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Internal Medicine > U World Cardiology > Flashcards

U World Cardiology Flashcards

1
Q

Mobitz type I

A
  • level of block is usually the AV node
  • Narrow QRS complex
  • Exercise or atropine improves it
  • Vagal maneuvers worsens the heart block
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2
Q

Mobitz type II

A
  • 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
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3
Q

Aortic stenosis

A
  • 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
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4
Q

Systemic sclerosis

A

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

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5
Q

Hypothermia QT prolongation

A
  • Usually refractory to atropine and pacing
  • Responds to warming
  • Magnesium is used for acquired QT prolongation, not hypothermia induced.
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6
Q

S4

A
  • Heard at the end of diastole, right before S1 (TEN-es-see)

- Associated with LVH and prolonged HTN

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7
Q

Theophylline toxicity

A
  • CNS stimulation
  • N/V
  • Arrhythmias
  • Broken down by the cyotchrome oxidase system in the liver.
  • metabolism inhibited by other drugs likes ciprofloxacin.
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8
Q

Cervical spondylosis

A
  • associated with osteophytes

- can cause specific localized sensory deficits

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9
Q

Patellofemoral syndrome

A
  • 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
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10
Q

Patellar tendonitis

A
  • primarily seen in athletes

- episodic pain and tenderness at inferior patella

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11
Q

Osgood - Schlatter

A
  • preadolescent/adolescent athletes w/ recent growth spurt
  • increased pain w/ sports, relieved by rest
  • tenderness and swelling at tibial tubercle
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12
Q

GERD-induced asthma

A
  • adult-onset
  • aggravated by lying down, eating, or exercise
  • treat with a trial of proton-pump inhibitors
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13
Q

Premature atrial complexes (PAC)

A
  • 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
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14
Q

Secondary amyloidosis

A
  • can be secondary to chronic inflammation
  • Diagnosed by abdominal fat pad aspiration biopsy
  • treat and prevent with colchicine
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15
Q

Hypertrophic cardiomyopathy

A
  • autosomal dominant

- mutations of the myosin binding protein C gene and cardiac beta-myosin heavy chain gene

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16
Q

Adenocarcinoma

A
  • associated with clubbing and hypertrophic osteoarthropathy
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17
Q

Squamous cell carcinoma

A
  • hypercalcemia
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18
Q

Small cell lung cancer

A
  • Cushing’s syndrome
  • Lambert-Eaton syndrome
  • SIADH
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19
Q

Large cell carcinoma

A
  • gynecomastia and galactorrhea
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20
Q

Mitral stenosis

A
  • loud S1 with opening snap after S2 and low-pitched diastolic murmur
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21
Q

atrial fibrillation

A

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
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22
Q

Paroxysmal supraventricular tachycardia

A

regular, narrow-complex tachycardia

  • Retrograde P waves
  • Adenosine and carotid massage can be used to treat
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23
Q

Lidocaine and amiodarone

A
  • Used to treat ventricular arrhythmias
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24
Q

Adenosine

A

used in the initial diagnosis and management of patients with narrow-QRS-complex tachycardia

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25
Q

Postinfectious glomerulonephritis

A
  • Associated with low C3 complement and subepithelial humps consisting of C3
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26
Q

Terminal hematuria

A
  • bleeding at the end of urination
  • suggests bladder or prostate disease
  • Evaluate for bladder cancer
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27
Q

Dermatomyositis

A
  • Elevated CPK
  • anti-Jo-1 (antisynthetase Ab) and anti-Mi-2(helicase)
  • More prone to internal malignancy
28
Q

Multiple myeloma

A
  • 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
29
Q

Succinylcholine

A
  • depolarizing neuromuscular blocker
  • Can potentially cause life-threatening hyperkalemia
  • Don’t use in burn and crush injury or pts with prolonged demyelination.
30
Q

Viral myocarditis

A
  • treat w/ NSAIDS and/or colchicine
31
Q

Pulsus paradoxus

A
  • exaggerated fall in systemic BP >10 mmHg during inspiration
  • Found in cardiac tamponade, asthma, or COPD
32
Q

Epidural spinal cord compression

A
  • motor and sensory abnormalities
  • Bowel and bladder dysfunction are late sequelae
  • Manage w/ IV glucocorticoids and MRI
33
Q

Atrial fibrillation origin

A

Pulmonary veins

34
Q

Electrolyte abnormalities in chronic alcoholics

A

Hypokalemia, hypomagnesemia, hypophosphatemia

- Hypomagnesemia can be the cause of refractory hypokalemia.

