U World Cardiology Flashcards
Mobitz type I
- level of block is usually the AV node
- Narrow QRS complex
- Exercise or atropine improves it
- Vagal maneuvers worsens the heart block
Mobitz type II
- level of block is below the level of the AV node (His-Purkinje system)
- narrow or widened QRS complex
- exercise or atropine worsens the heart block
- vagal maneuvers paradoxically make the heart block better
Aortic stenosis
- Begins after S1 and ends before S2
- Radiates to the carotids
- pulsus parvus et tardus (gradually rising pulse with delayed peak)
- Prolonged cardiac impulse at the apex
Systemic sclerosis
General: fatigue, joint stiffness, pain
Skin: telangiectasias, sclerodactyly, digital ulcers, calcinosis cutis
Vascular: Raynaud’s
GI: dysphagia, dyspepsia, angiodysplasia of stomach w/ GI bleeding, malabsorption due to bacterial overgrowth
Renal: acute onset oliguric renal failure with malignant HTN, thrombocytopenia, microangiopathic hemolytic anemia
Pulmonary: PAH leads to right heart failure, pulmonary fibrosis
Cardiac: myocarditis, pericarditis, and pericardial effusion
- anti-topoisomerase Ab
Hypothermia QT prolongation
- Usually refractory to atropine and pacing
- Responds to warming
- Magnesium is used for acquired QT prolongation, not hypothermia induced.
S4
- Heard at the end of diastole, right before S1 (TEN-es-see)
- Associated with LVH and prolonged HTN
Theophylline toxicity
- CNS stimulation
- N/V
- Arrhythmias
- Broken down by the cyotchrome oxidase system in the liver.
- metabolism inhibited by other drugs likes ciprofloxacin.
Cervical spondylosis
- associated with osteophytes
- can cause specific localized sensory deficits
Patellofemoral syndrome
- seen in young female athletes
- subacute chronic pain that is increased with squatting, running, prolonged sitting, and using stairs
- patellofemoral compression test
- NSAIDS are typically ineffective
- xray and MRI are typically not helpful
Patellar tendonitis
- primarily seen in athletes
- episodic pain and tenderness at inferior patella
Osgood - Schlatter
- preadolescent/adolescent athletes w/ recent growth spurt
- increased pain w/ sports, relieved by rest
- tenderness and swelling at tibial tubercle
GERD-induced asthma
- adult-onset
- aggravated by lying down, eating, or exercise
- treat with a trial of proton-pump inhibitors
Premature atrial complexes (PAC)
- premature activation of the atria that occur from somewhere other than the SA node.
- early P wave on EKG
- Alcohol and tobacco are modifiable risk factors
- treat only when symptomatic with beta-blockers
Secondary amyloidosis
- can be secondary to chronic inflammation
- Diagnosed by abdominal fat pad aspiration biopsy
- treat and prevent with colchicine
Hypertrophic cardiomyopathy
- autosomal dominant
- mutations of the myosin binding protein C gene and cardiac beta-myosin heavy chain gene
Adenocarcinoma
- associated with clubbing and hypertrophic osteoarthropathy
Squamous cell carcinoma
- hypercalcemia
Small cell lung cancer
- Cushing’s syndrome
- Lambert-Eaton syndrome
- SIADH
Large cell carcinoma
- gynecomastia and galactorrhea
Mitral stenosis
- loud S1 with opening snap after S2 and low-pitched diastolic murmur
atrial fibrillation
irregularly irregular rhythm with narrow complex tachycardia and no organized P waves
- Unstable pts receive cardioversion
- Stable pts get rate control (metoprolol, diltiazem, digoxin)
- Assess all pts with CHA2DS2-VASc score
Paroxysmal supraventricular tachycardia
regular, narrow-complex tachycardia
- Retrograde P waves
- Adenosine and carotid massage can be used to treat
Lidocaine and amiodarone
- Used to treat ventricular arrhythmias
Adenosine
used in the initial diagnosis and management of patients with narrow-QRS-complex tachycardia
Postinfectious glomerulonephritis
- Associated with low C3 complement and subepithelial humps consisting of C3
Terminal hematuria
- bleeding at the end of urination
- suggests bladder or prostate disease
- Evaluate for bladder cancer
Dermatomyositis
- Elevated CPK
- anti-Jo-1 (antisynthetase Ab) and anti-Mi-2(helicase)
- More prone to internal malignancy
Multiple myeloma
- RBCs forming rouleauxs
- Elevated ESR
- Bence Jones proteins in the urine
- Plasma cells producing IgG
- Hypercalcemia
1. Lytic bone lesions
2. Marrow plasmacytosis
3. Urine and serum monoclonal proteins
Succinylcholine
- depolarizing neuromuscular blocker
- Can potentially cause life-threatening hyperkalemia
- Don’t use in burn and crush injury or pts with prolonged demyelination.
