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Step 2 DIT > Associations 2 > Flashcards

Associations 2 Flashcards

1
Q

1st degree burn

A 
Epidermis
Painful
Erythema
No blisters
Blanching (intact cap refill)
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2
Q

2nd degree burn, superficial

A 
Epidermis + partial dermis
Painful
Erythema
Blisters
Blanching (intact cap refill)
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3
Q

2nd degree burn, deep

A 
Epidermis + partial dermis
Painful
Erythema
Blisters
No blanching (non-intact cap refill)
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4
Q

3rd degree burn

A

Epidermis + dermis + some fatty tissue
Painless
White/charred/gray
No blanching (non-intact cap refill)

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5
Q

Burn complications

A 
Infection/Sepsis (pseudomonas)
Curling stress ulcers
Aspiration/inhalation injury
Dehydration/hypovolemia/shock
Ileus
Renal insufficiency/rhabdomyolysis
Compartment syndrome
(Electrical): dysrhythmias, RF, bony injury, neuro issues, acidosis
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6
Q

Fresh water drowning

A

Decreased electrolyte concentrations
RBC lysis
(hypotonic water drawn into vasculature)

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7
Q

Salt water drowning

A

Pulmonary edema
Increased electrolyte concentrations
(hypertonic water draws more water into alveoli)

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8
Q

Parkland formula

A

4 mL x body mass (kg) x % surface burned
LR: Give 1/2 in first 8 hrs, 1/2 in next 16 hrs
May also need maintenance fluid

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9
Q

J wave (EKG)

A

Small bump after QRS
Hypothermia
(may also see Vtach/Vfib)

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10
Q

SCLC associations

A

Lambert-Eaton (muscle weakness improving w/ use)
Ectopic ACTH production
others??

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11
Q

Bradycardia in kids

A

R/O BB or CCB toxicity

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12
Q

Anticholinergic OD

A 
Hot as a hare
Dry as a bone
Red as a beet
Blind as a bat
Mad as a hatter
Bloated as a toad
Tachycardia
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13
Q

Cholinergic (organophosphate) OD

A 
DUMBBELSS
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Excitation of skeletal muscles/emesis
Lacrimation
Sweating
Salivation
Abdominal cramping
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14
Q

Carboxyhemoglobinemia causes

A

Usu from smoke inhalation
Ready to intubate quickly (airway edema)
Nitrates C/I (induce methemoglobinemia)

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15
Q

Methemoglobinemia causes

A

Familial
Anesthetics such as benzocaine
Benzene
Certain antibiotics (including dapsone and chloroquine)
Nitrites (used as additives to prevent meat from spoiling)
Nitrates (used to treat cyanide poisoning)

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16
Q

LAD EKG

A

V1-V3 (septal, IVS)

V2-V4 (anterior wall)

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17
Q

L circumflex EKG

A

I, aVL, V5, V6 (lateral wall)

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18
Q

R posterior descending EKG

A

II, III, aVF (inferior wall)

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19
Q

CO

A

SV x HR

rate of O2 use / (arterial O2 - venous O2)

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20
Q

SV determined by

A

Contractility
Preload (venous return)
Afterload (pressure in aorta)

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21
Q

SV increases from

A 
Catecholamine release
Increase in intracellular Ca
Decrease in extracellular Na
Digoxin
Anxiety
Exercise
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22
Q

SV decreases from

A

BB
Heart failure
Acidosis
Hypoxia

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23
Q

Exercise increases CO by

A 
Increased SV (initially)
Increased HR (later)
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24
Q

MAP

A

CO x TPR
2/3 DBP + 1/3 SBP
DBP + 1/3 pulse pressure

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25
Q

Increased PR interval

A

> 0.2 sec

Heart block

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26
Q

Elevated/depressed PR interval

A

Pericarditis

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27
Q

QRS complex, narrow

A

<0.12 sec is normal
SVT
Signal in AV node or above
Normal His/Purkinje

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28
Q

QRS complex, wide

A

> 0.12 sec
Delay in ventricular depolarization
Rhythm starting distal to AV node
Ventricular tachycardias

