Medicine Flashcards
1
Q
Psoriasis may be exacerbated by what three things
A
Strep infection, skin injury (sunburn/drug reaction), hiv
2
Q
What are the five ps of dx of lichen planus
A
Pruritic, purple, polygonal, planar, papules
3
Q
Clinical features of porphyria cutanea tarda
A
Facial hirsutism, milia, erosions, scars, tense bullae (frequently on hands)
4
Q
Porphyria cutanea tarda is associated with abuse of what substance
A
Alcohol
5
Q
Porphyria cutanea tarda is associated with hep ___ and ___ overload
A
C; iron
6
Q
Pemphigus vulgaris often involves the
A
Mouth
7
Q
Pemphigus vulgaris is diagnosed by
A
Immunofluorescent studies of perilesional skin
8
Q
Erythema nodosum, think
A
Ibs, sarcoid, strep infection, ocps
9
Q
Erythema multiforme lesions are known as
A
Target lesions
10
Q
With erythema multiforme, think
A
Hsv, drugs (penicillin, sulfa, phenytoin), or mycoplasma
11
Q
Acanthosis nigricans is associated with what malignancy
A
60% gastric
12
Q
In a younger pt with seborrheic dermatitis, think
A
Hiv
13
Q
In an older pt with seborrheic dermatitis, think
A
Parkinson’s
14
Q
Pts with alcoholic hepatitis have ast and alt levels of
A
Ast less than 300, trivial elevations of alt with an ast/alt ratio of >3
15
Q
Hemochromatosis and alcoholic liver disease share what features
A
Hepatomegaly, glucose intolerance, testicular atrophy and cardiomyopathy
16
Q
Nonalcoholic steatohepatitis occurs in
A
Middle aged women with obesity, diabetes and hypertension
17
Q
Clinical features of nonalcoholic steatohepatitis
A
Hepatomegaly and elevated transaminases (usually ast>alt)
18
Q
Causes of acute liver failure
A
Drugs (acetominophen), viral hepatitis, ischemia
19
Q
Autoimmune hepatitis usually occurs in
A
Women
20
Q
Serologically pts with autoimmune hepatitis have what antibodies
A
Antinuclear and anti smooth muscle antibodies as well as hyperglobulinemia
21
Q
What are the drugs that cause drug induced cholestasis
A
Chlorpromazine, gold, chlorpropamide, ocps, erythromycin, and amoxicillin/clavulanate
22
Q
Primary sclerosis cholangitis occurs in
A
Middle aged men with a hx of ulcerative colitis
23
Q
What are ways to control acute variceal bleeding
A
Sclerotherapy, variceal band ligation. B blockers for prophylaxis
24
Q
Spontaneous bacterial peritonitis is usually caused by
A
Gram negative rods
25
How to treat spontaneous bacterial peritonitis
Five day course of a third gen cephalosporin
26
Crohn's disease most commonly involves the
Terminal ileum and cecal region
27
Malabsorptive diarrhea, arthritis, fever, lymphadenopathy, clubbing, cns involvement and uveitis. Think
Whipples disease
28
Celiac sprue is associated with what skin thing
Dermatitis herpetiformis
29
Celiac sprue is associated with what immuno deficiency
Selective iga deficiency
30
Celiac sprue is associated with increased risk for what kind of lymphoma
Small bowel lymphoma
31
What serological tests help diagnose celiac sprue
Iga endomysial antibody, and iga tissue trans glutamine antibody
32
Chronic watery diarrhea in a middle aged woman without wt loss or pain, think
Microscopic (collaginous) colitis
33
Treatment of microscopic colitis
Bismuth
34
Diarrhea due to pancreatic insufficiency has a ___ amount of stool fat than normal
Greater
35
Pancreatic insufficiency have ___ small bowel absorption tests
Normal (d-xylose, hydrogen breath tests)
36
Three top causes of acute pancreatitis
Alcohol consumption, gallstones, triglycerides
37
Does uc involve skin lesions
No
38
Pseudocysts develop in __ % of pts with severe acute pancreatitis. Big cysts are at risk for
20; perforation, infection, hemorrhage
39
Read rate of ekg
300/# of large squares in between each consecutive r wave
40
P wave
Atrial depolarization
41
Q wave
Left to right depolarization of the iv septum
42
R wave
Early ventricular depolarization
43
T wave
Ventricular repolarization
44
Pr interval
Reflects conduction through the av node
45
Qt interval
Time for ventricular depolarization and repolarization
46
St interval
Time between ventricular depolarization and repolarization
47
In rbbb you see
Delayed r ventricular activation producing a secondary r wave (r') in v1-v3 and a wide S wave in lateral leads (I, avl, v5-6)
48
St elevations in v1-v3 means
Lad occlusion, anteroseptal infarct
49
V1-v4 elevations means
Anterior infarction
50
Metformin mechanism
Gluconeogenesis in the liver, esp creating glucose for the brain at night
51
Sulfonylurea mech of action
Make beta cells increSe insulin production
52
Sulfonylurea side effects
Stroke, heart attack
| Burns out the B cells
53
Liraglutide (victoza) and exenatide are ___. Positive ses are___
Glp1 agonists; delayed gastric emptying and wt loss
54
Sitagliptin (januvia) mech of action
Dpp4 inhibitor (dpp4 breaks down glp1)
55
Level of proteinuria in diabetes
3000 and above
56
Jiardance and drugs that end in flozin are___. They cause you to___.
