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USMLE Step 1 > Cardio > Flashcards

Cardio Flashcards

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USMLE® Step 1 flashcards
1
Q

What is epinephrine reversal?

A

Epi + phentolamine (non-selective alpha antag) = epi acts as vasodilator and decreases HR

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2
Q

Which antiarrhythmics prolong QT interval?

A

Class IA: Quinidine, Procainamide, Disopyramide (Quid Pro Do)
Class III: Amiodarone, Ibutilide, Dofetilide, Sotalol (AIDS)

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3
Q

What characterizes mitral stenosis?

A

LA pressure > LV pressure towards the end of diastole

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4
Q

What characterizes mitral regurg?

A

LA pressure > LV pressure towards the end of systole

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5
Q

What is Hypertrophic cardiomyopathy (aka HOCM)?

A

Assymetric cardiac hypertrophy: characterized by increased ejection fraction and impaired diastolic function
Causes syncope during exercise and may lead to sudden death in young athletes

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6
Q

Whats the equation for net filtration pressure?

A

(Hc-Hi)-(Oc-Oi)

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7
Q

What is coartation of the aorta?

A

Constriction of the aorta that decreases perfusion of the kidneys –> activates RAAS system –> increased systolic pressure

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8
Q

What drug do you use to treat Tetralogy of Fallot until surgery can be done?

A

Alprostadil (prostaglandin E1)

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9
Q

What maintains a PDA? what closes it?

A

Maintains: Prostaglandin E (like Alprostadil)
Closes: NSAIDs (Indomethacin)

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10
Q

What are 4 effects of chronic HTN on vasculature?

A
  1. decreased # of arterioles
  2. thickened arteriole walls
  3. increased vascular resistance of end organs
  4. ischemic/hemorrhagic end organ damage
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11
Q

What are the early side effects of digoxin toxicity?

A

anorexia, nausea, ecg canges

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12
Q

What are the late side effects of digoxin toxicity?

A

disorientation, yellow-green halos, cardiac arrhythmias

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13
Q

What is the path of drainage for the ovaries?

A

Right ovarian –> IVC
Left ovarian –> left renal –> IVC

Same applies to testicles.

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14
Q

What are the hallmarks of coartation of the aorta?

A

Brachial-femoral delay (HTN in upper extremities, weak pulse in lower)
Collateral arteries erode inferior aspect of ribs

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15
Q

What are the effects of ACEI toxicity?

A 
CATCHH:
Cough (brady block)
Angiodema
Teratogen
Creatinine increase
HyperK
HypoTN

Switch to AngioII block (Losartan)

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16
Q

Anterograde flow through which arteries is responsible for weak lower pulses in coartation of the aorta?

A

Internal thoracic (mammary) arteries

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17
Q

What is a common side effect of fibrates that activate PPAR-α?

A

LUQ pain (gallstones)

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18
Q

What is transposition of the great vessels?

A

Aorta and Pulm are switched = separates systemic and pulm circulations = death unless theres a shunt

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19
Q

Hallmarks of transposition of the great vessels?

A

Diabetic mother; early cyanosis

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20
Q

What is a concern for using beta-blockers in diabetics?

A

They block the symps of hypoglycemia with tachycardia

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21
Q

Cocaine-induced inhibition of which receptor causes cardiac arrest?

A

cocaine is a beta-blocker = unopposed alpha1-agonism

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22
Q

What is the clinical manifestation of VSD?

A

child* w holosystolic murmur that radiates over the precordium* and a palpable thrill at the left sternal border*
adult = tricuspid regurg

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23
Q

What transmitter/receptor comes into play in the anticipation of exercise (or anxiety)?

A

Norepinephrine, B1

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24
Q

What is the consequence for severing the glossophrangeal nerve?

A

Sends the medulla a false signal that theres a decrease in blood pressure –> HTN and tachy

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25
Q

What is a side effect of the repeated blood transfusion needed in Beta-thalasemia?

A

Fe overload –> hemosiderosis –> restrictive cardiomyopathy

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26
Q

Which beta-blocker is best used in asthmatics?

A

B1-(cardio)selective like atenolol

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27
Q

How to remember the beta-blockers?

A

A-M are B1-selective, N-Z are non-selective; C & L block all
(carvedilol & labetalol block a, b1, b2)

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28
Q

How does sepsis lead to pulm edema?

A

increase microvascular permeability

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29
Q

Which vein is the major accessory pathway for pts with portal HTN?

A

azygous vein (anterolateral aspect of spine)

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30
Q

What causes Thrombotic thrombocytopenic purpura?

A

deficiency of ADAMTS 13 (vWF metalloprotease) = platelet aggregates and thrombi

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31
Q

What cardiac structure can be found in the 3rd intercostal space of the left sternal border?

A

AV node

32
Q

When does coronary blood flow occur?

A

diastole

33
Q

How does nitroglycerin affect a normal person’s cardiac function?

A

decrease LV-EDV and decrease LV-ESV (bc BOTH arteries and veins are dilated)

34
Q

What is amourosis fugax and what causes it?

A

painless transient vision loss from atherosclerotic disease of the carotid (microemboli to ipsi eye)

35
Q

What is the pathogenesis of atherosclerotic plaques?

