts

Front 120

Aor Dissection
1) Aor Dissection that presents w/ leg weakness means what?

2) 2 possible findings on CXR?

3) 2 ways to dx?

Back 120

1) Dissection includes the descending aorta and arteries feeding spinal cord

2) Mediastinal widening;
Pleural effusion

3) TEE, CT chest

Front 121

Secondary HTN

1) HTN from hyperparathyroidism could present how?

Back 121

1) HTN;
Inc Ca;
"Stones, Bones, ABD Groans, Psychiatric Overtones"

Front 122

EKG Stress Testing

1) What medications should be witheld before a person has an EKG stress test?

Back 122

1) Anti-Ischemic Meds;
Digoxin;
Meds that slow the heart rate (beta-blockers)

Front 123

Chronic Venous Insufficiency

1) What?


2) Tx?

Back 123

1) Incompetent venous vales -->
Periph Edema,
Leg varicosities,
Stasis dermatitis,
Skin fibrosis,
Ulcers

2) Leg elevation;
Compression stockings

Front 124

Hyperthyroid Induced A-fib

1) How does hyperthyroidism induce A-fib?

2) Best Tx for these pts (Who are usually stable)?

Back 124

1) Hyperthyroid Increases sensitivity of beta-adrenoreceptors to sympathetic stimulie

2) beta-blocker

Front 125

Tachysystoli A-fib

1) What is tachysystolic A-fib?

2) 2 FX of TS a-fib on L. vent?

3) Best approach for tx-ing TSA A-fib?

Back 125

1) When a persin is in A-fib
BUT
Ventricular systole (QRS) is still > 100 BPM

2) LV Dilation -->
Dec EF

3) Rate or Rhythm CTL

Front 126

Secondary HTN

(Photocopy 1st AID notes on RAAS)

1) What is the MCC of secondary HTN?
a) Explain?
b) What is usually responsible for the stenosis of RAS?

2) Give some PE signs of RAS?

3) What RX class is CI in BIL RAS?
a) Why?

4) Misc Atherosclerosis Stuff
a) Assymetrically Inc BP in L. Arm?
b) Assym Inc BP in R. Arm
OR
Arms > Legs = what?

Back 126

1) RAS
a) RAS -->
Kidney sees less volume -->
Kidney releases Renin --.
Stim RAA System -->
Systemic Vasoconstriction
b) Atherosclerosis

2) Continuous periumbilical murmur

3) ACE I
a) BC ACE I -->
No Ang II.
Ang II maintains GFR by vasoconstriction Aff > Eff
a) Subclavian Art Stenosis
b) Coarctation of Aorta

Front 127

HCM

1) HCM leads to hypertropohy of what part of the myocardium?
a) HCM leads to what type of heart failiure?
b) TF what ;s the #1 tx? why?
c) Alternate Tx fr someone intol to beta-blockers?

Back 127

1) IV Septum
a) Diastolic heart failure
b) beta blockers. BC slow heart rate -->
Inc length of diastole -->
Inc heart filling (PL) -->
Dec outflow obstruction -->
Dec murmur
c) Cardiac CCB - Dilitiazem

Front 128

Lytes & HF
1) 3 electrolyte abnorms that are bad pognostic indicators for HF pts?

2) Why do pts in HF get hyponatremia?

3) Dec serum Na will -->
Inc in what 4 hormones?

4) 1st Tx to dec serum [Na]?

Back 128

1) Hyponatremia;
Hyperkalemia;
Hypokalemia

2) Inc HF -->
Inc H2O Retention -->
Dec [Na]

3) Renin;
Aldosterone;
Vasopressin (ADH(;
NE

4) Dec H2O Intake

Front 129

Pancreatitis --> ARDS

1) Pancreatitis can --> what?
a) 2 MCC pancreatitis?

2) What is the pathophys of ARDS?

3) Dx-ic criteria for ARDS?

4) Is ARDS a form cardiogenic or Non-cardiogenic pulm edema?
a) How to diff?

