Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
468 Cards in this Set
- Front
- Back
|
Q001. most common congenital cyanotic lesion in newborn; immediately vs later
|
A001. tetralogy of Fallow (later); transposition great arteries
|
|
|
Q002. cyanotic newborn or 2 week; heart failure; supracardiac shadow above enlarged heart increased pulmonary blood flow (snowman snowstorm); right heart enlargement
|
A002. total anomalous pulmonary venous return
|
|
|
Q003. straight narrow mediastium; globular heart (egg on string)
|
A003. transposition great arteries
|
|
|
Q004. severe cyanosis; heart failure once ductus closes; gray-blue color; right side predominance
|
A004. hypoplastic left heart
|
|
|
Q005. In truncus arteriosis
|
A005. common trunk supplying pulmonary and systemic circulations. Ventricular septal defect. Loud systolic murmur with thrill; mild cyanosis. Severe heart failure.
|
|
|
Q006. tricuspid atresia
|
A006. right ventricle hypoplasia; no tricuspid valve; usually persistent foramen ovale or atrial septal defect; cyanotic and quite ill; severe reduction in pulmonary blood flow on x-ray and left axis instead of right.
|
|
|
Q007. Innocent murmurs
|
A007. age 3 to 7; time increase cardiac output; soft vibratory or musical systolic ejections murmur at left lower midsternal boards <2/6 intensity
|
|
|
Q008. tall symmetric peaked T waves
|
A008. Hyper K
|
|
|
Q009. Widening of QRS complex
|
A009. hyper K
|
|
|
Q010. prolongation of P waves
|
A010. hyper K
|
|
|
Q011. Increased U wave
|
A011. Hypo K
|
|
|
Q012. ST segment depression and; T wave amplitude decreased
|
A012. Hypo K
|
|
|
Q013. Swelling of face after taking captopril or enalapril
|
A013. angioedema from angiotensin receptor blockers / ACE I (avoid -prils and valsartan)
|
|
|
Q014. Premature atrial contraction
|
A014. occurs 78% healthy male aviators; if symptomatic- b-blocker
|
|
|
Q015. Theophylline
|
A015. toxicity: seizures, hypotension, arrhythmias; dimethylxanthine for COPD
|
|
|
Q016. Ipratropium
|
A016. headache dryness pulmonary symptoms; Atrovent for COPD
|
|
|
Q017. livedo reticularis (lacy erythematous rash) peripheral ischemia (blue toes) eosinophilia; post coronary catheterization
|
A017. Suggestive of cholesterol emboli
|
|
|
Q018. Causes of renal failure; post coronary catheterization
|
A018. cholesterol embolization (blue toes) vs; contarast nephropathy
|
|
|
Q019. Coxsackie’s virus B and pregnancy
|
A019. mom ill, baby much more ill,; mechanical ventilation, shock hypotension, cardiogenic with ST- ECG
|
|
|
Q020. Parvovirus and pregnancy
|
A020. 5ths disease and; hydrops early in pregnancy
|
|
|
Q021. Myocarditis
|
A021. infection, toxins, granulmatous disease. febrile, coxsackie,; ST wave abnormality; Hepatic transaminase elevated; cardiomegaly with pulmonary edema
|
|
|
Q022. Echo instead of ECG when
|
A022. Left bundle branch block old; previous MI; pacemaker; digoxin
|
|
|
Q023. Murmurs best heard on expiration
|
A023. left sided
|
|
|
Q024. Dressler syndrome
|
A024. post CABG post cardioectomy pericarditis; Worse lying down better sitting up, rub
|
|
|
Q025. left ventricular dysfunction and hypertension
|
A025. concentric hypertrophy; dyspnea on exertion; treat with b blocker to improve relaxation allow better filling
|
|
|
Q026. equivalent right atrium, right ventricle and pulmonary wedge pressure; low blood pressure; tachycardia
|
A026. cardiac tamponade
|
|
|
Q027. SVT
|
A027. 180-300 bpm; tolerated well in kids; suggest underlying anomaly; Epstein and WPW; revert by dunking head in cold water
|
|
|
Q028. infant with no murmur,; precordial hyperactivity; loud second heart sound; grey or cyanotic
|
A028. hypoplastic left heart; underdevelopment of left cardiac chamber; atresia or stenosis of aortic or mitral orifices; hypoplasia of aorta; left atrium and ventricle endocardial fibroelastosis. patent foramen ovale; dilated hypertrophic right ventricle
|
|
|
Q029. right ventricular infarct vs cardiac tamponade
|
A029. hypotension; tachycardia; clear lungs; absence of pulsus paradoxus in Right ventricular infarction
|
|
|
Q030. lupus, contraceptive use; headache; upper extremity weakness; CT with infarct of anterior and posterior frontal lobes; parietyal lobes extending to white matter
|
A030. dural sinus thrombosis; superior sagital sinus; test for anti-phospholipid antibody; get cerebral venography
|
|
|
Q031. apical heave; thrill at second left intercostal space; loud systolic diastolic rasping murmur left sternal boarder; hyerdynamic left ventricle abnormal flow; prominence of pulmonary artery; increased pumonary vascular markings; wide pulse pressure; bounding arterial pulses; apical heave
|
A031. patent ductus arteriosus; failure of closure of the ductus arteriosis postnatally.
|
|
|
Q032. pulsus paradoxus,; hypotension; electrical alternans in pt with breast cancer; pericardial effusion; right ventricular collapse
|
A032. tamponade; treat pericardiocentesis
|
|
|
Q033. purpura, cytopenia, hemolytic anemia, neurologic signs, renal insufficiency, fever
|
A033. TTP
|
|
|
Q034. Angiomyolipoma
|
A034. Tuberous Sclerosis; Kidney Harmatoma: blood vessels, muscle, mature adipose tissue
|
|
|
Q035. Angiosarcoma
|
A035. Liver Angiosarcoma:; Polyvinyl chloride, arsenic, thorium dioxide
|
|
|
Q036. Bacillary angiomatosis
|
A036. Benign capillary proliferation involving skin and visceral organs in AIDs patients. Stimulates Kaposi Sarcoma in AIDS; Bartonella henselae, gram negative bacillus, causative agent
|
|
|
Q037. Capillary Hemangioma
|
A037. treatment: leave alone!; facial lesion in newborns, regresses with age
|
|
|
Q038. Cavernous hemangioma
|
A038. most common benign tumor of liver and spleen; may rupture if large
|
|
|
Q039. Cystic hygroma
|
A039. lymphangioma in neck; associated with Turner's syndrome
|
|
|
Q040. Glomus tumor
|
A040. Derive arteriovenous shunts in glomus bodies; Painful red subungual nodual in digit
|
|
|
Q041. Hereditary telangiectasia
|
A041. Dilated vessels on skin and mucous membranes in mouth and GI tract
|
|
|
Q042. Kaposi Sarcoma
|
A042. malignant tumor arising from endothelial cells or primitive mesenchymal cells; HSV type 8; raised red purple discoloration that progresses from plat lesion to a plaque to nodule that ulcerates
|
|
|
Q043. Lymphangiosarcoma
|
A043. malignancy of lymphatic vessels; arises out of longstanding chronic lymphadema after modified radial masectomy
|
|
|
Q044. Pyogenic granuloma
|
A044. vascular, red pedunculated mass that ulcerates and bleeds easily; post traumatic and associated with pregnancy
|
|
|
Q045. Spider telangiectasia
|
A045. arteriovenous fistula (disappears when compressed); associated with hyperestrinism
|
|
|
Q046. Sturge Weber syndrome
|
A046. Nevus flammeus on face in distribution of opthalamic branch of cranial nerve V (trigeminal)
|
|
|
Q047. VHL syndrome
|
A047. cavernous hemangioma in cerebellum and retina; increased incidence of pheochromocytoma and bilateral renal cell carcinomas.
|
|
|
Q048. What does "irregularly irregular" mean on an ECG?
|
A048. Irregular RR intervals
|
|
|
Q049. Irregularly irregular rhythm without p-waves prior to each QRS
|
A049. Atrial fibrillation
|
|
|
Q050. Etiologies of A-Fib (10)
|
A050. PIRATES:; Pulmonary (COPD, PE), Pheochromocytoma, Pericarditis;; Ischemic heart disease, HTN;; Rheumatic heart disease;; Anemia;; Thyrotoxicosis;; Ethanol (& cocaine), Endocarditis;; Sepsis
|
|
|
Q051. Signs/symptoms of A-Fib (5)
|
A051. A FL PT:; Asymptomatic patient;; Fatigue (most common);; Light headedness, syncope;; Palpitations, skipped beats;; Tachypnea, dyspnea
|
|
|
Q052. Complication of A-Fib
|
A052. diffuse Embolization (often to brain, leading to TIA or stroke)
|
|
|
Q053. One of two possible Drugs given to A-Fib to control rate in an emergent situation
|
A053. IV Calcium channel blocker: Diltiazem; (or); IV Beta-blocker: Metoprolol
|
|
|
Q054. Drugs given to A-Fib to control rate in a non-emergent situation (2)
|
A054. oral Beta-blocker:; Atenolol; (and); oral Calcium channel blockers:; Verapamil or Diltiazem
|
|
|
Q055. what are the (2) ways to cardiovert an A-Fib rhythm?; when should you not cardiovert?; what would the Tx be then?
|
A055. Medical: Amiodarone; Electrical: start at 100 J Do not cardiovert if patient is in A- Fib > 24 hours. Tx: Warfarin for 3-4 weeks before cardioversion
|
|
|
Q056. If cardioversion from A-Fib to sinus rhythm does not occur, what should patient be treated with?
|
A056. Long-term anticoagulants DOC:; Warfarin (1st); Aspirin (2nd)
|
|
|
Q057. how many seconds and boxes is a normal PR interval?
|
A057. 0.2 ms 5 small boxes
|
|
|
Q058. define:; Q-wave; When is it pathologic?
|
A058. when initial part of ventricular depolarization is downward; Pathologic: greater then 1 small box
|
|
|
Q059. normal time and boxes for QRS interval?
|
A059. < 0.12 ms 3 small boxes
|
|
|
Q060. normal sinus rate
|
A060. 60 - 100 bpm
|
|
|
Q061. define:; Junctional rhythm
|
A061. rhythm originating in the AV node and causing narrow QRS without P-waves
|
|
|
Q062. Dx:; no p-waves; all complexes are wide; no changes in height (amplitude) with each complex; > 100bpm
|
A062. Ventricular tachycardia
|
|
|
Q063. Dx:; wide QRS complexes that vary in amplitude; (2 names)
|
A063. Ventricular Fibrillation; Torsades de Pointes
|
|
|
Q064. Dx:; normal sinus rhythm with PR interval > 0.2 ms (> 5 small boxes)
|
A064. First-degree AV block
|
|
|
Q065. Dx:; PR interval elongates from beat to beat until it becomes so long that a beat drops
|
A065. Second-degree AV block, type 1 (Wenckebach)
|
|
|
Q066. Dx:; PR interval is fixed but every so often there is a P-wave without a QRS
|
A066. Second-degree AV block, type 2 (Mobitz)
|
|
|
Q067. Dx:; no relationship b/t P-waves and QRS complexes
|
A067. Third-degree AV block
|
|
|
Q068. Dx:; QRS > 0.12 (> 3 small boxes) RSR' in V1 + V2;; deep S-wave in lateral leads (I, aVL, V5 + V6)
|
A068. RBBB
|
|
|
Q069. Dx:; QRS > 0.12 (> 3 small boxes);; RSR' in V5 + V6; diffuse ST elevation
|
A069. LBBB
|
|
|
Q070. Dx:; Different shapes to 3 or more P-waves; normal rhythm; (what is it called if it is tachycardic?)
