medicine 1 Flashcards
audible S4, think…
aortic stenosis
pulsus parvus et tardus
diminished (amplitude) and delayed (upstroke) of carotid pulse
in aortic stenosis
exercise stress test or echo for syncope?
echo 1st, prior to exercise stress test
echo- for cardiomyopathy, valvular heart dz (eg. aortic stenosis)
exercise stress test: for known coronary dz (contraindicated in aortic stenosis)
acute arterial limb ischemia (6 P’s) post-MI is from thrombus or embolus?
embolus
what intervention post-STEMI can improve CV outcomes and overall mortality?
restore coronary blood flow with:
- primary percutaneous intervention
- fibrinolysis
etiologies of pericarditis
viral
autoimmune (SLE)
uremia (renal failure)
post MI
- early: peri-infarction pericarditis
- late: dressler syn
bounding pulses seen in
aortic regurgitation
aortic regurg is systolic or diastolic murmur?
diastolic
strongest predictors of AAA expansion/rupture
**smoking
large aneurysm diameter
rate of expansion
others: age, family hx, white, atherosclerosis
abrupt onset of tachycardia that resolves with cold water immersion. think…
supraventricular tachycardia-
more specifically, atrioventricular nodal reentrant tachycardia
how does cold water help SVT?
vagal maneuver
increase parasympathetic tone –> slow AV conduction and increase refractory period
wilson disease symptoms
hepatic (liver failure, cirrhosis, chronic hepatitis)
neuro (parkisonism, abnl gait, dysarthria)
psych (depression, personality changes)
wilson disease treatment
chelators (d-pencillamine, trientine)
zinc - interferes with Cu absorption
zencker diverticulum presentation
> 60 yo male
halitosis
dysphagia
regurgitation
neck mass
where is zencker diverticulum
above upper esophageal sphincter
with posterior herniation between crichophryngeal muscle
what causes zencker diverticulum
sphincter dysnfunction and dysmotility
diagnosis and treatment of zencker diverticulum
dx: barium esophogram
tx: surgery- excision or cricopharyngeal myotomy
how to improve steatorrhea in patients with chronic pancreatitis?
pancreatic enzyme supplementation
acute pancreatitis treatment
resolves in 4-7 days
supportive care, IVF, analgesics
elevated alk phosphatase and positive AMA. think…
primary biliary cholangitis (autoimmune)
primary biliary cholangitis symptoms
pruritus, fatigue
jaundice, hepatomegaly, steatorrhea, xanthelasma
primary biliary cholangitis treatment
ursodeoxycholic acid
- decreases biliary injury by hydrophobic bile acids
- increases biliary secretion
- anti-inflammatory
urinary outflow obstruction symtpoms
flank pain
low urinary output with periods of post-obstructive diuresis
–> potassium wasting –> weakness
is there screening for bladder cancer?
no
what is this: bladder pain, worse with filling, relief with voiding. frequency and urgency. also dyspareunia.
interstitial nephritis
how does acyclovir cause crystal-induced acute kidney injury?
acyclovir excreted into urine but has low urine solubility –> precipitates –> renal obstruction
–> AKI within 24-48 hours
symptoms of aut dom `polycystic kidney disease
intermittent flank pain and mass
hematuria
UTIs
nephrolithiasis
workup of BPH
- UA and PSA
- if significant symptoms or risk factors, test Cr
- if Cr elevated, do renal US to r/o hydronephrosis
most sensitive test for diabetic nephropathy
random urine for microalbumin/Cr ratio
multiple peptic ulcers and diarrhea. think…
zollinger-ellison (excess gastrin can cause ulcers and inactivate pancreatic enzymes)
first degree relative with colon cancer should make patient get screened when
age 40 or 10 years before diagnosis
what type of blood should be given to patient with low Hgb from upper GI bleed?
packed RBC
when is fresh frozen plasma given
severe coagulopathy (DIC, liver dz) with active bleeding
when are platelet transfusions given
<10,000 or <50,000 + bleed
when is whole blood transfusion given
severe hemorrhage
standard of care for pateints with FAP
annual c-scopes starting in childhood
elective proctocolectomy
screen for upper GI tumors
diarrhea, weight loss, and apthous ulcers. think…
Crohn’s
how is BUN/Cr ratio increased in someone with upper GI bleed?
increased urea production (from Hgb breakdown)
increased urea absorption (from hypovolemia)
can IBS diarrhea have mucous?
yes
