Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Internal Med > firecracker 11/28 > Flashcards

firecracker 11/28 Flashcards

1
Q

RHF

A

right ventricle cannot pump blood into lungs

blood accumulates in systemic venous system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

most common cause of RHF

A

left heart failure
also:
pulmonary HTN, L2R shunt, Tricuspid valve regurg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

most common cause of RHF if no LSHF

A

COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

cor pulmonale

A

rhf due to chornically elevated pulmonary artery pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

RSHF symptoms

A

HSM
peripheral edema
jugular venous distension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

hepatomegaly in RSHF

A

venous congestion of hepatic veins of liver

can cause portal htn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

hepato-jugular reflux

A

pressing on RUQ elcitis distension of right jugular vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

peripheral edema cause

A

increase in venous hydrostatic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

jugular venous distension

A

increased venous pressure in superior venous cava

>4cm abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

severe pulmonary hypertension ECG

A

P pulmonale
peaked P waves >2.5 in inferior leads II, III, avf
right axis deviation
right ventricular hypertrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

treatment for cor pulmonale

A

adequate oxygenation
correct respiratory acidosis
treat underlying infections
decrease work of breathing using positive pressure or bronchodilators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

HIT

A

immune mediated reaction after exposure to heparin products

paradoxically pro-thrombotic state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

pathophysiology of HIT

A 
auto-antibodies to platelet factor 4:heparin complex
Ab cross react with platelets
peripheral activation (thrombosis)
and destruction (thrombocytopenia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

HIT risk factors

A

unfractionated (vs LMWH)
higher doses
female
recent surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

timing of hit

A

5-10 days after exposure

early onset within 24 hrs if exposed to heparin in past 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

thrombocytopenia in HIT

A

drop in platelet count >50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

thrombosis in HIT

A

venous>arterial
skin necrosis at injection sites
limb gangrene
organ ischemia or infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

4 T score of HIT

A

thrombocytopenia
timing
thrombosis
oTher causes not present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

HIT diagnosis

A

immunoassay test anti-PF4 antibodies

serotonin release assay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

management of HIT

A

stop heparin
start direct thrombin inhibitor (argatroban or bivalirudin)
fondaparinux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

HIT - pts with renal dysfunction

A

argratroban

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

HIT - pts with hepatic dysfunction

A

fondaparinux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

gout

A

deposition of monosodium urate crystals in joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

primary gout

A

hyperuricemia due to nucleic acid metabolism disorders or underexcretion of uric acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

secoundary gout

A

diseases with high metabolic turnover (leukemia, psorasis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

gout age groupd

A

men, 40-60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

overproduction of uric acid

A

obesity, cancer, hemoglobinopathies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

underexcretion of uric acid

A

renal disease

diuretic use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

podagra

A

first metatarsophalangeal joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

gout diagnosis

A

needle shaped negatively birefringent crystals

not uric acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

tophi

A

x ray imaging that shows bony erosions and soft tissue crystal deposition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

gout treatment

A

nsaids, colchicine, corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

chronic gout treatment

A

allopurinol (decrease UA production)

probenecid (inhibit renal UA reabsorption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

pleural effusion

A

collection of fluid between parietal and visceral pleura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

causes of exudative pleural effusions

A

lung infections, tb
cancer
pulmonary embolism
impaired pleural lymphatic drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

transudative

A

increased hydrosatatic pressure or decreased serum oncotic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

exudate

A

increased vessel permeability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

causes of transudative pleural effusion

A

CHF
nephrosis, cirrhosis
injuries to pleural lining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

injuries to pleural lining

A

central venous catheter misplacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

pulmonary emobolism - type of pleural effusion

A

trans or exud

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

chylous effusions

A

iatrogenic (surgery)
traumatic
malignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

pleural effusion symptoms

A

dyspnea
pleuritic chest pain
worsens with time
associated symptoms (night sweats, wt loss, swelling)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

pleural effusion physical exam

A

decreased breath sounds
dullness to percrussion
decreased fremitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

pleural effusion cxr

A

blunting of costophrenic angle

transudative - bilateral, exudative - unilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

lateral decubitus cxr

A

most sensitive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

light’s criteria

A

pleural prot/serum >.5
pleural ldh/serum ldh >.6
pleural ldh greater than 2/3 of normal serum ldh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

treatment of parapneumonic effusions (around a pneumonia)

A

antibiotics if uncomplicated

chest tube drainage if complicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

ischemic atn most common cause

A

pre renal failure

  • decreased effective circulating load/preload
  • decreased cardiac output
  • nsaids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

