Cardiology Flashcards Preview

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Flashcards in Cardiology Deck (676):
1

effect of valsalva early strain(2)

decrease venous return
decrease all murmurs except HCM and MVP

2

effect of valsalva late release(2)

increase venous return
increase right sided murmurs

3

effect of standing(2)

decrease venous return
similar to the strain phase of valsalva

4

effect of squatting(3)

increase venous return
increase afterload by kinkingof femoral arteries
increase reverse flow

5

effect of handgrip(3)

increase afterload
increase blood pressure
increase reverse flow across valve

6

murmurs getting louder with valsalva(2)

HCM
MVP

7

why during valsalva murmur get louder in MVP (2)

decrease left ventricular volume
increase of leaflet prolapse

8

why during valsalva murmur get louder in HCM (2)

decrease left ventricular volume
increase gradient

9

effect of standing resembles what other effect

valsalva

10

murmurs that get louder with squatting(3)

aortic regurgitation
mitrel regurgitation
VSD

11

murmurs that get softer with squatting(2)

HCM
MVP

12

why murmurs get softer with squatting in HCM (4)

more blood less murmur
increase preload
decrease gradient across outflow obstruction
decrease obstruction and decrease afterload

13

why murmurs get softer with squatting in MVP(2)

increase left ventricular size
decrease mitral valve leaflets prolapse

14

murmurs getting louder with handgrip(3)

aortic regurgitation
mital regurgitation
VSD

15

murmurs getting softer with handgrip(3)

HCM
increase gradient across outflow obstruction
decrease flow

16

auscultation in mitral valve prolapse(2)

single or multiple non ejection clicks
plus
mid to late systolic of mitral regurgitation

17

CHF with ejection fraction a 55 dx

diastolic dysfunction

18

number 1 cause of diastolic dysfunction

HTA

19

rx of diastolic dysfunction(2)

diuretics
antihypertensives

20

physiopatho in diastolic dysfunction

impaired ventricular filling due to poor myocardial relaxation or diminished ventricular compliances

21

cause of AFIB in diastolic dysfunction(3)

left ventricular dilation
leads to left atrial dilation
which in turn causes atrial fibrillation

22

HTA in the setting of bilateral nontender masses

autosomal dominant polycystic kidney disease

23

HTA in the setting of bilateral nontender masses best test to do

abdomen ultrasonogram

24

clue for autosomal dominant polycystic kidney disease(5)

HTA
Hematuria
proteinuria
palpable renal masses
progressive renal insufficiency

25

flank pain in autosomal polycystic kidney disease cause(3)

renal calculi
cyst rupture or hemmorrage
upper urinary tract infection

26

the early common finding in autosomal polycystic kidney disease

HTA

27

extra renal manif of autosomal polykidney disease(5)

cerebral aneurisms
hepatic and pancreatic cysts
cardiac valve disorder
colonic diverticulosis
ventral and inguinal hernias

28

management of APKD(3)

follow blood pressure and renal function
aggressive control of cardiovascular risks factors
ACE inhibitor for HTA

29

end stage renal diasease in APKD(2)

dyalisis
renal transplant

30

patient with HTA is seen in consultation in history , he exercices regularly an eats low salt diet .but he drinks 3-4 glasses of wine every day and 6-8 beers on week end .he quits smoking 3 years ago next step in management of HTA in this patient

counsel for reduction of alcohol

31

quid of excessive alcohol intake

> 2 drinks a day

32

quid of binge drinking

> 5 drinks in a row

33

lifestyle modification in HTA(6)

low salt diet
diet rich in fruit and vegetables
low fat dairy products
regular aerobic exercices
lose weight
limit alcohol intake

34

patient with TA 160/85 while supine and 135/70 while standing dx

orthostatic hypotension

35

EKG for AFIB(3)

narrow qrs complex
no organised P waves
irregularly irregular rythm

36

stable patient with afib Management

Rate control

37

medication used for rate control

Betablocker
calcium blocker like Diltiazem

38

use of digoxin for rate control in AFIB(2)

AFIB due to heart failure
patient unable to tolerate B blocker or Calcium channel blocker

39

indication of cardiversion in Patient with AFIB(4)

less than 48 h
patient with hypotension
pulmonary edema
ischemic heart disease

40

what to do before beginning cardioversion in AFIB more than 48 h(2)

anticoagulation 3-4 weeks
plus
rate control

41

best test to see if AFIB is complicated with heart thrombus

TEE

42

patient with chest pain sus elevation of ST segment and ventricular premature beats administration of lidocaine will cause what in this patient

increase the risk in asystole

43

advantage and drawback of lidocaine in acute coronary syndrome(2)

decrease risk of VFIB
increase the risk of asystole

44

patient with history of rhinitis and eczema in childhood is coming for chest pain .ekg shows st segment depression .he is placed on aspirin bblocker etc.2 days later he develops respiratory distress with wheezing and prolonged expiratory.cause of that

medication side effect Bblocker and Aspirin

45

causes of acute dyspnee in hospitalized patients(7)

arrythmia
bronchoconstriction
CHF/hypervolemia
infection/pneumonia asppiration
pleural effusion
PE
anxiety

46

patient with cardiac disease or (electrolytes abnormalities) develops dizziness tachycardia(or braadycardia) during hospitalisation dx

arrythmia

47

patient with history of asthma ,is placed on aspirin and Bblocker develops wheezing and pprolonged expiratory phase during hospilaisation Cause of that

bronchoconstriction

48

patient with cardiac disease develops crakles high jugular venous pressure>8 cm h2o lower extremity edema cause of that

CHF

49

accidentaly patient has received 2000 cc de liquide develops dyspnea,develops crackles DX

hypervolemia

50

characteristics clinique of pleural effusion in tyhe context of acute dyspnee (2)

decreased breath sounds
dullness to percussion

51

clue for anxiety in the setting of acute dyspnea in hospitalised patient(4)

tachycardia
tachypnee
normal lung exam
normal oxygenation

52

EG in anterolateral MI

st segment elevation in 1 avl,v1-v3

53

what can happen in anterolateral MI(2)

muscle ischemia or rupture--->
mitral regurgitation

54

MI causing typically mitral regurge and why(2)

posteroseptal MI
a cause of solitary blood supply of of the post medial papillary muscle

55

consequence of lmitral regurge in anterolateral MI or post septal MI(4)

increase left atrial pressure
but no changes in left atrium size
in left ventricular sizes
and no changes in left ventricular ejection fraction

56

patient with chest pain during exercice but normal baseline resting EKG ,next step

exercice EKG

57

why patient with SLE are at risk for acute coronary syndrome(2)

most of the they are reiceiving prednisone
prednisone and Lupus cause acelarated coronary atherosclerosis

58

syncope during exercice(3)

aortic stenosis
HOC
VTAC

59

murmur in aortic stenosis(3)

2 nd intercostal space
radiation in caritids
crescendo-decrescendo

60

disease with pulsus parvus and tardus

aortic stenosis

61

quid of pulsus parvus and tardus

aotic stenosis

62

other finding in aortic stenosis

weak S2
S4

63

three possible symptoms in AS(3)

syncope during exercice
exertionnal angina
dyspnea

64

definitive dx of AS

echocardiogram

65

rx of symptomatic AS

valve replacement

66

patient with chest pain with normal QRS complex 80msec(n

first degree heart block

67

clue for first degree heart block(2)

prolonged PR interval
P wave always follows QRS unlikely other heart block

68

rx of first degree heart block with normal QRS duration

abservation

69

First degree AV block with prolonged QRS

electrophysiologic testing to determine the nature of the delay of conduction below the AV node