Back 129

1) ARDS
a) ETHOL, Gallstones

2) Endothelial Injury -->
Leakage of fluid from capps -->
Fluid fills alveoli -->
Inhib of gas exchange @ alveoli

3)
1. Acute onset
2. PaO@ / FIO2 < 200
3. BIL Infiltrates on CXR
4. Swanz-Ganz Pressure < 18 mm Hg

4) Non-cardiogenic pulm edema
a) Dec swanz-ganz pressure,
Absent JVD,
Absent cardiomegaly
=
Non-Cardiogenic Pulm Edema from ARDS

Front 130

Cocaine Induced Cx Pain

1) What kind of Rx is cocaine?
a) TF it can lead to what s/s?

2) What is 1st line meds for cocaine induced toxicity? Why for each:

Back 130

!) Sympathomimetic
a) Cx pain,
Tachy,
Vasoconstriciton --> Inc BP and Ischemia

2) Benzos = Dec anxiety, dec HTN, Dec tachy
ASA = Inhib thrombus formation
Nitrates = Vasodilate

Front 131

1st Degree Heart Block
1) What?
2) May be secondary to what 2 things?
3) Tx?

Back 131

1) PR Int > 0.2 S
2) Inc vagal tone;
Digitalis use
3) None! It is a benign Arrhythmia!

Front 132

Heat Stroke

1) Define?

2) Heat stroke -->
Hyperthermia & dehyderation. 5 signs of dehydration?

3) Hyperthermia can have multi-system FX. Why?
a) List some multi-system FX and theri manifestations (if possible)

Back 132

1) Body Temp > 105 degrees F

2) Hot, dry skin,
HYPO-TN,
Tachycardia,
Tachypnea,
Hemo [ ]

3) BC it disrupts enzymatic activity
a) Seizures
ARDS = Rales
DIC = Dec PLTs, Inc PT / INR, Inc PRR
Hepatic / Renal Failure

Front 133

PAC

1) How can you tell a premature atrial contraction on EKG?

2) Tx?

Back 133

1) Premie p-waves that differ in morphology from other p-waves

2) NONE. It's very benign.

Front 134

Pulsus Paradoxus

1) What?
a) Mech

2) When does PP become pathological?

3) Causes can be split into what 2 groups?
a) Mech in Asthma?

Back 134

1) A normal physiologic drop in SBP during inspiration
a)Inspiration -->
Inc blood into R. side of heart -->
R. side of heart pushes ito L. Heart -->
Dec filling of L. heart

2) When the drop in SBP during inspiration > 12 mm Hg

3) Cardiac and pulmonary
Cardiac:
Tamponade and Pericardial Effusion

Pulmonary:
Tension Pneumo and Severe asthma
a) Inc intrathoracic pressure -->
Dec filling L. Ventricle

Front 135

STEMI

1) Will pain from STEMIs ALWAYS improve w/ SL nitro?

2) What type of CCBs are CI'ed in cardiac ischemia.
Give example(s).
Why CI'ed?

3) Are non-dihydropyridine CCBs CI'ed in STEMI?
a) 2 examples of Non-dihydropyridine CCBs?

Back 135

1) No!

2) Dihydropyridine CCB.
Nifedipine.
Cause peripheral vasodilation and reflex tachycardia

3) NO
a) Dilitizaem; Verapamil

Front 136

V-Tach

1) Now I know when you hear VT you immediately think of ACLS algorhythm and think that the first tx is ALWAYS cardioversion. But that is not always teh case. Give the txs for cardioversion.

Back 136

1) VT w/out hemodynamic compromise:
Amiodarone (preferred);
Lidocaine

VT WITH Hemodynamic compromise:
Cardioversion

Front 137

Bacterial Endocarditis of TC valve

1) What pt pop is especially @ risk for BE of TC valve?

2) Vegetations on TC or pulm valve may go where and do what?

3) w/ IE septic emboli may also go to what other organ --> what?

4) What sort of murmur may you hear?

Back 137

1) IV drug users

2) May go to lung periphery and form round infiltrates as seen on CXR

3) Kidneys -->
Kidney probs (PRO-uria, inc BUN, Inc Cr)

4) Murmur of TC regurg

Front 138

BP

1) For most ppl, goal BP is < 140 / 90. However their are 2 groups of ppl who should keep their BP even lower. What are these 2 groups of ppl?

2) What should the BP be in diabetics and pts w/ CKD?

Back 138

1) Diabetics;
Pts w/ CKD.