|
A070. Wandering pacemaker; MFAT: Multifocal Atrial Tachycardia
|
|
|
Q071. Dx:; short PR interval; slurring delta wave connecting P-wave to QRS complex
|
A071. Wolff-Parkinson-White syndrome
|
|
|
Q072. Dx:; diffuse ST elevation that slopes in a concave manner back to baseline + diffuse PR segment depression in all leads except PR elevation in aVR
|
A072. Pericarditis
|
|
|
Q073. drug Tx of wandering pacemaker and MFAT?
|
A073. Verapamil (Ca channel block)
|
|
|
Q074. what Tx breaks SVT (superventricular tachy) in > 90%?
|
A074. Adenosine (failure to break r/o SVT)
|
|
|
Q075. Tx for V-tach with hypotension or no pulse
|
A075. Emergency defibrillation @ 200 - 360 J
|
|
|
Q076. Tx of asymptomatic V-tach; (2 meds)
|
A076. Amiodarone; or; Lidocaine
|
|
|
Q077. Tx of V-Fib
|
A077. Emergent electroshock @ 200 - 360 J
|
|
|
Q078. how do you distinguish Paroxysmal Nocturnal Dyspnea from asthma?
|
A078. no improvement with bronchodilators
|
|
|
Q079. Dx:; SVT with AV block + yellow skin
|
A079. Digoxin toxicity
|
|
|
Q080. How do you diagnose LVH from a ECG? (2)
|
A080. 1. S-wave in V1 + R-wave in V5 or V6 > 7 large boxes (35 small); 2. R-wave in V5 or V6 > 25 small boxes; OR; R-wave in lead aVL > 11 small boxes
|
|
|
Q081. Causes of prolonged QT (8)
|
A081. QT WIDTH:; QT: Prolonged QT syndrome; W: WPW; I: Infarction; D: Drugs; T: Torsades de pointes; H: HypoK, HypoC, Hypomagnesium
|
|
|
Q082. What electrolyte disorder causes short QT segments?
|
A082. HyperC
|
|
|
Q083. Causes of Torsades de Pointes (7)*
|
A083. POINTES:; Phenothiazines; Other meds (TCAs); Intracranial bleed; No known cause (idiopathic); Type 1 Anti-arrhythmics; Electrolyte abnormalities; Syndrome of prolonged QT
|
|
|
Q084. What can be given to a patient to temporarily slow a rapid supraventricular rhythm in order for you to be able to identify it?
|
A084. Adenosine
|
|
|
Q085. What drugs should not be given to someone with Wolff- Parkinson-White syndrome?; (4); What is the DOC?
|
A085. ABCD:; Adenosine; Beta-blockers; Calcium channel blockers; Digoxin; DOC: Procainamide
|
|
|
Q086. Causes of Mobitz I (3); Causes of Mobitz II (2)
|
A086. Mobitz I:; Inferior wall MI;; Digitalis toxicity;; Inc Vagal tone Mobitz II:; Inferior or septal wall MI;; Conduction system disease
|
|
|
Q087. Tx for Mobitz I & II; (2)
|
A087. Both:; Atropine & temporary pacing; (Mobitz II should have pacemaker)
|
|
|
Q088. Causes of third-degree heart block (3)
|
A088. Digitalis toxicity;; Inferior wall MI;; Conduction system disease
|
|
|
Q089. Causes of Bradycardia (6)
|
A089. if R-R is longer then "One INCH":; Overmedication;; Inferior MI / Inc intracranial Pressure;; Normal variant (athletes);; Carotid sinus hypersensitivity;; Hypoparathyroidism
|
|
|
Q090. Tx for bradycardia (3)
|
A090. 1. Atropine; 2. pacing; 3. pressors for hypotension
|
|
|
Q091. a 24-years old woman with preeclampsia Tx with IV drip of magnesium complains of difficulty breathing and has diminished reflexes. Next step? (2 together)
|
A091. 1. Stop magnesium; 2. give IV calcium
|
|
|
Q092. equation for Mean Arterial Pressure
|
A092. MAP = (2dBP + sBP)/3
|
|
|
Q093. Dilation of which heart chamber is a major cause of A-fib?
|
A093. Left atrium
|
|
|
Q094. (5)* deadly causes of chest pain
|
A094. TAPUM:; Tension pneumothorax;; Aortic Dissection;; PE;; Unstable Angina;; MI
|
|
|
Q095. how is the maximum HR determined?
|
A095. 220-patient's age = Max HR
|
|
|
Q096. (6) Major risk factors for CAD which is most preventable?; which is the greatest risk?
|
A096. Diabetes (greatest);; Smoking (most preventable);; HTN;; Hypercholesterolemia;; Family History;; Age
|
|
|
Q097. Dx:; Chest pain that has an established character, timing and duration; pain is transient, reproducible and predictable. What is cause?; What is Tx? (2 together)
|
A097. Dx: Stable Angina; Cause: Reduced coronary blood flow through fixed atherosclerotic plaque in vessel of heart; Tx: rest + Nitroglycerin
|
|
|
Q098. Exertional substernal (precordial) chest pressure and pain radiating to left arm, jaw or back. N/V, diaphoresis, dyspnea, HTN and tachycardia can accompany it. Name the types
|
A098. Angina:; Stable; Unstable; Variant (Prinzmetal's)
|
|
|
Q099. Angina type that is also considered an Acute Coronary Syndrome (ACS). What (3) factors must it have for diagnosis?
|
A099. Unstable Angina; 1) New-onset; 2) angina that changes or accelerates in pattern, location or severity; 3) Occurs at REST
|
|
|
Q100. Dx:; Similar characteristics of stable angina, but due to vasospasm instead of atherosclerosis. Tx? (2 drugs together)
|
A100. Variant (Prinzmetal's) Angina; Tx:; 1. Calcium Channel blockers +; 2. Nitrates
|
|
|
Q101. what (2) groups of patients may not show the classic signs pain seen in stable angina?; Why?
|
A101. Elderly and diabetics (b/c: neuropathies)
|
|
|
Q102. What does the EKG look like for the (3) angina types?
|
A102. Stable + Unstable:; ST Depression; T-wave Inversion; Variant: ST elevation
|
|
|
Q103. 62-years old smoker with 3 episodes of severe heavy chest pain in the morning. Each lasted 3 - 5 minutes, but he has no pain now. He has never had this before. What is it?
|
A103. Unstable Angina
|
|
|
Q104. 62-years old man with frequent episodes of chest pain on and off for 8 months. He says the pain wakes him from sleep at night. What is it?
|
A104. Variant (Prinzmetal's) Angina
|
|
|
Q105. what is the alternative to an exercise Stress Test if the patient cannot get on a treadmill?
|
A105. IV Dobutamine is given to stimulate myocardial function
|
|
|
Q106. What is the criteria for a "positive" Stress Test? (5)
|
A106. either:; ST elevation; ST depression >1 mm in multiple leads; Dec BP; failure to go more than 2 minutes; failure to complete for reason other then cardiac symptoms (i.e. arthritis)
|
|
|
Q107. what does Myocardial Perfusion Imaging detect? (3)
|
A107. - Myocardial perfusion; Ventricular volume; Ejection Fraction
|
|
|
Q108. An ultrasound of the heart revealing abnormal wall motion due to ischemia or infarction. It also assesses left ventricular function and EF
|
A108. Echocardiography
|
|
|
Q109. What are (5) Dx that need a cardiac catheterization?; Describe procedure for each
|
A109. 1) MI / Unstable angina: stent or angiography; 2) Valvular disease: valvuloplasty; 3) Arrhythmias: mapping bypass tracts; 4) Myocardial disease Bx: glycogen storage disease or cardiomyopathies; 5) Congenital heart disease identification: angiography and closure of defects
|
|
|
Q110. (4) serum markers for MI
|
A110. Myoglobin;; Troponin T/I;; CK;; Lactate Dehydrogenase
|
|
|
Q111. How is the right heart accessed in a cardiac catheterization? (2); Left heart? (2)
|
A111. Right:; Femoral or Internal Jugular; Left:; Femoral or Radial artery (from right heart)
|
|
|
Q112. what is the wave morphology changes sequence in a MI ECG? (6)
|
A112. 1. peaked T-waves; 2. T-wave inversion; 3. ST elevation; 4. Q-waves; 5. ST normalization; 6. T-waves return upright
|
|
|
Q113. which cardiac enzyme is the most sensitive and specific for acute MI?
|
A113. Troponin-I/T
|
|
|
Q114. which cardiac enzyme remains increased (peaked) the longest?
|
A114. LDH
|
|
|
Q115. what does ST depression mean?
|
A115. ST goes in the opposite direction of the QRS
|
|
|
Q116. what does a Q-wave on an EKG in the presence of an infarction indicate?
|
A116. Transmural infarction; (extends through full thickness of the myocardial wall)
|
|
|
Q117. Time of onset for the (4) serum markers for MI
|
A117. Myoglobin (1-4 hrs); Troponin-I/T (3-12); CK-MB (3-12); LDH (6-12)
|
|
|
Q118. which cardiac enzyme has the shortest duration?; Longest?
|
A118. Myoglobin (1 day); Troponin-I/T (7-10 days)
|
|
|
Q119. ST elevation in II, III & aVF
|
A119. Inferior wall MI
|
|
|
Q120. ST depression in II, III & aVF
|
A120. Cor Pulmonale; (right-sided heart failure)
|
|
|
Q121. ST elevation in V1, V2, V3
|
A121. Anterior/septal MI
|
|
|
Q122. ST elevation in V4, V5, V6
|
A122. Lateral wall MI
|
|
|
Q123. ST depression in V1, V2
|
A123. Posterior wall MI
|
|
|
Q124. difference b/t unstable angina & non-ST elevation MI? (2)
|
A124. non-ST elevation MI has:; 1. more severe lack of Oxygen (more severe myocardial damage); 2. Enzyme leakage (Unstable angina has none)
|
|
|
Q125. Tx for Unstable angina & MI (6)
|
A125. MONA has HEP B:; Morphine; Oxygen; Nitrates; Aspirin; HEParin; Beta-blockers
|
|
|
Q126. primary Tx (2) for the acute MI w/in 6 hours of infarct; (name 3 other drugs)
|
A126. Throbolytics:; 1. tPA + 2. Heparin (DOC); Urokinase; streptokinase; Alteplase
|
|
|
Q127. At what level should LDL be in person with MI history?; What is given to lower it?
