QG SB3 (F) Flashcards
W3 QG blocks (38,41,44,47) Deck is full
how does DiGeorge synd present?
CATCH-22 Cotruncal cardiac defects Abn facies Thymic hypoplasia Craniofacial abnormalities HypoCa/HypoPTH
what cotruncal cardiac defects are seen in DiGeorge synd?
- TOF
- TA
- interupted aortic arch
how does thymic hypo/aplasia present on labs?
T-cell def
what craiofacial abn is seen in DiGeorge synd?
cleft palate
what does PDA sound like?
washing machine / continuous murmur
Down’s synd is assoc w/ cardiac defect?
endocardial cushion defect
when does MVP present?
young females
what should you suspect if incr Ca + kidney stones?
hyperparathyroidism
where will CP of cardiac origin loacalize?
substernal/retrosternal
what is supraventricular AS
congenital defect = L vent outflow tract obstruction 2/2 diffuse narrowing of the asc. aorta
how does supraventricular AS present?
+palpable thrill (suprasternal)
+AS murmur @ 1st R intercostal space
+diff BP RUE vs LUE
if low BP is not responding to IVF (not vol problem), what is the cause of the low BP?
-pump failure
which side of the heart is the “main pump”?
right side
when does the heart receive O2?
diastole
SOC tx post-MI + stent placement = ?
- dual anticoag
- statin
- BB
- aldosterone antag
what is dual anticoag tx?
- ASA
2. P2Y12 inbib = clopidogrel, prasugrel, ticagrelor
what is the cause of anginal CP (regardless of if the pt has a murmur or not)?
- angina = ischemic pain!
- incr mycardial O2 demand
what is TRALI?
Transfusion Related Acute lung Injury
how does TRALI present?
=F, low BP, noncardiogenic pulm edema
when does TRALI present?
= onset w/in 6 hrs of receiving RBC transfusion
when/why do you hear crackles on lung ascultation?
LV can’t/doesn’t handle cardiac load –> fluid backs up into lungs –> pulm edema –> crackles
pt presents s/p sx w/ low BP, incr HR, crackles on p/e, and incr PCWP when tested. what do you expect?
MI (–> decr LV f(x) –> incr PCWP –> pulm edema –> crackles)
does post-sx MI always present w/ CP?
NO. may present w/o pain but in cardiogenic shock
how does cardiogenic shock present?
AMS, low BP, incr HR, cool extremities, pulm edema (crackles, JVD), decr urination
what does pulm cap wedge pressure estimate?
L atrial pressure
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?
-hemorrhage (this is a pump failure not a vol issue)
in CHF, what is the best indicator of worsening prognosis?
development of S3
S3 on exam + incr BNP is cause for high suspicion of what?
heart failure
what non cardiac conditions (not CHF) exhibit peripheral edema?
- IVC obstruction
- cirrhosis
- nephrotic synd
- LE venous insufficiency
why is S3 > peripheral edema @ suggesting worsening HF?
it is WAY MORE SPECIFIC
what are two types of syncope?
- neurogenic
2. cardiogenic
which type of syncope presents w/ prodrome?
neurogenic
pt presents w/ diaphoresis. what is your ddx (general)?
- heart problem
2. aorta problem
how does pain 2/2 AAA rupture present?
- L sided abd, flank, back, CVA pain/tenderness
- pain will range from dull –> severe
- *b/c leaked blood is irritating the retroperitoneal structures
how does AAA present (stable vs sudden expansion vs rupture)?
s: mostly asymp
se: dull abd/back pain; +/- distal emboli
r: sudden, severe abd/back pain; +/- shock, hematoma
what is Myxadematous Valve degeneration?
MCC of MVP
what are the 3 MCC AS in the general population?
- senile calcification (MCC, esp age>70)
- bicuspid aorta (MC age<70)
- rheumatic heart dz
what is the most important RF for aortic dissection?
HTN (esp age>60)
h/o what aside from HTN incr risk of aortic dissection?
- marfan’s (MC age<40)
- cocaine use
through what mechanism does reynaud’s phenom occur?
vasospasm (mainly digital)
what is the pathophys of intermittent claudication?