70

patient with history of respiratory infection one week ago develops Ta =100/60 distended neck veins and heart sounds distant dx

pericardial effusion

71

xray in pericardial effusion

enlarged cardiac silhouette

72

ekg clue for pericardial effusion

electrical alternans

73

quid of electrical alternans

qrs complexes whose amplitude vary from beat to beat on ekg

74

definitive dx in pericardial effusion

echocardiogram

75

quid hypertensive urgency(2)

severe HTA > ou egal 180/120
no symptoms ,no end organ damage

76

two divisions for hypertensive emergency(2)

malignant HTA
Hypertensiive encephalopathy

77

clue for malignant HTA(2)

severe HTA
plus
papilledema and retinal hemorrage

78

clue for hypertensive encephalopathy(2)

severe HTA
plus
cerebral edema and non localizing neurologic symptoms and signs

79

symptom in cerabral edema(4)

headache
nausea
vomiting
plus non localizing neurologic symptoms

80

quid of non localizing neurologic symptom(4)

restlessness
confusion
seizures
coma

81

organ atteint in malignat HTA(2)

rein
eye

82

rein problem in malignant HTA

nephrosclerosis

83

quid of manif of nephrosclerosis(3)

acute renal failure
hematuria
proteinuria

84

auscultation finding in aptient with aortic stenosis

systolic murmur ejection radiating to the apex and carotid arteries

85

teens and early twenties with AS cause

bicuspid valve

86

elderly with AS cause

Calcification of the trileaflet valve

87

muscle pain in patient taking statin

statin induced myopathy

88

mechanism of action of statin

inhibition of intracellular synthesis pathway

89

action of station intracellularly(3)

inhibit HMG co A reductase enzyme
prevent conversion of HMG co A to mevalonic acid
increase the number of cell membrane LDL receptors

90

why statin can induce myopathy

by decreasing co enzyme synthesis Q 10

91

role of Q10 coenzyme

involve in muscle cell energy

92

clue supraventricular tachycardia on EKG(4)

narrow QRS complex
tachycardia
no regular P waves as they are buried within QRS complex
retrograde P wave can occur

93

dx and management of supraventricular tachycardia(2)

adenosine
or vagal maneuvers

94

action of adenosine(3)

slows the sinus rate
increases AV nodal conduction delay
can cause a transient block in AV node conduction

95

role of adenosine in supraventricular tachycardia(2)

can help to identify P waves to clarify dx of atrial flutter or atrial tachycardia
terminate paroxysmal supraventricular tachycardia by interrupting the AV nodal reentry circuit

96

quid of vagal maneuvers(3)

carotid sinus massage
valsalva
eyeball pressure

97

patient smoker complain of cramping pain in his right thigh after walking 2 blocks ,the pain goes away once he stops and rests for several minutes

PAD

98

best initial management in PAD intermittent claudication

exercice therapy

99

indication of cilostazole in PAD

persistent symptom despite adequate supervised exercice therapy

100

indication of surgery in PAD

persistent symptom despite adequate supervised exercice therapy and cylostazole

101

HTA basic testing(4)

urinalysis for occult hematuria and urine protein creatinine ratio
chemistry panel
lipid profile
baseline ECG

102

when to search for secondary HTA(4)

severe or malignant HTA
resistant HTA requiring > ou egal a 3 drugs
sudden blood pressure rise in patient with previosly controled HTA
age of onset

103

patient with HTA ,hypokaliemia and hyperglycemia and weight gain dx

adrenal cortical disease
(cushing disease)

104

cause of cushing syndrome(4)

adrenal cortical hyperplasia
acth producing pituitary adenoma (cushing disease)
ectopic ACTH production
exogenous steroids

105

clue for cushing(7)

poximal muscle weaness
central adiposity
thinning of the skin
psychiatreic problem
hypokaliemia
hypertension
hyperglycemia

106

psychiatric problem in cushing(3)

sleep disturbances
depression
psychosis

107

quid of preload measurement(2)

right atrial pressure
pulmonary capillary wedge pressure

108

normal right atrial pressure

mean 4 mm of HG

109

normal pulmonary wedge pressure

mean of 9 mm de HG

110

quid of cardiac index

pump function measurement

111

normal cardiac index

2.8-4.2 l/mn/m2

112

quid of systemic vascular resistance

measure afterload

113

normal systemic vascular resistance

1150l/mn/m2

114

normal mixed venous oxygen saturation

60%-80%

115

the only parameter increase in Hypovolemic schock

everything is low except systemic vascular resistance

116

the only two parameters decrease in cardiogenic shock

everything is high except cardiac pump function
mixed venous oxygen saturation

117

the only shock syndrome with low vascular resistance and increased mixed venous oxygen saturation

septic shock

118

patient with hypotension, normal Pulmonary wedge pressure and increased mixed venous saturation

septic shock

119

hwat's the underlying basic pathophysiology in septic shock

decrease systemic vascular resistance due to overall peripheral vasodilation

120

swanz ganz catether in septic shock(4)

low pulmonary wedge pressure
low systemic vascular resistance
increased cardiac output
high mixed venous oxygen saturation

121

origin of formation of AFIB focii

pulmonary veins

122

quid for atrial flutter origin

reentrant circuit that rotates around the tricuspid annulus

123

quid for paroxysmal supraventricular tachycardia origin

reentry circuit most commonly oinvolved the AV node or via accessory bypass tract

124

patient on digoxin and furosemide present with wide complex tachycardia what to check

serum electrolytes

125

effect of furosemide(2)

low K
low MG++

126

effects of low K and low Mg++

ventricular tachycardia

127

risk factor for digoxin toxicity

low K

128

consequence of digoxin toxicity

ventricular tachycardia

129

side effect of thiazide (5)

hyperglycemia
increased LDL cholesterol and plasma triglycerides
hyponatremia
hypokaliemia
hypercalcemia

130

hypergluc in thiazide(4)

G= glycemia
L=lipidemia
U=uricemia
C=Calcemia

131

in swanx ganz catheter clue for cardiogenic shock(2)

reduced cardiac index
elevated pulmonary wedge pressure

132

how 's systemic vascular resistance in cardiogenic shock

high to maintain adequate perfusion of tissue

133

the most contributory factor in CHF edema

increased renal sodium retention

134

cause of increased renal sodium retention in CHF(2)

low renal perfusion----> stimulation of renin aldosterone system--->hypoperfusion renal secondary to cardiac output
renal arteries are constricted

135

patient with palpitations HR 160 suddenly with no history of haert problem.Symptoms improves when immersing face in cold water dx

paroxysmal supraventricular tachycardia

136

the cold therapy work s by affecting what

atrioventricular node conductivity

137

cause of supraventricular tachycardia

accessory conduction pathways

138

why you can have hepatomegaly,ascites, increased JVP in constrictive pericarditis

decreeased diastolic filling leafing to cardiac output impairment

139

common cause of constrictive pericarditis(4)

radiation therapy
viral pericarditis
cardiac surgery
idiopathic

140

kussmaul sign

failure of JVP to decrease during inspiration

141

other name of constrictive pericarditis

inelastic pericardium

142

dx of constrictive pericarditis(3)

calcified pericardium in xray
thickened pericardium on CT or MRI scanning
cardiac catheterisation

143

rx of constrictive percarditis(2)

diuretics
or
pericardiectomy

144

after anterior wall MI patient develops pleuritic chest pain improving when sitting and leaning forward.EKG shows diffuse ST segment elevation dx

acute pericarditis

145

laps de temps pour developper acute pericarditis post MI

within the first several days

146

EKG for acute pericarditis(2)

diffuse ST segment elevation
PR depressions

147

quid of lone AFIB

presence of paroxysmal persistent or permanent AFIb with no evidence of cardiopulmonary or structural heart disease

148

rx of lone AFIB

nothing

149

paroxysmal AFIB

reccurrent > a 2 episodes that terminate spontaneously in

150

persistent AFIB

episodes lasting more than 7 days

151

longstanding persistent AFIB

pesistent for more than 1 year duration

152

permanent AFIB

persistent with no further plans for ryhtm controls

153

CHADS 2 score 0(2)

no anticoagulation
aspirin preferred

154

CHADS 2 score 1 (2)

anticoagulation preferred
or
aspirin

155

CHADS 2 score 2-6

anticoagulation

156

cause of restrictive cardiomyopathy(4)

sarcoidosis
amyloidosis
hemochromatosis
fibrosis endomyocardial

157

clue for restrictive cardiomyopathy in echo

symmetrical thickening of the left ventricular walls and slightly reduced systolic function

158

the only reversible cause of restrictive cardiomyopathy

hemochromatosis

159

echo with interventricular septum thickness

hypertrophic cardiomyopathy

160

primary rx of hemochromatosis

phlebotomy

161

quid of the anti-ischemic nitrate action

systemic vasodilation rather than coronary dilation
systemic venodilation lowers (ventricular)preload and left ventricular end diastolic volume reducing wall stress and myocardial oxygen demand
dilation of capacitance vessels

162

action of nitrate

reduced left ventricular volume

163

supraventricular tachycardia in patient hemodynamically unstable management

DC cardioversion

164

anterior wall myocardial infarction with pulmonary edema what medication to give and why

furosemide
furosemide causes venodilation which further decreases the preload

165

anterior wall myocardial infarction with pulmonary edema what medication u cant give and why

betablocker
can worsen acute heart failure

166

other medication can be used in pulmonary edema caused by anterior wall myocardial infarction and why

Morphine
decrease prload and anxiolytic

167

patient with syncope with history of respiratotry infection 2 weeks ago EKG shows electrical alternans best next step in this patient

percardicenthesis

168

quid of electrical alternans

une onde qrs longue suivie d'une courte

169

EKG of pericardial effusion(3)

electrical alternans
sinus tachycardia
low QRS voltage in large pericardial effusion

170

quid of sinus tachycardia with electrical alternans

large pericardial effusion

171

problem in HIC(2)

abnormal mitral leaflet motion= systolic anterior motion of the mitral valve
septal hypertrophy

172

cause of systolic dysfunction

MI
...

