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USMLE STEP 2 CK RETAKE > Cardio > Flashcards

Cardio Flashcards

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USMLE® Step 1 flashcards
1
Q

Stable Angina Presentation

A 
Pain with exertion 
relieved by rest 
Neg troponins 
Negative ST Elevation 
~70% occlusion
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2
Q

Unstable Angina Presentation

A 
Pain at rest 
Nothing relieves the pain 
Negative Troponins 
Negative ST Elevation 
~90% occlusion
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3
Q

NSTEMI presentation

A 
Pain at rest 
Nothing relieves the pain 
Positive troponins 
Negative ST Elevvation
~90% occlusion
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4
Q

STEMI

A 
Pain at rest 
Nothing relieves the pain 
Positive troponins 
Positive ST Elevation 
100% Occlusion
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5
Q

Risk Factors for MI

A 
Diabetes 
HTN
HLD
Obesity
Family Hx 
Age >45M, >55 F
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6
Q

MI Presentation

A

Associated Symptoms
SOB, Nausea/Vomiting, Presyncope
Non-pleuritic pain, Non-positional pain, Non-tender

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7
Q

Angina Diagnostic Workup

A
  1. ECG
  2. Troponins
  3. Stress Test
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8
Q

Angina
Normal ECG
Positive Troponins
What next

A

Urgent Cath

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9
Q

Angina
ST Elevation
What Next

A

Emergent Cath

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10
Q

Angina
Normal ECG
Negative Troponins
Positive Stress Test

A

Elective Cath

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11
Q

MI 3 or more occluded Vessels

A

Perform CABG

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12
Q

MI 1 or 2 occluded vessels

A

Place Stent

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13
Q

Contraindicated in Right sided MI, (II, III, aVF)

A

Nitrates

Right sided infarcts are preload dependent, require preload support give IV fluids

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14
Q

Medical management before Cath lab in angina/MI

A 
MONA BASH
Morphine
Oxygen 
Nitrates 
Aspirin (ALWAYS GIVE FIRST)
Beta Blockers 
ACEi
Statin 
Heparin
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15
Q

What medications should a patient receive on discharge post MI?

A

Aspirin
B-Blocker
ACEi
Statin

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16
Q

Post MI, when do you add Nitrates to discharge medications

A

If patient has continuing chest pain

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17
Q

When do you add clopidogrel? For how long?

A

When a stent is placed
DES-1 year
Bare Metal- 1 month

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18
Q

When do you use tPa

A

When access to a cath lab is far away (60 Minutes)

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19
Q

Sx of right sided heart failure

A 
JVD 
Peripheral Edema 
HSM 
DOE 
Displaced PMI 
S3
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20
Q

Sx Left sided Heart Failure

A 
DOE-Crackles
Orthopnea 
PND 
Abdominal pain 
Weight Gain 
Displaced PMI S3
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21
Q

Diagnostic Tests in HF

A

BNP (released when RA stretches)
2D Echo
[Left Heart Cath-Ischemic or not]

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22
Q

CHF Stage I Treatment

A

Beta- blockers, ACEi/ARB

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23
Q

CHF Stage II Treatment

A

Stage I + Loop Diuretic (Furosemide)

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24
Q

CHF Stage III Treatment

A

Stage I and II + Isosorbide Dinitrite and hydralazine

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25
Q

CHF Exacerabtion Work up

A

CXR
BNP
ECG
Troponins

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26
Q

CHF Exacerbation Treatment

A 
Furosemide 
Morphine 
Nitrate
Oxygen 
Position
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27
Q

What murmurs need a work-up?

