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Internal Medicine > Cardiovascular And Metabolic Changes > Flashcards

Cardiovascular And Metabolic Changes Flashcards

1
Q

Dilated cardiomyopathy often leads to what type of dysfunction and physical exam.

A

Systolic HF ; both left and right

Left= Dyspnea; Cough; Wheeze

Right= Hepatomegaly; JVD; Peripheral Edema

PE= JVD and S3 gallop

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2
Q

What is the most common type of cardiomyopathy

A

Dilated

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3
Q

Etiologies of dilated cardiomyopathy (6)

A

Idiopathic (MC)
ETOH and Cocaine
Doxyrobicin
Infection(Cocksackie Virus)
Vitamin B1 Deficiency

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4
Q

Treatment for dilated cardiomyopathy

A

“BASH”

Beta blockers
Ace-I/Arbs
Spirinolactone
Hydralyzine

-Nitrates

Sxs control = loop diuretics; digoxin

Low EF = ICD

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5
Q

Restrictive cardiomyopathy explain pathophysiology

A

Stiff ventricles due to infiltration disease -> Inability to relax during diastole -> diastolic dysfunction

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6
Q

3 etiologies of restrictive cardiomyopathy

A

Amyloidosis (MC)
Hemochromatosis
Sarcoidosis

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7
Q

Sxs and physical exam findings restrictive cardiomyopathy

A

Hepatomegaly
Kussmauls JVD w/ inspiration
Peripheral edema

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8
Q

What does the echo show for dilated cardiomyopathy

A

Ventricular dilation
Thin ventricular walls
Low EF

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9
Q

What does the echo show for restrictive cardiomyopathy

A

NML to slightly thickened ventricles
Diastolic dysfunction
Atrial dilation due to ventricle resistance

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10
Q

Treatment for restrictive cardiomyopathy

A

Diastolic dysfunction meds
BB; CCB; Furosemide

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11
Q

HOCM pathophysiology

A

Genetic disorder of cardiac sarcomeres leading to ventricular hypertrophy
Diastolic dysfunction
+/- Outflow obstruction

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12
Q

Describe HOCM murmur

A

Harsh crescendo-decrescendo HOLOSYSTOLIC murmur best heard at LLSB ; DECREASES with valsalva

+S4

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13
Q

Treatment approach to HOCM

A

B-Blocker

CCB

Ablation of the septum

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14
Q

What meds should be avoided in HOCM (3)

A

Nitrates Digoxin Diuretics

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15
Q

What is the reason for Takotsubu

A

~ post menopausal : Catecholamine surge.

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16
Q

Where are STE likely present in Takatosubu

A

Anterior Leads

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17
Q

Treatment approach to takutsubu (4)

A

ASA

Nitrates

B-Blockers

Heparin

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18
Q

Elevated ; Stage 1 ; Stage 2 HTN

A

Elevated—120-130 and less than 80

Stage 1—130-139 and/ or 80-90

Stage 2— 140+ and/or 90+

2 high readings on 2 different visits

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19
Q

MC cause of secondary HTN

A

Renal Artery Stenosis

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20
Q

4 differentials for secondary HTN

A

Cushings
Hyperaldosteronism
Pheo
Sleep apnea

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21
Q

What ASCVD risk with HTN is okay to try lifestyle changes first

A

Less than 10%

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22
Q

First line medication to decrease blood pressure

A

A’ CE-I/ARBS
C’ CBs
T’ hiazide diuretics

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23
Q

What med should be initiated in all patients after MI to decrease mortality

A

B-Blockers

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24
Q

Define resistant HTN

A

3 different classes at max doses ; persistent HTN above 130/80

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25
Q

HTN Urgency

Vs

HTN emergency

A

U= greater 180/110 without EOD

E= greater 180/120 with EOD

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26
Q

Examples of HTN EOD

A

Retinopathy
Encephalopathy
Cerebral hemmorhage
MI
HF
AKI
Aortic Dissection

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27
Q

Treatment of HTN Emergency

A

IV medications :

Labetalol
Nitroprusside
Nitroglycerin
Hydralazine

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28
Q

4 goals of shock management

A

Keep CVP greater 8 w/ IVF
Keep MAP greater than 65mmHg w/ vasopressors
Keep hematocrit greater 30%
Inotropes can augment cardiac output - Dobutamine

