Deck 1 Flashcards
Treatment for SBP with renal failure
Intravenous albumin with antibiotic therapy
Intermediate risk cardiovascular patient asymptomatic next test performed
High sensitivity CRP can help reclassify patients with intermediate risk to either low or high
Bicuspid aortic valve patient with symptomatic aortic regurgitation and a sending aortic diameter greater than 45 mm
Aortic valve replacement and aortic root graft placement
Rhandomyositis from cyclosporine and statins in heart transplant patient - myalgia and elevated creatinine kinase
Calcium channel blockers, antifungal agents, antimicrobial agents, antiseizure medication
Asymptomatic patient was exposed pacemaker through skin minimal erythema no signs of infection
Extract device and leads
Leading cause of death in women
Coronary artery disease
Side effect of Dronedarone
Reduced creatinine clearance but does not decrease kidney function - contraindicated in decompensated heart failure
Symptomatic severe heart failure on beta blocker ace inhibitor and diuresis
-what to add next
Spironolactone - rales study
Or epleronone
NSTMI patient with high TIMI risk score started on heparin Plavix metoprolol sublingual nitro aspirin what else to add
Add Staten and GP IIb/IIIa inhibitor
Treatment for recurrent pericarditis
Aspirin plus colchicine - don’t use steroids because they cause recurrence
Treatment for atrial myxoma asymptomatic patient
Surgical resection
Chest pain in woman with interpretable EKG with intermediate risk of coronary artery disease
Exercise EKG stress test
Dyspnea, pedal edema, clear lungs, JVD with inspiration, cardiac CT pericardial thickening, ventricular interdependence, to and fro diastolic motion of ventricular septum, kusmal sign
Constrictive pericarditis
Management of symptomatic atrial fibrillation in setting of structural heart disease or heart failure
Amiodarone or dofetilide - can’t use negative Ionotropes or beta blockers
Ascending aortic dissection management
Emergency surgery - May not always have difference in left and right arm blood pressure
Single vessel disease asymptomatic now what will give the patient the greatest reduction in risk of MI
Aggressive risk factor reduction such as the addition statin
When to get in at go with asymptomatic heart murmurs
Systolic murmurs greater than three out of six or any diastolic or continuous murmurs
Restrictive cardiomyopathy
Infiltration from iron like in hemochromatosis amyloidosis sarcoidosis postradiation fibrosis of myocardium Loeffler syndrome
Constrictive pericarditis
Uniform diastolic pressures and all chambers caused by radiation, postinfection, postsurgical, connective tissue disorder, uremia, sarcoid
Severe symptomatic aortic’s to gnosis with abnormal ventricular function next step
Surgical aortic valve replacement if patients good operative candidate if not then Transcatheter aortic valve implantation
Peripartum cardiomyopathy therapy
During pregnancy should be treated with beta blockers, digoxin and diuretics and after delivery should add ace inhibitor
Patient with Hodgkins disease with prior radiation therapy and chemotherapy including doxorubicin with shortness of breath
First ruleout cardiomyopathy with transthoracic echocardiogram then consider exercise EKG stress testing to rule out ischemic disease which can be accelerated patients that underwent mantle radiation
Atrial septal defect
Fixed split S2, mitral regurgitation murmur, left axis deviation, first-degree AV block, intraventricular conduction delay
Symptomatic pulmonary valve stenosis or patients with severe pulmonary valve stenosis without symptoms
Pulmonary balloons out of your plaster you in patients with pulmonary valve stenosis with peak gradient greater than 50 and less than moderate pulmonary valve regurgitation - pulmonary vasodilator therapy would not be helpful with pulmonary valve stenosis -surgery only with patients with hypoplastic call Marianne illness, some valvular or supravalvular pulmonary stenosis or severe pulmonary valve regurgitation
Post infarction VSD
New holosystolic murmur with palpable thrill with hypotension and tachycardia
Cardiovascular risk assessment in young woman
Reynolds risk score better for young women versus Framingham risk score
Hemodynamically stable wide complex tachycardia - in patient with known coronary artery disease should be assumed to be ventricular tachycardia
Intravenous antiarrhythmic agents such as amiodarone procainamide sotalol and as a second line lidocaine - if does not work elective cardioversion can be used - do not use verapamil or beta blockers
Eisenmenger syndrome
