Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Project - USMLE Step 3 > Cardiology COPY > Flashcards

Cardiology COPY Flashcards

You may prefer our related Brainscape-certified flashcards:
USMLE® Step 1 flashcards
1
Q

mechanism of syncope

A

ONLY BRAINSTEM stroke can cause syncope (controls sleep/wake in brain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

exertional SOB: immigrant, pregnant

A

MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

treatment for pericarditis if pain persists after NSAID

A

prednisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

diagnostic test for valve rupture

A

echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

is pregnancy a contraindication to do balloon valvuloplasty in MS?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

if cardiac exam is ABNORMAL, possible causes could be?

A

structural heart disease:

  • aortic or mitral stenosis
  • HCM
  • mitral valve prolapse (rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

mechanism of increased MS symptoms in pregnancy

A
  • 50% increase in plasma volume
  • more volume = more pressure, backflow, and symptoms
  • ADH levels higher
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

best INITIAL treatment for WPW

A

procainamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MC complaint in MR

A

exertional dyspnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

mechanism of S4 gallop

A

atrial systole into a stiff or noncompliant left ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

possible causes of RESTRICTIVE cardiomyopathy

A
  • sarcoidosis
  • amyloidosis
  • hemochromatosis
  • cancer
  • myocardial fibrosis
  • glycogen storage diseases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CHF presentation

A
  • SOB, especially on exertion, and…
  • edema
  • rales
  • ascites
  • jugular venous distention
  • S3 gallop
  • orthopnea (SOB when lying flat)
  • paroxysmal nocturnal dyspnea (SOB attacks at night)
  • fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

treatment for RIGHT ventricular infarction

A

fluid loading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

decreases mortality in patients with

  • EF 120ms
A

biventricular pacemaker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

best INITIAL treatment for pericardial tamponade

A

pericardiocentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  • exertional SOB

- S4 gallop

A

hypertrophic cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

PARADOXICAL splitting of S2 (P2 delayed) causes

A
  • LBBB
  • AS
  • LVH
  • HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

benefit of using aspirin in ACS

A

instant effect of inhibiting platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what does EKG show in constrictive pericarditis?

A

low voltage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hill’s sign

A

BP gradient much higher in LE’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

if etiology of syncope is STILL NOT clear

A
  • tilt table test (to diagnose neurocardiogenic (vasovagal) syncope)
  • EP testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

CXR findings for MS (mitral stenosis)

A
  • straightening of left heart border

- elevation of left mainstem bronchus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

moderate AS pressure gradient

A

30-70mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

BLS for VF

A
  1. continue CPR
  2. defibrillate (UNsynchronized cardioversion)
  3. IV epinephrine/vasopressin
  4. defibrillate (UNsynchronized cardioversion)
  5. IV amiodarone/lidocaine
  6. defibrillate (UNsynchronized cardioversion)

repeat CPR between each shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

exertional SOB: palpitations, atypical chest pain NOT with exertion

A

MVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

possible causes of CHF

A
  1. HTN
  2. valvular heart disease
  3. MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

best treatment for REGURGITANT lesions

A

VASODILATORS

ACEIs, ARBs, or nifedipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

diagnosis of loss of pulse/VF

A

EKG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

when should you answer exercise thallium testing, or stress echocardiography?

A

EKG is unreadable for ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

if EKG does not detect VT then

A

telemetry monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

best INITIAL test for PAD

A

ankle-brachial index (ABI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

normal aortic valve pressure gradient

A

ZERO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q
  • low-voltage EKG

- speckled pattern on echo

A

amyloidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

management of syncope is based on 3 criteria

A
  1. was the loss of consciousness SUDDEN or GRADUAL?
  2. was the regaining of consciousness SUDDEN or GRADUAL?
  3. is the cardiac exam NORMAL or ABNORMAL?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

MOST EFFECTIVE treatment for dissection of thoracic aorta

A

surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

best INITIAL treatment for pericarditis

A

NSAID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

severe AS pressure gradient

A

> 70mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

test for ASD

A

echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

which murmurs are LOUDER with handgrip maneuver?

A
  1. AR
  2. MR
  3. VSD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

are beta blockers contraindicated with PAD?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

indications for thrombolytics

A
  1. cannot perform PCI

2. chest pain for

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

if cardiac exam is NORMAL, possible cause could be?