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29
Q

Signs of MI on EKG

A

Elevated ST segment

T wave inversion

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30
Q

T wave on EKG

A

Large - hyperkalmia
Flattened - hypokalemia
Inverted - MI

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31
Q

ST depression on EKG

A

Sign of ischemia

Downsloping/horizontal worse than upsloping

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32
Q

Myositis vs Myalgia

A

Check for muscle inflammation (CPK)

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33
Q

CCB

A

Non-DHP (verapamil, diltiazem) work on heart

DHP (nifedipine, amlodipine) work on periphery, causing VD, decreasing preload

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34
Q

More likely to have atypical or no angina w/ myocardial ischemia

A

DM (sensory neuropathy)
Elderly
Females
May have fatigue, exercise intolerance, flu-like symptoms

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35
Q

Causes of chest pain

A 
Cardiac (Angina, MI), GERD, MSK (MC)
Cocaine/Costochondritis
Hyperventilation/Herpes zoster
Esophagitis/Esophageal spasm
Stenosis of aorta
Trauma
Pulmonary embolism/Pneumonia/Pericarditis/Pancreatitis
Angina/Aortic dissection/Aortic aneurysm
Infarction (myocardial)
Neuropsychiatric (depression)
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36
Q

Chest pain that occurs w/ exercise, disappears w/ rest

A

Stable angina

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37
Q

Chest pain w/ ST elevation only during brief episodes

A

Prinzmetal angina (coronary artery vasospasm)

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38
Q

Chest pain where patient can localize w/ one finger

A

MSK

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39
Q

Chest pain w/ tenderness to palpation of chest wall

A

MSK

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40
Q

Chest pain w/ rapid onset, sharp, “tearing” that radiates to scapula or back

A

Aortic dissection

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41
Q

Chest pain w/ rapid onset, sharp in young person and associated w/ dyspnea

A

Spontaneous pneumothorax

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42
Q

Chest pain that occurs after heavy meals and is relieved by antacids

A

GERD, Esophageal spasm

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43
Q

Chest pain that is sharp, lasts for hours-days and is somewhat relieved by sitting forward

A

Pericarditis

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44
Q

Chest pain made worse by deep breathing and/or motion

A

MSK

Pleuritic pain

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45
Q

Chest pain in dermatomal distribution

A

Herpes zoster

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46
Q

MCC noncardiac chest pain

A

GERD, MSK

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47
Q

Chest pain w/ acute onset dyspnea, tachycardia, confusion in hospitalized patient

A

Pulmonary embolism

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48
Q

Chest pain began day after starting exercise program

A

MSK

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49
Q

Chest pain w/ widened mediastinum on CXR

A

Aortic dissection

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50
Q

Electrolytes in cardiac patients

A

K > 4, Mg > 2

Decreases potential risk of arrhythmias

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51
Q

New onset RBBB

A

Pulmonary embolism

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52
Q

New onset LBBB

A

MI

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53
Q

Difference btwn unstable angina and NSTEMI

A

-/+ cardiac enzymes

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54
Q

Cardiac enzymes (troponin, CK-MB)

A

Show cardiac muscle damage/cell death
Three sets 8 hrs apart
Troponin I increases faster, more sensitive/specific
CK-MB decreases 24-72 hrs later (troponin I takes 7 days)

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55
Q

U wave on EKG

A

Relative hypokalemia

Also hypercalcemia, hyperthyroidism

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56
Q

Q wave (big) on EKG

A

Post-MI, usu persists weeks later

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57
Q

MCC sudden cardiac death post-MI

A

Vfib
Vtach
Cardiogenic shock

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58
Q

Greatest risk of ventricular wall rupture post-MI

A

4-8 days later

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59
Q

Dressler syndrome

A

AI pericarditis (fever, +ESR) 2-4 weeks post MI

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60
Q

Delta wave on EKG (slurred upstroke of QRS)

A

Wolff-Parkinson-White syndrome (AV nodal reentry through accessory conduction pathway; PSVT)

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61
Q

Medications that can cause heart block arrhythmias (esp Mobitz I and above)

