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Shelf Exams > Internal Medicine > Flashcards

Internal Medicine Flashcards

1
Q

1st test for chest pain

2nd test for chest pain

A

EKG

Cardiac enzymes

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2
Q

EKG findings for STEMI

A
  • ST elevation (2mm)

- New LBBB (long, flattened QRS)

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3
Q

Order of EKG findings for STEMI (in time)

A
  1. ST elevation (immediate)
  2. T wave inversion (6 hrs - years)
  3. Q waves (forever)
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4
Q

Treatment of STEMI

A

Emergency reperfusion

- Cath lab (stent), OR...
- Thrombolytics (no contraindications, early enough)
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5
Q

Window for thrombolytics

Contraindications to thrombolytics

A

6 hours

  • Bleeding
  • Hemorrhagic stroke (ever)
  • Ischemic stroke (recent)
  • Closed head trauma (recent)
  • Surgery
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6
Q 
Hypotension
Tachycardia
JVD
Lungs clear
No pulsus paradoxus

Tx? What not?

A

R ventricular infarction (cardiogenic shock)

FLUIDS, not nitro (preload)

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7
Q

Normal EKG, elevated cardiac enzymes

A

NSTEMI

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8
Q

Order of enzyme rises (w/ timeframes)

A
  1. Myoglobin (peak 2hrs, nml 24hrs)
  2. CKMB (peak 24hrs, nml 72hrs)
  3. Troponin (peak 24-48hrs, nml 7-10 days)
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9
Q

Best cardiac maker for 2nd MI

Why?

A

Myoglobin

Falls in 24 hrs, will rise again if 2nd MI occurs

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10
Q

NSTEMI - Tx

A
  1. MON(A/C) + beta blocker
  2. Coronary angio (w/in 48 hrs)
  3. PCI w/ stent OR CABG
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11
Q

When is CABG preferred over PCI/stent?

A
  • L main dz
  • 3 vessel dz
  • > 70% occlusion
  • Pain after max medical tx
  • Post-infarct angina
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12
Q

D/C meds after MI

A
  • Aspirin (+ clopidogrel if stent)
  • Beta blocker
  • ACEI (if CHF or LVD)
  • Statin
  • Nitrates
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13
Q

MI-like chest pain, normal EKG, normal enzymes

Workup?

A

Unstable angina

STRESS TEST:

  1. Exercise stress EKG (D/C beta blockers and CCBs)
  2. Exercise stress echo if can’t do the EKG
  3. Chemical stress test (dobut./adenosine) if can’t exercise
  4. MUGA scan (radionuclide angio) (no caffeine/theoph)
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14
Q

Positive stress test signs?

What next?

A
  • Pain reproduced
  • ST depression
  • Hypotension

Coronary angio

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15
Q

Reasons a stress EKG would be too hard?

A
  • Old LBBB
  • Baseline ST elevation
  • On Digoxin
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16
Q

New systolic murmur 5-7 days after MI?

A

Papillary rupture –> regurg

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17
Q

MI –> murmur, hypotension, very sick

A

Free wall rupture

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18
Q

Step up O2 concentration from RA to RV?

A

Septal rupture

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19
Q

MI –> 1mo later persistent ST elevation + MR murmur

A

Ventricular aneurysm

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20
Q

Cannon A-waves - what are they?

Meaning?

A

Huge JVP pulses w/ heart beat

Right A-V dissociation (3rd degree block OR V-fib)

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21
Q

MI –> 5-10 wks later pleuritic CP + low fever

Tx?

A

Dressler syndrome (autoimmune pericarditis)

Aspirin + NSAIDs

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22
Q

Diffuse ST elevation

Other signs you’ll see?

A

Pericarditis

Worse w/ inspiration, better leaning forward, friction rub

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23
Q

Vague chest pain, murmur, hx of viral infection

A

Myocarditis

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24
Q

Prinzmetals - Dx?

Tx?

A

Ergonovine stimulation test

CCB or Nitrates

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25
Q

Varying PR intervals
3+ different P-wave forms in same lead

Meaning?

A

MAT

Bad pneumonia or chronic lung dz –> pending resp. failure

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26
Q

V-Tach (stable) - tx?

Unstable - tx?

A

Lidocaine or Amiodarone

Defibrillation

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27
Q

WPW - tx?

Contraindicated drugs?

A

Procainamide

A-V conduction blockers (BB, digoxin, Verap/Diltiazem)`

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28
Q

A-flutter (stable) - tx?

Unstable?

A

BB, digoxin

Defibrillation

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29
Q

Torsades - predisposing things?

