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USMLE Step 3 > Cardiology > Flashcards

Cardiology Flashcards

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USMLE® Step 1 flashcards
1
Q

Indications for Spironolactone for Heart Failure

A

1) Prior hospitalization with high BNP
2) EF<35%
3) Post MI , heart failure

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2
Q

In asthma diagnosis, broncho dilator should increase FEV1 by ____ percent

A

12%

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3
Q

Asthma with atopy, treatment can be augmented with ____ and ____ pharmaceuticals

A

1) Montelukast (Leukotriene antagonist)

2) Omalizumab (IgE binder)

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4
Q

Fixed P2 during auscultation can be found in this common condition ______

A

COPD (Delayed close in pulmonic valve), ASD

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5
Q

Treatment for central OSA ____ and ____

A

acetazolamide, medroxyprogesterone

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6
Q

Panacinar emphysema is characteristic of ____ disease that affects lung and liver

A

a1 antitrypsine [excess elastase activity since antitrypsine does not negatively regulate this]

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7
Q

2 strategies of treating ILD

1) Steroid responsive disease with ____
2) Steroid unresponsive disease with ___

A

1) Azathioprine (Berylliosis, common steroid responsive)
2) Cyclophosphamide

Most ILD tend to not be steroid responsive in general

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8
Q

Targeted Therapies for ILD

1) Perfenidone is a ____ inhibitor
2) ______ is a growth factor EGFR inhibitor

A

Collagenase

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9
Q

______ is like an acute ILD with myalgia, fever

A

BOOP (bronchiolitis obliterans)

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10
Q 
7th nerve palsy
Uveitis
Erythema Nodosum 
Restrictive Myopathy
CD4:CD8 elevated
Serum ACE

_____ condition

A

Sarcoidosis (Tx: Steroids)

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11
Q

Bosentan, Epoprostenol, Sildenifil, Riociguat are treatments for _____

A

primary hypertension

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12
Q

____ is a classic EKG finding of PE

A

S1Q3T3

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13
Q

When to use thrombolytics for PE _______

A

hemodynamic instability

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14
Q

2 treatment courses for latent TB

A

1) Isoniazid (9 months)

2) Isoniazid + Rifapentine (3 months)

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15
Q

_____ is a superimposed infection, usually on top of asthma/atopy. Treated with _____

A

ABPA

Itraconazole + oral steroids

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16
Q

Absolute limit for thrombolysis _____

A

4 hours

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17
Q

massive headache with indolent stroke like symptoms should be concerning for _____

A

cerebral venous thrombosis

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18
Q

Acute Seizure Medications

1) Ativan
2) ______
3) ______

A

2) Phosphophenytoin

3) Phenobarbital

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19
Q

______ is a syndrome, in which someone has Parkinson’s like symptoms + autonomic instability

A

Shy Drager (Tx: Fludrocortisone)

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20
Q

____ Parkinsons + impulsive behaviors

A

PSP

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21
Q

Parkinsons Treatment

A

Treatment

  • Mild: Benztropine-trihyexyphenadyl/Amantadine
  • Severe: Levodopa/Carbidopa , pramipexole, ropinerole, cabergoline
  • 2nd line (COMT/MAO): Entacapone, selegiline
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22
Q

Parkinsons produces a _____ tremor

A

resting

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23
Q

cerebellar and essential tremor, tends to be a ____ tremor

A

intention

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24
Q

Natalizumab + Fingolimod + dimethyl fumarate + glatiramer, B interferon are treatments for ____

A

Multiple Sclerosis

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25
Q

_____ Parkinson’s treatment increases risk of idiopathic PML

A

Natalizumab

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26
Q

_____ produces dementia with personality/behavior changes

A

Fronto-temporal dementia

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27
Q

Incontinence + Dementia + Ataxia/wide gait is a hallmark for _______

A

Normal pressure hydrocephalus (Tx: shunt)

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28
Q

Tetrabenazine is a treatment for _____

A

Huntington Disease

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29
Q

____/month is an indication for migraine prophylaxis

A

4 (propranolol, verapamil)

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30
Q

ICP symptoms in obese person, CN palsies (double vision, headache) is indicative of _____ condition

A

pseudotumor cerebri

  • risk : vitamin A, minocycline
  • Tx: Acetazolamide, VP shunt
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31
Q

_____ form of meningitis needs prophylaxis of contacted individuals with Rifampin

A

Neisseria

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32
Q

Treatment of herpes meningitis/encephalitis

A

1) Acyclovir

2) Foscarnet (resistant organism)

