Valves
80 year old patient present with a systolic crescendo-decrescendo murmur at 2nd right intercostal space. What is the classic symptomatic triad this patient is likely experiencing?
Angina, exertional syncope, and heart failure symptoms
What values fall under Stage 1 hypertension?
OR
DBP: 80-89
In which condition would electrical alternans be present?
Pericardial effusion/tamponade
What is the highest sensitivity cardiac biomarker?
Troponin I
What is shock?
Syndrome of impaired O2 delivery to tissues
A 68-year-old man presents with fatigue and shortness of breath. Exam reveals JVD, ascites, and peripheral edema. A holosystolic murmur is louder with inspiration. What does this indicate?
Tricuspid Regurgitation
Pt presents with a BP of 180/94 and is flushed, tachycardic, with a headache. What are you suspect to as the cause of the HTN?
Pheochromocytoma
What are the 3 phases of myocarditis?
Phase 1: Offending agent > myocardial injury
Phase 2: Immune mediated response
Phase 3: Resolution or progression into chronic disease
A 67-year-old patient presents with squeezing chest pain that is an 8/10. He says it worsens when he is walking and helps when he sits down. What other treatment can immediately relieve this acute episode (Need specific)?
Sublingual nitro 0.3-0.4mg q3-5min x 3 doses
What are the types of shock + brief description?
Distributive: Excess vasodilation
Hypovolemic: Fluid depletion
Cardiogenic: Compromise of myocardial performance (decreased output)
Obstructive: Obstruction of filling heart or ejecting into great vessels
A patient with systolic C>D murmur at the right 2md intercostal space undergoes a procedure where he reports "they shoved a camera up my groin" to fix this valve. What medications is he likely on now and for how long?
ASA 81mg for life
Clopidogrel 75mg qd x 3mo
52yo nonsmoker with a BMI 38 develops hypertension over 3 months. Pt was started on Losartan 25mg and has been tapered up to 100mg. Pt was also started on amlodipine 2.5mg. BP has not reduced at all. Thyroid studies unremarkable. What diagnostic tests should be ordered?
Renal US with duplex
Sleep study
What are the 4 stages of Pericarditis on 12 lead ekg?
Stage 2: ST segments + PR begin normalizing
Stage 3: T wave inversion widespread
Stage 4: Normalization of T waves
A patient had an MI 2 weeks ago. They now have malaise, a fever, sharp-pleuritic chest pain, and leukocytosis. How do you treat this?
NSAIDs or ASA
What test can be performed to determine if shock is fluid responsive?
Bonus 50 points if you can tell me what you will see to determine what makes it fluid responsive
Passive leg raise
SV increases by 10%, pulse pressure/BP/HR improves
A patient with chronic diastolic rumbling murmur with an opening snap over the apex presents with exertional dyspnea, syncope, and new-onset Afib. What physiologic change explains the Afib?
What else may result other than Afib from this?
Left atrial enlargement
Ortner's syndrome
Pt is 45 yo male with a history of DM. He had a BP reading of 144/84 one week ago and a reading of 142/80 today, and complaints of leg swelling the last time he was on a BP med. What is your treatment plan?
ACEi/ARB
Thiazide like diuretic
Lifestyle modifications
A 45 year old male who is otherwise healthy and weighs 75kg presents with chest pain that worsens with deep breath, pressure in his chest, and is relieved when he leans forward.
What 3 pharmacological meds should he be treated with? (need dosing for 2)
NSAID: Ibuprofen 600mg TID, ASA 500-1000mg QID, Indomethacin 25-50mg TID
Colchicine: 0.6mg PO BID
PPI
What are the 4 anticoagulation drugs used in ACS?
UFH, Bivalirudin, Enoxaparin, and Fondaparinux
30 year old patient presents to ER after getting T-boned on Mission St. He has several broken ribs, AMS, cool extremities, and chest pain. HR 120, BP 74/42, hemoglobin 8.6.
What type of shock and 3 treatments needed?
Hypovolemic shock
Blood +/- crystalloids
Stop the bleed
Norepinephrine
A patient present with a diastolic, decrescendo blowing murmur over the right 2nd intercostal space. What are 5 physical exam findings for this murmur?
Corrigan sign: Water hammer pulses
Hill sign: SBP in arms >20mmHg higher in legs than arms
Quincke sign: Capillary pulsations visible in lip/nail beds
DeMusset sign: Bobbing of head with heartbeat
Muller sign: Pulsating uvula d/t increased SV
A 28 year old 20 week pregnant lady presents to the ER with a BP of 180/110. How are you managing this? Need at least 2 drugs
Labetolol
Hydralyzine
Nicardipine (In this order)
According to UpToDate argue with them :)
A 32 year old presents to the ER with chest pain, palpitations (arrythmias), and rapid onset leg swelling + malaise after having COVID last week. Upon Physical examination, you note an S3 sound and JVD.
What should be ruled out?
What are the 2 definitive diagnosis options for your suspected condition?
ACS
Endomyocardial biopsy
Cardiac MRI
A patient presents with chest tightness/pain that is a 10/10. It has not resolved with rest. She is tachycardic, diaphoretic, and clammy. What is your undifferentiated initial treatment? (4 things-need dosing)
Bonus 100 if you tell me contraindication + replacement for 1 of those
Nitro 0.3-0.4mg tab sublingual q5 min x 3 (Must be hemodynamically stable)
Morphine sulfate 2-4mg IVP- NO if hypotensive- Fentanyl 25-50mcg IVP
ASA 162-325mg PO/PR
P2Y12 inhibitors (Prasugrel or Ticagrelor preferred)
70yo pt presents with a BP of 70/38, HR 110, temp 102.3, warm + mottled extremeties, and confusion. You start the first line vasopressor and BP is now 78/44. What was that first line pressor?
What 4 other things should be done?
5 total answers needed
First line: Norepinephrine
4 other things: Crystalloids 30mL/kg, Vasopressin, Steroids (Hydrocortisone 200mg/day), and antibiotics (cefepime, carbapenems)