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USMLE Step Two > Cardiovascular Disorders > Flashcards

Cardiovascular Disorders Flashcards

1
Q

most common site of coronary artery occlusion

A

left anterior descending artery

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2
Q

heart region supplied by left anterior descending artery

A

anterior wall of left ventricle

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3
Q

heart region supplied by LAD septal branch

A

anterior 2/3 of interventricular septum

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4
Q

heart region supplied by left coronary circumflex branch

A

left atrium, posterolateral left ventricle

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5
Q

heart region supplied by right coronary posterior descending branch

A

inferior wall of left ventricle, posterior 1/3 of interventricular septum

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6
Q

heart region supplied by right coronary marginal branch

A

right atrium, right ventricle

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7
Q

heart region supplied by right coronary nodal branches

A

SA and AV nodes

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8
Q

gold standard for identifying coronary artery disease

A

coronary aniography

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9
Q

next step when exercise stress test is equivocal

A

nuclear exercise test with thallium-201 or technetium-99m-sestamibi during exercise testing

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10
Q

second line when comorbidities prevent exercise stress test

A

pharmacologic stress testing with dobutamine

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11
Q

age to begin screening for hyperlipidemia

A

men after age 35

women after age 45

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12
Q

goal LDL for patients at high risk for CAD

A

< 100 mg/dL

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13
Q

goal LDL for patients with 2+ risk factors for CAD

A

< 130 mg/dL

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14
Q

goal LDL for patients with 0-1 risk factors for CAD

A

< 160 mg/dL

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15
Q

HMG-CoA reductase inhibitors

A

acts on liver
decreases LDL and triglycerides
increases HDL

SE: myositis, increases LFTs

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16
Q

ezetimibe

A

cholesterol absorption inhibitor acts on intestines
decreases LDL

SE: myalgias, increases LFTs

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17
Q

gemfibrozil, fenofibrate

A

stimulates lipoprotein lipase in blood
decreases LDL and triglycerides
increases HDL

SE: myositis, increases LFTs

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18
Q

cholestyramine, colestipol, colesevelam

A

bile acid sequestrants in GI tract
decreases LDL
increases triglycerides

SE: bad taste, abdominal discomfort

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19
Q

niacin

A

acts on liver
decreases LDL, triglycerides
increases HDL

SE: flushing, nausea, pruritis, insulin resistance, gout, paresthesias, increases LFTs

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20
Q

vessels most commonly used for CABG

A

saphenous vein

internal mammary artery

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21
Q

pharmacotherapy for unstable angina

A 
aspirin and clopidogrel (if no PTCA)
GP IIb/IIIa (if PTCA)
oxygen
nitroglycerin
heparin
beta-blockers
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22
Q

time limit for thrombolysis in MI

A

12 hours

use t-Pa or urokinase

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23
Q

cardiac enzyme to evaluate immediate re-infarct

A

CPK-MB

decreases in 2-3 days

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24
Q

risk reduction medications after MI

A 
low dose ASA
clopidogrel
beta-blockers
ACE inhibitors
K-sparing diuretics
HMG-CoA reductase inhibitors
exercise, smoking cessation, and dietary modifications
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25
Q

V2, V3, V4 infarction

A

anterior infarction

LAD artery

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26
Q

V1, V2, V3 infarction

A

septal infarction

LAD artery

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27
Q

II, III, aVF infarction

A

inferior infarction

posterior descending or marginal branch

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28
Q

1, aVL, V4, V5, V6

A

lateral infarction

LAD or circumflex artery

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29
Q

V1, V2

A

posterior infarction

posterior descending artery

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30
Q

first degree heart block

A

PR > 0.2 seconds

asymptomatic
caused by increased vagal tone or functional conduction impairment

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31
Q

second degree mobitz I heart block

A

progressive PR lengthening until skipped QRS

asymptomatic
caused by his bundle conduction defect, drug effects (beta-blockers, digoxin, calcium channel blockers), or increased vagal tone

adjust medications, consider pacemaker if symptomatic bradycardia is present

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32
Q

second degree mobitz II heart block

A

randomly skipped QRS without changes in PR interval

usually asymptomatic
caused by infranodal conduction problem in bundle of his or purkinje fibers
can progress to third degree heart block

treat with ventricular pacemaker

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33
Q

third degree heart block

A

no relationship between P waves and QRS complexes

syncope, dizziness, hypotension
absence of conduction between atria and ventricles

