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Internal Medicine > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Difference between MI and stable angina?

A

MI persists >30 mins and is NOT relieved by rest.

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2
Q

Findings for acute MI? Cardiac auscultation finding with Acute MI? (2)

A

Chest pain (heavy, squeezing, crushing pain localized to the retrosternal area or epigastrium sometimes radiating to the arm, lower jaw or neck)S4 - myocardial noncomplianceS3 - severe systolic dysfunction

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3
Q

ECG signs of Acute MI (4 Stages)

A
  1. Earliest: hyperacute T-waves (in the ischemic vascular territories) 2. ST elevation 3. Over hours to days: T-wave inversions4. Diminished R-wave amplitudes = Q-waves - significant myocardial necrosis and replacement of scar tissue
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4
Q

When does ST elevation occur?ST depression?

A

ST elevation - Acute transmural ischemiaST depression - Acute subendocardium ischemia

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5
Q

Definition of STEMI?

A

ST-segment elevations more than 1 mm (0.1 mV) in 2 or more contiguous leads (i.e. same vascular territories)

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6
Q

Elevations in Leads II, III, aVF

A

Inferior surface of the heart supplied by RCA

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7
Q

Elevation in V2 to V4

A

Anterior surface of the heart supplied by the Left Anterior Descending (LAD)

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8
Q

Elevation to Leads I, aVL, V5, V6

A

Lateral surface of the heart supplied by the LCX (Left circumflex coronary artery)

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9
Q

Rise and fall of:1. Creatine Phosphokinase (CK)(while CK is found in skeletal muscles and other tissues, CK-MB is not found in significant amounts outside of heart muscle)2. Cardiac specific troponin I and troponin T (cTnI, cTnT) - more specific to heart muscle and preferred markers for myocardial injury.

A

CK: rise within 4-8hrs. return to normal 48-72 hrs.

cTnI, cTnT: rise within 3-5 hours after infarct. cTnI remain elevated for 7-10 days. cTnT remain elevated for 10-14.

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10
Q

Other Dx with chest pain made worse with anticoagulants.

A

Aortic Dissection - unequal pulses or pressures in the arms, new murmur of aortic insufficiency, widen mediastinum

Acute pericarditis - pericardial friction rub, diffuse ST elevations

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11
Q

What is the management for Acute MI?

A

Antiplatelet agents: Aspirin, heparin
Beta-blockers - decrease myocardial oxygen demand
Nitrates - increase coronary blood flow
Morphine - pain, tachycardiaO2

Percutaneous Coronary Intervention (preferred for most) or Thrombolytics

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12
Q

What criteria are met for thrombolytic therapy? (5)

A
  1. Chest pain consistent with ischemia
  2. No contraindications to thrombolytics
  3. Age < 75 y.o.
  4. ST segment elevations more than 1 mm in at least 2 anatomically contiguous leads
  5. MI within 2-6 hours or within 12 hours with persistent chest pain + ST elevations
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13
Q

What criteria are met for PCI? (3)

A

Preferred method

  1. <1 hour-90 mins to reperfusion and/or
  2. contraindications to lytic therapy and/or
  3. hypotensive or in cardiogenic shock
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14
Q

Sinus Bradycardia is often seen with MI to which heart wall?

A

Inferior. RCA supplies the inferior wall of the left ventricle and the sinoatrial node.

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15
Q

What steps are taken for secondary prevention after a myocardial infarction to prevent recurrent cardiac events and death?

A 
Smoking cessation
Anti-platelets: Aspirin and clopidogrel
Beta-blockers
Ace-inhibitors 
Statins
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16
Q

Cardiogenic shock

A

Hypotension with systolic BP < 80mmHg
Reduced cardiac index less than 1.8 L/min/m^2Elevated LV filling pressure (pulmonary wedge pressure >18mmHg)Due to left ventricular pump failureEvaluated via Swan-Ganz catheterization

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17
Q

What mechanical complications can occur within 1 week of a MI? (4)Tx?

