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Internal Medicine > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Dilated Cardiomyopathy

cause

A

idiopathic; viral myocarditis; alcohol toxicity; post-partum, genetics

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2
Q

Dilated Cardiomyopathy

s/s

A

left congestive heart failure, dyspnea; S3 gallop, pulmonary rales, increased JVD

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3
Q

Dilated Cardiomyopathy

dx

A

echocardiogram (left ventricular dilation and dysfunction, large ventricular chamber, decreased ejection fraction); CXR (cardiomegaly, pulmonary congestion); EKG (nonspecific ST/T wave changes); nuclear studies, cardiac cath

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4
Q

Dilated Cardiomyopathy

tx

A

ACE, diuretics, BB, cardiac transplant, digoxin; alcohol cessation

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5
Q

Hypertrophic Cardiomyopathy cause

A

genetics (asian), elderly, young athletes

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6
Q

Hypertrophic Cardiomyopathy s/s

A

dyspnea, angina; syncope, arrhythmias; sudden cardiac death; sustained PMI, loud S4 gallop, variable systolic murmur, bisferiens carotid pulse, jugular venous pulsations

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7
Q

Hypertrophic Cardiomyopathy dx

A

echocardiogram (LVH, asymmetric septal hypertrophy, small left ventricle, diastolic dysfunction); EKG (nonspecific ST/T wave changes, exaggerated septal Q waves, LVH)

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8
Q

Hypertrophic Cardiomyopathy tx

A

BB, CBB; disopyramide; surgical ablation of septum, dual-chamber pacing

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9
Q

Restrictive Cardiomyopathy cause

A

fibrosis or infiltration of ventricular wall because of collage-defect diseases (amyloidosis, radiation, post-op changes, DM, fibrosis)

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10
Q

Restrictive Cardiomyopathy s/s

A

decreased exercise tolerance; right sided congestive heart failure; pulmonary HTN

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11
Q

Restrictive Cardiomyopathy dx

A

echocardiogram (diagnostic); CXR (enlarged cardiac silhouette); EKG changes; Cardiac MRI; cardiac cath (reduced LV function); endomyocardial biopsy (r/o other cardiomyopathies and pericarditis)

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12
Q

Restrictive Cardiomyopathy tx

A

diuretics

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13
Q

Takotsubo Cardiomyopathy (broken heart syndrome) cause

A

stress-induced; major catecholamine discharge

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14
Q

Takotsubo Cardiomyopathy (broken heart syndrome) s/s

A

indistinguishable from acute MI

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15
Q

Takotsubo Cardiomyopathy (broken heart syndrome) dx

A

EKG changes, mild cardiac enzyme elevation suggestive of MI; cardiac cath (hypocontractility of left ventricular apex, patent coronary arteries)

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16
Q

Takotsubo Cardiomyopathy (broken heart syndrome) tx

A

supportive; avoid inotropes

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17
Q

Atrial Fibrillation cause

A

age; excessive alcohol use/withdrawal; structural abnormality

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18
Q

Atrial Fibrillation s/s

A

palpitations, angina, fatigue, heart failure symptoms; irregularly irregular

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19
Q

Atrial Fibrillation dx

A

EKG (narrow-complex irregularly irregular rhythm)

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20
Q

Atrial Fibrillation tx

A

cardioversion (200 J; adenosine); anticoagulants (heparin, LMWH, warfarin, dabigatran); antiarrhythmics w/ heart failure (digoxin, amiodarone, dronedarone); w/o heart failure (metoprolol, diltiazem/verapamil)

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21
Q

Atrial Flutter cause

A

COPD, heart failure, atrial septal defect, CAD

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22
Q

Atrial Flutter s/s

A

palpitations, angina, fatigue, heart failure symptoms

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23
Q

Atrial Flutter dx

A

○ EKG (saw tooth pattern; no P waves)

