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USLME Step 2 > MTB Cardio > Flashcards

Flashcards in MTB Cardio Deck (43):
0

If the chest pain is not cardiac origin it is likely to be...

GI
GORD, ulcer, cholelithiasis, duodenitis, gastritis

1

Post menopausal sudden overwhelming emotional stress and anger with chest pain

Tako-Tsubo cardiomyopathy
Elevated troponin but normal angio and no vasospasm
Left ventricle dyskinesis causing ballooning

2

Three features of chest pain tell whether or not the pain is ischemic in nature:

Respiration
Position
Tenderness

3

Radiation to back, unequal blood with widened pressure between mediastinum, chest arms

Aortic dissection Chest x-ray

4

Pain worse with lying flat, better when with ST elevation sitting up, young everywhere, PR (<40)

Pericarditis Electrocardiogram

5

Epigastric discomfort, pain better when eating

Duodenal ulcer disease Endoscopy

6

Bad taste, cough, hoarseness

Gastroesophageal Response to PPis;

7

Cough, sputum, hemoptysis

Pneumonia Chest x-ray

8

Sudden-onset shortness of breath, tachycardia, hypoxia

Pulmonary embolus Spiral CT, V/Q scan

9

Sharp, pleuritic pain, tracheal deviation

Pneumothorax Chest x-ray

10

Maximum heart rate =

220 minus the age of patient

11

Use CCBs (verapamil/diltiazem) in CAD only with:

• Severe asthma precluding the use of beta blockers
• Prinzmetal variant angina
• Cocaine-induced chest pain (beta blockers thought to be contraindicated)
• Inability to control pain with maximum medical therapy

12

Adverse Effects of CCBs

• Edema • Constipation (verapamil most often) • Heart block (rare)

13

Acute coronary syndromes are associated with an S? gallop

Acute coronary syndromes are associated with an S4 gallop because of ischemia leading to noncompliance of the left ventricle. The 54 gallop is the sound of atrial systole as blood is ejected from the atrium into a stiff ventricle. A decrease of blood pressure of greater than 10 mm Hg on inspiration is a pulsus paradoxus and is associated with cardiac tamponade.

14

An increase in jugulovenous pressure on inhalation is...

the Kussmaul sign and is most often associated with constrictive pericarditis or restrictive cardio-myopathy.

15

ST elevation in leads II, Ill, aVF

ST elevation in leads II, Ill, and aVF is consistent with an acute myocardial infarc-tion, but of the inferior wall. Untreated, the mortality associated with an IWMI is less than 5% at 1 year after the event.

16

ST elevation in leads V2-V4

Leads V2 to V4 correspond to the anterior wall of the left ventricle. ST seg-ment elevation most often signifies an acute myocardial infarction. With an AWMI, mortality untreated is closer to 30%to40%.

17

ST depression in leads V1 and V2

ST depressions in leads V1 and V2 are suggestive of a posterior wall myocardial infarc-tion. Infarctions of the posterior wall are associated with a very low mortality, and again, there is no additional therapy to give because of it.

18

S3 gallop rhythm

CHF

19

Sudden onset, clear lungs dyspnea

PE

20

S udden onset, wheezing, increased expiratory phase dyspnea

Asthma

21

Slower, fever, sputum, unilateral rales/rhonchi

Pneumonia

22

Decreased breath sounds unilaterally, tracheal deviation dyspnea

Pneumothorax

23

Circumoral numbness, caffeine use, history of anxiety

Panic attack

24

Pallor, gradual over days to weeks dyspnea

Anemia

25

Pulsus paradoxus , decreased heart sounds, JVD dyspnea

Tamponade

26

Palpitations, syncope dyspnea

Arrthymia

27

Long smoking history, barrel chest dyspnea

COPD

28

Systolic Dysfunction (Low Ejection Fraction) treatment

ACE inhibitors or angiotensin receptor blockers (ARBs) • Beta blockers • Spironolactone • Diuretics • Digoxin

29

Acute pulmonary oedema presentation

• Rales
• JVD
• s3 gallop
• Edema
• Orthopnea

30

Which investigation if the diagnosis of the etiology of the shortness of breath is not clear?

Brain natriuretic peptide
Normal BNP exclude APO

31

Acute pulmonary oedema treatment

Morphine
Oxygen
Nitrate
Diuretics furosemide

32

Mitral stenosis unique features of presentation

Dysphasia
Hoarseness
AF
Hemoptysis

33

Mitral stenosis treatment

1 Diuretics and sodium restriction when fluid overload is present in the lungs
2. Balloon valvuloplasty done with a catheter
3. Valve replacement only when a catheter procedure cannot be done, or fails
4. Warfarin for atrial fibrillation to an INR of 2 to 3
5. Rate control of atrial fibrillation with digoxin, beta blockers, or diltiazem/ verapamil

34

Aortic stenosis presentation

Angina: most common presentation
Syncope
CHF: poorest prognosis with 2-year average survival

35

Besides CHF, AR has a large array of relatively unique physical findings such as:

• Wide pulse pressure
• Water-hammer (wide, bounding) pulse
• Quincke pulse (pulsations in the nail bed)
• Hill sign (BP in legs as much as 40 mm Hg above arm BP)
• Head bobbing (de Musset sign)

36

Mitral valve prolapse presentation

The symptoms of CHF are usually absent.
The most common presentation is:
• Atypical chest pain
• Palpitations
• Panic attack

37

MVP murmur

Opposite to other murmurs
Valsalva or standing worsens
Increasing the venous return improves/diminishes the murmur

38

Murmurs that do not increase with expiration:

• HOCM
• MVP

39

In addition to previous MI and ischemia, dilated cardiomyopathy can be from:

• Alcohol
• Postviral myocarditis
• Radiation
• Toxins such as doxorubicin
• Chagas disease

40

Digoxin and spironolactone in HCM

Always wrong

41

Restrictive cardiomyopathy Causes are:

• Sarcoidosis • Amyloid • Hemochromatosis • Endomyocardial fibrosis • Scleroderma

42

Pericarditis ECG findings

ST elevation in all leads and PR depression