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IM Shelf Review > IM Shelf Review PPT > Flashcards

IM Shelf Review PPT Flashcards

1
Q

Which EKG leads affected in an anterior infarct?

A

V1-V4

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2
Q

Which EKG leads affected in an inferior infarct?

A

II, III, aVF

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3
Q

Which artery affected in an inferior infarct?

A

RCA

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4
Q

Which artery affected in an anterior infarct?

A

LAD

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5
Q

R ventricular infarct s/s

A

hypoTN, tachycardia, + JVD, CLEAR lungs, NO pulsus paradoxus (looks like they are in shock w JVD)

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6
Q

R ventricular infarct Tx?

A

fluids; NO nitro bc lack of preload is problem, and that would make it worse

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7
Q

When does myoglobin peak after an MI?

A

2h

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8
Q

When does CKMB peak after an MI?

A

24h

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9
Q

When does troponin peak after an MI?

A

24-48h

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10
Q

What is the best test to check for a recurrent MI?

A

myoglobin

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11
Q

Name 2 medications that must be d/c’d prior to a stress test.

A

beta-blockers and Ca-channel blockers

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12
Q

Name 2 medications used for a chemical stress test.

A

dobutamine, adenosine

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13
Q

How does dobutamine work?

A

beta1-adrenergic receptor –> increased contractility and HR

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14
Q

What indicates a positive stress test?

A

+ CP, ST depression, or hypoTN

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15
Q

How do adenosine work?

A

causes coronary vasodilation and increases blood flow in normal coronary arteries; Slows conduction time through the AV node, interrupting the re-entry pathways through the AV node, restoring normal sinus rhythm

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16
Q

What meds do you d/c an MI pt home on?

A

aspirin/clopidogrel, beta-blocker, ace-I, statin, nitrates

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17
Q

What is the most common cause of death post-MI?

A

arrhythmia

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18
Q

S/p MI, new systolic murmur 5-7 days later?

A

papillary muscle rupture

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19
Q

S/p MI, acute hypoTN, new murmur?

A

ventricular free wall rupture

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20
Q

S/p MI, persistent ST elevation about 1 month later, with systolic MR murmur?

A

ventricular wall aneurysm

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21
Q

“Cannon A-waves”

A

JVP is bounding - tricuspid valve not opening in synchrony with cardiac cycle- atria and ventricles (AV) dissociation

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22
Q

S/p MI, pleuritic CP and low grade temp, 5-10 weeks later?

A

Dressler’s syndrome

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23
Q

Another name for autoimmune pericarditis?

A

Dressler’s syndrome

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24
Q

Dressler’s syndrome tx?

A

NSAIDs, aspirin

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25
Q

Young person, diffuse ST elevation?

A

pericarditis

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26
Q

CP worse with inspiration (pleuritic), improved with leaning forwards, friction rub

A

pericarditis

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27
Q

Tx for pericarditis?

A

NSAIDs

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28
Q

Vague CP + hx of viral infection + murmur?

A

myocarditis

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29
Q

CP at rest, worse at night, + migraines, transient ST elevation during episodes?

A

Prinzmetal’s angina

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30
Q

Prinzmetal’s angina tx?

A

nitrate, Ca++ channel blockers

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31
Q

Prinzmetal’s angina diagnostic test?

A

ergonovine stimulation test

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32
Q

EKG: progressive prolongation of the PR interval, with dropped beat?

A

Wenckebach/Mobitz type I

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33
Q

EKG: regular P-P and R-R interval, but not associated with each other?

A

3rd degree heart block

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34
Q

Physical exam 3rd degree heart block?

A

Cannon A-waves

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35
Q

EKG: varying PR intervals with >3 morphologically distinct P waves in the same lead

A

multifocal atrial tachycardia (MAT)

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36
Q

EKG: >3 consecutive beats with narrow QRS and rate >120

A

v-tach

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37
Q

Tx v-tach?

A

if pt unstable = shock, if pt stable = lidocaine, amiodarone

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38
Q

EKG: delta waves

A

WPW

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39
Q

EKG: short PR interval, wide QRS, slurred initial deflection

A

WPW

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40
Q

Tx WPW?

A

procainamide

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41
Q

What meds are contraindicated in WPW?

A

anything that slows AV conduction (beta-blockers, digoxin, verapamil, diltiazem)

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42
Q

EKG: sawtooth

A

A-flutter

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43
Q

Tx A-flutter?

A

unstable: shock
stable: beta-blockers, digoxin (kind of like a-fib)

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44
Q

EKG: regular rhythm, ventricular rate 125-150 and atrial rate 250-300

A

A-flutter

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45
Q

EKG: prolonged QT interval leading to undulating rotation of the complex around the EKG w/ low Mg and K

A

Torsades

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46
Q

What OD causes Torsades?

