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EOR 2 > EOR 2 > Flashcards

EOR 2 Flashcards

1
Q

Dilated CM

A
  • systolic dysfunction
  • 50% idiopathic, infective myocarditis, ETOH, beriberi, chagas, doxorubicin
  • mitral regurge murmur
  • tx w/BB, ACEI, VAD to transplant
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2
Q

HOCM

A
  • diastolic dysfunction, sudden death in teens
  • (Valsalva increases sound and squatting decreases it)
  • asymptomatic tx w/BB/verapamil, severe add diuretic
  • may need myectomy, transplant
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3
Q

Restrictive CM

A
  • diastolic dysfunction
  • caused by amyloid,sarcoid, idiopathic
  • tx w/diuretic, ACEI, transplant
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4
Q

acute vs suvbacute IE cause

A

acute-S. Aureus

subacute-S. Viridans

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5
Q

Duke Criteria

A

Major:  Positive blood culture (2 separate cultures drawn >12 hours apart)  Evidence of endocardial involvement  Positive ECHO- oscillating intracardiac mass on valve or supporting structures, abscess, new partial dehiscence of prosthetic valve or new valve regurgitation
Minor Predisposing heart condition or IVDA
 Fever (38 degrees)  Vascular phenomena- major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhage, Janeway lesions  Immunologic: glomerulonephritis, Oslers nodes, Roth spots, rheumatoid factor  Microbiologic: + blood culture but not meeting major criterion
 Echo: consistent with endocarditis but not meeting major criterion

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6
Q

roth spots vs janeway lesions

A

roth spots-retinal hemorrhage

janeway-palms/soles

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7
Q

Beck;’s triad for pericarditits

A
  1. Hypotension with narrow pulse pressure
  2. JVD
  3. Muffled heart sounds
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8
Q

how does pericarditis present

A

sharp chest pain relieved leaning forward
QRD alternans from heart swinging
tx w/NSAIDS and colchicine

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9
Q

erythema multiforme

A

Acute self limiting type 4 hypersensitivity reaction. MC in young adults 20-40y/o
-Skin lesions evolve over 3-5 days and persist about 2 weeks
-Associated with HSV and meds (sulfa drugs, beta lactams, phenytoin, phenobarbital) malignancies,
autoimmune

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10
Q

how does erythema multiforme present

A

Target lesions are classic, dull, dust violet, purple/blue/red, macules/vesicles or bullae in the center surrounded by
pale edematous rim and a peripheral red halo. Often febrile.

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11
Q

SJS vs TEN

A

SJS describes cases where total body surface area of blistering and detachment are <10%
TEN is used to describe cases w/ >30% detachment

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12
Q

drugs that can cause SJS

A

sulfonamides, allopurinol, antiepileptics
(lamotrigine, phenytoin, carbamazepine), oxicam NSAIDs, beta lactam and other abx,
and nevirapine

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13
Q

Bright cherry-red, Small – pinhead size to about one quarter inch (0.5 centimeter) in diameter  Smooth, or can stick out from the skin

A

cherry angioma

no tx needed

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14
Q

dilation of small superficial vessels and capillaries that cause numerous flat
red marks on the hands, face and tongue

A

telangectiasia

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15
Q

bullous pemphigoid

A

-Chronic widespread autoimmune blistering skin disease primarily of the elderly
- Type 2 HSN autoimmune attack on the epithelial basement membrane causing subepidermal blistering
- tense bullae that don’t rupture easily, blister roof contains epidermis, NEGATIVE NIKOLSKY
tx w/steroids

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16
Q

Pemphigus Vulgaris

A

Oral mucosal membrane erosions and ulcerations before painful flaccid skin bullae, ruptures easily, leaving painful erosions that bleed easily
+ nikolsky sign
tx w/steroids

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17
Q

metformin

A

decreases hepatic production of glucose

stop if creatinine ?1.5

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18
Q

sulfonylureas

A

stimulates pancreatic beta cell insulin release

glyburide, glipizide

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19
Q

Thiazolidinediones

A

increases insulin sensitivity in peripheral receptor site adipose and muscle has no effect on pancreatic beta cells “glitazones”

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20
Q

GLP-1 agonists

A

lowers blood sugar by mimicking incretin - causes insulin secretion and
decreased glucagon and delays gastric emptying

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21
Q

DDP-4 inh

A

inhibits degradation of GLP-1 so more
circulating GLP-1
“gliptans”

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22
Q

SGLT2 inh

A

increased urinary glucose excretion

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23
Q

Cranial nerve 8- schwannoma. Benign tumor of the schwann cells, which produce myelin sheath

A

acoustic neuroma

- Unilateral sensorineural hearing loss is an acoustic neuroma until proven otherwise

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24
Q

Vestibular neuritis & hearing loss/tinnitus (cochlear involvement)

