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COMLEX Level 2CE > QG SB3 (F) > Flashcards

QG SB3 (F) Flashcards

W3 QG blocks (38,41,44,47) Deck is full

1
Q

how does DiGeorge synd present?

A 
CATCH-22
   Cotruncal cardiac defects
   Abn facies
   Thymic hypoplasia
   Craniofacial abnormalities
   HypoCa/HypoPTH
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2
Q

what cotruncal cardiac defects are seen in DiGeorge synd?

A
  • TOF
  • TA
  • interupted aortic arch
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3
Q

how does thymic hypo/aplasia present on labs?

A

T-cell def

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4
Q

what craiofacial abn is seen in DiGeorge synd?

A

cleft palate

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5
Q

what does PDA sound like?

A

washing machine / continuous murmur

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6
Q

Down’s synd is assoc w/ cardiac defect?

A

endocardial cushion defect

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7
Q

when does MVP present?

A

young females

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8
Q

what should you suspect if incr Ca + kidney stones?

A

hyperparathyroidism

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9
Q

where will CP of cardiac origin loacalize?

A

substernal/retrosternal

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10
Q

what is supraventricular AS

A

congenital defect = L vent outflow tract obstruction 2/2 diffuse narrowing of the asc. aorta

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11
Q

how does supraventricular AS present?

A

+palpable thrill (suprasternal)
+AS murmur @ 1st R intercostal space
+diff BP RUE vs LUE

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12
Q

if low BP is not responding to IVF (not vol problem), what is the cause of the low BP?

A

-pump failure

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13
Q

which side of the heart is the “main pump”?

A

right side

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14
Q

when does the heart receive O2?

A

diastole

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15
Q

SOC tx post-MI + stent placement = ?

A
  1. dual anticoag
  2. statin
  3. BB
  4. aldosterone antag
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16
Q

what is dual anticoag tx?

A
  1. ASA

2. P2Y12 inbib = clopidogrel, prasugrel, ticagrelor

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17
Q

what is the cause of anginal CP (regardless of if the pt has a murmur or not)?

A
  • angina = ischemic pain!

- incr mycardial O2 demand

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18
Q

what is TRALI?

A

Transfusion Related Acute lung Injury

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19
Q

how does TRALI present?

A

=F, low BP, noncardiogenic pulm edema

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20
Q

when does TRALI present?

A

= onset w/in 6 hrs of receiving RBC transfusion

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21
Q

when/why do you hear crackles on lung ascultation?

A

LV can’t/doesn’t handle cardiac load –> fluid backs up into lungs –> pulm edema –> crackles

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22
Q

pt presents s/p sx w/ low BP, incr HR, crackles on p/e, and incr PCWP when tested. what do you expect?

A

MI (–> decr LV f(x) –> incr PCWP –> pulm edema –> crackles)

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23
Q

does post-sx MI always present w/ CP?

A

NO. may present w/o pain but in cardiogenic shock

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24
Q

how does cardiogenic shock present?

A

AMS, low BP, incr HR, cool extremities, pulm edema (crackles, JVD), decr urination

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25
Q

what does pulm cap wedge pressure estimate?

A

L atrial pressure

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26
Q

pt presents w/ low BP and hx suggestive of possible bleed. Large fluid bolus is given and no/min change is seen in blood pressure. what is not causing the low BP?

A

-hemorrhage (this is a pump failure not a vol issue)

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27
Q

in CHF, what is the best indicator of worsening prognosis?

A

development of S3

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28
Q

S3 on exam + incr BNP is cause for high suspicion of what?

A

heart failure

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29
Q

what non cardiac conditions (not CHF) exhibit peripheral edema?

A
  • IVC obstruction
  • cirrhosis
  • nephrotic synd
  • LE venous insufficiency
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30
Q

why is S3 > peripheral edema @ suggesting worsening HF?

A

it is WAY MORE SPECIFIC

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31
Q

what are two types of syncope?

A
  1. neurogenic

2. cardiogenic

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32
Q

which type of syncope presents w/ prodrome?

A

neurogenic

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33
Q

pt presents w/ diaphoresis. what is your ddx (general)?

A
  1. heart problem

2. aorta problem

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34
Q

how does pain 2/2 AAA rupture present?