PVD–> exertion induced ischemia –> m. cramps –> pain
CKD w/ BUN >60 sig incr risk of what complication? (hint: this is why emergent HD is done for uremia)
uremic pericarditis
what is apixaban?
factor Xa inhibitor
what are the uses of apixaban?
- nonvalvular afib
- DVT
- PE
how long should dual anticoag tx be used in pts w/ drug-eluting stents?
> = 12mos
what is the nL range for HDL?
HDL 30-70
what is the HDL target for therapy?
HDL > 40
what are the LDL targets for nonDM and DM pts w/ high cholesterol?
nonDM –> LDL < 100
DM –> DM < 70
pts w/ DM btwn what ages should receive ____ + lifestyle modifications + glucose control?
- between ages 40-75
- statins
what are 3 common causes of pulsus paradoxus?
- pericardial effusion/tamponade
- severe asthma
- COPD
BP falls by how much during insp. in pulsus paradoxus?
> 10mmHg
pt presents w/ CP and you suspect cocaine intox. how do you manage his/her pain?
- nitroglycerin
- CCB
pt presents w/ CP and you suspect cocaine intox. what do you give 1st?
IV benzos
why do you give IV benzos to pts w/ cocaine-associated chest pain?
- decr psychomotor agitation
- decr myocardial O2 demand
- decr cardiovasc s/s
what do you ABSOLUTELY NOT GIVE in cocaine-associated chest pain?
BB
what are the lifestyle mods recommended for HTN?
- weight loss (goal BMI <25) =BEST/MOST EFFECTIVE
- DASH diet
- exercise
- limit Na intake
- decr EtOH
how many mmHg will BP decr for every 10 kg weight lost?
5-10mmHg
what is the DASH diet?
- high fruit and veg
- low fat and salt
how much exercise is recommended per week?
30 min/d x5-6 d/wk
how much Na should be consumed per day by HTN pts?
< 3 g/day
how much EtOH is acceptable per day for HTN pts?
M –> <2 drink/d
F –> <1 drink/d
what lifestyle mod is most effective @ decr BP?
weight loss
how do AD genetic conditions generally present?
- age > 18 y/o (AD = aDults)
- mutation –> structural abnormality
how do AR genetic conditions generally present?
- age < 18 y/o
- mutation –> enzymatic abnormality
what type of genetic defect is hypertrophic cardiomyopathy?
AD
when to give nitroprusside?
HTN emergency
how do you medically manage aortic dissection?
control HTN & decr heart strain to decr dissection expansion:
- IV BB
- nitroprusside (only if BB fail)
why is hydralazine C/I in aortic dissection?
cause reflex tachy –> incr heart strain –> incr risk of enlarging the dissection
why is nitroprusside only used as 2nd line tx for aortic dissection?
can cause reflex tachy –> dissection enlargement
which IV BB are given as first line in aortic dissection and in what order are they given?
IV BB (decr HR-->decr heart strain-->decr risk enlargement) 1. labetolol 2 propranolol 3. esmolol **in that order**
what is the most likely cause of inguinal swelling + palpable thrill + new continuous murmur s/p heart cath?
abnormal AV communication
palpable thrill = ?
turbulence
what is a complication of cardiac cath that could lead to swelling, palpable thrill, and continuous murmur?
formation of an abn AV communication
how will an aneurysm feel on palpation?
pulsatile mass
a vein is occluded. how will the affected limp look?
red
an artery is occluded. how will the affected limb look?
pale
radiation of the chest can lead to ___?
constrictive pericarditis
infectious endocarditis will affect which valve 1st?
tricuspid valve (–> TR)
which murmurs are accenuated on insp vs expiration?
Right sided (Tricuspid, pulmonic)
Inspiration –> worsens murmur
Left sided (Mitral, aortic)
Expiration –> worsens murmur
what are the physiologic effects of BB on the heart?
decr HR
decr myocardial contractility
what are the physiologic effects of CCB on the heart?
decr HR
decr myocardial contractility
why can BB and CCB generally be used to tx the same conditions?
have same physiological effect via diff mechanisms (decr HR and contractility)
what do nondihydrapyrimadine CCB do?
