D\'s Cardio Step 2.txt

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D\'s Cardio Step 2.txt
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2010-07-24 16:54:34
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USMLE Step Cardio
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USMLE Step 2 Cardio
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  1. Pansystolic
    • Mitral Regurgitation
    • Tricuspid Regurgitation
  2. Late Systolic
    Mitral valve prolapse
  3. Early Diastolic
    • Aortic regurgitation
    • Pulmonic regurgitation
  4. Mid/late Diastolic
    Mitral stenosis
  5. Fick principle
    CO = SV x HR

    • Rate of O2 use
    • ------------------
    • arterial O2 - venous O2
  6. MAP
    CO x TPR

    Diastolic art pressure - 1/3 pulse pressure
  7. Pulse Pressure
    Systolic - Diastolic Arterial Pressure
  8. SV determine by
    • Contractility
    • Preload
    • Afterload
  9. SV increases with
    • 1. Catecholamonines
    • 2. Inc. Intracellular Ca
    • 3. Dec. Extracellular Na
    • 4. Digoxin
    • 5. Anxiety
    • 6. Exercise
    • 7. Inc preload
    • 8. Dec afterload
  10. SV decreases with
    • 1. B blockers
    • 2. CCB: verapamil
    • 3. CHF
    • 4. Acidosis
    • 5. Hypoxia
  11. LAD supplies? EKG?
    Ant wall of LV

    V2, V3, V4
  12. Septal branch (off LAD) supplies? EKG?
    Ant 2/3 of IV septum

    V1, V2, V3
  13. Circumflex branch (off LCA) supplies? EKG?
    • LA
    • Lat wall LV
    • Post wall LV

    AvL, V5, V6
  14. Posterior descending branch (off RCA usually) supplies? EKG?
    • Inf wall LV
    • Post 1/3 IV septum

    II, III, AVF
  15. Marginal Branch (off RCA) supplies? EKG?
    • RA
    • RV

    II, III, AVF
  16. SA, AV nodal branch (off RCA) supplies?
    • SA node
    • AV node
  17. Ideal Cholesterol levels:
    • <160 : 2 CAD risk factors
    • <130 : 2 or more risk factors
    • <100 : High risk of CAD
    • (age, high LDL, DM, MI)
  18. Risk Factors for CAD
    • 1. Smoking
    • 2. HTN > 140/90 or on HTN med
    • 3. HDL < 40
    • 4. FH CAD:  < 55 yrs  < 65 yrs
    • 5. Age: >45  > 55 

    HDL > 60 cancels 1 risk
  19. Statins effect? S.E.?
    •  LDL
    •  HDL
    •  Triglycerides

    S.E. Myositis, inc LFT

    Do NOT give with fibrates
  20. Ezetimibe effect? S.E.?
    • LDL
    • No effect on HDL or Triglyc.

    S.E.: myalgia, inc LFTs, inc plaque formation
  21. Fibric Acids. Effect? S.E.?
    • LDL
    • HDL
    • Triglycerides!

    S.E. Myositis, inc LFTs

    Do NOT give with statins!
  22. Bile Acid Sequestrants. Name. Effect. S.E.
    • Cholestyramine
    • Colestipol
    • Colesevelam

    • LDL
    • S.E. Bad taste, GI upset
  23. Niacin. Effect. S.E.
    • LDL
    • HdL!
    •  Triglycerides

    S.E. Facial flushing, nausea, paresthesia, pruritis, inc LFTs, insulin resistance, worsen gout
  24. How do you prevent flushing of niacin?
    Long term use & ASA
  25. Which bile acid resin also treats C. Diff colitis?
    Cholestyramine
  26. Omega 3 fatty acid. Effect
    Triglycerides!
  27. EKG findings on MI:
    • ST elevation
    • T-wave changes
    • Possible new arrhythmia
    • LBBB
    • Q wave changes
  28. Enzyme good for infarction?
    Troponin I
  29. Enzyme good for reinfarction?
    CPK-MB
  30. What enzyme increases in 3 hours, peaks in 6hr, and gradually decreases in 7 days?
    Troponin I
  31. Greatest risk for what 4-8 days post MI?
    Ventricular Wall Rupture
  32. What drugs  mortality of MI?
    • B blocker
    • ACE i
    • Thrombolytics
  33. EKG 1st *  Block. Tx.
    Prolonged PR > 0.2 sec (1 big box)