A

BB
Digoxin
CCB

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62
Q

Arrhythmia w/ narrow QRS, rate >100

A

Supraventricular tachycardia

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63
Q

Arrhythmia w/ no relationship between P wave and QRS

A

3rd degree heart block

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64
Q

Arrhythmia w/ 3+ P wave morphologies, rate >100

A

Multifocal atrial tachycardia

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65
Q

Arrhythmia w/ rate <50

A

Bradycardia

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66
Q

Arrhythmia w/ PR interval >0.2 sec

A

1st degree heart block

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67
Q

Arrhythmia w/ early, wide QRS w/o P wave

A

Premature ventricular contractions

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68
Q

Arrhythmia w/ wide QRS, HR 160-240

A

Ventricular tachycardia

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69
Q

Arrhythmia w/ PR interval becomes longer w/ dropped beat

A

2nd degree heart block, Mobitz type I (Wenckebach)

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70
Q

Arrhythmia w/ chaotic pattern, no P wave, no QRS

A

Ventricular fibrillation

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71
Q

Arrhythmia w/ normal PR, occasional dropped beat

A

2nd degree heart block, Mobitz type II

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72
Q

Arrhythmia w/ sawtooth pattern

A

Atrial flutter

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73
Q

Arrhythmia w/ no P waves, narrow QRS, irregularly irregular

A

Atrial fibrillation

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74
Q

Arrhythmia w/ sinusoidal pattern of QRS

A

Torsades de pointes (VTach)

75
Q

Antiarrhythmic classes

A

I - Na channel blockers - class IA, IB (lidocaine, tocainide), IC
II - BB - propanolol, esmolol, metoprolol
III - K channel blockers - amiodarone (also type I), sotalol
IV - CCB (NDP) - verapamil, diltiazem

76
Q

PVCs that are concerning

A

> 3/min

>3 in a row (VTach)

77
Q

Common causes of AFib

A 
PIRATES
Pulmonary disease/pericarditis
Ischemia (CAD)
Rheumatic heart disease
Anemia
**hyperThyroid
Ethanol
Sepsis
Also HTN, valvular disease
78
Q

Causes of PEA/Asystole

A 
Hs (7) & Ts (7)
Hypovolemia
Hypoxia
H ions (acidosis, common in prolonged code)
Hyperkalemia (common in prolonged code from acidosis)
Hypokalemia
Hypoglycemia
Hypothermia
Tamponade
Tension pneumothorax
Thrombosis (MI)
Thrombosis (PE)
Trauma
Tablets
Toxins
79
Q

Organism causing infection in burn victims

A

Pseudomonas

80
Q

S3 causes

A 
Dilated ventricles
HF (most frequent sign of CHF)
Dilated CMP
MR
Acute MI
81
Q

S4 causes

A

Stiff LV

82
Q

Systolic HF causes

A 
Decreased contractility
Increased preload (eventually)
Increased afterload
HR abnormalities (brady/tachy)
High output conditions (anemia, hyperthyroid, etc)
83
Q

Diastolic HF causes

A

LVH
Restrictive cardiomyopathy
Hypertrophic cardiomyopathy

84
Q

L CHF S/Sx

A 
Fatigue
DOE, orthopnea, PND, cough (pulm edema)
Displaced PMI
S3
Rales, crackles
85
Q

R CHF S/Sx

A

JVD
Peripheral edema (especially BLE)
Hepatomegaly, hepatic congestion

86
Q

CC R CHF

A 
L CHF (MCC)
Pulmonary HTN, COPD/pulmonary disease (cor pulmonale), valvular disease, congenital
87
Q

Normal EF

A

55-75%

88
Q

Diastolic murmur at L lower sternum that increases with inspiration

A

TS

89
Q

Late diastolic murmur w/ opening snap, no change with inspiration

A

MS

90
Q

Systolic murmur heard best in 2nd R interspace

A

AS

91
Q

Systolic murmur heard best in 2nd L interspace

A

PS

ASD (w/ fixed split S2)