A

ventricular arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

exertional SOB: young female, general population

A

MVP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

situations where EKG may be unreadable for ischemia

A
  1. LBBB
  2. digoxin use
  3. pacemaker
  4. LVH
  5. baseline ST segment abnormality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

causes of MR

A
  1. HTN
  2. ischemic heart disease
  3. any condition leading to dilation of heart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q
  • chest pain/syncope
  • older
  • h/o HTN
A

AS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

all LEFT-sided murmurs increase in intensity with

A

EXhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Duroziez’s sign

A

murmur heard over femoral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

treatment for myocardial wall rupture

A
  • pericardiocentesis

- urgent cardiac repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

next best step in patient with a-fib, that’s rate controlled

A

warfarin with goal INR of 2-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

CHADS2Vasc

indicates need for warfarin

A 
CHF +1
HTN +1
Age
≥ 75 +2
DM +1
Stroke/TIA/Thromboembolism +2
Vascular Disease +1
Age
> 65-74 +1
Female +1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

if return to consciousness onset was GRADUAL, possible causes could be?

A

neurological etiology (seizures)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

MORE ACCURATE test for AS

A

TEE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

INITIAL treatment for dissection of thoracic aorta

A

beta blocker, and get EKG/CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

S3 gallop indicates

A

DILATED left ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

sudden death

A

ventricular fibrillation (VF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

heart failure is primarily a clinical diagnosis:

name the MAJOR criteria

need either, 2 major criteria, or 1 major and 2 minor

A
  1. paroxysmal nocturnal dyspnea (PND)
  2. orthopnea
  3. raised jugular venous pressure (JVP)
  4. third heart sound
  5. increased cardiac silhouette on CXR
  6. pulmonary vascular congestion on CXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

lower mortality in ACS, but is NOT time critical

A

beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

best long-term management

A

radiofrequency catheter ablation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q
  • SVT that can alternate with ventricular tachycardia

- WORSENING of SVT after use of CCB or digoxin

A

Wolff-Parkinson-White syndrome (WPW)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

MOST ACCURATE test for MS

A

left heart catheterization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

best treatment for mitral stenosis

A

balloon valvuloplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

best INITIAL test for AR

A

TTE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

MOST ACCURATE test for PAD

A

angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

when is lidocaine or amiodarone used for AMI?

A
  • ONLY in Vtach, or Vfib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

diagnostic tests for MAT

A
  • EKG first

- if EKG is negative, Holter monitor or telemetry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

MOA of imamRINONE and milRINONE

A
  • PDE inhibitors
  • increase contractility
  • vasodilators= decrease AFTERload
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q
  • pleuritic chest pain (changes with respiration)
  • positional chest pain (better when sitting up/leaning forward)
  • pain is SHARP, and BRIEF
A

pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q
  • chest pain radiating to back between scapula
  • CP is INITIALLY very severe and “ripping”
  • difference in BP between RIGHT and LEFT arms
A

dissection of thoracic aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

PCI should be done within what timeframe of reaching the ER?

A

90 MINUTES

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

diagnostic test for VSD

A

echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

only given when angioplasty is done

A

prasugrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

AS is best heard where and radiates where?

A
  • 2nd RIGHT intercostal space

- carotid arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

ALWAYS lower mortality in ACS

A
  1. aspirin
  2. thrombolytics
  3. angioplasty
  4. metoprolol
  5. statins
  6. clopidoGREL/ticaGRELor/prasuGREL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

best INITIAL test for HYPERTROPHIC cardiomyopathy

A

echo

shows normal EF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

treatment for RCMP

A
  1. diuretics

2. correct underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

diagnostic test for sinus bradycardia

A

EKG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

complications of myocardial infarction

A
  1. cardiogenic shock
  2. valve rupture
  3. septal rupture
  4. myocardial wall rupture
  5. sinus bradycardia
  6. third degree (complete) heart block
  7. right ventricular infarction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q
  • palpitations

- REGULAR rhythm

A

atrial flutter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

treatment for VF

A

ALWAYS UNsynchronized cardioversion first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

VSD murmur description

A
  • holosystolic murmur

- LLSB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

what does CXR show in constrictive pericarditis?

