Cardiovascular Disorders Flashcards Preview

USMLE Step Two > Cardiovascular Disorders > Flashcards

Flashcards in Cardiovascular Disorders Deck (150):
1

most common site of coronary artery occlusion

left anterior descending artery

2

heart region supplied by left anterior descending artery

anterior wall of left ventricle

3

heart region supplied by LAD septal branch

anterior 2/3 of interventricular septum

4

heart region supplied by left coronary circumflex branch

left atrium, posterolateral left ventricle

5

heart region supplied by right coronary posterior descending branch

inferior wall of left ventricle, posterior 1/3 of interventricular septum

6

heart region supplied by right coronary marginal branch

right atrium, right ventricle

7

heart region supplied by right coronary nodal branches

SA and AV nodes

8

gold standard for identifying coronary artery disease

coronary aniography

9

next step when exercise stress test is equivocal

nuclear exercise test with thallium-201 or technetium-99m-sestamibi during exercise testing

10

second line when comorbidities prevent exercise stress test

pharmacologic stress testing with dobutamine

11

age to begin screening for hyperlipidemia

men after age 35
women after age 45

12

goal LDL for patients at high risk for CAD

< 100 mg/dL

13

goal LDL for patients with 2+ risk factors for CAD

< 130 mg/dL

14

goal LDL for patients with 0-1 risk factors for CAD

< 160 mg/dL

15

HMG-CoA reductase inhibitors

acts on liver
decreases LDL and triglycerides
increases HDL

SE: myositis, increases LFTs

16

ezetimibe

cholesterol absorption inhibitor acts on intestines
decreases LDL

SE: myalgias, increases LFTs

17

gemfibrozil, fenofibrate

stimulates lipoprotein lipase in blood
decreases LDL and triglycerides
increases HDL

SE: myositis, increases LFTs

18

cholestyramine, colestipol, colesevelam

bile acid sequestrants in GI tract
decreases LDL
increases triglycerides

SE: bad taste, abdominal discomfort

19

niacin

acts on liver
decreases LDL, triglycerides
increases HDL

SE: flushing, nausea, pruritis, insulin resistance, gout, paresthesias, increases LFTs

20

vessels most commonly used for CABG

saphenous vein
internal mammary artery

21

pharmacotherapy for unstable angina

aspirin and clopidogrel (if no PTCA)
GP IIb/IIIa (if PTCA)
oxygen
nitroglycerin
heparin
beta-blockers

22

time limit for thrombolysis in MI

12 hours
use t-Pa or urokinase

23

cardiac enzyme to evaluate immediate re-infarct

CPK-MB
(decreases in 2-3 days)

24

risk reduction medications after MI

low dose ASA
clopidogrel
beta-blockers
ACE inhibitors
K-sparing diuretics
HMG-CoA reductase inhibitors
exercise, smoking cessation, and dietary modifications

25

V2, V3, V4 infarction

anterior infarction
LAD artery

26

V1, V2, V3 infarction

septal infarction
LAD artery

27

II, III, aVF infarction

inferior infarction
posterior descending or marginal branch

28

1, aVL, V4, V5, V6

lateral infarction
LAD or circumflex artery

29

V1, V2

posterior infarction
posterior descending artery

30

first degree heart block

PR > 0.2 seconds

asymptomatic
caused by increased vagal tone or functional conduction impairment

31

second degree mobitz I heart block

progressive PR lengthening until skipped QRS

asymptomatic
caused by his bundle conduction defect, drug effects (beta-blockers, digoxin, calcium channel blockers), or increased vagal tone

adjust medications, consider pacemaker if symptomatic bradycardia is present

32

second degree mobitz II heart block

randomly skipped QRS without changes in PR interval

usually asymptomatic
caused by infranodal conduction problem in bundle of his or purkinje fibers
can progress to third degree heart block

treat with ventricular pacemaker

33

third degree heart block

no relationship between P waves and QRS complexes

syncope, dizziness, hypotension
absence of conduction between atria and ventricles

