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USMLE > UWorld Cardiology > Flashcards

UWorld Cardiology Flashcards

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USMLE® Step 1 flashcards
1
Q

Sterile, non-destructive vegetations on heart valves found on autopsy in a patient with a previous hx of MI is most similar to what condition in its pathogenesis?

A

Trousseau Syndrome - migratory thrombophlebitis due to tumour-released procoagulants

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2
Q

What is pulsus paradoxus?

A

A drop in arterial BP of more than 10 mmHg on inspiration. It is usually found in

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3
Q

What clinical findings do you expect in cardiac tamponade?

A

Pulsus paradoxus, arterial hTN

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4
Q

What is beri-beri a deficiency of?

A

Vitamin B1 (thiamine)

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5
Q

Gram-positive cocci that are catalase negative and grow in hypertonic saline and bile and cause endocarditis are what bacteria and associated with what procedure?

A

Enterococcus, cystoscopy

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6
Q

Where is the GSV harvested for CABG procedures?

A

Just inferolateral to the pubic tubercle

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7
Q

What mechanism is responsible for the rapid decrease of cytosolic Ca right before relaxation of cardiac muscle cells?

A

Na/Ca exchange mechanism

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8
Q

What are the symptoms of and how do you use to treat a B-blocker overdose

A

Low cardiac output leading to hTN, bradycardia. Treat with glucagon, which increases cAMP (and consequently intracellular Ca) in cardiac myocytes

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9
Q

What physiological state results from a PE?

A

Respiratory alkalosis because of hyperventilation driven by hypoxemia - aka you blow off too much CO2

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10
Q

What is the best indicator of severity for MR?

A

Presence of an audible S3

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11
Q

What class of drug should you use to counteract the paradoxical increase in myocardial demand from using nitrates?

A

B-blockers, as it counteracts catecholamines released by the perceived hTN from vasodilation by nitrates

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12
Q

Which anti-arrhythmic drug has the highest selectivity for ischemic myocardium?

A

Lidocaine (amiodarone, if available)

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13
Q

What are the hallmarks of Turner Syndrome?

A

Short, thick neck, shortened fourth metacarpals, short stature, broad chest, and bicuspid aortic valve

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14
Q

What valvular abnormality is commonly associated with Turner Syndrome?

A

Bicuspid aortic valve (and coarctation of aorta, too)

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15
Q

What is the primary type of collagen in mature scars?

A

Type 1

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16
Q

An echo that shows an aorta lying anterior and to the right of the pulmonary artery is diagnostic of what condition?

A

TGA

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17
Q

TGA results from the failure of what embryological process?

A

Septation

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18
Q

A double blind study is to prevent what kind of bias?

A

Observer bias

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19
Q

What process most likely preceded a heavily calcified aortic valve with no significant PMH?

A

Cellular necrosis leading to dystrophic calcification in normocalcemic conditions!

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20
Q

What effect does selective B1 selective antagonists like metoprolol have in the treatment of HTN?

A

Decrease cardiac output and block renin release from kidneys.

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21
Q

What condition does a patient with recurrent severe nosebleeds and pink spider-like lesions on his oral and nasal mucosa, face, and arms?

A

Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasias)

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22
Q

What is the major limiting factor for coronary blood flow during strenuous exercise?

A

Duration of diastole b/c most of coronary blood flow happens during diastole.

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23
Q

Repetitive ischemia of cardiac myocytes or persistent hypoperfusion can result in what chronic but reversible condition and how can it be reversed?

A

Hibernating myocardium, reversed by reperfusion of the area

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24
Q

What part of the heart is closest to the left sternal border at the 4th intercostal space?

A

RV

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25
Q

What do you expect to hear on auscultation for a VSD?

A

Harsh sounding holosystolic murmur

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26
Q

What is the law of conservation of mass?

A

V1A1 = V2A2

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27
Q

What is supine hypotension syndrome?

A

Pregnant uterus compresses IVC in pregnant women when they lie down, decrease VR, and causes hypotension

28
Q

Moderate increases in capillary fluid transudation can be offset by compensatory increase in what mechanism?

A

Tissue lymphatic drainage

29
Q

Which arteries does polyarteritis nodosa spare?

A

Pulmonary

30
Q

What is the triad of features in granulomatosis with polyangiitis?

