First Aid for the USMLE Step 1 2011 EXPRESS workbook

page 89

Cardiovascular
Questions
ANATOMY
1.

If the right coronary artery supplies the inferior portion of the left ventricle via the posterior
descending artery, is the heart right or left dominant? (p. 254) _____________________________

2.

A patient has a myocardial infarction that damages the anterior interventricular septum and the
apex. Which coronary artery is occluded? (p. 254) ______________________________________

3.

The posterior descending artery arises from the circumflex artery in __________ (20%/50%/80%)
of cases. Is this heart right or left dominant? (p. 254) ____________________________________

4.

Enlargement of the left atrium can compress the recurrent laryngeal nerve to cause ____________
or the esophageal nerve to cause __________. (p. 254)

PHYSIOLOGY
5.

Cardiac output = heart rate x _______________. (p. 254)

6.

With an increase in stroke volume, the heart would be expected to _______________

(decrease/increase) in preload, to _______________ (decrease/increase) in afterload, and to
_______________ (decrease/increase) in contractility. (p. 255)

7.

A 60-year-old man mistakenly receives triple the amount of maintenance intravenous fluids for 24
hours. Would his preload increase or decrease? (p. 255) _________________________________

8.

The cardiac ejection fraction is normally greater than what percentage of the total end-diastolic
volume? (p. 255) ________________________________________________________________

9.

Which blood vessels account for most of total peripheral resistance? (p. 256) _________________

10.

Which parameter does the viscosity of blood mostly depend on? (p. 256) ____________________

11.

A 23-year-old man has significant blood loss after a motor vehicle accident. A decrease in blood
volume leads to _______________ (increased/decreased) right atrial pressure and to
_______________ (increased/decreased) cardiac output. (p. 256)

12.

A 76-year-old man with congestive heart failure is given digoxin as a positive inotrope. An increase
in inotropy leads to _______________ (increased/decreased) cardiac output and to
_______________ (increased/decreased) right atrial pressure. (p. 256)

13.

A 10-year-old boy presents with dehydration following acute diarrhea. He receives 2 L of normal
saline. An increase in blood volume leads to _______________ (increased/decreased) right atrial
pressure and to _______________ (increased/decreased) cardiac output. (p. 256)

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14.

On auscultation of a patient with an atrial septal defect during inspiration, does the time between
pulmonic and aortic valvular closure increase, decrease, or stay the same? (p. 257)

15.

During physical examination, what diagnostic sign might be observed in the neck of a patient with
right heart failure? (p. 257) _________________________________________________________

16.

In normal splitting of the S2 heart sound, the pulmonic valve closes later during inspiration due to
_______________ (increased/decreased) blood flow in lungs, and the aortic valve closes earlier
during inspiration due to _______________ (increased/decreased) venous return to the left heart.
(p. 257)

17.

Fill in the blanks A-D with the correct valvular event that occurs at each stage of the left ventricular
cardiac cycle. Then fill in the blanks 1-5 with the correct phase of the left ventricular cardiac cycle.
(p. 257)

A. ____________________________

1. ____________________________

B. ____________________________

2. ____________________________

C. ____________________________

3. ____________________________

D. ____________________________

4. ____________________________
5. ____________________________

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18.

page 91

Fill in the blanks A-N with the correct heart sound, jugular venous pulse waveform, or ECG
waveform. Specify the cause of each. (p. 257)

A. ____________________________

H. ____________________________

B. ____________________________

I. _____________________________

C. ____________________________

J. _____________________________

D. ____________________________

K. _____________________________

E. ___________________________

L. _____________________________

F. ____________________________

M. _____________________________

G. ____________________________

N. _____________________________

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19.

First Aid for the USMLE Step 1 2011 EXPRESS workbook

Fill in the blanks A-E with the correct auscultation site. (p. 258)

A. ____________________________

D. ______________________________

B. ____________________________

E. ____________________________

C. ____________________________
20.

Name three pathological processes that can cause mitral regurgitation. (p. 259) _______________
______________________________________________________________________________

21.

Name three pathological processes that can cause aortic regurgitation. (p. 259) _______________
______________________________________________________________________________

22.

What is meant by pulsus parvus et tardus? (p. 259) ____________________________________

______________________________________________________________________________

23.

