UW 4 Flashcards
EKG for Complete AV block?
Regular P waves
Unrelated to QRS
Consistent of R-R wave
Tx for symptomatic complete AV block?
Temporary pacemaker insertion
Assess for cause
Complications for untreated complete heart block
Ventricular arrhythmias
Asystole
Causes of complete AV block?
Myocardial ischemia
Increased vagal tone
Metabolic changes (HyperKalemia)
AV nodal blockers
What does Adenosine do?
Inhibits L-type calcium channels ->decreases conduction velocity at AV node
When is adenosine used in tx?
termination of AV node dependent reentrant tachycardia
Most beneficial therapy to reduce progression of diabetic nephropathy
Strict BP control to maintain GFR
Tx for stroke in sickle cell pt in acute setting
Exchange transfusion
Hepatic hydrothorax
Causes transudative pleural effusion in cirrhosis pts w/underlying cardiac or pulm dz
- usually right sided
Tx for hepatic hydrothorax
- Salt restriction + Diuretics
2. TIPS if refractory
Supraventricular tachycardia (SVT)
Regular
Narrow-complex tachycardia
Tx for pts with persistent tachyarrhythmia causing hemodynamically unstable
Immediate synchronized DC cardioversion
SVT pt that is hemodynamically stable management?
- Vasovagal maneuvers - carotid sinus massage
OR
IV Adenosine/CCBs
When are IV antiarrhythmics like amiodarone and procainamide used?
Stable recurrent or refractory wide-complex tachycardia
- they can worsen hypoTN
Electrolyte abnormalities in heart failure
Hyponatremia = severe HF - Neurohumoral activation
Low Na = High renin, aldosterone, vasopressin, NE
Causes of QT Prolongation
Electrolytes
Meds
Inherited
Electrolyte derangements - QT Prolongation
Hypocalcemia
Hypokalemia
Hypomagnesemia
Meds that cause QT Prolongation
Macrolides Fluoroquinolones Antipsychotics TCAs SSRIs Opiods Antiarrhythmics - Quinidine, Sotalol, Procainamide, Flecainide, Amiodarone
Jervell and Lange-Nielsen syndrome
Congenital sensorineural deafness + long QT (600 ms) + FHx of sudden death
Defect in K channels
PTs w Prolonged QT at risk for?
Syncope
Life threatening ventricular arrhythmias = Torsade des pointes
Sudden death
Tx for QT prolongation
- Avoid vigorous exercise
- Maintain normal levels of calcium, potassium, magnesium
- Meds: Beta blockers
- long term control w pacemaker
Medication of choice for QT Prolongation?
Beta blockers
- blunt exertional heart rate
- shorten QT interval
Variable decelerations?
Umbilical cord compression
Oligohydramnios
Cord Prolapse
What is the relationship bt PRL and thyroid hormone
TRH and Serotonin stimulate PRL
Dopamine inhibits PRL
What antihypertensive limit ventricular remodeling
ACE Inhibitors
Most effective parameter to estimate fetal weight in suspected Fetal Growth Restriction
Abdominal Circumference
What will Biparietal Diameter be in FGR?
Asymmetric - Normal
Symmetric - Decreased
Dx study for esophageal perforation
Contrast Esophagram shows leakage of contrast outside of esophagus
How does esophageal perforation present
Sudden onset
Severe pain
Located retrosternally in neck, back, abdomen
Worse with swallowing
What does CXR look like in esophageal perforation
Widened Mediastinum
Air in paraspinal muscles
Pneumomediastinum
Pleural effusions
What does accuracy of a test measure
The true value of the test
What does validity measure
Measures what it is supposed to measure
What does precision measure
Reproducibility
What are si/sx’s of dilated CM secondary to alcoholism
Thrombocytopenia
Macrocytosis
Elevated transaminases
What can reverse CHF from Dilated CM
Alcohol abstinence
How does digitalis work in Heart failure?
Systolic Dysfnc and rapid ventricular rates
- Positive inotropic effect
- Negative dromotropic - slows AV conduction
What survival benefit does digitalis have in CHF
None.
Only tx for sx’s
What are the MCC of neonatal jaundice
Breastfeeding jaundice
Breast milk jaundice
Heme conditions
Sepsis
Presentation of neonatal sepsis
Temp instability Poor feeding Irritability/lethargy Resp distress Vomiting Seizures Jaundice Apnea Cyanosis Bulging fontanelle
Next step in management for suspected neonatal jaundice after CBC and BR levels
Blood cultures
LP
What labs are seen in HUS
MAHA Thrombocytopenia PS - schistocytes, giant platelets Intravscular hemolysis= High LDH, Indirect BR, Retic count High BUN/Cr
When is BNP secreted
In response to ventricular stretch and wall tension when cardiac filling pressures are elevated
What are high BNP levels indicative of
CHF
Level of correlates with:
- severity of LV filling pressure elevation
- mortality
What is an S3 and when do we hear it
Soft
Diastolic
Tensing of papillary chordal apparatus when rapid influx of blood into ventricle in early diastole
Ass’d with elevated ventricular filling pressures
Presentation of stress/hairline fx
Athletes - second metatarsal common
- slow onset foot pain first with activity -> then with rest
- Point tenderness over affected metatarsal
What are Turner syndrome pts at risk of developing?
Why
Osteoporosis
- Increased bone fx
- Low estrogen from gonadal dysgenesis
- Increased risk from one X
How to differentiate follicular cancer from adenoma?
Follicular cancer = early hematogenous spread to lung, brain, bone
- demonstrate invasion of tumor capsule and blood vessels
What does FNAB show in follicular cancer?
Large numbers
Normal appearing follicular cells
Are papillary cancer and follicular cancers encapsulated?
Follicular cancer is
Papillary Not
Which thyroid cancer secretes calcitonin
Medullary cancer of the thyroid
Where do we see Hurthle cells
Both Follicular and Papillary cancer
- Hurthle cell carcinoma is a variant of follicular cell ca.
What is the MC thyroid malignancy
Papillary thyroid cancer
How does papillary thyroid cancer present
Slow, infiltrative spread
Psammoma bodies
Papillary thyroid cancer - FNAB what is seen?
Large cells
Ground glass cytoplasm
Pale nuclei w inclusion bodies and central grooving