- cause coronary artery vasodilation
- decr afterload
how do nitrates work?
vasodilation –> decr preload and decr END diastolic vol
chronic refractory/peristent angina should be treated w/ what?
- nitrates
2. ranolazine
what does ranolazine do?
incr myocardial Ca influx
what is the 1st line tx of chronic stable angina?
BB
what drugs are 2nd line tx of chronic stable angina?
diltiazem and verapamil
what meds can be added to BB to tx stable angina?
dihydropyrimadine CCB (=dipines)
what drugs prolonge QT interval and incr risk of torsades de pointes?
ABCDEs
anti-Arrhythmics (class 1a and 3)
antiBiotics
anti-psyChotics
anti-Depressants and Diuretics
anti-Emetics (ondansetron)what anti-Arrhythmics cause QT prolongation?
- amiodarone
- flecanide
- sotolol
- ranolazine
what ABX cause QT prolongation?
- macrolides
- fluoroquinolones
- anti-fungals (=azoles)
what anti-psyChotics cause QT prolongation?
- haloperidol
- risperidone
- quetiapine
what anti-Depressants cause QT prolongation?
TCAs (esp. amitriptyline)
-SSRI (esp. citalopram)
aortic dissection is suspected but pt is unstable and/or has CKD. how do you confirm dx?
TEE
young pt presents w/ intermittent retrosternal CP. what should you suspect?
drugs
which drugs cause pupillary dilation?
- cocaine
- methamphetamines
- bath salts
which drugs cause pupillary constriction?
opioids
how to tx cocaine chest pain?
-IV Benzos (aggitation)
-nitroglycerin (pain)
NO BB!!!
in rheumatic heart dz what valve is most commonly affected?
mitral > aortic
in rheumatic heart dz what murmurs might you hear?
MC: early = MR –> MS = late
LC: early = AR –> AS = late
AR progresses to AS. what condition should you suspect?
- bicuspid aortic valve
2. h/o rheumatic heart dz
combo of irreg irreg rhythm + hemoptysis suggests what?
L atrial problem (enlargement)
L atrium is enlarged. what 2 symp may develop?
- dysphagia
2. hoarseness
pain is parasternal. where is the problem?
MSK or chest cavity
pt presents w/ sharp parasternal CP that is reproducible and pleuritic. dx = ?
costochondritis (MSK pain)
what is the mitral valve issue seen in HOCM?
abn mitral leaflet motion (=ant displacement –> obstr)
what is cor pulmonale?
enlargement of the R heart 2/2 lung dz
what causes cor pulmonale?
lung dz (COPD/PE) –> pulm HTN –> cor pulmonale
where can TB cause calcifications?
lung, kidney, bladder, spine, pericardium
how to tx TB infx of the bladder?
BCG vaccine
what two conditions cause distant heart sounds?
- tamponade
2. pericarditis
jugular venous pressure tracings show prominent x and y descents. what is this?
pulsus paradoxus
what are the MCC of cor pulmonale?
- COPD
- PE
trypanosoma cruzi causes what?
chagas dz
how does chagas dz present?
- megacolon
- megaesophagus
- cardiac dz
what cardiac problems are caused by chagas dz?
- systolic and diastolic HF
- MR and TR
- arrhythmias
CHF leads to third spacing which results in decr BP. how does the body respond?
incr RAAS –> constrict efferent arteriole –> incr filtration
what are the surgical options for AAA repair?
- unstable = open or EVAR
- stable = laprascopic
what might you hear on auscultation during acute phase of MI?
S4 gallop
fixed S2 splitting = ?
ASD
what is S4?
atrial gallop
how does fibromuscular dysplasia present?
- 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
what is the timeline for PCI of STEMI?
door –> cath time =< 90 min
renal stones smaller than what size will pass spontaneously?
< 1cm
what pharm tx can be used to help pass small kidney stones?
a-blockers = tamulosin
causes ureteral m. to relax –> ureters dilate –> stone passes more easily
how do you w/u metabolic derrangements?