A

1a. Papillary muscle dysfunction - cause mitral regurgitation that is hemodynamically significant
1b. Papillary muscle rupture - acute mitral regurgitation1c. Ventricular septal rupture
2. Rupture of ventricular free wall - filling of the pericardium, cardiac tamponade develops rapidly with sudden pulselessness hypotension. Almost Always fatal.

Use Doppler echocardiography to distinguish.Tx: Intravenous nitroglycerin or nitroprusside (after load reduction) or aortic balloon until definitive surgical repair can be done.

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18
Q

What late complications can occur after an MI?

A
  1. Ventricular aneurysms - if ST elevations persists weeks after the event
  2. Dressler’s syndrome - immune –> pericarditis, pleuritis, and fever
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19
Q

What is mortality in MI caused by? Management?

A

Ventricular arrhythmia (VT, VF), pump failure –> cardiogenic shock.

Direct current (DC) cardioversion or defibrillation followed by intravenous antiarrhythmics such as amiodarone

If bradycardia –> atropine
Symptomatic bradycardia –> pacemaker

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20
Q

Diastolic dysfunction

Symptoms

A

Impaired diastolic relaxation and decreased ventricular compliance, but with preserved ejection fraction > 40% to 50%

Dysnea, peripheral edema, ascites

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21
Q

Systolic dysfunction

Symptoms

A

Low cardiac output by impaired systolic function ( EF < 40%)Fatigue, lethargy, hypotension

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22
Q

Therapy for Congestive Heart Failure

A

Decrease mortality:

ACE inhibitors - Reduce preload and afterload so reduce right atrial, pulmonary pressures along with systemic vascular resistance and prevent remodeling.

Beta Blockers - prevent and reverse adrenergically mediated intrinsic myocardial dysfunction and remodeling

Aldosterone Antagonist

Salt restriction

Diuretics - decrease preload

Nitrates (vasodilators) - reduce preload, and clear pulmonary congestion

Digoxin - improve cardiac contractility

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23
Q

What devices are useful in heart failure?

A

If widen QRS > 120 ms, dysynchronous ventricular contraction –> Cardiac resynchronization therapy (CRT), a biventricular pacemaker.

Patients with EF Implantable cardiac defibrillator (ICD)

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24
Q

Most common symptomatic valvular abnormality in adults? Underlying etiology for 70y.o..

A

Aortic Stenosis
< 30 y.o. - congenital bicuspid valve
30-70 y.o. - congenital stenosis or rheumatic heart disease
>70 y.o. - degenerative calcific stenosis

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25
Q

Premature Ventricular Complexes

Treatment

A

Wide QRS, bizarre morphology, compensatory pause

Often in those with cardiac pathology and after an MI. Sometimes worsened with antiarrythmics, so don’t give unless symptomatic. First line: B-blockers. Second line: Amiodarone

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26
Q

Size of the boxes

Normal Range for PR, QT, QRS.

A

Large boxes: 0.2 sec
Small box: 0.4 sec

300, 150, 100, 75, 60, 50, 43

PR <0.12
QT

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27
Q

Uses of digoxin

A

Atrial flutter, fibrillation

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28
Q

What are symptoms of hypercalcemia?

A

Polyuria
Constipation
Neurological symptoms
Anorexia

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29
Q

Symptoms of Multiple Myeloma

A 
Constipation, HyperCalcemia
Renal failure
Anemia
Back pain, bone lytic lesions
Bence Jones in the urine
Infections
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30
Q

Diagnosis of Cardiac Tamponade due to large pericardial effusions.

A

Recent Upper Respiratory Infection
Enlarged Silhouette of the heart “water bottle”
Dysnea, elevated JVP, clear lung fields

Beck’s Triad: hypotension, Elevated JVP, muffled heart sounds

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31
Q

Viral Myocarditis presentation

A

Recent upper respiratory tract infection, fatigue, dysnea, elevated JVP,

but also S3 heart sound + bibasilar rales + pulmonary vascular congestion seen on imaging.

