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CVS2 USMLE

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Question
Answer
when to use thallium v stress treadmill to assess angina   when can't see ST changes well, incl abnl baseline EKG, LVH, MVP, WPW, LBB, pacemaker, young women (high false +), quinidine, procainamide, dig  
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contraindications to stress testing   USA, AoS, severe COPD, acute isch changes on ECG, severe uncontrolled HTN (and Ao dissection)  
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what's syndrome X   exertional angina, incl exercise testing and nuclear imaging showing myo isch, but no stenosis on cath  
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name non selective b blocker   propanolol, nadolol timolol, pindolol  
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name cardiac selective b blockers   esmolol (ultra fast), metoprolol, atenolol  
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2 alternatives to ASA   ticlopidine (watch for neutropenia)and clopidogrel  
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s/p PTCA what meds   ASA + ticlopidine/clopidogrel + GIIb/IIIa (abciximab, tirofiban, eptifibatide)  
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pathoophysiol and 5 elements of metabolic syn X   insulin resistance due to obesity; incrsd Chol&TG, impaired glu tol, DM, HTN, incrsd uric  
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contraindications to full dose heparin in AMI   HEAPS=HTN (>190/110), Endocarditis, Activ bleeding or hemorrhagic diathesis, Purpura, Surgery (recent neuro or ocular)  
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what parts of the heart do ea cor artery supply   RCA=P LV, RV and RA, SA and AV node; LCA=A LV, A 2/3 of interventricular septum; LCx=L LV  
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EKG of PE   S in I, Q in III, inverted T in III [think SQT in I,II, III]  
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MC cause in hospital mortality s/p MI, overall mortality s/p MI   CHF, arrhythmia  
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how tx 2nd degree type II block s/p MI   if anterior MI emergent temp pacemaker, if inferior MI IV atropine (if unsuccessful then pacemaker)  
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which are more likely to rupture, ventricular psudoaneur or aneur   pseudoaneur  
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how tx angina after tPA   angioplasty or bypass  
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what is amiloride? Triamterene? Bumetanide? Metolazone? Indapamide?   amiloride and triamterene are both K+ sparing like spironolactone, but don't cause gynecomastia; bumetanide is a loop; metolazone and indapamide are thiazide  
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what is the CHADS2 score   risk of stroke w non rheum A Fib: CHF, HTN, 75yo, h/o stroke/TIA (counts as 2, rest count as 1)  
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what are 2 common dig related conduction problems   paroxysmal atrial tachy w 2:1 block, A Fib w PVC and slow ventricular rate  
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2 congenital QT syndromes, genetics, tx   AR Jervell-Lange-Nielsen w congenital deafness, AD=Romano Ward; symptomatic tx w b blocker (QT will remain long)  
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which infarct area assoc w AV block   diaphragmatic  
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Lenerge dz   MC cause of 3rd degree block, senile fibrosis of conduction system  
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when see large v wave on JVP   TR (and MR)  
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when see incrsd a waves   pulHTN and RHF  
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when see cannon a waves in JVP   arrhythmias ie 3rd degree block when atria pushing ag closed TV, also V Tach or A Flutter  
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rapid y descent can be seen in 3 dz   constrictive pericarditis, restrictive CM, TR  
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describe how/why S2 splits   when inspire more blood in RV and PV stays open longer (AV then PV)  
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what leads to wide split S2   R vol overload, pulHTN, also MR  
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what leads reverse splitting S2   AS, HOCM (AV stays open longer)--maybe also pul HTN--not sure  
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3 CAD risk equivalents   DM, PVD, AAA  
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how tell when to put on 1 HTN med, 2 med   HTNI gets 1 med, HTNII needs 2 (both w lifestyle changes)  
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which BP med use in AA   diuretic (they are usu salt sensitive)  
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what causes an anterior infarct? Posterior? Lateral? Inferior?   LAD, PDA, LAD or LCx, RCA  
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which artery and infarct do you need to watch for RV failure   RCA and inferior  
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which are anterior leads? Lateral? Inferior? Septal?   anterior=I, V1-6; inferior=II, III, aVF, lateral=I, aVL, V5, V6; septal=V1,V2  
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definition of BBB   QRS>0.12  
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nml axis   positive I and aVF  
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LAD by I and aVF   I=+, aVF=-  
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RAD by I and aVF leads   I=-, aVF=- or +  
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in considering arrhythmias, when is a pt considered unstable   SBP <90, AMS, CP, SOB  
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LBBB v RBB on ECG   *W*i*LL*ia*M* *Ma*RR*o*W* W in QRS in V1-2 and M in V3-V6=LBBB; M in QRS in V1-2 and W in V3-V6=RBBB;  
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dx of LVH   amplititude of R in aVL + S in V3>24males or 20females  
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dx of RVH   RAD + R wave in V1>7  
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dx RAE   P in II>2.5  
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dx LAE   biphasic P in V1  
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3 features of WPW on ECG   short PR, delta wave, wide QRS  
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list of CAD risks used to calculate when to treat lipids   CAD equiv=DM, PVD, AAA; CAD risks: current smoking, HTN, DM, HDL <35 (>60 is negative), age m>45, f<55; male (don't count if already counting age), fam hx of MI in m<55 in f<65  
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what ECG change is specific for RV infarct   ST elevation in R sided V4 RV4  
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MC presenting sympt for HOCM, AS, MVP, long QT, myocarditis   HOCM=dyspnea, AS=dyspnea, MVP=CP, long QT=syncope, myocarditis=dyspnea& fatigue  
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MC arrhythmia s/p MI   V Fib  
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MC cause cardiogenic shock   s/p AMI  
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MC cause of death s/p endocarditis   CHF  
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general tx for regurg L heart lesions   decrs afterload w ACEI  
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pt h/o MI and MR, what Rx take them off   b blocker (incrses preload)  
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