Cardiology Flashcards
1
Q
effect of valsalva early strain(2)
A
decrease venous return
decrease all murmurs except HCM and MVP
2
Q
effect of valsalva late release(2)
A
increase venous return
increase right sided murmurs
3
Q
effect of standing(2)
A
decrease venous return
similar to the strain phase of valsalva
4
Q
effect of squatting(3)
A
increase venous return
increase afterload by kinkingof femoral arteries
increase reverse flow
5
Q
effect of handgrip(3)
A
increase afterload
increase blood pressure
increase reverse flow across valve
6
Q
murmurs getting louder with valsalva(2)
A
HCM
MVP
7
Q
why during valsalva murmur get louder in MVP (2)
A
decrease left ventricular volume
increase of leaflet prolapse
8
Q
why during valsalva murmur get louder in HCM (2)
A
decrease left ventricular volume
increase gradient
9
Q
effect of standing resembles what other effect
A
valsalva
10
Q
murmurs that get louder with squatting(3)
A
aortic regurgitation
mitrel regurgitation
VSD
11
Q
murmurs that get softer with squatting(2)
A
HCM
MVP
12
Q
why murmurs get softer with squatting in HCM (4)
A
more blood less murmur
increase preload
decrease gradient across outflow obstruction
decrease obstruction and decrease afterload
13
Q
why murmurs get softer with squatting in MVP(2)
A
increase left ventricular size
decrease mitral valve leaflets prolapse
14
Q
murmurs getting louder with handgrip(3)
A
aortic regurgitation
mital regurgitation
VSD
15
Q
murmurs getting softer with handgrip(3)
A
HCM
increase gradient across outflow obstruction
decrease flow
16
Q
auscultation in mitral valve prolapse(2)
A
single or multiple non ejection clicks
plus
mid to late systolic of mitral regurgitation
17
Q
CHF with ejection fraction a 55 dx
A
diastolic dysfunction
18
Q
number 1 cause of diastolic dysfunction
A
HTA
19
Q
rx of diastolic dysfunction(2)
A
diuretics
antihypertensives
20
Q
physiopatho in diastolic dysfunction
A
impaired ventricular filling due to poor myocardial relaxation or diminished ventricular compliances
21
Q
cause of AFIB in diastolic dysfunction(3)
A
left ventricular dilation
leads to left atrial dilation
which in turn causes atrial fibrillation
22
Q
HTA in the setting of bilateral nontender masses
A
autosomal dominant polycystic kidney disease
23
Q
HTA in the setting of bilateral nontender masses best test to do
A
abdomen ultrasonogram
24
Q
clue for autosomal dominant polycystic kidney disease(5)
A
HTA Hematuria proteinuria palpable renal masses progressive renal insufficiency
25
flank pain in autosomal polycystic kidney disease cause(3)
renal calculi
cyst rupture or hemmorrage
upper urinary tract infection
26
the early common finding in autosomal polycystic kidney disease
HTA
27
extra renal manif of autosomal polykidney disease(5)
```
cerebral aneurisms
hepatic and pancreatic cysts
cardiac valve disorder
colonic diverticulosis
ventral and inguinal hernias
```
28
management of APKD(3)
follow blood pressure and renal function
aggressive control of cardiovascular risks factors
ACE inhibitor for HTA
29
end stage renal diasease in APKD(2)
dyalisis
| renal transplant
30
patient with HTA is seen in consultation in history , he exercices regularly an eats low salt diet .but he drinks 3-4 glasses of wine every day and 6-8 beers on week end .he quits smoking 3 years ago next step in management of HTA in this patient
counsel for reduction of alcohol
31
quid of excessive alcohol intake
> 2 drinks a day
32
quid of binge drinking
> 5 drinks in a row
33
lifestyle modification in HTA(6)
```
low salt diet
diet rich in fruit and vegetables
low fat dairy products
regular aerobic exercices
lose weight
limit alcohol intake
```
34
patient with TA 160/85 while supine and 135/70 while standing dx
orthostatic hypotension
35
EKG for AFIB(3)
narrow qrs complex
no organised P waves
irregularly irregular rythm
36
stable patient with afib Management
Rate control
37
medication used for rate control
Betablocker
| calcium blocker like Diltiazem
38
use of digoxin for rate control in AFIB(2)
AFIB due to heart failure
| patient unable to tolerate B blocker or Calcium channel blocker
39
indication of cardiversion in Patient with AFIB(4)
less than 48 h
patient with hypotension
pulmonary edema
ischemic heart disease
40
what to do before beginning cardioversion in AFIB more than 48 h(2)
anticoagulation 3-4 weeks
plus
rate control
41
best test to see if AFIB is complicated with heart thrombus
TEE
42
patient with chest pain sus elevation of ST segment and ventricular premature beats administration of lidocaine will cause what in this patient
increase the risk in asystole
43
advantage and drawback of lidocaine in acute coronary syndrome(2)
decrease risk of VFIB
| increase the risk of asystole
44
patient with history of rhinitis and eczema in childhood is coming for chest pain .ekg shows st segment depression .he is placed on aspirin bblocker etc.2 days later he develops respiratory distress with wheezing and prolonged expiratory.cause of that
medication side effect Bblocker and Aspirin
45
causes of acute dyspnee in hospitalized patients(7)
```
arrythmia
bronchoconstriction
CHF/hypervolemia
infection/pneumonia asppiration
pleural effusion
PE
anxiety
```
46
patient with cardiac disease or (electrolytes abnormalities) develops dizziness tachycardia(or braadycardia) during hospitalisation dx
arrythmia
47
patient with history of asthma ,is placed on aspirin and Bblocker develops wheezing and pprolonged expiratory phase during hospilaisation Cause of that
bronchoconstriction
48
patient with cardiac disease develops crakles high jugular venous pressure>8 cm h2o lower extremity edema cause of that
CHF
49
accidentaly patient has received 2000 cc de liquide develops dyspnea,develops crackles DX
hypervolemia
50
characteristics clinique of pleural effusion in tyhe context of acute dyspnee (2)
decreased breath sounds
| dullness to percussion
51
clue for anxiety in the setting of acute dyspnea in hospitalised patient(4)
tachycardia
tachypnee
normal lung exam
normal oxygenation
52
EG in anterolateral MI
st segment elevation in 1 avl,v1-v3
53
what can happen in anterolateral MI(2)
muscle ischemia or rupture--->
| mitral regurgitation
54
MI causing typically mitral regurge and why(2)
posteroseptal MI
| a cause of solitary blood supply of of the post medial papillary muscle
55
consequence of lmitral regurge in anterolateral MI or post septal MI(4)
increase left atrial pressure
but no changes in left atrium size
in left ventricular sizes
and no changes in left ventricular ejection fraction
56
patient with chest pain during exercice but normal baseline resting EKG ,next step
exercice EKG
57
why patient with SLE are at risk for acute coronary syndrome(2)
most of the they are reiceiving prednisone
| prednisone and Lupus cause acelarated coronary atherosclerosis
58
syncope during exercice(3)
aortic stenosis
HOC
VTAC
59
murmur in aortic stenosis(3)
2 nd intercostal space
radiation in caritids
crescendo-decrescendo
60
disease with pulsus parvus and tardus
aortic stenosis
61
quid of pulsus parvus and tardus
aotic stenosis
62
other finding in aortic stenosis
weak S2
| S4
63
three possible symptoms in AS(3)
syncope during exercice
exertionnal angina
dyspnea
64
definitive dx of AS
echocardiogram
65
rx of symptomatic AS
valve replacement
66
patient with chest pain with normal QRS complex 80msec(n< 120) and PR interval 280 msec( normal
first degree heart block
67
clue for first degree heart block(2)
prolonged PR interval
| P wave always follows QRS unlikely other heart block
68
rx of first degree heart block with normal QRS duration
abservation
69
First degree AV block with prolonged QRS
electrophysiologic testing to determine the nature of the delay of conduction below the AV node
70
patient with history of respiratory infection one week ago develops Ta =100/60 distended neck veins and heart sounds distant dx
pericardial effusion
71
xray in pericardial effusion
enlarged cardiac silhouette
72
ekg clue for pericardial effusion
electrical alternans
73
quid of electrical alternans
qrs complexes whose amplitude vary from beat to beat on ekg
74
definitive dx in pericardial effusion
echocardiogram
75
quid hypertensive urgency(2)
severe HTA > ou egal 180/120
| no symptoms ,no end organ damage
76
two divisions for hypertensive emergency(2)
malignant HTA
| Hypertensiive encephalopathy
77
clue for malignant HTA(2)
severe HTA
plus
papilledema and retinal hemorrage
78
clue for hypertensive encephalopathy(2)
severe HTA
plus
cerebral edema and non localizing neurologic symptoms and signs
79
symptom in cerabral edema(4)
headache
nausea
vomiting
plus non localizing neurologic symptoms
80
quid of non localizing neurologic symptom(4)
restlessness
confusion
seizures
coma
81
organ atteint in malignat HTA(2)
rein
| eye
82
rein problem in malignant HTA
nephrosclerosis
83
quid of manif of nephrosclerosis(3)
acute renal failure
hematuria
proteinuria
84
auscultation finding in aptient with aortic stenosis
systolic murmur ejection radiating to the apex and carotid arteries