35
Q

Acute exacerbation of COPD

A
  • 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
36
Q

Dibasic amino acids (cystinuria)

A

cystine, lysine, ornithine, and arginine

37
Q

Warm agglutinin AIHA

A

Caused by:

  1. drugs
  2. viral infections
  3. autoimmune
  4. immunodeficiency
  5. lymphoproliferative (CLL)
  • Direct Coombs positive with positive anti-IgG, anti-C3 or both.

Treatment: corticosteroids and splenectomy

Complications: venous thromboembolism and lymphoproliferative disorders

38
Q

Cold agglutinin AIHA

A

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

39
Q

Heparin induced thrombocytopenia

A

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.
40
Q

Treatment for BPH

A

alpha-1-blockers (tamsulosin and doxazosin) and 5-alpha reductase inhibitors (finasteride)

41
Q

Light’s criteria

A
  1. pleural fluid protein/serum protein ratio >0.5
  2. pleural fluid lactate dehydrogenase (LDH)/serum LDH ratio >0.6
  3. 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
42
Q

Acute sever asthma exacerbation necessitating intubation

A
  1. elevated or normal PaCO2
  2. decreased breath sounds
  3. absent wheezing
  4. decreased mental status
  5. marked hypoxia with cyanosis
43
Q

Membranoproliferative glomerulonephritis type 2

A

dense intramembranous deposits that stain for C3 (IgG Abs directed against C3 convertase of the alternative complement pathway

44
Q

Post-seizure anion gap metabolic acidosis

A

results from lactic acidosis - production is accelerated in the muscle with decreased hepatic uptake
- Just observe and redo labs in a couple hrs

45
Q

Elevated A-a gradient

A
  • Diffusion limitation
  • V/Q mismatch
  • shunt
46
Q

Osmolar gap

A

calculate serum osmolarity: [2Na + Glu/18 + BUN/2.8]

Osmolar gap = observed osmolarity - calculated osmolarity

47
Q

Irradiation of RBCs

A

Given to bone marrow transplant recipients, those with acquired or congenital cellular deficiency

48
Q

Leukoreduced RBCs

A
  • Given to chronically transfused pts, CMV seronegative at risk pts, potential transplant recipients, previous febrile nonhemolytic transfusion reaction
49
Q

Washed RBCs

A

Given in IgA deficiency, complement dependent autoimmune hemolytic anemia, allergic rxns

50
Q

Abnormalities in old PRBC

A
  • Citrate can chelate calcium, leading to hypocalcemia and parasthesias
  • Potassium can leak out of cells and cause hyperkalemia
51
Q

Amitryptiline

A

Can cause urinary retention due to anticholinergic properties

52
Q

Medications that cause hyperkalemia

A
  1. Non-selective beta adrenergic blockers (interfere w/ beta-2-mediated intracellular potassium uptake)
  2. ACE inhibitors
  3. ARBs
  4. K+-sparing diuretics
  5. Cardiac glycosides
  6. NSAIDS (impaired local prostaglandin synthesis which reduces renin and aldosterone secretion)
53
Q

New pulmonary nodule

A
  1. Get CT
  2. If benign features, get serial CTs, if intermediate suspicion for malignancy do a biopsy or PET, if high suspicion for malignancy do a resection
54
Q

Hollenhorst plaques

A

bright, yellow refractile plaques in the retinal artery (emboli from internal carotid)

55
Q

Acute symptomatic hyponatremia treatment

A

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

56
Q

Lifestyle modifications for HTN

A

weight loss is most effective in obese pts, DASH diet is next, then exercise, then salt restriction,and finally alcohol avoidance

57
Q

Cor pulmonale

A

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

58
Q

Risk assessment for treatment of Community-aquired pneumonia

A 
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

59
Q

Treatment for community-aquired pneumonia

A

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

60
Q

Most common causes of community-aquired pneumonia

A

Strep pneumoniae, Haemophilus, and atypicals

61
Q

Sudden-onset of CHF in young patient

A

Consider viral myocarditis (Coxsackie B virus is most common)

62
Q

Multiple myeloma

A

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.
63
Q

Head and neck cancer

A
  • most commonly squamous cell carcinoma

- firm solitary lymph nodes in older patients with a smoking history.

64
Q

Hodgkin’s lymphoma

A

generalized lymphadenopathy

65
Q

Ways to assess for respiratory distress

A

Follow vital capacity

66
Q

How to diagnose acromegaly

A

Get IGF-1 level

Internal Medicine (12 decks)

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