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STEP 2 Medicine
Cardiovascular Rx
| Question | Answer |
|---|---|
| What is the 1st sign of STEMI? | Localized hyperacute T waves |
| What causes localized hyperacute T waves in a STEMI? | Myocardial necrosis leading to localized hyperkalemia |
| What is the definite treatment for an occluded vessel? | Percutaneous Coronary Intervention (PCI) |
| If an institution does not have PCI availability, what is used to treat a STEMI or occlusion of vessel? | Thrombolytic agents |
| When are thrombolytic agents used? | STEMI < 1hr onset of symptoms or while transport to facility with PCI installation |
| What is a contraindication for thrombolytics? | Recent surgery |
| What conditions are included in Acute Coronary Syndrome (ACS)? | Unstable angina, NSTEMI, and STEMI |
| Which conditions of ACS is the only one with elevated ST segment? | STEMI |
| What are ECG findings shared by Unstable angina and NSTEMI? | ↓ST segment and T-wave inversion |
| What is the best initial treatment for Cocaine induced arrhythmia? | Sodium bicarbonate |
| What are common ECG findings on TCA/or Cocaine-induced arrhythmias? | Wide QRS tachycardia with shift in axis of terminal portion of QRS complex |
| What is common cause of difficult-to-control HTN? | OSA |
| What study is used to confirm diagnosis of OSA? | Polysomnography |
| What the treatment of a diagnosed OSA patient? | Continuous Positive airway pressure (C-PAP) machine |
| What is the best and least invasive treatment for recurrent pericardial effusions? | Ballon pericardiotomy |
| What are the guidelines for Atherosclerotic Cardiovascular Disease (ASCVD)? | 1. Primary prevention in adults - 21 yo with LDL = 190 2. Primary prevention in adults with DM - 40- 75 yo and LDL 71-189 3. Primary prevention in adults 40-75 yo w/out DM with LDL 70-189 and 10-year ASCVD risk of = 7.5% |
| Which type of angina, stable or unstable, is relieved by rest? | Stable angina |
| What is the test of choice for angina in healthy and ambulant patient? | Exercise stress test |
| What drugs are used in echocardiography stress test? | Dobutamine |
| What drugs are sed in MPI stress test? | Adenosine or Dipyridamole |
| At what point are nitrates safe to be used in treating an MI? | Until it is known that the RIGHT VENTRICLE is not involved |
| What category of medications are strictly contraindicated in MI with R-sided HF? | Nitrates |
| What leads to diastolic dysfunction? | Inability of ventricle to relax and properly fill during diastole. |
| What is the result of EDV in diastolic dysfunction patients? | Normal/↓ EDV |
| What are common causes of diastolic dysfunction? | Acute ischemia, chronic HTN, severe Aortic Stenosis, infiltrative cardiomyopathy (e.g., amyloid), and HOCM. |
| What is the initial test and MC for any changes in bowel habits? | Colonoscopy |
| Mid-systolic crescendo-decrescendo murmur with greatest intensity over the RUSB | Aortic stenosis |
| Systolic crescendo-decrescendo murmur best heard at the apex that ↑ intensity with Valsalva and ↓ preload. | Hypertrophic Obstructive Cardiomyopathy |
| At which area is the VSD best heard in auscultation? | Tricuspid area |
| Which diastolic murmurs are heard at Erb's point? | Aortic regurgitation and Pulmonic regurgitation |
| In which thoracic area is HOCM best heard? | Erb's point |
| What is the 1st line of TX for Pericarditis? | NSAIDs |
| Which drugs are used in Isotopic Imaging (MPI) stress test? | Adenosine or Dipyridamole |
| What drug classes are the best for angina pectoris? | ß-blockers and Calcium-channel blockers |
| What is a common mnemonic for ischemic myocardium medications? | MONA BASH-C |
| What does MONA BASH-C stand for: | Morphine Oxygen Nitrates Aspirin ß-blockers ACE-inhibitors Statins Heparin (LMWH) Clopidogrel |
| Is it necessary to perform an UA in a diabetic hypertensive patient? | No, better to treat with ACE-inhibitor |
