Cardio Usmle Step 1

Front 1

Murmur: Mitral/tricuspid regurgitation

Back 1

Holosystolic, high ptched "blowing murmur

Front 2

When is a Mitral regurgitation murmur loudest/ enhanced?

Back 2

Loudest: at apex and radiates towards axilla
Enhanced by maneuvers that increase total preripheral resistance (squatting, hand grip)

Front 3

In what diseases would you commonly hear a Mitral regurgitation?

Back 3

Ischemic heart disease, mitral valve prolapse and Left ventricular dilation

Front 4

When is a Tricuspid regurgitation murmur loudest/ enhanced?

Back 4

-loudest at tricuspid area and radiates to right sternal border
-enhanced by inspiration (increases RA return)

Front 5

What does an aortic stenosis sound like?

Back 5

-Crescendo-descrescendo systeolic ejection murmur following an ejection click

Front 6

Clinical findings of Aortic stenosis other than sound?

Back 6

-Radiates to carotids/apex
-"pulsus parvus et tardus"--pulses weak compared to heart sounds
-can lead to syncope
-Age related calcific aortic stenosis or bicuspid aortic valve

Front 7

MCC of degenerative (senile) calcification of the valve leaflets

Back 7

Aortic stenosis

Front 8

Sound of VSD murmur? Where is it loudest?

Back 8

Holistic harsh sounding murmur. Loudest at tricuspid area.

Front 9

Sound of mitral prolapse? Loudest?

Back 9

-Late crescendo murmur with midsystolic click (MC; sue to sudden tensing of chordae tendinae)
-Loudest at S2

Front 10

Mitral polapse:
-What can it predipose you to?
-What can cause it?

Back 10

-Usually benign
-Can predispose to infective endocarditis
-Can be caused by myxomatous degeneration (excess dermatin sulfate in valve), rheumatic fever, chordae rupture

Front 11

Most frequent valvular lesion?

Back 11

Mitral prolapse

Front 12

What would make a mitral prolapse murmur closer to S1 than S2?

Back 12

Standing = less preload so click is closer to S1
When laying down: Increase preload so click is closer to S2
Anxiety: decreased preload so closer to S1

Front 13

What does a Aoritc regurgitation murmur sound like?

Back 13

Immediate high-pitched "blowing" diastolic murmur.

Front 14

Chronic aortic regurgitation?

Back 14

-Wide pulse pressure
-can present with bounding pulses and head bobbing

Front 15

What is aortic regurgitation due to?

Back 15

aortic root dilation, bicuspid aortic valve or rheumatic fever

Front 16

What does mitral stenosis sound like?

Back 16

Follows an opening snap (due to tensing of chordae tendinae). Delayed rumbling late diastolic murmur

Front 17

When does mitral stenosis occur?

Back 17

-rheumatic fever

Front 18

How is mitral stenosis enhanced?

Back 18

-expiration (increases LA return)

Front 19

What does a PDA murmur sound like?

Back 19

Continuous machine-like murmur. Loudest at S2

Front 20

Cardiac defect a/w 22q11 syndrome?

Back 20

Truncus arteriosus, tetralogy of fallot

Front 21

Congenital Cardiac defect a/w down's syndrome

Back 21

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

Front 22

Cardiac defect a/w congenital rubella?

Back 22

Septal defects, PDA, pulmonary artery stenosis

Front 23

Congenital Cardiac defect a/w Turner's syndrome

Back 23

coarctation of the aorta

Front 24

Congenital Cardiac defect a/w Marfan's syndrome?

Back 24

Aortic insufficiency

Front 25

Congenital Cardiac defect a/w infant diabetic mother?

Back 25

Transposition of the great vessels

Front 26

MCC of death in primary HTN?

Back 26

MI

Front 27

2nd MCC of death in primary HTN?
3rd?

Back 27

2nd = stroke
3rd = renal failure

Front 28

Monckeberg Arteriosclerosis

Back 28

Calcification in the media of the arteries, especially radial or ulnar. Usually benign; "pipestem arteries. Does not obstruct blood flow; intima not involved.

Front 29

3 types of angina in ischemic heart disease

Back 29

Stable, prinzmetal's variant, Unstable/crescendo

Front 30

Stable Angina

Back 30

-Mostly seondary to atherosclerosis
-ST depression
-restrosternal chest pain with exertion

Front 31

Prinzmetal's variant angina

Back 31

-occurs at rest secondary to coronary artery spasms (transmural ischemia)
-ST elevation

Front 32

Unstable/crescendo angina

Back 32

-thrombis but no necrosis
-ST depression
-worsening chest pain at rest or with minimal exertion

Front 33

Postinfarction fibrinous pericarditis

Back 33

-Friction rub (3-5 days post MI)
-Chest pain is relieved by leaning forward and worse when leaning back

Front 34

Dressler's syndrome

Back 34

-autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post MI)
-tx: non-steroidals

Front 35

Etiologies of Dilated (congestive cardiomyopathy)

Back 35

-Alchoholic use
-wet Beriberi
-Coxasackie B virus myocarditis, chronic Cocaine use, Chagas' dz
-Doxorubicin toxicity
-hemochromatosis and peripartum cardiomyopathy

Front 36

Would it be better to stand up or lay down if a pt had hypertrophic cardiomyopathy?

