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USMLE Step 2 CK > Cardiology > Flashcards

Cardiology Flashcards

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USMLE® Step 1 flashcards
1
Q

worst risk factor for CAD

A

DM

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2
Q

most common risk factor for CAD

A

HTN

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3
Q

what counts as premature CAD

A

male <65

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4
Q

most dangerous part of lipid panel

A

LDL

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5
Q

greatest improvement in pt outcomes with CAD from which lifestyle modification

A

smoking cessation

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6
Q

chest wall tenderness is most likely d/t

A

costochondritis

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7
Q

most accurate test for costochondritis

A

physical exam

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8
Q

chest pain radiating to back with unequal BP between arms most likely d/t

A

aortic dissection

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9
Q

most accurate test for aortic dissection

A

chest x ray (wide mediastinum) confirmed with CT, MRI or TEE

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10
Q

chest pain worse when lying flat, better with sitting, in young (<40) most likely d/t

A

pericarditis

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11
Q

most accurate test for pericarditis

A

EKG (ST elevation in all leads and PR depression)

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12
Q

sudden onset SOB, tachycardia, hypoxia most likely d/t

A

PE

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13
Q

sharp, pleuritic pain, tracheal deviation most likely d/t

A

pneumothorax

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14
Q

chest pain with ____ has worst prognosis

A

SOB

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15
Q

chest pain with fever suggests

A

PE or pneumonia

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16
Q

when is a stress test done

A

stable pts with chest pain and unclear diagnosis

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17
Q

maximum HR =

A

220 - pt age

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18
Q

stress testing if EKG can’t be read

A

nuclear isotope (thallium or sestamibi) or echo

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19
Q

Stress test if pt can’t exercise

A

Persantine (dipyrimadole) or adenosine with thallium or sestamibi or dobutamine echo

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20
Q

adverse effect with dipyridamole

A

bronchospasm - avoid in asthmatics

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21
Q

most accurate method of detecting CAD

A

angiography

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22
Q

significant stenosis

A

> 70% may be surgically correctable, <50% is insignificant

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23
Q

holter monitor is used to evaluate

A

rhythm

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24
Q

chronic angina txs that lower mortality

A

aspirin, BB, nitroglycerin

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25
Q

med used when aspirin intolerance or recent angioplasty with stenting

A

clopidogrel

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26
Q

med used when chronic angina refractory to other tx

A

ranolazine

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27
Q

use when intolerant to both aspirin and clopidogrel

A

triclopidine

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28
Q

adverse effects of triclopidine

A

neutropenia and TTP

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29
Q

when is prasugrel used

A

use in those undergoing angioplasty with stenting

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30
Q

adverse effect of prasugrel

A

> 75 increased risk of hemorrhagic stroke

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31
Q

best mortality of benefit of ACEi/ARB with EF <

A

40%

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32
Q

most common adverse effect of statins

A

elevated transaminases

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33
Q

lipid drug with best mortality benefit

A

statins

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34
Q

lipid drug that raises HDL

A

niacin

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35
Q

adverse effects of niacin

A

glucose intolerance, elevation of uric acid, pruritis

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36
Q

lipid drug that lowers triglycerides

A

genfibrozil

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37
Q

adverse effects of genfibrozil

A

increased risk of myositis when combined with statins

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38
Q

adverse effects of cholestyramine

A

GI (constipation, flatus), interacts with meds in gut preventing their absorption

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39
Q

lipid drug lowers LDL but no benefit to patient

A

ezetimibe

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40
Q

which CCBs do not increase HR

A

verapamil and diltiazem

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41
Q

CCBs used when BB not tolerated

A

verapamil and diltiazem

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42
Q

adverse effects of CCBs

A

edema, constipation, heart block

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43
Q

when are BB contraindicated

A

severe asthma, prinzmetal angina, cocaine induced chest pain

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44
Q

when is CABG done

A

3 vessels with >70% stenosis
Left main coronary artery occluded
2 vessel disease in DM
or persistent symptoms despite meds

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45
Q

how long do artery grafts last for

A

10yrs

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46
Q

how long do vein grafts last for

A

5 yrs

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47
Q

Best therapy in ACS especially if ST elevation

A

PCI

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48
Q

ACS is associated with what heart sound

A

S4 gallop – ischemia causes noncompliance of LV

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49
Q

acute myocardial damage in postmenopausal women immediately after stressful event

