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USMLE Step 2 - Top 5% > Cardiology ❤️ > Flashcards

Cardiology ❤️ Flashcards

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USMLE® Step 1 flashcards
1
Q

Patients who have recurrent AF, and cannot tolerate anticoagulation, what can we do for them

A

Left atrial appendage ablation

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2
Q

Rhythm control versus rate control in AF which provides a mortality benefit

A

Rate

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3
Q

If patient opts for rhythm control for the AF, and the AF generation was more than 48 hours. And rather than doing TEE they did three weeks of anticoagulation. Once cardioverted how long do they need more anticoagulation for

A

One month

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4
Q

Patient with supraventricular tachycardia and a background of wolf Parkinson white, patient a stable. What medication do I give

A

Procainamide. Not adenosine. And if they have AF, not beta blockers either

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5
Q

If for superventricular tachycardia, when you give adenosine, and the arrhythmia gets worse? What should you be thinking

A

WPW

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6
Q

If symptomatic bradycardia does not improve with atropine. What kind of other steps can I take

A

Temporary passing (transcutaneous). Dopamine or epinephrine can also be considered. A big step up would be transvenous passing. Permanent pacemaker for these patients going forward

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7
Q

What percentage and below is reduced ejection fraction which percentage What percentage of the body is preserved

A

40% is reduced. Above 50% is preserved

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8
Q

New York Heart Association classification heart failure

A

One is no limitation of activity. Four is discomfort on activity and rest. Class two and three is in between

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9
Q

Electrolyte disturbance parallels the severity of heart failure

A

Sodium is low

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10
Q

Give me a brief discussion on heart failure with reduced versus preserved ejection fraction

A

Reduced ejection fraction is your systolic heart failure. This is the main heart failure, and is usually caused by the whole elevation in our ESS and SNS systems, to eventually cause eccentric hypertrophy.

Preserved ejection fraction is yours diastolic heart failure. This is usually due to an actual event (prior MI, restrictive cardiomyopathy, scarring of the heart, chronic hypertension)

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11
Q

Answer these hard acute heart failure scenarios:

Wet and cold, systolic blood pressure less than 90

Wet and cold, systolic blood pressure more than 90

Dry and cold

A

Inatropic agent initially, then we can do diuretics after

Diuretics first, inatropic agent if refractory

Consider initial fluid challenge, but usually inatropic agent

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12
Q

 Best initial treatment for wet and warm CHF

A

Diuretics and vasodilators

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13
Q

Name two contraindications for manitall

A

kidney disease or heart failure 

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14
Q

Heart failure with severe hypertension, we could consider which medication

A

nitroprusside

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15
Q

Do you need to give VTE prophylaxis in acute heart failure

A

Yes

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16
Q

When to give ivabradine in heart failure

A

Patient on maximum beta blocker dose, pulse above 70 bpm. And needs more help

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17
Q

If patient is on heart failure regime and has potassium above five. Can I add on spironolactone

A

Of course not

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18
Q

When somebody says heart failure, which one are we usually talking about

A

Reduced ejection fraction

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19
Q

Quick overview of treatment for heart failure with preserved ejection fraction

A

Flow Zen are the only ones to reduced mortality. Try and treat specific cause. Did oxen and spironolactone do not benefit at all. Beta blockers an ace inhibitors are good for blood pressure control of his patients

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20
Q

What is the most common cause of dilated cardiomyopathy

A

Myocardial ischaemia. But this is really a phenotype, and is classified as a separate condition to proper dilated cardiomyopathy

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21
Q

Some rarer causes of dilated cardiomyopathy

A

Pheochromocytoma, HIV, zidovudine, cocaine

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22
Q

Can HCM cause a change in the S2

A

It can cause paradoxical S2

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23
Q

Septal Q waves are seen in which cardiomyopathy

A

HCM

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24
Q

What are some echo signs that distinguish HCM from athletes heart

A

Enlarged left atria, decrease in the left ventricle cavity size, focal step to hypertrophy, evidence of diastolic dysfunction

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25
Q

Advice to a HOCM patient about exercise

A

Avoid intense athletics and training

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26
Q

Treatment of HCM in fetus secondary to hyperinsulinaemia from maternal diabetes

A

IV fluids, beta blockers. It should regress by age 1

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27
Q

Just some random details of the echocardiograph findings of cardiac amyloidosis

A

(Usual restrictive signs) and relative sparing of longitudinal strain, thickened valves, speckled appearance of the myocardium.

