Surgery: Cardiology Topics (Ep 4)

Hello and welcome to Physician Assistant in a Flash. The Flash Card Style podcast yet you ready for your clinical medicine exams and a rotation exam, pants or pantry. By now you should know all of the content and you're ready to start actively recalling the information that you need to pass your exam. Join me if you are ready to become a Physician Assistant in a Flash. Part three of the general surgery topic list is cardiovascular conditions which make up 9% of this end of rotation exam. Cardiology is 13% of the pants and general surgery is 20% of the pants. So this episode is going to be very valuable for studying for any exam covering cardiology concerns. These topics overlap with emergency medicine, internal medicine, family medicine. All of this is going to come up on the pants. Even if you don't know the answer to something, think it through and give it your best guess. Remember, we're trying to actively recall information to make it easier to tackle questions on your exams and eventually think through these scenarios in clinical practice. Alright, let's begin. What is the recommended screening for aortic aneurysm? Do a one-time abdominal ultrasound for men aged 65 to 75 who have a history of tobacco use or if they have any first degree relative who had an aortic aneurysm? What is the most common sight of clotication in peripheral artery disease? The calf, either the superficial femoral artery or the popliteal artery. What is the management for an arterial embolism? Heparin or an imbelectomy? What are some risk factors for developing arterial ulcers? Smoking, diabetes, hyperlipidemia, and hypertension? A patient presents with a deep ulcer with a pale base color. The surrounding skin is shiny, thin, and cool. What is the most likely diagnosis? Arterial ulcer. What is the treatment for an arterial ulcer? Revascularization and anti-platelets. Next, some common comorbidities with prinsmetal vasospasm angina. Migraines, reynods, smoking, cocaine use, and arrhythmias. A patient has chest pain that wakes him up from sleep. An EKG shows transient ST elevation. Vasospasm angina, also called prinsmetal or variant angina. Which beta blockers are cardiac selective? Motoper law, a tenelol, and ezmalol. List three risk factors for an aortic aneurysm. Age greater than 50, male, family history, hypertension, COPD, hyperlipidemia, tobacco use, syphilis, tuberculosis, morphans, giant cell arteritis, and congestive heart failure. How do you diagnose an aortic dissection? CT angiogram is gold standard. Which tool is used to screen for peripheral arterial disease? An ankle, brachial index. What are some risk factors for varicose veins? Oral contraceptive pills, prolonged standing, pregnancy, obesity, venous insufficiency, and family history. What are some risk factors for an aortic dissection? Hypertension, weight lifting, pregnancy, aortic aneurysm, stimulant use, and genetics, such as morphans or healer's danlos syndrome. What is the most common site for a venous ulcer to develop? The medial lower extremity between the calf and the medial malleolus. What is the most common cause of syncopy? The vasovagal reflex, which is a parasympathetic response and is associated with hypotension. What EKG changes are associated with stable angina? T-wave inversion or flattening? What is the treatment for acute onset third-degree heart block? Transcutaneous pacing is preferred. You can consider atropine and a pacemaker placement. Which drug class is first line for heart failure? Eye blockers, particularly metoprolol. A patient presents with sudden onset chest and abdominal pain, high bow tension, diminished pulses, and a palpable pulsatile mass in the abdomen. What is the next best step in confirming the diagnosis? CTA or an ultrasound of the abdomen? Type a Stanford A aortic dissection. Any aortic dissection that involves the ascending aorta. Which ankle, brachial index is considered normal or no peripheral arterial disease? 