2) < 130/80

Front 139

Aortic Regurg

1) What is one maneuver that will increase afterload and TF make the murmur of aortic regurg more prominent?

2) What are the 2 best medical tx for Aortic Regurg?

Back 139

1) Handgrip

2) CCB or ACE I

Front 140

Cushings SYNDROME --> Secondary HTN

1) What is the problem in Cushing's SYNDROME that drives all the s/s?

2) What are 4 causes of excess blood cortisol?

3) High levels of cortisol --> What --> What s/s?

Back 140

1) Excess blood cortisol

2) Adrenal cortical hyperplasia;
Cushing's Dz (ACTH-producting pituitary adenoma);
Ectopic ACTH production;
Exogenous Steroid administration

3)
1. Vasoconstriction --> HTN
2. Insulin resistance --> Hyperglycemia, Central adiposity, thinning of skin, wt gain, psych problems
3. Hypokalemia --> Proximal muscle weakness

Front 141

A-Fib

***SEE case files for your flow chart of how to tx a-fib***

1) Remember, that in acute a-fib your first goal is to stabilize pt. If pt is stabilized, your 2nd goal is to CTL rhythm. What are 2 agents that are used to CTL rhythm in A-fib?
a) Why are they used?

Back 141

1) beta-blockers, CCB
a) BC they slow conduction through AV node

Front 142

PE

1) What is one part of a pt's hx that is "Classic" for PE?

2) What are the MC PE findigns in pts w/ PE?

3) 1 lab test for PE?

4) How will CXR look for PE?

5) pleural effsions will show what on CXR?

Back 142

1) Chest pain AFTER long periods of immobility

2) Tachypnea, Tachycardia

3) Elevated D-dimer

4) NORMAL!

5) Blunting of costophrenic angles

Front 143

Coarctation of Aorta

1) Coarctation of aorta most commonly occurs where?

2) Sx of coarctation of aorta?

3) PE for coarctation of aorta?

4) 4 signs on CXR?

Back 143

1) Distal to the origin of the L. subclavian artery,
@ the site of the ligamentum arteriosum

2) HA, Epistaxis, Cold extremities

3) Delayed femoral artery pulses;
HTN in UE

4) Dilated L. Subclavian Art;
Dilated Ascending Aorta;
Rib notching;
"3-sign"

Front 144

Cardiac Tamponade

1) What are the classic PE findings for cardiac tamponade?

2) Is cardiac tamponade a systolic OR diastolic dysfnctn?

Back 144

1) Beck's Triad:
HYPO-TN,
JVD,
Muffled Heart Sounds
AND
Pulsus Paradoxus

2) DIASTOLIC DYSFNCTN

Front 145

Statins SE

1) Statins can --> what complaints by pt?

2) statins can elevate what enz levels?

Back 145

1) Myalgias (aches and pains)

2) CPK,
AST,
ALT

Front 146

Some Cardiac Measurements

1) PCWP indicates what?
a) If elevated it indicates what?

2) If systemic vascular resistance is elevated in heart failure, explain why?


2)

Back 146

1) L. atrial pressure and
TF
LV End Diastolic Pressure
a) Low CO and LV failure

2) SVR will be elevated in heart failure as a result of neurohumoral activation (symp stim of RAAS) in order to preserve CO and maintain perfusion pressure

Front 147

Rheumatic Heart Dz

1) Rheumatic heart dz will occur when after a pt has an episode of what?
a) What is rheumatic fever?
b) So give the progression.

2) How to dx Rheumatic Fever?
a) Give the major and minor criteria

3) What is the MC valvular complication of Rheumatic Fever?

4) Repeat episodes of rheumatic fever --> Rheumatic heart dz can significantly worsen valvular fncnt. TF it is nevesarry that pts w/ a prior episode of rheumatic fever be given what?

Back 147

1) Rheumatic fever
a) A sequelae of untreated strep phargyngitis (GAS pharyngitis)
b) Untreated strep pharyngitis (GAS Pharyngitis)
-->
Rheumatic Fever -->
Rheumatic Heart Dz

2) 2 Major Criteria
OR
2 Major Criteria and 2 Minor Criteria
OR
5 Minor Criteria

a)
Major Criteria:
Carditis,
Chorea,
Polyarthritis,
Rash (Erythema Marginatum),
Sub-Q Nodules

Minor Criteria:
Arthralgias,
Fever,
Elevated Acute Phase Reactants,
Prolonged PR Interval

3) Mitral Stenosis

4) PCN prophylaxis until 18 y/o

Front 148

RCA occlusion

1) Occlusion of the R. coronary artery will show what on EKG?

