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First Aid for the USMLE Step 2 CK (8th Ed.) | Medicine (MD/DO) School Study Aid

Mitral Regurgitation

Holosystolic

Blowing Murmur

Loudest at Apex

Radiates toward Axilla

Louder by Squatting

Hand Grip

Expiration

1 min

Aortic Stenosis

Age-related Calcifications

Bicuspid Aortic Valve

Crescendo-decrescendo Murmur

Systolic Murmur

Ejection Murmur

Ejection Click

Radiates to Carotids and Apex

Pulsus Parvus et Tardus

Syncope

Helmet Cells

2 mins

Tricuspid Regurgitation

Holosystolic

Blowing Murmur

Radiates to Right Sternal Border

Enhanced by Inspiration

1 min

Aortic Regurgitation

Diastolic Murmur

Immediate High-pitched

Blowing Murmur

Wide Pulse Pressure

Water Hammer Pulse

Head Bobbing

Pulsating Nail Bed

Can Cause Austin Flint Murmur

1 min

Mitral Stenosis

Murmur Follows Opening Snap

Late Diastolic Murmur

Enhanced by Expiration

Low-Pitched Rumbling

Dilation of Left Atrium (LA)

Recurrent Attacks of Rheumatic Fever

2 mins

Types of Heart Failure

Left Sided

Pulmonary Congestion

Right Sided

Peripheral Edema

High Output

Unable to Meet Metabolic Needs

1 min

Left Heart Failure Assessment

Pulmonary Congestion

Pink Frothy Sputum

Wheezing or Crackles

Dyspnea with Exertion

Cough

Fatigue

Tachycardia

Weak Peripheral Pulse

S3, S4 Heart Sounds

1 min

Right Heart Failure Assessment

Jugular Venous Distention (JVD)

Peripheral Edema

Hepatosplenomegaly

Nocturia

Weight Gain

Ascites

Fatigue

1 min

Heart Failure Interventions

Echocardiogram

Invasive Hemodynamic Monitoring

High Fowler's Position

Oxygen

Advanced Airway

Diuretics

Beta Blockers

Angiotensin II Receptor Blockers (ARBs)

ACE Inhibitors

Digoxin (Lanoxin)

Pacemaker

2 mins

Hydrochlorothiazide HCTZ

Inhibits Reabsorption NaCl and H₂O

Edema

Mild to Moderate Hypertension

Hypokalemia

Hyponatremia

Dehydration

Hyperglycemia

Gout

Sulfa Allergy

Pregnancy and Breastfeeding

1 min

K+ Sparing Diuretics

CHF and Hypertension

Hypokalemia

Hyperaldosteronism

Collecting Tubule

Spironolactone

Competitive Aldosterone Receptor Antagonist

Amiloride and Triamterene

Block Na+ Channels

Hyperkalemia

Gynecomastia

2 mins

Acetazolamide

Glaucoma

Altitude Sickness

Pseudotumor Cerebri

CHF

Metabolic Alkalosis

Carbonic Anhydrase Inhibitor

Sodium Bicarbonate (NaHCO3) Diuresis

Metabolic Acidosis

Paresthesias

1 min

Loop Diuretics

Thick Ascending Limb of Loop of Henle

Inhibits Na+-K+-2Cl- Symporter

Sulfa Drug

Furosemide

Lasix

Gout

Ototoxicity

Hypocalcemia

Hypokalemia

4 mins

Mannitol (Osmitrol)

Increased Intracranial Pressure (ICP)