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29
Q

3 reasons for a hypovolemic state ; what is its effects on the heart ; TXM

A

Hemmorhage
Dehydration
3rd spacing

Decreased Preload ; CO
Increased SV

TXM = IVF or Blood

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30
Q

2 reasons for distributive shock

A

Sepsis or anaphylaxis

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31
Q

Sxs of distributive shock ; effects on the heart

A

Warm
Dry
Bounding pulses
Altered Body Temperature

Decreased Preload / CO
Increased SV

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32
Q

Distributive shock TXM

A

Vasopressors ; IVF

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33
Q

Differentials for acute hypotension (3)

A

Neurogenic (Barorefflex)
Chronic sympathetic efferent dysfunction decreases BP while increasing HR
Orthostatic HTN = SYS drop of 20; DIAST drop of 10

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34
Q

Reflex syncope patho ; causes

A

Low BP and Low HR
VV
Situational
Carotid sinus hypersensitivity

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35
Q

Tachycardic causes of cardiac syncope

A

WPW
V-tach
Long QT syndrome
Short QT

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36
Q

Bradycardic causes of cadiac syncope

A

AV Block
Sick Sinus syndrome

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37
Q

What is the murmur of atrial myxoma

A

Mid-Diastolic dysfunction
Crescendo Murmur

“AV valve obstruction” due to tumor in the Left Atrium

Positional - Louder when upright ; Dyspnea often improves when laid flat

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38
Q

Patho of mitral stenosis

A

MC : Rheumatic Fever

Decreased blood flow to the left ventricle

LLB = loudest ; and Low pitch rumble or whoosh sound

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39
Q

What 4 things can cause Dyslipidemia

A

Increased cholesterol
Hypothyroidism
Pregnancy
CKD

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40
Q

Triglycerides increase with: 5 [DOSEE]

A

DM
Obesity
Steroids
Estrogen
ETOH

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41
Q

Increased triglycerides can lead to what over what

A

Pancreatitis

over 500

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42
Q

What is the screening protocols for dyslipidemia

A

Greater than 35 y/o
Age 20-29 with ASCVD risk

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43
Q

High Intensity Statins

A

Atorvastatin [40-80] - Lipitor
Rosuvastatin [20-40] - Crestor [less lipophilic]

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44
Q

Moderate Intensity Statins

A

Atorvastatin [10-20]-Lipitor

Simvastatin [20-40] - Zocor

Rosuvastatin [5-10] -Crestor

Primvastatin [40-80] -Pravachol

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45
Q

Low Intensity Statin

A

Simvastatin [10]

Pravastatin [10-20]

Lovastatin [20] - Mevacor

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46
Q

MOA of statins

Contraindicated in :

A

Inhibit HMG COA to increase LDL receptors

Pregnancy Liver Dz Nursing

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47
Q

MOA of Fibrates

Contra

A

Good for decreasing Tri’s

PPAR Agonsit

-Contra = renal dz ; liver dz

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48
Q

Niacin MOA

ADE

A

ONLY: Fam HyperChol
Increases HDL production

ADE=Flush; Hyperglycemia

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49
Q

Who needs 1 degree prevention statin therapy

A

FHx of Early ASVD
Pre-eclampsia
LDL greater 160
Metabolic Synd.
CKDs
Autoimmune Diseases
TGs greater than 175

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50
Q

Who gets 2nd degree prevention?

A

ASCVD Equivalents = DM; HF
ACS
MI
Angina
Revascularization
TIA CVA
PAD

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51
Q

Who gets 2nd degree prevention

A

ASCVD Equivalents
ACS
MI
Angina
Revascularation
TIA ; CVA
PAD

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52
Q

Consider what CAC Score:

A

0 = No Statin

1-99 age 50 greater ; smokers ; CAD = statin

Greater 100 = statin

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53
Q

Age 40-75 ASCVD 5% = what TXM?

A

NONE

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54
Q

Age 40 -75; ASCVD 5-7.5% ; should get what TXM

A

Moderate Intensity Statin

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55
Q

Age 40-75 ; ASVD 7.5% -20% ; gets what txm?