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32
Q

Fixed splitting of the second heart sound

A

Atrial Septal defect. Will also see enlarge right atrium and ventricle + prominent hilar or proximal pulmonary arterial vasculature.

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33
Q

Early symptoms of Alzheimer’s

A

Visual-spatial deficit (lost in own neighborhood)
Anterograde memory loss (remember past memories)
Cognitive deficiency that progresses
Speech impairment

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34
Q

Late findings of Alzheimer’s

A

Neuropsychiatric (i.e. hallucination, wandering)
Dyspraxia (Inability to performed learned motor skills)
Lack of insight regarding the deficits
Non-cognitive neurologic deficits (pyramidal, and extrapyramidal motor, myoclonus, seizure)
Urinary incontinence

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35
Q

Diagnosis of Alzheimers

A

Mini Mental Status Examination, Neuropsychological testing, and the following clinical criteria:

Two+ of cognitive deficits
Progressively worsening memory + other cognitive function
No disturbances of consciousness
Age >60
Absence of other systemic or neurological disorder causing the progressive cognitive deficit.

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36
Q

Ankylosing spondylitis

A

Male:Female 2>1
Morning pain for 30 mins
Low back pain + spine stiffness >3months duration should be investigated.

AP x-ray of sacroiliac joints are used to confirm the diagnosis: showing fusion and a bamboo spine

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37
Q

Paroxysmal Nocturnal Hemoglobinuria

Classic 3 conditions

A

Hemolytic anemia
Hepatic vein thrombosis
Diminished hematopoesis (anemia)

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38
Q

Craniopharyngiomas

A

Benign tumor arising from Rathke’s pouch, more common in children, located above Sella Turcica and consists of multiple cysts.

Hypopituitarianism, Bitemporal blindness, headaches

+ amenorrhea in women, +sexual dysfunction in adults, +retarded growth in children

Diagnosis: MRI or CT. Tx: surgery, radiotherapy

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39
Q

What drugs are used during acute exasperations of multiple sclerosis? To decrease the frequency?

A

corticosteroids

Interferons, Cyclophosphamide, plasmapheresis, IVIG, glatiramer acetate

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40
Q

Chalazion

A

Painful swelling that progresses to nodular rubbery lesion as a result of obstruction of meibornian glands.

Need histological examination to rule out basal cell carcinoma.

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41
Q

Hordeolum (stye)

A

Acute infection of one of the glands of the eyelid (due to staph normally). Frequent hot compresses + antibiotics are used to treat.

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42
Q

Torsades de Pointe

A

Polymorphic ventricular tachycardia associated with a prolonged QT interval.

Usually in those with familial prolonged QT or malnourished individuals (i.e. alcoholism) that cause hypomagnesemia.
Those taking antibiotics (fluconazole, moxifloxacin)
Antiarrhythmics (amiodarone, sotalol)
Tricyclic antidepressants

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43
Q

Hyperkalemia

A

Peaked T-waves.

Tx: Calcium gluconate

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44
Q

Chronic lymphocytic leukemia

A

Older patients
Patients are often asymptomatic, but when they are, it is due to lymphadenopathy.
Smudge cells

Staging:
0 lymphocytosis
1 lymphocytosis + adenopathy
2 Splenomegaly
3. anemia
4. thrombocytopenia
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45
Q

Dietary Recommendations to prevent renal calculi

A
  1. Increase fluid intake
  2. Increase Ca intake
  3. Reduce dietary protein and oxalate
  4. Decrease sodium intake
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46
Q

NNT

A

Number needed to treat = 1/ARR (absolute risk reduction)

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47
Q

Triad of gait disturbance, urinary incontinence, dementia. Lumbar picture shows normal CSF pressure and MRI shows enlarged ventricles

A

Normal pressure hydrocephalus

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48
Q

Drugs that can cause G6PD oxidative dress?

