Step 2 CK Cardiology(with Errorless answers)
64 yo with sharp L sided pleuritic CP, TIIDM with CKD, friction rub. EKG with NSR, TWIs,
BUN 96 Cr 5.1. Best therapy? correct answersHemodialysis - this is uremic pericarditis. BUN >
60
Little known etiologies of pericarditis correct answersRadiation
Rheumatoid arthritis
SLE
Dressler syndrome (1-6 weeks s/p MI)
Uremia
Cancer
Basic work-up for a patient newly diagnosed with HTN? correct answersUA (for occult
hematuria, protein/Cr ratio)
BMP
Lipids (risk strat for CAD)
Baseline EKG (CAD, LVH)
If red flags (malignant HTN, resistant HTN requiring >= 3 drugs, sudden BP rise in patient with
previously controlled BP, age of onset < 30 without fam hx of HTN) evaluation for secondary
HTN.
42 yo M with 2 weeks weakness, lowgrade fever, DOE, fingertip pain, dark/cloudy urine,
swollen prox and distal interphalangeal joints. Diagnosis? correct answersIE. The painful
fingertips are Osler's nodes. Arthritis can be part of the IE constellation, as can conjunctival
hemorrhage.
Osler nodes = painful violaceous nodules on fingertips & toes
Janeway lesions = macular, erythematous *nontender* lesions on palms/soles
Roth spots = edematous/hemorrhagic retinal lesions
Cardiovascular Effects of Thyrotoxicosis correct answersRhythm: Sinus tachy, PACs/PVCs,
Afib/flutter
Hemodynamics: Systolic HTN, High pulse pressure, High contractility and CO, Low SVR, High
myocardial O2 demand
Heart Failure: High Output or exacerbation/decompensation of pre-existing low-output failure
Angina: Coronary vasospasm
Valves: MV prolapse, MR, TR
Thyrotoxicosis causes increased sensitivity to catecholamines due to increased expression of B1-
adrenergic receptors as well as changes in proteins controlling post B1 adrenergic receptor
activity
,HTN in hypo- vs hyper-thyroidism correct answersHTN in both! In hyper you have a decreased
SVR but BP (primarily systolic) rises due to pos inotropic and chronotropic effects. In hypo,
HTN is due to increased SVR.
Reversible causes of PEA arrest: the 5 H's and T's correct answers5 Hs = Hypovolemia,
Hypoxia, Hydrogen ions (acidosis), Hypo or hyperkalemia, Hypothermia
5 Ts = Tension ptx, Tamponase, Toxins (narcotics, benxos), Thrombosis, Trauma
Treating fat embolus? What organs get affected? correct answersSupportive treatment
Affects GI (intestinal ischemia pancreatitis) skin (livedo reticularis, gangrene, ulcers esp toes,
blue toe syndrome), eyes (Hollenhorst plaques), kidneys (AKI), CNS (stroke, amaurosis fugax)
RFs = HLD, HTN, T2DM, cath/other precdures
Dx: high Cr, eosinophilia/uria, *low complement*, biopsy showing biconvex needle shaped
clefts within occluded vessels or perivascular inflammation with eos
Deep S wave in lead I, Q wave in III, inverted T wave in III. correct answersS1Q3T3, PE
Ranolozine correct answersLate sodium channel blocker used occasionally in stable angina
patients with recurrent symptoms who are taking combo of beta blockers, CCBs or nitrates. Not
recommended as initial therapy for stable angina (that would be beta blockers)
Child develops tachycardia, tachypnea, distant "muffled" heart sounds 1 week after cardiac
surgery. CXR shows cardiomegaly that wasn't present at discharge. correct answersPericardial
effusion => tamponade. *Postpericardiotomy syndrome" - a pleuropericardial disease that occurs
days-months after cardiac surgery, due to inflammation from surgery. Most children develop
small and selfplimited pericardial effusions post-op. Infants with larger effucions can develop
abdominal pain, vomiting, decreased appetite. Older children usually present with pericardial
friciton rub and pleuritic chest pain exacerbated by inspiration or laying supine.