A

Moderate Intensity Statin

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56
Q

ASCVD greater than20% ; Age 40-74 ; gets what txm

A

high intensity statin

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57
Q

What is the goal LDL for patients with more than 2 risk factors

A

50% reduction in LDL

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58
Q

Age 20-39 ; w/ Fam Hx Early ASCVD or LDL greater 160; gets what txm

A

Moderate Intensity Statin

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59
Q

LDL over 190 gets what?

A

High Intensity Statin

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60
Q

Main ADE’s of Statin therapy (4)

A

Muscle paresthesias / Atony

Liver Damage

Hyperglycemia

Neurologic Defects

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61
Q

Last resort statin therapy

A

PCSK-9’s [MABS]
HIS -> still over 70 LDL

Degradation of low density lipoprotein

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62
Q

Good adjunct to PCSK-9s

A

Ezetimibe

Inhibit small intestine absorption of cholesterol

Strongest for statins ; greater 70 LDL

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63
Q

[omega 3s]

A

Good for decreasing TGs

Caution = increase LDL dyspepsia

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64
Q

Risk Factors for high ASCVD

A

DM
Obesity
HTN
Smoking
Fam Hx
Inactive Lifestyle
Dyslipidemia

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65
Q

Definition of dyslipidemia

A

LDL greater 70

Tris greater 200

HDL less 40

Total Cholesterol over 200 / 240

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66
Q

Test of choice for thyroid concerns

A

TSH / FT4

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67
Q

What do you need to rule out if you suspect Hashimotos

A

Addisons Disease

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68
Q

3 drugs that can induce hypothyroidism

A

Amiodarone
Iodine
Lithium

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69
Q

What metabolic concerns often follow Hashimotos (4)

A

Low B12
Low Vit C
IDA
Low PTH

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70
Q

Hypothyroid is what on tests and what ab for Hashimotos

A

TSH HIGH
Low FT4

Thyroglobulin Ab +

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71
Q

Sxs of hypothyroidism (6)

A

Dry skin
NP edema
Decreased DTRs
Hoarse / Fatigue
Constipation
Menorrhagia

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72
Q

Ab test of choice for graves

A

AntiTPO Ab

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73
Q

What will a RAIU scan show in graves hyperthyroid.?

A

Increased uptake

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74
Q

Sxs hyperthyroid

A

Wt loss
Palpitations
Weak
Fine tremor
+/- AFIB

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75
Q

TXM for HYPERTHYROID

A

RAI ; ablation
Methimazole; best otherwise
PTU; best in preg.
R2 the gland

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76
Q

Most common type of thyroid cancer

A

Papillary

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77
Q

Physiologic parathyroid response

A

Increased PTH ; Decreased CA2+ ; Decreased Vit D = activation of Ca2+

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78
Q

HyperPTH sxs

A

If Ca2+ high = stones groans moans and overtones

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79
Q

4 reasons to remove the Parathyroid gland

A

Kidney stones
Vertical compression
Age over 50
24 hr ca 2+ urine over 400

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80
Q

What is increased commonly in hypothyriodism

A

Phosphate

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81
Q

Sxs of hypoPTH

A

If low Ca2+ = paresthesias tetany seizures Chovstek Trousseau

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82
Q

Mg effect on PTH

A

Sub low = increases PTH

High low = decreased PTH

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83
Q

What effectively lowers blood phosphates

A

Calcitonin

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84
Q

Dx of choice for pagets disease

A

Bone Bx

85
Q

TXM of Paget’s disease

A

Bisphosphonates
Calcitonin

86
Q

What substances/meds can induce gynecomastia (5)

A

ETOH
Steriods

Amiodarone
Spirinolactone
Ketoconazole

87
Q

3 causes of unilateral gyencomastia

A

Cancer
Lipoma
NF

88
Q

2 causes of bilateral gynecomastia

A

Obesity
Pseudo

89
Q

6 labs to get to eval gynecomastia

A

PRL
HCG
LH
TEST
ESTRADIOL
TSH/FT4

90
Q

What are good 2 ways to characterize gynecomastia

A

Glandular vs Fatty

91
Q

Osteoporosis increased risk of fx if what levels

A

Greater -2.5 = OPO
Greater -1.5 = OSTOPE

TXM = Calcitonin / Vit D
OPO= Bisphosphonates

92
Q

3 ADEs of Bisphosphonates

A

Jaw necrosis
Hoarse
HA

93
Q

Sxs of Cushing syndrome (5)