    No tx.
  34. 2nd *  Block (mobitz I/wenckebach) EKG. tx. Causes.
    Progressive PR lengthening untill skip QRS. PR progression. Then reset

    Adjust med doses. No tx unless symptomatic bradycardia

    B blocker, digoxin, CCB
  35. 2nd *  Block (mobitz II): EKG, Tx, causes.
    • Randomly skipped QRS
    • Normal PR

    Ventricular pacemaker

    Caused by infranodal conduction prob; bundle of his
  36. 3rd *  Block: EKG, Tx, Cause
    No relationship b/t P and QRS.

    • Ventricular Pacemaker
    • Avoid meds affecting AV conduction

    Absense of conduction b/t atria & ventricles
  37. PSVT. EKG. Tx
    • Tachycardia 150-250
    • narrow/norm QRS
    • P waves hidden in T waves

    • Carotid Massage/valsalva
    • Cardiovert: adenosine
    • CCB
  38. MAT. EKG. Tx.
    Variable morphology of P waves. At least 3.

    HR>100bpm

    • B blockers
    • CCB: nondihydro: vera, dilt
    • Ablation
  39. Bradycardia. EKG, tx B blocker or CCB induced.
    <60bpm

    • Stop meds
    • Atropine
    • Glucagon
    • Ca
    • Insulin
    • Glucose
  40. A fib. EKG. Tx
    • Irregularly irregular.
    • No P waves.
    • Irregular QRS

    • Anticogulate
    • Rate control: CCB, BB, digoxin
  41. A flutter. EKG. Tx
    • Regular tachycardia
    • Sawtooth p waves

    • Rate control: CCB, BB, electrical or chemical
    • Cardiovert
    • Catheter ablation
  42. PVC. EKG. Tx.
    Early and wide QRS without preceding P wave followed by brief pause in conduction.

    • No tx.
    • BB in py with CAD
  43. V tach. EKG. Tx
    • 3+PVCs with HR 160-240
    • Regular, wide QRS independent of P waves

    • Electrical cardiovert
    • Antiarrhythmic
    • Internal defibrillator
  44. V fib. EKG. tx.
    Totally erratic tracing. No p or QRS

    • CPR
    • immediate electric (+\- chemical) cardioversion
  45. S3 
    • CHF
    • Dilated cardiomyopathy
    • M.R.
    • MI
  46. S4 
    • Aortic stenosis
    • LVH
    • MI
    • Hypertrophic cardiomyopathy
    • Restrictive cardiomyopathy
  47. Eisenmenger
    L-R shunt  PH RVH  R-L shunt
  48. CXR of CHF
    • 1. Cardiac enlargement
    • 2. Kerley B lines
    • 3. Cephalization of pulm ves
  49. What are Kerley B lines?
    Increased marking of lung interlobular septa caused by pulm edema.

    In CHF
  50. Cephalization of pulmonary vessels?
    Increased marking of superior pulmonary vessels caused by congestion and stasis.

