MKSAP questions 1 Flashcards
What is cause of stable angina?
Due to fixed atherosclerotic lesion that narrows major coronary artery = > imbalance btwn O2 in blood & need of tissue
What is worst rx fx for stable angina?
DM, other risk fx include htn, hld, smoking
Sx of stable angina?
substernal chest pain x 10-15 minutes, pain w/ activity, relieved w/ rest/nitrates
What is LDL goal in patient w/ CAD?
Ideally LDL < 100 (probably will change soon)
If ST segment or T wave chngs px w/ pain?
tx as unstable angina/ MI
How does stress test work?
Do ECG before, during, and after exercise
What is + finding on stress test?
Ischemia px w/ ST depression, also + if si/sx of heart failure, ventric arrythmia.
Do what after + stress test?
Do cardiac cath
How does dipyramidal thallium work?
Dipyramidal causes dilation of coronary vessels. obstrctd vessels already max dilated. coronary steal occurs, ischemia occurs in obstructed area
What compensations occur w/ anemia?
get incrsd CO, extraction ration, plasma volume. also Rward shift w/ incr 2,3-DPG
Si/Sx of anemia?
HA, fatigue, poor concentration, nausea, ab discomfort, pallor, hypotension, tachy
What should be assess if anemia is px?
Determine retic count, if nl then know have bone marrow response
What is ffp and when given?
contains all clotting factors w/ no RBCs/WBCs. Given if elevated PT/PTT, coagulopathy, or clotting fx deficiency
What is cryoprecip and when given?
contains VIII and fibrinogen. For hemophillia A, vWD, DIC (dcrsd fibrinogen)
What does retic >2% mean? <2%?
excessive RBC dstrxn if >2%, if <2%, then adequate response by marrow.
Causes of microcytic anemia?
iron deficiency, ACD, thalassemia, ring sideroblastic anemia
What is ringed sideroblastic anemia?
due to defective protoporphyrin synth, get buildup of iron in mitochondria.
When does ringed sideroblastic anemia occur?
lead poisoning, pyridoxine deficiency, excessive ETOH
Causes of normocytic anemia?
aplastic anemia, bone marrow fibrosis, tumor, renal failure, ACD
Most common cause of anemia in adults?
chronic blood loss.
What is RDW and when abnormal?
Measures variation in RBC size, abnml in Fe deficiency but not others
When is percutaneous intervention (cath lab) most effective for MI?
if tx w/in 12 hours of onset of chest pain
What are contraindications to thrombolytics?
prior hemorrhagic stroke, ischemic stroke w/in 3 mo, suspected aortic dissection, active bleeding
What is seen on ECG w/ acute pericarditis?
See diffuse ST elevation w/ depression of PR segment
What is preferred form of tx of MI?
best to do PCI over thrombolysis
Si/sx of aortic dissection?
tearing back pain, unequal blood pressures, widened mediastinum on CXR
What is common finding w/ ischemic HD?
substernal chest pain associated w/ exercise and relief w/ rest
How tx R heart MI?
tx w/ volume expansion w/ fluids, if this fails tx w/ ionotrope like dobutamine
What is classic triad of R sided MI?
hypotension, clear lung fields, incrsd CVP
What is lyme carditis?
development of acute onset high grade AV cndxn defect that may be assoc w/ myocarditis
What is primary AV block?
PR segment >0.20 secs
What is secondary AV block?
type 1, progressively elongate until 1 p wave is dropped, type 2, every second, third, or fourth, etc P wave is dropped.
What can progress to 3rd degree AV block?
mobitz type 2
What is mobitz type 2 associated w/?
bundle branch block, bifascicular or trifascicular block
What is goal of beta blocker tx in CAD?
restin HR <60 and nl limits of BP
Si/sx of P.E.?
pleuritic chest pain, dyspnea, SHOB, asymmetric leg edema, incrsd CVP, tachy
When should adenosine stress test not be used?
if patient has bronchospastic problem such as asthma
What is vtach?
vent rate > 100 w/ widened QRS (qrs > 0.12)
ECG findings w/ WPW?
widened QRS, shortened PR interval, presence of delta wave
What does Q wave signify?
old xmural infarct 2-48 hrs old at least. Meaningless if leads III, V5, or V6 solely.
When does pappilary muscle rupture occur?
a couple days following MI?
How does papillary muscle rupture px?
New holosystolic murmur & resp distress several days after MI
When OK to xfer to OSH for PCI?
if door to needle in 60 min
Si/sx of RV infarction?
hypotension, JVD
What is sick sinus snydrome?
symptomatic SA node dysfxn
Si/Sx of SA node dysfxn?
sinus arrest, sinus exit block, sinus brady, may also have afib/ aflut
What is commonly used drug that causes heart blog?
donepezil can cause heart block due to cholinergic side effects.
Wen electrical cardioversion indicated?
unstable pts w/ arryhtmia other than sinus tach
How tx afib?
always metoprolol
When use implantable cardioverter- defib?
any VT esp if 2/2 to prior MI, must be unstable pt before will consider ICD.
Si/sx ofl ong QT?
syncope, cardiac arrest due to long QT
How tx class IV hf?
tx w/ digoxin, an ionotrope for sx relief
What is peripartum cardiomyopathy?
