Shared Flashcard Set

Details

Cardiology
PANRE prep
288
Medical
Not Applicable
02/17/2016

Additional Medical Flashcards

 


 

Cards

Term
What underlying disease state is likely in a patient with a malar rash and a recurrent DVT?
Definition

Systemic Lupus Erythematosus (SLE) with antiphospholipid syndrome

Term
Calf pain with dorsiflexion of the ankle describes what sign?
Definition
Homan's Sign
Term
What skin condition is commonly associated with venous insufficiency of the lower extremities?
Definition
Stasis Dermatitis
Term
What congenital abnormality should be considered with a child who frequently squats?
Definition
Tetralogy of Fallot
Term
What is the medical treatment of patent ductus arteriosus (PDA)?
Definition
Indomethacin
Term
What are painless lesions on the hands which occur with endocarditis?
Definition
Janeway lesions
Term
What are painful lesions on the hands which occur with endocarditis?
Definition
Osler's nodes
Term
What is the pathognomonic echocardiogram finding in pericardial tamponade?
Definition
Collapse of the right ventricle
Term
You have performed pericardial centesis. How do you ensure you are in the pericardial space?
Definition
Blood evacuated from the pericardial space does not clot.
Term
What is the rise in jugular pressure which occurs with inspiration in a patient with pericardial tamponade called?
Definition
Kussmaul sign
Term
What are the 3 "D" findings of pericardial tamponade?
Definition
Distant heart sounds - Distended jugular veins - Decreased arterial pressure
Term
What is the diameter of an aortic aneurysm at which surgical intervention is recommended?
Definition
> 5.4 cm
Term
What is the recommended initial treatment for a Stanford type B aortic dissection?
Definition
Medical treatment
Term
What is the diameter of an aortic aneurysm at which surgical intervention is recommended?
Definition
> 5.4 cm
Term
What is the Stanford classification of an aortic dissection of the descending aorta?
Definition
Type B
Term
What is the Stanford classification of a dissection of the ascending aorta?
Definition
Type A
Term
What is the initial dose of clopidogrel (Plavix) in acute MI?
Definition
300 mg
Term
Should heparin or enoxaparin (Lovenox) be used for a patient with a CrCl < 15?
Definition
Heparin (enoxaparin is contraindicated for CrCl < 15)
Term
What diuretic can be used if furosemide is not available?
Definition
Bumetanide
Term
List 5 side effects of amiodarone.
Definition

-Pulmonary HTN

- Elevated LFTs

- Hypothyroid

- Hyperthyroid

- Iodine allergy

Term
What are the 2 recommended statins for treatment in acute MI?
Definition
Atorvastatin 80 mg or rosuvastatin 40 mg
Term
What three tests are recommended before starting amiodarone?
Definition

-Thyroid panel

- Pulmonary function testing

- Liver function test

Term
What is the treatment for angina in a patient who is allergic to nitrates?
Definition
Calcium channel blockers
Term
What is the treatment for Prinzmetal angina?
Definition
Calcium channel blockers
Term
What is Virchows triad?
Definition

-Stasis

- Hypercoagulable state

- Trauma

= risk of venous thrombus

Term
What is the most likely cause of syncope which occurs after a period of prolonged motionless standing?
Definition
Neurocardiogenic (vasovagal)
Term
What is the most likely cause of syncope which occurs in a child during an argument?
Definition
Long QT syndrome
Term
What is the most likely cause of syncope in an older adult which occurs during an argument?
Definition
Myocardial ischemia
Term
What is the most likely cause of syncope which occurs while shaving and has an associated bradycardia?
Definition
Carotid sinus hypersensitivity
Term
What is the most likely cause of syncope which occurs after arising quickly form a chair?
Definition
Orthostasis
Term
What is the most likely cause of orthostatic hypotension in which there is no reflex increase in heart rate?
Definition

Autonomic dysfunction

(examples: age diabetes)

Term
What does severe elevation of BP without end organ dysfunction define?
Definition
Hypertensive urgency
Term
What does a BP> 180/120 with end organ dysfunction define?
Definition
Hypertensive emergency
Term
Use of which antihypertensive medications is cautioned after recent MI?
Definition
Minoxidil - Clonidine
Term
Use of which antihypertensive medications is cautioned after cataract surgery?
Definition
Alpha blockers
Term
Which antihypertensive medications are contraindicated with bradycardia or heart block?
Definition

-Beta blockers

- Non-dihydropyridine CCB

- Central agents (clonidine)

Term
Which antihypertensive medications are contraindicated with asthma and isolated PAD?
Definition
Beta blockers
Term
Which antihypertensive medications are contraindicated with pregnancy?
Definition