173

catetherisation during systolic heart failure(3)

CI decreased
left ventricular end diastolic volume increased
total peripheral resistance increased

174

how 's the left ventricular end diastolic heart failure

normal

175

patient with tachysystolic AFIB what to do to improve the left ventricular function in those patients

control the rate and the rythm

176

why tachysystolic AFIB causes significant left ventricular dialtion and depressed EF(4)

tachycardia
neurohumoral activation
absence of atrial kick
atrial ventricular desynchronisation

177

importance of atrial kick

it accounts for 25% of LV end diastolic volume

178

tachysystolic AFIB (3)

irregular irregualr rythm
tachycardia
no P waves ion EKG

179

cardiac problem in hemochromatosis(3)

cardiac conduction abnormalities
dialted cardiomyopathy
heart failure

180

the greatest risk factor for printzmetal angina

smoking

181

young female with nocturnal chest pain lasting 15-20 mn .EKG shows St segment elevation in lead 1 avl,v4-v6 during the episode rx

diltiazem
or
nitrate

182

why to not give bblocker or aspirin in printz metal angina

cause vasoconstriction

183

other name of printz metal

variant angina

184

after long trip to central asia female using OCP develops hemoptysis and pleuritic chest paincause of these symptoms

pulmonary infarction

185

number one cause of pleuritic chest pain

PE

186

gold standard Dx in PE

helical CT

187

patient with chest pain palpitations is seen in emergency .Physical exam reveals HTA ,dilated pupils ,small amount of blood at the external nares St segment elevation in V1-V4.explanation of the symptoms

drugs induced vasospasm
cocaine abuse

188

why you cant give bblocker to patietn in cocaine abuse

unopposed alpha agonist will worsen vasospasm in cocaine abuse

189

cause of St segment elevation(4)

MI
Cocaine abuse
acute pericarditis
printzmetal

190

clue for aortic regurge

wide pulse pressure

191

manif of wide pulse pressure in reality

water hammer pulse
=pounding heartbeat

192

way for the patient hear better the pounding heart(2)

lying supine and
lying on the left

193

most common cause of aortic dilation in The US(2)

aortic root dialtion
bicuspid aortic valve

194

the greater non pharmocologic rx with greatest impact on HTA and why(2)

weight loss
reduce HTA of 5-20 per 10 kg loss

195

the second non pharmocologic rx with greatest impact on HTA and why(2)

DASH diet
reduce HTA 8-14 mm de hG

196

thethird non pharmocologic rx with greatest impact on HTA and why(2)

exercice
reduce HTA 4-9 mm de hg

197

the 4 e non pharmocologic rx with greatest impact on HTA and why(2)

dietary sodium
reduce HTA 2-8 mm de hg

198

the 5 e non pharmocologic rx with greatest impact on HTA and why(2)

alcohol intake
reduce HTA 2-4 mm de hg

199

quid of DASH diet(2)

Diet rich in fruits and vegetables
and low saturated fat and total fat

200

time to work out in HTA(2)

30 min /day
5-6 days /semaine

201

dietary sodium restriction in HTA

202

alcohol intake restriction in HTA(2)

2 drinks /day in men
1 drink /day in women

203

first line rx for newly dx hypertension satge 1

lifestyle modification

204

patient with pedal edema ascite emigrating from china to come in the US.chest xray reveals decreased heart sound and an accentuated sound directly after the second heart sound in ear;y diastole .chest xray shows ring calcification around the heart and jugular venous pressure tracings show prominent x and y descents cause of the patient symptoms and Dx

tuberculosis
constrictive pericarditis

205

clinical presentation of constrictive pericarditis(4)

fatigue and dyspnee on exertion
peripheral edema and ascites
high jugular venous pressure
pericardial knock

206

dx findings in constrictive pericarditis(2)

X and Y descents during jugular venous pulse tracing
imagind shows pericardial thickening and calcification

207

pericardial knock

early heart sound after S2

208

heart dysfunction in constrictive pericarditis

diastolic

209

endemic areas for TB(3)

africa
india
china

210

EKG for Mobitz type 1(wenkeback)

PR interval growing slowly progressively leading up to a dropped beat

211

problem in mobitz one

impaired AV node conduction

212

sudden tearing chest pain in aptient with chest xray showing widened mediastinum dx and medical condition causing that

dissection aortic
HTA

213

drugs increasing the riosk of bleeding when taking warfarin(9)

acetaminophen
NSAIDS
antibiotis/antifungal
amiodarone
canberry juice
ginkgo biloba viit E
omeprazole
thyroid hormone
selectice serotonin reuptake inhibitors

214

drugs decreasing the effect of warfarin(6)

rifampin
carbamazepine
oral contraceptives
ginseng
st jhon's wort
green vegetables(spinach)

215

dose of acetaminophen to cause bleeding with warfarin ingestion

> 2 g /jour for 1 week

216

the most important factor for survival in out hospital sudden cardiac arrest

time to rythm analysis and defibrillation=elapse time to effective resuscitation
en d'autres mots:prompt effective resuscitation with adequate bystander CPR,prompt rythm analysis and defibrillation

217

number one cause of outhospital sudden cardiac arrest(2)

sustained VTAC
sustained VFIB
both cause by MI or ischemia

218

murmur in aortic dissection

diastolic murmur in left sternal border

219

3 clinical findings in aortic dissection with 2 you make the DX

tearing chest pain radiating in the back
variation in pulse or blood pressure between the right and the left arm
widened mediastinum

220

complication of dissection aortic

extend to pericardium=tamponnade
extend to coronary arteries=stroke
extend to carotid arteries=stroke

221

dissection aortic plus hemiplegia dx

stroke

222

incidence of aortic dissection when 2 clinical symptoms are present see question above

80 %

223

patient found with pulsatile mass above umbilicus creat 2.0 and TA:160/90 dx and best test to confirm the DX(2)

abdominal aneurism of aorta
abdominal ultrasound

224

quid of BNP

release by dilated ventricle

225

value for BNP to Dx CHF(4)

> 100 pg /ml
specificity 76
sensitivity 90
predictive value 83

226

importance of BNP

helps to differentiate dyspnea of cardiac origin with any other origin

227

cause of right Heart failure in COPD

pulmonary artery systolic pressure

228

sequence of event causing right heart failure in COPD

hypoxemia causes constriction of the pulmonary artery and with time pulmonary hypertension---> will lead to right ventricular hypertrophy and right ventricular failure

229

does right ventricular failure cause pulmonary edema

it s not a common cause of pulmonary edema

230

management of STEMI(6)

oxygen
nitrates
antiplatelet therapy
anticoagulation
bblockers
prompt reperfusion with PCI

231

antiplatelet therapy used in STEMI

platelet P2y12 receptor inhibitor

232

anticoagulation used in STEMI

bivalirudin is preferred over heparin

233

ideal first rx for STEMI

prompt reperfusion with PCI

234

clue for benign essential tremor(3)

tremor worst with activity
improves with with alcohol
family inheritance autososmal dominant

235

HTA plus benign esential tremor Rx

propranolol

236

the most effective non pharmacological rx of HTA

weight loss

237

clue for venous insufficiency(4)

pedal edema
medial ankle ulcer
dilated and tortuous superficial veins
normal physical exam