Which murmur is often caused by age-related calcification? (p. 259) ________________________

24.

How is cardiac myocyte physiology different from that in skeletal muscle? (p. 260) _____________
______________________________________________________________________________

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25.

page 93

Fill in the blanks (A-E) with the correct phase of the ventricular action potential and the ionic current
responsible for each phase. (p. 260)

A. ____________________________

D. ______________________________

B. ____________________________

E. ____________________________

C. ____________________________
26.

Fill in the blanks A-C with the correct phase of the pacemaker action potential and the ionic current
responsible for each phase. (p. 261)

A. ____________________________

C. ______________________________

B. _____________________________
27.

As compared with the myocardial action potential, which phases are absent from the pacemaker
potential? (p. 261) _______________________________________________________________

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28.

First Aid for the USMLE Step 1 2011 EXPRESS workbook

What is the physiologic benefit of atrioventricular delay? (p. 262) ___________________________

______________________________________________________________________________

29.

What are the most dangerous sequelae of torsades de pointes? (p. 262) _____________________
______________________________________________________________________________

30.

Patients with Wolff-Parkinson-White syndrome have a higher risk for which type of arrhythmia? (p.
263) __________________________________________________________________________

31.

A 67-year-old man has an irregularly irregular ECG tracing during a routine visit to his doctor.
Which drug can decrease his risk of stroke? Which drug can control his heart rate? (pp. 263, 285286) __________________________________________________________________________

32.

The ECG tracing of a 73-year-old woman shows a "sawtooth" pattern. Which three classes of
drugs could be given to treat her condition? (pp. 263, 284-285) ____________________________

33.

Progressive lengthening of the PR interval take place in _______________ (Mobitz type I/Mobitz
type II/both Mobitz type I and type II) heart block. (p. 264) ________________________________

34.

An ECG shows no identifiable waves. What is the most likely diagnosis? (p. 264) ______________

35.

A 65-year-old man presents with an ECG tracing that displays P waves and QRS complexes that
occur independently of each other. Which therapeutic intervention would be most appropriate? (p.
264) __________________________________________________________________________

36.

Which infectious disease can cause third-degree heart block? (p. 264) ______________________

37.

By what mechanism does activation of the renin-angiotensin system cause an increase in mean
arterial pressure? (p. 265) _________________________________________________________

38.

By what mechanism does activation of the sympathetic nervous system cause an increase in mean
arterial pressure? (p. 265) _________________________________________________________

39.

By what mechanism does activation of 1-receptors cause an increase in cardiac output? (p. 265) _
______________________________________________________________________________

40.

By what mechanism does activation of 1-receptors cause an increase in mean arterial pressure?
(p. 265) ________________________________________________________________________

41.

What chemical changes of blood elicit a response from peripheral chemoreceptors? How do central
chemoreceptors differ? (p. 265) _____________________________________________________
______________________________________________________________________________

42.

A 25-year-old athlete begins training for the Olympics. As she runs her standard 3 miles, is the
increased oxygen demand of the heart met by increased coronary blood flow or by increased
extraction of oxygen? (p. 265) ______________________________________________________

43.

In the lungs, what is the physiologic advantage of vasoconstriction in response to hypoxia? (p. 266)
______________________________________________________________________________

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44.

page 95

An 80-year-old man with a history of right-sided heart failure presents with bilateral ankle edema. In
terms of capillary fluid exchange, what is the mechanism by which his edema developed? (p. 266)
______________________________________________________________________________

45.

A 55-year-old man with longstanding alcoholic cirrhosis presents with bilateral pedal edema and
ascites. In terms of capillary fluid exchange, what is the mechanism by which his edema
developed? (p. 266) ______________________________________________________________

46.

A 43-year-old woman presents with bilateral pitting leg edema and laboratory results remarkable
for high low-density lipoprotein, low albumin, and proteinuria (likely nephrotic syndrome). In terms
of capillary fluid exchange, what is the mechanism by which her edema developed? (p. 266) _____
______________________________________________________________________________

47.

A 50-year-old Ethiopian man presents with severe bilateral leg and scrotal edema due to
elephantiasis (lymphatic obstruction caused by filarial nematodes). In terms of capillary fluid
exchange, what is the mechanism by which his edema developed? (p. 266) __________________
______________________________________________________________________________

48.