A

tricyclics

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47
Q

EKG: regular rhythm with rate 150-220 and sudden onset and offset palpitations

A

SVT

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48
Q

1st line Tx SVT?

A

carotid massage

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49
Q

Drug tx for SVT?

A

adenosine

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50
Q

EKG: peaked T waves?

A

hyperkalemia

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51
Q

EKG: Wide QRS, short QT, prolonged PR

A

hyperkalemia

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52
Q

EKG: undulating, low amplitude, alternate beat variation in direction

A

tamponade (electrical alternans)

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53
Q

Pulsus paradoxus, hypoTN, distant heart sounds, JVD?

A

tamponade (electrical alternans)

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54
Q

EKG: undulating baseline, irregular R-R interval

A

A-fib

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55
Q

Rate control drugs for a-fib?

A

beta-blockers

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56
Q

SEM cresc/decressc, louder with squat, softer with valsalva, parvus et tardus

A

aortic stenosis

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57
Q

Causes of aortic stenosis?

A

old age- calcific stenosis; bicuspid aortic valve

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58
Q

Tx aortic stenosis?

A

valve replacement

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59
Q

SEM louder with valsalva, softer with squatting or handgrip

A

HOCM

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60
Q

How does valsalva affect the heart?

A

decreases preload

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61
Q

Late systolic murmur with a click, louder with valsalva, softer with squatting

A

MVP

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62
Q

Holosystolic murmur radiating to axilla

A

mitral regurg

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63
Q

Holosystolic murmur w late diastolic rumble in kids

A

VSD

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64
Q

continuous machine-like murmur

A

PDA

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65
Q

wide fixed and split S2

A

ASD

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66
Q

rumbling diastolic murmur w opening snap

A

mitral stenosis

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67
Q

blowing diastolic murmur with a widened pulse pressure

A

aortic regurg

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68
Q

If PE is highly suspected: first step?

A

give heparin

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69
Q

Hx of CHF and murmur present?

A

get echo

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70
Q

Tx acute pulm edema?

A

nitrates, lasix, and morphine

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71
Q

young pt, sxs of CHF w prior hx of viral infection?

A

myocarditis (coxsackie B)

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72
Q

Reversible causes of CHF?

A

EtOH, hemachromatosis

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73
Q

Tx CHF?

A

ace-i, beta-blocker, spironolactone, furosemide, digoxin

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74
Q

CHF tx that improve survival?

A

ace-i, beta-blocker, spironolactone

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75
Q

CXR: thickened peritracheal stripe and splayed carina bifurcation

A

LA enlargement from bad mitral stenosis; cancer

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76
Q

Name 3 transudative causes.

A

CHF, nephrotic syndrome, cirrhosis

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77
Q

Transudative w low glucose?

A

RA

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78
Q

Transudative with high lymphocytes?

A

TB

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79
Q

Transudative with blood?

A

PE or cancer

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80
Q

Name 2 exudative causes.

A

PNA, cancer

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81
Q

What is a complicated plural effusion?

A

positive bugs, low glucose, low pH

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82
Q

What is the tx for complicated plural effusion?

A

insert chest tube for drainage

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83
Q

Lights criteria for transudate?

A

1) LDH <200
2) LDH eff/serum < 0.6
3) protein eff/serum < 0.5

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84
Q

3 diagnostic criteria for ARDS?

A

1) PaO2/FiO2 <200
2) bilateral alveolar inf on CXR
3) pulm cap wedge pressure <18 (r/o cardiac causes)

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85
Q

ARDS tx?

A

PEEP

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86
Q

COPD dx?

A

productive cough >3mos in 2 consecutive years

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87
Q

COPD tx?

A

ipratroprium, beta-agonist, theophylline

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88
Q

When is O2 initiated in COPD?

A

pulse ox <88 or blood gas <55

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89
Q

COPD acute exasherbation dx?

A

any change with the sputum, increasing dyspnea

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90
Q

COPD acute exasherbation tx?

A

O2, nebs, corticosteroids, FQ or macrolide

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91
Q

Best prognostic indicator for COPD?

A

FEV1

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92
Q

What improves COPD mortality?

A

long-term O2, d/c smoking

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93
Q

COPD pt with clubbing?

A

lung cancer! get CXR (hypertrophic osteoarthropathy)

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94
Q

Name a long acting beta-agonist.

A

salmetrol

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95
Q

PCO2 in the middle of an asthma attack?

