IMC 2.0 Flashcards

1
Q

Define Cardiomyopathy

? is the MC type of cardiomyopathy

What causes this MC type to develop

A

Heart muscle dz

Dilated; Systolic dysfunction

Injury/damage (CAD/MI/ETOH) to myocardium leading to weakened ventricular contractions

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2
Q

? is the primary indication for cardiac transplant

This condition is also the MC cause of ?

A

Idiopathic dilated cardiomyopathy

Heart failure

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3
Q

What is the hallmark of Dilated Cardiomyopathy

What are the possible etiologies of this Dz

What infections can cause this

A

Dilation and impaired contraction of one/both ventricles

PG CEVICHE:
Post-partum Genetics
Chemo ETOH Viral Ischemic Cocaine Heavy-metal Endocrine

Chagas HIV Lyme

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4
Q

What is seen on PE for Dilated Cardiomyopathy

What is the main Dx modality

What would be seen on CXR

A

Left sided HF:
Dyspnea Fatigue S3 gallop
Cardiomegaly

Echo: ventricular dilation and dysfunction (EF 40% or

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5
Q

How is Dilated Cardiomyopathy Tx

What medication is used if increased contractility is needed

What mnemonic can be used to Tx

A

Loop + ACEI + BB

Digitalis

AABCD:
Anti-coagulation ACEI BBs CCBs Diuretic/Digoxin

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6
Q

What is the MC form of HOCM

How is this conditions passed along

What would be seen on PE since most of these are ASx

A

Septal hypertrophy- narrows LV outflow tract

Autosomal dominant defect of sarcomeric proteins

Bifid carotid pulse
S4 gallop
Dyspnea w/ exertion

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7
Q

What type of murmur does HOCM present with

What causes murmur to be louder/quieter

These characteristics are exact opposite of ? murmur

A

High pitched cresc-decresc at LLSB

Inc: Valsalva/Stand
Dec: Squat, Grip, Leg raise

AS:
Dec w/ valsalva
Inc w/ squat
Dec w/ stand

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8
Q

How is HOCM differentiated from Athletic Heart

How does HOCM appear on EKGs

What is the Dx test of choice

A

Athletes won’t have diastolic dysfunction

Septal depolarization: dagger-like septal q-waves w/ LVH

TTEcho

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9
Q

How is HOCM Tx

What drugs need to be avoided

What drug is c/i

A

Metoprolol and/or Verapamil to dec contractility/HR

Nitrates
Decreasing preload: diuretics, ACEIs, ARBs

Digoxin

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10
Q

When is implantable de-fib considered for HOCM Tx

What definitive tx options are available

A

+ syncope
sudden arrest
LV >30mm thick

Surgical (septal myectomy- considered best) or,
Alcohol ablation of hypertrophy

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11
Q

Metoprolol

Verapamil

Digoxin

A

Class 2, decreases HR, increases PR
B1 selective

Class 4; greater action on heart than peripheral vessels
Dose reduction needed in hepatic dzs

Derived from Foxglove; inhibits NaKATP in cardiac membrane to dec intracellular K levels to increase contraction w/out increasing O2 demands
Overcome/inhibited by sympathetic nervous system
HypoK= inc effect of medication
Antidote: Digoxin Immune Fab (Digibind)

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12
Q

Define Constrictive Cardiomyopathy

What is the MC etiology of this world wide

What other etiologies can cause this

A

RHF w/ Hx of infiltrative process

Tropical Endomyocardial Fibrosis

Amyloidosis-MC
Sarcoidosis
Rad/Chemo

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13
Q

What will be seen on PE of Restrictive Cardiomyopathy

What abnormals will be seen

How is this Dx

What is the next step if Dx is doubtful?

A

P-HTN w/ normal EF, size and wall thickness

Large atria
Early diastolic filling

Echo: dilated atria, hypertrophy, ‘starry night/speckle pattern’

MRI- abnormal textures

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14
Q

What could be seen on EKG of Restrictive Cardiomyopathy

This can mimic ? other Dx, so what test is used to differentiate

What is used for Txs

A

Non-specifics w/ low voltage waves

Constrictive pericarditis- cardiac MRI

Diuretics if edema/pulmonary congestion present
Rate/Rhythm: BB/Verapamil

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15
Q

Define an ASDn and the MC type

What type of murmur does this defect produce and

What condition can chronic defects develop into

A

Non-cyanotic defect w/ diastolic L-R shunt causing volume over load to RA/RV d/t failure of foramen ovale to close;
Osteum Secundum

Wide-fixed split S2: lub, dub-dub
at Pulmonic area

Eisenmenger’s: chronic L-R shunting causing cyanosis/clubbing that dec as shunt progresses

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16
Q

ASDs are the second most common defects behind ? defect

Most Pts w/ small ASDs can be ASx until ? age, but then develop ?

What abnormal clot event can ASDs allow to happen

A

VSD

<30: ASx
>30: dyspnea, angina
>50: Afib, RVF

Paradoxical embolization

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17
Q

How are ASDs definitively Dx

What can be seen on EKG

What would be seen on CXR

A

Echo

R axis deviation
RVH
RBBB w/ rSR pattern in V1

Cardiomegaly w/ dilated RA/RV

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18
Q

How are ASDs Tx

A

<3mm- spontaneous closure, usually by 3y/o

ASx and small: observe w/ serial Echos

Med/Large w/ evidence of RV volume overload on echo- closed between 2-6y/o

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19
Q

Coarctations of the aorta present w/ Sxs of ? and PE findings of ?

Half of Pts w/ have ? defect which puts the at increased risk to develop ?

What will be seen on EKG/CXR

A

L sided HF;
Bounding Arm BP > Leg BP

Bicuspid aorta:
Berry aneurysm

EKG: LVH
CXR: notched ribs, figure-3 sign of aorta

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20
Q

How is a Dx of Coarctated Aorta made

How are these Tx

How are these Tx if found in neonates

A

Echo

Ages 2-4y/o: balloon angioplasty w/ stent placement/surgical repair

Prostaglandin E-1- keeps ductus arteriosus open

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21
Q

When is emergent surgical repair of an aortic coarctation warranted

What happens if these are left untreated

A

Circulatory shock
Cardiomegaly
Severe HTN/CHF

Death by 50y/o d/t:
Aortic rupture/dissection
CVA

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22
Q

What are the 3 types of aortic coarctations by location

A

Preductal: narrowing proximal to ductus arteriosus; life threatening, Turners/Intracranial aneurysm

Ductal: narrowing at insertion of ductus arteriosus, appears when ductus closes

Post-Ductal: narrowing distal to ductus arteriosus; MC in adults

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23
Q

Define a PDA

What ‘saying’ is used to remember this type of defect’s murmur

How do Pts present

A

Blood flows aorta to L Pulm Artery causing transient systolic murmur d/t

Patent for your machine- machinery like murmur at 1st ICS LSB

Poor feeding
FTT
Tachy/Tachy

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24
Q

What are the two “classic findings” of a PDA

What would be seen on EKG

What is best for Dx

A

Wide pulse pressure w/ low DBP
Harsh, continuous machinery murmur at 2nd ICS (pulmonic)