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24
Q

Atrial Flutter tx

A

cardioversion (50 J; ibutilide); anticoagulants (heparin, LMWH, warfarin, dabigatran); antiarrhythmics (amiodarone, procainamide); chronic (metoprolol, diltiazem/verapamil)

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25
Q

Atrioventricular Block cause

A

refractory conduction of impulses from atria to ventricles through AV node or bundle of HIS

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26
Q

Atrioventricular Block s/s

A

asymptomatic (1st degree); weakness, fatigue, light-headedness, syncope

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27
Q

Atrioventricular Block dx

A

EKG
■ 1st degree block: PR interval is >0.21s
■ 2nd degree block type 1 (Wenckebach): progressive lengthening of PR interval, shortening of RR, dropped beat
■ 2nd degree block type 2: normal length PR interval, dropped beat
■ 3rd degree block: complete dissociation between P waves and QRS intervals

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28
Q

Atrioventricular Block tx

A

no treatment (1st degree); permanent pacing (esp type 2 and 3rd degree)

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29
Q

Bundle Branch Block cause

A

myocardial infarctions; CAD

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30
Q

Bundle Branch Block dx

A

EKG
■ RBBB: wide QRS >.12s; RsR in V1/ V2 (“m”)
■ LBBB: wide QRS >.12s; broad slurred R in V5/V6, deep S in V1; ST elevations in V1-V3

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31
Q

Sick Sinus Syndrome cause

A

digitalis, CCB, BB, sympathologic agents, antiarrhythmic drugs, aerosol propellant abuse; underlying collagen vascular or metastatic disease, surgical injury, coronary disease

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32
Q

Sick Sinus Syndrome s/s

A

asymptomatic; syncope, dizziness, confusion, heart failure, palpitations, decreased exercise tolerance

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33
Q

Sick Sinus Syndrome dx

A

EKG (sinus brady, sinus pause, sinus arrest)

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34
Q

Sick Sinus Syndrome tx

A

permanent pacing

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35
Q

Paroxysmal Supraventricular Tachycardia cause

A

not structural, Wolff-parkinson white syndrome

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36
Q

Paroxysmal Supraventricular Tachycardia s/s

A

palpitations, angina, fatigue, heart failure symptoms

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37
Q

Paroxysmal Supraventricular Tachycardia dx

A

EKG (regular, p wave, narrow-complex tachy)

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38
Q

Paroxysmal Supraventricular Tachycardia tx

A

valsalva maneuvers; adenosine IV push -> BB/CBB; synchronized cardioversion prn; catheter ablative surgery (recurrent/sustained)

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39
Q

premature beats

A

PAc, PJC, PVC

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40
Q

PAC’s

A

benign; no treatment required

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41
Q

PJC

A

drug toxicity, electrolyte imbalance, mitral valve surgery, cold water immersion

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42
Q

PVC

A

benign; ischemia, electrolyte disturbance; skipped beats; BB/CBB

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43
Q

Ventricular Tachycardia cause

A

electrolyte abnormalities; acute MI; dilated cardiomyopathy

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44
Q

Ventricular Tachycardia s/s

A

palpitations; dizziness, syncope, sudden death; severe hypotension

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45
Q

Ventricular Tachycardia dx

A

EKG (>100bpm w/ 3 PVCs, nonsustained <30s vs sustained >30s)

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46
Q

Ventricular Tachycardia tx

A

cardioversion (amiodarone) vs defibrillation/CPR; lidocaine, procainamide; ICD (sustained/recurrent)

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47
Q

Ventricular Fibrillation cause

A

disorganized electrical impulses, no pumping action of heart

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48
Q

Ventricular Fibrillation s/s

A

sudden unconsciousness and death

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49
Q

Ventricular Fibrillation dx

A

EKG (irregular, rapid waveform of varying amplitude)

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50
Q

Ventricular Fibrillation tx

A

Defibrillation/CPR and cardioversion

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51
Q

Torsades de Pointes cause

A

spontaneous; hypokalemia, hypomagnesaemia following administration of drugs that prolong QT

