Usmle Step 1 Flashcards - Cardiovascular

Front 1

5 factors that decrease cardiac contractility?

Back 1

1. Beta blockers (decrease cAMP)
2. Heart failure (systolic dysfunction)
3. Acidosis
4. Hypoxia/hypercapnea
5. Non-DHP CCBs

Front 2

3 conditions that increase blood viscosity?

Back 2

1. Polycythemia
2. Hyperproteinemic state (ie: MM)
3. Spherocytosis

Front 3

Period in the cardiac cycle with the highest O2 consumption?

Back 3

Isovolumetric contraction

Between mitral valve closure and aortic valve opening.

Front 4

In who could an S3 be normal?

Back 4

Children (or < 40 yo) and pregnant women

Front 5

Order of JVP waves and significance?

Back 5

a - atrial contraction
x - atrial relaxation
v - atrial filling
y - atrial emptying

Front 6

What is wide S2 splitting associated with?

Back 6

Pulmonic stenosis or right bundle branch block

Front 7

What is fixed S2 splitting associated with?

Back 7

ASD

Front 8

What is paradoxical S2 splitting associated with?

Back 8

Aortic stenosis or Left BBB

Front 9

Where does the posterior descending artery (PD) come from and what does it supply?

Back 9

Comes from RCA 80% of the time, 20% from CFX (from LCA)

Supplies posterior septum, inferior portion of LV

Front 10

What murmurs does an ASD present with?

Back 10

Pulmonary flow murmur (increased flow through pulmonary valve)

Diastolic rumble (increased flow across tricuspid)

Front 11

What murmurs are heard at the left sternal border?

Back 11

Diastolic: aortic regurg and pulmonic regurg

Systolic: HCM

Front 12

What murmurs are heard at the tricuspid area?

Back 12

Pansystolic murmurs: tricuspid regurg and VSD

Diastolic: tricuspid stenosis and ASD

Front 13

Common causes of mitral regurgitation?

Back 13

Ischemic heart disease
MV prolapse
LV dilation
Rheumatic fever

Front 14

JVP change with mitral regurgitation?

Back 14

Increased "v" wave

("V" for atrial "villing")

Front 15

Late systolic crescendo murmur with midsystolic click?

Back 15

Mitral prolapse

Front 16

Causes of mitral prolapse?

Back 16

Myxomatous degeneration
Rheumatic fever
Chordae rupture

Front 17

JVP change with mitral stenosis?

Back 17

Increased "a" wave

Front 18

Ejection click followed by crescendo-descrescendo systolic murmur?

Back 18

Aortic stenosis

Front 19

Opening snap followed by delayed rumbling late diastolic murmur?

Back 19

Mitral stenosis

Front 20

Common causes of PDA?

Back 20

Congenital rubella
Prematurity

Front 21

When is PDA heard loudest?

Back 21

At S2

Front 22

Phases of AP present in pacemaker cells?

Back 22

Phase 0 (Ca)
Phase 3 (K+)
Phase 4 (Na+)

Front 23

Cardiac muscle contraction depends on Ca from where?

Back 23

Extracellular Ca (enters during plateau of AP)
AND
Ca released from sarcoplasmic reticulum
(Ca-induced Ca release)

Front 24

What can a U wave on EKG be caused by?

Back 24

Hypokalemia
Bradycardia

Front 25

Relative speed of conduction in various cardiac locations?

Back 25

Purkinje > atria > ventricles > AV node

Front 26

Which artery normally supplies the SA and AV nodes?

Back 26

RCA

Front 27

What is Wolff-Parkinson-White syndrome also referred to as and why?

Back 27

Ventricular pre-excitation syndrome.

Ventricles depolarize earlier than normal due to accessory conduction pathway (bundle of Kent) --> leads to characteristic delta wave on EKG

Front 28

Treatment for atrial flutter?

Back 28

Convert to sinus rhythm

Class IA, IC, or III anti-arrhythmics.

Front 29

Long term treatment for 3rd degree AV block?

Back 29

Dual chamber pacemaker

Front 30

What do the aortic arch and carotid sinus respond to?

Back 30

Aortic arch: ONLY to increases in BP

Carotid sinus: increase and decrease in BP

Front 31

What do peripheral and central chemoreceptors respond to?

Back 31

Peripheral: PO2 < 60, Increased PCO2, and decreased pH

Central: respond to pH and PCO2

Front 32

Local metabolites that determine blood flow autoregulation in the heart? Skeletal muscle?

Back 32

Heart: O2, adenosine, NO

Skeletal muscle: lactate, adenosine, K+

Front 33

What does a patient with tricuspid atresia require for viability?

Back 33

Both ASD and VSD

Front 34

"5 T's" of cyanotic congenital heart disease?

Back 34

1. Tetralogy of Fallot
2. Transposition of the great vessels
3. Truncus arteriosus
4. Tricuspid atresia
5. Total anomalous pulmonary venous return (TAPVR)

Front 35

What conditions is VSD associated with?

Back 35

Corrected transposition
Tetralogy of Fallot
Cri du chat
FAS

Front 36

4 components of Tetralogy?