Normal/LVH

Echo

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25
How are PDAs Tx Normally, a ductus arteriosus closes to form ? structure ? is the MC pathological murmur of childhood
Indomethacin, possibly w/ fluid restriction Surgical/Catheter correction Ligamentum arteriosum VSD- hole in interventricular setum (large= L-R shunt)
26
How do VSDs present on exam If left un-Tx, what can these defects lead to? What will be seen on EKG/CXR and what is best for Dx
Loud, harsh holosystolic murmur at LLSB w/ systolic thrill Eisenmengers EKG: norm/LVH CXR: inc pulm vasculature Dx w/ Echo
27
How are VSDs Tx When is Tx changed for infants?
Watchful expectation: as VSDs become smaller, murmur shortens CHF and Retarded growth= Digoxin and Diuretics Tx failure= surgery within first 6mon of life
28
What are the 4 parts of Tetrology of Fallot Why is this defect a cyanotic one What 'spells' will be seen here
PROVe: PS RVH Overriding VSD PS causes R -L shunt through VSD Tet- hypercyanotic during crying/feeding
29
Unique fact of Tetrology of Fallot What kind of murmur occurs How is this condition Dx
Only cyanotic congenital herat Dz on PANCE blue-print Harsh systolic ejection at LSB Echo
30
What is the CXR finding for Tetrology What would be seen on EKG and why are serial EKGs needed annually How are these Pts Tx
Boot shaped heart Enlarged RA/RV; QRS width d/t risk for sudden death/HF Surgery w/in first year of life
31
# Define NSTEMI How will Pts present What drugs are used for Txs
Myocardial necrosis w/out ST elevation/q-waves d/t incomplete blockage causing sub-endocardial infarct SOB Pain radiation to jaw/shoulder BB ASA/Clop Statin Heparin Ng ACEI PCI reperfustion
32
What are the 3 biomarkers used during N/STEMI workups and timing to appear/peak/return to baseline
Troponin: most sens/spec 2-4hrs, 12-24hrs, 7-10days CK/CKMB: 4-6hrs, 12-24hrs, 48-72hrs Myoglobin- 1-4hrs, 12hrs, 24hrs
33
# Define STEMI What Tx is done first How quickly must PCI be done
Myocardial necrosis w/ ST elevations d/t fully blocked artery involving full wall thickness ASA/Clopidogrel PCI <90min Thrombolysis <3hrs no PCI ability
34
What are the absolute c/i's for thrombolytic therapy for NSTEMIs What is NOT an absolute c/i
``` ICH Hx Cerebral vascular lesion Dx Malignant intracranial neoplasm Ischemic stoke <3mon Suspected ADissection ``` Active menses
35
# Define Angina Pectoris What is done for work up What test provides definitive Dx
Chest pain/discomfort inc w/ exertion/emotion, is predictable, lasts <15min, and relieved w/ rest/nitro Stress Test: reversible wall motion abnormality/ST depression <1mm Coronary angiography
36
How is Angina Pectoris Tx What surgical Txs are avail? Pts w/ ? Hx have poorer prognosis
``` Sublingual Nitro (or IV) BB ``` Angioplasty and Bypass LVEF <50% Left main artery
37
# Define Unstable Angina What process causes this pain How is this type Tx
Chest pain that inc w/ exertion/emotion and is now increasing/present at rest Unchanged O2 demand Decreased supply ``` Ntg/Morphine ASA/Clopidogrel LMWH x 2days BB ACEI Statin ```
38
Why is Clopidogrel used in Unstable Angina Pts that respond to medical therapy have ? next step What is the next step if they don't respond to medical therapy
Decreases incidence of MIs Stress test Revascularization
39
All Pts w/ Unstable Angina/NSTEMI w/ high LDL get ? Rx'd Define Prinzmetal Angina What are possible triggers
ACEI and Statin (HMG-CoA reductase inhibitor) Smooth muscle in coronary artery spasms causing ST elevations w/out clot present ``` Hyperventilation Acetylcholine Ergonovine Histamine Serotonin NO deficiency ```
40
What is the first and second RF for Prinzmetal Angina What do Pts describe pain as and what may be seen on EKG How is Prinzmetal Tx
1- smokine 2- cocaine Cyclical in early morning hrs Inverted U-waves ST/T abnormalities Initially: Nitrates After Dx: Amlodpine and long acting nitrates
41
HF is a syndrome of ? LV failure causes ? S/Sxs RV failure causes ? S/Sxs
Ventricular dysfunction SOB, Fatigue Peripheral edema Abdominal fluid accumulation
42
Systolic L HF will present w/ ? How is this form of HF Tx How is an acute exacerbation Tx
S3 Thin, dilated LV w/ EF <40% Displaced down/left apical impulse Loop and ACEI and BB D/c BB O2 ACEI Nitro IV Diuretic x2 normal dose
43
Diastolic L HF will present w/ ? This Dx will increase in severity in Pts older than ? and w/ ? predisposing Dx What will be seen on Echo How is this form Tx and what is avoided
S4 LVH w/ dec relaxation Apical heave/lift >55y/o w/ HTN Normal EF ACEI and BB or CCB No diuretics in chronic Pts Never use digoxin
44
Right HF can be d/t ? What PE findings will be absent How is this Dx
P-HTN Rales JVD Edema Gold standard: Echo and Doppler
45
# Define High Output HF What can cause this type of HF What will be the first S/Sx of Dx
Increased metabolic demand surpasses heart output Hyperthyroid Severe anemia Beriberi Thiamine deficient Tachycardia progressing into systolic failure
46
A normal EF if between ? Pts are at risk for increased mortality if EF is below ? What are these high risk Pts next step
55-60 <35 Cardio defib placed
47
BNP levels >100 indicate ? issue present in a Pt What are the 4 NYHA classifications What Tx step needs to be started ASAP in HF Pts
CHF 1: no limitations 2: slight limitation 3: marked limitation 4: unable to carry out activities w/out discomfort and have Sxs at rest ACEI- decreases comorbidity and mortality
48
What are 3 specific beta-1 drugs used in HF to reduce mortality from HF Only heart valve to have two leaflets, all other have 3 Diastolic murmurs almost always indicate ?
Bisprolol Metoprolol succinate Carvedilol Mitral Heart Dz
49
What are the two basic types of diastolic heart murmurs ? category of murmurs is the MC kind
Early decrescendo: regurg through incompetent semilunar valve Rumbling: stenosis of AV valve Mid-systolic- AS, PS
50
What are the 4 diastolic murmurs
AR: high pitch, blowing murmur Pt sits, leans fwd Diaphragm at Erb's MS: low decrescendo rumble w/ opening snap at apex Pt supine w/ bell at mitral PR: high pitch decrescendo, inc w/ inspiration Pt leans fwd, diaphragm at pulmonic TS: mid-diastolic rumble w/ opening snap Pt supine, bell at tricuspid
51
What are the four mid-systolic murmurs
AS: ejection cresc-decrescen Pt sits, diaphragm at aortic PS: harsh mid-systolic crescen-decrescen w/ wide-split S2 radiating to L shoulder/neck Pt supine, bell at tricuspid HOCM: mid-systolic murmur w/ S4 and apical lift Pt supine, diaphragm at mitral MVP: mid-systole click at apex Pt supine, diaphragm at mitral
52
What are the pan/holosystolic murmurs
MR: blowing murmur at apex w/ split S2 Pt supine, diaphragm at mitral TR: high pitched murmur Pt supine, diaphragm at tricuspid VSD: harsh murmur w/ wide radiation and fixed, split S2 Pt supine, diaphragm at tricuspid