85
teens and early twenties with AS cause
bicuspid valve
86
elderly with AS cause
Calcification of the trileaflet valve
87
muscle pain in patient taking statin
statin induced myopathy
88
mechanism of action of statin
inhibition of intracellular synthesis pathway
89
action of station intracellularly(3)
inhibit HMG co A reductase enzyme
prevent conversion of HMG co A to mevalonic acid
increase the number of cell membrane LDL receptors
90
why statin can induce myopathy
by decreasing co enzyme synthesis Q 10
91
role of Q10 coenzyme
involve in muscle cell energy
92
clue supraventricular tachycardia on EKG(4)
narrow QRS complex
tachycardia
no regular P waves as they are buried within QRS complex
retrograde P wave can occur
93
dx and management of supraventricular tachycardia(2)
adenosine
| or vagal maneuvers
94
action of adenosine(3)
slows the sinus rate
increases AV nodal conduction delay
can cause a transient block in AV node conduction
95
role of adenosine in supraventricular tachycardia(2)
can help to identify P waves to clarify dx of atrial flutter or atrial tachycardia
terminate paroxysmal supraventricular tachycardia by interrupting the AV nodal reentry circuit
96
quid of vagal maneuvers(3)
carotid sinus massage
valsalva
eyeball pressure
97
patient smoker complain of cramping pain in his right thigh after walking 2 blocks ,the pain goes away once he stops and rests for several minutes
PAD
98
best initial management in PAD intermittent claudication
exercice therapy
99
indication of cilostazole in PAD
persistent symptom despite adequate supervised exercice therapy
100
indication of surgery in PAD
persistent symptom despite adequate supervised exercice therapy and cylostazole
101
HTA basic testing(4)
urinalysis for occult hematuria and urine protein creatinine ratio
chemistry panel
lipid profile
baseline ECG
102
when to search for secondary HTA(4)
severe or malignant HTA
resistant HTA requiring > ou egal a 3 drugs
sudden blood pressure rise in patient with previosly controled HTA
age of onset < 30 without family history of HTA
103
patient with HTA ,hypokaliemia and hyperglycemia and weight gain dx
adrenal cortical disease
| cushing disease
104
cause of cushing syndrome(4)
adrenal cortical hyperplasia
acth producing pituitary adenoma (cushing disease)
ectopic ACTH production
exogenous steroids
105
clue for cushing(7)
```
poximal muscle weaness
central adiposity
thinning of the skin
psychiatreic problem
hypokaliemia
hypertension
hyperglycemia
```
106
psychiatric problem in cushing(3)
sleep disturbances
depression
psychosis
107
quid of preload measurement(2)
right atrial pressure
| pulmonary capillary wedge pressure
108
normal right atrial pressure
mean 4 mm of HG
109
normal pulmonary wedge pressure
mean of 9 mm de HG
110
quid of cardiac index
pump function measurement
111
normal cardiac index
2.8-4.2 l/mn/m2
112
quid of systemic vascular resistance
measure afterload
113
normal systemic vascular resistance
1150l/mn/m2
114
normal mixed venous oxygen saturation
60%-80%
115
the only parameter increase in Hypovolemic schock
everything is low except systemic vascular resistance
116
the only two parameters decrease in cardiogenic shock
everything is high except cardiac pump function
| mixed venous oxygen saturation
117
the only shock syndrome with low vascular resistance and increased mixed venous oxygen saturation
septic shock
118
patient with hypotension, normal Pulmonary wedge pressure and increased mixed venous saturation
septic shock
119
hwat's the underlying basic pathophysiology in septic shock
decrease systemic vascular resistance due to overall peripheral vasodilation
120
swanz ganz catether in septic shock(4)
low pulmonary wedge pressure
low systemic vascular resistance
increased cardiac output
high mixed venous oxygen saturation
121
origin of formation of AFIB focii
pulmonary veins
122
quid for atrial flutter origin
reentrant circuit that rotates around the tricuspid annulus
123
quid for paroxysmal supraventricular tachycardia origin
reentry circuit most commonly oinvolved the AV node or via accessory bypass tract
124
patient on digoxin and furosemide present with wide complex tachycardia what to check
serum electrolytes
125
effect of furosemide(2)
low K
| low MG++
126
effects of low K and low Mg++
ventricular tachycardia
127
risk factor for digoxin toxicity
low K
128
consequence of digoxin toxicity
ventricular tachycardia
129
side effect of thiazide (5)
```
hyperglycemia
increased LDL cholesterol and plasma triglycerides
hyponatremia
hypokaliemia
hypercalcemia
```
130
hypergluc in thiazide(4)
G= glycemia
L=lipidemia
U=uricemia
C=Calcemia
131
in swanx ganz catheter clue for cardiogenic shock(2)
reduced cardiac index
| elevated pulmonary wedge pressure
132
how 's systemic vascular resistance in cardiogenic shock
high to maintain adequate perfusion of tissue
133
the most contributory factor in CHF edema
increased renal sodium retention
134
cause of increased renal sodium retention in CHF(2)
low renal perfusion----> stimulation of renin aldosterone system--->hypoperfusion renal secondary to cardiac output
renal arteries are constricted
135
patient with palpitations HR 160 suddenly with no history of haert problem.Symptoms improves when immersing face in cold water dx
paroxysmal supraventricular tachycardia
136
the cold therapy work s by affecting what
atrioventricular node conductivity
137
cause of supraventricular tachycardia
accessory conduction pathways
138
why you can have hepatomegaly,ascites, increased JVP in constrictive pericarditis
decreeased diastolic filling leafing to cardiac output impairment
139
common cause of constrictive pericarditis(4)
radiation therapy
viral pericarditis
cardiac surgery
idiopathic
140
kussmaul sign
failure of JVP to decrease during inspiration
141
other name of constrictive pericarditis
inelastic pericardium
142
dx of constrictive pericarditis(3)
calcified pericardium in xray
thickened pericardium on CT or MRI scanning
cardiac catheterisation
143
rx of constrictive percarditis(2)
diuretics
or
pericardiectomy
144
after anterior wall MI patient develops pleuritic chest pain improving when sitting and leaning forward.EKG shows diffuse ST segment elevation dx
acute pericarditis
145
laps de temps pour developper acute pericarditis post MI
within the first several days
146
EKG for acute pericarditis(2)
diffuse ST segment elevation
| PR depressions
147
quid of lone AFIB
presence of paroxysmal persistent or permanent AFIb with no evidence of cardiopulmonary or structural heart disease
148
rx of lone AFIB
nothing
149
paroxysmal AFIB
reccurrent > a 2 episodes that terminate spontaneously in < 7 days usually within 24 hours
150
persistent AFIB
episodes lasting more than 7 days
151
longstanding persistent AFIB
pesistent for more than 1 year duration
152
permanent AFIB
persistent with no further plans for ryhtm controls
153
CHADS 2 score 0(2)
no anticoagulation
| aspirin preferred
154
CHADS 2 score 1 (2)
anticoagulation preferred
or
aspirin
155
CHADS 2 score 2-6
anticoagulation
156
cause of restrictive cardiomyopathy(4)
sarcoidosis
amyloidosis
hemochromatosis
fibrosis endomyocardial
157
clue for restrictive cardiomyopathy in echo
symmetrical thickening of the left ventricular walls and slightly reduced systolic function
158
the only reversible cause of restrictive cardiomyopathy
hemochromatosis
159
echo with interventricular septum thickness
hypertrophic cardiomyopathy
160
primary rx of hemochromatosis
phlebotomy
161
quid of the anti-ischemic nitrate action
systemic vasodilation rather than coronary dilation
systemic venodilation lowers (ventricular)preload and left ventricular end diastolic volume reducing wall stress and myocardial oxygen demand
dilation of capacitance vessels
162
action of nitrate
reduced left ventricular volume
163
supraventricular tachycardia in patient hemodynamically unstable management
DC cardioversion
164
anterior wall myocardial infarction with pulmonary edema what medication to give and why
furosemide
| furosemide causes venodilation which further decreases the preload
165
anterior wall myocardial infarction with pulmonary edema what medication u cant give and why
betablocker
| can worsen acute heart failure
166
other medication can be used in pulmonary edema caused by anterior wall myocardial infarction and why
Morphine
| decrease prload and anxiolytic
167
patient with syncope with history of respiratotry infection 2 weeks ago EKG shows electrical alternans best next step in this patient
percardicenthesis
168
quid of electrical alternans
une onde qrs longue suivie d'une courte
169
EKG of pericardial effusion(3)
electrical alternans
sinus tachycardia
low QRS voltage in large pericardial effusion
170
quid of sinus tachycardia with electrical alternans
large pericardial effusion
171
problem in HIC(2)
```
abnormal mitral leaflet motion= systolic anterior motion of the mitral valve
septal hypertrophy
```
172
cause of systolic dysfunction
MI
| ...