2) What else will you notice w/ R. coronary artery occlusion?

Back 148

1) ST elevation in II, III, aVF

2) Bradycardia and HYPO-TN bc RCA also supplies the SA node

Front 149

SVT

1) 1st line tx for SVT?

2) 2nd line tx for SVT?

3) 3rd line tx for SVT?

Back 149

1) Carotid massage

2) Adenosine

3) CCB, beta blocker or cardioversion

Front 150

HTN

1) What is 1st line intervention for someone w/ High BP?

2) IF lifestyle mods don't work, what class of meds should be given first?

3) What class of medication is CI'ed in asthma pts?

Back 150

1) Lifestyle mods

2) Thiazide diuretics

3) beta-blockers

Front 151

Niacin (Nicotinic acid) for TGs

1) What are 2 SE of niacin (Nicotinic ACid) for TGs?
a) MEch by which niacin (nicotinic acid ) causes flushing and pruritus?
c) How can the flushing and pruritus be tx'ed?

Back 151

1) Flushing and pruritus
a) PG induced peripheral vasodilation
b) ASA

Front 152

Study the diff types of shock!

Study what MVO2 means!

Back 152

Study the diff types of shock!

Study what MVO2 means!

Front 153

Secondary Preventions

1) What 4 meds should be given as secondary preention after an MI?

2) What medication is used in secondary prevention for all pts w/ UA / NSTEMI?

3) What medication should be used as secondary prevention for all pts post-PCI?

4) MOA of clopidogrel?

5) What is another drug w/ the same MOA as clopidogrel?

Back 153

1) ASA;
beta-blockers;
ACE I;
Statins

2) Clopidogrel

3) Clopidogrel

4) ADP receptor antagonist -->
No PLT aggregation

5) Ticlopidine

Front 154

Edema

1) Both heart disease AND liver liver dz can cause edema. How can you differentiate b/t them on PE?

Back 154

1) Cardiac Et: Positive Hepato-Jugular reflex
Hepatic et: Negative Hepato-Jugular Reflex

Front 155

1) Name 5 lifestyle modifications to decrease BP?

Back 155

1) Diet,
Salt restriction,
Exercise,
Smoking cessation,
Modest ETHOL intake

Front 156

Edema

1) Both heart disease AND liver liver dz can cause edema. How can you differentiate b/t them on PE?

Back 156

1) Cardiac Et: Positive Hepato-Jugular reflex
Hepatic et: Negative Hepato-Jugular Reflex

Front 157

Secondary Preventions

1) What 4 meds should be given as secondary preention after an MI?

2) What medication is used in secondary prevention for all pts w/ UA / NSTEMI?

3) What medication should be used as secondary prevention for all pts post-PCI?

4) MOA of clopidogrel?

5) What is another drug w/ the same MOA as clopidogrel?

Back 157

1) ASA;
beta-blockers;
ACE I;
Statins

2) Clopidogrel

3) Clopidogrel

4) ADP receptor antagonist -->
No PLT aggregation

5) Ticlopidine

Front 158

Edema

1) Both heart disease AND liver liver dz can cause edema. How can you differentiate b/t them on PE?

Back 158

1) Cardiac Et: Positive Hepato-Jugular reflex
Hepatic et: Negative Hepato-Jugular Reflex

Front 159

1) Name 5 lifestyle modifications to decrease BP?

Back 159

1) Diet,
Low salt intake,
Exercise,
Smoking cessation,
Modest ETHOL intake

Front 160

PKD (Polycystic Kidney Disease)

1) Give the clinical picture of polycystic kidney dz?

2) What are the genetics of PKD?

3) PKD is associated w/ what vascular disorder?

4) PTs w/ PKD may have a family hx of what 2 things?

