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USMLE Step 1 > Cardiovascular > Flashcards

Cardiovascular Flashcards

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USMLE® Step 1 flashcards
1
Q

Drug causes of prolonged QT interval

A

ABCDE

  • AntiArrythmics (class IA, III)
  • AntiBiotics (eg macrolide)
  • Anti”C”ychotics (eg haloperidol)
  • AntiDepressants (eg TCAs)
  • AntiEmetics (eg ondansetron)
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2
Q

Causes of prolonged QT interval

A

Drugs
HypoK
HypoMg
Congenital abnormalities

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3
Q

Features of Brugada syndrome

A
  • AD disorder common in Asian males
  • Pseudo-RBBB and ST-elevations in V1-3
  • increased risk of VT and sudden cardiac death
  • prevent SCD with implantable cardioverter-defibrillator (ICD)
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4
Q

Sudden cardiac death

  • definition
  • causes
A 
Unexpected death due to cardiac disease; without sx or <1 hr since onset of sx
Fatal ventricular arrhythmia caused by:
- Acute ischemia 
- Mitral valve prolapse
- Cardiomyopathy
- Cocaine abuse
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5
Q

Complications of acute infarction (<24hrs)

A

Cardiogenic shock
CCF
Arrhythmia

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6
Q

Complications of MI (1 week)

A 
1-3 days: neutrophils = fibrinous pericarditis (only in transmural infarcts)
4-7 days: macrophages = rupture of:
- ventricular free wall
- interventricular septum
- papillary muscles
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7
Q

Complications of chronic MI (months)

A

Seen with fibrous scar formation:

  • aneurysm
  • mural thrombus
  • Dressler syndrome
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8
Q

How to tell if AS cx by “wear & tear” vs by RHD

A

Coexistence of MS and fusion of commissures in RHD

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9
Q

Complications of MS

A

Dilatation of LA cx:

  • Pulmonary congestion: edema and alveolar macrophages
  • Pulm HPT –> RHF
  • AF –> mural thrombi
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10
Q

Key organism cx endocarditis in:

  • prosthetic valves
  • colorectal CA
A
  • strep epidermidis

- strep bovis

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11
Q

Causes of restrictive cardiomyopathy

A 
Amyloidosis
Sarcoidosis
Haemochromatosis
Endocardial fibroelastosis
Loeffler syndrome (endomyocardial fibrosis with eosinophilic infiltrate and eosinophilia)
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12
Q

What is rhabdomyoma associated with?

A

Rhabdomyoma = benign hamartoma

Assoc with tuberous sclerosis in children

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13
Q

Common mets to heart:

A

Lung CA
Breast CA
Melanoma
Lymphoma

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14
Q

T21 associated with which cardiac lesions:

A

Endocardial cushion defects eg ostium primum ASD, VSD, AVSD

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15
Q

Cardiac lesions assoc with DiGeorge’s

A

Tetralogy of Fallot

Interrupted aortic arch

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16
Q

Cardiac lesion assoc with Friedreich Ataxia

A 
Hypertrophic cardiomyopathy
(mutations in Frataxin - mitochondrial protein NB in Fe homeostasis and resp function)
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17
Q

Cardiac lesion assoc with Marfan’s

A

Cystic medial necrosis (eg aortic dissection & aneurysm)

Mitral valve prolapse

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18
Q

Cardiac lesions assoc with tuberous sclerosis

A

Valvular obstruction due to cardiac rhabdomyomas

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19
Q

Cardiac lesions seen in Turners

A

Coarctation of aorta

Bicuspid aortic valve

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20
Q

Papillary muscle rupture post-MI:

  • days after MI
  • which papillary muscle highest risk
A

2-7 days post MI

posteromedial papillary muscle - because of single blood supply from posterior descending artery (PDA)

21
Q

Causes of restrictive cardiomyopathy

A

“Puppy LEASH”

  • Post-radiation fibrosis
  • Loeffler syndrome
  • Endocardial fibroelastosis
  • Amyloidosis
  • Sarcoidosis
  • Haemchromatosis
22
Q

Signs of digoxin toxicity

A

Cholinergic: nausea and vomiting, diarrhoea, blurry yellow vision (xanthopsia), arrythmias, AV block
Hyperkalaemia

23
Q

Predisposition factors for digoxin toxicity

A

HypoK
Renal failure
Decreased clearance (eg cx by amiodarone, verapamil, quinidine)

24
Q

Rx for digoxin toxicity

A
  • slowly normalise K
  • cardiac pacer
  • anti-digoxin Fab
  • Mg2+
25
Q

Describe Ortner syndrome

A

Recurrent laryngeal nerve palsy due to cardiovascular disease (eg MS –> LA enlargement –> impingement of nerve)

26
Q

Morphologic changes in affected vs non-stenotic kidney in RAS

A

Affected:

  • Diffuse cortical thinning and atrophy
  • Diffuse tubular atrophy and fibrosis
  • Glomerular crowding
  • Juxtaglomerular apparatus enlargement
  • Focal inflammatory infiltrates