    CHF
  51. What decreased mortality in CHF?
    • Ace i
    • BB
    • Spironolactonr
  52. Systolic  drugs:
    • Loop diuretics
    • ACE i /ARB
    • BB
    • Digoxin!
    • Spironolactone
    • Vasodilators!
  53. Diastolic dysfunction drugs :
    • CCB!
    • ACE i/ ARB
    • BB
    • K sparers
  54. Acute CHF tx:
    • Lasix
    • Morphine
    • Nitrates/Nesiritide (rBNP)
    • O2
    • Positioning/Pressors (dopa, dobutamine)
  55. Valsava and effect on aortic stenosis vs. HOCM?
    • A.S.:  murmur
    • HOCM:  murmur
  56. Causes of acute pericarditis:
    • Viral
    • TB
    • SLE
    • Uremia
    • Neoplasm
    • Drug: INH, hyralazine
    • Post-MI (dressler)
    • Radiation
    • Recent  surgery
  57. Pain lessens when leaning fwd, pleuritic CP, friction rub, fever, pulsus paradoxus. Name disease.
    Acute pericarditis
  58. What is pulsus paradoxus?
    Fall in systolic BP >10 mmHg with inspiration.
  59. Global ST elevation
    Acute pericarditis
  60. Tx acute pericarditis:
    • Underlying cause
    • Pericardiocentesis
    • NSAID
    • Colchicine: recurrence

    If untreated can become chronic constrictive pericarditis.
  61. Pericardial effusions are usually?
    Transudates protein

    If exudate protein workup for neoplasm or gibrotic disease.
  62. Chronic constrictive pericarditis causes:
    • Radiation
    •  surgery
  63. RIght  failure signs, kussmauls sign, cath: equal pressure in all chambers. Diagnosis?
    Chronic constrictive pericarditis.
  64. Kussmauls sign?
     JVD with inspiration
  65. Tx for chronic constrictive pericarditis:
    • NSAID
    • Colchicine
    • Steriods
    • Surgical excision of pericardium (high mortality)
  66. What is  tamponade?
    Large pericardial effusion compressing  =  CO
  67. Causes of  Tamponade
    • Acute pericarditis
    • Chest trauma
    • LV rupture from MI
    • Dissecting aortic aneurysm
  68. Low voltage EKG, sinus tach, dyspnea, tachycardia, JVD, pulsus paradoxus, enlarged  shadow on CxR, large effusion on echo. Disease?
     tamponade
  69. Tx  tamponade:
    Immediate pericardiocentesis
  70. Causes of dilated cardiomyopathy:
    • Idiopathic
    • Etoh
    • Beriberi
    • Coxsackie B
    • Cocaine
    • Doxurubicin
    • HIV
    • Pregnancy
  71. CxR of dilated cardiomyopathy:
    • Balloon like 
    • "water bottle"
  72. Causes of restrictive cardiomyopathy:
    • Sarcoidosis
    • Amyloidosis
    • Hemochromatosis
  73. Myocarditis causes:
    • Cosackie
    • Echo, adeno, EBV, CMV, influ
    • Drugs: doxorubicin, daunorubicin, chloroquine, penicillins, sulfonamides, cocaine, radiation
    • Toxin
    • Endocrine
  74. Recent URI, pleuritic CP, dyspnea, s3 or s4, diastolic murmur, friction rub. Cardiomegaly. Disease? Tx?
    Myocarditis

    • Treat infection
    • Stop offending agent
    • Treat CHF symptoms.
  75. Chagas triad:
    • Cardiomegaly
    • Megaesophagus
    • Megacolon

    Assoc: acalasia
  76. Immigrant with recent untreated infxn. Hx  dz. Recent fevers, painless rash, hot & swollen joints. WBC, CRP, ESR
    Rheumatic  dz.
  77. RHD sequela of
    Untreated group A streptoccus.

