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USMLE Step 2 CK > Cardiology > Flashcards

Cardiology Flashcards

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USMLE® Step 1 flashcards
1
Q

TIP- AGE OF WOMEN WHERE RISK OF CAD IS EQUAL TO MEN

TIP-CAD RISK FACTORS

TIP-CAD RISK FACTORS WITH HIGHEST RATES

TIP- CAD RISK FACTORS FAMILY HAS TO BE HOW CLOSE AND HOW YOUNG

TIP- CAD RISK FACTORS-HYPERLIPIDEMIA ESPECIALLY WHAT LIPID?

TIP- CAD LESS OF A RISK FACTOR/S… MORE ENVIRONMENTAL

TIP- CAD RISK PREVENTION MOST BENIFICIAL

TIP- AKO-TSUBO CARDIOMYOPATHY MECH. AND
TREATMENT

TIP- HOW MUCH DOES SMOKE QUITING REDUCE RISK?

A

55-60 YEARS

DIABETES, HYPERTENSION, TOBACCO, HYPERLIPIDEMIA, FAMILY HISTORY, AGE MEN 45 WOMEN 55

HYPERTENSION>DIABETES (IS WORSE)

FIRST DEGREE RELATIVES SIBLING AND PARENTS AND AGE=MEN

LDL

PHYSICAL ACTIVITY, ALCOHOL, LOW FRUIT AND VEG., EMOTIONAL STRESS, CARDIAC CT SCAN HIGH IN CA, PET

EXERCISE

CATECHOLAMINE DISCHARGE CAUSES BALLOONING, TREAT AS MI BETA BLOCKERS AND ACE INH.

1 YEAR = 50%, 2 YEARS =90%

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2
Q

DIAGNOSIS- DULL/SORE/SQUEEZING /PRESSURE-LIKE CHEST PAIN ONGOING/INTERMITTENT

TIP-SHARP/PIN-LIKE/LAST SECONDS PAIN AND CHANGES W/RESPIRATION,POSITION,TOUCH

A

ISCHEMIC HEART OR CAD

NON ISCHEMIC 95% OF THE TIME

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3
Q

DIAGNOSIS-CHEST PAIN W/CHEST WALL TENDERNESS

ACC. TEST-

A

CHOSTOCHONDIRITIS

PE

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4
Q

DIAGNOSIS-CHEST PAIN W/RADIATION TO BACK UNEQUAL BLOOD PRESSURE BETWEEN ARMS

ACC. TEST-

A

AORTIC DISSECTION

CHEST X-RAY WITH WIDENED MEDIASTINUM, CHEST CT, MRI, OR TEE CONFIRMS THE DIESEASE

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5
Q

DIAGNOSIS- PAIN WORSE WITH LYING FLAT BETTER WHEN SITTING UP, YOUNG <40

ACC. TEST-

A

PERICARDITIS

ELECTROCARDIOGRAM WITH ST ELEVATION EVERYWHERE, PR DEPRESSION

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6
Q

DIAGNOSIS- EPIGASTRIC DISCOMFORT PAIN BETTER WHEN EATING

ACC. TEST-

A

DOUDENAL ULCER

ENDOSCOPY

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7
Q

DIAGNOSIS- BAD TASTE, COUGH, HOARSENESS

ACC. TEST-

A

GERD

RESPONSE TO PPI, ALUMINUM HYDROXIDE AND MG OH, VISCOUS LIDOCAINE

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8
Q

DIAGNOSIS-COUGH, SPUTUM, HEMOPTYSIS

ACC. TEST-

A

PNEUMONIA

CXR

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9
Q

DIAGNOSIS-SUDDEN ONSET, SHORTNESS OF BREATH, TACHYCARDIA, HYPOXIA

ACC. TEST-

A

PULMONARY EMBOLUS

SPIRAL CT, V/Q SCAN

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10
Q

DIAGNOSIS- SHARP, PLEURITIC PIN, TRACHEAL DEVIATION

ACC. TEST-

A

PNEUMOTHORAX

CXR

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11
Q

INITIAL TEST- CHEST PAIN OFFICE SETTING DAYS TO WEEKS
INITIAL TEST-CHEST PAIN ER SETTING HOURS
INITIAL TEST- CHEST PAIN WITH EKG NORMAL
TIP- ETT TWO FACTORS TO PERFORM
TIP- MAXIMUM HR FOR EXERCISE AND MIN FOR CARDIO
TIP-ETT CANNOT READ EKG
TIP-EKG BASELINE CANNOT BE READ BECAUSE OF?