A
  • L sided abd, flank, back, CVA pain/tenderness
  • pain will range from dull –> severe
  • *b/c leaked blood is irritating the retroperitoneal structures
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35
Q

how does AAA present (stable vs sudden expansion vs rupture)?

A

s: mostly asymp
se: dull abd/back pain; +/- distal emboli
r: sudden, severe abd/back pain; +/- shock, hematoma

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36
Q

what is Myxadematous Valve degeneration?

A

MCC of MVP

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37
Q

what are the 3 MCC AS in the general population?

A
  1. senile calcification (MCC, esp age>70)
  2. bicuspid aorta (MC age<70)
  3. rheumatic heart dz
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38
Q

what is the most important RF for aortic dissection?

A

HTN (esp age>60)

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39
Q

h/o what aside from HTN incr risk of aortic dissection?

A
  • marfan’s (MC age<40)

- cocaine use

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40
Q

through what mechanism does reynaud’s phenom occur?

A

vasospasm (mainly digital)

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41
Q

what is the pathophys of intermittent claudication?

A

PVD–> exertion induced ischemia –> m. cramps –> pain

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42
Q

CKD w/ BUN >60 sig incr risk of what complication? (hint: this is why emergent HD is done for uremia)

A

uremic pericarditis

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43
Q

what is apixaban?

A

factor Xa inhibitor

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44
Q

what are the uses of apixaban?

A
  • nonvalvular afib
  • DVT
  • PE
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45
Q

how long should dual anticoag tx be used in pts w/ drug-eluting stents?

A

> = 12mos

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46
Q

what is the nL range for HDL?

A

HDL 30-70

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47
Q

what is the HDL target for therapy?

A

HDL > 40

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48
Q

what are the LDL targets for nonDM and DM pts w/ high cholesterol?

A

nonDM –> LDL < 100

DM –> DM < 70

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49
Q

pts w/ DM btwn what ages should receive ____ + lifestyle modifications + glucose control?

A
  • between ages 40-75

- statins

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50
Q

what are 3 common causes of pulsus paradoxus?

A
  • pericardial effusion/tamponade
  • severe asthma
  • COPD
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51
Q

BP falls by how much during insp. in pulsus paradoxus?

A

> 10mmHg

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52
Q

pt presents w/ CP and you suspect cocaine intox. how do you manage his/her pain?

A
  • nitroglycerin

- CCB

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53
Q

pt presents w/ CP and you suspect cocaine intox. what do you give 1st?

A

IV benzos

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54
Q

why do you give IV benzos to pts w/ cocaine-associated chest pain?

A
  1. decr psychomotor agitation
  2. decr myocardial O2 demand
  3. decr cardiovasc s/s
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55
Q

what do you ABSOLUTELY NOT GIVE in cocaine-associated chest pain?

A

BB

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56
Q

what are the lifestyle mods recommended for HTN?

A
  1. weight loss (goal BMI <25) =BEST/MOST EFFECTIVE
  2. DASH diet
  3. exercise
  4. limit Na intake
  5. decr EtOH
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57
Q

how many mmHg will BP decr for every 10 kg weight lost?

A

5-10mmHg

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58
Q

what is the DASH diet?

A
  • high fruit and veg

- low fat and salt

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59
Q

how much exercise is recommended per week?

A

30 min/d x5-6 d/wk

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60
Q

how much Na should be consumed per day by HTN pts?

A

< 3 g/day

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61
Q

how much EtOH is acceptable per day for HTN pts?

A

M –> <2 drink/d

F –> <1 drink/d

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62
Q

what lifestyle mod is most effective @ decr BP?

A

weight loss

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63
Q

how do AD genetic conditions generally present?

A
  • age > 18 y/o (AD = aDults)

- mutation –> structural abnormality

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64
Q

how do AR genetic conditions generally present?

A
  • age < 18 y/o

- mutation –> enzymatic abnormality

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65
Q

what type of genetic defect is hypertrophic cardiomyopathy?

A

AD

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66
Q

when to give nitroprusside?

A

HTN emergency

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67
Q

how do you medically manage aortic dissection?

A

control HTN & decr heart strain to decr dissection expansion:

  1. IV BB
  2. nitroprusside (only if BB fail)
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68
Q

why is hydralazine C/I in aortic dissection?

