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Dimensions are used to trigger your knowledge regarding the need for valve replacement or valve repair.  You should know the dimensions that should trigger valve replacement in the guidelines.
Dimensions are used to trigger your knowledge regarding the need for valve replacement or valve repair.  You should know the dimensions that should trigger valve replacement in the guidelines.


==EKG==
==EKG Readings==
Tests for pattern recognition skills.  Review lots of complex EKGs.  The EKGs can be tough but are fair. It usually comes down to 2 diagnoses, not 5 or 6.  If you see VT, it is most likely it.  Pick the most serious diagnosis that is threatening to the patient if you are not sure. Don't want left atrial enlargement, want ST elevation, heart block. Not small findings.
Tests for pattern recognition skills.  Review lots of complex EKGs.  The EKGs can be tough but are fair. It usually comes down to 2 diagnoses, not 5 or 6.  If you see VT, it is most likely it.  Pick the most serious diagnosis that is threatening to the patient if you are not sure. Don't want left atrial enlargement, want ST elevation, heart block. Not small findings.


Line 63: Line 63:
[[Peripartum CMP]]
[[Peripartum CMP]]
[[Coronary dissection]]
[[Coronary dissection]]
[[Mechanical valve]]


==Long Plane Flight==
==Long Plane Flight==
Line 71: Line 72:


==Deafness==
==Deafness==
Long QT
[[Long QT syndrome]]


==Swimming syncope==
==Swimming and Syncope==
Long QT
[[Long QT syndrome]]


==Irish==
==Irish==
Line 80: Line 81:


==Japan==
==Japan==
Apical HOCM
Apical [[HOCM]]
Black
 
repol
==Black Patient==
Htn
*[[Early repolarization]]
response to meds
*[[Hypertension]]
Haitian
*Differential response to medications
Peripartum CMP
 
Portugese
==Haitian Patient==
Amyloid
*Increased risk of [[peripartum cardiomyopathy]]
 
==Portugese Patient==
*[[Amyloid]] cardiomyoopathy
 
==Dialysis Patient==
*[[Hyperkalemia]]
 
==If you see a Fairly Normal EKG Consider the Following Diagnoses==
*[[Long QT syndrome]]
*[[Brugada syndrome]]
*[[Ebstein's]]
*[[ASD]]
*[[WPW]]
 
==PET Images==
*You are being asked to assess [myocardial viability]]
 
==Long Narratives==
Read last paragraph, read questions
 
==Shipyard==
==Shipyard==
[[Asbestosis]]
[[Asbestosis]]
Line 128: Line 149:
*Trials < 2 years old
*Trials < 2 years old
*Guidelines < 1-2 years old
*Guidelines < 1-2 years old
==Common Diseases and Questions==
*[[Constriction]]
*[[Restriction]]
*[[Myocarditis]]
*[[Ebstein's]]
*[[Cocaine toxicity]]
*[[Thrombophilia]] and [[anti-phospholipid syndrome]]
*Complications
*Contraindications
==Physical Examination==
*Know maneuvers that exacerbate or reduce physical examination findings
*[[Valsalva maneuver]]
*Leg rasing
*Know how to differentiate chronic versus acute valvular disease on physical examination
==Criteria for Thrombolysis in a Stroke Patient==
*Know that thrombolysis should be administered to ischemic strokes within 3 hours of symptoms, and in certain subgroups up to 6 hours after symptoms onset
==Risk Factors for [[ICH]] with Thrombolytic Administration==
*Increasing age
*Female gender
*Elevated blood pressure
*Black race
*Prior stroke
*Low body weight
==Peripheral Vascular Disease==
*Know how to interpret peripheral arterial testing like ABIs, exercise ABIs
==Cerbrovascular Disease==
*Know the indications for [[carotid endarterectomy]] based upon carotid imaging
==Marfan mMnagement==
*Know when to intervene
==Peripheral Vascular Disease==
*[[Stroke]]
*[[Vasculitis]]
*[[Giant cell arteritis]]
*[[Takaysus arteritis]]
*[[Abdominal Aortic Aneurysm]]
*[[Thoracic aneurysm]] diagnosis and managment
*[[Aortic ulceration]] and vasculitis
==Congenital Heart Disease==
*[[PFO]]
*[[ASD]]
*[[VSD]]
*[[Tetralogy of Fallot]]
*[[Ebsteins]]
*Pulmoanry valve disease sometime tested on
*[[Bicuspid aortic valve disease]]
*No complex congenital heart disease is tested on like double outlet ventricle
sudden death
platypnea ortho doxia: PFO ASD hered tel
PFO: seconary prev
anticog
knwo i
23 to 25 valve questions
Mitral and aortic rev
AS with poor LV
asx pat
repair vs repl
low gradient AS
choice of prosthesis
pericarial:
3%
pericarditis
constriction
congenital absence of pericardial dz
tamponade vs constriction
EKG of acute peric trick you into given lytic, always remember peric and PR depression
regional tamponade after surgery, take back to surgery, usually of RV
low pressure tamponade
==TTP on Clopidogrel==
Know the treatment
==Pulmonary Hypertension==
*Know managment including use fo calcium channel blockers
==Lateral CXR==
Look for
*[[Pericardial calcification]]
*Pacer lead position
*RV size is a less likely choice
==Physiology==
*RAS system
*Endothelial function
*Platelet receptor physiology

Latest revision as of 15:01, 29 September 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Data

There is no random data provided on the test. Capture the one line summary of what they are telling you in all the data. This is there for a reason. Use it to guide you in discerning what they are trying to test you on in this question. They ar testing you on scientifically validated in the peer review literature and in the guidelines. They are asking "Do I know the results of the __ trial". They keep the questions where half the people get it right. They throw out the ones with 80% right or 20% right.