|
A127. less then 100; statins
|
|
|
Q128. When are throbolytics indicated in MI? (3)
|
A128. patients < 80 years old; within 6-12 hrs of chest pain; evidence of infarct on ECG
|
|
|
Q129. Contra-indications of Throbolytics (9)
|
A129. Having Some Breaks A Blood Clot In Small Pieces:; History of intracranial bleed; stroke < 1 year - BP > 180/110; active internal bleed; bleeding disorder; CPR; Intracranial tumor; suspected aortic dissection; Peptic ulcer
|
|
|
Q130. drug class that is used to break up clots
|
A130. thrombolytics
|
|
|
Q131. name a specific drug that prevents future clots from forming
|
A131. heparin
|
|
|
Q132. procedure Tx of choice for MI if there is a high risk of ST elevation (cardiogenic shock) or it has been 3 hours since initial symptoms presented?
|
A132. PTCA; (Percutaneous Transluminal Coronary Angioplasty)
|
|
|
Q133. which thrombolytic is highly immunogenic and cannot be used in the same patient twice in a 6 month period?
|
A133. streptokinase
|
|
|
Q134. what should be given 48 hours post infarct if tPA was used?
|
A134. heparin
|
|
|
Q135. drug class that is excellent for late and long-term therapy for acute MI to decrease afterload and prevent remodeling?
|
A135. ACEi
|
|
|
Q136. 58-years old man discharged from hospital after MI 2 weeks ago presents with fever, chest pain and malaise. EKG shows diffuse ST-T wave changes. What is Dx?; What is Tx?; (2 possible meds)
|
A136. Dressler's syndrome; Tx:; 1. NSAIDs or 2. Corticosteroids
|
|
|
Q137. Medication orders with discharge of an ACS (post-MI) patient? (5)
|
A137. easy AS ABC:; Aspirin (indefinitely); Statin to lower LDL < 100; ACE-inh (if EF <40%); Beta-blocker (indefinitely); Clopidogrel for 1 - 12 mo depending on stent placement
|
|
|
Q138. Dx:; fever, pericarditis and possible pericardial or pleural effusions post cardiac surgery
|
A138. Dressler's syndrome
|
|
|
Q139. Most common infectious cause of Myocarditis
|
A139. Coxsackie B
|
|
|
Q140. (4) systemic diseases that causes Myocarditis
|
A140. KISS:; Kawasaki's; Inflammatory conditions; SLE; Sarcoidosis
|
|
|
Q141. (4) Parasites that cause Myocarditis
|
A141. Trypanosoma Cruzi (Chagas);; Toxoplasmosis;; Trichinella;; Echinococcus
|
|
|
Q142. (5) Bacterial causes of Myocarditis
|
A142. women Trick Corny Men to Strip and Lie down:; Group A beta-hemolytic Strep (rheumatic fever);; Corynebacterium;; Meningococcus;; Lyme (B. burgdorferi);; Trichinella
|
|
|
Q143. (8) viral causes of myocarditis
|
A143. Coxsackie A or B;; HIV;; Echovirus;; EBV:; CMV;; HBV;; Influenza;; Adenovirus
|
|
|
Q144. (3) drugs that cause pericarditis
|
A144. It Hurts Pericardium:; Isoniazid;; Hydralazine;; Procainamide
|
|
|
Q145. Etiology of Pericarditis (5)
|
A145. Bacterial, viral or fungal infections;; Post-MI (Dressler's);; Uremia;; Serositis from: RA or SLE; Scleroderma;
|
|
|
Q146. Tx for pericarditis if:; infection; pain/inflammation; Dressler's; Recurrent cases
|
A146. Infection - Abx;; Relieve pain + reduce inflammation - NSAIDs;; Dressler's - Steroids;; Recurrent Cases - Pericardectomy; (only of recurrent cases)
|
|
|
Q147. Dx:; Transient fall in BP > 10 mmHg during inspiration
|
A147. Pulsus Paradoxus
|
|
|
Q148. Dx:; Physiologic result of rapid accumulation of fluid in the pericardial sac; impairs cardiac filling and reduces cardiac output
|
A148. Pericardial Tamponade
|
|
|
Q149. Etiology of Pericardial Tamponade (3)
|
A149. - Aortic dissection or ventricular rupture into pericardium; Pericarditis; Trauma
|
|
|
Q150. Beck's triad of the pericardial tamponade; (4) other signs/Sx
|
A150. Beck's triad:; JVD; Muffled heart sounds; Hypotension; Other Sx:; Tachycardia; Pulsus Paradoxus*;; Dyspnea;; Narrow Pulse Pressure
|
|
|
Q151. Tx for Pericardial Tamponade for:; 1. unstable; 2. stable; 3. both
|
A151. Unstable:; Immediate Pericardiocentesis;; Stable:; Pericardial window; Both:; Infuse fluids to expand volume
|
|
|
Q152. Failure of venous pressure to fall during inspiration
|
A152. Kussmaul's sign
|
|
|
Q153. If pericardiocentesis has clots, what is likely source of blood?
|
A153. Right Ventricle
|
|
|
Q154. Dx:; Patient has chest pain with inspiration that radiates to the left trapezial ridge; Pain is relieved by sitting up and leaning forward; does not respond to nitroglycerine
|
A154. Pericarditis
|
|
|
Q155. additional signs/Sx for Constrictive pericarditis (versus pericarditis); (4)
|
A155. Extra fluid:; JVD; Kussmaul's sign; peripheral edema; LV failure
|
|
|
Q156. When a patient has VHD or previous endocarditis, what (3) procedure types must they obtain endocarditis prophylaxis medications?
|
A156. Dental procedures; Urologic procedures; GI procedures
|
|
|
Q157. Dx:; acute onset of fever, chills and rigors; new cardiac murmur, possible associated meningitis or pneumonia
|
A157. Acute Bacterial Endocarditis (ABE)
|
|
|
Q158. Infection of healthy heart valves by high-virulence organisms; MCC?; Prognosis if not treated?
|
A158. ABE; S. Aureus; Prognosis: fatal if not Tx w/i 6 weeks
|
|
|
Q159. Dx:; seeding of previously damaged heart valves by rheumatic fever, mitral prolapse, etc by low-virulence organisms; MCC?; What valve is affected the most?
|
A159. Subacute Bacterial Endocarditis; Strep Viridans; Mitral valve
|
|
|
Q160. What valve is most commonly affected with IV drug users?; What bug?
|
A160. Tricuspid; S. Aureus
|
|
|
Q161. what endocarditis bug is associated with colonic neoplasms?
|
A161. Strep Bovis
|
|
|
Q162. Dx:; gradual onset of fever, sweats, weakness, anorexia, new murmur, splenomegaly, Osler's nodes, splinter hemorrhages, Janeway lesions, Roth spots
|
A162. Subacute Bacterial Endocarditis (SBE)
|
|
|
Q163. Name sign:; Tender violaceous subcutaneous nodules on fingers & toes
|
A163. Osler's nodes (SBE)
|
|
|
Q164. Name sign:; fine linear hemorrhages in the middle of nailbeds
|
A164. Splinter Hemorrhages
|
|
|
Q165. Name sign:; multiple hemorrhagic nontender macules or nodules on palms & soles
|
A165. Janeway Lesions
|
|
|
Q166. Name sign:; retinal hemorrhages with clear central areas seen on fundoscopy (with new murmur)
|
A166. Roth's spots (SBE)
|
|
|
Q167. What is considered Major criteria in the Duke's criteria for endocarditis?; (2)
|
A167. 1. Two positive blood cultures; 2. Echo showing vegetations
|
|
|
Q168. What are the (6) Minor criteria in the Duke's criteria for endocarditis?
|
A168. 1. Fever; 2. Predisposing heart abnormality; 3. Arterial emboli (Janeway); 4. Osler nodes or Roth's spots; 5. positive blood culture not meeting major criteria; 6. Echo suspicious of endocarditis, but not meeting major criteria
|
|
|
Q169. For the Duke's criteria of Endocarditis, what are the (3) ways to dx with major and minor signs?
|
A169. 1. (2) major criteria; 2. (1) major + (3) minor; 3. (5) minor criteria
|
|
|
Q170. Tx for endocarditis that cultures:; 1. Strep; 2. Staph; 3. MRSA
|
A170. 1. Ceftriaxone or Penicillin G (4 weeks); 2. Naficillin (4 weeks); 3. Vancomycin (4 weeks)
|
|
|
Q171. What is the Tx for patients with Valular abnormalities if they are having dental procedures, GI or GU surgery? (2 possible)
|
A171. Prophylactic:; 1. Amoxicillin; or; 2. Clarithromycin
|
|
|
Q172. Valvular dysfunction requiring surgery is common with which type of organism?
|
A172. Fungi (Candida or Aspergillus)
|
|
|
Q173. Endocarditis type:; due to cancer seeding heart valves during metastasis what can it lead to?
|
A173. Marantic endocarditis; leads to cerebral infarcts
|
|
|
Q174. Endocarditis type:; may be due to autoantibody damage of valves by SLE
|
A174. Libman-Sacks endocarditis
|
|
|
Q175. MC valve affected by RHD
|
A175. Mitral
|
|
|
Q176. Cause of Rheumatic fever?; What does it lead to?
|
A176. Group A Strep leads to Rheumatic Heart Disease (RHD); immune complex deposits on valves
|
|
|
Q177. Major criteria (JONES criteria) for Dx Rheumatic fever (5)
|
A177. JCNES:; Joints (arthritis); Carditis (myo-, endo- or peri-); Nodules (sub-Q); Erythema marginatum rash; Sydenham's chorea (face, tongue, upper limb)
|
|
|
Q178. Minor criteria for Dx Rheumatic fever (5)
|
A178. Pump FEAR:; Prolonged PR interval;; Fever;; Elevated ESR;; Arthralgias;; Recent Strep infection;
|
|
|
Q179. Tx for Rheumatic fever due to:; 1. Strep; 2. Arthritis; 3. Carditis
|
A179. Penicillin for strep;; ASA for arthritis;; Steroids for carditis
|
|
|
Q180. Etiology of Dilated Cardiomyopathy; (6)*
|
A180. TIMED:; Toxic (EtOH, heavy metals); Infectious / Ischemic; Metabolic / Mechanical (arrhythmia, valve disease); Endocrine; Drugs
|
|
|
Q181. what are the Reversible and Irreversible(2) toxic causes of Dilated Cardiomyopathy?
|
A181. Reversible:; prolonged EtOH use; Irreversible:; Cocaine;; heavy metal toxicity
|
|
|
Q182. what are the Reversible and Irreversible(2) endocrine causes of Dilated Cardiomyopathy?
