dif to remember

Question 1

Myocardial infraction complication - Interventricular septal rupture, papillary muscle rupture, ventricular pseudoaneurysm, ventricular free wall rupture - time

Answer 1

Interventricular septal rupture –> 3-5 d
papillary muscle rupture –> 3-4 d
ventricular pseudoaneurysm –> 3-14 d
ventricular free wall rupture –> 5-14 d

Question 2

antiarrhytmics Class IC - clinical use

Answer 2

1. SVT (including atrial fibrillation)

2. Only last resort in refractory VT

Question 3

GPIIb/IIIa inhibitors - clinical use / pt

Answer 3

acute coronary sundromes (only unstable angina and non-stemi) in those who are to undergo angioplasty and stenting
they lead to reduction in mortality on those with ST depression, esp with high enzymes who then develop muocardial infraction requiring PCI with stenting

Question 4

AR - valve replacement

Answer 4

• EF less than 55 or LVESD greater than 55

- Repairing the valve means tightening the ends of the valve with sutures

Question 5

MR - valve replacement

Answer 5

When LVESD is above 40 mm or EF drops below 60%

–> surgical valve repair or replacement

Question 6

MI criteria

Answer 6

1. at least 1 mm segment elevation in at least 2 contiguous limb leads
2. 2mmm elevation in 2 continguous precordial limbs
3. New LBBB

Question 7

Diastolic dysfunction - treatment

Answer 7

• the management here is not as clear as in the systolic
• b-blockers have clear benefits
• digoxin and spironolactone has no benefit and should not used
• diuretics to control symptoms
• unclear benefit for ACEi and ARBs and hydralazine

Question 8

AR - physical findings (not the murmur)

Answer 8

1. wide pulse pressure
2. water-hammer (wide,dounding) pulse
3. Quincke pulse (puslations in the nail)
4. Hill sign (BP in legs as much as 50 above arm)
5. head bobbing (de Musset sign)

Question 9

HF with preserved EF - spironolactone

Answer 9

• not decreased mortality
• reduced hospitalisation rate
• indication in peripheral edema and lung congestion fnsaid

Question 10

drug that is contraindicated in patients with dilated cardiomyopathy and why

Answer 10

NSAID

worsen afterload by inhibiting prostagladin synthesis and by counteracting the benefits of ACEi

Question 11

large vessel vasculitis types (and epidemiology)

Answer 11

1. Temporal (giant cels) arteritis (older female)

2. Takayasu arteritis (usually asian females under 40)

Question 12

Medium-vessel arteritis types

Answer 12

1. Polyarteritis nodosa
2. Kawasaki disease
3. Buerger disease (thrommboangiitis obliterans)

Question 13

small vessel vasculitis types

Answer 13

1. Granulomatosis with polyangiitis (Wegener)
2. Microscopic polyangiitis
3. Eosinophilic granulomatosis with polyangiitis (Chung strauss)
4. Henoch-Schonlein purpura

Question 14

Takayasu arteritis - sign and symptoms

Answer 14

1. weak upper extremity pulses (pulseless disease)
2. fever 3. night sweats 4. arthritis 5. myalgias
3. skin nobules 7. ocular disturbances

Question 15

Polyarteritis nodosa - symptoms

Answer 15

1. fever 2. weight loss 3. malaise 4. headache
2. GI (abdominal pain, MELENA) 6. hypertension
3. neurologc dysfunction 8. cutaneous eruption
4. renal damage
   typically involves renal and visceral vessels
   NOT PULMONARY ARTERIES

Question 16

Polyarteritis nodosa - histological appearance

Answer 16

transmural inflammation of the arterial wall with fibrinoid necrosis

Question 17

Polyarteritis nodosa - association with (and proportion)

Answer 17

hepatitis B seropositivity in 30% of patients

Question 18

Beurger disease (thromboangitis obliterans) - symptoms

Answer 18

1. intermittent claudication may lead to gangere
2. autoamputation of digits
3. superficial nodular phlebitis
4. Raynaud phenomenon

Question 19

Kawasaki disease - Mucocutaneous lymph syndrome

Answer 19

mnemonic: CRASH (and fever)
1. Conjuctival injection 2. Rash (polymorphous–> desquamating) 3. Adenopathy (cervical) 4. Strawberry tongue (oral mucositis) 5. Hand foot changes (edema, erythema) 6. fever

Question 20

MC childhood systemic vasculitis (often follows)