-ACE inhibitors

- Angiotensin II receptor blockers

- Thiazide diuretics

- Direct renin inhibitors

Term
Which antihypertensive medications are contraindicated with renal artery stenosis?
Definition

ACE inhibitors and Angiotensin II receptor blockers

(Note: caution with direct renin inhibitors)

Term
Which anti hypertensive medications can cause pericardial effusion?
Definition
Minoxidil
Term
What class of medication should you think of when you see the suffix "azosin"?
Definition

Alpha blockers

- example doxAZOSIN

Term
What class of medication should you think of when you see the suffix "dipine"?
Definition

Dihydropyridine calcium channel blockers

- example amloDIPINE

Term
What class of medication should you think of when you see the suffix "sartan"?
Definition

Angiotension II receptor blockers

- example loSARTAN

Term
What class of medication should you think of when you see the suffix "olol"?
Definition

Beta blockers

- example metoprOLOL

Term
What class of medication should you think of when you see the suffix "pril"?
Definition

ACE inhibitors

- example enalaPRIL

Term
Which antihypertensive medication can cause hypertrichosis?
Definition
Minoxidil
Term
Which antihypertensive medications can cause hyperuricemia?
Definition

Thiazide diuretics

(e.g. Hydrochlorothiazide (HCTZ) - Chlorthalidone)

Term
Which antihypertensive medications can cause hypokalemia?
Definition
Thiazide diuretics (e.g. Hydrochlorothiazide (HCTZ) - Chlorthalidone)
Term
Which antihypertensive medications can cause edema?
Definition

-Dihydropyridine CCB  (e.g. amlodipine nifedipine)             - Benzothiazepine CCB  (diltiazem)

- Minoxidil

Term
Which antihypertensive medications can cause diarrhea?
Definition
Direct renin inhibitors
Term
Which antihypertensive medications can cause constipation?
Definition
Verapamil - Central agents (clonidine)
Term
Which antihypertensive medications can cause AV block?
Definition
Non-dihydropyridine CCB - Central agents (clonidine)
Term
Which antihypertensive medications can cause depression?
Definition
Beta blockers - Central agents (clonidine)
Term
Which antihypertensive medications can cause bradycardia?
Definition
Beta blockers - Non-dihydropyridine CCB - Central agents (clonidine)
Term
Which antihypertensive medications can cause cough?
Definition
ACE inhibitors
Term
Which antihypertensive medications can cause hyperkalemia?
Definition
ACE inhibitors - Angiotensin II receptor blockers (ARBs) - Direct renin inhibitors - Aldosterone antagonists (spironolactone)
Term
Which antihypertensive medications can cause angioedema?
Definition
ACE inhibitors - Angiotensin II receptor blockers (ARBs) - Direct renin inhibitors
Term
What is the treatment for constrictive cardiomyopathy?
Definition
Pericardial stripping
Term
What is the most common cause of constrictive cardiomyopathy?
Definition
Radiation therapy
Term
List 6 causes of restrictive cardiomyopathy.
Definition
Amyloidosis - Hemochromatosis - Sarcoidosis - Scleroderma - Fibrosis - Cancer
Term
List two types of surgical procedures to correct HOCM.
Definition
Open heart and excision - Alcohol ablation done through cardiac cath
Term
What heart sound will likely be present with HOCM?
Definition
S4
Term
List three medications which may be used both to prevent arrhythmia and ease symptoms with HOCM.
Definition
Diuretics - Beta blockers - Non-dihydropyridine CCB (verapamil or diltiazem)
Term
Once a patient is diagnosed with HOCM what family counseling must be done?
Definition
Entire family must be screened for HOCM
Term
Angina syncope and heart failure in a child likely represents ____________.
Definition
HOCM (Hypertrophic Cardiomyopathy)
Term
Angina syncope and heart failure in an adult likely represents _____________.
Definition
Aortic stenosis
Term
What condition is right ventricular collapse on echocardiogram pathognomonic for?
Definition
Pericardial tamponade
Term
What type of heart failure may pericardial tamponade initially present like?
Definition
Right heart failure: Tamponade looks like right heart failure because the right ventricle is the weakest of the two and collapses first due to the fluid around the heart
Term
What type of heart failure will have an abnormal E-A wave ratio on echocardiogram?
Definition
Diastolic heart failure
Term
What two populations more commonly have diastolic heart failure?
Definition
Elderly women and black patients
Term
Digoxin should never be used for which type of heart failure?
Definition
Diastolic
Term
List 5 causes of systolic heart failure.
Definition
CAD (ischemia) - Tako Tsubo - Cocaine - Viral illness - Chemo/radiation
Term
Once a patient on a balloon pump can tolerate a ratio of ___:___ removal may be considered.
Definition
3 : 1 - Once patient only requires assist every third beat removal may be considered
Term
What balloon pump setting would be best for initial treatment of the acute patient in cardiogenic shock?
Definition
1 : 1 Balloon pump assists with every beat
Term
What is the most likely disorder in a patient with apical ballooning on echo and a presentation similar to MI?
Definition
Tako Tsubo
Term
List the major systemic affects of amiodarone therapy?
Definition
Pulmonary fibrosis - Infiltrative liver disease - Hyper OR hypothyroid state
Term
What will most likely happen to the INR of a patient on warfarin when they are given amiodarone?
Definition
INR increases
Term
What characteristic will be seen in blood which is drawn from with in the pericardial sac during pericardial centesis?
Definition
Blood does not clot when put into tray (+ clotting = not in the pericardial space)
Term
What is the INR goal for a patient on warfarin for a mechanical heart valve?
Definition
2.5 - 3.5
Term
What is the treatment for thrombophlebitis?
Definition
One month of low molecular weight heparin
Term
Orthostasis is defined as a change of > __ mmHg systolic or __ mmHg diastolic BP __ minutes after change from supine to standing.
Definition
> 20 mmHg systolic or 10 mmHg diastolic BP 2-5 minutes after change from supine to standing
Term
What test should be ordered for a patient with suspected pheochromocytoma?
Definition
Urine for VMA (Vanillylmandelic acid)
Term
What secondary cause of HTN will present with abdominal bruits? What is the first diagnostic test?
Definition
Renal artery stenosis - Renal artery doppler is the initial test
Term
Combination therapy with at least 2 agents is recommended for patients with which stage of HTN?
Definition
Stage 2 HTN - Initiate treatment with 2 or more agents
Term
When treating a patient with hypertensive urgency the goal is not to reduce the BP more than __% in __ hours?
Definition
Goal is to reduce blood pressure no more than 25% every 1-2 hours
Term
List the classifications of blood pressure as per JNC VII.
Definition
Prehypertension = 120-139/80-90 - Stage 1 = 140-159/90-99 - Stage 2 = >160/100
Term
List the NYHA classification of CHF.
Definition