53
# Define A-Fib What are two possible etiologies
Irregular, Irregular w/ narrow QRS complexes but w/out defined P-waves Age ETOH abuse
54
# Define A-Flutter What are 4 possible etiologies
Regular, sawtooth pattern EKG w/ atrial rate between 250-350 and narrow QRS complexes COPD CHF ASD CADz
55
How is A-fib Tx How are unstable Pts w/ rapid ventricular rates Tx
Rate control <110 w/: Diltiazem Metoprolol Verapamil Rhythym control depends on duration: Afib <48hrs= amiodarone, TEE, cardioversion Afib >48hrs= anticoag x 21days, then cardioversion Synchronized cardioversion
56
How is anticoagulation for A-fib/Flutter determined
CHA2DS2-VASc: 0 pts= 81-325mg ASA/day 1pt: either 81-325mg/day or anticoag 2pts or more= anticoagulation ``` CHF/LVEF <40-1 HTN-1 Age +/>75- 2 DM-1 Stroke/TIA/Throm-embolism- 2 Vasc Dz- 1 Age 65-74-1 Female- 1 ```
57
What DOACs can be used for anticoagulation when Tx Afib/Flutter When is Warfarin indicated What is the INR target if Warfarin is used
Dabigatran Edoxaban Apixaban Rivaroxaban ``` Rx- phenytoin/antivirals Unacceptable cost increase Mechanical valves Mitral stenosis EGFR <30 ``` 2-3 (2.5)
58
# Define PSVT What are 3 etiologies
SVT w/ abrupt on and offset d/t short-circuit arrhythmia w/out other structural heart Dzs AVNRT- tachydysrhythmia starting above BoHis WPW- abnormal accessory electrical conduction pathway in Bundle of Kent between atria and ventricles AVNRT: small pathway in/near AV node allows impulse to travel in circles causing fast, regular beating
59
? is the MC sustained dysrhythmia in adults A-flutter is seen in Pts w/ ? 4 Dx/comorbidities What are the 3 EKG characteristics for WPW
A-fib COPD ETOH abuse MV Dz Thyrotoxicosis D-wave Wide QRS >120msec Short PR <120msec
60
# Define Orthodromic tachycardia Define Antidromic tachycardia How is PSVT Dx
Accessory path to AV to accessory path (tall, deep QRS) AV node to accessory to AV node (D-wave, tall QRS) Holter Monitor to catch episodes
61
How is PSVT Tx vis non-Rx maneuvers What meds are used if Sxs are present or if only PSVT is present What is definitive Tx What needs to be avoided in WPW
Vagal Carotid massage Valsalva +Sxs= adenosine Regular- BB/CCBs Wide QRS= procainamide Radio frequency ablation No adenosine No CCBs
62
# Define the 3 types of premature beats These may have an increased frequency d/t ? What are two variants
Atrial- abnormal shape P-wave Ventrical- early, wide QRS w/out p-wave Junctional- narrow QRS (0.10msec) no/inverted p-wave Stimulants (caffeine) Trigeminy- every 3rd beat Every other- bigeminy
63
Premature Atrial Beats are common in ? population Pts w/ heart Dz, PACs can precedde ? issues PVCs can be ASx or be felt where?
COPD Pts PSVT A-fib/flutter Throat
64
How are premature beats Dx How are they Tx depending on the type Define V-Tach
EKG or Holter monitor PAC: reassure PVC: BB, consider ablation PJC: only Tx if >10/min w/ lidocaine/antiarrhythmic EKG w/ 3 or more consecutive premature ventricular beats (QRS complex loses sharp peak, becomes wide/bizarre)
65
V-Tach is a common complication from ? two issues Unstable Pts w/ monomorphic VT should be immediately Tx w/ ? How is unstable polymorphic V-Tach Tx Stable Pts w/ V-Tach and adequate end organ perfusion are Tx w/ ?
MI Dilated myopathy Synchronized direct current cardioversion starting at 100J Immediate D-fib In order: Amiodarone Lidocaine Procainamide
66
# Define V-Fib How is this Tx
Uncoordinated quivering of ventricles w/out useful contractions ``` CPR Defib w/ non-synchronized cardioversion (120, 150, 180) Intubate Amiodarone x 2 q2-4min 1mg Epi q 3-5min ```
67
# Define Sick Sinus Syndrome What are the 4 types of this condition How are these Dx How are these Tx
Dysfunction of Sinus Node's automaticity and impulse generation Brady: resting HR <60 Pause < 3 sec Arrest > 3 sec Tachy-Brady Syndrome- alternating tachy/brady EKG/Holter monitor Most PTs w/ Sxs= Pacemaker BB/CCB/Digoxin in Pts w/ tach risk for block/arrest, also prepared for pacing
68
# Define AV Block What are the 2 MC causes What are the 3 types
Interruption of impulse transmission from atria to ventricles Idiopathic fibrosis/sclerosis of conduction system Ischemic heart dz 1st: PR >0.2sec (5 small square) 2nd: Type 1: longer longer drop, Wenckebach Type 2: some dropped, some get through, Mobitz 2 3: Ps and Qs dont agree, not you've got a 3rd degree
69
How is a 1st AV Block Tx How are 2nd* Blocks Tx How are 3* blocks Tx
ASx: none Unstable: pacing Type 1: Tx only if Sx bradycardia and other causes have been excluded Type 2: pacer, these almost always progress to 3* block R/o ischemic cause Pacer
70
# Define Cardiogenic Shock What are the 3 MC causes How is this Dx How is this Tx
Impaired cardiac contractility and pump failure d/t dec cardiac output HF Acute MI Tamponade Inc pulm cap wedge pressure >15mm Fluids Pressors: dobutamine, NorEpid, Ultimately balloon pump
71
# Define O-HOTN What is the MC cause of this in diabetics What is the next test ordered for these Pts How is this Tx
Dec SBP >20mm Dec DBP >10mm Both 2-5min after standing Autonomic dysfunction; lack of HR increase by >10bpm Tilt table; if HR increases >15bpm, d/t low volume Dec venous pooling Inc Na/fluid intake
72
# Define Essential/Primary HTN What are the ACC/AHA Classifications What are the target goals for Tx
Resting SBP 130 or higher Resting DBP 80 or higher On two separate visits Norm: <1120/80 and <80 Elevate: 120-129 and <80 Stage 1: 130-139 or 80-89 Stage 2: 140 or > or 90 or > + comorbidiites: <130/80 <60y/o/DM/CKDz: <140/90 60 or >: <150/90
73
How is normal BP Tx How is elevated BP Tx How is Stage 1 Tx How is Stage 2 Tx
Yearly eval w/ healthy lifestyle Healthy lifestyle and reassess 3-6mon ASCVD calculator: <10% risk: healthy life style and reassess 3-6mon >10% risk/CVD/DM/CKDz: lifestyle mod and 1 medication w/ reassess in 1mon; Goal met- reassess 3-6mon Goal not met- different med or titrate w/ montly f/u until goal met Healthy lifestyle and 2 meds Goal met at 1mon f/u: reassess 3-6mon Not met at f/u: different med/titrate up Continue monthly f/u until goal met
74
How is Primary HTN in nonblacks, even w/ DM, Tx How are Black Pts w/ HTN Tx
ACEI/ARB CCB- Amlodipine or, Thzd like- chlorthalidone/indapamide Thzd type and CCB
75
When are the following classes of meds c/i d/t previous Dx: CCB ACE/ARB BB
Angina pectoris Diabetics w/ proteinuria Pregnancy Asthma
76
Side effect of using the following classes for HTN Tx: ACEI Spironolactone BBs CCBs Hydralazine
Cough Angioedema HyperK HyperK Impotence Leg edema Lupus-like syndrome pericarditis
77
# Define Secondary HTN When does this Dx need to be considered What is the MC cause and what is a common combo cause
SBP 130 or > DBP 80 or > or, Both w/ correctable cause Pt refractory to antihypertensive meds or severe Primary aldosteronism OCP + ETOH