A

Nitrofurantoin, sulfa drugs, anti-malarials

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49
Q

Side effect of fluphenazine

A

hypothermia

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50
Q

Common side effects of amitriptyline

A

insomnia, weight changes, dizziness

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51
Q

Heat Stroke

A

Failure of body thermoregulation upon exposure to high environmental temperatures. Very high core body temperature of >105F, dehydration, confusion, coma, dry skin, flushed skin

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52
Q

Vestibular neuronitis

A

Acute onset of nystagmus and vertigo without other neurological defects

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53
Q

Meniere’s disease

A

Increased pressure of the endolymph, thereby causing vertigo, hearing loss, tinnitus, hearing problem.

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54
Q

Hypertension patient who develops vertigo, vomiting, and occipital headache. Dx?

A

Cerebellar hemorrhage

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55
Q

Overdose on B-blockers Symptoms

A

Bradycardia, AV block, hypotension, diffuse wheezing

Tx: Fluids, atropine. Anecdote: Glucagon which increases cAMP and causes higher levels of intracellular Ca causing increase contratility.

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56
Q

5 common side effects of amiodarone

A 
Pulmonary fibrosis
Corneal deposits
Hepatotoxicity
Skin changes (blue-gray discoloration)
Thyroid dysfunction
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57
Q

Most common cause of endocarditis due to dental caries.

A

Strep. viridans (including mutans, sanguis)

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58
Q

What are the clinical features of fibromyalgia

A

Young to middle age women
Widespread musculoskeletal pain on both sides above and below the waist.
Fatigue when waking up in the morning and mid afternoon pain
Cognitive difficulties
Nonspecific gastrointestinal symptoms

59
Q

Lab/diagnosis of Fibromyalgia

A

No abnormal lab values
Increasing in severity score over a period >3 months
Local tenderness on physical exam

60
Q

Clinical features of polymyositis

A

Proximal muscle weakness (inability to climb stairs, get up from a chair, carry heavy groceries)

Less prominent hip/shoulder involvement

61
Q

Labs/diagnosis of Polymyositis

A

Elevated muscle enzyme (i.e. creainine kinase, aldolase, lactate dehydrogenase, aspartate aminotransferase)

Possible autoantibodies

Electromyography is abnormal.

62
Q

Clinical features of Polymyalgia Rheumatica.

A

Age>50
Aching and morning stiffness > pain in shoulders, hips, neck, torso
Synovitis, bursitis, decreased range of motion
No significant muscle tenderness
Possible systemic symptoms

63
Q

Labs/Diagnosis of Polymyalgia Rheumatica.

A

Erythrocyte Sedimentation rate is significantly elevated
Clinical features make the diagnosis
Symptoms improve with corticosteroids

64
Q

What is Giant Cell Arteritis (temporal arteritis)

A

Associated with polymyalgia rheumatica, has systemic symptoms, headaches, claudication, visual disturbances, elevated ESR.

65
Q

What is hypertensive urgency?

A

BP >= 180/120, however no signs of end-organ damage

66
Q

What is hypertensive emergency?

A

BP >= 180/20 with signs of acute, life-threatening, end-organ damage.

Malignant hypertension - retinal hemorrhage, papilledema, or exudates

Hypertensive encephalopathy - cerebral edema and non-localizing neurological symptoms

67
Q

Management of Right Ventricular infarcts and Right heart failure.

A

Requires a high preload to maintain their blood pressure and therefore treated with IV fluids. Preload reducing agents such as nitroglycerine and diuretics should be avoided.

68
Q

Pansystolic murmur heard loudest at the apex with radiation to the axilla.

What about pansystolic murmur that is best heard at the left sternal border

A

Mitral regurgitation (i.e. due to papillary muscle rupture)

Ventricular septal rupture.