Beck's triad = distant heart sounds, distended jugular veins, hypotension.
Tr = pericardiocentesis or pericariectomy
Best way to investigate a murmur heard on exam in the outpatients setting? correct
answersECHO.
Diastolic and continuous murmurs as well as loud systolic murmurs as well as loud systolic
murmurs revealed on cardiac auscultation should always be investigated using TTE. Midsystolic
soft murmurs in an asymptomatic young patient are usually
What lung manifestation is more common in IE related to IVDU? correct answersSeptic
pulmonary emboli.
Abx for IE correct answersDon't use clinda - assoc with IE relapse
, Native valve IE due to viridans strep - penicillin G
Pen-resistant enterococcus or HACEK organisms = ampicillin-sulfbactam
Complications of aortic dissection
How to confirm dx? correct answersStroke (carotid arteries)
Acute AR
Horner's syndrome
Acute MI
Pericardial effusion/tamponade
Hemothorax
LE weakness or ischemia (spinal or common iliac arteries)
Abdominal pain (mesenteric artery)
*Confirm diagnosis with contrast chest CT or TEE, the latter if Cr is elevated or if patient has
contrast allergy*
Meds for HCM? correct answersBeta blockers - prolong diastole leading to more filling time,
less outflow obstruction.
CCB such as diltiazem is also a good option if patient cant tolerate BB
Digoxin, nitrates are CI
What murmur is heard with aortic dissection correct answersDiastolic decrescendo murmur at R
sternal border
Heart problems in Turnder syndrome correct answersbicuspid aortic valve
aortic coarctation
Use of clopidogrel as secondary prevention following:
UA/NSTEMI
BMS
DES correct answersUA/NSTEMI - one year
BMS - 30 days
DES - one year
Poor prognostic factors in systolic heart failure correct answersResting tachycardia
S3 gallop
Low BP
Mod to severe MR
Low maximal O2 consumption
Hyponatremia
Renal insufficiency
64 yo with sharp L sided pleuritic CP, TIIDM with CKD, friction rub. EKG with NSR, TWIs,
BUN 96 Cr 5.1. Best therapy? correct answersHemodialysis - this is uremic pericarditis. BUN >
60
Little known etiologies of pericarditis correct answersRadiation
Rheumatoid arthritis
SLE
Dressler syndrome (1-6 weeks s/p MI)
Uremia
Cancer
Basic work-up for a patient newly diagnosed with HTN? correct answersUA (for occult
hematuria, protein/Cr ratio)
BMP
Lipids (risk strat for CAD)
Baseline EKG (CAD, LVH)
If red flags (malignant HTN, resistant HTN requiring >= 3 drugs, sudden BP rise in patient with
previously controlled BP, age of onset < 30 without fam hx of HTN) evaluation for secondary
HTN.
42 yo M with 2 weeks weakness, lowgrade fever, DOE, fingertip pain, dark/cloudy urine,
swollen prox and distal interphalangeal joints. Diagnosis? correct answersIE. The painful
fingertips are Osler's nodes. Arthritis can be part of the IE constellation, as can conjunctival
hemorrhage.
Osler nodes = painful violaceous nodules on fingertips & toes
Janeway lesions = macular, erythematous *nontender* lesions on palms/soles
Roth spots = edematous/hemorrhagic retinal lesions
Cardiovascular Effects of Thyrotoxicosis correct answersRhythm: Sinus tachy, PACs/PVCs,
Afib/flutter
Hemodynamics: Systolic HTN, High pulse pressure, High contractility and CO, Low SVR, High
myocardial O2 demand
Heart Failure: High Output or exacerbation/decompensation of pre-existing low-output failure
Angina: Coronary vasospasm
Valves: MV prolapse, MR, TR
Thyrotoxicosis causes increased sensitivity to catecholamines due to increased expression of B1-
adrenergic receptors as well as changes in proteins controlling post B1 adrenergic receptor
activity
,HTN in hypo- vs hyper-thyroidism correct answersHTN in both! In hyper you have a decreased
SVR but BP (primarily systolic) rises due to pos inotropic and chronotropic effects. In hypo,
HTN is due to increased SVR.
