UWorld 3 Flashcards
1
Q
left ventricular aneurysm
A
etiology: scar tissue deposition following transmural MI
CP:
-several months following MI
-HF and angina
-ventricular arrhythmia (ventricular tachycardia)
-systemic embolization (eg stroke)
diagnosis:
- ecg: persistent ST elevation, deep Q waves
- echo: thin and dyskinetic myocardial wall
2
Q
general manifestations of HYPERthyroidism
A
symptoms: anxiety and insomnia, palpitations, heat intolerance, inc perspiration, weight loss sans dec appetite
PE: goiter, HTN, tremors involving fingers/hands, hyperreflexia, proximal muscle weakness, lid lag, afib
3
Q
hypothyroidism
A
- can cause additional metabolic abnormalities such as: hyperlipidemia, hyponatremia, and asymptomatic elevations of creatinine kinase and serum transaminases (AST, ALT)
- most pts have hypercholesterolemia alone (d/t dec LDL surface receptors and/or dec LDL receptor activity) or combined hyperTG (d/t dec lipoprotein lipase activity)
4
Q
chagas dz
A
chronic dz that can cause megaesophagus, megacolon, and/or cardiac dysfunction
-protozoan Trypanosoma cruzi, endemic to Latin America is responsible
5
Q
renal vein thrombosis
A
- important complication of all causes of nephrotic syndrome
- most commonly associated with membranous glomerulopathy
6
Q
miliary TB
A
- typically presents with subacute or chronic fevers, weight loss, fatigue, and pulmonary symptoms
- CXR classically reveals a diffuse reticulonodular patter (millet seed)
- m.c behavioral RF for TB in the US is substance abuse
7
Q
what can precipitate priapism
A
- meds: trazadone, prazosin
- medical conditions: SCD, perineal trauma
8
Q
tumor lysis syndrome
A
risk: initiation of cytotoxic chemo
manifestations: severe electrolyte abnormalities (inc phosphorus, potassium, uric acid; dec calcium); acute kidney injury (d/t uric acid/calcium phosphorus); cardiac arrhythmias
tx: continue telemetry, aggressive electrolyte monitoring/tx
ppx: IV fluids, allopurinol or rasburicase
9
Q
NSAIDs and anemia
A
- NSAIDs are a common cause of iron deficiency anemia often through chronic blood loss from the GI tract
- elderly pts often have a low-grade chronic anemia at baseline and may not tolerate additional blood loss
10
Q
initial tx regimen in pts with intermitten cluadication
A
- should include a supervised exercise program
- pharm therapy with cilostazol and percutaneous or surgical revascularization should be reserved for those with persistent symptoms despite adequate supervised exercise therapy
11
Q
isolated systolic HTN
A
- important cause of HTn in elderly pts
- caused by inc stiffness or dec elasticity of the arterial wall
- assoc with an inc in CV m&m and management should be similar to that of primary HTN with lifestyle modifications and pharm therapy
12
Q
chronic mesenteric ischemia
A
etiology: atherosclerosis (smoking, dyslipidemia)
clinical features: crampy, postprandial, epigastric pain; food aversion and weight loss
diagnosis: signs of malnutrition, abdominal bruit, CT angiography (preferrd), Doppler US
management: risk reduction (tobacco reduction), nutritional support; endovascular or open surgical revascularization
13
Q
negative predictive value
A
- probability of being free of a disease if the test result is negative
- NPV will vary with the pretest probability of a dz
- -a pt with a high probability of having a dz will have a low NPV
- -a pt with a low probability of having a dz will have a high NPV
14
Q
what is the mainstay of symptom management in COPD
A
- inhaled anti-muscarinic bronchodilators agents such as Ipratropium
- these anti-cholinergic meds may be combined with short-actin beta-adrenergic agonists for greater symptom relief
15
Q
etiology of acute limb ischemia
A
- cardiac/arterial embolus (AF, LV thrombus, IE)
- arterial thrombosis (PVD)
- iatrogenic/blunt trauma
16
Q
clinical features and management of acute limb ischemia
A
6Ps of acute limb ischemia
- pain
- pallor
- paresthesias
- pulselessness
- poikilothermia (cool extremity)
- paralysis (late)
management: anticoagulation (heparin) and thrombolysis versus surgery
17
Q
common causes of myopathy
A
connective tissue diseases
- polymyositis/dermatomyositis
- inclusion body myositis
- overlap syndrome (mixed CTD)
endocrine/metabolic
- hypothyroidism, thyrotoxicosis
- Cushing syndrome
- electrolytes (dec K, Ca, Phosphorus)
drugs/toxins
- corticosteroids, statins
- zidovudine, colchicine
- EtOH, cocaine, heroin
miscell.