69
Q

Pulmonary Embolism clinical presentation

A

Dysnea, Tachypnea, pleuritic chest pain, and hypotension

70
Q

Aortic Dissection clinical presentation

A

Tearing chest pain and back pain and unequal pulses, and hypertension.

71
Q

Clinical presentation of pleural effusion and cardiac tamponade?

A

Pericardial fluid causes reduction in diastolic filling and preload, resulting in hypotension and syncope (due to decreased cranial blood flow). Examination shows tachycardia, distended neck vein, pulsus, paradoxus, and muffled heart sounds.

72
Q

Pulsus Paradoxus

A

Reduction of the SBP by >10mmHg during inspiration

Seen in cardiac tamponade, pericarditis,

73
Q

Diagnosis/EKG findings or pericardial effusions

Tx?

A

Electrical alterans (variation in QRS amplitude) due to heart swinging in the pericardial cavity. Sinus tachycardia.

Tx: Pericardiocentesis

74
Q

What is the leading cause of secondary hypertension?

A

Renal Artery Stenosis

Periumbillical systolic-diastolic bruits and history of atherosclerosis.

75
Q

Abdominal aneurysms

A

Older men with a smoking + atherosclerotic history

Pulsatile abdominal mass or systolic bruits

76
Q

Aortic Coarctations

A

Congenital strictures along the aorta that causes hypertension and differences in blood pressure in upper and lower extremities.

77
Q

Tricuspid endocarditis (IV drug user) presentation?

A

Holosystolic murmur of tricuspid regurgitation that is accentuated by inspiration

78
Q

Early diastolic murmur at the left sternal border. Electrocardiogram shows a sinus rhythm with 2:1 second degree atrioventricular block

A

Aortic valve endocarditis with perivalvular abscess with regurgitation.

79
Q

Third heart sound

A

Ventricular gallop sound after S2.
Heart during rapid filling of the ventricle during diastole.
Turbulent blood flow to the ventricles + stretching of the chordate tendinae due to increased volume.
Normal in children, young adults, pregnancy

Abnormal + associated conditions: Age >40, heart failure, restrictive cardiomyopathy, high output states.

(systolic dysfunction)

80
Q

Fourth Heart sound

A

Atrial gallop sound (before S1)
Heard immediately after atrial contraction phase as blood is forced into a stiff ventricle.

Normal: Healthy, older adults
Abnormal/associations: Younger adults, children, ventricular hypertrophy, acute MI.

(diastolic dysfunction)

81
Q

When is wide and fixed splitting in S2 seen?

A

Atrial Septal Defect

82
Q

How does pericardial friction rub present?

A

Pleuritic chest pain that increases with inspiration and coughing. It decreases when patient sits and leans forward.

83
Q

Recent RBBB is suggestive of what condition.

A

Pulmonary embolism

84
Q

What confers a survival benefit for CHF?

A

ARBs, Ace inhibitors, Spiranolactone, B-blockers.

While loop diuretics and digoxin can reduce hospitalizations, they do not improve mortality.

85
Q

What are the hemodynamic result of hypovolemic shock?

A

Loss in intravascular volume leads to
Right atrial pressure (preload) = decreased
Pulmonary wedge pressure (preload) = decreased
Systemic blood pressure = decreased

Stimulation of the sympathetic
Systemic vascular resistance = increased

86
Q

What are the hemodynamic result of cardiogenic shock?

A

Cardiac pump failure leads to decrease cardiac output and blood pressure.
Preload (right atrial pressure, PWP) = increased

Sympathetic:
Systemic vascular resistance = increased

87
Q

Values as a result of vasodilatory or distributive shock

A

Caused by sepsis, anaphylaxis, systemic inflammatory response, central nervous injury:
Systemic vascular resistance: decreased
Blood pressure: reduced
Preload ( PCWP and Right atrial pressure) = decreased

Compensatory:
Heart Rate and CO = increase

88
Q

Common causes of hemoptysis?

