Cardiology Quiz on EKG Patterns

High Yield Internal Medicine Shelf Exam Review

• Cardiology review is included in the material provided.
• Key tests for chest pain include EKG, cardiac enzymes (q8hrs×3), and others based on findings.
• Key findings and management for STEMI and NSTEMI are outlined.
• Post-MI complications, such as arrhythmias and wall ruptures, are discussed.
• Additional conditions, like pericarditis and costochondritis, and their EKG/clinical presentations are covered.
• Details on workup, diagnosis, and treatment of unstable angina are included.
• Important cardiac enzymes like myoglobin, CK-MB, and Troponin I are discussed in terms of their timing of elevation and return to normal.

Murmur Buzzwords

• Aortic stenosis is characterized by louder murmurs during squatting and softer murmurs during valsalva, along with parvus et tardus.
• Hypertrophic Obstructive Cardiomyopathy (HOCM) shows louder murmurs during valsalva and softer during squatting/handgrip.
• Mitral valve prolapse presents with a late systolic murmur with a click, louder with valsalva and handgrip, but softer with squatting.
• Mitral regurgitation presents with a holosystolic murmur radiating to the axilla with left atrial enlargement.

More Murmurs

• Ventricular septal defect (VSD) typically presents with a holosystolic murmur.
• Patent ductus arteriosus (PDA) presents with a continuous machine-like murmur.
• Atrial septal defect (ASD) may have a fixed, wide split S2.
• Rumbling diastolic murmur with an opening snap and left atrial enlargement suggests mitral stenosis.
• A blowing diastolic murmur with widened pulse pressure and an associated eponymous sign may point to aortic regurgitation.

Pulmonary Embolism

• High risk from surgery, long car rides, and hypercoagulable states.
• Symptoms include pleuritic chest pain, hemoptysis, and tachypnea along with decreased pO2 and tachycardia.
• Random findings may include right heart strain on EKG and decreased vascular markings on CXR.
• Initial management includes heparin therapy.
• Further workup includes V/Q scan and spiral CT.
• Treatment may involve thrombolytics in severe cases, surgical thrombectomy for life-threatening situations, and IVC filter placement where appropriate.

CXR Buzzwords

• Key terms like "opacification, consolidation, air bronchograms," "hyperlucent lung fields with flattened diaphragms," and "heart >50% AP diameter" to highlight key findings in CXR.
• Other terms like "cavity containing an air-fluid level," "upper lobe cavitation," and “thickened peritracheal stripe" relate to specific CXR findings.
• The descriptions help with analysis when a CXR presents certain findings related to various disorders.

Pleural Effusions

• Pleural effusions present as a fluid collection greater than 1cm on lateral decubitus radiographs, necessitating thoracentesis.
• Transudative effusions are likely due to CHF, nephrotic syndrome, or cirrhosis, potentially showing decreased pleural glucose or increased lymphocytes suggesting other conditions (e.g., RA, tuberculosis).
• Exudative effusions indicate causes like parapneumonic effusion and malignancies, sometimes complicated by gram-negative infections and low glucose.
• Diagnostic thoracentesis might be necessary for complicated effusions, guided by Light's criteria (LDH, protein, and LDH/serum comparisons).

Acid Base Disorders

• Check pH; less than 7.4 indicates acidosis, and greater than 7.4 indicates alkalosis.
• If bicarbonate (HCO3) and partial pressure of carbon dioxide (pCO2 ) are both elevated, it suggests metabolic alkalosis.
• If urine chloride (Cl-) is >20 and there is hypertension, hyperaldosteronism (Conn's syndrome) or Bartter/Gitelman syndrome is possible.
• Chloride is less than 20 and vomiting and/or diuretics or antacids are used, metabolic alkalosis is possible.
• If both HCO3 and pCO2 are low, it suggests metabolic acidosis.
• Anion gap (AG) calculations aid in determining the cause of the metabolic acidosis.

Acute Renal Failure

• 25% or 0.5 rise in creatinine, over baseline creatinine levels.