A

low

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96
Q

CXR: 1cm nodules in upper lobes with eggshell calcifications?

A

silicosis

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97
Q

Silicosis predisposes to ___.

A

TB

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98
Q

Asbestosis predisposes the patient to ____.

A

cancer

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99
Q

CXR: reticulonodular process in lower lobe with pleural plaques.

A

asbestosis

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100
Q

CXR: patchy lower lobe infiltrates, thermophyilic actinomyces

A

hypersensitivity pneumonitis (farmer’s lung)

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101
Q

CXR: hilar lymphadenopathy, increase ACE, erythema nodosum

A

sarcoidosis

102
Q

Why hypercalcemia in sarcoid?

A

microphages make vitamin D

103
Q

Tx sarcoid?

A

steroids

104
Q

Benign lung nodule characteristics?

A

popcorn calcification (hamartoma), concentric calcification (old granuloma)

105
Q

Malignant lung nodule characteristics?

A

> 3cm, eccentric calcification, older pt, smoker

106
Q

Most common lung cancer in nonsmokers?

A

adenocarcinoma

107
Q

Where does adenocarcinoma of the lung arise?

A

peripheral

108
Q

Where does adenocarcinoma of the lung metastasize?

A

liver, bone, brain, adrenals

109
Q

Plural effusion of adenocarcinoma of the lung?

A

exudative with high hyaluronidase

110
Q

kidney stones, constipation, + malaise with low PTH and central lung mass?

A

paraneoplastic syndrome of squamous cell carcinoma (PTH RH)

111
Q

shoulder pain, ptosis, constricted pupil, facial edema

A

pancoast tumor/superior sulcus syndrome- from small cell carcinoma

112
Q

ptosis better after 1 min of upward gaze

A

Lambert-Eaton (small cell lung ca)

113
Q

old smoker, low Na+, moist mucous membranes, no JVD

A

SIADH from small cell carcinoma

114
Q

IBD with p-ANCA?

A

UC

115
Q

Tx IBD?

A

ASA, sulfasalazine, corticosteroids

116
Q

2 liver markers in EtOH?

A

AST, GGT

117
Q

ALT>AST and in the 1000s?

A

viral hepatitis

118
Q

ALT and AST and in the 1000s

A

ischemic hepatitis/shock liver

119
Q

elevated D-bili?

A

obstruction (biliary tract, gallbladder, Dubin-Johnson, Rotor)

120
Q

elevated indirect bili?

A

hemolysis, Gilbert, Criglar-Najar

121
Q

elevated alk phos and GGT?

A

obstruction in biliary ducts

122
Q

elevated alk phos, normal GGT, normal Ca++?

A

Paget’s disease

123
Q

ANA+, antismoothmuscle Ab with liver dz?

A

autoimmune hepatitis

124
Q

high Fe, low ferritin, low Fe binding capacity, liver problems?

A

hemachromatosis

125
Q

low ceruloplasmin, urinary Cu++ high

A

Wilsons

126
Q

Tx Paget’s disease?

A

bisphosphonates

127
Q

meningitis in young and old bug? tx?

A

listeria- add ampicillin

128
Q

meningitis in brain surg bug? tx?

A

staph- vanc

129
Q

meningeal Tb tx?

A

add steroids to RIPE therapy

130
Q

Lime dz meningitis?

A

IV ceftriaxone

131
Q

Most common PNA bug in young, healthy people? tx?

A

mycoplasma- tx = macrolide

132
Q

HAP bugs?

A

Pseudomonas
Klebsiella
E. coli

133
Q

old smoker with COPD. PNA?

A

H. influenza- 2nd/3rd generation cephalosporin

134
Q

PNA after the flu?

A

Staph

135
Q

PNA after delivering a baby cow?

A

Q fever (coxiella)

136
Q

PNA after skinning a rabbit?

A

tularemia

137
Q

Who gets Tb exposure prophylaxis? With what?

A

kids <4yo with INH

138
Q

SE rifampin?

A

red/orange body fluids; CYP450 inducer

139
Q

SE INH?

A

neuropathy- give B6 (pyridoxine)

140
Q

SE pyrazinamide?

A

hyperuricemia

141
Q

SE ethambutol?

A

optic neuritis

142
Q

most common bug endocarditis of ?

A

Staph

143
Q

most common valve endocarditis?

A

mitral valve

144
Q

IV drug user endocardidits valve?

A

tricuspid

145
Q

What murmur is worse with inspiration?

A

right-sided

146
Q

Endocarditis complication?

A

emboli, CHF

147
Q

Strep bovis bacteremia?