-infections, trauma, hyperthermia
18
Q
long term cyclophosphamide use
A
associated with inc incidence of acute hemorrhagic cystitis and bladder carcinoma
19
Q
S4**
A
low frequency sound heard at the end of diastole just before S1 that is commonly associated with LVH from prolonged HTN
20
Q
what is the most dangerous complication of Marfan syndrome
A
AORTIC DISSECTION
- typically presents as tearing CP radiating to the back and neck
- must be identified immediately to dec r/o death
- aortic regurg is a complication of aortic dissection and presents with an early diastolic murmur
21
Q
massive pulmonary embolism
A
likely in a postop pt with: hypoTN, jugular vein distention, and new-onset RBBB
22
Q
clinical manifestations of hereditary hemochromatosis
A
- skin: hyperpigmentation (bronze diabetes)
- MSK: arthralgias, arthropathy, chondrocalcinosis
- GI: elevated hepatic enzymes with hepatomegaly (early), cirrhosis (later), and inc r/o HCC
- endo: DM, secondary hypogonadism, hypothyroidism
- cardiac: restrictive or dilated cardiomyopathy and conduction abnormalities
- infections: inc susceptibility to Listeria, vibrio vulnificus, and yersinia enterocolitica
23
Q
mitral valve prolapse
A
m/c c/o mitral regurg in developed countries
- usually causes mild MR with mid-systolic click and mid-to-late systolic murmur
- pts with severe leaflet dysfunction an dprolapse can develop severe MR and holosystolic murmur on PE
- chronic severe MR causes LA and ventricular enlargement leading to afib, LV dysfunction, and CHF
24
Q
secondary malignancy in pts with Hodgkin lymphoma
A
- is common when pt is treated with chemo and radiation
- m/c secondary solid tumor malignancies are lung (especially in smokers), breast, thyroid, bone, and GI (colorectal, esophageal, gastric tumors)
25
major RF for pancreatic cancer
hereditary:
- first degree relative with pancreatic ca
- hereditary pancreatitis
- germline mutations (BRCA1, BRCA2, Peutz-Jeghers syndrome)
environmental
- cigarette smoking (most significant)
- obesity, low physical activity
- nonhereditary chronic pancreatitis
26
what are some RF for premature atrial contractions
- tobacco and alcohol are reversible ones
| - beta blockers often help symptomatic pts
27
pathophysiology of GERD
- dec tone or excessive transient relaxations of LES
- anatomic disruption to gastroesophageal jxn (hiatal hernia)
- inc risk with obesity, pregnancy, smokine, EtOH intake
28
manifestations of GERD
- regurg of acidic material in mouth
- heartburn
- odynophagia (often indicates reflux esophagitis)
- extraesophageal: cough, hoarseness, wheezing
29
complications and tx of GERD
complications:
- esophageal-erosive esophagitis, Barrett esophagus, strictures
- extraesophageal-asthma, laryngitis
tx: lifestyle (weight loss) and dietary changes, H2R blocker or PPI
co-morbid GERD is common in pts with asthma and can worsen asthma s/s 2/2 microaspiration
30
TPN
causes gallbladder stasis and predisposes to gallstone formation and bile sludging-->can both lead to cholecystitis
31
RA tx
-start with MTX (DMARD)
-if persistent s/s >6mo either do:
---step-up therapy: add biologic agent (TNF inhibitor)
or
---parallel therapy (add another nonbiologic agent: sulfasalazine, hydroxychloroquine)
if step-up therapy is an inadequate response switch to alternate TNF inhibitor and continue MTX
32
angiodysplasia
- characterized by dilated submucosal veins and AV malformations
- common c/o recurrent, painless GI bleeding
- diagnosis made on colonoscopy
- asymptomatic pts dont need tx
- with anemia or bleeding can be treated with cautery
