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Family med > deck 33 > Flashcards

deck 33 Flashcards

1
Q

pathophys of AVMs in the lungs

A

Shunt blood from the right to the left side of the heart, causing chronic hypoxemia and reactive polycythemia OR can present as massive or sometimes fatal hemoptysis

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2
Q

treatment of homocystinuria

A

B6 (lowers homocysteine by acting as a cofactor for enzyme cystathionione beta-synthase, which metabolizes homocysteine into cystathionine)

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3
Q

other features of opioid intoxication

A
  • AMS + hypothermia (opioids can impair thermogenesis) + miosis (which may be absent due to co-ingestions)
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4
Q

distillation of alcohol think

A

lead poisoning

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5
Q

labs with vitamin K deficiency

A

prolonged PT + PTT

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6
Q

management of symptomatic 3rd degree AV block

A

temporary pacemaker insertion

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7
Q

viral conjunctivitis treatment

A

1) warm or cold compresses

2) +/- antihistamine/decongestant drops

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8
Q

dual anti platelet therapy is…

A

aspirin + P2y12 receptor blocker (clopidogrel, prasugrel, ticagrelor)

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9
Q

STEMI in patient who recently had drug-eluting stent placed think…

A
  • subacute stent thrombosis from medication noncompliance
  • premature discontinuation of anti platelet therapy is the strongest predictor of stent thrombosis within the first 12 months
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10
Q

initial workup of HTN

A

UA (for occult hematuria and protein/creatinine ratio) + chem panel + lipid profile (risk stratification for CAD) + baseline ECG (to evaluate for CAD or LVH)

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11
Q

early finding in macular degeneration

A

Distortion of straight lines such that they appear wavy (use grid test to determine)

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12
Q

primary RFs for mac degeneration

A

Increasing age + smoking

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13
Q

presentation of macular degeneration

A

progressive and bilateral loss of central vision

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14
Q

PEA or systole management

A
  • Uninterrupted CPR + vasopressors to maintain adequate cerebral and coronary perfusion
  • no role for defibrillation or synchronized cardioversion
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15
Q

pulseless electrical cavity (PEA)

A

Presence of an organized rhythm on cardiac monitoring without a measurable BP or palpable pulse

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16
Q

cardioversion

A

delivers energy synchronized to the QRS complex

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17
Q

defibrillation

A

delivers energy randomly during the cardiac cycle without synchronization to the QRS complex

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18
Q

shockable rhythms

A

1) v fib

2) pulsess v tach

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19
Q

Exam findings suggestive of severe AS

A

1) diminish and delayed carotid pulse (“pulses parvus and tardus”) due to blood flow obstruction
2) mid to late-peaking systolic murmur from turbulence due to stenosis
3) presence of soft and single second heart sound (thickening and calcification of aortic leaflets leads to reduced mobility and causes a soft S2, as S2 is due mainly to sudden aortic valve closure)

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20
Q

presentation of spontaneous bacterial peritonitis

A

febrile + diffuse abdominal pain + AMS + hypotension + hypothermia (cirrhotics are often relatively hypothermic)

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21
Q

how to determine etiology of ascites

A

calculate serum-to-ascites albumin gradient (greater than 1.1 indicates portal hypertensive etiologies)

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22
Q

first question in evaluation of rectal bleeding

A

ask if low or large volume

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23
Q

minimal rectal bleeding causes

A

usually due to hemorrhoids or other benign conditions

24
Q

minimal rectal bleeding evaluation

A
  • if young (under 40) and no other CRC RF’s –> anoscopy (for hemorrhoids)
  • if older than 50, then colonoscopy
25
Q

general manifestations of hyperthyroidism

A 
anxiety and insomnia
palpitations
heat intolerance
increased perspiration
weight loss without decreased appetite
goiter
26
Q

important cause of proximal muscle weakness with atrophy to think about

A

chronic hyperthyroid myopathy

27
Q

cause of zenker diverticulum

A

sphincter dysfunction + esophageal dysmotility

28
Q

evaluation of subclinical hypothyroidism

A

antithyroid peroxidase antibodies (patients with hashimoto’s can have subclinical hypothyroidism preceding overt hypothyroidism)

29
Q

other impt cause of recurrent miscarriage

A

Hashimotos

30
Q

most common presentation of primary hyperparathyroidism

A

asymptomatic hypercalcemia with elevated parathyroid hormone level

31
Q

initial step in evaluation of cushing syndrome

A

Confirm hypercortisolism with a late-night salivary cortisol assay, 24-hour urine free cortisol measurement, and/or overnight low-dose dexamethasone test. If confirmed, then differentiate ACTH-dependent from ACTH-independent causes.