173
catetherisation during systolic heart failure(3)
CI decreased
left ventricular end diastolic volume increased
total peripheral resistance increased
174
how 's the left ventricular end diastolic heart failure
normal
175
patient with tachysystolic AFIB what to do to improve the left ventricular function in those patients
control the rate and the rythm
176
why tachysystolic AFIB causes significant left ventricular dialtion and depressed EF(4)
tachycardia
neurohumoral activation
absence of atrial kick
atrial ventricular desynchronisation
177
importance of atrial kick
it accounts for 25% of LV end diastolic volume
178
tachysystolic AFIB (3)
irregular irregualr rythm
tachycardia
no P waves ion EKG
179
cardiac problem in hemochromatosis(3)
cardiac conduction abnormalities
dialted cardiomyopathy
heart failure
180
the greatest risk factor for printzmetal angina
smoking
181
young female with nocturnal chest pain lasting 15-20 mn .EKG shows St segment elevation in lead 1 avl,v4-v6 during the episode rx
diltiazem
or
nitrate
182
why to not give bblocker or aspirin in printz metal angina
cause vasoconstriction
183
other name of printz metal
variant angina
184
after long trip to central asia female using OCP develops hemoptysis and pleuritic chest paincause of these symptoms
pulmonary infarction
185
number one cause of pleuritic chest pain
PE
186
gold standard Dx in PE
helical CT
187
patient with chest pain palpitations is seen in emergency .Physical exam reveals HTA ,dilated pupils ,small amount of blood at the external nares St segment elevation in V1-V4.explanation of the symptoms
drugs induced vasospasm
| cocaine abuse
188
why you cant give bblocker to patietn in cocaine abuse
unopposed alpha agonist will worsen vasospasm in cocaine abuse
189
cause of St segment elevation(4)
MI
Cocaine abuse
acute pericarditis
printzmetal
190
clue for aortic regurge
wide pulse pressure
191
manif of wide pulse pressure in reality
water hammer pulse
| =pounding heartbeat
192
way for the patient hear better the pounding heart(2)
lying supine and
| lying on the left
193
most common cause of aortic dilation in The US(2)
aortic root dialtion
| bicuspid aortic valve
194
the greater non pharmocologic rx with greatest impact on HTA and why(2)
weight loss
| reduce HTA of 5-20 per 10 kg loss
195
the second non pharmocologic rx with greatest impact on HTA and why(2)
DASH diet
| reduce HTA 8-14 mm de hG
196
thethird non pharmocologic rx with greatest impact on HTA and why(2)
exercice
| reduce HTA 4-9 mm de hg
197
the 4 e non pharmocologic rx with greatest impact on HTA and why(2)
dietary sodium
| reduce HTA 2-8 mm de hg
198
the 5 e non pharmocologic rx with greatest impact on HTA and why(2)
alcohol intake
| reduce HTA 2-4 mm de hg
199
quid of DASH diet(2)
Diet rich in fruits and vegetables
| and low saturated fat and total fat
200
time to work out in HTA(2)
30 min /day
| 5-6 days /semaine
201
dietary sodium restriction in HTA
< 3 g /day
202
alcohol intake restriction in HTA(2)
2 drinks /day in men
| 1 drink /day in women
203
first line rx for newly dx hypertension satge 1
lifestyle modification
204
patient with pedal edema ascite emigrating from china to come in the US.chest xray reveals decreased heart sound and an accentuated sound directly after the second heart sound in ear;y diastole .chest xray shows ring calcification around the heart and jugular venous pressure tracings show prominent x and y descents cause of the patient symptoms and Dx
tuberculosis
| constrictive pericarditis
205
clinical presentation of constrictive pericarditis(4)
fatigue and dyspnee on exertion
peripheral edema and ascites
high jugular venous pressure
pericardial knock
206
dx findings in constrictive pericarditis(2)
X and Y descents during jugular venous pulse tracing
| imagind shows pericardial thickening and calcification
207
pericardial knock
early heart sound after S2
208
heart dysfunction in constrictive pericarditis
diastolic
209
endemic areas for TB(3)
africa
india
china
210
EKG for Mobitz type 1(wenkeback)
PR interval growing slowly progressively leading up to a dropped beat
211
problem in mobitz one
impaired AV node conduction
212
sudden tearing chest pain in aptient with chest xray showing widened mediastinum dx and medical condition causing that
dissection aortic
| HTA
213
drugs increasing the riosk of bleeding when taking warfarin(9)
```
acetaminophen
NSAIDS
antibiotis/antifungal
amiodarone
canberry juice
ginkgo biloba viit E
omeprazole
thyroid hormone
selectice serotonin reuptake inhibitors
```
214
drugs decreasing the effect of warfarin(6)
```
rifampin
carbamazepine
oral contraceptives
ginseng
st jhon's wort
green vegetables(spinach)
```
215
dose of acetaminophen to cause bleeding with warfarin ingestion
> 2 g /jour for 1 week
216
the most important factor for survival in out hospital sudden cardiac arrest
time to rythm analysis and defibrillation=elapse time to effective resuscitation
en d'autres mots:prompt effective resuscitation with adequate bystander CPR,prompt rythm analysis and defibrillation
217
number one cause of outhospital sudden cardiac arrest(2)
sustained VTAC
sustained VFIB
both cause by MI or ischemia
218
murmur in aortic dissection
diastolic murmur in left sternal border
219
3 clinical findings in aortic dissection with 2 you make the DX
tearing chest pain radiating in the back
variation in pulse or blood pressure between the right and the left arm
widened mediastinum
220
complication of dissection aortic
extend to pericardium=tamponnade
extend to coronary arteries=stroke
extend to carotid arteries=stroke
221
dissection aortic plus hemiplegia dx
stroke
222
incidence of aortic dissection when 2 clinical symptoms are present see question above
80 %
223
patient found with pulsatile mass above umbilicus creat 2.0 and TA:160/90 dx and best test to confirm the DX(2)
abdominal aneurism of aorta
| abdominal ultrasound
224
quid of BNP
release by dilated ventricle
225
value for BNP to Dx CHF(4)
> 100 pg /ml
specificity 76
sensitivity 90
predictive value 83
226
importance of BNP
helps to differentiate dyspnea of cardiac origin with any other origin
227
cause of right Heart failure in COPD
pulmonary artery systolic pressure
228
sequence of event causing right heart failure in COPD
hypoxemia causes constriction of the pulmonary artery and with time pulmonary hypertension---> will lead to right ventricular hypertrophy and right ventricular failure
229
does right ventricular failure cause pulmonary edema
it s not a common cause of pulmonary edema
230
management of STEMI(6)
```
oxygen
nitrates
antiplatelet therapy
anticoagulation
bblockers
prompt reperfusion with PCI
```
231
antiplatelet therapy used in STEMI
platelet P2y12 receptor inhibitor
232
anticoagulation used in STEMI
bivalirudin is preferred over heparin
233
ideal first rx for STEMI
prompt reperfusion with PCI
234
clue for benign essential tremor(3)
tremor worst with activity
improves with with alcohol
family inheritance autososmal dominant
235
HTA plus benign esential tremor Rx
propranolol
236
the most effective non pharmacological rx of HTA
weight loss
237
clue for venous insufficiency(4)
pedal edema
medial ankle ulcer
dilated and tortuous superficial veins
normal physical exam
238
initial rx of venous insufficiency(3)
leg elevation
exercice
compression stockings
239
method to hear aortic regurgitation murmur(4)
diastolic murmur
best heard along the left sternal border at the third and fourth interspaces
best heart when you apply firm pressure with the diaphragm of the sthetoscope while patient is sitting up leaning forward and holding the breath in full expiration
240
cause of aortic regurge in developed countries in young adults
bicuspid aortic valve
241
cause of aortic regurge in developing countries in young adults
rheumatic heart disease
242
common cause of aortic regurgitation involving the aortic valve leaflet(8)
```
rheumatic heart disease
endocarditis
bicuspid aortic valve
trauma
myxomatous degeneration
ankylosing spondylitis
acromegaly
medications
```
243
common cause of aortic regurgitation involving trhe ascending aorta or aortic root disease (8)
```
hta
aortitis syphilitic
ankylosing spondylitis
dissection aortic
ehlers danlos
IBD