treat with ventricular pacemaker and avoid medications affecting AV conduction

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34
Q

next step of management in congenital heart disease with early cyanosis

A

prostaglandin E

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35
Q

medication that closes PDA

A

indomethacin

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36
Q

6 week old infant has signs of left heart failure and EKG shows left-sided MI

A

anomalous origin of the left coronary artery

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37
Q

most common vasculitis

A

temporal arteritis

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38
Q

defects of tetrology of fallot

A

VSD, pulmonary stenosis, RVH, overriding aorta

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39
Q

management for DVT in patient with high likelihood of falling

A

IVC filter

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40
Q

management of peripheral vascular disease

A

smoking cessation, glucose and lipid control, exercise

cilostazol, statins, aspirin

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41
Q

indications for operating on AAA

A

greater than 5.5 cm

growing more than 0.5 cm in 6 months

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42
Q

mechanism of PSVT

A

accessory conduction pathways through AV node

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43
Q

treatment for ventricular tachycardia

A

hemodynamically stable: amiodarone or lidocaine

hemodynamically unstable: cardioversion

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44
Q

treatment for paroxysmal noctural dyspnea

A

acute: nitroglycerin
chronic: furosemide

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45
Q

drug that blocks ventricular remodeling s/p myocardial infarction

A

ACE-inhibitor

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46
Q

periumbilical systolic-diastolic bruit

A

renal artery stenosis

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47
Q

abdominal systolic bruit

A

more classically associated with AAA

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48
Q

blood pressure discrepancy in coarctation of the aorta

A

if coarctation is distal to the subclavian artery: upper extremity pressure is higher than lower extremity pressure

if coarctation is proximal to the subclavian artery: right arm pressure higher than left arm pressure

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49
Q

indications for class IA anti-arrhythmics

A

PSVT, Afib, Aflutter, Vtach

quinidine, procainamide

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50
Q

indications for class IB anti-arrhythmics

A

Vtach

lidocaine, tocainide

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51
Q

indications for class IC anti-arrhythmics

A

PSVT, Afib, Aflutter

flecainide, propafenone

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52
Q

indications for beta-blockers used as anti-arrhythmics

A

PVC, PSVT, Afib, Aflutter, Vtach

propanolol, esmolol, metoprolol

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53
Q

indications for K-channel blockers

A

Afib, Aflutter, Vtach (not bretylium)

amiodarone, sotalol, bretylium

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54
Q

indications for calcium channel blockers used as anti-arrhythmics

A

PSVT, MAT, Afib, Aflutter

verapamil, diltiazem

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55
Q

drug used in PSVT that activates K-channels and decreases intracellular cAMP

A

adenosine

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56
Q

first drug that should be administered when coronary artery event is suspected

A

aspirin to prevent platelet aggregation

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57
Q

situational syncome

A

autonomic dysregulation that may occur when an older man is micturating or coughing

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58
Q

treatment for prolonged QT

A

asymptomatic: propranolol
symptomatic: propranolol plus a DDD pacemaker (dual chamber)

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59
Q

treatment for pulseless electrical activity

A

initiate CPR followed by epinephrine or vasopressin

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60
Q

treament of asymptomatic young patient with no other health problems and CHADS2 score of 0

A

aspirin

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61
Q

CHADS2 score

A 
congestive heart failure - 1
hypertension - 1
age > 75 - 1
diabetes mellitus - 1
stroke - 2
62
Q

causes of pulsus paradoxus

A

cardiac tamponade, tension pneumothorax, and severe asthma

63
Q

treatment of unstable patient with Afib

A

immediate cardioversion

64
Q

treatment of stable patient with Afib

A

< 48 hours: cardioversion

> 48 hours: 3-4 weeks of rate control and antiocogulation prior to cardioversion

65
Q

mechanism of dipyramidole infused myocardial perfusion scanning

A

dipyramidole is a vasodilator, diseased vessels are already maximally dilated, so dipyramidole vasodilates non-disease vessels and draws even more blood away from diseased vessels

66
Q

treatment for aortic regurgitation

A

afterload reduction with ACE-inhibitor or nifedipine, severe cases should undergo valve replacement

67
Q

ranking of lifestyle modifications for high blood pressure

A 
weight loss
DASH diet
dietary sodium
exercise
alcohol intake

smoking has little effect on hypertension but does contribute to heart disease

68
Q

treatment of cocaine-induced STEMI

A

PTCA or thrombolysis
aspirin, nitrates appropriate, avoid beta-blockers which will allow unopposed alpha-activity and further vasoconstriction