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33
Q

Auto-immune encephalitis is associated with _____ in women

A

ovarian teratoma

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34
Q

Ring enhancing lesion in HIV : _____ and _____

A

1) PML

2) Toxoplasmosis : Bacterim x 14 days

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35
Q

Neurocystcircosis, active lesions have NO calcifications . Treatment for active lesions_______

A

Albendazole, + Praziquantel , inactive can be managed purely with seizure prophylaxis

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36
Q

This type of syndrome is from hypertension, results in cerebral edema

A

PRES syndrome

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37
Q

Management of ICP

A

1) Mannitol
2) Hyperventilation: reduced ICP
3) Surgical evacuation

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38
Q

_____ result in cape like distribution of pain/temperature deficits in upper extremity

A

Syringiomyelia , Dx: MRI

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39
Q

______ results in ipsilateral dorsal column, contralateral pain/temp

A

Brown Sequard

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40
Q

amifampridine is a treatment for _____

A

LEMS

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41
Q

Treatment for Gulllan Barre_____

A

Plasmapharesis

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42
Q

When to use a dobutamine ECHO/Thalium stress test________

A

When EKG changes cannot be appropriately interpreted under stress, so you have to visualize heart through ECHO/Nuclear imaging

1) LBBB
2) Digoxin Use
3) Pacemaker
4) Baseline ST aberrance’s

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43
Q

Most common cause of death post MI_____

A

Ventricular Arythmia

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44
Q

For MI, when to choose Ca2+ instead of B blocker, since b-blocker is known to improve mortality

A

1) B agonism needed : Asthma

2) Vasospastic causes: prinzmetal, cocaine

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45
Q

________ is a Ca2+ blocker famously known to cause neutropenia

A

Ticlodipine

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46
Q

Indications for Pacemaker

A

1) Low EF HF, NYHA Class III-IV
2) LBBB
3) Mobitz II, Third Degree Heart Block
4) Bifascicular Block
5) Symptomatic bradycardia

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47
Q

abciximab only lowers mortality for ________

A

NSTEMI

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48
Q

Indications for IABP (Intra-aortic balloon pump)

A

1) Post MI Valvular Rupture
2) Unstable HFrEF, MI, Ventricular Arythmia
3) Post CABG cardiogenic shock

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49
Q

Ranazolin is used for ______

A

chronic angina, 2nd line with nitrates

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50
Q

LDL goals

1) ASCVD>7.5% _____
2) Diabetic _____
3) Normal ______

A

1) 100
2) 70
3) 190

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51
Q

CHF

1) Acute Management: Diuresis, O2, ______ pressor

A

Dobutamine (contracility, increases peripheral resistance) /Milronone (contractility)

Nesritide (ANP analog)

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52
Q

Ivrabradine

Side effect______

A

1) 3rd Line agent after B-blocker/Imdur combination for chronic management
2) If b-blocker cannot be used
3) Bright, luminous vision

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53
Q

Bicuspid aortic valve is associated with _____ genetic syndrome

______ is associate with mitral stenosis

A

Turners

Rheumatic heart disease

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54
Q

_______ valve is associated with young females

A

Mitral prolapse

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55
Q

Murmurs that decrease with increased venous return (squatting, valsalva, hand grip)______ and _______

A

HOCM

Mitral Prolapse

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56
Q

The oddball murmur _______, softens with hand grip (increase preload) and with amyl nitrate (decrease pre-load), physiology in valve gradient dependent

A

Aortic Stenosis

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57
Q

Difference between TAVR vs Surgery for Aortic Stenosis regarding complications :

1) TAVR______
2) Surgery______

A

1) Arythmia, requirement of pacemaker

2) Afib/Aki

58
Q

When to do surgery for aortic regurgitation

1) _________
2) _______

A

EF<55%

LV diameter >5.5cm

5 and 5 rule

59
Q

________ is a valvular heart disease notorious for revealing itself during pregnancy

A

Mitral stenosis, associated with rheumatic heart disease

60
Q

When to do surgery for mitral regurgitation

1) ________
2) ________

A

EF<60%

LV Diameter >4cm

More strict criteria than aortic regurgitation

61
Q

Causes of Fix Split S2

1) ________
2) _______

A

1) ASD

2) Pulm HTN: COPD

62
Q

Rapid X decent on venous tracing is characteristic of _______

A

Constrictive disease: pericarditis, restrictive cardiomyopathy

63
Q

______ is defined as an increase in JVP with inhalation

A

Kussmaul sign

64
Q

_____ is defined as a decrease in BP by 10 during inhalation, when u expect an increase

A

pluses paradoxus (tamponade)

+electrical alternans

65
Q

Best initial management for dissection _____, _____

A

B blocker, nitroprusside (artery and vein dilation)

