MedSchool Boards

Episode 7: Structural and Infectious Diseases & SyncopePericardial Disease: Describe Acute Pericarditis (pleuritic chest pain that improves when leaning forward, diffuse ST elevations on ECG) and Constrictive Pericarditis (pericardial knock). Detail Pericardial Effusions (water bottle heart on CXR, electrical alternans) and Cardiac Tamponade (Beck triad: hypotension, muffled heart sounds, JVD).Endocarditis: Contrast infective endocarditis (Staphylococcus aureus, Viridans streptococci, HACEK organisms) with non-bacterial thrombotic endocarditis. Discuss physical exam clues like Osler nodes, Janeway lesions, and Roth spots, alongside the Duke Diagnostic Criteria.Valvular Heart Disease & Syncope: Review the diagnostic criteria and treatment thresholds for severe Aortic Stenosis, Aortic Regurgitation, Mitral Stenosis, Mitral Regurgitation, and Tricuspid Regurgitation. Conclude with an overview of Syncope, differentiating neurally mediated (vasovagal, carotid sinus), orthostatic, and cardiac etiologies.

Episode 6: Blood Pressure and Vascular PathologyHypertension: Discuss the threshold for Stage 1 hypertension, the signs of end-organ damage (retinopathy, nephrosclerosis), and the first-line pharmacotherapy options (thiazides, ACEI/ARBs, CCBs). Differentiate primary hypertension from secondary causes using the CODER mnemonic, and distinguish hypertensive urgency from emergency.Aortic Disease: Detail Aortic Aneurysms (screening protocols, tracking size, and surgery indicated at >5.5 cm for abdominal aneurysms). Explain Aortic Dissection, differentiating Stanford Type A (ascending aorta, requires emergency surgery) from Type B (descending aorta, often medically managed with beta-blockers).Peripheral Vascular Disease: Cover Deep Venous Thrombosis (DVT) using the Virchow triad and Wells criteria. Detail Peripheral Arterial Disease (PAD), focusing on intermittent claudication, ankle-brachial index (ABI) testing, and the "6 Ps" of acute limb ischemia (Pain, Pallor, Paralysis, Pulse deficit, Paresthesias, Poikilothermia)

Episode 5: Ischemia and Vascular Risk (CAD, ACS, & Dyslipidemia)Coronary Artery Disease: Differentiate classic Angina Pectoris (substernal pain provoked by stress and relieved by rest or nitrates) from Prinzmetal variant angina (caused by vasospasm and treated with calcium channel blockers). Discuss diagnostic stress testing and the coronary steal syndrome.Acute Coronary Syndromes (ACS): Clearly define Unstable Angina, NSTEMI, and STEMI based on pain duration, the presence of positive cardiac biomarkers (troponins, CK-MB), and ST-segment elevations. Detail the acute management protocols, including antiplatelet therapy, beta-blockers, nitrates, and the timelines for percutaneous coronary intervention (PCI) versus thrombolytic therapy (tPA).MI Complications & Dyslipidemia: Review post-MI complications by timeline, such as ventricular arrhythmias (first day), wall rupture or papillary muscle rupture (days to weeks), and Dressler syndrome (weeks to months). Discuss hyperlipidemia screening and the ACC/AHA guidelines for moderate and high-intensity statin therapy.

Episode 4: Muscle Disease (Cardiomyopathies)Dilated & Restrictive Cardiomyopathy: Explain the impaired contractility and massive ventricular dilation seen in Dilated Cardiomyopathy, often accompanied by an S3 gallop. Contrast this with Restrictive Cardiomyopathy, which features impaired elasticity due to infiltrative diseases like amyloidosis, sarcoidosis, and hemochromatosis.Hypertrophic Cardiomyopathy (HCM & HOCM): Focus on the genetics, the asymmetric hypertrophy of the interventricular septum, and its role as the most common cause of sudden cardiac death in young athletes. Discuss the harsh systolic crescendo-decrescendo murmur and the use of beta-blockers as first-line therapy.Other Pathologies: Detail Arrhythmogenic Right Ventricular Dysplasia (ARVD), highlighting the fibrofatty tissue replacement and ECG epsilon waves. Briefly cover secondary cardiomyopathies, myocarditis, peripartum cardiomyopathy, and Takotsubo (broken heart) syndrome