Non-stenotic:

  • Hypertensive nephrosclerosis - intimal hyperplasia and hyaline arteriolosclerosis
  • hyperplastic arteriolosclerosis and fibrinoid necrosis in severe cases
27
Q

Congenital cardiac lesions seen in DiGeorge’s syndrome

A

TOF
Truncus arteriosus
Transposition of Great Arteries

28
Q

Outline Trousseau syndrome

A

Migratory superficial thrombophlebitis associated with visceral adenoCA of pancreas, colon and lung
- Hypercoagulability and DIC

29
Q

Diagnostic criteria for Kawasaki Disease

A

Fever for =/>5 days AND 4 of:

  • Bilateral non-exudative conjunctival injection
  • Cervical lymphadenopathy
  • Mucositis: strawberry tongue, fissured lips, erythema of palantine mucosa
  • Extremity changes: edema hands and feet, erythema palms and soles, desquamation of fingertips
  • Rash: urticarial, spreads centripetally to the trunk
30
Q

Aortic arch derivatives

A

1st - part of maxillary a.
2nd - Hyoid a, Stapedial a.
3rd - Common carotid a, proximal internal carotid a.
4th - Left = aortic arch, right = prox. right subclavian
6th - proximal pulmonary aa, left = ductus arteriosus

31
Q

Which area is targeted in radiofrequency ablation of atrial flutter?

A

Cavotricuspid isthmus:

area between tricuspid valve and IVC in the right atrium

32
Q

Pulse character in HOCM

A

Bifid carotid pulse with brisk upstroke (“spike-and-dome”) - seen in dynamic LVOT obstruction during systole

33
Q

Morphologic changes in heart with normal ageing

A
  • decreased LV chamber size
  • sigmoid shaped interventricular septum
  • increased interstitial connective tissue
  • accumulation of intracellular lipofuscin granules
34
Q

Clinical manifestations of reperfusion injury

A
  • arrhythmias
  • microvascular dysfunction with myocardial stunning
  • myocyte injury and death
35
Q

Describe the concept of myocardial hibernation

A

chronic myocardial ischemia –> decreased myocardial contractility (altered cytoskeletal proteins, adrenergic control, and calcium responsiveness) = decreased metabolism and function to match decreased blood supply

36
Q

Describe Aschoff bodies

A

Seen in myocarditis in rheumatic fever:

- giant cells, Anitschkow cells (reactive histiocytes with slender, wavy nuclei), fibrinoid material

37
Q

Light microscopy of viral myocarditis and list some cx

A

Lymphocytic interstitial infiltrates (mononuclear) with focal myofibrillary necrosis
Adenovirus, Coxsackie B, Parvovirus B19

38
Q

Causes of constrictive pericarditis

A

Idiopathic or viral pericarditis
Cardiac surgery or post-radiation therapy
TB

39
Q

Signs of constrictive pericarditis

A 
Predominantly R-sided signs
Raised JVP 
Kussmaul's (paradoxical raised JVP on inspiration)
Pulsus paradoxis
Pericardial knock (early diastolic sound before S3)
40
Q

Factors increased likelihood of atheroma plaque rupture

A
  • Thin fibrous cap
  • Large lipid/necrotic core
  • inflammation (activated macrophages secrete MMPs)
41
Q

Triad seen on ECG for WPW

A
  • shortened PR interval
  • widened QRS
  • delta waves
42
Q

Granulomatous inflammation of media with intimal thickening characteristic of:

A

Giant cell arteritis

Takayasu arteritis

43
Q

Homogenous acellular thickening of arteriolar walls characteristic of:

A

Hyaline arteriosclerosis (benign HPT or diabetes)

44
Q

Onion-like concentric thickening of arteriolar walls characteristic of:

A

Hyperplastic arteriosclerosis (malignant hypertension)

45
Q

Transmural inflammation with fibrinoid necrosis of arteries characteristic of:

A

Polyarteritis nodosa

Malignant hypertension

46
Q

Medication that inactivates the metalloprotease that breaks down ANP and BNP

A

Neprilysin inhibitor - eg sacubitril

47
Q

Action of ANP and BNP

A

Binds receptors –> activates guanylate cylcase to form cGMP –> stimulates diuresis and peripheral vasodilation

  • Kidneys: dilates afferent and constricts efferent arterioles
  • Adrenal glands: inhibits secretion of aldosterone
  • Blood vessels: vasodilates arteriolar and venular vessels
48
Q

5 types of xanthomas

A
  • Eruptive xanthomas: yellow papules abruptly appear when TGs are high
  • tuberous and tendinous xanthomas (eg Achilles tendon, extensor tendons fingers)
  • plane xanthomas (linear lesions in skin folds assoc with primary biliary cirrhosis)
  • xanthelasma (soft eyelid/periorbital plaques, no lipid abn in 50% individuals)

USMLE Step 1 (11 decks)

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