78
What labs are ordered for newly Dx Secondary HTN Define Infective Endocarditis What does the infective process cause
UA Spot urine albumin/cr ratio EKG Infection of endocardium w/ Strep/Staph/Fungi Fever* Murmurs Vegetations
79
# Define Acute Bacterial Endocarditis Define Subacute Bacterial Endocarditis Endocarditis in IVDA is usually d/t ? Prosthetic valves are usually infected w/ ?
Infection of normal valves w/ Staph A Infection of abnormal valves w/ Strep Viridians Staph A Staph Epidermis
80
How is endocarditis caused by fungus differentiated When are these types of infections commonly seen How are they Tx
Usually from contaminated lines, causes large, slow growing vegetations Post-valve replacement, <2mon post-op Amphotericin B
81
What types of microbes can grow on native heart valves and cause endocarditis ? is the MC cause of endocarditis How does this type present
``` HACEK: Haemophilus Aggregatibacter Cardiobacterium Eikenelia Kingellia ``` Strep Viridians Late complication of valve replacement w/ small vegetations and emobli
82
What are the peripheral stigmata of Infective Endocarditis seen on exam How is this Dx What is the gold standard for Dx
``` Splinter hemorrhages Olser nodes- painful Roth spots- retinal hemorrhage Janeway lesion- septic emboli Petechia, palate/conjunctiva Splenomegaly Hematuria ``` 3 blood cultures, 1hr apart TEE echo
83
What criteria is used for Dx Infective Endocarditis
Modified Duke: Definite: 2 Major or 1 Major, 3 minor or 5 minor Possible: 1 major and 1 minor or, 3 minor Fill in, finish
84
How are native valves, no IVDA w/ endocarditis Tx How are prosthetic valves w/ endocarditis Tx How are IVDA w/ endocarditis Tx If any endocarditis Pt is PCN allergic, ? is used for substitution
IV Nafcillin, Ampicillin, Gentamicin IV Vanc Gentamicin Rifampin IV Nafcillin Vanc
85
What is used for endocarditis prophylaxis Define Acute Pericarditis What is the form of pericarditis seen 3-5d after MI
2g Amoxicillin 30-60min prior to procedures MC Coxsackie infection causing inflamed sac Dresslers Syndrome
86
How is acute pericarditis Dx What PE finding may be present This PE finding is common in Pts w/ ?
EKG Echo: Complications/effusion/tamponade Kussmaul- inc of CVP during inspiration instead of normal decrease Constrictive pericarditis
87
How is acute pericarditis Tx Define Cardiac Tamponade What are the 3 Ds of this What triad
NSAID/ASA x 7-14d CCS if Sxs >48hrs Fluid between sac and heart causing constriction Distant sounds Distended jugular vein Dec arterial pressure Becks: HOTN Muffled sounds JVD
88
What is a classic finding in cardiac tamponads? What is seen on EKGs What is seen on CXRs
Pulsus Paradoxus- SBP drop of 10mm w/ inspiration Narrow pulse pressures Electrical alternans w/ low voltage QRS Water bottle heart
89
What is the Gold standard for Dx cardiac tamponades How are these Tx What causes Rheumatic Fever
Echo IV fluids- increase preload, prevent RV collapse Centesis- therapeutic Balloon pericardiotomy, window- if compensation Hx of GAS infections
90
How do Pts w/ Rheumatic Fever present What mnemonic is used for PE How is this Tx
Red skin lesions on trunk Non-tender lumps on joints ``` JONES: Joints Oh no, carditis Nodules Erythema marginatum Sydenhams chorea ``` NSAIDs, ABX
91
How do Pts w/ aortic dissection present What would be seen on CXR What is the gold standard test for Dx How are these Tx
Sudden, tearing chest pain that radiates between scapula and w/ diminished pulses Wide mediastinum MRI angiography Ascending: surgery Descending: BB, observe
92
Indications to repair AAA When is annual monitoring used When is q6mon monitoring used What class medicaiton is used for these PTs
>5.5cm or, Expands >0.6cm/year >3cm >4cm BB
93
# Define Varicose Veins What makes these symptomatic How are these Tx
Dilated superficial veins Pain w/ exertion ``` Compression Elevation Wound care Sclerotherapy Surgery ```
94
# Define Chronic Venous Insufficiency What is a common skin finding in these PTs What is a common but severe finding How are these Tx
Impaired venous return causing edema/discomfort Stasis dermatitis Non-healing ulcer at medial malleolus Compression Wound care Surgery
95
# Define Esophagitis What are the two categories and causes of each
Inflammation that can damage tissue ``` Non-infectious: Reflux Medication (BisPhos/NSAID) Eosinophilic- barium swallow= multiple corrugated rings Radiation Corrosive ``` Infectious, hallmark= odynophagia Fungal: linear white plaques HSV: punched out lesions CMV: solitary ulcer/erosion
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How is Fungal Esophagitis Tx How is HSV Esophagitis Tx How is CMV Esophagitis Tx How is Corrosive Esophagitis Tx How is Eosinophilic Esophagitis Tx
PO Fluconazole Acyclovir Ganciclovir Steroids Steroids via inhaler
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How is Esophagitis Dx How is Bisphosphonate induced esophagitis prevented
Edondoscopy Biopsy Double contrast esophogram Culture Take w/ 4oz water Avoid laying down x 30-60min
98
# Define Achalasia What is this a MC of How is it Dx How is it Tx
LES fails to relax and d/t loss of Auerbach plexus MC motility d/o w/ dysphagia to liquid and solid Barium swallow- bird beak Botulinum injection- temporary
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How will esophageal strictures present Define Esophageal Web Define Schatzki Ring What is a major contributor to ring development
Solid food dysphagia w/ Hx of GERD Thin membrane in esophagus Mucosal ring at B-ring junction; associated w/ hiatal hernia GERD
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# Define Plummer Vinson What is another term for esophageal strictures How are these Dx and Tx
Esophageal webs and Dysphagia and Fe Deficient Anemia Steakhouse syndrome- gradually progressive dysphagia to solids that occur when meal is wolfed down Endoscopy/Dilation
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# Define Esophageal Spasms How is it Dx How is a Dx confirmed How is it Tx
Non-peristaltic contraction causing stabbing chest pain after ingesting hot/cold liquids and foods Barium swallow- corkscrew Manometry Nitrate, CCB
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How does esophageal cancer present What is the MC type in the world What is the MC type in the US and d/t ? complications
Difficulty swallowing solids to liquids w/ adenopathy SCC Adenocarcinoma in distal esophagus- d/t GERD/Barrett's
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How is esophageal cancer Dx and staged What treatment options are available How often should Pts w/ Barretts have endoscopic screening
