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USMLE Step 2 > Cardiology > Flashcards

Cardiology Flashcards

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USMLE® Step 1 flashcards
1
Q

What is first indicator for hypovolemia?

A

Pulse

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2
Q

What is caused by tachyarrhythmia

A

Tachycardia-mediated cardiopathy

  • Chronic tachy –> LV dilation & myocardial dysfunction
  • Palpitations and/or CHF
  • Tx: rate or rhythm control
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3
Q

How do I diagnose tachycardia-mediated cardiomyopathy?

A

EKG, echo

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4
Q

What is the MCC of LE edema?

A

Venous insufficiency

- Causes venous HTN

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5
Q

What diseases do you see pulsus paradoxus in?

A

Tamponade, COPD, asthma, pericarditis, croup

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6
Q

What murmurs can Marfan’s have?

A

MVP and aortic regurg

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7
Q

What occurs 5 days - 3 months after MI with persistent ST elevation after MI and deep q waves in same lead?

A

Ventricular aneurysms

  • progressive LV enlargement –> HF, arrhythmia, mural thrombosis, miral regurg
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8
Q

What causes premature atrial complexes?

A

Activation of atria from site other than SA

  • Benign
  • Can cause skipped beats
  • Eliminate etoh, alcohol, caffeine, stress
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9
Q

What do you think of with BUN >60?

A

Uremic pericarditis

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10
Q

How do you treat uremic pericarditis?

A

Hemodialysis

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11
Q

What is MC location of ectopic foci that cause Afib?

A

Pulmonary veins

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12
Q

How do you treat Afib with RVR

A

Beta blockers, dilitazem, digoxin

Rhythm control for those with recurrent episodes

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13
Q

What artery is affected with inferior wall MI?

A

RCA

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14
Q

What causes flash pulmonary edema?

A

Secondary to Acute MI

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15
Q

Tx for flash pulm edema

A

loop diuretic (not if hypovolemic)

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16
Q

What is most frequent arrhythmia causing Sudden cardiac arrest?

A

Vfib

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17
Q

What is wide complex tachycardia with 2 fusion beats?

A

Sustained monomorphic ventricular tachycardia

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18
Q

Risk factors for SMVT

A

CAD, left ventricular systolic dysfunction

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19
Q

Tx for SMVT?

A

Amiodarone

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20
Q

What to think of if right heart strain seen as RBBB on EKG + hypotension?

A

PE

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21
Q

Mixed venous O2 sat in septic shock?

A

High

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22
Q

What to do if lone afib (one episode)?

A

No treatment

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23
Q

What to do if right ventricular MI?

A

High flow IVF (if hypotensive)

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24
Q

What causes N/V, dec appetite, confusion, weakness?

A

Digoxin toxicity

  • can have scotoma and blurry vision
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25
Q

What increases digoxin toxicity?

A

Hypokalemia

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26
Q

What causes PVT?

A

Re-entry into AV node

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27
Q

Tx for PVT?

A

Cold water immersion, carotid sinus massage, valsalva, inc vagal tone , dec conduction through AV node

  • Adenosine
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28
Q

Who generally gets PVT?

A

PPl w/ no strctural heart disease

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29
Q

Tx for WPW?

A

Unstable: cardiovert
Stable: IV ibutilide or procainamide

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30
Q

What causes stent thrombosis?

A

Premature d/c of antiplatelet therapy

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31
Q

What is key for prerenal azotemia?

A

BUN/Cr >20

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32
Q

Indications for carotid endardectomy?

A

symtpomatic 70-99% stenosis

Asymptomatic 60-99%

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33
Q

Which antiarrhythmics have use dependence?

A

Class IC: flecainide and propafone?

  • Fast HR → less time to dissociate → higher # blocked Na channels → dec impulse conduction → widening of QRS complex
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34
Q

Causes of aortic aneurysms?

A

Ascending: cystic medial necrosis
Descending: atherosclerosis

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35
Q

Young women with random chest pain, worse at night, smoker

A

Prinzmetal angina

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36
Q

What is prinzmetal aw/

A

Raynauds

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37
Q

Tx for prinzmetal?

A

CCB or nitrates

38
Q

What to do if large STEMI at risk for LV thrombus and anteroapical aeurysm formatioN?

A
  • Use TTE to asesss

- Immediate anticaog (risk for embolization)

39
Q

How does NE induced vasospasm work?

A

If dec bloof flow in patient, NE can cause vasoconstriction resulting in ischemia and necrosis of distal fingers & toes

40
Q

What is a common complication of CABG?

A

Afib

41
Q

What pw/ strong peripheral artieral pulse (brisk carotid upstroke), systolic flow murmur, flushed extremities, left ventricular hypertrophy?

A

AVF

  • shunting dec SVR, inc preload and output
42
Q

What is dressler?

A

Malaise, fever, inc ESR, autoimmune

43
Q

Tx for dressler

A

NSAIDs

44
Q

Tx for pulseless electrical activity ?

A

CPR + vasopressor

45
Q

Tx for PAD

A

Aspirin + statin + exercise

46
Q

BNP level in CHF?

A

> 100

47
Q

What lab abnormality parallels severity of HF?

A

Hyponatremia

48
Q

Disease?

Blue toe syndrome, livedo reticualris, bright yellow plaques in retinal artery (hollenhorst plaques) after cardiac cath

A

Cholesterol embolism

Tx: supportive
- can go to brain, intestine, pancreas, kidneys

49
Q

Dx?
Hepatomegaly, kussmaul, ascites, inc JVP, X&Y descents, hepatojugular reflex, pericardial knock, pericardial calcifications?

A

Constrictive pericarditis

50
Q

What cause constrictive pericarditis?

A

Radiation, TB

51
Q

Tx for constrictive pericarditis

A

Diuretics temporarily, pericardiectomy

52
Q

Medication that causes bradycardia, AV block, hypotension, diffuse wheezing?

A

Beta blockers

53
Q

Physiology behind MI w/ papillary muscle displacement?

A

Leads to MR → excessive diastolic volume overload → elevated LVEDP → reflected back in left atrium and pulm circulation → CHF & pulm edema

54
Q

What is a known complication of AAA?

A

Bowel ischemia
- from inadequate colonic collateral arterial perfusion to left and sigmoid colon after loss of IMA

  • Fever & leukocystosis
55
Q

How to Dx for bowel ischemia?

A

Abdominal US

56
Q

All patients with systemic HTN should be evaluated for?

A

Coarctation of aorta

57
Q

What is a reversible cause of restrictive cardiomyopathy?

A

Hemochromatosis

58
Q

What pw/ dyspnea, epigastric pain, N/V?

A

Atypical ACS

59
Q

What drug increases digoxin levels?

A

Amiodarone, verapamil, quinidine

60
Q

Dx?
CXR: enlarged, water bottle shaped cardiac silhouette

Diminished heart sounds, nonpalpable apical impulse

A

Pericardial effusion

61
Q

What do you see a dual upstroke to midsystolic obstruction during contraction?

A

HCM

62
Q

Tx for HCM?

A

Beta blockers

63
Q

Murmur in aortic dissection?

A

Aortic regurg: descrescendo diastolic murmur

64
Q

MC risk factor for aortic dissection?

A

HTN

65
Q

Dx for aortic dissection?

A

urgent TEE

66
Q

Tx for aortic dissection?

A

IV labetalol

67
Q

Tx for type A vs B aortic dissection?

A

A: surgery
B: medically

68
Q

What tx for left ventricular systolic dysfunction?

A

Beta blockers, ACE/ARB, spironolactone

African Americans: also hydralazine and nitrates

69
Q

What is resistant HTN?

A

Persistent despite >3 antihypertensive

70
Q

What disease to think ofwith resistant HTN?

A

Renal artery stenosis

Will hear abdominal bruits

71
Q

How do nitrates cause anti-ischemic effect?

A

Systemic vasodilation & dec in cardial preload –> less wall stress on left ventricular wall

72
Q

Most effect non-med way to dec BP?

A

Weight loss

73
Q

What is malignant HTN?

A

Severe HTN with retinal hemorrhages, exudates, papilledema

74
Q

What has alternating amplitude of QRS complex/

A

Electrical alternans - pericarditis

75
Q

What bug if endocarditis and nosocomial UTI?

A

Enterococci

76
Q

Periodontal infection + endocarditis. What bug?

A

Eikenella

77
Q

Endocarditis + round lesions in peripheral lung fields?

A

Septic emboli from valvular vegetations

78
Q

Holosystolic murmur that inc with inspiration in endocarditis?

A

Tricuspid regurg in IVDU

79
Q

Cause of new conduction abnormality in patients with endocarditis?

A

Perivalvular abscess

80
Q

IVDU + HIV. What do you think?

A

Endocarditis. HIV increases risk.

  • May not have tricuspid murmur
  • Septic pulm emboli
  • caused by S. aureus
81
Q

How do dx endocarditis?

A

Serial blood culture (3 from 3 venipuncture sites)

82
Q

Tx for s. aueus endocarditis?

A

Empiric vanc

83
Q

Tx for HACEK endocarditis?

A

Ampicillin- sulbactam

84
Q

Tx for viridans endocarditis?

A

PCN G or ceftriaxone IV

85
Q

What causes S4 gallop during acute phase of MI?

A

L ventricular wal stiffening and dysfunction

86
Q

What has fibrillatory waves and absence of QRS?

A

Vfib

87
Q

Tx for Vfib?

A

Early defib until CPR ongoing then antiarrhythmic

88
Q

Harsh crescendo descresendo murmur at LLSB

A

HCM

89
Q

MCC of isolated aortic regurg in young adults?

A

Bicuspid aortic valve

90
Q

What has “pounding heart”, widened pulse pressure?

A

Aortic regurg

91
Q

Early diastolic murmur that is high pitched and sustained or descrendo

A

Aortic regurg

USMLE Step 2 (5 decks)

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