A

calcification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

mechanism of opening snap earlier in worsening MS

A

worse MS = higher LA pressure = mitral valve opens earlier

mitral valve opens when LA pressure > LV pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

if syncope onset was SUDDEN, next question is?

A

was the regaining of consciousness SUDDEN or GRADUAL?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

what does CT and MRI show in constrictive pericarditis?

A

thickening of pericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

diagnostic test for RIGHT ventricular infarction

A

EKG showing right ventricular leads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

treatment for syncope

A

based on etiology

but most cases lack specific diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

calcium channel blockers are used in ACS when

A
  • intolerance to beta blockers (e.g. asthma)
  • cocaine-induced CP
  • coronary vasospasm/Prinzmetal’s angina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

mechanism of rales

A

increased HYDROSTATIC pressure in pulmonary capillaries –> transudation of liquid into alveoli –> “popping” sound during inhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

how long do bioprosthetic valves last?

A

about 10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

what EKG shows in CHF patient

A
  1. sinus tachycardia

2. atrial and ventricular arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

if syncope onset was GRADUAL, possible causes could be?

A
  • toxic-metabolic
  • hypoglycemia
  • anemia
  • hypoxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

treatment for VT in patient that hemodynamically STABLE

A
  • amiodarone
  • lidocaine
  • procainamide
  • magnesium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

what echo shows in CHF patient

A

distinguishes systolic vs diastolic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

treatment for cardiogenic shock

A
  • ACE inhibitor

- urgent revascularization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

treatment for VT in patient that hemodynamically UNSTABLE

A

synchronized cardioversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

standard of care for pulmonary edema

A
  1. oxygen
  2. furosemide (preload reduction)
  3. nitrates
  4. morphine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q
  • SUDDEN onset loss of pulse and COLD extremity
  • painful
  • can have h/o AS or atrial fibrillation
A

acute arterial embolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

best INITIAL therapy for MS

A

diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

special features of MS

A
  1. dysphagia (LA pressing on esophagus)
  2. hoarseness (pressure on recurrent laryngeal nerve)
  3. a-fib (stroke)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

MOST ACCURATE test for valvular heart disease

A

left heart catheterization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

mainstay of diagnosis of RCMP

A

echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

treatment of choice for AS

A

valve replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

ALL post-MI patients should go home on

A
  1. aspirin
  2. clopidoGREL, or prasuGREL
  3. beta blocker
  4. statin
  5. ACE inhibitor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

effect of handgrip on aortic stenosis

A

SOFTENS murmur

less blood travels from LV to aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

AR, tricuspid murmurs, and VSD are best heard where?

A

LLSB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

treatment for valve rupture

A
  • ACE inhibitor
  • nitroprusside
  • intra-aortic balloon pump as bridge to surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

MOST ACCURATE for dissection of thoracic aorta

A

CTA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

NEXT BEST step in management if vagal maneuvers do NOT work

A

IV adenosine

most frequently asked SVT question

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

treatment for ASD

A

percutaneous or catheter repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

do NOT use what in MAT?

A

beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

CAD equivalents

A
  1. DM
  2. PAD
  3. aortic disease
  4. carotid disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

exertional SOB: healthy young athlete

A

HCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

MOST EFFECTIVE treatment for constrictive pericarditis

A

surgical removal of pericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

screening US of abdominal aorta should be done in?

A

MEN OVER 65 who are current or were former SMOKERS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

which murmurs are LOUDER with amyl nitrate?

A
  1. MVP

2. HCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

in evaluation of syncope, if the neuro exam is FOCAL, or there’s h/o head trauma

A

order CTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Corrigan’s pulse

A

high bounding pulses

“water-hammer” pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

mechanism of fixed splitting of S2 in ASD

A

equal pressure between LA and RA = no change in splitting

120
Q

which maneuver increases afterload?

A

handgrip

121
Q

ONLY 2 murmurs that LOUDER with STANDING/Valsalva

A
  1. MVP

2. HCM

122
Q

in evaluation of syncope, if headache is described

A

order CTH

123
Q

best INITIAL management for STABLE patients

A

vagal maneuvers

  • carotid sinus massage
  • ice immersion of the face
  • Valsalva
124
Q

diagnostic test for myocardial wall rupture

A

echo

125
Q

what if PCI cannot be done within 90 minutes?