Back 36

1. Pulmonary stenosis
* most important determinant of prognosis
2. VSD
3. Overriding aorta
4. RV hypertrophy

Front 37

Cause of tetralogy of Fallot?

Back 37

Anterosuperior displacement of the infundibular septum

Front 38

Congenital cardiac defect associated with infant of diabetic mother?

Back 38

Transposition of the great vessels

Front 39

Congenital cardiac defect associated with 22q11?

Back 39

Truncus arteriosus
Tetralogy of Fallot

Front 40

Congenital cardiac defect associated with Down syndrome?

Back 40

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

Front 41

Plaque with lipid laden histiocytes in the skin of the eyelids?

Back 41

Xanthelasma (type of xanthoma)

Front 42

What is corneal arcus?

Back 42

Lipid deposit in the cornea
- Nonspecific (arcus senilis)

Front 43

Common location for Monckeberg's medial calcification?

Back 43

Radial and ulnar arteries
- "Pipestream" arteries

Front 44

What is adult type coarctation associated with?

Back 44

Bicuspid aortic valve

Front 45

What can coarctation of the aorta result in?

Back 45

Aortic regurgitation

Front 46

Findings in adult type coarctation?

Back 46

Notching of the ribs (due to collateral circulation)
HTN in upper extremities
Weak pulses in lower extremities

Front 47

Immune response in acute vs subacute endocarditis?

Back 47

Acute: neutrophilic leukocytosis

Subacute: monocytosis

Front 48

Complications of endocarditis?

Back 48

Chordae rupture
Glomerulonephritis
Suppurative pericarditis
Emboli

Front 49

Endocarditis-causing organism of prosthetic valves?

Back 49

S. epidermidis

Front 50

Major Duke criteria for endocarditis?

Back 50

2/2 + blood cultures
Endocardial lesion (TEE, TTE)
New valvular regurg

Front 51

What is the hepatojugular reflex?

Back 51

Compress a congested liver and get jugular venous distention

Seen in CHF

Front 52

What are early deaths due to in rheumatic fever?

Back 52

Myocarditis

Front 53

2 histo findings in acute rheumatic fever?

Back 53

Aschoff bodies (granuloma with giant cells)

Anitschkow cells (activated histiocytes)

Front 54

Early and late valvular lesions with rheumatic fever?

Back 54

Early: mitral valve prolapse

Late: mitral stenosis

Front 55

Calcification and "tree bark" appearance of aorta?

Back 55

Syphilitic heart disease (disrupts vasa vasorum of aorta --> dilation of aorta and valve ring)

Front 56

In what conditions is pulsus paradoxus seen?

Back 56

Severe cardiac tamponade
Asthma
Obstructive sleep apnea
Pericarditis
Croup

Front 57

Triad of findings in cardiac tamponade?

Back 57

1. Hypotension
2. Increased venous pressure (Beck's JVD)
3. Distant heart sounds

Front 58

Most common primary cardiac tumor in adults and kids?

Back 58

Adults: myxomas (L atrium)

Kids: rhabdomyomas (hamartoma)

Front 59

Metastatic tumors to heart come from where and go to what part of the heart?

Back 59

From melanoma, lymphoma

Often go to pericardium

Front 60

Findings in Sturge-Weber disease?

Back 60

Port-wine stain (nevus flammeus) on face
Ipsilateral leptomeningeal angiomatosis (intracerebral AVM)
Seizures
Early-onset glaucoma

Front 61

Microscopic polyangiitis vs Wegener's?

Back 61

Microscopic polyangiitis: like Wegener's but without granulomas, pANCA (+)

Wegener's: cANCA (+)

Front 62

Benign painful red-blue tumor under fingernails from smooth muscle cells of glomus body?

Back 62

Glomus tumor

Front 63

What is a pyogenic granuloma and what's it associated with?

Back 63

Polypoid capillary hemangioma that can ulcerate and bleed.

Assoc w/ trauma & pregnancy

Front 64

Arteriogram findings in PAN?

Back 64

Multiple aneurysms and constrictions

Front 65

Epidemiology and findings in Takayasu's arteritis?

Back 65

Asian females < 40 yo

"OW, FAN MY SKIN"
Ocular disturbances, Weak pulses in upper extremities, Fever, Arthritis, Night sweats, MYalgia, SKIN nodules

Front 66

Strongest CCB for vascular smooth muscle and heart?

Back 66

Vascular: nifedipine

Heart: verapamil

Front 67

Best anti-hypertensive treatment for diabetes mellitus?

Back 67

ACE inhibitors
- protective against diabetic nephropathy

Front 68

Common locations of atherosclerosis?

Back 68

Abdominal aorta > coronary > popliteal > carotid

Front 69

Type A vs B aortic dissection?

Back 69

Type B only involves descending aorta – not an emergency

Type A: involves ascending +/- descending → surgical emergency

Front 70

What is aortic dissection associated with?

Back 70

HTN and Cystic medial necrosis (Marfan’s)

Front 71

EKG finding with stable angina?

Back 71

ST segment depression (subendocardial)

Front 72

Cause of stable vs unstable angina?

