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UWORLD Flashcards

1
Q

lab values cholesterol embolism

A

eosinophilia
eosinouria
hypocomplementemia

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2
Q

ICU patient who was being treated for hypotension develops ischemia of distal fingers and toes; symmetric duskiness and coolness of fingertips noted

A

norepinephrine induced vasospasm

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3
Q

physical exam findings suggestive of AS

A
  • diminished and delayed carotid pulse “pulses parvus and trades” due to blood flow obstruction
  • mid to late peaking systolic murmur from turbulence due to stenosis
  • SOFT AND SINGLE S2
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4
Q

how does septic shock affect SVR, pulmonary cap wedge pressure, cardiac output, and mixed venous o2 sat?

A
  • DECREASED SVR (peripheral vasodilation)
  • nml to low PCWP
  • increased CO initially to make up for low SVR
  • increased mixed venous o2 sat because tissues cannot extract o2 effectively, esp during lactic acidosis
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5
Q

patient admitted for MI is being treated medically when one day later develops left leg pain…on exam left leg cold and mottled, minimal swelling, absence of distal pulses…dx and what to do next

A

acute limb ischemia (usually from cardiac emboli)

get TTEto check for LV thrombus

immediately start anticoagulant and consult vascular

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6
Q

patient with hypercalcemia, recurrent kidney stones, and confusion/depression/psychosis presents with HTN
dx and what to do next

A

primary hyperparathyroidism

evaluate for MEN 2A (parathyroid, medullary thyroid, pheo)

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7
Q

indication for Holter monitor for arrhythmia

A
  • intermittent arrhythmia in patients with SYMPTOMS (syncope/palpitations)
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8
Q

risk factors and treatment for persistent symptomatic PACs

A

risk - tobacco and alcohol

rx with low dose beta blockers

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9
Q

acute treatment for afib in patient with WPW (HDS and not HDS)

A

HDS - rhythm control with IV PROCAINAMIDE or ibutillide

non-HDS - immediate electrical cardioversion

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10
Q

which meds to avoid in WPW

A

AV nodal blocking agents such as adenosine, beta blockers, CCBs, and digoxin as they may promote conduction across accessory pathway and lead to degeneration of AF into VF

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11
Q

characteristic of MVP murmur

A

similar to MR murmur sometimes with systolic click….squatting from standing will increase preload and LV volume which will decrease intensity of murmur

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12
Q

CCBs can treat both prinzmental angina and what other process that is physiologicall ysimilar

A

think vasospasm so

RAYNAUD PHENOMENON

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13
Q

patient complaining of ear pain worse with chewing, has hx of nocturnal teeth grinding…dx?

A

TMJ dysfunction

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14
Q

patient with hx of childhood eczema and allergic rhinitis being treated for chest pain develops SOB with prolonged expiration and bilateral wheezes…

A 
med side effect
nonselective Bblocker (i.e. propanolol) can trigger bronchoconstriction)
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15
Q

Young woman presents with systemic HTN, recurrent headaches, carotid bruit

A

carotid bruit suggets carotid atherosclerosis…THINK FIBROMUSUCLAR DYSPLASIA

can also have abdominal bruits since these involve renal, ICA, vertebral, iliac, mesenteric arteries as well

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16
Q

pathophysiology of Meniere disease

A

increased volume and pressure of endolymph (endolymphatic hydrops)

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17
Q

initial mono therapy for HOCM

A

anything that decreases LVOT obstruction and improves angina symptoms

BETA BLOCKERS good initially
then Verapamil and disopyramide

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18
Q

ST elevation in II, III, aVF with reciprocal ST depression in I and avL

A

inferior wall MI from RCA

can also be LCX but usually doesn’t have reciprocal depression in I and avL

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19
Q

healthy person develops signs of CHF after cold…pathophysiology of heart abnormality

A

dilated cardiomyopathy 2/2 viral myocarditis

echo will show dilated ventricles with diffuse hypokinesia resulting in low EF

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20
Q

aortic dissection patient develops acute worsening chest pain, hypotension, pulmonary edema

A

acute aortic regurg

NOT TAMPONADE (lung fields will be clear and JVP will be elevated)