Reversible causes of PEA arrest: the 5 H's and T's correct answers5 Hs = Hypovolemia,
Hypoxia, Hydrogen ions (acidosis), Hypo or hyperkalemia, Hypothermia
5 Ts = Tension ptx, Tamponase, Toxins (narcotics, benxos), Thrombosis, Trauma
Treating fat embolus? What organs get affected? correct answersSupportive treatment
Affects GI (intestinal ischemia pancreatitis) skin (livedo reticularis, gangrene, ulcers esp toes,
blue toe syndrome), eyes (Hollenhorst plaques), kidneys (AKI), CNS (stroke, amaurosis fugax)
RFs = HLD, HTN, T2DM, cath/other precdures
Dx: high Cr, eosinophilia/uria, *low complement*, biopsy showing biconvex needle shaped
clefts within occluded vessels or perivascular inflammation with eos
Deep S wave in lead I, Q wave in III, inverted T wave in III. correct answersS1Q3T3, PE
Ranolozine correct answersLate sodium channel blocker used occasionally in stable angina
patients with recurrent symptoms who are taking combo of beta blockers, CCBs or nitrates. Not
recommended as initial therapy for stable angina (that would be beta blockers)
Child develops tachycardia, tachypnea, distant "muffled" heart sounds 1 week after cardiac
surgery. CXR shows cardiomegaly that wasn't present at discharge. correct answersPericardial
effusion => tamponade. *Postpericardiotomy syndrome" - a pleuropericardial disease that occurs
days-months after cardiac surgery, due to inflammation from surgery. Most children develop
small and selfplimited pericardial effusions post-op. Infants with larger effucions can develop
abdominal pain, vomiting, decreased appetite. Older children usually present with pericardial
friciton rub and pleuritic chest pain exacerbated by inspiration or laying supine.
Beck's triad = distant heart sounds, distended jugular veins, hypotension.
Tr = pericardiocentesis or pericariectomy
Best way to investigate a murmur heard on exam in the outpatients setting? correct
answersECHO.
Diastolic and continuous murmurs as well as loud systolic murmurs as well as loud systolic
murmurs revealed on cardiac auscultation should always be investigated using TTE. Midsystolic
soft murmurs in an asymptomatic young patient are usually
What lung manifestation is more common in IE related to IVDU? correct answersSeptic
pulmonary emboli.
Abx for IE correct answersDon't use clinda - assoc with IE relapse
, Native valve IE due to viridans strep - penicillin G
Pen-resistant enterococcus or HACEK organisms = ampicillin-sulfbactam
Complications of aortic dissection
How to confirm dx? correct answersStroke (carotid arteries)
Acute AR
Horner's syndrome
Acute MI
Pericardial effusion/tamponade
Hemothorax
LE weakness or ischemia (spinal or common iliac arteries)
Abdominal pain (mesenteric artery)
*Confirm diagnosis with contrast chest CT or TEE, the latter if Cr is elevated or if patient has
contrast allergy*
Meds for HCM? correct answersBeta blockers - prolong diastole leading to more filling time,
less outflow obstruction.
CCB such as diltiazem is also a good option if patient cant tolerate BB
Digoxin, nitrates are CI
What murmur is heard with aortic dissection correct answersDiastolic decrescendo murmur at R
sternal border
Heart problems in Turnder syndrome correct answersbicuspid aortic valve
aortic coarctation
Use of clopidogrel as secondary prevention following:
UA/NSTEMI
BMS
DES correct answersUA/NSTEMI - one year
BMS - 30 days
DES - one year
Poor prognostic factors in systolic heart failure correct answersResting tachycardia
S3 gallop
Low BP
Mod to severe MR
Low maximal O2 consumption
Hyponatremia
Renal insufficiency