A

Chronic bronchitis, pulmonary embolism, bronchiectasis, lung cancer, mitral stenosis, acute pulmonary edema, tuberculosis, lung abscess, coagulopathy, AVM formations, Wegner’s granulomatosis, goodpasture’s syndrome, systemic lupus erythematous, vasculitis

89
Q

Papillary muscle rupture

A

Occures 3-5 days. Acute and severe pulmonary edema and holosystolic murmur. Echo shows a severe mitral regurgitation with flail leaflet

90
Q

Intraventricular septal rupture/defect

A

Acute and within 3-5 days. LAD: apical septal rupture. RCA: basal septal rupture. Shock and chest pain, at level of the ventricle, biventricular failure. Left to right shunt at the ventricle

91
Q

Free wall rupture

A

Between 5 days to 2 weeks. LAD. Shock and chest pain. Jugular venous distention, distant heart sounds. Pericardial effusion with tamponade. Presents with acute pain, profound shock, and rapid progression to pulseless, electrical activity and death.

92
Q

Clinical presentation of asbestosis

A 
Prolonged exposure to asbestosis (i.e. shipyard, mining, construction, pipe fitters)
Symptoms develop >20 years after initial exposure
Progressive dysnea (over months), bibasilar end inspiratory fine crackles & clubbing. Increased risk of malignancies like lung cancer and malignant mesothelioma.
93
Q

Diagnosis of asbestosis?

A

History or clinical finding of exposure (i.e. pleural plaques,)

Interstitial fibrosis on imaging or histology and/or pulmonary function test with restrictive pattern. Progressive dysnea.

Physical exam can show digital clubbing, end inspiratory crackles

94
Q

What is restrictive pattern pattern?

A

FEV1/FVC = normal or elevated > 80%

Force expiratory volume in 1 sec
Force vital capacity

95
Q

What is an obstructive pattern?

A

FEV1/FVC < 80%

96
Q

Treatment for Community acquired pneumonia

A

Empirical treatment with moxifloxacin or levofloxacin, which covers strep pneumo, moraxella catarralis, and haemophilus influenza for inpatient. For outpatient, either azithromycin and doxycycline can be used.

97
Q

What is used if worried about aspirational pneumonia?

A

clindamycin

98
Q

Intermittent asthma

A

daytime symptoms < 2days/week
nighttimes awakenings < 2x/week
Baseline FEV1 and FEV1/FVC are normal, no limitations on daily activities

Management: short acting bronchodilator (albuterol)

99
Q

mild persistent asthma

A

symptoms > 2days/week but less than daily
Night-time awakenings 3-4x/month
minor limitation of activity and normal PFTs

Management: low dose inhaled corticosteroids + albuterol

100
Q

moderate persistent asthma

A

daily symptoms
weekly night awakenings
FEV1 60-80% should be prescribed:

Long-acting inhaled beta 2-agonist inhaler, low dose inhaled corticosteroids + albuterol prn

101
Q

Severe persistent asthma

A

symptoms throughout the day, frequent night-time awakening, extremely limited activity, and FEV1 < 60% as predicted

Management: PRN albuterol inhaler, long acting beta 2 agonist, high dose corticosteroids. Oral prednisone can also be used in cases of severe persistent asthma

102
Q

How does multiple sclerosis present?

A

Patchy neurological problems (upper right, lower left, and optical neuritis)

Clinical diagnosis: MRI of brain - cerebellar and cerebral plaques in the periventricular regions, corpus callosum, deep white matter, and basal ganglia

CSF shows increase in immunoglobulin and oligoclonal bands are present in 85-95%.

103
Q

PPD testing is positive when?

A

In HIV patients >5mm within 48-72 hours of intradermal injection of 5 tuberculin units

Isoniazid is given for chemoprophylaxis for 9 months in PPD positive HIV infected patients. Pyridoxine is given to prevent neuropathy caused by Isoniazid. Periodic liver function should be monitored.