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52
Q

Torsades de s/s

A

polymorphic Vtach; palpitations, dizziness, syncope, sudden death

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53
Q

Torsades de Pointes dx

A

Vtach w/ QRS twists on baseline

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54
Q

Torsades de Pointes tx

A

IV magnesium; correct electrolyte abnormalities; isoproterenol infusion; permanent pacemaker

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55
Q

Brugada Syndrome s/s

A

syncope, ventricular fibrillation, sudden death

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56
Q

Heart Failure cause

A

myocardial/pericardial disorders; valvular/congenital abnormalities; noncardiac (thyrotoxicosis, severe anemia)

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57
Q

Heart s/s

A

exertional dyspnea, cough, fatigue, orthopnea, paroxysmal nocturnal dyspnea, bibasilar rales, gallops, exercise intolerance (left-sided, exertional pulmonary congestion); JVD, nontender hepatic congestion, decreased appetite/nausea, pitting edema (right-sided, systemic pulmonary congestion); parasternal lift, enlarged displaced, hyperdynamic apical impulse, diminished S1, S3 gallop, pallor, clammy skin, nocturia, hypotension

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58
Q

Heart Failure dx

A

echocardiogram (decreased ejection fraction, change in size/function of chambers, valve abnormalities, etc); CXR (cardiomegaly, pulmonary effusions, Kerley B lines, venous dilation); elevated BNP; cardiac cath; anemia, renal insufficiency, hyperkalemia, hyponatremia

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59
Q

Heart Failure tx

A

exercise, low Na diet, stress reduction, no alcohol/smoking; ACEI/ARBs, loop/HCTZ diuretics; BB, aldosterone receptor agonists; digitalis

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60
Q

Cardiogenic Shock cause

A

hypovolemic shock (hemorrhage, loss of fluid/electrolytes); cardiogenic shock (MI, dysrhythmias, HF, HTN, contusion, myocarditis); obstructive shock (tension pneumo, tamponade, COPD, PE); septic/neurogenic shock (sepsis/infection, spinal cord injury, ADEs of spinal/epidural anesthesia)

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61
Q

Cardiogenic Shock s/s

A

hypotension, lack of hypovolemia, poor tissue perfusion; AMS (confusion, obtunded), oliguria, insulin resistance, metabolic acidosis, cool/mottled extremities, diminished cap refill, weak peripheral pulses

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62
Q

Cardiogenic Shock dx

A

CBC, blood type/cross match, coags, electrolytes, glucose, urinalysis, creatinine (determine cause), ABG, EKG, biomarkers, lactate levels

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63
Q

Cardiogenic Shock tx

A

airway, breathing, circulation; treat cause of shock; oxygen/fluid bolus; inotropes to increase cardiac output (epi, dobutamine), chronotropes to alter rate (adrenaline, digoxin), pressors to increase vascular tone (dopamine, phenylephrine); PCI

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64
Q

Orthostatic Hypotension cause

A

reduced cardiac output, paroxysmal cardiac dysrhythmias, low blood volume, medications, endocrine, neurologic, and metabolic disorders

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65
Q

Orthostatic Hypotension s/s

A

dizziness, worse with movement; headache

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66
Q

Orthostatic Hypotension dx

A

orthostatic vitals (>20mmHg drop in SBP or >10mmHg drop in DBP between sitting and standing, rise in pulse of >15bpm); CBC, BMP, EKG, tilt test

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67
Q

Orthostatic Hypotension tx

A

fluids; remove medication causes

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68
Q

Essential Hypertension cause

A

genetic, increased age, black ethnicity, environmental factors, tobacco, sedentary lifestyle, polycythemia, NSAID use, metabolic syndrome

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69
Q

Essential Hypertension s/s

A

most asymptomatic or nonspecific headache

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70
Q

Essential Hypertension dx

A

BP >140/>90 at 2 visits; EKG (LVH and strain); CXR (ventricular hypertrophy); dec H&H, elevated BUN, creatinine, or glucose; urinary glucose, protein, sediment, lipid profile