A

cause reflex tachy –> incr heart strain –> incr risk of enlarging the dissection

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69
Q

why is nitroprusside only used as 2nd line tx for aortic dissection?

A

can cause reflex tachy –> dissection enlargement

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70
Q

which IV BB are given as first line in aortic dissection and in what order are they given?

A 
IV BB (decr HR-->decr heart strain-->decr risk enlargement)
  1. labetolol
  2 propranolol
  3. esmolol
 **in that order**
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71
Q

what is the most likely cause of inguinal swelling + palpable thrill + new continuous murmur s/p heart cath?

A

abnormal AV communication

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72
Q

palpable thrill = ?

A

turbulence

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73
Q

what is a complication of cardiac cath that could lead to swelling, palpable thrill, and continuous murmur?

A

formation of an abn AV communication

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74
Q

how will an aneurysm feel on palpation?

A

pulsatile mass

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75
Q

a vein is occluded. how will the affected limp look?

A

red

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76
Q

an artery is occluded. how will the affected limb look?

A

pale

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77
Q

radiation of the chest can lead to ___?

A

constrictive pericarditis

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78
Q

infectious endocarditis will affect which valve 1st?

A

tricuspid valve (–> TR)

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79
Q

which murmurs are accenuated on insp vs expiration?

A

Right sided (Tricuspid, pulmonic)
Inspiration –> worsens murmur
Left sided (Mitral, aortic)
Expiration –> worsens murmur

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80
Q

what are the physiologic effects of BB on the heart?

A

decr HR

decr myocardial contractility

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81
Q

what are the physiologic effects of CCB on the heart?

A

decr HR

decr myocardial contractility

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82
Q

why can BB and CCB generally be used to tx the same conditions?

A

have same physiological effect via diff mechanisms (decr HR and contractility)

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83
Q

what do nondihydrapyrimadine CCB do?

A
  • cause coronary artery vasodilation

- decr afterload

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84
Q

how do nitrates work?

A

vasodilation –> decr preload and decr END diastolic vol

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85
Q

chronic refractory/peristent angina should be treated w/ what?

A
  1. nitrates

2. ranolazine

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86
Q

what does ranolazine do?

A

incr myocardial Ca influx

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87
Q

what is the 1st line tx of chronic stable angina?

A

BB

88
Q

what drugs are 2nd line tx of chronic stable angina?

A

diltiazem and verapamil

89
Q

what meds can be added to BB to tx stable angina?

A

dihydropyrimadine CCB (=dipines)

90
Q

what drugs prolonge QT interval and incr risk of torsades de pointes?

A 
ABCDEs
      anti-Arrhythmics (class 1a and 3)
       antiBiotics
anti-psyChotics
      anti-Depressants and Diuretics
      anti-Emetics (ondansetron)
91
Q

what anti-Arrhythmics cause QT prolongation?

A
  • amiodarone
  • flecanide
  • sotolol
  • ranolazine
92
Q

what ABX cause QT prolongation?

A
  • macrolides
  • fluoroquinolones
  • anti-fungals (=azoles)
93
Q

what anti-psyChotics cause QT prolongation?

A
  • haloperidol
  • risperidone
  • quetiapine
94
Q

what anti-Depressants cause QT prolongation?

A

TCAs (esp. amitriptyline)

-SSRI (esp. citalopram)

95
Q

aortic dissection is suspected but pt is unstable and/or has CKD. how do you confirm dx?

A

TEE

96
Q

young pt presents w/ intermittent retrosternal CP. what should you suspect?

A

drugs

97
Q

which drugs cause pupillary dilation?

A
  • cocaine
  • methamphetamines
  • bath salts
98
Q

which drugs cause pupillary constriction?

A

opioids

99
Q

how to tx cocaine chest pain?

A

-IV Benzos (aggitation)
-nitroglycerin (pain)
NO BB!!!

100
Q

in rheumatic heart dz what valve is most commonly affected?

A

mitral > aortic

101
Q

in rheumatic heart dz what murmurs might you hear?

A

MC: early = MR –> MS = late
LC: early = AR –> AS = late

102
Q

AR progresses to AS. what condition should you suspect?