Dx: endoscopy w/ biopsy Stage w/ CT Resection Radiation Chemo w/ 5-FU q3-5yrs
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SCC of the esophagus is associated w/ ? Hxs What part of the esophagus is affected Define GERD
Smoking ETOH use Upper 2/3 Incompetent LES allows reflux of contents into esophagus
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What are the risks of long standing GERD What drugs can cause this issue to develop What is the gold standard study for Dx
Metaplasia Esohpagitis Barretts/Cancer Stricture ``` Antihistamines TCAs Progesterone Anticholinergics Nitrates CCBs ``` pH probe
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What is a common c/c of GERD that is easily/commonly overlooked Typical Sxs of GERD can be Tx w/ trial of ? What is done if Pt fails to improve, is long standing, or has complications?
Chronic cough PPI Endoscopy w/ cytologic washings and biopsy
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What is the only test to consistently detect Barretts Esophagus What are the red flags that put PTs at high risk for GI malignancy How is GERD Tx
Endoscopic biopsy ``` GERD Sxs and: Dysphagia Recurrent vomitting Weight loss Hematemesis Anemia Melena >50y/o ``` ``` Weight loss HOB elevated 6" H2 antagonist PPI Tx 8wks after Sxs resolve ```
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# Define Gastritis What are the common Sxs that indicate this Dx What are the two categories of gasgritis
Inflammation of stomach lining Dyspepsia Abdominal pain Acute: rapidly developing lesions in gasgric antrum Chronic: Type A: slowly developing lesions in fundus from anti-parietal Abs; associated w/ pernicious anemia; risk for adenocarcinoma Type B: slowly developing lesions in gastric antrum; often ASx; inc risk to develop PUD
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What is the gold standard test for Dx gastritis What 3 tests can be used to detect presence of H Pylori What is the risk of using PPIs during Tx
Endoscopy w/ four biopsies Fecal Ag Serology Ag Urea breath test Dec Ca absorption (hip Fx) Dec B12/Mg Inc respiratory infection (pneumonia) C Diff
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What meds are used for the Tx of gastritis What happens if Pts Sxs return after Tx What are the two types of ulcers seen in PUDz
H2RA: Famotidine, Cimetidine Omeprazole D/c PPI when ASx x 8wks Sxs return <3mon- d/c PPI for upper endoscopy Gastric- pain worse w/ meals Duodenal- pain better w/ meals and change in stool color
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What is the MC cause of gastric ulcers These ulcers are usually anatomically located where? Rarely, these can develop into ?
H Pylori Anterior duodenum- if develop on posterior, inc risk for bleeding from gastroduodenal artery or causes pancreatitis Zollinger Ellison Syndrome- gastrinoma, tumor of pancreas causing stomach to make too much gastrin; Dx when gastrin >200pg Tx: PPI and resection
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Where are gastric ulcers MC found anatomically PUD is the MC cause of ? that presents as ? What is the most accurate method for Dx
Lesser curvature of antrum Non-hemorrhagic GI bleeds that present w/ melena Upper endoscopy
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How is a ruptured gastric ulcer Dx How is H Pylori Tx What is the next step if biopsy is negative for Pylori
Serum amylase Free air under diaphragm on upright CXR 4wks of: Clarithromycin Amoxicillin (metronidazole) PPI (omeprazole) Breath test Stool Ag test
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MC causes of acute pancreatitis What two PE findings indicate Dx
``` GET SMASHED: Gallstones Ethanol Trauma Steroids Mumps Autoimmune Scorpion sting HyperCa/lipid ERCP Drugs ``` Cullens- umbilical bruising Grey-Turner- flank bruising
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What is Ranson's Criteria used for during acute pancreatitis
Predicts severity, 3 or more means severe: ``` At admission: Glucose >200 Age >50 Leukocyte >16K AST >250 ``` ``` At 48hrs: BiCarb <20 BUN inc by 1.8 or > Arterial PO2 <60 Ca <8 Hct dec by 10% Fluid sequestriation >6L ```
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How is Chronic Pancreatitis different than Acute What is the classic triad? What may be seen on PE imaging
Same clinical features + fat malabsorption and statorrhea Pancreatic calcification Statorrhea DM Pancreatic pseudocyst
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How is pancreatitis Dx What is seen on x-ray What would be heard w/ auscultation on exam What are the best initial tests for Dx Chronic Pancreatitis
Amylase, only if 3x higher Abdominal CT- TOC Sentinal loops Dec bowel sounds CT pancreatic protocol MRI w/ MRCP
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How is acute pancreatitis Tx What is needed if biliary sepsis is suspected Why can mild pancreatitis progress to severe <48hrs What is the only definitive Tx for chronic pancreatitis
NPO, IV fluids Analgesics Bowel rest ERCP Inadequate fluid replacement Address: Alcohol/low fat diet
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What is the MC form of pancreatic cancer What 'sign' is seen on PE What node can be present
Ductal adenocarcinoma at head of pancreas ``` Courvoisier's Sign: Jaundice Abdominal pain Palpable gallbladder Light stool, dark urine ``` Virchows- lymph node in left supraclavicular fossa; take lymph from abdominal cavity AKA- seat of the devil
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How are pancreatic neoplasms Dx Where are they more likely to be found in ascending order What tumor marker is used to track progression/therapy How are pancreatic neoplasms Tx
Abdominal CT Head>body
121
# Define Celiac Dz This is a ? d/o What are 4 common c/c
Inflammation of the small bowel d/t ingestion of gluten (wheat, rye, barley) leading to malabsorption Autoimmune Diarrhea Flatulence Weight loss Steatorrhea
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How is Celiac Dz Dx How is a Dx confirmed This confirmation is only done after ?
- IgA anti-endomysial Abs- specificity nearly 100%, sensitivity lower than TG-IgA - IgA Antitissue transglutaminase Ab- will be +98% of Pts Mucosal biopsy of proximal/bulb and distal duodenum IF Pt tested pos for IgA endomysial Ab
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How is Celiac Dz Tx Supplementation may be needed if Pt becomes ? deficient Define Lactose Intolerance
Gluten free diet ``` Fe B12 Folic acid Ca Vit D ``` Insufficient lactase enzyme- hydrolysis of lactose to glucose/galactose
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How is a Dx of Lactose Intolerance made by presumption How is a definitive Dx made What other lab results can indicate this Dx