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71
Q

Essential Hypertension tx

A

DASH diet; ACE inhibitors, diuretics (loop vs HCTZ), Beta blockers, CCB (amlodipine), aldosterone receptor antagonists (spironolactone), renin inhibitor (aliskiren)

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72
Q

Secondary Hypertension cause

A

renal disease, renal artery stenosis, coarctation of aorta, pheochromocytoma, cushing syndrome, hyperthyroidism, chronic steroid use, NSAID use

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73
Q

Secondary Hypertension s/s

A

most asymptomatic; nonspecific headache

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74
Q

Secondary Hypertension dx

A

BP >140/>90 at 2 visit; EKG (LVH and strain); CXR (ventricular hypertrophy); dec H&H, elevated BUN, creatinine, or glucose; urinary glucose, protein, sediment, lipid profile; determine underlying disease process

75
Q

Secondary Hypertension tx

A

DASH diet; ACE inhibitors, diuretics (loop vs HCTZ), Beta blockers, CCB (amlodipine), aldosterone receptor antagonists (spironolactone), renin inhibitor (aliskiren)

76
Q

Hypertensive Emergencies cause

A

uncontrolled hypertension

77
Q

Hypertensive Emergencies s/s

A

papilledema, encephalopathy, nephropathy, ICH, aortic dissection, preeclampsia/eclampsia, pulmonary edema, unstable angina, MI

78
Q

Hypertensive Emergencies dx

A

SBP >130 with end organ damage; CT, MRI, echo, renal vessel imaging

79
Q

Hypertensive Emergencies tx

A

sodium nitroprusside; labetalol, fenoldopam, nicardipine; NTG; slowly lower BP to prevent stroke 25% in MAP w/in 1st hour

80
Q

Acute Myocardial Infarction: STEMI cause

A

acute coronary thrombosis; CAD, Afib, etc

81
Q

Acute Myocardial Infarction: STEMI s/s

A

chest pain (pressure) radiating to neck, arm, back; lasts longer than angina; diaphoresis, N/V

82
Q

Acute Myocardial Infarction: STEMI dx

A

EKG (ST elevation, reciprocal ST depression, inverted T waves)

83
Q

Acute Myocardial Infarction: STEMI tx

A

aspirin, morphine, NTG; oxygen; cardiac cath; heparin/tpa prn

84
Q

Acute Myocardial Infarction: NSTEMI cause

A

acute coronary thrombosis

85
Q

Acute Myocardial Infarction: NSTEMI s/s

A

chest pain (pressure) radiating to neck, arm, back; lasts longer than angina; diaphoresis, N/V; asymptomatic

86
Q

Acute Myocardial Infarction: NSTEMI dx

A

EKG (nonspecific ST changes, NO ST elevation); elevated cardiac enzymes

87
Q

Acute Myocardial Infarction: NSTEM tx

A

aspirin, morphine, oxygen, NTG; cardiac stents

88
Q

Stable Angina Pectoris cause

A

CAD, DM, hyperlipidemia, smoking, HTN, males

89
Q

Stable Angina Pectoris s/s

A

chest pain, may radiate, lasts <30min; relieved with NTG or rest; dyspnea, nausea, diaphoresis, numbness, fatigue

90
Q

Stable Angina Pectoris dx

A

coronary angiogram (definitive); EKG (ST depression w/ exertion, T wave inversion, poor R wave progression); Non-invasive stress test

91
Q

Stable Angina Pectoris tx

A

BB, ASA; NTG prn; angioplasty, CABG

92
Q

Unstable Angina Pectoris cause

A

CAD, DM, hyperlipidemia, smoking, HTN, males

93
Q

Unstable Angina Pectoris s/s

A

severe and worsening from prior; chest pain, may radiate, lasts >30min; relieved with NTG or rest; dyspnea, nausea, diaphoresis, numbness, fatigue