A
  1. bicuspid aortic valve

2. h/o rheumatic heart dz

103
Q

combo of irreg irreg rhythm + hemoptysis suggests what?

A

L atrial problem (enlargement)

104
Q

L atrium is enlarged. what 2 symp may develop?

A
  1. dysphagia

2. hoarseness

105
Q

pain is parasternal. where is the problem?

A

MSK or chest cavity

106
Q

pt presents w/ sharp parasternal CP that is reproducible and pleuritic. dx = ?

A

costochondritis (MSK pain)

107
Q

what is the mitral valve issue seen in HOCM?

A

abn mitral leaflet motion (=ant displacement –> obstr)

108
Q

what is cor pulmonale?

A

enlargement of the R heart 2/2 lung dz

109
Q

what causes cor pulmonale?

A

lung dz (COPD/PE) –> pulm HTN –> cor pulmonale

110
Q

where can TB cause calcifications?

A

lung, kidney, bladder, spine, pericardium

111
Q

how to tx TB infx of the bladder?

A

BCG vaccine

112
Q

what two conditions cause distant heart sounds?

A
  1. tamponade

2. pericarditis

113
Q

jugular venous pressure tracings show prominent x and y descents. what is this?

A

pulsus paradoxus

114
Q

what are the MCC of cor pulmonale?

A
  • COPD

- PE

115
Q

trypanosoma cruzi causes what?

A

chagas dz

116
Q

how does chagas dz present?

A
  • megacolon
  • megaesophagus
  • cardiac dz
117
Q

what cardiac problems are caused by chagas dz?

A
  • systolic and diastolic HF
  • MR and TR
  • arrhythmias
118
Q

CHF leads to third spacing which results in decr BP. how does the body respond?

A

incr RAAS –> constrict efferent arteriole –> incr filtration

119
Q

what are the surgical options for AAA repair?

A
  • unstable = open or EVAR

- stable = laprascopic

120
Q

what might you hear on auscultation during acute phase of MI?

A

S4 gallop

121
Q

fixed S2 splitting = ?

A

ASD

122
Q

what is S4?

A

atrial gallop

123
Q

how does fibromuscular dysplasia present?

A
  • F age > 50yo
  • refractory HTN starting age < 35yo
  • sudden inc HTN from baseline
  • Cr incr > 0.5-1 after starting an ACEi/ARB
  • abd bruit
124
Q

what is the timeline for PCI of STEMI?

A

door –> cath time =< 90 min

125
Q

renal stones smaller than what size will pass spontaneously?

A

< 1cm

126
Q

what pharm tx can be used to help pass small kidney stones?

A

a-blockers = tamulosin

causes ureteral m. to relax –> ureters dilate –> stone passes more easily

127
Q

how do you w/u metabolic derrangements?

A
  1. look @ pH
  2. look @ paCO2
  3. look @ HCO3
128
Q

what is nL pH?

A

= 7.45

129
Q

what is nL paCO2?

A

= 40

130
Q

what will paCO2 be in the 2 types of alkalosis?

A

resp alk - paCO2 decr

met alk - paCO2 incr (comp)

131
Q

what will paCO2 be in the 2 types of acidosis?

A

resp acidosis - paCO2 incr

met acidosis - paCO2 decr (comp)

132
Q

what is the first line tx for renovasc HTN?

A

ACEi

133
Q

what is the earliest sign of kidney damage seen in DM?

A

hyperfiltration –> microalbuminuria

134
Q

what is the MC complication in nephrotic synd?

A

renal vein thrombosis 2/2 loss of anti-thrombin 3

135
Q

muddy brown casts = ?

A

ATN

136
Q

broad, waxy casts = ?

A

chronic renal failure

137
Q

RBC casts = ?

A

nephritis (1. glomerular dz 2. vasculitis)

138
Q

WBC casts = ?

A
  1. AIN

2. pyelonephritis

139
Q

fatty casts = ?

A

nephrotic synd

140
Q

hyaline casts = ?

A

-prerenal azotemia

141
Q

chron’s is associated w/ which type of kidney stone?

A

CaOxalate stones

142
Q

what factors do you look at to determine the cause of vaginitis?

A

color, pH, pmHx, pSocialHx

143
Q

when would you get a voiding cystogram on a kid?