A

thrombolytics

126
Q

lower mortality in ACS in CERTAIN CONDITIONS

A
  1. ACE/ARBs inhibitors IF EF is LOW
127
Q

should be given to ALL patients with ACS, but only lower mortality if there is LEFT VENTRICULAR DYSFUNCTION, or SYSTOLIC DYSFUNCTION

A

ACE inhibitors

128
Q

right heart catheterization findings of pericardial tamponade

A

EQUALIZATION of ALL pressures in heart during systole

129
Q

treatment for DCMP

A
  1. ACEI/ARB
  2. BB
  3. spironolactone/eplerenone (decrease work of heart)
130
Q

only pertinent positive PE finding for pericarditis

A

FRICTION RUB

131
Q

UNSTABLE patient with atrial fibrillation

(unstable = SBP

A

SYNCHRONIZED electrical cardioversion

132
Q

Musset’s sign

A

head bobbing with pulse

133
Q

best INITIAL therapy for AS

A

diuretics

don’t improve long-term prognosis
OVERDIURESIS IS DANGEROUS

134
Q

when do you add ranolazine?

A

persistent chest pain

135
Q

when do you use a pacemaker for AMI?

A
  • 3rd degree AV block
  • Mobitz II, second degree AV block
  • bifasicular block
  • NEW LBBB
  • symptomatic bradycardia
136
Q

non-ST segment elevation myocardial infarction treatment

A
  1. no thrombolytics
  2. low molecular weight heparin
  3. glycoprotein IIb/IIIa inhibitors (lower mortality)
137
Q

MS murmur description

A

diastolic RUMBLE after OPENING SNAP

opening snap moves closer to S2 as mitral stenosis worsens

138
Q

all RIGHT-sided murmurs increase in intensity with

A

INhalation

139
Q

best initial therapy for all cases of ACS

A

ASPIRIN

140
Q

complaint in VSD

A

SOB

141
Q

when do you do SURGERY for MR?

EVEN IF PATIENT IS ASYMPTOMATIC

A
  • LVEF 40mm
142
Q

best INITIAL management for UNSTABLE patients

A

synchronized cardioversion

143
Q

diagnostic tests for syncope evaluation

A
  • cardiac/neurological exam
  • EKG
  • chemistries (looking at glucose, and electrolytes)
  • oximeter
  • CBC (looking for anemia)
  • cardiac enzymes
144
Q

MR murmur description and location it’s best heard

A
  • holosystolic murmur that obscures S1 and S2

- apex radiating to axilla

145
Q

MOST ACCURATE test for RCMP

A

endomyocardial biopsy

146
Q

possible PE findings in valvular heart disease

A
  • peripheral edema
  • carotid pulse findings
  • gallops
147
Q

atrial fibrillation/atrial flutter WITH:

  • borderline hypOtension
A

digoxin

148
Q

best long-term treatment for WPW

A

radiofrequency catheter ablation

149
Q

MOST ACCURATE test for pericardial tamponade

A

echo

150
Q
  • claudication (pain in calves on exertion)
  • “smooth, shiny skin” with loss of HAIR and SWEAT GLANDS
  • loss of pulses in feet
A

PAD

151
Q

best treatment for STENOTIC lesions

A

anatomic repair

152
Q

atrial fibrillation/atrial flutter WITH:

  • asthma
  • migrains
A

calcium channel blockers (diltiazem)

153
Q

MOA of heparin

A

potentiates effect of antithrombin

154
Q

handgrip makes it worse/amyl nitrate improves murmur

A

ACEI indicated

155
Q

which murmurs are SOFTER with handgrip?

A
  1. MVP

2. HCM

156
Q

if return to consciousness onset was SUDDEN, next question is?

A

is the cardiac exam NORMAL or ABNORMAL?