A

EKG

EKG THEN ENZYMES (TROPONIN, CK-MB)

STRESS TEST (ETT)

READ A EKG, PATIENT CAN EXERCISE

220-AGE, 85% IS MIN. FOR CARDIO

NUCLEAR ISOTOPE: THALLIUM OR SESTAMIBI, OR ECO OF WALL MOTION

BUNDLE BRANCH BLOCK, LEFT VENTRICULAR HYPERTORPHY, PACEMAKER USE, OR DIGOXIN USE

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12
Q 
TIP-HOW DOES THALLIUM TEST WORK?
TIP- ISCHEMIA VS INFARCTION
TIP-ETT CANNOT EXERCISE
INITIAL TEST- CHEST PAIN + POSITIVE EKG AND ENZYMES FOR CAD
TIP- PURPOSE OF ANGIOGRAPH
ACC. TEST- CAD
TIP- STENSOSIS 50% IS?
TIP-STENSOSIS >70% IS?
A

TAKEN UP LIKE K+ AND READ FOR WALL MOTION

INFARCTION IS IRREVERSABLE SLOW/NO WALL MOTION OF AREA SEEN ON THALLIUM TEST

DIPYRIDAMOLE OR ADENOSINE + NUC. ISOTOPES THALLIUM OR SESTAMIBI/ DOBUTAMINE + ECO WALL MOT. ABNORMALITIES

ANGIOGRAPHY

DETERMINE SURGERY OR ANIOPLASTY (PCI)

ANGIOGRAPHY

IRRELAVENT

RELAVENT

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13
Q

INITIAL TEST- IRREGULAR EKG BUT NOT ISCHEMIC OR CAD
INITIAL TREAT- CHRONIC CAD
IT/TIP- SUBLINGUAL, PASTE AND IV NITROGLYCERIN ARE FOR?

A

HOLTER

ASPIRIN, BETA BLOCKERS, NITROGLYCERIN

ACS

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14
Q

IT/TIP-CAD=CLOPIDOGREL IS USED IN?
IT/TIP- CAD=PRASUGREL WHEN TO USE AND SIDEFFECTS?
IT/TIP-CAD=TICLOPIDINE WHEN TO USE AND SIDE EFFECTS?
IT/TIP-CAD=RANOLAZINE WHEN TO USE AND SIDE EFFECTS?
IT/TIP- CAD/CHF=ACE INHIBITORS/ANGIOTENSIN RECEPTOR BLOCKERS USE AND SIDE EFFECTS?
IT/TIP- CAD/CHF=LOW EF ON ACE INHIBITOR WITH HYPERKALEMIA SWITCH TO?

A

ASPIRIN INTOLERANCE (ALLERGY) AND RECENT

ANGIOPLASTY WITH STENTING

ANDIOPLASTY AND STENTING, HEMORRHAGIC STROKE IN AGES 75 AND OLDER

ASPIRIN AND CLOPIDOGREL INTOLERANCE (ALLERGY), NEUTROPENIA AND TTP

IF ALL OTHERS FAIL

LOW EF AND REGURGITANT VALVULAR DISEASE, COUGH AND HYPERKALEMIA

HYDRALAZINE AND NITRATES

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15
Q

P. ASS.- CAD
IT/TIP-CAD=STATINS WHEN TO USE AND SIDE EFFECTS?
TIP-CAD= OTHER LIPID LOWERING DRUGS NOT PROVEN TO DECREASE MORTALITY ALONE BUT HELP STATINS MORE
TIP-CAD=NIACIN SIDE EFFECTS
TIP-CAD=FIBRATES SIDE EFFECTS

A

CHF, LIPID ATHEROSCLEROSIS, HYPERTENSION

HI LDL (ENDOTHELIAL ANTIOXIDANT), LIVER DYSFUNCTION>RHABDOMYOLYSIS AND RISK OF DIABETES 9%

NIACIN, GEMFIBROZIL, CHOLESTYRAMINE, EZETIMIBE

ELEVATION IN GLUCOSE AND URIC ACID LEVEL, PRURITUS, FLUSH

INCREASE STATIN SIDE EFFECTS IF USED TOGETHER + GALL STONES

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16
Q

TIP-CAD/HYPERTENSION= CALCIUM CHANNEL BLOCKERS
TIP-CAD/HYPERTENSION= TRUE OR FALSE DIHYDROPYRINDINE INCREASE MORTALITY
TIP-CAD/HYPERTENSION= DIHYDROPYRINDINE SIDE EFFECTS
TIP-CAD/HYPERTENSION=WHEN TO USE CCB
TIP-CAD/REVASCULARIZATION= WHEN TO TREAT WITH BY PASS (CABG)

