Rapid Review Flashcards
classic ECG finding in atrial flutter
sawtooth P waves
definition of unstable angina
angina that is new, is worsening, or occurs at rest
antihypertensive for a diabetic patient with proteinuria
ACEI
Beck’s triad for cardiac tamponade
hypotension, muffled heart sounds, JVD
drugs that slow heart rate
beta- blockers, calcium channel blockers, digoxin, amiodarone
hypercholesterolemia treatment that leads to flushing and pruritis
niacin
murmur- hypertrophic obstructive cardiomyopathy (HOCM)
a systolic ejection murmur heard along the lateral sternal border that increase with decreased preload (valsalva)
murmur- aortic insufficiency
Austin Flint murmur, a diastolic, decrescendo, low-pitched, blowing murmur that is best heard sitting up; increases with increased afterload (handgrip maneuver)
murmur- aortic stenosis
systolic crescendo/decrescendo murmur that radiates to the neck; increases with increase preload (squatting maneuver)
murmur- mitral regurgitation
holosystolic murmur that radiates tot he axilla; increases with increase afterload (handgrip maneuver)
murmur- mitral stenosis
diastolic, mid- to- late, low- pitched murmur preceded by an opening snap
treatment for atrial fibrillation and atrial flutter
if unstable, cardiovert. If stable or chronic, rate control with CCBs or beta blockers
treatment for ventricular fibrillation
immediate cardioversion
Dressler syndrome
autoimmune reaction with fever, pericarditis, and increased ESR occurring 2-4 weeks post MI
IV drug use with JVD and a holosystolic murmur at the left sternal border. Treatment?
Treat existing heart failure and replace the tricuspid valve
Diagnostic test for hypertrophic cardiomyopathy
echocardiogram (showing a thickened left ventricular wall and outflow obstruction)
pulsus paradoxus
a decrease in systolic BP of more than 10mm Hg with inspiration; seen in cardiac tamponade
classic ECG findings in pericarditis
low- voltage, diffuse ST- segment elevation
definition of hypertension
BP> 140/90 mm Hg on 3 separate occasions 2 weeks apart
eight surgically correctable causes of hypertension
renal artery stenosis, coarctation of aorta, pheochromocytoma, Conn’s syndrome, Cushing’s syndrome, unilateral renal parenchymal disease, hyperthyroidism, hyperparathyroidism
evaluation of a pulsatile abdominal mass and bruit
abdominal ulstrasound and CT
indications for surgical repair of abdominal aortic aneurysm
> 5.5 cm, rapidly enlarging, symptomatic, or ruptured
treatment for acute coronary syndrome
ASA, heparin, clopidogrel, morphine, O2, sublingual nitrogen, IV beta-blockers
metabolic syndrome
abdominal obesity, high triglycerides, low HDL, hypertension, insulin resistance, prothrombotic or proinflammatory states
Appropriate diagnotic test for a 50yo man with stable angina who can exercise to 85% of maximum predicted heart rate
exercise stress treadmill with ECG
Appropriate diagnotic test for a 65yo woman with left bundle branch block and severe osteoarthritis who has unstable angina
pharmacologic stress test (dobutamine echo)
target LDL in a patient with diabetes
signs of active ishemia during stress testing
angina, ST-segment changes on ECG, or decrease in BP
ECG findings suggesting MI
ST-segment elevation (depression means ischemia), flattened T waves, and Q waves
coronary territories in MI
anterior wall (LAD/diagonal) inferior wall (PDA) posterior wall (left circumflex/oblique, RCA/marginal) septal wall (LAD/diagonal)
A young patient with angina at rest and ST-segment elevation with normal cardiac enzymes
Prinzmetal’s anging
common symptoms associated with silent MIs
CHF
shock
altered mental status
diagnostic test for pulmonary embolism (PE)
spiral CT with contrast
protamine
reveres effects of heparin
prothrombin time
coagulation parameter affected by warfarin