A

labyrinthitis, MC from a viral infection

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25
Q

Celiac

A

-Small bowel Autoimmune disorder to rye, wheat, and
barley
-dermatitis herpetiformis is seen

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26
Q

how to test for Celiac

A

Serum immunoglobulin A (IgA) endomysial antibodies and IgA tissue transglutaminase (tTG) antibodies.
Sensitivity and specificity > 95%

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27
Q

intussusception

A
  • common 6-18 months
  • preceded often by viral syndrome
  • vomiting, abdominal pain, passage of blood per rectum
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28
Q

how to dx/tx intussception

A
  • barium enema

- may show spring-coil sign

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29
Q

MCC LBO

A

adhesions

colon cancer in older folks

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30
Q

Most common cause of painless rectal bleeding in the pediatric population

A

polyps

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31
Q

how to tx cryptorchidism

A

orchiopexy ideally before 1 year old  hCG or GRH hormones can be used to induce descension. May be used prior to surgery but not often
done

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32
Q

is a condition in which urine flows retrograde, or backward, from
the bladder into the ureters/kidneys

A

vesicoureteral reflux

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33
Q

This results from autoimmune antibody formation against host platelets. Occurs in acute
form and chronic form.
Clinical features:  Petechiae and ecchymosis on the skin Bleeding of mucus membranes  No splenomegaly

A

immune thrombocytopenia purpura
Plt <20K
tx w/steroids, IVIG

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34
Q
  • rare disorder of platelet consumption

- hemolytic anemia, thrombocytopenia, acute renal failure, fever, fluctuating, transient neurologic signs

A

thrombotic thrombocyopenia purpura

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35
Q

↓ Platelets + anemia + renal failure

A

HUS

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36
Q

VWD

A

missing or defective von Willebrand factor (VWF), a clotting protein. VWF binds factor VIII, a key clotting protein

37
Q

hemophila A

A

factor VIII deficiency
x-linked recessive
prolonged PTT

38
Q

hemophilia B aka christmas disease

A

factor IX deficiency

39
Q

hemophilia C

A

factor XI deficiency comon in AJ

40
Q

how to tx botulism

A

hospitalization

antitoxin does not treat, but prevents further damage

41
Q

From contaminated water, fish, shellfish, street vendor food  Clinical features: diarrhea RICE WATER

A

vibrio cholera

42
Q

BLOOD AND MUCUS (PUS) IN STOOL

A

shigella

tx w/bactrim

43
Q

Infection occurs from consuming food products with organisms: poultry, reptiles and amphibians
(pet turtle)

A

salmonella

44
Q

how to tx diphtheria

A

diphtheria equine antitoxin, removal membrane direct laryngoscopy, PCN or
erythromycin, isolation

45
Q

JONES criteria for rheumatic fever

requires 2 major or 1 major plus 2 minor

A 
Major
● Carditis
● Chorea
● Erythema marginatum
● Polyarthritis
● Subcutaneous nodules
Minor
● Arthralgia
● Elevated ESR or C-reactive protein
● Fever
● Prolonged PR interval (on ECG)
46
Q

group of clinical syndromes characterized by motor and postural dysfunction due
to permanent and non-progressive disruptions in the developing fetal brain

A

cerebral palsy
MC type is spastic syndrome
dx via cranial MRI

47
Q

Autoimmune, inflammatory demyelinating disease of the CNS of idiopathic origin with axon
degeneration

A

MS, MC type is relaxing remitting

Slow nerve impulses weakness numbness pain and vision loss

48
Q

LLhermites

A

lightning shock pain

49
Q

pulfrich effect

A

sense of disorientation in moving traffic

50
Q

uhthoffs

A

worsening of symptoms with heat

51
Q

Autoimmune disorder causes decrease in acetylcholine receptors at post synaptic junction
MUSCLE WEAKNESS AND FATIGABILITY IMPROVES WITH REST,

A

Myasthenia Gravis

52
Q

how to tx MG

A

ACHase inhibitors like pyridiostigmine and neostigmine

53
Q

Excessive anxiety and worry about daily events and activities (job, school, work, marriage) for at least 6
months

A

GAD

54
Q

Period of extreme anxiety that peaks 10 minutes declines within 30 minutes, RARELY LASTS FOR LONGER than 1 HOUR

A

panic attack

55
Q

MC mental disorder

A

phobia

56
Q 
Chronic progressive interstitial scarring from persistent inflammation resulting in loss of pulmonary
function w/ restrictive component
A

idiopathic pulmonary fibrosis
-CXR: bilateral reticular opacities in periphery
and lower lobes- honeycombing

57
Q

PFT of IPF

A

normal to increased FEV1/FVC ratio; RV decreased; VC decreased;