A

Moon Face
Truncal obesity
DM2
HTN
Buffalo Hump

94
Q

3 lab tests for Cushing syndrome

A

Dex. Suppression test = + serum cortisol over 1.7
24 hr Free urine = + greater 300
Serum ACTHa dep. = + Low ACTH ; High cortisol

95
Q

Think Cushing disease think

A

Pituitary adenoma

Or ectopic ; get a CT chest

96
Q

Hirsituism in women think

A

PCOS

97
Q

3 labs for Hirsituism

A

Free and Total Testosterone
DHEA
17-Hydroxyurea

98
Q

17 and 21 Hydroxy test for what

A

Classic = ACTH stimulation

Non Classic = High 17

-Adrenal Hyperplasia

99
Q

MC Pituitary Adenoma manifestation

A

Acromegaly

HTN ; enlarged with Wt gain; vision changes ; oily skin

100
Q

How could Hyperprolactinemia present (4)

A

A Pituitary Adenoma w/

Gynecomastia
Infertile
Galactorrhea
Bit. Hemaniiopsia

101
Q

TXM Hyperprolactinemia

A

Cabergoline
Dopamine
Bromocritptine
R2 adenoma

102
Q

Hemochromatosis presentation ; txm

A

Iron increased deposits in liver
Dark skin
Koilynychia
OPO

TXM = blood letting

103
Q

hypoNA+ presentation ; txm

A

Increased water retention ; or ; Increased Salt Loss

ADH dependent or independent

Hyper/Hypo/Euvolemic

1st : Check tonicity
(Increased glucose /azotemia)

TXM= IVF HS

Pseudo -HL

104
Q

HyperNA+ presentation TXM

A

Decreased water or increased salt retention

Aldosterone = increased salt retention
Cortisol will increase

TXM= IVF-HS o Dextrose over 48 hours

105
Q

PAI = Primary Adrenal Insufficiency

A

Addisons Disease
Deceased cortisol / Increased ACTH

106
Q

Sxs and causes of PAI

A

Sxs : hypovolemia ; hyponatremia ; skin pigmentation increase l hyperK+

Causes = TB ; histoplasmosis

107
Q

Dx of PAI ; TXM

A

Cosyntropin stim test =+ if cortisol over 18
TXM= Prednisone or Hydrocortisone

108
Q

4 things to do acutely to manage cardiac syncope

A

Get an EKG to check for arrhythmia’s
Echo to rule out structural causes
Head CT / EEG to rule out seizure
Tilt table if you suspect Vasovagal

109
Q

What is a good test if you suspect CAD risk or LVOO/RVOO

A

Stress testing to r/o ischemia

110
Q

If cardiac syncope sxs occur daily or hourly what monitoring should be done

A

24 hour Holter

111
Q

Ischemia is a mismatch of what

A

Supply and Demand of blood

112
Q

What is the triad of RV infarct

A

JVP
clear lungs
Positive Kussmaul breathing

113
Q

What 3 populations can have atypical presentation of ACS

A

Women
Diabetics
Elderly

114
Q

Characteristics of unstable angina

A

Sxs at rest not relieved by nitro
Negative cardiac enzymes
NO STE

= partial occlusion of vessels

115
Q

Unstable angina or NSTEMI management

A

MONA
Heparin
B-Blocker

TIMI score or HEART risk assessment

116
Q

STE = what

A

ST elevations > 1 mm in 2+ contiguous leads w/ reciprocal changes in opposite leads

117
Q

Location of STE in
Anterior
Posterior
Lateral
Inferior

A

A = 1 AVL V2-V6

P= Depressions in V1-V3

L = 1, AVL , V4-V-6 ; depressions in Inferior Leads

I = 2 3 AVF

118
Q

AMI protocol

A

a. ECG w/in 10 mins
b. Door to thrombolytics w/in 30 mins
c. Door to PCI w/in 90 mins (+/- 30 mins)
d. “MONA” → Morphine, O2, Nitrates, ASA e.

