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Year 2 CV > Exam 3, Darrow, chest pain and fever > Flashcards

Exam 3, Darrow, chest pain and fever Flashcards

1
Q

tick bite in New England 2 mo ago
biphasic high pitched squeaky sound at left sternal border, louder with expiration and leaning forward
inverted T waves on EKG
most likely Dx?

A

chronic pericarditis

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2
Q

firemans cap is concave or convex

A

convex. pericarditis is concave

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3
Q

what position makes pericarditis worse

A

worse laying down, relieved by sitting

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4
Q

what are common causes of pericarditis

A 
viral (coxsackie or echo)
TB
bacterial
uremia
neoplastic
inflammtory reaction/Dresslers
radiation
drugs
myxedema
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5
Q

what cause heart block myocarditis or pericarditis or both?

A

myocarditis

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6
Q

do you need a pacemaker if heart block has narrow QRS

A

no

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7
Q

what is classic triad for early disseminated lyme disease

A

acute neurlologic abnormalities is meninfitis, cranial nerve neuropathy and motor or sensory radiculopathy

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8
Q

what is cardiac involvement with early disseminated lyme disease

A

heart block and myopericarditis

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9
Q 
DM renal failure
BUN 120
creatinine 6.2
dyspnea, fatigue, neck vein distention, muffled heart sounds and BP 90/70
EKG shows electrical alterans
What does the triad suggest? EKG?
A

Becks triad

cardiac tamponade

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10
Q

what is pulses paradoxus indicative of

A

cardiac tamponade

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11
Q

a decreased y descent (more shallow) is seen in what cases

A

tricuspid stenosis and cardiac tamponade

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12
Q

55 female with chest trauma with fatigue, weakness, inc JVP, edema, hepatomegaly and ascites
Kussmaul sign present
These signs suggest what?

A

constrictive pericarditis

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13
Q

What is Kussmaul sign

A

vein increases in size during inspiration

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14
Q

what conditions are seen with kussmaul

A

COPD, pulm HTN with RV failure, rarely cardiac tamponade

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15
Q

If atrial emptying is abrupt and sharp (steep y descent on jugular curve) what does that suggest? “M configuration or W

A

constrictive pericarditis

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16
Q

What are other signs of constrictive pericarditis

A

diatolic pericardial knock (like S3) and echo from rapid early filling
square root sign- heart cath, rapid ventricular filling followed by plateau phase durine rest of diastole because of rigid pericardium

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17
Q

what are causes of constrictive pericarditis

A

TB
post radiation
cardiac surgery
viruses and trauma

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18
Q

what are some restrictive cardiomyopathies that may present like restrictive pericarditis

A

amyloidosis, endomyocardial fibrosis, hemochromatosis, sarcoidosis
decreased ventricular filling

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19
Q

how do you differentiate restrictive cardiomyopathy vs constrictive pericarditis

A

look at EDPressure in LV and RV, in constrictive pericarditis they are equal
BNP elevated in restrictive cardiomyopathies or LV diastolic dysfunction

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20
Q

What is Tx for constrictive pericarditis

A

torsemide

pericardectomy

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21
Q 
homeless man iwth right hemiparesis
had fever 101F covered in lice
total 6 blood cultures had been negative
diastolic decrescendo murmur at Erbs
What is this?
A

fever of undetermined origin

22
Q

What can cause a FUO fever of undetermined origin

A

Infection:TB, endocartis, occult abscess
Cancer:lymphoma, leukemia
Autoimmune/CTDisease: Still’s, SLE, cryoglobulinemia, PAN
Mischellaneous: sarcoid, FMF, whipples thyroiditis

23
Q

What are the main criteria for duke criteria endocarditis

A

two positibe blood cultures
ECHO evidence of endocardial involvement
new regurgitant murmur

24
Q

what are the minor criteria for duke criteria endocardtitis

A

predisposing condition
fever of 100.4 or higher
vascular emooli: janeway lesion, splinter hemorrhages, mycotic aneurysm, conjunctival or cutaneous hemorrhage, PE, strok, MI
Immunologic phenomena with agglutinating Ab: (osler node- painful and vasculitic), roth spots, RF, GN(hematuria and proteinuria)

25
Q

what is considered a + dukes criteria for endocarditis

A

2 major criteria
one major and 3 minor
5 minor

26
Q

what are predisposing conditions to infective endocarditis

A

regurgitant valves, bicuspid valves, rheumatic valves, calcific valces, MVP, PDA, coarctation, VSD

27
Q

IV drug use predominately will affect what valve

A

tricuspid

28
Q

native valve endocarditis are acused by what pathogens

A

staph, strep viridans, bovis, Group D strep or HACEK

29
Q

what pathogens affect prosthetic valve early on? how about after 2 mo

A

early- staph

late- strep or staph

30
Q

how do you Dx endocarditis

A

raw 3 cultues one hour apart

31
Q

If culture for endocarditis is negative what do you do next

A

think fungi
special media to grow legionella, bartonella and abiotrophia
now growth on artifical media- whipelli and psittacosis
slow growing with prolonged incubation- Brucella anareobes (HACEK + by 5 days)

32
Q

third most common infection from human bite

A

eikenella

33
Q

how can endocarditis lead to abdominal aortic aneurysm

A

mycotic aneurysm

34
Q

complications of endocarditis

A

heart blok, CHF, emboli, mycotic aneurysms, myocardial abscess

35
Q

Patient with cat and endocarditis was most likely what organism

A

coxiella burnetti

36
Q

coxiella infection is Tx with what

A

doxy

37
Q

strep endocarditis is Tx how

A

penicillin

38
Q

enterococcal endocarditis is Tx how

A

penicillin with gentamicin

39
Q

Staph endocarditis is Tx how

A

nafcillin, if MRSA- vancomycin

40
Q

if there is staph on prosthetic valve what do you use to Tx

A

vancomycin
gentamycin
Rifampin– kills foreign material

41
Q

strep bovis endocarditis, where did it come from

A

GI tract

usually GI neoplasms

42
Q

strep mutans endocarditis came from where

A

dental

43
Q

enterococci endocarditis is common in what population

A

elderly wiht urinary problems

44
Q

HACEK endocarditis will grow on media when

A

around 5 days or more

45
Q

no growth on media from endocarditis could be what

A

tropheyma, Q fever

46
Q

When do you use antibiotic endocardtisi prophylaxis

A

previous IE
prosthetic valves or material
cyanotic congenital heart disease (tetralogy of fallot, eisenmenger syndrome) (not so if repaired >6 mo)

47
Q

You give prophylactic antibiotics to patients with high risk endocarditis if they are having surgery in what areas?

A

teeth, lungs and skin

48
Q

what antibiotic is given for dental procedures in someone with infective endocarditis

A

amoxicillin

49
Q

fever, weight loss, leukocytosis, elevated sed rate, elevated RF and episodic pulmonary edema and syncope, especially with standing
recent troke
diastolic rumble with ocassional extra sound at mitral valve area upon standint
osler node on right great toe
most likley has?

A

atrial myxoma which is giving off emboli that present like endocarditis with negative cultures.

50
Q

why do you get syncope with standing with an atrial myxoma

A

gravity pulls myxoma down and occludes mitral or tricuspid valve

51
Q

patient has endocrine neoplasia, pigmented skin lesions and atrial myxoma, what is this

A

Carney complex

52
Q

What causes Carney complex

A

cAMP activated PKA with activated cell proliferation, multiple neoplasia syndrome

Year 2 CV (31 decks)

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