A

Any systolic murmur grade 3+ and any diastolic murmur

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28
Q

Dx Test for Murmur

A

TTE, if not good then

TEE

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29
Q

Mitral Stenosis

Path, Dx, Tx

A 
Pt-Younger (20-30), Rhuematic Disease
Sx: CHF, A-fib 
Dx: Rumbling Diastolic, with an opening snap 
best heard at the apex 
Tx: Balloon Valvuloplasty
Valve Replacement
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30
Q 
Aortic insufficiency (Regurgitation)
Path, Dx, Tx
A 
Pt: Infection/Infarction 
Aortic Dissection 
Sx: Acute- Cardiogenic shock, Flash pulm Edema
Chronic-CHF, Chest Pain 
Dx: base of heart (2 ICS RSB)
Rumbling Diastolic murmur
Tx:  Valve replacement
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31
Q

Aortic Stenosis

Path, Dx, Tx

A 
Atherosclerosis, Ca Depostion 
Pt: Older male 
Sx: Chest pain, CHF, Syncope 
Dx: Systolic, crescendo-decrescendo; Base of the heart 
Tx: Replacement
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32
Q 
Mitral Insufficiency (Regurg)
Path, Dx, Tx
A

Sx: Acute-cardiogenic shock, Flash Pulmonar Edema
Chronic: CHF, A-Fib
Dx: Apex, Holosystolic, high pitched blowing

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33
Q

Maneuvers to increase venous return to the heart

A

Squatting/ Leg Lift

34
Q

Maneuver to decrease venous return to the heart

A

Valsalva

35
Q

HOCM Pathology

A

Asymmetric septum hypertrophy causing left ventricular outlet obstruction

36
Q

HOCM patient, Dx, Tx

A

Young athlete with SOB, syncope with exertion, Family history of sudden cardiac death
Dx: systolic murmur (Sounds like AS), more blood improves the murmur
Tx: B-Blockers, avoid dehydration

37
Q

Mitral Valve Prolapse

Dx, Tx

A

Patient is usual a young woman
Dx: like mitral regurg, but improves with more blood
Tx: Avoid dehydration
B-Blockers

38
Q

Causes of Restrictive Cardiomyopathy

A

Amyloidosis, Sarcoid, Hemochromatosis

39
Q

Restrictive Cardiomyopathy presentation

A

Sx of diastolic heart failure

perform Echo

40
Q

Dx of Restrictive cardiomyopathy

A

Amyloid-Myocardial biopsy
Sarcoid- Endomyocardial biopsy
Hemo-Ferritin increased, genetic test

41
Q

Treatment restrictive cardiomyopathy

A

Beta blockers are equal to CCB
Gentle Diuresis
Transplant
Treat underlying cause

42
Q

Pericarditis Presentation

A

Viral, Uremia

Pt: Pleuritic chest pain, and positional

43
Q

Pericarditis Dx and Tx

A

Best MRI, First ECG ( Diffuse ST Elevations and Depressed PR segments)
Tx: NSAIDs and colchicine the best

44
Q

Contraindications for NSAIDs Pericarditis treatment

A

CKD, Thrombocytopenia, PUD

45
Q

Pericardial Effusion Path, Dx, Tx

A

caused by Pericarditis
Dx: Echo
Treat the pericarditis, if continues perform pericardial window

46
Q

Cardiac Tamponade Presentation

A

CHF Sx
Becks Triad (JVD, Hypotension, Muffled Heart sounds)
Pulsus Paradoxus >10mmHg
Clear Lungs

47
Q

Tamponade Treatment

A

Pericardiocentesis

if cant reach OR quickly give IV fluids

48
Q

Constrictive Pericarditis Path, Presentation, Dx, Tx

A 
Due to chronic pericarditis 
Sx: Diastolic CHF 
Pericardial Knock 
Dx: Echo 
Tx: Pericardiectomy
49
Q

Vasovagal Syncope Presentation, Tx

A

Situational and reproducible with a prodrome
Vasovagal organ stimulation, carotid body stimulation (micturation, defecation, coughing)
Tx: Beta blockers

50
Q

Orthostatic Syncope Presentation, Tx

A 
Standing up get dizzy 
Dx: Systolic change 20
Diastolic change 10 
HR change 15 
Tx: Fluids
51
Q

