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usmle step 2 secrets > chapter 4 cards > Flashcards

chapter 4 cards Flashcards

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USMLE® Step 1 flashcards
1
Q

becks triad

A

distended neck veins
muffled heart sounds
hypotension

alteration of QRS complexes in 2:1 = electrical alternans
increased pulsus paradoxus = mean drop of 15+ mmhg w/ inspiration
seen in cardiac tamponade

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2
Q

ekg changes in MI

A

flat T waves/inverted T waves
ST elevation = infarct
depression = ischemia
q waves

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3
Q

how to dx MI

A

troponin levels every 8 hours 3x
cardiomegaly/pulmonary congestion
LV motion abnormalities
diaphorectic, tachycardic, tachypneic, N/V, BL pulmonary rales, distened neck veins, new S3 or S4, new murmurs, hypotension, shock
hx of angina or chest pain, arrhythmias, murmur, hypertension , diabetes, digoxin, furosemide, other cardiac meds

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4
Q

tx MI

A

admit to ICU/CCU
early reperfusion is time from onset of s/s <12 hrs
early perfusion <6 hours = fibrinolysis or baloon angioplasty or stent

EKG monitoring, if vtach - give amio.

Give O2 <90

pain control w/ morphine. which can help w/ pulm edema

aspirin + nitroglycerin + BBs + clopidogrel + LMWH + ACEI WITHIN 24 hours + statin

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5
Q

when to give heparin in chest pain?

A

unstable angina
cardiac thrombus
severe CHF

don’t give if active bleeding

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6
Q

achalasia
esophageal spasm

negative w/u of MI

A

botox + pneumatic dilation for achalasia

esophageal spasm - CCB

surgical myomotomy

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7
Q 
URI preceding chest pain
low grade fever
diffuse ST elevation
ESR is elevated
low grade fever is present!!
relieved by sitting forward
A

viral percarditis

TB uremia malignancy coxsackie lupus

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8
Q

pneumonia

A

pleuritis

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9
Q

severe tearing pain to back
hypertension
marfans syndrome

A

aortic dissection

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10
Q

blunt chest trauma

A

aortic laceration or speudoaneurysm

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11
Q

stable angina

A 
exertion
reproducible
beter w/ rest
pressure/squeezing to shoulders
acc by dyspnea, diaphoresis
relieved by nitro
ST depressed
normal if no pain
relieved with SL nitroglycerin
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12
Q

unstable angina

A

change from prior
at rest or in greater frequency
normal CK or minimally elevated

EKG: ST depression + prolonged chest pain W/O improvement w/ nitro
TX is similar to that for M

1) O2, nitro, aspirin
2) bb, clopidogrel, heparin, duap, aceI

if pain not resolving? emergent PT CA

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13
Q

variant prinzmetal angina

A

pain at rest not related to exertion
early morning or at middle of night
ST elevations but normal CK

tx w/ nitro and LT CCB to reduce spasm

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14
Q

silent MI

A

chf, CONFUSION, delirium = w/o pain

seen in old and diabetes

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15
Q

MS

A

rheumatic fever

dyspnea, orthopnea, PND

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16
Q

MR

A

rheumatic fever

post MI chordae tendinae rupture

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17
Q

AS

A 
bicuspid valves w/ sx in childhood
dyspnea on exertion
elderly only 
agina, syncope, CHF
highest mortality = if CHF present
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18
Q

AR

A

congenital rheumatic
endocarditis
aortic dissection/root dilation
marfans

(cream)

dyspnea, pulm congestion, shock
DOE, orthopnea, PND

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19
Q

late diastolic BLOWING murmur at apex with opening snap, loud S1
afib + pulm HTN

A

MS
tx w/ baloon valvutomy or surgery
diuretics, digoxin, BB are sx tx

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20
Q

soft S1, LAE, pulm HTN, LVH

A

MR
tx if flail leaflet, or severe regurgitation
hydralazine + nitroprusside = vasodilator

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21
Q 
hard systolic murmur radiation to caortids
slow carotid upstroke
s3 and s4
ejection click
LVH, CM
A

AS

tx w/ TAVR if symptomatic

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22
Q

early diastolic decrescendo
wide pulse pressure
S3

A

AR
tx w/ TAVR if symptomatic + chronic
or if asymptomatic w/ LV enlargement

tx w/ vasodilators

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23
Q

mid systolic click, late systolic murmur

panic d/o

A

MP

24
Q

right HF

A

long standing MS

25
Q

ENDOCARDITIS PPX

A

only dental procedures
if prosthetic cardiac valves, prior endocarditis, congential heart disease (cyanotic, shunts, residual defects), cardiac transplants

ABX w/ amoxicillin prior to procedure only one dose

26
Q

virchows triad

A

3 findings!

endothelial damage, hypercoagulable, venous stasis

27
Q

DVT

A

surgery malignancy trauma pregnancy OCP DIC factor 5 lelilden, AT 3, P C/S, PTT mutation, hyperhomocysteinemia aps

28
Q

DVT S/S

A

UL leg swelling, tenderness
homans
superficial palpable cords = superficial thrombophlebitis = not a RF (erythema/tenderness) for PE = can be a/w pancreatic cancer or other malignancy. TX: nsaids + warm compress

venography if not clear (as oppposed to doppler or impedence test) but invasive

29
Q

DVT TX

A

Heparin/LMWH –> warfarin bridge
3-6 mo
If 1+ DVT, then for life

30
Q

DVT PPX

A

If surgery: early ambulation if low risk
if moderate risk, LMWH, low dose UFH, fondaparinaux
if high risk, LMWH, fondaprinaudx, or vitK antagonist
if bleeding: compression stockings

31
Q

PE?

