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64 Cards in this Set
- Front
- Back
What are the pathognomonic clinical features of stable angina?
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Substernal chest pain brought on by exertion/emotion lasting less than 10-15 minutes and relieved by rest or nitroglycerin.
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If patients have a positive exercise stress test what is the next appropriate step?
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Cardiac catheterization
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What drugs are used to perform a pharmacological stress test?
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IV adenosine, dobutamine, dipyramidole.
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What drug is indicated in all patients with a coronary artery disease?
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Aspirin
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when is a CABG indicated over PTCA?
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Indicated in patients with left main artery disease, three-vessel disease w/ reduced left ventricular function, 2-vessel disease with proximal LAD stenosis, or severe ischemia for palliation of symptoms
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What are the clinical features of unstable angina?
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1. Angina at rest
2. Chronic angina that is getting progressively worse. 3. New onset angina that is severe and worsening. |
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What enzymes must be ordered in a patient with unstable angina and why?
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Troponins to rule out the possibility of an NSTEMI. These 2 present very similar clinically but are managed differently and therefore must be distinguished.
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T/F: calcium channel blockers have not been proven to be beneficial in unstable angina
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True. They are only helpful as a second line treatment for stable angina.
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Along with aspirin what other classes of drugs are considered first line therapy for treatment of unstable angina?
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1. Beta-blockers
2. LMWH - enoxaparin is the DOC. 3. Nitrates. |
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What are the 7 risk factors used to calculate the TIMI score?
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1. Age > 65
2. More than 3 risk factors for CAD. 3. Known CAD 4. At least 2 episodes of severe angina in the last 24 hrs. 5. Aspirin use in the last 7 days. 6. Elevated cardiac enzymes 7. ST changes > .5mm |
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What are the hallmark clinical symptoms of a myocardial infarction?
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Severe crushing substernal chest pain, greater than 30 min not relieved by rest + diaphoresis.
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What is seen very early on EKG in an MI patient?
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Hyperacute T-wave changes
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How soon after an MI do troponins increase in blood and how long do they stay in blood?
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They increase 3-5 hours after onset and return to normal in a week.
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T/F: Troponins have less sensitivity/specificity than CK-MB for myocardial injury
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False. Troponins have a greater sensitivity and specificity than CK-MB and are the gold standard for diagnosing MI.
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ST segment elevations in which leads suggest an anteroseptal MI?
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V1-V4
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ST segmenet elevations in leads II, III, and aVF suggest an MI in which portion of the heart
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Inferior
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What ST segment changes suggest a posterior wall MI?
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ST depression in V1-V2 with a large R and large T wave in V1-V2.
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Which classes of drugs are the only ones show to decrease mortality in patients with MI?
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Aspirin, Beta-blockers, and ACE inhibitors.
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If there are no contraindications what treatment should be administered ASAP for patients with acute MI?
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thrombolytic therapy
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What are the contraindications for thrombolytic therapy?
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1. Uncontrolled HTN
2. Trauma 3. Previous stroke 4. Recent invasive procedure or surgery 5. Dissecting aortic aneurysm 6. Active peptic ulcer disease 7. Patient who is having a NSTEMI. |
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What therapy is indicated in patients with MI who are contraindicated for thrombolytic therapy?
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PTCA
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What is the most common cause of death in MI patients?
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Vfib
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What does a repeat ST elevation on EKG 24 hours after a recent MI indicate
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recurrent infarction.
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what is the treatment for a free wall rupture of the heart post-MI
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hemodynamic stabilization, pericardiocentesis, and surgical repair.
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Papillary muscle rupture in an MI patient can lead to what valvular abnormality?
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Mitral regurgitation.
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What drugs are contraindicated in patients with acute pericarditis post-MI
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NSAIDS and corticosteroids.
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What is the treatment for Dressler's syndrome?
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Aspirin
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What is the most common cause of systolic congestive heart failure?
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Myocardial Infarction
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What is the most common cause of diastolic heart failure?
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Myocardial hypertrophy 2dary to HTN.
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What are the characteristic clinical symptoms of CHF?
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dsypnea
orthopnea PND |
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What is the most common cause of right sided heart failure?
