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USMLE > Cardio > Flashcards

Cardio Flashcards

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USMLE® Step 1 flashcards
1
Q

Cushing’s Reflex

A

Respiratory depression, HTN, and bradycardia due to increased ICP Increased ICP = medullary compression = respiratory depression - cerebral arteriole constriction - increase sympathetic outflow to improve cerebral perfusion = HTN - increased baroreceptor outflow = bradycardia

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2
Q

Congenital heart defect associated with Fetal Alcohol Syndrome

A

VSD

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3
Q

Congenital heart defect associated with Down Syndrome

A

Endocardial cushion defects (ASD ostium primum type, VSD)

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4
Q

Congenital heart defect associated with Turner Syndrome

A

Coarctation of the aorta, bicuspid aortic valve

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5
Q

Congenital heart defect associated with maternal pre gestational DM

A

Transposition of the great vessels

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6
Q

Congenital heart defect associated with lower extremity cyanosis (differential cyanosis)

A

Coarctation of the aorta (infantile type - distal to PDA), PDA (late - following development of Eisenmenger Syndrome)

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7
Q

Evolution of MI (process, complication)
X 1 day X 1 wk X 1 mo X

A

Coagulative necrosis. Arrythmia, cardiogenic shock
-1 day-

Inflammation (PMN, M0). Papillary muscle rupture (esp RCA to posterior m), ventricular wall rupture

-1 wk-

Granulation tissue. Papillary muscle rupture (esp RCA to posterior m), ventricular wall rupture

-1 mo-

Fibsosis. Dressler syndrome, CHF.

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8
Q

Treatment for Acute MI

A

ABCs

MONA (morphine, O2, nitroglycerin, aspirin)

Anticoagulation (clopidogrel + heparin)

Beta blocker

Statin

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9
Q

Dilated Cardiomyopathy Causes

(ABCCCD)

A

Alcohol, wet beriberi (thiamine deficiency, vitB1), Coxsackie B, cocaine, Chagas disease, Daunorubicin/doxorubicin toxicity

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10
Q

Restrictive Cardiomyopathy Causes

(LEASH restricts your dog)

A

Loffler syndrome (eosinophilic myocardial fibrosis), Endocardial fibroelastosis (fibroelastic endocardium in African children), amyloidosis, sarcoidosis, hemachromatosis

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11
Q

What medications improve survival in chronic CHF?

A

ACEI/ARBs

Alsoderone antagonist (spironolactone, eplerenone)

B blockers (Metoprolol, carvediolo)

In AAs with moderate-severe symptoms - Nitrates + hydralazine

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12
Q

How do you treat acute CHF exacerbation?

(NO LIP)

A

Nitrates (nitroglycerin)

O2 - only if hypoxic

Loop diuretics

Inotropes (Dobutamine)

Positioning

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13
Q

Pathogens in bacterial endocarditis

Acute, subacute, culture negative, IV drugs

A

Acute - Staph aureus

Subacute - Viridans Strep

Culture negative - Coxiella burnetti (Q fever), Bartonella (Cat scratch fever)

IV drugs - Staph aureus, Pseudomonas, Candida

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14
Q

Causes of acute pericarditis:

Fibrinous, serous, hemorrhagic

A

Fibrinous - Dressler Syndrome, uremia, radiation

Serous - viral, inflammatory disease (SLE, RA)

Hemorrhagic - TB, melanoma

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15
Q

Kussmaul sign vs pulsus peridoxus

A

Kussmal sign - JVD with inspiration = RV insufficiency. Pericarditis

Pulsus peridoxus - BP drop > 10 mmHg with inspiration - LV insufficiency. Cardiac tamponade

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16
Q

HTN Treatment

Primary, + CHF, + BPH

A

Primary - HCTZ, ACEI/ARB

+ CHF - add BB, aldosterone antagonist

+ BPH - use a blocker instead of HCTZ

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17
Q

What CCB is used for subarachnoid hemorrhage?

A

Nimodipine (prevents ischemia-induced vasodilation of ruptured cerebral arteries)

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18
Q

What HTN drugs are safe in pregnancy?

(Hypertensive Moms Love Nifedipine)

A

Hydralazine

Methyldopa

Labetalol

Nifedipine

19
Q

What medication class is used for aortic dissection?

