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USMLE Cardiology

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mlinnie's version from 2017-09-18 06:38

Valvular Heart Disease

LesionAuscultation
Mitral StenosisDiastolic OS/decrescendo-crescendo
Mitra RegurgPansystolic/S3
Mitral ProlapseMidsystolic click/murmur
Aortic StenosisSystolic crescendo/decrescendo at base/neck/paradoxic S2 split
Acute Aortic RegurgDiastolic decrescendo ending quickly/systolic ejection murmur
Chronic Aortic RegurgDiastolic decrescendo/ULSB systolic/EC/systolic ejection murmur
Tricuspid StenosisDiastolic OS/decrescendo-crescendo
Tricuspid RegurgSystolic decrescendo
Pulmonary StenosisSystolic crescendo-decrescendo/delayed and softened P2 (widened split)
Pulmonary RegurgDiastolic decrescendo/LSB systolic/EC
ASDFixed S2 split/ULSB systolic
VSDPansystolic Left SB murmur/possible S3/mid diastolic rumble
PDAContinuous ULSB murmur/diastolic diminished if Eisenmenger
COARCNone inherent/others w/other lesions
ToFCrescendo/Decrescendo ULSB systolic/S2 single/soft P2
TGA Usually ASD/PDA/Shunts to surviveAccentuated S2
InspirationNormal splitting
RV emptying delay (PuSt/RBBB)Wide but dynamic splitting
ASD/left to right shunt perpetually increases right side flowFixed wide and static splitting
LV emptying delay (AoSt/LBBB)Paradoxical splitting
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Vasculitidies