238

initial rx of venous insufficiency(3)

leg elevation
exercice
compression stockings

239

method to hear aortic regurgitation murmur(4)

diastolic murmur
best heard along the left sternal border at the third and fourth interspaces
best heart when you apply firm pressure with the diaphragm of the sthetoscope while patient is sitting up leaning forward and holding the breath in full expiration

240

cause of aortic regurge in developed countries in young adults

bicuspid aortic valve

241

cause of aortic regurge in developing countries in young adults

rheumatic heart disease

242

common cause of aortic regurgitation involving the aortic valve leaflet(8)

rheumatic heart disease
endocarditis
bicuspid aortic valve
trauma
myxomatous degeneration
ankylosing spondylitis
acromegaly
medications

243

common cause of aortic regurgitation involving trhe ascending aorta or aortic root disease (8)

hta
aortitis syphilitic
ankylosing spondylitis
dissection aortic
ehlers danlos
IBD
reactve arthritis
Marfan syndrome

244

Medication to hold for 48 h prior to cardiac testing(3)

Bblocker
calcium blocker
nitrates

245

medication to hold 48 h prior to vasodilator stress test

dipyridamole

246

medication to hold 12 h prior to vasodilator stress test

caffeine containing food or drinks

247

medication you can continue prior to to cardiac stress testing(5)

ACE inhibitor
ARBs
digoxin
statins
diuretics

248

gold standard Dx of CAD

coronary angiography

249

indication of amiodarone(3)

ventricular arythmias
rythm control in AFIB
left ventricular systolic dysfuction

250

toxicity of amiodarone(7)

hypo or hyper thyroidism
hepatotoxicity
bradycardia
heart block
pneumonitis
neurologic symptoms
visual disturbances

251

visual probelm associated with amiodarone(2)

corneal microdeposits
optic neuropathy

252

heart problem with amiodarone(2)

Qt prolongation
risk de torsades de pointes

253

dermatologic problem associated with amiodarone

blue gray skin discoloration

254

neurologic problem associated with amiodarone

peripheral neuropathy

255

gastrointestinal and hepatic problem associated with amiodarone(2)

elevated transaminases
hepatitis

256

mark for IV drug user in USMLE

needle tracks on arms

257

IV drug user with fever andround lesions in lungs and sinus tachycardia.what accompanying finding is expected

systolic murmur that increases with inspiration

258

bug in infective endocarditris in IV drug user

staph aureus

259

what increases the risk of infective endocarditis in IV drug user

HIV infection

260

holosystolic murmur increasing with inspiration quid of that

tricuspid involvement

261

IE with round lung opacity

septic pulmonary emboli

262

what must be done in young patient with systemic HTA

evaluation for coarctation of aorta

263

assessment of coarctation of aorta in physical exam(3)

search for brachio femoral delay
upper extremity hypertension lower extremity hypotension
continuous cardiac murmur from large collaterals

264

acqiured cause of coarctation of aorta

maladue de takayasu

265

chest xray for aaortic coarctation

notching of the 3 th-8th ribs from enlarged intercostal arteries

266

confirmatory dx for aortic coarctation

echocardiography

267

rx of aortic coarctation(2)

balloon angioplasty
plus or minus
stent

268

complication of CABG

AFIB

269

AFIB in hemodynamically unstable patient rx

DC cardioversion

270

EKG of AFIB(3)

absent P waes
an irregularly irregylar rate
narrow QRS complex

271

clinical features for cocaine abuse(4)

sympathetic activity
chest pain
psychomotor agitation
seizures

272

sympathetic activity in cocaine abuse(3)

tachycardia
HTA
dilated pupils

273

why chest pain in cocaine abuse

coronary vasodilation

274

complication of cocaine abuse(3)

acute MI
aortic dissection
intracranial hemorrage

275

clue in USmle for cocaine abuse

nasal mucosa is atrophic

276

chest pain management in cocaine abuse(5)

benzodiazepines
aspirin
Nitrate and calcium blocker
no Bblocker
immediate cardiac catheterisation with reperfusion when indicated

277

why you ccant use fibrinolytics in the management of chest pain caused by cocaine abuse

increased risk of intracranial hemorrage

278

patient with infective endocarditis is started on vancomycin .Days later culture grows streptococcus mutans highly sensitive to PNC next step

switch antibiotics to IV ceftriaxone

279

rx of infective endocarditis caude by step mutans(3)

IV pNC
IV ceftriaxone
for 4 weeks

280

what intervention in STEMI will improve the long term prognosis of patient

restore coronary blood flow

281

inferior MI

2 ,3 avf

282

two primary options to restore coronary blood flow(2)

PTCA
fibrinolysis

283

when to do exercice EKG or pharmacologic stress testing in patient with chest pain

when you have intermediate risk of CAD

284

quid of intermediate risk of CAD(3)

atypical angina in men of all ages
atypical angina in women > ou egal 50
typical angina in women age 30-50

285

high risk for CAD(2)

typical angina in men > ou egal a 40 ans
typical angina in women age > ou egal a 60 ans

286

low risk for CAD(2)

atypical chest pain in women age

287

high risk for CAD CAT(2)

start Rx
coronary angiography if unstable angina

288

patient with ant.hypertension with hypotension tachycardia,distended neck veins pulsus paradoxus with teraing chest pain dx

pericardial tamponnade due to dissection aortique

289

USMLE pulsus paradoxus

respiratory variation in systolic blood pressure or
decrease > 10mm de hg drop in systolic pressureduring inspiration

290

why syncope and hypotension in tamponnade(4)

compression of cardiac chambers by fluid in pericardium
limit diastolic filling of trhe right sided chambers
decreases preload
reduces cardiac out put

291

young age under 70 patient with aortic stenosis cause

bicuspid aortic valve

292

elderly 70 patient with aortic stenosis cause

calcification of aorta

293

tearing cehst pain in thew context of hypotension with respiratory variation in systolic blood pressure hypotension ,distended jugular veins dx

dissection aortique

294

dissection aortic wuth Ta higher in right arm than the left arm why

extension of the dissection into the great vessels feeding the left arm

295

after myocardial infarction patient develops develops widened QRS complex with compensatory pause next step but patietn is asymptomatic

observation

296

PVC in symptomatic patient rx

Bblocker

297

when you cant use nitrates in in MI

right ventricular MI

298

when to suspect right ventricular MI

often accompany post MI

299

when to suspect right ventricular MI(5)

hypotension
with clear lung fields
high JVP
Kussmaul's sign positif

300

Left ventricular infarct(2)

hypotension
pulmonary edema

301

correction of hypotension in right ventricular infarct(2)

administer normal saline bolus
don't give nitro

302

patient developping dyspnea after stab wound to the right thigh 10 months ago .In EP,right leg is warmer and apperas flushed compared to his left leg cause of the patient symptom

increased cardiac preload

303

patient developping dyspnea after stab wound to the right thigh 10 months ago .In EP,right leg is warmer and apperas flushed compared to his left leg cause of the patient symptom dx

AV fistula

304

congenital cause of AV fistula(4)

PDA
angiomas
pulmonary AVF
CNS AVF

305

acquired cause of AVF(4)

trauma
iatrogenic ( femoral catheterisation)
atherosclerosis(aortocava fistula)
cancer

306

why heart failure in AVF

the circulation is unable to meet the oxygen demand of the peripheral tissues

307

patietn with dyspnes and elevate BNP what you expect to find in this patient

S3

308

meaning of S3 and elevated BNP

increased cardiac filling pressures

309

patinet with left sided chest pain improving with leaning forward and creat 5.1 dx and rx(2)

pericarditis
hemodyalisis

310

most common cause of pericarditis

viral infection

311

rx of viral pericarditis

NSAID

312

cause of pericarditis(5)

iatrogenic
connective tissue disease
cardiac
uremic
malignancy

313

iatrogenic cause of pericarditis(4)

surgery
trauma
radiation
drug related/chemo

314

connective tissue causing pericarditis(2)

RA
SLE

315

cardiac problem causing pericarditis

dressler syndrome

316

quid of dressler syndrome(2)

post MI infarction
usually 1 -6 weeks after MI

317

when you will have uremic pericarditis

whrn BUN> 60 mg/dl

318

CHADS 2 score(5)

C=CHF =1 pt
H=hypertension=1
A=age . ou egal a 75=1
D=diabetes=1
S=prior stroke =2