Mils Sxs after >2 servings/day or >1 serving not associated w/ meal and, Resolves in 5-7 days w/ avoidance and, Reoccurs w/ rechallenge Lactose breath Hydrogen test- Pt drinks lactose liquid Breath into machine q30min += >H than usual (>20ppm) Acidic feces- normally alkaline, acidic indicated lactose intolerance or E Colie/Rotavirus contagion
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How is Lactose Intolerance Tx Facts of Crohns: involvement, visual finding, diarrhea type, fistulas, esophageal finding, histology, smoking impact and serology result
Avoid dairy Lactose free food Lactase supplements ``` Anywhere in GI rectum spared; Skip lesions Non-bloody w/ abdominal pain +fistula Endoscopy= aphthoid, deep (cobblestone) Transmural, noncaseating granuloma Smoking worsens ASCA ```
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Facts of Ulcerative Colitis: involvement, visual finding, diarrhea type, fistulas, esophageal finding, histology, smoking impact and serology result
``` Only involves colon including rectum Continuous pattern of involvement Bloody Rare abdominal pain No fistula/perianal dz Erythematous, friable tissue Tubular/lead pipe radiograph finding Mucosa only crypt abscess Smoking protects p-ANCA ```
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How does UC present Where does the inflammation affect the colon What is the MC site
Bloody pus diarrhea w/ pain, fever, urgency Inflammation only in colon, not transmural Rectum
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What is the bimodal distribution of UC How is it Dx What Ab tests are run
15-25y/o and 55-65y/o Barium enema w/ lead pipe appearance Biopsy w/ continuous inflammation w/ lost haustral markings and lumen narrowing Antineutrophil cytoplasmic Abs (p-ANCA)
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How does Crohns Present What is the MC site What is this conditions distribution
Abdominal pain, non-bloody diarrhes and PO aphthous ulcers Terminal ilium Mouth to anus w/ transmural cobblestoning and skip lesions
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What complications can arise from Crohns What complications can arise from UC What antibody test is run for Crohns
Strictures- string sing w/ barium study Toxic mega colon Colorectal cancer Anti-Saccharomyces cerevisiae Abs (ASCA)
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How is UC/Crohns Dx w/ colonoscopy What is the risk in UC if haustral markings are lost Why are LFTs needed What annual/2yr monitoring should these PTs have
US: continuous inflammation Crohns- focal ulcerations that alternate w/ normal mucosa Toxic megacolon Inc ALT/y-glutamyl transpeptidase suggest primary sclerosing cholangitis Vit D, B12
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How are Crohns/UC Tx What is the MOA of these meds
If colon involved- Sulfasalazine Mesalamine (UC>Crohns) No 5-ASA response= Metronidazole No response to Metro/acute exacerbations= Budesonide/Predisone No response to any- Azathioprine/6-Mercaptopurine 5-ASA block prostaglandin release to reduce inflammation
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What meds are added to UC/Crohns Tx if terminal ileal dz is present preventing bile acid absorbtion What meds need to be avoided How can UC be Tx w/ surgery What surgical option is avail for Crohns Pts
Bile acid sequestrants Anti-diarrheals- induce ileus Total colectomy Segmental resection
134
What criteria is used to Sx-base Dx IBS What is the criteria for Mixed IBS What red flags need to be r/o
Rome: Abdominal pain for 3d/mon in past 3mon w/ 2 or more: Improved w/ defecation Onset associated w/ change of defecation frequency Change in stool consistency More than 1/4 are diarrhea More than 1/4 are constipated Rectal bleeding Weight loss Fever + red flag= imaging/colonoscopy
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Why are lab results useless in IBS Dx How is this Tx How does Acute Mesenteric Ischemia present
CBC/Chemistries are normal in IBS Anticholinergics: Hyoscyamine Sudden onset severe abdominal PooP to exam w/ Hx of PVDz/Smoking/DM
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Board review questions will have Pts w/ Acute Mesenteric Ischemia present w/ ? issues What x-ray sign is seen What is the MC site of obstruction to cause this
Afib/MI/CHF Thumb-printing Superior mesenteric artery
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What can cause younger Pts to have Acute Mesenteric Ischemia What is the gold standard for Dx How is this Tx
OCPs/Illicit drugs Mesenteric angiography Revascularization
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# Define Polyps Once Dx, what meds can help prevent formation of new polyps What MC does this cause in Peds
Clumps of cells on lining of colon/rectum ASA Cox-2 inhibitors Painless rectal bleeding
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Where are adenomatous polyps commonly found in the colon What type of polyp has a 30-70% risk of malignant transformation Define Familial Adenomatous Polyposis
Distal colon/rectum Villous adenomas Hundred/thousands of colorectal polyps by 15y/o and cancer by 40y/o
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What is the recommended screening for 1st degree relatives of Pts w Familial Adenomatous Polyposis What screening is recommended for family members How are Polyps Tx
Genetic screening after 10y/o Annual sigmoidoscopy starting 12y/o Snare/Electrosurgical forceps during total colonoscopy Unsuccessful colonoscopy removal= laparotomy
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Colon Ca is the 3rd leading cause of cancer death behind ? When is colon cancer screenings recommended for average risk Pts w/ stool tests
1st: lung; 2nd: skin Start 50, end 75y/o Guaiac fecal occult test 1/yr Fecal immunochemical test 1/year FIT-DNA test q1/3yrs
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When is flexible sigmoidoscopy recommended for colon cancer screenings When is colonoscopy recommended for colon cancer screenings When is CT colonoscopy recommended
Once q5yrs or, Once q10yrs w/ FIT every year q10yrs q5yrs
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When are colon cancer screening started if single first degree relative is Dx How is colon cancer Tx What is monitored during Tx
<60 at Dx: start colonoscopy at 40 or 10yrs younger than age of Dx; if negative- q5yrs 5-FU mainstay of chemo Surgical resection CEA
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# Define Diverticulosis How does this present Define Diverticulitis How does this present
Large outpouching of mucosa in colon Painless rectal bleeding Infammed diverticula d/t obstructing matter LLQ pain Fever Inc WBC/CRP