NO morphine or Nitroglycerin for inferior wall MI

119
Q

Time frame to PCI for likely ACS chest pain

A

90-120 minutes PCI
OMI + MONA + BASH-C

120
Q

What can definitive dx stable angina

A

Coronary angiography

121
Q

When is nitroglycerin contraindicated (3)

A

if SBP < 90 mmHg, RV infarction, use of Sildenafil

122
Q

Coronary artery spasm causing transient ST-segment elevations; not assoc. w/ clot

A

Prinzemetals

123
Q

What are known triggers of Prinzmetals Angina (4)

A

Hyperventilation
Cocaine / Tobacco Use
Acetylcholine
Histamine/ Serotonin

(constriction of stenotic vessels)

124
Q

2 TXM’s for printzmetals

A

Nitroglycerin
CCBs

125
Q

Underlying cause for dresslers syndrome

A

Inflammation of the pericardium post MI

ASA and Colchicine for 2 weeks

126
Q

Systolic dysfunction results in ___
Diastolic dysfunction results in ____

A

S = loss of contraction; S3 sounds

D = increased stiffness; decreased preload ; S4 sounds

127
Q

Systolic HF TXM

A

ACE-I
B-Blocker
Loop Diuretic

128
Q

Examples of loop diuretics

A

Furosemide
Bumetanide
Torsemide

129
Q

Diastolic HF TXM

A

ACE-I
B-blocker
CCB

130
Q

S/Sx: dyspnea, orthopnea, weakness, fatigue, tachycardia
iii. PE: S3, rales (indicating fluid in lungs), Cheyne-stokes breathing, cool extremities

Findings for what?

A

Left sided heart failure

131
Q

MC cause = LHF, COPD ii. Acute = PE

A

Right Heart Failure

132
Q

BNP values that indicate cardiac conditions

A

i. > 450 pg/mL if < 50 y/o
ii. > 900 pg/mL if 50 - 75 y/o
iii. > 1,800 pg/mL if > 75 y/o

133
Q

What are good treatments for HFpEF

A

Lifestyle Modifications
Diuertics to decrease volume overload
SGLT-2’s [flozin]

134
Q

Acute cold and wet management [LMNOP] ; in decompensating HF

A

Loop diuretics
Morphine
Nitroglycerin
Oxygen
Position upright

135
Q

acute cold and dry management ; in decompensating HF

A

ICU Inotropes

136
Q

What are 3 A-cyanotic cardiac lesions ; think what kind of shunting

A

VSD
ASD or PFO
PDA

L to R shunt.

137
Q

Cyanotic cardiac lesions = what kind of shunting ; possible etiologies (3)

A

R to L shunt

Truncus arteriosis
Tetrology of Falot
Transposition of the great arteries

138
Q

MC adult congenital cardiac abnormality ; they may develop what?

A

ASD

Severe pulmonary HTN

139
Q

ASD TXM involves?

A

Diuretics
Digoxin
Surgical closure

140
Q

Peds Decresed wt gain; tachycardia; Tachypnea think? And what murmur?

A

PDA

Continuous machine like murmur at the LUSB

141
Q

TXM of PDA in infants

A

Indomethacin
Surgery

142
Q

Murmurs of VSD

A

Pancystolic harsh murmur at LSB

143
Q

What age gets surgical closure of VSD

A

2 y/o

144
Q

upper/lower extremity systolic pressure mismatch&raquo_space; 20 mmHg;
Think?

A

Coarctation of the aorta

Could lead to aneurysm or dissection

145
Q

Murmurs of Tetrology? CXR shows?

A

Harsh systolic ejection murmur at LUSB that radiates to back

Boot shaped heart

146
Q

TXM of tetrology

A

PGE-1 and surgery

147
Q

Bubble studies can help identify what?

A

Intracardiac shunt

148
Q

What should you eval for when assessing tachycardia

A

Wide complex or Narrow complex QRS

149
Q

A flutter can lead to what?

A

High output heart failure

150
Q

What could be underlying cause of AFIB

A

Hyperthyroidism

151
Q

What drugs slow AV node conduction (4)

A

Metoprolol
Carvedilol
Verapamil
Diltiazem

152
Q

Rate control is preferred in who? And What drugs?

A

Older patients

B-blockers and CCBs

153
Q

Who gets rhythm control?

A

Less than 60 with intolerable sxs

154
Q

If AFIB onset with sxs ; less than 48 hours ; less than 60YRS OLD what management?

A

anticoags and immediate electrocardioversion

Flecainimide
Amiodarone

rhythm control

155
Q

If AFIB onset and unstable do what?

A

Cardioversion and IV Heparin [to prevent stroke]

156
Q

In Torsades TXM? In V fib TXM?