319

CHF apres recent cold

dilated cardiomyopathy

320

finding on echo in dilated cardiomyopathy(2)

dilated ventricles with diffuse hypokinesia
low ejection fraction

321

viral myocarditis cause #1

coxsackievirus B

322

viral myocarditis other cause(4)

parvovirus B19
human herpes virus 6
adenovirus
enterovirus

323

tracing of arterial line and BP

compare pick lors de l'inspiration and pic in systolic presure to understand the graphics

324

quid of pulsus paradoxus

decrease of ten mm de hg of systolic pressure during inspiration

325

explanation of pulsus paradoxus

in inspiration the intrathoracic pressure is negative
incresase venous return to the right heart
interventricular septum shifs into the left ventricular cavity reducing the left ventricular and diastolic volume
d'ou decreasd systolic blood pressure in the case of tamponnade

326

other cause of pulsus paradoxus(2)

severe asthma
COPD

327

why isolated systolic hypertension in elderly

rigidity of the arterial wall

328

rx of isolated systolic hypertension in elderly

monotherapy with thiazide
or ACE inhibitor
or
long acting calcium channel blocker

329

heart problem in Marfan(3)

aortic dilation
regurge
aortic dissection

330

murmur in Marfan

early diastolic murmur

331

skeletal problem in Marfan(5)

arachnodactyly
pectus deformity
joint hypermobility
increase arm to height ratio
decrease upper to lower body segment ratio

332

ocular problem in marfan

ectopia lentis

333

why marfan patient tend to have spontaneous pneumothorax

rupture of apical blebs

334

skin finding in Marfan(2)

reccurrent or incisionnal hernia
skin striae

335

Marfan patient with acute chest pain

acute aortic dissection

336

syncope provoked by strong emotion

vasovagal syncope

337

inciting event of vasovagal syncope in patient

emotionnal stress(venipuncture)
orthostatic stress(prolonged standing)

338

inciting event of vasovagal syncope in patient > 60 ans(3)

micturition
cough
defecation

339

dx of uncertain vasovagal syncope

upright tilt table testing

340

dx of vasovagal syncope

clinical

341

what medication should be given to all patient with MI within 24 hours

ACE inhibitor

342

why ACE inhibitor in post MI(2)

to prevent remodelling of the ventricle and
possible dilation of the ventricle leading to CHF

343

military recruit with body temperature > 40 during exercice with central nervous system dx

heat stroke

344

common symptom in heat stroke(3)

dehydration
hypotension
tachycardia

345

systemic effects of heat stroke(4)

seizures
acute respiratory distress syndrome
DIC
hepatic and renal failure

346

rx of heat stroke(4)

rapid cooling with ice water immersion
fluid resuscitation
electrolyte correction
management of end organ damage

347

antipyretic in heat stroke

any role

348

risk factors for heat stroke(6)

strenuous activity during hot and humid weather
dehydration
poor acclimatisation
lack of physical fittness
obesity
medications

349

medication involved in heat stroke(4)

anticholinergics
antihistamines
phenothiazines
tricyclics

350

murmur on right sternal border increased with expiration

left side heart murmurs

351

symptom of aorti stenosis(3)

S=Syncope
A=angine
D=Dyspnea

352

indication of surgery in Aortic stenosis(3)

symptomatic patient
patients with severe AS undergoing CABG or other valvular surgery
asymptomatic patient with severe AS and poor LV systolic function=LV hypertrophy >15 mm
valve area

353

cause of anginal pain in aortic stenosis

increased myocardial oxygen demand

354

medication with decreased mortality following MI(4)

aspirin
B blockers
ACE inhibitor
lipid lowering statins

355

indication of clopidogrel in MI(3)

intolerance to aspirin
post US/NSTEMI
following PCI

356

duration of taking of aspirin and clopidogrel after UA/NSTEMI

12 months for clopidogrel
definitely for aspirin

357

role of clopidogrel and aspirin inn post PCI

prevent stent thrombosis

358

AFIB with cardiac arrest next step

chest compression

359

quid of pulseless electrical activity

the presence of organized rythm on cardiac monitoring without a measurable BP or palpable pulse in a cardiac arrest patient

360

wht to do in pulseless electrical activity(2)

chest compression
no defibrillator
nosynchronised cardioversion

361

AFIB with cardiac arrest Dx

pulseless electrical activity

362

reversible causes of asystole/pulselkess electrical activity 5H(5)

hypovolemia
hypoxia
hydrogen nions( acidosis)
hypo or hyperkaliemia
hypothermia

363

reversible causes of asystole/pulselkess electrical activity 5T(5)

tension pneumothorax
tamponnade
toxins
thrombosis(pulmonary or coronary)
trauma

364

elderly with diarrhea develops orthostatic hypotension,mucosal dryness, what's the most sensitive indicator to see if elder is dehydrated

increase BUN/CREAT ratio

365

after MI patient develops leg Pain dx

occlusion of popliteal artery

366

5 P in occlusion artery

Pain
pulselessness
paresthesia
poikilothermia
pallor

367

tr of occlusion artery(2)

embolectomy
or
intra arterial fibrinolysis/mechanical embolectomy via interventionnal radiology

368

pleuritic chest pain normal cardiac exam, tenderness to palpation over the sternum

costochondritis

369

clue for pain from musculoskeletal origin

reproducible with palpation

370

papiltaion with AFIB in patient with lid lag retraction and tremor dx

graves disease

371

rx of hyperthyroidism related tachysystolic AFIB

propranol

372

patient with HTA is receiving a drug whicn enhances natriuresis,decreases serum angiotensin 2 concentration and decreases aldosterone production action of that drug

direct renin inhibitor

373

example of direct renin inhibitor

aliskiren

374

drugs affecting the renin angiotensin aldosterone axis(3)

ACE inhibitors
angiotensin receptor blockers
direct renin inhibitor

375

MI plus flash pulmonary edema management

furosemide

376

initial stabilisation of acute ST segment elevation MI(7)

02 if sao2

377

ST segment elevation plus unstable sinus bradycardia management

IV atropine

378

ST segment elevation plus persistent severe pain ,management

IV morphine

379

ST segment elevation plus persistent
pain,hypertension or heart failure ,management

IV nitroglycerine

380

when you cant use nitro in MI(3)

hypotension
right ventricular infarct
severe aortic stenosis

381

when you cant use b blockers in MI(2)

CHF
bradycardia

382

laps of time to perform percutaneous transluminal coronary angioplasty following MI

within 90 mn preferred

383

if PTCA within 120 mn not available in case of acute ST segment elevation next step

thrombolysis

384

patient is receiving a medication for palpitation ,he undergoes a stres test for chest pain durinfg the test his heart rate increases form 65 to 175 and qrs duration from 0,09 to 0.13 seconds .which medication was used for palpitation in thsis patient

flecainide

385

why during stress test if you are taking flecainide heart rate will increase and QRS complex prolonged

the medication has a use dependance prperty
more effective at higher heart rates because there is not as much time between heartbeats for the medication to dissociate from its receptor

386

action of flecainide

block sodium channel

387

indication of flecainide(2)

ventricular arythmias
supraventricular tavhycardia as AFIB

388

class of antiarrythmic involved in use dependence phenomenon

class 1c
class iV

389

does class IV prolong QRS complex

no

390

patient with MI under rx 4 days later develops chest pain .the best marker to be useful in this patient

CK MB

391

the most specific and sensitive test for MI(2)

troponin T
return to normal in 10 days post MI

392

wy CKMB is the best test in reocclsuion following a previous recent one

it takes 1-2 days to become normal after MI

393

murmur in mitral regurge

holosystolic murmur

394

features for mitral regurgitation(4)

exertional dyspnea
fatigue
AFIB
heart failure signs

395

aortic stenosis in elderly cause

sclerocalcific changes

396

you perform myocardial perfusion scanning for a patient,it reveals uniform distribution at rest but inhomogenesity of the distribution after dipyridamole injection.waht effect of dipyridamole helps in making the dx of ischemic heart disease

coronary steal phenomenon

397

indication of myocardial perfusion scanning with dipyridamole

amputated patient

398

quid of coronary steal

redistribution of coronary blood flow to non diseases segments

399

whta other substance can be used in myocardial perfusion scanning

adenosine

400

risk of mitral stenosis

left atrial dilation
AFIB
cardiac emboli

401

consequence of pressure transmitted to pulmonary vasculature inmitral stenosis(3)

dyspnea
cough
hemoptysis

402

patient with right sided weakness cough hemoptyis dyspnes from cambogia dx

stroke caused by cardiac emboli inthe setting of mitral stenosis

403

quid of mallory weiss(2)

upper gastrointestinal mucosal tear
caused by forceful retching

404

quid of boerhave syndrome(3)

esophageal transmural tear
caused by forcefu retching
esophageal air and fluid leakage in nearby areas