EF <45% btwn 3-6 mo following delivery of baby
Si/Sx of HF?
exertional dyspnea, orthopnea, elevated JVD, crackles, S3&S4
How evaluate new onset HF?
do echo to determine if HF systolic or diastolic and whether any strxrl or fxnl abnormalities exist.
How tx systolic HF?
give beta blocks and ACE, can use amlodipine if uncontrolled angina or HTN
Additional medication for HF if continues to progress?
Add spironolactone, dont use if Cr> 2.5 inM or >2 in F or if K>5
Si/sx of aortic regurg?
pistol shot sound over periph arteries, head bobs w/ each beat, systolic and diastolic murmur over femoral A
Si/Sx of MVP?
midsystolic click w/ late apical systolic murmur
Si/sx of coarctation of aorta in adult?
htn + continu or late systolic murmur, dcrs pulses distally
What is alternative tx for syphillis if allergy to penicillin?
14 day doxy tx.
What vaccinations needed in pt w/ liver disease?
influ, HAV, HBV, tdap, penumovax
What is de Quervans tenosynovitis?
affects new mothers who hold infants w/ thumb outstretched, due to inflamm of abductor pollicus longus and extensor pollicus brevis,
Px of de Quervans tenosynovitis?
tenderness of thenar prominence and + finkelstein test
What is trigger thumb?
locking of thumb in flexion
What is si/sx of flexor carpii radialis tenosynovitis?
results in pain w/ radial flexion of wrist and point tenderness over trapezium.
What is loop diuretic effects on lytes?
hypokalemia, alkalsosis due to Incrsd H+ excretion
What are less common cause of acute pancreatitis?
high tg, hypercalcemia, recent ERCP, trauma, infxn, certain medications
Cause of hypocalcemia in chronic alcohlic w/ recurrent ETOH use?
Vit D deficiency due to malabsorption or pancreatic necrosis - panc enzymes released, saponification of fats occurs, leads to Ca deposition and dcrsd Ca.
What is signif side effect of ACE inhibitors?
ANGIOEDEMA
What is pseudotumor cerebri?
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.
How tx uric acid stone?
hydration, alkalinize urine w/ K+ citrate, low purine diet w/ or w/out allopurinol
What is suggestive of R sided HF?
elevated JVD, periph edema, HSM, ascites, no pulmo congetion
What is cor pulmonale
R sided HF due to pulmonary disease. Most often due to COPD.
What is matching?
statistic tool use to control for confounding by comparing groups of people w/ disease to people w.out that are very similar.
How tx asx SIADH?
water restriction.
Findings w/ SIADH?
low plasma osmolality, w/ elevated urine osmol and elevated urine Na
How tx svr SIADH?
hypertonic saline, do not incrs Na >8meq/24hr or >0.5meq/hr
What are eruptive xanthomas?
yellow-red papules on arms and shoulders
How know secondary hyperaldo?
incrsd renin, incrsd aldo, due to renin secreting tumor producing malignant htn
How know primary hyperaldo?
incrsd aldo, dcrsd renin, aldo producing tumor or bilateral adrenal hyperplasia
What causes angioedema w/ ace inhibitors?
proinflamm action of excessive kinin
Si/sx of paget’s disease?
usually asx, can px w/ incrsd alk phos w/ nl calcium. Due to excessive activation of osteoclasts
Common problem following gastrectomy?
B12 deficiency due to lack of intrinsic factor. Px w/ megaloblastic, macrocytic anemia, impaired DNA synth is the cause
Causes of B12 deficiency?
pernicious anemia (lack of intrinsic fx), gastrectomy, poor diet, crohns, ileal rsxn
Si/sx of B12 deficiency?
anemia, sore tongue (stomatitis, glossitis), neuropathy, urinary and fecal incontinence 2/2 to neuropathy and dementia
Blood smear w/ B12 deficiency, blood levels?
MCV>100, hypersex neutros, incrsd methylmalonic acid and homocystein
Test for B12 deficiency?
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.
Causes of folate deficiency?
Poor PO intake w/ odd diets, ETOH use, long term ABX use, incrsd demand, prego, hemolysis, folate antag (MTX)
How differentiate folate defic from B12?
folate deficiency does not present w/ neuro deficits like B12
Lab tests in hemolytic anemia?
elevated retic count,. incrsd LDH, dcrsd haptoglobin, dcrsd H/H, may also have incrsd bili and jaundice
What do spherocytes/ helmet cells suggest?
suggest extravascular hemolysis. Can also see heinz bodies w/ G6PD defiency.
Genetics of sickle cell?
AR, need 2 mutations to get hgbS
Effect of SS on heart and lugns?
Can get high output CHF, incrsd risk for lung infxns and acute chest syndrom.
What correlates w/ survival in SS?
freq of vaso-occlusive crises correlate w/ survival
What is concern for ingestion of lye?
Get liquefactive necrosis of esophageal wall can lead to perf or mediastinitis. Needs endoscopy ASAP to determine extent of injury.
NL CSF findings?
protein < 40, gluc 40-70, 0-5 cells/mm3
Si/sx of coccidioidomycosis?
fvr, dry cough, fatigue, weight loss, pleuritic CP. skin findings incl erythema multiforme & erythema nodosum
CXR w/ invasive aspergillosis? CT
cavitary lesions, pulm nodules on CT w/ halo sign or lesions w/ an air crescent
What is amarosis fugax?
painless loss of of vision in eye due to emboli or other cause.