157
Q

MC adverse effect of statins

A

LIVER TOXICITY

158
Q

treatment for SYSTOLIC dysfunction (low EF)

A
  1. ACEI or ARB
  2. metoprolol/carvedilol/bisoprolol
  3. spironolactone/eplerenone
  4. diuretic
  5. digoxin
159
Q

other PO AC’s for a-fib besides warfarin

A
  • dabigatran (direct THROMBIN inhibitor)
  • rivaroxaban (factor Xa inhibitor)
  • apixaban (factor Xa inhibitor)
160
Q

most common cause of death in US

A

CAD

161
Q

Valsalva improves murmur

A

diuretics indicated

162
Q

what is a NORMAL ankle-brachial index (ABI)?

A

greater than or equal to 0.9

> 10% difference = OBSTRUCTION

163
Q

WIDE splitting of S2 (P2 delayed) causes

A
  • RBBB
  • pulmonic stenosis
  • RVH
  • pulmonary HTN
164
Q

MR is best heard where and radiates where?

A
  • apex (5th intercostal space)

- axilla

165
Q

diagnosis of WPW

A

DELTA WAVE on EKG

166
Q

MCC of MS

A

rheumatic fever

167
Q

best INITIAL test for valvular heart disease

A

ECHO

168
Q

initial test for atrial fibrillation

A
  • telemetry monitoring as INpatient

- Holter monitoring as OUTpatient

169
Q

in evaluation of syncope, if murmur is present

A

order an echo

170
Q

in evaluation of syncope, if seizure is described, OR SUSPECTED

A

order CTH and EEG

171
Q

MC causes of dilated CMP

A
  • ischemia (MOST COMMON)
  • alcohol
  • adriamycin
  • radiation
  • Chagas’ disease
172
Q

PAIN + PALLOR + PULSELESS =

A

ARTERIAL OCCLUSION

173
Q

best INITIAL step in presentation of chest pain

A

ASPIRIN

174
Q

mechanism of WPW

A

neutralized cardiac muscle going around AV node creating aberrant pathway

175
Q

Quincke pulse

A

arterial or capillary pulsations in FINGERNAILS

176
Q

why does high pressure dilate aortic valve?

A

LaPlace’s law

tension = radius x pressure

177
Q

treatment for third-degree (complete) heart block

A
  • atropine

- pacemaker EVEN IF symptoms resolve

178
Q

MOST EFFECTIVE treatment for pericardial tamponade

A

pericardial window placement

179
Q

mechanism of thrombolytics

A

ACTIVATE plasminoGEN into PLASMIN

chops up fibrin strands into D-dimers
(does nothing if already stabilized by factor XIII)

180
Q

CAD risk factors (8)

A
  1. diabetes mellitus
  2. hypertension
  3. tobacco use
  4. hyperlipidemia
  5. peripheral arterial disease (PAD)
  6. obesity
  7. inactivity
  8. family history
181
Q

prognosis of AS

A
  • CAD = 3-5-year average survival
  • syncope = 2-3-year average survival
  • CHF = 1.5-2-year average survival
182
Q

mechanism of S3 gallop

A

rapid ventricular filling during diastole

183
Q

mechanism of thallium (nuclear isotope)

A

decreased uptake = damage

184
Q

causes of PLEURITIC chest pain

A
  1. PE
  2. pneumonia
  3. pleuritis
  4. pericarditis
  5. pneumothorax
185
Q

right heart catheter results in acute pulmonary edema

A
  • CO = decreased
  • SVR = increased
  • wedge pressure = increased
  • RA pressure = increased

(wedge pressure = indirect LA pressure measurement)

186
Q

atrial fibrillation/atrial flutter WITH:

  • ischemic heart disease
  • migraines
  • Graves disease
  • pheochromocytoma
A

beta blockers (metoprolol)

187
Q
  • palpitations
  • IRREGULAR pulse
  • h/o HTN, ischemia, or CMP
A

a-fib

188
Q

CAD + LDL > 100

A

give statins

189
Q

when do you do SURGERY for AR?

EVEN IF PATIENT IS ASYMPTOMATIC

A
  • EF 55mm
190
Q

chest pain that changes with RESPIRATION

A

pleuritic pain

191
Q

MC of post-MI erectile dysfunction d/t medication

A

beta blockers

192
Q

which medications should only be used in congestive heart failure, systolic dysfunction, or low ejection fraction?

A

ACE inhibitors or ARBs

193
Q

MOST ACCURATE test for WPW

A

electrophysiologic studies

194
Q

what is considered “significant” in the family history of CAD?