405

chest xray in boerhave syndrome(3)

unilateral pleural effusion
with or without pneumothorax
subcutaneous or mediastinal emphysema
widened mediastinum

406

pleurl fluid analysis in boerhave syndrome(2)

high amylase > 2500 UI
food particles

407

dx of boerhave syndrome(*2)

CT
contrast esophagography with gastrographin

408

confirnatory dx in mallory weiss

endoscopy gastro digestive

409

risk factor for variant angina

smoking

410

EKG in variant angina

ST segment elevation

411

condition associated with printzmetal angina(2)

migraine
raynauds phenomenon

412

pain characteristic in prntzmetal

occurs at night
goes spontaneously after 15-20 mn

413

hypertension in the setting of hypercalcemia

parathyroid gland disease

414

secondary HTA caused by renal parenchymal disease(2)

elevated serum creat
abnormal urinalysis (proteinuria,red blood cell casts)

415

secondary HTA caused by reno vacular disease(4)

severe HTA > ou egal 180/120 after 55
abdominal bruit
flash pulmonary edema
unexplained rise in creat

416

secondary HTA caused by primary aldosteronism(3)

hypokaliemia
slight hypernatremia
adrenal incidentaloma

417

secondary HTA caused by pheochromocytoma (3)

paroxysmal elevated BP with tachycardia
pounding headaches papiltations and diaphoresis
adrenal incidentaloma

418

secondary HTA caused by hypothyroidism(5)

constipation
weight gain
bradycardia
cold intolerance
dry skin

419

secondary HTA caused by primary hyperparathyroidism(3)

hypercalcemia
kidney stones
neuropsychiatric disease

420

secondary HTA caused by coarctation of aorta

differential HTA with brachio femoral pulse delay

421

xray findingds in pericardial effusion

water bottle cardiac silhouette

422

how 's the jugular venous pressure in viral pericarditis

could be normal

423

how 's the point of maximal impulse in viral pericarditis

non palpable

424

first test to do in a setting of syncope

EKG

425

syncope occuring during prolonged standing position distress or painful stimuli dx

vasovagal or neurally mediated syncope

426

syncope occuring during postural changes with changes in heart rate and blood pressure

orthostatic hypotension

427

syncope during exercice or with exertion(4)

aortic stenosis
HOC
anomalous coronary arteries
VTAC

428

syncope with sinus pauses on monitor prolonged PR interval or QRS duration(3)

sick sinus syndrome
bradyarythmiasd
av block

429

syncope with hypokaliemia or hypomg++ or any medication causing prolonged QT interval

torsades de pointes
(acquired long QT syndrome)

430

syncope with triggers ( swimming,during sleep sudden noice) family history of sudden daerth prolonged qt interval on ECG

congenital long Qt syndrome

431

ECG findings suggesting arrythmia as the cause of syncope(6)

innaproppriate sinus bradycardia
sino atrial block
sinus pauses
AV block
nonsustained VTAC
short or long QTC interval

432

murmur in aortic regurge(2)

early diastolic murmur
left sternal border

433

bounding pulse or water hammer peripheral pulse

aortic regurgitation

434

aortic murmur in regurgitation localisation in valvular disease

diastolic murmur in left sternal border 3 e 4 e espace intercostal

435

aortic murmur in regurgitation localisation in aortic root disease

diastolic murmur in right sternal border

436

conduction abnormality in the setting of infective endocarditis

perivalvular abcess

437

risk in acute endocarditis involving the aortic valve in IV drug user

periannular extension of endocarditis

438

peripheral edema with normal physical exam in a patient taking calcium blocker cause of edema

dihydropyridine Ca channel antagonist

439

sudden death in young athlete

hypertrophic cardiomyopathy

440

risk factor for coroanry syndrome(3)

smoking
family history
estrogen therapy

441

patientin EB with chest pain and suspected coronary syndrome .what drug should be administered first

aspirin

442

why aspirin is so important in acute coronary syndrome(2)

reeudces risk of MI
decrease mortality overall

443

apical holosystolic murmur

mitral rergurgitation

444

apical mid late systolic murmur

mitral valve prolapse

445

apical mid late diastolic murmur

mitral stenosis

446

left sternal border systolic ejection murmur

Hypertrophic cardiomyopathy

447

left sternal border early diastolic murmur(2)3 e espace intercostal

aortic regurgitation
pulmonic regurgitation

448

quid of pulomonic area

2 espace intercostal G

449

systolic ejection murmur in pulmonic area

pulmonic stenosis
flow murmur
ASD

450

systolic ejection click in pulmonic area

pulmonic stenosis

451

quid aortic area

2 e espace intercostal droit

452

systolic ejection murmur in aortic area

aortic stenosis

453

holosystolic murmur in tricuspid area

tricuspid regurge
VCD

454

quid of tricuspid area

4 e espace intercostal in the left close to sternum

455

mid late diastolic murmur(2)

tricuspid stenosis
ASD

456

cause of mitral regurgitation in developed countries

mitral valve prolapse=myxomatous degeneration of the valve

457

complication of severe chronic Mitral regurgitation(3)

AFIB
left ventricular dysfunction
CHF

458

most common benign tumor in heart

Myxoma

459

Symptom for atrial myxoma(3)

systemic embolization
cardiovascular symptoms simulating mitral valve disease
constitutioonnal symptoms

460

most sensitive test to Dx atrial myxoma

transesophageal echocardiography

461

complication of myxoma

sudden death

462

murmur in myxoma

early diastolic sound=tumor flop

463

why constitutionnal symptoms in myxoma

overproduction of interleukin 6

464

anterior wall MI

V1- V6

465

hemodynamic hypotension compromises 3 a 7 jours after anterior MI(3)

paillary muscle rupture
left ventricle free wall rupture
interventricular septum rupture

466

hypotension with pansystolic murmur apical after anterior wall MI

acute mitral regurgitation caused by papillary muscle dysfunction

467

normal heart rate at rest

60-100

468

symptomatic sinus bradycardia(dizziness) rx

iV atropine

469

symptomatic sinus bradycardia unresponsive to atropine

permanent pace maker

470

cause of sinus bradycardia(4)

sick sinus syndrome
hypoglycemia
medication
exagerated vagal activity

471

medication involved in sinus bradicardia(3)

digitalis
B blocker
Calcium channel blocker

472

first line antianginal rx used in stabe chronic angina

B blocker

473

antianginal drug(3)

bblocker
calcium channel blocker
nitrates

474

action of BBlocker as antianginal drug

decrease myocardial contractility and heart

475

action of calcium channel blocker as antianginal drug

peripheral and coronary vasodilation

476

can you combine Bblocker and calcium blocker as antianginal

yes
in persisting angina

477

preventive rx in stable chronic angina(5)

aspirin
statin
smoking cessation
regular exercices and weight loss
control of BP and diabetes

478

when to use nitrate in stable chronic angina

when B blocker and calcium blocker are contindicated

479

medication which has not been shown to improve survival in patients with CHF(2)

digoxin
furosemide

480

medication which has been shown to improve survival in patients with CHF(5)

ace inhibitor
ARB's
bblocker
aspirin
spironolactone

481

S4 meaning

diastolic disfunction

482

why S4 in MI

ischemic damage may lead to diastolic dysfuction and stiffened ventricle

483

rx of dressler syndrome

NSAIDS

484

indication of corticosteroids in dressler syndrome(2)

refractory cases
contrindication of NSAIDS

485

why you should avoid anticoagulation if you suspect dressler syndrome

risk of hemorragic pericardial effusion

486

bad prognosis factor in heart failure

hyponatremia

487

why hyponatremia is a factro of bad prognosis in heart failure(2)

it indicates sever heart failure
high level of neurohumoral activation

488

cause of hypo or hyperkaliemia in CHF(2)

drugs induced
reflection of renin angiotensin aldosterone system activity

489

CHF with echo finding of concentric thickening of the ventricular walls ,normal ventricular chamber dimensions and diastolic dysfunction cause of that

amyloidosis

490

type of amyloidosis(2)

primary=AL
secondary=AA

491

cause of amyloidosis

any chronic inflammator conditions

492

some examples of chronic inflammatory disease(5)

inflammatory arthritis
chronic infections
IBD
Malignancy
vasculitis

493

CHF in amyloidosis

restrictive

494

dx of amyloidosis

tissue biopsy(abdominal fat pad biopsy)

