Usmle 2

Many have asked me for missing numbers that aren't in theirs, so I'm just going to post it the way I have it..complete (#1-666). Cram-Facts: CARDIOLOGY: 1. Stable angina – chest discomfort, can be felt in back/arms/jaw/abdm, occurs c stress/emotion, relief c rest, dx c stress test. Tx c nitrates, bb, Cabs, heparin, aspirin, if 3 vessels or L main do CABG 2. Unstable angina – unpredictable atrest or abruptly worsening pattern of angina, prolonged duration (>20), dx c ECG (st depression/t inversion) or cath shows CAD, but negative cardiac markers, tx c nitrates, cabs, bb, heparin 3. Variant/Prinzmetal Angina – chest pain at rest, ST elevation (note the 3 causes of ST elevation are MI (inferior (LDA) is II, III AVF; lateral (circumflex a)is I, AVL, V5, V6; anterior is V1-V4),Pericarditis (diffuse, meaning every lead has it), and Variant Angina) with negative markers. Treat with Ca-channel blockers (Cabs) or nitrates. 4. Acute MI – chest discomfort, crushing pain without warning (females and diabetics get atypical chest pain, which is abdm pain, fatigue, neck pain or weakness), prolonged duration (hours), ECG may be abnormal (st elevation or depression), increased markers,tx c MONA, ACEI, heparin, bb, tPA’s if 60, subtract one). >2 risk factors: diet if >160, drugs if >190; 2 or more risk factors: diet if >130, drugs if >160, pt has CHD: diet if >100, drugs if >130. 6. Causes of high output heart failure – severe anemia, thyrotoxicosis, acute beriberi, paget’s dz, large AV fistula 7. Acute Pulmonary edema – tx – 1st upright position and O2, 2nd loops,nitrates, morphine, and 3rd intubate if severe. 8. HOCM – tx – 1st avoid dehydration, 2nd strenuous activity prohibited, 3rd BB, 4th Cab’s, 5th surgical myectomy. Best dx is history (screen family) and physical, then Echo. 9. Restrictive CM – JVD, edema and ascites, dx c echo, tx 1st diuretics/ decrease salt 10. Myocarditis – history or URI (coxsackie) then fever, dyspnea, CP, edema, tachy11. Acute Pericarditis – positional CP, tx c NSAIDS 12. Pericardial effusion – pericardial friction rub, tx c pericardiocentesis 13. Tamponade – becks triad (JVD, muffled heart sounds, pulsus paradoxicus c hypotension), tx c pericardiocentesis 14. Constrictive pericarditis – pericardial knock, kussmaul breathing, CXR shows pericardial calcification, tx c diuretics 15. Acute RF – PECCS(polyarthrtitis, erythema marginatum, carditis, chorea, subQ nodules) in kids 5-15yo due to group A strep. Tx is Abx, bed rest, salicylates, sedatives for chorea, steroids for carditis. 16. Mitral stenosis – most associated c RHD, LA enlargement à hoarseness, dysphagia, and A.fib, diastolic rumble at LV apex, tx c diuretics, coumadin for a.fib, endocarditis prophylaxis, balloon vulvoplasty 17.Mitral regurge – a/w marfans, RHD, myxomatous change, high-pitched holosystolic murmur at left sternal border, tx c diuretics, dilators, endocarditis prophylaxis, mitral valve respacement/repair 18. Aortic regurge – congenital, marfans, trauma, aortitis, high-pitched decrescendo diastolic murmur at left sternal border and/or apex and wide pressure, tx c valve diuretics, dilators, endocarditisprophylaxis, valve replacement (last) 19. Aortic stenosis – calcific in elderly, bucuspid in congenital, angina, dyspnea, syncope, mid-late systolic murmur at base radiating to carotids, tx c replacement (1st step) 20. Endocarditis – if dental procedure give amoxicillin (clindamycin if allergic), if GI/GU procedure give amoxicillin c gentamycin (vanco with gentamycin in allergic) 21. VSD –membranous septum, harsh systolic murmur at L sternal border, spontaneous closure in 30-50%, tx – for small vsd observe, for large vsd and significant shunt, surgical repair and endocarditis prophylaxis. 22. ASD – wide, fixed splitting S2, tx – if small observe, if large surgery 23. PDA – machinery murmur, wide systemic pulse pressure, tx c indomethacin then surgery 24. Aortic Coarctation –...