Back 160

1) Bilateral cystic dilation of renal tubules,
HTN,
HEmaturia,
Flank / ABD masses,
Pain,
Secondary Erythrocytosis (from EPO production),
renal failure

2) Autosomal dominant

3) Cerebral aneurysms

4) Stroke and sudden death

Front 161

CHF

1) In otherwise young, healthy pts w/ CHF, what dx should be considered high on the DDX?
a) What is the MCC of myocarditis?

Back 161

1) Myocarditis
a) Viral Infxn (esp Coxsackie B)

Front 162

Bacterial Endocarditis

1) Infxn of native heart valves during an episode of bacterial endocarditis, is usually w/ what organism?

2) Are PO ABX ever appropriate tx for bacterial endocarditis!

3) What is appropriate tx for Strep viridans bacterial endocarditis?

Back 162

1) Strep viridans

2) NO!

3) IV Pen G
or
IV Ceftriaxone

Front 163

Ventricular Aneurysm

1) VA's often often after what?

2) Give the common sequelae of ventricular aneurysms?

3) Give some of the characteristics of mitral regurg

4) What is seen on EKG for pts w/ Ventricular Aneurysms?

5) What does echocardiography show for pts w/ Ventricular wall aneurysms?

Back 163

1) VAs often occur after MIs

2) Sx of CHF;
Ventricular Arrythmias,
Mitral Regurg;
Thrombus Formation

3) PAnsystolic murmur @ apex w/ radiation to the axilla

4) Persistent ST elevations

5) Dyskinetic or Akinetic wall motion

Front 164

2nd degree AV block Mobitz Type I Wenckebach

1) What are some causes of 2nd Degree AV block, Mobitz Type I Wenckebach?

Back 164

1) Digitalis toxicity,
Inc vagal tone,
Inferior wall MI,
Structural heart dz that FX that AV node

Front 165

Glomerulonephritis Induced Peripheral Edema

1) Glomerular dz can present w/ signs of significant volume overload. Give 3 examples?

2) What does the urine sediment show in Glomerulonephritis?

3) In glomerulonephritis, 3rd spacing can occur. This will have what effect on the GFR --> what?

Back 165

1) Pulmonary Edema;
Distended Neck Veins;
Anasarca

2) RBCs, RBC Casts, WBCs

3) 3rd spacing -->
Dec intravascular volume -->
Dec GFR -->
Na retention -->
HTN!!

Front 166

Orthostatic HTN

1) When you think about orthostatic HTN, do NOT ONLY think about autonomic dysregulation. You also need to consider what as a cause of his / her OH?

2) Give one value that is VERY sensitive, but NOT very specific, for a pts hydration status?
a) Will the BUN / Cr be high or low in a dehydrated pt?

Back 166

1) Dehydration (Hypovolemia)

2) BUN / CR
a) High!

Front 167

CHF
1) Name the drugs that are helpful in the reduction of SX of CHF?

2) Name the drugs that have a long term mortality benefit for CHF?

Back 167

1) Na Restriction, Loop Diuretics;
Nitrates, Nitrites;
Digoxin

2) ACE I, ARBs, beta-blockers and Aldosterone Antags (Spirinolactone)

Front 168

Pacemaker Insertion

1) What are the indications for pacemaker insertion?

Back 168

1) Sx-ic Bradycardia;
2nd Degree AV node block Mobitz Type II;
3rd Degree AV node block

Front 169

Murmur Investigation

1) What type of murmurs should and shouldn't be investigated?
a) How to investigate murmurs further?

2) What type of murmurs do NOT need further investigation?

Back 169

1) YOU SHOULD INVESTIGATE:
Diastolic murmurs;
Continuous murmurs;
Loud Systolic murmurs
a) Doppler echocardiography

2) Midsystolic soft murmurs (grade I - II / VI) in an asx-ic young pt

Front 170

Flecainide

1) Belongs to what class of Rx?

2) MOA of class IC AA?
a) Of all the class I agents, Class IC medications have what unique effect?
b) TF what effect of Class IC agents can be seen on EKG?

Back 170

1) Class IC Anti-arrhythmics

2) Block Na channs -->
Lengthen the amt of time for depolarization and TF prolong the A.P.
a) They have the slowest binding and dissocation from the Na channel
b) Prolonged QRS

Front 171

Aor Dissection --> Tamponade

1) Tamponade will show what 3 signs (Beck's Triad)?