33
malignant otitis externa
- serious infection of ear seen in elderly pts with poorly controlled diabetes
- m/c 2/2 Pseudomonas
- CP: ear pain and ear drainage, granulation tissue may be seen within the ear canal on exam
- progression of infection can lead to osteomyelitis of the skull base and destruction of the facial nerve
34
acute mitral regurg
- can occur d/t papillary muscle displacement in pts with acute MI
- leads to abrupt and excessive volume overload causing elevated LA and ventricular filling pressures and acute pulm edema
- unlike chronic MR, acute MR doesnt cause any significant change in LA or ventricular size and/or compliance
35
AF with rapid ventricular response
- rate control should be attempted initially with beta blockers or CCB
- immediate synchronized electrical cardioversion is indicated in hemodynamically unstable pts with rapid AF
36
ARP
=(risk in exposed-risk in unexposed)/risk in exposed
| =(RR-1)/RR
37
vasospastic angina
path: hyperactivity of coronary smooth muscle
CP: young pts (<50), smoking (minimal other CAD RF), recurrent chest discomfort (occurs at rest or d/r sleep, spontaneous resolution =15mins)
diagnosis: ambulatory ecg: ST elevation, coronary angiography: no CAD
tx: CCB (preventive), sublingual nitroglycerin (abortive)
38
intravascular hemolytic anemia
- elevated retic count: d/t inc BM production in setting of anemia
- inc LDH: f/m LDH release from broken down erythrocytes
- dec haptoglobin: the released Hgb binds to haptoglobin, and the haptoglobin-Hgb complex is hepatically cleared, leading to low or undetectable plasma haptoglobin levels
39
macrovascular traumatic hemolysis
- when hemolysis is caused by mechanical trauma from calcified aortic valves
- usually seen with artificial heart valves or markedly calcified valves
- periph blood smear of pts typically reveals helmet cells or fragmented erythrocytes
40
COPD
characterized by progressive expiratory airflow limitation which causes air trapping, dec VC and inc TLC
-FEV1 is disproportionately dec as compared to VC
41
infective endocarditis in IVDU
- HIV infection inc IE risk in IVDU
- S. aureus is the m/c organism
- tricuspid involvement (r-sided) m/c than aortic valve
- -often lacks audible heart murmur
- -septic PE common
- -fewer peripheral IE manifestations (splinter hemorrhages, Janeway lesions)
- -HF more common in aortic valve involvement, but rare with tricuspid valve dz
42
giant cell tumor of bone
- benign and locally aggressive skeletal neoplasm that usually presents with pain, swelling, and dec range of jt motion at involved ite
- typically presents as osteolytic lesions (with a "soap-buttle" appearance on radiographs) in the EPIPHYSEAL regions of the long bones and m/c involves the distal femur and proximal tibia a/r the knee jt
43
glomerular hyperfiltration
- earliest renal abnormality seen in diabetic nephropathy
- major pathophysiologic mechanism of glomerular injury in these pts
- thickening of the glomerular basement membrane is the first change that can be quantitated
44
alveolar hypoventilation with CO2 retention
can lead to respiratory acidosis along with CO2 narcosis
-acute kidney injury can cause a non anion gap metabolic acidosis d/t impaired acid excretion or an anion gap acidosis d/t retention of unmeasured uremic toxins
45
RF/association sof aortic dissection
- HTN (m/c)
- Marfan syndrome
- cocaine use
46
clinical features of aortic dissection
- severe, sharp, tearing chest or back pain
| - >20mmHg variation in systolic BP b/w arms
47
complications (involved structure) of aortic dissection