495

inthe USMLE clue for syncope caused by arrythmia(4)

syncope without warning
presence of structural disease(post infarction)
frequent ectipic beats
thiazide is taking by teh patient

496

patient after MI develops cold leg next step and why(2)

echo cardiography
search for intraventricular thrombus

497

patietn presenting with left chestpain 5 days ago he was diagnosed for ant MI with complete occlsuion of LAD 2 miniutes later he is unresponsive with no pulse palpated and death(possible)dx

ventricular free wall rupture

498

mechanical complication of MI(4)

right ventricular failure
papillary muscle rupture
interventricular sseptum rupture
free wall rupture

499

artery involved in right ventricular failure

RCA

500

time course for right ventricular failure

acute

501

finding in right ventricular failure(2)

hypotension with clear lungs
kussmaul sign

502

echo finding in right ventricular failure

hypokinetic RV

503

artery involved in papillary mx rupture

RCA

504

time course for papillary mx rupture

acute and within 3 -5 days

505

finding in papillary mx rupture

acute severe pulmonary edema
new holosystolic murmur

506

echo finding in papillary mx rupture

severe mitral regurge with flail leaflet

507

artery involved in interventricular septum rupture or defect(2)

LAD for apical rupture
RCA for basal rupture

508

time course in interventricular septum rupture or defect

acute and within 3 -5 days

509

finding in interventricular septum rupture or defect(4)

shock
chest pain
new hollow systiolic murmur
biventricular failure

510

echo finding in interventricular septum rupture or defect(2)

left to right shunt level of ventricle
step up oxygen between right atrium and ventricle

511

artery involved in free wall rupture

LAD

512

time course in free wall rupture

within first 2 days - 2 weeks

513

finding in free wall rupture(3)

shock and chest pain
jugular venous distension
distant heart sounds

514

echo finding in free wall rupture

pericardial effucion with tamponnade

515

SMVT

sustained monomorphic ventricular tachycardia

516

cause of SMVT

post MI complication 6 a 48 h apres MI

517

EKG of SMVT

wide complex tachycardia with 2 fusion beats

518

rx of hemodynamic stable SMVT(3)

IV amiodarone
lidocaine
procainamide

519

rx of hemodynamic unstable SMVT

electrical cardioversion

520

heart and alcohol

dilated cardiomyopathy

521

measures most likely to reverse heart failure in alcoholic CHF

total abstinence from alcohol

522

mainstay of rx of alcoholic CHF

total abstinence from alcohol

523

what disease patient with intermittent claudication will have over the next 5 years

MI

524

major cause of mortality in patient with PAD

cardiovascular disease

525

probability of non fatal MI and stroke in patient with intermittent claudication

20% 5 year risk

526

probability of death to cardiovascular causes in patient with intermittent claudication

15 a 30 %

527

probability of critical limb ischemia with risk of limb amputation in patient with intermittent claudication

1 a 2 %

528

stanford classification of dissection aortic (2)

type A
B

529

rx of type A aortic dissection(2)

Labetalol
surgery

530

rx of type A aortic dissection

Labetalol

531

quid of type A aortic dissection

ascending aorta is involved

532

quid of type B aortic dissection

descending aorta

533

CT for aortic dissection

descending aorta with false and true lumen separated by an intimal flap

534

aortic mur murmur caused by aortic dissection

right sternal border compared to primary aortic valvular disease ,murmur is herad to the left

535

best test to Dx aortic dissection

TEE
CT with contrast

536

when to use CT with contrast in the Dx of aortic dissection

when renal function is normal

537

artery and lead in anterior MI(2)

LAD
v1 a V6

538

artery and lead in inferior MI(2)

RCA or left circumflex artery 9LCX)
ST elevation 2,3 avf

539

artery and lead in post MI(4)

RCA or left circumflex artery
ST depression in leads V1-V3
ST elevation in 1 and AVL(LCX)
ST depression in leads 1 and AVL (RCA)

540

artery and lead in lat MI(3)

LCX/diagonal
St elevation in leads 1 avl v5 v6
St depression in leads 2, 3 avf

541

right ventricular MI when it occurs

in inferior MI

542

artery in right ventricular MI(2)

RCA
St segment elevation in leads V4-V6R

543

MI plus hypotension plus clear lung

right ventricular failure

544

MI with sinus bradycardia

inferior MI

545

why inferior MI cangive bradycardia(2)

increased vagal tone
RCA supply blood to sinoatrial node

546

complication of RCA occlusion and why

AV block
RCA supply AV node through AV nodal artery

547

ST segment elevations in 2,3 avf and ST segment depression in V1 V2

inferior MI with posterior MI associated

548

hypotension AV block and bradycardia in the setting of MI

inferior MI

549

clue for MI inferior involving right heart(2)

ST segment elevation ,2,3 AVL
St segment depression in i and AVL

550

EKG in atrial premature beats

early P wave

551

risk factor for atrial premature beats(4)

tobacco
alcohol
caffeine
stress

552

symptomatic patient with atrial premature beats rx

B blocker

553

xray in thoracic aorta aneurism(3)

widened mediastinum
increased aortic knob
tracheal deviation

554

cause of ascending aorta aneurism(2)

cystic medial necrasis
connective tissue disorders

555

cause of descending aorta aneurism

atherosclerosis

556

enlarged aorta in xray

aneurism

557

patient with low grade fevers exertionnal dyspnea
fingerttip pain and dark and cloudy urine.In physical exam proximal and distal interphalangeal joints are swollen

infective endocarditis

558

quid of osler nodes

painful fingertip

559

dark and cloudy urine(2)

proteinuria
hematuria

560

swollen interphalangeal joints

arthritis

561

vascular phenomoenon in infective endocarditis(5)

systemic arterial emboli
septic pulmonary infarcts
mycotic aneurism
conjonctival hemorrage
janeway lesions

562

quid of Janeway lesions

macular erythematous nontender lesions on the palms and soles

563

systemic emboli manifestation(3)

focal neurologic deficits
renal infarcts
splenic infarcts

564

definitice dx or infective endocarditis

DUKE criteria

565

inheritance of hypertrophic cardiomyopathy

autosomal dominant

566

quid of masive pulmonary embolism(2)

PE complicated by hypotension
and acute right strain

567

sign of right heart strain in PE(2)

high JVP
RBBB

568

complication of right heart strain in PE(6)

right ventriculr dysfunction
decreasde to the left side of the heart
decreased cardiac output
left heart pump failure
bradycardia
cardiogenic shock

569

fibrinolysis in PE in the setting of post op

can't be given within the past 10 days of surgery

570

CHF with normal TA or elevated TA(3)

supplement o2
IV loops diuretics
consider IV vasodilators as nitroglycerin or nitroprusside

571

CHF plus sign de shock(3)

supplement o2
IV loops diuretics
IV vasopressors as norepinephrine

572

side effect of digoxin(5)

nausea
vomiting
diarrhea
vision changes
arythmias

573

patient is taking digoxin develops diarrhea what to do

measure digoxin levels

574

patient taking an anti arrythmic in teh setting of VTAC develops fibrose pulmonaire .what drug was used to rx the patient

amiodarone

575

patient with diatolic and continuous murmur at left sternal border next step

echocardiography

576

rule for diastolic and continuous murmur as well as loud systolic murmurs next step

investigate with transthoracic echodopler

577

midsystolic murmur grade 1-2 /6 in young patient next step(2)

nothing
benign

578

medication reducing overall mortality in CHF(4)