Alternatives include rifampin with pyrazinamide for 2 months or rifampin alone for 4 months.

104
Q

Immune complex mediated kidney damage

A

post-streptococcal, lupus

105
Q

IgE mediated kidney damage

A

allergic interstitial nephritis including methicillin induced interstitial nephritis

106
Q

Cytotoxic antibodies kidney damage

A

Goodpasture’s syndrome

107
Q

Delayed hypersensitivities to the kidneys

A

Non specific chronic glomerulonephritis

108
Q

Non immune mediated kidney damage

A

toxins, hypertension, diabetes, other factors

109
Q

Presentation of Scabies

A

Infestation of Sarcoptes Scabiei

Generalized itching. Lesions are pruritic vesicles and pustules in “runs” over the finger webs, heels of the palms, and wrist creases. Pruritic papules may be seen over the nipples and areola of the female and scrotum/penis of the male. Head and neck are spared.

Scraping from excoriated lesions show mites, ova, and feces.

Tx: permethrin for adult applied over the neck and down. Low potency steroids to treat the dermatitis. Bedding and clothing should be set aside and cleaned for 2 weeks.

110
Q

How do body lice present?

A

Body life infect the seams of clothing, and the nits (lice eggs) are often found in the seams not on human hairs. Maculae cerulean (hemosiderin stained purpuric spots are where lice have fed and is diagnostic of lice infestation.

111
Q

Urticaria

A

Evanescent wheals or hives with intense itchiness. Most are acute, self limited and can result from immunological or non immunological conditions

112
Q

Insect bites

A

Often grouped in one area, can be vesicles and bullae

113
Q

Bed bugs

A

Tend to hide in old furniture and hide in the seams and folds of the mattress. Bites are painless, but pruritic and purpuric macules appear. Bites are in groups of 2 or 3 over exposed areas.

114
Q

Risk factors for an Aortic Aneurysm rupture

A

Diameter, rate of expansion, and currently smoking

115
Q

Conditions for operative and endovascular repair of aortic aneurysm

A

> 5.5 cm diameter, growing by 1cm/year or 0.5/ half year and presence of abdominal pain, or flank pain, or limb ischemia.

116
Q

Atheroembolism

A

Most commonly seen as a complication of cardiac catheterization and other procedures. Skin manifestations are the most common manifestation: blue toe syndrome, livedo reticularis (lacy skin discoloration). Hollenhorst plaques (bright yellow refractive plaques in the retinal artery which indicates a proximal source such as the internal carotid artery). Intestinal ischemia, gastrointestinal bleeding, cerebral ischemia, acute kidney injury may also occur

117
Q

What infections are caused by Group B Strep?

A 
NIPPLES
Necrotizing fasciitis 
Impetigo
Pneumonia
Pharyngitis
Lymphangitis
Erysipelas or cellulitis
Scarlet Fever/Strep TSS
118
Q

What is Erysipelas?

A

Erysipelas is an inflammation of the superficial dermis most commonly caused by Group B Strep. Sharply demarcated, erythematous, edematous, tender, skin with raised borders. Legs are the most frequently involved site.

119
Q

What can cause cool, dusty finger tips and necrosis of the finger tips

A

Norepinephrine-induced vasospasm

120
Q

Symptoms of alcohol withdrawal

A

Reflex hyperactivity manifesting as anxiety, insomnia, tremors and diaphoresis in the 6-24 hours. After 48 hours, it can cause hallucinations and withdrawal seizures. The most serious alcohol withdrawal symptom is after 48-96 hours and due to delirium tremens, which includes hypertension, agitation, tachycardia, hallucinations, and fever, and mortality up to 5%.

121
Q

What is the top choice for alcohol withdrawal

A

Benzodiazepine. Particularly chlordiazepoxide

122
Q

Side effects of vancomycin

A

Red man syndrome, ototoxicity, and nephrotoxicity

123
Q

Opiate withdrawal

A

Dilated pupils, piloerection, and complaints of dysphoria, myalgia, and abdominal pain.