Sglt2 agonists; cause you to pee out sugar
57
Side effects of sglt2 agonists
Infection (utis) and hypoglycemia
58
Abx used to treat community acquired mrsa
Doxy, clinda, bactrim
59
Mechanism of doxy
Binds to the 30s ribosomal subunit; bacteriostatic
60
Mech of clindamycin
Binds 50s rna subunit; bacteriostatic
61
Lantus (glargine)
Long acting basal insulin
62
Humalog (lispro)
Fast acting short term insulin
63
Levemir (detemir)
Long acting insulin
64
Nph
Medium acting insulin
65
Glyburide is a ___ with what serious side effect?
Sulfonylurea; severe hypoglycemia and stroke
66
Rosiglitazone increases the risk of development of
Symptomatic heart failure
67
Diagnosis of dka
Glucose 250-500 mg/dl, bicarb<18, elevated anion gap, positive serum ketones
68
Why can hypercalcemia be caused by immobilization?
Due to increased osteoclastic bone resorption
Higher risk in younger pts
69
Symptoms of hypercalcemia
Nausea, polyuria
70
Treatment of hypercalcemia due to immobilization
Bisphosphonates
71
What four things do amoxicillin and ampicillin cover
E. coli, h flu, enterococcus and listeria
72
What derivative of penicillin is good at covering staphylococcus
Methicillin and its derivatives (doxicillin, nafcillin, diclaxicillin)
73
What is zosyn/what does it cover?
Piptazo; covers gn Rods and gut anaerobes and pseudomonas
74
What is augmentin
Amoxicillin and clavulanate
75
Keflex is a
First gen cephalosporin also known as cefalexin
76
What are the second gen cephalosporins?
Furry fox drinking tea: cefuroxine, cefoxitine, cefetetan
77
What is cefipime and what does it cover?
Fourth gen cephalosporin: covers pseudomonas
78
How is insulin cleared?
Renally
79
With sinusitis, what do you ask about?
Pain, pressure, duration
80
How do you tell this difference between bacterial and viral uri?
If it's been over ten days and it hasn't gone away it's probably bacterial, give abx
81
Immediate management of acute coronary syndrome
Aspirin, ecg, lab draw for troponins
82
Benefit of aspirin in pts with acute coronary syndrome
Reduces risk of mi in unstable angina, prevents platelet aggregation thus reducing mortality in pts with an mi
83
Mechanism of sublingual nitroglycerin
It's a vasodilator used to alleviate chest pain
84
What associated sx should you ask about in suspected acute coronary syndrome
Nausea, diaphoresis, sob, fatigue and malaise in days preceding
85
Mechanism of angina
Imbalance between myocardial oxygen supply and demand related to atherosclerotic plaque
86
Difference between stable and unstable angina
Unstable is when chest pain occurs at rest not just with exertion
87
What is unstable angina caused by
Unstable plaque that has ruptured and caused a non occlusive thrombus
88
Treatment of unstable angina
Sublingual nitroglycerin, beta blockers, aspirin, heparin, angiography with percutaneous coronary intervention, statins
89
Inferior mi is associated with what coronary artery lesion
RCA
90
Anterior infarcts are associated with what coronary artery lesion
Lad
91
Lateral infarcts are associated with what coronary artery occlusions
Left circumflex
92
Crackles and s3 are signs of
Elevated left heart pressures
93
S3 heart sound is caused by
Large amount of blood striking a very compliant left ventricle. Often but not necessarily a sign of systolic heart failure.