A

tachycpnea chest pain hemoptysis hypotension sycnope death

wedge shaped defect

right heart strain

32
Q

DVT cannot lead to stroke unless?

A

ASD/VSD/, PFO, Fistula
ARTERIAL INFARCTS?
afib, CHF, endocarditis, aneurysm can cause arteriral infarcts = renal infarcts/stroke

33
Q

If V/Q scan or CTPA is indeterminate for PE?

A

DO pulmonary angiogram conventional

34
Q

If low probability VQ but high likelihood?

A

pulmonary angiogram

35
Q

how to treat PE???

A

LMWH or IV UFH
switch to oral warfarin for 3-6 mos

if recurrent clots or CI: DO IVC FILTER

if massive PE: do embolectomy or TPA

36
Q

most impt SE of heparin

A

non-immune thrombocytopenia (slight fall in 2 days w/ quick return)
HIT type 2(AB against PF4, immune mediated, 50% drop 5-10 days post heparin therapy. arterial and venous thrombuses)
Confirm w/ functional assay
Measure CBCs

37
Q

aspirin - give platelets
heparinLMWH - protamine
warfarin - FFP, clotting factors, or vit K (longer)

A

how to reverse anticoagsss

38
Q

bleeding tendency w/ normal anticoag tests?

A

steroids + vit C def

39
Q

Chronic CHF tx

A

Na restriction ACEi BB DIURETICS DIGOXIN

40
Q

Acute CHF tx

A

inpatient: O2, diuretics, positive inotropics

stable = digoxin
unstable = dobutamine, milrlinone
41
Q

what precipitators exacerbation CHF

A

noncompliance w/ diet or meds

MI, severe HTN, arrhythmia, fever, infection, PE, anemia, thyrodi issues, myocarditis

42
Q

Corpulmonale

A 
RVH due to lung disease
COPD, PE
if young women = idiopathic pulm HTN
sleep apnea!!!!
tachypnea, cyanosis, loud P2, S4

tx: prostacyclin, epoprostanal, viagra, bosentan

heart lung transplant

43
Q

restriictive CM

A

AMYLOID, SARCOID, HEMOCHROMATOSIS, myocardial fibroelastosis

abnormal bx

44
Q

constrict pericarditis

A 
pericardial knock 
calcification
normal ventricular biopsy
S4, right sided HF = jvd, peripheral edema
restrictive CM

need to remove constrictive via surgery

45
Q

dilated CM

A

chronic CAD causes it

alcohol, myocarditis, doxorubicin

46
Q

asymmetric LVH diastolic dysfunction
systolic ejection murmur on LSB but increases w/ standing and valsalva due to less volume of blood in LV
tx w/ BB or disopyrimide to allow more time for ventricles to fill

A

digoxin, diuretics, vasodilators are CI

47
Q

afib

A

sx: BB, CCB, digoxin
if <24 hrs: cardioversion w/ amio, procainamide, or desynch
if chronic: anticoagulate, then cardiovert

if recurrence: warfarin + rate control meds

48
Q

if aflutter

A

tx like afib + vagal maneuvers = carotid massage

49
Q

sinus tachycardia

A

check TSH

50
Q 
chads score
chf
htn 
age 75 2+
DM 
S2 - stroke or TIA 2+
v -vascular disease
a - 64+
f - female
A

1 = asa

2 + = oral anticoag

51
Q

WPW?

A

child becomes dyspneic and recovers
transient arrhytmia via accessory pathway
delta waves

tx: RF catheter ablation of pathway

52
Q

PDA = constant machine like murmur LSB, dyspnea, CHF. tx = indomethacin or surgery last resort. keep open w/ PGE1L

A

seen w/ high altitude or congential rubella

53
Q 
TOF
pulm stenosis
LVH
overriding aorta
VSD
A

tet spells

54
Q

upper extremity HTN
radiofemoral delay
systolic murmur over mid upper back
rib notching on radiograph + ass w/ turner syndrome!

A

aortic coarctationsss

55
Q

non cyanotic congenital heart defects

A

L to R shunts: blood goes back to lung even though O2

VSD
ASD
PDA

D’s

56
Q

cyanotic defects

A

R to L shunts – no oxygentation

truncusu arteriosus = one vessel leaving ventricles
transposition of great vessels
tricuspid atresia
tetralogy of fallot
total anamous pulm venous return
57
Q

what closes foramen ovale?

what closes ductus arteriosus?

A

foramen ovale = clamping of cord and decreased pulm vascular resistance due to first breath
ductus arterious = oxygen causing low PGE2

usmle step 2 secrets (9 decks)

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