Mksap 16 Cardio Part 1

Front 1

xtypical innocent-sounding heart murmurs

Back 1

1-2/6 short systolic mid-peaking murmurs along left sternal border

Front 2

When is coronary angiography indicated? (3)

Back 2

CSAP with progressive symptoms despite optimal medical therapy, difficulty tolerating medical therapy; high-risk findings on exercise testing

Front 3

How frequently should routine periodic echo be obtained in mild AS, asymptomatic patients?

Back 3

not more than every 3-5 years

Front 4

treatment of claudication symptoms that is stable

Back 4

medical therapy + exercise; NOT percutaneous or revascularization

Front 5

screening for AAA - who should be screened, how and how often?

Back 5

men 65-75 who smoked, 1-time abd US; do not repeat after a normal study

Front 6

leading cause of death in CKD patients

Back 6

CV disease

Front 7

What is the LAPS trial (Lupus Atherosclerosis Prevention Study)?

Back 7

this study failed to show benefit of statins on progression of coronary artery calcification, carotid intima media thickness, or carotid plaque over 2-years in SLE

Front 8

preferred diagnostic test in symptomatic patients with intermediate probability of CAD

Back 8

cardiac stress testing

Front 9

medication change prior to exercise stress testing

Back 9

β-Blockers should be withheld for 24 to 48 hours

Front 10

what is an "indeterminate" or "submaximal" stress test?

Back 10

negative stress test but adequate workload was not achieved

Front 11

When to use pharmacologic stressors?

Back 11

when patient cannot achieve at least 5 METS

Front 12

MOA of dobutamine as pharmacologic stressor

Back 12

increases myocardial contractility and oxygen demand

Front 13

MOA of adenosine, dipyridamole, regadenoson as a pharmacologic stressor

Back 13

induce regional hypoperfusion through coronary vasodilation

Front 14

Contraindications to exercise ECG testing (6)

Back 14

(MI, arrhythmia, AS, HF, PE, Ao diss) = recent MI (<30 days), uncontrolled arrhythmia, symptomatic severe AS, acute decompensated HF, acute PE, acute aortic dissection

Front 15

radioisotopes used in SPECT studies

Back 15

thallium and technetium

Front 16

medication change prior to adenosine

Back 16

caffeine hold x 24 hours before adenosine (caffeine is an adenosine receptor antagonist)

Front 17

NOTE: CAC scoring is

Back 17

sensitive but not very specific for CAD.

Front 18

cholesterol embolism - lab findings?

Back 18

urine and peripheral eosinophilia

Front 19

groin tenderness, a pulsatile mass, or a femoral bruit is present following coronary angio - Dx? Tx?

Back 19

AV fistula or pseudoaneurysm; Tx with US-guided compression, surgical repair if still bleeding, or nerve compression

Front 20

post-coronary angio, patient presents with hemodynatmic instability or rapidly decreasing Hct - next step?

Back 20

noncontrast abdominal CT

Front 21

TEE provides clearer images of these structures

Back 21

LA and MV

Front 22

TEE appropriate as initial test in these conditions (4)

Back 22

detection of LA thrombus, prosthetic valve dysfunction, and aortic dissection, high probability of endocarditis

Front 23

indication for PA catheters

Back 23

hemodynamically unstable patients, typically those requiring inotropic or vasopressor support

Front 24

goals of B blocker therapy in CSAP

Back 24

HR 55-60/min and ~75% of the heart rate that produces angina with exertion

Front 25

Absolute contraindications to β-blockers (4)

Back 25

severe bradycardia, advanced AV block, decompensated HF, severe reactive airways disease. (use calcium channel blockers instead)

Front 26

Side effects of calcium channel blockers (4)

Back 26

peripheral edema, constipation, dizziness, headache

Front 27

when is ranolazine indicated?

Back 27

symptomatic CSAP despite B blockers, calcium channel blockers and nitrates

Front 28

MOA of ranolazine

Back 28

selective inhibition of the late sodium channel

Front 29

S/E of ranolazine

Back 29

prolonged QT, caution with kidney or liver disease

Front 30

2 indications for combination therapy with ASA and clopidogrel

Back 30

recent MI or stent placement

Front 31

MOA of ezetimibe

Back 31

inhibits cholesterol absorption

Front 32

NOTE: Although studies have found dramatic reductions in LDL cholesterol levels,

Back 32

ezetimibe has not been shown to reduce the progression of atherosclerosis or future cardiovascular events.