dec 13 firecracker cases etc Flashcards
1
Q
cardiac tamponade, compressed right atrium
A
JVD
2
Q
cardiac tamponade, compressed left atrium
A
pulmonary edema
3
Q
cardiac tamponade preload/etc
A
decrease preload
decrease systolic stroke volume
diminished CO
4
Q
cardiac tamponade etiologies
A
post viral
uremia
neoplastic
5
Q
acute hemopericardium
A
blunt/penetrating chest trauma
reputure of free wall of LV following MI
complication of retrograde aortic dissection
6
Q
Beck’s triad + one more
A
JVD, muffled heart sounds, systemic hypotension
pulsus paradoxus
7
Q
Kussmaul sign
A
JVD with inspiration
constrictive pericarditis
8
Q
pulsus paradoxus
A
drop of 10 or more systolic with inspiration
exaggeration of normal physiology
9
Q
cardiac tamponade - ec ho
A
severe compression of RA and RV
10
Q
cardiac tamponade definitive diagnosis
A
cardiac catheterization
11
Q
cardiac tamponade treatment
A
pericardiocentesis
12
Q
what to avoid in cardiac tamponade
A
positive pressure ventilation
13
Q
untreated cardiac tamponade
A
extra-cardiac obstructive shock
14
Q
abd aorta screening
A
65-75
less than 4cm, yearly
4 cm, 6months
5 cm - surgery
15
Q
achalasia LES
A
elevated LES pressure
inability to relax LES during swallowing
16
Q
Waldenstrome macroglobinuria
A
igm spike
hyperviscosity
17
Q
organism involved in RHD vegetations
A
streptoccus mutans
18
Q
NMS
A
fever, rigidity, increased CK
treat with dantrolene, bromocriptine
19
Q
Renal Cell Carcinoma
A
hematuria
left sided variocele
paraneoplastic symptoms: anemia/eryhtocytosis, leukocytosis
20
Q
Hep C and pregnancy
A
low chance of transmission
21
Q
Proteus UTI
A
ph >7
struvite stones
22
Q
cutaneous ulcer + hemoptysis
A
wegners
23
Q
chronic pancreatitis
A
inflamm process
- fibrosis
- calcification
- irreversible damage
24
Q
number one cause of chronic pancreatitis
A
alcohol
25
chronic pancreatiitis risk factors
male, recurrent acute attacks
gallstones, triglycerides
CF, PBC, PSC
26
difference between acute and chronic pancreatitis
irreversibly of damage
27
pathogenesis of chronic pancreatitis
repeated bouts of acute pancreatitis
- loss of parencyhma
- duct distortion
- fibrosis
- impaired secretion
28
duct flow becomes obstructed as a result of
fibrosis
| pancreatic concretions
29
pancreatic concretions
due to increased protein concentration in pancreatic fluid
30
chronic pancreatitis - s/sx
epigastric pain
steatorrhea
wt loss, nausea
mild fever
31
gold standard diagnosis for chronic pancreatitis
72 hr quantitative fecal fat determination
32
chronic pancreatitis complications
fat/fat soluble vit/b12 malabsoprtion
pseudocyst, abscess formation
glucose intolerance
bile duct obstruction
33
pancreatitic insuff can be due to
cystic fibrosis
cancer causing obstruction (pancratitc)
pancreatic failure
34
pancreatic insufficiency diagnosis
fecal elastase
| <200
35
pancreatic insuff treatment
pancreatic enzyme supplementation (lipases, proteases, amylases)
low fat diet
36
treatmetn of chornic pancreatitis
alcohol/smoking cessation
pain control
b12/adek suppl
pancreatic enzyme suppl
37
chronic pancreatitis - strictures
ERCP to dilate and stent pancreatic ducts
38
spontaneous ptx
due to rupture of apical blebs
| tall, thin, healthy males
39
secondary spontaneous ptx
underlying path: COPD, trauma, infections
40
tension ptx
one-way valve effect
air can enter pleural space but not not exit
pressure on mediastinum --> hemodynamic instability
- mediastinal shift, tracheal deviation AWAY
41
tracheal deviation in tension ptx
AWAY
42
pneumothorax presentation
Pleuritic Chest Pain, Tracheal Deviation, Hyperresonace, Occurs Suddenly, reduced breath sounds, absent fremitus, x ray shows collapse
43
ptx diagnosis
chest xray
hyperlucent lung fields due to air accumulation
visceral pleural line
44
spontaneous ptx - tracheal deviation
spontateous: deviates towards affected lung due to decreased pressure from atelectasis on that side