Cyanotic congenital disease characterized by irreversible pulmonary vascular disease from atrioventricular septal defect showing cyanosis right ventricular hypertrophy decrease pulmonary vascularity, and large central pulmonary arteries, associated with down syndrome
Two strongest risk factors associated with myocardial infarction
Smoking and dyslipidemia
Pregnant woman with mechanical heart valves
warfarin - though can cause teratogenicity, miscarriage, fetal loss, increased fetal risk is only option with mechanical valve
Life-threatening diagnoses with chest pain in the emergency room
Pulmonary embolism, aortic dissection, acute coronary syndrome, pericardial tamponade, pneumothorax, esophageal rupture
Hypertrophic cardiomyopathy
Dynamic left ventricular outflow tract obstruction, systolic murmur decreased by handgrip which increases after load and increased by maneuvers decreasing preload like Valsalva also asymmetric septal hypertrophy and small ventricular cavity and enlarged left atrium
Anticoagulation after atrial fibrillation ablation
All patients should be on Coumadin for first to get three months then you should be anticoagulated as if oblation never occurred - use CHADS2 score
Cholesterol embolization syndrome
Red to purple to blue discoloration of toes livedo reticularis signs of systemic illness elevated white count elevated ESR elevated creatinine
Tetralogy of fallot repair
Often have pulmonary valve regurgitation and require pulmonary valve replacements and tricuspid valve repair from right-sided chamber enlargement as well as maze procedure for a afib developed
Unstable angina in patients with contraindication to beta blockers
Use calcium channel blockers when blockers are contraindicated
SVT not terminated by adenosine
Likely atrial tachycardia
Peripheral arterial disease with borderline resting ABI
Check exercise ABI
Treatment for PJP pneumonia
Bactrim and if hypoxic or PaO2 less than 70 or AA gradient greater than 35 then at steroids
HIV-AIDS patients exposed to patient with TB
Treat patients like latent TB because patient with AIDS can have negative tuberculin skin test despite real exposure
Life-threatening candidemia
Treat with echinocandin ie caspofungin - can switch to fluconazole when stabilized -don’t use amphotericin B if patient in renal failure
Recurrent mild to moderate C diff
Can repeat Flagyl 14 day course if my out to moderate c diff again - this is not resistance but hatching of spores present on initial infection - if recurrent severe then treat with prolonged vancomycin taper
Primary genital herpes simplex infection - painful the vesicular lesions with erythematous base as well as malaise fevers - chronic suppression therapy with Valacyclivir
Empiric acyclovir here valacyclovir here or famciclovir
Candida vaginitis with fissures and excoriations from pruritis
Single dose from fluconazole
Histoplasmosis
Ohio Valley with bats - acute pulmonary symptoms fever headache cough shortness of breath chest pain, hilar lymphadenopathy and interstitial infiltrates
Blastomycosis
No hilar lymphadenopathy - soil exposure wood products - Great Lakes Mississippi River Valley Eastern North America - acute pulmonary infection flulike symptoms cough chest pain
Coccidiomycosis
Southwest United States farming soil handling - flulike illness the kid pulmonary infection arthralgia maculopapular rash and erythema Nodosum
Prosthetic joint infection
If no further surgery then lifelong therapy with Bactrim
Hemorrhagic colitis
Shiga toxin producing E. coli - Gross blood uncooked hamburger
Campylobacter jujuni
Preformed toxin symptoms occur less than 24 hours after ingestion with nausea vomiting diarrhea but no blood
Shigellosis with diarrhea now resolved but patient works in day care setting
Empiric Treatment with ciprofloxacin indicated as patient in either food service industry or childcare center where infection may spread
Vancomycin intermediate methicillin-resistant staph aureus bacteremia
Daptomycin is recommended for treatment when staff aureus partially resistant to vancomycin mic >2
Cervicitis - Mucopurulent cervicitis caused by gonorrhea and chlamydia with leukocytes elevated pH negative with test
Ceftriaxone IM and azithromycin orally
For chlamydia
Pelvic inflammatory disease must have cervical motion tenderness
Cefoxitin plus doxycycline
Tuberculous screening in patients that received BCG cancer therapy or vaccine
Interferon gamma release assay
Human bites injury prophylaxis - Strep , staph, eikenella, anaerobes
Augmentin and if penicillin allergic then clindamycin and moxifloxacin
Varicella prophylaxis patient with leukemia or immunocompromise
Varicella zoster immune globulin
Bicuspid aortic valve patient with symptomatic aortic regurgitation and a sending aortic diameter greater than 45 mm
Aortic valve replacement and aortic root graft placement