A
  • Hypokalemia
  • Hypomagnesium
  • TCA overdose
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30
Q

Sudden onset and offset of palpitations and dizziness, very fast HR (150-220)

1st tx?
Or?

A

SVT

Carotid massage

Adenosine

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31
Q

Widened QRS, Prolonged PQ, Short QT

Other finding?

A

Hyperkalemia

Peaked T-waves

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32
Q

Pulsus paradoxus - what is it?

Seen in what?

A

Large (>10) drop in SBP on inspiration

Cardiac tamponade, pericarditis, croup, severe obstructive lung dz, chronic obstructive sleep apnea

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33
Q

A. fib - causes

Symptoms?

Tx?

A
  • Hyperthyroidism / Synthroid OD
  • Mitral valve dz / CHF

SOB, palpitations, dizziness

RATE control (beta blocker or digoxin)

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34
Q

Diastolic murmurs

Systolic murmurs

A

ARMS PITS

Other 4

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35
Q

Systolic ejection murmur, louder w/ squatting, softer w/ valsalva, parvus et tardus

Treatment?

A

Aortic stenosis

Valve replacement

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36
Q

Systolic ejection murmur, louder w/ valsalva, softer w/ squatting or handgrip

A

Hypertrophic obstructive cardiomyopathy

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37
Q

What does valsalva do?

A

Decreases pre-load

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38
Q

Late systolic murmur w/ click, louder w/ valsalva, softer w/ squatting and handgrip

A

MVP

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39
Q

Holosystolic murmur w/ radiation to axilla

A

Mitral regurg

40
Q

Holosystolic murmur w/ late diastolic rumble

A

VSD

41
Q

Wide fixed and split S2

A

ASD

42
Q

Rumbling diastolic murmur w/ opening snap

A

Mitral stenosis

43
Q

Blowing diastolic murmur w/ widened pulse pressure

A

Aortic regurgitation

44
Q

Suspect PE…1st thing to do?

What else?

A

HEPARIN

Check O2 sat (give O2 if under 90%)

45
Q

Suspect pneumonia…1st thing to do?

A

CXR

46
Q

If murmur or CHF history…1st thing to do? Why?

A

Echo - get ejection fraction

47
Q

Acute pulmonary edema…treatment?

A

Nitrates, lasix, morphine

48
Q

Young, CHF symptoms w/ prior viral illness…Dx?

A

Myocarditis (Coxsackie B)

49
Q

Young, SOB but no cardiomegaly on CXR…Dx?

How to Dx for sure? How?

A

Pulmonary HTN

R heart cath - PCWP normal (high in CHF)

50
Q

What does PCWP symbolize?

A

L atrial pressure

51
Q

Sign of systolic CHF

Causes?

Reversible one?

A

EF under 55% (ischemic, dilated heart)

Viral, EtOH, Cocaine, Chagas, Idiopathic

Alcoholic - STOP DRINKING

52
Q

Sign of diastolic CHF

Causes?

Reversible one?

A

Normal EF (heart can’t fill)

HTN, amyloidosis, hemochromatosis

Hemochromatosis (phlebotomy)

53
Q

CHF - treatments

Which ones increase survival?

A
  1. ACEI - survival (less aldosterone remodeling)
  2. Beta-blocker (metoprolol, carvedilol) - survival (less catecholamine remodeling)
  3. Spironolactone - survival (NYHA class 3 or 4)
  4. Furosemide - SYMPTOM improval (SOB, crackles, edema)
  5. Digoxin - decreased SYMPTOMS
54
Q

Lobar consolidation, air bronchograms

A

Pneumonia

55
Q

Hyper-lucent lungs, flat diaphragms

A

COPD

56
Q

Cardiomegaly, Kerley B lines, interstitial edema

A

CHF

57
Q

Cavity w/ air-fluid level

A

Abscess (anaerobes, staph)

58
Q

Upper lobe cavitation and consolidation, hilar LAD

A

TB

59
Q

Thickened peritracheal stripe, splayed carina bifurcation

A
  1. LAE (Mitral stenosis)

2. Mediastinal CA

60
Q

> 1cm of fluid at costophrenic recess when lat. decub.

Tx?

A

Pleural effusion

Thoracentesis

61
Q

Transudative pleural effusion - causes?

A

CHF, nephrotic, cirrhotic

62
Q

Transudative w/ low glucose

Why?

A

Rheumatoid arthritis

Lots of inflammatory cells –> eat up glucose

63
Q

Transudative w/ high lymphocytes

A

TB

64
Q

Transudative w/ blood

A

PE or cancer

65
Q

Exudative effusion - causes?