treat with ventricular pacemaker and avoid medications affecting AV conduction

34

next step of management in congenital heart disease with early cyanosis

prostaglandin E

35

medication that closes PDA

indomethacin

36

6 week old infant has signs of left heart failure and EKG shows left-sided MI

anomalous origin of the left coronary artery

37

most common vasculitis

temporal arteritis

38

defects of tetrology of fallot

VSD, pulmonary stenosis, RVH, overriding aorta

39

management for DVT in patient with high likelihood of falling

IVC filter

40

management of peripheral vascular disease

smoking cessation, glucose and lipid control, exercise
cilostazol, statins, aspirin

41

indications for operating on AAA

greater than 5.5 cm
growing more than 0.5 cm in 6 months

42

mechanism of PSVT

accessory conduction pathways through AV node

43

treatment for ventricular tachycardia

hemodynamically stable: amiodarone or lidocaine
hemodynamically unstable: cardioversion

44

treatment for paroxysmal noctural dyspnea

acute: nitroglycerin
chronic: furosemide

45

drug that blocks ventricular remodeling s/p myocardial infarction

ACE-inhibitor

46

periumbilical systolic-diastolic bruit

renal artery stenosis

47

abdominal systolic bruit

more classically associated with AAA

48

blood pressure discrepancy in coarctation of the aorta

if coarctation is distal to the subclavian artery: upper extremity pressure is higher than lower extremity pressure

if coarctation is proximal to the subclavian artery: right arm pressure higher than left arm pressure

49

indications for class IA anti-arrhythmics

PSVT, Afib, Aflutter, Vtach

quinidine, procainamide

50

indications for class IB anti-arrhythmics

Vtach

lidocaine, tocainide

51

indications for class IC anti-arrhythmics

PSVT, Afib, Aflutter

flecainide, propafenone

52

indications for beta-blockers used as anti-arrhythmics

PVC, PSVT, Afib, Aflutter, Vtach

propanolol, esmolol, metoprolol

53

indications for K-channel blockers

Afib, Aflutter, Vtach (not bretylium)

amiodarone, sotalol, bretylium

54

indications for calcium channel blockers used as anti-arrhythmics

PSVT, MAT, Afib, Aflutter

verapamil, diltiazem

55

drug used in PSVT that activates K-channels and decreases intracellular cAMP

adenosine

56

first drug that should be administered when coronary artery event is suspected

aspirin to prevent platelet aggregation

57

situational syncome

autonomic dysregulation that may occur when an older man is micturating or coughing

58

treatment for prolonged QT

asymptomatic: propranolol
symptomatic: propranolol plus a DDD pacemaker (dual chamber)

59

treatment for pulseless electrical activity

initiate CPR followed by epinephrine or vasopressin

60

treament of asymptomatic young patient with no other health problems and CHADS2 score of 0

aspirin

61

CHADS2 score

congestive heart failure - 1
hypertension - 1
age > 75 - 1
diabetes mellitus - 1
stroke - 2

62

causes of pulsus paradoxus

cardiac tamponade, tension pneumothorax, and severe asthma

63

treatment of unstable patient with Afib

immediate cardioversion

64

treatment of stable patient with Afib

< 48 hours: cardioversion
> 48 hours: 3-4 weeks of rate control and antiocogulation prior to cardioversion

65

mechanism of dipyramidole infused myocardial perfusion scanning

dipyramidole is a vasodilator, diseased vessels are already maximally dilated, so dipyramidole vasodilates non-disease vessels and draws even more blood away from diseased vessels

66

treatment for aortic regurgitation

afterload reduction with ACE-inhibitor or nifedipine, severe cases should undergo valve replacement

67

ranking of lifestyle modifications for high blood pressure

weight loss
DASH diet
dietary sodium
exercise
alcohol intake

smoking has little effect on hypertension but does contribute to heart disease

68

treatment of cocaine-induced STEMI

PTCA or thrombolysis
aspirin, nitrates appropriate, avoid beta-blockers which will allow unopposed alpha-activity and further vasoconstriction