2) What type of dysfnctn will occur in a pt w/ cardiac tamponade?

3) One unusual pulse sign that may occur in tamponade?

Back 171

1) HYPO-TN;
Muffled Heart Sounds;
JVD

2) Diastolic dysfnctn -->
Dec preload -->
Dec CO -->
SYNCOPE!

3) Pulsus paradoxus

Front 172

MR

1) Describe the murmur o Mitral REgurg?

Back 172

1) Holosystolic murmur, best heard @ the apex w/ radiation to teh axilla

Front 173

Myxomas

1) What is the MC primary intracardiac tumors?

2) What is the MC location for atrial myxomas?

3) If a mass is demonstrated in the L. atrium, there is a DDx of 2 things. What are those 2 things?

4) Atrial myxomas in the L. atrium can cause a murmur that resembles what?

Back 173

1) Atrial myxomas

2) L. atrium

3) Thrombus, Tumor

4) Mitral Stenosis

Front 174

MISC

1) What is teh best SCREENING test for underlying cardiac dz in a low risk population?

2) What test is teh standard method for confirming possible HCM after suspicion has been raised on H&P?

Back 174

1) H&P

2) Echocardiography

Front 175

More CHF

1) BNP is secreted by what and when?
a) BNP is used to differentiate what?

Back 175

1) Ventricles in response to increase venticular stretch
a) Dyspnea of Heart failure (high BNP) from dyspnea of non-cardiac etiology (Low BNP)

Front 176

What are the American College of Cardiology's and AHA's Indications for Aortic Valve Replacement?

Back 176

Anyone of the Following:
1. Sx-ic (SAD: Syncope, Angina, Dyspnea)
2. Pts w/ severe AS undergoing CABG or valvular surgery
3. Asx-ic pts w/ severe AS and either:
a) poor LV systolic Fnctn
b) LV Hypertrophy > 15 mm
c) Valve Area < 0.6 cm2
d) Abnormal response to exercise (HYPO-TN)

Front 177

Norepinenphrine Induced Vasospasm

1) What is one negative effect of nor-epi on extremities?

Back 177

1) NE can lead to peripheral vasospasm -->
ischemia and necrosis of fingers and toes (as evidenced by symmetric duskiness and coolness of fingers and toes)

Front 178

Where Are The Following Potential Causes of Bacterial Endocarditis Originate:
a) Upper respiratory tract
b) Urinary tract?
c) Skin?
d) In pt w/ normal heart valves?

Back 178

a) Viridans Streptococci?
b) Enterococci
c) Coag Negative Staph
d) Staph aureus

Front 179

Heart Failure TX

1) Give the tx for HF sx?
a) Which one works the fastest?
b) Apart from NTG, what is the mainstay for CHF sx?

2) What are the 2 drugs used to tx HF LT (dec mortality)

Back 179

1) Na restriction, Loop Diuretics;
Nitrates and Nitrites;
Digoxin
a) Nitrates (Nitroglycerin - NTG)
b) Loop diuretics

2) ACEI,
beta-blockers

Front 180

Vasovagal Syncope

1) What is another name for vaso-vagal syncope?

2) How do you dx vasovagal syncope?

Back 180

1) Neurocardiogenic Syncope

2) Tilt Table Test

Front 181

FX of Nitrates (Like Nitroglycerin)

1) How do Nitrates (Like NTG) decrease pain from MI?

Back 181

1) Nitrates (Like NTG) Have 2 Major MOAs:
a) MOST IMPT MOA:
Venodilation -->
Inc venous capacity -->
Dec PL -->
Dec Myocardial Work -->
Dec MvO2

b) LESS IMPT MOA:
Arterial Vasodilation -->
Dec afterload -->
Dec Myocardial work -->
Dec MVO2

Front 182

OCPs

1) You already know that one of the major risks of OCPS is thrombus formation. But you also need to remember that another potential risk of OCPs is what?

Back 182

1) HTN

Front 183

Stable Angina

1) A person w/ stable angina should have what test performed first?
a) If baseline EKG is normal, what is the next best step?

2) 2 RF for atherosclerosis that you probably didn't think about?

Back 183

1) Baseline EKG
a) Exercise EKG

2) SLE and Chronic Steroid Use