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What are the 3 clinical indicators used to Dx Diverticulitis How is this Dx What needs to be avoided during work up
Absent vomiting CRP >5mg LLQ tenderness only CT- fat stranding and bowel wall thickening Colonoscopy- risk of perf
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How is mild diverticulitis Tx How is Constipation defined by Rome 3 criteria
Low residue diet Broad ABX NG tube if +ileus ``` Any two x 3mon w/ Sxs onset >6mon prior: Sensation of obstruction <3 bm/wk Straining Lumpy/hard stool Incomplete sensation Digital maneuvers needed ```
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How is constipation Tx w/ fiber What are the bulk forming laxatives used What is the next step if Pts don't respond to bulkers Constipation lasting longer than ? needs to have further investigatory studies
20-25gm/day Psyllium seed Methylcellulose Calcium polycarbophil Wheat Dextrin Osmotics, start w/: Polyethylene glycol >2wks and refractory to Txs
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Diarrhea after picnic w/ egg salad is d/t ? Diarrhea from shellfish is d/t? Diarrhea from poultry/pork is d/t? Diarrhea from poorly canned food is d/t? Diarrhea from daycare outbreak is d/t? Diarrhea from cruise ships is d/t? Diarrhea from fresh water consumption is d/t?
Staph A Vibrio cholera Salmonella C perfringens Rotavirus Norovirus Giardia
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How does acute/chronic hepatitis present How is Hep A passed How is it Dx and what result shows prior infection How is it Tx How is it vaccinated
Tea urine, pale stool Pruritus Vague abdominal pain Fecal-oral transmitted Serum IgM anti-HAV IgG Ab to HAV distinguishes acute from prior infection; +IgG= prior infection, acquired immunity Tx: supportive Vaccine x 2, first at 1y/o
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How is Hep B passed How is it Dx How is it prevented What is the risk of this Dx
Sex/Sanguineous HBeAg- highly infectious HBsAg- ongoing infection anti-HBc- have/had infection Anti-HBs- immune Vaccine x 3: birth, 1mon, 6-18mon Hepatocellular carcinoma
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How is Hep C passed How is this screened for How is this Dx What is the risk of the Dx How is this Tx
ASx transmision through IVDA , sex, sanguineous Anti-HCV Abs HCV RNA quantitation Cirrhosis/hepatocellular carcinoma Antiretrovirals against RNA synthesis
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How is Hep D passed What is the risk of the Dx How is this Dx How is this Tx
Only w/ co-infection of Hep B Hepatocellular carcinoma Anti-HDV- active infection Tx/prevent infection
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How is Hep E passed How is this Tx What lab result suggests alcoholic hepatitis
Pregnant mother to baby Support/vaccinate AST:ALT ration >2:1
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3 RFs for Fatty Liver Dz How is this Dx How is this Tx
Obese Hyperlipid Insulin resistance ALT>AST US: steatohepatitis (inc echogenicity and coarse texture) Biopsy: large fat droplets Lifestyle mod/DM control
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# Define Cirrhosis What is the MC cause What will be seen on lab results
Chronic liver dz w/ fibrosis, disrupted liver architecture and widespread nodules Alcoholic liver Dz AST > ALT
156
What Syndrome are liver cirrhosis PTs at risk for What is the MC complication of cirrhosis When is paracentesis warranted for Tx
Budd Chiari: abdominal pain Ascities Hepatomegaly Ascites- abdominal fluid collection from portal-HTN and hypoalbumin SOB Early satiety Tense ascites
157
How does hepatic encephalopathy present on PE How is cirrhosis Tx Define Cholelithiasis
Asterixis- flapping tremor when Pt flexes hands Avoid alcohol Salt restriction Transplant Gallstones w/out inflammation
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90% of cholelithiasis is ? saying What are the other 10% What is the cardinal Sx What referred sign can be seen
Fat Female Forty Fertile w/ cholesterol stones Pigmented- brown/black Biliary colic from obstructed cystic duct Boas- right subscapular pain of biliary colic
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What is the Dx modality of choice for cholelithiasis What lab result will be elevated during obstructions What clotting factors does the liver make
Abdominal US 8hrs after fasting ALK-P 1 2 5 7 9 10 12 13
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# Define Cholecystitis What PE finding helps w/ Dx Chronic Cholecystitis can develop into ?
Inflammed gallbladder d/t cholelithiasis and an obstructed biliary duct Murphys- pain in RUQ w/ palpation and inspiration Porcelain GB, premalignant condition
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How is cholecystitis Dx Define Cholangitis What presenting triad can be seen What pentad can this develop into
US- 1st line Gold standard: HIDA scan if equivocal US/suspected acalculous cholecystitis Infected obstruction d/t stones w/ E Coli Charcot's Triad: F/C RUQ pain Jaundice Reynolds- HOTN, AMS
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How is Cholangitis Dx What tumor marker indicates liver neoplasms When does hematuria become 'clinically significant'?
Initial: RUQ US Optimal: ERCP for Dx and Tx + Charcots- go direct to ERCP Alpha-fetoprotein and abnormal images >3 RBCs/high power field on two different occasions
163
How does Nephrolithiasis/Urolithiasis present What are the 4 types of stones
Colicky flank pain w/ +CVA tenderness Calcium oxalate- MC, avoid grapefruit juice Struvite- chronic UTIs, w/ Klebsiella/Proteus origins Uric acid- acidic urine; excess meat/ETOH and gout Cystine- rare genetic, young male w/ stones
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What is the gold standard for Dx Nephrolithiasis/Urolithiasis What would be seen on UA What labs need to be ordered
Spiral CT w/out contrast Microscopic hematuria BUN, Cr levels to eval renal function
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How is Nephrolithiasis/Urolithiasis Tx What are 3 indications Pts need admission
IV morphine/ketorolac Hydration ABX if UTI present Flomax- alpha blocker if stone >5mm but <10mm Pain uncontrolled w/ PO meds Anuria Renal colic, UTI and fever
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What size Nephrolithiasis/Urolithiasis stones are expected to pass naturally What sizes are not expected to pass and what is done When is Urology consult needed
5-10mm, may require elective lithotripsy >10mm- ureteral stend or percutaneous nephrostomy (gold standard) Stone doesn't pass in 3days