A

tako-tsubo cardiomyopathy

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50
Q

tako-tsubo cardiomyopathy pathology d/t

A

ballooning and LV dyskinesis

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51
Q

tx for tako-tsubo cardiomyopathy

A

BB and ACEi

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52
Q

MI with worst prognosis

A

anterior wall MI

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53
Q

ST elevation in V2 and V4

A

anterior wall MI

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54
Q

ST elevation in II, III, and aVF

A

Inferior wall MI

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55
Q

ST depression in V1 and V2

A

Posterior wall MI

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56
Q

tx for posterior wall MI

A

no additional tx needed - low mortality

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57
Q

what type of BBB is more dangerous

A

LBBB

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58
Q

tx of PVCs

A

no tx - tx worsens outcome

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59
Q

tx for stable angina

A

aspirin, BB, nitrates

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60
Q

ACS abnormalities show up on EKG

A

immediately

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61
Q

ACS abnormalities show up on myoglobin

A

after 1-4 hrs

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62
Q

ACS abnormalities show up on CK-MB

A

after 4-6hrs

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63
Q

ACS abnormalities show up on troponin

A

after 4-6 hrs

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64
Q

myoglobin stays elevated for

A

1-2 days

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65
Q

CK-MB stays elevated for

A

1-2 days

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66
Q

troponin stays elevated for

A

10-14 days

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67
Q

first tx for STEMI

A

aspirin

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68
Q

complications of PCI

A

rupture, restenosis, hematoma

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69
Q

PCI for STEMI should be done within

A

90 mins

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70
Q

thrombolytics for STEMI should be given within

A

30 mins

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71
Q

contraindications to thrombolytics

A

brain or bowel bleed, surgery within 2 weeks, BP >180/110, nonhemorrhagic stroke within 6 mo

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72
Q

when is heparin used in STEMI

A

after thrombolytics

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73
Q

STEMI, contraindication to thrombolytics, next step?

A

transfer for PCI

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74
Q

what drugs should be given in STEMI but are not time dependent

A

BB, ACEi, statins

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75
Q

first tx in NSTEMI

A

heparin - prevents clot formation

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76
Q

what type of heparin is superior for NSTEMI

A

LMWH

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77
Q

NSTEMI undergoing angioplasty and stenting, give

A

Glycoprotein IIb/IIIa inhibitors (abciximab, tirofiban, eptifibitide)

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78
Q

NSTEMI, all meds given but not better

A

PCI

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79
Q

what drugs are NOT given in STEMI

A

GPIIb/IIIa, CCBs, or warfarin

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80
Q

what drugs are NOT given in NSTEMI

A

thrombolytics, CCBs, or warfarin

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81
Q

most common cause of death post MI

A

ventricular arrhythmia (keep in ICU)

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82
Q

Recurrence of pain, new onset of rales, sudden onset pulmonary edema

A

reinfarction

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83
Q

suspected reinfarction, next step

A

EKG for new ST abnormalities, and CK-MB levels

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84
Q

tx for reinfarction

A

repeat angioplasty

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85
Q

tx for symptomatic sinus bradycardia

A

atropine if symptomatic, pacemaker if ineffective

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86
Q

sinus bradycardia post MI d/t

A

vascular insufficiency of SA node

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87
Q

what are Cannon A waves

A

bounding of jugulovenous wave bouncing into neck

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88
Q

cannon waves and Sinus bradycardia

A

third degree AV block

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89
Q

tx for third degree AV block

A

pacemaker

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90
Q

third degree AV block post MI is associated with

A

RV infarction

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91
Q

New inferior wall MI and clear lungs

A

RV infarction

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92
Q

dx of RV infarction

A

flip EKG, ST elevation in RV4

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93
Q

the Right coronary artery supplies

A

RV, AV node, inferior wall

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94
Q

tx of RV infarct

A

high volume fluid replacement

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95
Q

avoid ____ in RV infarct

A

nitroglycerine

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96
Q

Several days after MI – sudden loss of pulse

A

tamponade or free wall rupture

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97
Q

dx of tamponade or free wall rupture

A

emergency echo

98
Q

tx for tamponade or free wall rupture

A

emergency pedicardiocentesis

99
Q

tx for V tach or V fib

A

cardioversion/defibrillation

100
Q

New onset murmur and pulmonary congestion post MI

A

valve or septal rupture

101
Q

most accurate test for valve or septal rupture

A

echo

102
Q

Step up in oxygen (from RA to RV)