Glaucoma

Drug Overdose

Osmotic diuretic

Increased Urine Flow

Dehydration

Anuria

CHF

2 mins

Thiazide Diuretics

Early Distal Tubule

Inhibits Na/Cl Reabsorption

Sulfa Drug

Hyperglycemia

Hyperlipidemia

Hypercalcemia

Hyperuricemia

Hyponatremia

Hypokalemic Metabolic Alkalosis

2 mins

Dilated Cardiomyopathy

Chronic Alcohol Abuse

Doxorubicin Toxicity

Cocaine Use

Wet Beriberi

Hemochromatosis

Coxsackie B

Chagas Disease

Peripartum

Eccentric Hypertrophy

2 mins

Hypertrophic Cardiomyopathy Mechanisms

2/3 Autosomal-Dominant

1/3 Sporadic Type

Mutation in Gene for Sarcomere Protein

Cardiac Myosin Binding Protein C

Asymmetric Septal Hypertrophy

Outflow Tract Obstruction

Diastolic Dysfunction

2 mins

Hypertrophic Cardiomyopathy Signs, Symptoms and Treatment

Sudden Death Of Young Athlete

Heart Failure

Angina

Arrhythmias

Syncope

Harsh Systolic Ejection Murmur

S4 Heart Sound

Beta Blocker

Non-dihydropyridine Calcium Channel Blocker

2 mins

Restrictive Cardiomyopathy

Sarcoidosis

Amyloidosis

Post-radiation Fibrosis

Endocardial Fibroelastosis

Löffler's or Loeffler's Syndrome with Eosinophilia

Hemochromatosis

2 mins

Stable Angina

Chest Pain with Exertion

Relieved within 15 Minutes

ST Depression

Nitroglycerin

Up to 3 Doses q 5 Minutes

Rest

Antiplatelet Medication

CABG

Angioplasty

2 mins

Unstable Angina

Chest Pain with Rest or Exertion

Limits ADLs

> 15 Minutes

Less Likely Relieved by Nitroglycerin

ST Depression

Fatigue

Acute Coronary Syndrome (ACS) Treatment

Emergency Treatment

2 mins

Cardiac Enzyme Evaluation: Creatine Kinase CK-MB

Skeletal or Cardiac Muscle Injury

Onset: 4-8 Hours

Peak: 12-24 Hours

Return to Normal: 2-3 Days

1 min

Cardiac Enzyme Evaluation: Myoglobin

Skeletal or Cardiac Muscle Injury

Onset: 1 - 4 Hours

Peak: 12 Hours

Return to Normal: 24 Hours

Elevation After 24 Hours: Reinfarction

2 mins

Cardiac Enzyme Evaluation: Troponin

Cardiac Muscle Injury

Detection in Blood: 4 Hours

Peak: 24 - 36 Hours

Return to Normal: 5 - 14 Days

Most Specific for Cardiac Muscle

Treat Aggressively

2 mins

Myocardial Infarction Assessment

Substernal Chest Pain

Crushing or Dull Sensation

Arm, Jaw, and Neck

> 20 Minutes

Unrelieved by Nitro

Palpitations

Diaphoresis

Fear of Impending Doom

Nausea and Vomiting

Shortness of Breath

Monitor for Arrhythmias

2 mins

Myocardial Infarction Diagnosis

12 Lead ECG

ST Elevation

Q Wave

T Wave Inversion

Troponin T and I

CK-MB

Early ECG

Cardiac Stress Test

2 mins

Myocardial Infarction Interventions

Morphine

Oxygen

Nitrates

Aspirin

Thrombolytics (tPA)

Cardiac Catheterization

Stent Placement

Angioplasty

Coronary Artery Bypass Grafting (CABG)

Decrease Modifiable Risk Factors

Resuming Activity (Physical, Sexual)

2 mins

Bile Acid Resins

Hyperlipidemia

Bile Acid Reabsorption Prevented

Slight Increase HDL/Triglycerides

Decrease LDL

Colestipol (Colestid)

Cholestyramine

Colesevelam

Cholesterol Gallstones

Decreased Absorption of Fat-soluble Vitamins

Patients Hate It

2 mins

Ezetimibe

Hyperlipidemia

Cholesterol Absorption Blocker

Decreases LDL

Diarrhea

Increased LFT Values

1 min

Fibrates

Hyperlipidemia

Upregulate LPL

Decreases Triglycerides

Slight Increase in HDL

Slight Decrease in LDL

Hepatotoxicity

Cholesterol Gallstones

1 min

Niacin Therapy (Vitamin B3)

Inhibits Lipolysis in Adipose Tissue

Reduces Hepatic VLDL Secretion

Decrease Triglycerides

Decrease LDL

Increase HDL

Flushing

Decreased by Aspirin

Hyperglycemia

Hyperuricemia

2 mins

Statins

Rhabdomyolysis

Hepatotoxicity

HMG-CoA reductase inhibitors

Decrease LDL

Decrease Triglycerides

Increase HDL

2 mins

Vitamin B3 (Niacin)

Derived from Tryptophan

Synthesis Requires Vitamin B6

Constituent of NAD+

Hartnup Disease

Carcinoid Syndrome

Pellagra

Diarrhea

Dermatitis

Dementia

Glossitis

Flushing

2 mins

Hypertension Medications

Diuretics

ACE Inhibitors

Angiotensin Receptor Blockers (ARBs)

Beta Blockers

Dihydropyridine Calcium Channel Blockers

2 mins

Pheochromocytoma

Adrenal Medulla Tumor

Increased Catecholamines

Episodic Hypertension

Diaphoresis

Abdominal or Chest Pain

Surgery

Antihypertensives

Phenoxybenzamine

Metyrosine (Demser)

