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Usmle step 2 NL > Cardio > Flashcards

Cardio Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the symptoms of beta blocker overdose?

A 
Bradycardia
Hypotension
AV block
Wheezing
Hypoglycemia
Delirium
seizuer
cardiogenic shock (from low HR and BP. cold and clammy extremities):
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2
Q

Management of beta blocker overdose

A
  1. 1st line: IV fluids and atropine

2. If refractory or profound low BP use Glucagon

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3
Q

Management of CAD based on pretest probability

A
  1. low risk: no diagnostic test
  2. intermediate: stress test based on EKG finding and ability to exercise
  3. high risK start on medical therapy and consider coronary angiography
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4
Q

Management of AF with rapid ventricular response

A

attempt rate control with b-blocker and CCB (such as diltiazem)

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5
Q

Managment of AF with hemodynamic instability

A

immediate synchronized electrical cardioversion

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6
Q

Common side effect of dihydropyridine calcium channel blocker

A

peripheral edema

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7
Q

How to reduce CCB-associated peripheral edema?

A

ACE inhibitor or angiotensin receptor blocker (ARB)

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8
Q

What type of patients get uremic pericarditis?

A

uremic pericarditis (UP) occurs in 6-10% of renal failure pts, typically thosw with urea nitrogen levels above 60 mg/dL

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9
Q

EKG difference between Uremic Pericarditis (UP) and classic pericarditis? why?

A

UP does not have diffuse ST elevation bc only visceral and parietal layers of pericardium are inflammed due to uremia. myocardium is not inflammed.

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10
Q

Treatment of uremic pericarditis

A

Hemodyalisis->fast chest pain resolution and reduce size of cardiac effusion

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11
Q

Advantage of dual antiplatelet therapy (aspirin with P2Y12 receptor blocker), compared to aspirin alone

A
  1. reduce reccurent MI
  2. reduce CV death in pt with NSTEMI
  3. reduce risk of stent thrombosis
  4. recommended for at least 12 months following drug eluting stent placement
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12
Q

Cause of Chagas disease

A

protozoan trypanosoma cruzi (endemic in latin america)

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13
Q

Sequelae of chagas disease

A

Chagas disease is a chronic disease that can cause megaesophagus, megacolon +/- cardiac dysfunction

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14
Q

Characteristic of AR

A
  1. early diastole murmur 2. hyperdynamic pulse
  2. wide pulse pressure, 4. bounding or water hammer peripheral pulse
  3. LV enlargement
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15
Q

common effect of left ventricular systolic/diastolic dysfunction on lungs

A

pulm htn

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16
Q

initial mgt of pulm htn

A

loop diuretidcs and ace inhibitors or ARBs.

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17
Q

Study of choice for diagnosis and f/u of AAA

-sensitivity and specificity

A

-abd US
100% sensitive
100% specific

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18
Q

Cause of vasospastic angina

A

hyper-reactivity of intimal smooth muscle-> intermittent coronary art. vasospasm

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19
Q

Preferred med for vasospastic angina

A

CCB bc they cause coronary art. vasodilation

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20
Q

Cause of MR in pt with acute MI

A

Papillary muscle displacement (2-3days post MI)

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21
Q

Effects of acute MR

A

Abrupt and excessive vol. overload->increased left atrial and ventricle filling pressure and acute pulm edema.

No effect on left atrial/ventricle size or compliance unlike chronic MR

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22
Q

Potential causes of 2ndary htn in young adults

A
  • Coarctation of aorta
  • Fibromuscular dysplasia
  • Adrenal adenoma
  • Cushing syndrome
  • pheochormocytoma
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23
Q

Initial evalutation of pts with coarctation of aorta

A
  1. simultaneous palpation of brachial and femoral pulses to assess for brachial-femoral delay.
  2. bilat upper and lower ext. BP to assess BP differential
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24
Q

how to reduce risk of systemic thromboembolism in pt with AF and mod-high risk of thromboembolic events (CHA2DS2-VASc score>or=2

A

give warfarin or non vit-K antagonist oral anticoagulant like apixaban, dabigatran, rivaroxaban

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25
Q

define use dependence

A

def: enhanced pharm effect of a drug during fast HR

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26
Q

what drugs show use dependence?

A 
antiarrythmic agents in class 1 (especially 1C) and class IV (CCBs)
Class 1C antiarrythmics: Encainide Flecainide Propafenone Moricizine
Class IV antiarrythmics = slow CCBs (nondihydro) like Verapamil, Diltiazem
27
Q

use dependence effect of Class IC antiarrythmic on EKG

A

progressive decrease in impulse conduction with faster HR->increased QRS complex duration

28
Q

Mainstay of therapy in pt with alcoholic cardiomyopathy and its effect on fxn

A
  • complete cessation of alcohol consumption

- improved or normalized left ventricular function over time

29
Q

recommended tx for acute pulm edema from acute MI

A

Diuretics

30
Q

is standard therapy in MI but should be avoided in pt with decompensated CHF or bradycardia