A

septal rupture

103
Q

mitral valve regurge is best heard

A

at apex with radiation to axilla

104
Q

ventricular septal rupture is best heard

A

at lower left sternal border

105
Q

pericarditis post MI

A

dressler syndrome

106
Q

dx of persistent ischemia post MI

A

stress test before discharge

107
Q

ACEi are best for what type of MI

A

anterior wall

108
Q

should prophylactic antiarrhythmics be used post MI

A

no - increase mortality

109
Q

routine post MI care

A

Aspirin, BB (metoprolol), statins, ACEi

110
Q

should dipyramidamole be used post MI

A

NO

111
Q

post MI erectile dysfunction is most often due to

A

anxiety, but can be from BB

112
Q

how long do you have to wait post MI to have sex

A

you don’t

113
Q

Decrease of BP >10 on inspiration

A

pulsus paradoxus

114
Q

pulsus paradoxus is associated with

A

cardiac tamponade

115
Q

kussmaul sign is most often associated with

A

constrictive pericarditis or restrictive cardiomyopathy

116
Q

most common cause of hospital admission

A

CHF

117
Q

most common cause of death in CHF

A

arrhythmia

118
Q

cause of CHF

A

Infarction → dilation → regurgitation → CHF

119
Q

Dyspnea on exertion, peripheral edema, rales, JVD, PND, S3 gallop

A

CHF

120
Q

CHF with low EF

A

systolic dysfunction

121
Q

CHF with preserved EF

A

diastolic dysfunction

122
Q

best initial test for CHF

A

TTE

123
Q

most accurate test for EF

A

MUGA or nuclear ventriculography

124
Q

when do u get BNP

A

acute SOB with unclear etiology and no time for echo

125
Q

swan ganz cath can distinguish

A

CHF from ARDS (but not routinely done)

126
Q

adverse effect of lisinopril

A

hyperkalemia

127
Q

B1 specific BB

A

metoprolol and bisoprolol

128
Q

nonspecific BB with a1 blockage

A

carvedilol

129
Q

CHF - SOB with minimal exertion or at rest is what class

A

III or IV

130
Q

adverse effects of spironolactone

A

hyperkalemia, gynecomastia

131
Q

med that inhibits aldosterone but no antiandrogenic effects

A

eplerenone

132
Q

implantable defribillator in CHF (systolic dysfunction) if EF

A

<35%

133
Q

biventricular pacemaker for CHF (systolic dysfunction) if

A

Dilated cardiomyopathy and EF 120) with persistent symptoms

134
Q

drugs with mortality benefit in CHF with systolic dysfunction

A

ACEi/ARBs, BB, spironolactone/eplerenone, hydralazine/nitrates, implantable defibrillator

135
Q

routine anticoagulation for CHF (systolic dysfunction)

A

WRONG unless clot in heart

136
Q

drugs with clear mortality benefit in CHF (diastolic dysfunction)

A

BB

137
Q

drugs with NO clear mortality benefit in CHF (diastolic dysfunction)

A

digoxin and spironolactone

138
Q

drug for symptom control in CHF (diastolic dysfunction)

A

diuretics - but contraindicated in HOCM

139
Q

Rales, JVD, S3 gallop, Edema, orthopnea, ascites and hepatosplenomegaly

A

acute pulmonary edema

140
Q

most important acute test for acute pulmonary edema

A

EKG

141
Q

chest x ray for acute pulmonary edema shows

A

cephalization of flow

142
Q

acid base disorder in acute pulmonary edema

A

respiratory alkalosis - from hyperventilation (CO2 leaves easier than O2 enters)

143
Q

best initial tx for acute pulmonary edema

A

remove large volume with loop diuretic (furosemide, bumetinide)
oxygen, morphine, nitrates

144
Q

IV form of atrial natriuretic peptide, only a weak diuretic so no mortality benefit