92
Q

Late systolic murmur heard best at apex

A

MVP

93
Q

Diastolic murmur with widened pulse pressure

A

AR

94
Q

Holosystolic murmur louder w/ inspiration at L lower sternum

A

TR

VSD

95
Q

Holosystolic murmur heard at apex, radiates to axilla

A

MR

96
Q

MCC hypertrophic cardiomyopathy

A

Congenital (50% autosomal dominant)

97
Q

Systolic murmur louder w/ Valsalva

A

Hypertrophic cardiomyopathy

98
Q

MC cardiomyopathy

A

Dilated

99
Q

Causes dilated cardiomyopathy

A 
Idiopathic
Alcohol use
Beriberi
Coxsackievirus B (myocarditis)
Cocaine use
Doxorubicin
Hemochromatosis
HIV
Ischemic heart disease
Pregnancy
Chagas disease
100
Q

Restrictive cardiomyopathy - causes and dx

A

Sarcoidosis
Amyloidosis
Hemochromatosis
Dx: biopsy

101
Q

Equal pressure in all chambers on cardiac cath

A

Chronic constrictive pericarditis

102
Q

Transudative pericardial effusion

A

Low in protein, spec gravity <1.012, more common

103
Q

Exudative pericardial effusion

A

High in protein, spec gravity >1.020

Workup for neoplasm, fibrotic disease, TB

104
Q

Beck triad

A

Hypotension, distant heart sounds, distended neck veins

Think cardiac tamponade and perform urgent pericardiocentesis (echo first if patient stable)

105
Q

Low voltage globally on EKG

A

Cardiac tamponade

106
Q

Global ST elevation, PR depression

A

Acute pericarditis

107
Q

Kussmaul sign causes

A 
JVD w/ inspiration (from decreased RV capacity)
Constrictive pericarditis
Restrictive CMP
RV infarct
Massive PE
Cardiac tamponade (rare)
108
Q

Pulsus paradoxus causes

A

Decreased SBP > pericarditis

109
Q

Heart failure + diabetes + elevated LFTs

A

Hemochromatosis (usu dilated, can be restrictive CMP)

110
Q

Chagas disease

A

Trypanosoma cruzi
Cardiomegaly
Mega-esophagus (achalasia)
Megacolon

111
Q

Causes of myocarditis

A 
MCC infection: viruses (Coxsackie, adenovirus, echovirus, EBV, CMV, influenza; parvovirus B19, HHV-6), bacteria, rickettsiae, fungi, parasites
Drug toxicity (chemo, penicillins, sulfonamides, cocaine, radiation), toxins, endocrine abnl
112
Q

Acute rheumatic fever cause

A

Untreated GAS -> autoantibodies

113
Q

Rheumatic heart disease diagnosis

A 
Recent strep + 2 major or 1 major, 2 minor
JONES (major)
Joints (polyarthritis, hot and swollen joints)
Heart (carditis, valve damage M>A>T)
Nodules (SQ, extensor)
Erythema marginatum (painless)
Sydenham chorea
PEACE (minor)
Previous rheumatic fever
EKG w/ PR prolongation
Arthralgias
CRP/ESR
Elevated temp
114
Q

Libman-Sacks endocarditis

A

SLE, noninfective endocarditis

115
Q

At risk patients for endocarditis

A

Congenital heart defects
IVDU
Prosthetic valves

116
Q

Negative-culture endocarditis bacteria

A 
HACEK
Haemophilus
Actinobacilus
Cardiobacterium
Eikenella
Kingella
117
Q

Acute endocarditis bacteria

A

Staph aureus (esp prosthetic valves)
Strep pneumo
Strep pyogenes
Neisseria gonorrhoea

118
Q

Subacute endocarditis bacteria

A

Viridans strep (esp dental)
Enterococcus
Fungi
Staph epidermidis (coag neg) (esp prosthetic valves)

119
Q

Infective endocarditis diagnosis

A 
Direct histologic evidence OR 
Positive gram stain from surgical debridement/autopsy OR 
2 major Duke criteria OR 
1 major + 3 minor OR 
5 minor
120
Q

Major Duke criteria

A

Infective endocarditis (2 major or 1+3 or 5)
Serial blood cultures + for organisms associated
Blood culture + for Coxiella burnetii
Presence of vegetations or cardiac abscess seen on echo
Evidence of new onset valvular regurgitation

