Deck 42: Medicine Flashcards
3 common causes of aortic stenosis
- senile calcific aortic stenosis
- bicuspid aortic valve
- rheumatic heart disease
cause of aortic stenosis in majority of patients under 70 years old
bicuspsid aortic valve
Myxomatous valve degeneration usually causes what problem
mitral valve prolapse
Most common cause of aortic stenosis in patients older than 70
senile calcific aortic stenosis
Initial imaging study of choice in patients with unprovoked first seizure to exclude acute neurologic problems
CT without contrast
- MRI if elective or nonemergency
What can noncontrast CT show of brain
intracranial or subarachnoid bleed
CT of brain with contrast can identify
structural abnormality or mass lesions
initial management of forstbite
rapid rewarming of affected tissues
Difference between hypopituitarism and primary adrenal insufficiency
Aldosterone is normal in central adrenal insufficiency due to hypopituitarism
3 things that characterize hypopituitarism
- glucocorticoid deficiency
- hypogonadism
- hypothyroidism
what is not made in primary adrenal insufficiency? consequenses
- decrease aldosterone
- hyperkalemia and severe hypotension
- increase ACTH, hyperpigmentation
aburpt onset of regular tachycardia that resolves with col-water immersion, what do I have
paroxysmal supraventricular tachycardia
most common form of paroxysmal supraventricular tachycardia? who gets it?
atrioventricular nodal reentrant tachycardia
- young patients with a structurally normal heat
Vagal maneuver does what do the heart
increase parasympathetic tone
- slowing conduction in AV node
- increase in AV node refractory period
Atrial fibrillation with rapid ventricular response, initial treatment
- beta blockers
- calcium channel blockers
3 main goals for atrial fibrillation
- control ventricular rate
- restore normal sinus rhythm
- asses need for anticoagulation
how do you determine if an Afib patient needs antithrombolytics
CHAD2DS2-VASc score
CHAD2S2-VASc
- congestive heart failure
- hypertension
- age 75 older
- diabetes mellitus
- stroke/TIA/thromboembolism
- vascular disease
- age 65-74
- sex
drug treatment for paroxysmal supraventricular tachycardia
adenosine: slows AV node to interrupt reentry pathway
what should be suspected in any patient with cirrhosis and ascites who presents with low-grade fever, abdominal discomfort, or altered mental status
spontaneous bacterial peritonitis
Reitain trail test
- timed connect-the-numbers test,
- detects subtle mental status changes
first step in evaluation for thyroid nodule
TSH and ultrasound
when do you use radionuclide scan in thyroid nodule
patients with low TSH
how do you treat hot thyroid nodules
most are benign, treated for hyperthyroidism
what happens in popliteal (baker) cyst
- extrusion of synovial fluid from knee joint into gastrocnemius or semimembranosus brusa
2 risk factors for popliteal (Baker) cyst
- trauma
- underlying joint disease
clinical presentation for popliteal (Baker) cyst
- chronic, painless bulge behind knee
- crescent sign: arc of ecchymosis visible distal to medial malleolus
anserine bursitis
subacute medial knee pain
Meningococcal vaccination should be given when ?
age 11-12
booster: 16
3 contraindications for yellow fever vaccine
- allergy to egg
- AIDS
- immunosuppressive therapy
biopsy for UC
- mucosal and submucosal inflammation
- crypt abscesses
what age group gets UC
bimodal
- 15-40
- second peak 50-80 years
complications of UC
toxic megacolon
arthritis
endoscopy for UC
erythematous and friable mucosa with ulcers
define chronic cough
greater than 8 weeks
3 common etiologies for chronic cough
- upper airway cough syndrome ( postnasal drip)
- GERD
- asthma
HIV patients with less than 200 CD4 count should start what antibiotics
- Azithromycin or clarithromycin for mycobacterium avium
- Trimethoprim-sulfamethoxazole for pneumocystis jirovicci and toxo
parasympathetic innervation of bladder does what
- regulates detrusor muscle contraction
- internal sphincter relaxation
allow voiding of urine
pelvic floor weakness causes what
stress incontinence in women
stress continence
increased intraabdominal pressure after coughing or sneezing, pee a little bit after
diabetic autonomic neuropathy
- overflow incontinence
- high post-void residual volume
ice pack applied over eyelids for several minutes, leading to improvement in ptosis. diagnosis
myasthenia gravis
Lambert-Eaton myasthenic syndrome is associated with what
small cell lung cancer
what therapy is useful in managing bone pain in patients with prostate cancer who have undergone orchiectomy
radiation therapy
ST elevation in leads II, III, aVF
inferior heart
right coronary artery
ST elevation in I, and aVL
lateral
- LCX
Clinical signs of inferior wall MI
- jugular venous distension
- Kussmaul’s sign: increase in JVD with inspiration)
- clear lung fields
Most common side effect of recombinant erythropoietin therapy
- hypertension
- headaches
- flu-like symptoms
what should be considered for end stage renal failure, normochromic normocytic anemia
first: iron deficiency
second: erythropoietin therapy
what is PaCO2 levels in acute PE
decrease PaCO2 due to hyperventillation
what is the alveolar-arterial gradient on arterial blood gas for someone who has a PE
its higher
symptoms of leprosy
chronic, anesthetic, hypo-pigmented lesions with peripheral nerve involvement
( nodular/painful nerve deformations with diminished sensory/motor activity)
how do you diagnose leprosy
biopsy
common infection in patient on immunosuppressant medication after solid organ transplantation
pneumocystis pneumonia
how do you diagnose pneumocystis pneumonia
- stain respiratory secretion
second: bronchoscopy with bronchoalveolar lavage