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USMLE Step 2CK > MTB CardioPulm > Flashcards

MTB CardioPulm Flashcards

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USMLE® Step 1 flashcards
1
Q

________ women virtually never have MIs

A

Menstruating

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2
Q

Risk Factors for CAD

1) worst RF
2) most common RF
3) most immediate effect if changed RF
4) FH RF details

A

1) DM
2) HTN
3) smoking cessation
4) FIRST DEGREE relatives with premature CAD events (male

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3
Q

Most dangerous HLD risk factor

A

Elevated LDL

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4
Q

Post menopausal woman with chest pain upon hearing news of her son’s death. + ST elevation on EKG.

1) diagnosis?
2) echo results?
3) angiography results?
4) management?

A

1) Tako-Tsubo Cardiomyopathy
2) Echo will show apical ballooning
3) Normal angiography
4) B-blockers and ACE-Inhibitors (no revascularization!)

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5
Q

Worst prognostic indicator in patient with ‘chest pain’?

A

Shortness of breath

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6
Q

Chest Pain - best initial test?

A

EKG

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7
Q

Indications for EKG Exercise Stress Test

A

Etiology of chest pain is unclear - EKG non-diagnostic - trying to determine if there is Ischemia

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8
Q

Unsure if patient’s chest pain is ischemic events but there are underlining ST segment abnormalities (left bundle branch block, left ventricular hypertrophy, pacemaker use)
What test?

A

Exercise thallium or exercise echo

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9
Q

Unsure if patient has ischemic heart disease but they cannot exercise…what test?

A

Dipyridamole thallium or dobutamine echo

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10
Q

Dipyridamole cannot be used in…

A

Asthmatics because may provoke bronchospasm

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11
Q

What percentage stenosis calls for stent/CABG consideration?

A

70%

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12
Q

CABG indications

A

1) 3 vessel disease
2) 2 vessel disease in a diabetic
3) left main artery stenosis

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13
Q

Angina medications that actually lower mortality.

A

Beta blockers
ACE inhibitors
Nitroglycerin

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14
Q

What forms of nitroglycerin used in stable angina vs acute coronary syndrome

A

Angina: oral, transdermal patch

ACS: sublingual, paste, IV

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15
Q

________ women virtually never have MIs

A

Menstruating

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16
Q

Risk Factors for CAD

1) worst RF
2) most common RF
3) most immediate effect if changed RF
4) FH RF details

A

1) DM
2) HTN
3) smoking cessation
4) FIRST DEGREE relatives with premature CAD events (male

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17
Q

Most dangerous HLD risk factor

A

Elevated LDL

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18
Q

Post menopausal woman with chest pain upon hearing news of her son’s death. + ST elevation on EKG.

1) diagnosis?
2) echo results?
3) angiography results?
4) management?

A

1) Tako-Tsubo Cardiomyopathy
2) Echo will show apical ballooning
3) Normal angiography
4) B-blockers and ACE-Inhibitors (no revascularization!)

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19
Q

Worst prognostic indicator in patient with ‘chest pain’?

A

Shortness of breath

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20
Q

Chest Pain - best initial test?

A

EKG

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21
Q

Indications for EKG Exercise Stress Test

A

Etiology of chest pain is unclear - EKG non-diagnostic - trying to determine if there is Ischemia

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22
Q

Unsure if patient’s chest pain is ischemic events but there are underlining ST segment abnormalities (left bundle branch block, left ventricular hypertrophy, pacemaker use)
What test?

A

Exercise thallium or exercise echo

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23
Q

Unsure if patient has ischemic heart disease but they cannot exercise…what test?

A

Dipyridamole thallium or dobutamine echo

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24
Q

Dipyridamole cannot be used in…

A

Asthmatics because may provoke bronchospasm

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25
Q

What percentage stenosis calls for stent/CABG consideration?

A

70%

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26
Q

CABG indications

A

1) 3 vessel disease
2) 2 vessel disease in a diabetic
3) left main artery stenosis

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27
Q

Angina medications that actually lower mortality.

A

Beta blockers (esp B blocker + aspirin)
ACE inhibitors
Nitroglycerin

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28
Q

What forms of nitroglycerin used in stable angina vs acute coronary syndrome

A

Angina: oral, transdermal patch

ACS: sublingual, paste, IV

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29
Q

Indications for anti-platelet medications

A

Acute coronary syndrome

Recent angioplasty with stunting (use namely prasugrel and ticagrelor)

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30
Q

Ticlopidine- what is it used for and side effects

A

Anti-platelet medication

Neutropenia and TTP

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31
Q

Patient just had STEMI 2 weeks ago and is on all recommended ACS medications…suddenly develops fever and bruise-like lesions on abdomen and studies show normocytic anemia, thrombocytopenia, and renal failure. What test to confirm diagnosis? What happened?

A

Blood smear will show schistocytes

TTP from ticlopidine or clopidogrel

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32
Q

Ranolazine - used for?

A

Persistent or refractory cases of angina

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33
Q

Systolic dysfunction - drug that has best mortality benefit?
Side effects?
Best second line medication?