EntityQuestionAnswer
Giant cell/temp artEpid>50 y/o f>m
Takayasu'sEpid15-40 y/o f>m asian
PANEpidYoung adults
Churg-Strauss/allergic granulomatosisEpidYoung/middle adult
Kawasaki'sEpid<4 y/o asian
Thromboangiitis obliterans/BuergerEpid<35-40 y/o male
Hypersensitivity angiitis/microscopic PAEpid5th decade
Wegener's granulomatosisEpid5th decade
Henoch Schonlein purpuraEpidMost common childhood vasculitis/often follows URI
PANAssocHep B (in 30%)
Thromboangiitis obliterans/BuergerAssocCigarette smoking/Raynaud's (often present)
Giant cell/temp artLocUsually temporal artery/branches of carotids
Takayasu'sLocAortic arch/large branches/descending aorta
PANLocKidney/liver/heart/GI muscular arteries (not lung)
Churg-Strauss/allergic granulomatosisLocLung/GI/heart/skin/kidneys
Kawasaki'sLocCoronary (aneurisms)
Thromboangiitis obliterans/BuergerLocSmall vessels to medium muscular arteries
Hypersensitivity angiitis/microscopic PALocSkin/mucous/lungs/brain/heart/GI/kidneys/muscle
Wegener's granulomatosisLocKidney/upper/lower respiratory
Giant cell/temp artHistoGranulomatous/intimal proliferation/fibrosis/segmental
Takayasu'sHistoGranulomatous/intimal proliferation/fibrosis
PANHistoFibrinoid necrosis/segmental/transmural
Churg-Strauss/allergic granulomatosisHistoFibrinoid necrosis/segmental/granulomas/eosinophilia
Kawasaki'sHistoFibrinoid necrosis
Thromboangiitis obliterans/BuergerHistoSegmental thrombosing vasculitis
Hypersensitivity angiitis/microscopic PAHistoFibrinoid necrosis/no granulomas/leukocytoclastic vasculitis
Wegener's granulomatosisHistoFibrinoid necrosis/some granulomas
Giant cell/temp artSizeLarge Vessel
Takayasu'sSizeLarge Vessel
PANSizeMedium Vessel
Churg-Strauss/allergic granulomatosisSizeSmall Vessel
Kawasaki'sSizeMedium Vessel
Thromboangiitis obliterans/BuergerSizeMedium Vessel
Hypersensitivity angiitis/microscopic PASizeSmall Vessel
Wegener's granulomatosisSizeSmall Vessel
Giant cell/temp artPresHeadache/jaw claudication/visual symptoms/fever/weight loss
Takayasu'sPresPulseless disease/fever-night sweats/arthritis-myalgias/skin nodules/ocular disturbances
PANPresSystemic (fever/weight loss/malaise/headache)/GI (abdominal pain/melena)/HTN/neurologic/cutaneous eruptions/renal damage
Churg-Strauss/allergic granulomatosisPresResp (bronchial asthma/allergic rhinitis/lung)/palpable purpura/peripheral neuropathy (foot drop)/heart/GI/kidney (pauci-immune glomerulonephritis)
Kawasaki'sPresCRASH and Burn/Conjunctivitis/desquamating Rash/cervical Lymphadenopathy/erythema oral (Strawberry tongue)/Hand-foot edema-erythema/fever
Thromboangiitis obliterans/BuergerPresIntermittent claudication/may lead to gangrene/autoamputation of digits/superficial nodular phlebitis
Hypersensitivity angiitis/microscopic PAPresLung/kidney/skin rash/pauci-immune glomerulonephritis/palpable purpura
Wegener's granulomatosisPresCs/C shaped nose (sinusitis/otitis media/mastoiditis)/Cavitary lesions (pneumonitis/hemotysis/cough)/Crescentic glomerulonephritis (failure/hematuria/RBC casts)
PANMarkpANCA
Churg-Strauss/allergic granulomatosisMarkpANCA in <50-75%/elevated IgE
Kawasaki'sMarkAnti-endothelial cells
Hypersensitivity angiitis/microscopic PAMarkpANCA
Wegener's granulomatosisMarkCs/cANCA
Giant cell/temp artMarkESR
Giant cell/temp artTreatCorticosteroids
Giant cell/temp artAssocPolymyalgia rheumatica
Takayasu'sMarkESR
Takayasu'sTreatCorticosteroids
PANMarkImmune complex mediated
PANLesionsDifferent ages
PANTreatCorticosteroids/cyclophosphamide
Kawasaki'sTreatIV Ig/aspirin
Hypersensitivity angiitis/microscopic PATreatCorticosteroids/cyclophosphamide
Wegener's granulomatosisTreatCorticosteroids/cyclophosphamide
Wegener's granulomatosisCXRLarge nodular densities
Henoch SchonleinPresSkin (palpable purpura on buttocks/legs)/Arthralgia/GI (abdominal pain/melena/multiple lesions of same age)
Henoch SchonleinAssocIgA nephropathy
Henoch SchonleinMarkIgA complex deposition
Henoch SchonleinLesionsSame age
Sturge Weber diseaseSizeSmall Vessel
Sturge Weber diseasePresPorte-wine stain (nevuse flammeus) on face/ipsilateral leptomeningeal angiomatosis (intracerebral AVM)/seizures/early onset glaucoma
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Vascular Tumors

Question Answer Column 3
Strawberry hemangiomaBenign/capillary hemangioma of infancy (first few weeks/regresses spontaneously at 5-8y)2
Cherry hemangiomaBenign/capillary hemangioma of elderly/does not regress/frequency increases with age2
Pyogenic hemangiomaPolypoid capillary hemangioma/can ulcerate and bleed/assoc w/trauma and pregnancy3
Cystic hygromaCavernous lymphangioma of the neck/Assoc w/ Turner syndrome2
Glomus tumorBenign/painful/red blue tumor under fingernail/modified smooth muscle cells of glomus body4
Bacillary angiomatosisBenign/capillary skin papules/in AIDS patients/Bartonella henselae/mistaken for Kaposi's4
AngiosarcomaRare malignancy/of blood vessel/head-neck-breast/Assoc w/ radiation4
LymphangiosarcomaMalignancy/of lymphatics/Assoc w/ persistent lymphedema (post radical mastectomy)3
Kaposi's sarcomaMalignancy/of endothelia/skin>mouth-GI-respiratory tract/HHV8-HIV4
MyxomaMost common cardiac tumor in adults/90% atrial-left/ball valve obstruction in left atrium causes syncopal episodes3
RhabdomyomasMost common cardiac tumor in children/Assoc w/ tuberous sclerosis2
Papillary fibroelastomaNonneoplastic/thrombotic fibrin core/endothelial coat/LV most common4
Hereditary hemorrhagic telangiectasia/Osler Weber RenduAutosomal dominant/dilation of skin-mucus membrane capillaries/epistaxis/GI bleeding4
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Congenital HD