Orthostatic Syncope causes

A

Diarrhea, Dehydration, Diuresis, Hemorrhage

Diabetes, Parkinsons, Age

52
Q

Syncope caused by valvular lesions

A

exertional syncope (AS or HOCM)
Dx: Echo
TX; Depends on lesion

53
Q

Syncope due to Arrhythmia

A

Sudden loss of consciousness without prodrome

Tx: Depends on the arrhythmia

54
Q

Syncope Due to Arrhythmia workup

A

ECG
24 hour Holter monitor
Event Recorder

55
Q

Who should receive Statin Therapy

A
  1. Anyone with Valvular disease
  2. if LDL >190
  3. if LDL is 70-189 aged 40-75 with diabetes
  4. LDL 70-189 aged 40-75 with calculated 10 year risk for MI
56
Q

What are the Statins used for therapy and dosages for high and moderate

A 
High -
Atorvastatin 40, 80
Rosuvastatin 20, 40
Moderate- 
Atorvastatin 20, 40 
Rosuvastatin 10, 20
57
Q

When should you use moderate statin therapy

A

age >75, statin intolerance, liver or renal disease

58
Q

What tests should you run before statin therapy

A

HbA1c, CK, LFTs, Lipids
Recheck Lipids in one year
recheck HbA1c if patient has DM

59
Q

If muscle soreness or weakness develop after starting statin therapy what should you do

A

perform CK and UA
LFTs if with hepatitis
discontinue Statin until symptoms resolve and then restart at lower dose

60
Q

Hypertension treatment for Elevated Stage

A

<130/<80

Lifestyle modifications and f/u in 6 months

61
Q

Hypertension treatment for Stage 1

A

<140/<90
Lifestyle modifications f/u 3 months or
lifestyle modifications and 1 medication follow up in 1 month

62
Q

Hypertension treatment for stage 2

A

> 140/>90

2 medications follow up in 1 month

63
Q

Hypertension treatment for patients with comorbid conditions

A

HF: Beta blockers, ACEi
Stroke: ACEi, HCTZ
CKD: ACE/ARB unless stage IV
DM: ACE

64
Q

CCB Side Effects and uses

A

SE: Peripheral edema

Antianginal DO NOT USE IN HF

65
Q

ACEi/ARB Side effects

A

Increase creatinine and potassium

Use ARBs for ACE angioedema

66
Q

Thiazides Side Effects

A

Decrease potassium and calcium

Can be used for kidney stones

67
Q

Fast Narrow Arrhythmias

A

SVT, A-fib/flutter

68
Q

Fast Wide Arrhythmias

A

V-tach, Torsades

69
Q

Slow Wide Arrhythmias

A

3rd degree AV block, Idioventricular

70
Q

Slow Narrow Arrhythmias

A

Sinus Brady, 1st and 2nd (type i and ii) heart block

71
Q

SVT Tx

A
  1. Adenosine-stable

2. shock

72
Q

A-Fib/flutter Tx

A
  1. Beta-blocker=CCB

2. Shock

73
Q

V-tach Tx

A

Amiodarone

74
Q

Torsades Tx

A

Magnesium

75
Q

A-fib workup, stable, old, and cardiovert

A
  1. Rate control, CCB= Beta blockers
  2. old, >48 hr or unknown
  3. TTE-valvular or non-valvular
  4. Anti-coagulate for 3 weeks with warfarin
  5. TEE and cardioversion
  6. Anti-coagulate for 1 month
76
Q

A-fib workup, unstable

A

Cardiovert, shock

77
Q

when should you anti-coagulate in A-fib

A

if CHADSS score is greater than 2

78
Q

CHADSS SCORE

A 
CHF 
HTN
Age >75 
DM 
Stroke 
Stroke 
0-none 
1- ASA or anticoag 
>2 anticoagulate
79
Q

When there is a valvular lesion what changes for anticoagulation

A

bridge with LMWH if going for a procedure, give warfarin

80
Q

if patient has a slow rhythm and is unstable what do you do

A

PACE

81
Q

What rhythms can you give atropine

A

Sinus Brady, 1st degree AV block, 2nd degree type 1

82
Q

What drugs are used for a pharmacologic stress test

A

Adenosine/dobutamine

USMLE STEP 2 CK RETAKE (15 decks)

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