Usmle 3 Cardiology 2

Front 1

INR

Back 1

- < 5 : hold warfarin 1-2 days
5-9: hold warfarin, admin low dose vit K
- > 9 high dose vit K
- any bleeding: IV K, FFP, recombinant factor VIIa, or prothrombin complex concentrate

Front 2

3v disease

Back 2

- CABG
- stenting is bad in DM pts because high risk of restenosis

Front 3

when do you see brady s/p MI?

Back 3

- inferior wall MI
- usually resolves in 24-48 hours, and asympt
- if hemodynamically unstable then first temporary transvenous pacer and then get perQ transluminal coronary angioplasty (PTCA)

Front 4

most common cause of secondary HTN in young pts?

Back 4

- renal parenchymal disease
- next is endocrine etiology
- third is renovascular disease

Front 5

hyponatremia in CHF?

Back 5

- pt is volume overloaded but b/c of HF, renal arterioles are not perfused and so increase ADH and no diuresis
- pt usually asymptomatic, just fluid restrict

Front 6

which DM med causes CHF?

Back 6

- pioglitazone (thiazolidinediones)

Front 7

stable angina-- next step?

Back 7

- rx nitro and do excercise stress NOT AS A DX WORKUP but as a RISK STRATIFICATION
- angiography for chronic stable angina only if high risk on exercise stress or sx despite max medical therapy

Front 8

greatest risk factor in AAA?

Back 8

- smoking >HTN, cholesterol, alcohol, DM

Front 9

young kid with mitral regurg?

Back 9

- chordae tendinae rupture
- old guys s/p MI have papillaru muscle rupture

Front 10

marfan vs ehlers danlos

Back 10

- marfan: (tall and thin-- mitral valve is stretched) chronic progressive mitral regurg, rarely acute regurg 2/2 ruptured chordae tendineae; arachnodactyly, loose joints
- ehlers: (hyperflexible-- including vessels = berry aneurysms) acute rupture of chordae tendineae, pes planus, scoliosis, velvety thin scars

Front 11

tx of torsades

Back 11

- unstable: defib (polymorphic Vtach)
- stable: mg sulfate

Front 12

tx of acute decompensated HF?

Back 12

- decrease preload e.g. diuretics