A

ACE inhibitors/ARBs best for low ejection fraction and/or regurgitant valvular disease
Side effects: cough, hyperkalemia
2nd line: hydralazine (decreases after load via arterial vasodilation) with nitrates (allow coronary dilation as well so blood doesn’t travel path of least resistance and leave them empty)

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34
Q

Most common statin side effect

A

Elevated liver enzymes

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35
Q

Triglyceride lowering medication and its side effect

A

Fibrates

Myositis

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36
Q

Medication that raises HDL and its side effects

A

Niacin

High uric acid, flushing, itchiness, glucose intolerance

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37
Q

Which lipid lowering drug has best mortality benefit and why? Its side effects?

A

Statins: antioxidant effect on endothelial lining in addition to LDL lowering effect
Side effects: liver damage, myositis, Rhabdomyolysis

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38
Q

CAD Indications and adverse effects of CCBs

A

Indication: verapamil and diltiazem can be used in CAD with sever asthma that cannot use beta blockers; prinzmetal angina; chest pain caused by cocaine use

Side effects: edema, constipation (esp verapamil), rarely heart block

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39
Q

CABG grafts and how long they typically last

A

Internal mammary artery - 10 years

Great saphenous vein - 5 years

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40
Q

Patient presents who has history of stable angina and is on all proper medications. Asks why he can’t have a stent put in to prevent the MI if we already know his arteries are clogging up…what do u say?

A

Maximum medical therapy (beta blocker, ACE inhibitor, statin, and aspirin) has proven to be equal to or of greater effect than PCI in stable angina.

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41
Q

Lead changes associates with: anterior wall MI, inferior wall MI, posterior wall MI

A

AWMI: St elevation in V2-V4 MOST DANGEROUSLY left main
IWMI: St elevation in II, III, aVf
PWMI: St depression in V1-V2

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42
Q

What do you give first in ACS? Best effect on mortality…

A

Aspirin

….then angiography/angioplasty

43
Q

What test is first to show result and what test is last to show result for ACS?

A

1) EKG changes
2) myoglobin
3) CK-MB
4) Troponins
Myoglobin and CK-MB are also first to leave the system…good for re-infarction tests

44
Q

Patient has creatinine of 2.4 and BUN of 40, and troponins are positive, what is next step in management?

A

Check other tests (EKG, CK-MB) because troponins are excreted through the kidneys and therefore run high in renal failure.

45
Q

Concerned for reinfarction…first and second step in management?

A

1) EKG to look for new changes

2) CK-MB

46
Q

Standard of care for PCI is “door to balloon” time in…

A

90 minutes

47
Q

Do drug-eluting stents change morbidity of disease process? If so, how?

A

Yes, decrease the rate of re-infarction/re-stenosis by inhibiting T-cell response (sirolimus and paclitaxel)

48
Q

Indications for thrombolytics

Contraindication for thrombolytics

A

If the hospital does not have capabilities to perform PCI and within 12 hours of chest pain

Contrindications: hemorrhagic stroke EVER, ischemic stroke in last 6 months, surgery in last 2 weeks, severe hypertension (>180/110)

49
Q

Patient presents with crushing chest pain for 1 hour and EKG shows ST depressions- what is first and second step in management?

A

1) aspirin

2) low molecular weight heparin - want to prevent clot from progressing further

50
Q

What is eptifabatide?

A

Glycoproteins IIb/IIIa inhibitor

51
Q

What is tirofiban?

A

A glycoprotein IIb/IIa inhibitor

52
Q

Indication for glycoprotein IIb/IIIa inhibitors in ACS?

A

In unstable angina…especially when enzymes come back showing nonSTEMI…decreases mortality

53
Q

Which is better in terms of mortality for ACS - LMWH or unfractionated heparin?

A

LMWH

54
Q

DONT WORRY!

A

“I can do ALL things in Christ Who strengthens me”

55
Q

Stay focused…on Your Beloved

A

“…in all your ways, submit to Him, and He will make your way straight…” Proverbs

56
Q

Don’t be afraid…

A

“So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand.” Isaiah 41:10

57
Q

Patient presents with crushing chest pain, JVD, but lungs are clear…what to avoid giving?

A

No nitrates! Give high volume fluid replacement.

58
Q

Patient has an MI and 5 days later presents with pulmonary congestion and new onset murmur…what happened? What is first step in management?

A

Valvular or septal rupture

Intra-aortic balloon pump to bridge to surgery

59
Q

Erectile dysfunction after MI - what is the most likely reason?

A

Probably from anxiety

Must consider if beta blockers are contributing though

60
Q

Dyspnea + circumolar numbness

A

Anxiety attack

61
Q

Chocolate/Brown blood + dyspnea

A

Methemoglobinemia

62
Q

CHF picture, first best test?

A

TTE

63
Q

Most accurate test for ejection fraction

Indication?

A

MUGA or nuclear ventriculogram

Use when precision is necessary - like when dosing doxorubicin in chemotherapy

64
Q

Does spironalactone have a role in CHF treatment?

A

Yes, systolic dysfunction type…CHF stage III/IV - proven mortality benefit

65
Q

How does spironalactone work in CHF?