- stroke (carotid arteries)
- acute aortic regurg (aortic valves)
- Horner syndrome (superior cervival sympathetic ganglion)
- acute myocardial ischemia/infarction (coronary artery)
- pericardial eddusion/cardiac tamponade (pericardial cavity)
- hemothorax (pleural cavity)
- LE weakness or ischemia (spinal or common iliac arteries)
- abdo pain (mesenteric artery)
48
pts with severe BOO d/t BPH
- can develop AKI
| - renal US is advised for assessment of hydronephrosis in those with worsening kidney function
49
solid organ transplant
- at risk for opportunistic infections (most notable Pneumocystitis PNA and CMV)
- in absence of ppx, pts who present with a systemic illness involving multiple organ systems (eg pneumonitis, hepatitis, gastroenteritis) should be tested for CMV viremia
50
hypovolemia
- common cause of orthostatic hypotension and orthostatic syncope especially in elderly pts
- d/t dec renal perfusion and activation of the RAAS dec urine sodium is usually present in pts with hypovolemia
51
syncope
- pts with an arrhythmic c/o syncope usually have underlying structural heart disease and may not have any prodromal s/s prior to the syncopal episode
- in contrast, those with vasovagal or neurocardiogenic syncope frequently experience a prodrome with nausea, pallor, diaphoresis, and generalized sense of warmth prior to the syncopal episode
52
UC
- s/s: bloody diarrhea, weight loss, fever
- endoscopic findings: erythema, friable mucosa, pseudopolyps, involvement of rectosigmoid, continuous colonic involvement (no skip lesions)
bx: muscosal and submucosal inflamm, crypt abscesses
complications: toxic megacolon, PSC, CRC, erythema nodosum, pyoderma gangrenosum, spondyloarthritis
53
tinea corporis (ringworm)
RF:
- athletes who have skin-to-skin contact
- humid environment
- contact with infected animals (rodents)
presentation:
- scaly, erythematous, pruritic patch with centrifuged spread
- subsequent central clearing with raised annular border
tx:
- first-line/localized: topical antifungals (Clotrimazole, Terbinafine)
- second-line/extensive: oral antifungals (Terbinafine, Griseofulvin)
54
bacterial meningitis should be suspected in pts with >/=2 of the following manifestations:
- HA
- fever (usually >38 C [100.4F])
- nuchal rigidity
- AMS
55
EPO
- tx of choice for anemia related to CKD
- HTN is a common SE of EPO
- pts who receive large doses or experience a rapid rise in Hgb concentration are at highest risk
56
m/c c/o mitral stenosis
- m/c d/t rheumatic heart dz and presents with gradual and progressively worsening dyspnea or orthopnea
- afib is a common complication and can cause rapid decompensation in previously asymptomatic pts
- longstanding mitral stenosis can cause severe LAE leading to an elevation of the left main bronchus on chest radiograph
57
euthyroid conditions that alter TBG concentration
- INC TBG (inc total T4; nml free T4)
- -estrogens (pregnancy, OCPs, HRT)
- -hepatic dysfunction (acute hepatitis)
- -medications (Tamoxifen)
- dec TBG (dec total T4, nml free T4)
- -hormonal abnormalities (Cushing, GC)
- -hypoproteinemia (nephrotic syndrome, starvation)
- -medications (niacin, high-dose androgens)
58
arsenic poisoning
mech: binds to sulfhydryl groups and disrupts cellular respiration and gluconeogenesis
sources: pesticides/insecticides; contaminated water (often from wells), pressure-treated wood
manifestations:
- acute: garlic breath, vomiting, watery diarrhea, QTc prolongation
- chronic: hypo/hyperpigmentation, hyperkeratosis, stocking-glove neuropathy
tx: dimercaprol (british anti-Lewisite); DMSA
