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USMLE Step 1 > Cardiovascular > Flashcards

Cardiovascular Flashcards

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USMLE® Step 1 flashcards
1
Q

MV auscultation

A

apex

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2
Q

TV auscultation

A

left parasternal border

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3
Q

TV auscultation

A

Left parasternal border

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4
Q

AV auscultation

A

Right 2nd intercostal border

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5
Q

PV auscultation

A

left 2nd intercostal border

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6
Q

S1

A

closure of MV and TV valves

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7
Q

S2

A

closure of AV and PV

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8
Q

Inspiration

A

split in A2 and P2; due to increased blood in right side of heart

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9
Q

S3

A

abnormal

due to blood entering volume overloaded ventricle in early diastole

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10
Q

S4

A

abnormal

due to blood entering non-compliant ventricle with atrial contraction in late diastole

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11
Q

Causes S4

A

Volume overloaded ventricle, hypertrophy

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12
Q

Causes S3

A

Valve regurgitation; congestive heart failure

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13
Q

Murmurs

A

stretching valve ring or damage to valve

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14
Q

Inspiration

A

increases right-sided abnormal heart sounds and murmurs

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15
Q

Expiration

A

increases left sided abnormal heart sounds and murmurs

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16
Q

Stenosis murmurs

A

problem in opening valve

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17
Q

Regurgitation murmus

A

problems in CLOSING valve

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18
Q

Valves opening in systole

A

AV and PV

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19
Q

Valves opening in diastole

A

MV and TV

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20
Q

Valves closing in systole

A

MV and TV

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21
Q

Valves closing in diastole

A

AV and PV

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22
Q

LDL

A

primary vehicle for carrying cholesterol

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23
Q

VLDL

A

primary vehicle for carrying liver-synthesized triglyceride

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24
Q

Familial hypercholesterolemia (type II)

A

Autosomal dominant
deficiency of LDL receptors
- increased LDL

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25
Q

Type III hyperlipoproteinemia

A 
defiency in apo E
increased remnants (chylomicrons, IDL)
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26
Q

Type IV hyperlipoproteinemia

A

increased VLDL

seen in alcoholics

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27
Q

Apo B deficiency

A

deficiency

  • apo B48 (chylomicrons)
  • apo B100 (VLDL)
  • decrease in cholesterol and triglycerides
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28
Q

Clinical findings in apo B deficiency

A

fat malabsorption

hemolytic anemia

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29
Q

Atherosclerosis

A

reaction to injury of endothelial cells

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30
Q

Risk factors for atheroscleroris

A
  • smoking
  • increased LDL
  • increased homocysteine
  • Chlamydia pneumoniae infection
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31
Q

Cells involved in atherosclerosi

A
  • Platelets
  • Macrophages
  • Smooth muscle cells
  • T cells with cytokine release
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32
Q

Fibrous plaque

A

Pathgnomonic lesion of atherosclerosis

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33
Q

C-reactive protein

A

marker of inflammatory atheromatous plaque

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34
Q

Inflammatory atheromatous plaque

A

predisposes to platelet thrombosis

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35
Q

Increased plasma homocysteine

A

Increased vessel thrombosis
Folate (most common)
Vitamin B12 deficiency

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36
Q

Hyaline arteriosclerosis

A

small vessel disease of DM and hypertension

Excess protein in vessel wall

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37
Q

Mechanisms of Hyaline arteriosclerosis in DM

A

Non-enzymatic glycosylation

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38
Q

Non-enzymatic glycosylation

A

Glucose attaches to amino acids in basement membrane

- causes increased permability to protein –> diabetic nephropathy

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39
Q

Abdominal aortic aneurysm rupture

A

due to atherosclerosis
flank pain
hypotension
pulsatile mass

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40
Q

Syphillitc aneurysm

A

vasculitis of vasa vasorum of aortic arch

aortic regurgitation

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41
Q

Aortic dissection

A

due to hypertension and collagen tissue disorders (e.g. Marfan)