94
S1 represents
Shutting of tricuspid and mitral valves
95
S2 represents
Shutting of aortic and pulmonic valves after heart is done squeezing
96
Use CBC to check for
Blood counts e.g. Anemia
97
Use a bmp to check for
Electrolyte abnormalities and renal function, including signs of volume depletion
98
Bnp had a high negative predictive value for diagnosis of
Heart failure
99
How to tell difference between systolic and diastolic heart failure
Systolic: signs and sx of hf and reduced left ventricular ejection fraction
Diastolic: signs and sx of hf with preserved lvef and a nondilated lv chamber
100
Spironolactone is a ___ blocker
Aldosterone
101
Hydralazine reduces ___
Afterload
102
Htn plus hypokalemia, think
Hyperaldosteronism
103
If you suspect hyperaldosteronism what do you do
Measure plasma renin activity and aldosterone concentration
104
What is secreted in acromegaly to cause its clinical manifestations ?
Insulin like growth factor 1 (stimulated by growth hormone)
105
Side effect of thionamide drugs for hyperthyroid (methimazole, propylthiouracil)
Agranulocytosis
| Propylthiouracil can also cause hepatic failure
106
Radioiodine ablation can cause what side effects
Permanent hypothyroidism, worsening of opthalmopathy
107
Osteomalacia is due to
Defective mineralization of organic bone matrix (impaired osteoid matrix mineralization)
108
Left shift means
There are a high number of young immature wbcs present (usually indicating infection or inflammation)
109
Right shift means
Lack of immature (young) neutrophils...suppression of bone marrow activity
110
Oral estrogen supplementation ___ need for levothyroxine in hypothyroid pts
Increases. Estrogen increases level of thyroxine binding globulin
111
Hypothyroidism can cause what metabolic abnormalities
Hyperlipidemia, hyponatremia, asymptomatic increases in creatinine kinase
112
Can hyperthyroidism cause proximal muscle weakness?
Yes
113
Dx h pylori
Stool test>urease breath test
114
Etiology of ulcers
NSAIDs, h pylori, etoh, burns (curling), smoking, stress, head injury (Cushing), ze syndrome (gastrinoma)
115
Triple therapy treatment for ulcers
Clarithromycin + omeprazole + metronidazole or ampicillin
116
How do you treat toxic adenoma
Radioactive iodine if under 2cm, lobectomy if over 2cm
117
Etiology of t1dm
Autoimmune destruction of B cells leading to lack of insulin
118
Pancoast tumors can be associated with what syndrome
Horner syndrome (ipsilateral ptosis, miosis, etc)
119
Involvement of what nerve roots cause weakness/atrophy of hand muscles in pancoast tumors
C8-t2
120
emphysema is associated with what dlco?
Low due to alveolar destruction
121
Chronic bronchitis is associated with what dlco?
Normal
122
Asthma is associated with what dlco?
Normal or high
123
Positive bronchodilator response plus sx of wheezing, dyspnea and cough =
Asthma
124
What lab do you see in hypovolemia
Decreased urine sodium
125
Discordant blood pressure with higher pressure in the arms, think
Coarctation of the aorta
126
Depth of S wave in v1 or v2 plus the height v5 or v6 is >35mm, indicates
Lvh
127
Most common side effects of ace inhibitors
Cough and hyperkalemia
128
Mech of thiazides
Blocks sodium reabsorption in the dct
129
What findings on eye exam indicate hypertensive emergency
Papilledema and hemorrhage
130
Exopthalmos in Graves' disease is due to
Orbital tissue expansion
131
Small fiber injury in diabetes patient causes what symptoms?
Positive symptoms: pain, paresthesias, allodynia
132
Large fiber injury in diabetes patient causes what symptoms?
Negative symptoms: numbness, loss of proprioception and vibration sense, diminished ankle reflexes
133
Normal lvef
55-70%
134
Reduced lvef is suggestive of what kind of chf
Systolic
135
In diastolic hf, lvef will be
Normal
136
Side effect of spironolactone
Hyperkalemia
137
Increased cardiogenic edema is due to
Increases hydrostatic pressure due to increased backup
138
Pt presents with worsening fatigue, dyspnea, and a hx of untreated strep infection and longstanding murmur, think
Mitral valve stenosis
139
Pt with severe dyspnea, sob, longstanding hx of uncontrolled htn , think
Diastolic hf
140
Pt is a few days post mi and suddenly has severe dyspnea, pink frothy sputum, and new systolic murmur, think
Papillary muscle rupture
141
Pt is very tachycardic, presents with anxiety, chest pain, and sob and has ekg that shows wide qrs complexes with no discernible p or t waves , think
Ventricular tachycardia
142
Abcde of cxr
Apices, bones, cardiac shadow, diaphragm, edge of image
143
What scoring system do you use for stroke?