A
  • females > 65 years of age

- males > 55 years of age

195
Q

LDL goal in ACS patient with DIABETES

A

< 70

196
Q

what oximeter shows in CHF patient

A
  1. hypoxia

2. respiratory alkalosis (from tachypnea)

197
Q

mechanism of why CCB don’t work in PAD

A

CCB dilate muscular layer EXterior to atherosclerotic clot which is INterior

198
Q

MC presentation of AR

A
  1. SOB

2. FATIGUE

199
Q

clopidoGREL or ticaGRELor is used in ACS when

A
  • aspirin allergy
  • patient undergoes angioplasty/stenting
  • acute MI
200
Q

which test is best to detect REINFARCTION a few days after initial infarction?

A

CK-MB

201
Q

which cardiac enzyme rises first?

A

myoglobin

202
Q

best INITIAL test for MS

A

TTE

203
Q

mechanism of syncope/angina in AS

A

blocked flow with increased demand = chest pain

204
Q

added to aspirin for patients with ACUTE MI

A

clopidogrel or ticagrelor

205
Q

mild AS pressure gradient

A

< 30mmHg

206
Q

MOA of carvedilol

A

antagonist of B1, B2, and a1 receptors

  1. antiarrhythmic
  2. anti-ischemic
  3. antihypertensive
207
Q

perform surgical bypass in PAD when

A

signs of ischemia:

  • gangrene
  • pain at REST
208
Q

MORE ACCURATE test for MR

A

TEE

209
Q

effect of amyl nitrate on aortic stenosis

A

makes it LOUDER

decreases afterload

210
Q

MOST ACCURATE diagnostic test for VT

A

electrophysiologic studies

211
Q

used to determine degree of left-to-right shunting

A

catheterization

212
Q

most effective therapy for MS

A

balloon valvuloplasty

213
Q

best INITIAL treatment for MR

A
  • ACEI/ARB, or nifedipine
214
Q

heart failure is primarily a clinical diagnosis:

name the MINOR criteria

need either, 2 major criteria, or 1 major and 2 minor

A
  1. B/L LE edema
  2. nocturnal cough
  3. exertional dyspnea
  4. tachycardia
  5. presence of pleural effusion
  6. hepatomegaly
215
Q
  • exertional SOB

- Kussmaul’s sign (increase in jugular venous pressure on inhalation)

A

restrictive cardiomyopathy

216
Q

role of colchicine in pericarditis

A

adds efficacy to NSAIDs and prevents recurrent episodes

217
Q
  • atrial arrhythmia IN ASSOCIATION WITH COPD/EMPHYSEMA

- tachycardia (HR > 100)

A

multifocal atrial tachycardia (MAT)

218
Q

can be given in ACS, but do NOT lower mortality

A

nitrates and morphine

219
Q

should be given to ALL patients with ACS, regardless of EKG/enzyme levels

A

statins

220
Q

when is ASD repair most often indicated?

A

if shunt ratio exceeds 1.5:1

221
Q

causes of AR

A
  • HTN
  • rheumatic heart disease
  • endocarditis
  • cystic medial necrosis
222
Q

clues that chest pain is ISCHEMIC in nature

A
  1. dull pain
  2. last 15-30 minutes
  3. exertional
  4. substernal location
  5. radiates to jaw or left arm
223
Q

treatment for HCMP

A
  1. BB

2. diuretics

224
Q

if ventricular dysrhythmia is diagnosed as etiology of syncope, what is indicated?

A

implantable cardioverter/defibrillator

225
Q

MOST ACCURATE test for AR

A

left heart catheterization

226
Q

AE of ACEI and ARBs

A
  • hyperkalemia with both

- cough with ACEIs

227
Q

when do you repair AAA?

A

> 5cm

228
Q

which medications can be given for atrial fibrillation to control the rate?