A

1) Focal necrotizing vasculitis
2) Necrotizing granulomas in lung and upper airway
3) Necrotizng glomerulonephritis

31
Q

String of pearls appearance of blood vessels points towards what disease?

A

Polyarteritis nodosa

32
Q

How do you treat GCA?

A

High dose corticosteroids

33
Q

What is Buerger disease associated with?

A

Smoking

34
Q

What’s involved in Wegener’s? (Granulomatosis with polyangiitis)

A

Nose, lung, kidney

35
Q

How do you distinguish Churg-Strauss from microscopic polyangiitis, given that they are both p-ANCA positive?

A

Granulomas, eosinophilia, asthma in CS

36
Q

What is Henoch-Schonlein Purpura classically associated with?

A

IgA nephropathy

37
Q

How does Angiotensin II increase blood pressure?

A

1) Contracting arteriolar smooth muscle

2) Promotes aldosterone

38
Q

What are the 4 key modifiable risk factors for atherosclerosis?

A

1) Smoking
2) HTN
3) Hyperlipidemia
4) Diabetes

39
Q

What are the two causes of hyaline arteriosclerosis?

A

Benign HTN and DM

40
Q

What arteriosclerotic condition should you think about in patients with benign HTN and DM?

A

Hyaline arteriosclerosis

41
Q

Where do abdominal aortic aneurysms typically occur?

A

Below the renal arteries but above the aortic bifurcation

42
Q

What are thoracic aortic aneurysms classically associated with?

A

3 syphilis

43
Q

What do you do to treat a hemangioma in a kid?

A

Nothing. Usually self resolves.

44
Q

What condition is most commonly associated with a VSD?

A

Fetal alcohol syndrome

45
Q

What condition is most commonly associated with an ASD?

A

Down Syndrome

46
Q

What condition is most commonly associated with a PDA?

A

Congenital Rubella

47
Q

What condition is most commonly associated with a TGA?

A

Maternal diabetes

48
Q

What is Dressler syndrome?

A

AI condition resulting in fibrinous pericarditis 6-8 weeks post-MI.

49
Q

What are the physical signs of reperfusion injury in the heart?

A

Contraction bands

50
Q

Transient myocardial ischemia causes myocardial cells to increase in size due to what effect?

A

Intracellular Ca accumulation

51
Q

What fetal heart condition do you worry about in a mother with diabetes?

A

TGA

52
Q

What is standard therapy for heart failure?

A

ACEi, digoxin, diuretic + spironolactone

53
Q

8 year old boy with AMI, lab shows increased methionine level. What amino acid is essential and what is the underlying mech?

A

Cystine. Dx: Homocystinuria, can’t convert homocysteine to cystathionone.

54
Q

How do you avoid infectious complications from a central catheter?

A

Wash your hands before you place it…

55
Q

Right side face and right arm swelling, engorgement of subC veins on R. side of face. Where’s the obstruction?

A

Brachiocephalic vein

56
Q

What two parts of the heart cause obstruction in HCM?

A

Mitral valve cusp and LV septum

57
Q

What are the most important local factors regulating blood flow in the zone of autoregulation?

A

Adenosine and NO

58
Q

What is the order of cardiac conduction velocity?

A

Purkinje, Atria, Ventricles, AV node

Park At Ventura Avenue

59
Q

What do you see in the lungs in LHF?

A

Heart failure cells with hemosiderin in them

60
Q

What determines the significance of ToF?

A

Pulm Stenosis

61
Q

What pathway does ANP and BNP act through?

A

cGMP

62
Q

Ventricular septum with sigmoid shape, decreased ventricular chamber size, and brown perinuclear cytoplasmic inclusions. Cause?

A

Old age

63
Q

What is the biochemical endpoint of nitrate therapy?

A

Decreased IC Ca and dephosphorylated myosin

64
Q

Where do the leads of a biventricular pacemaker go?

A

RA, RV, and finally, if 3rd lead, in coronary sinus (AV groove)

65
Q

Why is skeletal muscle resistant to CCBs?

A

Because it doesn’t depend on influx of external Ca

66
Q

What cells are responsible for creating the fibrous cap of collagen and ECM in atherosclerosis?

A

Vascular smooth muscle cells

USMLE (23 decks)

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