| What is the constellation of findings for metabolic syndrome? | 1. ↑↑ waist circumference (>94 M, 80 F) + 2 of the following: - Hypertriglyceridemia (>150) - Hyperglycemia (Fasting sugar >100) - BP >130/85 or, - Drug TX for HTN |
| Which type of aortic dissection is only treated with drugs? | Descending (type B) |
| Which are the preferred medications used for Descending Aortic dissection? | Short-acting ß-blockers |
| Which ß-blockers are most commonly used in Type B (descending) aortic dissection TX? | Labetalol or Esmolol |
| What kind of drugs are avoided in treating Descending aortic dissection? | Vasodilators |
| Why are vasodilators avoided in treatment of Type B Aortic Dissection? | Due to reflex tachycardia |
| What is the best test or study to diagnose or determine the presence of a murmur? | Echocardiography |
| What is evidenced by an Echocardiogram? | Endocardial involvement or a new murmur |
| What is the initial drug management in an acute STEMI? | Aspirin and oxygen |
| What is the purpose of using nitrates, morphine, and ß-blockers in acute STEMI TX? | Control cardiac discomfort |
| What are common PCI contraindications? | 1. Intracranial hemorrhage 2. Ischemic strokes w/in preceding 3 months 3. S/S of Aortic dissection |
| What arrhythmia is most often associated with HOCM? | AFIB |
| What serum imbalance may be caused by ACE-inhibitors in treating HTN? | Hyperkalemia |
| What is the effect of Thiazide + ACE-inhibitor? | Synergistic effect leading to ↓↓BP and K+ levels |
| What is the most important risk factor for stroke? | Hypertension |
| What risk factors are important in stroke, after HTN? | Obesity, DM, smoking, and dyslipidemia |
| What is the best pharmacological TX for DVT? | Unfractionated heparin or LMWH |
| When is an IV catheter filter used in treatment of DVT instead of unfractionated Heparin? | Only when anticoagulation therapy is contraindicated |
| What is the most common pathogen involved/causative of community-acquired endocarditis? | Viridian group streptococci |
| What findings are almost exclusively of Subacute endocarditis? | Osler nodes (fingers) and Roth spots (eyes) |
| What is the treatment of choice for SBE due to S. viridians? | Penicillin G |
| What condition is most commonly associated with MAT? | COPD |
| What arrhythmia is often associated with COPD? | MAT |
| How is MAT treated? | Tx underlying disease and the hypoxia |
| What medications are avoided in MAT leading to HF? | ß-blockers, due to risk of bronchoconstriction |
| What type of anti-arrhythmic are used to TX MAT if it causes HF? | Non-dihydropyridine Calcium-channel blockers |
| What the of heart dysfunction is commonly seen after an MI? | Asymptomatic LV systolic dysfunction |
| Why are all asymptomatic LV systolic dysfunction patients placed on ACE-inhibitors? | Reduce risk of asymptomatic LV failure progress to symptomatic. |
| How much percentage of blood pressure is intended to be reduced within 1 hour of treating an HTN emergency? | 10-20% |
| What drug is used in treating a renal patient with a hypertensive emergency? | Nicardipine |
| What procedure provides the best prognosis for Unstable Angina patients? | CABG |
| What are the DOC category for anticoagulation in AFIB pts? | Apixaban, dabigatran, edoxaban, or Rivaroxaban |
| DOC for symptomatic bradycardia? | Atropine |
| What are the indications for surgery in pts with Peripheral Vascular disease (PVD)? | 1. Interfere with lifestyle 2. Pain at rest 3. Non-healing ulcers 4. Disabling claudication |
| What does "SAAG" stand for? | Serum-Ascites Albumin Gradient |
| What measurement is often used to determine the etiology of Ascites? | SAAG |
| What does a SAAG equal or greater to 1.1 mean? | Indicates underlying Pulmonary HTN and rules out malignancy |
| What is a common cause of Pulmonary hypertension? | Right-sided HF |
Created by:
rakomi
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