young patient with a family history of sudden death collapses and dies while exercising
hypertrophic cardiomyopathy
endocarditis prophylaxis regimens
oral surgery-amoxicillin for certain situations; GI or GU procedures- not recommended
Virchow’s triad
stasis, hypercoagulability, endothelial damage
MCC htn in young women
OCPs
MCC HTN in young men
excessive EtOH
Figure 3 sign
aortic coarctation
Water-bottle-shaped heart
percardial effusion- look for pulsus paradoxus
“stuck on” appearance
seborrheic keratosis
red plaques with silvery-white scales and sharp margins
psoriasis
MC type of skin cancer; the lesion is a pearly-colored papule with a translucent surface and telangiectasias
basal cell carcinoma
honey-crusted lesions
impetigo
febrile patient with a history of diabetes presents with a red, swollen, painful lower extremity
cellulitis
positive Nikolsky sign
pemphigus vulgaris
negative Nikolsky sign
bullous pemphigoid
55-year old obese patient presents with dirty, velvety patches on the back of the neck
acanthosis nigricans. check fasting blood glucose to rule out diabetes
dermatomal distribution
varicella zoster
flat- topped papules
lichen planus
iris- like target lesion
erythema multiforme
lesions characteristically orrutting in a linear pattern in areas where skin comes into contact with clothing or jewelry
contact dermatitis
presents with a herald patch, christmas-tree pattern
pityriasis rosea
pinkish, scaling, flat lesions on the chest and back; KOH prep has a ‘spagghetti-and-meatballs’ appearance
tinea (pityriasis) versicolor
four characteristics of a nevus suggestive of melanoma
asymmetry, border irregularity, color variation, and large diameter
a premalignant lesion from sun exposure that can lead to squamous cell carcinoma
actinic keratosis
“dewdrops on a rose petal”
lesions of primary varicella
cradle cap
seborrheic dermatitis
treat conservatively with bathing and moisturizing agents
associated with propionibacterium acnes and changes in androgen levels
acne vulgaris
painful, recurrent vesicular eruption of mucocutaneous surfaces
herpes simplex
inflammation and epithelial thinning of the anogenital area, predominantly in postmenopausal women
lichen sclerosus
exophytic nodules on the skin with varying degrees of scaling or ulceration; the second most common type of skin cancer
squamous cell carcinoma
MCC hypothyroidism
Hashimoto thyroiditis
Lab findings in Hashimoto thyroiditis
High TSH, low T4, anti-TPO abs
Exophthalmos, pretibial myxedema, and decreased TSH
Graves’ disease
MCC Cushing syndrome
iatrogenic corticosteroid administration. second most common cause is Cushing disease
a patient presents with signs of hypocalcemia, high phosphorus, and low PTH
hypoparathyroidism
“stones, bones, groans, psychiatric overtones”
signs and symptoms of hypercalcemia
a patient complains of headache, weakness, and pulyuria; examination reveals hypertension and tetany. Labs show hypernatremia, hypokalemia, and metabolic alkalosis
primary hyperaldosteronism (due to Conn’s syndrome or bilateral adrenal hyperplasia)
a patient presents with tachycardia, wild swings in BP, HA, diaphoresis, AMS, and a sense of panic
pheochromocytoma
which should be used first in treating pheochromocytoma, alpha or beta antagonists?
alpha antagonists (phentolamine and phenoxybenzamine)
A patient with a history of lithium use presents with copious amounts of dilute urine
nephrogenic diabetes insipidus (DI)
Treatment of central DI
Administration of DDAVP and free- water restriction
A postoperative patient with significant pain presents with hyponatremia and normal volume status
SIADH due to stress
An antidiabetic agent associated with lactic acidosis
Metformin
A patient presents with weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show hyponatremia and hyperkalemia. Treatment?