Describe the pressures in the left ventricle and aorta for a patient with aortic stenosis. (p. 266) ___
______________________________________________________________________________

PATHOLOGY
49.

How do neonates with tricuspid atresia remain viable given their severely compromised circulation?
(p. 267) ________________________________________________________________________

50.

What are the four clinical features of tetralogy of Fallot? (p. 267) ___________________________
______________________________________________________________________________

51.

What must be present for a fetus with D-transposition of great vessels to remain viable? (p. 268) __
______________________________________________________________________________

52.

What physical exam findings are associated with adult-type coarctation of the aorta? (p. 268) ____
______________________________________________________________________________

53.

Describe the murmur of patent ductus arteriosus. (p. 268) ________________________________

54.

Which three cardiac defects are associated with Down syndrome? (p. 269) ___________________
______________________________________________________________________________

55.

List the five general risk factors for hypertension. (p. 269) _________________________________
______________________________________________________________________________

56.

An 80-year-old veteran is told by his physician that he has calcification of his radial arteries and
that the condition is relatively benign. What disease does he have? (p. 269) __________________
______________________________________________________________________________

57.

What are the six common complications of atherosclerosis? (p. 270) ________________________
______________________________________________________________________________

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58.

A patient presents to the emergency department with tearing chest pain radiating to the back and
dies soon after presentation. What vascular pathology would most likely be seen at autopsy? What
would most likely be seen on x-ray of the chest? (p. 270) _________________________________

59.

At what point is ischemic heart disease given the term "myocardial infarction" rather than "unstable
angina"? (p. 270) ________________________________________________________________

60.

List the nine common symptoms of myocardial infarction. (p. 271) __________________________
______________________________________________________________________________

61.

Describe the time frame for events after a myocardial infarction. (p. 271)
A.

Coagulative necrosis becomes apparent _________________________________________

B.

Contraction bands become apparent ____________________________________________

C.

Tissue around infarct shows acute inflammation ___________________________________

D.

Hyperemia develops _________________________________________________________

E.

Granulation tissue appears ____________________________________________________

F.

Contracted scar complete _____________________________________________________

62

After a myocardial infarction, when is the risk for arrhythmia greatest? The risk for free wall rupture
or interventricular septal rupture? The risk for ventricular aneurysm? (p. 271)
______________________________________________________________________________

63.

Six days after having a myocardial infarction, a patient presents with a new-onset murmur. Which
type of murmur is the most likely? (pp. 259, 271) _______________________________________

64.

ST-segment elevation on an ECG indicates _______________ (subendocardial/transmural)

infarction of the myocardium, while ST-segment depression indicates _______________
(subendocardial/transmural) infarction. (p. 272)

65.

Which ECG leads are best for diagnosing an infarct of the LAD? (p. 272) ____________________
______________________________________________________________________________

66.

A 16-year-old boy presents for a school physical. Physical examination reveals a 2/6 systolic
murmur at the left sternal border. Upon questioning, he mentions that he has had several fainting
episodes. His father, a former Italian soccer player, had similar episodes and died suddenly at the
age of 25 years. What is this patient's most likely diagnosis? What would a cardiac biopsy
specimen reveal? (p. 273) _________________________________________________________
______________________________________________________________________________

67.

In congestive heart failure, _______________ (increased/decreased) cardiac output leads to

_______________ (increased decreased) activity of renin-angiotensin-aldosterone, which leads to
_______________ (increased/decreased) systemic venous pressure, and ultimately the physical
finding of _______________ (peripheral/pulmonary) edema. (p. 274)

68.

In congestive heart failure, _______________ (increased/decreased) left ventricular contractility

leads to _______________ (increased/decreased) pulmonary venous pressure, ultimately leading
to _______________ (peripheral/pulmonary) edema. (p. 274)

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69.

page 97

With respect bacterial endocarditis, what symptoms and signs are represented by the mnemonic
FROM JANE? (p. 275) ____________________________________________________________
______________________________________________________________________________

70.

What type of endocarditis occurs in patients with lupus? (p. 275) ___________________________

71.

Rheumatic fever is caused by infection with which organism? (p. 276) _______________________

72.