    Autoantibodies attacking  valves & joints
  78. RHD. Valve affected in general public? IVDA?
    Mitral valve

    Tricispid valve
  79. RHD criteria?
    Jones

    • Major: "jnes"
    • Minor: peace
  80. Jnes criteria for RHD:
    • Joints
    • pancarditis
    • Nodules: SQ, extensor
    • Erythema nodusum: painless
    • Sydenhams chorea

    • Previous rhuematic fever
    • ECG with PR prolongation
    • Arthralgia
    • CRP & ESR elevated
    • Elevated Tenperature
  81. Treatment RHD
    • NSAID
    • Steriods
    • Prophylactic antibiotics
  82. Prophylactic antibiotics for pt with hx of RHD damage to valves:
    Oral: amoxicillin (before & after sx)

    GU/GI: ampicillin & gentamycin (before), amoxicillin (after)
  83. Endocarditis
    Bacterial infxn of endocardium +\- valve involvement
  84. Endocarditis more common in
    • Congenital  defects
    • IVDA
    • Prosthetic valves
  85. Endocarditis & SLE
    Libman-Sacks endocarditis
  86. Acute endocarditis causes:
    • Staph. Aureus
    • Strep. Pneumo
    • Strep. Pyogenes
    • Neisseria gonorrhea
  87. Subacute endocarditis causes:
    • Strep viridans
    • Strep mutans
    • Enterococcus (VRE)
    • Staph epidermidis (coag - staph)
  88. Negative culture endocarditis:
    • Haemophilus
    • Actinobacillus
    • Cardiobacterium
    • Eikenella
    • Kingella
  89. Endocarditis valve in gen? IVDA?
    Mitral valve

    Tricuspid valve
  90. Prosthetic valves susceptible to?
    Staph epidermis
  91. Duke criteria for endocarditis:
    • Major:
    • Blood cx.
    • Echo: vegetations/ absces
    • New onset valvular regurg.
    • Blood cx: + coxiella burnetii

    • Minor:
    • Predisposing  dz, IVDA
    • Fever
    • Vasc.
    • Immunologic
    • + cx not meeting requirements for major criteria
  92. S/S endocarditis
    • Janeaway lesions: petechiae
    • Osler nodes: painful nodule
    • Roth spots: retinal hemorr.
    • New murmur
    • Fever, arthralgia
    • Chills, night sweats, fatigue
  93. Treatment endocarditis
    Gentamycin with either ceftriaxone/vancomycin
  94. Complication of endocarditis
    Septic embolization

    • Brain: focal neuro deficits
    • Kidney: hematuria
    • Spleen: abd/shoulder pain
  95. Fundoscopic exam of HTN complications
    • AV nicking
    • Cotton wool spots
    • Retinal hemorrhage (flame hemorrhage)
  96. 1st drug for HTN
    Thiazide
  97. HTN drug for DM. Relative C.I.?
    ACE i/ ARB

    • CI:
    • thiazide: impaired glucose tolerance
    • BB: mask hypoglycemia
  98. CHF HTN med? CI?
    • ACE i/ ARB
    • Diuretic (aldactone)

    • CI: CCB-nondhydro: dilt/vera
    • Lowers  contractility
  99. Post MI HTN meds?
    • ACE i/ARB
    • BB
  100. Benign essential tremor, migraine, anxiety? htn med?
    Propanolol
  101. Osteoporosis & HTN. Med?
    Thiazide: maintains high/normal calcium level
  102. Do not give asthma/COPD pts what anti-HTN?
    Nonselective BB
  103. Anti HTN drugs for pregnancy:
    • Labatelol
    • Methyldopa
    • Hydralazine
    • Nifedipine

    No ACE i /ARB!!
  104. Do not give gout pts what anti-HTN?
    Diuretic
  105. Do not give depression PTA what anti-HTN?
    BB
  106. Dihydropyridines (nefidipine, amlodipine) are also used for?
    • HTN
    • Esophageal Spasm
    • Prinzmetal's Angina
  107. Nitroprusside side effect?
    CN toxicity
  108. Causes of secondary HTN
    • Renal dz
    • Renal artery stenosis
    • OCP
    • Pheochromoctyoma
    • 1* hyperaldosteronism (cushing/conns)
    • Coarctation of aorta
  109. BP 200/120 & end organ damage. Diagnosis? tX?
    HTN emergency