45
tension ptx - tracheal deviation
away from affected lung, due to increased pressure on that side
46
tension ptx symptoms
can also have shock, JVD due to compression of SVC
47
spontaneous ptx if untreated
progress to tension ptx
48
large tension ptx
hemodynamic instability due to pressure on great vessels
49
treatment of small spontaneous ptx
resolves spontenous
| o2 can expedite recovery
50
large, simple pneumothorax treatment
chest tube
51
treatment of secondary spontaneous ptx
hospitalized and pneumo drained
52
tension ptx treatment
needle decompression (needle thoracostomy)
53
needly thoracostomy placement
bottom of 2nd intercostal space at midclavicular line
54
PCP type of pneumonia
atypical pneumonia with dry cough, diffuse interstitial
55
PCP histological
fluffy, foamy exudate in alveolar spaces
| BAL - silver stain
56
PCP clinical presentation
HIV cd4 <200
dry cough, fatigue, fevers, chills
- pnemothorax
57
PCP CXR
diffuse bilateral ground glass infiltrates extending from perihilar region
58
PCP treatment
tmp-smx
| po2 less than 70 give prednisone (21 days)
59
PCP prophylaxis if sulfa allergic
dapsone (test g6pd def first)
60
cytoisospora
cd4 <50
diarrhea, wt loss
treat with tmp-smx or cipro
61
Kaposi sarcoma clinical presentation
rash that is non responsive to treatments
associated with HHV-8
low cd4 count makes visceral involvement more likely
62
kaposi sarcoma treatment
HAART
| chemotherapy for lesions
63
hemothorax
blood in pleural space
| - trauma, pulmonary infarction, TB, malignacy
64
hemothorax cxr
blunting of costophrenic angles
65
hemothorax treatment
underlying cause
supplemental o2
chest tube
66
hemothorax untreated
formation of thrombi and fibrosis
67
hypomagnesmia
<1.3
68
impaired intestinal absorption of magnesium in
alcoholics, malabsorption, diarrhea, NG suction
69
increased renal excretion of magnesium in
increased renal tubular flow such as osmotic diuresis, diuretic use
70
meds associated with hypomagnesium
aminoglycosides, amph b
| cisplatin, pentamidine, cyclosporine
71
s/sx hypomagnesemia
neuromusculuar and cardiac
72
neuromuscular symptoms of hypomagnesemia
tremor, ataxia, nystagmus, tetany, seizures
73
cardiac symptoms of low mag
atrial and ventricular arrhythmias
| - especially in pts being treated with digoxin
74
low mag can also cause
low calcium and potassium
75
low mag EKG
pr, qt prolong
widened qrs
potential torsades de pointes
76
mag replacement
asymptomatic - oral
| symptomatic - IV mag sulfate, check tendon reflexes
77
Familial Adenomatous Polyposis
- AD, APC gene
- hundreds of adenomas
- treatment is proctocolectomy
78
Good Pasture's symptoms
renal + lung
| dysmoprhic RBCs
79
Good Pastures' antibody
alpha 3 chain of type IV collagen
80
pt has LDL >/= 190
high intensity statin
81
pt has ASCVD 10 year higher than 7.5%
moderate-high intensity statin
82
pt is 40-75 yr old with DM
high intensity if ASCVD greater tahn 7.5
| moderate intensity if ASCVD less than 7.5
83
pt has clinical atherosclerotic disease
less than or equal to 75, high intensity
| older than 75, moderate intensity
84
crystal induced nephropathy in HIV pts
indinaivr (protease inhibitor)
85
didanosine
reverse transcripatse inhibitor
| pancreatitis
86
abacavir
NRTI
| hypersensitivity syndrome
87
NRTIs
nucleoside reverse transcripatase inhibitor
| lactic acidosis
88
NNRTIs
SJS
89
Nevirpine
liver failure, NNRTI
90
cyclosporine AE
nephrotoxitiy/neurotoxicity
glucose intolerance
gingivial hypertrophy
91
cafe au lait spots
neurofibromatosis
92
chagaz dz
megacolon/esophagus + cardiac disease
| protozoan
93
hep c virus type
single stranded RNA flavivirus
94
initial diagnostic test for hep C
anti-HCV antibody test
95
test for confirmation of Hep C
qualitative PCR
96
other tests for Hep C
quantitatie HCV testing
| genotype testing
97
HCV treatment standard of care