124
Q

Hypothesuria

A

Impairment in the kidney’s ability to concentrate urine. Commonly found in sickle cell disease and sickle cell trait.

125
Q

Glucagonoma

A

Mild diabetes usually easily controlled with oral agents and diet, usually not requiring insulin.

Hyperglycemia with necrotic migratory erythema, diarrhea, anemia and weight loss. Erythematous papules on the face, perineum, and extremities.

Glucagon > 500 pg/mL confirms the diagnosis , anemia, CT/MRI of abdomen showing tumor.

126
Q

Type 2 heparin induced thrombocytopenia

A

Heparin-platelet-PF4 induce platelet activation –> procoagulant micro particle release, platelet aggregation –> thrombosis

Heparin-platelet-PF4 also induces removal by splenic macrophages –> thrombocytopenia

127
Q

Hemarthosis

A

Bleeding into the joints, which is characteristic of hemophilias.

128
Q

Ankylosing Spondylitis

A

Associated with HLA-B27, morning stiffness than improves throughout the day, and onset at 20-30’s, and more in males. Anterior uveitis is the most common extra-articular manifestation.

129
Q

What does synovial fluid analysis show for gouty arthritis?

A

White blood cell count between 2,000 - 50,000/ml, needle-shaped, negative birefringent, crystals under polarized light and gram -
It can help distinguish between septic arthritis and pseudo gout.

130
Q

B-thalassemia presentation

A

Asymptomatic with mild anemia and disproportionately high RBC count, low mean corpuscular volume, and hemoglobin > 10 g/dL. Target cells are on smear. Normal to increased iron and ferritin. Does not respond to iron supplementation. Elevated hemoglobin A2 on electrophoresis.

131
Q

Iron Deficiency Anemia

A

Iron deficiency anemia has a low red blood cell coin which rarely becomes microcytic until the hemoglobin is < 10g/dL.

132
Q

A-thalassemia presentation

A

Asymptomatic with mild anemia and disproportionately high RBC count (Hematocrit > 30%). Low mean corpuscular volume, and target cells are on the smear. Normal to increased iron and ferritin. Normal hemoglobin on electrophoresis.

133
Q

Deferoxamine

A

Iron chelator used in iron overloaded state in transfusion dependent thalassemia major or sickle cell patients.

134
Q

Hydroxyurea

A

Decreases the frequency and severity of pain crisis in patients with sickle cell by increasing hemoglobin F levels.

135
Q

Treatment of choice for Anemia of Chronic Disease?

A

Erythropoietin. Also used in anemia associated with chronic kidney disease and transient bone marrow failure after chemotherapy or bone marrow transplant.

136
Q

Treatment of choice for autoimmune hemolytic anemia

A

Prednisone

137
Q

Treatment for symptomatic hereditary spherocytosis

A

Splenectomy

138
Q

Inflammatory myopathy

A

Polymyositis and dermatomyositis both show elevated ESR and creatinine kinase, and associated with proximal muscle weakness. It is confirmed with muscle biopsy.

139
Q

Colchicine

A

Inhibits microtubules activity and used to treat flares of gouty arthritis.

140
Q

Amyotrophic Lateral Sclerosis (ALS)

A

Presents with progressive weakness of the arms, legs and cranial nerves with mixture of upper and lower motor signs. Riluzole is used to slow down the progression.

141
Q

Fibromyalgia treatment

A

TCA, particularly amitriptyline. Mostly muscle pain without objective weakness.

142
Q

Treatment for myasthenia gravis

A

Pyridostigmine (an anticholinesterase)

143
Q

Treatment for cold extremities

A

Rapid rewarming with warm water (40-44C) No attempts should be made initially to debride frostbite tissues

Internal Medicine (4 decks)

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