    • IV Nitroprusside or
    • Labetalol or
    • Nicardipine or
    • Fenoldapam

    Once controled oral BB & ACE i
  110. HTN emergency initial decrease in diastolic BP should not exceed
    25% of presenting pressure to avoid triggering ischemic event.
  111. Cardiogenic shock tx
    • IVF
    • Dobutamine
    • Intra-aortic ballon pump
    • PTCA
  112. Septic shock tx.
    • Underlying infxn.
    • IVF
    • Norepi
  113. Hypovolemic shock tx.
    • IVF
    • Tranfusion
    • SX
    • Skin graft
  114. Anaphylactic Shock tx.
    • Airway
    • Epi
    • Benadryl
    • Cimetidine
    • IVF
  115. Neurogenic Shock tx.
    • IVF
    • Dobutamine or atropine

    Stop at MAP 85 otherwise cord swelling.
  116. Biggest risk factor for AAA? Aortic dissection?
    • AAA: atherosclerosis
    • Aortic dissection: HTN
  117. AAA vs aortic dissection pathology?
    AAA: localized dilation of aorta

    Aortic dissection: intimal tear leads to blood entering media causing formation of false lumen.
  118. False lumen
    Aortic dissection
  119. Surgery for AAA if:
    • Symptomatic
    • Rapidly enlarging
    • Greater than 5.5 cm
  120. Screen for AAA
    Males 65-70 yrs with smoking hx.
  121. ST elevation only during brief episodes of CP. Diagnosis?
    Prinzmetals
  122. Pt can localize CP with one finger
    Muskulosketal
  123. Chest wall tenderness on palpation
    Muskl.
  124. Recent onset sharp CP radiates to scapula.
    Aortic dissection
  125. Rapid onset CP in 20 yr old and associated with dyspnea.
    Spont. PTX.
  126. CP after heavy meals an improved by antacids
    • Gerd
    • Esophageal spasm
  127. Sharp pain lasting days, relieved by sitting forward
    Pericarditis
  128. CP worse by deep breathing and motion
    MSKL.
  129. CP in dermatome
    Zoster
  130. MCC non  CP
    GERD
  131. Acute onset dyspnea, tachycardia, confusion in hospitalized pt with CP
    P.E.
  132. Pain begin day after new exercise program
    MSKL
  133. Widened mediastinum on CXR
    Aortic dissection

    Do CT!!!
  134. PTCA in pt with CAD when?
    • Medical therapy fails
    • High risk criteria

    if Sig proximal L main CAD, 3v CAD with LVEf <50% CABG
  135. Prinzmetal's Angina tx
    • CCB
    • Nitrates

    No BB & ASA (worsen vasospasm)
  136. MCC of death in pt with Acute MI?
    Arrythmia- vfib.
  137. SE lipid lowering: elevated LFTs & myositis
    • Statins
    • Fibrates
  138. SE lipid lowering med with GI discomfort, bad taste
    Bile acid binding resins
  139. Lipid lowering med with best effect on HDL
    Niacin
  140. Lipid lowing med with best effect on triglycerides/VLDL
    Fibrates
  141. Lipid lowering med with beat effect on LDL/cholesterol?
    Statin
  142. Mech: streptokinase
    Thrombolytic
  143. ASA mech
    COX 1&2 i
  144. Clopidogrel mech
    Inhibit ADP receptors on platlets
  145. Abciximab & tirifiban & eptifibatide mech?
    Inhibit gp IIb/IIIA
  146. Ticlopidine
    Inhibit ADP r on platlets