A

DIHYDROPYRIDINE: NIFEDIPINE, NITENDIPINE,
NICARDIPINE AND NIMODIPINE

TRUE

REFLEX TACHYCARDIA, EDEMA, CONSTIPATION, HEART BLOCK

CANNOT USE BETA BLOCKERS-ASTHMA, PRINZMETAL VARIANT ANGINA, COCAINE USE

THREE VESSELS >70% OCL. LEFT MAIN OCL., TWO VESSELS >70% IN DIABETICS, RECURRENT EVENTS

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17
Q

TIP-CAD/REVASCULARIZATION= PCI WITH 5YR DURATION AND 10YR DURATION
DIAGNOSIS- CULL/SORE/SQUIIZING /PRESSURELIKE CHEST PAIN ACUTE (HOURS)
DIAGNOSIS-ACS=S4

A

SAPHENOUS AND INTERNAL MAMMARY

ACS

HYPERTENSION>DIABETES (IS WORSE)

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18
Q

DIAGNOSIS- >10MMHG SYSTOLIC DROP (DECREASE) WITH INHALATION
DIAGNOSIS-INCREASED JVD ON INHALATION
DIAGNOSIS-TRIPHASIC SCRATCHY SOUND ON AUSCULTATION
DIAGNOSIS- MAXIMAL IMPULSE DISPLACED TO AXILLA (PMI)

A

P.PARADOX=TAMPONADE

KUSSMAUL SIGN=CONSTRICTIVE PERICARDITIS OR RESTRICTIVE CARDIOMYOPATHY

PERICARDIAL FRICTION RUB (DRESSLER)

LVH OR DIALATED CARDIOMYOPATHY

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19
Q

P.ASS.- V2 TO V4 ST ELEVATION PROGNOSIS
P.ASS.- II, III, AND AVF LEADS ST ELEVATION
P.ASS.-V1-V2 ST ELEVATION
P.ASS.- RBBB

A

WORST PROGNOSIS LEFT ANTERIOR WALL (IF UNTREATED MORTALITY 30-40%)
LEFT INFERIOR WALL (IF UNTREATED MORTALITY 5%)
POSTERIOR WALL INFARCTION (READ OPPOSITE)
BENIGN COMPARED TO LEFT

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20
Q

INITIAL TREAT- ACS
INITIAL TREAT-PVC PREMATURE VENTRICULAR COMPLEXES OR FIRST DEG. AV BLOCK
IT/TIP- IN ACS THINK FIRST ________ THEN ___________ WITH TIME.

A

MONA-ASPIRIN THEN ANGIOPLASTY ONLY DECREASES MORTALITY WITH TIME CONSTRAINT

NOTHING

DOES IT LOWER MORTALITY THEN MOST IMPORTANT TO DO FIRST

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21
Q

INITIAL TEST- ACS IMMEDIATELY
INITIAL TEST-ACS 1-4 HOURS
INITIAL TEST- ACS 4-6 HRS AND WHAT LIMITATION???????REALLY
INITIAL TEST- ACS 4-6 HRS MORE ACC. AND WHAT TWO LIMITATIONS?????

A

EKG

MYOGLOBIN LASTS 1-2DAYS

CK-MB LASTS 1-2DAYS (CHECK FOR REINFARCT AFTER 2 DAYS)

TROPONIN LASTS 10-14DAYS (FALSE POSITIVE WITH KIDNEY INSUFFICIENCY AND CANNOT DETECT REINFARCT)

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22
Q

DIAGNOSIS- NORMAL ECG ONLY TROPONIN ELEVATED AND HX OF MI OR ANGINA
P.ASS.- MOST COMMON CAUSE OF DEATH WITH MI
INITIAL TREAT- VT OR VF
BEST TREAT- ACS =ANGIOPLASTY VS THROMBOLYTICS

A

NSTEMI

VT OR VF

CARDIOVERSION OR DEFIBRILLATION

ANGIOPLASTY

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23
Q

TIP-ACS= ANGIOPLASTY BETTER B.C.
TIP-ACS=ANGIOPLASTY DOOR TIME
P.ASS.- PCI COMPLICATIONS

A

MORTALITY BENEFIT, FEWER HEMORRHAGIC EVENTS, FEWER MI COMPLICATIONS

BALLOON= 90 MIN

RUPTURE, RESTENOSIS (THROMB.), HEMATOMA AT ENTRY

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24
Q

TIP- MOST IMPORTANT TO DECREASE RESTENOSIS IN PCI
TIP- V&W ANTI-THROMBI
TIP- 4 CONTRAINDICATION FOR THROMBOLITIC TREATMENT IN ACS
TIP- THROMBOLIC ASC DOOR TIME