|
A182. Reversible:; Thyroid disease; (hypo or hyper); Irreversible:; Acromegaly;; Pheochromocytoma
|
|
|
Q183. Reversible metabolic deficiencies that cause Dilated Cardiomyopathy? (4)
|
A183. HypoC;; HypoP;; Thiamine deficiency (wet beri-beri);; Selenium deficiency
|
|
|
Q184. Infections that cause Dilated Cardiomyopathy; (3)
|
A184. HIV;; Coxsackie virus;; Chagas disease
|
|
|
Q185. Drugs that cause Dilated Cardiomyopathy (2)
|
A185. Doxorubicin (Adriamycin);; AZT
|
|
|
Q186. Dx:; Cardiomyopathy with R + L Heart failure; A-fib; Mitral regurgitation; S-3 Gallop
|
A186. Dilated Cardiomyopathy
|
|
|
Q187. Diastolic or Systolic Disease Cardiomyopathy:; 1. Dilated; 2. Restrictive; 3. Hypertrophic
|
A187. Systolic:; Dilated; Diastolic:; Restrictive & Hypertrophic
|
|
|
Q188. Diagnostic results of Dilated cardiomyopathy; auscultation; EKG (3); CXR (2); Echo (2)
|
A188. Auscultation: S-3;; EKG: Vent Hypertrophy, BBB and/or A-fib;; CXR: Inc heart size; pulm congestion; Echo: low EF, large ventricles
|
|
|
Q189. Tx Dilated Cardiomyopathy; (3)
|
A189. stop any toxic agents;; Anticoagulation with coumadin (even without evidence of thrombus);; Heart transplant
|
|
|
Q190. Dx:; Right or left ventricular enlargement with loss of contractile function causing CHF, arrhythmia, or thrombus formation.
|
A190. Dilated Cardiomyopathy
|
|
|
Q191. Definition:; Scarring and infiltration of the myocardium causing decreased right or left ventricular filling
|
A191. Restrictive Cardiomyopathy
|
|
|
Q192. Etiology of Restrictive Cardiomyopathy; (7)*
|
A192. ACHES:; Amyloidosis;; Carcinoid heart disease / Congenital;; Hemochromatosis;; Endomyocardial fibrosis; Sarcoidosis / Scleroderma
|
|
|
Q193. Dx:; Pulmonary HTN (right CHF); S-4 gallop; Low QRS voltage on EKG; Exercise intolerance; Diastolic disease
|
A193. Restrictive Cardiomyopathy
|
|
|
Q194. *Aside from the normal cardiac work-up, what is the gold standard Dx test for Restrictive CM?
|
A194. Endomyocardial Bx
|
|
|
Q195. Definition:; Increase in the size of the interventricular septum causing narrowing of the LV outflow tract leading to anterior mitral valve outflow obstruction
|
A195. Hypertrophic Cardiomyopathy
|
|
|
Q196. another name for Hypertrophic Cardiomyopathy
|
A196. IHSS; (Idiopathic Hypertrophic Subaortic Stenosis)
|
|
|
Q197. (3) causes of paradoxical splitting of S-2
|
A197. Hypertrophic cardiomyopathy (IHSS);; Aortic stenosis;; LBBB
|
|
|
Q198. murmur that decrease with squatting (and increases when returning to standing position)
|
A198. Hypertrophic CM (IHSS)
|
|
|
Q199. Etiology of Hypertrophic Cardiomyopathy; (2)
|
A199. 50% idiopathic; 50% familial (autosomal dominant, with variable penetrance)
|
|
|
Q200. Dx:; Angina (at rest or exercise); Syncope; Arrhythmias; CHF
|
A200. Hypertrophic Cardiomyopathy
|
|
|
Q201. sudden death from Hypertrophic CM is usually due to what?
|
A201. Arrhythmias
|
|
|
Q202. Dx:; 25-years old man becomes severly dyspneic and collapses while running laps, His father died suddenly at an early age.
|
A202. Hypertrophic CM (IHSS)
|
|
|
Q203. Diagnostic results to Dx Hypertrophic CM; Auscultation (2); EKG (4); Echo (2)
|
A203. Auscultation - Systolic ejection murmur, Paradoxical splitting of S2;; EKG - LVH, PVCs, A-fib, ST + Q abnormalities;; Echo - septal hypertrophy, LVH with small LV
|
|
|
Q204. Tx for Hypertrophic CM; (2 together); if becomes more severe?
|
A204. 1. No exercise; 2. Beta-blocker; More severe: implantable Cardiac Defibrillator
|
|
|
Q205. What is the BP limit for Malignant HTN?; Difference b/t HTN Urgency vs Emergency?
|
A205. Systolic >210 or diastolic >110; Hypertensive URGENCY:; WITHOUT evidence of end-organ damage; Hypertensive EMERGENCY:; Severe HTN with evidence of end-organ damage (encephalopathy, renal failure, CHF, etc)
|
|
|
Q206. what is important to remember about treating a hypertensive emergency?; What meds can be given for Tx? (3 possible)
|
A206. Do NOT lower BP by more then 1/4 at first, or patient can have a stroke; Meds:; IV drip w/; 1. Nitroprusside; 2. Nitroglyerin; 3. Beta-blocker
|
|
|
Q207. DOC for HTN without any comorbid disease
|
A207. Thiazide
|
|
|
Q208. DOC for HTN with CHF; (choice of 3)
|
A208. 1. ACEI / ARBs; 2. B-blocker; 3. Spirolactone (K-sparing)
|
|
|
Q209. DOC for HTN with MI; (2 together)
|
A209. B-blocker + ACEI
|
|
|
Q210. DOC for HTN with osteoporosis
|
A210. Thiazide (dec. calcium excretion)
|
|
|
Q211. DOC for HTN with BPH
|
A211. Terazosin (Alpha-blocker)
|
|
|
Q212. DOC for HTN with pregnancy
|
A212. alpha-methyldopa
|
|
|
Q213. (3) contraindications for Beta-blockers
|
A213. 1. COPD; 2. Diabetes; 3. HyperK
|
|
|
Q214. (3) contraindications for ACEI
|
A214. 1. Pregnancy; 2. Renal artery stenosis; 3. Renal Failure (creatinine >1.5)
|
|
|
Q215. contraindication of all diuretics
|
A215. Gout
|
|
|
Q216. (2) hypersteroidism syndromes that cause HTN with hyperK
|
A216. Cushing's; Conn's
|
|
|
Q217. endocrine system abnormality that can lead to HTN due to episiodic autonomic bursts of epinepherine
|
A217. Pheochomocytoma
|
|
|
Q218. congenital cause of HTN that leads to HTN in arms and low BP in legs
|
A218. Coartation of the Aorta
|
|
|
Q219. renal artery stenosis that causes HTN in:; 1) older men; 2) younger women
|
A219. 1) Atherosclerosis; 2) Fibromuscular dysplasia
|
|
|
Q220. Dx:; valvular problem that causes HTN with a wide PP; Physiologic cause?
|
A220. Aortic Regurgitation; cause: Inc SV
|
|
|
Q221. Dx:; congenital problem that causes HTN with a wide PP; Physiologic cause for HTN?
|
A221. Patent Ductus Arteriosus; cause: Inc SV
|
|
|
Q222. (3) drug classes that cause HTN; What metal poisoning?
|
A222. makes vessels like COAL:; Corticosteroids; Oral contraceptives; Amphetamines; Lead poisoning
|
|
|
Q223. (5) deadly causes of chest pain
|
A223. TAPUM:; Tension pneumothorax; Aortic Dissection; PE; Unstable Angina; MI
|
|
|
Q224. heart medication that can cause cyanide toxicity
|
A224. Nitroprusside
|
|
|
Q225. First Rx Tx for Hypertensive emergency due to pheochromocytoma
|
A225. Phentolamine
|
|
|
Q226. (2) possible Tx for a preclampsia-related hypertensive emergency
|
A226. Hydralazine or Magnesium
|
|
|
Q227. What is the most commonly seen early sign of right CHF, which is not seen in early left CHF?
|
A227. JVD
|
|
|
Q228. What are the systolic dysfunctions of CHF? (EF, Preload, LVEDP, contractility)
|
A228. Ejection Fraction < 40%; Preload and LVEDP: Inc; Contractility: Dec; (leads to LV hypertrophy)
|
|
|
Q229. What causes CHF exacerbation in previously stable patients? (10)
|
A229. FAILURE:; Forgot medication;; Arrhythmia, Anemia;; Ischemia, Infection;; Lifestyle (Inc sodium);; Upregulation (Inc cardiac output--pregnancy or hyperthyroidism);; Renal failure with fluid overload;; Emboli (pulmonary); Endocarditis
|
|
|
Q230. What are the diastolic dysfunctions of CHF? (compliance, contraction, recoil, stiffness, LVEDP, CO, EF)
|
A230. Compliance: Decreased; Contraction: Normal; Recoil: Decreased; Stiffness: Increased; LVEDP: Increased; CO: Normal; EF: normal to high
|
|
|
Q231. Which type of CHF dysfunction--systolic or diastolic has a normal ejection fraction and is more common in women?
|
A231. diastolic
|
|
|
Q232. What related heart conditions are seen in the systolic dysfunction of CHF that deals with decreased contractility? (4)
|
A232. Ischemia (most common);; Dilated Cardiomyopathy;; HTN;; Valvular disease
|
|
|
Q233. What related conditions are seen in the systolic dysfunction of CHF that deals with Inc afterload? (3)
|
A233. Hypertension;; Aortic stenosis;; Aortic regurgitation
|
|
|
Q234. What related conditions are seen in the diastolic dysfunction of CHF that deals with abnormal active relaxation? (2)
|
A234. Ischemia;; Hypertrophic cardiomyopathy; (from disorders causing LVH)
|
|
|
Q235. What related conditions are seen in the diastolic dysfunction of CHF that deals with abnormal passive filling? (2)
|
A235. Restrictive cardiomyopathy;; Concentric hypertrophy from HTN
|
|
|
Q236. What are the early signs of Left-sided CHF? (2)
|
A236. Dyspnea on exertion;; Dec exercise tolerance
|
|
|
Q237. What are the late sx of Left-sided CHF? (8)
|
A237. PORNS DD ****:; Paroxysmal Nocturnal Dyspnea;; Orthopnea;; Rales and crackles;; Nocturia;; S-3 gallop;; Diaphoresis;; Displaced PMI (laterally);; Tachycardia
|
|
|
Q238. What are the early signs of Right-sided CHF? (6)
|
A238. A Juicy CHERry:; Anorexia; JVD*; Cyanosis; Hepatomegaly; Edema in periphery; RUQ pain
|
|
|
Q239. What are the late sx of Right-sided CHF? (2)
|
A239. abnormal Hepatojugular reflex;; Ascites
|
|
|
Q240. What force causes the pulmonary congestion in diastolic dysfunction?
|
A240. Increased hydrostatic pressure
|
|
|
Q241. what (3) ways can CHF be diagnosed by a CXR?
|
A241. Enlargement of cardiac silhouette;; Pulmonary vascular congestion;; Kerley-B lines
|
|
|
Q242. (3) lab methods of diagnosing CHF
|
A242. CXR;; Echocardiogram (function of ventricles);; Basic Natriuretic Peptide (BNP elevation)
|
|
|
Q243. AHA staging guidelines for CHF (stages A-D)
|
A243. A: at risk but without structural heart disorder; B: no sx, with structural disorder; C: prior or current sx + structure disorder; D: end-stage disease
|
|
|
Q244. NY Heart Assoc Functional Classes of Heart Failure (I-IV); [measures pt activity limitation]
|
A244. I: No limitation; II: slight limitation; III: Sx with minimal effort, ok at rest; IV: Sx at rest
|
|
|
Q245. SOB while lying flat
|
A245. Orthopnea
|
|
|
Q246. What drug classes are good versus CHF? (3); Which ones are only helpful if patient has a diastolic dysfunction? (2)
|
A246. Systolic or Diastolic dysfunction:; ACEIs/ARBs; Beta-blockers; diuretics; Diastolic dysfunction only:; Calcium channel blockers; Nitroglycerin
|
|
|
Q247. Name the diuretic used for mild CHF and the 2 for significant CHF
|
A247. Mild:; Thiazides; Significant CHF:; Loop diuretics; Spirolactone
|
|
|
Q248. What is the difference in the signs/sx of people with right CHF and cirrhosis? (2)
|
A248. Right CHF also has:; 1. JVD; 2. Orthopnea
|
|
|
Q249. what are the (5) Tx for Acute Pulmonary Edema and Paroxysmal Nocturnal Dyspnea?
