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Online med ed misc Flashcards

1
Q

Unstable angina vs NSTEMI vs STEMI

A

UA: no trops, no ST #
NSTEMI: trops, no ST #
STEMI: trops, ST #

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2
Q

If heart failure and EF < 35% but not class IV, give___

A

AICD

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3
Q

Progression of heart failure management

A

class I beta-blockers + ACE-i/ARB –> class II Loop diuretics –> class III Isosorbide dinitrate-hydralazine + spironolactone –> AICDif not class IV and EF <35%

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4
Q

Management of CHF exacerbation

A 
Lasix
Morphine
Nitrates
O2
Position
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5
Q

Potential causes of CHF exacerbation

A

MI

med/diet non-compliance

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6
Q

Pathologic murmurs (2)

A

systolic grade 3 or murmur
any diastolic murmur

Always get an ECHO

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7
Q

Mitral stenosis: auscultation findings

A

left atrial stretch and fluid in the lungs –> afib and or CHF sxs

Findings: rumbling diastolic murmur with an opening snap heard best at Apex

NOTE: often from rheumatic heart disease and occurs in younger people

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8
Q

Mitral stenosis: TX

A

Initial: balloon valvuloplasty (through left heart cath) as valve is not calcified as in other valvular d/os

late: replacement

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9
Q

Aortic regurgitation: auscultation findings

A

Aortic valve insufficiency –> left venticular dilation

Findings: rumbling diastolic murmur heard at base

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10
Q

Causes of aortic insuffiency

A

acute: aortic dissection, infection, and infarction

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11
Q

Presentation of aortic insufficiency

A

acute: cardiogenic shock, flash pulmonary edema, CP
chronic: CHF, CP

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12
Q

Aortic insufficiency: TX

A

replacement

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13
Q

Aortic stenosis: auscultation findings

A

left ventricular dilation –> CHF as seen also in aortic insufficiency

Findings: systolic murmur heard best at base in crescendo-decrescendo quality

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14
Q

Causes of AS

A

ATHEROSCLEROSIS

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15
Q

Mitral insufficiency: auscultation findings

A

left atrial dilation –> afib and CHF sxs

Findings: holosystolic murmur heard best at apex

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16
Q

Hypertrophic obstructive cardiomyopathy: auscultation findings

A

systolic murmur like AS, but more blood with physical exam maneuvers in heart makes better

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17
Q

SOB or syncope with exertion in a young athlete

A

HCOM

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18
Q

HOCM: TX

A

beta-blockade (want heart to be slow enough for long enough diastole)

AVOID decreases in pre-lod (dehydration, exercise)

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19
Q

Mitral valve prolapse: auscultation findings

A

Findings: systolic murmur heard at apex, better with physical exam maneuvers that increase preload (leg left and squatting)

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20
Q

MVP: TX

A

beta-blockade

avoid dehydration

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21
Q

Systolic vs diastolic HF

A

systolic: Echo shows dilated LV, caused by viruses, alcohol, pregnancy, ischemia, TX with beta-bloackade, ACE-is, and diuretics

Diastolic: Echo shows concentric LVH, caused by hypertension or material restriction from amyloid/sarcoid/hemochromatosis, TX with beta-blockade or CCBs (verapimil or dilt), avoidance of HTN and dyhydration