-I asymptomatic

- II symptoms with moderate exertion

- III symptoms with minimal exertion

- IV symptoms at rest

Term
What are the signs of HOCM on exam?
Definition

-Apical lift

- S4 gallop

- Ejection murmur medial to apex

Term
Constrictive Cardiomyopathy occurs by what mechanism?
Definition
Pericardial sac constricts
Term
Restrictive Cardiomyopathy occurs by what mechanism?
Definition
Deposition into or between the myocardial cells
Term
What causes the sudden cardiac death in a HOCM patient?
Definition
Ventricular tachycardia that degenerates into ventricular fibrillation
Term
What maneuver makes the HOCM murmur louder?
Definition
Valsalva or standing
Term
What is the treatment for dilated cardiomyopathy?
Definition

Same as systolic heart failure

(- Beta blocker - Loop Diuretic - ACE inhibitor)

Term
Non-cardiac hypoxia (e.g. pneumonia, COPD) commonly causes what arrhythmia?
Definition
Atrial fibrillation
Term
What arrhythmia can occur with structural changes such as hypertrophy or dilatation of the ventricle?
Definition
Ventricular tachycardia
Term
What two murmurs are most associated with atrial fibrillation?
Definition

 -Mitral stenosis

- Mitral regurgitation

Term
What valvulopathy increases afterload?
Definition
Aortic stenosis
Term
What murmur is heard with MVP (Mitral Valve Prolapse)?
Definition
Midsystolic click
Term
What heart valve murmur rarely causes a symptomatic problem?
Definition
Pulmonary regurgitation
Term
Which electrolyte disorder can increase the chance of digoxin toxicity?
Definition
Hypokalemia
Term

What drug can produce blue vision?