|
A249. NOMAD:; Nitroglycerin; Oxygen; Morphine; Aspirin; Diuretic
|
|
|
Q250. What is the rule for prescribing beta-blockers for CHF?
|
A250. never give during active CHF--add beta-blockers once the patient is diuresed to dry weight and on stable doses of other medications
|
|
|
Q251. Heart valve disease almost always due to Rheumatic Fever
|
A251. Mitral Stenosis
|
|
|
Q252. Murmur type:; Dyspnea on Exertion; Cough, rales; signs of RV failure; RV precordial thrust; Hoarse voice
|
A252. Mitral Stenosis; (Hoarse voice is from enlarged LA on recurrent laryngeal nerve)
|
|
|
Q253. Diagnostic results for Mitral Stenosis; Auscultation; CXR (2); EKG (3); Echo
|
A253. Auscultation: mid-diastolic low-pitched rumble with opening snap;; CXR: large Left atrium and Kerely B lines; EKG: LA enlargement; RV hypertrophy; A-fib; Echo: abnormal valve
|
|
|
Q254. Tx for mitral stenosis with each grade:; I (4);; II (2);; III/IV (1); What should always be avoided with mitral stenosis tx?
|
A254. Grade:; I: Diuretics; B-Blockers; Anticoagulants; Digitalis; II: Drugs from I + Balloon valvuloplasty (if drugs dont work); III/IV: Balloon Valvuloplasty; Avoid: Inotropic Agents!
|
|
|
Q255. Etiology of Acute Mitral Regurgitation; (2)
|
A255. MI with papillary muscle rupture;; Endocarditis
|
|
|
Q256. Etiology of Chronic Mitral Regurgitation; (3)
|
A256. Rheumatic fever;; Mitral Prolapse;; LV dilation
|
|
|
Q257. Diagnostic tests for Mitral Regurgitation; Auscultation; EKG; Echo
|
A257. Auscultation: Loud, holosystolic apical murmur radiating to axilla; EKG: large LA; Echo: valve problem
|
|
|
Q258. Tx for Mitral Regurgitation (6)*
|
A258. DAVES Deal:; Diuretics;; ACEi;; Vasodilators;; Endocarditis prophylaxis;; Surgery if severe;; Digitalis
|
|
|
Q259. Most common valvular disorder
|
A259. Mitral prolapse
|
|
|
Q260. Asymptomatic murmur with genetic predisposition, seen most commonly in women
|
A260. Mitral Prolapse
|
|
|
Q261. What (2) murmurs are seen in Marfan's syndrome?
|
A261. Mitral prolapse; Aortic Regurgitation
|
|
|
Q262. Tx for mitral prolapse?
|
A262. not necessary to tx unless symptomatic
|
|
|
Q263. Mean survival rate for patients with Aortic Stenosis and:; 1. Angina; 2. Syncope; 3. Heart failure
|
A263. 1. 5 years; 2. 2 - 3 years; 3. 1 - 2 years
|
|
|
Q264. Etiology of Aortic Stenosis (2)
|
A264. - Calcific disease with age; Bicuspid valve (around age 40)
|
|
|
Q265. Conditions with a wide Pulse Pressure; (6)*
|
A265. WAH-HA-H-ide pulse pressure:; Wet beri-beri;; Aortic Regurgitation;; Hyperthyroidism;; HTN;; Anemia;; Hypertrophic Subaortic Stenosis (IHSS)
|
|
|
Q266. What (2) valve disorders result in severe decompensation to CHF due to the absence of hemodynamic compensation?; How are they treated?
|
A266. Mitral Regurgitation; Aortic Regurgitation; Tx: Emergent surgery
|
|
|
Q267. Classic triad* of Sx for Aortic Stenosis; (4) other signs
|
A267. SAD:; Syncope;; Angina;; Dyspnea on Exertion; Others:; Forceful apex beat; narrow Pulse Pressure; Paradoxical S2 split; heard in carotids
|
|
|
Q268. Diagnostic test results for Aortic Stenosis; Auscultation; EKG; Echo; CXR
|
A268. Auscultation: Loud systolic crescendo-decrescendo murmur;; EKG: LV strain; CXR: calcifications on valve; Echo: diseased valve
|
|
|
Q269. What is the EKG LV strain pattern seen in aortic stenosis?; (hint: affects 4 leads)
|
A269. ST depression + T-wave inversion in I, aVL, V5 and V6
|
|
|
Q270. Tx for aortic stenosis; What should be avoided?; (2)
|
A270. Valve replacement; AVOID Afterload reducers (ACEi & beta-blockers)
|
|
|
Q271. (2) main etiologies for Aortic Regurgitation
|
A271. Aortic root dilatation or dissection;; Valvular disease;
|
|
|
Q272. (3)* causes of Aortic root dilatation thereby causing Aortic Regurgitation
|
A272. Marfan's;; Idiopathic (but inc with HTN);; Collagen vascular disease
|
|
|
Q273. (2) causes of Valvular disease thereby causing Aortic Regurgitation
|
A273. Rheumatic heart disease;; Endocarditis
|
|
|
Q274. (6)* causes of proximal Aortic root dissection thereby causing Aortic Regurgitation
|
A274. "THE MTS":; Third Trimester Pregnancy;; HTN;; Ehlers-Danlos;; Marphans (Cystic medial necrosis);; Turner's syndrome;; Syphilis;; (Aortic arch is shaped like a mountain)
|
|
|
Q275. Names of the unique signs of Aortic regurgitation; (7)*
|
A275. Tap Water Quickly Complicates De-Murmur Designs:; 1. Traube's sign; 2. Water-Hammer pulse; 3. Quincke's sign; 4. Corrigan's pulse; 5. de Musset's sign; 6. Muller's sign; 7. Duroziez's sign
|
|
|
Q276. Aortic regurgitation sign:; wide pulse pressure presenting w/forceful arterial pulse upswing with rapid falloff
|
A276. Water-Hammer pulse
|
|
|
Q277. Aortic regurgitation sign:; pistol-shot bruit over femoral pulse
|
A277. Traube's sign
|
|
|
Q278. Aortic regurgitation sign:; unusually large carotid pulsations
|
A278. Corrigan's pulse
|
|
|
Q279. murmur sign:; pulsatile blanching & reddening of fingernails upon light pressure; What murmur?
|
A279. Quincke's sign; (Aortic Regurgitation)
|
|
|
Q280. Aortic regurgitation sign:; head bobbing caused by carotid pulsation
|
A280. de Musset's sign; (head bobs like listening to "De Mussic")
|
|
|
Q281. Aortic regurgitation sign:; pulsatile bobbing of the uvula
|
A281. Muller's sign
|
|
|
Q282. Aortic regurgitation sign:; to-and-fro murmur over femoral artery (heard best with mild pressure applied to artery)
|
A282. Duroziez's sign
|
|
|
Q283. Murmur presentation:; dyspnea, orthopnea, paroxysmal nocturnal dyspnea, angina, LV failure, wide pulse pressure
|
A283. Aortic regurgitation
|
|
|
Q284. Murmur presentation:; starts asymptomatic, then dyspnea, angina, syncope, heart failure
|
A284. Aortic stenosis
|
|
|
Q285. Murmur presentation:; mostly asymptomatic, atypical chest pain, SOB, fatigue
|
A285. Mitral Prolapse
|
|
|
Q286. Murmur presentation:; dyspnea, fatigue, weakness, cough, A-fib, systemic emboli
|
A286. Mitral Regurgitation
|
|
|
Q287. Murmur presentation:; DOE, rales, cough, hemoptysis, systemic emboli, RV precordial thrust, RV failure, Hoarse voice
|
A287. Mitral stenosis
|
|
|
Q288. What is heard on Auscultation for Aortic regurgitation?; (3)
|
A288. 1. High-pitched, blowing decrescendo diastolic murmur; 2. Apical diastolic rumble; (mitral stenosis without snap); 3. Midsystolic flow murmur at base
|
|
|
Q289. Tx for Aortic regurgitation problems; (3)
|
A289. Tx LV heart failure;; Endocarditis prophylaxis;; Valve replacement
|
|
|
Q290. Etiology of Tricuspid stenosis (3)*
|
A290. CCR:; Congenital;; Carcinoid;; Rheumatic heart disease
|
|
|
Q291. Murmur presentation:; peripheral edema, JVD, hepatomegaly, ascites, jaundice; (2)
|
A291. Tricuspid stenosis; or; Tricuspid Regurgitation
|
|
|
Q292. Auscultation results for Tricuspid stenosis?; Tx?
|
A292. Diastolic, rumbling low-pitched heard with Inspiration; Tx: Repair valve
|
|
|
Q293. Dx:; Patient with DVT has a stroke. He has a fixed S2 split
|
A293. Atrial-Septal Defect; (with right-to-left emboli)
|
|
|
Q294. Etiology of Tricuspid Regurgitation (4)
|
A294. Increased pulmonary artery Pressure; (from L-CHF or Mitral stenosis/regurgitation);; R-CHF;; Right papillary muscle rupture with MI;; Tricuspid valve lesions; (rheumatic heart or bacterial endocarditis)
|
|
|
Q295. Holosystolic murmurs; (3)*
|
A295. MTV; Mitral Regurgitation;; Tricuspid regurgitation;; Ventricular Septal Defect
|
|
|
Q296. Number 1 cause of death in CHF patients
|
A296. Arrhythmia
|
|
|
Q297. Diagnostic results for Tricuspid Regurgitation:; Auscultation; EKG (2); Echo
|
A297. Auscultation: Holosystolic murmur increasing with inspiration; EKG: RV enlargement; A-fib; Echo: diseased valve
|
|
|
Q298. Tx for Tricuspid Regurgitation; (3)*
|
A298. Tricuspid Dying Slowly:; Tx heart failure;; Diuresis;; Surgical repair of valve
|
|
|
Q299. What is done first if a patient has hyperK and peaked T- waves? Why?
|
A299. give Calcium to stabilize cardiac membrane
|
|
|
Q300. Murmur:; Diastolic apical rumble and opening snap
|
A300. Mitral stenosis
|
|
|
Q301. Murmur:; Late systolic murmur with midsystolic click; What is confirming test?
|
A301. Mitral Prolapse; Valsalva - click starts earlier, murmur prolonged
|
|
|
Q302. Murmur:; High-pitched apical blowing holosystolic murmur; where does it radiate?