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42
Q

Cystic medial degeneration

A

elastic tissue degeneration creates spaces filled with mucopolysaccharides

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43
Q

Intimal tear in aorta

A

due to wall stress from hypertension and structural weaknesses

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44
Q

Types of dissection

A

Proximal (most common)

Distal or combination of both

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45
Q

Sx of proximal aortic dissection

A

Chest pain radiating to back
Lack of pulse
Cardiac tamponade (most common cause of death)

46
Q

Marfan’s Syndrome

A

Autosomal dominant
Fibrillin defect
- Associated with aortic regurgitation/ dissection
- Lens dislocation
- Mitral valve prolapse with sudden death

47
Q

Most common cause of death: Ehlers Danlos and Marfan’s

A

Aortic dissection

48
Q

Phlebothrombosis

A

Stasis of blood flow

Deep veins below knee (most common site)

49
Q

Pulmonary thromboembolism

A

Emboli originate from femoral veins

50
Q

Superficial migratory thrombophlebitis

A

Sign of carcinoma of head of pancreas

51
Q

Thoracic outlet syndrome

A

Lymphedema hands/feet in newborn

  • Preductal coarctation
  • Bicuspid aortic valve
52
Q

Thoracic outlet syndrome

A

Absent radial pulse with positional change

53
Q

Spider telangiectasia

A

Arteriovenous fistula

Due to hyperestrinism (cirrhosis, pregnancy)

54
Q

Capillary hemangioma in newborn

A

Regress with age

Do not surgically remove

55
Q

Kaposi’s sarcoma

A

HHV - 8
Vascular malignancy
most common cancer in HIV

56
Q

Bacillary angiomatosis

A

Bartonella henselae

vascular infection in AIDS

57
Q

Small vessel vasculitis

A

Palpable purpura

e.g. Henoch Schonlein purpura

58
Q

Muscular artery vaculitis

A

Vessel thrombosis with infarction (e.g. classical polyarteritis nodosa)

59
Q

Elastic artery vasculitis

A

Absent pulse

- stroke

60
Q

Takayasi’s arteritis

A

Pulseless disease

- young Asian woman

61
Q

Giant cell arteritis

A 
temporal artery granulomatous arteritis
ipsilateral blindness (ophthalmic artery)
62
Q

Classical polyarteritis nodosa

A

Muscular artery vasculitis with vessel thrombosis infarction

63
Q

Path findings of classical polyarteritis nodosa

A

Vessel inflammation at different stages

Aneurysms from vessel weakness

64
Q

Sx of polyarteritis nodosa

A

Infarctions in kisneys, skin, GI tract, heart

HBsAg in 30%

65
Q

Kawasaki’s disease

A

coronary artery vasculitis/thrombosis/ aneurysms in children

66
Q

Sx: Kawasaki’s disease

A 
Typically seen in young children
Chest pain
Desquamating rash
Swelling/hands feet
Cervical lymphadenopathy
67
Q

Rx for Kawasaki’s disease

A

IV Gamma-globulin

68
Q

Buerger’s disease (thromboangittis oblierans)

A

Smoker’s digital vasculitis

Digital infarction

69
Q

Reynaud’s syndrome

A

Digital vasculitis in systemic sclerosis and CREST syndrome

70
Q

Sx of Reynaud’s syndrome

A

Digital pain, white-blue-red color changes

71
Q

Cryoglobulinemia

A

Protein gels in cold temperature;

- asociated with Reynaud’s syndrome; HCV association

72
Q

Sx of cryoglobulinemia

A

Acral cyanosis relieved by coming indoors

73
Q

Wegener’s granulomatosis

A

Associated with c-ANCA
Sinusitis (nose)
Lung infarction (lung)
Crescentic GN (kidney)

74
Q

Microscopic polyangiitis

A

Palpable purpura
Crescentic GN
association with p-ANCA

75
Q

Henoch-Schonlein purpura

A

IgA-anti-IgA immune complexes
palpable purpura on buttocks/legs
arthritis
IgA glomerulonephritis

76
Q

Serum sickness vasculitis

A

Horse antivenin in treatment of rattlenake venom

77
Q

Rocky Mountain Spotted Fever

A
  • tick borne Rickettsia infection

- vasculitis causes petichiae on palms –> trunk

78
Q

Meningiococcemia

A

sepsis causes petichia/ecchymoses; potential for Waterhouse Friderichesen syndrome