 

Definition

Sildenafil

 

Term
What cardiac drug can cause hypo or hyperthyroidism?
Definition
Amiodarone
Term
What cardiac drug can produce yellow vision?
Definition
Digoxin
Term
What does a Beta blocker do for a post AMI patient?
Definition
Prevents arrhythmia and reduces cardiac work load
Term
What does an ACE inhibitor/ARB do for a post AMI patient?
Definition
Decreases afterload to rest myocardium and prevents/decreases remodeling
Term
After a stent, in addition to ASA, what oral antiplatelet agent is used?
Definition
Clopidogrel
Term
What leads represent lateral wall?
Definition

V5

V6

I

AVL

Term
What leads represent anterior wall?
Definition

V3

V4

Term
What three leads represent inferior wall of the heart?
Definition

II

III

AVF

Term
What lab most sensitive for AMI?
Definition

Troponin

 

Term
Myocardial damage occurs after how many minutes of ischemia?
Definition

30 minutes

 

Term
Agent of choice for acute angina treatment?
Definition

Nitroglycerine

 

Term
What medication is best for Prinzmetal's angina?
Definition

Calcium channel blockers

 

Term
What EKG changes are seen in a patient during a Prinzmetal attack?
Definition

ST elevations which resolve after attack (Persistent elevations suggest MI)

 

Term
First medication to give in a patient suspected of having an AMI?
Definition

Aspirin

 

Term
What is a complication of cardiac cath that causes Grey-Turner's sign?
Definition

Retroperitoneal hematoma

 

Term
What disorder is most likely in a patient with calf pain with walking that improves with rest?
Definition

Peripheral Artery Disease

 

Term
What is calf pain with walking that improves with rest called?
Definition

Claudication

 

Term
What three criteria define a heart attack?
Definition

- EKG changes

- Chest pain

- Elevated cardiac enzymes

Term
Why are post menopausal women more prone to heart disease?
Definition

Estrogen is cardio protective

 

Term
What are the modifiable cardiac risk factors?
Definition

- Smoking

- DM

- Cholesterol

- Blood pressure

- Obesity

Term
What do low ejection fraction and hypertrophic (HOCM) heart have in common?
Definition

Sudden death due to VT

 

Term
Stress heart attack (Tako Tsubo) treatment?
Definition

Same as acute myocardial infarction patient

 

Term
What happens to renal function during cardiogenic shock?
Definition

Reduced cardiac flow = reduced kidney perfusion this leads to pre-renal failure then ATN if not corrected

 

Term
What mechanical intervention can improve coronary perfusion and work load of heart?
Definition

Aortic Balloon Pump

 

Term
Best medication for blood pressure support in cardiogenic shock?
Definition

Dobutamine

 

Term
Most common cause of cardiogenic shock?
Definition

Myocardial Infarction

 

Term
What medications are recommended for a patient with CAD?
Definition

Beta blocker

and

ACE inhibitor

Term
What are the most common side effects of dihydropyridine calcium channel blockers (amlodipine felodipine)?
Definition

Lower extremity edema

and

headache

Term
Can digoxin be used for HTN?
Definition

No

 

Term
Which lab value must be obtained before initiating ACE inhibitor therapy?
Definition

Potassium

 

Term
What HTN med classes can cause bradycardia?
Definition

- Beta Blockers

- Central agents (clonidine)

- Verapamil and Cardizem

Term
What HTN medication may cause a dry cough?
Definition

ACE inhibitor

 

Term
What would a blood pressure of 128/86 by classified as?
Definition

Pre-hypertension

 

Term
First line HTN agent for Diabetic?
Definition

Ace inhibitor

 

Term
What is the medication suggested by JNC VII for a patient who has no compelling indications?
Definition

Diuretic

(Hydrochlorothiazide is the most common)

Term
Adrenal tumor which causes HTN?
Definition

Pheochromocytoma

 

Term
What is the likely cause of HTN in a 30 year old female who is still poorly controlled after 3 medications?
Definition

Renal Artery Stenosis

 

Term
Does renal artery stenosis cause primary or secondary HTN?
Definition

Secondary

 

Term
Meds for chronic diastolic CHF?
Definition

Ace inhibitor

plus

either a beta blocker

or calcium channel blocker

Term
Three meds for acute decompensated CHF?
Definition

- Nitroglycerin

- ACE inhibitor

- Loop Diuretic

Term
Most common cause of Diastolic CHF?
Definition

Hypertension

 

Term
JVD and clear lung fields describes what type CHF?
Definition

Right Heart Failure

 

Term
What is most common cause of right heart failure?
Definition

Left heart failure

 

Term
Vitamin deficiency that causes high output cardiac failure?
Definition

Thiamine - Beriberi

 

Term
What congenital abnormality should be considered with a child who frequently squats?
Definition

Tetralogy of Fallot

 

Term
What two calcium channel blockers affect the AV node conduction?
Definition

Diltiazem

and

verapamil

Term
What is Beck's triad?
Definition

- Muffled heart sounds

- JVD

- Hypotension

(seen with pericardial tamponade)

Term
What EKG changes are seen with a ring abscess of the mitral valve?
Definition

