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USMLE step 2 cardiology > cardio 6 > Flashcards

cardio 6 Flashcards

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USMLE® Step 1 flashcards
1
Q

Poor prognostic factor in systolic heart failure indicators?

A

Clinical, laboratory, ECG, ECG, and Ass. symptoms

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2
Q

Clinical?

A

Hypotension Resting tachycardia Low maximal o2 consumption S3 gallop Elevated JVP Moderate to severe MR High NYHA class

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3
Q

Laboratory?

A

Hyponatremia(indipedent prognostic indicator) High pro-BNP(a non-functional hormone secreted with VNP) level Renal failure

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4
Q

ECG?

A

Wide QRS(>120ms) left bundle branch block

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5
Q

ECHO?

A

Severe LV dysfunction Concomitant diastolic dysfunction Reduced right ventricular function Pulmonary HYTN

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6
Q

Associated factor?

A

Anemia Atrial fibrilation DM

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7
Q

electrolyte abnormality in HF?

A

Hyponatremia Hyperkalimia

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8
Q

Hyponatremia mechanism and management?

A

Due to high ADH Treat with free water restriction Don’t give free salt unlike SIADH secretion-it will Exacerbate fluid retention.

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9
Q

Hyperkalemia mechanism and management?

A

Low distal Na delivery–Poor K excretion The loop diuretic will lower it

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10
Q

Clinical future of MS?

A

SOCPS

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11
Q

Skeletal?

A

Archinoductly(spider finger) Decrease upper to lower body segment ratio Increase arm to length ratio Pectus deformity, scoliosis, and kyphosis Joint hypermotility

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12
Q

Ocular?

A

Ectopia lentis(Upward and lateral)

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13
Q

CVS?

A

Aortic regurgitation, dilation, and dissection MVP

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14
Q

pulmonary?

A

Spontaneous pneumothorax from apical blub

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15
Q

Skin?

A

Recurrent incisional hernia Skin stria

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16
Q

How we differentiate the cause of AR based on the location of the murmur?

A

If due to aortic dilation -we hear on right 2nd ICS If due to valvular disease-we hear on left 3rd and 4th ICS.

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17
Q

Genetics of MS?

A

It is Autosomal dominant Defect in fibrillin 1 gene

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18
Q

What is holt ORAM disease?

A

Is ASD with upper extremity deformity

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19
Q

Acute decompesated HF managment clasification?

A

Patient with normal or elevated blood pressure and hypotension.

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20
Q

Patient with normal or elevated blood pressure?

A

Oxygen Agresive Diuretic treatment vasodilator(notroglycerine or nitropuriside)

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21
Q

Patient with low blood pressure?

A

oxygen Diuretic as apropriate IV vasopressor (NE,Dobutamin..)

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22
Q

Role of nitrate?

A

Decrease preload –Decrease dyspnea

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23
Q

When a patient with normal LV function develops pulmonary edema?

A

When patient has High blood pressure Renal artery stenosis severe renal disease with volume overload

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24
Q

Ethology of aortic coarctation?

A

Congenital Acquired(rare)–Takayasu

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25
Q

clinical manifestations(in post ductal/adult form0?

A

UB-well developed, HTN(Headache and epitaxis0 LB-Underdevelopment,claudication Brachiofemoral delay Blood pressure difference in U nad L ex. Left intercostal continuous or systolic murmur NB:In preductal there is other finding

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26
Q

ECG finding?

A

Left ventricular hypertrophy(high QRS, ST depression, and T wave inversion in the left precordial lead.

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27
Q

Echo?

A

Diagnostic confirmation(coarctaation mainley at distal segment)

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28
Q

CXR

A

inferior noching in 3-8 ribs 3-sign

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29
Q

treatment?

A

Balloon angioplasty +- stent Surgery

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30
Q

How to measure b/p

A

Bilateral in both extremity Upper on supine lower on pron position

31
Q

Benifit of asprin in MI?

A

Reduce the rate of MI Decrease risk of strok Reduce mortality

32
Q

When we give heparin in ACS suspicion?

A

when we have ECG confirmation

33
Q

Walles criterion in PE?

A

3,1.5, and 1 score criterion <=4–less likely >4—high likely

34
Q

3 point

A

-DVT -Other than PE is less likely

35
Q

1.5

A

-Previous history of DVT -HR>100 -Recent surgery or immobilization

36
Q

1

A

-Hemoptisis -cancer

37
Q

supraventricular tacycardia diagosis?

A

Regular(exept Af,AFl), narrow QRS, and high HR

38
Q

Types of SVT?

A

sinus T AVNRT AVRT AFIB AFLU multifocal AT junctional T

39
Q

symptom of SVT?

A

palpitation dizziness and lightheadedness syncope diaphoresis and SOB

40
Q

Type of PSVT?