• workup: BUN/Creatinine (Cr) ratio, to confirm prerenal causes. FENA tests. FENurea, for prerenal in those on diuretics.
• Treatment aims to address prerenal causes, meaning to improve kidney blood flow/perfusion (e.g., fluid administration).

Intrinsic Renal Causes

• Muddy brown casts in a patient with amphotericin B, AG, cisplatin administration, or prolonged ischemia can point toward acute tubular necrosis (ATN).
• Protein, blood, and eosinophils in the urine, alongside fever and rash following trim-sulfa usage, may indicate acute interstitial nephritis (AIN).
• Elevated CPK in trauma or crush victims can suggest rhabdomyolysis.
• Enveloped crystals on UA could hint towards ethylene glycol toxicity.
• A creatinine increase within 48-72 hours after a cardiac catheterization may suggest contrast nephropathy.

Infectious Disease

• Meningitis causes (in kids and adults, and after brain surgery) and their specific treatments (antibiotics for bacterial meningitis)
• Empiric treatment for suspected bacterial meningitis, including steroids in cases strongly suspected of being bacterial.
• Laboratory testing/diagnostic tests(e.g. gram stain, high WBC count) for bacterial meningitis which suggest the infection.

Infectious Disease Buzzwords

• Target rash, fever, facial nerve palsy, and AV block may point towards Lyme disease.

• Rickettsia, can be suspected by rash at joints (wrist, ankles, or soles) that shows an association with fever and headache.

• Tick-borne diseases (like Ehrlichiosis) may present with myalgia, fever, headache, and low platelets or white blood cells along with possibly a skin rash.

• Immune deficiency from prior treatment(like those with history of recent antibiotic use) may pose an increased risk towards opportunistic infections like the involvement of c. diff toxin antigen

Other Infections

• Viral or bacterial URI may produce multiple problems in the kidneys, like Henoch-Schönlein Purpura (HSP) with kidney failure, and abdominal pain, or other symptoms.
• Multiple other related infections can include Cardiac conditions, and blood disorders like Thrombocytopenia along with fever, high white blood cells, and other related issues.
• Important diagnostic considerations for possible infections that present as related conditions.

HIV-related Conditions

• The possibility of infections like PCP(Pneumocystis jirovecii pneumonia) or other infections in patients with suppressed immune systems from HIV/AIDS
• Considerations for the diagnoses and treatments of various problems that potentially occur in patients with HIV

Respiratory Infections

• Key infections that cause pulmonary problems, such as pneumonia, from various sources and treatment approach needed
• Important infections like tuberculosis (TB) and pneumococcal pneumonia
• How to differentiate these infections based on presentation and other related tests (like CXR)

Immunological and Inflammatory

• Autoimmune issues and related conditions that can cause various problems (sometimes affecting multiple organs) requiring a multifaceted approach to treatment.
• Information regarding the types of syndromes, what criteria to check for to rule them out, and related symptoms.
• Diagnosis and treatment strategies depending on the type of immune disorder.

Other Hematologic

• Understanding different blood disorders (blood dyscrasias) and their possible causes
• Conditions that can cause anemia or thrombocytopenia depending on the type and presenting features
• Understanding the cause/s behind specific conditions and treatment considerations

Other Skin Related Conditions

• Diagnosing the different skin-related conditions (possibly systemic) based on specific features
• Conditions presenting with pain and other associated features of inflammations to other related problems in the body

Important Diagnostic and Treatment Considerations

• Considerations for the specific clinical features and supporting tests(x-rays, scans, blood tests) for various conditions.
• Management/treatment approach for related symptoms and conditions presented for the particular situation

Other Considerations

• Conditions related to different organs/systems/conditions that may present (or require further diagnostics/workups to rule them out, especially if they are rare)

Additional Points

• Information about specific testing, treatment and management decisions for particular patients and features present.

Test your knowledge on EKG patterns and cardiac conditions with this quiz. It includes questions about intervals, QRS complexes, and various types of tachycardia. Perfect for medical students and healthcare professionals looking to refresh their understanding of cardiology.