List the components of the FEVERSS mnemonic for rheumatic heart disease. (p. 276) __________
______________________________________________________________________________

73.

What six physical findings are commonly associated with cardiac tamponade? (p. 276) _________
______________________________________________________________________________

74.

A 70-year-old former prostitute presents with chest pain radiating to the back and worsening
shortness of breath on exertion. Her cardiac enzymes are negative and she has no ST changes on
ECG. An echocardiogram shows aortic regurgitation and a dilated aortic root. Laboratory tests are
significant for a positive rapid plasma reagin. What is the most likely cause of her pain and
shortness of breath? (p. 276) _______________________________________________________

75.

Which cardiac tumor may present with multiple syncopal episodes? (p. 277) __________________

76.

A 60-year-old woman with varicose veins experiences chest pain and shortness of breath in the
hospital after left knee replacement surgery. A CT angiogram shows multiple pulmonary emboli.
What is the most likely cause of her pulmonary emboli? (p. 277) ___________________________

77.

Raynaud's disease may be associated with which rheumatologic diseases? (p. 277) ___________
______________________________________________________________________________

78.

List eight signs or symptoms of Wegener's granulomatosis. (p. 277) ________________________

______________________________________________________________________________

79.

In microscopic polyangiitis, the patient will test positively for __________ (p-ANCA/c-ANCA) in the
serum. In Wegener's granulomatosis, the patient will test positively for __________ (p-ANCA/cANCA). (p. 277)

80.

Patients with Churg-Strauss syndrome usually present with which signs or symptoms? (p. 277) ___
______________________________________________________________________________

81.

A patient is diagnosed with Sturge-Weber disease. What neurologic manifestation are most likely to
be seen? (p. 277) ________________________________________________________________

82.

A 7-year-old boy has a viral urinary tract infection followed by worsening abdominal and joint pain.
Purpura develops on his legs. What is the most likely diagnosis? (p. 278) ____________________

83.

Which four clinical findings are associated with Buerger's disease? (p. 278) __________________
______________________________________________________________________________

84.

A 7-year-old Japanese child has 1 week of fever, palpable lymph nodes, erythema of the
conjunctiva and tongue, and desquamation of the palms of the hands. What is the most likely
diagnosis? What is the preferred treatment? (p. 278) ____________________________________

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85.

Which infectious disease is strongly associated with polyarteritis nodosa? (p. 278) _____________

86.

Which arteriographic findings are seen with polyarteritis nodosa? (p. 278) ____________________
______________________________________________________________________________

87.

A 75-year-old woman presents with new-onset right jaw pain and headache at the right temple.
What is the most likely diagnosis? (p. 279) ____________________________________________

88.

Temporal arteritis is associated with what laboratory finding? (p. 279) _______________________

89.

What is a strawberry hemangioma? (p. 279) ___________________________________________

90.

What is a cherry hemangioma? (p. 279) ______________________________________________

91.

What is Kaposis sarcoma? (p. 279) __________________________________________________

PHARMACOLOGY
92.

Why are ACE inhibitors especially important for patients with diabetes mellitus? (p. 280) ________
______________________________________________________________________________

93.

What two agents are first-line therapy for hypertension in pregnancy? (p. 280) ________________

94.

A patient is started on antihypertensive therapy. One week later he returns, complaining of swollen
ankles and flushed skin. Which class of medication was he likely prescribed? (p. 280) __________

95.

List four adverse effects of nitroglycerin. (p. 280) _______________________________________

96.

What is an adverse effect of diazoxide? (p. 280) ________________________________________

97.

What is the mechanism by which medications can reduce angina? (p. 281) ___________________
______________________________________________________________________________

98.

A 50-year-old man with hypercholesterolemia is deficient in vitamins A, D, E, and K. He also

complains of gastrointestinal discomfort since starting a lipid-lowering agent. Which lipid-lowering
agent is the most likely cause? (p. 282) _______________________________________________

99.

