Cardiology Board Review general tips: Difference between revisions
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==Data== | ==Data== | ||
There is no random data provided on the test. | 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. | 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== | ==Goal of the Exam== | ||
| Line 27: | Line 27: | ||
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. | 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== | ==On Cardiac Mediciation== | ||
| Line 41: | Line 63: | ||
[[Peripartum CMP]] | [[Peripartum CMP]] | ||
[[Coronary dissection]] | [[Coronary dissection]] | ||
[[Mechanical valve]] | |||
==Long Plane Flight== | |||
*[[PE]], [[DVT]] | |||
==Weight Loss== | |||
*Fen fen | |||
==Deafness== | |||
[[Long QT syndrome]] | |||
==Swimming and Syncope== | |||
[[Long QT syndrome]] | |||
==Irish== | |||
*[[Hemochromatosis]] | |||
==Japan== | |||
Apical [[HOCM]] | |||
== | ==Black Patient== | ||
*[[Early repolarization]] | |||
*[[Hypertension]] | |||
*Differential response to medications | |||
== | ==Haitian Patient== | ||
*Increased risk of [[peripartum cardiomyopathy]] | |||
==Portugese Patient== | |||
*[[Amyloid]] cardiomyoopathy | |||
== | ==Dialysis Patient== | ||
Long QT | *[[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]] | |||
==Post-operative EKG]] | |||
Hypocalcemia | [[Hypocalcemia]] will be seen on the EKG | ||
Asymptomatic | ==Vomitting== | ||
Pilot for | [[Hypokalemia]] | ||
LVH + HOCM | ==The Asymptomatic Patient== | ||
WPW | Pilot is seen for an exam. There will not be a normal EKG. Look for: | ||
Long QT | *[[Early repolarization]] | ||
Brugada | *[[LVH]] + [[HOCM]] | ||
LBBB | *[[WPW]] | ||
RBBB | *[[Long QT]] | ||
Atrial fibrillation | *[[Brugada]] | ||
*[[LBBB]] | |||
*[[RBBB]] | |||
*[[Atrial fibrillation]] | |||
==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== | ==Diastolic Sound== | ||
*Is this a pericardial knock. | |||
==Splinter Hemorrhages== | ==Splinter Hemorrhages== | ||
| Line 94: | Line 143: | ||
==Forced Breath Holding== | ==Forced Breath Holding== | ||
This is another term for the [[valsalva maneuver]] | 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== | |||
*[[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
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
Swimming and Syncope
Irish
Japan
Apical HOCM
Black Patient
- Early repolarization
- Hypertension
- Differential response to medications
Haitian Patient
- Increased risk of peripartum cardiomyopathy
Portugese Patient
- Amyloid cardiomyoopathy
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
==Post-operative EKG]] Hypocalcemia will be seen on the EKG
Vomitting
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
- 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