A

Parapneumonic, cancer

66
Q

Effusion w/ low glucose, low pH, and/or positive for bugs

Treatment?

A

Pneumonia

Chest tube drainage

67
Q

****How to distinguish transudative vs. exudative

A

LIGHT’S CRITERIA (all 3 = transudative)

  1. LDH < 200
  2. LDH eff/serum < 0.6
  3. Protein eff/serum < 0.5
68
Q

Risk factors for PE

A

Surgery, stasis, nephrotic syndrome, cancer

69
Q

Symptoms of PE

A 
Pleuritic chest pain
Hemoptysis
Tachycardia
Tachypnea
Decreased pO2
70
Q

Lab/imaging signs of PE

A 
Sinus tachycardia
R heart strain on EKG
Decreased vascular markings
Wedge infarct
Low O2 and CO2 on ABG
71
Q

PE…Dx and Tx steps

A
  1. HEPARIN (w/ warfarin bridge)
  2. V/Q scan OR spiral CT
  3. Pulmonary angiography (gold standard, if necessary)
  4. Thrombolytics if severe (unless contraindicated)
  5. Surgical thrombectomy (IF IMMEDIATELY LIFE THREATENING)
  6. IVC Filter (if can’t take chronic blood thinners)
72
Q

B/l fluffy infiltrates on CXR

Pathophysiology

***Causes?

A

ARDS

Inflammation at alveolar walls –> impaired gas exchange, inflammatory mediator release, hypoxemia

Sepsis (LPS), aspiration, trauma, pancreatitis, low perfusion

73
Q

***3 Dx criteria for ARDS

A
  1. PaO2 / FiO2 < 200
  2. Bilateral infiltrates on CXR
  3. PWCP < 18 (NOT cardiogenic infiltrates)
74
Q

Treatment for ARDS

A

O2 w/ PEEP

75
Q

Obstructive or restrictive…

Low FEV1/FVC ratio

A

Obstructive

76
Q

Obstructive or restrictive…

High TLC and RV

A

Obstructive

77
Q

Obstructive or restrictive…

Low TLC and RV

A

Restrictive

78
Q

What disease…

Improves w/ bronchodilator (at least 12%)

A

ASTHMA

79
Q

What diseases…

Reduced DLCO (and why?)

A

Emphysema - alveolar destruction

Interstitial lung disease (sarcoid, silicosis, asbestos) - fibrosis/thickening

80
Q

Causes of restrictive lung disease

A 
ILD (sarcoid, silicosis, asbestos)
Obesity
MG/ALS
Phrenic nerve paralysis
Scoliosis
81
Q

Criteria for COPD diagnosis

A

Productive cough for > 3 mo for > 2 consecutive years

82
Q

COPD - treatment options

A
  1. Ipratropium/Tiotropium (anticholinergic, antimuscarinic)
  2. Beta-2 agonists (albuterol, terbutaline, salmeterol, etc.)
  3. Theophylline (PDE inhibitor - inhibits LTs and TNF-a)
83
Q

When to start oxygen?

A

PaO2 < 55

O2 sat < 88%

84
Q

COPD exacerbation - treatment?

A

O2 to sat of 90%
SABA/Ipratropium
Steroids
Abx (FQ or macrolide)

85
Q

Best prognostic indicator for COPD

A

FEV1

86
Q

How to improve mortality in COPD

A
  • Quit smoking

- Continuous O2 >18 hrs/day

87
Q

COPD - important vaccinations?

A

Pneumococcus w/ 5 yr boosters

Influenza annually

88
Q

NEW clubbing in a COPDer…MC cause?

Test?

A

Lung malignancy

CXR

89
Q

Asthma…

Sxs 2x per wk, normal PFTs

A

Albuterol

90
Q

Asthma…

Sxs 4x per wk, night cough 2x per mo, normal PFTs

A

Albuterol + inhaled CS

91
Q

Asthma…

Daily sxs, night cough 2x per wk, FEV1 60-80% –

A

Albuterol, inhaled CS, LABA

92
Q

Asthma…

Daily sxs, night cough, FEV1 < 60%

A

Albuterol, inhaled CS, montelukast and oral steroids

93
Q

Asthma exacerbation

If CO2 starts to normalize?

A

Albuterol + PO/IV steroids

INTUBATE

94
Q

Small nodules in upper lobes, eggshell calcifications

What next?

A

Silicosis

TB test

95
Q

Reticulonodular process in lower lobes w pleural plaques

Increased risk?

A

Asbestosis

Bronchogenic carcinoma OR mesothelioma

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