A

nesiritide

145
Q

meds for acute afterload reduction

A

Nitroprusside and Hydralazine

146
Q

phosphodiesterase inhibtors (amironone and milrinone) effect on heart

A

increase contractility and decease afterload

147
Q

digoxin effect on heart

A

increases contractility, but takes several weeks

148
Q

most common valve disease in rheumatic fever

A

mitral stenosis

149
Q

valve disease associated with aging and calcification

A

aortic stenosis

150
Q

regurge valve diseases most commonly from

A

HTN and ischemic heart disease

151
Q

right sided valve diseases increase with

A

inhalation

152
Q

left sided valve disease increases with

A

exhalation

153
Q

best initial test for valvular heart disease

A

ech

154
Q

most accurate test for valvular heart disease

A

cath

155
Q

all valvular heart diseases benefit from

A

diuretics

156
Q

which valve disease to Look for in young adult, pregnant immigrant

A

mitral stenosis

157
Q

dysphagia, hoarseness, A fib and stroke, hemoptysis, murmur

A

mitral stenosis

158
Q

EKG in mitral stenosis shows

A

LA hypertrophy shows as biphasic P wave in Leads V1 and V2

159
Q

x ray in mitral stenosis shows

A

second bubble behind heart

160
Q

Murmur – diastole, just after opening snap

A

mitral stenosis

161
Q

tx for mitral stensosis

A

diuretics, Na restriction, Balloon valvuloplasty, warfarin for a fib, rate control

162
Q

poorest prognosis with aortic stenosis

A

CHF - 2 yr survival

163
Q

Murmur – systolic, crescendo-decrescendo. Heard best at second right intercostal space, radiates to carotid artery.

A

aortic stenosis

164
Q

angina, syncope, CHF, murmur

A

aortic stenosis

165
Q

EKG in aortic stenosis shows

A

LVH. S wave in V1 plus R wave in V5

166
Q

tx of aortic stenosis

A

valve replacement

167
Q

Murmur – pansystolic (holosystolic), obscuring S1 and S2. Radiates to axilla.

A

mitral regurgitation

168
Q

tx for mitral regurgitation

A

ACEi/ARBs are best – decrease rate of progression

169
Q

when is valve replacement indicated in mitral regurge

A

heart starts to dilate, LVESD >40 or EF <60%

170
Q

Murmur – diastolic, decrescendo. Heard best at lower left sternal border.

A

aortic regurgitation

171
Q

tx for aortic regurge

A

ACEi/ARBs or nifedipine delay progression

172
Q

valve replacement in aortic regurge indicated when

A

acute valve rupture or EF 55

173
Q

de musset sign

A

head bobbing (aortic regurge)

174
Q

hill sign

A

BP in legs as much as 40 > than in arms (aortic regurge)

175
Q

quinke pulse

A

pulsations in nail bed (aortic regurge)

176
Q

water hammer pulse

A

wide, bounding (aortic regurge)

177
Q

which conditions are associated with mitral valve prolapse

A

marfans and ehler danlos

178
Q

which valvular disease is most often asymptomatic

A

mitral valve prolapse

179
Q

dx of mitral valve prolapse

A

echo is best (cath should rarely be done)

180
Q

murmur - midsystolic clock

A

mitral valve prolapse

181
Q

tx of mitral valve prolapse

A

BB when symptomatic, then valve repair (with catheter)

182
Q

Atypical chest pain, palpitations, panic attack, murmur

A

mitral valve prolapse

183
Q

all forms of cardiomyopathy benefit from

A

diuretics

184
Q

dilated cardiomyopathy is ___ dysfunction

A

systolic = low EF

185
Q

tx for dilated cardiomyopathy

A

ACEi/ARBs, BB – lower mortality
Diuretics and digoxin - control symptoms
If wide QRS – biventricular pacemaker improves symptoms and survival

186
Q

hypertrophic cardiomyopathy is ___ dysfunction

A

diastolic = preserved EF

187
Q

most common cause of hypertrophic cardiomyopathy

A

HTN

188
Q

heart sound associated with hypertrophic cardiomyopathy

A

S4 gallop

189
Q

hypertrophic cardiomyopathy symptoms worsened by

A

increased HR and decreased LV size

190
Q

best initial test for hypertrophic cardiomyopathy

A

echo

191
Q

most accurate test for hypertrophic cardiomyopathy

A

cath

192
Q

Septal Q waves in inferior and lateral leads

A

HOCM (not MI)

