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USMLE Step 2CK > MTB CardioPulm > Flashcards

MTB CardioPulm 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!)

How well did you know this?
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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
What percentage stenosis calls for stent/CABG consideration?
70%
26
CABG indications
1) 3 vessel disease 2) 2 vessel disease in a diabetic 3) left main artery stenosis
27
Angina medications that actually lower mortality.
Beta blockers (esp B blocker + aspirin) ACE inhibitors Nitroglycerin
28
What forms of nitroglycerin used in stable angina vs acute coronary syndrome
Angina: oral, transdermal patch ACS: sublingual, paste, IV
29
Indications for anti-platelet medications
Acute coronary syndrome | Recent angioplasty with stunting (use namely prasugrel and ticagrelor)
30
Ticlopidine- what is it used for and side effects
Anti-platelet medication | Neutropenia and TTP
31
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?
Blood smear will show schistocytes | TTP from ticlopidine or clopidogrel
32
Ranolazine - used for?
Persistent or refractory cases of angina
33
Systolic dysfunction - drug that has best mortality benefit? Side effects? Best second line medication?
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)
34
Most common statin side effect
Elevated liver enzymes
35
Triglyceride lowering medication and its side effect
Fibrates | Myositis
36
Medication that raises HDL and its side effects
Niacin | High uric acid, flushing, itchiness, glucose intolerance
37
Which lipid lowering drug has best mortality benefit and why? Its side effects?
Statins: antioxidant effect on endothelial lining in addition to LDL lowering effect Side effects: liver damage, myositis, Rhabdomyolysis
38
CAD Indications and adverse effects of CCBs
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
39
CABG grafts and how long they typically last
Internal mammary artery - 10 years | Great saphenous vein - 5 years
40
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?
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.
41
Lead changes associates with: anterior wall MI, inferior wall MI, posterior wall MI
AWMI: St elevation in V2-V4 MOST DANGEROUSLY left main IWMI: St elevation in II, III, aVf PWMI: St depression in V1-V2
42
What do you give first in ACS? Best effect on mortality...
Aspirin ....then angiography/angioplasty
43
What test is first to show result and what test is last to show result for ACS?
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
Patient has creatinine of 2.4 and BUN of 40, and troponins are positive, what is next step in management?
Check other tests (EKG, CK-MB) because troponins are excreted through the kidneys and therefore run high in renal failure.
45
Concerned for reinfarction...first and second step in management?
1) EKG to look for new changes | 2) CK-MB
46
Standard of care for PCI is "door to balloon" time in...
90 minutes
47
Do drug-eluting stents change morbidity of disease process? If so, how?
Yes, decrease the rate of re-infarction/re-stenosis by inhibiting T-cell response (sirolimus and paclitaxel)
48
Indications for thrombolytics | Contraindication for thrombolytics
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
Patient presents with crushing chest pain for 1 hour and EKG shows ST depressions- what is first and second step in management?
1) aspirin | 2) low molecular weight heparin - want to prevent clot from progressing further
50
What is eptifabatide?
Glycoproteins IIb/IIIa inhibitor
51
What is tirofiban?
A glycoprotein IIb/IIa inhibitor
52
Indication for glycoprotein IIb/IIIa inhibitors in ACS?
In unstable angina...especially when enzymes come back showing nonSTEMI...decreases mortality
53
Which is better in terms of mortality for ACS - LMWH or unfractionated heparin?
LMWH
54
DONT WORRY!
"I can do ALL things in Christ Who strengthens me"
55
Stay focused...on Your Beloved
"...in all your ways, submit to Him, and He will make your way straight..." Proverbs
56
Don't be afraid...
"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
Patient presents with crushing chest pain, JVD, but lungs are clear...what to avoid giving?
No nitrates! Give high volume fluid replacement.
58
Patient has an MI and 5 days later presents with pulmonary congestion and new onset murmur...what happened? What is first step in management?
Valvular or septal rupture Intra-aortic balloon pump to bridge to surgery
59
Erectile dysfunction after MI - what is the most likely reason?