A
  • high suspicion of anatomical defect/abn

- U/S +

144
Q

HCV is associated w/ which nephritis?

A

mixed cryoglobulinemia

145
Q

Cl is decr. what do you suspect?

A

incr vomiting or diarrhea

146
Q

pt presents w/ recent h/o of ABX + WBC casts. Dx = ?

A

AIN

147
Q

what is seen later on in diabetic kidney damage?

A

nodular sclerosis (kimmel-wilson bodies)

148
Q

general principle: the “most appropriate” test = what?

A

-quickest, cheapest, “best initial” test

149
Q

pt presents w/ F + incr WBC + new mitral murmur + h/o recent viral infec. what do you suspect?

A

infectious endocarditis

150
Q

how will renal infarct present?

A
  • flank pain, n/v

- U/A + RBC + protein - (NO) casts

151
Q

what is a complication of endocarditis?

A

septic emboli

152
Q

anion gap is > 12. what could be the cause?

A 
MUDPILES
   Methanol
   Uremia
   Diabetic ketoacidosis
   Paraaldehyde
   Iron, isoniazid
   Lactic acid
   Ethylene glycol
   Salicylates
153
Q

pt presents w/ bilat flank pain + HTN + famHx. what should you suspect?

A

PCKD (AD)

154
Q

when do PCKD pts start to exhibit s/s of dz?

A

age 30-40s

155
Q

why is urine dark in rhabdo?

A

myoglobin in the urine

156
Q

what are the common causes of rhabdo?

A
  • trauma
  • crush/compression injury
  • dehydration
  • excessive exercise
  • uncontrolled shivering
  • NEMS
157
Q

what is nL BUN?

A

12-18

158
Q

what is pathomneumonic for interstitial cystitis?

A

bladder pain relieved w/ urination

159
Q

what will the U/A findings be w/ interstitial cystitis?

A

nL

160
Q

interstitial cystitis tx = ?

A
  • amitriptyline
  • pentosan polysulfate
  • analgesics
161
Q

when might pre-eclampsia, gestational DM, and gestational HTN present?

A

@ >= 20 wks gestation w/o prior hx of complaint

162
Q

levofloxacin doesn’t cause actute renal failure. but what can it cause?

A

AIN

163
Q

amikacin = aminoglycoside that causes what?

A

acute renal failure

164
Q

what drug is used to tx MDR pyelonephritis but can cause acute renal failure?

A

amikacin

165
Q

when should stenting be used to tx HTN 2/2 RAS?

A
  • ACEi intolerant
  • failed pharm tx
  • recurrent flash pulm edema
  • refractory CHF 2/2 HTN
166
Q

what is the dx when a sickle cell pt has reticulocyte count < 1%

A

-aplastic crisis

167
Q

how do you differentiate btwn a mixed germ cell tumor and a seminoma via labs?

A 
mixed = incr B-hCG + incr alpha-fetoprotein (APF)
seminoma = incr B-hCG + nL AFP
168
Q

pt presents w/ a mediastinal mass. what is your ddx?

A

Terrible Ts

  1. Thymoma
  2. Terrible lymphoma
  3. Thyroid
  4. Teratoma
169
Q

when a lymph node is tender, what do you suspect?

A

infx

170
Q

when a lymph node is non-tender, what do you suspect?

A

malignancy

171
Q

what might head and neck cancer present w/ ear pain + nL ear exam?

A

mass can put pressure on CN 9 afferent fibers

172
Q

what is the MC head and neck Ca?

A

SCC

173
Q

how does polycythemia vera present?

A
  • AQUAGENIC PRURITIS
  • facial plethora
  • INCR HCT
174
Q

pt presents w/ s/s of polycythemia vera + incr LFTs. what do you suspect?

A

Budd-Chiari synd

175
Q

what is a common cause of Budd-Chiari synd?

A

hepatic vein thrombosis 2/2 polycythemia vera

176
Q

how does Budd-Chiari synd present?

A
  • vague progressive abd pain
  • ascites
  • hepatosplenomegaly
177
Q

what mutation is assoc w/ polycythemia vera?

A

JAK2v617F

178
Q

what is nL MCHC?

A

< 35%

179
Q

what MCHC should you expect in hereditary spherocytosis?

A

> 35% (cells are smaller but contain same amount of Hgb)

180
Q

which microcytic anemia is often asymp?