94
Q

Unstable Angina Pectoris dx

A

coronary angiogram (definitive); non elevated cardiac enzymes; EKG (ST depression w/ exertion, T wave inversion, poor R wave progression); Non-invasive stress test

95
Q

Unstable Angina Pectoris tx

A

NTG, ASA, BB; (LMWH, clopidogrel); oxygen, fluids; cardiac cath

96
Q

Prinzmetal Variant Angina cause

A

CAD, DM, hyperlipidemia, smoking, HTN, males

97
Q

Prinzmetal Variant Angina s/s

A

occurs in morning, at rest; chest pain; not due to exertion; ventricular dysrhythmias

98
Q

Prinzmetal Variant Angina dx

A

EKG (transient ST elevation); Non-invasive stress test; cardiac angiogram

99
Q

Prinzmetal Variant Angina tx

A

CCB, NTG

100
Q

Aortic Aneurysm/Dissection cause

A

weakness in vessel wall, atherosclerosis, congenital defects due to syphilis, trauma, vasculitis, Marfan syndrome

101
Q

Aortic Aneurysm/Dissection s/s

A

asymptomatic; pulsatile abdominal mass; abdominal/back pain radiating to leg or testis, dyspnea, “ripping”/”tearing” chest pain radiating to back, hypotension, shock; BP difference of >20mmHg between upper and lower extremities

102
Q

Aortic Aneurysm/Dissection dx

A

abdominal US (abdominal), CT w/ IV contrast (identifies rupture) CT/MRI (thoracic); CXR (widened mediastinum, displaced aortic notch); CBC, BMP, coag studies

103
Q

Aortic Aneurysm/Dissection tx

A

endovascular/open surgical repair; manage BP w/ labetalol, nitroprusside [goal BP <150]; symptomatic will likely rupture, ruptured are fatal

104
Q

Arterial Embolism/Thrombosis cause

A

hx of Afib; injury to vessel wall, increased clotting, atherosclerosis

105
Q

Arterial Embolism/Thrombosis s/s

A

decreased pulses, cold extremities, lack of movement, muscle pain, numbness in fingers and hands

106
Q

Arterial Embolism/Thrombosis dx

A

angiography; duplex ultrasound; PT, CBC

107
Q

Arterial Embolism/Thrombosis tx

A

anticoagulant/antiplatelet; thrombolytics; pain meds

108
Q

Giant Cell Arteritis (Temporal arteritis) cause

A

affects superficial temporal arteries; unknown cause (genetic, environmental, autoimmune)

109
Q

Giant Cell Arteritis (Temporal arteritis) s/s

A

abrupt or insidious onset; unilateral headache, jaw claudication, fever, fatigue, malaise; neck/torso/shoulder/pelvic girdle pain

110
Q

Giant Cell Arteritis (Temporal arteritis) dx

A

biopsy; elevated ESR/CRP; angiography, ultrasound, MRI/MRA

111
Q

Giant Cell Arteritis (Temporal arteritis) tx

A

glucocorticoid therapy (prednisone)

112
Q

Peripheral Arterial Disease cause

A

atherosclerosis; trauma, hypovolemia, inflammatory arteritis, polycythemia, dehydration, hypercoaguable states

113
Q

Peripheral Arterial Disease s/s

A

intermittent claudication, foot/lower leg pain w/ exercise relieved by rest; weak/absent femoral/distal pulses; aortic/iliac/femoral bruits; loss of hair, shiny atrophic skin, and pallor with dependent rubor to skin; numbness, tingling, ischemic ulcerations

114
Q

Peripheral Arterial Disease dx

A

angiography; doppler ultrasound; ankle-brachial index

115
Q

Peripheral Arterial Disease tx

A

control underlying diseases (tobacco use, DM, HTN, hyperlipidemia); BB, ACEI, statins, exercise; antiplatelet therapy; revascularization