Question Answer Column 3
R to L shunt/early cyanosis/blue babiesTetralogy/Transposition/Truncus/Tricuspid atresia/TAPVR5 T's
ToFPu stenosis/RVH/Overriding Ao/VSD4 PROV
TGAVSD/PDA/or PFO for adequate mixingAcc by
PTAVSDAcc by
Tricuspid atresiaASD and VSDAcc by
TAPVRASD and sometimes PDA (maintain CO w/R to L shunt)Acc by
L to R shunt/late cyanosis/blue kidsVSD>ASD>PDA3 with frequency
Eisenmenger's syndromeVSD/ASD/PDA (L to R shunt)3 causes
Eisenmenger's syndromeCyanosis/Clubbing/polyCythemia (reversal of shunt from PHTN)3 results (3 C)
Ao coarcAo regurg (common)Acc by
Ao coarcInfantile preductal/adult postductal2 types
Adult Ao coarcTurner syndromeAssoc w/
Infantile Ao coarcBicuspid aortic valveAssoc w/
22q11Truncus arteriosus/ToFAssoc w/
Down syndromeASD/VSD/AV septal defect (endocardial cushion defect)Assoc w/
Congenital rubellaASD/VSD/PDA/PuA stenosisAssoc w/
Turner syndromePreductal Ao coarc/bicuspit AoVAssoc w/
Marfan's syndromeAo insufficiency/dissectionAssoc w/
Infant of diabetic motherTGAAssoc w/
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Misc

Question Answer Column 3
AtheromasPlaque in blood vessel wall1
XanthomasPlaques or nodules/lipid laden histiocytes in skin2
XanthomasEyelids common (xanthelasma)Where
Tendinous xanthomaLipid deposit in tendon1
Tendinous xanthomaAchillesWhere
Corneal arcusLipid deposit in cornea/nonspecific2
Monckeberg arteriosclerosisCalcification of artery media/usually benign/pipestem arteries3
Monckeberg arteriosclerosisRadial/ulnar artery/NOT intima/NO obstructionWhere
Hyaline artiolosclerosisSmall arteries in essential HTN/DM2
Hyperplastic artiolosclerosisOnion skinning in malignant HTN2
AtherosclerosisFibrous plaques and atheromas2
AtherosclerosisIntima of arteriesWhere
AtherosclerosisEndothelial dysfunction to accumulation of foam and fatty streaks/SM migration from PDGF and FGF/ECM deposition to fibrous plaque3 steps
Abdominal aortic aneurismAtherosclerosis/hypertensive smokers >50Assoc w/2 (also/Atherosclerosis causes AAA)
Thoracic aortic aneurismHTN/cystic medial necrosis (Marfan's)/tertiary syphilisAssoc w/3
Aortic dissectionHTN/bicuspid AoV/cystic medial necrosis/inherited connective tissue disordersAssoc w/4
Stable anginaAtherosclerosisAssoc w/
Prinzemetal's variant anginaCoronary artery spasmAssoc w/
Unstable/cresecendo anginaThrombosis with incomplete coronary artery occlusionAssoc w/
MIThrombosis with complete coronary artery occlusion/atherosclerosis/myocyte deathAssoc w/3
Postinfarction fibrinous pericarditisFriction rub1
Postinfarction fibrinous pericarditis1-3d post MIWhen
Dressler's syndromeAutoimmunity/fibrous pericarditis2
Dressler's syndromeSeveral weeks post MIWhen
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MI ECG

Question Answer Column 3
MIST dep progressing to ST elevECG
Stable anginaST depECG
Prinzemetal's variant anginaST elevECG
Unstable/cresecendo anginaST depECG
Transmural infarctST elev/Q waves pathologyECG
Subendocardial infarctST depECG
Anterior wall/LADV1-V4Leads
Anteroseptal/LADV1-V2Leads
Anterolateral/LCXV4-V6Leads
Lateral wall/LCXI/aVLLeads
Inferior wall/RCAII/III/aVFLeads
Fibrinous pericarditisST elev/PR depECG
Serous pericarditisST elev/PR depECG
Suppurative/purulent pericarditisST elev/PR depECG
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Cardiomyopathies

