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Professional Development > Part 15 > Flashcards

Part 15 Flashcards

1
Q

AV nodal re-entry tachycardia treatment (3)

A
  • mammalian diving reflex, vagal maneuvers of carotid, valsalva
  • adenosine 6mg rapid IV bolus (stops heart with a chemically short half life drug to allow for full refractory period to return)
  • Electrophysiologist (EP) lab referral***
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2
Q

Mammalian diving reflex

A

When water fills the nostrils, the autonomic nervous system redirects blood flow thru peripheral vasoconstriction from the limbs and viscera to the heart and brain to conserve oxygen, causes slowing of the heart rate

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3
Q

AV reentrant tachycardia (AVRT) nick name

A

Wolf parkinson white syndrome

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4
Q

Atrial flutter

A

Involves circus movement (conduction around same loop in atrium) generally 250-350 bpm, saw tooth pattern, often with picket fence P waves seen in leads 2, 3, and AVF

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5
Q

atrial flutter treatment (4)

A
  • Digoxin
  • B blockers or Ca2+ blockers
  • pacemaker
  • ablation
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6
Q

Atrial fibrillation

A

Occurs when atrial rate is 350-700 bpm, ventricular rate may be normal or rapid, involves a complete lack of P waves, irregularly irregular rhythm, at risk for stroke and hypotension

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7
Q

Common causes of atrial fib (4)

A
  • thyroid abnormalities
  • alcohol
  • COPD
  • underlying heart disease
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8
Q

Afib treatment (3)

A
  • rate control (B blockers, Ca2+ channel blockers, digoxin
  • anticoagulation before and after cardioversion
  • rhythm control
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9
Q

Defibrillation will not work on a heart that has reached what stage of arrest?

A

Asystole

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10
Q

Ventricular arrhythmias occur from the…

A

….AV node down

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11
Q

ventricular tachycardia

A

3 or more successive PVC’s, nonsustained is less than 30 sec and sustained is more, rate >100bpm usually regular rhythm, may or may not see P waves

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12
Q

Torsades de pointes

A

Form of polymorphic ventricular tachycardia assoc with prolonged QT interval >500ms, changes in amplitude and morehphology of QRS around isoelectric line, causes of prolonged QT interval can be congenital or acquired

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13
Q

Ventricular fib requires…

A

…electric shock

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14
Q

Brugada syndrome

A

Congenital channelopathy caused by mutation of cardiac Na+, K+ or Ca2+ , ST segment elevation in one of the right precordial leads (V1-V3) at baseline or after use of Na+ blockers, 3 subtypes

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15
Q

Commotio cordis

A

Ventricular fib caused by blunt, non-penetrating blow to chest during vulnerable portion of ventricular repolarization, more common in children and adolescents, more common with moderate to high velocity strike usually projectile right during a T wave

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16
Q

Ventricular flutter

A

Ventricular tachyarrhythmia 250-350 bpm, rapidly deteriorates into ventricular fib

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17
Q

Ischemia will manifest on an EKG as…

A

…ST depression

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18
Q

ST elevation indicates…

A

Acute injury within past 24-48 hrs

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19
Q

T wave inversion or ST elevation or depression across all leads is pathonomonic of what condition?

A

Pericarditis

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20
Q

Punumbra

A

Direct death of tissue from blocked artery that is not perfused, surrounded by ischemic and injured tissue in a circular area around the source

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21
Q

Lesions that occlude LAD represent ___% of MI’s, RCA represents ___%, and circumflex represents ___%

A

50, 30, 20

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22
Q

Inferior wall MI is represented in leads…

A

II, III, and AVF

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23
Q

Lateral wall MI is represented in leads…

A

I, AVL, V5, V6

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24
Q

Septal/anterior wall MI is represented in leads…

A

Septum: V1,2,
Anterior: V3,4

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25
Q

Posterior wall MI findings on EKG

A

ST DEPRESSION in V1 ,2, 3,

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26
Q

Early treatment of MI (3)

A 
Coronary angioplasty with balloon angiogram 
Stent placement (bare metal or drug eluding)
-Coronary artery bypass graft either by harvesting saphenous vein, radial artery, or left internal thoracic artery
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27
Q

Lateral wall MI occludes what artery?

A

Circumflex

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28
Q

Posterior and inferior MI occludes what artery?

A

Posterior descending artery

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29
Q

S1 heart sound occurs during what phase of the heart cycle? What about S2?

