Cardiology

Question 1

What are the symptoms of atherosclerosis?

Answer 1

Chest pain, SOB, TIA, intermittent claudication.

Question 2

Who should be screened for cholesterol?

Answer 2

• Men >40
• Women >50 or post-menopausal
• Anyone with cardiac RF (HTN, DM, smoking, obesity, FHx premature CVD, hyperlipidemia stigmata, atherosclerosis).

Question 3

What are the components of the Framingham risk score?

Answer 3

Age, total cholesterol, smoking, HDL, systolic BP (treated/untreated), gender.

Question 4

What are the LDL & TC/HDL targets by risk?

Answer 4

• High risk: LDL >2.0, TC/HDL <4.0
• Moderate: LDL <3.5, TC/HDL <5.0
• Low: LDL , TC/HDL <6.0.

Question 5

What are the 5 features of metabolic syndrome?

Answer 5

HTN >130/85, fasting glucose 6.2–7.0, waist >102 cm men / >88 cm women, TG >1.7, HDL <1.0 men / <1.3 women.

Question 6

First-line treatment of dyslipidemia?

Answer 6

Lifestyle + statin (simvastatin 40 mg OD).

Question 7

Second-line agents?

Answer 7

Niacin derivatives, fibrates, bile acid sequestrants.

Question 8

Side effects: statins, fibrates, niacin?

Answer 8

• Statins → rhabdomyolysis, ↑LFTs, GI upset
• Fibrates → GI upset, gallstones
• Niacin → flushing, ↑LFTs, impaired glucose tolerance, severe HTN, pruritus.

Question 9

What advanced lipid/lab markers can refine risk?

Answer 9

ApoB (<0.9), Lipoprotein(a), hs-CRP.

Question 10

Indications for thrombolysis?

Answer 10

Chest pain >30 min within 12h + STEMI (≥2mm in 2 precordial or ≥1mm in 2 limb leads) or new LBBB.

Question 11

Absolute contraindications?

Answer 11

Prior ICH, AVM, intracranial tumor, ischemic stroke <3mo, aortic dissection, active bleeding, major head trauma <3mo, allergy.

Question 12

Relative contraindications?

Answer 12

Severe HTN >180/110, prior ischemic stroke >3mo, dementia, recent surgery/bleed, pregnancy, peptic ulcer, anticoagulation, prior streptokinase.

Question 13

Key acute treatments besides lytics?

Answer 13

ASA 160 mg chew, morphine, O₂, nitro, telemetry, β-blocker, ACEi, statin, clopidogrel.

Question 14

PCI vs fibrinolysis?

Answer 14

• PCI: preferred if available within 90 min, unstable, age >75, recent trauma/bleed.
• Fibrinolysis: if PCI not accessible within 90 min, early presentation <3h.

Question 15

Success rate of fibrinolysis?

Answer 15

~50% reperfused; ~15% not thrombolysed.

Question 16

What are the 4 mortality-reducing drugs post-MI?

Answer 16

ASA, β-blockers, ACE inhibitors, statins.

Question 17

What other meds may be added?

Answer 17

Clopidogrel, nitro (symptoms), CABG if left main/3-vessel with LV dysfunction.

Question 18

What lifestyle changes are crucial post-MI?

Answer 18

Exercise, healthy diet, smoking cessation, BP/lipid/DM control.

Question 19

When can HTN be diagnosed?

Answer 19

• ≥140/90 on 2–5 visits (or >180/110 with target organ damage).
• Home BP >135/85, ambulatory daytime >135/85, 24h >130/80.

Question 20

Hypertensive urgency vs emergency?

Answer 20

• Urgency: BP >180/120, no end-organ damage → oral meds
• Emergency: + end-organ damage (encephalopathy, papilledema, renal failure) → IV meds.

Question 21

Secondary causes of HTN? (ABCDE)

Answer 21

• A: Apnea (OSA)
• B: Bad kidneys (renal artery stenosis, renal disease)
• C: Catecholamines (pheo), Cushing’s, Coarctation
• D: Drugs (OCP, steroids, NSAIDs)
• E: Endocrine (thyroid, hyperparathyroid, primary aldosteronism).

Question 22

Which HTN drug commonly causes erectile dysfunction?

Answer 22

Thiazides.

Question 23

First-line in Black patients?

Answer 23

Thiazide diuretics.

Question 24

Causes of AFib?

Answer 24

• Cardiac: MI, valvular disease, myocarditis, pericarditis, ASD, congenital
• Non-cardiac: PE, EtOH withdrawal, hyperthyroid, COPD, OSA, stimulants.

Question 25

Initial investigations in new AFib?

Answer 25

ECG, Echo, TSH, CBC, lytes, BUN/Cr.

Question 26

Rate vs rhythm control options?

Answer 26

• Rate: β-blocker, diltiazem • Rhythm: amiodarone, sotalol, flecainide, propafenone.

Question 27

Unstable AFib management?

Answer 27

Oxygen + urgent synchronized cardioversion.

Question 28

Anticoagulation rules?

Answer 28

• If unstable → cardiovert, start heparin, anticoagulate 3–4 weeks. • If rhythm control → anticoagulate 3 weeks pre + 4 weeks post. • Lifelong anticoagulation if chronic risk.

Question 29

Classic triad of symptoms in Aortic Stenosis?

Answer 29

Syncope, angina, dyspnea/heart failure.

Question 30

Murmur in Aortic Stenosis?

Answer 30

Systolic crescendo–decrescendo at RUSB.

Question 31

Definitive treatment for Aortic Stenosis?

Answer 31

Valve replacement if valve area <1 cm² or symptomatic.

Question 32

NYHA classes?

Answer 32

• I: No symptoms • II: Symptoms with ordinary activity • III: Symptoms with less than ordinary activity • IV: Symptoms at rest.

Question 33

3 medication classes with proven mortality benefit in CHF?

Answer 33

β-blockers, ACE inhibitors, spironolactone.

Question 34

2 β-blockers with strongest evidence?

Answer 34

Metoprolol, carvedilol.

Question 35

Most sensitive vs specific symptom in CHF?

Answer 35

Dyspnea (sensitive), PND (specific).

Question 36

Pathophysiology of CHF?

Answer 36

Fluid overload.

Question 37

Which drugs are affected by grapefruit juice?

Answer 37

Calcium channel blockers (except amlodipine), statins (except rosuvastatin).