|
A302. Mitral Regurgitation; radiates: Axillae
|
|
|
Q303. Murmur:; Diastolic rumble louder with inspiration
|
A303. Tricuspid stenosis
|
|
|
Q304. Murmur:; High-pitched blowing holosystolic murmur heard better with inspiration; Where is it heard?; Where are pulsations seen?
|
A304. Tricuspid Regurgitation; heard at left sternal border; Jugular pulsations
|
|
|
Q305. Name sign:; Peripheral pulses that are weak and late compared to heart sounds; What murmur?
|
A305. Pulsus Parvus et Tardus; Aortic Stenosis
|
|
|
Q306. Murmur:; midsystolic crescendo-decrescendo murmur; Where does it radiate? (2); What heart sound is also heard?
|
A306. Aortic stenosis; radiates to: Carotids and Apex; S4 also heard
|
|
|
Q307. Name sign:; Double-peaked arterial pulse; what murmur?
|
A307. Pulsus Bisferiens; Aortic regurgitation
|
|
|
Q308. Murmur:; Blowing early diastolic, apical diastolic rumble, midsystolic flow murmurs
|
A308. Aortic Regurgitation
|
|
|
Q309. Dx that causes Murmur:; Systolic murmur at apex and left sternal boarder not transmitted to carotids; How is it heard better?
|
A309. IHSS; heard better with standing after squat
|
|
|
Q310. When during S1-S2 do you hear the "flow murmur" (murmur heard with any high flow state)?; What is differential dx? (5)*
|
A310. Midsystolic:; Aortic Regurgitation; Atrial-Septal defect (fixed split S2); Anemia; Adolescence; Pregnancy
|
|
|
Q311. difference b/t Type A and Type B Aortic Dissections
|
A311. Type A: involves the ascending aorta and can extend into the descending aorta; Type B: descending aorta only
|
|
|
Q312. Debakey Classification of Aortic Dissection Types I-III Which is most common?
|
A312. I: Ascending plus part of distal aorta (most common); II: Ascending only; III: Descending only
|
|
|
Q313. What is infected on the aorta when the aortic dissection is due to syphilis?
|
A313. Vasa Vasorum
|
|
|
Q314. Etiology of Aortic Dissection (7)
|
A314. PATC3H:; Pregnancy (3rd trimester);; Aortic Coarctation (Turners or idiopathic);; Trauma;; Congenital heart disease / CT disease (Marfans and E-D syndromes) / Cocaine;; HTN
|
|
|
Q315. Dx:; Severe tearing chest pain that radiates to the back, HTN, possible unequal pulses distally, possible aortic regurgitation murmur
|
A315. Aortic Dissection
|
|
|
Q316. (3) tests to confirm Dx of aortic dissection
|
A316. Angiogram (gold standard);; CXR - wide mediastinum;; CT with contrast
|
|
|
Q317. Drug Tx for Aortic dissection to stabilize BP; (2); What is the next step for Type A vs. Type B?
|
A317. Rx: Beta-blocker + nitroprusside to keep BP < 120; Type A: Immediate surgery; Type B: medical stabilization
|
|
|
Q318. Etiologies of Syncope (7)
|
A318. SVNCOPE:; Situational (valsalva, tight collar);; Vasovagal response (common faint);; Neurogenic;; Cardiac;; Orthostatic hypotension;; Psychiatric (faking it);; Everything else (idiopathic)
|
|
|
Q319. At what level is HDL cardioprotective?
|
A319. > 60
|
|
|
Q320. What "type" is all isolated hypercholesterolemia?
|
A320. Type IIa
|
|
|
Q321. What transports cholesterol from the gut to the bloodstream?
|
A321. Chylomicrons
|
|
|
Q322. What is left over after lipoprotein lipase liberates FFA from chylomicrons for use in tissues?
|
A322. Chylomicron remnants
|
|
|
Q323. What is secreted from the liver and carries endogenous cholesterol?
|
A323. VLDL
|
|
|
Q324. What is metabolized from VLDL?
|
A324. Intermediate-Density Lipoproteins (IDL)
|
|
|
Q325. What is metabolized from IDL and carries cholesterol in the bloodstream to the tissues?
|
A325. LDL
|
|
|
Q326. What takes up free cholesterol secreted by the tissues and transports it to the liver?
|
A326. HDL
|
|
|
Q327. What is the name for the (3) Type IIa Isolated Hypercholesterolemias?; What is abnormal with all of them?; What is the total cholesterol range?
|
A327. Familial Hypercholesterolemia;; Familial defective apo-B100;; Polygenic Hypercholesterolemia; High LDL; total cholesterol from 240 - 500
|
|
|
Q328. What are the (3) isolated Hypertriglyceridemias and each "Type"?; What is elevated with each?
|
A328. 1. familial Hypertriglyeridemia Type IV - high VLDL; 2. familial Apo-CII deficiency; 3. familial Lipoprotein Lipase deficiency; (2 and 3 are both Type I + V - high chylomicrons)
|
|
|
Q329. Class of drugs that that reduce LDL by binding bile acids in the gut. name (2) drugs
|
A329. Bile Acid Sequestrants; Cholestyramine; Colestipol
|
|
|
Q330. which drug class is best for reducing triglycerides in VLDL and chylomicrons?
|
A330. Fibrinates
|
|
|
Q331. Etiologies of A-Fib; (10)
|
A331. PIRATES:; Pulmonary (COPD, PE), Pheochromocytoma, Pericarditis;; Ischemic heart disease & HTN;; Rheumatic heart disease; Anemia;; Thyrotoxicosis;; Ethanol & cocaine;; Sepsis
|
|
|
Q332. Signs/symptoms of A-Fib; (5)
|
A332. A FL PT:; Asymptomatic patient;; Fatigue (most common);; Light headedness, syncope;; Palpitations, skipped beats;; Tachypnea, dyspnea
|
|
|
Q333. Drugs given to A-Fib to control rate in a non-emergent situation; (2)
|
A333. oral Beta-blocker:; Atenolol; (and); oral Calcium channel blockers:; Verapamil or Diltiazem
|
|
|
Q334. what are the (2) ways to cardiovert an A-Fib rhythm?; when should you not cardiovert?; what would the Tx be then?
|
A334. Medical: Amiodarone; Electrical: start @ 100 J; Do not cardiovert if patient is in A-Fib > 24 hours. Tx: Warfarin for 3-4 weeks before cardioversion
|
|
|
Q335. Dx:; when the heart is unable to pump sufficient amounts of blood to meet the O2 requirement of the body causing blood to backup
|
A335. Congestive Heart Failure; (CHF)
|
|
|
Q336. What are the systolic dysfunctions of CHF?; (EF, Preload, LVEDP, contractility)
|
A336. Ejection Fraction < 40%; leading to Inc preload & LVEDP,; which leads to Dec contractility and Inc cardiac hypertrophy
|
|
|
Q337. What causes CHF exacerbation in previously stable patients?; (10)
|
A337. FAILURE:; Forgot medication;; Arrhythmia, Anemia;; Ischemia, Infection;; Lifestyle (Inc sodium);; Upregulation (Inc cardiac output--pregnancy or hyperthyroidism);; Renal failure with fluid overload;; Emboli (pulmonary); Endocarditis
|
|
|
Q338. What are the diastolic dysfunctions of CHF?; (compliance, contraction, recoil, LVEDP, CO, EF)
|
A338. Decreased compliance with normal contractile function; (ventricle either cant relax or fill properly); leading to Inc stiffness, Dec recoil & coencentric hypertrophy. LVEDP is Inc,; CO is nml,; EF is nml to high
|
|
|
Q339. What related heart conditions are seen in the systolic dysfunction of CHF that deals with decreased contractility?; (4)
|
A339. Ischemia(most common);; Dilated Cardiomyopathy;; Hypertensive burnout;; Valvular disease
|
|
|
Q340. What related conditions are seen in the systolic dysfunction of CHF that deals with Inc afterload?; (3)
|
A340. Hypertension;; Aortic stenosis;; Aortic regurgitation
|
|
|
Q341. What related conditions are seen in the diastolic dysfunction of CHF that deals with abnormal active relaxation?; (2)
|
A341. Ischemia;; Hypertrophic cardiomyopathy; (from disorders causing LVH)
|
|
|
Q342. What related conditions are seen in the diastolic dysfunction of CHF that deals with abnormal passive filling?; (2)
|
A342. Restrictive cardiomyopathy;; Concentric hypertrophy from HTN
|
|
|
Q343. What are the early signs of Left-sided CHF?; (2)
|
A343. Dyspnea on exertion;; Dec exercise tolerance
|
|
|
Q344. What are the late sx of Left-sided CHF?; (8)
|
A344. PORNS DD ****:; Paroxysmal Nocturnal Dyspnea;; Orthopnea;; Rales & crackles;; Nocturia;; S-3 gallop;; Diaphoresis;; Displaced PMI (laterally);; Tachycardia
|
|
|
Q345. What are the early signs of Right-sided CHF?; (6)
|
A345. A Juicy CHERry:; Anorexia; JVD*; Cyanosis; Hepatomegaly; Edema in periphery; RUQ pain
|
|
|
Q346. What are the late sx of Right-sided CHF?; (2)
|
A346. abnormal Hepatojugular reflex;; Ascites
|
|
|
Q347. NY Heart Assoc Functional Classes of Heart Failure (I-IV); [measures pt activity]
|
A347. I: No limitation; II: slight limitation; III: Sx with minimal effort, ok at rest; IV: Sx at rest
|
|
|
Q348. What drug classes are good versus CHF? Which ones are only helpful if patient has a diastolic dysfunction?
|
A348. Systolic or Diastolic dysfunction:; ACEIs/ARBs; Beta-blockers; diuretics; Diastolic dysfunction only:; Calcium channel blockers; Nitroglycerin
|
|
|
Q349. What diuretics are used for mild CHF and (2 for) significant CHF?
|
A349. Mild:; Thiazides; Significant CHF:; Loop diuretics; Spirolactone
|
|
|
Q350. What is the difference in the signs/sx of people with right CHF and cirrhosis?; (2)
|
A350. Same sx, except right CHF patients have trouble lying flat & have JVD
|
|
|
Q351. what are the (5) Tx for Acute Pulmonary Edema & Paroxysmal Nocturnal Dyspnea?
|
A351. NOMAD:; Nitroglycerin; Oxygen; Morphine; Aspirin; Diuretic
|
|
|
Q352. Describe (2) types of Malignant HTN; (+ BP limits)
|
A352. Hypertensive URGENCY:; systolic >200 or diastolic >110; WITHOUT evidence of end-organ damage; Hypertensive EMERGENCY:; Severe HTN with evidence of end-organ damage; (encephalopathy, renal failure, CHF, etc)
|
|
|
Q353. what is important to remember about treating a hypertensive emergency?; (2)
|
A353. 1) Immediate therapy is needed; 2) IV drip with Nitroprusside or Nitroglyerin, but do not lower BP by more then 1/4 at first, or patient can have a stroke
|
|
|
Q354. DOC for HTN with CHF; (3)
|
A354. ACEI / ARBs; B-blocker,; K-sparing diuretic
|
|
|
Q355. DOC for HTN with MI; (2)
|
A355. B-blocker & ACEI
|
|
|
Q356. renal artery stenosis that causes HTN in:; 1) older men; 2) younger women
|
A356. 1) atherosclerosis; 2) fibromuscular dysplasia
|
|
|
Q357. valvular problem that causes HTN with a wide PP due to Inc SV
|
A357. Aortic Regurgitation
|
|
|
Q358. congenital problem that causes HTN with a wide PP due to Inc SV
|
A358. Patent Ductus Arteriosus
|
|
|
Q359. (3) drug classes that cause HTN; What metal poisoning?