Variable heart block

 

Term
A patient with pericarditis feels better in what position?
Definition

Leaning forward

 

Term
What is most common pathogen causing of subacute endocarditis?
Definition

Strep. viridans

 

Term
What is the most common skin manifestation seen in endocarditis?
Definition

Petechiae are not specific for infective endocarditis but are its most common skin manifestation

 

Term
Roth spots in a drug user are most likely caused by which organism?
Definition

Staph aureus

 

Term
What EKG changes are seen in pericarditis?
Definition

Diffuse ST elevations through out all leads

 

Term
Rheumatic fever affects which valve first?
Definition

Mitral valve

 

Term
What sign distinguishes mitral regurgitation from tricuspid regurgitation?
Definition

Carvallo s sign

(The murmur of tricuspid regurgitation increases in intensity during held deep inspiration)

Term
What is the term for a hoarse voice caused by mitral stenosis?
Definition

Ortner's syndrome

 

Term
What physical sign is easily seen with tricuspid stenosis?
Definition

JVD

(Jugular Venous Distension)

Term
Most common cause of tricuspid stenosis?
Definition

Rheumatic fever

 

Term
What is the treatment for mitral valve prolapse?
Definition

Reassurance

and

Beta Blockers

Term
During pregnancy what murmur is commonly first discovered?
Definition

Mitral stenosis

 

Term
What are the 3 main causes of mitral and tricuspid regurgitation?
Definition

- Dilatation (Aneurysm)

- Degeneration of leaflets

- Chordae tendineae rupture

Term
What are the two main causes of aortic and pulmonic regurgitation?
Definition

- Dilatation (Aneurysm)

- Degeneration of leaflets

Term
What are the mainstay meds for chronic diastolic heart failure?
Definition

- ACE inhibitor

- Beta blocker or calcium channel blocker

(diltiazem or verapamil)

Term
What are the mainstay meds of acute decompensated heart failure?
Definition

- NTG

- ACE inhibitor

- Loop diuretic

Term
What are the big three meds for chronic systolic heart failure?
Definition

- Beta blocker

- ACE inhibitor

- Loop diuretic

Term
What murmur radiates to the carotids?
Definition

Aortic stenosis

 

Term
Gallavardin Phenomena is associated with what valvulopathy?
Definition

Aortic Stenosis

 

Term
Austin Flint murmur is associated with which murmur?
Definition

Aortic regurgitation

 

Term
What are the three main symptoms of Aortic stenosis?
Definition

ASH

(Angina - Syncope - Heart Failure)

Term
What are the three main symptoms of Mitral stenosis?
Definition

PHD

(Palpitations - Heart Failure - Dyspnea on exertion)

Term
Aortic stenosis in a 50 year old is likely due to what abnormality?
Definition

Bicuspid aortic valve

 

Term
What murmur has a continuous machinery quality?
Definition

PDA

(Patent Ductus Arteriosus

Term
What finding is pathognomonic for Rheumatic fever?
Definition

Aschoff bodies

(Subcutaneous nodules)

Term
Name the Major Jones criteria.
Definition

-Carditis

- Migratory polyarthritis

- Subcutaneous nodules -

Erythema marginatum

- Chorea

Term
Acute Rheumatic fever occurs after what event?
Definition

Strep throat

 

Term
What condition occurs when congenital cyanotic heart murmurs cause right heart failure?
Definition

Eisenmenger syndrome

 

Term
What murmur is pansystolic and is best heard mid sternal border?
Definition

VSD

(Ventricular Septal Defect)

Term
What is the treatment for a non-surgical cyanotic heart disease causing polycythemia?
Definition

Phlebotomy

 

Term
Name the 4 components of Tetralogy of Fallot.
Definition

- Pulmonary valve stenosis

- VSD (Ventricular Septal Defect)

- Overriding aorta

- RVH (Right Ventricular Hypertrophy)

Term
What medication can assist in closing an open PDA (Patent Ductus Arteriosus)?
Definition

Indomethacin

 

Term
What has high blood pressure equally in arms but lower pressure in the legs?
Definition

Coarctation of aorta

 

Term
What murmur has a Left parasternal lift pulmonic area ejection murmur and fixed splitting of S2?
Definition

ASD

(Atrial Septal Defect)

Term
What cardiac abnormality is associated with a bicuspid aortic valve?
Definition

Coarctation of aorta

 

Term
A venous ulcer most often forms where?
Definition

Medial malleolus

 

Term
What mechanism causes varicose veins?
Definition

Non compliant venous valves

 