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21
Q

two consequences of aortic dissection

A

acute aortic regurgitation

pericardial tamponade

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22
Q

most effective nonpharmacologic way to lower BP

A

weight control

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23
Q

hours after femoral lower extremity embolectomy, patient has acute pain and paresthesias of leg, worsened with passive extension. pulses present

A

compartment syndrome (due to repercussion)

causes interstitial edema and increased pressure

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24
Q

malignant HTN vs. hypertensive encephalopathy

A

malignant HTN - retinal hemorrhages, papilledema, exudates

encephalopathy - cerebral edema and non-localizing neurologic symptoms like progressive headache

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25
Q

common cause conductive hearing loss in adults 20-30s

A

OTOSCLEROSIS

can also have cerumen impaction and middle ear infection

26
Q

young patient presents with dyspnea, orthopnea, PND, and hemoptysis…afib on exam

A

rheumatic mitral stenosis…causes left atrial enlargement which predisposes to afib and STROKE!

27
Q

ECG findings mitral stenosis

A

“P mitrale” (broad and notched P wave), RVH (R waves in V1, V2), atrial tachyarrhythmias

28
Q

physical exam findings mitral stenosis

A
  • mitral facies (pinkish purple patches on cheeks)
  • loud S1
  • opening snap (high frequency early diastolic sound)
  • mid diastolic rumble best heard at apex)
29
Q

common heart finding in newborn with small head, overlapping fingers, absent palmar creases,, convexity of bilateral soles and limited hip abduction

A

this is Edwards syndrome (trisomy 18)

more predisposed to VSD!!! holosystolic murmur at left sternal border

30
Q

initial treatment for claudication due to PAD

A

after low dose aspirin and statin therapy are started, patient should undergo SUPERVISED EXERCISE PROGRAM to improve exercise tolerance

31
Q

for newly diagnosed HTN, rank best lifestyle modifications in descending order

A
  1. weight control (esp obese patients)
  2. DASH diet (fruits, veggies, low fat dairy)
  3. aerobic exercise
  4. limit alcohol

light smoking linked with slightly less BP…recommended but diet modifications better

32
Q

inferior MI patient develops new mitral regurg and cardioogenic shock 4 days after MI

A

papillary muscle rupture

33
Q

anterior MI patient develops hypotension, JVD, distant heart sounds and death 5 days after MI

A

left ventricular free wall rupture leading to pericardial tamponade

34
Q

3 conditions that can lead to new MR after MI

A
  • papillary muscle rupture (usually inferior MI)
  • intraventricular septum rupture (usually in LAD or RCA distribution)
  • left ventricle free wall rupture (usually anterior MI)
35
Q

which meds should be held 48 hours before exercise stress test

A

CCBs, beta blockers, anti anginal agents like nitrates

36
Q

which meds should be held 48 hours before chemical stress test

A

dipyridamole

37
Q

treatment for vfib or pulseless ventricular tachycardia

A

immediate defibrillation

NOT CARDIOVERSION…this is for non HDS narrow/wide QRS complex tachyarrhythmia (like afib, flutter, VT with pulse)

38
Q

distant heart sounds, hypotension, JVD

A

tamponade (pericardial effusion)

39
Q

how to differentiate intraventricular septum rupture from free wall rupture

A

both will present with chest pain and shock, but free wall rupture is usually associated with pericardial tamponade (look for pulseless electrical activity, distant heart sounds)

40
Q

loud mid systolic murmur set heard at first right intercostal space, difference in BP between right and left, palpable thrill present in suprasternal notch

A

supravalvular aortic stenosois (usually due to congenital left ventricular outflow obstruction)…can cause left ventricular hypertrophy over time and coronary artery stenosis leading to ischemia…can present in younger patients

angina happens during instances of increased myocardial o2 demand

41
Q

meds that can cause sensorineural hearing loss

A

aminoglycosides
chemo agents like cisplatin
aspirin (more often tinnitus)
loop diuretics

42
Q

first line antihypertensives in pregnancy

A
  • methyldopa
  • betablockers (labetlol)
  • hydralazine
  • CCBs
43
Q

common adverse effect CCBs (esp dihydropyridines like -dipine)

A

peripheral edema due to preferential dilation of pre capillary vessels

44
Q

how to counteract peripheral edema due to CCBs

A

add on ACEI or ARB

45
Q

what additional treatment besides ASA, statin, and anticoagulant to do in case of acute STEMI with bibasilar crackles in lung fields?