121
Q

MC valve involved in infective endocarditis

A

Mitral valve (regurgitation)

122
Q

Valve involved in IVDU + infective endocarditis

A

Tricuspid regurgitation

123
Q

Minor Duke criteria

A

Infective endocarditis (2 or 1+3 or 5 minor)
Predisposing heart condition or IVDU
Fever >38C
Vascular phenomenon (emboli, infarcts, aneurysm, hemorrhage, Janeway lesions)
Immunologic phenomenon (glomerulonephritis, Osler nodes, Roth spots, +RF)
Positive cultures not meeting major requirements or serologic evidence of infection w/ neg culture

124
Q

Osler nodes

A

Painful nodules on fingertip or toe pads

125
Q

Janeway lesions

A

Painless petechiae on palms/soles

126
Q

Roth spots

A

Retinal hemorrhages

127
Q

Reasons for prophylaxis for endocarditis

A 
Prosthetic cardiac valves
Previous history IE
Congenital heart disease (unrepaired cyanotic, repaired w/ prosthetic, not fully repaired)
Cardiac transplant w/ valve problems
Not before GI/GU procedures
Not rheumatic heart disease anymore
128
Q

Dx HTN

A

> 140 or >90 at 3 separate readings

129
Q

HTN urgency

A

BP >180/120

130
Q

HTN emergency

A

BP >180/120 + end-organ damage (renal failure, pulmonary edema, aortic dissection, unstable angina, MI, AMS, papilledema, retinal vascular changes)

131
Q

HTN in UE but low BP in LE

A

Aortic coarctation (assoc w/ Turner’s, AV pathology, PDA)

132
Q

HTN + proteinuria

A

Renal disease

133
Q

MCC secondary HTN

A

Renal disease

134
Q

HTN + hypokalemia

A 
Primary hyperaldosteronism (Conn)
Secondary hyperaldosteronism (renal artery stenosis)
135
Q

HTN + tachycardia, diarrhea, heat intolerance

A

Hyperthyroidism

136
Q

HTN + hyperkalemia

A

Renal failure

137
Q

HTN + episodic sweating, tachycardia

A

Pheochromocytoma

138
Q

ACE/ARB AE

A

Dry cough, angioedema (ACE)
Azotemia (monitor)
Hyperkalemia (C/I)
Teratogen (affects fetal kidneys)

139
Q

Thiazide diuretic AE

A 
Increased serum glucose (mild)
Increased serum cholesterol, TG
Hypokalemia
Hyponatremia
Increased serum Ca (decreased excretion)
140
Q

Loop diuretic AE

A 
Increased serum glucose (mild)
Increased serum cholesterol, TG
Hypokalemia
Hyponatremia
Decreased serum Ca (increased excretion)
141
Q

Swan Ganz catheter measures?

A

PCWP (estimates LA pressure)

142
Q

Transfusion rxn w/ fevers, chills, rigors, malaise 1-6 hrs after transfusion

A

Nonhemolytic febrile (Abs to HLA antigens)

143
Q

Transfusion rxn w/ fever, chills, nausea, flushing, tachycardia, tachypnea, hypotension during transfusion

A

Acute hemolytic (ABO incompatibility)

144
Q

Transfusion rxn w/ slight fever, falling H/H, mild increase in unconjugated bili 2-10 days after transfusion

A

Delayed hemolytic (Abs to Kidd/Rh antigens)

145
Q

Transfusion rxn w/ rapid onset of shock and hypotension, maybe angioedema and resp distress

A

Anaphylactic (maybe anti IgA Abs in IgA deficiency)

146
Q

Transfusion rxn w/ urticaria

A

Minor allergic rxn (plasma present in donor blood)

147
Q

Transfusion rxn w/ thrombocytopenia developing 5-10 days after transfusion

A

Post-transfusion purpura (usu women sensitized by pregnancy)

148
Q

Biggest risk factors for AAA

A

Tobacco use, age >55

atherosclerosis, HTN, fam hx

149
Q

Screening for AAA

A

Men 65-75 w/ smoking hx, one time abd US

150
Q

Indications to surgically repair AAA

A

> 5.5 cm (men) or 5 cm (women)
Increase in diameter by >0.5 cm in 6 months
Symptomatic

