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USMLE Step 2 > Cardio > Flashcards

Cardio Flashcards

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USMLE® Step 1 flashcards
1
Q

risks assc with right sided endocarditis vs left sided

A

Right: (IV drug use) –> PE

Left: roth spots, splinter hemor (not specific), janeway lesions (asymptomatic lesions of palms and soles), ossler nodes (not seen in acute IE)

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2
Q

most common endocarditis bugs

A 
predamaged valve (ie bicuspid)= S. sanguinis, viridans
IV drug user: staph a

prostethic valve: staph epi

another way to think of it:

  • ACUTE= staph A
  • Subacute= S. Sanguinis
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3
Q

explain pulsus paradoxus

A

inhale –> inc venous return in RA –> RV bulges with blood, pushes IV septum into LV –> decrease systolic BP

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4
Q

new onset murmur in post op patient with shock like vitals?

A

consider post op MI with subsequent papillary muscle rupture

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5
Q

how do you manage acute rheumatic fever recurrence?

A

with carditis: IM pen G benz for 10 years or until age 21

without carditis= 5 years

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6
Q

first line PSVT?

A

vagal maneuvers

next: IV adenosine

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7
Q

what type of valve in young persn (<65) for AR?

A

mechanical

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8
Q

“plop” on auscultation with orthostatic signs

A

cardiac myxoma

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9
Q

pulse control goal in chronic stable angina with Beta blockers?

A

<70 bpm

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10
Q

first line dx for chronic venous stasis

A

duplex ultrasound

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11
Q

true vs false aneurysm

A

true: involves all three layers of vessel wall
false: break in vessel wall with extravascular hematoma

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12
Q

treatment of post catheter pseudoaneurysms?

A

ultrasound guided thrombin injection

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13
Q

abi

A

1-1.3 is normal

.4-.9= borderline
>1.3= medial sclerosis
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14
Q

how does an AV fistula create high output heart failure

A

dec peripheral vascular resistance –> dec SVR–> dec CO –> inc RAAS –>

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15
Q

strongest risk factor for development/ rupture of AAA

A

smoking

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16
Q

cause of polycythemia in VSD?

A

eisinmengers

PVR inc as inc blood flow through R side –> shunt reversal –> dec O2 sats –>body responds with EPO

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17
Q

a murmur found in kids that goes away with neck compression?

A

venous hum –> turbulence in internal jugular

continuous murmur in supraclavicular region

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18
Q

digeorge

A

CATCH22
Cleft palate
Abnormal facies –> short philthrum, low set ears
Thymic aplasia –> recurrent infx
Cardiac defects –> TOF, truncus arteriousos
Hypocalcemia –> no parathyroids

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19
Q

what determines the degree of cyanosis in TOF

A

R ventricular outflow obstruction

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20
Q

transposition of great vessels assoc with?

A

maternal diabetes

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21
Q

findings in coarctation

A

rib notching –> doesn’t happen until 5-10 yo

arm diff in BP –> only if proximal to subclavian

22
Q

tricuspid atresia

A

blood moves from RA through ASD –> LA/LV –> systemic circ (hypoxic blood) and through VSD into RA –> into lungs

hypertrphied LV –> left axis dev

23
Q

mech/ prevention of flushing with niacin?

A

niacin upregulates prostaglandin synth –> take an NSAID 30 mins before

24
Q

approach to premature atrial beats

A

1) avoid triggers

2) sx–> flecanaide, metop

25
Q

timing of Trop vs CKMB

A

CKMB: peak 12-24h, fall 2-3 days

Trop: normalize in 6-14 days –> BUT 20% rise 3-6 hours after initial suggests reinfarction

26
Q

beta blocker CI in cocaine induced ischemia

A

selective beta blockade –> can cause unopposed alpha blockage

***use CCB

27
Q

hereditary angioedema

A

AD, C1 inhibitor deficiency

episodes are self limiting, resolve 2-4 days

triggers: trauma (dental procedures), stress

28
Q

describe a WPW EKG and moa

A
  • shortened PR intervals during preexcitation
  • slurred to wide QRS complex
  • delta waves

AV reentrant pathway

29
Q 
describe PR interval:
first degree
second degree
-----> mobitz I
----->mobitz II
A

first degree= prlonged > 200ms

mobitz I= prolonging followed by drop

mobitz II= constant!! single or intermittent non conducted P waves

30
Q

name the three HOLOSYSTOLIC murmurs

A

mitral regurg
tricuspid regug
VSD

31
Q

open PDA is required for survival in…..

A

transposition of great vessels

hypoplastic left heart

32
Q

presentation of hypoplastic left heart

A

absent pulses with single S2
R axid dev
grayish cyanosis

****truncus art also has single S2 (bc only one valve) but will have bounding pulses

33
Q

infant who is otherwise health, with holosystolic murmur, developing sx of FTT

A

VSD with rvh

34
Q

pda anatomy

A

connects pulmonary artery to aorta
*machinery like murmur is pathologic 24 hours after birth

PGE keeeeeps the pda open –> NSAIDS (indomethacin) closes it

35
Q

presentation of long QT syndrome. Tx?

A

Jervell and Leing Nielson syndrome: syncope, hearing loss, fam hx of sudden death

The AD form has no deafness

beta blockers

36
Q

as far as lifestyle factors, what will result in most immediate decrease in CAD risk

A

smoking cessation

37
Q

reasons for baseline EKG abnormality in which you have to do nuc stress test or echo

A

LBBB
LVH
pacemaker
dig

38
Q

drugs that lower mortality in CAD

A

aspirin, beta blockers

CCBs DO NOT!!

39
Q

antiplatelet therpay in CAD

A

stable= 1 agent= aspirin

ACS= 2 agents= aspirin + clopidogrel, prasugrel, ticagrelor

40
Q

prasugrel is CI in…

ticlopidine causes….

A

patients > 75 –> inc risk of hemorragic stroke

neutropenia, ttp

41
Q

fibrates vs statins

A

fibrates are better for tris

when combined, inc risk for myositis

42
Q

how is an S4 related to ACS

A

ischemia –> non compliant, stiff ventricle

43
Q

other EKG findings in inferior MI (II, III, avF)

A

ST dep in I, avL –> reciprocal

depression or elevation in V2,V3 –> this means POSTERIOR inferior RV

44
Q

someone has STEMI in ambulance, you give them ASA and sublingual nitrogen bc you’re a good EMT, and then they’re pressures tank. What happened?

A

RV MI!

decreased preload –> give ICF

45
Q

ST depression in V1, V2

A

posterior wall MI (read these leads backwards)

46
Q

distinguish third degree AV block from bradyardia

A

cannon A wave

47
Q

first line meds for vasospastic angina

A

CCB

48
Q

pulsus parvus et tardus

A

delayed pulse in AS

49
Q

aliskiren

A

direct renin inhibitor

50
Q

leriche’s syndrome triad

A

triad of

  1. hip/thigh/buttock pain
  2. impotence
  3. absent/diminished distal pulses, generally symetrically

*cause by arterial occlusion at aortoiliac jx

51
Q

best test for suspected thoracic aortic an rupture?

A

CT with contrast vs TEE if poor renal function

52
Q

presentation of adult with coarctation

A

high blood pressure
continuous murmur –> collaterals –> rib notching
S4 –> hypertrophied LV from HTN

USMLE Step 2 (18 decks)

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