69
Q

pulsus parvus et tardus

A

decreased pulse amplitude and delayed pulse upstroke seen in aortic stenosis

70
Q

mechanism of decreased preload in cardiac tamponade

A

pericardial fluid pressure exceeds ventricular pressure and inhibits ventricles from expanding and filling properly

71
Q

drug of choice in patient with stable angina and hypertension

A

beta-blocker

72
Q

mixed venous oxygen concentration in hypovolemic shock

A

decreased from increased oxygen extraction by hypoperfused tissue

73
Q

mixed venous oxygen concentration in septic shock

A

normal from hyperdynamic circulation and improper distribution of the cardiac output

74
Q

mechanism by which nitroglycerin relieves angina

A

dilaiton of veins decreases preload and stretching of myocardial muscle

it is actually unclear if nitroglycerin increases coronary blood flow in diseased patients although it performs this function in healthy coronary vessels, so this is not the major way angina is relieved

75
Q

metabolic abnormalities found in hyperaldosteronism (conn’s syndrome)

A

low renin, high aldosterone

high sodium, low potassium, high bicarbonate (metabolic alkalosis)

76
Q

pansystolic murmur at the apex with radiation to the axilla days to months after a myocardial infarction

A

ventricular aneurysm

papillary muscle rupture occurs 3-7 days after

77
Q

normal right atrial pressure

78
Q

normal pulmonary artery pressure

A

25/15 mmHg

79
Q

normal PCWP

80
Q

right atrial pressure > 10 mmHg

pulmonary artery systolic pressure > 40 mmHg

A

diagnostic criteria for massive pulmonary embolism

81
Q

unstable angina pharmacotherapy if no percutaneous intervention is planned

A

aspirin, clopidogrel

82
Q

unstable angina pharmacotherapy if percutaneous intervention is planned

A

gp IIb/IIIa inhibitor

83
Q

intranodal or bundle of His conduction problem

A

second degree mobitz I heart block

84
Q

infranodal conduction problem

A

second degree mobitz II heart block

85
Q

absence of conduction between atria and ventricles

A

third degree heart block

86
Q

AV nodal reentry anomaly

A

PSVT

treatment: adenosine, carotid massage, valsalva maneuver

87
Q

AV reentry (not through the node, through accessory pathway)

A

wolff-parkinson-white

treatment: amiodarone, procainamide

88
Q

treatment of hemodynamically stable ventricular tachycardia

A

amiodarone

89
Q

complication of esophageal dilation

A

esophageal rupture, penumomediastinum, and mediastinitis

90
Q

causes of mediastinitis

A

iatraogenic procedure, boerrhave tear

91
Q

biliary side effect of gastric bypass surgery

A

increased risk of gallstones

treatment: ursodeoxycholic acid prophylactically for 6 months after surgery

92
Q

somatic pain

A

sharp, localized pain

93
Q

visceral pain

A

generalized, crampy pain

94
Q

referred pain

A

visceral fibers enter spinal cord at the same location as somatic fibers and brain misinterprets visceral pain as somatic

95
Q

wide fixed splitting of second heart sound

A

atrial septal defect

96
Q

normal PCWP pressure

97
Q

normal right atrial pressure

98
Q

normal pulmonary artery pressure

A

does not exceed 25/15 mmHg

99
Q

treatment of hemodynamically unstable PSVT

A

cardioversion or calcium channel blocker

100
Q

treatment of stable PSVT

A

carotid massage or valsalva maneuver

pharmacotherapy: beta-blocker or CCB

101
Q

treatment for wolff-parkinson-white

A

amiodarone or procainamide

NO adenosine

102
Q

progressive PR lengthening until dropped QRS

A

second degree mobitz I heart block

103
Q

randomly skipped QRS without changes in PR interval

A

second degree mobitz II

104
Q

when is pacemaker indicated in heart bock

A

second degree mobitz II and third degree

only indicated in mobitz I if there is symptomatic bradycardia present

105
Q

several ectopic foci in the atria that discharge automatic impulses
usually asymptomatic

A

multifocal atrial tachycardia

treatment: CCB or beta-blockers acutely, catheter ablation of surgery to eliminate abnormal pacemakers