    Like clopidogrel
  147. Enoxaparin mech
    + AT III

    LMW heparin
  148. EKG: narrow QRS, not associated with P waves. rate 60
    3*  Block
  149. EKG chaotic, erratic, wide QRS
    V. Fib
  150. EKG. Wide QRS not associated with P waves. Rate >40, but<100
    Accelerated junctional rhythm.
  151. Narrow QRS, not associated with P waves, rate >100
    Junctional tachycardia
  152. Wide QRS not associated with P waves. Rate 20-40
    Ventricular rhythm
  153. Wide QRS not associated with P waves. Rate >100
    Ventricular tachycardia
  154. Narrow QRS, not associated with P waves. Rate >60 but <100
    Accelerated junctional rhythm
  155. Erratic QRS that varies in amplitude in a repeating pattern.
    Torades
  156. Treatment for premature atrial contractions
    Observe
  157. Antiarrhythmic that should be avoided in pts with preexisting lung dz?
    Amiodarone
  158. DOC for acute onset a fib with RVR in pt with WPW?
    Electrical cardiovert or procainamide.
  159. EKG shows complete independence of P and QRS. Next step?
    Pacemaker
  160. DOC PSVT
    Carotid massage/valsava then

    IV adenosine
  161. Kerley B lines seen in:
    • LVF
    • MV dz
    • Lymphatic obstruction
    • Lymphangitis carcinomatosis
    • Asbestosis
    • Sarcoidoisis
  162. Systolic  murmurs
    • Aortic atenosis
    • Pulmonic stenosis
    • M.R.
    • T.R.
    • VSD
  163. Diastolic murmurs
    • Tricuspid stenosis
    • Mitral stenosis
    • Aortic regurg
    • Pulmonic regurg
  164. Kussmauls sign seen more in
    Constrictive pericarditis > tamponade
  165. Pulsus paradoxus seen more in
     tamponade > pericarditis
  166. HF + DM + elevated LFTs
    Hemochromatosis

    Restrictive  dz reversible with phlebotomy
  167. Workup of low grade systolic murmur in healthy asymptomatic pt.
    Benign!!

    If symptoms: echo
  168. Work up of diastolic murmur in healthy asymptimatic patient?
    ECHO
  169. Tests to diagnose renal artery stenosis
    • Renal arteriogram: gold standard
    • MRA: most freq used
    • Renal A duplex: bilateral but time consuming
    • Helical CT of renal artery with IV contrast
    • Captopril renalogram (renal US)
  170. Anti HTN with s.e of 1st dose orthostatic hypotension.
    Alpha blockers
  171. Anti-HTN s.e hypertrichosis?
    Minoxidil
  172. Anti HTN with SE dry mouth, sedation, severe rebound HTN
    Clonidine
  173. Anti HTN causing drug induced lupus.
    Hydralazine
  174. False lumen, widened mediastinum dx?
    Aortic dissection
  175. Sanford A vs Sanford B dissections
    A: aortic dissections involving ascendimg aorta, surgery

    B: aortic dissection distal to left subclavian artery, med management unless rupture or occlusion
  176. ABI < 1
    Vascular insufficiency
  177. ABI <0.4
    Severe disease, resting pain
  178. Treatment of PVD
    • Excercise
    • Foot exams
    • ASA
    • Pentoxifylline
    • Cilostazol
    • PTA
    • Bypass grafting
    • Limb amputation
  179. Diagnosis of PVD
    • US: locates stenosis
    • Arteriography: map narrowing in arterial distribution of interest
  180. Varicosities: define & s/s
    Incompetent venous valves

    • Asymptomatic
    • Pain/fatigue better with elevation
    • Visible/palpable veins
    • Increased pigmentation
    • Edema
    • Ulceration
  181. Treating varicosities
    • Excercise
    • Compression hose
    • Leg elevation
    • Surgical removal
    • Sclerotherapy
  182. Try not to remove what varicose vein?
    Saphenous vein

    Potential use in bypass grafting!
  183. Palpable, warm, pulsating mass.
    AVM

    Surgicak remocal if symptomatic on brain or bowel
  184. Complication of AVM
    • Local ischemia
    • Increasef risk of thrombus
  185. Detecting DVT
    Compression venous US & contrast venography
  186. Risk factors for polyarteritis nodosa
    • Hepatitis B or C
    •  > 
    •  > 
  187. Organs PAN effects:
    • Kidneys, heart, gi
    • (anything with vascular supply)
  188. Treatment & radio for PAN
    Angiography: numerous aneurysms