A

T = cardioversion = good synchronization ; repair to baseline

V- fib = defibrillate = cant synchronize themselves ; create new baseline

157
Q

Describe 2nd degree wenckebach

A

Some P waves are not followed by QRS 3.
“Longer, longer, longer, drop– then you have a Wenckebach”

158
Q

Describe 2nd degree Mobitz 2

A

No preceding prolongation of PR
“When there’s more P’s than Q’s consider a Mobitz 2”

159
Q

AV blocks are often treated with what?

A

Pacemakers

160
Q

Etiologies of sick sinus syndrome

A

SINUS NODE FIBROSIS

Can result from senescent fibrosis of sinus node or extrinsic causes including meds, hypothyroidism,
hypothermia, ↑ ICP, electrolyte abnormalities, ↑ vagal tone, ischemia, and surgical trauma

161
Q

What two labs should you get in sick sinus syndrome

A

TSH and Electrolytes

162
Q

Indications for ICD vs CRT

A

ICD = i. NYHA 2-3 w/ EF < 35% (> 40d after MI)
ii. NYHA 4
iii. Survivor of sudden cardiac arrest/sustained VT
iv. VT related syncope or predisposing condition

CRT = i. HF w/ EF < 35% w/ LBBB and wide QRS; after 3 mo of otherwise optimal therapy
ii. Benefits: CRT ↑ functional status and ↓ re-hospitalization

163
Q

Adult Bradycardia with decompensation management

A

Atropine

And/or

Dopamine
Epinephrine

And

Transvenous pacing

164
Q

What should you make a difference between when eval bradycardia

A

Wide complex or Narrow Complex

Ventricular? Atrial?

165
Q

4 reasons for sinus tachycardia

A

Fever
Hypovolemia
Pulmonary disease
Anxiety/Drugs

166
Q

First Dose of what to slow down Tachycardia greater 150, but regular/narrow/monomorphic + -(Negative) sxs

A

ADENOSINE = 6mg Rapid IV push with Rapid NS Flush [good for wide or narrow and regular]

Or Vagal Maneuver

2nd Dose= 12 mg

167
Q

3 antiarrhythmic’s for wide complex tachycardia

A

Procainamide [20-50mg] (wide and irregular)

Amiodarone [150mg over 10 minutes] —> Mx infusion 1mg/min for first 6 hours

Sotalol [IF NO PROLONGED QT]= 100mg over 5 minutes

168
Q

4 sxs that are concerning when in tachyarrythmia

A

Hypotension
AMS
Chest Pain
Signs of Shock

169
Q

What to slow down Tachycardia greater 150, but regular and monomorphic + -(Positive) sxs

A

Synchronized Cardioversion

170
Q

TACHY + Hemodynamically unstable

A

=CARDIOVERT

171
Q

Narrow and Irregular with sxs and NO WPW; what can you do

A

BB or CCB

172
Q

What rhythm in cardiac arrest = SHOCKABLE

A

VFib or Pulseless V TACH

With CPR sandwich

173
Q

What rhythm is not Shockable and WHAT DO YOU DO

A

Asystole / PEA

GIVE : EPI [every 3-5 mins]

With CPR sandwich

174
Q

Hs and T’s of cardiac arrest ; reversible! [6H/4T]

A

Hypovolemia
Hypoxia
Hydrogen Ion [Acidosis]
Hypo/Hyper-Kalemia
Hypothermia

Tension PTX
Tamponade
Toxins
Thrombosis ; pulmonary or coronary

175
Q

IV drug use effects what part of the heart and what organisms common?

A

Tricuspid Valve

Pseudomonas and Candida

MSSA

176
Q

Prosthetic valves are often effects by what organism?

A

Staph epidermis

177
Q

Think Cows Sheep Goats ; with Q fever?