reactve arthritis
Marfan syndrome
```
244
Medication to hold for 48 h prior to cardiac testing(3)
Bblocker
calcium blocker
nitrates
245
medication to hold 48 h prior to vasodilator stress test
dipyridamole
246
medication to hold 12 h prior to vasodilator stress test
caffeine containing food or drinks
247
medication you can continue prior to to cardiac stress testing(5)
```
ACE inhibitor
ARBs
digoxin
statins
diuretics
```
248
gold standard Dx of CAD
coronary angiography
249
indication of amiodarone(3)
ventricular arythmias
rythm control in AFIB
left ventricular systolic dysfuction
250
toxicity of amiodarone(7)
```
hypo or hyper thyroidism
hepatotoxicity
bradycardia
heart block
pneumonitis
neurologic symptoms
visual disturbances
```
251
visual probelm associated with amiodarone(2)
corneal microdeposits
| optic neuropathy
252
heart problem with amiodarone(2)
Qt prolongation
| risk de torsades de pointes
253
dermatologic problem associated with amiodarone
blue gray skin discoloration
254
neurologic problem associated with amiodarone
peripheral neuropathy
255
gastrointestinal and hepatic problem associated with amiodarone(2)
elevated transaminases
| hepatitis
256
mark for IV drug user in USMLE
needle tracks on arms
257
IV drug user with fever andround lesions in lungs and sinus tachycardia.what accompanying finding is expected
systolic murmur that increases with inspiration
258
bug in infective endocarditris in IV drug user
staph aureus
259
what increases the risk of infective endocarditis in IV drug user
HIV infection
260
holosystolic murmur increasing with inspiration quid of that
tricuspid involvement
261
IE with round lung opacity
septic pulmonary emboli
262
what must be done in young patient with systemic HTA
evaluation for coarctation of aorta
263
assessment of coarctation of aorta in physical exam(3)
search for brachio femoral delay
upper extremity hypertension lower extremity hypotension
continuous cardiac murmur from large collaterals
264
acqiured cause of coarctation of aorta
maladue de takayasu
265
chest xray for aaortic coarctation
notching of the 3 th-8th ribs from enlarged intercostal arteries
266
confirmatory dx for aortic coarctation
echocardiography
267
rx of aortic coarctation(2)
balloon angioplasty
plus or minus
stent
268
complication of CABG
AFIB
269
AFIB in hemodynamically unstable patient rx
DC cardioversion
270
EKG of AFIB(3)
absent P waes
an irregularly irregylar rate
narrow QRS complex
271
clinical features for cocaine abuse(4)
sympathetic activity
chest pain
psychomotor agitation
seizures
272
sympathetic activity in cocaine abuse(3)
tachycardia
HTA
dilated pupils
273
why chest pain in cocaine abuse
coronary vasodilation
274
complication of cocaine abuse(3)
acute MI
aortic dissection
intracranial hemorrage
275
clue in USmle for cocaine abuse
nasal mucosa is atrophic
276
chest pain management in cocaine abuse(5)
```
benzodiazepines
aspirin
Nitrate and calcium blocker
no Bblocker
immediate cardiac catheterisation with reperfusion when indicated
```
277
why you ccant use fibrinolytics in the management of chest pain caused by cocaine abuse
increased risk of intracranial hemorrage
278
patient with infective endocarditis is started on vancomycin .Days later culture grows streptococcus mutans highly sensitive to PNC next step
switch antibiotics to IV ceftriaxone
279
rx of infective endocarditis caude by step mutans(3)
IV pNC
IV ceftriaxone
for 4 weeks
280
what intervention in STEMI will improve the long term prognosis of patient
restore coronary blood flow
281
inferior MI
2 ,3 avf
282
two primary options to restore coronary blood flow(2)
PTCA
| fibrinolysis
283
when to do exercice EKG or pharmacologic stress testing in patient with chest pain
when you have intermediate risk of CAD
284
quid of intermediate risk of CAD(3)
atypical angina in men of all ages
atypical angina in women > ou egal 50
typical angina in women age 30-50
285
high risk for CAD(2)
typical angina in men > ou egal a 40 ans
| typical angina in women age > ou egal a 60 ans
286
low risk for CAD(2)
atypical chest pain in women age < 50 ans
| asymptomatic people of all ages
287
high risk for CAD CAT(2)
start Rx
| coronary angiography if unstable angina
288
patient with ant.hypertension with hypotension tachycardia,distended neck veins pulsus paradoxus with teraing chest pain dx
pericardial tamponnade due to dissection aortique
289
USMLE pulsus paradoxus
respiratory variation in systolic blood pressure or
| decrease > 10mm de hg drop in systolic pressureduring inspiration
290
why syncope and hypotension in tamponnade(4)
compression of cardiac chambers by fluid in pericardium
limit diastolic filling of trhe right sided chambers
decreases preload
reduces cardiac out put
291
young age under 70 patient with aortic stenosis cause
bicuspid aortic valve
292
elderly 70 patient with aortic stenosis cause
calcification of aorta
293
tearing cehst pain in thew context of hypotension with respiratory variation in systolic blood pressure hypotension ,distended jugular veins dx
dissection aortique
294
dissection aortic wuth Ta higher in right arm than the left arm why
extension of the dissection into the great vessels feeding the left arm
295
after myocardial infarction patient develops develops widened QRS complex with compensatory pause next step but patietn is asymptomatic
observation
296
PVC in symptomatic patient rx
Bblocker
297
when you cant use nitrates in in MI
right ventricular MI
298
when to suspect right ventricular MI
often accompany post MI
299
when to suspect right ventricular MI(5)
hypotension
with clear lung fields
high JVP
Kussmaul's sign positif
300
Left ventricular infarct(2)
hypotension
| pulmonary edema
301
correction of hypotension in right ventricular infarct(2)
administer normal saline bolus
| don't give nitro
302
patient developping dyspnea after stab wound to the right thigh 10 months ago .In EP,right leg is warmer and apperas flushed compared to his left leg cause of the patient symptom
increased cardiac preload
303
patient developping dyspnea after stab wound to the right thigh 10 months ago .In EP,right leg is warmer and apperas flushed compared to his left leg cause of the patient symptom dx
AV fistula
304
congenital cause of AV fistula(4)
PDA
angiomas
pulmonary AVF
CNS AVF
305
acquired cause of AVF(4)
trauma
iatrogenic ( femoral catheterisation)
atherosclerosis(aortocava fistula)
cancer
306
why heart failure in AVF
the circulation is unable to meet the oxygen demand of the peripheral tissues
307
patietn with dyspnes and elevate BNP what you expect to find in this patient
S3
308
meaning of S3 and elevated BNP
increased cardiac filling pressures
309
patinet with left sided chest pain improving with leaning forward and creat 5.1 dx and rx(2)
pericarditis
| hemodyalisis
310
most common cause of pericarditis
viral infection
311
rx of viral pericarditis
NSAID
312
cause of pericarditis(5)
```
iatrogenic
connective tissue disease
cardiac
uremic
malignancy
```
313
iatrogenic cause of pericarditis(4)
surgery
trauma
radiation
drug related/chemo
314
connective tissue causing pericarditis(2)
RA
| SLE
315
cardiac problem causing pericarditis
dressler syndrome
316
quid of dressler syndrome(2)
post MI infarction
| usually 1 -6 weeks after MI
317
when you will have uremic pericarditis
whrn BUN> 60 mg/dl
318
CHADS 2 score(5)
```
C=CHF =1 pt
H=hypertension=1
A=age . ou egal a 75=1
D=diabetes=1
S=prior stroke =2
```
319
CHF apres recent cold
dilated cardiomyopathy
320
finding on echo in dilated cardiomyopathy(2)
dilated ventricles with diffuse hypokinesia
| low ejection fraction
321
viral myocarditis cause #1
coxsackievirus B
322
viral myocarditis other cause(4)
parvovirus B19
human herpes virus 6
adenovirus
enterovirus
323
tracing of arterial line and BP
compare pick lors de l'inspiration and pic in systolic presure to understand the graphics
324
quid of pulsus paradoxus
decrease of ten mm de hg of systolic pressure during inspiration
325
explanation of pulsus paradoxus
in inspiration the intrathoracic pressure is negative
incresase venous return to the right heart
interventricular septum shifs into the left ventricular cavity reducing the left ventricular and diastolic volume
d'ou decreasd systolic blood pressure in the case of tamponnade
326
other cause of pulsus paradoxus(2)
severe asthma
| COPD
327
why isolated systolic hypertension in elderly
rigidity of the arterial wall
328
rx of isolated systolic hypertension in elderly
monotherapy with thiazide
or ACE inhibitor
or
long acting calcium channel blocker
329
heart problem in Marfan(3)
aortic dilation
regurge
aortic dissection
330
murmur in Marfan
early diastolic murmur
331
skeletal problem in Marfan(5)
```
arachnodactyly
pectus deformity
joint hypermobility
increase arm to height ratio
decrease upper to lower body segment ratio
```
332
ocular problem in marfan
ectopia lentis
333
why marfan patient tend to have spontaneous pneumothorax
rupture of apical blebs
334
skin finding in Marfan(2)
reccurrent or incisionnal hernia
| skin striae
335
Marfan patient with acute chest pain
acute aortic dissection
336
syncope provoked by strong emotion
vasovagal syncope
337
inciting event of vasovagal syncope in patient < 60 ans(2)
```
emotionnal stress(venipuncture)
orthostatic stress(prolonged standing)
```
338
inciting event of vasovagal syncope in patient > 60 ans(3)
micturition
cough
defecation
339
dx of uncertain vasovagal syncope
upright tilt table testing
340
dx of vasovagal syncope
clinical
341
what medication should be given to all patient with MI within 24 hours
ACE inhibitor
342
why ACE inhibitor in post MI(2)
to prevent remodelling of the ventricle and
| possible dilation of the ventricle leading to CHF
343
military recruit with body temperature > 40 during exercice with central nervous system dx
heat stroke
344
common symptom in heat stroke(3)
dehydration
hypotension
tachycardia
345
systemic effects of heat stroke(4)
seizures
acute respiratory distress syndrome
DIC
hepatic and renal failure
346
rx of heat stroke(4)
rapid cooling with ice water immersion
fluid resuscitation
electrolyte correction
management of end organ damage
347
antipyretic in heat stroke
any role
348
risk factors for heat stroke(6)
```
strenuous activity during hot and humid weather
dehydration
poor acclimatisation
lack of physical fittness
obesity
medications
```
349
medication involved in heat stroke(4)
anticholinergics
antihistamines
phenothiazines
tricyclics
350
murmur on right sternal border increased with expiration
left side heart murmurs
351
symptom of aorti stenosis(3)
S=Syncope
A=angine
D=Dyspnea
352
indication of surgery in Aortic stenosis(3)
symptomatic patient
patients with severe AS undergoing CABG or other valvular surgery
asymptomatic patient with severe AS and poor LV systolic function=LV hypertrophy >15 mm
valve area <0,6 cm2 or abnormal response to exercice
353
cause of anginal pain in aortic stenosis
increased myocardial oxygen demand
354
medication with decreased mortality following MI(4)
aspirin
B blockers
ACE inhibitor
lipid lowering statins
355
indication of clopidogrel in MI(3)
intolerance to aspirin
post US/NSTEMI
following PCI
356
duration of taking of aspirin and clopidogrel after UA/NSTEMI
12 months for clopidogrel
| definitely for aspirin
357
role of clopidogrel and aspirin inn post PCI
prevent stent thrombosis
358
AFIB with cardiac arrest next step
chest compression
359
quid of pulseless electrical activity
the presence of organized rythm on cardiac monitoring without a measurable BP or palpable pulse in a cardiac arrest patient
360
wht to do in pulseless electrical activity(2)
chest compression
no defibrillator
nosynchronised cardioversion
361
AFIB with cardiac arrest Dx
pulseless electrical activity
362
reversible causes of asystole/pulselkess electrical activity 5H(5)
```
hypovolemia
hypoxia
hydrogen nions( acidosis)
hypo or hyperkaliemia
hypothermia
```
363
reversible causes of asystole/pulselkess electrical activity 5T(5)
```
tension pneumothorax
tamponnade
toxins
thrombosis(pulmonary or coronary)
trauma
```
364
elderly with diarrhea develops orthostatic hypotension,mucosal dryness, what's the most sensitive indicator to see if elder is dehydrated
increase BUN/CREAT ratio
365
after MI patient develops leg Pain dx
occlusion of popliteal artery
366
5 P in occlusion artery
```
Pain
pulselessness
paresthesia
poikilothermia
pallor
```
367
tr of occlusion artery(2)
embolectomy
or
intra arterial fibrinolysis/mechanical embolectomy via interventionnal radiology
368
pleuritic chest pain normal cardiac exam, tenderness to palpation over the sternum
costochondritis
369
clue for pain from musculoskeletal origin
reproducible with palpation
370
papiltaion with AFIB in patient with lid lag retraction and tremor dx
graves disease
371
rx of hyperthyroidism related tachysystolic AFIB
propranol
372
patient with HTA is receiving a drug whicn enhances natriuresis,decreases serum angiotensin 2 concentration and decreases aldosterone production action of that drug
direct renin inhibitor
373
example of direct renin inhibitor
aliskiren
374
drugs affecting the renin angiotensin aldosterone axis(3)
ACE inhibitors
angiotensin receptor blockers
direct renin inhibitor
375
MI plus flash pulmonary edema management
furosemide
376
initial stabilisation of acute ST segment elevation MI(7)
```
02 if sao2 < 90% or dyspnea
aspirin 325 mg
P2y12 inhibitor(clopidogrel)
nitrates
beta blocker
high dose statin (atorvastatin 80 Mg)
anticoagulation
```
377
ST segment elevation plus unstable sinus bradycardia management
IV atropine
378
ST segment elevation plus persistent severe pain ,management
IV morphine
379
ST segment elevation plus persistent
| pain,hypertension or heart failure ,management
IV nitroglycerine
380
when you cant use nitro in MI(3)
hypotension
right ventricular infarct
severe aortic stenosis
381
when you cant use b blockers in MI(2)
CHF
| bradycardia
382
laps of time to perform percutaneous transluminal coronary angioplasty following MI
within 90 mn preferred
383
if PTCA within 120 mn not available in case of acute ST segment elevation next step
thrombolysis
384
patient is receiving a medication for palpitation ,he undergoes a stres test for chest pain durinfg the test his heart rate increases form 65 to 175 and qrs duration from 0,09 to 0.13 seconds .which medication was used for palpitation in thsis patient
flecainide
385
why during stress test if you are taking flecainide heart rate will increase and QRS complex prolonged
the medication has a use dependance prperty
more effective at higher heart rates because there is not as much time between heartbeats for the medication to dissociate from its receptor
386
action of flecainide
block sodium channel
387
indication of flecainide(2)
ventricular arythmias
| supraventricular tavhycardia as AFIB
388
class of antiarrythmic involved in use dependence phenomenon
```
class 1c
class iV
```
389
does class IV prolong QRS complex
no
390
patient with MI under rx 4 days later develops chest pain .the best marker to be useful in this patient
CK MB
391
the most specific and sensitive test for MI(2)
troponin T
| return to normal in 10 days post MI
392
wy CKMB is the best test in reocclsuion following a previous recent one
it takes 1-2 days to become normal after MI
393
murmur in mitral regurge
holosystolic murmur
394
features for mitral regurgitation(4)
exertional dyspnea
fatigue
AFIB
heart failure signs
395
aortic stenosis in elderly cause
sclerocalcific changes
396
you perform myocardial perfusion scanning for a patient,it reveals uniform distribution at rest but inhomogenesity of the distribution after dipyridamole injection.waht effect of dipyridamole helps in making the dx of ischemic heart disease
coronary steal phenomenon
397
indication of myocardial perfusion scanning with dipyridamole
amputated patient
398
quid of coronary steal
redistribution of coronary blood flow to non diseases segments
399
whta other substance can be used in myocardial perfusion scanning
adenosine
400
risk of mitral stenosis
left atrial dilation
AFIB
cardiac emboli
401
consequence of pressure transmitted to pulmonary vasculature inmitral stenosis(3)
dyspnea
cough
hemoptysis
402
patient with right sided weakness cough hemoptyis dyspnes from cambogia dx
stroke caused by cardiac emboli inthe setting of mitral stenosis
403
quid of mallory weiss(2)
upper gastrointestinal mucosal tear
| caused by forceful retching
404
quid of boerhave syndrome(3)
esophageal transmural tear
caused by forcefu retching
esophageal air and fluid leakage in nearby areas
405
chest xray in boerhave syndrome(3)
unilateral pleural effusion
with or without pneumothorax
subcutaneous or mediastinal emphysema
widened mediastinum
406
pleurl fluid analysis in boerhave syndrome(2)
high amylase > 2500 UI
| food particles
407
dx of boerhave syndrome(*2)
CT
| contrast esophagography with gastrographin
408
confirnatory dx in mallory weiss
endoscopy gastro digestive
409
risk factor for variant angina
smoking
410
EKG in variant angina
ST segment elevation
411
condition associated with printzmetal angina(2)
migraine
| raynauds phenomenon
412
pain characteristic in prntzmetal
occurs at night
| goes spontaneously after 15-20 mn
413
hypertension in the setting of hypercalcemia
parathyroid gland disease
414
secondary HTA caused by renal parenchymal disease(2)
```
elevated serum creat
abnormal urinalysis (proteinuria,red blood cell casts)
```
415
secondary HTA caused by reno vacular disease(4)
severe HTA > ou egal 180/120 after 55
abdominal bruit
flash pulmonary edema
unexplained rise in creat
416
secondary HTA caused by primary aldosteronism(3)
hypokaliemia
slight hypernatremia
adrenal incidentaloma
417
secondary HTA caused by pheochromocytoma (3)
paroxysmal elevated BP with tachycardia
pounding headaches papiltations and diaphoresis
adrenal incidentaloma
418
secondary HTA caused by hypothyroidism(5)
```
constipation
weight gain
bradycardia
cold intolerance
dry skin
```
419
secondary HTA caused by primary hyperparathyroidism(3)
hypercalcemia
kidney stones
neuropsychiatric disease
420
secondary HTA caused by coarctation of aorta
differential HTA with brachio femoral pulse delay
421
xray findingds in pericardial effusion
water bottle cardiac silhouette
422
how 's the jugular venous pressure in viral pericarditis
could be normal
423
how 's the point of maximal impulse in viral pericarditis
non palpable
424
first test to do in a setting of syncope
EKG
425
syncope occuring during prolonged standing position distress or painful stimuli dx
vasovagal or neurally mediated syncope
426
syncope occuring during postural changes with changes in heart rate and blood pressure
orthostatic hypotension
427
syncope during exercice or with exertion(4)
aortic stenosis
HOC
anomalous coronary arteries
VTAC
428
syncope with sinus pauses on monitor prolonged PR interval or QRS duration(3)
sick sinus syndrome
bradyarythmiasd
av block
429
syncope with hypokaliemia or hypomg++ or any medication causing prolonged QT interval
torsades de pointes
| acquired long QT syndrome
430
syncope with triggers ( swimming,during sleep sudden noice) family history of sudden daerth prolonged qt interval on ECG
congenital long Qt syndrome
431
ECG findings suggesting arrythmia as the cause of syncope(6)
```
innaproppriate sinus bradycardia
sino atrial block
sinus pauses
AV block
nonsustained VTAC
short or long QTC interval
```
432
murmur in aortic regurge(2)
early diastolic murmur
| left sternal border
433
bounding pulse or water hammer peripheral pulse
aortic regurgitation
434
aortic murmur in regurgitation localisation in valvular disease
diastolic murmur in left sternal border 3 e 4 e espace intercostal
435
aortic murmur in regurgitation localisation in aortic root disease
diastolic murmur in right sternal border
436
conduction abnormality in the setting of infective endocarditis
perivalvular abcess
437
risk in acute endocarditis involving the aortic valve in IV drug user
periannular extension of endocarditis
438
peripheral edema with normal physical exam in a patient taking calcium blocker cause of edema
dihydropyridine Ca channel antagonist
439
sudden death in young athlete
hypertrophic cardiomyopathy
440
risk factor for coroanry syndrome(3)
smoking
family history
estrogen therapy
441
patientin EB with chest pain and suspected coronary syndrome .what drug should be administered first
aspirin
442
why aspirin is so important in acute coronary syndrome(2)
reeudces risk of MI
| decrease mortality overall
443
apical holosystolic murmur
mitral rergurgitation
444
apical mid late systolic murmur
mitral valve prolapse
445
apical mid late diastolic murmur
mitral stenosis
446
left sternal border systolic ejection murmur
Hypertrophic cardiomyopathy
447
left sternal border early diastolic murmur(2)3 e espace intercostal
aortic regurgitation
| pulmonic regurgitation
448
quid of pulomonic area
2 espace intercostal G
449
systolic ejection murmur in pulmonic area
pulmonic stenosis
flow murmur
ASD
450
systolic ejection click in pulmonic area
pulmonic stenosis
451
quid aortic area
2 e espace intercostal droit
452
systolic ejection murmur in aortic area
aortic stenosis
453
holosystolic murmur in tricuspid area
tricuspid regurge
| VCD
454
quid of tricuspid area
4 e espace intercostal in the left close to sternum
455
mid late diastolic murmur(2)
tricuspid stenosis
| ASD
456
cause of mitral regurgitation in developed countries
mitral valve prolapse=myxomatous degeneration of the valve
457
complication of severe chronic Mitral regurgitation(3)
AFIB
left ventricular dysfunction
CHF
458
most common benign tumor in heart
Myxoma
459
Symptom for atrial myxoma(3)
systemic embolization
cardiovascular symptoms simulating mitral valve disease
constitutioonnal symptoms
460
most sensitive test to Dx atrial myxoma
transesophageal echocardiography
461
complication of myxoma
sudden death
462
murmur in myxoma
early diastolic sound=tumor flop
463
why constitutionnal symptoms in myxoma
overproduction of interleukin 6
464
anterior wall MI
V1- V6
465
hemodynamic hypotension compromises 3 a 7 jours after anterior MI(3)
paillary muscle rupture
left ventricle free wall rupture
interventricular septum rupture
466
hypotension with pansystolic murmur apical after anterior wall MI
acute mitral regurgitation caused by papillary muscle dysfunction
467
normal heart rate at rest
60-100
468
symptomatic sinus bradycardia(dizziness) rx
iV atropine
469
symptomatic sinus bradycardia unresponsive to atropine
permanent pace maker
470
cause of sinus bradycardia(4)
sick sinus syndrome
hypoglycemia
medication
exagerated vagal activity
471
medication involved in sinus bradicardia(3)
digitalis
B blocker
Calcium channel blocker
472
first line antianginal rx used in stabe chronic angina
B blocker
473
antianginal drug(3)
bblocker
calcium channel blocker
nitrates
474
action of BBlocker as antianginal drug
decrease myocardial contractility and heart
475
action of calcium channel blocker as antianginal drug
peripheral and coronary vasodilation
476
can you combine Bblocker and calcium blocker as antianginal
yes
| in persisting angina
477
preventive rx in stable chronic angina(5)
```
aspirin
statin
smoking cessation
regular exercices and weight loss
control of BP and diabetes
```
478
when to use nitrate in stable chronic angina
when B blocker and calcium blocker are contindicated
479
medication which has not been shown to improve survival in patients with CHF(2)
digoxin
| furosemide
480
medication which has been shown to improve survival in patients with CHF(5)
```
ace inhibitor
ARB's
bblocker
aspirin
spironolactone
```
481
S4 meaning
diastolic disfunction
482
why S4 in MI
ischemic damage may lead to diastolic dysfuction and stiffened ventricle
483
rx of dressler syndrome
NSAIDS
484
indication of corticosteroids in dressler syndrome(2)
refractory cases
| contrindication of NSAIDS
485
why you should avoid anticoagulation if you suspect dressler syndrome
risk of hemorragic pericardial effusion
486
bad prognosis factor in heart failure
hyponatremia
487
why hyponatremia is a factro of bad prognosis in heart failure(2)
it indicates sever heart failure
| high level of neurohumoral activation
488
cause of hypo or hyperkaliemia in CHF(2)
drugs induced
| reflection of renin angiotensin aldosterone system activity
489
CHF with echo finding of concentric thickening of the ventricular walls ,normal ventricular chamber dimensions and diastolic dysfunction cause of that
amyloidosis
490
type of amyloidosis(2)
primary=AL
| secondary=AA
491
cause of amyloidosis
any chronic inflammator conditions
492
some examples of chronic inflammatory disease(5)
