Rosh Review- Cardiology Exam Questions With Verified Answers

Rosh Review- Cardiology Exam Questions With Verified Answers What is the adequate anti arrhythmic for patients in Atrial fibrillation with RVR? What is the adequate anticoagulant for patients in Atrial fibrillation? - answerAnti arrhythmic: Diltiazem or Cardizem (CCBs) Anticoagulant: Warfarin (w/ CHAD2VASC score >1) Anti platelet or anticoagulant considered for CHAD2VASC score of 1 What is the scoring scale used to assess treatment for patients with atrial fibrillation? - answerCHADS2VASC! C-CHF +1 H-Hypertension +1 A- Age>65 +1, >75 +2 D- Diabetes +1 S- Stroke history (DVT/TIA/CVA/Thromboembolism) +2 V- Vascular history +1 Female -+1 0- no need for treatment 1- consider anti platelet or anticoagulation >2- anticoagulation necessary What is the INR range for patients taking warfarin for atrial fibrillation? - answer2-3 ! What presents with intermittent claudication (pain in a muscle group induced by exercise and relieved with rest), decreased distal pedal pulses, cool, shiny extremity with decreased hair? Dx and Tx? - answerPeripheral Arterial Disease! Dx: ABI- Ankle-Brachial Index (measure BP in arm vs leg) <.9% indicates stenosis , <.4% indicates ischemia --> Simple, quick, noninvasive most useful screening tool Arteriography--> Gold standard (visualizes atherosclerosis inducing ischemia) US--> noninvasive, used for visualizing stenosis Tx: Lifestyle modifications, increased exercise & tobacco cessation Statins, ASA, Antiplatelets (Clopidogrel, Cilostazol) Peripheral arterial disease most commonly affects which vessels? - answerSuperficial femoral artery (calf pain) Aortoiliac system (thigh/buttock pain). Which of the following features can differentiate myocardial infarction from pericarditis? - answerReciprocal changes in EKG! Meaning... ST depression in the leads opposing ST elevation!--> ONLY occurs in MI, will never occur in pericarditis Ex: Anterior vs Inferior are reciprocal leads, so if anterior has elevations, inferior would have depressions What is Dressler's syndrome? - answerPost-myocardial infarction pericarditis. What presents with pleuritic chest pain radiating to back, worse when laying back, improved when leaning forward, with tachycardia and pericardial friction rub? Dx and Tx? - answerPericarditis! Dx: EKG: Diffuse ST elevations(concave) May also show PR depression/elevation Tx: NSAIDs (Indomethacin) What is the most common cause of Pericarditis? - answerIdiopathic!! 2nd most commonly cause by Viral--> Cocksackie! What cardiac biomarker occurs first? Which one is most specific? Timeline of each? - answer1st occurring: Myoglobin Most Specific: Troponin I or T Timeline: Myoglobin--> 1-2 hours onset, peaks 8-10 hours, gone by 1-2 days Creatine Phosphokinase (CK-MB)--> 3-12 hour onset, peaks 24 hours, gone 48-72 hours Troponin --> 3-12 hour onset, peak 24-48 hours, lasts up to 5-14 days What is the role of beta-adrenergic blocking agents in acute myocardial infarction? - answerWithin 24 hours of presentation reduce the risk of developing ventricular dysrhythmias! Which cardiac biomarker is useful for assessing a re-infarction during the hospital stay? - answerCK-MB , because troponin will last for up to 14 days and therefore would not be good indicator of whether another heart attack occurred ! What is the earliest ECG sign of MI? - answerhyperacute T waves What cardiac biomarker has the highest sensitivity and specificity? - answerTroponin I! What is the #1 cause of death in the US? - answerIschemic Heart Disease! What is the most common symptom of cardiac ischemia in patients older than 85 years? - answerDyspnea! Which of the following is the most predictive risk factor for cardiac ischemia? - answerPMH of CAD! Tobacco smoking, family history of CAD, and DM are also risk factors, but not as strong as having personal history of CAD What is the most common cause of cardiac related syncope? - answerCardiac Dysrhythmias What is the scaling used for assessing syncope? - answerSan Francisco Syncope Scale: CHESS C-CHF H-Hematocrit <30% E-EKG abnormal S- SOB S- Systolic <90 What presents with Adolescent athlete + s