A
  • beta blockers (metoprolol/esmolol)
  • calcium channel blockers (diltiazem)
  • digoxin

should be given IV

229
Q

STABLE patient with atrial fibrillation

A

slow ventricular HR if > 100-110

230
Q

do NOT lower mortality in ACS

A
  1. oxygen
  2. morphine
  3. nitrates
  4. calcium channel blockers (actually INCREASE; avoid!)
  5. lidocaine
  6. amiodarone
231
Q

next diagnostic test to evaluate an abnormal stress test

A

angiography

232
Q

MOA of clopidoGREL, ticaGRELor, and prasuGREL

A

inhibit ADP activation of platelets

233
Q
  • SOB
  • signs of chronic right heart failure (edema, JVD, hepatosplenomegaly, ascites)
  • Kussmaul’s sign (increase in JVD on INhalation)
  • PERICARDIAL KNOCK (extra diastolic sound from heart hitting calcified thickened pericardium)
A

constrictive pericarditis

234
Q

diagnostic tests for septal rupture

A
  • echo

- right heart cath showing STEP UP IN SATURATION FROM RIGHT ATRIUM TO RIGHT VENTRICLE

235
Q

FIXED splitting of S2

A

ASD

236
Q

what does cardiac catheterization show in RCMP?

A

rapid x and y descent

237
Q

ONLY 2 murmurs that become SOFTER with SQUATTING/leg raise

A
  1. MVP

2. HCM

238
Q

treatment for DIASTOLIC dysfunction (normal EF)

A
  1. metoprolol/carvedilol/bisoprolol

2. diuretic

239
Q
  • FIXED splitting of S2
  • SOB
  • parasternal heave
A

ASD

240
Q

treatment for sinus bradycardia

A
  • atropine

- pacemaker IF there are STILL symptoms

241
Q

MORE ACCURATE test for AR

A

TEE

242
Q

initial diagnostic tests for CHF patient

A
  1. CXR
  2. EKG
  3. oximeter (maybe an ABG)
  4. echo
243
Q

mechanism for need of synchronization

A
  • T-wave represents refractory period

- electrical shock delivered during the T-wave can set off a WORSE rhythm; VF, and ASYSTOLE

244
Q

diagnostic test for third-degree (complete) heart block

A
  • EKG

- canon “a” waves

245
Q

further management of dissection of thoracic aorta

A
  1. order CTA = TEE = MRA

2. start nitroprusside

246
Q

best treatment for severe aortic stenosis

A

aortic valve replacement

247
Q

at what CHADS2Vasc score should a pt be started on warfarin, and should the pt be bridged on heparin?

A
  • 2, or more points

- NO!

248
Q

best INITIAL diagnostic test for pericarditis

A

EKG

GLOBAL ST elevation
(PR segment depression in lead II is pathognomonic)

249
Q

MOA of dobutamine

A
  • increase contractility

- vasoconstriction= increases AFTERload

250
Q

S3 gallop can be normal in which patients?

A

age

251
Q

improve mortality of chronic angina

A

aspirin and metoprolol

252
Q
  • palpitations and tachycardia
  • occasionally syncope
  • NOT associated with ischemic heart disease
  • REGULAR RHYTHM WITH VENTRICULAR RATE OF 160-180
A

supraventricular tachycardia (SVT)

253
Q
  • palpitations
  • syncope
  • chest pain
  • sudden death
A

ventricular tachycardia (VT)

254
Q

VSD treatment

A

mechanical closure if severe

255
Q

thrombolytics should be done within what timeframe of reaching the ER?

A

30 MINUTES

256
Q

indications for CABG

A
  1. THREE coronary vessels > 70% stenosis
  2. left main coronary artery > 50-70% stenosis
  3. TWO vessels in a DIABETIC
  4. 2 or 3 vessels with LOW EF
257
Q

if initial EKG and/or enzymes do NOT establish diagnosis of CAD, next step

A

stress test

258
Q

treatment for septal rupture

A
  • ACE inhibitor
  • nitroprusside
  • urgent surgery
259
Q

best INITIAL treatment for constrictive pericarditis

A

diuretic

260
Q
  • causes acute chest pain
  • can occur with exertion or at rest
  • ST segment elevation, depression, or normal EKG
  • NOT based on enzyme levels, angiography, or stress test results
  • BASED ON h/o chest pain with features suggestive of ischemic disease
A

definition of acute coronary syndrome (ACS)

261
Q

what CXR shows in CHF patient

A
  1. pulmonary vascular congestion
  2. cephalization of flow
  3. effusion
  4. cardiomegaly
262
Q

AR murmur description and location it’s best heard

A
  • diastolic decrescendo murmur

- LEFT sternal border

263
Q

when do you balloon dilate AS?