A

DRUG ELUTING STENT (PACLITAXEL AND SIROLIMUS)
DECREASE FROM 40 TO 10%

VIENS ANTI THROMBI IS WARFARIN

BLEEDING, RECENT SURGERY(2 WKS), SEVER HYPERTENSION, STROKE IN LAST 6 MONTHS

NEEDLE = 30MIN

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25
Q

INITIAL TREAT- AFTER ACS THROMBOLICS, ST DEPRESSION OR NSTEMI/ANGINA
INITIAL TREAT- AFTER ACS NSTEMI AND PCI AND STENTING

A

HEPARIN (DECREASES MORTALITY UNDER THESE EVENTS)

GII/III INHIBITORS

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26
Q

P.ASS.- BRADYCARDIA, CANON A WAVES

P.ASS. COMPLICATION: BRADYCARDIA (SINUS), HYPOTENSION WITH NITROGLYCERIN

A

3RD DEG. AV BLOCK

RIGHT VENTRICAL MI

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27
Q

INITIAL TREAT- BRADYCARDIA
P.ASS.- COMPLICATION: TACHYCARDIA, CLEAR LUNGS, ST ELEVATION AS RIGHT (FLIP EKG) RV4
INITIAL TREAT- INFERIOR WALL MI
P.ASS.- COMPLICATION: DAYS AFTER MI, SUDDEN LOSS OF PULSE, LUNGS CLEAR

A

ATROPINE AND PACEMAKER CHRONIC

NEW INFERIOR WALL MI

HIGH VOL. FLUID REPLACEMENT, AVOID NITROGLYCERIN (WORSEN CARDIAC FILLING

FREE WALL RUPTURE AND TAMPONADE

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28
Q

INITIAL TEST- FREE WALL RUPTURE AND TAMPONADE
INITIAL TREAT- TAMPONADE
P.ASS.- COMPLICATION V TACHYCARDIA OR V FIBRILLATION
INITIAL TREAT- VTACH OR VFIB

A

ECHO

PERICARDIOCENTESIS AND SURGERY

MI

CARDIOVERION/ DEFIB

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29
Q

P.ASS.- NAME 6 MI COMPLICATION

ACC. TEST- VALVE/SEPTAL RUPTURE

A

BRADY/TACHYCARDIA, WALL RUPTURE/TAMP, VTACH/FIB, VALVE/SEPTAL RUPTURE, BIGGER INFARCT/REINFARCTION, ANEURYSM/MURAL THROMBUS

ECHO

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30
Q

DIAGNOSIS- POST MI STEP UP SATURATION OF O2 FROM R. ATRIUM TO R. VENTRICAL
DIAGNOSIS- POST MI PULMONARY CONG. AND MITRAL REGURG. MURMUR
INITIAL TREAT- POST MI STRUCTURE COMPLICATION PENDING TO BE FIXED SURGERY

A

SEPTAL RUPTURE

VALVE RUPTURE

INTRAAORTIC BALLOON PUMP IABP

31
Q

DIAGNOSIS- POST MI BUMPUP IN CK-MBS ON DAY 2 + PULMONARY EDEMA

INITIAL TEST-

A

REINFARCT

EKG + CK-MB BUMP UP

32
Q

TIP- MI DISCHARGE MUST DO?
BEST TREAT- GO HOME POST MI
TIP- NEVER A PROPHYLACTIC IN MI
IT/TIP- BETA BLOCKER SIDE EFFECT?

A

DETECTION OF PERSISTENT ISCHEMIA=STRESS TEST, IF (+) NEW ANGIOGRAGHY

ASPIRIN, BETA BLOCKERS, STATINS, ACE INHIBITORS( ANTERIOR WALL MI/ LOW EF)

ANTIARRHYTHMIC

ERECTILE DISFUNCTION

33
Q

TIP- HOW LONG BEFORE POST MI SEX?

TIP- HOW LONG BEFORE POST MI EXERCISE?