Term
Venous insufficiency is differentiated from right heart CHF in a patient with lower extremity edema by what exam finding?
Definition

A patient in CHF will have JVD

and

hepatojugular reflux

Term
Radiologic test of choice in pregnant woman suspect of pulmonary embolus?
Definition

VQ scan

 

Term
What are two CXR findings in pulmonary embolus?
Definition

- Hamptons hump

- Westermark sign

Term
Patient has DVT and unable to take Coumadin what is next step?
Definition

IVC Filter

 

Term
Does pregnancy fit into the Virchows triad?
Definition

Yes

- Pregnancy is a hypercoagulable state

Term
What is most common genetic hypercoagulable state?
Definition

Factor V deficiency

 

Term
Cancer is an example of what part of Virchow's triad?
Definition

Hypercoagulable state

 

Term
What is Virchow triad?
Definition

- Stasis

- Hypercoagulable state

- Trauma to vessel

Term
PVD commonly manifests as what symptom?
Definition

Calf pain with exertion that relieves with rest (claudication)

 

Term
Initial procedure to evaluate for PVD?
Definition

ABI

(Ankle brachial index)

- ABI < 0.8 = PAD

 

Term
What lab is elevated in temporal arteritis?
Definition

ESR (erythrocyte sedimentation rate)

- ESR is suggestive but biopsy is definitive

Term
Untreated amaurosis fugax with temporal arteritis leads to what?
Definition

Blindness

(High dose steroids most be started ASAP to avoid blindness

Term
What arrhythmia is associated with arterial embolism?
Definition

Atrial fibrillation

 

Term
A patient has a cold left arm due to arterial clot - what is the most likely valvulopathy?
Definition

Mitral stenosis

 

Term
What arm does anginal pain tend to radiate toward?
Definition

Left

 

Term
What must be ruled out in a Marfan patient with chest pain radiating to the back?
Definition

Aortic dissection

 

Term
An untreated deep vein thrombosis can lead to what condition?
Definition

Pulmonary embolus

 

Term
What underlying disease state is likely in a patient with a malar rash and recurrent DVT?
Definition

Systemic Lupus Erythematosus(SLE)

with antiphospholipid syndrome

Term
Calf pain with dorsiflexion of the ankle describes what sign?
Definition

Homan's sign

 

Term
What skin condition is commonly associated with venous insufficiency of the lower extremities?
Definition

Stasis dermatitis

 

Term
What is first-line treatment for varicose veins?
Definition

Compression stockings

 

Term
What is the treatment for phlebitis due to an IV
Definition

- Elevation

- Warm compress

- NSAIDs

Term
What is the first medication to be given to a patient with an acute arterial emboli?
Definition

Heparin

 

Term
What valvular abnormality is most commonly associated with a peripheral arterial emboli?
Definition

Mitral stenosis

 

Term
What blood pressure medication can make peripheral artery disease symptoms worse?
Definition

Beta blockers

 

Term
What is the gold standard to evaluate peripheral artery disease?
Definition

Angiography

 

Term
What is the first step and evaluation of a patient with calf pain when he walks that is relieved with rest?
Definition
Ankle brachial index
Term
Why is it important to treat giant cell arteritis quickly and definitively?
Definition

To prevent blindness

 

Term
What condition is commonly associated with giant cell arteritis?
Definition

Polymyalgia rheumatica

 

Term
Temporal arteritis is also known as what condition?
Definition

Giant cell arteritis

 

Term
A 24 year old has a syncopal event. EKG demonstrates a short PR interval with an upswept initial QRS. What underlying condition caused the syncope?
Definition

Wolf Parkinson White

 

Term
A 30 year old male has a syncopal event three days after taking an antibiotic. EKG at the scene reveals ventricular tachycardia. What disease condition do you suspect?
Definition

Acquired long QT syndrome due to the antibiotic or medications

 

Term
After running a mile a 16 year old suffers chest pain and syncope. He is asymptomatic in the ER. Examination is normal. What underlying condition do you suspect?
Definition

Anomalous coronary artery

 

Term
Upon auscultation of a patient’s carotid artery they become bradycardic with a three second pause. What is the suspected underlying condition?
Definition

Carotid sinus hypersensitivity

 

Term
What test can be performed to evaluate neurocardiogenic syncope?
Definition

Tilt table test

 

Term
A military recruit passes out while standing in formation for a long period of time. What type of syncope is this called?
Definition

Neurocardiogenic syncope

a.k.a. Vasovagal syncope

Term
A 13 year old boy passes out while having an argument with his principal. His examination findings are normal. What heart conduction condition do you suspect?
Definition

Long QT syndrome

 

