hammer17 Flashcards
When are HPV vaccines given?
9-11 and through age 26 in women and 21 for men
What is the presentation of traumatic carotid injury?
Gradual inset hemiplegia, aphasia, neck pain and thunderclap headache
What is the management of infectious mononucleosis?
Avoid contact sports for >3 weeks due to risk of splenic rupture
What is the treatment for bipolar disorder in patients not adequately controlled with monotherapy?
Lithium or valproate PLUS second generation antipsychotic
What is a characterstic feature of hydroceles and when do most hydroceles resolve? What do they incresae the risk for?
Transillumination. By 12 months of age. Inguinal hernia.
What is the cause of pain from a PE?
Occlusion of pulmonary artery by thrombus. Not distension of artery.
What are features of inflammatory cause of back pain?
Gradual onset, onset at age
What is the pathophysiology of hypertrophic cardiomyopathy?
Systolic anterior motion of the mitral valve leading to anterior motion of mitral valve leaflets toward interventricular septum. Contact berween mitral valve and thickened septum during systole leads to LVOT obstruction.
What is the treatment for uncomplicated cystitis?
Nitrofurantoin for 5 days, TMP/SMX, fosfomycin single dose. Urine cultire if first treatment fails.
What is the treatment for complicated cystitis and pyelonephritis?
fluoroquinolones
What murmur is heard in complete atrioventricular septal defect adn which childhood disorder?
Down syndrome. Loud S2. Systolic ejection murmur from increased flow across pulmonary vales from teh L to R shunt across ASD. Holosystolic VSD murmur.
What is Wallenberg syndrome? What causes it and what is presentation?
Lateral medullary infarct 2/2 PICA or vertrbral artery occlusion. Loss of pain and temperature over ipsilateral face and contralateral body, ipsilateral bulbar muscle weakness, vertigo, nystagmus, Horner’s syndrome. Motor function of the face and body is typically spared.
What should you suspect in Down patietns who present with UMN findings?
Atlantoaxial instability
What is the presentation of allergic contact dermatitis?
Primarily on exposed skin, erythema, papules, vesicles, chronic lichenification
What is the worst risk factor and most common risk factor for CAD?
Worst - DM. Most common is HTN.
How does sublingual nitroglycenrin have antiischemic effects in patients?
Systemic vasodilation, decrease in cardiac preload, decrease in LV systolic wall stress, decrease in afterload
What is the pathophysiology behing broken heart (tako-tsubo) cardiomyopathy? Treatment?
Massive discharge of catecholamines. Beta blockers and ACEi
What are risk factors for CAD? Correcting which factors provides the greatest immediate benefit?
DM, HTN, HLD, Cigarette smoking, Family history of premature CAD, Age above 45 in men and 55 in women. Smoking (50% decrease in 1 year adn 90% in 2 years)
What are the characteristics of ischemic pain?
Stable angina >2 to 10 to 30 min. Associated with SOB, nausea, diaphoresis, dizziness, lighheadedness, fatigue. Substernal, alleviated by rest. Radiates to neck, lower jaw and teeth, arms, shoulders
What is the best method of detecting ischemia without the use of EKG?
- Nuclear isotope uptake (thallium of sestamibi) 2. Echocardiographic detection of wall motion abnormalities
What is the best method to detect ischemia in a patient who cannot exercise?
Dipyridamole or adenosine in combination with thallium or sestamibi. 2. Dobutamine in combo with echo
What is the next step after determining someone has reversible ischemia? in someone who has chest pain and is stable?
Cornary angiography which is the most accurate method of detecting CAD. Exercise tolerance test
When is CABG indicated?
3 vessel disease with atleast 70% occlusion, left main or 2 vessel disease in diabetics
What medications lower mortality in chronic angina?
Aspirin, beta blockers, nitroglycerin (oral, transdermal)
What meds are used in ACS when patients arrive in the ED? Which ones are best used to prevent restenosis?