32
Q

first step in evaluation of hypogonadism

A

1) determine if primary or secondary (if primary, LH/FSH should be elevated)

33
Q

evaluation of secondary hypogonadism

A
  • Measure serum prolactin + screen for other pituitary hormone deficiencies
34
Q

causes of secondary hypogonadism

A

mass lesion in hypothalamus or pituitary, hyperprolactinemia, long-term use of glucocorticoids or opiates, severe systemic illness

35
Q

prolactin relevance to hypogonadism

A

high prolactin can suppress testosterone production

36
Q

euthyroid sick syndrome labs

A

fall in total and free T3 with normal T4 and TSH levels

37
Q

irritant contact dermatitis of hand presentation

A

pruritus, erythema, vesicles, hyperkeratosis and fissuring of skin

38
Q

DASH diet

A

diet high in fruits and vegetables and low in saturated fat and total fat

39
Q

lifestyle modification with greatest efficacy

A

DASH diet then exercise then dietary sodium then alcohol

40
Q

other promotility agent

A

erythromycin

41
Q

diabetes drug category that induces weight loss

A

GLP-1 agonists (eg eventide, liraglutide)

42
Q

aortic regurgitation presentation

A

exertional dyspnea + pounding heart sensation + widened pulse pressure

43
Q

chronic aortic regurg pathophys

A
  • portion of LV output leaks back into the LV, causing an increase in LV end-diastolic volume, myocardial hypertrophy, and chamber enlargement
  • this increase in LV size brings the apex close to the chest wall, causing a pounding sensation and uncomfortable awareness of heartbeat, especially in the left lateral decubitus position.
44
Q

chest pain with aortic stenosis

A

aortic outflow obstruction from supravalvular aortic stenosis can lead to LVH and exertional angina due to subendorcadial ischemia with increased myocardial oxygen demand during exercise

45
Q

peri-infection pericarditis presentation

A

pleuritic chest pain + pericardial friction rub + diffuse ST-segmeent elevations on ECG less than 4 days following MI

46
Q

renovascular HTN setting

A

1) resistant, severe HTN + diffuse atherosclerosis
2) also suspect if asymmetric kidney size, recurrent flash pulmonary edema or elevation in serum creatinine after starting ACE or ARB

47
Q

clinical features of primary aldosteronism

A

1) easily provoked hypokalemia
2) slight hypernatremia
3) HTN w/ adrenal incidentaloma

48
Q

important confounder of serum calcium

A

albumin (hypoalbuminemia)

49
Q

ambulatory blood pressure monitoring (ABPM)

A
  • pt wears BP cuff throughout a 24-hour period and BP is measured and recorded at routine intervals.
  • used for masked HTN
50
Q

masked HTN

A
  • normal BP readings in clinic but elevated average BP throughout the day. Suggested by signs of hypertensive end-organ damage
51
Q

signs of HTN end-organ damage

A

1) retinal arteriovenous nicking consistent with HTN retinopathy
2) increased QRS-complex voltage consistent with LV hypertrophy

52
Q

signs of RV failure

A

1) elevated JVP
2) RV 3rd heart sound
3) tricuspid regurgitation murmur
4) hepatomegaly with pulsatile liver
5) lower-extremity edema + ascites + pleural effusions

53
Q

right heart catheterization with cor pulmonale

A

elevated pulmonary systolic pressure

54
Q

feature of edema that suggests nephrotic syndrome

A

periorbital/facial edema and pedal edema

55
Q

when is wedge pressure elevated?

A

LV systolic or diastolic dysfunction

56
Q

major COPD heart sequela

A

cor pulmonale

Family med (48 decks)

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