A

furosemide (flash pulmonary edema)

DO NOT GIVE BETA BLOCKER (c/I in pulmonary edema/CHF/bradycardia since they cause bronchoconstriction)

46
Q

Which arrhythmia is most specific for digitalis toxicity?

A

atrial tachycardia with AV block

47
Q

infective endocarditis patient with AV block and diastolic murmur on left sternal border

A

raise suspicion for AORTIC REGURGITATION 2/2 PERIVALVULAR ABSCESS

tricuspid regurg is more common but presents with systolic murmur

48
Q

new fib with acute onset CHF symptoms in otherwise asymptomatic patient

A

rheumatic mitral stenosis

49
Q

patient presents with lower extremity edema…how to differentiate between cardiac and liver disease?

A

cardiac cause - positive hepatojugular reflex (sign of right side heart failure)
liver - normal or reduced JVP and no hepatojugular reflex

50
Q

Bradycardia, hypotension, wheezing, hypoglycemia, delirium, seizures, cardiogenic shock…suicide attempt
dx and rx

A

beta blocker overdose

rx with IV atropine and fluids…refractory hypotension treated with IV glucagon

51
Q

abrupt onset regular tachycardia that resolves with cold water immersion…dx and treatment mechanism

A

paroxysmal supra ventricular tachycardia (PSVT) usually due to atrioventricular nodal re-entrant tachycardia (usu. seen in younger patients with structurally normal heart)

vagal maneuvers increase parasympathetic tone in heart which will result in temporary slowing of AV NODE conduction and prolonged of refractory period which will terminate AVNRT

52
Q

how to manage profound hypotension found in patient with right ventricular MI?

A

normal saline bolus to increase right ventricular preload and increase CO
then if refractory give inotropic agents like dopamine/dobutamine

53
Q

cyanotic baby with left axis deviation, small/absent R waves, decreased pulmonary markings on chest xray, asd/vsd

A

tricuspid atresia

54
Q

which conditions besides cardiac tamponade can cause pulses paradoxus

A

asthma

COPD

55
Q

first line pharmacologic treatment for torsades in HDS patient

A

magnesium sulfate

56
Q

bounding pulses vs. pulsus parvus trades vs. pulsus paradoxus

A

bounding pulses - aka water hammer, seen in aortic regurg, due to increased stroke volume and sudden increase in systolic BP (hyper dynamic pulse)
pulsus parvus/tardus - decreased pulse amplitude and upstroke, seen in aortic stenosis
pulsus paradoxus - SBP decrease > 10 mmhg in inspiration, seen in tamponade

57
Q

reversible H causes of of PEA or asystole

A
  • hypovolemia
  • hypoxemia
  • hyperkalemia
  • hypokalemia
  • hypoglycemia
  • hypothermia
  • H+ ions (acidosis)
58
Q

reversible T causes of PEA or asystole

A
  • trauma
  • tension pneumo
  • tamponad
59
Q

pounding heart sensation, more aware of heartbeat lying on left side, BP 150/45

A

aortic regurg (widened pulse pressure, collapsing/water hammer pulse)

aortic regurg will increase LV size which will bring enlarged ventricle closer to chest wall and create pounding sensation

60
Q

bilateral hip pain, thigh and butt claudication, impotence, symmetric atrophy of bilateral lower extremities

A

aortoiliac occlusion (Leriche syndrome)…due to arterial occlusion at aortic bifurcation into common iliac arteries

leads to chronic ischemia

61
Q

elderly male comes in with BP 165/75

A

isolated systolic hypertension (systolic>140, diastolic<90)…primary hypertension caused by increased stiffness/decreased elasticity of arterial walls

62
Q

cyanosis aggravated by feeding and relieved by crying

A

choanal atresia (baby can only breathe through mouth)

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