U World Flashcards
Aortic valve replacement indications:
- Symptomatic (SAD) - syncope, angina, dyspnea
- Severe AS in pts undergoing CABG or other valvular surgery
- A symptomatic pts with severe AS and either poor LV systolic fx, LV hypertrophy >15mm, valve area
Phase 1a ventricular arrhythmias
within 10 mins of coronary occlusion; acute ischemia causes heterogeneity in conduction, delayed conduction increases the chance of re-entry.
Phase 1b ventricular arrhythmias
10-60 mins after MI; due to abnormal automaticity
Mitral regurgitation
seen in dilated and ischemic cardiomyopathy; holosystolic murmur at apex with radiation to the axilla
Causes of outflow obstruction in hypertrophic cardiomyopathy
- Bulging of the interventricular septum
2. systolic anterior motion (SAM) of mitral valve leaflets
Bronchiectasis appearance on CT and potential complication
tubular airways with thickened walls; hemoptysis
Treatment for infective endocarditis due to strep mutans
IV antibiotics (aqueous pencillin G or IV ceftriaxone) for 4 wks
Myasthenia gravis (paraneoplastic syndrome) involved site and clinical features:
acetylcholine receptor in postsynaptic membrane; fluctuating muscle weakness - ocular (ptosis and diplopia), bulbar (dysphagia, dysarthria) and facial, neck, and limb muscles
Lambert-Eaton syndrome (paraneoplastic syndrome) involved site and clinical features:
presynaptic membrane voltage-gated calcium channels; proximal muscle weakness, autonomic dysfunction (dry mouth), cranial nerve involvement (ptosis), diminished or absent DTRs
Dermatomyositis/polymyositis (paraneoplatic syndrome) involved sites and clinical features:
muscle fiber injury; symmetrical and proximal muscle weakness, interstitial lung disease, Raynaud’s, and esophageal dysmotility, polyarthritis, skin findings (Gottron’s papules and heliotrope rash)
Female athlete triad
- decreased caloric intake
- oligo-amenorrhea
- osteoporosis
Morton’s neuroma
pain btwn the 3rd and 4th toes on the plantar surface w/ clicking sensation (Mulder’s sign)
Tarsal tunnel syndrome
compression of the tibial nerve that causes numbness, burning, and aching of the distal plantar surface of the foot and toes
Isolated systolic hypertension (ISH)
decreased compliance of the arteries with age that causes isolated systolic pressure increase and widened pulse pressure; treat with thiazides, CCBs, or ACE inhbitor
Pulmonary HTN
pulmonary artery pressure >25 mm at rest or >30 mm w/ exercise
Causes of pulmonary HTN
- Disorders of the respiratory system, hypoxemia
- Pulmonary venous HTN (LV disease, mitral valve disease, pulmonary veno-occlusive disease)
- chronic thromboembolic disease
- Pulmonary arterial HTN (primary or associated with vasculopathy)
- Pulmonary capillary hemangiomatosis
Modified Wells criteria for pretest probability of PE
- Clinical signs of DVT (+3)
- Alternate diagnosis less likely (+3)
- Previous PE or DVT (+1.5)
- HR >100 (+1.5)
- Recent surgery or immobilization (+1.5)
- Hemoptysis (+1)
- Cancer (+1)
Total score: > or = to 4, PE likely
Cardiac index
CO/body surface area
Normal hemodynamic measurements
Right atrial pressure (preload) - 4mmHg
Pulmonary capillary wedge pressure (preload) - 9mmHg
Cardiac index (pump function) - 2.8 to 4.2 L/min/m2
Systemic vascular resistance (after load) - 1150 dynes*sec/cm5
Mixed venous oxygen saturation - 60-80%
Hypovolemic shock
Decreased right atrial pressure, pulmonary capillary wedge pressure, cardiac index, and mixed venous O2 saturation
Increased systemic vascular resistance
Cardiogenic shock
Increased right atrial pressure, pulmonary capillary wedge pressure, systemic vascular resistance
Decreased cardiac index and mixed venous O2 saturation
Septic shock
Normal to decreased right atrial pressure and pulmonary capillary wedge pressure
Increased cardiac index and mixed venous O2 saturation
Decreased systemic vascular resistance
Avascular necrosis
Progressive hip pain w/o restriction of ROM or abnormality of radiographs.
MRI is diagnostic.
Ertapenem
Doesn’t cover pseudomonas
Methotrexate
Inhibits dihydrofolate reductase
Nonallergic rhinitis
Nasal congestion, rhinorrhea, sneezing, postnasal drainage w/o specific etiology.
- routine allergy testing not necessary prior to empiric therapy.
- treat with intranasal antihistamine, intranasal glucocorticoids.
Esophageal chest pain
- Prolonged pain lasting more than an hour
Medications causing diabetes insipidus
lithium, demeclocycline, foscarnet, cidofovir, and amphotericin
Giant cell tumor of bone
- “soap bubble” appearance
- Benign tumor of young adults that an lead to pain, swelling, and decreased ROM as well as potential fractures
- Located in the epiphyseal region of long bones
- Osteoclasts
- Treat with surgery.
Osteoid osteoma
- sclerotic cortical lesion w/ central lucency
- Pain that’s worse at night and relieved by nonsteroidal anti-inflammatory medications.
CYP 450 inhibitors
- Increase Warfarin’s effect
- Acetaminophen/NSAIDS
- Antibiotics/antifungals
- Amiodarone
- Cimetidine
- Cranberry juice, Ginko balboa, vitamin E
- Omeprazole
- Thyroid hormone
- SSRIs
CYP 450 Inducers
-Decrease Warfarin’s effects
- Carbamazapine
- Ginseng
- Green vegetables
- oral contraceptives
- Phenobarbital
- Rifampin
- St. john’s wart
Crystal-induced AKI
Common etiology:
- acyclovir
- sulfonamides
- methotrexate
- ethylene glycol
- protease inhibitors
- Increase risk with volume depletion and CKD
Hereditary telangiectasia (Osler-Weber-Rendu syndrome)
- Autosomal dominant
- Diffuse telangiectasias, recurrent epistaxis, and widespread AV malformations (usually in the mucous membranes, skin and GI tract, but also liver, brain and lung)
- Pulmonary AVMs can shunt blood from the right to the left side of the heart causing chronic hypoxemia and reactive polycythemia; can also cause massive hemoptysis)
Vitamin K deficiency
- Vitamin K is a cofactor in the carboxylation of glutamic acid residues on PT complex proteins
- Decreases all PT complex proteins (II, VII, IX, X, proteins C and S)
- Increases both PT and PTT
- Due to inadequate intake, intestinal malabsorption, or hepatocellular disease.
Prophylaxis for splenectomy
daily oral penicillin prophylaxis for 3-5 yrs following splenectomy
DVT algorithim
Proximal lower extremity DVT —–> PE w/ hemodynamic instability or massive DVT w/ severe swelling or threatened ischemia —–> if no contraindications to anticoagulation, start thrombolytic therapy. If contraindications exist, consider mechanical thrombectomy, iliac stenting, or surgical thrombectomy
- Less severe DVT —–> treat with anticoagulation unless contraindicated in which IVC filter placement is indicated
Aquired sideroblastic anemia
- Defective heme synthesis
- Often due to pyrodoxine-dependent impairment in early steps of protoporphyrin synthesis
- Isoniazid is a pyrodoxine inhibitor.
- Dimorphic RBC populations (normocytic and hypochromic)
- Increased serum iron and decreased TIBC
