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GK General Surgery > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is 1st line mgmt of orthostatic hypotension?

A

Remove medications that cause it

Ex: Doxazosin (BPH med): alpha adrenergic antagonist

anti-HTN meds, nitrates, antidepressants

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2
Q

What are some additional things to know about medications regarding Orthostatic hypotension?

A
  • In patients that continue to be symptomatic despite non-pharmacologic measures, fludrocortisone can be used as monotherapy.
  • Patients with both anemia and orthostatic hypotension should begin a trial of erythropoietin.
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3
Q

What confirms orthostatic hypotension?

A

Decrease in systolic BP 20

Decrease in diastolic BP 10

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4
Q

What are the 6 Ps of Acute Arterial Occlusion?

A
  1. Paresthesia
  2. Pallor
  3. Pulselessness
  4. Poikilothermia (unable to regulate body temperature)
  5. Paralysis
  6. Pain out of proportion to exam
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5
Q

What is the recommended imaging modality for Acute Arterial Occlusion?

A

CTA of the pelvis with runoff

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6
Q

What are late findings of acute arterial occlusion?

A

paralysis

gangrene

loss of sensation

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7
Q

What is the primary risk associated with CTA?

A

contrast nephropathy

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8
Q

What is the gold standard of diagnosing arterial occlusion?

A

Digital subtraction angiography because has the additional benefit of potential treatment at the time of assessment

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9
Q

What is the most common limb artery to be affected by acute arterial occlusion?

A

The superficial femoral artery

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10
Q

What PMH will you see in pt who presents with thromboembolsim?

A

hx of recent MI or a-fib

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11
Q

What is the MC sirte of an acute arterial occlusion?

A

femoral artery bifurcation

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12
Q

What are treatments for acute arterial occlusion/thromboembolism?

A

thrombolysis

stenting

thrombectomy

surgery (bypass)

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13
Q

What is 1st line treatment for varicose veins?

A

Conservative measures: leg elevation, compression stockings, and exercise

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14
Q

If conservative measures faily to treat varicose veins, what is the next step?

A

vein ablation:

  • sclerotherapy
  • laser therapy
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15
Q

Subcutaneous dilated, tortuous veins

A

varicose veins

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16
Q

Pt is complaining of a dull ache in her legs after prolonged standing.

What dz?

A

varicose veins

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17
Q

Will pt with gastric cancer present with dysphagia?

A

They can if the cancer is at the proximal stomach

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18
Q

What are signs of metastatic disease in gastric cancer?

A

left supraclavicular node (Virchow’s node)

left axillary node (Irish node)

periumbilical node (Sister Mary Joseph’s node)

19
Q

What is the diagnostic test of choice in patients with suspected deep vein thrombosis?

A

Doppler US

20
Q

What will PE for DVT show?

A

dilated superficial veins, with unilateral edema, warmth, tenderness, and erythema

+ Homan sign (

21
Q

What will Doppler US show for DVT?

A

Demonstrates noncompressibility of imaged vein, indicating a thrombus.

22
Q

What is the gold standard for DVT?

A

venography

23
Q

What is the triad that causes DVT?

A

Virchow triad

  1. stasis
  2. hypercoaguable state
  3. trauma
24
Q

What will PE for PAD show?

A

loss of hair

skin atrophy/shiny skin

cool temperature

pale color

ulceration

weal lower extremity pulses

decreased sensation

25
Q

How is dx of PAD made?

A

ankle-brachial index (ABI) value of ≤0.9

systolic BP of ankle/systolic BP of brachial artery

26
Q

1st line tx of PAD

A

anti-platelet agents such as aspirin or clopidogrel (use for all patients)

aggresive risk factor modifications: complete tobacco cessation, exercise, antihypertensives, statin, and diabetes management

27
Q

When is carotid endarterectomy recommended?

A

If pt has symptomatic carotid artery disease and >70 occlusion whose perioperative morbidity and mortality risk is < 6%

28
Q

How can symptomatic carotid artery disease manifest?

A

transient ischemic attacks

cerebrovascular accidents

29
Q

What is the gold standard dx for carotid artery disease?

A

cerebral angiography

30
Q

What medical mgmt should be started following a carotid endarterectomy?

A

antiplatelet therapy and statin therapy

31
Q

Cardiac Functional Status Level 1

A

Can take care of self, such as eat, dress or use toilet

32
Q

Cardiac Functional Level Status 3-4

A

can walk up a flight of steps or a hill or walk on ground level at 3-4 mph

33
Q

Cardiac Functional Status 4-10

A

can do heavy work around the house, such as scrubbing floors or lifting or moving heavy furniture, or climb 2 flights of stairs

34
Q

Cardiac Functional Status > 10

A

can participate in strenuous sports such as swimming, singles tennis, football, basketball and skiing

35
Q

What is bilirubin?

A

Bilirubin is a byproduct of heme metabolism, which occurs in three phases: prehepatic, intrahepatic, and posthepatic.

36
Q

Prehepatic processes result in what form of bilirubin?

A

Prehepatic processes, such as red cell breakdown, hemolysis, erythropoiesis, hematoma resorption, and myoglobin breakdown, often result in unconjugated bilirubin or indirect bilirubin

37
Q

What is unconjugated bilirubin?

A

Unconjugated bilirubin is fat soluble, however, the majority is bound to albumin in plasma, which prevents diffusion across the blood-brain barrier and kernicterus (bilirubin encephalopathy) in newborns.

38
Q

In what phase is direct bilirubin formed?

A

In the hepatic phase of bilirubin metabolism, conjugated bilirubin, or direct bilirubin, is formed by enzymatic binding to a sugar making it water soluble.

39
Q

Another word for direct bilirubin is?

A

conjugated bilirubin

40
Q

What are common intrahepatic causes of hyperbilirubinemia?

A

autoimmune, infectious (hepatitis), genetic defects involving conjugation (Gilbert syndrome, Crigler-Najjar syndrome), or pharmacologic

41
Q

What happens during the posthepatic phase of bilirubin?

A

The posthepatic phase involves excretion of conjugated bilirubin into bile.

42
Q

What are posthepatic causes of hyperbilirubinemia related to?

A

biliary obstruction (cholelithiasis, choledocholithiasis, Mirizzi syndrome)

infectious (cholecystitis, cholangitis)

secondary to neoplasm in or around the biliary tract

43
Q
A

GK General Surgery (11 decks)

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