Aspirin + clopidogrel, prasugrel or ticagrelor (P2Y12 inhibitors on platelet). Prasugrel or ticagrelor
When is clopidogrel used?
In combination with aspirin on all acute ACS. Aspirin intolerance. Recent angioplasty with stenting.
What is a risk of using Prasugrel?
Dangerous in patients 75 and older because of risk of hemorrhagic stroke.
When is Ticlpidine used and what is its side effects? What do you use in angina refractory ot persistent through other treatment?
IN patients intolerant of both aspirin and clopidogrel. Causes neutropenia and TTP. Ranolazine.
When do you use ACEi/ARBs in CAD?
Low EF/systolic dysfunction (best mortality benefit). Regurgitant valvular disease.
How does hydralizine work and why is it used?
Direct acting arterial vasodilator. Decreases afterload and has a clear mortality benefit in patients with systolic dysfunction.
What is the LDL goal in patients with CAD?
Less than 100 mg/dL
What are CAD equivalents?
PAD, Carotid disease, Aortic disease, Stroke, DM
What is the most common effect of statins?
Elevated AST and ALT
Which hyperlipedemia drugs are associated with a clear mortality benefit? What effects does it have on coronary arteries?
Statins. Antioxidant effect on endothelial lining of coronary arteries
What is an adverse effect of fibric acid derivatives? cholestyramine?
Increased risk of myositis when combined with statins. Flatus and abdominal cramping.
When do you use CCBs in CAD?
- Severe asthma precluding the use of betablockers
- Printzmetal variant angina
- Cocaine induced chest pain
- Inability to control pain with maximum medical therapy
What is the lifetime of internal mammary artery grafts? saphenous vein grafts?
10 years. 5 years.
Which conditions is angioplasty (PCI) best suited for?
Acute coronary syndrome, particularly with ST elevations
What murmur is acute coronary syndrome associated with?
S4 gallop which is the sound of atrial systole as blood is ejected from the atrium into a stiff ventricle.
What are the EKG findings in anterior vs inferior wall MI? Which one has the worst prognosis?
IWMI - ST elevation in II, III and AVF. AWMI - ST elevation in V2-V4. AWMI
What is the First step and second step in treating a patient with ACS?
Aspirin, Angioplasty before pain control. Betablockers can be given any time during the hospital stay.
When can you detect CK-MB and Troponin abnormalities? How long do they last?
Within 4-6 hours. CK-MB (1-2days) and Troponin (10-14 days). Renal insufficiency can give FP results for Troponin
What is the most common cause of death after an MI in the first several days?
Ventricular arrhythmia (ventricular tachycardia, ventricular fibrillation)
How is angioplasty superior to thrombolytics? What is the door to balloon time in PCI? Door to thrombolytic time?
Survival and mortality benefit, fewer hemorrhagic complications, likelihood of developing complications of MI. 90 minutes. 30 minutes upto 12 hours.
What are complications of PCI?
Rupture of coronary artery, restenosis of vessel after angioplasty, hematoma at site of entry into teh artery
What are absolute contraindications to thrombolytics? How long does the mortality benefit of thromoblytics last? When are thrombolytics only beneficial?
Major bleeding into the bowel (melena) or brain, recent surgery, severe THN (above 180/110), non hemorrhagic stroke within the last 6 months. Extends out to 12 hours after onset of chest pain. STEMI only
When is Heparin first line treatment?
Initial therapy with ST depression and other NON-ST elevation events as it prevents clot formation that closes off the coronary artery.
When are GPIIb/IIIa inhibitors indicated? Which patients do they give mortality benefit?
Abciximab, Tirofiban and eptifibatide are used in ACS patients who undergo stenting and angioplasty. Mortality benefit in those with ST depression
When are antiplatelet drugs indicated in cardiac events? What other drugs do both conidtions get?
In STEMI and NSTEMI/unstable angina. Aspirin, beta blockers, statins, ACEi, morphine, nitrates.
When do you do Post-MI stress test?
Identify those with residual ischemia prior to leaving the hospital