Episode 3: Heart Failure and Pump DysfunctionHeart Failure Classifications: Differentiate between Heart Failure with Reduced Ejection Fraction (HFrEF, systolic dysfunction, EF <40%) and Heart Failure with Preserved Ejection Fraction (HFpEF, diastolic dysfunction, EF >50%). Discuss the New York Heart Association (NYHA) functional classes I through IV and the differences between left-sided symptoms (dyspnea, orthopnea) and right-sided symptoms (JVD, peripheral edema).Pathophysiology & Diagnosis: Detail how chronic activation of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system leads to maladaptive cardiac remodeling. Review chest x-ray findings like Kerley B lines, cardiomegaly, and pleural effusions.Acute & Chronic Management: Explain the hemodynamic profiles ("Warm and Wet", "Cold and Wet", etc.) and the acute use of loop diuretics, vasodilators, and inotropic agents. For chronic heart failure, detail the mortality-reducing medications, including ACE inhibitors, beta-blockers, spironolactone, and SGLT-2 inhibitors like dapagliflozin and empagliflozin

Episode 2: Electrical Disturbances (Arrhythmias & ACLS)Mechanisms & Bradyarrhythmias: Explain the primary mechanisms of tachyarrhythmias: abnormal automaticity, triggered activity, and reentry. Cover sinus bradycardia, the different types of Atrioventricular (AV) blocks (First-degree, Second-degree Mobitz I and II, and Third-degree complete block), and Sick sinus syndrome.Tachyarrhythmias: Detail the ECG findings and treatments for Atrial flutter, Atrioventricular nodal reentry tachycardia (AVNRT), Wolff-Parkinson-White (WPW) syndrome (including the characteristic delta wave), Ventricular tachycardia (VT), Ventricular fibrillation (VF), and Torsades de pointes.Atrial Fibrillation: Focus heavily on the pathophysiology, history, and physical exam findings of atrial fibrillation. Explain stroke prevention using the CHA2DS2-VASc scoring system and the differences between rate control (beta-blockers, calcium channel blockers) and rhythm control strategies.Cardiac Life Support Basics: Discuss the indications for synchronized cardioversion (for unstable but perfusing rhythms) versus unsynchronized defibrillation (for pulseless VT and VF). Detail the "5 Hs and 5 Ts" mnemonic for diagnosing the underlying causes of pulseless electrical activity

Episode 1: Foundations of Cardiac Evaluation (ECG & Physical Exam)ECG Basics: Focus on calculating heart rate (300 divided by the number of large boxes between QRS complexes), identifying normal sinus rhythm, and determining the QRS axis (normal, left, right, or extreme deviation).Intervals & Conduction: Detail the PR interval (120-200 msec) and QRS interval (<120 msec). Explain the morphology of Left Bundle-Branch Block (LBBB) using the "W" in V1 and "M" in V6, the Right Bundle-Branch Block (RBBB) using the "M" in V1 and "W" in V6, and the necessity of the Smith-Modified Sgarbossa Criteria for diagnosing myocardial infarctions (MI) when an LBBB is present. Discuss QT prolongation and its congenital causes, such as Romano Ward syndrome and Jervell and Lange-Nielsen syndrome.Ischemia & Chamber Enlargement: Explain the progression of ST-segment elevation MI (STEMI) from hyperacute T waves to pathologic Q waves, and how to localize infarcts using specific ECG leads (e.g., inferior wall via leads II, III, aVF). Describe signs of right and left atrial enlargement (P pulmonale vs P mitrale) and ventricular hypertrophy.Physical Exam Findings: Detail neck vein assessments like Jugular Venous Distention (JVD), hepatojugular reflux, and the Kussmaul sign. Break down the murmurs of Aortic Stenosis, Mitral Regurgitation, Mitral Valve Prolapse, Aortic Regurgitation, and Mitral Stenosis, including how maneuvers (squatting, Valsalva, leg raises) change their intensity. Conclude with descriptions of S3 and S4 gallops and pulse abnormalities like pulsus paradoxus and pulsus parvus et tardus