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Internal Medicine > U World > Flashcards

U World Flashcards

1
Q

Aortic valve replacement indications:

A
  1. Symptomatic (SAD) - syncope, angina, dyspnea
  2. Severe AS in pts undergoing CABG or other valvular surgery
  3. A symptomatic pts with severe AS and either poor LV systolic fx, LV hypertrophy >15mm, valve area
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2
Q

Phase 1a ventricular arrhythmias

A

within 10 mins of coronary occlusion; acute ischemia causes heterogeneity in conduction, delayed conduction increases the chance of re-entry.

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3
Q

Phase 1b ventricular arrhythmias

A

10-60 mins after MI; due to abnormal automaticity

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4
Q

Mitral regurgitation

A

seen in dilated and ischemic cardiomyopathy; holosystolic murmur at apex with radiation to the axilla

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5
Q

Causes of outflow obstruction in hypertrophic cardiomyopathy

A
  1. Bulging of the interventricular septum

2. systolic anterior motion (SAM) of mitral valve leaflets

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6
Q

Bronchiectasis appearance on CT and potential complication

A

tubular airways with thickened walls; hemoptysis

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7
Q

Treatment for infective endocarditis due to strep mutans

A

IV antibiotics (aqueous pencillin G or IV ceftriaxone) for 4 wks

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8
Q

Myasthenia gravis (paraneoplastic syndrome) involved site and clinical features:

A

acetylcholine receptor in postsynaptic membrane; fluctuating muscle weakness - ocular (ptosis and diplopia), bulbar (dysphagia, dysarthria) and facial, neck, and limb muscles

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9
Q

Lambert-Eaton syndrome (paraneoplastic syndrome) involved site and clinical features:

A

presynaptic membrane voltage-gated calcium channels; proximal muscle weakness, autonomic dysfunction (dry mouth), cranial nerve involvement (ptosis), diminished or absent DTRs

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10
Q

Dermatomyositis/polymyositis (paraneoplatic syndrome) involved sites and clinical features:

A

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)

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11
Q

Female athlete triad

A
  1. decreased caloric intake
  2. oligo-amenorrhea
  3. osteoporosis
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12
Q

Morton’s neuroma

A

pain btwn the 3rd and 4th toes on the plantar surface w/ clicking sensation (Mulder’s sign)

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13
Q

Tarsal tunnel syndrome

A

compression of the tibial nerve that causes numbness, burning, and aching of the distal plantar surface of the foot and toes

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14
Q

Isolated systolic hypertension (ISH)

A

decreased compliance of the arteries with age that causes isolated systolic pressure increase and widened pulse pressure; treat with thiazides, CCBs, or ACE inhbitor

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15
Q

Pulmonary HTN

A

pulmonary artery pressure >25 mm at rest or >30 mm w/ exercise

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16
Q

Causes of pulmonary HTN

A
  1. Disorders of the respiratory system, hypoxemia
  2. Pulmonary venous HTN (LV disease, mitral valve disease, pulmonary veno-occlusive disease)
  3. chronic thromboembolic disease
  4. Pulmonary arterial HTN (primary or associated with vasculopathy)
  5. Pulmonary capillary hemangiomatosis
17
Q

Modified Wells criteria for pretest probability of PE

A
  • 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

18
Q

Cardiac index

A

CO/body surface area

19
Q

Normal hemodynamic measurements

A

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%

20
Q

Hypovolemic shock

A

Decreased right atrial pressure, pulmonary capillary wedge pressure, cardiac index, and mixed venous O2 saturation

Increased systemic vascular resistance

21
Q

Cardiogenic shock

A

Increased right atrial pressure, pulmonary capillary wedge pressure, systemic vascular resistance

Decreased cardiac index and mixed venous O2 saturation

22
Q

Septic shock

A

Normal to decreased right atrial pressure and pulmonary capillary wedge pressure

Increased cardiac index and mixed venous O2 saturation

Decreased systemic vascular resistance

23
Q

Avascular necrosis

A

Progressive hip pain w/o restriction of ROM or abnormality of radiographs.
MRI is diagnostic.

24
Q

Ertapenem

A

Doesn’t cover pseudomonas

25
Q

Methotrexate

A

Inhibits dihydrofolate reductase

26
Q

Nonallergic rhinitis

A

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.
27
Q

Esophageal chest pain

A
  • Prolonged pain lasting more than an hour
28
Q

Medications causing diabetes insipidus

A

lithium, demeclocycline, foscarnet, cidofovir, and amphotericin

29
Q

Giant cell tumor of bone

A
  • “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.
30
Q

Osteoid osteoma

A
  • sclerotic cortical lesion w/ central lucency

- Pain that’s worse at night and relieved by nonsteroidal anti-inflammatory medications.

31
Q

CYP 450 inhibitors

A
  • Increase Warfarin’s effect
  1. Acetaminophen/NSAIDS
  2. Antibiotics/antifungals
  3. Amiodarone
  4. Cimetidine
  5. Cranberry juice, Ginko balboa, vitamin E
  6. Omeprazole
  7. Thyroid hormone
  8. SSRIs
32
Q

CYP 450 Inducers

A

-Decrease Warfarin’s effects

  1. Carbamazapine
  2. Ginseng
  3. Green vegetables
  4. oral contraceptives
  5. Phenobarbital
  6. Rifampin
  7. St. john’s wart
33
Q

Crystal-induced AKI

A

Common etiology:

  1. acyclovir
  2. sulfonamides
  3. methotrexate
  4. ethylene glycol
  5. protease inhibitors
  • Increase risk with volume depletion and CKD
34
Q

Hereditary telangiectasia (Osler-Weber-Rendu syndrome)

A
  • 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)
35
Q

Vitamin K deficiency

A
  • 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.
36
Q

Prophylaxis for splenectomy

A

daily oral penicillin prophylaxis for 3-5 yrs following splenectomy

37
Q

DVT algorithim

A

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
38
Q

Aquired sideroblastic anemia

A
  • 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

Internal Medicine (12 decks)

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