Do Not Palpate Abdomen

3 mins

Acute Pericarditis Assessment

Pericardial Sac Inflammation

Sharp Chest Pain

Increased with Inspiration

Pain Decreased by Leaning Forward

Pericardial Friction Rub

Diffuse ST-Elevation

T Wave Inversion

Fever

May Be Asymptomatic

Cardiac Tamponade

2 mins

Acute Pericarditis Causes

Idiopathic

Infection

Trauma

Cardiac

Myocardial Infarction

Autoimmune Diseases

Uremia

Tumor

Radiation

2 mins

Acute Pericarditis Interventions

Treat Underlying Disorder

Antibiotics

Colchicine + NSAIDs

Corticosteroids

Place Patient Upright with Head of Bed at 45°

Pericardiocentesis

Pericardial Window

2 mins

Angiotensin Receptor Blockers (ARBs)

-sartan suffix

Hypertension

CHF

Diabetic Nephropathy

Angiotensin II Receptor Blockers

Hyperkalemia

Pregnancy

1 min

Cardiovascular Effects of Beta-Blockers

Cardiac Myocytes and Vasculature

Decrease cAMP

Decreases SA and AV Node Conduction Velocity

Lower Blood Pressure

Decrease O2 Consumption

Decreases Mortality Post-MI

2 mins

Class IV Antiarrhythmics (Ca2+ Channel Blockers)

SVT

Subarachnoid Hemorrhage

Decrease Conduction Velocity

Increase PR Interval and ERP

Verapamil

Diltiazem

Nimodipine

Cardiovascular

Constipation

2 mins

Hydralazine

Reduce Afterload

Severe Hypertension

Safe during Pregnancy

CHF

Increases cGMP

Vasodilates Arterioles

Drug-induced Lupus

Reflex Tachycardia

1 min

Selective Alpha-1 Blockers

"-osin" suffix

Blocks Alpha1 Receptors

Hypertension

Benign Prostatic Hyperplasia (BPH)

Syncope

Orthostatic Hypotension

1 min

Nonselective Alpha-Blockers

Phentolamine

Reversible

Pheochromocytoma (Diagnosis)

Hypertensive Crisis

Phenoxybenzamine

Pheochromocytoma (Treatment)

Orthostatic Hypotension

Reflex Tachycardia

2 mins

Selective Alpha-2 Blockers

Mirtazapine

Depression Treatment

Blocks Alpha2 Receptor

Antagonist at 5-HT receptors

Sedation

Weight gain

Increased Serum Cholesterol

1 min

Nonselective Beta-Blockers

"-olol" Suffix

Nonselective

Propranolol

Timolol

Nadolol

Partial β Agonist

Pindolol

Nonselective β with α Blocking

Carvedilol

Labetalol

2 mins

Selective Beta-1 Blockers

"-olol" Suffix

Beta-1 Selective

Atenolol

Esmolol

Metoprolol

Partial Beta agonists

Acebutolol

1 min

Systemic Effects of Beta-Blockers

Respiratory

Bronchoconstriction

Metabolic

Decreased Insulin

Decreased Glycolysis and Lipolysis

Eye

Reduces Intraocular Pressure

1 min

ACE Inhibitors

-Pril Suffix

Hypertension

CHF

Diabetic Nephropathy

Inhibits ACE

Decreases GFR

Inhibits Constriction of Efferent Arteriole

Increased Bradykinin

Cough

1 min

Abdominal Aortic Aneurysm (AAA) Assessment

Atherosclerosis

Bruit

Pulsation in Abdomen

Abdominal or Lower Back Pain

Tearing Pain

Ultrasound

Rupture

Shock

Surgical Repair

1 min

Cardiac Tamponade

Fluid in the Pericardial Sac

Pericarditis

Decreased Cardiac Output

Beck's Triad

Hypotension

Jugular Venous Distention (JVD)

Distant Heart Sounds

Pulsus Paradoxus

Electrical Alternans

Pericardiocentesis

1 min

Deep Vein Thrombosis (DVT) Characteristics

Virchow's Triad

Venous Stasis

Endothelial Damage

Hypercoagulability

Tenderness

Homan's Sign

Warmth

Redness

Swelling

Asymptomatic

1 min

Deep Vein Thrombosis (DVT) Management

Compression Ultrasound (CUS) with Doppler

D-Dimer

Contrast Venography

IVC Filter

Heparin for Acute Management

Warfarin for Long-term Management

Thrombectomy/Thrombolysis

Stockings

Walking

4 mins

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