Term
A 75 year old patient passes out while having an argument with his landlord over money. What three conditions should you rule out first?
Definition

- Acute coronary syndrome

- Ventricular arrhythmia

- Aortic stenosis

Term
What condition is most likely in a patient who suffers syncope associated with standing up suddenly?
Definition

Orthostatic hypotension

 

Term
What hypertension agent is commonly associated with edema in the lower extremities?
Definition

Calcium channel blockers

 

Term
What blood pressure medicine is commonly associated with impotence in men?
Definition

Beta blockers

 

Term
Angioedema is commonly associated with what blood pressure agents?
Definition

Ace inhibitors

and

Angiotensin II receptor blockers

Term
What are the three core medications used to treat dilated cardiomyopathy?
Definition

- Ace inhibitor

- Beta blocker

- Loop diuretic

Term
A patient undergoing radiation therapy of the chest is likely to get what type of cardiomyopathy?
Definition

Constrictive cardiomyopathy

 

Term
In addition to dyspnea on exertion what sign is commonly noted in patients with constrictive cardiomyopathy?
Definition

Jugular venous distention

 

Term
Hemochromatosis will lead to what type of cardiac cardiomyopathy
Definition

Restrictive cardiomyopathy

 

Term
What is affected in the genetic mutation which occurs in hypertrophic cardiomyopathy?
Definition

The genetic mutation is at the sarcomere

 

Term
Chronic alcohol ingestion can lead to what type of cardiomyopathy?
Definition

Dilated cardiomyopathy

 

Term
What is the difference between constrictive cardiomyopathy and restrictive cardiomyopathy?
Definition

- Constrictive cardiomyopathy is the pericardial sac squeezing around the heart

 

- Restrictive is caused by deposition between the heart muscle cells

Term
A 14 year old boy presents to your office. Upon examination you note an apical lift an S4 gallop. What is the underlying heart condition?
Definition

Hypertrophic cardiomyopathy

 

Term
Systolic heart failure is categorized as what type of cardiomyopathy?
Definition

Dilated cardiomyopathy

 

Term
Name four causes of high output heart failure.
Definition

- Hyperthyroidism

- Severe anemia

- AV shunts

- Thiamine deficiency aka Beriberi

Term
What will auscultation of a patient’s lungs who is in pure right heart failure reveal?
Definition

In pure right heart failure, the lungs will be clear to auscultation

 

Term
What condition is the most common cause of right heart failure?
Definition

Left heart failure is the most common cause of right heart failure

 

Term
In addition to an ace inhibitor in the treatment of diastolic heart failure, what two medications are preferred?
Definition

Beta Blockers for young patients with hypertrophic cardiomyopathy,

 

Calcium Channel Blockers for left ventricular hypertrophy due to hypertension

Term
What are the three core medications in the treatment of systolic heart failure?
Definition

- Ace inhibitor

- Beta blocker

- Loop diuretic

Term
Describe the ejection fraction in a patient with systolic heart failure versus a patient with diastolic heart failure.
Definition

- A patient with Systolic heart failure usually has an ejection fraction less than 40%

 

- Diastolic failure has a preserved  ejection fraction

Term
Where will the apical impulse be palpated in systolic heart failure and in diastolic heart failure?
Definition

In systolic heart failure, it will be displaced downward into the left.

 

In diastolic heart failure the apical impulse will be in the mid-clavicular line fifth intercostal space

Term
What condition other than diastolic heart failure is the S4 heart sound is also associated with?
Definition

In acute coronary syndrome the ischemia causes the heart muscle to stiffen leading to an S4

 

Term
The S4 heart sound is typically associated with what type of heart failure?
Definition

Diastolic heart failure

 

Term
The S3 heart sound is typically associated with what type of heart failure?
Definition

Systolic heart failure

 

Term
Tricuspid stenosis is most commonly caused by what condition?
Definition

Rheumatic fever

 

Term
What murmur do you suspect with an opening snap and a decrescendo diastolic rumble best heard at the apex with the bell of the stethoscope?
Definition

Mitral stenosis

 

Term
A Graham steel murmur is associated with what murmur?
Definition

Pulmonic regurgitation

 

Term
An Austin Flint murmur is associated with what heart murmur?
Definition

Aortic regurgitation

 

Term
A 20 year old anxious female presents with a sharp stabbing chest pain. She has a a mid systolic click. What heart murmur do you suspect?
Definition

Mitral valve prolapse

 

Term
Epstein anomaly is associated with what heart murmur?
Definition

Tricuspid regurgitation

 

Term
What are the three clinical presentations of mitral stenosis and mitral regurgitation?
Definition

PHD

(Palpitations, Heart failure, Exertional Dyspnea)

Term
What heart murmur presents as a crescendo decrescendo systolic ejection murmur best heard at the upper left sternal border and does not radiate?
Definition

Pulmonary stenosis

 

Term
What is the name of the murmur which is associated with aortic stenosis?
Definition

Gallivardin’s phenomenon

 

Term

What are the three clinical presentations of aortic stenosis?