    Treat: steriods & immunosuppressors
  189. Pts on steriods >3 months should also be on:
    • Ca
    • Vit D
    • Bisphosphonates
  190. Subacute granulomatous inflammation of external carotid & vertebral arteries with  ESR, older female
    Temporal arteritis
  191. Mskl condition associated with GCA
    Polymyalgia Rheumatica
  192. Treatment for GCA
    • High dose prednisone (1-2mos)
    • Low dose ASA
    • Vit D
    • Ca
  193. Inflammation of aorta, pulseless dz in young Asian female
    Takayasu's arteritis
  194. Takayasu arteritis. Radiology, treatment.
    • Arteriography: abnormal vessel & stenosis
    • CT/MRI: vessel wall abnormalities

    Causea Cerebrovasculat & myocardial ischemia.

    Tx: steriods, immunosuppressives, bypass grafting obstructed vessels
  195. Asthma symptoms, erythematous rash, ESR, eosinophilc granuloma on lung biopsy. Disease?
    Churg Strauss (allergic angiitis)
  196. IgA immune complex mediated vasculitus affecting arterioles, capillaries, venues.
    Henoch schonlein purpura
  197. Recent URI, polyarticulat arthritis, palpable purpura, abd pain, GIB. Disease? Tx?
    Henoch schonlein purpura

    Self limited, steriods if severe GI symptoms

    IgA deposition on Renal & Purpura biopsy
  198. Young child with fever, lymphadenopathy, conjuctival lesion, maculopapular rash, desquamation of hands & feet. Diagnosis? Treatment? Complication?
    Kawasaki

    • High dose ASA, IVIG
    • No steriods!!

    MI, aneurysm, sudden death

    Do echo!!!
  199. What keeps PDA open?
    PGE2
  200. What closes PDA?
    Indomethacin
  201. MC congenital  defect
    VSD
  202. MC cyanotic  defect
    Tetralogy of Fallot
  203. VSD murmur
    • Pansystolic at lower left sternal border
    • Loud pulmonic S2
  204. Noncyanotic  defects:
    • VSD
    • PDA
    • ASD
  205. Cyanotic  defects:
    • Truncus arteriosus
    • Transposition of great vessels
    • Tricuspid atresia
    • Tetralogy of Fallot
    • Total anomalous pulmonary venous return
  206. Untreated VSD can have what complication?
    Eisenmenger's syndrome
  207. ASD murmur
    • Wide fixed split S2
    • Systolic ejection murmur at upper left sternal border

    Need antibiotic prophylaxis!
  208. ASD pts more susceptible to:
    O2 desaturation at high altitudes

    Decompression sickness during deep sea diving
  209. PDA murmur
    Machinery murmur @ 2nd left intercostal space, loud S2, bounding pulses
  210. Transposition of great vessels need what to survive?
    VSD or PDA
  211. Risk factors for transposition of GV?
    • Aperts syndrome
    • Down syndrome
    • Cri-du-chat
    • Trisomy 13 or 18
  212. Failure of aorta and pulmonary artery to separate during development, resulting in single vessel.
    Persistent truncus arteriosus
  213. Murmur of truncus arteriosus
    • Harsh systolic murmur @ Lower left sternal border
    • Loud S1 & S2
    • Bounding pulses

    Surgery!
  214. Endocardial cushion defect
    Down syndrome
  215. Components of tetraology of fallot:
    • Pulmonary stenosis
    • RVH
    • Overriding aorta
    • VSD
  216. Risk for tetraology:
    • Down syndrome
    • Cri du chat
    • Trisomy 13 & 18
  217. Treating tetralogy:
    • Prostaglandin E
    • O2
    • Propanolol
    • IVF
    • Morphine
    • Knee to chest position

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