```
inflammatory arthritis
chronic infections
IBD
Malignancy
vasculitis
```
493
CHF in amyloidosis
restrictive
494
dx of amyloidosis
tissue biopsy(abdominal fat pad biopsy)
495
inthe USMLE clue for syncope caused by arrythmia(4)
syncope without warning
presence of structural disease(post infarction)
frequent ectipic beats
thiazide is taking by teh patient
496
patient after MI develops cold leg next step and why(2)
echo cardiography
| search for intraventricular thrombus
497
patietn presenting with left chestpain 5 days ago he was diagnosed for ant MI with complete occlsuion of LAD 2 miniutes later he is unresponsive with no pulse palpated and death(possible)dx
ventricular free wall rupture
498
mechanical complication of MI(4)
right ventricular failure
papillary muscle rupture
interventricular sseptum rupture
free wall rupture
499
artery involved in right ventricular failure
RCA
500
time course for right ventricular failure
acute
501
finding in right ventricular failure(2)
hypotension with clear lungs
| kussmaul sign
502
echo finding in right ventricular failure
hypokinetic RV
503
artery involved in papillary mx rupture
RCA
504
time course for papillary mx rupture
acute and within 3 -5 days
505
finding in papillary mx rupture
acute severe pulmonary edema
| new holosystolic murmur
506
echo finding in papillary mx rupture
severe mitral regurge with flail leaflet
507
artery involved in interventricular septum rupture or defect(2)
LAD for apical rupture
| RCA for basal rupture
508
time course in interventricular septum rupture or defect
acute and within 3 -5 days
509
finding in interventricular septum rupture or defect(4)
shock
chest pain
new hollow systiolic murmur
biventricular failure
510
echo finding in interventricular septum rupture or defect(2)
left to right shunt level of ventricle
| step up oxygen between right atrium and ventricle
511
artery involved in free wall rupture
LAD
512
time course in free wall rupture
within first 2 days - 2 weeks
513
finding in free wall rupture(3)
shock and chest pain
jugular venous distension
distant heart sounds
514
echo finding in free wall rupture
pericardial effucion with tamponnade
515
SMVT
sustained monomorphic ventricular tachycardia
516
cause of SMVT
post MI complication 6 a 48 h apres MI
517
EKG of SMVT
wide complex tachycardia with 2 fusion beats
518
rx of hemodynamic stable SMVT(3)
IV amiodarone
lidocaine
procainamide
519
rx of hemodynamic unstable SMVT
electrical cardioversion
520
heart and alcohol
dilated cardiomyopathy
521
measures most likely to reverse heart failure in alcoholic CHF
total abstinence from alcohol
522
mainstay of rx of alcoholic CHF
total abstinence from alcohol
523
what disease patient with intermittent claudication will have over the next 5 years
MI
524
major cause of mortality in patient with PAD
cardiovascular disease
525
probability of non fatal MI and stroke in patient with intermittent claudication
20% 5 year risk
526
probability of death to cardiovascular causes in patient with intermittent claudication
15 a 30 %
527
probability of critical limb ischemia with risk of limb amputation in patient with intermittent claudication
1 a 2 %
528
stanford classification of dissection aortic (2)
type A
| B
529
rx of type A aortic dissection(2)
Labetalol
| surgery
530
rx of type A aortic dissection
Labetalol
531
quid of type A aortic dissection
ascending aorta is involved
532
quid of type B aortic dissection
descending aorta
533
CT for aortic dissection
descending aorta with false and true lumen separated by an intimal flap
534
aortic mur murmur caused by aortic dissection
right sternal border compared to primary aortic valvular disease ,murmur is herad to the left
535
best test to Dx aortic dissection
TEE
| CT with contrast
536
when to use CT with contrast in the Dx of aortic dissection
when renal function is normal
537
artery and lead in anterior MI(2)
LAD
| v1 a V6
538
artery and lead in inferior MI(2)
RCA or left circumflex artery 9LCX)
| ST elevation 2,3 avf
539
artery and lead in post MI(4)
RCA or left circumflex artery
ST depression in leads V1-V3
ST elevation in 1 and AVL(LCX)
ST depression in leads 1 and AVL (RCA)
540
artery and lead in lat MI(3)
LCX/diagonal
St elevation in leads 1 avl v5 v6
St depression in leads 2, 3 avf
541
right ventricular MI when it occurs
in inferior MI
542
artery in right ventricular MI(2)
RCA
| St segment elevation in leads V4-V6R
543
MI plus hypotension plus clear lung
right ventricular failure
544
MI with sinus bradycardia
inferior MI
545
why inferior MI cangive bradycardia(2)
increased vagal tone
| RCA supply blood to sinoatrial node
546
complication of RCA occlusion and why
AV block
| RCA supply AV node through AV nodal artery
547
ST segment elevations in 2,3 avf and ST segment depression in V1 V2
inferior MI with posterior MI associated
548
hypotension AV block and bradycardia in the setting of MI
inferior MI
549
clue for MI inferior involving right heart(2)
ST segment elevation ,2,3 AVL
| St segment depression in i and AVL
550
EKG in atrial premature beats
early P wave
551
risk factor for atrial premature beats(4)
tobacco
alcohol
caffeine
stress
552
symptomatic patient with atrial premature beats rx
B blocker
553
xray in thoracic aorta aneurism(3)
widened mediastinum
increased aortic knob
tracheal deviation
554
cause of ascending aorta aneurism(2)
cystic medial necrasis
| connective tissue disorders
555
cause of descending aorta aneurism
atherosclerosis
556
enlarged aorta in xray
aneurism
557
patient with low grade fevers exertionnal dyspnea
| fingerttip pain and dark and cloudy urine.In physical exam proximal and distal interphalangeal joints are swollen
infective endocarditis
558
quid of osler nodes
painful fingertip
559
dark and cloudy urine(2)
proteinuria
| hematuria
560
swollen interphalangeal joints
arthritis
561
vascular phenomoenon in infective endocarditis(5)
```
systemic arterial emboli
septic pulmonary infarcts
mycotic aneurism
conjonctival hemorrage
janeway lesions
```
562
quid of Janeway lesions
macular erythematous nontender lesions on the palms and soles
563
systemic emboli manifestation(3)
focal neurologic deficits
renal infarcts
splenic infarcts
564
definitice dx or infective endocarditis
DUKE criteria
565
inheritance of hypertrophic cardiomyopathy
autosomal dominant
566
quid of masive pulmonary embolism(2)
PE complicated by hypotension
| and acute right strain
567
sign of right heart strain in PE(2)
high JVP
| RBBB
568
complication of right heart strain in PE(6)
```
right ventriculr dysfunction
decreasde to the left side of the heart
decreased cardiac output
left heart pump failure
bradycardia
cardiogenic shock
```
569
fibrinolysis in PE in the setting of post op
can't be given within the past 10 days of surgery
570
CHF with normal TA or elevated TA(3)
supplement o2
IV loops diuretics
consider IV vasodilators as nitroglycerin or nitroprusside
571
CHF plus sign de shock(3)
supplement o2
IV loops diuretics
IV vasopressors as norepinephrine
572
side effect of digoxin(5)
```
nausea
vomiting
diarrhea
vision changes
arythmias
```
573
patient is taking digoxin develops diarrhea what to do
measure digoxin levels
574
patient taking an anti arrythmic in teh setting of VTAC develops fibrose pulmonaire .what drug was used to rx the patient
amiodarone
575
patient with diatolic and continuous murmur at left sternal border next step
echocardiography
576
rule for diastolic and continuous murmur as well as loud systolic murmurs next step
investigate with transthoracic echodopler
577
midsystolic murmur grade 1-2 /6 in young patient next step(2)
nothing
| benign
578
medication reducing overall mortality in CHF(4)
ACE inhibitor
b blocker
ARBs
spironolactone
579
complication of niacin(2)
pruritis
| flushing
580
how to explain niacin complication
prostaglandin related vasodilation
581
rx of niacin induced pruritis and flushing
low dose of aspirin
582
patient with medical history of wolt parkinson white develops palpitations and AFIB rx
procainamide
583
rx of AFIB normally
AV nodal blockers
584
quid AV nodal blocker(4)
b blocker
calcium channel blocker
digoxin
adenosine
585
middle aged or older male loses consciuousness immediately after urination or during coughing fits