106
Q

causes of PVCs

A

hypoxia, abnormal serum electrolytes, hyperthyroidism, caffeine use

107
Q

what do PVCs look like

A

early and wide QRS without preceding P waves

108
Q

treatment of PVCs

A

none if patient is healthy, beta-blocker in patients with CAD

109
Q

treatment for atrial flutter

A

rate control with CCB, beta-blockers, cardioversion if unable to be controlled with medication, and catheter ablation to remove ectopic focus

110
Q

treatment for torsades de pointes

A

magnesium sulfate

111
Q

treatment for stable ventricular tachycardia

A

procainamide or amiodarone

amiodarone is drug of choice in patients with CHF

112
Q

treatment for symptomatic bradycardia

113
Q

most frequent physical exam finding of CHF

114
Q

kerley B lines

A

increased marking of lung interlobular septa caused by pulmonary edema

115
Q

indication for K-sparing diuretics in congestive heart failure

A

reduce cardiac hypertrophy caused by aldosterone

116
Q

treatment for pericarditis

A

NSAIDs, colchicine
pericardiocentesis for large effusions
hemodialysis for uremic pericarditis

117
Q

cardiac catherization shows equal pressure in all chambers

A

chronic constrictive pericarditis

118
Q

causes of cardiac tamponade

A

pericarditis, chest trauma, LV rupture following MI, or dissecting aortic aneurysm

119
Q

treatment for cardiac tamponade

A

immediate pericardiocentesis

120
Q

harsh blowing holosystolic murmur radiating from apex to axilla

A

mitral regurgitation

121
Q

widely split S2

A

mitral regurgitation

122
Q

midsystolic click

A

mitral regurgitation

123
Q

opening snap after S2

A

mitral stenosis

124
Q

diastolic rumble

A

mitral stenosis

125
Q

loud S1

A

mitral stenosis

126
Q

widened pulse pressure

A

aortic regurgitation

127
Q

bounding pulses

A

aortic regurgitation

128
Q

diastolic decrescendo murmur

A

aortic regurgitation

129
Q

late diastolic rumble

A

aortic regurgtation

130
Q

crescendo-decrescendo systolic murmur

A

aortic stenosis

131
Q

weak S2

A

aortic stenosis

132
Q

dual stroke carotid pulse, systolic murmur, S4

A

hypertrophic obstructive cardiomyopathy

133
Q

treatment for hypertrophic obstructive cardiomyopathy

A

beta-blockers, CCBs

pacemaker or partial septal excision

134
Q

treatment for mitral regurgitation

A

arterial vasodilators if symptomatic (nitroprusside)

prophylactic antibiotics for increased infection risk

135
Q

treatment for aortic regurgitation

A

decrease afterload with ACE-inhibitors, CCBs, or nitrates

136
Q

treatment for aortic stenosis

A

beta-blockers

diuretics to decrease preload

137
Q

treatment for bacterial endocarditis

A

4-6 weeks IV antibitoics
beta-lactam plus an aminoglycoside
antibiotic prophylaxis before surgery or dental work

138
Q

heart sounds you may hear with hypertension

A

loud S2, possible S4

139
Q

causes of thoracic aortic aneurysms

A

marfan’s syndrome, ehlers-danlos, and syphilis

140
Q

most common location of aortic aneurysm

A

abdominal below the renal arteries

141
Q

anti-hypertensive used in migraine headaches

A

beta-blockers

142
Q

aortic dissection: stanford A v. stanford B

A

stanford A: ascending aorta, requires emergency surgery

stanford B: distal to left subclavian, treat medically with nitroprusside, beta-blockers

143
Q

wide fixed split S2, systolic ejection murmur at upper left sternal border

A

atrial septal defect

144
Q

loud pumonic S2, systolic thrill

A

ventricular septal defect

145
Q

loud S2, bounding pulses at birth

A

patent ductus arteriosus

accompanied by a “machinery” murmur

146
Q

risk factors for transposition of the great vessels

A

diabetic mother

apert’s syndrome, down syndrome, cri-du-chat, trisomy 13, trisomy 18

147
Q

cardiac pathologies with “boot-shaped” heart on imaging

A

hypertrophic obstructive cardiomyopathy
tetralogy of fallot
persistent truncus arteriosus

148
Q

treatment for tetralogy of fallot

A

prostaglandin E to maintain PDA, propranolol, morphine, knee-to-chest positioning during cyanotic episodes

149
Q

treatment of mediastinitis

A

surgical debridement and prolonged antibiotic therapy

150
Q

prophylactic treatment for long QT syndrome

A

propranolol

USMLE Step Two (17 decks)

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