Cardio/Neuro (40) Flashcards
Vibratory/muscial systolic ejection murmur loudest @ LLSB in a child that increases when the pt lies down. What is it and what do you do next?
parental reassurance of the Still’s murmur. innocent murmur
what class of monotherapy for hyperlipidemia shows clear improvement in overall mortality
statins (HMG-CoA reductase inhibitors)
second line hyperlipidemia medication to add to statin (never a monotherapy)
ezetimibe (inhibit dietary absorption of cholesterol by binding Niemann-Pick C1-like 1 protein)
Diastolic rumbling murmur without an opening snap. Widened pulse pressure, head bobbing, uvula pulsations, etc.
AR
Apex. Diastolic rumbling murmur with an opening snap.
MS
Apex. Late systolic murmur preceded by a click
MVP
L2ICS. Harsh crescendo-decrescendo, mid-systolic ejectino murmur with palpable thrill.
PS
L2ICS. early diastolic, high pitched, blowing decrescendo murmur
PR
mid diastolic rumbling murmur with opening spap and wide splitting S1
TS
holosystolic murmur incrasing intensity with inspiration
TR
dx + test: 50+yo w/ HA, tenderness of scalp, jaw caludication, visual changes
temporal arteritis
ESR, then biospy
DoC for ALS
riluzole
botulism in (
babies - ingestion of clostridial
adults - ingestion of preformed botulinum toxin
hyperlipidemia drug that causes myopathy and hepatotoxicity
statins
tx for giant cell (temporal) arteritis WITH visual disturbances vs. WITHOUT
WITH = IV methylprednisolone for >3 days then oral prednisone
WITHOUT = oral prednisone
Dx and tx: tachycardia, narrow QRS, no P-waves.
SVT
vagal maneuver, then adenosine (AVnode blocking agent)
**friction rub = ??
sx: chest pain worse w/ deep inspiration and improves w/ leaning forward
PE: friction run
EKG: ST elevation
pericardial friction rub = pericarditis (inflamm of pericardial sac = thickened pericardial membrane and/or pericardial effusion)
MCC of dementia >65 and
> 65 = Alzheimers
Tx of moderate to severe migraines in pregnancy
sumitriptan (avoid long half life of frovatriptan)
Menstrual migraines DoC
- NSAIDs
- triptans(suma)
- OCP
young teen with brief, arrhythmic, involuntary, bilateral UE myoclonic jerks w/o LoC.
Juvenile Myoclonic Epilepsy
systolic crescendo-decrescendo ejection murmur loudest at RUSB that radiates to neck.
Elderly w/ syncope, angina, dyspnea dt HF
AS - age related calcification of AV
Dx and first line of testing: young active person with crescendo-decrescendo systolic ejection murmur at LLSB worsened w/ valsalva.
Hypertrophic obstructive cardiomyopathy (Interventricular septum hypertrophy)
echocardiogram
when is genetic testing appropriate for heart malformaiton?
left ventricular hypertrophy ID’d on echo.
infant with FTT, poor feeding, diaphroesis, holosystolic murmur at LLSB
VSD - volume overlaod and CHF. left to right shunt
ACYONOTIC (PDA and ASD too)
dx test for peripheral arterial occlusive disease
ankle-brachial index (systolic of affected ankle/systolic of arm) THEN angiography
asx in childhood. wide fixed, split S2 heart sound that maybe accompanied by systolic ejection murmur at left upper sternal border.
ASD
progressive prolongation of PR interval on consecutive beats eentually followed by dropped P wave and no QRS
type one, second degree AV block (Mobitz1)
disturbance in conduction through AV node
PR interval remains constant with intermittent dropped P wave and no QRS (i.e .3 normal cycles:1dropped P wave and no QRS)
type two, second degree AV block (mobitz2)
disturbance in AVn His-Purkinje
PR interval >0.2sec
Narrow QRS, regular P-P interval, slowed conduction of P-waves
first degree AV block
wide QRS, regular P-P interval, no conduted P-waves (P-QRS independent)
third degree AV block
erb duchenne palsy associated with what?
prolonged 2nd stag elabor (>120min), multiparity, large for gestational age infants (90th percentile, >4000g), previous infant with brachial plexus injury
Dx steps for Guillain Barre Syndrome
CSF, Nerve conduction studies
recommended Infective Endocarditis prophylaxis
amoxicillin for those with unrepaired cyanotic congenital heart disease and those iwth prosthetic valves. also and congenital heart dz repaired w/ prosthetic material for first 6mo.
LDL goal in nondiabetic, very healthy, none-one risk factors
LDL goal if two or more risk factors
LDL goal if CV disease or DM or CAD, rardless of risk factors
less than 160
less than 140
less than 100
risk factors: Males more than 45y, F greater than 55 y, HDL less than 40, smoker, HTN greater than 140 or controlled with HTN meds, premature CAD in family in M less than 55/female less than 65
HDL goal
CHF pts should not receive what class of drug for pain?
NSAIDs - they cause Na and H20 retention
muscle pain relieved by rest in a smoker/HTN/DM
peripheral artery disease secondary to atherosclerosis
intermittent claudications
SE and CI to ethosuximide
pancytopenia
max HR from SA node = ?
220-age
max HR from AV node = ?
40-60 per min
max HR fro m ventricles = ?
stroke risk factor that is most improtant
HTN
recommended age for aspirin to prevent MI in @risk v. not
45-79
55-79
central v peripheral nerve palsy
central spares the forehead (involved UMN) - can wrinkle forehead
peripheral - unilateral muscle paralysis f entire face
most effective first line treatment for insomnia
CBT
repair an AAA when?
> 5.5cm
screen 4-4.5cm AAA how often
q6mo
if a person in asystole, when two meds can be used?
epinepherine and vasopressin
no electrical defibrillation
acute onset unilateral weakness or speech impairment that resolves within 1hr
TIA - MRI is best next step
Dx and tx: episodes of severe I/L periorbital HA with ipsilateral lacrimation and/orrhinorrhea
cluster HA
100%O2