TypeQuestionAnswerMnemonic
DCMEtioAlcohol/wet Beriberi/Coxackie B/Cocain/Chagas/Doxorubicin/Hemochromatosis/Peripartum8 ABCCCDHP
HCMEtio60-70% from autosomal dominant beta myosin heavy chain mutation1
RCMEtioAmyloidosis/hemochromatosis/scleroderma/post radiation fibrosis/Loffler's syndrome5
DCMPERV failure JVD/hepatomegaly/edema4
HCMPEApical impulse1
RCMPERV failure/JVD/hepatomegaly/edema4
DCMPathophysImpaired systolic contraction1
HCMPathophysImpaired diastolic relaxation/LV systolic vigorous/dynamic obstruction1
RCMPathophysImpaired diastolic relaxation/systolic usually normal1
DCMCardiac SizeEnlarged1
HCMCardiac SizeNormal or enlarged1
RCMCardiac SizeUsually normal1
DCMEchoDilated/poor LV contraction2
HCMEchoLV hypertrophy a/symmetric/anterior MV movement/Regurg4
RCMEchoUsually normal systolic contraction/speckled appearance if infiltrative2
DCMTreatLow salt/diuretics/ACE/ARB/Beta blocker5
HCMTreatBeta blocker/CCB (nondihydropyridine)2
DCMShapeEccentric (sarcomeres added in series)2
HCMShapeConcentric (sarcomeres added in parallel)2
DCMMurmurS31
HCMMurmurS4/systolic ejection or mitral regurg/increased on vasalva/standing/decreased on squat5
RCMAssociationLoffler's syndrome (endomyocardial fibrosis w/eosinophilic infiltrate)3
HCMAssociationFriedreich's ataxia (neural tissue degeneration/spinal connections with cerebellum)1
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Misc

Question Answer Column 3
Bacterial endocarditisFever/Roth's spots/Osler's nodes/Murmur/Janeway lesions/Anemia/Nailbed hemorrhage/Emboli8 symptoms FROM JANE
Roth's spotsWhite on retina surrounded by hemorrhage2
Osler's nodesTender/raised/nodules on finger/toe pads4
Janeway lesionsSmall/painless/erythematous lesions on palm or sole4
Bacterial endocarditisS aureus1 acute cause
Bacterial endocarditisViridians1 subacute cause
Tricuspid endocarditisIVDA/S aureus/Pseudomonas/Candida4 causes
Bacterial endocarditisS bovis1 cause w/colon cancer
Bacterial endocarditisS epidermidis1 cause w/prosthetic valves
Nonbacterial endocarditisMalignancy/hypercoagulable state/lupus3 nonbacterial causes
Libman Sacks endocarditisLupusCause
Rheumatic feverFever/Erythema marginatum/Valvular damage/ESR/Red hot joints/Subcutaneous nodules/St Vitus dance or Sydenham's Chorea7 signs/symptoms FEVERSS
Aschoff bodiesGranuloma w/giant cells/in rheumatic fever3
Anitschkow's cellsActivated histiocytes/in rheumatic fever2
Fibrinous pericarditisDressler's syndrome/uremia/radiation3 causes
Serous pericarditisViral/noninfectious inflammatory (RA/SLE)3 causes
Fibrinous pericarditisLoud friction rubDistinct PE sign
PericarditisSharp pain/aggravated in inspiration/relieved by sitting up and forward/friction rub4 signs/symptoms
Pulsus paradoxusSystolic BP drops >10mmHg on inspiration1
Pulsus paradoxusCardiac tamponade/asthma/obstructive sleep apnea/pericarditis/croup5 causes
Syphilitic heart diseaseTertiary syphilis disrupts vasa vasorum of aorta/atrophy leads to dilation of aorta and valve ring2 Pathogenesis
Syphilitic heart diseaseCalcification of aortic root and ascending arch/tree bark appearance2 Appearance
Kussmaul's signIncrease of JVP on inspiration/negative pressure not conducted to heart/decreased flow from JV to heart3 Pathogenesis
Kussmaul's signConstrictive pericarditis/restrictive cardiomyopathies/right sided tumors/cardiac tamponade4 causes
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USMLE Cardiology Pharmacology