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USMLE step 2 cardiology > cardio 4 > Flashcards

cardio 4 Flashcards

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USMLE® Step 1 flashcards
1
Q

First-line treatment of chronic stable angina

A

Beta-blocker

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2
Q

What can be used as an alternative?

A

Non dihydrophinCCB

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3
Q

What other drug can be added to BB?

A 
Dihydropin CCB(If needed, but not used alone b/c of risk of reflex tachycardia)
Nitrates(short-acting (sublingual nitroglycerin PRN for intermittent angina and long-acting Isosorbide mononitrate and isosorbide mononitrate for persistent one)
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4
Q

What drug can be used for refractory one?

A

Ranolazine

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5
Q

Mechanism of BB and NDCCB?

A

Decrease contraction and HR

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6
Q

CCB mechanism?

A

Coronary artery dilation and afterload reduction

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7
Q

Ranolazine?

A

Decrease Na influx–increase Na/Ca exchanger activity–increase calcium efflux—decrease myocardial wall stress and o2 demand.

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8
Q

Holter monitoring?

A

24 hour continuous ECG monitoring used for intermittent arrhythmia.

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9
Q

Symptoms of AS?

A

Chest pain, dizziness, dyspnea, and syncope
Delayed and diminished carotid pulse.
Single and soft s2 and s4 sound
Harsh ejection crescendo decrescendo murmur.

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10
Q

Upright tilt test?

A

For Diagnosis vagovagal syncop?

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11
Q

what is the cardiac complication of methamphetamine?

A

Dilated cardiomyopathy.

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12
Q

What are the benefits and use of dobutamine?

A

High B-1 and minimal B-2 and alpha 1
In symptomatic HF and cardiogenic shock
Increase cardiac contractility

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13
Q

Hypertrophic Cardiomyopathy symptom?

A

incidental finding
exertional dyspnea, chest pain, fatigue, palpitation, and syncope ad presyncope.
Harsh crescendo decrescendo murmur lsb or apex

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14
Q

what causes the murmur?

A

The systolic anterior motion of M.valve leaflet—LVO

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15
Q

mechanism cause of MV lesion.

A

Annular calcification
Myxomatous degeneration
papillary muscle rapture.
annular dilation

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16
Q

Annular calcification cause?

A

old age–mostly asymptomatic/MS

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17
Q

Myxomatous degeneration cause?

A

Affect leaflet and cordea tendina

CTD

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18
Q

cordea tendine rupture cause?

A

MVP
IE
MI
trauma

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19
Q

annular dilation?

A

Ischemic cardimyophaty

Dilated cardiomyopathy

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20
Q

MVP murmur?

A

Mid systolic ejection click with mid-late systolic Crescendo murmur of MR.

21
Q

TAA feature?

A

Widened midiasternum
Tracheal deviation
enlarged aortic knob

22
Q

Symptom?

A

mild chest pain and symptoms of nearby organ compression.

60% involve ascending

23
Q

Risk factor?

A

CTD
age-related medial wall calcification
hypertension

24
Q

confirmed diagnosis by?

A

contrast chest CT(B/C X-ray not d/t it from the tortuous aorta)

25
Q

Achalaxia x-ray feucher?

A

absence of gastric bubble.

26
Q

ADPKD symptom?

A 
Asymptomatic 30-40 years of age
Hypertension
Flank pain and hematuria
Bilateral palpable abdominal mass
CKD
27
Q

extrarenal fetcher?

A 
Cerebral aneurysm
Hepatic and Pancreatic cyst
MVP and AR
Colonic Diverticulosis
Ventral and Inguinal hernia
increase hematocrit(due to localize ischemia around cyst)
28
Q

Diagnosis?

A

Abdominal ultrasound

29
Q

management?

A

CVS risk management
ACE inhibitor for HYTN
Hemodialisis, renal transplant for ESKD

30
Q

chronic valve insufficiency cause?

A

due to deep viens valve incopitency

31
Q

Risk?

A 
Obesity
Family history
Advanced age
Sedentary life
previous LE trauma and thrombosis
32
Q

sign?

A 
pitting edema due to venous HYTN worse in evening/p.standing
superficial venous telangiectasia
skin discoloration
lipodermatosclerosis
skin ulcer on medial leg
33
Q

treatment?

A

leg elevation
exercise
compression stocking

34
Q

Diagnosis?

A

Retrograde flow in the deep venous system

35
Q

differential for chest pain?

A

CAD–ECG abnormality–radiate to jaw, shoulder, and arm
Prizimital angina—last only for a minute
Gerd and dysphagia–substernal/upper abdomen and radiate to neck and GI symptom
MSK; pain persists and aggravated by movt and change in position
Pleuritic CP: aggravated by inspiration
A.disection:radiate to back
emphysema–hypoxia and distress
Pericarditis–Aggravate lying flat, radiates to back to lower border of trapezius /scapula

36
Q

The most acute intervention that improves patient long-term prognosis?

A

PCI(within 90 min for the patient directly to come to the center and 120 minutes for referred patients).
lower risk of MI recurrence, ICH and improve survival to that of fibrinolytic treatment)

37
Q

If endocarditis involves which valve can cause conduction abnormality?

A

Aortic valve root due to its proximity to the conduction system(AV block), especially when there is a perivalvular abscess(30-40 % risk)
Conduction block–syncope

38
Q

A.pericarditis highly specific symptom?

A

Friction rub(both S and D phase granting and squawking sound)

39
Q

ECG sign?

A

Diffuse ST elevation with PR depression

40
Q

Cause other than virus and MI

A

Uremia and autoimune (e.g SLE)

41
Q

Treatment?

A

NSAID and colchicine for viral or idiopathic ut variable for other.

42
Q

What is unique for uremic pericarditis?

A

May not have the ECG feucher of AP b/c inflammation doesn’t involve myocardium.
Dialysis is indicated if not have tamponade

43
Q

Treatment and risk of post-infarction pericarditis.

A

Typical in <4 day
Revascularization done > 3 days.
Avoid NSAID and steroid–Affect collagen formation–increase risk of mechanical complication(e.g ventricular rapture)

44
Q

Acute stent thrombosis unique feature?

A

Onley localize pericarditis

45
Q

colestrol crystal embolism risk?

A 
CNS(stroke,amaurosis fugax)
Kidney: Renal failure
Eye:
Dermatologic: ulcer, livedo reticularis,gangren,e, and blu tooth syndrome.
Ocular: Hollenhorst plaque
GI-Intestinal ischemia and pancreatitis
46
Q

A Hollenhorst plaque?

A

is an embolus formed from cholesterol deposition that typically originates from the ipsilateral carotid artery? They appear as refractile, crystal-like emboli and usually are lodged at arteriole bifurcations.

47
Q

Risk factor CCE?

A

Comorbidity(Hytn, DM, and hypercholesterolemia)

Cardiac catheterization and vascular procedure

48
Q

laboratory sign of CCE?

A

Elevated serum creatinine
Hypocomplementia
eosinophilia
urine. benign but may have eosinophilia

49
Q

a common thing to used to differentiate syncope and epilepsy?

A 
Tongue biting (more of if it is lateral) 
In syncope even if present it present at Tip.

USMLE step 2 cardiology (16 decks)

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