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28
Q

Patient with restrictive heart failure in the midst of easy bruising, proteinuria, hepato-megaly, macroglossia

A

I
amyloidosis

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29
Q

Cardiac sarcoidosis has which main presentation

A

AV block

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30
Q

Generally the best diagnostic test for cardiac sarcoidosis, amyloid dosis, haemachromatosis

A

Obviously biopsy is usually best for all of these. Haemochromatosis really benefits from an MRI which can quantify the iron overload in the myocardium

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31
Q

Heart failure in the midst of arthritis, diabetes, liver problem

A

Haemochromatosis

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32
Q

Heart failure in the midst of bilateral hilar lymphadenopathy

A

Sarcoidosis

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33
Q

ECG with low voltages, yet echo shows increase thickness of ventricle

A

Sign of restrictive cardiomyopathy, especially Amyloidosis

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34
Q

What is the main prognostic Determinant for AL amyloidoses

A

Cardiac involvement

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35
Q

Peripartum cardiomyopathy. How to manage if patients to intrapartum

A

Diuretics, beta blockers or hydralazine plus nitrate. Just avoid RASS drugs. Avoid future pregnancies of persistent low ejection fraction.

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36
Q

What are the different types of neurally mediated syncopes

A

Carotid hyperstimulation, vasovagal, situation at

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37
Q

Head up tilt testing can be used to rule out which syncopes (more than you think)

A

Vasovagal, situational, orthostatic

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38
Q

Patient with syncope, that is worse or initiated with arm exercises.

A

Subclavian steal syndrome

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39
Q

Patient who has tacky cardia on assuming an upright posture, and even has syncope. However there is no orthostasis what is the diagnosis

A

Postural tachycardia syndrome. Doesn’t need syncope in symptoms

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40
Q

General overview of management for lymphoedema

A

Symptom management Like massage, exercise, pressure garments. Do not give diuretics. Hypervigilance for cellulitis

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41
Q

What is critical limb ischaemia

A

Chronic limb threatening ischaemia. PAD, with pain at rest, and evidence of gangrene or ulceration for more than two weeks

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42
Q

Can we see muscle atrophy in chronic ischaemia

A

Yes, alongside shiny skin, cyanosis, gangrene, pallor, lack of sebaceous glands

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43
Q

Normal range for ABPI

A

1 to 1.4

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44
Q

An ABPI of less than what is usually correlated to pain at rest

A

0.4

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45
Q

Best initial test for peripheral arterial disease (chronic or acute limb ischaemia). Than which are the two most accurate tests

A

ABPI. Then the most accurate test is either angiography or CTA, but these are only needed if you’re planning to revascularise

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46
Q

Medication often used for intermittent claudication

A

Cilostazol. Contraindicated in heart Phalia

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47
Q

Aortic stenosis with fusion at the commissure

A

Rheumatic heart disease

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48
Q

Vasodilators for aotic regurgitation.

A

They are good, but they don’t delay progression

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49
Q

What medications can we give for mitral stenosis

A

Beta blockers and CC bees are quite good to essentially increase the diastolic filling time

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50
Q

Recall difference in murmur intensity between mitral prolapse and mitral
regurgitation

A

Prolapse equals softer when you squat (anything decreasing the size will increase murmur)

regurgitation equals louder with increase venous return

51
Q

Quick fact

A

Any regurgitation can have medical therapy using vasodilators. Aortic stenosis doesn’t have much medical therapy. mitral stenosis can use beta blockers or CCB

52
Q

If someone has a functional mitral regurgitation (due to deleted ventricles) how can we medically treat

A

Diuretics to decrease the size of the ventricle Anthos stop the regurg

53
Q

List me the cardiovascular conditions are contraindicated in pregnancy

A

Any valve stenosis. Heart failure with an injection fraction of less than 30%. Unstable/dilated aorta . Pulmonary hypertension

54
Q

Ascending versus descending aortic aneurysm. Which is more cystic medionecrosis/connective tissue disorder in which is more atherosclerosis

A

In that order

55
Q

Most common association with AAA

A

Atherosclerosis. But smoking is the strongest predictor of rupture. HTN main association with dissec

56
Q

Can an uruptured but symptomatic AAA cause limb ischemia 

A

Yea

57
Q

Patient who has unstable AAA (could be ruptured), but no history of AAA recorded. What should be done

A

Do the ultrasound first. If they have a history of AAA can go straight to repair

58
Q

What is considered a rapidly expanding AAA

A

Expanding more than 5 mm in six months

59
Q

What question do I ask in stand for B sorted dissection, to know whether to do surgery or not

A

If there is evidence of ischaemia do surgery, if not just continue with your beta blocker. Of course if there’s leak, then do Sx

60
Q

What is phlegmasia alba dolens and phlegmansua cerulea dolens

A

The first is oedema pain and white blanching skin

The second is oedema pain and blue skin

Both are potential signs of DVT

61
Q

Remember we always said provoked three months anticoagulation, unprovoked six months anticoagulation. What does first aid say about DVT treatment

A

Provoked, or first occurrence of unprovoked three months only. Cancer or second unprovoked, Indefinit

62
Q

Patient following a DVT, has severe venous insufficiency, varicose vein, recurrent DVT, heaviness in the leg

A

Post thrombotic syndrome.