A

WHEN SYMPTOM FREE (SEX DOES NOT LAST ENOUGH TO INCREASE OXYGEN DEMAND ON HEART)

WHEN SYMPTOM FREE (STRESS TEST MUST BE TOLERATED)

34
Q

DIAGNOSIS 2 OF 2- DYSPNEA/PULMONARY EDEMA, S3, HX OF CARDIOMYOPATH(HYPERTENSION)/MI/VALVE DISEASE

A

CHF

35
Q

TIP- MOST COMMON CAUSES OF CHF?
TIP- OTHER CAUSES OF CHF- TRACT PHAP
TIP- TYPES OF CHF AND KEY FEATURES

A

CARDIOMYOPATHY(HYPERTENSION)/MI/VALVE DISEASE

THIROID, RADIATION, ALCOHOL, CHAGAS, THIAMINE– PERIPARTUM, HEMOCHROMATOSIS ADRIAMYACIN, POST VIRAL

SYSTOLIC DYSFUNCTION AND EVENTUAL LOW EF, DIASTOLIC DYSFUNCTION AND INABILITY TO RELAX/ HIGH TO NORMAL EF

36
Q

DIAGNOSIS 1 OF 2- ORTHOPNEA, PAROXYSMAL NOCTURNAL DYSPNEA, S3 GALLOP, PERIPHERAL EDEMA*, RALES, JVD
DIAGNOSIS- DYSPNEA, SUDDEN ONSET, CLEAR LUNGS
DIAGNOSIS- DYSPNEA, SUDDEN ONSET, WHEEZING, INCREASED EXPIRATORY PHASE
DIAGNOSIS- DYSPNEA, SLOWER, FEVER, SPUTUM, UNILATERAL, RALES/RHONCHI

A

CHF
PULMONARY EMBOLUS
ASTHMA
PNEUMONIA

37
Q

DIAGNOSIS-DYSPNEA, DECREASED BREATH SOUNDS UNILATERALLY, TRACHIAL DEVIATION
DIAGNOSIS-DYSPNEA, CIRCUMORAL NUMBNESS ECAFFEINE USE, HISTORY OF ANXIETY
DIAGNOSIS-DYSPNEA, PALLOR GRADUAL OVER DAYS TO WEEKS
DIAGNOSIS-DYSPNEA,PULSUS PARADOXUX, DECREASED HEART SOUNDS, JVD

A

PHEUMOTHORAX

PANIC ATTACK

ANEMIA

TAMPONADE

38
Q

DIAGNOSIS-DYSPNEA,PALPIATIONS, SYNCOPE
DIAGNOSIS- DYSPNEA,DULLNESS TO PERCUSSION AT BASES
DIAGNOSIS- DYSPNEA,LONG SOMOKING HISTORY, BERREL CHEST
DIAGNOSIS- DYSPNEA, RECENT ANESTHETIC USE, BROWN BLOOD NOT IMPROVED WITH OXYGEN, CLEAR LUNGS ON AUSCULTAITION, CYANOSIS

A

ARRHYTHMIAS

PLEURAL EFFUSION

COPD

METHEMOGLOBINEMIA

39
Q

DIAGNOSIS- DYSPNEA, BURNING BUILDING OR CAR, WOOD BURNING IN WINTER, SUICIDE ATTEMPT
TIP- THREE SYMPTOMS + DYSPNEA THAT EQUAL CHF

A

CO POISION

S3, ORTHOPNEA, PND

40
Q

INITIAL TEST- CHF

ACC. TEST- CHF

A

TRANSTHORACIC ECHO + EF

MULTIPLE GATED ACQUISITION SCAN (MUGA) OR NUCLEAR VENTRICULOGRAPHY

41
Q

ACC. TEST- VALVE PATHOLOGY
INITIAL TEST- CHEMO/ CONTROL OF DOXORUBICIN FOR CARDIOMYAPATHY
INITIAL TEST- CHF CAUSE WITH MI, HEART BLOCK
INITIAL TEST- CHF CAUSE WITH DILATED CARDIOMYOPATHY

A

TEE
VENTRICULOGRAPHY
EKG
CHEST X-RAY

42
Q

INITIAL TEST- CHF CAUSE WITH PAROXYSMAL ARRHYTHMIAS
INITIAL TEST- CHF CAUSE WITH PERCISE VALVE DIAMETERS, SEPTAL DEFECTS
INITIAL TEST- CHF CAUSE WITH ANEMIA
INITIAL TEST CHF CAUSE WITH HIGH AND LOW THYROID LEVELS

A

HOLTER
CARDIAC CATHETERIZATION
CBC
TST/T4

43
Q

INITIAL TEST- CHF CAUSE WITH EXCLUDES INFILTRATIVE DISEASE SUCH AS SARCOID OR AMYLOID WHEN OTHER SITES FOR BIOPSY IS MOST ACCURATE TEST FOR SOME INFECTIONS

INITIAL TEST- CHF CAUSE WITH DISTINGUISHES FROM ARDS

A

ENDOMYOCARDIAL BIOPSY

SWAN-GANZ RIGHT HEART CATH

44
Q

INITIAL TREAT- 5 TYPES OF PHARM FOR LOW EF CHF
INITIAL TREAT- 3 TYPES OF PROCEEDURE TREATMENT FOR CHF
INITIAL TREAT- CHF DIASTOLIC DYSFUNCTION NORMAL/HIGH EF NON-HOCM
INITIAL TREAT- CHF DIASTOLIC DYSFUNCTION NORMAL/HIGH EF HOCM

A

ACE INH., BETA BLOCKERS(ONLY METROPOLOL,BISOPROLOL, CARVEDILOL), SPIRANOLACTONE (ONLY CHF III/IV NON-DIURETIC EFFECT), DIURETICS (LOOPS), DIGOXIN (ONLY HELPS WITH SYMPTOMS)

IMPLANTABLE DEFIBRILLATOR (EF

45
Q

DIAGNOSIS- DYSPNEA+RALES,JVD,S3,EDEMA ORTHOPNEA, ACITES

A

P.EDEMA FULL CHF

46
Q

INITIAL TEST- P. EDEMA

INITIAL TREAT- ACUTE P.EDEMA/ TEMP. AND SEC. CHOICE FOR ACUTE/ CHRONIC P.EDEMA ADD?

A

BNP,CXR,OXIMETRY, EKG,ECHO

PRELOAD REDUCTION: (O2,DIURETIC,MORPHINE, NITRATES)/ INOTROPE: DOBUTAMINE/ AFTERLOAD RED.: ACE INH

47
Q

TIP- MURMURS: INCREASE LOUDNESS WITH INSPIRATION/CVR
TIP-MURMURS: INCREASE LOUDNESS WITH EXPIRATION/
INITIAL TEST- VALVE DIESEASE
ACC. TEST-VALVE DIESEASE

A

RIGHT SIDE OF HEART VALVES

LEFT SIDE OF HEART VALVES

TTE(LESS ACC) THEN TEE (TRANSESOPHAGEAL ECHO)

CATHETERIZATION

48
Q

INITIAL TREAT- VALVE DIESEASE
TIP- INCREASE LOUDNESS LEAN FORWARD OR LEFT DECUBITUS POSSITION (WITH BELL)
TIP- HOLOSYSTOLIC MURMUR RADIATS TO AXILA
TIP-IF END-SYSTOLIC DIAMETER EXPANDS? >40MM

A

DIURETICS (ALL CAUSE LUNG FLUID OVERLOAD), STENOSIS=NO PHARM(BALLOON (MS), SURGICAL(AS)),REGURG:VASODILATOR(ACE INH, NIFEDIPINE,HYDRALAZINE)+SURG.

DIASTOLIC MURMUR

MITRAL REGURGITATION

REPLACE REGURG VALVE

49
Q

TIP-COMMON ETIOLOGY OF MITRAL STENOSIS AND 1 OTHER/ COMMON AGE
TIP-MS CRITICAL NARROWING IS VALVE AREA OF?
P.ASS.-DYSPHAGIA, HOARSENESS, ATRIAL FIBRILLATION, HEMOPTYSIS,EKG(V1,2): BIPHASIC P WAVE
TIP- NAME AND DESCRIBE TWO DIASTOLIC MURMURS AND CHARACTORISTIC

A

RHEUMATIC FEVER, PREGNANCY INDUCED CARDIOMYOPATHY/ YOUNG ADULT IMMIGRANT PATIENTS

1CM SQUARD

MS

MS/AR, OPEN SNAP/DECRESIENDO, HEARD BEST ON APPEX/HEARD BEST ON LOWER LEFT STERNAL B. AND INC. WITH HANDGRIP AND BETTER WITH VALSAVA AND STANDING

50
Q

P.ASS.-CXR STRAIGHTENING OF THE LEFT HEART BORDER,ELEVATION OF THE LEFT MAIN STEM BRONCHUS,SECOND BUBBLE BEHID HEART
P.ASS.-ANGINA,SYNCOPE,CHF, OLD OR CONGENITAL
TIP- DESCRIBE AS MURMUR

A

MS

AS

HEARD BEST SECOND R. INTERCOSTAL AND RATIATES TO CAROTID, (VALSAVA, HANDGRIP AND STANDING IMPROVE)

51
Q

P.ASS.- CXR RIGHT VENTRICULAR HYPERTROPHY, EKG: S WAVE IN V1 AND R WAVE IN V5 >35MM
TIP- COMMON ETIOLOGY OF MITRAL REGURG
TIP-DESCRIBE MR MURMUR
TIP- MURMUR INCREASES WITH HANDGRIP

A

AS

HYPERTENSION, MI OR DILATED HEART(CHF
SYSTOLIC DYSFUNCTION), ENDOCARDITIS

PAN/HOLOSYSTOLIC, RADIATES TO AXILLA HANDGRIP WORSENS

AR AND MR

52
Q

TIP- LEFT MURMUR THAT DOES NOT INCREASE WITH EXPIRATION

INITIAL TREAT- MR LVESD ABOVE 40MM OR EF

A

MVP OR HOCM

SURGICAL VALVE REPAIR OR REPLACMENT

AR

53
Q

DIAGNOSIS- WIDE PULSE PRESSURE, WATER HUMMER PULSE, QUINCKE PULSE,HILL SIGN, HEAD BOBBING

A

AR

54
Q

TIP- DESCRIBE AR MURMUR

TIP- 2-5% HAVE WHAT ANATOMICAL VALVE?

A

DIASTOLIC DECRESIENDO MURMUR, HEARD BEST LOWER LEFT STERNAL BOARDER, INCREASES WITH HANDGRIP

MVP

55
Q

DIAGNOSIS- CHEST PAIN, PALPITATIONS, PANIC ATTACK, MURMUR: MIDSISTOLIC CLICK
TIP- WHAT INCREASES AND DECREASES MVP SOUND?

A

MVP

VALSALVA AND STANDING (DECREASE RETURN) AND HANDGRIP AND SQUAT (INCREASE PRE AND AFTERLOAD)

56
Q

DIAGNOSIS- DYSPNEA, EDEMA, RALES, JVD,
INITIAL TEST- CARDIOMYOPATHY
INITIAL TREAT- CARDIOYOPATHY
TIP- MURMURS THAT DO NOT INCREASE WITH EXPIRATION/MORE BLOOD

A

CARDIOMYOPATHY

TTE(LESS ACC) THEN TEE (TRANSESOPHAGEAL ECHO)

DIURETICS NEVER WITH HOCM

HOCM AND MVP

57
Q

P.ASS.- ALCOHOL, POSTVIRAL,TADIATION, TOXINS, CHAGAS

INITIAL TREAT- DILATED CARDIOMYOPATHY

A

DILATED CARDIOMYOPATHY

SAME AS SYSTOLIC DYSFUNCTION CHF

58
Q

DIAGNOSIS- YOUNG CHEST PAIN WITH EXERCISE, INC. HR, DEC. LEFT VENT. CHAMBER SIZE, LIKE AS

TIP- WHAT DECREASES LEFT VENTRICULAR CHAMBER SIZE?

A

HOCM

ACEI, ARB, DIGOXIN, HYDRALAZINE, VALSALVA, AND STANDING SUDDENLY

59
Q

DIAGNOSIS- HYPERTENSION, S4 GALLOP, NO R. CHF SIGNS

A

HCM

60
Q

INITIAL TREAT- HOCM OR HCM
INITIAL TREAT- HOCM SPECIFIC
TIP- PHARM QUANTITY FOR DILATED VS HYPERTROPHY CARDIOMYOPATHY
TIP- ETIOLOGY OF RESTRICTIVE CARDIOMYOPATHY?

A

BETA BLOCKERS, NEG. INOTROPS, NEVER DIURETICS IN HOCM
IMPLANT DEFIB AND ABLATION OF SEPTUM W/ CATH ALCOHOL INDUCED INFARCT OR MYOMECTOMY
5 VS 2
INFILTRATED MUSCLE CAUSES BOTH EFFECTS OF DILATED AND HYPERTROPHIED HEART DUE TO IMMOBILITY.

61
Q

P.ASS.- SARCOIDOSIS, AMYLOID, HEMOCHROMATOSIS, ENDOMYOCARDIAL FIBROSIS, SCLERODERMA, EKG:LOW VOLTAGE
DIAGNOSIS- DYSPNEA + R.CHF SIGNS, KUSSMAUL SIGN, PULMONARY HYPERTENSION

A

RESTRICTIVE CARDIOMYOPATHY

RESTRICTIVE CARDIOMYOPATHY

62
Q

TIP- WHAT IS KUSSMAUL SIGN?