151
Q

Risk factors aortic dissection

A

HTN
Trauma, aortic coarctation
Syphilis, Ehlers-Danlos, Marfan

152
Q

Widened mediastinum on CXR

A

Think aortic dissection (get CT w/ contrast) or aortic rupture

153
Q

Intermittent claudication

A

Think PVD

154
Q

PVD severity

A 
Pain
Pallor
Poikilothermia (can't regulate temperature)
Pulsenessness
Paresthesia
Paralysis
155
Q

Virchow’s triad

A

Blood stasis
Hypercoagulability
Vascular damage

156
Q

Dx criteria for PVD

A

ABI <0.4 severe disease

157
Q

Palpable purpura

A

Think vasculitis

158
Q

Vasculitis + hepatitis B or C

A

Polyarteritis nodosa

159
Q

Vasculitis + kidneys, GI, but spares lungs, w/ neg p-ANCA

A

Polyarteritis nodosa

160
Q

Vasculitis + women >50

A

Temporal (giant cell) arteritis

161
Q

Vasculitis + polymyalgia rheumatica

A

Temporal (giant cell) arteritis

162
Q

Vasculitis + headache, blindness

A

Temporal (giant cell) arteritis

163
Q

Vasculitis + Asian woman age 10-40

A

Takayasu arteritis

164
Q

Vasculitis + decreased UE pulses

A

Takayasu arteritis

165
Q

Vasculitis + asthmatic symptoms

A

Allergic granulomatosis w/ angiitis (Churg-Strauss)

166
Q

Vasculitis + p-ANCA

A

Allergic granulomatosis w/ angiitis (Churg-Strauss)

167
Q

Vasculitis + eosinophilia

A

Allergic granulomatosis w/ angiitis (Churg-Strauss)

168
Q

Vasculitis + LE palpable purpura

A

Henoch-Schonlein purpura

169
Q

Vasculitis + recent upper respiratory infection

A

Henoch-Schonlein purpura

170
Q

Vasculitis + IgA nephropathy

A

Henoch-Schonlein purpura

171
Q

Vasculitis + lung disease + renal disease

A

Goodpasture (anti-GBM)
Granulomatosis w/ polyangiitis (Wegener) (upper airway involvement, + c-ANCA)
Henoch-Schonlein purpura (recent URI, IgA immune complexes, palpable LE purpura, usu kids)

172
Q

Vasculitis (focal necrotizing) + granulomas in lungs and upper airway + glomerulonephritis

A

Granulomatosis w/ polyangiitis (Wegener)

173
Q

Vasculitis + c-ANCA

A

Granulomatosis w/ polyangiitis (Wegener)

174
Q

Vasculitis + young male smokers

A

Thromboangiitis obliterans (Buerger disease)

175
Q

Non-cyanotic congenital heart defects

A

VSD
ASD
PDA

176
Q

Cyanotic congenital heart defects

A 
5Ts
Tetralogy of Fallot
Transposition of the great vessels
Truncus arteriosus
Total anomalous pulmonary venous return
Tricuspid atresia
177
Q

MC congenital heart defect

A

VSD (30%)

178
Q

MC cyanotic congenital heart defect

A

Tetralogy of Fallot

179
Q

Medication to close PDA

A

Indomethacin

180
Q

Medication to keep PDA open

A

Prostaglandin E

181
Q

Eisenmenger syndrome

A

L to R shunt -> pulmonary HTN -> RVH -> reverses into R to L shunt (becomes cyanotic)

182
Q

Continuous “machinery” murmur at L 2nd IC space

A

PDA

183
Q

Pathognomonic injuries for child abuse

A 
Multiple simultaneous facial injuries
Bruises in shapes of objects
Bruises over trunk and abdomen
Multiple burns (esp in shape of objects)
Rib or skull fractures
Long bone fractures in non-ambulatory kids
184
Q

Physician obligated to report

A 
Child abuse
Elder abuse (>60)

Step 2 DIT (23 decks)

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