A

b-blockers

31
Q

meds that trigger bronchoconstriction in asthma pts

A

aspirin, b-blocker

32
Q

definition of hypertensive emergency

A

marked severe htn associated with malignant htn or hypertensive encephalopathy

33
Q

define maligant hypertension

A

bp: >or=180/120
retinal hemorrhage
retinal exudates
+/- papilledema

34
Q

WPW EKG pattern

A
  • short PR (<120msec)
  • slurred inital upstroke of QRS complex (delta wave)
  • wide QRS complex with ST/T wave changes
35
Q

Cause of WPW

A

accessory pathway that bypasses the AV node and directly connect atria to ventricles

36
Q

Definition of fibromuscular dysplasia

-pt demographic

A

noninflammatory and nonatherosclerotic condition that causes abnml cell development in arterial wall->stenosis, aneurysm, dissection. primaryly affects renal arteries
-pt demographic: female 15-50yo

37
Q

Different Presentations of fibromuscular dysplasia and why.

A

htn: renal artery involvment
Cerebrovascular arteries: TIA, amaurosis fugax, stoke
HA, pulsatile tinnitus, dizziness

38
Q

Digoxin adverse effect

A

NVD, vision changes, arrythmias

39
Q

Electric alternans definition and diagnosis

A

amplitude of QRS complex vary from beat to beat

dx=pericardial effusion

40
Q

Electric alternans is specific for

A

pericardial effusion

41
Q

Diagnosis of pericardial effusion

A
  • electric alternans on EKG
  • enlarged cardiac silhouette on CXR
  • Echocardiogram (more definite)
42
Q

murmurs that are usually pathologic

A

diastolic murmurs

continuous murmurs

43
Q

how to evaluate murmurs

A

transthoracic echocardiogram

44
Q

Ventricular aneurysm and MI

A

Vent aneurysm=late complication of acute STEMI or transmural MI.

45
Q

EKG findings in Post MI Ventricular aneurysm

A

persistent ST elevation along with deep Q waves

46
Q

complications of Post MI ventricular aneurysm

A

progressive L. Vent enlargment->HF, refractory angina, ventricular arrythmia, functional MR, or mural thrombus

47
Q

How long after MI do the following occur?

  1. reinfarct
  2. vent septal rupture
  3. free wall rupture
  4. postinfarct angina
  5. papillary muscle rupture
  6. pericarditis (dressler)
  7. left ventricular aneurysm
A
  1. reinfarct: hrs to 2 days
  2. vent septal rupture: hrs to 1 week
  3. free wall rupture: hrs-2 wks
  4. postinfarct angina: hrs to 1 month
  5. papillary muscle rupture: 2 days-1 week
  6. pericarditis: 1 day to 3 months
  7. left vent aneurysm: 5 days-3 months
48
Q

Use of amiodarone

A
  1. ventricular arrythmia

2. rhythm control in afib with left ventricular systolic dysfunction

49
Q

Amiodorone adverse effect

A 
hypo/hyperthyroid
hepatotoxic
bradycardia/heart block
pneumonitis
neurologic symptoms
visual disturbance
50
Q

Post MI Papillary muscle rupture leads to

A

acute MR and cardiogenic shock

51
Q

Presentation of aortic stenosis

A

decreased exercise tolerance, exertional dyspnea, angina, syncope

52
Q

AS phys exam findings

A
  • delayed/diminished carotid pulse
  • soft heart sound
  • mid to late peaking systolic murmur with max intensity at 2nd right intercostal space and radiation to carotids
53
Q

Treatment of choice for dressler’s syndrome

A

NSAIDS

54
Q

Should pts with dressler syndrome be anticoagulated?

A

No! Anticoagulation might lead to hemorrhagic pericardial effusion

55
Q

When to perform PCI

A

within 90 minutes for acute STEMI

56
Q

When to perform fibrinolysis in acute STEMI pts?

A

within 12 hrs of symptoms onset for pts who cannot undergo PCI

57
Q

Drug interaction: loop diuretics and digoxin

A

loop diuretics enhance side effects of digoxin, they casue low K+ and low Mg->vent tach

58
Q

most common benign primary cardiac tumor

A

myxoma

59
Q

80% of myxomas are located in…

A

left atrium

60
Q

Presentation of myxoma

A
  1. constitutional symptoms: fatigue, low fever, weight loss
  2. systemic emboli: TIA, ischemic stroke, acute embolic arterial occlusion
  3. CVS: ~mitral valve disease (dysnea, orthopnea, pulm edema, hemoptysis
61
Q

hypotension, distended neck veins, muffled heart sounds

A

beck’s triad for cardiac tamponae

62
Q

cause of cardiac tamponade classic triad

A

exaggerated shift of intervent. septum to left vent cavity-> decreased L. vent preload, stroke volume and CO.

63
Q

Presentation of latex allergy

A

hypotension, tachycardia, urticarial rash, wheezing

may have life threatening upper airway edema

Usmle step 2 NL (1 decks)

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