|
A359. Oral contraceptives; Corticosteroids; Amphetamines; Lead poisoning
|
|
|
Q360. (6) Major risk factors for CAD; which is most prevetable?; which is the greatest risk?
|
A360. Diabetes (greatest); Smoking (most preventable); HTN; Hypercholesterolemia; Family History; Age
|
|
|
Q361. Chest pain that has an established character, timing and duration; pain is transient, reproducible and predictable. What is cause?; What is Tx? (2)
|
A361. Stable Angina; Reduced coronary blood flow through fixed atherosclerotic plaque in vessel of heart; rest & nitroglycerin
|
|
|
Q362. exertional substernal (precordial) chest pressure and pain radiating to left arm, jaw or back. N/V, diaphoresis, dyspnea, HTN and tachycardia can accompany it. Name the types
|
A362. Angina:; Stable; Unstable; Variant (Prinzmetal's)
|
|
|
Q363. Angina type that is also considered an Acute Coronary Syndrome (ACS). What (3) factors must it have for diagnosis?
|
A363. Unstable Angina; 1) New-onset; 2) angina that changes or accelerates in pattern, location or severity; 3) Occurs at REST
|
|
|
Q364. Similar characteristics of stable angina, but due to vasospasm instead of atherosclerosis. (2) Tx?
|
A364. Variant (Prinzmetal's) Angina; Nitrates & Calcium Channel blockers
|
|
|
Q365. what (2) groups of patients may not show the classic signs pain seen in stable angina?; Why?
|
A365. Elderly & diabetics; (b/c: neuropathies)
|
|
|
Q366. 62-years old smoker with 3 episodes of severe heavy chest pain in the morning. Each lasted 3 - 5 minutes, but he has no pain now. He has never had this before. What is it?
|
A366. Unstable Angina
|
|
|
Q367. 62-years old man with frequent episodes of chest pain on and off for 8 months. He says the pain wakes him from sleep at night. What is it?
|
A367. Variant (Prinzmetal's) Angina
|
|
|
Q368. What is the criteria for a "positive" Stress Test?; (5)
|
A368. either:; ST elevation; ST depression >1 mm in multiple leads; Dec BP; failure to go more than 2 minutes; failure to complete for reason other then cardiac symptoms (i.e. arthritis)
|
|
|
Q369. what does Myocardial Perfusion Imaging detect?; (3)
|
A369. - Myocardial perfusion; Ventricular volume; Ejection Fraction
|
|
|
Q370. (5) uses for a cardiac catherization
|
A370. 1) MI / Unstable angina: stent or angiography; 2) Valvular disease: valvuloplasty; 3) Arrhythmias: mapping bypass tracts; 4) Myocardial disease Bx: glycogen storage disease or cardiomyopathies; 5) Congenital heart disease identification: angiography & closure of defects
|
|
|
Q371. How is the right heart accessed in a cardiac catheterization? (2); Left heart? (2)
|
A371. Right:; Femoral or Internal Jugular; Left:; Femoral or Radial artery (from right heart)
|
|
|
Q372. what is the wave morphology changes sequence in a MI ECG?; (6)
|
A372. 1. peaked T-waves; 2. T-wave inversion; 3. ST elevation; 4. Q-waves; 5. ST normalization; 6. T-waves return upright
|
|
|
Q373. which cardiac enzyme has the shortest duration?; Longest?
|
A373. Myoglobin (1 day); Troponin-I/T (7-10 days)
|
|
|
Q374. difference b/t unstable angina & non-ST elevation MI?; (2)
|
A374. non-ST elevation MI has:; 1. more severe lack of Oxygen (more severe myocardial damage); 2. Enzyme leakage (Unstable angina has none)
|
|
|
Q375. Tx for Unstable angina & MI; (6)
|
A375. MONA has HEP B:; Morphine; Oxygen; Nitrates; Aspirin; HEParin; Beta-blockers
|
|
|
Q376. primary Tx (2) for the acute MI w/in 6 hours of infarct; (name 4 drugs)
|
A376. Thrombolytics:; tPA + Heparin (DOC); Urokinase; strptokinase; Alteplase
|
|
|
Q377. At what level should LDL be in person with MI history?; What is given to lower it?
|
A377. less then 100; statins
|
|
|
Q378. When are thrombolytics indicated in MI?; (3)
|
A378. - patients < 80 yo; within 6-12 hrs of chest pain; evidence of infarct on ECG
|
|
|
Q379. Contra-indications of Thrombolytics; (9)
|
A379. Having Some Breaks A Blood Clot In Small Pieces:; History of intracranial bleed; stroke < 1 year; BP > 180/110; active internal bleed; bleeding disorder; CPR; Intracranial tumor; suspected aortic dissection; Peptic ulcer
|
|
|
Q380. drug that prevents future clots from forming
|
A380. heparin
|
|
|
Q381. Tx of choice for MI if there is a high risk of ST elevation (cardiogenic shock) or it has been 3 hours since initial symptoms presented?
|
A381. PTCA; (Percutaneous Transluminal Coronary Angioplasty)
|
|
|
Q382. which throbolytic is highly immunogenic and cannot be used in the same patient twice in a 6 month period?
|
A382. streptokinase
|
|
|
Q383. drug class that is excellent for late & long-term therapy for acute MI to decrease afterload and prevent remodeling?
|
A383. ACEi
|
|
|
Q384. how many seconds & boxes is a normal PR interval?
|
A384. 0.2 ms; 5 small boxes
|
|
|
Q385. define:; Q-wave; When is it pathologic?
|
A385. when initial part of ventricular depolarization is downward; Pathologic: greater then 1 small box
|
|
|
Q386. normal time & boxes for QRS interval?
|
A386. < 0.12 ms; 3 small boxes
|
|
|
Q387. define:; Junctional rhythm
|
A387. rhythm originating in the AV node & causing narrow QRS without P-waves
|
|
|
Q388. no p-waves;; all complexes are wide;; no changes in height (amplitude) with each complex;; > 100bpm
|
A388. Ventricular tachycardia
|
|
|
Q389. wide QRS complexes that vary in amplitude; (2 names)
|
A389. Ventricular Fibrillation; Torsades de Pointes
|
|
|
Q390. normal sinus rhythm with PR interval > 0.2 ms (> 5 small boxes)
|
A390. First-degree AV block
|
|
|
Q391. PR interval elongates from beat to beat until it becomes so long that a beat drops
|
A391. Second-degree AV block, type 1; (Wenckebach)
|
|
|
Q392. PR interval is fixed but every so often there is a P-wave without a QRS
|
A392. Second-degree AV block, type 2; (Mobitz)
|
|
|
Q393. no relationship b/t P-waves and QRS complexes
|
A393. Third-degree AV block
|
|
|
Q394. QRS > 0.12 (> 3 small boxes); RSR' in V1 & V2;; deep S-wave in lateral leads (I, aVL, V5 & V6)
|
A394. RBBB
|
|
|
Q395. QRS > 0.12 (> 3 small boxes);; RSR' in V5 & V6;; diffuse ST elevation
|
A395. LBBB
|
|
|
Q396. Different shapes to 3 or more P-waves;; normal rhythm; (what is it called if it is tachycardic?)
|
A396. Wandering pacemaker; MFAT:; Multifocal Atrial Tachycardia
|
|
|
Q397. short PR interval;; slurring delta wave connecting P-wave to QRS complex
|
A397. Wolff-Parkinson-White syndrome
|
|
|
Q398. diffuse ST elevation that slopes in a concave manner back to baseline + diffuse PR segment depression in all leads except PR elevation in aVR
|
A398. Pericarditis
|
|
|
Q399. Tx of wandering pacemaker & MFAT?; (1 drug / 1 "other")
|
A399. Verapamil (Ca channel block); &; Tx underlying condition
|
|
|
Q400. what Tx breaks SVT (supraventricular tach) in > 90%?
|
A400. Adenosine; (failure to break r/o SVT)
|
|
|
Q401. Tx of asymptomatic V-tach; (2)
|
A401. Amiodarone; Lidocaine
|
|
|
Q402. 58-years old man discharged from hospital after MI 2 weeks ago presents with fever, chest pain & malaise. EKG shows diffuse ST-T wave changes. What is Dx?; What is Tx?
|
A402. Dressler's syndrome; NSAIDs
|
|
|
Q403. Medication orders with dischsrge of an ACS (post-MI) patient?; (5)
|
A403. easy AS ABC:; Aspirin (indefinitely); Statin to lower LDL < 100; ACE-inh (if EF <40%); Beta-blocker (indefinitely); Clopidogrel for 1 - 12 mo depending on stent placement
|
|
|
Q404. Dx:; fever, pericarditis & possible pericardial or pleural effusions post cardiac surgery
|
A404. Dressler's syndrome
|
|
|
Q405. SVT with AV block & yellow skin
|
A405. Digoxin toxicity
|
|
|
Q406. Etiology of Dilated Cardiomyopathy; (6)
|
A406. TIMED:; Toxic (EtOH, heavy metals); Infectious / Ischemic; Metabolic / Mechanical (arrhythmia, valve disease); Endocrine; Drugs
|
|
|
Q407. what is the Reversible & Irreversible(2) toxic causes of Dilated Cardiomyopathy?
|
A407. Reversible:; prolonged EtOH use; Irreversible:; Cocaine;; heavy metal toxicity
|
|
|
Q408. what is the Reversible & Irreversible(2) endocrine causes of Dilated Cardiomyopathy?
|
A408. Reversible:; Thyroid disease (hypo or hyper); Irreversible:; Acromegaly;; Pheochromocytoma
|
|
|
Q409. Reversible metabolic causes of Dilated Cardiomyopathy?; (4)
|
A409. HypoC;; HypoP;; Thiamine deficiency (wet beri-beri);; Selenium deficiency
|
|
|
Q410. Infections that cause Dilated Cardiomyopathy; (3)
|
A410. HIV;; Coxsackie virus;; Chagas disease
|
|
|
Q411. Drugs that cause Dilated Cardiomyopathy; (2)
|
A411. Doxorubicin (Adriamycin);; AZT
|
|
|
Q412. Signs/Sx of Dilated Cardiomyopathy
|
A412. RAMS:; R & L Heart failure;; A-fib;; Mitral regurgitation;; S-3 Gallop
|
|
|
Q413. Diastolic or Systolic Disease Cardiomyopathy:; 1. Dilated; 2. Restrictive; 3. Hypertrophic
|
A413. Systolic:; Dilated; Diastolic:; Restrictive &; Hypertrophic
|
|
|
Q414. Diagnostic results of Dilated cardiomyopathy; auscultation; EKG (3); CXR (2); Echo (2)
|
A414. Auscultation: S-3;; EKG: Vent Hypertrophy, BBB &/or A-fib;; CXR: Inc heart size; pulm congestion; Echo: low EF, large ventricles
|
|
|
Q415. Tx Dilated Cardiomyopathy; (3)
|
A415. - stop any toxic agents; anticoagulation with coumadin (even without evidence of thrombus); heart transplant
|
|
|
Q416. Right or left ventricular enlargement with loss of contractile function causing CHF, arrhythmia, or throbus formation.