Back 36

-lay down (if you increase preload to decrease the obstruction)

Front 37

Causes of restrictive/obliterative cardiomyopathy

Back 37

-sarcoidosis
-amyloidosis
-postradiation fibrosis
-endocardidial fibroelastosis
-Loffler's syndrome (endomyocardial fibrosis with a prominent eosinophilic infiltrate)
-hemochromatosis (dilated cardiomyopathy can also occur)

Front 38

MC reason for a child to get a heart transplant?

Back 38

endomyocardial fibrosis

Front 39

Best treatment for CHF?

Back 39

ACE and sprinolactone

Front 40

s/s of bacterial endocarditis

Back 40

FROM JANE
-Fever
-Roth spots (red w/ white center)
-Osler's nodes (ouch)
-Murmur
-Janeway lesions (small erythematous lesions on palm or sole
-Anemia
-Splinter hemorrhages on nail bed
-Emboli

Front 41

Pt presents with colon cancer/ ulcerative colitis and endocarditis. Whats the organism?

Back 41

Strep Bovis

Front 42

Pt has prosthetic valves and presents with endocarditis. Organism?

Back 42

S. epidermis

Front 43

Libman-Sacks endocarditis

Back 43

-Verrucous (wartlike), sterile vergitations occur on both sides of the valve.
-Usually benign
-a/w mitral regurg and less commonly mitral stenosis
-MC heart manifestation of SLE (SLE causes LSE)

Front 44

What is the most common heart manifestation of SLE?

Back 44

Libman-Sacks enodocarditis

Front 45

s/s of Rheumatic fever

Back 45

FEVERSS
-Fever
-Erthema marginatum
-Valvular damage (vegitation and fibrosis)
-increased ESR
-Red-hot-joints (migratory polyarteritis)
-Subcutaneous nodules (Aschoff bodies)
-St. Vitus' dance (chorea)

Front 46

pulsus paradoxus (Kussmaul's pulse)

Back 46

-Seen in Cardiac tamponade
-exaggerated decrease in amplitude of pulse during inspiration. Seen in severe cardiac tamponade, asthma, sleep apnea, pericarditis and croup

Front 47

What causes serous pericarditis?

Back 47

SLE, rheumatoid arthritis, viral infection, uremia

Front 48

What causes fibrinous pericarditis?

Back 48

Uremia, MI (Dressler's syndrome), rheumatic fever

Front 49

What causes hemorrhagic pericarditis?

Back 49

TB, malignancy (melanoma)

Front 50

Findings in pericarditis?

Back 50

pericardial pain, friction rub, pulsus paradoxus, distant heart sounds, ST elevation

Front 51

pericardial knock?

Back 51

constrictive pericarditis

Front 52

MC overall cause of Pericarditis?

Back 52

-coxasackievirus

Front 53

MCC for constrictive pericarditis?

Back 53

TB

Front 54

MC primary cardiac tumor in adults?

Back 54

myxoma,

Front 55

myxoma?

Back 55

-produces VEGF vascular endothelial growth factor
-occur in the atria (usually left atrium)
-ball valve obstruction
-a/w syncopal episodes

Front 56

Wegner's granulomatosis

Back 56

1) necrotizing vasculitis
2) necrotizing granulomas in the lungs and upper airway
3) necrotizing glomerulonephritis
-Hemoptysis, hematura, perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea

c-ANA and treated with Cyclophosphamide and Corticosteroids

Wegner was a small grandma horse, who wore a saddle. She worked very hard, breathing heavy and having dyspnea. The horse couldn't hear (otitis media), so one day a Cycler hit her, she bled out and necrotized.

Front 57

Sturge-Weber dz

Back 57

-Effects capillary sized blood vessels, port wine stain, leptomeningeal angiomatosis (AV malformations), seizures and early onset glaucoma



Sturgey weber was small and retarded and liked to drink wine. One day he drank so much he gave himself a seizure and he went blind

Front 58

Buerger's dz

Back 58

-a/w smoking
-aka thromboagniitis obliterans
-intermiitent claudication (Ryanauds)
-Can lead to gangrene
-tx: smoking cessation

Front 59

Kawasaki dz

Back 59

-necrotizing vasculitis in infants/children
-Asians
-Fever, conjunctivitis, changes in lips/oral mucosa, strawberry tongue, lymphadentitis, desquamative skin rash. May develop coronary aneurysms
Tx: IV immunoglobin, aspirin

Front 60

Polyarteritis nodosa

Back 60

-fever, weightloss, malaise, abdominal pain, melena, headahce, myalgia, HTN, neurologic dysfunction, cutaneous eruptions
-Hep B
-Tx: corticosteroid and cyclophamide
-P-ANCA
-Renal and visceral vessels NOT pulmonary arteries

Front 61

Takayasu's arteritis symptoms

Back 61

-Fever, Arthritis, Night sweats, Myalgia SKIN nodules, Ocular disturbaces, Weak pulses in upper extremities

FAN MY SKIN ON Wednesday

Front 62

essential hypertension therapy?

Back 62

Diuretics, ACE inhibitors, angiotension II receptor blockers (ARBs), calcium channel blockers

Front 63

CHF therapy?

Back 63

-Diuretics, ACE inhibitors/ARBs
-Beta blockers (compensated CHF, C/I in decompensated CHF)
-K-sparing diuretics

Front 64

Diabetes antihyptension therapy?

Back 64

-Ace inhibitors/ARBs
-calcium channel blockers
-diuretics
-B-blockers
-alpha blockers