A
  • At the end of diastole/start of systole
    • At the end of systole/start of diastole
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30
Q

Pulse pressure definition

A

Difference between systolic and diastolic blood pressure

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31
Q

End systolic volume

A

Volume of blood remaining in LV following cardiac contraction and ejection of blood

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32
Q

Ejection fraction and avg value

A

Stroke volue/end diastolic volume, should be about 55%

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33
Q 
Aortic area
Pulmonic area
Erb's point
Tricuspid area
Mitral area
Locations
A
  • 2nd intercostal space right sternal border
  • 2nd intercostal space, left sternal border
  • third intercostal space, left sternal border
  • 4th intercostal space, left sternal border
  • 5th intercostal space, mid clavicular line
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34
Q

S3 gallop

A

Early diastolic sound following S2 with new blood entering a dilated ventricle, may be normal in children or indicative of CHF, CAD, or aortic/mitral insufficiency

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35
Q

S4 gallop

A

Late diastolic sound right before S1 due to ejection of blood from atria during atrial contraction hitting a stiff noncompliant wall, long standing hypertension causing LV hypertrophy is key, may be normal but almost always pathologic

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36
Q

Cardiac friction rub

A

Creaking, grating, or scratching sound heard with pericardial inflammation, classically has 2 systolic and one diastolic component, heard best at the left sternal border (increased when leaning forward) when patient is not breathing

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37
Q

Erythema nodosum

A

An idiopathic inflammatory disease affecting primarily the skin in the front of the legs below the knees causing very painful macules

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38
Q

Wegener’s granulomatosis

A

Autoimmune inflammatory disease of the blood vessels that has a distinct saddle nose appearance

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39
Q

Xanthelasma (hyperlipoproteinemia)

A

Sharp demarcated deposits of cholesterol underneath the skin, usually near the eyelids, usually not painful or problematic

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40
Q

Kawasaki’s disease

A

Inflammation of blood vessels often seen in children less than 5 years old, presents with a week of high fever, bilateral conjunctivitis, strawberry tongue, cervical lymphadenopathy and plaque-like rash on trunk and proximal extremities.

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41
Q

Acanthosis nigricans

A

Characterized by dark discoloration of body folds and creases seen in obese or diabetic patients

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42
Q

Cowden’s disease

A

Sees development of multiple noncancerous growths called hamartomas that are associated with development of breast and thyroid cancer

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43
Q

Peutz Jegher’s syndrome

A

Genetic disorder causing benign hyperpigmented macules on lips and mucosa

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44
Q

Infective endocarditis

A

From infection of the endocardium, can see janeway lesions (spots on palms and soles), oslers nodes (painful red lesions on hands and feet), and splinter hemorrhages (tiny blood spots under nails)

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45
Q

Steven johnson syndrome

A

An emergency reaction to medication or disease that causes red/purple purpura rash to spread systemically

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46
Q

Neurofibromatosis

A

A genetic condition that causes tumors to form on nervous tissue, skin can see pigmentation and freckling

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47
Q

Pityriasis rosacea

A

hAn unknown triggered rash that begins as a large oval patch herald patch before a fawn colored generalized rash appears, spontaneously resolves in 6 weeks, common and harmless

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48
Q

Schleroderma

A

Hardening and tightening of skin often seen in women 30-50, co-occurs with raynauds often

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49
Q

Cautions against iodinated contrast (3)

A
  • Iodine allergy
  • Shellfish allergy
  • Renal insufficiency (relative contraindication depending on severity)
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50
Q

Gadolinium

A

Used in MRI and MRA but highly contraindicated in renal failure because it cannot dialysize out and thus ends up depositing into soft tissue resulting in possible nephrogenic systemic fibrosis (stiffening of all tissue similar to scleroderma but caused by gadolinium)

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51
Q

CT is better for ___ visualization, MRI is better for ___ or ___, MRA is best for ___

A

Bone, soft tissue, nerve, vascular

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52
Q

Generalized pruritis all over can be a sign requiring further evaluation as it may be due to…

A

….lymphoma

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53
Q

FEES

A

Fiberoptic endoscopic evaluation of swallowing, passing a scope thru the nose and down into the back of the throat then having a patient eat and drink, a non radiation alternative to X ray to visualize food bits left in piriform sinus (posteriolateral on either side of laryngeal opening)

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54
Q

Sialogram of parotid

A

Dilation and cannulation of parotid with plastic tube followed by injection of dye to assess for sialolith or other blockage, not often used opposed to sialendoscopy (can visualize and treat in one go) or the CT

55
Q

PET scan

A

Positon emission tomography, use of X ray or CT following injection of radionucleotide product most often using fluorodeoxyglucose (FDG) (radiotagged sugar that measures high metabolic activity)