Viral myocarditis
- treat w/ NSAIDS and/or colchicine
Pulsus paradoxus
- exaggerated fall in systemic BP >10 mmHg during inspiration
- Found in cardiac tamponade, asthma, or COPD
Epidural spinal cord compression
- motor and sensory abnormalities
- Bowel and bladder dysfunction are late sequelae
- Manage w/ IV glucocorticoids and MRI
Atrial fibrillation origin
Pulmonary veins
Electrolyte abnormalities in chronic alcoholics
Hypokalemia, hypomagnesemia, hypophosphatemia
- Hypomagnesemia can be the cause of refractory hypokalemia.
Acute exacerbation of COPD
- treat with noninvasive positive-pressure ventilation (NPPV)
- Endotracheal intubation w/ mechanical ventilation recommended for pts who fail a 2-hr trial of NPPV
- NPPV decreases the work of breathing, improves alveolar ventilation, decreases RR, decreases PaCO2, increases tidal volume, increases minute ventilation, and increaases PaO2
Dibasic amino acids (cystinuria)
cystine, lysine, ornithine, and arginine
Warm agglutinin AIHA
Caused by:
- drugs
- viral infections
- autoimmune
- immunodeficiency
- lymphoproliferative (CLL)
- Direct Coombs positive with positive anti-IgG, anti-C3 or both.
Treatment: corticosteroids and splenectomy
Complications: venous thromboembolism and lymphoproliferative disorders
Cold agglutinin AIHA
Caused by: Infections (Mycoplasma pneumonaie and infectious mononucleosis) and lymphoproliferative disease
Clinical presentation: livedo reticularis and acral cyanosis with exposure to cold
- Direct Coombs positive with anti-C3 or anti-IgM, but not anti-IgG
Treatment: avoid the cold, rituximab +/- fludarabine
Complications: Ischemia and peripheral gangrene, lymphoproliferative disorder
Heparin induced thrombocytopenia
heparin exposure >5 days
- Due to Abs against platelet factor 4 complexes.
- Platelet reduction >50% from baseline
Diagnosis: seratonin release assay, but start treatment before results
- Start on direct thrombin inhibitor (argatroban) or fondaparineaux
- Do NOT start warfarin due to the transient pro-thrombotic state after starting it.
