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Family med > deck 12 > Flashcards

deck 12 Flashcards

1
Q

palpitations in young patients with structurally normal heart usually due to…

A

Atrioventricular nodal reentrant tachycardia (AVNRT)

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2
Q

Atrioventricular nodal reentrant tachycardia (AVNRT) pathophys

A

Due to presence of 2 conduction pathways (slow and fast) in the AV node.

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3
Q

how do vagal maneuvers change heart? (carotid sinus massage, cold-water immersion or diving reflex)

A

Increase parasympathetic tone through slowing of conduction in the AV node

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4
Q

how do nitrates have anti-ischemic effects?

A
  • systemic dilation of veins lowers preload and LVEDP and reduces myocardial oxygen demand by reducing wall stress.
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5
Q

Mitral valve prolapse presentation

A
  • atypical chest pain + dyspnea + palpitations + dizziness + anxiety + panic disorder
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6
Q

mitral valve prolapse murmur

A
  • short systolic murmur at apex
  • disappears with squatting
  • clicks
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7
Q

Right sided heart failure in patient with pacemaker think…

A
  • tricuspid regurg

-

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8
Q

tricuspid regurg murmur

A

holosystolic

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9
Q

aortic regurg murmur

A

diastolic decrescendo murmur

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10
Q

meds that confer a survival benefit in HCF

A

ACEIs, ARBs, beta-blockers, spironolactone

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11
Q

pathophys of pericardial effusion

A

Fluid accumulation in the pericardial cavity increases intrapericardial pressure above diastolic ventricular pressure. This restricts venous return to the heart and lowers right and left ventricular filling. Net result –> DECREASED PRELOAD/SV/CO

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12
Q

first-line for chronic stable angina

A

beta-blockers

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13
Q

alternatives to bbs for chronic stable angina

A

CCBs + long-acting nitrates

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14
Q

concerning murmur type

A

diastolic and continuous

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15
Q

CYP450 inducers

A 
carbamazepine, phenytoin
ginseng, st. john's wort
OCPs
phenobarbital
rifampin
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16
Q

CYP450 inhibitors

A 
acetaminophen, NSAIDs
antibiotics/antifungals (eg metronidazole)
amiodarone
cimetidine
cranberry juice, ginkgo, vitamin E
omeprazole
thyroid hormone
SSRIs
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17
Q

management of persistent tachyarrhythmia causing hemodynamic instability

A

immediate synchronized direct current cardioversion.

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18
Q

digoxin toxicity

A

N/V + diarrhea + vision changes + arrhythmias

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19
Q

exam findings suggestive of severe aortic stenosis

A

1) delayed (slow-rising) and diminished (weak) carotid pulse (“pulsus parvus and tardus”)
2) presence of single and soft second heart sound
3) mid to late peaking systolic murmur with maximal intensity at 2nd right intercostal space radiating to the carotids

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20
Q

nonallergic rhinitis presentation

A

1 of nasal congestion, rhinorrhea, sneezing, and postnasal drainage without a specific etiology

21
Q

nonallergic rhinitis treatment

A
  • intranasal antihistamine, intranasal glucocorticoid, or combination therapy
22
Q

solids vs liquids for dysphagia

A
  • solids only suggests mechanical obstruction (liquids can still pass)
  • solids and liquids suggest neuromuscular
23
Q

granulomatosis w/ polyangiitis

A

recurrent sinusitis and otitis + auditory canal ulceration + fatigue + anemia + microscopic hematuria

24
Q

Urine profile of hypovolemic patient

A

Hypovolemia –> decreased renal perfusion –> RAAS activation –> aldosterone stimulates aggressive sodium reabsorption –> decreased urine sodium –> FENA less than 1%

25
Q

high risk lung nodules

A

old age
greater than 2 cm
smoking history

26
Q

management of high risk lung nodules

A

surgical excision

27
Q

impt MSK side effect of beta-2 agonists

A
  • reduce serum K levels by driving potassium into cells –> hypokalemia with muscle weakness, arrhythmias, EKG changes
28
Q

Secondary spontaneous pneumothorax (SSP)

A
  • occurs in patients with known lung disease (COPD, CF)
  • acute-onset SOB + hypoxia + unilaterally decreased breath sounds + CP
  • smoking RF
29
Q

laterality of pulmonary edema

A

ARDS and acute MI leading to pulmonary edema is usually symmetric.

30
Q

pulmonary causes of hemoptysis

A

bronchitis
lung cancer
bronchiectasis

31
Q

cardiac causes of hemoptysis

A

mitral stenosis/acute pulmonary edema

32
Q

think bronchiectasis with//

A

recurrent respiratory tract infections + chronic cough

33
Q

cough duration suggestive of acute bronchitis

A

greater than 5 days

34
Q

sequela of PE

A

10% of patients with PE have occlusion of a peripheral pulmonary artery by thrombus, causing pulmonary infarction

35
Q

common complication of mitral stenosis

A

atrial fibrillation

36
Q

elevation of left main bronchus on CXR suggests

A

severe LA enlargement –> elevation of left main bronchus

37
Q

Mitral stenosis symptoms

A
  • gradual + worsening DOE + orthopnea + hemoptysis (due to pulmonary edema)
38
Q

chronic pulmonary aspergillosis

A
  • common in TB patients, immunocompromised, underlying lung disease
  • greater than 3 months of weight loss, cough, hemoptysis, and fatigue
39
Q

chronic pulmonary aspergillosis diagnosis

A

IgG serology

40
Q

common feature of ACEI cough

A

tickling or scratching sensation in the throat

41
Q

mainstay of symptom management in COPD

A

inhaled anti-muscarinic agents (eg ipratropium)

42
Q

issue with beta blockers in COPD

A

Can exacerbate pulmonary symptoms in its with severe reactive airway disease.
Safe in most patients with mild to moderate COPD and asthma

43
Q

tactile fremitus changes

A
  • Increased with consolidation (lobar pneumonia)

- Decreased with pleural effusions, pneumos, emphysema, atelectasis

44
Q

problem with supplemental oxygen in patients with advanced COPD

A

Can worsen hypercapnia due to a combination of increased dead space perfusion causing VQ mismatch + decreased affinity of oxyhemoglobin for CO2 + reduced alveolar ventilation. Can lead to seizures.

45
Q

goal oxyhemoglobin saturation in its with advanced COPD

A

90%-93%

46
Q

treatment goals for DM2

A

1) AIC less than 7%
- long-standing DM w/ high RF’s for cardiovascular disease –> less aggressive
2) Newly diagnosed DM less than 6.5% is reasonable

47
Q

when do people start feeling hyperglycemic?

A

9%

48
Q

hyperglycemia symptoms

A 
Polyphagia - frequent hunger, especially pronounced hunger
Polydipsia - frequent thirst, especially excessive thirst
Polyuria - increased volume of urination (not an increased frequency for urination)
Blurred vision
Fatigue
Weight loss
Poor wound healing (cuts, scrapes, etc.)
Dry mouth
Dry or itchy skin
Tingling in feet or heels
Erectile dysfunction
Recurrent infections, external ear infections (swimmer's ear)
Cardiac arrhythmia
Stupor
Coma
Seizures
49
Q

problem with sulfonylureas

A
  • eventually lose efficacy

Family med (48 decks)

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