Usmle - Cv

Front 1

What causes a U wave on an ECG?

Back 1

Hypokalemia or bradycardia

Front 2

What drugs prolong the QT interval?

Back 2

Macrolides, antimalarial drugs, haloperidol, risperadone, methadone, protease inhibitors, and antiarrhythmics.

Front 3

Anything that prolongs the QT interval can predisopose to what?

Back 3

Torsades de pointes

Treatment - push magnesium

Front 4

What syndrome presents with a delta wave on ECG? What does this represent?

Back 4

Wolff-Parkinson-White syndrome; the delta wave represents an accessory conduction pathway from atria to ventricle (bundle of Kent), bypassing the AV node. As a result, ventricles begin to partially depolarize earlier.

May result in reentry current leading to supraventricular tachycardia.

Front 5

Wolff-Parkinson-White treatment

Back 5

Procainamide or amiodarone; NOT adenosine

Front 6

Atrial fibrillation treatment

Back 6

Beta blocker, calcium channel blocker, and digoxin to avoid SVT; prophylaxis against thromboembolism with warfarin; rhythm control with sodolol and amiodarone.

Front 7

Atrial naturetic peptide

Back 7

Released from atria in response to increased blood volume and atrial pressure. Causes generalized vascular relaxation. Constricts efferent renal arterioles, dilates afferent arterioles. Involved in "escape from aldosterone" mechanism.

Front 8

Solitary nucleus of the medulla

Back 8

Changes (incareased or decreased) in blood pressure detected at the carotid sinus and transmitted by the glossopharyngeal nerve received here.

Front 9

Cushing reaction

Back 9

Increased intracranial pressure constricts arterioles; cerebral ischemia; hypertension (sympathetic response); reflex bradycardia.

Cushing triad = hypertension, bradycardia, and respiratory depression

Front 10

Eisenmenger's syndrome

Back 10

Uncorrected VSD, ASD, or PDA causes compensatory vascular hypertrophy, which results in progressive pulmonary hypertension. As pulmonary resistance increases, the shunt reveres from left to right, to right to left, which causes late cyanosis (clubbing and polycythemia).

Front 11

What other malformation is coarctation of the aorta most common associated with?

Back 11

Bicuspid aortic valve

Front 12

What is the physical manifestation of uncorrected PDA?

Back 12

Late cyanosis in the lower extremities; can become clubbing of toes.

Front 13

What congenital cardiac defect is associated with 22q11 syndromes?

Back 13

Truncus arteriosus, tetralogy of Fallot

Front 14

What congenital cardiac defect is associated with Down syndrome?

Back 14

ASD, VSD, AV septal defect (endocardial cushion defect)

Front 15

What congenital cardiac defect is associated with congenital rubella?

Back 15

Septal defects, PDA, pulmonary artery stenosis

Front 16

What congenital cardiac defect is associated with Turner's syndrome?

Back 16

Coarctation of the aorta

Front 17

What's the most common cause of secondary (non-essential) hypertension?

Back 17

Renal disease

Front 18

What is Monckeberg arteriosclerosis?

Back 18

Calcification in the media of the arteries, espcially radial or ulnar. Usually benign; "pipestem" arteries. DOES NOT OBSTRUCT BLOODFLOW; intima is not involved.

Front 19

Arteriolosclerosis

Back 19

Hyaline thickening of small arteries in essential hypertension or diabetes mellitus. Hyperplastic "onion skinning" in malignant hypertension.

Front 20

Atherosclerosis

Back 20

Fibrous plaques and atheromas form in intima of arteries.

Front 21

What is the drug of choice for aortic dissection?

Back 21

Beta blocker, because they also decrease the slope of the rise of the blood pressure.

Front 22

What are the most likely locations for atherosclerosis?

Back 22

Abdominal aorta > coronary artery > popliteal artery > carotid artery

Front 23

At what CAD narrowing would angina manifest?

Back 23

> 75%

Front 24

What is the treatment for Prinzmetal's angina?

Back 24

CCB like nifedapine

Front 25

What types of angina present with ST depression? What type presents with ST elevation?

Back 25

Stable and unstable angina present with ST depression; Prinzmetal's angina presents with ST elevation.

Front 26

What are the most common sites of coronary artery occlusion?

Back 26

LAD > RCA > circumflex

Front 27

Myocardial ischemia is reversible up to ____________ minutes.

Back 27

20-40 minutes

Front 28

When does cardiac troponin rise after an MI and how long is it elevated for?

Back 28

It rises after 4 hours and is elevated for 7-10 days.

Front 29

Myoglobin as a cardiac biomarker

Back 29

Can be indicative of an MI, although it is nonspecific. Can be elevated even before troponin, however.

Front 30

After an MI, papillary muscle rupture would cause what?

Back 30

Severe mitral regurgitation

Front 31

Dressler's syndrome

Back 31

Autoimmune phenomenon resulting in fibrinous pericarditis SEVERAL WEEKS after an MI

Front 32

Postinfarction fibrinous pericarditis

Back 32

Friction rub present 3-5 days after an MI.