56
Q

Radioactive Iodine uptake scan

A

Discontinued practice compared to ultrasound when formerly used to assess thyroid but often still used in whole body radioactive iodine uptake scan in order to see post thyroidectomy/thyroid cancer to assess treatment

57
Q

Iodine doesn’t just isolate to the thyroid but also the…

A

…salivary glands (if using radioactive iodine uptake scan must keep fluids to push it and avoid xerostomia as an unpleasant side effect)

58
Q

Hereditary hemorrhagic telangectasias (HHT)/osler-weber-rendu disease

A

AV vascular malformations that can occur anywhere in mucosal surfaces of the body and result in large bleed putting at risk often requiring intervention

59
Q

Videostroboscopy

A

Visual assessment of various vocal cord conditions and abnormalities thru mouth or nose, gold-standard in laryngological diagnostic care

60
Q

Parts of the jaw (parasymphyseal/mental, body, angle, ramus, condyle, and coronoid process)

A
  • Parasymphyseal/mental is near the chin
  • the body is the horizontal portion protruding back
  • angle is the shift to the vertical
  • ramus is the vertical portion before the condyle (posterior) and coronoid processes (anterior)
61
Q

Mandible condylar fracture common causes, diagnostic study, and treatment

A
  • Often seen with falling and hitting chin on ground or being uppercut
  • evident on CT
  • not typically treated with intervention but only soft diet (retain bite strength)
62
Q

Mandible ramus fracture

A

Sees condyle displacement within the joint and often occurs with counter fracture on opposite side, have a weak bite, treated with surgical intervention

63
Q

Lefort I-III scale

A

-Scale to measure midface fractures described as either complete or one sided (hemi lefort)
I is a palate fracture and can move palate with thumb manipulation
II also includes the nose
III includes the zygomata (craniofacial dysjunction, the face completely removed from the cranium)

64
Q

Zenker diverticulum

A

An outpouching just below or around the cricopharyngeus where the internal lining of esophagus pouches outward, often diagnosed when swallowed items sit for a period of time and then are coughed back up days later, surgically repairable

65
Q

Steeple sign

A

A sign on x ray of narrowing of trachea indicative of croup (laryngotracheobronchitis)

66
Q

Thumb print sign

A

A sign of epiglotitis seen on a lateral x ray of the head

67
Q

Hot potato voice

A

A characteristic sign of epiglotitis or peritonsillar abscess seen in someone with a thick and muffled voice

68
Q

Invasive fungal sinusitis vs allergic fungal sinusitis (mycetoma)

A

Invasive is an emergency as it eats into bone requiring surgical intervention most often seen in immunocompromised while allergic fungal sinusitis is relatively harmless and can be removed easily

69
Q

Concha bullosa

A

An enlarged middle turbinate seen in approx half the population that can be resected if causes issue such as congestion or runny nose

70
Q

Patients with nasal polyps (mucus retention cysts) present completely…

A

…asymptomatic

71
Q

Thyroglossal duct cyst origin and sign

A

Because the thyroid begins growth at the base of the tongue before moving forward and down, congenital malformation of the thyroid gland resulting in cyst in duct located anterior midline neck can result in elevation visually upon sticking tongue out

72
Q

Why is it important to remove part of the hyoid bone when treating a thyroglossal duct cyst via surgical removal?

A

Part of the duct travels thru the hyoid bone in order to prevent remnants of the cyst from remaining (sistrunk procedure)

73
Q

What layer of epidermis contains melanocytes?

A

Stratum basale

74
Q

What type of sudoriferous glands produce watery sweat?

A

Eccrine glands

75
Q

Keratinocytes definition

A

Skin cells, the most common cell type in the epidermis composing the superficial layer of skin

76
Q

Langerhan’s cells definition

A

Specialized epidermal cells that function immunologically

77
Q

Merkel’s cells definition

A

Specialized epidermal cells that function to provide somatosensory function (light touch and discrimation)

78
Q

5 layers of epidermis from base up

A
  • stratum basale (germinativum)
  • stratum spinosum
  • stratum granulosum
  • stratum lucidum
  • stratum corneum
79
Q

Stratum granulosum

A

3rd deepest layer of epidermis composed of cells that flatten and form granules in the cytopalsm creating a water proof barrier of the skin

80
Q

2 layers of the dermis and their characteristics

A

1) Papillary dermis - thin layers of collagen popping into the epidermis
2) Reticular dermis - deep, dense, irregular collagen

81
Q

Sebaceous glands

A

Glands associated with hair follicles that secrete oil onto hair surface

82
Q

Eccrine (merocrine) sweat glands, what stimulation are they from sympathetic NS?