A

colonoscopy looking for colon cancer

148
Q

Strep bovis bacteremia?

A

colonoscopy looking for colon cancer

149
Q

When do you start HAART?

A

CD4<350 or viral load >55,000 (unless pregnant)

150
Q

What HIV drug causes leukopenia, GI sx, and macrocytic anemia?

A

zidovudine (AZT)

151
Q

What HIV drug causes pancreatitis, peripheral neuropathy?

A

didanosine

152
Q

Post-exposure HIV prophylaxis?

A

AZT + lamivudine + nelfinavir for 4 weeks

153
Q

HIV pt with DOE, dry cough, fever, CP?

A

pneumocystic pna

154
Q

Blood test PCP?

A

elevated LDH

155
Q

1st line tx PCP?

A

tmp-smx

156
Q

2nd line tx PCP?

A

dapsone, pentamiadine

157
Q

PCP prophylaxis indicated when? What is used?

A

CD4<200

tmp-smx

158
Q

3 bugs causing diarrhea in HIV+ pt?

A

CMV
MAC
cryptosporidium

159
Q

HIV+, one ring enhancing brain lesion?

A

primary CNS lymphoma

160
Q

Tx toxo?

A

pyramethamine-sulfadiazine

161
Q

HIV+ pt with sz and dejavu aura? Tx?

A

HSV encephalitis- acyclovir

162
Q

What virus goes to the temporal lobe?

A

HSV

163
Q

Most common cause of meningitis in an HIV+ pt? What else is worrysome?

A

strep pneumo, cryptococcus

164
Q

Tx Cryptococcus?

A

amphotericin IV

165
Q

HIV+ with hemisensory loss, visual impairment, Babinski?

A

PML from JC polyomavirus

166
Q

HIV+ with memory problems or gait disturbance?

A

aids dementia complex

167
Q

Most common bugs in neutropenic fever?

A

pseudomonas, MRSA

168
Q

Target rash, fever, CN7 palsy, AV block, meningitis dx? tx?

A

Lyme dz

doxycycline (if under 8, give amox)

169
Q

Rash @ wrists, palms, soles, ankles, fever, HA. Dx and tx?

A

Rocky Mountain Spotted Fever (Rickettsia); doxy for everyone

170
Q

Tick bite tx?

A

doxycycline

171
Q

gram + branching, partially acid fast?

A

nocardia

172
Q

Nocardia tx?

A

tmp-smx

173
Q

Numbness, Chvostek or Trousseau, prolonged QT interval?

A

hypocalcemia

174
Q

Bones, stones, groans, psycho, short QT?

A

hypercalcemia

175
Q

Paralysis, constipated, ST depression and U waves?

A

hypokalemia

176
Q

Peaked T waves, prolonged PR and QRS, sine waves?

A

hyperkalemia

177
Q

Tx hyperkalemia?

A

1) calcium gluconate to stabilize cardiac memb
2) insulin + glucose, or kayexalate, diuretics, albuterol, sodium bicarb
3) dialysis

178
Q

Tx Type 1 renal tubule acidosis?

A

bicarb

179
Q

BUN/Cr ration >20:1?

A

prerenal azotemia

180
Q

if FENA <1%?

A

prerenal azotemia

181
Q

Muddy brown casts?

A

ATN

182
Q

protein, blood, and eos in urine + fever and rash 1-2 weeks ago?

A

AIN

183
Q

Tx ATN?

A

fluids, stop drugs

184
Q

CPK 50,000?

A

rhabdo

185
Q

What is the first test in suspected rhabdo?

A

check K+ or get EKG

186
Q

envelope-shape crystals on UA?

A

ethylene glycol intox (antifreeze)

187
Q

increased Cr s/p cardiac cath or contrast CT?

A

contrast-induced nephropathy

188
Q

AEIOU dialysis?

A 
acidosis
electrolytes
intoxication
overload volume
uremia
189
Q

painless hematuria dx?

A

cancer

190
Q

terminal hematuria with tiny clots?

A

bladder CA

191
Q

dysmorphic RBCs in UA?

A

glomerular problems

192
Q

blood in urine 1-2 days after runny nose, sore throat, cough?

A

IgA nephropathy (Bergers)

193
Q

hematuria + deafness?

A

Alport

194
Q

kid with arthralgias, purpura, abd pain, blood in urine?

A

Henoch-Schonlein Purpura (IgA)

195
Q

Tx HSP?

A

steroids

196
Q

Tx TTP?

A

plasmapheresis

197
Q

DIC-looking but normal PT/PTT?