A

thalassemia

181
Q

what are the uses of hemoglobin electrophoresis?

A
  • distinguish btwn Hgb E or C
  • dx thalassemia A/B
  • dx sickle cell dz
182
Q

what are the coag studies in hemophelia A vs B?

A

Hem A: plt-nL aPTT-incr PT-nL F8-decr F9-nL

Hem B: plt-nL aPTT-incr PT-nL F8-nL F9-decr

183
Q

what is the tx for mild hemophilia?

A

desmopressin (DDAVP)

184
Q

what is the tx for mod/severe hemophilia?

A

replace missing factor (cryoprecipitate)

185
Q

what is a normal anti-D Ab titer level?

A

=< 1 : 8
1 = amount baby has
8 = amount mom has

186
Q

Eosin-5-maleimide binding is what kind of test?

A

flow cytometry

187
Q

what is another name for the acidified glycerol lysis test?

A

osmotic fragility test

188
Q

what dz is diagnosed w/ either the osmotic fragility test (acidified glycerol lysis test) or Eosin-5-maleimide binding flow cytometry?

A

hereditary spherocytosis

189
Q

what are 4 common leukemias?

A
  • ALL
  • AML
  • CML
  • CLL
190
Q

which leukemias present w/ >=25% BLASTS on BM bx?

A

ALL and AML

191
Q

which leukemia is seen predominantly in kids?

A

ALL

192
Q

which leukemia is seen predominantly in the elderly?

A

CLL

193
Q

which leukemias are seen predominantly in middle-aged adults

A

AML and CML

M = middle aged

194
Q

which leukemia presents w/ auer rods?

A

AML

A = Auer rods = AML

195
Q

which leukemia presents w/ smudge cells?

A

CLL

elderly are waiting for kids to call but the phone# got smudged

196
Q

which leukemia is PAS+ and Tdt+ ?

A

ALL

197
Q

which specific variant of AML has Auer rods?

A

APL variant = (t 15:17)

198
Q

which gene mutation is CML associated w/ ?

A

(t 9:22) = bcr-abl fusion protein

199
Q

if pt presents w/ pancytopenia, what must you do?

A

BM bx

200
Q

what condition is assoc w/ ALL and AML?

A

Down’s synd

201
Q

a pt w/ down’s synd presents to the ED. what must you want out for?

A

alanto-axial insufficiency

202
Q

pt presents w/ >50K WBC + incr LAP. dx = ?

A

leukemoid rxn

203
Q

what is LAP?

A

= leukocyte alkaline phosphatase

-elevated in leukemoid rxns

204
Q

pt presents w/ >50k WBC + nL LAP. dx = ?

A

CML

205
Q

what are the stages of granulocyte development?

A
  1. myeloblast
  2. promyelocyte
  3. myelocyte
  4. metamyelocyte
  5. band form
  6. neutrophil
206
Q

which presents w/ more mature precursors CML or leukemoid rxn?

A 
Leukemoid = More mature (L so has More)
cMl = Less mature (M so has Less)
207
Q

will leukemoid rxn have more metamyelocytes or myelocytes?

A

metamyelocytes > myelocytes

208
Q

will CML have more metamyelocytes or myelocytes?

A

myelocytes > metamyelocytes

209
Q

what causes CML?

A

philadelphia chromosome = (t 9:22) –> bcr-abl fusion protein

210
Q

what causes leukemoid rxn?

A

severe infx

211
Q

pt presents w/ h/o prostate ca + LE neuro issues + back pain. what do you suspect?

A

bone mets

212
Q

when do you suspect epidural spinal cord compression?

A
  • h/o malig + new back pain + motor/sensory abnormalities

- loss of bowel and/or bladder control = late s/s

213
Q

how do you tx suspected epidural spinal cord compression?

A
  1. IV glucocorticoids
  2. emergent MRI
  3. rad-onc/ neuro-sx consults
214
Q

what bone marrow problem can cause anemia?

A

infiltration w/ Ca cells

215
Q

what are the common renal tubular acidosis associations?

A

type 1 = AI conditions
type 2 = mult. myeloma, osteomalacia, Ricketts
type 4 = DM2

COMLEX Level 2CE (23 decks)

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