Front 33

What is the most common organism associated with IV drug user's tricuspid valve endocarditis?

Back 33

S. aureus

Pseudomonas and Candida also associated with this condition, but not as frequently.

Front 34

What type of murmur comes with bacterial endocarditis?

Back 34

Regurgitation; causes destruction rather than fibrosis of the valve.

Front 35

Libman-Sacks endocarditis

Back 35

Verrucous (wart-like) sterile vegetations occuring on BOTH sides of the valve. Most often benign; can be associated with mitral regurgitation and, less commonly, mitral stenosis. The most common heart manifestation of SLE.

Front 36

What is the most common cause of death in lupus?

Back 36

Renal disease

Front 37

What condition are Aschoff bodies characteristic of?

Back 37

Rheumatic heart disease; there are granulomas with giant cells.

Front 38

What is the most common cause of mitral stenosis?

Back 38

Fibrosis of mitral valve leaflets in chronic rheumatic disease.

Front 39

What type of hypersensitivity reaction is rheumatic heart disease?

Back 39

Immune mediated (type II)

Front 40

What EKG finding is usually found with cardiac tamponade?

Back 40

Electrical alterans

Front 41

What is the most common primary cardiac tumor in adults?

Back 41

Myxoma

Front 42

What is the most frequent primary cardiac tumor in children?

Back 42

Rhabdomyoma (associated with tuberous sclerosis)

Front 43

Osler-Weber-Rendu syndrome

Back 43

Autosomal dominant disorder which presents with recurrent epistaxis, skin discolorations, mucosal telangiectasias, and GI bleeds.

AFFECTS SMALL VESSELS

Front 44

What is the treatment for Raynaud's disease?

Back 44

Aspirin (prevent clots), dihydropyradine CCBs (vasodilate), or sildenafil (vasodilate)

Front 45

Is thromboembolism common with varicose veins?

Back 45

No

Front 46

Wegener's granulomatosis treatment

Back 46

Cyclophosphamide and corticosteroids

Front 47

Microscopic polyangiitis

Back 47

Like Wegener's granulomatosis, but lacks granulomas. p-ANCA positve

Front 48

Primary pauci-immune crescentic glomerulonephritis

Back 48

Vasculitis limited to the kidney.

p-ANCA and mpo-ANCA positive

Front 49

Wegener's granulomatosis biomarker

Back 49

c-ANCA

Front 50

Churg-Strauss syndrome

Back 50

Granulomatous vasculitis with eosinophilia. Most often presents with asthma, sinusitis, skin lesions, and peripheral neuropathy (wrist drop/foot drop); can also involve heart, GI, and kidneys.

p-ANCA positive.

Front 51

Henoch-Schonlein purpura

Back 51

Most common form of childhood systemic vasculitis. Skin rash on buttocks and legs (palpable purpura), arthralgia (commonly of knees), intestinal hemorrhage, abdominal pain, and melena. Follows URIs. IgA immune complexes. Associated with IgA nephropathy.

Front 52

What are the symptoms and treatment of Kawasaki disease?

Back 52

Fever, conjunctivitis, changes in lips/oral mucosa ("strawberry tounge"), lymphadenitis, desquamative skin rash. May develop coronary aneurysms (peeling of palms and soles).

Treatment is high dose aspirin and IV immunoglobin.

Front 53

Polyarteritis nodosa

Back 53

Immune complex mediated transmural vasculitis with fibrinoid necrosis.

Symptoms include fever, weight loss, malaise, abdominal pain, melena, headache, myalgia, hypertension, neurologic dysfunction, cutaneous eruptions.

HEPATITIS B SEROPOSITIVITY IN 30% OF PATIENTS. Typically involves renal and visceral vessels, NOT pulmonary arteries.

Front 54

What are the symptoms of Takayasu's arteritis?

Back 54

Fever, arthritis, night sweats, myalgia, skin nodules, ocular disturbances, weak pulses in upper exremities.

Think TB + no pulse in upper extremities.

Front 55

What condition is associated with temporal arteritis?

Back 55

Polymyalgia rheumatica

Front 56

What is the treatment for temporal (giant cell) arteritis?

Back 56

High dose steroids (often for over a year)

Front 57

Angiosarcoma

Back 57

Highly lethal malignancy of the liver. Associated with vinyl chloride, arsenic, and ThO2 (thorotrat) exposure.

Front 58

Glomus tumor

Back 58

Benign, painful, red-blue tumor under fingernails. Arises from modified smooth muscle cells of glomus body.

Front 59

Cystic hygroma

Back 59

Cavernous lymphangioma of the neck. Associated with Turner's syndrome.

Front 60

Pyogenic granuloma

Back 60

Polypoid capillary hemangioma that can ulcerate and bleed. Associated with trauma and pregnancy.