69

pulsus parvus et tardus

decreased pulse amplitude and delayed pulse upstroke seen in aortic stenosis

70

mechanism of decreased preload in cardiac tamponade

pericardial fluid pressure exceeds ventricular pressure and inhibits ventricles from expanding and filling properly

71

drug of choice in patient with stable angina and hypertension

beta-blocker

72

mixed venous oxygen concentration in hypovolemic shock

decreased from increased oxygen extraction by hypoperfused tissue

73

mixed venous oxygen concentration in septic shock

normal from hyperdynamic circulation and improper distribution of the cardiac output

74

mechanism by which nitroglycerin relieves angina

dilaiton of veins decreases preload and stretching of myocardial muscle

it is actually unclear if nitroglycerin increases coronary blood flow in diseased patients although it performs this function in healthy coronary vessels, so this is not the major way angina is relieved

75

metabolic abnormalities found in hyperaldosteronism (conn's syndrome)

low renin, high aldosterone
high sodium, low potassium, high bicarbonate (metabolic alkalosis)

76

pansystolic murmur at the apex with radiation to the axilla days to months after a myocardial infarction

ventricular aneurysm

papillary muscle rupture occurs 3-7 days after

77

normal right atrial pressure

4-6 mmHg

78

normal pulmonary artery pressure

25/15 mmHg

79

normal PCWP

6-12 mmHg

80

right atrial pressure > 10 mmHg
pulmonary artery systolic pressure > 40 mmHg

diagnostic criteria for massive pulmonary embolism

81

unstable angina pharmacotherapy if no percutaneous intervention is planned

aspirin, clopidogrel

82

unstable angina pharmacotherapy if percutaneous intervention is planned

gp IIb/IIIa inhibitor

83

intranodal or bundle of His conduction problem

second degree mobitz I heart block

84

infranodal conduction problem

second degree mobitz II heart block

85

absence of conduction between atria and ventricles

third degree heart block

86

AV nodal reentry anomaly

PSVT
treatment: adenosine, carotid massage, valsalva maneuver

87

AV reentry (not through the node, through accessory pathway)

wolff-parkinson-white
treatment: amiodarone, procainamide

88

treatment of hemodynamically stable ventricular tachycardia

amiodarone

89

complication of esophageal dilation

esophageal rupture, penumomediastinum, and mediastinitis

90

causes of mediastinitis

iatraogenic procedure, boerrhave tear

91

biliary side effect of gastric bypass surgery

increased risk of gallstones
treatment: ursodeoxycholic acid prophylactically for 6 months after surgery

92

somatic pain

sharp, localized pain

93

visceral pain

generalized, crampy pain

94

referred pain

visceral fibers enter spinal cord at the same location as somatic fibers and brain misinterprets visceral pain as somatic

95

wide fixed splitting of second heart sound

atrial septal defect

96

normal PCWP pressure

6-12 mmHg

97

normal right atrial pressure

4-6 mmHg

98

normal pulmonary artery pressure

does not exceed 25/15 mmHg

99

treatment of hemodynamically unstable PSVT

cardioversion or calcium channel blocker

100

treatment of stable PSVT

carotid massage or valsalva maneuver
pharmacotherapy: beta-blocker or CCB

101

treatment for wolff-parkinson-white

amiodarone or procainamide
NO adenosine

102

progressive PR lengthening until dropped QRS

second degree mobitz I heart block

103

randomly skipped QRS without changes in PR interval

second degree mobitz II

104

when is pacemaker indicated in heart bock

second degree mobitz II and third degree
only indicated in mobitz I if there is symptomatic bradycardia present

105

several ectopic foci in the atria that discharge automatic impulses
usually asymptomatic

multifocal atrial tachycardia
treatment: CCB or beta-blockers acutely, catheter ablation of surgery to eliminate abnormal pacemakers