situationnal syncope
586
cause of situationnal syncope
autonomic dysregulation
587
beck triad in tamponnade(3)
hypotension
muffled heart sound
distended neck veins
588
hypotension in tamponnade(3)
shift of interventricular septum toward the left ventricular cavity
reduces left ventricular preload
stroke volume and cardiac output
589
clue for GERD(3)
retrosternal burning sensation after eating and with lying down
hoarseness
chronic cough
590
initial rx of GERD(2)
proton pump inhibitor
| H2 receptor antagonist
591
quid of resistant HTA
persistent HTA persistent despite using > ou egal a 3 antihypertensive agents
592
what to do in front of all resistant HTA
check secondary HTA
593
when to suspect renovascular HTA in case of secondary HTA(6)
severe HTA with recurrent flash pulmonary edema
severe HTA with diffuse atherosclerosis
onset of severe HTA after 55
HTA with asymetric kidney size or small atrophic kidney unilateral
presence of abdominal bruit
elevation of serun creat > 30 % from baseline after starting ACE inhibitor or ARbs
594
clue for renovascular HTA
continuous abdominal bruit
595
young patient with CHF first dx
viral myocarditis
596
trap to avoid in viral myocarditis
most of hte time you can have no preceding symptom
597
clue for cardiac cause of pedal edema
hepatojugular refux
598
importance of reflux hepatojugular
helps to differentiate cadiac from other causes(hepatic) of edema
599
clue for ventricular aneurism following MI(2)
persistent ST segment elevation after a recent MI
| deep q waves in the same leads
600
complication of ventricular aneurism(5)
```
CHF
refractory angina
ventricular arythmias
mural thrombus
mitral regurgitation
```
601
dx of ventricular aneurism
echocardiography
602
echo in ventricular aneurism
dyskinetic wall motion of a portion of the left ventricle
603
laps of time to have ventricular aneurism
5 days or 3 months following MI
604
which type of MI can cause ventricular aneurism(2)
transmural MI
| acute ST segment elevation MI
605
complication of MI acute hours to 2 days
reinfarction
606
laps of time to have ventricular septum rupture following MI
hours - 1 week
607
laps of time to have free wall rupture following MI
hours - 2 weeks
608
laps of time to have free wall rupture following MI
hours - 1 month
609
laps of time to have papillary muscle rupture following MI
2 days--1 week
610
laps of time to have pericarditis following MI
1 day-3 months
611
laps of time to haveleft ventricular aneurism following MI
5 days to 3 months
612
most following arythmias for digitalis toxicity
atrial tachycardia with AV block
613
why digitalis causes atrial tachycardia with AV block(2)
increased ectopy
| increased vagal tone
614
most common findings in pulmonary embolism
sinus tachycardia
615
westermak sign in xray thorax in PE
dilation of the pulmonary proximal to the clot
616
hampton's hump
pleural infiltrates corresponding to pulmonary infarction
617
murmur in hypertrophic cardiomyopathy
systolic ejection murmur alomg the left sternal border
618
rx of VFIB and pulseless VTAC
defibrillation
619
energy used to defibrillate VFIB or pulseles VTAC
200-360 joules
620
3 degree heart block or complete atrioventricular block(2)
conastant R-R interval
| P wave activity unrelated to qrs
621
symptomatic third degree block rx
temporary pacemaker(cardiac pacing)
622
risk factor in aortic dissection(3)
HTA
Marfan
cocaine use
623
blood pressure in Aortic dissection
> 20 mm de hg variation in systolic blood pressure btween arms
624
complictaion of aortic dissection(8)
```
stroke
acute aortic regurgitation
horner's syndrome
acute MI
pericardial effusion or tamponnade
hemothorax
lower extremity weakness or ischemia
abdominal pain
```
625
lower extremity weakness in aortic dissection
spinal illliac artery involved in the process
626
abdominal pain in aortic dissection
mesenteric artery
627
patietn with restrictive lung diseaseby rheumatoid lung disease comes with AFIB with a rapid ventricular response what drug toavoid in this patient
amiodarone
628
ECG findings in MOBITZ one second degree AV block
progressive prolonged PR interval leads to a non conducted P wave ( group beating)
629
ECG findings in MOBITZ 2 second degree AV block
PR interval remains constant with intermittent non conducted P waves
630
level of block in Mobtz 1
usually AV nodal
631
level of block in Mobtz 2
below the level of AV node
632
QRS complex in Mobitz 1
narrow
633
QRS complex in Mobitz 2
narrow or wide
634
what happen with execice or atropin in MOBITZ one
improves type 1 AV block
635
what happen with execice or atropin in MOBITZ 2
worsens type 2 block
636
what happen with vagal maneuver in MOBITZ 2
improves it
637
what happen with vagal maneuver in MOBITZ 1
worsens it
638
risk of complete heart in MOBITZ one
low risk
639
risk of complete heart in MOBITZ 2(2)
high risk
| indictaion of pace maker
640
drug causing AV block mobitz 1(3)
digoxin
B blocker
calcium blocker
641
group beating
after 3 PQRS complexes you have one drop
642
cause of Mobitz one(4)
healthy people
athletes
heart problem
drugs
643
muscle pain with high CPK in patient taking statin
stop simvastatin
644
muscle pain in aptient taking statin first step
check CPK level
645
syncope in post MI
ventricular arrythmias
646
quid of ventricular arrythmia(3)
ventricular premature beats
nonsustained and sustained VTAC
VFIB
647
most common cause of sudden cardiac death in the setting of acute MI
VFIB
648
laps of time for cardiac sudden arrest in the setting of MI
first hour
649
predominant mechanism for ventricular arythmia
reentry
650
mechanism of arhytmia in post MI occuring within 10 mn of MI and name of that process in arythmia
reentrant arythmias
| immediate or phase 1 a ventricular arrhytmias
651
mechanism of arhytmia in post MI occuring 10 a 60 mn after MI and name of that process in arythmia (2)
abnormal automaticity
| delayed or phase 1b arrhytmias
652
most common cause of sudden cardiac arrest death in the immediate post MI
reentrant ventricular arrythmias
653
CHF in patient from brazil with history of megacolon bug causing that
chagas disease
| protozoal disease
654
Manif of chagas disease(3)
Megaesophagus
megacolon
cardiac dysfunction
655
bud in chagas
Tripanosoma cruzi in latin america
656
trick to know S4
TENessee first syllable S4
657
when do you hear S4(2)
just before s1
| its a diatolic sound
658
meaning of S4 and cause of S4(2)
ventricular hypertrophy
| HTA
659
clue for anaphylactic shock(2)
hypotension
| diffuse rash
660
medical cause of anaphylaxis
latex containing products like gloves
661
first line rx of Hypertrophic cardiomyopathy(2)
```
B blocker
calcium blocker(diltiazem)
```
662
why Bblocker or calcium blocker are good in the treatment of HOC
they promote diastolic relaxation
663
trick to know S3
kentucKY third syllable is S3
664
when you hear S3
just after S2
665
meaning of S3
left ventricular failure
666
best drug to use intially in patient with S3 with shortness of breath
IV diuretics
667
parameter in hemorragic shock
```
Cardiac ouput (CO) decreased
PCWP decreases(pulmonary capillay wedge pressure)
SVR increases( peripheral resistance)
BP decreases
Heart rate increases
```
668
hta plus systolic diastolic abdominal bruit
renal artery stenosis
669
syncope in HOCM(4)
outflow obstruction
arrythmia
ischemia
ventricular baroreceptors response
670
quid of orthostatic hypotension
drop in systolic pressure greater than 20 mm de hg whn moving from lying down to standing
671
risk for orthostatic hypotension(5)
```
prolonged recumbence
diuretics
adrenergic blocking agent
vasodilators
elderly hypovolemic and/or with autonomic neuropathy
```
672
blue hands and feet following administration of vasopressor in the setting of an accident
norepinephrine induced vasospasm
673
risk in the development of AAA(4)
cigarette smoking
family history of AAA
white race
atherosclerosis
674
strongest predictor of abdominal aortic aneurism expansion and rupture(3)
large aneurism diameter
rapid rate of expansion
current cigarette smoking
675
current indication for surgery in aneurism
< 5.5 cm
rapid rate of expansion .0,5 cm in 6 months or 1 cm per year
presence of symptoms
676
symptomatic AAA(2)
abdominal back flank pain
| limb ischemia