primary adrenal insufficiency (Addison disease). Treat with glucocorticoids, mineralocorticoids, and IV fluids
Goal HbA1C for a patient with DM
Treatment of DKA
fluids, insulin, and electrolyte repletion (eg K+)
Why are beta blockers contraindicated in diabetics?
they can mask symptoms of hyperglycemia
How do you interpret the following 95% CI for RR of 0.582 (0.502, 0.637)
These data are consistent with RRs ranging from 0.502 to 0.673 with 95% confidence (ie we are confident that the true RR will be between 0.502 and 0.637 95 out of 100 times)
Bias introduced into a study when a clinician is aware of the patient’s treatment type
observational bias
bias introduced when screening detects a disease earlier and thus lengthens the time from diagnosis to death
lead-time bias
if you want to know if geographical location affects infant mortality rate but most variation in infant mortality is predicted by SES, then SES is a
confounding variable
the proportion of people who have the disease and test positive is the
sensitivity
sensitive tests have few false negatives, and are used to rule ___ a disease
out
PPD reactivity is used as a screening test because most people with TB (except those who are anergic) will have a positive PPD. Highly sensitive or specific?
Highly sensitive for TB (screening tests with high sensitivity are good for diseases with low prevalence)
chronic diseases such as SLE- higher prevalence or incidence?
higher prevalence
epidemics such as influenza- higher prevalence or incidence?
higher incidence
what is the difference between incidence and prevalence?
Prevalence is the percentage of cases of disease in a population at 1 snapshot in time. Incidence is the percentage of new cases of disease that develop over a given time period among the total population at risk.
cross- sectional survey- incidence or prevalence?
prevalence
cohort study- incidence or prevalence?
incidence and prevalence
case- control study- incidence or prevalence?
neither
describe a test that consistently gives identical results, but the results are wrong
high reliability (prevision), low validity (accuracy)
difference between a cohort and a case- control study
cohort studies can be used to calculate RR, incidence, and/or odds ratio (OR). Case- control studies can be used to calculate an OR, which is an estimate of RR when the disease prevalence is low.
Attributable risk?
difference in risk in the exposed and unexposed groups (ie the risk that is attributable to the exposure)
relative risk?
incidence in the exposed group divided by incidence in the non-exposed group
the results of a hypothetical study found an association between ASA intake and risk of heart disease. How do you interpret an RR of 1.5?
in patients who took ASA, the risk of heart disease was 1.5 times that of patients who did not take ASA
Odds ratio?
In cohort studies, the odds of developing the disease in the exposed group divided by the odds of developing the disease in the non-exposed group.
In case- control studies, the odds that the cases were exposed divided by the odds that the controls were exposed.
In cross- sectional studies, the odds that the exposed group has the disease divided by the odds that the non-exposed group has the disease
The result of a hypothetical study found an association between ASA intake and risk of heart disease. How do you interpret an OR of 1.5?
In patients who took ASA, the odds of acquiring heart disease were 1.5 times those of patients who did not take ASA.
In which patients do you initiate colorectal cancer screening early?
Patients with IBD; those with familial adenomatous polyposis (FAP)/ hereditary nonpolyposis colorectal cancer (HNPCC); and those who have first- degree relatives with adenomatous polyps (
The most common cancer in men and the most common cause of death from cancer in men
prostate is the most common cancer in men. Lung cancer causes more deaths
percentage of cases within 1 SD of the mean? 2 SDs? 3 SDs?
68%, 95.4%, 99.7%
birth rate?
number of live births per 1000 population in 1 year
mortality rate?
number of deaths per 1000 population in 1 year
neonatal mortality rate?
number of deaths from birth to 28 days per 1000 live births in 1 year
infant mortality rate?
number of deaths from birth to 1 year of age per 1000 live births (neonatal and postnatal mortality) in 1 year
maternal mortality rate
number of deaths during pregnancy to 90 days postpartum per 100,000 live births in 1 year