116
Q

Phlebitis/Thrombophlebitis cause

A

virchow triad (stasis, vascular injury, hypercoagulability); spontaneous, following trauma, PICC line; hormone replacement, bed rest; clotting problems (factor 5 leiden, protein C, protein S); cancer

117
Q

Phlebitis/Thrombophlebitis s/s

A

dull pain, erythema, tenderness, induration of involved vein (MC saphenous v); swelling, warmth, erythema to lower extremity

118
Q

Phlebitis/Thrombophlebitis dx

A

duplex ultrasound; Wells score; venography; d-dimer; CT angiography (chest)

119
Q

Phlebitis/Thrombophlebitis tx

A

LMWH (enoxaparin), then warfarin; bed rest, heat to area, elevation, NSAIDs; antibiotics w/ infection; frequent ambulation, compression devices

120
Q

Varicose Veins cause

A

pregnancy, obesity, family history, prolonged sitting; incompetent valves

121
Q

Varicose Veins s/s

A

Dilated, tortuous superficial veins; smaller blue-green, flat reticular veins, telangiectasias, spider veins; aching with fatigue; chronic distal edema, abnormal pigmentation, fibrosis, atrophy, skin ulceration

122
Q

Varicose Veins dx

A

doppler sonography

123
Q

Varicose Veins tx

A

elastic stockings, leg elevation, regular exercise; Laser ablation, endovenous radiofrequency, compression sclerotherapy

124
Q

Venous Insufficiency cause

A

incompetent valves; thick, scarred veins, dilated veins

125
Q

Venous Insufficiency s/s

A

pruritus, swelling of legs and ankles, eczema, pitting edema, fibrosis of skin, skin hyperpigmentation, stasis dermatitis, dull ache

126
Q

Venous Insufficiency dx

A

duplex ultrasound

127
Q

Venous Insufficiency tx

A

compression stocking, avoid long sitting/standing, elevate leg, reduce edema, pneumatic compression

128
Q

Venous Thrombosis cause

A

stasis, vascular injury, hypercoagulability; OC, obesity, long-distance travel, lupus

129
Q

Venous Thrombosis s/s

A

dull pain, erythema, swelling, tenderness, induration of vein

130
Q

Venous Thrombosis dx

A

duplex US, venography, d-dimer and CT (pulmonary)

131
Q

Venous Thrombosis tx

A

bed rest, heat, elevation, NSAIDs, anticoagulation with LMWH or UFH and warfarin

132
Q

Aortic Stenosis cause

A

bicuspid AV, congenital, rheumatic heart disease, connective tissue disorders, infection, senile degeneration

133
Q

Aortic Stenosis s/s

A

dyspnea, fatigue, decreased exercise tolerance, cough, rales, paroxysmal nocturnal dyspnea, hemoptysis, hoarseness; thready pulses; harsh midsystolic murmur in 2nd RICS, radiates to LSB and neck, with thrill

134
Q

Aortic Stenosis dx

A

transesophageal echocardiogram and cardiac cath (definitive); CXR (left sided atrial enlargement, ventricular hypertrophy)

135
Q

Aortic Stenosis tx

A

surgical repair/replacement of valve (PCI, balloon valvuloplasty); diuretics, vasodilators (pulmonary congestion); digoxin, BB (dysrhythmias)

136
Q

Aortic Regurgitation cause

A

bicuspid AV, congenital, rheumatic heart disease, connective tissue disorders, infection, senile degeneration

137
Q

Aortic Regurgitation s/s

A

dyspnea, fatigue, decreased exercise tolerance, cough, rales, paroxysmal nocturnal dyspnea, hemoptysis, hoarseness; bounding pulses, widened pulse pressure; soft systolic and diastolic decrescendo “blowing” murmur in 2nd/4th LICS radiating to RSB and apex

138
Q

Aortic Regurgitation dx

A

transesophageal echocardiogram and cardiac cath (definitive); CXR (left sided atrial enlargement, ventricular hypertrophy)

