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usmle step 3 > cardiology > Flashcards

cardiology Flashcards

1
Q

VSD - murmur?

A

holosystolic murmur w/palpable thrill

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2
Q

sign of coarctation of aorta on exam?

A

brachial-to-femoral ulse delay

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3
Q

PDA - exam finding?

A

continuous murmur in L infraclavicular area

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4
Q

most common cyanotic congenital heart defect?

A

tetralogy of fallot

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5
Q

characteristic anomalies of tetralogy of fallot?

A
  • RV outflow obstruction
  • overriding aorta
  • RV hypertrophy
  • VSD
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6
Q

what defect causes wide, fixed S2 split?

A
  • ASD

- large R-to-L shunts (ASD, ventricular defect, PDA)

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7
Q

newborn decompensates after PDA closes - dx?

A

hypoplastic LV

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8
Q

Ebstein anomaly - what causes it?

A

Lithium during pregnancy

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9
Q

Ebstain anomaly - what is it?

A

atrialized RV (presents w/tricuspid regurg + cyanosis)

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10
Q

fetal hypertrophic cardiomyopathy - caused by what?

A

maternal hyperglycemia (deposits of glycogen in myocardium)

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11
Q

TIMI score - variables?

A

1 point for each

  • age >= 65
  • > = 3 risk factors for CAD
  • known CAD w/ >50% stenosis
  • use of ASA in past 7d
  • > = 2 anginal episodes in past 24 hours
  • elevated cardiac biomarkers
  • ST segment deviation >0.5 mm on admission EKG
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12
Q

TIMI low risk 0-2 - next step?

A

stress test

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13
Q

TIMI intermediate (3-4) or high risk (5-7) - next step?

A

early coronary angio (w/in 24h)

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14
Q

indications for immediate coronary angio?

A
  • HD instability
  • HF or new MR
  • recurrent CP
  • ventricular arrhythmia
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15
Q

mitral stenosis murmur

A

diastolic low pitched rumble

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16
Q

manuever to bring out mitral stenosis?

A

exhale, lay in left lateral decub

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17
Q

EKG findings diagnostic of STEMI?

A
  • new ST elevation at the J point in >= 2 natomically contiguous leads w/threshold:
  • – >1mm in all leads except V2/V3
  • –>= 1.5mm in women, >=2mm in men in leads V2/V3
  • NEW LBBB w/clinical presentation of ACS
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18
Q

acute pericarditis - EKG findings?

A
  • diffuse ST elevation

- PR depression

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19
Q

coronary revascularization is indicated for who?

A
  1. pts w/refractory angina despite max medical tx
  2. pts in whom revasc will improve long term survival
    - – those w/LM coronary stenosis
    - – those w/multivessel CAD (Esp prox LAD) and w/LV systolic dysfunction
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20
Q

what is ranolazine?

A

anti-anginal agent

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21
Q

pt develops cardiogenic shock after STEMI and tx w/nitro + morphine - where is MI?

A

right ventricle

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22
Q

what to do w/pt w/acute inferior MI and RV systolic failure + hypotension?

A

bolus with IVF if JVP is normal/low

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23
Q

which type of MI can cause transient bradycardia or AV block 2/2 increased vagal tone?

A

inferior MI

24
Q

which medication decreases vagal tone?

25
after which type of MI might you need to use an intra-aortic balloon pump?
LV dysfunction (LAD, LCx)
26
RVMI w/persistent hypotension despite fluid resuscitation - what do you use?
- dopamine (1st choice) | - dobutamine (@nd choice 2/2 lowering of peripheral vascular resistance)
27
indications for ICD for primary prevention (5)
- fam hx of sudden cardiac death - syncope (recurrent or assoc w/exertion) - nonsustained VT on Holter - hypoT BP response to exercise - extreme LVH (>3cm septal wall thickness)
28
indications for ICD for secondary prevention (2)?
- survivors of cardiac arrest | - sustained spontaneous ventricular arrhythmias
29
when perform alcohol septal ablation?
pts w/symptoms of HCM refractory to medical therapy
30
what things can impair conduction across AV node?
- ischemia - electrolyte abnrmality - medications - infiltrative dz - age-related fibrosis
31
mobitz type 1 - what happens w/PR?
progressively prolongs, then drop beats
32
mobitz type 2 - what happens with PR?
normal PR, intermittently drop beats
33
mobitz type 1 and 2 - which has higher rate of progression to CHB?
type 2
34
sign of pHTN on exam?
- L para-sternal lift, RV heave - loud P2, r-sided S3 - tricuspid regurg - JVD, ascites, peripheral edema, hepatomegaly
35
5 groups of pHTN
1) pulmonary arterial htn 2) 2/2 L-sided heart dz 3) 2/2 chronic lung dz 4) 2/2 chronic PE 5) 2/2 other (sarcoid, MCTD)
36
diagnostic criteria for pHTN?
RHC w/mean pulm aterial pressure >25mmHg
37
How rule out pHTN 2/2 L heart failure?
pulmonary capillary wedge pressure <18
38
how treat idiopathic pulm arterial htn?
- endothelin receptor antagonists (bosentan, ambrisentan) - PDEs (sildenafil, tadalafil) - prostacyclin antagonists (epoprostenol, treprostinil, iloprost)
39
beck triad - what does this refer to?
cardiac tamponade
40
beck triad - what are the components?
- hypotension - JVD - decerased heart sounds
41
pulsus paradoxus - definition / which phase of respiration does pressure change?
SBP decreases >10 mmHg with inspiration 2/2 bowing of RV into LV during inspiration
42
cardiac tamponade - physiology?
impaired diastolic filling of RIGHT SIDE of heart
43
on TTE - what see in cardiac tamponade?
early diastolic collapse of RV and RA
44
Kussmaul sign - what is it?
abnormal increase (or lack of decrease) in JVP during inspiration
45
Kussmaul sign - when do you see it?
- constrictive pericarditis | - restrictive CMP
46
TIMI risk score components?
- age > 65 - >=3 risk factors for CAD - known CAD w/>50% stenosis - use of ASA in past 7d - >=2 anginal episodes w/in preceding 24h - elevated trop ST-segment deviation >05mm on admission EKG
47
TIMI - what is low risk score?
0-2
48
TIMI intermed or high risk score - what is recommendation?
cath within 24h
49
inferior wall MI - what see on EKG?
ST elevations in II, III, aVF
50
stent thrombosis - most events happen how soon after stenting?
30 days
51
hypertrophic CMP w/LVOT obstruction - murmur?
systolic murmur
52
who should be on a statin?
- clinically sig. athero - -- ACS, MI - -- stable or unstable angina - -- coronary stent/CABG - -- stroke, TIA, PAD - LDL > 190 - DM ages 40-75 - ASCVD risk >7.5
53
if pt w/very high triglycerides (>1000) what give them?
fibrate niacin fish oil
54
inotropic agents used in heart failure?
- dobutamine | - milrinone
55
which class of chemo agents leads to dose-dependent decline in EF --> dilated CMP?
anthracyclines
56
routine testing for initial dx of essential htn?
- CBC - BMP - UA - 12 lead EKG - lipids
57
when do workup for secondary htn?
- non-obese non-black pts <30 yo w/ fam hx htn - htn starting before puberty - severe/refractry htn - acute-onset htn

usmle step 3 (14 decks)

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