Chads 2: chf, htn, age, dm, stroke hx
144
What are bundle branch blocks? Do you treat them?
Block in bundle of his (usually due to ischemia) which interferes with the ventricular conduction pattern. Don’t treat unless symptomatic
145
What is premature ventricular contraction?
Something In ventricle causing it to contract. Isolated, not repetitive, events
146
Risk factors for premature ventricular contraction
Mi, digoxin tox, drugs
147
If pt is hemodynamically unstable with premature ventricular contractions, treat with
Iv amiodarone
148
What is sinus tachycardia?
Heart rate over 100 but otherwise normal sinus rhythm
149
What is d dimer
Fibrin degradation product in blood after blood clot is degraded by fibrinolysis
150
Mechanism of beta blockers
Decreases myocardial contractility and heart rate
151
Mechanism of nondihydropyridine ccbs
Decreases myocardial contractility and heart rate
| Verapamil and dilt
152
Mechanism of dihydropyridine ccbs
Coronary artery vasodilation and decreases afterload by systemic vasodilation
153
Electrical alternans is a pathognomic finding on ecg for
Pericardial effusion
154
Electrical alternans with sinus tachy is highly specific but not very sensitive for
Pericardial effusion
155
Stable afib patients get what treatment
Beta blockers, diltiazem, digoxin
156
How to treat beta blocker overdose (diffuse wheezing, bradycardia, hypotension)
Glucagon
157
Heart failure exacerbation treatment
Ace inhibitor (or arb), b blocker (not acutely), statin, spironolactone
158
What is the heart murmur of mitral stenosis
Mid diastolic murmur and opening snap
159
Development of av block in pt with infective endocarditis should raise suspicion for
Perivalvular abscess
160
Murmur of tricuspid endocarditis: describe
Holosystolic murmur accentuated by inspiration
161
Orthostatic hypotension in an old person is due to
Loss of baroreceptor sensitivity
Also arterial stiffness, decreases norepinephrine at nerve endings, and reduced myocardial sensitivity to sympathetic stimulation
162
What meds do you stop at least 48 hours before stress testing
Bblockers, ccbs, nitrates
163
Special quality of versed
Induces amnesia
164
Why can massive transfusions cause hypocalcemia?
Packed rbcs have citrate in them, which can chelate calcium
165
Chronic co toxicity is a cause of secondary ___?
Polycythemia
166
Pica is a symptom of what anemia?
Iron deficiency anemia
167
Anemia of lymphoproliferative disorders is due to
Bone marrow infiltration with cancerous cells
168
Photosensitive rash and symmetric oligoarthritis in a young woman suggests
Sle
169
Thrombosis and a hx of miscarriages in a woman with suspected sle suggest
Antiphospholipid syndrome
170
How are encapsulated organisms eliminated from body?
They resist phagocytosis, so are eliminated by the humoral immune response with antibody mediated phagocytosis (opsonization) and antibody mediated compliment activation
171
What is salvage therapy
A form of treatment for a disease when a standard treatment fails
172
For combined folic acid and vit b12 deficiency, replenishing folic acid without vit b12 leads to
Correction of megaloblastosis but leads to rapid progression of neuro sx
173
Causes of microcytic anemia
Iron def, anemia of chronic dz, thalassemia
174
What is haptoglobin
A serum protein that binds free hemoglobin and promotes its excretion
175
Pts with hereditary hemochromatosis have a 20x increased risk of what kind of cancer?
Hepatocellular
176
How do you dx dvt?
Compression ultrasonography
177
How do you treat hypercalcemia
Bisphosphonates
178
How do bisphosphonates work?
Inhibit the osteoclastic activity of the bone
179
What does kidney failure do to phosphorus levels?
Hyperphosphotemia due to inability of kidney to excrete dietary phosphorus
180
Hypocalcemia causes what ekg changes?
Shortened pr interval
Prolonged qt interval
181
What is etidronate sodium?
A bisphosphonate useful for reducing bone resorption in patients with bony metastasis
Good for chronic bone pain but not acute
182
Method to manage bone pain in patients with prostate cancer who have undergone orchiectomy
Radiation therapy
183
Bite cells and Heinz bodies are associated with
G6pd
184
Head and neck cancer is primarily what kind of cancer?
Squamous cell carcinoma
185
What cancer is associated with smudge cells and severe leukocytosis?
CLL
186
T9:22 cancer?
Cml
187
Increased reticulocyte counts suggest
Increased erythropoiesis
188
Main categories of acute kidney injury
Prerenal, infrarenal, post renal
189
Symptoms of hyperuremia
Metabolic acidosis, tachypnea, tremors, altered mental status
190
Maintenance rate of iv hydration
4321
4: first ten kg, give 4cc/hr
3: second ten kg, give 3cc/hr
2: third ten kg, give 2cc/hr
1: every additional kilo, give 1cc/hr
191
Abx can cause atn or ain. How dx?
See casts on UA
192
Tx of stable angina for symptoms? Mortality?
Symptoms:
Nitroglycerin, diltiazem, metoprolol
Mortality:
Metoprolol, aspirin, acei, statin
193
Is stenting helpful for symptoms or mortality or both in stable angina
Symptoms
194
Complications of stemi anterior
Vtach, decompensated hf causing sob
195
Use what with caution in stemi (inferior)
Use nitrates with caution because venodilation is going to affect preload
Also b blockers
196
Wide qrs often means
Bbb
197
New lbbb equals a
Stemi
198
St elevation in all the leads and possibly pr depression is
Pericarditis
199
What is the tx for dressler syndrome pericarditis
Aspirin
200
St depressions May be sign of
Nstemi
| Not all of the wall infarcts, just part of it
201
Only diff between stemi and unstable angina is
Troponins
202
How to tx acs
Mona bs
Morphine
Oxygen
Nitroglycerin* only if not hypotension or r sided infarct
Aspirin
Beta blocker * only if he isn’t already hypotensive
Statin
203
Why wouldn’t you give plavix in acs management
You might have to give the pt a cabg soon
204
Contraindications to using nitrates
R sided infarct, hypotension, pde inhibitor (sildenafil)
205
When do you use thrombolytics in a stemi pt
When you can’t get to a catch lab in less than 90min
206
Do you get cathed with a stemi
Yes
207
Do you get cathed with a nstemi
When med management isn’t working, or really high risk, or arrythmia, or elevated trops
208
Svt is a reentry loop in the ___. You might see retrograde __waves.
Av node; p wave
209
Psvt tx
Valsalva, shock, ablate
B blockers prophylaxis
210
Tx of acute afib (hemodynamically unstable)
cardiovert but know they might have a clot
Could maybe do transesophageal echo to check for clot
211
Stable afib rate control
B blocker or digoxin
212
Rate control vs Rhythm control in a young afib pt?
Rhythm (amiodarone)
213
Afib stroke prevention scoring system?
Use chads2 or chads2 vasc
214
Chads2 score of zero tx?
None
215
Chads2 score of one tx?
Aspirin or anticoagulant
216
Chads2 score of two tx?
Anticoagulant (warfardin or dabigatron/apixaban)
217
When looking at a tachyarythmia what’s the first thing you think about
Wide or narrow
218
Wide tachyarythmia-what are the kinds
Vtach, vfib, torsades
219
Tx vtach?
Shock them
220
What kind of murmur?
| Blowing diastolic murmur at l sternal border with wide pulse pressure
Aortic regurg
221
What are the chf meds that improve mortality
Spironolactone, ace/arbs, b blocker, for Black pts hydralazine/isosorbide
222
Clopidogrel (plavix) blocks what receptor? What is it’s mech of a?
P2y12 receptor
Inhibits activation of platelets and eventual cross linking of fibrin
223
In addition to aspirin, beta blocker, statin, and acei, what med should be used in nstemi?
Clopidogrel or another p2y12 receptor blocker
224
Mech of a of aspirin
Irreversible cox inhibitor-blocks formation of thromboxane a2 in platelets producing inhibitory effect on platelet aggregation
225
Decreased cardiac output in heart failure patients leads to activation of the __ system and thus __
Raas; increased atII levels leading to vasoconstriction of efferent glomerular arterioles
226
When do you use unsynchronized cardioversion (defibrillation)?
In resuscitation efforts in pts with pulseless cardiac arrest who have shockable rhythm (vfib, pulseless vtach)
227
Side effect of dihydropyridine ca channel antagonists like amlodipine
Peripheral edema
228
Symmetric edema without skin changes or varicosities argues for or against venous insufficiency?
Against
229
X-ray findings of thoracic aortic aneurysm
Tracheal deviation, widened mediastinum, widened aorta
230
Cardiac sarcoidosis is a dz of ___ infiltration into the myocardium
Nomcaseating granuloma
231
Aortic regurg presents with what murmur?
Early diastolic
232
Systolic diastolic abdominal bruit has high specificity for presence of
Renovascular hypertension
233
Symptomatic sinus bradycardia should be treated initially with
Iv atropine
234
What do you ask to take a htn hx?
```
Home bp readings
Salt intake
Alcohol intake
Exercise
Meds
```
235
Workup of htn
Ekg (lvh)
UA (proteinuria-will tell you whether esrd is present)
BMP (ckd, baseline cr, k)
236
What are first line for garden variety htn?
Aces, ca channel blockers, thiazides diuretics
NOT bblockers
237
Side effects of the pines (ca channel blockers)
Le edema, constipation
238
Side effects of thiazide diuretics
Hypokalemia, hyponatremia, gout flares
239
What is cor pulmonale
Impaired function of the right ventricle caused by pulm htn that occurs due to underlying diseases of the lung (copd), pulm vasculature Or osa
240
Constrictive pericarditis is a potential late complication of
Radiation therapy
241
Constrictive pericarditis occurs as a result of
Scarring and subsequent loss of normal elasticity of the pericardial sac
242
What is pulsus paradoxus
Abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration
243
Class I antiarrhythmic drugs block
Sodium channels, inhibiting initial depolarization channels
244
What are the class Ic antiarrhythmics
Flecanide and propafenone
245
Use dependence, aka widening of the qrs complex in faster heart rates, can be due to what drugs?
Class Ic antiarrhythmics (flecanide)
246
Imaging modality for abdominal aortic aneurysm
Ultrasound
247
Stemi in a pt with a recent drug eluting stent is likely due to
Medication noncompliance (premature discontinuation of antiplatelet therapy)
248
What drugs when used with digoxin causes digoxin tox
Amiodarone, verapamil, propafenone
249
What should you use within 90min of stemi
Percutaneous intervention (pci) to restore coronary blood flow
250
6 ps of acute arterial occlusion
```
Pain
Pallor
Poikilothermia (cool extremity)
Paresthesia
Pulselessness
Paralysis
```
251
Pts with acute arterial occlusions leading to immediately threatened limb should be started on
Heparin
252
Can hyperthyroidism cause new onset afib
Yes
253
What testing should you perform on a pt newly diagnosed with htn
UA for occult hematuria and urine protein/creatinine ratio
Chemistry panel
Lipid profile
Baseline ecg
254
Are diastolic and continuous murmurs usually due to pathological cause?
Yup
255
What is supravalvular aortic stenosis
Second most common type of as
Congenital lv outflow tract obstruction due to narrowing of ascending aorta
256
Pe findings of supravalvular aortic stenosis
Systolic murmur best heard at first right intercostal space, higher than normal as; unequal carotid pulses; differential bp in upper extremities; palpable thrill in suprasternal notch; may develop coronary artery stenosis
257
Acute limb ischemia after MI suggests
Possible arterial embolus from left ventricular thrombus
258
Side effect of niacin
Cutaneous flushing and pruritus due to prostaglandin induced peripheral vasodilation
259
Initial tx of hcm
Beta blockers
260
Lab findings with a cholesterol embolism
Elevated serum creatinine, eosinophilia, hypocomplementemia
261
Most common causes of positive hepatojugular reflux
Constrictive pericarditis
Rv infarction
Restrictive cardiomyopathy
262
Tx of afib + hyperthyroidism
B blocker
| Controls hr and hyperadrenergic sx, also decreases conversion of t4 to t3 in peripheral tissues
263
Progressive dyspnea on exertion, fatigue and exertional syncope are suggestive of ___ obstruction
Outflow
264
Delayed and diminished carotid pulse (pulsus parvus and tardus), soft second heart sound, and murmur, are suggestive of severe ___
As
265
Exertional syncope usually portends to what pathological causes?
Ventricular arrythmias and outflow obstruction
266
Fourth heart sound is due to
Blood is forced into a stiff ventricle
267
Causes of fourth heart sound?
Ventricular hypertrophy (as, hocm) and also during the acute phase of MI due to ischemia
268
Displaced apical impulse, holosystolic murmur and third heart sound are consistent with severe
Mitral regurg
269
What is the most common cause of chronic MR in developed countries
Mitral valve prolapse
270
Pathophys of mvp
Myxomatous degeneration of mitral valve leaflets and chordae causing a mid systolic click
271
Why do you get hyponatremia in heart failure?
Body senses low cardiac output and secretes adh. Adh promotes water reabsorption which leads to dilutional hyponatremia
272
Treatment of stable vtach
Iv amiodarone
273
Lung and heart major side effects of amiodarone
Chronic interstitial pneumonitis that can cause ards, torsades
274
Ocular side effects of amiodarone
Corneal microdeposits, optic neuropathy
275
Dermatological side effects of amiodarone
Blue gray skin discoloration
276
What is becks triad
Becks triad of cardiac tamponade: hypotension, distended neck veins, muffled heart sounds
Pulsus paradoxus is also a common finding
277
Why is there decreased stroke volume and cardiac output in cardiac tamponade
Decreased ventricular preload
278
Bun>60 and pericarditis-etiology?
Uremic pericarditis
279
Most effective treatment for uremic pericarditis
Dialysis
280
Tx for pts with viral or idiopathic pericarditis
NSAIDs, colchicine
281
What is more specific for chf, third heart sound or peripheral edema?
S3
282
In pts with manifestations of chf, ecg findings of concentric lv hypertrophy and non dilated lv cavity, in absence of htn, suspect
Restrictive cardiomyopathy esp due to cardiac amyloidosis
283
Restrictive cardiomyopathy (r hf sx), proteinuria, waxy skin, anemia, easy bruising, neuropathy may be signs of
Amyloidosis
284
Tx for vfib
Defibrillation
285
Define cardioversion
Any process that aims to convert an arrhythmia back to sinus rhythm
286
___ is a common trigger for bronchoconstriction in pts with asthma, especially those with concurrent rhinitis and nasal polyps
Aspirin
| Also nonselective B.Blockers (propranolol)
287
Can cardiac myxoma cause fever, wt loss, and raynauds
Yes
288
What is pulseless electrical activity? How to tx?
Presence of organized rhythm on cardiac monitoring without a measurable bp or palpable pulse in cardiac arrest pt
Tx-cpr
289
Mitral valve abnormality in hocm pts?
Abnormal mitral leaflet motion
290
Do pts in septic shock have decreased preload or afterload
Both
291
Why do septic shock pts have elevated mixed venous oxygen?
Increased cardiac output in response to reduced svr to maintain peripheral tissue perfusion with inability of tissues to adequately extract oxygen
292
What are the most frequent location of ectopic Foci that cause afib?
Pulmonary veins
293
Bounding pulses are associated with what murmur?
Aortic regurg
294
Pulsus parvus and tardus is associated with what murmur?
Aortic stenosis
295
Tx for chronic venous insufficiency?
Frequent leg elevation and compression therapy and exercise
296
Genetic inheritance in hocm
Autosomal dominant
297
Side effect of amoxicillin
Rash
298
Major complication of gas
Pign
299
With an esr over 100 in an older woman, what are the three things it could be
Vasculitis (temporal arteritis), endocarditis, malignancy
300
Temporal arteritis goes hand and hand with what diagnosis?
Pmr
301
Levaquin is what kind of antibiotic?
Fluoroquinolone
302
Side effect of fluoroquinolones
Tendon rupture, diarrhea
303
Notching of third to eighth ribs in the back may be due to what cardiac cause?
Coarctation of the aorta
304
What arrythmia is associated with digitalis toxicity?
Atrial tachycardia with av block
305
Can fluconazole and moxifloxacin give you qt prolongation
Yes
306
Treatment of torsades
Mag sulfate for stable pts; defibrillation for unstable pts
307
Can asthma/copd cause pulsus paradoxus
Yes
308
Can aortic regurg cause pulsus paradoxus
No it prevents it
309
Define bronchiectasis
Abnormal permanent airway dilation.
310
Non massive hemoptysis work up
Hpi, cxr, labs=chem panel, coags, ua
311
What four questions should you ask in non massive hemoptysis work up?
Age <40?
Non smoker?
Neg cxr?
<1 wk hemoptysis?
If reassuring answers you can send Home
312
With chronic dyspnea what should you order?
Pfts
313
Increased tlc means
Hyperinflation
314
Increased residual volume means
Air trapping
315
If flow vol loop looks like a squashed oval, what does it mean?
Obstruction in the upper airway
316
Most likely causes of cough for under three weeks
Viral/bacterial URI
| Post infectious
317
Most likely causes of cough for 3-8 weeks
Post infectious
| Pertussis
318
Most likely causes of cough for over eight weeks
Upper airway cough syndrome
Asthma
GERD
Get cxr
319
Define platypnea
Dyspnea worse in upright than supine position
320
Acute dyspnea work up
```
Pulse ox
CBC
Chem 7
Abg
Bnp
Cxr
Ecg
```
321
Differential of dyspnea in a young patient
Asthma
Deconditioning
Paradoxical vocal cord motion
Psych disorder
322
Diff dx of orthopnea
Hf, diaphragmatic paralysis, asthma, sleep apnea, obesity
323
Diff dx of platypnea
Intrapulmonary shunt (avm)
Intracardiac shunt
Hepatopulm syndrome
324
Chronic dyspnea workup
Cxr
Pulse ox
Spirometry
Cardiopulm exercise testing
325
Leading causes for transudative pleural fluid
```
HF
Hepatic hydrothorax
Atelectasis
Nephrotic syndrome
Hypoalbuminemia
```
326
What is levofloxacin?
Also levaquin
| A fluroquinolone
327
Tx of cap outpt
In previously healthy pt, macrolide or doxy
In comorbid pt, fluroquinolone (not cipro) or b-lactam + macrolide
328
Do cap pts have rhinorrhea or sore throat?
No
329
Tx of cap inpt (not icu)
In comorbid pt, fluroquinolone (not cipro) or b-lactam + macrolide
330
Cxr of idiopathic pulm fibrosis
Reticular opacities, opacities have a basilar predominance
331
Describe alveolar opacities
More white than black
Opacities are “fluffy” like cotton wool
Opacities obscure underlying structures
332
Describe interstitial opacities
More black than white (alveoli are open)
| Reticular appearance
333
Ideal scan for pe
Ct pulm angio
334
Ideal scan for aortic dissection
Ct aortic dissection protocol
335
Ideal scan for mediastinum, pleural space, questionable malignancy
Plain contrast ct
336
Ideal scan for lung parenchyma (interstitial diseases)
Non contrast ct
337
On us what color is fluid
Black
338
Exudative pleural fluid means
Inflammation, infection
339
Serum LDH ratio in exudate
>0.6
340
Dx of active tb
Afb smears of sputum
341
Se of isoniazid
Peripheral neuropathy (prevent with pyroxidine), and hepatitis
342
Se of rifampin
Hepatits, high drug interactions with haart, ocp, warfarin
343
Se of pyrazinamide
Hepatotox
| Hyperurecemia
344
Se of ethambutol
Optic neuritis
345
Criteria for dx of pulm htn
Mean pa pressure >25mmhg at rest
346
How to describe visual sx in temporal arteritis
Window shade blinders
347
What does bile do
Emulsifies fats
348
Cough lasting >5 days to 3 weeks with no fever or chills, but with wheezing or ronchi and chest wall tenderness
Acute bronchitis
349
Can you have small amounts of hemoptysis in acute bronchitis
Yes
350
Tx for acute bronchitis
Generally symptomatic only
351
Most common three causes of secondary nail clubbing
Lung malignancies
Cystic fibrosis
Right to left cardiac shunts
352
Is hypoxemia in copd (in absence of malignancy) associated with clubbing?
No
353
Tx of anaphylaxis
Epinephrine
354
How do you dx upper airway cough syndrome
Elimination of nasal discharge and cough with h1 histamine receptor antagonists (chlorpheniramine)
355
Pts with asthma exacerbation usually have respiratory ____ with a ___ paco2
Alkalosis; low due to hyperventilation
356
Normal or elevated paco2 in acute asthma exacerbation is concerning for
respiratory failure
357
Suspect what kind of lung cancer in a pt with significant smoking hx, hypercalcemia and a hilar mass
Squamous cell carcinoma
358
Atelectasis causes respiratory ___
Alkalosis due to compensatory tachypnea
359
PE and pleural effusion cause respiratory ___
Alkalosis due to compensatory tachypnea
360
Hypoventilation is associated with a ___ aa gradient and respiratory ___
Normal; acidosis
361
Dry cough and malaise for two months with bilateral hilar adenopathy is suggestive of
Sarcoidosis (noncaseating granulomatous inflammation)
362
Are breath sounds increased in consolidation? How about in pleural effusion?
Yes; no
363
In pulmonary fibrosis, you have ___ lung volumes, ___ fev1, ___dlco, and ___ aa gradient
Decreased
Normal or increased
Decreased
Increased
364
Lifespan of platelets
One week
365
How long does aspirin last
Forever it’s irreversible
366
Left atrial pressure equals what pressure?
Lv end diastolic pressure
367
Fick equation
Cardiac output=(oxygen consumption)/(arteriovenous oxygen difference)
368
Mammary artery
Also internal Thoracic artery. Branches off subclavian and goes down inside of rib cage.
369
Bivalirudin (angiomax)-what is it
Direct thrombin inhibitor
| Reversible
370
Bivalirudin (angiomax)-when is it used?
Used as an anticoagulant during coronary angioplasty or pci
Or for pts with hit syndrome