106

causes of PVCs

hypoxia, abnormal serum electrolytes, hyperthyroidism, caffeine use

107

what do PVCs look like

early and wide QRS without preceding P waves

108

treatment of PVCs

none if patient is healthy, beta-blocker in patients with CAD

109

treatment for atrial flutter

rate control with CCB, beta-blockers, cardioversion if unable to be controlled with medication, and catheter ablation to remove ectopic focus

110

treatment for torsades de pointes

magnesium sulfate

111

treatment for stable ventricular tachycardia

procainamide or amiodarone
amiodarone is drug of choice in patients with CHF

112

treatment for symptomatic bradycardia

atropine

113

most frequent physical exam finding of CHF

S3 sound

114

kerley B lines

increased marking of lung interlobular septa caused by pulmonary edema

115

indication for K-sparing diuretics in congestive heart failure

reduce cardiac hypertrophy caused by aldosterone

116

treatment for pericarditis

NSAIDs, colchicine
pericardiocentesis for large effusions
hemodialysis for uremic pericarditis

117

cardiac catherization shows equal pressure in all chambers

chronic constrictive pericarditis

118

causes of cardiac tamponade

pericarditis, chest trauma, LV rupture following MI, or dissecting aortic aneurysm

119

treatment for cardiac tamponade

immediate pericardiocentesis

120

harsh blowing holosystolic murmur radiating from apex to axilla

mitral regurgitation

121

widely split S2

mitral regurgitation

122

midsystolic click

mitral regurgitation

123

opening snap after S2

mitral stenosis

124

diastolic rumble

mitral stenosis

125

loud S1

mitral stenosis

126

widened pulse pressure

aortic regurgitation

127

bounding pulses

aortic regurgitation

128

diastolic decrescendo murmur

aortic regurgitation

129

late diastolic rumble

aortic regurgtation

130

crescendo-decrescendo systolic murmur

aortic stenosis

131

weak S2

aortic stenosis

132

dual stroke carotid pulse, systolic murmur, S4

hypertrophic obstructive cardiomyopathy

133

treatment for hypertrophic obstructive cardiomyopathy

beta-blockers, CCBs
pacemaker or partial septal excision

134

treatment for mitral regurgitation

arterial vasodilators if symptomatic (nitroprusside)
prophylactic antibiotics for increased infection risk

135

treatment for aortic regurgitation

decrease afterload with ACE-inhibitors, CCBs, or nitrates

136

treatment for aortic stenosis

beta-blockers
diuretics to decrease preload

137

treatment for bacterial endocarditis

4-6 weeks IV antibitoics
beta-lactam plus an aminoglycoside
antibiotic prophylaxis before surgery or dental work

138

heart sounds you may hear with hypertension

loud S2, possible S4

139

causes of thoracic aortic aneurysms

marfan's syndrome, ehlers-danlos, and syphilis

140

most common location of aortic aneurysm

abdominal below the renal arteries

141

anti-hypertensive used in migraine headaches

beta-blockers

142

aortic dissection: stanford A v. stanford B

stanford A: ascending aorta, requires emergency surgery
stanford B: distal to left subclavian, treat medically with nitroprusside, beta-blockers

143

wide fixed split S2, systolic ejection murmur at upper left sternal border

atrial septal defect

144

loud pumonic S2, systolic thrill

ventricular septal defect

145

loud S2, bounding pulses at birth

patent ductus arteriosus
accompanied by a "machinery" murmur

146

risk factors for transposition of the great vessels

diabetic mother
apert's syndrome, down syndrome, cri-du-chat, trisomy 13, trisomy 18

147

cardiac pathologies with "boot-shaped" heart on imaging

hypertrophic obstructive cardiomyopathy
tetralogy of fallot
persistent truncus arteriosus

148

treatment for tetralogy of fallot

prostaglandin E to maintain PDA, propranolol, morphine, knee-to-chest positioning during cyanotic episodes

149

treatment of mediastinitis

surgical debridement and prolonged antibiotic therapy

150

prophylactic treatment for long QT syndrome

propranolol