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EOR - Internal Med > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

predictable chest pain relieved by rest and/or nitro

A

stable angina

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2
Q

previously stable/predictable chest pain that is more frequent, increasing, or present at rest

A

unstable angina

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3
Q

coronary artery vasospasm that causes transient ST segment elevations NOT associated w. ischemia/clot

A

primzmetal variant angina

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4
Q

cardiac arrhythmias/conduction d.o’s to know

A

premature beats
paroxysmal SVT
afib/flutter
sick sinus syndrome
sinus arrhythmia

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5
Q

ventricular arrhythmias to know

A

pvc’s
v tach
v fib
torsades

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6
Q

what are the 3 types of premature beats

A

pvc
pac
pjc

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7
Q

what is this showing

A

early wide, bizarre qrs
no p wave

pvc

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8
Q

what is this showing

A

abnormally shaped p wave/qrs

pac

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9
Q

what is this showing

A

narrow qrs
no p wave or inverted p wave

pjc

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10
Q

what is this showing

A

narrow, complex tachy
no discernable p wave

svt

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11
Q

what is this showing

A

irregularly irregular rhythm
disorganized/irregular atrial activity
absence of p waves

afib

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12
Q

what is this showing

A

regular, sawtooth pattern
narrow qrs

aflutter

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13
Q

what is this showing

A

alternating brady-tachy
sinus arrest
prolonged absence of sinus node activity - absent p waves > 3 seconds

sick sinus syndrome

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14
Q

normal/minimal variations in SA node pacing rate associated w. phases of respiration (increase w. inspiration, decrease w. expiration)

A

sinus arrhythmia

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15
Q

what is this showing

A

3 or more consecutive pvc’s
broad qrs tachy

v tach

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16
Q

what is this showing

A

erratic rhythm
no discernable waves

vfib

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17
Q

what is this showing

A

polymorphic v tach twisting around a baseline

torsades

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18
Q

3 cardiomyopathies to know

A

dilated
hypertrophic obstructive (hocm)
restrictive

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19
Q

mc cardiomyopathy

A

dilated

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20
Q

event or pathologic process damages the myocardium -> weakens heart muscle -> decreased ventricular contraction/strength -> dilated left ventricle

A

dilated cardiomyopathy

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21
Q

dilated cardiomyopathy causes _ heart failure

A

systolic

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22
Q

3 causes of dilated cardiomyopathy

A

CAD
MI
arrhythmia

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23
Q

4 PE findings of dilated cardiomyopathy

A

dyspnea
S3 gallop
rales
JVD

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24
Q

which abnl heart sound can be a normal finding in kids, pregnant females, and well trained athletes

A

S3

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25
Q

which extra heart sound is always pathologic

A

S4

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26
Q

tx for dilated cardiomyopathy

A

no etoh
ACEI
diuretic

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27
Q

genetic mutation -> hypertrophic portion of ventricular septum -> thickened cardiac muscle -> narrowed LV outflow tract

A

HOCM

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28
Q

3 HPI clues for HOCM

A

young athlete
positive fam hx of sudden death
syncopal episode

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29
Q

HOCM causes _ heart failure

A

diastolic

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30
Q

3 PE findings of HOCM

A

sustained PMI
S4 gallop
mid systolic murmur

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31
Q

describe the HOCM murmur (3)

A

high pitched
midsystolic
heard best at LLSB

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32
Q

the HOCM murmur is increased with _ (2)
and decreased w. _

A

increased: standing, valsalva
decreased: squatting, handgrip

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33
Q

management of HOCM (4)

A

refrain from PA
bb vs ccb
surgery vs ablation
defibrillator insertion

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34
Q

6 causes of restrictive cardiomyopathy

A

amyloidosis
sarcoidosis
hemochromatosis
scleroderma
fibrosis
ca

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35
Q

infiltrative process -> stiff heart muscle

A

restrictive cardiomyopathy

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36
Q

5 echo findings of restrictive cardiomyopathy

A

normal EF
normal heart size
large atria
normal LV wall
early diastolic filling

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37
Q

tx for restrictive cardiomyopathy

A

diuretics
acei
ccb

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38
Q

3 PE findings of CHF

A

S3
crackles
displaced apical impulse

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39
Q

4 mcc of CHF

A

CAD
HTN
MI
DM

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40
Q

CHF leads to _ remodeling, which causes dilation, thinning, _ valve incompetence, and _ ventricle remodeling

A

left ventricle
mitral valve
right ventricle

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41
Q

6 sx of CHF

A

exertional dyspnea -> dyspnea at rest
chronic, nonproductive cough
fatigue
orthopnea
nocturnal dyspnea
nocturia

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42
Q

PE findings associated w. CHF (8)

A

cheyne stokes breathing
edema
rales
S3/S4
JVD > 8 cm
cyanosis
hepatomegaly
jaundice

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43
Q

S4 heart sound is associated w.

A

diastolic HF
presrved EF

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44
Q

pathologic S3 heart sound is associated w.

A

systolic HF
reduced EF

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45
Q

NY HF classification

A

class 1: no PA limitation
class 2: slight PA limitation, comfortable at rest
class 3: marked PA limitation, comfortable at rest
class 4: can’t carry on PA, angina at rest

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46
Q

dx for CHF (4)

A

BNP
EKG
CXR
echo

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47
Q

gs dx for CHF

A

echo

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48
Q

what is this showing

A

kerley lines -> CHF

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49
Q

tx for CHF systolic vs diastolic

A

systolic: ACEI, bb, diuretics
diastolic: ACEI, bb, CCB

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50
Q

2 causes of CAD

A

vasospastic (prinzmetal)
atherosclerotic dz

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51
Q

rf for CAD

A

smoking
DM
dyslipidemia
HTN
fam hx
men > 55
women > 65

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52
Q

dx for CAD

A

high sensitivity CRP
lipids/TG
carotid US

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53
Q

primary preventive tx for CAD

A

PLT inhibitors: ASA, clopidogrel

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54
Q

secondary prevention for CAD

A

ASA
bb
ACEI/ARB
nitro

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55
Q

atherosclerosis is due to _ cells that are attracted to lipids on the cell wall, and trigger cytokine release

A

foam cells (dead macrophages)

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56
Q

_ plaque is stable
_ plaque is easily ruptured

A

thick: stable
thin: easily ruptured

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57
Q

steps in plaque bulid up

A
  1. adhesion
  2. activation
  3. aggregation
  4. propagagion
  5. PLT adherence
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58
Q

inflammation of the heart lining or heart valves caused by bacteria in the bloodstream

A

endocarditis

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59
Q

what 3 procedures increase risk for endocarditis

A

dental
intestinal
urinary tract

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60
Q

2 hallmark sx of endocarditis

A

fever
PLUS
new murmur

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61
Q

pathogen associated w. endocarditis:
acute:
subacute:
IVDU:
prosthetic valve:

A

acute: s. aureus
subacute: s. viridans
IVDU: s. aureus
prosthetic valve: staph epidermidis

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62
Q

duke’s criteria

A

2 major
OR
1 major PLUS 3 minor
OR
5 minor

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63
Q

3 major duke criteria

A

2 positive cultures 12 hr aprt
echo findings
new murmur

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64
Q

minor duke criteria

A

from jane:
fever > 100.5
roth spots
osler nodes
murmur
janeway lesions
anemia
nail bed hemorrhages
emboli

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65
Q

valve associated w. endocarditis in IVDU vs non drug users

A

IVDU: tricuspid
non IVDU: mitral

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66
Q

what is this showing

A

painless lesions on the palms/soles -> janeway lesions

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67
Q

what is this showing

A

raised, painful, tender nodule -> osler node

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68
Q

what is this showing

A

exudative lesions on the retina -> roth spots

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69
Q

2 nail findings of endocarditis

A

clubbing
splinter hemorrhages

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70
Q

tx for endocarditis:
empiric:
prosthetic valve:
pre procedure prophylaxis:

A

empiric: vanco OR amp/sulbactam PLUS aminoglycoside
prosthetic valve: same as empiric, add rifampin
pre procedure prophylaxis: amoxicillin

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71
Q

murmurs to know (7)

A

aortic stenosis
aortic regurgitation
mitral stenosis
mitral regurgitation
MVP
tricuspid stenosis
tricuspid regurgitation
pulmonary regurgitation

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72
Q

harsh systolic ejection crescendo decrescendo murmur heard best at the USB

A

aortic stenosis

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73
Q

aortic stenosis murmur radiates to the

A

neck
apex

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74
Q

sx of aortic stenosis

A

dyspnea
angina
syncope w. exertion

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75
Q

aortic stenosis murmur increases w.

A

squatting

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76
Q

soft, high pitched blowing crescendo decrescendo murmur best heard along LSB

A

aortic regurgitation

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77
Q

what increases the murmur of aortic regurgitation

A

leaning forward

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78
Q

water hammer pulse

A

large/bounding arterial pulse -> aortic regurgitation

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79
Q

diastolic low pitched decrescendo rubling w. an opening snap heard best at the apex

A

mitral stenosis

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80
Q

mitral stenosis murmur is best heard w. the pt in the _ position

A

left lateral decubitus

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81
Q

mcc of mitral stenosis

A

rheumatic fever

82
Q

blowing holosystolic murmur heard best at the apex

A

mitral regurgitation

83
Q

mitral regurgitation murmur radiates to the

A

left axilla

84
Q

5 causes of mitral regurgitation

A

CAD
HTN
MVP
rheumatic fever
heart valve infxn

85
Q

midsystolic ejection click heard best at the apex

86
Q

mid diastolic rumbling murmur at LLSB w. opening snap

A

tricuspid stenosis

87
Q

high pitched holosystolic murmur at LLSB that radiates to the sternum

A

tricuspid regurgitation

88
Q

the murmur of tricuspid regurgitation increases w.

A

inspiration

89
Q

harsh, loud medium pitched systolic murmur heard best at the 2nd/3rd intercostal space

A

pulmonary stenosis

90
Q

high pitched early diastolic decrescendo murmur at LUSB that increases w. inspiration

A

pulmonary regurgitation

91
Q

screening guidelines for HLD:
USPSTF vs NCEP

A

USPSTF: start at 35 yo
NCEP: start at 20 yo

92
Q

4 groups most likely to benefit from statins

A

any form of ASCVD
LDL > 190
DM, 40-75 yo, LDL 70-189
40-75 yo w. ASCVD >/= 7.5%

93
Q

what are the 2 high intensity statins

A

atorvastatin 40, 80 mg
rosuvastatin: 20, 40 mg

94
Q

definition of primary HTN

A

2 readings on 2 separate visits w. no identifiable cause:
SBP >/= 130
OR
DBP >/= 80

95
Q

adult HTN classifications

A

normal: <120/80
elevated: 120-129 AND < 80
stage 1: 130-139 OR 80-89
stage 2: >/= 140 OR >/= 90

96
Q

ACC/AHA BP targets

97
Q

HTN tx based on classificaiton

A

-normal: lifestyle, evaluate annually
-elevated: lifestyle, re-evaluate 3-6 mo
-stage 1 and <10% ASCVD risk: lifestyle, re-evaluate 3-6 mos
-stage 1 and >10% ASCVD risk OR CVD, DM, CKD: lifestyle PLUS 1 med, re-evaluate in 1 month
-stage 2: lifestyle + 2 BP meds, re-evaluate in 1 month

98
Q

first line pharm for HTN for non black pt

A

ACEI vs ARB
CCB (dihydropiridine)
HCTZ

99
Q

tx for HTN for black pt’s

100
Q

contraindication for bb

101
Q

major s.e consideration for bb

102
Q

best med for htn + angina

103
Q

t/f: ACEI are contraindicated in pregnancy

104
Q

common s.e of ccb

A

peripheral edema

105
Q

best med for HTN plus BPH

A

alpha blockers

106
Q

2 major s.e of hydralazine

A

lupus like syndrome
pericarditis

107
Q

definition of htn emergency vs urgency

A

urgency: >180/120 w.o end organ damage
emergency: >180/120 + impending or progressing end organ damage

108
Q

definition of malignant htn

A

DBP > 140
PLUS
papilledema, encephalopathy, or nephropathy

109
Q

tx for htn urgency vs emergency vs malignant

A

urgency: clonidine
emergency: sodium nitroprusside
malignant: hydralazine

110
Q

what are the 2 rate control ccb

A

verapamil
diltiazem

111
Q

management of MI

A

bb
NTG
ASA and plavix
heparin
statins
reperfusion

112
Q

door to balloon time goal for MI

113
Q

2 reperfusion options for MI

A

angioplasty
thrombolytic

114
Q

4 contraindications for fibinolytic therapy

A

ICH
ischemic stroke in past 3 mos
confirmed or suspected dissection
active bleeding

115
Q

indication for fibrinolytic therapy for MI

A

PCI not available

116
Q

goal timing for fibrinolytic therapy

A

w.in first 3 hr

117
Q

myocardial necrosis and rise in cardiac markers w.o complete coronary a blockage or ST elevation

118
Q

cardiac labs and when they become elevated w. MI

A

myoglobin: 1-4 hr
troponin: 2-4 hr
CK/CK-MB: 4-6 hr

119
Q

mcc of myocarditis

A

viral infxn

120
Q

3 causes of myocarditis

A

infxn
xrt
hypersensitivity

121
Q

6 sx of myocarditis

A

fatigue
fever
chest pain
dyspnea
palpitations
tachycardia

122
Q

gs dx for myocarditis

A

endomyocardial bx

123
Q

severe complication of myocarditis

A

heart failure

124
Q

45 yo M w. T1DM and ESRD on hemodialysis - dyspnea, cough, and CP that is worse during inspiration and when lying on back

A

pericarditis

125
Q

10 causes of pericarditis

A

SLE
uremia
coxsackie virus
TB
RA
neoplasm
drugs
xrt
scleroderma
MI

126
Q

pain w. pericarditis is relieved by (2)

A

sitting
leaning forward

127
Q

heart sound associated w. pericarditis

A

pericardial friction rub

128
Q

what is dressler’s syndrome

A

pericarditis 2-5 days after acute MI

129
Q

ekg findings of pericarditis

A

diffuse ST elevations

130
Q

echo findings of pericarditis

A

effusion
+/- tamponade

131
Q

tx for pericarditis

A

nsaids
steroids if sx > 48 hr
abx
pericardiocentesis
head at 45 degrees

132
Q

atherosclerotic dz of the lower extremities and vessels outside the heart/brain

A

peripheral vascular dz

133
Q

mc presentation of PVD

A

intermittent claudication: intermittent pain brought on w. exercise and relieved w. rest

134
Q

what is leriche syndrome

A

PVD in the iliac arteries

135
Q

leriche triad

A

claudication
impotence
decreased femoral pulses

136
Q

mc location for PVD

A

femoral a: thigh/upper calf claudication

137
Q

claudication in lower calf indications PVD in what artery

138
Q

5 sx of PVD

A

weak/absent distal pulses
arterial bruits
loss of hair
shiny, atrophic skin
pallor w. dependent rubor

139
Q

6 p’s of arterial embolism

A

pain
pulselessness
pallor
paresthesias
poikilothermia
paralysis

140
Q

dx for PVD: initial vs gs

A

initial: ABI
gs: arteriography

141
Q

what ABI indicates PVD

142
Q

mainstay pharm for PVD

A

cliostazol

143
Q

all pharm options for PVD

A

bb
ACEI
statins
cliostazol
ASA
clopidogrel

144
Q

surgical management of PVD

A

angioplasty/bypass
endarterectomy

145
Q

mc location for varicose veins

A

greater saphenous

146
Q

describe varicose veins

A

turguous
reticular
telangiectasias

147
Q

management of varicose veins

A

wt loss
compression stockings
leg elevation
radiofrequency vs lasaer ablation
sclerotherapy
surgical stripping

148
Q

what is this showing

A

phlebitis: inflammation of a vein near the surface of the skin

149
Q

sx of phlebitis

A

dull pain
erythema
swelling/heat

150
Q

PE sign associated w. phlebitis

A

homan’s sign: pain w. dorsiflexion of the foot

151
Q

dx for phlebitis

A

US
venography
d dimer

152
Q

management of phlebitis: superficial vs deep

A

superficial: bed rest, local heat, elevation, NSAIDs
deep: anticoagulation vs surgery

153
Q

4 sx of chronic venous insufficiency

A

progressive edema
itching
dull pain
ulcerations
shiny, thin, atrophic skin

154
Q

complications of chronic venous insufficiency

A

ulcerations

155
Q

management of chronic venous insufficiency

A

elevation
compression

156
Q

inflammatory rxn to GAS that causes antistreptolysin abs to form

A

rheumatic fever

157
Q

dx for rheumatic fever

A

e.o recent GAS infxn PLUS Jones criteria:

2 major
OR
1 major and 2 minor

158
Q

major jones criteria

A

joint pain (poly)
(o) carditis
nodules
erythema marginatum
sydenham’s chorea

159
Q

minor jones criteria

A

mono arthralgia
elevated ESR/CRP
fever
prolonged PR

160
Q

tx for rheumatic fever

A

ASA vs NSAIDs
steroids
abx

161
Q

post rheumatic fever antistreptococcal prophylaxis guidelines

A

pen g ->
kids w.o carditis: up to 5 yr or til 21 yo
kids w. carditis w.o residual heart damage: 10 yr
kids w. carditis and e.o heart damage: indefinitely

162
Q

consequence of rheumatic fever that causes inflammation and scarring of the heart valves

A

rheumatic heart dz

163
Q

rheumatic heart dz mc affects the _ valve

164
Q

what protein is associated w. rheumatic fever/heart dz

165
Q

rheumatic heart dz is a type __ hypersensitivity

166
Q

complication of rheumatic heart dz: early vs late

A

early: mitral regurgitation
late: mitral stenosis

167
Q

onset of rheumatic heart dz sx occurs _ yrs after rheumatic fever

168
Q

sx of rheumatic heart dz

A

palpitations
dyspnea
mitral regurg/stenosis
aortic regurg/stenosis

169
Q

dx for rheumatic heart dz

A

echo
anti streptolysin O (ASO) titers
histology

170
Q

histology findings of rheumatic heart dz

A

aschoff bodies on heart valves (granulomas w. giant cells)

171
Q

pharm for GAS prophylaxis if pcn allergy

A

sulfadiazine

172
Q

early murmur suggests

A

regurgitative flow (usually aortic)

173
Q

rumbling murmur suggests

A

stenosis (usually mitral)

174
Q

mc type of murmur

A

midsystolic (ejection)

175
Q

describe ejection murmurs

A

peak near mid systole
stop before S2
gap between murmur and S2

176
Q

4 ejection/midsystolic murmurs to know

A

aortic stenosis
pulmonic stenosis
HOCM
MVP

177
Q

systolic ejection crescendo decrescendo murmur heard best in the RUSB

A

aortic stenosis

178
Q

hard midsystolic ejection crescendo decrescendo murmur w. widely split S2 at LSB

A

pulmonic stenosis

179
Q

pulmonic stenosis murmur radiates to the

A

left shoulder
neck

180
Q

the HOCM murmur increases w. _
and decreases w. _

A

increases: straining
decreases: squatting

181
Q

midsystolic ejection click at the apex

182
Q

3 pansystolic murmurs to know

A

mitral regurgitation
tricuspid regurgitation
VSD

183
Q

blowing holosystolic murmur at the apex w. a split S2

A

mitral regurgitation

184
Q

high pitched holosystolic murmur at the mid LSB

A

tricuspid regurgitation

185
Q

harsh holosystolic murmur heard at LSB w. wide radiation and fixed split S2

186
Q

who should get screened for aortic aneurysm

A

> 65 yo male
hx smoking

187
Q

management of aortic aneurysm

A

> 3 cm: monitor annually
4 cm: bb
5.5 cm or 0.5 cm expansion/year: surgery

188
Q

management of aortic dissection

A

ascending: surgical emergency
descending: bb

189
Q

gs dx for arterial embolism

A

angiography

190
Q

management of arterial embolism

A

IV heparin
angioplasty vs graft vs endarterectomy

191
Q

inflammation of large and medium vessels

A

giant cell arteritis

192
Q

5 sx of giant cell arteritis

A

jaw claudication
HA
thickened temporal a
ttp of scalp
amaurosis fugax

193
Q

amaurosis fugax is caused by

A

anterior ischemic optic neuritis

194
Q

dx for giant cell arteritis

A

ESR > 100
temporal a bx

195
Q

management of giant cell arteritis

A

prednisone ASAP

196
Q

palpable cord makes you think of

A

phlebitis/thrombophlebitis

197
Q

ulcers caused by venous insufficiency are mc located

A

above the medial malleolus

198
Q

initial vs dx for venous thrombosis

A

initial: US
gs: venography

199
Q

tx for venous thrombosis

A

heparin to coumadin bridge

200
Q

which 3 murmurs are holosystolic

A

mitral regurgitation
tricuspid regurgitation
VSD

201
Q

which 4 murmurs are midsystolic

A

aortic stenosis
pulmonic stenosis
HOCM
ASD
MVP

EOR - Internal Med (13 decks)

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