PANCE PREP PEARLS LATEST COMPREHENSIVE
EXAM QUESTIONS AND ANSWERS SURE A+
✔✔diagnostic test of choice for heart failure - ✔✔echocardiogram
note: ejection fraction is most important determinant in prognosis
✔✔systolic vs diastolic failure on echocardiogram - ✔✔systolic failure
-decreased EF
-thin ventricular walls
-dilated LV chamber
diastolic failure
-normal/increased EF
-thick ventricular walls
-small LV chamber
✔✔______ may identify CHF as the cause for dyspnea in ER - ✔✔increased B-type
natriuretic (BNP)
✔✔how can congestive (decompensated) heart failure be dx on CXR - ✔✔kerley b lines
cardiomegaly
pleural effusions
,✔✔1st line tx for heart failure - ✔✔ACEI
"prills"
lisinopril
benazepril (Lotensin)
captopril (Capoten)
✔✔what is the MOA, SE, CI for ACEI - ✔✔MOA: decrease preload and afterload,
decrease aldosterone production
SE: hypotension, renal insufficiency, hyperkalemia, cough, angioedema
CI: hypotension, pregnancy
✔✔name some angiotensin II receptors (ARBs) - ✔✔"sartans"
losartan (Cozaar)
valsartan (Diovan)
(MOA: block angiotensin II effects)
✔✔what drug combo is used for AA in heart failure - ✔✔hydralazine + nitrates
✔✔hydralazine is safe during ____ - ✔✔pregnancy
✔✔furosemide (Lasix)
bumetanide
torsemide - ✔✔loop diuretics that are most effective for sx tx of mild-moderate CHF
note:
can lead to hyPOkalemina/calcemia/natremia
can lead to hyPERglycemia/uricemia
✔✔spironolactone
amiloride - ✔✔potassium sparing diuretics
note:
adverse effects include hyPERkalemia, gynecomastiaa
✔✔digoxin
dobutamine
dopamine - ✔✔sympathomimetics
positive inotropes and negative chronotrope
narrow TI!!!
(all are used short term in heart failure except digoxin)
, ✔✔what worsens dig toxicity - ✔✔hypokalemia
✔✔what meds reduce mortality when used in heart failure - ✔✔ACEI, ARB, B-Blockers,
nitrates+hydralazine, spironolactone
✔✔unlike systolic heart failure, ______ are helpful for diastolic HF - ✔✔calcium channel
blockers
✔✔what is the outpatient tx for HF - ✔✔ACE + diuretic initially + B blockers
✔✔what is needed in HF w/ EF<35% - ✔✔implantable cardioverter defibrillator
✔✔ivadradine - ✔✔used in symptomatic chronic stable HF w/ EF <35% in sinus rhythm
w/ resting pulse >70 and already maxed out on B blockers or cant take BB
✔✔sacubitril-valsartan - ✔✔increase levels of natriuretic peptides
reduces mortality and decreases hospitalization for chronic HF
✔✔what is tx for acute pulmonary edema/congestive heart failure - ✔✔LMNOP: lasix,
morphine, nitro, oxygen, position (upward)
✔✔sharp chest pain worse w/ lying down
pain relieved by sitting/leaning fwd
pericardial friction rub
diffuse, ST elevations in precordial leads - ✔✔acute pericarditis
✔✔most common causes of acute pericarditis is ______________. What is the tx? -
✔✔enteroviruses: coxsackie and echovirus
(idiopathic is also very common)
NSAIDs 1st line
colchicine 2nd line
✔✔what is dressler's syndrome? - ✔✔post-MI pericarditis
note: tx w/ aspirin or colchicine
✔✔what causes electrical alternans on an EKG and muffled heart sounds? what is the
tx? - ✔✔pericardial effusion (fluid in pericardial space)
(note: low voltage QRS complexes suggests large effusion)
EXAM QUESTIONS AND ANSWERS SURE A+
✔✔diagnostic test of choice for heart failure - ✔✔echocardiogram
note: ejection fraction is most important determinant in prognosis
✔✔systolic vs diastolic failure on echocardiogram - ✔✔systolic failure
-decreased EF
-thin ventricular walls
-dilated LV chamber
diastolic failure
-normal/increased EF
-thick ventricular walls
-small LV chamber
✔✔______ may identify CHF as the cause for dyspnea in ER - ✔✔increased B-type
natriuretic (BNP)
✔✔how can congestive (decompensated) heart failure be dx on CXR - ✔✔kerley b lines
cardiomegaly
pleural effusions
,✔✔1st line tx for heart failure - ✔✔ACEI
"prills"
lisinopril
benazepril (Lotensin)
captopril (Capoten)
✔✔what is the MOA, SE, CI for ACEI - ✔✔MOA: decrease preload and afterload,
decrease aldosterone production
SE: hypotension, renal insufficiency, hyperkalemia, cough, angioedema
CI: hypotension, pregnancy
✔✔name some angiotensin II receptors (ARBs) - ✔✔"sartans"
losartan (Cozaar)
valsartan (Diovan)
(MOA: block angiotensin II effects)
✔✔what drug combo is used for AA in heart failure - ✔✔hydralazine + nitrates
✔✔hydralazine is safe during ____ - ✔✔pregnancy
✔✔furosemide (Lasix)
bumetanide
torsemide - ✔✔loop diuretics that are most effective for sx tx of mild-moderate CHF
note:
can lead to hyPOkalemina/calcemia/natremia
can lead to hyPERglycemia/uricemia
✔✔spironolactone
amiloride - ✔✔potassium sparing diuretics
note:
adverse effects include hyPERkalemia, gynecomastiaa
✔✔digoxin
dobutamine
dopamine - ✔✔sympathomimetics
positive inotropes and negative chronotrope
narrow TI!!!
(all are used short term in heart failure except digoxin)
, ✔✔what worsens dig toxicity - ✔✔hypokalemia
✔✔what meds reduce mortality when used in heart failure - ✔✔ACEI, ARB, B-Blockers,
nitrates+hydralazine, spironolactone
✔✔unlike systolic heart failure, ______ are helpful for diastolic HF - ✔✔calcium channel
blockers
✔✔what is the outpatient tx for HF - ✔✔ACE + diuretic initially + B blockers
✔✔what is needed in HF w/ EF<35% - ✔✔implantable cardioverter defibrillator
✔✔ivadradine - ✔✔used in symptomatic chronic stable HF w/ EF <35% in sinus rhythm
w/ resting pulse >70 and already maxed out on B blockers or cant take BB
✔✔sacubitril-valsartan - ✔✔increase levels of natriuretic peptides
reduces mortality and decreases hospitalization for chronic HF
✔✔what is tx for acute pulmonary edema/congestive heart failure - ✔✔LMNOP: lasix,
morphine, nitro, oxygen, position (upward)
✔✔sharp chest pain worse w/ lying down
pain relieved by sitting/leaning fwd
pericardial friction rub
diffuse, ST elevations in precordial leads - ✔✔acute pericarditis
✔✔most common causes of acute pericarditis is ______________. What is the tx? -
✔✔enteroviruses: coxsackie and echovirus
(idiopathic is also very common)
NSAIDs 1st line
colchicine 2nd line
✔✔what is dressler's syndrome? - ✔✔post-MI pericarditis
note: tx w/ aspirin or colchicine
✔✔what causes electrical alternans on an EKG and muffled heart sounds? what is the
tx? - ✔✔pericardial effusion (fluid in pericardial space)
(note: low voltage QRS complexes suggests large effusion)