Goal of the Exam

They are looking for you to integrate knowledge, not just regurgitate knowledge. This is not a test of basic science or rote knowledge.

Distracting Answers

These answers are not that close to the correct answer so that the test is fair. They are somewhat distant from the correct answer. Usually comes down to two answers.

Geography

Living in South America should trigger consideration of Chagas disease for instance.

Symptoms

Symptoms are provided because the guidelines are often based upon symptoms.

Treatment versus Diagnosis Options

Look for the one choice that is not diametrically opposed to the others, that is different from the others.

Dimensions

Dimensions are used to trigger your knowledge regarding the need for valve replacement or valve repair. You should know the dimensions that should trigger valve replacement in the guidelines.

EKG Readings

Tests for pattern recognition skills. Review lots of complex EKGs. The EKGs can be tough but are fair. It usually comes down to 2 diagnoses, not 5 or 6. If you see VT, it is most likely it. Pick the most serious diagnosis that is threatening to the patient if you are not sure. Don't want left atrial enlargement, want ST elevation, heart block. Not small findings.

Images

Wrong answers are counted against you. Review still images

Distribution

  • Valve dz 12%
  • Arrhythmias 12%
  • MI 12%
  • Coronary artery disease 12.5%
  • Vascular medicine 9% (aneurysms, Beurgers disease)
  • Pharmacology 5%
  • CHF 13%
  • Phsyiology 6%
  • Congenital heart disease 7%
  • Hypertension 7%
  • Pericardial disease 3%
  • Miscellaneous / ethics / statistics / trial design 1.5%

Ethics

  • Report impaired MDs
  • Patient can shut their AICD off, and make decisions about their care.

On Cardiac Mediciation

This is a question about digoxin. They don't say what the medicine is.

South America

Scuba DIver

PFO with paradoxical embolism. TIA after scuba diving is PFO

Preganancy

Peripartum CMP Coronary dissection Mechanical valve

Long Plane Flight

Weight Loss

  • Fen fen

Deafness

Long QT syndrome

Swimming and Syncope

Long QT syndrome

Irish

Japan

Apical HOCM

Black Patient

Haitian Patient

Portugese Patient

Dialysis Patient

If you see a Fairly Normal EKG Consider the Following Diagnoses

PET Images

  • You are being asked to assess [myocardial viability]]

Long Narratives

Read last paragraph, read questions

Shipyard

Asbestosis

==Post-operative EKG]] Hypocalcemia will be seen on the EKG

Vomitting

Hypokalemia

The Asymptomatic Patient

Pilot is seen for an exam. There will not be a normal EKG. Look for:

Clinical Trials

  • The board is one to two years behind.
  • Trials that are two to five years old are included.
  • Will ask about SCDheft trial

Diastolic Sound

  • Is this a pericardial knock.

Splinter Hemorrhages

Will be called subungual hemorrhages

Forced Breath Holding

This is another term for the valsalva maneuver

What is not on the Test

  • Questions with no clear answer
  • Controversies
  • Trials < 2 years old
  • Guidelines < 1-2 years old

Common Diseases and Questions

Physical Examination

  • Know maneuvers that exacerbate or reduce physical examination findings
  • Valsalva maneuver
  • Leg rasing
  • Know how to differentiate chronic versus acute valvular disease on physical examination

Criteria for Thrombolysis in a Stroke Patient

  • Know that thrombolysis should be administered to ischemic strokes within 3 hours of symptoms, and in certain subgroups up to 6 hours after symptoms onset

Risk Factors for ICH with Thrombolytic Administration

  • Increasing age
  • Female gender
  • Elevated blood pressure
  • Black race
  • Prior stroke
  • Low body weight

Peripheral Vascular Disease

  • Know how to interpret peripheral arterial testing like ABIs, exercise ABIs

Cerbrovascular Disease

Marfan mMnagement

  • Know when to intervene

Peripheral Vascular Disease

Congenital Heart Disease

sudden death

platypnea ortho doxia: PFO ASD hered tel

PFO: seconary prev anticog knwo i

23 to 25 valve questions Mitral and aortic rev

AS with poor LV asx pat repair vs repl

low gradient AS choice of prosthesis

pericarial: 3% pericarditis constriction congenital absence of pericardial dz tamponade vs constriction EKG of acute peric trick you into given lytic, always remember peric and PR depression regional tamponade after surgery, take back to surgery, usually of RV low pressure tamponade

TTP on Clopidogrel

Know the treatment

Pulmonary Hypertension

  • Know managment including use fo calcium channel blockers

Lateral CXR

Look for

Physiology

  • RAS system
  • Endothelial function
  • Platelet receptor physiology