Treatment for BPH
alpha-1-blockers (tamsulosin and doxazosin) and 5-alpha reductase inhibitors (finasteride)
Light’s criteria
- pleural fluid protein/serum protein ratio >0.5
- pleural fluid lactate dehydrogenase (LDH)/serum LDH ratio >0.6
- Pleural fluid LDH >2/3 of the upper limit of normal for serum LDH
- One or more of these criteria being true indicates an exudative effusion
- Exudative effusions include infection, malignancy, PE, connective tissue disease
Acute sever asthma exacerbation necessitating intubation
- elevated or normal PaCO2
- decreased breath sounds
- absent wheezing
- decreased mental status
- marked hypoxia with cyanosis
Membranoproliferative glomerulonephritis type 2
dense intramembranous deposits that stain for C3 (IgG Abs directed against C3 convertase of the alternative complement pathway
Post-seizure anion gap metabolic acidosis
results from lactic acidosis - production is accelerated in the muscle with decreased hepatic uptake
- Just observe and redo labs in a couple hrs
Elevated A-a gradient
- Diffusion limitation
- V/Q mismatch
- shunt
Osmolar gap
calculate serum osmolarity: [2Na + Glu/18 + BUN/2.8]
Osmolar gap = observed osmolarity - calculated osmolarity
Irradiation of RBCs
Given to bone marrow transplant recipients, those with acquired or congenital cellular deficiency
Leukoreduced RBCs
- Given to chronically transfused pts, CMV seronegative at risk pts, potential transplant recipients, previous febrile nonhemolytic transfusion reaction
Washed RBCs
Given in IgA deficiency, complement dependent autoimmune hemolytic anemia, allergic rxns
Abnormalities in old PRBC
- Citrate can chelate calcium, leading to hypocalcemia and parasthesias
- Potassium can leak out of cells and cause hyperkalemia
Amitryptiline
Can cause urinary retention due to anticholinergic properties
Medications that cause hyperkalemia
- Non-selective beta adrenergic blockers (interfere w/ beta-2-mediated intracellular potassium uptake)
- ACE inhibitors
- ARBs
- K+-sparing diuretics
- Cardiac glycosides
- NSAIDS (impaired local prostaglandin synthesis which reduces renin and aldosterone secretion)
New pulmonary nodule
- Get CT
- If benign features, get serial CTs, if intermediate suspicion for malignancy do a biopsy or PET, if high suspicion for malignancy do a resection
Hollenhorst plaques
bright, yellow refractile plaques in the retinal artery (emboli from internal carotid)
Acute symptomatic hyponatremia treatment
immediate infusion of 3% or hypertonic saline at a rate of no more than 0.5 mEq/L/hr to avoid causing CNS osmotic demyelenation syndrome
Lifestyle modifications for HTN
weight loss is most effective in obese pts, DASH diet is next, then exercise, then salt restriction,and finally alcohol avoidance
Cor pulmonale
Isolated RH failure with most common cause being COPD
Symptoms: SAD syndrome, loud P2, tricuspid regurgitation, JVD, peripheral edema, hepatomegaly and ascites, and right ventricular heave
Risk assessment for treatment of Community-aquired pneumonia
CURB-65 Confusion Uremia (BUN>20) Respirations>30 Blood pressure
Patients with a score of 2 or more —-> inpatient treatment
Score >or= to 4 ——-> ICU admission
Treatment for community-aquired pneumonia
Outpatient: healthy - macrolide or doxycycline
healthy patient with comorbid conditions (diabetes or malignancy, etc.) - fluoroquinolone or beta-lactam + macrolide
Inpatient (non-ICU) - fluoroquinolone or beta lactam + macrolide
Inpatient (ICU) - beta lactam + macrolide(IV) or beta-lactam +fluoroquinolone
Most common causes of community-aquired pneumonia
Strep pneumoniae, Haemophilus, and atypicals
Sudden-onset of CHF in young patient
Consider viral myocarditis (Coxsackie B virus is most common)
Multiple myeloma
Signs: normocytic anemia, hypercalcemia, renal failure, elevated ESR, Bence Jones proteinuria and elevated total protein with normal albumin
- Back pain is also usually present.
- M spike due to IgGs.
- Bone scan will not show lytic lesions of MM, do bone xray.
Head and neck cancer
- most commonly squamous cell carcinoma
- firm solitary lymph nodes in older patients with a smoking history.
Hodgkin’s lymphoma
generalized lymphadenopathy
Ways to assess for respiratory distress
Follow vital capacity
How to diagnose acromegaly
Get IGF-1 level