63
Q

Above how much fluid in the pericardial sac would constitute an infusion (millimetre

A

Above 3 to 4

64
Q

On ECG of pericarditis what do we see you later on

A

Can see diffuse T-wave

65
Q

After initial acute symptoms of pericarditis have resolved, what do we do with the NSAIDs and colchicine in

A

Type of the NSAIDs to weekly to reduce recurrence. Colchicine can be used for up to 3 months

66
Q

Preferred treatment of pericarditis if due to SLE

A

Steroids

67
Q

Septal bounce on echocardiograph is seen in which disease

A

Chronic/constrictive pericarditis

68
Q

Main two causes of pericardial knock

A

Constrictive pericarditis and restrictive cardiomyopathy

69
Q

Can hypothyroidism cause pericardial effusion

A

Weirdly yes

70
Q

Ewart sign

A

Dull percussion at the base of the left inferior scapular border, and tubular breath sounds/egophony in this area. Seen in pericardial effusion

71
Q

If idiopathic pericardial effusion has been going on for more than three months, what can we do

A

Consider putting in a drain (maybe peritoneal?)

72
Q

Cardiac tamponade. Is the pulse pressure changed? What are the lung fields like on examination?

A

Narrowed. And clear (high yield)

73
Q

Echo free zone around the heart

A

Effusion

74
Q

Other than urgent pericardiocentesis for Tampa nard, what else do we have to do

A

Aggressive volume expansion with IV fluids

75
Q

Infective endocarditis after GI or GU procedure in old man

A

Enterococcus

76
Q

Endocarditis affecting both sides of the valve, is a sign of what

A

Marantic or Lipman sacks endocarditis

77
Q

We all know about strep office, but what about clostridium septicum

A

Also associated with endocarditis in colon cancer

78
Q

Man recently had TURP, now has a subacute endocarditis. What’s the most likely cause

A

Enterococcus

79
Q

Treatment failure for IE, can do what

A

Can do ECG to check for new AV block, maybe paravalvular abscess?

80
Q

Contrast the time antibiotics given IV for left versus right infective endocarditis

A

Four left it’s given for a month. For right it’s given for two weeks

81
Q

You know that for MSSA Infective endocarditis we could try oxacillin, nafcillin. If it’s a prosthetic valve we do the same but we just add which antibiotic

A

Gentamicin

82
Q

You know that for MRSA Infective endocarditis we could try VANCO. If it’s a prosthetic valve we do the same but we just add which antibiotic

A

Gentamicin

83
Q

Entra cockers for fecalis versus enterococcus feacium 

A

Ampicillin and gentamicin. Vancomycin and gentamicin.

84
Q

Strep virodans infective endocarditis treatment

A

Foxy

85
Q

HACEK or Coxiella/Bartonella infective endocarditis. Treatment

A

Foxy

86
Q

Consider these circumstances of IE:

Prosthetic valves

Paravalvular extensions

Fistula formation

Highly resistant microbes or persistent symptoms for more than a week, despite being on antibiotics

Vegetations of more than 10 to 15 mm

Acute heart failure due to valve damage

Fungal infective endocarditis

A

All of the circumstances need surgical intervention

87
Q

Regarding our infective endocarditis antibiotic prophylaxis. Which are the qualifying cardiac issues the patient should have

A

Prosthetic valve, or history of endocarditis, or unrepaired congenital heart disease, or a cardiac transplant

88
Q

Regarding our infective endocarditis antibiotic prophylaxis. Which are the qualifying procedures the patient should have

A

Dental work, even bleeding. All respiratory base stuff (biopsy incision et cetera). Skin or musculoskeletal tissue stuff like incisions and biopsies. Cardiac surgery with any prosthetic material

89
Q

What is the infective endocarditis prophylaxis protocol (Abx)

A

 amoxicillin is usually given 30 to 60 minutes prior to procedure. Consider allergy (macrolide, ceph, doxy).

90
Q

In our endocarditis antibiotic prophylaxis, or mitral valve prolapse, or native mitral valve stenosis qualifying conditions?

A

No

91
Q

Regarding a infective endocarditis antibiotic prophylaxis. Our routine GI endoscopy, cystoscopy qualifying procedures?

A

No

92
Q

And in terms of family history CAD risk factors for your own CAD. What is the age of a father versus a mother having CAD being a risk factor

A

Men less than 55 in the family or women less than 65 and the family.