DKA potassium levels

A

low total body levels

normal/high on labs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

common cause of nephrotoxic ATN

A

aminoglycosides, amph b, cisplatinum

heavy metals, contrast, gram negative sepsis, myoglobinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

meds for pts with coronary interventions

A

clopidogrel

gb11a/111b inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

decreased effective circulating blood volume

A

hypovolemia
systemic vasodilation/septic shock
cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

chylous pleural effusion

A

iatrogenic (surgery)
traumatic
malignant

54
Q

CXR RSHF

A

right ventricular enelargement

pulmonary artery dilatation

55
Q

delta gap

A

AG - 12
/
24 - HCO3

56
Q

ATN - ischemic and nephrotoxic have in common…

A

disturbances in renal blood flow

tubular injury

57
Q

RSHF echo

A

tricuspid regurg

paradoxical displacement of IV septum into LV during systole

58
Q

agents that cause CAP

A 
streptococcus pnemoniae
haemophilus influenzae
klebsiella pneumonia
pseudomonas aeruginosa
staphylococcus aureus
59
Q

most common cause of pneumonia

A

streptococcus pneumoniae

60
Q

risk factors for streptococcus pneumoniae

A

smoking
copd
immunocompromised

61
Q

H influenzae risk factors

A

sickle cell dz
copd, smoking
immunocomprimised
alcoholism, diabetes

62
Q

klebsiella risk factors

A

alcoholics, strokes, elderly, decreased LOC

63
Q

pseudomonas risk factors

A

structural lung dz: bronchiectasis, cystic fibrosis, copd
hosp or nursing home residents
pts who have received broad spectrum antibiotics or high dose steroid therapy

64
Q

s. aureus risk factors

A

recent flu or viral illness
skin colonization or staph infection
laryngeal cancer
immunosuppressoin

65
Q

pseudomonas treatment

A

piperacillin/tazobactam
cefepime
imipenem
meropenem + fluroquinolone

66
Q

symptoms for pneumonia

A

increased tactile fremtius
dullness to percussion
pleural friction rub

67
Q

atelectasis is

A

decrease in lung volume secondary to partial collapse of lung tissue

68
Q

atelectasis caused by

A

operations, impaired inspiratory ability, lack of cough reflex, obstructions/tumors, foreign body in children

69
Q

resorption atelectasis

A

airway obstructed by foreign object, tumor or thick mucus plug
devoid of lung sounds

70
Q

compression atelectasis

A

space occupying lesion in pleural caivty (air or fluid) increases pressure

71
Q

atelectasis symptoms

A

dyspnea, fever
pleuritic chest pain
tachycardia, hypoxia

72
Q

atelectasis physical exam

A

dullness to percuss
decreased breath sounds
crackles on ausuclation

73
Q

atelectasis CXR

A

raised diaphram in lower lobe atelectasis
tracheal deviation towards atelectasis in upper lobes
fluffly infiltrates

74
Q

atelectasis treatment

A

incentive spirometry
deep breathing
ambulation
(bronchoscopy)

75
Q

atelectasis complications

A

damange to lung parenchyma
pneumonia
resp failure

76
Q

maintaining body ph

A

bicarbonate buffer in ECF

proteins and phosphates in ICF

77
Q

phosphate regulation

A

PTH decreases
insulin lowers
vit D increases

78
Q

signs of pulmonary emoblism - later

A

resp alkalosis with hypoxia, hypocarbia
loud p2
right heart failure

79
Q

unstable angina

A

1) chest pain at rest >10 min
2) severe and new onset
3) cresendo pattern

80
Q

most common cause of UA/NSTEMI

A

rupture of coronary artery plaque –> down stream occlusion

81
Q

unstable angina cause

A

incomplete stenosis or presence of well-perfused collaterals

82
Q

st depression

A

subendocardial ischemia

83
Q

NSTEMI vs UA

A

elevations in cardiac enzymes in NSTEMI

84
Q

pts w/ UA/NSTEMI admit

A
  • telemetry
  • serial cardiac enzymes
  • possible coronary angiography if indicated
85
Q

Thrombolysis Infarction Risk score

A

> /= 3 consider LMWH, angiography
Severe angina, coronary artery stensosi >50%, age >65, aspirin use within past 7 days, three or more Risk factors for cad, enzymes elevated, ST segment changes

86
Q

cardiac stress test

A
  • diagnose ischemic heart disease
87
Q

cardiac stress test, how test is performed

A

exercise –> increase cardiac oxygen demand

dobutamine – cardiac INOTROPE

88
Q

stress test with adenosine or dipyridamole

A

coronary vasodilators
stenotic vessels will dilate less
blood flow through stenotic vessels will be decreased and those tissues will get less oxygen –> “cardiac steal”