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Extracorporeal shock wave lithotripsy Tx for Nephrolithiasis/Urolithiasis is best for ? sizes What is the next step and indicated for ? size
>5mm <2cm Percutaneous nephrolithotomy- >2cm
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# Define a UTI What is the MC and 2nd MC cause How do these present
Infection in any part- kidney, bladder or urethra 1st- E Coli 2nd- Enterococcus/Saprophyticus Dysuria w/out urethral d/c No F/C/flank pain
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# Define Honeymoon Cystitis What is the MC cause of recurrent cystitis in men How are UTIs Dx
Uncomplicated UTI in women preceded by sex Chronic bacterial prostatitis ``` Urine dipstick- nitrie, leukocyte esterase UA: pyuria Culture- gold standard; >100K CFU for women >1K CFu for men/cath Pts ```
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What is an uncomplicated UTI
Female w/out comorbidities Fosfomycin- single dose, expensive Allergic to TMP and resistance to E coli: Nitrofuantoin/Flqn TMP/SMX for resistant E Coli strains Phenazopyridine- urethral analgesic
171
How is a lower UTI in pregnancy Tx How are post-coidal UTIs Tx How are complicated UTIs Tx
Nitrofurantoin Cephalexin TMP-SMX Cephalexin Fluoroquinolone TMP-SMC Cephalosporin Avoid- Nitrofurantoin
172
How is pediatric cystitis Tx How
Cephalosporin- first line Keflex Cefixime/Cefdinir/Cefibutene if inc likelihood of renal involvement
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# Define Pyelonephritis How doe Pyelonephritis present What is the MC microbe to cause this How is this Dx and what is pathognemonic
Ascending UTI that reaches renal pelvis (staph A- hematogenous) Fever CVA tenderness N/V E coli UA: WBC casts (nomonic for pyelo and interstitial nephritis)
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What is the next step if complicated pyelonephritis is seen How is this Tx outpatient How is this Tx inpatient How is this Tx in pregnancy
Renal US Cipro Levo Cephalexin Ceftriaxone Admit Ceftriaxone
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# Define Nephrotic Syndrome What would be seen on a 24hr UA collection What lab results would be abnormal
Peripheral/Periorbital edema Ascites/effusion HTN >3.5g/day Hypoalbuminemia Hyperlipidemia
176
How is nephritic syndrome different from nephrotic syndrome? What are the two classifications of nephrotic syndrome
``` Peripheral/Periorbital edema HTN Oliguria Hematuria Proteinuria 1-3gm/day ``` Primary- Dx w/ kidney biopsy Secondary- DM, HIV, Hep B/C, Lupus, Antiphospholipid syndrome
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Why is proteinuria seen in nephrotic syndromes? What type of cells make up the basement membrane What Pt presentation makes nephrotic syndrome a possible Dx
Capillary endothelial cells change and unable to filter serum protein by sizes Podocytes Young child w/ unexplained edema/ascites: Edema + 3.5gm of protein on 24hr collection Fatty casts w/ maltese cross Oval fat bodies Hypoalbumin Hyperlipid
178
What are the MC causes of primary nephrotic syndrome in adults What is the MC cause in Peds What form affects IVDA
Membranous nephropathy- malignancy/Hep B Minimal Change Dz: assume Dx if syndrome improves after CCS Txs Focal Segment Glomerulosclerosis- obese Pt w/ HIV and IVDA, probably black w/ SCDz
179
What are the MC causes of secondary nephrotic syndrome How is nephrotic syndrome Dx How is this Tx
Lupus DM Pre-eclampsia Proteinuria >3.5g/day Casts- lipiduria Hypoalbumin <3.5g Hyperlipid: LDL >130, Tgly >150 Statin Angiotensis inhibition Na restricion Diuretic
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How is Minimal Change Dz Tx What is used for Tx if Pt is a frequent relapser How is Membranous Nephorpathy Tx
ACEI- for mild condition Prednisone ImmSupp w/: Chlorambucil Cyclo-sporine/phosphamide ``` High risk progressing to ESRD: Glucocorticoids and, Cyclophosphamide Low risk: ACEI Persistent- lipid lowering Rx ```
181
How is Focal Segmental Glomerulosclerosis Tx How are steroid resistant cases Tx
Prednisone- 1st line ACEI- dec proteinuria Cyclosporine addition
182
What defines HyperK What is seen on EKG What is seen on PE How is it Tx
Serum K >5 Peaked T wave, prolonged QRS Muscle fatigue Sodium bicarb Glucose Caclidum gluconate
183
What define HypoK What is seen on EKG What is seen on PE How is it Tx
Serum K <3.5 Flat/inverted T-wave, Uwave Muscle cramps, constipation No dextrose fluids Replete K/Mg
184
HypoCa is defined as ? What is the MC cause and other possibles What is seen on EKG What is seen on PE How is it Tx
Serum Ca <8.4 Ionized Ca <4.4 MC: hypoparathyroid Other: thryoid surgery, renal dz QT prolongation Trousseaus Chvosteks IV calcium gluconate
185
IF suspecting imbalance of phosphorous or Ca, always order ? lab HyperCa in elderly is Dx as ? until disproven
PTH Ca
186
HyperCa is defined as ? What is the MC cause and other causes Saying for remembering PE findings What is seen on EKG How is it Tx
Serum Ca >10.5 Ionized Ca >5.6 MC: hyperparathyroid Other: mets, MM, TB, sarcoidosis Stone Bones Groans Moans Short QT IV NS and Furosemide
187
HypoNa is defined as ? What causes this What is seen on PE
Serum Na <135 ETOH Hypervolemia- CHF, nephrotic syndrome, RF, cirrhosis Euvolemic- SIADH, steroids, hypothyroid Hypovolemic- Na loss Seizures Altered gait Mimics HypoK if <105
188
Why does HypoNa need to be Tx slowly How is it Tx How fast should a deficiency be corrected
Osmotic demyelination syndrome ASx: water restriction Moderate: IV NS, Loops Sev: 50mL 3% NS 10mEq or less over 24hrs
189
What defines HyperNa How does it present How is it Tx What happens if Tx is too fast
Serum Na >145 Poor tugor Dry skin Flat veing IV D5W Cerebral edema Pontine herniation
190
What Na lab result indicates Diabetes Insipidus What are the two possible locations of the issue What consistent lab result indicates DI
Low urine Na High serum Na Polyuria Neurogenic/central- deficient ADH from posterior pituitary Nephrogenic- kidneys don't respond to vasopressin or d/t lithium/renal dz Urine osmolality <250 despite hyperNa
191
What is the 3 step approach to Acid-Base D/o What causes respiratory acidosis What causes respiratory alkalosis
1st: ph (7.35-7.45) 2nd: PCO2 (35-45) 3rd: HCO3 (20-26) Lungs fail to excrete CO2 Excessive CO2 loss
192
What is the next step if metabolic acidosis is encountered What causes a high anion gap What causes a low anion gap
Anion Gap- Na - (Cl+BiCarb)= 10-16 Excess H+ ions >16; MUDPILES: Methanol Uremia DKA Paraldehyde Infection LAcidosis Ethylene glycol Salicylates <16Loss of BiCarb- diarrhea
193
What causes metabolic alkalosis Saying to remember average normal valued for acid-base numbers
Loss of H+L vomit, bulemia, OD of antacids Additional bicard- hyperalimentation therapy 24/7 40/40 BiCarb/pH CO2/acid