0.9 to 1.3 is normal. What is the most common site for a varicose veins to develop? At the superficial saffinous vein. A patient has an ulcer on the plantar surface of the foot. The wound appears dry and deep and is surrounded by a callus. What is the most likely cause of this ulcer? Diabetes. This is a diabetic ulcer. What are some complications of carotid artery disease? Transient ischemic attack, stroke, dizziness, syncopy, and amyrosis fougox. What is the timeline for initiating percutaneous coronary intervention for patients with stemmy? PCI within 90 to 120 minutes. But if that is impossible, give fibrinolidics within 30 minutes. What are some causes of cardiogenic syncopy? Aortic stenosis is the most common cause. Others are arrhythmias, pacemaker malfunction, valvular disease, cardiac tamponod, congestive heart failure, pulmonary embolism, or hypertrophic cardiomyopathy. How do you diagnose angina? Stress test. What is the treatment for six sinus syndrome? Pacemaker. What is the mechanism of amiodarone? It's a potassium channel blocker. What are the criteria for a surgical repair of an aortic aneurysm? Any aneurysm that has ruptured or is causing symptoms? An aneurysm greater than 5.5 centimeters in males or 5 centimeters in females? or an aneurysm that has grown five millimeters in six months or ten millimeters in 12 months. A patient presents with a abrupt onset tearing chest pain, hypertension with variation in blood pressure on the right and left, and a decryscendo murmur. What is the best initial step in managing the condition? IV libatalol and consult surgery. This patient has an aortic dissection. What is the treatment for peripheral artery disease? First line is lifestyle modifications. Medications include aspirin, statins, or anti-platelets, and amputation is last resort. What is the most common site for a pressure ulcer to develop? The heel of the foot or the sacrum. Which heart murmur is associated with an aortic dissection? Aortic regurgitation. It will be described as a decryscendo washing machine murmur. Describe the characteristics of a venous ulcer. It's open, drained, shallow, irregular, red or hyperpigmented, and it has a burning ache or pain. List some medications that prolong the QT interval. On dancetron, haloparital, tetracycline, macrolides, fluconazole, amiodarone, resparidone, and amitriptoline. What EKG changes are associated with unstable angina? ST depression or T-wave inversion? What are the indications for adenosine? SVT is the only labeled indication. What drugs are anti-coagulants? Warpherin, haparins, direct thrombone inhibitors like argatriban, bivalorudin, tetbigatran, and factor 10 inhibitors like revoroxaban, epixaban, and edoxaban. Where do most aortic dissections occur? The ascending aorta. What is luricace syndrome? It is a triad of claudication, diminished femoral pulses, and erectile dysfunction. It's common in peripheral artery disease. What is the difference between a thrombosis and embolism? A thrombosis is a partial occlusion that occurs over hours to days. It's often caused by atherosclerosis. An embolism is a complete occlusion or ischemia that occurs over seconds to minutes. A patient has dilated, elongated, tortuous veins along the legs with a diffuse ache and tightness. Pain is worse during menstruation. What is the best initial step in treatment? Can pression stockings and elevation of the legs? She has varicose veins. Describe the presentation of an aortic dissection. The classic triad is an abrupt onset of tearing chest pain, variation in pulses on the left and right, and media-stinal or aortic widening on chest x-ray. Other signs are pain that radiates to the back, hypertension, neurologic signs, aortic regurgitation, diaphoresis, syncopy, nausea, and vomiting. What is the best treatment for a venous ulcer? Can pression, elevation, and considered debridement? What are the components of the San Francisco syncopy rule? Ingestive heart failure, low hematocrit, EKG changes, low systolic blood pressure, and shortness of breath. What is the treatment for vasospasm angina? Calcium channel blockers. Which calcium channel blockers are non-dihydropyridines? Diltiasum and verapimil. List some anti-platelet medications. Inceds, aspirin, dipyridamol, salostisol, take a griller, cangriller, clopidogrel, prasogrel, eptophibotide, tearify van, and vorepaxar. That's all I have for you on cardiology topics as they relate to the general surgery end of rotation exam. I review the PAEA topic list and come up with some questions that I think are most likely to appear on your exams, so hopefully reviewing this episode will be helpful in your studying. Thanks for joining me here on Physician Assistant in a Flash, and I hope you'll tune in next time as we cover surgical endocrinology.