Answer 20

Henoch-Schonlein purpura / URI

Question 21

Henoch-Schonlein purpura - classic triad

Answer 21

1. Skin: palpable purpura on buttocks/legs
2. Arthralgias
3. GI: abdominal pain

Question 22

strauss) - labs

Answer 22

1. biopsy granoulomatous, necrotizing vaculitis with eosinophilia
2. increased IgE level
3. MPO-ANCA/p-ANCA

Question 23

eosinophilic granulomatosis with polyangiitis (Churg strauss) - clinical manifestation

Answer 23

1. Asthma 2. sinusitis 3. skin nobules or purpura
2. periperal neuropathy (wrist/foot drop) 5. heart 6. GI
3. kidneys (pauci-immune glomerulonephritis)

Question 24

microscopic polyangiitis - labs

Answer 24

1. MPO-ANCA/p-ANCA (anti-myeloperoxidase)

2. histology: a. NO GRANULOMAS b. necrotizing vasculitis

Question 25

microscopic polyangiitis - manifestation - involve

Answer 25

1. lung 2. kidneys 3. skin (palpable purpura) 4. pauci-immune glomerulonephritis

Question 26

microscopic polyangiitis vs wegener

Answer 26

similar but without nasopharyngeal involvement in microscopic polyangitis

Question 27

granulomatosis with polyangitis (wegener) - characteristic lab

Answer 27

PR3-ANCA/c-ANCA (anti-proteinase 3)

Question 28

granulomatosis with polyangitis (wegener) - upper respiratory tract

Answer 28

1. perforation of nasal septum 2. chronic sinusitis 3. otitis media 4. mastoiditis

Question 29

granulomatosis with polyangitis (wegener) - labs

Answer 29

1. CXR: large nodular densities 2. PR3-ANCA/c-ANCA (anti-proteinase 3) 3. histological appearance: a. focal necrotizing vasculitis b. necrotizing vasculitis in the lung and upper airway c. necrotizing glomerulonephritis

Question 30

medium size vasculitis - epidimiology and treatments

Answer 30

Buerger disease --> male smoker under 40 --> stop smoking Kawasaki --> asian under 4 --> IV immunogl + aspirin Pol nodosa --> young adults (HBV in 30%) --> corticosteroids + cyclophosp

Question 31

initial management of GERD

Answer 31

- fewer than 2 episodes of symptoms per week: lifestyle changes and antihistamines as needed - patients with more frequent or severe symptoms, evidence of erosive esophagitis, or laryngopharyngeal involvement should be managed with an 8-week course of a PPI

Question 32

β-blockers intoxication - treatment

Answer 32

- IV fluids and atropine are the first line options | - if profound or refractory hypotension --> glucagon

Question 33

hypertensive emergencies - target (if fast decreasing?)

Answer 33

target: lowering 10-20% in the first hour and by another 5-15% in the next 23 hours excessive drop can cause cerebral iscemia (mental status + seizures)

Question 34

HOCM - ECG

Answer 34

LV hypertrofy: tall R in aVL + Depp S in V3 (Cornell criteria) 2. Repolarization changes in anterolateral leads (I, aVL, V4, V5, V6)

Question 35

Approximate decrease in BP with life style modification

Answer 35

1. Weight loss: 5-20 per 10 kg loss 2. Diet with fruit + vegetables + low fat: 8-14 3. Exercise: 30 min / d 5 days per week: 4-8 4. Less than 3 g sodium /day: 2-8 Less than 2 drinks in men and 1 in women : 2-4

Question 36

Medication withhold prior to cardiac stress

Answer 36

Hold for 2 days: b-blockers, CCB, nitrates Hold 2 days prior to vasodilatory test: dypirodamole Hold 12 h prior to vasodilatory test: caffeine Continue: ACEi, digoxin, diuretics,statins

Question 37

HyperTG - management

Answer 37

- evaluation of 2ry causes - if less 150-500: lifestyle modification (and statin in cardiovascular risk) - if more than 1000: pancreatitis prevention (fibrates, fish oil, no alcohol) --> if drop more than 500 -> lifestyle modif

Question 38

Guidelines for lipid-lowering therapy (general)

Answer 38

1. LDL more than 190 2. Clinically significant atherosc disease (ASC, angina, mi, stoke, TIA, PAD: if younger than 75: high intenisity, moderate for older than 75 3. age 40-75 with DM 40-75 4. estimated 10 years ASCVD risk 7.5% or more: moderate to high