|
A416. Dilated Cardiomyopathy
|
|
|
Q417. Scarring & infiltration of the myocardium causing decreased right or left ventricular filling
|
A417. Restrictive Cardiomyopathy
|
|
|
Q418. Etiology of Restrictive Cardiomyopathy; (7)
|
A418. ACHES:; Amyloidosis;; Carcinoid heart disease / Congenital;; Hemochromatosis;; Endomyocardial fibrosis; Sarcoidosis / Scleroderma
|
|
|
Q419. Dx:; Pulmonary HTN (right CHF);; S-4 gallop; Low QRS voltage on EKG; Exercise intolerance;; Diastolic disease
|
A419. Restrictive Cardiomyopathy
|
|
|
Q420. (5) tests used to assist in the Dx of Restrictive Cardiomyopathy
|
A420. Auscultation;; EKG;; CXR;; Echo;; Endomyocardial Bx*
|
|
|
Q421. Increase in the size of the interventricular septum causing narrowing of the LV outflow tract leading to anterior mitral valve outflow obstruction
|
A421. Hypertrophic Cardiomyopathy
|
|
|
Q422. etiology of Hypertrophic Cardiomyopathy
|
A422. 50% idiopathic; 50% familial (autosomal dominant, with variable penetrance)
|
|
|
Q423. Dx:; Angina (at rest or exercise); Syncope; Arrhythmias; CHF
|
A423. Hypertrophic Cardiomyopathy
|
|
|
Q424. 25-years old man becomes severely dyspneic & collapses while running laps, His father died suddenly at an early age.
|
A424. Hypertrophic CM (IHSS)
|
|
|
Q425. Diagnostic results to Dx Hypertrophic CM; Auscultation (2); EKG (4); Echo (2)
|
A425. Auscultation - Systolic ejection murmur;; Paradoxical splitting of S2;; EKG - LVH, PVCs, A-fib, ST & Q abnormalities;; Echo - septal hypertrophy, LVH with small LV
|
|
|
Q426. Tx for Hypertrophic CM; (3)
|
A426. - No exercise; Beta-blocker; implantable cardiac defibrillator
|
|
|
Q427. Etiology of Pericarditis; (6)
|
A427. Bacterial, viral or fungal infections;; Serositis from:; RA;; SLE;; Scleroderma;; Uremia;; post-MI (Dressler's syndrome)
|
|
|
Q428. Tx for pericarditis if:; infection; pain/inflammation; Dressler's; Recurrent cases
|
A428. - Tx infection with Abx;; NSAIDs to relieve pain & reduce inflammation;; Steroids for Dressler's;; Pericardectomy only with recurrent cases
|
|
|
Q429. Transient fall in BP > 10 mmHg during inspiration
|
A429. Pulsus Paradoxus
|
|
|
Q430. Physiologic result of rapid accumulation of fluid in the pericardial sac; impairs cardiac filling & reduces cardiac output
|
A430. Pericardial Tamponade
|
|
|
Q431. Etiology of Pericardial Tamponade; (3)
|
A431. - Pericarditis; Trauma; Aortic dissection or ventricular rupture into pericardium
|
|
|
Q432. Beck's triad of the pericardial tamponade; (4) other signs/Sx
|
A432. Beck's triad:; Hypotension; Muffled heart sounds; JVD; Other Sx:; Dyspnea;; Tachycardia;; Pulsus Paradoxus*; narrow Pulse Pressure
|
|
|
Q433. Tx for Pericardial Tamponade for:; 1. unstable; 2. stable; 3. both
|
A433. Unstable: Immediate Pericardiocentesis;; Stable: Pericardial window; Both: Infuse fluids to expand volume
|
|
|
Q434. Patient has chest pain with inspiration that radiates to the left trapezial ridge;; Pain is relieved by sitting up and leaning forward; does not respond to nitroglycerine
|
A434. Pericarditis
|
|
|
Q435. Murmur type:; Dyspnea on Exertion; Cough, rales; signs of RV failure;; RV precordial thrust; Hoarse voice (from enlarged LA on recurrent laryngeal nerve)
|
A435. Mitral Stenosis
|
|
|
Q436. Diagnostic results for Mitral Stenosis; Auscultation; CXR; EKG
|
A436. Auscultation: mid-diastolic opening snap;; CXR: large Left atrium & Kerely B lines; EKG: LA enlargement; RV hypertrophy; A-fib
|
|
|
Q437. Tx for mitral stenosis with each grade (I-IV); What should always be avoided with mitral stenosis tx?
|
A437. Grade:; I: Diuretics; B-Blockers; Anticoagulants; Digitalis; II: Drugs from I + Balloon valvuloplasty (if drugs dont work); III/IV: Balloon Valvuloplasty; Avoid: Inotropic Agents!
|
|
|
Q438. Acute etiology of Mitral Regurgitation; (2)
|
A438. MI with papillary muscle rupture;; Endocarditis
|
|
|
Q439. Chronic etiology of Mitral Regurgitation; (3)
|
A439. Rheumatic fever;; Mitral Prolapse;; LV dilation
|
|
|
Q440. Diagnostic tests for Mitral Regurgitation; Auscultation; EKG; Echo
|
A440. Auscultation: Loud, holosystolic apical murmur radiating to axilla; EKG: large LA; Echo: valve problem
|
|
|
Q441. Tx for Mitral Regurgitation; (6)
|
A441. ACEinh;; Diuretics;; Vasodilators;; Digitalis;; Endocarditis prophylaxis;; Surgery if severe
|
|
|
Q442. What murmur is seen in Marfan's syndrome?
|
A442. Mitral prolapse
|
|
|
Q443. Mean survival rate for patients with Aortic Stenosis and:; 1. Angina; 2. Syncope; 3. Heart failure
|
A443. 1. 5 years; 2. 2 - 3 years; 3. 1 - 2 years
|
|
|
Q444. Etiology of Aortic Stenosis; (2)
|
A444. - Calcific disease with age; Bicuspid valve (around age 40)
|
|
|
Q445. Conditions with a wide Pulse Pressure; (6)
|
A445. WAH-HAH-ide pulse pressure:; Wet beri-beri; Aortic Regurgitation;; Hyperthyroidism;; Hypertension;; Anemia;; Hypertrophic Subaortic Stenosis (IHSS)
|
|
|
Q446. WHat (2) valve disorders result in severe decompensation to CHF due to the absence of hemodynamic compensation. How is it treated?
|
A446. Mitral Regurgitation; Aortic Regurgitation; Tx: Emergent surgery
|
|
|
Q447. Classic triad of Sx for Aortic Stenosis; (4) other signs
|
A447. SAD:; Syncope;; Angina;; Dyspna on Exertion; Others:; Forceful apex beat; narrow Pulse Pressure; Paradoxical S2 split; heard in carotids
|
|
|
Q448. Diagnostic test results for Aortic Stenosis; Auscultation; EKG; Echo; CXR
|
A448. Auscultation: Loud systolic crescendo-decrescendo murmur;; EKG: LV strain; CXR: calcifications on valve; Echo: diseased valve
|
|
|
Q449. What is the EKG LV strain pattern seen in aortic stenosis?
|
A449. ST depression & T-wave inversion in I, aVL, V5 & V6
|
|
|
Q450. Tx for aortic stenosis; (2)
|
A450. - avoid Afterload reducers (ACEinh & beta-blockers); Valve replacement
|
|
|
Q451. (3) main etiologies for Aortic Regurgitation
|
A451. Aortic root dilatation;; Valvular disease;; Proximal Aortic root dissection
|
|
|
Q452. (3) causes of Aortic root dilatation thereby causing Aortic Regurgitation
|
A452. Marfan's;; Idiopathic (but inc with HTN);; Collagen vascular disease
|
|
|
Q453. (6) causes of proximal Aortic root dissection thereby causing Aortic Regurgitation
|
A453. "C 3 SHET":; Cystic medial necrosis (Marfans);; 3rd trimester pregnancy;; Syphilis;; HTN;; Ehlers-Danlos;; Turner's syndrome
|
|
|
Q454. Names of the 7 unique signs of Aortic regurgitation
|
A454. 1. Water-Hammer pulse; 2. Traube's sign; 3. Corrigan's pulse; 4. Quincke's sign; 5. de Musset's sign; 6. Muller's sign; 7. Duroziez's sign
|
|
|
Q455. Aortic regurgitation sign:; wide pulse pressure presenting w/forceful arterial pulse upswing with rapid falloff
|
A455. Water-Hammer pulse
|
|
|
Q456. Aortic regurgitation sign:; pistol-shot bruit over femoral pulse
|
A456. Traube's sign
|
|
|
Q457. Aortic regurgitation sign:; unusually large carotid pulsations
|
A457. Corrigan's pulse
|
|
|
Q458. Aortic regurgitation sign:; pulsatile blanching & reddening of fingernails upon light pressure
|
A458. Quincke's sign
|
|
|
Q459. Aortic regurgitation sign:; head bobbing caused by carotid pulsation
|
A459. de Musset's sign
|
|
|
Q460. Aortic regurgitation sign:; pulsatile bobbing of the uvula
|
A460. Muller's sign
|
|
|
Q461. Aortic regurgitation sign:; to-&-fro murmur over femoral artery (heard best with mild pressure applied to artery)
|
A461. Duroziez's sign
|
|
|
Q462. Murmur presentation:; dyspnea, orthopnea, paroxysmal noctournal dyspnea, angina, LV failure,; wide pulse pressure
|
A462. Aortic regurgitation
|
|
|
Q463. Murmur presentation:; starts asymptomatic, then dyspnea, angina, syncope, heart failure
|
A463. Aortic stenosis
|
|
|
Q464. Murmur presentation:; mostly asymptomatic, atypical chest pain, SOB, fatigue
|
A464. Mitral Prolapse
|
|
|
Q465. Murmur presentation:; dyspnea, fatigue, weakness, cough, A-fib, systemic emboli
|
A465. Mitral Regurgitation
|
|
|
Q466. Murmur presentation:; DOE, rales, cough, hemoptysis, systemic emboli, RV precordial thrust, RV failure, Hoarse voice
|
A466. Mitral stenosis
|
|
|
Q467. How do you diagnose LVH from a ECG?; (2)
|
A467. 1. S-wave in V1 + R-wave in V5 or V6 > 7 large boxes (35 small); 2. R-wave in V5 or V6 > 25 small boxes OR R-wave in lead aVL > 11 small boxes
|
|
|
Q468. Diagnostic tests for Aortic Regurgitation; Auscultation (3); EKG
|
A468. Auscultation:; 1. Holosystolic, blowing decrescendo diastolic murmur; 2. Apical diastolic rumble (mitral stenosis without snap); 3. Midsystolic flow murmur at base; EKG: LVH; Echo: regurgitant valve
|