A

ONLY when patient can’t tolerate surgery

264
Q

how long do mechanical valves last?

A

15-20 years

need to be on warfarin with INR of 2-3

265
Q

what does EKG show in RCMP?

A

low voltage

266
Q

best INITIAL test for AS

A

TTE

267
Q

diagnostic tests for cardiogenic shock

A
  • echo

- Swan-Ganz (right heart) catheter

268
Q

best INITIAL test for MR

A

TTE

269
Q

situations where patient won’t be able to do an exercise stress test

A
  1. COPD
  2. amputation
  3. deconditioning
  4. weakness/previous stroke
  5. LE ulcer
  6. dementia
  7. obesity
270
Q

exertional SOB: Turner’s syndrome, coarctation of aorta

A

BICUSPID aortic valve

271
Q

treatment for MAT

A
  1. oxygen FIRST

2. THEN diltiazem

272
Q

contraindicated with sildenafil (PDI’s)

A

nitrates

273
Q

cause of chest pain that is tender to palpation

A

costochondritis

274
Q

causes of POSITIONAL chest pain

A

pericarditis

275
Q

MOST DANGEROUS thing to give a patient with pericardial tamponade

A

diuretics

276
Q

when should you order a dipyridamole or adenosine thallium stress test, or dobutamine echocardiogram?

A

patient can’t exercise to target HR of > 85% of maximum

277
Q

best INITIAL treatment for PAD

A
  1. aspirin
  2. BP control with ACEI
  3. exercise as tolerated
  4. cilostazol
  5. statin with LDL goal
278
Q

mechanism of crescendo-decrescendo murmur of AS

A
  • isovolumetric contraction = no blood moving = no murmur

- mid-systole = peak flow = peak noise

279
Q

clinical diagnosis of acute pulmonary edema

A
  1. SOB
  2. rales
  3. S3 (splash)
  4. orthopnea
280
Q
  • SOB
  • hypOtension
  • jugular venous distention
  • lungs CTA
  • PULSUS PARADOXUS (BP decrease > 10mmHg on INhalation)
  • ELECTRICAL ALTERNANS (alternating QRS complex heights)
A

pericardial tamponade

281
Q

pulmonic valve murmurs are best heard where?

A

2nd LEFT intercostal space

282
Q

AS murmur description and location it’s best heard

A
  • crescendo-decrescendo

- 2nd RIGHT intercostal space radiating to CAROTIDS

283
Q

S4 gallop indicates

A

left ventricular HYPERTROPHY

284
Q
  • holosystolic murmur at LLSB
  • SOB
  • parasternal heave
A

VSD

285
Q

best INITIAL therapy for AR

A
  • ACEI/ARB, or nifedipine

- and loop diuretic

286
Q

MAT EKG finding

A

POLYMORPHIC P waves

287
Q

MORE ACCURATE test for MS

A

TEE

288
Q

best INITIAL test for DILATED cardiomyopathy

A

echo

check EF and wall motion abnormality

289
Q

best INITIAL test for dissection of thoracic aorta

A

CXR showing WIDENED MEDIASTINUM

290
Q

other tests to order once atrial fibrillation is diagnosed

A
  1. echo: looking for clots, valve function, LA size
  2. TFT: TSH, T4
  3. electrolytes: K+, Mag2+, Ca2+
  4. troponin/CK
291
Q

which medications decrease afterload?

A
  1. amyl nitrate

2. ACEIs

292
Q

MC of post-MI erectile dysfunction

A

anxiety

293
Q

mechanism of pulsus paradoxus

A

inhale = big RV = smaller LV = BP drop > 10mmHg

294
Q

further evaluation of syncope if diagnosis is still unclear after INITIAL tests

A
  • Holter monitor as outpatient
  • telemetry monitor as inpatient
  • repeat cardiac enzymes
  • urine/blood toxicology
295
Q

finding on echo in pericardial tamponade

A

diastolic collapse of RA and RV

296
Q

MOST ACCURATE test for AS

A

left heart catheterization

297
Q

what LOWER MORTALITY in STEMI and are TIME DEPENDENT?

A

thrombolytics and PCI

Project - USMLE Step 3 (82 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions