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Uworld questions > MKSAP questions 1 > Flashcards

MKSAP questions 1 Flashcards

1
Q

What is cause of stable angina?

A

Due to fixed atherosclerotic lesion that narrows major coronary artery = > imbalance btwn O2 in blood & need of tissue

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2
Q

What is worst rx fx for stable angina?

A

DM, other risk fx include htn, hld, smoking

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3
Q

Sx of stable angina?

A

substernal chest pain x 10-15 minutes, pain w/ activity, relieved w/ rest/nitrates

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4
Q

What is LDL goal in patient w/ CAD?

A

Ideally LDL < 100 (probably will change soon)

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5
Q

If ST segment or T wave chngs px w/ pain?

A

tx as unstable angina/ MI

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6
Q

How does stress test work?

A

Do ECG before, during, and after exercise

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7
Q

What is + finding on stress test?

A

Ischemia px w/ ST depression, also + if si/sx of heart failure, ventric arrythmia.

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8
Q

Do what after + stress test?

A

Do cardiac cath

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9
Q

How does dipyramidal thallium work?

A

Dipyramidal causes dilation of coronary vessels. obstrctd vessels already max dilated. coronary steal occurs, ischemia occurs in obstructed area

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10
Q

What compensations occur w/ anemia?

A

get incrsd CO, extraction ration, plasma volume. also Rward shift w/ incr 2,3-DPG

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11
Q

Si/Sx of anemia?

A

HA, fatigue, poor concentration, nausea, ab discomfort, pallor, hypotension, tachy

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12
Q

What should be assess if anemia is px?

A

Determine retic count, if nl then know have bone marrow response

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13
Q

What is ffp and when given?

A

contains all clotting factors w/ no RBCs/WBCs. Given if elevated PT/PTT, coagulopathy, or clotting fx deficiency

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14
Q

What is cryoprecip and when given?

A

contains VIII and fibrinogen. For hemophillia A, vWD, DIC (dcrsd fibrinogen)

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15
Q

What does retic >2% mean? <2%?

A

excessive RBC dstrxn if >2%, if <2%, then adequate response by marrow.

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16
Q

Causes of microcytic anemia?

A

iron deficiency, ACD, thalassemia, ring sideroblastic anemia

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17
Q

What is ringed sideroblastic anemia?

A

due to defective protoporphyrin synth, get buildup of iron in mitochondria.

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18
Q

When does ringed sideroblastic anemia occur?

A

lead poisoning, pyridoxine deficiency, excessive ETOH

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19
Q

Causes of normocytic anemia?

A

aplastic anemia, bone marrow fibrosis, tumor, renal failure, ACD

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20
Q

Most common cause of anemia in adults?

A

chronic blood loss.

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21
Q

What is RDW and when abnormal?

A

Measures variation in RBC size, abnml in Fe deficiency but not others

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22
Q

When is percutaneous intervention (cath lab) most effective for MI?

A

if tx w/in 12 hours of onset of chest pain

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23
Q

What are contraindications to thrombolytics?

A

prior hemorrhagic stroke, ischemic stroke w/in 3 mo, suspected aortic dissection, active bleeding

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24
Q

What is seen on ECG w/ acute pericarditis?

A

See diffuse ST elevation w/ depression of PR segment

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25
Q

What is preferred form of tx of MI?

A

best to do PCI over thrombolysis

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26
Q

Si/sx of aortic dissection?

A

tearing back pain, unequal blood pressures, widened mediastinum on CXR

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27
Q

What is common finding w/ ischemic HD?

A

substernal chest pain associated w/ exercise and relief w/ rest

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28
Q

How tx R heart MI?

A

tx w/ volume expansion w/ fluids, if this fails tx w/ ionotrope like dobutamine

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29
Q

What is classic triad of R sided MI?

A

hypotension, clear lung fields, incrsd CVP

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30
Q

What is lyme carditis?

A

development of acute onset high grade AV cndxn defect that may be assoc w/ myocarditis

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31
Q

What is primary AV block?

A

PR segment >0.20 secs

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32
Q

What is secondary AV block?

A

type 1, progressively elongate until 1 p wave is dropped, type 2, every second, third, or fourth, etc P wave is dropped.

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33
Q

What can progress to 3rd degree AV block?

A

mobitz type 2

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34
Q

What is mobitz type 2 associated w/?

A

bundle branch block, bifascicular or trifascicular block

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35
Q

What is goal of beta blocker tx in CAD?

A

restin HR <60 and nl limits of BP

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36
Q

Si/sx of P.E.?

A

pleuritic chest pain, dyspnea, SHOB, asymmetric leg edema, incrsd CVP, tachy

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37
Q

When should adenosine stress test not be used?

A

if patient has bronchospastic problem such as asthma

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38
Q

What is vtach?

A

vent rate > 100 w/ widened QRS (qrs > 0.12)

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39
Q

ECG findings w/ WPW?

A

widened QRS, shortened PR interval, presence of delta wave

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40
Q

What does Q wave signify?

A

old xmural infarct 2-48 hrs old at least. Meaningless if leads III, V5, or V6 solely.

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41
Q

When does pappilary muscle rupture occur?

A

a couple days following MI?

42
Q

How does papillary muscle rupture px?

A

New holosystolic murmur & resp distress several days after MI

43
Q

When OK to xfer to OSH for PCI?

A

if door to needle in 60 min

44
Q

Si/sx of RV infarction?

A

hypotension, JVD

45
Q

What is sick sinus snydrome?

A

symptomatic SA node dysfxn

46
Q

Si/Sx of SA node dysfxn?

A

sinus arrest, sinus exit block, sinus brady, may also have afib/ aflut

47
Q

What is commonly used drug that causes heart blog?

A

donepezil can cause heart block due to cholinergic side effects.

48
Q

Wen electrical cardioversion indicated?

A

unstable pts w/ arryhtmia other than sinus tach

49
Q

How tx afib?

A

always metoprolol

50
Q

When use implantable cardioverter- defib?

A

any VT esp if 2/2 to prior MI, must be unstable pt before will consider ICD.

51
Q

Si/sx ofl ong QT?

A

syncope, cardiac arrest due to long QT

52
Q

How tx class IV hf?

A

tx w/ digoxin, an ionotrope for sx relief

53
Q

What is peripartum cardiomyopathy?

A

EF <45% btwn 3-6 mo following delivery of baby

54
Q

Si/Sx of HF?

A

exertional dyspnea, orthopnea, elevated JVD, crackles, S3&S4

55
Q

How evaluate new onset HF?

A

do echo to determine if HF systolic or diastolic and whether any strxrl or fxnl abnormalities exist.

56
Q

How tx systolic HF?

A

give beta blocks and ACE, can use amlodipine if uncontrolled angina or HTN

57
Q

Additional medication for HF if continues to progress?

A

Add spironolactone, dont use if Cr> 2.5 inM or >2 in F or if K>5

58
Q

Si/sx of aortic regurg?

A

pistol shot sound over periph arteries, head bobs w/ each beat, systolic and diastolic murmur over femoral A

59
Q

Si/Sx of MVP?

A

midsystolic click w/ late apical systolic murmur

60
Q

Si/sx of coarctation of aorta in adult?

A

htn + continu or late systolic murmur, dcrs pulses distally

61
Q

What is alternative tx for syphillis if allergy to penicillin?

A

14 day doxy tx.

62
Q

What vaccinations needed in pt w/ liver disease?

A

influ, HAV, HBV, tdap, penumovax

63
Q

What is de Quervans tenosynovitis?

A

affects new mothers who hold infants w/ thumb outstretched, due to inflamm of abductor pollicus longus and extensor pollicus brevis,

64
Q

Px of de Quervans tenosynovitis?

A

tenderness of thenar prominence and + finkelstein test

65
Q

What is trigger thumb?

A

locking of thumb in flexion

66
Q

What is si/sx of flexor carpii radialis tenosynovitis?

A

results in pain w/ radial flexion of wrist and point tenderness over trapezium.

67
Q

What is loop diuretic effects on lytes?

A

hypokalemia, alkalsosis due to Incrsd H+ excretion

68
Q

What are less common cause of acute pancreatitis?

A

high tg, hypercalcemia, recent ERCP, trauma, infxn, certain medications

69
Q

Cause of hypocalcemia in chronic alcohlic w/ recurrent ETOH use?

A

Vit D deficiency due to malabsorption or pancreatic necrosis - panc enzymes released, saponification of fats occurs, leads to Ca deposition and dcrsd Ca.

70
Q

What is signif side effect of ACE inhibitors?

A

ANGIOEDEMA

71
Q

What is pseudotumor cerebri?

A

idiopathic incrsd in ICP w/ no focal neuro signs, no evidence of cause w/ incrsd opening pressure. 1st tx w/ diavax which inhibits choroid plexus carbonic anhydrase.

72
Q

How tx uric acid stone?

A

hydration, alkalinize urine w/ K+ citrate, low purine diet w/ or w/out allopurinol

73
Q

What is suggestive of R sided HF?

A

elevated JVD, periph edema, HSM, ascites, no pulmo congetion

74
Q

What is cor pulmonale

A

R sided HF due to pulmonary disease. Most often due to COPD.

75
Q

What is matching?

A

statistic tool use to control for confounding by comparing groups of people w/ disease to people w.out that are very similar.

76
Q

How tx asx SIADH?

A

water restriction.

77
Q

Findings w/ SIADH?

A

low plasma osmolality, w/ elevated urine osmol and elevated urine Na

78
Q

How tx svr SIADH?

A

hypertonic saline, do not incrs Na >8meq/24hr or >0.5meq/hr

79
Q

What are eruptive xanthomas?

A

yellow-red papules on arms and shoulders

80
Q

How know secondary hyperaldo?

A

incrsd renin, incrsd aldo, due to renin secreting tumor producing malignant htn

81
Q

How know primary hyperaldo?

A

incrsd aldo, dcrsd renin, aldo producing tumor or bilateral adrenal hyperplasia

82
Q

What causes angioedema w/ ace inhibitors?

A

proinflamm action of excessive kinin

83
Q

Si/sx of paget’s disease?

A

usually asx, can px w/ incrsd alk phos w/ nl calcium. Due to excessive activation of osteoclasts

84
Q

Common problem following gastrectomy?

A

B12 deficiency due to lack of intrinsic factor. Px w/ megaloblastic, macrocytic anemia, impaired DNA synth is the cause

85
Q

Causes of B12 deficiency?

A

pernicious anemia (lack of intrinsic fx), gastrectomy, poor diet, crohns, ileal rsxn

86
Q

Si/sx of B12 deficiency?

A

anemia, sore tongue (stomatitis, glossitis), neuropathy, urinary and fecal incontinence 2/2 to neuropathy and dementia

87
Q

Blood smear w/ B12 deficiency, blood levels?

A

MCV>100, hypersex neutros, incrsd methylmalonic acid and homocystein

88
Q

Test for B12 deficiency?

A

Schilling test, Give IM dose unlabled B12, PO dose labeled B12, measure amount of each in urine and plasma. Repeate w/ addition of intrinsic fx.

89
Q

Causes of folate deficiency?

A

Poor PO intake w/ odd diets, ETOH use, long term ABX use, incrsd demand, prego, hemolysis, folate antag (MTX)

90
Q

How differentiate folate defic from B12?

A

folate deficiency does not present w/ neuro deficits like B12

91
Q

Lab tests in hemolytic anemia?

A

elevated retic count,. incrsd LDH, dcrsd haptoglobin, dcrsd H/H, may also have incrsd bili and jaundice

92
Q

What do spherocytes/ helmet cells suggest?

A

suggest extravascular hemolysis. Can also see heinz bodies w/ G6PD defiency.

93
Q

Genetics of sickle cell?

A

AR, need 2 mutations to get hgbS

94
Q

Effect of SS on heart and lugns?

A

Can get high output CHF, incrsd risk for lung infxns and acute chest syndrom.

95
Q

What correlates w/ survival in SS?

A

freq of vaso-occlusive crises correlate w/ survival

96
Q

What is concern for ingestion of lye?

A

Get liquefactive necrosis of esophageal wall can lead to perf or mediastinitis. Needs endoscopy ASAP to determine extent of injury.

97
Q

NL CSF findings?

A

protein < 40, gluc 40-70, 0-5 cells/mm3

98
Q

Si/sx of coccidioidomycosis?

A

fvr, dry cough, fatigue, weight loss, pleuritic CP. skin findings incl erythema multiforme & erythema nodosum

99
Q

CXR w/ invasive aspergillosis? CT

A

cavitary lesions, pulm nodules on CT w/ halo sign or lesions w/ an air crescent

100
Q

What is amarosis fugax?

A

painless loss of of vision in eye due to emboli or other cause.

Uworld questions (13 decks)

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