INITIAL TEST- RESTRICTIVE CARDIOMYOPATHY

A

INSPIRATION INCREASES JVD

TTE(LESS ACC) THEN TEE (TRANSESOPHAGEAL ECHO)

63
Q

TIP- ECHO SPECKLING SEPTUM
ACC. TEST- RESTRICTIVE CARDIOMYOPATHY
TIP-STANDING AND VALSALVA

A

RESTRICTIVE CARDIOMYOPATHY

ENDOMYOCARDIAL BIOPSY

DECREASE BLOOD RETURN TO HEART

64
Q

TIP- TRUE OR FALSE? STANDING AND VALSAVA = DIURETIC USE
TIP- TRUE OR FALES? HANDGRIP = FULLER LEFT VENTRICLE
TIP- TRUE OR FALSE? AMYL NITRATE=ACEi= EMPTIER LEFT VENTRICLE
TIP-REGURG VALVE SOUNDS BEST FULLER AND ALL REST SOUND BEST EMPTY (L.VENTRICAL)
TIP-PERICARDIAL DISEASE: CHRONIC FLUID LEADS TO FIBROSIS/CALCIFICATION= CONSTRICTIVE PERICARDITIS
TIP-PERICARDIAL DISEASE: ACUTE LOTS OF FLUID LEADS TO TAMPONADE

A

TRUE

65
Q

DIAGNOSIS- SHARP PAIN INCREASED INTENSITY WITH RESPIRATION AND POSITION(FLAT), EKG: ST ELEVATION AND PR DEPRESSION

A

PERICARDITIS

66
Q

TIP- ETIOLOGY OF PERICARDITIS
TIP- AMOUNT OF FLUID IN TAMPONADE
INITIAL TEST- CARDIAC TAMPONADE

A

ANY INFLAMATION NEAR THE HEART: MAINLY VIRAL OR SYSTEMIC DISEASE

50ML TO 2000ML

ECHO

67
Q

DIAGNOSIS- EKG: ELECTRICAL ALTERNANS( DIFF. HIGHT QRS),CXR:GLOBULAR HEART,COLLAPSE DIASTOLIC R. ATRIAL AND VENT
DIAGNOSIS- R. HEART CATHETER: EQUALIZATION OF PRESSURES IN DIASTOLE

A

TAMPONADE

TAMPONADE

68
Q

INITIAL TREAT- TAMPONADE

A

PERICARDIOCENTESIS, IV FLUIDS AND WINDOW

69
Q

DIAGNOSIS- R. HEART FAILURE SIGNS +CHRONIC INFLAMATORY DISEASE

P.ASS.- KNOCK HEART SOUND AND KUSSMAUL SIGN

INITIAL TEST-
ACC. TEST-
INITIAL TREAT-

A

CONSTRICTIVE PERICARDITIS

CONSTRICTIVE PERICARDITIS

CXR-SHOWS CALCIFICATION FIRST THEN CT/MRI THEN ECHO (TO RULE OUT MYOPATHY)

CT AND MRI

DIURETICS THEN SURGICAL REMOVAL

70
Q

DIAGNOSIS- LEG PAIN IN CALVES ON EXERTION, LOSS:HAIR FOLLICLES, SWEAT GLANDS, SEBACEOUS GLANDS, SKIN SHINY

TIP- PAIN WHEN WALKING UP HILL OR DOWN
INITIAL TEST-
INITIAL TREAT-

A

PAD PERIPHERAL ARTERY DISEASE

PAD PERIPHERAL ARTERY DISEASE

ANKLE-BRACHIAL INDEX (ABI) LESS THAN .90 IS + FOR DISEASE

CONTROL CAUSE, ASPIRIN, STOP SMOKING, CILOSTAZOL THEN SURGERY IF ALL FAILS

71
Q

DIAGNOSIS-PAIN IN BETWEEN SCAPULAE AND BP DIFF. BETWEEN ARMS

INITIAL TEST- AORTIC DISSECTION
ACC. TEST- AORTIC DISSECTION
INITIAL TREAT- AORTIC DISSECTION

A

AORTIC DISSECTION

CXR- WIDE MEDIASINUM

ANGIOGRAM

CONTROL BP: BETA BLOCKERS, NITROPRUSSIDE, SURGICAL CORRECTION

TIP- ACCURACY IS MRA=CTA=TEE

72
Q

DIAGNOSIS- BACK PAIN, PULSADING ABDOMIN

A

AORTIC ANEURYSM

73
Q

TIP- SCREENING TEST FOR AORTIC ANEURISM AND WHO
TIP- WHEN TO SURGICALLY/CATHETER REPAIR AORTIC ANEURYSM?
TIP- WORST CARDIAC DISEASE IN PREGNANT WOMEN AND TREAT

A

ULTRASOUND AND SMOKERS OVER 65YEARS

OVER 5CM IN DIAMETER

PERIPARTUM CARDIOMYOPATHY TX: LIKE DILATED CHF, THEN EISENMENGER SX. FROM VSD

USMLE Step 2 CK (9 decks)

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