Back 72

Stable: secondary to atherosclerosis

Unstable: thrombosis of vessel but NO necrosis (compare with MI: has necrosis)

Front 73

Risk within first 4 days of MI?

Back 73

Arrhythmia

Front 74

Risk between 5-10 days after MI?

Back 74

Free wall rupture (LAD) → cardiac tamponade

Papillary muscle rupture (RCA) → mitral regurg

Interventricular septal rupture (LAD) → VSD

Front 75

Risk over 7 weeks after MI?

Back 75

Ventricular aneurysm
- decreased CO, risk of arrhythmia, embolus from mural thrombus
(Contracted scar is complete)

Front 76

First histological findings after MI?

Back 76

Coagulative necrosis after 4 hours
Contraction bands between 12-24 hours

Front 77

Histological findings after MI from 2-4 days?

Back 77

Acute inflammation (neutrophils), dilated vessels (hyperemia), extensive coagulative necrosis

Front 78

Histological findings after MI from 5-10 days?

Back 78

Macrophages and ingrowth of granulation tissue (can be hyperemic)

Front 79

Postinfarction fibrinous pericarditis vs Dressler’s syndrome?

Back 79

Both are complications of MI.

Post-infectious: acute inflammation, 3-5 days post-MI

Dressler’s: autoimmune (Abs against damaged pericardial antigens), fibrinous, several weeks post-MI

Front 80

Where is AST found?

Back 80

Cardiac, liver, skeletal muscle cells

Front 81

When is cardiac troponin I positive after MI?

Back 81

Rises 4 hours after (before CK-MB) and is elevated for 7-10 days (longer than CK-MB)

Front 82

ST elevation in leads V1-V4: which area and artery are affected? V1-V2?

Back 82

V1-V4 → anterior wall (LAD)

V1-V2 → anteroseptal (LAD)

Front 83

ST elevation in leads V4-V6: which area and artery are affected? I, aVL?

Back 83

V4-V6 → anterolateral (LCX)

I, aVL → lateral wall (LCX)

Front 84

ST elevation in leads II, III, aVF: which area and artery are affected?

Back 84

Inferior wall (RCA)

Front 85

Causes of dilated (congestive) cardiomyopathy?

Back 85

Alcohol abuse, wet Beriberi, Coxsackie B viral myocarditis, chronic Cocaine use, Chagas’ disease, Doxorubicin toxicity, hemochromatosis, peripartum cardiomyopathy

- Also glue sniffing, acromegaly, and myxedema

Front 86

Treatment for HCM?

Back 86

Beta blocker, non-DHP CCB (verapamil), ICD

Front 87

Causes of restrictive cardiomyopathy?

Back 87

Sarcoidosis, Amyloidosis, Postradiation fibrosis, Endocardial fibroelastosis, Loffler’s syndrome (endomyocardial fibrosis w/ eosinos), Hemochromatosis, Systemic sclerosis, Pompe’s glycogenesis

Front 88

What vessels does PAN usually involve?

Back 88

Renal and visceral vessels.

NOT pulmonary arteries.

Front 89

Mechanism and AE of Diazoxide?

Back 89

K+ channel opener. Hyperpolarizes and relaxes vascular smooth muscle.

Used for malignant HTN.

AE: hyperglycemia (reduces insulin release)

Front 90

AEs of CCBs?

Back 90

Cardiac depression
AV block
Peripheral edema
Flushing
Dizziness
Constipation

Front 91

Mechanism of hydralazine?

Back 91

Increase cGMP --> smooth muscle relaxation

Vasodilates arterioles > veins

Front 92

Toxicity of digoxin?

Back 92

Cholinergic: n/v, diarrhea, blurry yellow vision

ECG: increase PR, decrease QT, scooping, T wave inversion, arrhythmia, hyperkalemia

- Worsened by renal failure, hypokalemia, quinidine

Front 93

Which lipid lowering agent slightly increases triglyceride levels?

Back 93

Bile acid resins

Front 94

AE of cholesteral absorption blocker (ezetimibe)?

Back 94

Rare increase in LFTs

Front 95

Mechanism and AEs of fibrates?

Back 95

Upregulate LPL --> decrease TGs

AEs: myositis (w/ statins), hepatotoxicity, cholesterol gallstones

Front 96

Mechanism of niacin for lipid lowering?

Back 96

Inhibit lipolysis in adipose tissue

Reduce hepatic VLDL secretion

Front 97

How does K+ work as an anti-arrhythmic?

Back 97

Depresses ectopic pacemakers in hypokalemia (eg: digoxin toxicity)

Front 98

What blocks the effects of adenosine?

Back 98

Theophylline

Front 99

Which class of anti-arrhythmics are best and worse post-MI?

Back 99

IB: Best post-MI

IC: Contraindicated post-MI

Front 100

Class IA anti-arrhythmics?

Back 100

Quinidine
Procainamide
Disopyramide

Front 101

Class IB anti-arrhythmics?

Back 101

Lidocaine
Mexiletine
Tocainide

Front 102

Class IC anti-arrhythmics?

Back 102

Flecainide
Encainide
Propafenone