A

fatty streak –> fibrous plaque –> rupture of plaque –> rough surface induces clotting –> thrombotic occlusion of artery –> MI

36
Q

What causes increased blood flow thru coronary arteries due to aortic stenosis?

A

Adenosine (vasodilator)

37
Q

Enlargement of which chamber causes esophageal compression?

A

Left atrium

38
Q

What is a paradoxical embolism?

A

Patent foramen ovale has clots bypass pulm and go into brain (stroke) and other organs

39
Q

Which beta blocker is contraindicated in angina?

A

Pindolol bc its a partial agonist and thus does not lower HR enough

40
Q

What causes varicose veins?

A

chronically high pressure in the leg veins

41
Q

Which drugs cause gynecomastia?

A 
Some Drugs Create Awesome Knockers
Spironolactone, 
Digoxin, 
Cimetidine, 
Alcohol, 
Ketoconazole
42
Q

What causes “double bubble” on xray in infants?

A

Duodenal atresia bc inadequate migration of neural crest cells

43
Q

Whats the drug of choice for pts with HOCM?

A

beta blocker

44
Q

How do loop diuretic contribute to digoxin toxicity?

A

They cause hypoK and hypoMg

45
Q

What is niacin used to treat and what is its biggest side effect?

A

dyslipidemia; lowers levels of VLDL and raises levels of HDL.
-facial flushing (aspirin helps)

46
Q

How does anemia affect arterial diameter?

A

Causes small arteries and arterioles to dilate to allow greater amounts of blood to return to the heart

47
Q

1 cause of death in men and women?

A

cardiovascular disease

48
Q

Where does the thoracic portion of the esophagus get blood supply?

A

branches of the aorta and the bronchial arteries.

49
Q

What is the most common cause of renovascular HTN in middle-aged women?

A

Fibromuscular dysplasia (also has beads on string)

-atherosclerosis in men

50
Q

What is the classic presentation of Dressler Syndrome (fibrinous pericarditis)?

A

fever, positional substernal chest pain (prefer upright or lean forward), and friction rub 4-6wks after MI

51
Q

What are the classic findings of aortic dissection?

A
  • sudden, severe chest pain radiating to the back
  • aortic regurg w diastolic murmur
  • wide mediastinum on x-ray
52
Q

What is digoxin MOA?

A

decreases conduction thru AV node by inhibiting Na-K ATPase (for A-fib w rapid ventricular rate)

53
Q

What additional finding often accompanies aortic regurg?

A

widened pulse pressure

54
Q

What disease is dextrocardia (situs inversus) assoc with?

A

Kartagener disease (immotile cilia due to a dynein arm defect.)

55
Q

Associate the change in pressure pulse with disease: increased pulse pressure

A 
arteriosclerosis
aortic regurg (dec diastolic)
56
Q

Associate the change in pressure pulse with disease: decreased pulse pressure

A 
aortic stenosis
mitral stenosis (inc diastolic)
57
Q

Associate the change in pressure pulse with disease: increased diastolic pressure

A

mitral stenosis

58
Q

Associate the change in pressure pulse with disease: decreased diastolic pressure

A

aortic regurg

PDA

59
Q

What is a cystic hygroma?

A

Cavernous lymphangioma of the neck; creates the webbed neck in Turner syndrome.

60
Q

What causes unstable angina?

A

thrombosis (of coronary artery) with incomplete coronary artery occlusion

61
Q

What causes angina?

A

atherosclerosis

62
Q

The smooth part of the right atrium comes from which embryonic structure?

A

Sinus venosus

63
Q

What causes muffled heart sounds?

A

cardiac Tamponade

64
Q

What is Beck’s triad for cardiac tamponade?

A
  1. hypoTN
  2. JVD
  3. muffled heart sounds
65
Q

What clinical signs strongly suggest pulm embolism?

A
  1. sudden hypoemia
  2. afebrile/bedridden
  3. but normal BP
66
Q

What condition causes loss and vacuolization of myocytes with fibrosis in the heart?

A

chronic stable angina

67
Q

You have an older pt with a history of MI, what would make you think of CHF?

A

(new) S3 heart sound

68
Q

What causes a primum type ASD?

A

Failure of septum primum to fuse completely w endocardial cushions, leaves a persistent ostium primum

69
Q

What drug is used to treat pregnant women w chronic HTN?

A

methyldopa (a2-agonist)

70
Q

What drug is used to treat HTN and BPH?

A

Terazosin (a1-antagonist)

71
Q

What are key side effects of Terazosin?

A

“first dose” syncope/hypoTN/dizziness

72
Q

What pharmacotherapy is used to treat methemoglobinemia?

A

methylene blue

73
Q

Where do the right and left umbilical arteries arise from?

A

internal iliac arteries

74
Q

What happens to the umbilical arteries after birth?

A

They obliterate and become the medial umbilical ligaments

75
Q

Which 2 enzyme elevations indicate atypical MI?

A

AST(w/o ALT increase) and lactate dehydrogenase

76
Q

Which antihypertensive meds cause lipid abnormalities?

A

metoprolol and thiazides

77
Q

Which drug class causes gout by decreasing elimination of uric acid?

A

Thiazide diuretics

USMLE Step 1 (13 decks)

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