58
Q

Multisystem disorder characterized by alveolitis followed by epithelioid granulomas •
Associated with inclusion bodies such as Schaumann’s bodies and asteroid bodies •
NON-CASEATING GRANULOMAS, HILAR ADENOPATHY • Most common African
Americans; young people (< 40 y/o); females

A

Sarcoidosis

59
Q

Chronic progressive disease with multisystem involvement of pulmonary and GI tract which
ultimately results in death
 Autosomal recessive on chromosome 7
o Defect of the CFTR gene amusing alterations of salt and water movements across
membranes –> abnormally thick secretions

A

cystic fibrosis

60
Q

how to tx cystic fibrosis

A

o aimed at pulmonary, GI, nutritional, infectious disease
o Exacerbations: antibiotics with augmented airway clearing
 Pseudomonas infections: tobramycin or aztreonam and Azithromycin
o Enzyme replacement for pancreatic insufficiency
o High fat diet

61
Q

hyaline membrane disease

A

Surfactant production begins 24-48 weeks- by 35 weeks, enough surfactant is produced
-CXR will demonstrate diffuse bilateral atelectasis causing a “ground glass appearance” and air bronchograms

62
Q

nephrotic syndrome

A

Heavy proteinuria >3.5 g/14 hours

Hypoalbuminemia <3 g/dl

63
Q

Minimal change disease aka Nil’s

A

M/C Cause of NS in KIDS <10 and can follow a viral URI
In adults, its M/C associated with NSAIDs
proteinuria w/no hematuria

64
Q

membranous nephropathy

A

M/C primary cause of NS in adults,

65
Q

M/C/C of ESRD in USA(second being HTN)

A

diabetic nephropathy

66
Q

acute renal failure

A

Low GFR with accumulation of nitrogenous wastes

67
Q

HPV strains

A

16 and 18 cause cancer

6 and 11 cause warts

68
Q

cervical cancer screening guidelines

A

 First PAPat theage of 21regardless of sexual activity (no pap indicated prior to that)
 Age less than 30:do not screen withHPV testing
 Age 21-65:Screen with PAPevery 3 years
 Age 30-65:Screen with PAP and Cytologyevery 5 years
 Age > 65:Screen with adequate prior screening: do not screen

69
Q

when to start HPV vaccine

A

11-12

70
Q

Pregnant woman + trauma + PAIN =

A

abruptio placentae

71
Q

Bright red vaginal bleeding that PAINLESS, 3rd trimester

A

placenta previa

72
Q

Beta hcg level above which IUP should be visualized on US

A

 1000-1500 on transvaginal
 4000-6500 on transabdominal
Methotrexate in patients with <5000 hcg and ectopic mass <3-4 cm

73
Q

Premature cervical dilation especially in the 2 nd trimester that leads to spontaneous
abortions

A

incompetent cervix
painless dilation of cervix
tx w/Weekly injection of 17-alpha-hydroxyprogesterone

74
Q

postpartum hemmorhage

A

Blood loss > 500 mL in vaginal delivery > 1,000 for C-section following delivery (difficult to quantify)

75
Q

MCC pospartum hemorrhage

A

uterine atony
because normally the uterus should contract
therefore compressing blood vessels and preventing bleeding, over distension,
Oxytocin use during labor, uterine exhaustion, retained placenta or blood clots, full
bladder, uterine infection, cervical or vulvar or vaginal lacerations, and
coagulopathy

76
Q

PROM

A

Premature rupture denotes spontaneous rupture of fetal membranes before the onset of
labor
-alkaline ph is amniotic fluid

77
Q

PPROM

A

Preterm (<37 weeks) premature rupture of membranes

-risk of oligohydramnios

78
Q

prolonged rupture of membranes

A

Rupture of membranes that lasts > 18 hours

-risk of chorioamnionitis

79
Q

how to manage PROM

A

-tocolytics (terbutaline, nifedipine, indomethacin, Mg Sulfate)
< 34 weeks give steroids

80
Q

give rhogam to…

A

RH - moms at 28-30 weeks

81
Q

HTN meds for AA

A

thiazide or CCB

82
Q

HTN meds for DM or chronic kidney disease

A

ACE/ARB

83
Q

tx of choice in uncomplicated HTN

A

thiazide diuretic

prevents kidney water/Na reabsorption at DCT

84
Q

dihydropyridines

A 
potent vasodilators (little effect on cardiac contractility)
-nifedipine/amlodipine
85
Q

non-dihydropyridines

A

affect contractility and conduction

  • verapamil/diltiazem
  • used for prinzmetal angina also
86
Q

A1 blockers

A

“azosin”

good for HTN w/BPH

87
Q

nitroglycerin

A

-increase blood supply
-decrease cardiac work, deny preload
C/I w/PDE5 inhibitors

88
Q

1st line tx for chronic angina

A

BB

89
Q

ASA inhibits

A

thromboxane A2

EOR 2 (1 decks)

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