A

Coxiella Burnetti

178
Q

Left Side vs Right Side emboli

A

Left = brain ischemia —> stroke

Right = pulmonary edema

179
Q

Major (2) and Minor (5) criteria for DUKES - Endocarditis

A

Major =
1) Vegetations on echo
2) Positive Blood cultures from multiple sites

Minor=
1) Hx o drug injections ; cardiac lesions
2) Fever
3) Septic Emboli : Janeway Lesions ; conjunctival hemm ; pulmonary infarcts
4) Autoimmune conditions : Oslers Nodes ; Roth Spotds ; glomerulonephritis
5) Micro/serologic Evidence

180
Q

What is considered Dx for Dukes

A

1 major and 3 minors
Or
5 minors
Or
2 majors

181
Q

Rheumatic fever commonly affects what populations

A

5-15 yrs/old ; post strep pharyngitis

182
Q

Acute RF Major/Minor Criteria

A

Major= JONES
Joint = Polyarthralgias
O= pancarditis
E= erythema marginatum
S= Sydenhams Chorea

Minor =
Arthralgia
Fever
increased ESR
Prolonged PR on EKG
Rapid Strep Positive ; ASO titer

183
Q

3 heart effects from rheumatic heart disease

A

Regurge
Stenosis
Mitral Valve disease

Aortic Valve disease

184
Q

Acute RF mangement

A

PCN!!
Anti-inflammatory drugs

185
Q

1 st line TXM of endocarditis

A

IV ABX
Amocxicillin
Ampicillin
Cefazolin
Ceftriaxone
Cephalexin

186
Q

Sxs of acute pericarditis ; ECG

A

Friction Rub worse when laying down ; improved when leaning forward

ECG: PR depressions IN AVR ; diffuse STE’s

+/-Troponin = myopericardial infvolvement

187
Q

Dresslers syndrome

A

2-5 days post MI

ASA ; colchicine ; NSAID
Pregnant = Prednisone
Hx of ischemia = ASA

188
Q

Acute pericarditis TXM

A

NSAIDs and Colchicine

189
Q

Constrictive pericarditis sxs :

A

Increase in venous pressure

JVD
Peripheral edema
Ascites
Pericardial knock @ diastole

TXM = pericardiectomy

190
Q

When you think increase in venous pressure think
Vs. Arterial pressure?

A

Venous = stasis of blood volume ; blood forced toward the heart ; AKI

Arterial = cardiac output working too hard! ; decrease elasticity ; decreased oxygenation to the heart; increased pressure on smaller vessels

191
Q

3 causes of myocarditis

A

Lyme Dz
Cocksackie virus
takutsubo

192
Q

TXM of acute myocarditis

A

ACE-I
B blocker
Diuretics

193
Q

Becks triad for cardiac Tamponade

A

JVD
Hypotension
Muffled heart sounds

194
Q

Leave a drain in cardiac Tamponade for how long?

A

Until fluid is less than 25 ml

195
Q

Good management of peripheral vascular disease (Meds)

A

Cilostazol - for vasodilation ; PD inhibition

ASA
Clopidogrel if allergy

196
Q
  1. Ps of arterial occlusion
A

Compartment syndrome

Pain pallor paresthesia pulselesness poiklythermia paralysis

197
Q

When you think vasculitis think what two diseases and what txm?

A

Takayasu
Temporal Arteritis

TXM = cc’s

198
Q

AAA unstable #1 diagsostic ; all others?

A

FAST

TEE = all others (A-TAA/D-TAA)

199
Q

Indications for urgent repair A-TAA/ D-TAA/ AAA

A

A = any sxs

D = greater than 5-5.5 cm

AAA= expanding more than 0.5cm per year

200
Q

Secondary (meds) prevention for A/D TAA

A

Beta blockers
Statin therapy
ACE-I

201
Q

Secondary prevention AAA

A

Smoking cessation

202
Q

Describe aortic dissection chest pain

A

Ripping pain either retrosternal or towards the back
>20 mmHg difference blood pressure in UE

203
Q

medical txm for distal aortic dissection

A

Propanolol only ;

Urgent EVAR

204
Q

Proximal dissection management

A

Decrease HR and cardiac output=
Esmolol / Labetalol / Propanolol

205
Q

Best initial dx for dissection

A

CXR

206
Q

Amaurosis faugax is associated with what condition

A

Carotid artery dissection

207
Q

MC location for varicose veins

A

= Greater saphenous veins

208
Q

Pitting vs Non pitting edema

A

Pitting = CHF

Non pitting = Lymphedema ; Mxedema (thyroid) ; electrolyte distrurbance ; liver

209
Q

TXM of pressure ulcers

A

Elevation
Topical ABX
Silvadene = silver sulfadiazene
Wet to dry dressing

Internal Medicine (6 decks)

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