139
Q

Aortic Regurgitation tx

A

surgical repair/replacement of valve (PCI, balloon valvuloplasty); diuretics, vasodilators (pulmonary congestion); digoxin, BB (dysrhythmias)

140
Q

Mitral Stenosis cause

A

bicuspid AV, congenital, rheumatic heart disease, connective tissue disorders, infection, senile degeneration

141
Q

Mitral Stenosis s/s

A

dyspnea, fatigue, decreased exercise tolerance, cough, rales, paroxysmal nocturnal dyspnea, hemoptysis, hoarseness; mid-diastolic murmur in apex, snap follows S2

142
Q

Mitral Stenosis dx

A

transesophageal echocardiogram and cardiac cath (definitive); CXR (atrial enlargement)

143
Q

Mitral Stenosis tx

A

surgical repair/replacement of valve (PCI, balloon valvuloplasty); diuretics, vasodilators (pulmonary congestion); digoxin, BB (dysrhythmias)

144
Q

Mitral Regurgitation cause

A

bicuspid AV, congenital, rheumatic heart disease, connective tissue disorders, infection, senile degeneration

145
Q

Mitral Regurgitation s/s

A

dyspnea, fatigue, decreased exercise tolerance, cough, rales, paroxysmal nocturnal dyspnea, hemoptysis, hoarseness; pansystolic blowing murmur in apex, radiates to left axilla

146
Q

Mitral Regurgitation dx

A

transesophageal echocardiogram and cardiac cath (definitive); CXR (atrial enlargement)

147
Q

Mitral Regurgitation tx

A

surgical repair/replacement of valve (PCI, balloon valvuloplasty); diuretics, vasodilators (pulmonary congestion); digoxin, BB (dysrhythmias)

148
Q

Mitral Valve Prolapse cause

A

congenital, thin females w/ minor chest wall deformities

149
Q

Mitral Valve Prolapse s/s

A

asymptomatic; midsystolic clicks, late systolic murmur

150
Q

Mitral Valve Prolapse dx

A

transesophageal echocardiogram and cardiac cath (definitive); CXR (atrial enlargement)

151
Q

Mitral Valve Prolapse tx

A

surgical repair/replacement of valve (PCI, balloon valvuloplasty); diuretics, vasodilators (pulmonary congestion); digoxin, BB (dysrhythmias)

152
Q

Tricuspid Stenosis cause

A

congenital (during infancy/childhood); rheumatic scarring, connective tissue disease, endocarditis (adults)

153
Q

Tricuspid Stenosis s/s

A

exercise intolerance, JVD, peripheral edema, hepatomegaly; diastolic murmur

154
Q

Tricuspid Stenosis dx

A

echocardiogram and cardiac cath (definitive); CXR (prominent right heart border w/ dilation of SVC); EKG (RAD, right atrial enlargement, RVH)

155
Q

Tricuspid Stenosis tx

A

surgical repair/replacement; sodium restriction, diuretics; vasodilators, positive inotropic agents (pulmonary HTN)

156
Q

Tricuspid Regurgitation cause

A

congenital (during infancy/childhood); rheumatic scarring, connective tissue disease, endocarditis (adults); intrinsic or functional

157
Q

Tricuspid Regurgitation s/s

A

exercise intolerance, JVD, peripheral edema, hepatomegaly; holosystolic murmur at LLSB, radiates to right sternum and xiphoid

158
Q

Tricuspid Regurgitation dx

A

echocardiogram and cardiac cath (definitive); CXR (prominent right heart border w/ dilation of SVC); EKG (RAD, right atrial enlargement, RVH)

159
Q

Tricuspid Regurgitation tx

A

surgical repair/replacement; sodium restriction, diuretics; vasodilators, positive inotropic agents (pulmonary HTN)

160
Q

Pulmonary Stenosis cause

A

congenital (during infancy/childhood); rheumatic scarring, connective tissue disease, endocarditis (adults)

161
Q

Pulmonary Stenosis s/s

A

exercise intolerance, JVD, peripheral edema, hepatomegaly; midsystolic crescendo-decrescendo murmur in 2nd/3rd LICS, radiates to left shoulder/neck

162
Q

Pulmonary Stenosis dx

A

echocardiogram and cardiac cath (definitive); CXR (prominent right heart border w/ dilation of SVC); EKG (RAD, right atrial enlargement, RVH)

163
Q

Pulmonary Stenosis tx

A

surgical repair/replacement; sodium restriction, diuretics; vasodilators, positive inotropic agents (pulmonary HTN)

164
Q

Pulmonary Regurgitation cause

A

congenital (during infancy/childhood); rheumatic scarring, connective tissue disease, endocarditis (adults)

165
Q

Pulmonary Regurgitation s/s

A

exercise intolerance, JVD, peripheral edema, hepatomegaly; diastolic murmur

166
Q

Pulmonary Regurgitation dx

A

echocardiogram and cardiac cath (definitive); CXR (prominent right heart border w/ dilation of SVC); EKG (RAD, right atrial enlargement, RVH)

167
Q

Pulmonary Regurgitation tx

A

surgical repair/replacement; sodium restriction, diuretics; vasodilators, positive inotropic agents (pulmonary HTN)

168
Q

Bacterial Endocarditis cause

A

staph aureus (acute); strep viridans (subacute); staph epidermidis (prosthetic)

169
Q

Bacterial Endocarditis s/s

A

fever, cough, dyspnea, pallor, splenomegaly; palatal/conjunctival/subungual petechiae, splinter hemorrhages, osler nodes (painful), janeway lesions (not painful)

170
Q

Bacterial Endocarditis dx

A

echocardiogram; blood cultures q1hr x3; Duke Criteria

171
Q

Bacterial Endocarditis tx

A

gentamicin, cephalosporin, vancomycin (empirical); nafcillin, gentamicin (acute); PCN, gentamicin (subacute)

172
Q

Acute Pericarditis cause

A

idiopathic; viral/bacterial infection; autoimmune (RA, SLE); radiation therapy, myxedema, TB, post-MI (dressler syndrome)

173
Q

Acute Pericarditis s/s

A

sharp, pleuritic substernal chest pain, radiates to back/neck/shoulders; relieved by sitting upright and leaning forward, worse with inspiration; cardiac friction rub, JVD, cardiac tamponade (hypotension, tachycardia)

174
Q

Acute Pericarditis dx

A

elevated WBC; EKG (diffuse ST elevation, T wave inversions, PR depression); CT/MRI

175
Q

Acute Pericarditis tx

A

steroids (prednisone), NSAIDs/ASA; pericardiectomy, antibiotics, IV hydration

176
Q

Cardiac Tamponade cause

A

fluid compromises cardiac filling and impairs cardiac output; MI, PE, trauma

177
Q

Cardiac Tamponade s/s

A

tachycardia, tachypnea, narrow pulse pressure, JVD, pulsus paradoxus; becks triad (low BP, JVD, muffled heart sounds)

178
Q

Cardiac Tamponade dx

A

CXR, echo, EKG, clinical (becks triad + pulsus paradoxus)

179
Q

Cardiac Tamponade tx

A

pericardiocentesis (hemodynamic compromise), steroids/NSAIDs (inflammation), pericardiectomy

180
Q

Pericardial Effusion cause

A

pericarditis, uremia, cardiac trauma

181
Q

Pericardial Effusion s/s

A

painless; chest pain, cough, dyspnea

182
Q

Pericardial Effusion dx

A

CXR (fluid around heart); echocardiogram; EKG (nonspecific T changes, low QRS, electrical alternans)

183
Q

Pericardial Effusion tx

A

pericardiocentesis (hemodynamic compromise), steroids/NSAIDs (inflammation), pericardiectomy

Internal Medicine (9 decks)

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