193
Q

Systolic anterior motion of mitral valve

A

HOCM

194
Q

best initial tx for hypertrophic cardiomyopathy

A

BB

195
Q

what tx is always WRONG for hypertrophic cardiomyopathy

A

digoxin and spironolactone

196
Q

increased jugulovenous pressure on inhalation

A

kussmaul sign

197
Q

tx of restrictive cardiomyopathy

A

tx underlying cause, diuretics

198
Q

best initial test of restrictive cardiomyopathy

A

echo

199
Q

most accurate test for restrictive cardiomyopathy

A

endometrial biopsy

200
Q

speckling of septum on echo or cardiac MRI

A

amyloidosis

201
Q

which valve diseases do not increase with expiration

A

HOCM, MVP

202
Q

All murmurs decrease with less blood except

A

HOCM, MVP

203
Q

Standing and valsalva ____ venous return to heart

A

decrease

204
Q

Handgrip _____ LV emptying

A

decreases

205
Q

Amyl nitrate_____LV emptying

A

increases

206
Q

amyl nitrate mimicks

A

ACEi

207
Q

Squatting and leg raise increase, standing and valsalva decrease, handgrip decreases, amyl nitrate increases

A

AS

208
Q

Squatting and leg raise increase, standing and valsalva decrease, no effect with handgrip or amyl nitrate

A

MS

209
Q

Squatting and leg raise increase, standing and valsalva decrease, handgrip increases, amyl nitrate decreases

A

AR and MR

210
Q

Squatting and leg raise decrease, standing and valsalva increase, handgrip decreases, amyl nitrate increases

A

MVP and HOCM

211
Q

most common infection causing pericarditis

A

viral (coxsackie B)

212
Q

most common connective tissue disorder causing pericarditis

A

SLE

213
Q

EKG on pericarditis shows

A

ST elevation all leads, PR depression

214
Q

tx of pericarditis

A

NSAIDs

215
Q

tx of pericarditis that decreases recurrences

A

colchicine

216
Q

in pericardial tamponade which side of heart is compressed first

A

right - thinner walls

217
Q

Hypotension, tachycardia, distended neck veins, clear lungs, pulsus paradoxus

A

pericardial tamponade

218
Q

most appropriate test for pericardial tamponade

A

echo

219
Q

EKG in pericardial tamponade shows

A

electrical alternans

220
Q

pericardial tamponade on x ray

A

globular heart

221
Q

pericardial tamponade on echo

A

RA and RV diastolic collapse

222
Q

right heart cath in pericardial tamponade shows

A

equilization of pressures in diastole

223
Q

tx of pericardial tamponade

A

pericardiocentesis, IV fluids, window in pericardium if recurrent

224
Q

what worsens pericardial tamponade

A

diuretics

225
Q

heart sound with constrictive pericarditis

A

knock in diastole

226
Q

tx of constrictive pericarditis

A

diuretics first, then surgical removal of pericardium

227
Q

best initial test for PAD

A

ABI, <0.9 = disease

228
Q

most accurate test for PAD

A

angiogram

229
Q

best initial tx for PAD

A

aspirin, smoking cessation, cilostazol

230
Q

single most effective med for PAD

A

cilostazol

231
Q

best initial test for aortic dissection

A

x ray

232
Q

Pain between scapulae, difference in BP between arms

A

aortic dissection

233
Q

most accurate test for aortic dissection

A

angiography

234
Q

tx of aortic dissection

A

control BP - BB, nitropruside, surgery

235
Q

for aortic dissection what must be done before starting nitropruside

A

BB - prevents reflex tachycardia

236
Q

heart disease most dangerous to pregnant woman

A

peripartum cardiomyopathy

237
Q

heart disease second most dangerous to pregnant woman

A

eisenmenger

238
Q

tx for peripartum cardiomyopathy

A

ACEi/ARB, BB, spironolactone, diuretics, digoxin

239
Q

peripartum cardiomyopathy usually happens when after delivery

A

post partum

240
Q

after peripartum cardiomyopathy LV dysfunction doesn’t improve then

A

cardiac transplant, no repeat pregnancy of will provoke enormous antibody production

241
Q

peripartum cardiomyopathy MOA

A

antibodies against myocardium

USMLE Step 2 CK (11 decks)

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