A

HUS or TTP

198
Q

c-ANCA, kidney, lung, sinus involvement, peeing blood

A

Wegeners

199
Q

p-ANCA, renal failure, asthma, eos

A

Churg-Strauss

200
Q

tx Wegeners?

A

steroids, cyclophosphamide

201
Q

tx Churg-Strauss?

A

cyclophosphamide

202
Q

p-ANCA, no lung involve, Hep B

A

polyarteritis nodosa

203
Q

tx polyarteritis nodosa?

A

cyclophosphamide

204
Q

Most common type of kidney stone?

A

calcium oxalate

205
Q

Fam hx kidney stones?

A

cysteine stones

206
Q

Kidney stones with a chronic indwelling foley?

A

struvite stones (proteus, pseudo, kleb, staph)

207
Q

leukemia + kidney stones?

A

uric acid stones

208
Q

kidney stone s/p bowel resection?

A

pure oxylate stone (ca++ not reabsorbed by gut and pooped out)

209
Q

Best first test for protinurea?

A

repeat the test

210
Q

most common cause nephrotic syndrome in kids?

A

minimal change

211
Q

most common cause nephrotic syndrome in adults?

A

membranous

212
Q

fusion of foot processes?

A

minimal change dz

213
Q

minimal change dz tx?

A

steroids

214
Q

thick capillary walls with subepi spikes?

A

membranous

215
Q

nephrotic syndrome in heroin, HIV?

A

FSGS

216
Q

nephrotic syndrome in chronic hepatitis and low complement?

A

membranoproliferative

217
Q

nephrotic syndrome with sudden flank pain?

A

renal vein thrombosis bc peeing out clotting factors

218
Q

mesangial IgM deposits?

A

FSGS

219
Q

tram-tracking basement membrane with subendothelial deposits?

A

membranoproliferative

220
Q

unique proteins in multiple myeloma?

A

Bence-Jones

221
Q

MCV 70, low Fe, high TIBC, low retic, high RDW, low ferritin.

A

Fe deficiency anemia

222
Q

MCV 70, low Fe, low TIBC, low retic, high RDW, low ferritin.

A

anemia of chronic dz

223
Q

MCV 60, low RDW

A

thalassemia

224
Q

MCV 70, high Fe, high ferritin, low TIBC

A

sideroblastic anemia

225
Q

INH for Tb blood SE?

A

sideroblastic anemia

226
Q

MCV 100, low retics, high homocysteine, normal methylmelonic acid

A

folate defic

227
Q

MCV high with acanthocyte?

A

liver dz

228
Q

MCV 100, low retics, high homocysteine, high methylmelonic acid

A

B12 deficiency

229
Q

normal MCV, high LDH, high indirect bili, low haptoglobin

A

hemolysis

230
Q

sickle cell kid with sudden drop in Hct?

A

aplastic crisis

231
Q

hemolysis with cyanosis of fingers, ears, nose, and recent Mycoplasma PNA?

A

cold agglutinins (IgM mediated)

232
Q

sudden onset hemolysis after PCN?

A

warm agglutinins (igG mediated)

233
Q

dark urine in the morning?

A

paroxysmal nocturnal hemoglobinuria

234
Q

sudden onset hemolytic anemia after primiquine, sulfas, or fava beans?

A

G6PD deficiency

235
Q

young female, recurrent epistaxis, heavy menses, only CBC abnormal is low plates

A

ITP

236
Q

Tx ITP?

A

prednisone, splenectomy, IVIG

237
Q

young female, recurrent epistaxis, heavy menses, bleeding time and PTT high?

A

von-Willebrands

238
Q

von-Willebrands tx?

A

replace factor 8

239
Q

mixing study corrects PTT?

A

hemophilia- give factor

240
Q

1st clotting factor depleted in liver dz?

A

VII (high PT)

241
Q

Which 2 clotting are made by the endothelium?

A

VIII, von Willebrands

242
Q

PT and PTT high, fibrinogen low, d-dimer and split products high?

A

DIC

243
Q

Tx DIC?

A

FFP, plates, correct underlying problem

244
Q

PT and PTT normal, fibrinogen low, d-dimer and split products high?

A

TTP or HUS

245
Q

Tx TTP or HUS?

A

plasmapheresis

246
Q

7 days post op, arterial clot, low plates. Dx?

A

HIT

247
Q

Mechanism of HIT?

A

Ab that binds to heparin and PF4

248
Q

Tx HIT?

A

stop heparin, start lepirudin

249
Q

Warfarin, then skin necrosis?

A

protein C/S deficiency

250
Q

factor V leiden?

A

hypercoag state

251
Q

Clotting on heparin?

A

ATIII deficiency

IM Shelf Review (10 decks)

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