66
Q

Multifocal Atrial Tachycardia treated with ________

A

Ca2+ blocker

67
Q

Indication for surgery for hyper PTH:

A

1) Calcium>12.5
2) Renal Insufficiency
3) Symptoms: Polyuria, constipation, confusion

*Sestamibi/nuclear imaging is purely for surgical planning

68
Q

When to do petrosal vein sampling for cushing syndrome______

A

When imaging indeterminate

69
Q

Medical therapy of cushing/hypercortisol
______

____

A

Mifepristone

Pasireotide (somatostatin analog)

70
Q

Cosyntropin is a _____ analog used to test for ______

A

ACTH

Addison’s

71
Q

______ is a specialized scan used for pheochromocytoma. Pheo is associated with _____ genetic condition

A

MIBG

Men II a, b

72
Q

Hirsutism, virilization, high 17-OH is characteristic of ________

A

21 Hydroxylase deficiency [CAH]

73
Q

Pearls of CAH

A

21 Hydroxylase Deficiency (most common)
High androgen, 17OH progesterone levels, hirsuitism (virilization), No HTN

11B hydroxy deficiency
Both HTN and virilization

17 Hydroxylase deficiency (less common)
HTN, no virilization

74
Q

Cyanotic heart diseases (D transposition, TOF), are examples of _____ shunt

A

R –> L

75
Q

_______ is a congenital heart disease characterized by essentially total walling off, of the R atrium

A

Tricuspid Atresia , relies upon PDA/PFO like connection. Prostaglandins would close this

76
Q

_____ is an EKG findings characteristic of abstain anomaly, caused by _____ drug

A

Tall p waves ( R atrial loading from giant R atrium), lithium

77
Q

statin inhibit ___ enzyme

A

HMG-COA reductase

78
Q

Use dual anti platelet therapy (Clopidogrel) for ____ months after stent placement

A

12 months

79
Q

Lateral leads

A

I, AvL, V5, V6

80
Q

Diastolic murmur with opening snap ______

Treated with _______

Associated with ______

A

mitral stenosis

balloon valvuloplasty

Rheumatic fever

81
Q

Systolic murmur radiating to the axilla _____

Tx: surgery with EF

A

Mitral regurgitation

60%

82
Q

_____ mid-systolic click, murmur increased with valsalva

A

mitral valve prolapse

83
Q

Parvus et tardus(slow carotid upstroke), associated with ____

A

Aortic stenosis

84
Q

wide pulse pressure, diastolic murmur radiating to axilla______

Tx: Hydralazine, ACE (after load reduction)

Associated with systemic disease: Marfan, Syphillis, _____

A

Aortic regurgitation

Ankylosing Spondylitis

85
Q

Pacemaker indicated for EF120 seconds)

A

35%

86
Q

Restrictive systemic diseases usually cause_____ heart failure

A

diastolic

87
Q

Post MI pericarditis is called____

A

Dressler syndrome , pericarditis pain relieved sitting forward

88
Q

First line BP control for Africam____

A

Thiazide, calcium channel blocker

89
Q

Early treatment of aortic dissection with BP control using
_______

_______

A

Nitroprusside

B blocker

90
Q

How to diagnose aortic dissection, if contrast allergy______

A

TEE

91
Q

_____ is a 2nd line for LDL/cholestrol lowering, no clear mortality benefit

A

Ezetimibe

92
Q

____ is a HDL improving medication that may cause flushing

A

Niacin

93
Q

_______ is a valvular vegetation caused by Lupus

A

Libman-Sacks

94
Q

Most common organism for acute endocarditis_____

A

S.Aureus

95
Q

Any patient with S.Aureus needs ECHO (T/F)

A

Now its true

96
Q

endocarditis generally needs____ time for treatment

A

4-6 weeks

97
Q

Major Duke Criteria

  • 2 different Bcx(+) 2 intervals (12 hrs)
  • _____
A

ECHO evidence

98
Q

Minor criteria

  • Fever
  • ____
  • Osler nodes, laneway, roth spots (antibody-autoimmune complex)
  • Emboli evidence
A

Predisposition (IV drugs, prosthetic valve)

99
Q

Endocarditis diagnosis
____ major criteria
1 major ___ minor
___ minor alone

A

2

3

5

100
Q

Indication for Endocarditis Prophylaxis

1) Congenital Heart Disease
2) _____
3) Prior endocarditis
4) Heart transplant, where transplant heart has valvulopathy

A

Prosthetic valve

Most common: Dental procedures, patient with heart condition

101
Q

Troponin,CK-MB takes ____ hours to get elevated, thats why EKG is always the best first test

A

3-6 hours

102
Q

How to get EF number in obese patients___

A

MUGA Scan (Nuclear schintigraphy)