A patient who recently started taking lovastatin presents with diffuse muscle pain and weakness.
Which laboratory test should be ordered? (p. 282) ______________________________________

100. Digoxin inhibits which mechanism of transport in the cell membrane? (p. 283) _________________
101. List six ECG findings characteristic of digoxin toxicity. (p. 283) _____________________________
______________________________________________________________________________
102. What are the mechanisms of action of cardiac glycosides? (p. 283) _________________________
______________________________________________________________________________
103. Facial rash and joint pain develop in a patient who is taking procainamide for an arrhythmia.
Antihistone antibodies are present in her serum. What is the most likely diagnosis? (p. 284) ______
______________________________________________________________________________
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page 99

104. Quinidine causes symptoms of headache and tinnitus, which collectively are known as
_______________. (p. 284)
105. Fill in the blanks A-F with the correct subclass of class I antiarrhythmics, and give examples of
each subclass. (p. 284)

(Adapted, with permission, from Katzung BG, Trevor AJ. Pharmacology:

Examination & Board Review, 5th ed. New York: McGraw-Hill, 2011: 284.)

A. ____________________________

D. ______________________________

B. ____________________________

E. ______________________________

C. ____________________________

F. ______________________________

106. What are the toxicities of -blockers? (p. 285) __________________________________________

______________________________________________________________________________
107. What is the mechanism of action of -blockers? (p. 285) _________________________________
______________________________________________________________________________
108. What three types of testing must be performed periodically for patients who take amiodarone? (p.
285) __________________________________________________________________________
109. What is a potentially fatal adverse effect of ibutilide? (p. 285) ______________________________
110. What are the adverse effects of calcium channel blockers? (p. 286) ________________________
______________________________________________________________________________
111. What do calcium channel blockers work? (p. 286) _______________________________________
______________________________________________________________________________

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112. Which antiarrhythmic is a first-line drug for diagnosing and abolishing supraventricular tachycardia?
(p. 286) ________________________________________________________________________
113. Which ion is infused to treat torsades de pointes and digoxin toxicity? (p. 286) ________________
114. Name three toxicities of the antiarrhythmic drug adenosine. (p. 286) ________________________

Answers
ANATOMY
1.

Right dominant.

2.

The left anterior descending artery.

3.

20%; left dominant.

4.

Hoarseness; dysphagia.

PHYSIOLOGY
5.

Stroke volume.

6.

Increase; decrease; increase.

7.

Increase.

8.

55%.

9.

Arterioles.

10.

Hematocrit.

11.

Decreased; decreased.

12.

Increased; increased.

13.

Increased; increased.

14.

Stays the same. (Because pressures can equalize across the atrial wall, there is no change in
splitting during inspiration.)

15.

Elevated jugular venous pressure.

16.

Increased; decreased.

17.

A = Aortic valve closes; B = aortic valve opens; C = mitral valve closes; D = mitral valve opens; 1 =
isovolumetric contraction; 2 = systolic ejection; 3 = isovolumetric relaxation; 4 = rapid filling; 5 =
reduced filling.

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page 101

18.

A = S4; atrial kick, caused by high atrial pressures and associated with ventricular hypertrophy and
a stiff ventricle. B = S1; mitral and tricuspid valve closure. C = S2; aortic and pulmonary valve
closure. D = S3; associated with increased filling pressures, and more common in dilated
ventricles. E = a wave; atrial contraction. F = c wave; RV contraction (closed tricuspid valve bulging
into right atrium). G = x wave; first down slope of the jugular venous pulse. H = v wave; increased
right atrial pressure due to filling against a closed tricuspid valve. I = y wave; second down slope of
the jugular venous pulse. J = P wave; atrial depolarization. K = QRS complex; ventricular
depolarization. L = QRS complex; ventricular depolarization. M = QRS complex; ventricular
depolarization. N = T wave; ventricular repolarization.

19.

A = Aortic area; B = left sternal border; C = pulmonic area; D = tricuspid area; E = mitral area.

20.

Ischemic heart disease, mitral valve prolapse, and left ventricular dilatation.

21.

Aortic root dilatation, bicuspid aortic valve, and rheumatic fever.

22.

Pulses are weak, and the strongest part of the peripheral pulse occurs late after the S1 is heard;
this is because it takes a long time for blood to cross the stenotic aortic valve to fill the vessels.

23.

Aortic stenosis.

24.

The cardiac muscle action potential has a plateau due to calcium ion influx; cardiac nodal cells
display automaticity by spontaneously depolarizing; and cardiac myocytes are electrically coupled
via gap junctions.

25.

A = Phase 0; Na current. B = Phase 1; K current. C = Phase 2; Ca

+
+
K current. E = Phase 4; K current.

26.

A = Phase 4; Na current. B = Phase 0; Ca

27.

Phases 1 and 2.

28.

AV delay allows time for ventricular filling.

29.

Ventricular fibrillation and death.

30.

Supraventricular tachycardia.

31.

Warfarin prevents thromboembolism. -blockers and calcium channel blockers control heart rate.

32.

Class IA, IC, and III antiarrhythmics.

33.

Type I. Type I involves progressive lengthening followed by a dropped beat. In type II, there are
dropped beats without progressive lengthening.

34.

Ventricular fibrillation.

35.

An implantable pacemaker.

36.

Lyme disease.

37.

By production of angiotensin II and aldosterone, which causes increased total peripheral resistance
and increased blood volume, respectively.

2+

2+

and K current. D = Phase 3;

current. C = Phase 3; K current.

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38.

By activation of 1 and 1 receptors, which causes an increase in cardiac output and total
peripheral resistance, respectively.

39.

Activation of 1 receptors causes an increase in heart rate and contractility.

40.

1 receptor activation causes venoconstriction (which increases venous return and thus cardiac
output) and arteriolar vasoconstriction (which causes an increase in total peripheral resistance).

41.

Low PO2 (<60 mmHg), high PCO2, and low pH of blood; central chemoreceptors are not sensitive
to oxygen.

42.

Increased coronary blood flow (the heart always operates with maximal oxygen extraction).

43.

This mechanism allows for only well-ventilated areas to remain perfused, optimizing gas exchange.

44.

Heart failure results in increased capillary pressure, which causes fluid to move out of the
capillaries and into the interstitial space.

45.

Liver failure results in decreased plasma proteins, which decreases plasma colloid oncotic
pressure, and in turn causes fluid to move out of the capillaries and into the interstitial space.

46.

Nephrotic syndrome results in proteinuria and subsequent hypoalbuminemia, which decreases

plasma colloid oncotic pressure, and in turn causes fluid to move out of the capillaries and into the
interstitial space.

47.

Lymphatic obstruction causes increased interstitial fluid colloid osmotic pressure, which causes
fluid to move out of the capillaries and into the interstitial space.

48.

In a patient with aortic stenosis, the pressure in the left ventricle is higher than that in the aorta; the
ventricle squeezes blood past a stenotic valve. Thus, the pressure before the valve (the ventricle)
is higher than the pressure after the valve (in the aorta).

PATHOLOGY
49.

To maintain viability, both an ASD and a VSD are required for babies with tricuspid atresia.

50.

Pulmonary stenosis, Right ventricular hypertrophy, Overriding aorta, and Ventricular septal defect.
(Remember: PROVe)

51.

A shunt must be present, which allows adequate mixing of pulmonary and systemic blood (i.e.,
VSD, ASD, or patent foramen ovale).

52.

Notched ribs due to increased collateral circulation, hypertension in the upper extremities, and
weak pulses in the lower extremities.

53.

Continuous "machine-like" murmur.

54.

ASD, VSD, and atrioventricular septal defect.

55.

Increased age, obesity, diabetes, smoking, and genetics.

56.

Mnckeberg arteriosclerosis.

57.

Infarcts, peripheral vascular disease, thrombi, emboli, aneurysms, and ischemia.

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page 103

58.

Longitudinal intraluminal tear forming a false lumen, indicative of aortic dissection. Mediastinal
widening is suggestive of aortic dissection.

59.

When acute thrombosis due to coronary artery atherosclerosis results in myocyte necrosis.

60.

Severe retrosternal pain, nausea, vomiting, pain in the left arm, diaphoresis, jaw pain, shortness of
breath, fatigue, and adrenergic symptoms.

61.

A = 4 hours; B = 12-24 hours; C = 2-4 days; D = 5-10 days; E = 5-10 days; F = 7 weeks.

62.

First 4 days; 5-10 days; 7 weeks.

63.

Holosystolic murmur of mitral regurgitation, best heard over the apex of the heart.

64.

Transmural infarct; subendocardial infarct.

65.

Leads V1-V4.

66.

