UWorld Step 2 CK Notes - 2015

7/23/2019 UWorld Step 2 CK Notes - 2015

http://slidepdf.com/reader/full/uworld-step-2-ck-notes-2015 1/4

CARDIOLOGY

Qid 3635Recent Immigrant from China Endemic Areas (Africa, India &China)

CC:• Fatigue and Dyspnea on Exertion = decrease Cardiac Output

• !domina" distention for the Past 2 mnths =

!epatsp"enme#a"$#$x: Farmer his entire "ife%#: &n"'E: (%i#ns f enus O'er"ad)

• 'eda" Edema

• Increase admina" #irth ith free *uid + Ascities

• E"e(ated )%' &ithout Inspiratory dec"ine = -%%.A-L %IG/

Chest uscu"ation = decrease heart sounds * ccentuated sounddirect"y after the #+ in Ear"y Diasto"e = 0/OC1 O %3 GALLOPC,R = ring of ca"ci-cation around the heart Pericardia" irsis )%' .racing: 'rominent , * / DE#CE0.#Q: 1ost "i2e"y cause of symptoms 45 666Dx: Cnstricti'e Pericarditis

In -%, .CC f Cnstricti'e Pericarditis inc"ude7

• Idiopathic or %ira" 'ericarditis 4789

• Radiation .herapy 43789

• Cardiac #urgery 4;789

• Connecti(e .issue Disorders

.achypnea * Dyspnea occurs &hen C< !ecomes compromised

Qid: 6+Rena" Arter$ %tensis 's8 Admina" Artic Aner$sm

• Di>erenia" in ?' !@& the 'xAs rm B secondary to #u!c"a(ian

therosc"erotic do Artic Dissectin = reater RIG!4 AR. 5P 9

%.OI/G !:

%Y%4OLIC 5R-I4o RA% + Greater LE4 AR. 5P

%Y%4OLIC;DIA%4OLIC 5R-I4

QID: 36Adensine inhiits L;t$pe Ca channe"s decreasing conduction(e"ocity in the % node



Qid: 5G+/rma" <u#u#"ar enus Pressure ( =3 cm a'e the %terna"An#"e) = suggest 0H Centra" %enous 'ressure = ma2es Right * Heft $FHess Hi2e"y

'eriphera" Edema due to %enous InsuJciency:• Heg discomfort 'ain or #&e""ing

o Korsens: 'ro"onged #tanding

o Impro(es: fter Ka"2ing or Him! E"e(ation

• Depending on the se(erity

o %enous Di"ation 4.e"angiectasia %aricose %eins9

o 'itting Edema

o #2in disco"oration

o Dermatitis@Ecema

o Hipodermatosc"erosis

o #2in L"ceration B 'x 1edia" n2"e L"cer

• Initia" .x of Chronic %enous D:

o re>uent Le# E"e'atin

o E?erciseo Cmpressin %tc@in#

'x 0<. responding to Initia" Conser(ati(e

measurement reMuire E/O-% D-PLE:-L4RA%O-/D to Identify %enous ReNux orInsuJciency

• 'x &@ 'ersistent symptoms * DocumentedReNux shou"d !e referred for E/DOE/O-%

A5LA4IO/

Qid: +;53Artic %tensis7

• E?ertina" %$mptms Chest 'ain Dyspnea Diiness *

#yncope

• De"ayed * Diminished Carotid 'u"se 4'LH#L# 'R%L# E.

.RDL#9

• #ing"e and #oft #+ audi!"e #

• $arsh EOection 4CrescendoPDecrescendo9 #ysto"ic 1urmur in

#econd Right Intercosta" #pace &ith Radiation to CarotidsEchcardi#ram shou"d !e o!tained in HH 'x &ith #/0C<'E dueto suspected structura" $eart D

Qid: 75Lar#e %D Fai"ure to .hri(e Easy Fatiga!i"ity * $eart Fai"ure

Pans$st"ic .urmur Ludest at Lt Ler %terna" 5rder

(LL%5)



o DD?7 4etra"#$ f a""t frm Pu"mnic %tensis !arsh, %$st"ic Eectin .urmur 'er Lt -pper

%terna" 5rder (L-%5)

• Diasto"ic Rum!"e at the pex due to increased No& across the

1itra" %a"(e

• #ma"" %#D symptomatic• Harge %#D Quieter due to HE## .LR?LHE0CE through a Harge

<ri-ceo #igni-cant Left t Ri#ht %huntin#

Dx: Echcardi#ram E(a"uate the "ocation * sie of the defectDDx: Eisenmen#er : Cyanosis * Dyspnea secondary to Ri#ht tLeft %huntin#

Qid: G+Periphera" Arter$ DB (PAD)7

C"audicatin e?7 Crampin# Pain in Rt thi#h after a"@in# 2

"c@s (Limp)

C"audicatin r Pain in Le# .usc"e ru#ht n $ apredica"e amunt f a"@in# (r ther frm f e?ercise)and re"ie'ed $ rest8

• Intermittent C"audicatin Diminished 'u"ses 4;9 n2"e

?rachia" Index

• Intermittent C"audicatin = #trong 'redictor of Future Ris2 of

Cardio(ascu"ar 1or!idity * 1orta"ityo +78 5 year ris2 of 0onfata" 1yocardia" Infarction * #tro2e

o ;58 to 378 5 year ris2 of death due to Cardio(ascu"arcauses

Qid: 3;%$ncpa" Episde7

• 1ost pro!a!"e exp"anation of Episode is:

• ARR!Y4!.IA7o #udden <nset of #yncope &ithout &arning sings

o 'resence of #tructura" $eart D 4'ostPinfarction #car *

'ro!a!"e 1itra" Regurgitation = mi"d ho"osysto"ic pica"1urmur9

o FreMuent Ectopic ?eats

o .hiaide diuretic = E"ectr"$te disturance predisposing

to %entricu"ar rrhythmia

A%OAGAL %Y/COPE7o Common Fainting #pe""

o 'recipitated !y Emotiona" Reaction

o 'receded !y: 'resyncopa" Diiness Kea2ness * 0ausea



A-4O/O.IC DY%-/C4IO/ OR DR-G;I/D-CED PO%4-RAL!YPO4E/%IO/7

o <rthostatic in 0ature

o <ccurs on #tanding &hen !"ood is redistri!uted

%EI-RE7

o $x of #eiure

'remature %entricu"ar Comp"exes 4'%Cs9:

• Kide QR# 4;+7 msec9

• ?iarre morpho"ogy

• Compensatory pause

• 1C in 'x &ith Cardiac 'atho"ogy fo""o&ing 1I

• 1u"tip"e '%Cs may indicate a &orse prognosis

• .x &ith antiarrhythmic medications has actua""y !een sho&n to&orse sur(i(a" <?#ER%.I<0SS

o 0o .x indicated if 'x is symptomatico ?etaP!"oc2ers are D<C for #ymptomatic 'x

Documents

UWorld Step 2 CK Notes - 2015