pegylated interferon and ribavirin
98
2014 HCV recommendations
add polymerase inhibitor --> sofosbuvir
99
time period for spontaneous clearance of HCV
12 weeks
100
most common causes of digital clubbing
lung malignancy
cystic fibrosis
r to l shunt
101
Pseudogout
calcium pyrophosphate deposition
| rhomboid shaped crystals with positive bireferengence
102
most common cause of liver malignancy
metastasis
103
PAD treatment
exercise
| antiplatelet
104
pain relief related to malignacy
start with short acting morphine
105
HACEK
```
hameophilus
aggregitabcteier(actinobaccilus)
cardiobacterium hominis
e corrodens
kingella kingae
```
106
d xylose test
absorption in proximal SI
| celiac sprue
107
widened mediastinum and gi symptoms
esophageal perforation
| order water soluble contrast esophogram
108
rifampin ae
red urin
109
extramsucular findings of dermatomyositis
interstitial lung dz, dysphagia, myocarditis
| association with malignancy
110
wisconsin
blastomycosis
111
blastomycosis
lung/tb like symptoms
| skin lesions
112
most common complication of PUD
hemorrhage
113
cervical sponyldosis xray
bony spurs
| sclerotic facet joints
114
toxo infections in immunosuppressed
pneumonitis
myocarditis
necrotiizing encephalitis
115
SIADH meds
antidepressants, antipsychotics
narcotics, nsaids
chlorpropamide
116
antipseudomonal B lactam
cefotaxime, ceftriaxone, or ampicillin-sulbactam
117
what are ranson's criteria
WBC count of >16,000 on admission
Age >55, Glucose >200 mg/dL on admission
AST >250 on admission
LDH >350 on admission
118
what kind of defect is osteoporosis
quantittive
119
osteoprosis =
loss of osteoid (organic bone matrix)
120
WHO osteoporosis defintion
L2-L4 2.5 sd below normal
121
decreased bone mass manifests as`
decreased thickness of cortical and trabecular bone
| fewer trabecular interconnections
122
why is osteoporosis more common in women?
- they have lower peak bone mass
- live longer
- rapid bone loss during menopause secondary to decreased estrogen production
123
role of genetics in osteoporsis
greater than daily activity or calcium intake
124
osteoporosis most common patient type
older caucasion postmenopausal woman
125
decreased peak bone mass
- due to malnutrition
| - malabsorptive dz (celiac)
126
increased resportion
old age (decreased osteoblasts)
sex steroid def
decreased load bearing
glucocorticoid use
127
lifestyle factors associated with osteoporosis
alcohol
| smoking
128
most common fractures in osteoporosis
vertebral > hip > Colles
129
hip fractures
femoral head
130
colles fracture
radial fractue
131
osteoporosis diagnosis
DEXA
| also look for hypothyroidism, hypercortisoloism, hyperPTH, renal/hepatic dysfxn
132
DEXA scan age
65
133
treatment of osteoporis
vit d and calcium supplementation
| bisphosphonates
134
osteoporosis - lifestyle adjustments
wt bearing exercise, smoking cessation, limit alcohol, more calcium and vit d
135
raloxifene
SERM, inhibits bone turnover
anatgnoist to estrogen on breast and endometrial tissue
decrease risk of breast and uterine cancer
increased risk of thromboembolic events
136
PTH - osteoporosis
pts with one fracture, intolerance to bisphosphonates
| osteoblastic activation in periodic doses
137
DJD also called
osteoarthritis
138
DJD =
chronic noninflammatory deterioration of articular cartilage
139
DJD pathophysiological
cartilage deteriorates
| lytic lesions with sclerotic edges
140
DJD most common joints
knee, hand, hip
141
DJD modificable risk factors
obestiy
trauma
labor-intensive occupations
142
non-modifiable DJD risk factors
age
family hx
female gender
143
DJD presentation
joint pain, stiffness
| worse with activity, wt bearing
144
DJD PE findings
```
decreased ROM
effusion
malalignment
joint creptius
DIP, PIP joint osteophytes with MCP sparing
```
145
DJD xray
joint space narrowing, osteophytes, subchondral sclerosing, subchondral cysts
146
DJD first line
acetaminophen if no symptoms of inflamm
| NSAIDs
147
nonoperative DJD treatment
bracing
wt loss if bmi >25
pt
corticosteroid injection
148
DJD operative treatment
arthrosocopy in degenerative meniscal tears
| total joint replacement
149
causes of pulseless electrical activity
6hs and 5ts
150
6 h's
hypovolemia, hypoxia, hydorgen ions (acidosis) hyper/hypokalemia, hypoglycemia, hypothermia
151
5 t's
toxins/drugs, tamponade, tension ptx, thrombosis (myocardial or PE), trauma
152
diffuse esophageal spasm
chest pain and dysphagia
153
osteomalacia - lab valuves
low ca, phosphate
| increased pth, alk phos
154
osteomalacia - xray
pseudofractures
155
laryngeal edema
acute onset dyspnea
156
splenic abscess triad
fever, leukocytosis, LUQ pain
157
splecic abscess cause
staphylococcus, streoptocccus, salmonella
158
splenic abscess treatment
bs antibiotics and splenectomy
159
RA - part of spine invovled
cervical
160
gastric adenocarcinoma diagnosis
endoscopy/biposy
| CT abd/pelvis
161
hereditary spherocytosis genetics
AD
| defective proteins - spectrin, ankyrin
162
hereditary spherocytosis - defect in RBC
spherical shape, causes them to get stuck in narrow passages of splenic cord --> destroyed = extravascular hemolysis
163
hereditary spherocytosis presentation
hemolytic anemia
jaundice
splenomegaly, gallstone formation
164
hereditary spherocytosis labs
anemia, reticulorcytosis
MCHC elevated
increased membrane fragility
165
hereditary spherocytosis complications
hemolytic crises
leg ulcers
priapism
hypertrophic cardiomyopathy
166
hereditary spherocytosis treatment
splenectoy
167
herediatary sphereocytosis supportive care
folic acid
blood transfusions
EPO
168
abnormal eosin 5-maleimide binding test
hereditary spherocytosis
169
causes of epididymitis
young - chlyamydia, gonorrhea
| old - GNR (e coli)
170
antiphospholipid lab abnormality
elevated PTT due to phopholipids binding in vitro
171
PTHrp associated with
squamous cell carcinomas
172
s sanguininis
viridians group, endocarditis after dental procedures
173
antithyroidperoxidase antibody
hasiomoto
174
pneumonia with GI symptoms
legionella!!!
175
legionella treatment
azithromycin or fluoroquinolone
176
acromegaly - first test to order
IGF-1
177
erytheum nodosum differential
streptococcus, TB/histo, sarcoid, IBD
178
infective endocarditis - what valve
tricuspid
| holosytolic murmur that increases with inspiration
179
paget's disease treatment
bisphosphonates
180
vipoma - symptoms
watery diarrhea, flushing
hypokalemia, hypercalecemia, hyperglycemia
pancreatic mass
181
malt treatment if no metastases
treat for h pylori
| omperazole + clarithomycin + amoxicillin
182
periotonsillar bascess
muffled voice/hot potato voice
unilated LAD
deviated uvula
183
prevention of uric acid stones
potassium citrate to alkalinize urine
184
zinc def
alopeica
skin lesions
abnormal taste
185
cutaneous larva migrans
creeping eruption
| sand boxes/beaches
186
lymph nodes <1 cm
benign
187
rubella in adults
arthralgia/arthritis
188
rubella in children
conjunctivitis, coryza, cervical LAD
forschemier spots
cephalocaudal spread of blancing maculopapular rash
189
ADPCK complications
intracranila aneurysms
valvular heart disease
hepatic cysts, colonic diverticula, abdomainal wall and inguinal hernia
190
complications of anklyosing spondylitis if present for two decades
osteopenia/osteoporisi
191
spinal ostemomyelitis physical exam
tender to percussion
192
reactive arthritis
urethritis, oligoarthirit, conjunctiviti
| achilles tendon pain
193
AVF
high output cardiac failure
194
conn syndrome
low renin, increased aldosterone
195
lidocaine in ACS
don't use
| decreases VF but increases asystole
196
hereditary spherocytosis symptoms
hemolytic anemia
splenomegaly
jaundice
197
RPGN presentation
acute renal fialure, oliguria, nephritic
198
How is echocardiography used in cardiac arrest?
distinguish pulseless electrical activity (PEA) that results in myocardial contraction from patients with no mechanical activity
199
bone marrow biopsy of multiple myeloma patients?
myeloma cells are present on bone marrow biopsy, which are plasma cells in various stages of maturation. They will have acidophilic cytoplasmic inclusions of immunoglobulin called Russell bodies.
200
What is the role of lidocaine in adult cardiac arrest?
v. fib/v. tach cardiac arrest if amiodarone fails.
201
What antiplatelet medications are indicated for patients who have received coronary interventions for STEMI?
aspirin and a P2Y12 blocker (ticagrelor, prasugrel)
202
CO =
SV x HR
203
SV is and =
LVEDV - LVESV
| blood ejected from ventricle during systolic
204
SV and hypovolemic shock
decrease in SV --> increase in HR
205
MAP =
average arterial pressure over cardiac cycle
| (CO x SVR) + CVP
206
MAP calculation
1/3 systolic + 2/3 diastolic
207
main resistance vessels
arterioles
| determine SVR
208
septic shock and CO
decrease in SVR
| increase CO
209
causes of pulsus paradoxus
cardiac tamponade
| copd, asthma
210
arrhythmia in digitalis
atrial tachycardia with AV block
211
drug that causes prolong QRS during exercise
flecainamide (IC)
212
Acute infective endocarditis caused by
S. aureus
213
subacute infective endocarditis caused by
viridans streptococci
s epidermis
enterococci
HACEK
214
HACEK =
hameophilus, actinobacillus, cardiobacterium, eikenella, kingella
215
culture negative cause of endocarditis
HACEK
216
nonbacterial thrombotic endocarditis
sterile vegetations of platelets and thrombi form on valves
| highly susceptible to emoblization
217
marantic endocarditis
NBTE in setting of advanced malignancy
218
s bovis
infective endocarditis in colon cancer
219
veridans group
occurs on native valves
| sanguinis
220
infective endocarditis - FROM JANE
fever, roth's spots, osler's nodes, murmur
| janeway lesions, anemia, nailbed hemorrhage, emboli
221
roth's spots
retinal hemorrhages around white spots
222
osler's nodes
tender raised lesions on toes and fingers
223
janeway lesions
nontender erythematous lesions on sole and palm
224
empiric infective endocarditis therapy
vancomycin + aminoglycoside (gentamicin)
225
therapy for Viridans, Strep bovis
(Penicillin or ceftriaxone) + gentamicin
or
vancomycin
226
therapy for staph endocarditis
Oxacillin + gentamicin, or
Nafcillin + gentamicin, or
Cefazolin + gentamicin, or
Vancomycin for patients with penicillin allergy or MRSA endocarditis.
227
if pt has prosethic valve and endocarditis
need gentamicin and rifampin
228
antibiotic prophylaxis for infective endocarditis
Congenital cyanotic lesions (ventricular septal defect and atrial septal defects should NOT be treated)
Prior valve repair using prosthetic material (mitral valve prolapse should not be treated)
A prior history of endocarditis
A history of heart transplant
229
untreated endocarditis
heart failure, abscess formation, emboliation causing end-organ damage
230
reversible cause of HF
hemochromatosis
231
cardiac myoxoma
left atrium
constitutional symptoms
diastolic heart sound
embolization
232
acute limb ischemia after MI
arterial embolus from LV thrombus (order TEE)
