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Cardio PANCE

Cardio PANCE

Last update 

Cardio Part 2

Items (99)

  • A sawtooth pattern on EKG should make you think of what diagnosis?

    Atrial flutter

  • List the 4 minor criteria for diagnosing endocarditis.

    Fever, embolic event (Janeway lesions or petechiae, splinter hemorrhages), immunological event (osler nodes, glomerulonephritis), 1 positive blood culture

  • An RSR prime in leads V5 or V6 should make you think of what diagnosis?

    Left bundle branch block

  • What is the first line IV inotropic agent when dealing with cardiogenic shock?

    Dopamine

  • A blockage of which artery causes an anterior wall MI?

    Left anterior descending artery

  • Following a myocardial infarction what medication should you be using to treat hypertension?

    Beta blocker

  • Tall peaked P waves should make you think of what diagnosis?

    Right atrial enlargement

  • Which EKG leads are used to diagnose an anterior wall MI?

    V1, V2 and V3

  • Clot busting drugs should be used within 3 hours of which two cardiac events?

    STEMI and new left bundle branch block

  • On an EKG you notice a patient has a gradually lengthening PR interval and then a missed QRS complex. The pattern repeats again. What type of AV block is this?

    Mobitz I or Wenckebach

  • What is the therapeutic range for INR following a mechanical valve replacement?

    2.5-3.5

  • What are the three major criteria for endocarditis?

    2 positive blood cultures, a positive transesophageal echocardiography, new murmur

  • A continuous murmur most likely involves what area of the heart?

    It is most likely a septal defect

  • Where on your patient should you listen for the murmur associated with an atrial septal defect?

    At the left second or third interspace

  • An EKG shows two premature ventricular contractions. These two QRS waves look very different. What is the term for this?

    Multifocal premature ventricular contractions

  • On EKG there is an early but otherwise normal PQRS complex. After that beat there is a slight pause and then a normal rhythm continues. What is the term for this one beat?

    Premature atrial contraction

  • On physical exam you hear a harsh systolic murmur along the right sternal border. What is the most likely diagnosis?

    Aortic stenosis

  • An RSR prime in leads V1 or V2 should make you think of what diagnosis?

    Right bundle branch block

  • A patient has just received a cardiac stent. How long will he be on aspirin and clopidogrel?

    One year

  • A beta natriuretic peptide below what level rules out CHF?

    <100

  • Which EKG leads are used to diagnose an anterolateral MI?

    V5 and V6

  • What two leads do you use to determine the axis of the heart?

    Lead I and AVF

  • Bat wing vessels or Kerley B lines on a CXR should make you think of what diagnosis?

    CHF

  • Both lead I and AVF have positive QRS complexes. Does this represent normal axis, left axis deviation or right axis deviation?

    Normal axis

  • What is the first line medical treatment for torsades de pointes?

    Magnesium sulfate

  • What is the appropriate treatment for a patent ductus arteriosus.

    Indomethacin

  • Does a patient with mitral valve prolapse require prophylactic antibiotics for dental work?

    No, a recent change moves mitral valve prolapse from high risk to moderate risk.

  • What is the best test for diagnosing CHF?

    Echo

  • In a patient with aortic stenosis, will the PMI be medially displaced, normal or laterally displaced?

    It will be laterally displaced due to left ventricular hypertrophy.

  • What are the three inferior leads?

    II, III and aVF

  • The EKG shows irregularly irregular narrow QRS waves. What is the most likely diagnosis?

    Atrial fibrillation

  • Lead I has a QRS that is up and the AVF lead has a QRS complex that is down. Does this represent normal axis, left axis deviation or right axis deviation?

    Left axis deviation

  • What is the most common congenital heart disease?

    Ventricular septal defect

  • An EKG shows a regular heart rate of 200 bpms. QRS is narrow. What is the most likely diagnosis?

    Supraventricular tachycardia

  • A U wave on EKG should make you think of what diagnosis?

    Hypokalemia

  • Tall peaked T waves should make you think of what diagnosis?

    Hyperkalemia

  • A patient complains of pain in his legs when he walks. It goes away after sitting. What term comes to mind for this symptom? What diagnosis is it associated with?

    Intermittent claudication caused by peripheral arterial disease.

  • A question stem includes an IV drug user with a new heart murmur and fever. What is the most likely diagnosis?

    Endocarditis

  • A question about Prinzmetal's angina will often contain what key thing in the patient's history?

    Cocaine use

  • Which are painful and found on the fingers and toes, Osler nodes or Janeway lesions?

    Osler nodes

  • What is the definitive treatment for a patient with recurrent ventricular tachycardia?

    Implanted defibrillator

  • What is the only cyanotic congenital heart disease on the NCCPA blueprint?

    Tetralogy of Fallot

  • What is the most common cause of sudden death?

    Ventricular fibrillation

  • How do you define 1st degree AV block?

    The PR interval is longer than 0.2 seconds or one block on EKG.

  • List three congential heart diseases.

    Atrial septal defect (ASD), ventricular septal defect (VSD), coarctation of the aorta, patent ductus arteriosus (PDA), tetralogy of Fallot

  • A blockage of which artery causes a lateral wall MI?

    Left circumflex artery

  • List the six P's of an ischemic limb.

    Pain, paresthesias, pallor, pulselessness, poikilothermia, paralysis

  • What ejection fraction is typical for a patient with CHF?

    35-40%

  • The accessory pathway known as the James bundle should make you think of what syndrome?

    Lown-Ganong-Levine syndrome

  • What medication class is used to lower triglycerides?

    Fibric acid derivatives

  • On EKG there is an early wide QRS complex with no associated P wave. After that beat there is a slight pause and then a normal rhythm continues. What is the term for this one beat?