A

Does not have anti-diuretic effect, but helps in its inhibition of aldosterone

66
Q

Patient has history of MI, long history of CAD, presents with peripheral edema, JVD, pulmonary congestion…ejection fraction is found to be below 35%
Next step in management ?

A

Implantable defibrillator

67
Q

Patient has history of MI, long history of CAD, presents with peripheral edema, JVD, pulmonary congestion…ejection fraction is found to be below 35%
QRS complex is above 120 milliseconds
Symptomatic even at maximal medical therapy with ACE inhibitors, diuretics, beta blocker…
Next step in management ?

A

Biventricular pacemaker

68
Q

Patient presents with acute pulmonary edema possibly secondary to CHF with systolic dysfunction, what is best first step in medical management?

A

IV furosemide

69
Q

Most common valvular defect in rheumatic fever?

A

Mitral stenosis, but any defect can result

70
Q

Why does exhaling exaggerate L sided murmurs?

A

Increase pulmonary venous return from lungs to heart

71
Q

When to do TTE vs TEE?

A

TTE: CHF evaluation initially…to get rough measurement of ejection fraction

TEE: for valvular disease, better picture and more accurate for dilatation measurements

72
Q

Immigrant + murmur

A

Mitral stenosis

73
Q

Pregnant + new heart murmur

A

Mitral stenosis (50% plasma increase)

74
Q

Young patient + diastolic murmur

A

Mitral stenosis

75
Q

Diastolic murmur + dysphagia/hoarseness/hemoptysis

A

Mitral stenosis

76
Q

QUICK!! Diastolic murmur could be…

A

AR

MS

77
Q

Diastolic murmur + Marfan

A

Aortic regurgitation

78
Q

Diastolic murmur + seronegative spondy

A

Aortic regurg

79
Q

Diastolic murmur + syphilis

A

AR

80
Q

Murmur + quincke pulse

A

Quincke pulse = pulsation sin nail beds

AR

81
Q

Murmur + hill sign

A

Hill sign: BP in legs higher than in arms

AR

82
Q

Murmur + de Musset sign

A

De Musset sign: head bobbing

AR

83
Q

Systolic murmur + Marfan

A

MVP

84
Q

What murmurs get better with expiration and why?

A

MVP and HOCM
Because they get better when there is more blood filling the heart, and expiration increases pulmonary vein return flow from the lungs to the heart

85
Q

Indication for endocarditis prophylaxis? (4)

A

Prosthetic valve
Prior endocarditis
Cardiac transplant patient with valve dz
Dental work with blood

86
Q

Treatment for aortic stenosis

A

Valve replacement

87
Q

Treatment for aortic regurgitation

A

ACE inhibitors/ARB

88
Q

Treatment for mitral stenosis

A

Valvuloplasty

89
Q

Treatment for mitral regurgitation

A

ACE inhibitors

ARBs

90
Q

Treatment for Mitral valve prolapse

A

Beta blockers if asymptomatic

Valve repair

91
Q

Patient recently traveled from South America + esophageal problem + CHF picture

A

Chagas disease (causes achalasia and dilated cardiomyopathy)

92
Q

6 causes of dilated cardiomyopathy

A 
Alcohol 
Ischemia 
Chagas' disease
Radiation
Postviral myocarditis 
Toxins- eg doxorubicin
93
Q

Systolic anterior motion of mitral valve

A

HOCM

94
Q

How to treat HOCM?

A

Beta blockers
Verapamil/diltiazem
Implantable defibrillators for syncope patients
Septum ablation with alcohol…then myomectomy if still symptoms persist

95
Q

ST elevation everywhere + depressed PR interval

Diagnosis and treatment

A

Pericarditis
(If no underlying etiology that is treatable)
NSAIDs and Colchicine

96
Q

Cardinal tamponade treatment

A

Pericardiocentesis
IV fluids to prevent heart collapse
Hole or “window” if recurrent

97
Q

Constrictive pericarditis XRay findings

A

Calcification over heart

98
Q

Kussmaul sign - Dx?

A

JVP increases on inhalation

Constrictive pericarditis or severe restrictive cardiomyopathy

99
Q

ABI difference to indication peripheral vascular disease

A

ABI

100
Q

Treatment for peripheral artery disease

A

Stop smoking
Aspirin
Cilostazol- most effective medication

101
Q

What is cilostazol? Indication?

A

Peripheral artery disease tx

Phosphodiesterase inhibitor

102
Q

Treatment for aortic dissection?

A

Beta blocker, nitroprusside, surgical correction (BP control is most important)

103
Q

Screening for AAA?

A

Men over 65 who have ever smoked with ultrasound

104
Q

Worst 2 cardiac complication in pregnancy? How do they harm?

A

1) Peripartum Cardiomyopathy: antibodies made against myocardium - presents after delivery - treat like dilated cardiomyopathy
2) eisenmenger syndrome: already exists a left-to-right shunt (VSD), increase in plasma causes pulmonary hypertension to worsen quickly - causing a right-to-left shunt (cyanotic disease)

USMLE Step 2CK (8 decks)

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