79
Q

Essential hypertension

A
  • associated w/ blacks
  • defect in renal excretion of Na
  • Increased plasma volume
  • decreased plasma renin activity
80
Q

Renovascular hypertension

A

atherosclerosis renal artery in men

- fibromuscular hyperplasia renal artery in women

81
Q

Sx of renovascular hypertension

A

Epigastric bruit

  • Increased plasma renin activity (in affected kidney)
  • Decreased plasma renin activity (in unaffected kidney)
82
Q

Hypertension

A
  • Left Ventricle Hypertrophy (most common complication)

- acute myocardial infarction (most common cause of death) followed by stroke and renal failure

83
Q

Endocrine hypertension

A
  • primary hyperparathyroidism
  • Graves/hypothyroidism
  • Cyshings
  • Primary hyperaldosteronism
  • Pheochromocytoma
84
Q

Afterload

A
  • resistance ventricles contract against
85
Q

Preload

A

volume ventricles must eject

86
Q

Concentric LVH

A

increased afterload (e.g. essential hypertension, aortic stenosis)

87
Q

LVH with dilation/ hypertrophy

A

increased preload (e.g. valve regurgitation; left to right shunts)

88
Q

Left Heart Failure

A

Forward failure
Pulmonary edema
Pillow orthopnea
Paroxysmal nocturnal dyspnea

89
Q

Systolic dysfunction

A

Left Heart Failure due to decreased ventricular contractility (ischemia)

90
Q

Diastolic dysfunction

A

LHF due to decreased ventricular compliance (hypertrophy)

91
Q

Right Heart Failure

A 
Backward failure
Increased venous hydrostatic pressure
Neck vein distension
Hepatomegaly
Edema
92
Q

ACE inhibitos

A

Decrease afterload and preload in heart failure

93
Q

Diuretics in CHF

A

Reduce preload

94
Q

Non-pharm Rx to CHF

A

Restrict salt and water

95
Q

Acute Myocardial infarction

A

Most common cause of death in US
Left anterior descending coronary artery thrombosis (most common cause)
- rupture of inflammatory plaque produces platelet thrombus

96
Q

Exertional angina

A

Coronary artery atherosclerosis
Subendocardial ischemia
ST elevation

97
Q

Sudden cardiac death

A

Death within 1 hour of symptoms

98
Q

Pathological findings of sudden cardiac death

A

Severe coronary atherosclerosis

Absence of occlusive thrombosis

99
Q

LAD coronary artery

A
  • supplies anterior 2/3 of interventricular septum

- supplies anterior portion of left ventricle

100
Q

RCA

A
  • supplies posterior portion of left ventricle and papullary muscle
  • supplies inferor 1/3 of interventricular septum
  • supplies right ventricle
101
Q

Ventricular fibrillation

A

most common cause of death in AMI

102
Q

Path findings 24 hours after acute MI

A

No gross changes

103
Q

Sx of acute myocardial infarction

A

retrosternal pain radiating down arms

diaphoresis

104
Q

Risk of acute myocardial infarction ruptures occur when?

A

On the 3rd to 7th day of AMI

105
Q

Most common type of Acute MI rupture

A

Anterior wall rupture

  • due to LAD thrombosis
  • cardiac tamponade
106
Q

Cause of posteromedial papillary rupture

A

RCA thrombosis

Mitral regurgitation with LHF

107
Q

Interventricular rupture

A
  • cause of LAD thrombosis
  • left to right shunt
  • RHF
108
Q

Mural thrombus

A
  • caused by anterior AMI

- Danger embolization

109
Q

Pericarditis

A
  • can occur within 1st week of transmural AMI

- 6 weeks later ( it has an autoimmune cause)

110
Q

Speed of conduction

A

Pukinje > Atria > Ventricles > AV node

111
Q

Pacemaker speed

A

SA > AV > bundle of His/Purkinjeventricles

USMLE Step 1 (34 decks)

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