- look @ pH
- look @ paCO2
- look @ HCO3
what is nL pH?
= 7.45
what is nL paCO2?
= 40
what will paCO2 be in the 2 types of alkalosis?
resp alk - paCO2 decr
met alk - paCO2 incr (comp)
what will paCO2 be in the 2 types of acidosis?
resp acidosis - paCO2 incr
met acidosis - paCO2 decr (comp)
what is the first line tx for renovasc HTN?
ACEi
what is the earliest sign of kidney damage seen in DM?
hyperfiltration –> microalbuminuria
what is the MC complication in nephrotic synd?
renal vein thrombosis 2/2 loss of anti-thrombin 3
muddy brown casts = ?
ATN
broad, waxy casts = ?
chronic renal failure
RBC casts = ?
nephritis (1. glomerular dz 2. vasculitis)
WBC casts = ?
- AIN
2. pyelonephritis
fatty casts = ?
nephrotic synd
hyaline casts = ?
-prerenal azotemia
chron’s is associated w/ which type of kidney stone?
CaOxalate stones
what factors do you look at to determine the cause of vaginitis?
color, pH, pmHx, pSocialHx
when would you get a voiding cystogram on a kid?
- high suspicion of anatomical defect/abn
- U/S +
HCV is associated w/ which nephritis?
mixed cryoglobulinemia
Cl is decr. what do you suspect?
incr vomiting or diarrhea
pt presents w/ recent h/o of ABX + WBC casts. Dx = ?
AIN
what is seen later on in diabetic kidney damage?
nodular sclerosis (kimmel-wilson bodies)
general principle: the “most appropriate” test = what?
-quickest, cheapest, “best initial” test
pt presents w/ F + incr WBC + new mitral murmur + h/o recent viral infec. what do you suspect?
infectious endocarditis
how will renal infarct present?
- flank pain, n/v
- U/A + RBC + protein - (NO) casts
what is a complication of endocarditis?
septic emboli
anion gap is > 12. what could be the cause?
MUDPILES Methanol Uremia Diabetic ketoacidosis Paraaldehyde Iron, isoniazid Lactic acid Ethylene glycol Salicylates
pt presents w/ bilat flank pain + HTN + famHx. what should you suspect?
PCKD (AD)
when do PCKD pts start to exhibit s/s of dz?
age 30-40s
why is urine dark in rhabdo?
myoglobin in the urine
what are the common causes of rhabdo?
- trauma
- crush/compression injury
- dehydration
- excessive exercise
- uncontrolled shivering
- NEMS
what is nL BUN?
12-18
what is pathomneumonic for interstitial cystitis?
bladder pain relieved w/ urination
what will the U/A findings be w/ interstitial cystitis?
nL
interstitial cystitis tx = ?
- amitriptyline
- pentosan polysulfate
- analgesics
when might pre-eclampsia, gestational DM, and gestational HTN present?
@ >= 20 wks gestation w/o prior hx of complaint
levofloxacin doesn’t cause actute renal failure. but what can it cause?
AIN
amikacin = aminoglycoside that causes what?
acute renal failure
what drug is used to tx MDR pyelonephritis but can cause acute renal failure?
amikacin
when should stenting be used to tx HTN 2/2 RAS?
- ACEi intolerant
- failed pharm tx
- recurrent flash pulm edema
- refractory CHF 2/2 HTN
what is the dx when a sickle cell pt has reticulocyte count < 1%
-aplastic crisis
how do you differentiate btwn a mixed germ cell tumor and a seminoma via labs?
mixed = incr B-hCG + incr alpha-fetoprotein (APF) seminoma = incr B-hCG + nL AFP
pt presents w/ a mediastinal mass. what is your ddx?
Terrible Ts
- Thymoma
- Terrible lymphoma
- Thyroid
- Teratoma
when a lymph node is tender, what do you suspect?
infx
when a lymph node is non-tender, what do you suspect?
malignancy
what might head and neck cancer present w/ ear pain + nL ear exam?
mass can put pressure on CN 9 afferent fibers
what is the MC head and neck Ca?
SCC
how does polycythemia vera present?