103
Q

Aspirin is the best initial therapy for both STEMI and ____

A

NSTEMI

104
Q

Time cutoff before TPA for STEMI____

A

90 minutes

105
Q

ACE/ARB is mortality lowering in ACS only if _____-

A

Reduced EF, LV dysfunction

106
Q

Prasugrel is technically better than clopidogrel for pre PCI loading, however should be avoided in age >____

A

75, bleeding risk

107
Q

Unstable angina/NSTEMI, treatment is _________

A

Heparin

108
Q

Treatment range for thrombolytics:

Ideal:

A

90 minutes - 12hours

109
Q

Heparin activates ______, which is chief mechanism of anti-coag

A

antithrombin

110
Q

CABG can be done with either internal mammary artery, or saphenous vein grafts. The lifespans

1) Mammary artery : ____
2) Saphenous Vein :____

A

10 years

5 years

111
Q

Pacemaker indication for CHF

1) EF

A

35%

QRS>120s

112
Q

GDMT for aortic regurgitation, mitral regurgitation___

A

ACE/ARB

113
Q

Handgrip ____afterload, amyl nitrate _____ afterload

A

increases, decreases

114
Q

Mitral regurgitation murmurs radiate to ______

A

Axilla

115
Q

Best initial test for valvular lesion______. Most accurate test______

A

ECHO

L Heart Cath

116
Q

Regurgitant heart valvulopathy are best treated with ________

A

ARB/ACE

117
Q

Surgical Repairs

1) MS: ______
2) As:_______

A

1) Balloon Valvuloplasty

2) TAVR vs Open repair

118
Q

Aortic Stenosis Treatment

1) Careful Diuresis: Preload dependent, due to high afterload
2) TAVR: High risk of mortality within 5 years for AS patients , bioprosthetic valve lasts____

A

10 years

119
Q

Aortic regurgitation is associated with many systemic diseases

  • Genetic : Marfan, Turner
  • Structural : Bicuspid Aortic Valve
  • Rheum: Reiters, Ankylosing Spondylitis, RA

Treated with _____

A

ACE/ARB

Surgery: EF:55%, Diameter>55mm (rule of 5s)

120
Q

Most common cause of MS______, treated with :

A

Rheumatic Fever ; Opening snap with diastolic rumble

Diuretics, Balloon valvuloplasty , it can be done during pregnancy as the condition is revealed during pregnancy

121
Q

S3 should make you think of ____ and ____

A

CHF, Mitral regurgitation

122
Q

Mitral regurgitation treated with ______

A

Tx: ACE/ARB, diuresis, Nifedipine, Surgery (EF<60%, diameter>40mm

123
Q

INR target for mitral valve repair_____

A

INR = 2.5 - 3.5

124
Q

Low voltage EKG can be clue to ________ myopathy

A

Restrictive (Amyloid), Tamponade

125
Q

EKG findings on pericarditis

1) Global , Inflecting ST elevations
2) _______, more specific but less frequent

A

PR depression in lead II

126
Q

Medications to start for Aortic dissection______

A

B blocker, Nitroprusside

127
Q

LDL goal for PAD

A

100

128
Q

Drug that does not work in PAD, because outer artery (muscularis) layer is influenced rather than the intima_____

A

Ca2+ blocker

129
Q

Rivaroxaban + Apixaban are ____ inhibitors , Dabigatran is a ______ inhibitor

A

Factor 10a, Thrombin

130
Q

Idarucizumab is used to reverse _____

A

Dabigatran

131
Q

_____ can look similar to Afib

A

MAT

132
Q

_____ type of SVT is worsened with Ca2+ blocker

A

WPW, forced conduction down abnormal tract instead of AV node

133
Q

Only kind of stroke causing syncope ______

A

Vertebral/Basilar (Brainstem), bilateral stroke needed for LOC, vertebral is midline

134
Q

____ is used to diagnose vaso-vagal syncope

A

Tilt table test

135
Q

If ventricular arythmia is uncovered during syncope evaluation, a _____ is needed

A

implantable Defib

136
Q

Treatment of Vtach with pulm edema_____

A

synchronized cardioversion

137
Q

Handgrip _____ aortic stenosis murmur, _____ increased aortic stenosis

A

decreased, increases

138
Q

Most accurate test for aortic stenosis _____

A

L heart cath

139
Q

TAVR increases risk of post procedural _______

A

heart block (requiring pacemaker), surgery increases risk of AKI, afib

140
Q

Opening snap _____ is worse mitral stenosis

A

earlier

141
Q

Treatment of dilated cardiomyopathy/HOCM_____

A

Spironolactone

USMLE Step 3 (19 decks)

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