Hypertrophic cardiomyopathy; biopsy shows disoriented, tangled, hypertrophied myocardial fibers.

67.

Decreased; increased; increased; peripheral edema.

68.

Decreased; increased; pulmonary edema.

69.

FROM JANE = Fever, Roth spots, Osler's nodes, Murmur, Janeway lesions, Anemia, Nail-bed
hemorrhages, and Emboli.

70.

Libman-Sacks endocarditis. (Remember: SLE causes LSE.)

71.

Group A -hemolytic streptococci.

72.

FEVERSS = Fever, Erythema marginatum, Valvular damage (vegetation and fibrosis), ESR
increase, Red-hot joints (migratory polyarthritis), Subcutaneous nodules (Aschoff bodies), and St.
Vitus' dance (chorea).

73.

Hypotension, jugular venous distention, distant heart sounds, increased heart rate, and pulsus
paradoxus.

74.

Ascending aortic aneurysm due to tertiary syphilis.

75.

Myxoma; syncope can occur with ball-valve obstruction of the mitral valve.

76.

Thromboembolism from stasis in a deep vein of the leg. Despite her varicose veins,
thromboembolism from superficial veins is very rare.

77.

Mixed connective tissue disease, SLE, and CREST syndrome.

78.

Perforation of the nasal septum, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea,
hemoptysis, and hematuria.

79.

p-ANCA; c-ANCA.

80.

Asthma, skin lesions, sinusitis, and peripheral neuropathy (e.g., wrist/foot drop).

81.

Leptomeningeal angiomatosis (intracerebral arteriovenous malformations) and seizures.

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82.

Henoch-Schnlein purpura.

83.

Intermittent claudication, superficial nodular phlebitis, Raynaud's phenomenon, and severe pain in
the digits.

84.

Kawasaki disease; treat with intravenous immunoglobulin and aspirin.

85.

Hepatitis B.

86.

Multiple aneurysms and constrictions.

87.

Temporal arteritis.

88.

Elevated erythrocyte sedimentation rate.

89.

A benign capillary hemangioma of infancy, which initially grows and then spontaneously regresses.

90.

A benign capillary hemangioma of the elderly; they become more numerous with age.

91.

An endothelial malignancy of the skin associated with human herpes virus type 8 and AIDS.

PHARMACOLOGY
92.

ACE inhibitors can delay progression to diabetic nephropathy.

93.

Hydralazine with methyldopa.

94.

Calcium channel blockers.

95.

Reflex tachycardia, hypotension, flushing, and headache.

96.

Hyperglycemia, secondary to a reduction in insulin release.

97.

Reduction of myocardial oxygen consumption by decreasing one or more of the determinants of

oxygen consumption: end diastolic volume, blood pressure, heart rate, contractility, and ejection
time.

98.

Bile acid resin.

99.

Creatine kinase to test for rhabdomyolysis.

+

100. Na /K /ATPase.
101. Prolonged PR interval, shortened QT interval, scooping, T-wave inversion, arrhythmia, and signs of
hyperkalemia.
102. They increase intracellular calcium (thereby acting as a positive inotrope) and stimulate the vagus
nerve.
103. Reversible SLE-like syndrome.
104. Cinchonism (which can occur with all quinine derivatives).

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page 105

105. A = all class I drugs; B = class IA (quinidine procainamide, disopyramide); C = class IB (lidocaine,
methilextine, tocainide); D = class IC (flecainide, encainide, propafenone); E = all class I drugs; F =
all class I drugs.
106. Impotence, asthma exacerbation, cardiovascular effects (bradycardia, AV block, and CHF), and
CNS effects (sedation and sleep alterations).
107. -Blockers decrease cAMP and calcium ion current, and suppress abnormal pacemakers by
decreasing the slope of phase 4 of the pacemaker action potential.
108. Pulmonary function, liver function, and thyroid function.
109. Torsades de pointes.
110. Constipation, flushing, edema, and cardiovascular effects (CHF, AV block, sinus node depression).
111. They are used to prevent nodal arrhythmias, such as supraventricular tachycardia.
112. Adenosine.
113. Magnesium.
114. Flushing, hypotension, and chest pain.

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page 106

First Aid for the USMLE Step 1 2011 EXPRESS workbook

Notes
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