- AQUAGENIC PRURITIS
- facial plethora
- INCR HCT
pt presents w/ s/s of polycythemia vera + incr LFTs. what do you suspect?
Budd-Chiari synd
what is a common cause of Budd-Chiari synd?
hepatic vein thrombosis 2/2 polycythemia vera
how does Budd-Chiari synd present?
- vague progressive abd pain
- ascites
- hepatosplenomegaly
what mutation is assoc w/ polycythemia vera?
JAK2v617F
what is nL MCHC?
< 35%
what MCHC should you expect in hereditary spherocytosis?
> 35% (cells are smaller but contain same amount of Hgb)
which microcytic anemia is often asymp?
thalassemia
what are the uses of hemoglobin electrophoresis?
- distinguish btwn Hgb E or C
- dx thalassemia A/B
- dx sickle cell dz
what are the coag studies in hemophelia A vs B?
Hem A: plt-nL aPTT-incr PT-nL F8-decr F9-nL
Hem B: plt-nL aPTT-incr PT-nL F8-nL F9-decr
what is the tx for mild hemophilia?
desmopressin (DDAVP)
what is the tx for mod/severe hemophilia?
replace missing factor (cryoprecipitate)
what is a normal anti-D Ab titer level?
=< 1 : 8
1 = amount baby has
8 = amount mom has
Eosin-5-maleimide binding is what kind of test?
flow cytometry
what is another name for the acidified glycerol lysis test?
osmotic fragility test
what dz is diagnosed w/ either the osmotic fragility test (acidified glycerol lysis test) or Eosin-5-maleimide binding flow cytometry?
hereditary spherocytosis
what are 4 common leukemias?
- ALL
- AML
- CML
- CLL
which leukemias present w/ >=25% BLASTS on BM bx?
ALL and AML
which leukemia is seen predominantly in kids?
ALL
which leukemia is seen predominantly in the elderly?
CLL
which leukemias are seen predominantly in middle-aged adults
AML and CML
M = middle aged
which leukemia presents w/ auer rods?
AML
A = Auer rods = AML
which leukemia presents w/ smudge cells?
CLL
elderly are waiting for kids to call but the phone# got smudged
which leukemia is PAS+ and Tdt+ ?
ALL
which specific variant of AML has Auer rods?
APL variant = (t 15:17)
which gene mutation is CML associated w/ ?
(t 9:22) = bcr-abl fusion protein
if pt presents w/ pancytopenia, what must you do?
BM bx
what condition is assoc w/ ALL and AML?
Down’s synd
a pt w/ down’s synd presents to the ED. what must you want out for?
alanto-axial insufficiency
pt presents w/ >50K WBC + incr LAP. dx = ?
leukemoid rxn
what is LAP?
= leukocyte alkaline phosphatase
-elevated in leukemoid rxns
pt presents w/ >50k WBC + nL LAP. dx = ?
CML
what are the stages of granulocyte development?
- myeloblast
- promyelocyte
- myelocyte
- metamyelocyte
- band form
- neutrophil
which presents w/ more mature precursors CML or leukemoid rxn?
Leukemoid = More mature (L so has More) cMl = Less mature (M so has Less)
will leukemoid rxn have more metamyelocytes or myelocytes?
metamyelocytes > myelocytes
will CML have more metamyelocytes or myelocytes?
myelocytes > metamyelocytes
what causes CML?
philadelphia chromosome = (t 9:22) –> bcr-abl fusion protein
what causes leukemoid rxn?
severe infx
pt presents w/ h/o prostate ca + LE neuro issues + back pain. what do you suspect?
bone mets
when do you suspect epidural spinal cord compression?
- h/o malig + new back pain + motor/sensory abnormalities
- loss of bowel and/or bladder control = late s/s
how do you tx suspected epidural spinal cord compression?
- IV glucocorticoids
- emergent MRI
- rad-onc/ neuro-sx consults
what bone marrow problem can cause anemia?
infiltration w/ Ca cells
what are the common renal tubular acidosis associations?
type 1 = AI conditions
type 2 = mult. myeloma, osteomalacia, Ricketts
type 4 = DM2