    Premature ventricular contraction

  • List three side effects of digoxin.

    Nausea/vomiting, anorexia, confusion, arrhythmias(sinus brady, AV block), fatigue, vision disturbances etc.

  • You hear a loud, harsh pulmonary murmur along the left sternal border. What is the most likely diagnosis?

    Ventricular septal defect

  • You are counting boxes from the peak of a QRS wave on an EKG in order to determine the heart rate. What would the heart rate be if the next QRS wave peak were three boxes away? What numbers are associated with the first five boxes?

    The answer is 100. The heart rates by conting boxes are 300, 150, 100, 75, 60.

  • What is the initial treatment for a myocardial infarction?

    MONA - morphine, oxygen, nitroglycerin and aspirin

  • What is the first line medication for a patient with symptomatic bradycardia?

    Atropine

  • You see regular P waves and regular QRS complexes, but they do not seem to have any correlation to each other. What is the diagnosis?

    Third degree AV block

  • What is the best location to hear problems with the aortic valve?

    2nd right intercostal space

  • A boot-shaped heart on CXR should make you think of what congenital heart condition?

    Tetralogy of Fallot

  • A patient presents to the ER in acute CHF. What drug class will likely be the first choice?

    Loop diuretics

  • What is the treatment for a patient with a Mobitz II AV block?

    Pacemaker

  • You see a short PR interval and a delta wave on EKG. What is the most likely diagnosis?

    Wolff-Parkinson-White syndrome

  • Which finding requires immediate attention, left bundle branch block or right bundle branch block?

    New left bundle branch block is a STEMI equivalent. Right bundle branch block is usually not a problem.

  • What is represented by ST segment depressions greater than 1mm on EKG?

    Ischemia

  • What is the therapeutic range for INR following an organic valve replacement?

    2 to 3

  • Name a common cause of a junctional rhythm.

    Digitoxin toxicity

  • What is the most common cause of CHF?

    Coronary artery disease

  • A patient in the ER has no pulse, but on EKG there are wide irregular "complexes" which are at an irregular rate. They all appear very different from one another. What is the treatment for this patient?

    He is in ventricular fibrillation. The treatment is defibrillation.

  • A biphasic P wave should make you think of what diagnosis?

    Left atrial enlargement

  • What is the management of a patient in supraventricular tachycardia?

    Vagal maneuvers, carotid massage, adenosine

  • What is the most common cause of sudden cardiac death?

    Ventricular fibrillation

  • What is the other term for Mobitz type I?

    Wenckebach

  • Subacute endocarditis is most commonly caused by what organism?

    Strep Viridans

  • An Osborne or J wave on EKG should make you think of what diagnosis?

    Hypothermia

  • What is the most common cause of an atrial septal defect?

    Patent foramen ovale

  • What is the definitive treatment for cardiac tamponade?

    Pericardiocentesis

  • A CXR shows a "3" sign with notching of the ribs. What is the most likely diagnosis?

    Coarctation of the aorta

  • What will the heart rate be if the AV node is pacing the heart?

    40-60 beats per minute

  • The heart rate is irregular so you can't count boxes between QRS waves to determine heart rate. What is another method you can use to determine rate on an EKG?

    Count QRS waves in a six second strip and multiply by 10 to get beats per minute.

  • What is the accessory pathway associated with Wolff-Parkinson-White syndrome?

    The bundle of Kent

  • What is the most likely diagnosis for a youngman who experiences sudden death while playing sports?

    Hypertrophic cardiomyopathy

  • Paroxysmal nocturnal dyspnea should make you think of what diagnosis?

    CHF

  • List three catastrophic complications of a myocardial infarction.

    Papillary muscle rupture, myocardial wall rupture and left ventricular aneurysm

  • Acute endocarditis is most commonly caused by what organism?

    Staph aureus

  • You hear a continuous machine-like murmur. What is the most likely diagnosis?

    Patent ductus arteriosus (PDA)

  • A patient complains of severe crushing chest pain. EKG shows ST segment elevations. All labs including troponins and CK-MB are negative. What is the most likely diagnosis?

    Prinzmetal's angina

  • You suspect mitral regurgitation. What is the most accurate way to prove your diagnosis?

    Transesophageal echo

  • Which cardiac medication is used to help with cardiac contractility after you have optimized most of the other cardiac medications?

    Digoxin

  • What is the gold standard for diagnosing coronary artery disease?

    Cardiac catheterization

  • What are the five components of tetralogy of Fallot?

    Ventricular septal defect, right ventricular hypertrophy, right ventricular outflow obstruction (pulmonary valve stenosis), overriding aorta, right sided aortic arch

  • List two diagnoses which require antibiotic prophylaxis for "dirty procedures? AKA Dental"

    Prosthetic valve, valve repair with any prosthetic material, prior endocarditis diagnosis, congential cyanotic heart defect

  • An EKG shows a regular rate of 50 beats per minute. The QRS is narrow and there is no visible P wave. What is the most likely diagnosis?

    Junctional rythm

  • What is the first medication you should give for atrial flutter?

    Adenosine

  • A patient presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all of the leads. What is the most likely diagnosis?

    Pericarditis

  • List two causes of right atrial enlargement?

    Pulmonary HTN, severe lung disease, pulmonary valve stenosis

  • A pathologic S3 is most commonly associated with what diagnosis?

    CHF

  • A fixed or consistent split S2 should make you think of what diagnosis?

    Atrial septal defect

  • 5

    Vancomycin and ceftriaxone together are first line empiric treatment

  • What is the heart rate for tachycardia? How about bradycardia?

    Tachycardia >100, bradycardia <60