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22
Q

Diastolic HF with neuropathy =

A

amyloidosis

Dx: fat pad/gingiva bx

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23
Q

Diastolic HF with pulmonary disease =

A

sarcoid

Dx: cardiac MRI and endomyocardial bx

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24
Q

Diastolic HF with cirrhosis and bronze DM =

A

hemachromatosis

Dx: ferritin and genetic testing

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25
Types of causes of pericardial disease (4)
(1) infection (remember TB) (2) autoimmune (RA, dresslers, uremia) (3) trauma (penetrating and blunt, dissection) (4) cancer (breast, lung, lymphoma, esophageal)
26
Best TX for pericarditis
NSAIDs and colchicine NOTE: can use steroids, but this makes recurrence more likely
27
Best imaging modality for pericarditis
MRI NOTE: EKG used though
28
Findings on EKG for pericaditis
PRsegment depression and diffuse ST segment elevation
29
indications for statin therapy
vascular disease (MI, PVD, CAS) LDL > 190 LDL btw 70-189 + 40-75yo + DM LDL btw 70-189 + 40-75yo + high ASCVD
30
syncope considerations
``` W vasovagal Orthostatic hypotension Mechanical cardiac (can cause SCD) Arrythmogenic cardiac (can cause SCD) Neurologic Psych Electrolytes ```
31
High-intensity statins
atrovastatin 40 or 80 ruvastatin 20 or 40 DO NOT use with fibrates
32
Moderate-intensity statins
atorvastatin 10 or 20 ruvastatin 5 or 10 NOTE: also for people who need statins but contraindicated against high-intensity (GI upset, age > 75yo, liver or renal dysfxn, past myositis or hepatitis with high dose statin)
33
Causes of secondary HTN
Consider in pts < 35yo with HTN or those with refractory HTN ``` Hypercalcemia Hyperthyroid Hyperaldosteronism Aortic coarctation Renovascular Pheo Cushings OSA ```
34
Initial basic testing for patient diagnosed with HTN (4)
UA, CMP (need initial LFTs), lipid profile, baseline ECG
35
Aspirin + ____ improves survival in pts following NSTEMI
P2y12 receptor blocer (clopidogrel, prasugrel, or ticagrelor)
36
Aspirin + _____ for >12 months following drug-elating stent placement
P2y12 receptor blocer (clopidogrel, prasugrel, or ticagrelor)
37
Lytes criteria
LDH fluid > 2/3 ULN LDH fluid/serum >0.6 Total protein fluid/serum >0.5 Need any one to be exudate If all positve = transudate
38
Causes of exudate vs transudate
exudate: malignancy, PNA, TB transudate: CHF, nephrosis, gastrosis, cirrhosis
39
Cell count finds in thoracentesis
PMNS: PNA Lymphs: TB/malignancy RBCs: cancer (automatically stage IV)
40
Virchows triad
(1) venous stasis (2) endothelial injury (3) Hypercoaguability
41
EKG finding in PE
s1q3T3
42
What to get to reassure self that pt does not have pe
d-dimer (only get with low pre-test probablity)
43
If PE suspected but pt allergic to contrast or has CKD, give ____
V/Q scan (not Cta) if CXR normal
44
If massive PE, give ____
tPa
45
Management in ARDs
CO2: low tidal volume, higher respiratory rate | O2: choose PEEP over FIO2 recruit alveoli!
46
Pt coming in with chronic insidious progression of hypoxemia, with dry cough and crackles heard on auscultation
Suspect ILD
47
Imaging for suspected ILD
high res CT (shows ground glass opacities)
48
Tx of ILD
steroids, sometimes DMARDs
49
Causes of ILD
rheumatologic disease (RA, SLE, DCSS) primary (sarcoid) exposures (asbestos, hypersensitivity pneumonitis, pneumoconiosis) Idiopathic (acute is < 6wks, chronic >6months) Drug-induced (amio, bleomycin, radiation)
50
AA female with hypoxemia, heart block, bells palsy, and erythema nodosum
SARCOID
51
W/U of ILD
Hi res CT (ground glass opacity) PFTs (restrictive pattern) biopsy
52
Silicosis associations
rock quarry and sand blasting NOTE: rule out TB
53
Arthralgias and ILD
coal miners pneumoconiosis
54
Visualization/biopsy of different locations of lung nodules
if in bronchiole or around: EGUS if in periphery: CTguided percutaneous if in middle: VATS
55
Work up of lung cancer before TX
CT chest staging PET PFTs
56
Determination of risk with lung nodule
``` (low-risk qualities) Size (small <2cm) Surface (smooth) smoking Self (age < 45) NOTE: if calcified, less likely cancer ```
57
Types of secondary DM
Endocrine diseases (cushing, acromegaly, glucogonoma) pancreatic conditions pancreatic cancer drug-induced genetic syndromes
58
Initial testing in an acute asthma exacerbation vs nonacute asthma