A

AVRT AVNRT Atrial tachycardia and junctional tachycardia

41
Q

How to differentiate Type of SVT? done in the first step in hemodynamically stable patients.

A

Vegal maneuver or adenosine–slow AV conduction

42
Q

Effect in node dependent T(AVRT and AVNRT)

A

terminate arrhythmia

43
Q

Effect in AFLU and atrial tachycardia?

A

slow conduction–unmask hidden p wave

44
Q

supra ventricular ECG future?

A

Narrow QRS Absent P wave(masked in QRS) Retrograde p wave

45
Q

Retrograde p wave location?

A

Before QRS After QRS at the apex of QRS

46
Q

Risk factors for SVT?

A

Age. Coronary artery disease Congenital heart disease. Thyroid problems. Drugs and supplements. cough and cold medicines Anxiety or emotional stress Physical fatigue Diabetes. Obstructive sleep apnea. Nicotine and illegal drug use.

47
Q

When we consider isolated ambulatory hypertension?

A

When a patient has normal blood pressure but has hypertension-related complication signs snd symptoms.

48
Q

IAH (masked hypertension) diagnosis?

A

By ambulatory blood pressure monitoring.

49
Q

How ABPM did

A

First morning 2x and evening 3x record of elevated blood pressure monitoring.–If abnormality detected do 24 hr continuous B/P monitoring IF B/P >135>85 diagnos HTN

50
Q

How do we manage pulseless electrical activity?

A

If SVT is like AF–consider it as asystole, so DO CPR and give vasopressor first then use a defibrillator if you find shockable waves. If VT–Do defibrillation

51
Q

What is the D/C between defibrillation and Synchronized cardioversion?

A

three

52
Q

Defibrillator?

A

Give just energy to heart electrical activity without synchronization to QRS complex.

Used for VT(with asystole also)

Used for SCA with VF Not used for PEA until you get shockable wave

53
Q

SCV?

A

used in persistent symptomatic or hemodynamic unstable patients with VTAC and SVT with rapid ventricular response synchronized to QRS complex

54
Q

epistaxis and cold symptom in cocaine?

A

Nasal usage and HTN. A patient may have a tremor

55
Q

less common endocrine cause of 2ndary HYTN?

A

hypothyroidism a primary hyperparathyroidism

56
Q

Renal venous pressure in HF?

A

Increase due to increase systemic pressure

57
Q

Stent thrombosis cause?

A

Medication non adherence (Asprin and Clopidogril)

58
Q

Duration post stent antithrombotic treatment

A

6-12 month(recapitalization occur afterward)

59
Q

Cause of MS in western?

A

Age-related or radiation-induced

60
Q

Diagnosis?

A

Early diastolic sound(OS) with mid-diastolic murmur Echo: high-velocity blood flow through the mitral valve

61
Q

Management of MS?

A

Percutaneous valvotomy or surgery If have concomitant AF: warfarin

62
Q

S/E latex found in glove and folly catheter?

A

anaphylaxis

63
Q

c.menifestation of ventricular aneurysm?

A

Several weeks following MI Heart failure and angina ventricular arrhythmia Systemic embolization

64
Q

Diagnosis?

A

ECG: Persistent ST elevation and Q wave ECHO: Thin dyskinetic ventricular wall

65
Q

What is the specificity of the S3 gallop and its correlation?

A

99% correlated with left atrial with/out ventricular increment in pressure and BNP

66
Q

What is specific for digoxin toxicity in ECG?

A

Atrial tachycardia with AV block(Toxicity)

Below mentioned may not indicate toxicity

1-Downsloping ST depression

2-Flattened, inverted, or biphasic T waves.

3-Shortened QT interval.

67
Q

Is digoxin use other than HF?

A

Atrial fibrillation

68
Q

Clinical presentation of vasospastic angina?

A

young patient <50

smoking

recurrent chest pain

pain occurs in rest mainly at sleep

resolve within 10-15 min

69
Q

Diagnosis?

A

Ambulatory ECG—Transient ST elevation Coronary angiography–no NAD

70
Q

TREATMENT

A

CCB(PREVENTIVE) NITRATE(abortive)

71
Q

Stress-induced (Tocostubo) cardiomyopathy risk

A

Postmenopausal women Recent physical or emotional stress

72
Q

Clinical manifestation?

A

Chest pain mimicking MI Heart failure Moderate troponin elevation ECG-Ischemia sign

73
Q

Diagnosis?

A

Catheterization: No CAD ECHO: LV hypokinesis and basilar hyperkinesis

74
Q

Pathophysiology of TC?

A

Caticolamin surge –vessel obstruction –myocardial stunning — contractile dysfunction

USMLE step 2 cardiology (16 decks)

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