A

Produce watery sweat not associated with hair follicles all around the body stimulated by heat and cholinergic SANS stimulation

83
Q

Apocrine sweat glands, what stimulation are they from sympathetic NS?

A

Thick milky sweat glands that leads to extensive odor and is concentrated in axilla, perianal and genital regiions, associated with hair follicles and activated by adrenergic SANS from stress or sex stimulation

84
Q

Dermis and blood shunting

A

When body is hot, vasodilation occurs shunting blood to the skin surface to lose heat to surrounding area, and inverse in the cold

85
Q

Meissner’s and Vater pacini corpuscles

A

Specialized nervee cells that transmit sensations of touch and pressure via mechanoreceptors found in the dermis

86
Q

Terminal hairs

A

Thick pigmented hair that is androgen sensitive!!!!

87
Q

Vellus hairs

A

Short, fine, nonpigmented hair that covers much of the body and is not androgen dependant

88
Q

Lanugo hairs

A

Fine hair found on the fetus and some anorexics normally shed and replaced with vellus hair within months

89
Q

Anagen, catagen, and telogen phases of hair

A

growth, transition, cessation and shedding phases respectively

90
Q
A
91
Q

Lunula

A

Crecent shaped dome at base of nail

92
Q

Nail bed

A

Flesh beneath nail, contains blood vessels, nerves, and melanocytes (can still get melanoma!)

93
Q

Nail plate

A

Actual fingernail, made of transulcentt keratin

94
Q

Eponychium

A

Cuticle, skin of the finger and the fusing of that with the nail to provide a wataerproof barrier at the base of the nail

95
Q

Paronychium

A

Lateral nail folds, skin that lies over the nail plate on its sides

96
Q

HPV subtypes associated with malignancy (6)

A

6, 11, 16, 18, 31, 35

97
Q

Verruca vulgaris

A

Common wart, usually asymptomatic but painful at times and appears as a hyperkaratotic papule with rough irregular surface and often seen on hands and knees but can occur anywhere, often resoves without intervention

98
Q

Filform (digitate) warts

A

Long slender growths with stalk like appearance that manifest on areas of thin skin (such as face) and commonly bleed, often need treatment

99
Q

Concerns of pregnancy and genital warts

A

-Neonates may acquire infection when passing thru infected birth canal so depending on number of lesions may advise C section to avoid transmission to neonate

100
Q

2 biggest treatments for genital warts

A

-surgical excision (lowest recurrence rate) -cryotherapy (safe even during pregnancy)

101
Q

Molluscum contagiosum

A

Caused by a DNA poxvirus strictly in humans, has distinct appearance of single or multiple umbilicated (caseous plug, distinct clinical diagnosis) papular lesions round, dome shaped and waxy

102
Q

Most effective treatment for molluscum contagiosum

A

Curettage, most of the time spontaneously resolves tho

103
Q

Herpetic whitlow Herpes gladiatorum

A

-HSV of finger following inoculation from self or other -Face, arms, neck, and trunk infection from contact sport players

104
Q

HSV gold standard diagnositc test

A

Isolation of virus by culture

105
Q

Tzank smear

A

A quick rapid means of testing HSV but does not distinguish between 1 and 2

106
Q

Characteristic rash of varicella zoster virus

A

“Dewdrop on roses” maculopapular lesions

107
Q

Eczema of children and adolescents often occurs in these locations

A

-lichen plaques of flexural distribution, palamar aspect of wrists, neck

108
Q

First, second, and third line treatment for atopic dermatitis

A

Topical corticosteroids, systemic corticosteroids (prednisone), topical calcineurin inhibitors (cyclosporine)

109
Q

Contact dermatitis treatments (3)

A

-topical steroids -oral antihistamines -systemic corticosteroid s reserved for severe cases

110
Q

Nummular eczema and what should be ruled out prior to diagnosing

A

Chronic inflammatory skin disease characterized by pruritic coin shaped lesions often on the extremities (and never on the head) sometimes with central clearing

Tinea corporis

111
Q

Seborrheic dermatitis

A

Dandruff, relapsing skin disorder with erythematous, scaley patches located in areas with high density of sebacious glands such as lateral nasiolabial folds, eyebrows, or scalp

112
Q

Perioral dermatitis

A

Presents with small inflammatory papules around the mouth that spares the vermillion border of the lip, differentiated from acniform by lack of comedomes, self limiting, seen pirmarilyin women btwn 16-45

113
Q

Lichen planus, whats the buzz word with it?