 

Definition

ASH

(Angina - Syncope - Heart failure)

Term
Transposition of the great vessels of an infant is common in mothers with what condition?
Definition

Diabetes

 

Term

A child with tetralogy of Fallot will often squat when they are short of breath.

Why does squatting increase oxygenation in these patients?

Definition

Tetralogy of Fallot is a central cyanosis condition - Squatting temporarily reverses the shunt providing oxygenated blood to the body

 

Term

You notice a holosystolic murmur that is heard at the mid sternal border in a child.

What heart murmur do you think this is?

Definition

VSD

 

Term
What is the most common cardiac defect?
Definition

VSD

 

Term
What medication would you administer to a baby with continuous machinery murmur?
Definition

Indomethacin

 

Term
A 12 year old boy gets calf cramping and pain when running. You note radial femoral pulse lag on examination. What condition do you expect?
Definition

Coarctation of the aorta

 

Term
A patient presents with a pulmonic area ejection murmur with fixed splitting of S2. What are the expected chest X-ray findings?
Definition

Dilated pulmonary arteries

 

Term
We observe a patient with an aortic aneurysm up to what size before we proceed with surgery?
Definition

5.5 cm

 

Term
What is the anatomical difference between an aortic aneurysm and an aortic dissection?
Definition

- Aortic aneurysm involves all three layers of the artery

- Aortic dissection involves only the intima

Term
What is the most common cause of aortic dissection?
Definition

Hypertension

 

Term

A 75 year old male presents with a severe tearing sensation that radiates to his back.

What is the gold standard test for this disease condition?

Definition

Aortic angiography

 

Term
What are the three components of Beck’s Triad?
Definition

- Distant heart sounds

- Jugular venous distention

- Hypotension

Term
What heart condition is associated with Beck’s Triad?
Definition

Pericardial tamponade

 

Term

A patient has chest pain worse when he lays flat and an EKG showing ST segment elevations in all leads.

What condition do you suspect?

Definition

Pericarditis

 

Term
What bacteria that causes endocarditis is most common in IV drug users?
Definition

Staphylococcus aureus

 

Term
What bacteria that causes endocarditis is most common in the general population?
Definition

Streptococcus viridans

 

Term
Petechiae, Janeway lesions, Osler’s nodes and Roth spots are associated with what disease condition?
Definition

Endocarditis

 

Term
ASCHOFF bodies are associated with what disease condition?
Definition

Acute rheumatic fever

 

Term
Which cardiac enzyme lasts the longest?
Definition

Troponin lasts the longest

 

Term
Which cardiac enzyme peaks first?
Definition

CKMB peaks first

 

Term

A 55 year old male with DM, HTN and high cholesterol presents with a good cardiac chest pain story, a normal EKG but low positive troponins.

What does he have?

Definition

Non ST elevation AMI

 

Term

A patient is admitted for chest pain. MI workup is negative. He has several CAD risk factors and strong family history.

What outpatient evaluation is recommended?

Definition

Walking nuclear stress test

 

Term
How does ACS often present in an elderly patient?
Definition

Syncopal event

 

Term
What type of disease process is CAD?
Definition

Inflammatory disease process

 

Term
Name the 4 non modifiable risk factors for CAD.
Definition

- Age

- Sex

- Genetics

- Ethnicity

Term
What are the three factors that classify ACS?
Definition

- Chest pain story,

- EKG changes consistent with ACS

- Elevated troponins

Term
What are the disease conditions associated with acute coronary syndrome (ACS)?
Definition

- Unstable angina

-  NSTEMI

- STEMI

Term
Does a high blood pressure mean a higher or lower afterload?
Definition

A high blood pressure means higher afterload and more work for the ventricles leading to long term development of left ventricular hypertrophy.

 

Term
What is afterload?
Definition

Afterload is the pressure the left ventricle needs to overcome in order to open the aortic valve.

 

Term
If a patient is in atrial fibrillation, do they have preload?
Definition
In atrial fibrillation there is no preload since the atrium are not contracting.
Term
What is preload and what part of the heart generates preload?
Definition

Preload is the stretch created in the ventricles when the atrium contract and force blood down into the ventricles.

 

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