A

B blockers (decreases slope of BP rise)

20
Q

What is Fenoldopam and when is it used?

A

D1R agonist = vasodilation

Used in HTN emergency, maintains renal perfusion (renal a dilation) to promote natriuresis

21
Q

How does Nitroglycerin improve symptoms of angina?

A

CANT directly vasodilate coronary arteries becuase theyre already maximally dilated.

Causes systemic venodilation - decreased preload - decreased myocardial O2 demand

22
Q

What is a side effect specific to Nitroprusside? How would you treat it?

A

CN toxicity

Thiosulfate + vitamin B12 (sequesters CN)

Nitrate (causes metHb that CN cannot bind) + Methylene Blue (rescues the metHb)

23
Q

What are the classes of antiarrhythmics?

(No BadBoy Keeps Clean)

A
24
Q

What drugs are Class 1A, 1B, and 1C antiarrhytmics?

A

Class 1A (Double Quarter Pounder) - Disopyramide, Qunidine, Procainamide

Class 1B (Mayo, Lettuce, Tomato) - Mexiletine, Lidocaine, Tocainide

Class 1C (Fries, Please) - Flecanide, Propafenone

25
Q

What is the clinical use for Procainamide? What side effect is specific to it?

A
26
Q

What is Cinchonism? What drugs cause it?

A

Headache, dizziness, tinnitus

Quinidine (class 1A antiarrhythmic), Quinine (antimalarial)

27
Q

What is the clinical use of Lidocaine? Why?

A

Tachyarrhytmias after an MI. It preferentially blocks Na channels in ischemic myocardial tissue.

28
Q

How do you treat B blocker overdose?

A

Glucagon

29
Q

What is the clinical use for Amiodarone? What are the side effects?

A

WPW

Check PFTs, LFTs, TFTs (pulmonary fibrosis, hepatotoxicity, dysthroid because high I content), photosensitivity

Less specific - neurological, constipation

30
Q

How does Adenosine work?

When is it used clinically?

What drug can block it’s effect?

A

MOA: Increases K effluc, hyperpolarizing cardiomyocytes

Used to restart the heart in SVT at a slower rate

Blocked by Theophylline (COPD PDE inhibitor that causes bronchodilation)

31
Q

What two ions can most strongly trigger dangerous arrhythmias if not optimized?

A

K and Mg

32
Q

What drugs can be used to lower LDL?

A

Statins

Less effective - bile acid resins, ezetimibe (inhibits cholesterol uptake at the brush boarder)

33
Q

What are the side effects of statins?

A

Hepatotoxicity, rhabdomyolysis (esecially + fibrates or niacin)

34
Q

What lipid lowering agent can be given to bind C diff toxin?

A
35
Q

What drug can be used to increase HDL? What are the side effects?

A

Niacin

Facial flushing, rhabdomyolysis if used with statins

36
Q

What drug can be used to decrease TGs? What are the side effects?

A

Fibrates

Myositis (increased with concurrent statins), hepatotoxicity, cholesterol gallstones

37
Q

Which lipid lowering drugs increase the risk of cholesterol gallstones?

A

Bile acid resins and fibrates

38
Q

What are the side effects of Digoxin?

What puts you at higher risk for toxicity?

What is the antidote?

A

Bradycardia/AV block, blurry yellow vision, hyperkalemia

Higher risk of OD with renal failure, hypoK (increased Na/K ATPase binding)

Antidote = anti-digoxin Fab fragments

39
Q

What is Sturge-Weber Syndrome?

A

Non-inherited mutation in GNAQ gene resulting in anomolies of neural crest derivatives (specifically, blood vessels)

Port-wine stain in CV V1 dermatome (non-neoplastic capillary overgrowth), leptomeningeal angioma (seizures, intellectual disability), and episcleral hemangioma (increases intra-ocular P = glaucoma)

40
Q

What is Romano-Ward syndrome?

A
41
Q

What is Jervell and Lange-Nielsen Syndrome?

A

Congenital long QT + sensorineural deafness

42
Q

Pt with AF and CHF with bradycardia and hyperK - what is the cause?

A

Digoxin toxicity

43
Q

What is the treatment for TdP?

A

IV Mg

USMLE (12 decks)

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