93
Q

We always learnt that in evaluation of stable angina, to know whether to do exercise ECG or exercise imaging stress test, we needed to know if they had underlying ECG problem. What does this actually mean

A

Doesn’t necessarily mean if they have some ischaemia an ECG, it means are they able to read potential ischaemia. So patient with left bundle branch block paced ventricular rhythm you cannot

94
Q

Name me for instances where the dipyridamole and adenosine stress tests are contraindicated

A

Asthma, bronchospasm

Severe low heart rate, second or 3rd° heart block, sick sinus syndrome

Systolic blood pressure less than 90

Methylxanthine

95
Q

When is coronary angiography OCTA used m to diagnose stable angina

A

If the ECG or stress testing is equivocal (not what my flowchart said). Or if the patient is high pretest probability

96
Q

Is hormone replacement therapy protective postmenopausal women for angina and coronary artery disease

A

No

97
Q

My two drugs are contraindicated in variant angina

A

Aspirin and beta blockers

98
Q

Impatience with unstable angina, why do we have to do ECGs every 15-30 minutes

A

To assess if there is progression to an MI

99
Q

MONA for unstable angina or NSTEMI. What are a couple of things that are potentially missing from this

A

Beta blockers should be given in less contraindicated. And low molecular weight heparin as well

100
Q

 Generally in NSTEMI and unstable angina, who usually always gets coronary angio

A

Haemodynamically unstable, refractory, electrical instability. Is the unstable do very very quickly, otherwise you have 24 hours

101
Q

Chest pain and a new S4

A

Often a sign of an STEMI

102
Q

Best predictor of survival in STEMI

A

Left ventricular ejection fraction

103
Q

why is it important to do x-rays before treating M I

A

Just in case it is aortic dissection, you need to roll this

104
Q

In am I does the ST segment or T-wave normalise first

A

ST first

105
Q

Alongside MONA What to give if left ventricle heart failure sign

A

Ivy loop

106
Q

Alongside MONA If patient has unstable sinus bradycardia consider what


A

Ivy atropine or transcutaneous pacing

107
Q

In STEMI patient has sublingual nitro glycerin but yet they’ve persistent chest pain. Can add what

A

Ivy nitroglycerin

108
Q

If going to have fibrinolysis instead of PCI… give which antiPLT

A

CLoppy (floppy = not the best option). Tiggy and prasgruel are kinda CI

109
Q

If going to have PCI, which anticoag we give

A

Tiggy (biggy = big win for the patient), or prasgruel

110
Q

 talk to me about thrombolyse sis and its place in STEMI

A

Obviously PCI is better. If PCI cannot be done within 120 minutes, we do thrombolyses. Thrombolyses best performed within three hours, but essentially can be used up until 12 hours. It’s actually contra indicated if beyond 24 hours

111
Q

Patient had an STEMI. A stent was placed. They were on dual antiplatelet therapy for 30 days. What stent was placed

A

Bare metal

112
Q

Patient had an STEMI. A stent was placed. They were on dual antiplatelet therapy for 12 months. What stent was placed

A

Drug eluting

113
Q

What is the indication to do a CABG

A

Left main CAD, triple vessel disease, two vessel disease in diabetic, Max medical therapy and still symptomatic, PCI not able to fix obstruction

114
Q

Full right ventricle infarction, we know we have to avoid diuretics and nitrates. What can we give to boost the preload

A

IV fluids

115
Q

What does first-aid say is a carotid artery disease symptomatic type

A

Sudden onset of focal Neuro in the past six months

116
Q

Give me some examples of high cholesterol patients that should be evaluated for primary causes of hyperlipidaemia

A

LDL above 190, triglyceride above 500, family history, obvious physical signs (xanthomas for example)

117
Q

Recall hyperlipidaemia screening

A

Everyone above 35. Everybody above 20 if they have risk factors for ASCVD. Repeat every five years. Or smokers should be evaluated to

118
Q

Went to give statin:

A

Anyone with atherosclerotic disease

LDL above 190

LDL above 160 family history of ASCVD

40 years old and diabetes mellitus

119
Q

If a patient has high triglycerides, what’s the overview of management

A

Do lifestyle and treat causes first. If the ASCVD risk is above 7.5% start statins.

If above 1000 triglycerides give vibrate

120
Q

Went to give PCS K9 inhibitors

A

This is evil Ali. Used for family or hypercholesterolaemia or statin resistant/statin intolerant patients

121
Q

We both know that weight loss in a fat person, and dash diet are the best to lower blood pressure. What comes after

A

Exercise then reduce salt then alcohol limitation

122
Q

 Hypertensive crisis treatment goals

A

25% reduction of blood pressure from baseline or to less than 160/100. This is a rule for both urgency and emergency. However with emergency we want to do 20% within the first hour.

123
Q

What’s more important in diagnosis of hypertensive emergency, the end organ damage or the actual blood pressure reading

A

The end organ damage. Blood pressure reading doesn’t actually matter that much

USMLE Step 2 - Top 5% (34 decks)

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