ACE inhibitor
b blocker
ARBs
spironolactone

579

complication of niacin(2)

pruritis
flushing

580

how to explain niacin complication

prostaglandin related vasodilation

581

rx of niacin induced pruritis and flushing

low dose of aspirin

582

patient with medical history of wolt parkinson white develops palpitations and AFIB rx

procainamide

583

rx of AFIB normally

AV nodal blockers

584

quid AV nodal blocker(4)

b blocker
calcium channel blocker
digoxin
adenosine

585

middle aged or older male loses consciuousness immediately after urination or during coughing fits

situationnal syncope

586

cause of situationnal syncope

autonomic dysregulation

587

beck triad in tamponnade(3)

hypotension
muffled heart sound
distended neck veins

588

hypotension in tamponnade(3)

shift of interventricular septum toward the left ventricular cavity
reduces left ventricular preload
stroke volume and cardiac output

589

clue for GERD(3)

retrosternal burning sensation after eating and with lying down
hoarseness
chronic cough

590

initial rx of GERD(2)

proton pump inhibitor
H2 receptor antagonist

591

quid of resistant HTA

persistent HTA persistent despite using > ou egal a 3 antihypertensive agents

592

what to do in front of all resistant HTA

check secondary HTA

593

when to suspect renovascular HTA in case of secondary HTA(6)

severe HTA with recurrent flash pulmonary edema
severe HTA with diffuse atherosclerosis
onset of severe HTA after 55
HTA with asymetric kidney size or small atrophic kidney unilateral
presence of abdominal bruit
elevation of serun creat > 30 % from baseline after starting ACE inhibitor or ARbs

594

clue for renovascular HTA

continuous abdominal bruit

595

young patient with CHF first dx

viral myocarditis

596

trap to avoid in viral myocarditis

most of hte time you can have no preceding symptom

597

clue for cardiac cause of pedal edema

hepatojugular refux

598

importance of reflux hepatojugular

helps to differentiate cadiac from other causes(hepatic) of edema

599

clue for ventricular aneurism following MI(2)

persistent ST segment elevation after a recent MI
deep q waves in the same leads

600

complication of ventricular aneurism(5)

CHF
refractory angina
ventricular arythmias
mural thrombus
mitral regurgitation

601

dx of ventricular aneurism

echocardiography

602

echo in ventricular aneurism

dyskinetic wall motion of a portion of the left ventricle

603

laps of time to have ventricular aneurism

5 days or 3 months following MI

604

which type of MI can cause ventricular aneurism(2)

transmural MI
acute ST segment elevation MI

605

complication of MI acute hours to 2 days

reinfarction

606

laps of time to have ventricular septum rupture following MI

hours - 1 week

607

laps of time to have free wall rupture following MI

hours - 2 weeks

608

laps of time to have free wall rupture following MI

hours - 1 month

609

laps of time to have papillary muscle rupture following MI

2 days--1 week

610

laps of time to have pericarditis following MI

1 day-3 months

611

laps of time to haveleft ventricular aneurism following MI

5 days to 3 months

612

most following arythmias for digitalis toxicity

atrial tachycardia with AV block

613

why digitalis causes atrial tachycardia with AV block(2)

increased ectopy
increased vagal tone

614

most common findings in pulmonary embolism

sinus tachycardia

615

westermak sign in xray thorax in PE

dilation of the pulmonary proximal to the clot

616

hampton's hump

pleural infiltrates corresponding to pulmonary infarction

617

murmur in hypertrophic cardiomyopathy

systolic ejection murmur alomg the left sternal border

618

rx of VFIB and pulseless VTAC

defibrillation

619

energy used to defibrillate VFIB or pulseles VTAC

200-360 joules

620

3 degree heart block or complete atrioventricular block(2)

conastant R-R interval
P wave activity unrelated to qrs

621

symptomatic third degree block rx

temporary pacemaker(cardiac pacing)

622

risk factor in aortic dissection(3)

HTA
Marfan
cocaine use

623

blood pressure in Aortic dissection

> 20 mm de hg variation in systolic blood pressure btween arms

624

complictaion of aortic dissection(8)

stroke
acute aortic regurgitation
horner's syndrome
acute MI
pericardial effusion or tamponnade
hemothorax
lower extremity weakness or ischemia
abdominal pain

625

lower extremity weakness in aortic dissection

spinal illliac artery involved in the process

626

abdominal pain in aortic dissection

mesenteric artery

627

patietn with restrictive lung diseaseby rheumatoid lung disease comes with AFIB with a rapid ventricular response what drug toavoid in this patient

amiodarone

628

ECG findings in MOBITZ one second degree AV block

progressive prolonged PR interval leads to a non conducted P wave ( group beating)

629

ECG findings in MOBITZ 2 second degree AV block

PR interval remains constant with intermittent non conducted P waves

630

level of block in Mobtz 1

usually AV nodal

631

level of block in Mobtz 2

below the level of AV node

632

QRS complex in Mobitz 1

narrow

633

QRS complex in Mobitz 2

narrow or wide

634

what happen with execice or atropin in MOBITZ one

improves type 1 AV block

635

what happen with execice or atropin in MOBITZ 2

worsens type 2 block

636

what happen with vagal maneuver in MOBITZ 2

improves it

637

what happen with vagal maneuver in MOBITZ 1

worsens it

638

risk of complete heart in MOBITZ one

low risk

639

risk of complete heart in MOBITZ 2(2)

high risk
indictaion of pace maker

640

drug causing AV block mobitz 1(3)

digoxin
B blocker
calcium blocker

641

group beating

after 3 PQRS complexes you have one drop

642

cause of Mobitz one(4)

healthy people
athletes
heart problem
drugs

643

muscle pain with high CPK in patient taking statin

stop simvastatin

644

muscle pain in aptient taking statin first step

check CPK level

645

syncope in post MI

ventricular arrythmias

646

quid of ventricular arrythmia(3)

ventricular premature beats
nonsustained and sustained VTAC
VFIB

647

most common cause of sudden cardiac death in the setting of acute MI

VFIB

648

laps of time for cardiac sudden arrest in the setting of MI

first hour

649

predominant mechanism for ventricular arythmia

reentry

650

mechanism of arhytmia in post MI occuring within 10 mn of MI and name of that process in arythmia

reentrant arythmias
immediate or phase 1 a ventricular arrhytmias

651

mechanism of arhytmia in post MI occuring 10 a 60 mn after MI and name of that process in arythmia (2)

abnormal automaticity
delayed or phase 1b arrhytmias

652

most common cause of sudden cardiac arrest death in the immediate post MI

reentrant ventricular arrythmias

653

CHF in patient from brazil with history of megacolon bug causing that

chagas disease
protozoal disease

654

Manif of chagas disease(3)

Megaesophagus
megacolon
cardiac dysfunction

655

bud in chagas

Tripanosoma cruzi in latin america

656

trick to know S4

TENessee first syllable S4

657

when do you hear S4(2)

just before s1
its a diatolic sound

658

meaning of S4 and cause of S4(2)

ventricular hypertrophy
HTA

659

clue for anaphylactic shock(2)

hypotension
diffuse rash

660

medical cause of anaphylaxis

latex containing products like gloves

661

first line rx of Hypertrophic cardiomyopathy(2)

B blocker
calcium blocker(diltiazem)

662

why Bblocker or calcium blocker are good in the treatment of HOC

they promote diastolic relaxation

663

trick to know S3

kentucKY third syllable is S3

664

when you hear S3

just after S2

665

meaning of S3

left ventricular failure

666

best drug to use intially in patient with S3 with shortness of breath

IV diuretics

667

parameter in hemorragic shock

Cardiac ouput (CO) decreased
PCWP decreases(pulmonary capillay wedge pressure)
SVR increases( peripheral resistance)
BP decreases
Heart rate increases

668

hta plus systolic diastolic abdominal bruit

renal artery stenosis

669

syncope in HOCM(4)

outflow obstruction
arrythmia
ischemia
ventricular baroreceptors response

670

quid of orthostatic hypotension

drop in systolic pressure greater than 20 mm de hg whn moving from lying down to standing

671

risk for orthostatic hypotension(5)

prolonged recumbence
diuretics
adrenergic blocking agent
vasodilators
elderly hypovolemic and/or with autonomic neuropathy

672

blue hands and feet following administration of vasopressor in the setting of an accident

norepinephrine induced vasospasm

673

risk in the development of AAA(4)

cigarette smoking
family history of AAA
white race
atherosclerosis

674

strongest predictor of abdominal aortic aneurism expansion and rupture(3)

large aneurism diameter
rapid rate of expansion
current cigarette smoking

675

current indication for surgery in aneurism

676

symptomatic AAA(2)

abdominal back flank pain
limb ischemia