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Left sided heart failure
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Fill in the blank:
____ are short horizontal lines seen near the periphery of the lung near the costophrenic angle on a CXR. They indicate pulmonary congestion |
Kerley B lines
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What is the initial test of choice for evaluating someone with suspected CHF?
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Echocardiogram
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Patients with systolic heart failure typically have an ejection fraction less than what %
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40-45%
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The initial treatment in all patients with symptomatic CHF includes what classes of drugs?
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Diuretics (preferably a loop diuretic) and an ACE inhibitor
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What class of drug is indicated in all patients with CHF
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ACE inhibitor
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which class of drug has been shown to reduce mortality and is therefore indicated in patients with post-MI CHF?
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Beta-Blockers
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What is the INR goal range for someone on anticoagulation and what is the one exception to this?
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2-3. However, if the patient is on anticoagulation s/p heart valve replacement then the goal range is 2.5-3.5
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If a patient with Afib is hemodynamically unstable what is the next step?
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Immediate electrical cardioversion
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If a patient with Afib is hemodynamically stable and has a ventricular rate of 150 what is the next step.
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Rate control with CCB or beta-blockers.
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what is the INR goal range in a patient who you are treating for Afib with anticoagulation?
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2-3
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What are the indications for electrical cardioversion in a patient with a dysrhythmia?
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Afib, Atrial flutter, VTach (w/ pulse), SVT
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What are the indications for defribillation in a patient with a dysrhythmia?
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Vfib, VTach (w/o pulse)
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What are the indications for autonomic implantable defribrillator in a patient with an arrhythmia?
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VFib and/or VTach unresponsive to medical therapy
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What are the indications for anticoagulation in a patient with acute Afib
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Afib longer than 48 hours or for an unknown amount of time.
Afib with a thrombus present on TEE. |
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What test is required for a definitive diagnosis of hepatocellular carcinoma?
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-Liver biopsy
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Which tumor marker is elevated in hepatocellular carcinoma?
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-AFP
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Which enzyme shows decreased activity in patients with Gilbert's Syndrome?
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-UDPGT
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What is the only elevated marker in Gilbert's Syndrome?
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-Unconjugated bilirubin
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Is the serum-ascites albumin gradient above or below 1.1 g/dL in a patient with Budd-Chiari?
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-Above
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What is the best diagnostic test for a patient with Budd-Chiari syndrome?
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-Hepatic venogram
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What is the treatment for a patient with Budd-Chiari syndrome?
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-Surgery with placement of a stent in IVC.
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Which type of bilirubin is more toxic, conjugated or unconjugated? Why?
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-Unconjugated because it can cross the BBB and cause neurological damage and also cannot be excreted in the urine.
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T/F: conjugated bilirubin can be excreted in the urine.
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-True. Unconjugated bilirubin cannot.
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If ALT & AST are elevated in the low hundreds what are the most likely causes?
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chronic viral hepatitis, or acute alcoholic hepatitis
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If ALT & AST are moderately elevated in the hundreds to thousands what are the most likely causes?
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Acute viral hepatitis
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If ALT & AST are elevated above 10,000 what are the most likely causes?
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hepatic necrosis either from:
1. ischemic liver disease 2. Acetaminophen toxicity 3. Severe viral hepatitis |
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Alkaline phosphatase is an enzyme not specific to the liver. where else can it be found?
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Bone, gut, and placenta
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What other lab value should be measured to confirm whether an elevation of alkaline phosphatase is biliary in origin?
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GGT
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A positive Boa's sign is suggestive of what disease?
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cholelithiasis
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What is the best diagnostic test for cholelithiasis?
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Ultrasound
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how is the pain of cholelithiasis different from the pain of acute cholecystitis?
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Cholelithiasis: pain is colicky and precipitated by meals or at night and the pain resolves after some time.
Acute cholecystitis: the pain is constant and not related to food and also can radiate to the right scapula/shoulder. |
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What is Murphy's sign? What does it indicate?
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Murphy's sign is arrest of inspiraition during palpation of the RUQ. This sign is pathognomonic for acute cholecystitis.
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What is the gold standard test for choledocolithiasis?
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ERCP
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