A

Rare Immune mediated mechanism that causes development between 30’s-60’s of papulosquamous eruption with violaceous (buzz word) papules on skin

114
Q

Wickham’s striae

A

Reticulated and lacey marks located on lichen planus eruption

115
Q

Tullio phenomenon

A

Physical manifestation of dizziness following exposure to loud sounds, typically an issue of the semicircular canals requiring CT

116
Q

Kiesselbach plexus

A

Located in the anterior nasal septum, this highly vascular arterial area is formed from terminal branches anastamosing of the internal and external carotids and is the most common cause of anterior epistaxis (this is why you hold the lower part of the nose during a nosebleed and not up at the bridge)

117
Q

Dental occlusion measurement

A

Either normal occlusion, overbite (class II), underbite (class III), open bite (cannot bring teeth together no matter what, can make it impossible to eat things like yummy carrots :’((((( )

118
Q

Weber and rinne hearing tests

A

Weber test that doesn’t lateralize is normal.
Weber test that lateralizes to one side has either conductive loss of the same ear or sensorineural loss of the opposite ear, rinne test with air conduction greater than bone is normal or confirmatory of contralateral sensorineural loss, and bone conduction greater than air conduction is confirmatory of conductive loss

119
Q

Torus palentine

A

A form of exostosis (which can be seen in the ear), hard lumps on the roof of mouth that if present for long time then not problematic as it is just overgrowth of the palate bone

120
Q

Ranula

A

Cyst or obstruction of submandibular or sublingual duct that will enlarge upon eating and occasionally pop with clear salty drainage, benign and may require surgical incision

121
Q

Nasal septal perforation complications (4)

A

Saddle nose malformation, whistling noise when breathing, epistaxis, and foul smell

122
Q

Mastoiditis

A

Resultant from ottitis media that is left untreated or in countries that do not have good infrastructure, sees ears sticking out away from head at a downward angle with soft red tissue, requires tubal drainage immediately to prevent development of meningitis or epidural abscess

123
Q

Otitis media with effusion will have a distinct __ color defining the diagnosis on physical exam, hemotympanum will have a distinct __ color

A

Amber yellow, purple

124
Q

Cholesteatoma

A

Collection of epithelialized skin debris in the middle ear that will erode the ossicles over time that will locally grow and destroy hearing, eventually causing facial paralysis but requires surgical intervention

125
Q

Removal of bugs from the ears should be done with….

A

….oil or lidocaine, NOT water as that will cause swelling

126
Q

Components of outer, middle, and inner ear

A

Outer: auricle and external auditory canal
Middle: tympanic membrane, ossicles, middle ear space
Inner: cochlea, semicircular canals, vestibulocochlear nerve

127
Q

Microtia, Anotia

A

Congenital malformation of pinna, complete absence of pinna

128
Q

Most common malignant tumor of the external auditory canal

A

Squamous cell carcinoma

129
Q

Exostosis

A

Multiple benign bony growths of the external auditory canal arising from compact bone commonly in individuals exposed to repeated cold water (surfer’s ear) can be removed surgically if too large

130
Q

Treacher collin’s syndrome (TCS), Robin sequence, Crouzon syndrome

A
  • TCS is a genetic disorder characterized by deformities of eyes, ears, mouth, cheekbones, and chin that may result in complications
  • Pierre Robin sequence is a condition where an infant has a smaller than normal jaw with the tongue often falling back into the throat creating difficulty breathing often alongside cleft palate that can be treated surgically
  • Crouzon syndrome is a genetic disorder characterized by the premature fusion of certain skull bones (craniosynostosis). This early fusion prevents the skull from growing normally and affects the shape of the head and face sometimes needing surgery to treat
  • All often see microtia, anotia, atresia, or congenital malformation of the ossicular chain
131
Q

Viral cochleitis symptoms (3) and treatment (1)

A

Sudden hearing loss, vertigo, facial paralysis, or pain, treated with oral steroids

132
Q

Meniere disease

A

Episodic vertigo and hearing loss that lasts for hours, fullness, and tinnitus, hearing loss is usually low frequency but can progress and is usually unilateral

133
Q

Acoustic neuroma

A

Most common benign tumor that originates from the vestibular portion of the 8th cranial nerve presenting with unilateral or asymmetrical hearing loss, tinnitus, dizziness, headaches, and disequilibrium

Professional Development (19 decks)

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