Probably from anxiety Must consider if beta blockers are contributing though
60
Dyspnea + circumolar numbness
Anxiety attack
61
Chocolate/Brown blood + dyspnea
Methemoglobinemia
62
CHF picture, first best test?
TTE
63
Most accurate test for ejection fraction | Indication?
MUGA or nuclear ventriculogram Use when precision is necessary - like when dosing doxorubicin in chemotherapy
64
Does spironalactone have a role in CHF treatment?
Yes, systolic dysfunction type...CHF stage III/IV - proven mortality benefit
65
How does spironalactone work in CHF?
Does not have anti-diuretic effect, but helps in its inhibition of aldosterone
66
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 ?
Implantable defibrillator
67
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 ?
Biventricular pacemaker
68
Patient presents with acute pulmonary edema possibly secondary to CHF with systolic dysfunction, what is best first step in medical management?
IV furosemide
69
Most common valvular defect in rheumatic fever?
Mitral stenosis, but any defect can result
70
Why does exhaling exaggerate L sided murmurs?
Increase pulmonary venous return from lungs to heart
71
When to do TTE vs TEE?
TTE: CHF evaluation initially...to get rough measurement of ejection fraction TEE: for valvular disease, better picture and more accurate for dilatation measurements
72
Immigrant + murmur
Mitral stenosis
73
Pregnant + new heart murmur
Mitral stenosis (50% plasma increase)
74
Young patient + diastolic murmur
Mitral stenosis
75
Diastolic murmur + dysphagia/hoarseness/hemoptysis
Mitral stenosis
76
QUICK!! Diastolic murmur could be...
AR | MS
77
Diastolic murmur + Marfan
Aortic regurgitation
78
Diastolic murmur + seronegative spondy
Aortic regurg
79
Diastolic murmur + syphilis
AR
80
Murmur + quincke pulse
Quincke pulse = pulsation sin nail beds AR
81
Murmur + hill sign
Hill sign: BP in legs higher than in arms AR
82
Murmur + de Musset sign
De Musset sign: head bobbing AR
83
Systolic murmur + Marfan
MVP
84
What murmurs get better with expiration and why?
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
Indication for endocarditis prophylaxis? (4)
Prosthetic valve Prior endocarditis Cardiac transplant patient with valve dz Dental work with blood
86
Treatment for aortic stenosis
Valve replacement
87
Treatment for aortic regurgitation
ACE inhibitors/ARB
88
Treatment for mitral stenosis
Valvuloplasty
89
Treatment for mitral regurgitation
ACE inhibitors | ARBs
90
Treatment for Mitral valve prolapse
Beta blockers if asymptomatic | Valve repair
91
Patient recently traveled from South America + esophageal problem + CHF picture
Chagas disease (causes achalasia and dilated cardiomyopathy)
92
6 causes of dilated cardiomyopathy
``` Alcohol Ischemia Chagas' disease Radiation Postviral myocarditis Toxins- eg doxorubicin ```
93
Systolic anterior motion of mitral valve
HOCM
94
How to treat HOCM?
Beta blockers Verapamil/diltiazem Implantable defibrillators for syncope patients Septum ablation with alcohol...then myomectomy if still symptoms persist
95
ST elevation everywhere + depressed PR interval | Diagnosis and treatment
Pericarditis (If no underlying etiology that is treatable) NSAIDs and Colchicine
96
Cardinal tamponade treatment
Pericardiocentesis IV fluids to prevent heart collapse Hole or "window" if recurrent
97
Constrictive pericarditis XRay findings
Calcification over heart
98
Kussmaul sign - Dx?
JVP increases on inhalation | Constrictive pericarditis or severe restrictive cardiomyopathy
99
ABI difference to indication peripheral vascular disease
ABI
100
Treatment for peripheral artery disease
Stop smoking Aspirin Cilostazol- most effective medication
101
What is cilostazol? Indication?
Peripheral artery disease tx | Phosphodiesterase inhibitor
102
Treatment for aortic dissection?
Beta blocker, nitroprusside, surgical correction (BP control is most important)
103
Screening for AAA?
Men over 65 who have ever smoked with ultrasound
104
Worst 2 cardiac complication in pregnancy? How do they harm?
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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