acute asthma: ABG and peak expiratory flow nonacute asthma: methacholine/histamine challenge NOTE: methacholine is an artifical form of acetylcholine used in diagnostic testing
59
Asthma in which IgE is eleveated: associations
Atopy, asthma, and allergy triad allergic bronchopulmonary asperigillosis
60
Asthma in which IgE is elevated: TX
omalizumab
61
Asthma that is part of atopy and allergy triad: long-term control agent
leukotriene modifiers (montelukast, zafirleukast, or zileuton)
62
Acute asthma exacerbation: TX
O2 albuterol steroids (NOTE: takes a while to kick in) duonebs (albuterol and iprtropium) Magnesium will relieve bronchospasm while steroid still kicking in
63
Possible EKG findings in pt with COPD
RAH and RVH | Afib or MAT
64
TX progression in COPD not controlled with albuterol
anti-cholinergic (tiotropium), then ICS
65
Findings of bronchiectasis on CXR
dilated, thickened bronchi, sometimes with tram tracks NOTE: most accurate imaging is high res CT
66
An asthmatic patient with recurrent episodes of brown-flecked sputum and transient infiltrates on CXR
Allergic bronchopulmonary aspergillosis NOTE: can also present with cough, wheezing, hemoptysis, and bronchiectasis
67
Allergic bronchopulmonary aspergillosis: TX
Oral steroids and | oral itraconazole for severe cases
68
A young pt with chronic lung disease (cough, sputum, hemoptysis, wheezing, and dyspnea) and recurrent episodes of infection/sinusitis who is infertile
cystic fibrosis
69
Cystic fibrosis
antibiotics inhaled recombinant human deoxynuclease albuterol pneumococcal and influenza vaccines lung transplant if tx refractory advanced disease Ivacaftor increases the activity of CFTR in some patients
70
3 most common pathogens in COPD exacerbation
strep pneumo H influenzae moraxella catarrhalis
71
Atypical pna =
organisms (mycoplasma, chlamydophila, legionella, Coxiella, and viruses) that are not visible on gram stain and not culturable on standard blood agar
72
Ventilator-associated pneumonia
3 different agents (1) anti-pseudomonal beta-lactam (cephalosporin or pip-tazo, or carbapenem) (2) 2nd anti-pseudomonal agent (aminoglycoside or fluoroquinolone) (3) MSSA agent (vanc or linezolid)
73
Aminoglycosides
gentamicin tobramicin amikacin
74
fluoroquinolones
ciprofloxacin | levofloxacin
75
CAP: TX outpatient vs inpatient
Outpatient: If previosuly healthy--macrolide or doxycycline If comorbidities or recent antibx--levofloxacin or moxifloxican (respiratory fluoroquinolones) Inpatient: respiratory fluoroquinolone or ceftriaxone+azithro
76
Macrolides
azithromycin | clarithromycin
77
Type of vision loss with open angle glaucoma
gradual bilateral loss of peripheral vision over a period of years --> tunnel vision Central vision spared
78
Euthyroid sick syndrome =
low T3 syndrome a fall in total and free T3 levels with normal T4 and TSH levels
79
Warm vs cold agglutinin disease: TX
Warm: Steroids initially, IVIG with acute episode does not respond to steroid, splenectomy if recurrence, rituximab if all else fails Cold: warming of limbs, rituximab, sometimes plasmapharesis
80
G6PD deficiency: Dx
PBS showing heinz bodies ad bite cells Most accurate test is G6PD level 1-2months after an acute episode of hemolysis
81
TTP or HUS: TX
severe episodes treated with plasmapheresis or plasma exchange
82
Paroxysmal nocturnal hemoglobinuria: clinical presentation
episodic dark urine, pancytopenia, clots in unusual places (mesenteric and hepatic veins)
83
Paroxysmal noctrunal hemoglobinuria: TX
Prednisone, BMT for cure Eculizumab for episodes of hemolysis and thrombosis
84
Chronic aplastic anemia: TX
BMT for cure antithymocyte globulin (ATG) and cyclosporine
85
Essential thrombocytosis: TX
hydroxyurea
86
Non-hodgkin lymphoma: diagnostic testing and tx
Dx: excisional biopsy TX: stage 1&2--local radiation and small course of chemi stage 3,4, or any B sxs--CHOP (cyclophosphamide, hyrdoxyaunorubicin/adriamycin, vincristine/oncovin, prednisone)
87
Hodgkin lymphoma: DX and TX
DX: Reed-sternberg cells on patholgy TX: stages 1&2--chemo and radiation stages3,4, or B sxs--ABVD (adriamycin, bleomycin, vinblastine, dacarbazine)
88
Multiple Myeloma: TX
HSCT for cure Chemo otherwise Meds: steroids + lenalidomide OR melphalen (in older pts)
89
Waldentrom macroblobulinemia: TX
rituximab

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