89
Q

pre test probability of coronary artery disease

A

age
sex
typical/definitive AP vs atypical probably AP
nonagnial chest pain

90
Q

high probability patients

A

more likely to have false negative

91
Q

diagnostic testing for CAD warranted in

A

pts with symptoms of CAD
asymptomatic pts with high pre test CAD probability
pts with newly diagnosed heart failure

92
Q

asymptomatic pts who should undergo stress testing

A

> 20% 10-year CAD risk

exercise ECG

93
Q

symptomatic pts with low or intermediate pre-test probability

A

if able to exercise and have interpretable ECG –> undergo stress exercise testing

94
Q

test of choice for symptomatic pts unable to exericse or uninterpretable ECG

A

stress radionuclide imaging or echo

95
Q

stress cardiac mri

A

symptomatic high pre test

96
Q

symptomatic pt with high pre test probability should receive

A

stress radionucleide imaging, stress echo, stress MRI, or coronary angiography
not exercise ecg

97
Q

newly diagnosed CHF pts

A

evaluated similarity to symptomatic with high pre test probability

98
Q

exercise stress test that diagnose coronary artery stenosis show

A

greater than 2mm ST segment depression

greather than 10mmhg drop in systolic blood pressure

99
Q

drugs that should be held before exercise stress test

A

beta blockers, non-dihydropyridine calicum channel blockers
certain antiarrhthm - amiodaraone, sotalol
digoxin, nitrates

100
Q

exercise stress testing contraindicated in

A

unstable patients
patients who cannot exercise
patients with uninterpreable EKGs

101
Q

nuclear stress testing

A

thallium
accumulates in well-perfused heart tissue
approriate in pts with baseline EKG abnormalities

102
Q

coronary angiography

A

most sensitive and specific for CAD

allows immediate intervention (stent placement)

103
Q

A fib

A

signal from SA node is overwhelmed by disorganized signals from other areas
myocytes contracting at different times

104
Q

most important risk factor for A fibrillation

A

mitral valve stenosis

105
Q

A fib incidence increases with

A

age

106
Q

atrial rate vs ventricular rate

A

500bpm vs 120-180

107
Q

A fib symptoms

A

palpitations
exercise intolerance
venous statsis –> SOB, edema

108
Q

A fib EKG/PE

A

> 100 bmp
irregularly regular rhythm with ventricular rate >100 bmp
absence of p waves
narrow QRS complexes

109
Q

lab tests for A fib

A

renal function
electrolytes
TSH
CBC

110
Q

complications of a fib arise from

A

reduced CO
increased cardiac oxygen demand
thromboembolism

111
Q

A fib - blood remains

A

in atrium, may lead to clot –> emoblic event –> stroke

112
Q

increased cardiac oxygen demand

A

can lead to MI

113
Q

reduced cardiac output can lead to

A

CHF symptoms like pulmonary or lower leg edema

114
Q

treatment of a fib - ventricular rate

A

beta blocker, calcium channel blocker

115
Q

chemical cardioversion of a fib

A 
class IC (propafenone, flecainide)
class III (ibutilide, dofetilide > amiodarone, sotalol)
116
Q

electric cardioversion in afib

A

delivery of DC synchronized with QRS complex

117
Q

CHADS

A

CHF, HTN, Age > 75 (2 pts)
DM
Previous stroke or TIA (2)

118
Q

VASC

A

vascular dz
age >65 but less than 75
sex cateogry - female

119
Q

anticoagulation with a fib

A

warfarin

dabigatran

120
Q

warfarin causes prolongation of

A

PT/INR, aPTT

121
Q

a fib rate control

A 
class II (BB) 
class IV (CCBs)
122
Q

ventricular rate ontrol

A

slows conduction from fibrilating atria to ventricles

pts >65

123
Q

rhythm control

A

propafenone, dofetilide, amiodarone

alter cardiac potential

124
Q

CHADSVASC of 1

A

aspirin

125
Q

CHADSVASC of 2

A

anticoagulation

126
Q

TTP and HUS characterized by

A

microangiopathic hemolytic anemia
+
thrombocytopenia

127
Q

TTP vs HUS

A

neuro symptoms - TTP

renal symptoms - HUS

128
Q

TTP/HUS pentad

A 
F - fever
A - micoangiopathic anemia
T - thrombocytopenia
R - acute kidney injury
N - neuro abnormalities (AMS)
129
Q

MAHA

A

non-immune hemolysis

RBC fragmentation = schitocytes

130
Q

TTP/HUS associated symptoms

A

bloody diarrhea ( e coli 0157h7)
pregnancy
meds - mitomycin C, cyclosporine, gemcitabine

131
Q

lab studies for TTP/HUS

A

schistocytes
elevated LDH
decreased haptoglobin
<10% ADAMTS13

132
Q

TTP/HUS treatment

A

plasma exchange

normalize platelet count, LDH level

Internal Med (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions