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Uworld Flashcards

1
Q

Paraneoplastic syndromes

A
  1. secreatory, watery diarrhea due to VIP-secreting tumors.
  2. carcinoid syndrome
  3. Gastroparesis due to autoimmune destruction of GI neurons caused by variety of tumors
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2
Q

Management of first degree AV block with normal QRS duration

A

no further evaluation

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3
Q

Management of first degree Av block and prolonged QRS duration

A

electrophysiology testing

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4
Q

Dobutamine

A

Beta 1 receptor agonist

Increases myocardial contractility

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5
Q

Recent MI, now shows up with acute limb ischemia. Next 3 steps

A
  1. Anticoagulation
  2. contact vascular surgeon
  3. Transthoracic echocardiography
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6
Q

What is Peri-infarction pericarditis? Treatment?

A
  • Post MI early onset pericardidits (Dressler is late MI complication)
  • supportive treatment
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7
Q

How is the diagnosis of amyloidosis confirmed

A

tissue biopsy (abdominal fat pad).

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8
Q

Name 3 drugs good for heart rate and left systolic dysfunction <40% ejection fraction

A
  1. metoproplol succinate
  2. Carvedilol
  3. bisoproplol
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9
Q

3 risk factors for aortic aneurysms

A
  1. large diameter
  2. rapid rate of expansion
  3. SMOKING (not htn)
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10
Q

Interrupt EKG reading
1. High-voltage QRS complexes
2 Lateral ST segment depression
3. Lateral T wave inversion

A

left ventricular hypertrophy

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11
Q

Risk factors for aortic dissection

A
  1. Hypertension
  2. Marfan
  3. Cocaine
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12
Q

Suspected diagnosis of aortic dissection in patients with hemodynamic instability and renal insufficiency, next step?

A

transesophageal echocardiogram

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13
Q

Pulsus parvus et tardus

A

Arterial pulse with decreased amplitude and delayed peak

Seen in aortic stenosis

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14
Q

Initial diagnostic study of choice for a hemodynamically stable patient with type A aortic dissection

A

CT angiogram

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15
Q

Congenital bicuspid aortic valve can turn into what murmur

A

aortic regurgitation

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16
Q

What murmur is beast heard

Sitting up, leaning forward, holding breath in full expiration

A

aortic regurgitation

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17
Q

Most common cause of aortic stenosis in elderly patients

A

degenerative calcification of aortic valve leaflets

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18
Q

What heart sound changes in aortic stenosis

A

soft second heart sound

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19
Q

Name situations where you’ll hear an S3

A

Chronic mitral regurgitation
Chronic aortic regurgitation
Heart failure
High cardiac output states (pregnancy or thyrotoxicosis)

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20
Q

CYP Inducers

A 
BullShit CRAP GPS:
Barbituates
St. John's Wart 
Carbamazepine
Rifampin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas
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21
Q

What position brings the enlarged left ventricle closer to the chest wall?

A

Left lateral decubitus position

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22
Q

Laboratory findings for atheroembolism (cholesterol crystal embolism)

A

eosinophilia

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23
Q

Location of cause: Atrial fibrillation

A

pulmonary veins

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24
Q

Location of cause: Atrial flutter

A

Tricuspid annulus

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25
Q

Location of cause: AV nodal reentry tachycardia

A

AV node

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26
Q

Next step for a patient with atrial fibrilation RVR and hemodynamically unstable

A

Immediate synchronized electrical cardioversion

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27
Q

When is immediate debfribrillation recommended

A

V. fib or pulseless ventricular tachycardia

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28
Q

Location of cause: atrioventricular reentrant tachycardia

A

accessory atrioventricular bypass tract

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29
Q

Reversible risk factors for premature atrial contractions? treatment for symptomatic treatment?

A

tobacco and alcohol

beta blockers

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30
Q

Treatment for beta blocker poisoning?

A

1st: fluids and atropine
2nd: glucagon

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31
Q

Why can you use Dobutamine for bradycardia but not beta blocker poisoning?

A

Dobutamine causes more vasodilation and worsen hypotension

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32
Q

First step in treatment for pulseless electrical activity?

A

fluids

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33
Q

Pulsus paradoxus

A

Cardiac tamponade

SBP decrease >10 mmHg with inspiration

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34
Q

When do you hear pulsus bisferiens

A

aortic regurgitation

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35
Q

What is seen on EKG for cardiac tamponade

A

electrical alternans: amplitudes of QRS complexes vary from beat to beat

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36
Q

Classification of classic angina

A
  1. Typical location (substernal)
  2. provoked by exercise or emotional stress
  3. relieved by rest or nitroglycerin
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37
Q

Valsalva

A

decreases preload

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38
Q

Abrupt standing

A

Decreases preload

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39
Q

Nitroglycercin administration

A

decrease preload

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40
Q

Sustained handgrip

A

increase afterload

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41
Q

squating

A

increase preload and afterload

42
Q

passive leg raise

A

increase leg raise

43
Q

If someone has pulsus paradoxus what do they likely have?

What is pulsus paradoxus?

A

cardiac tamponade
asthma
COPD

fall in BP >10 mmHg during inspiration

44
Q

What is electrical alteranans? what is this specific for?

A

varying amplitude of QRS complexes

pericardial effusion

45
Q

What pharmacologic therapy is used for persistent peripheral vascular disease despite supervised exercise therapy

A

cilostazol

46
Q

What is abnormal ankle brachial index number

47
Q

what does an ankle brachial index number of >_1.30 mean?

A

suggestive of calcified and incompressible vessels; additional vascular studies should be considered

48
Q

What is the LDL level someone should start on Statin?

49
Q

Adrenal hyperplasia and adrenal adenoma both are primary causes of hyperaldosteronism? how do you differentiate the both?

A

adrenal vein sampling.

50
Q

Medication treatment for supraventricular complex narrow-QRS complex

51
Q

Medication of choice for hemodynamically stable patients with wide-QRS complex tachycardia

A

Amiodarone or lidocaine

52
Q

When do you see Target cells

A

thalassemia or chronic liver disease

53
Q

What is peripheral smear for scleroderma renal crisis

A

Schistocytes and thrombocytopenia

54
Q

Treatment for Takayasu arteritis

55
Q

What can happen to the heart following an implantable pacemaker or cardioverter-defrillator placement?

A

right sided heart failure due to tricuspid regurgitation

- transvenous lead placement through tricuspid valve can lead to direct valve damage or inadequate leaflet coaptation.

56
Q

Palpable thrill is usually associated with what murmur

57
Q

First line treatment for ventricular tachycardia

A

amiodarone

58
Q

frist line treatment for torsades de pointes

A

Mg in stable patient

Defibrillation in unstable patient

59
Q

Defibrillation

A

unsynchronized

60
Q

Treatment for Wolf-Parkinson-White Syndrome

A

procainamide

61
Q

Achalasia has dysphagia to what

A

solids and liquids

62
Q

what is used to diagnose achalasia

63
Q

Clues pointing to pseudoachalaisa

A

weight loss
rapid symptom onset
presentation <60

64
Q

What is pseudoachalaisa

A

narrowing of distal esophagus secondary to causes other than denervation (esophageal cancer)

65
Q

Polymyositis impacts what part of the esophagus

A

upper third of esophagus

66
Q

Define acute liver failure? treatment?

A
  1. AST & ALT >1,000
  2. hepatic encephalopathy
  3. INR >1.5

Liver transplant

67
Q

What lab value indicates biliary pancreatitis?

68
Q

Ascites: SAAG >_1.1

A

indicates portal hypertension

cardiac ascites, cirrhosis, Budd-Chiari syndrome

69
Q

Ascites: protein >_2.5

A

High protein ascites

CHF, TB,

70
Q

Acities: <2.5

A

Low protein ascites

Cirrhosis, nephrotic syndrome

71
Q

How do you calculate SAAG

A

[peritoneal fluid albumin] - [serum albumin]

72
Q

Initial step in management for oropharyngeal dysphagia

A

videofluroscopic modified barium swallow

73
Q

Difference between oropharyngeal dysphagia and esophageal dysphagia?

A

esophageal dysphagia = a few seconds after swallowing but does not cause difficulty initiating swallowing (oropharyngeal dysphagia)

74
Q

Next step in management for oropharyngeal dysphagia

A

videofluoroscopic modified barium swallow

75
Q

Next step in management for esophageal dysphagia with both solids and liquids

A

Barium swallow followed by possible manometry

76
Q

esophageal dysphagia with solids progressing to liquids most likely cause? what is the next question you should ask?

A

mechanical obstruction
h/o radiation, caustic injury, stricture
yes: barium swallow
no: upper endoscopy

77
Q

treatment of Carcinoid tumors

A

Octreotide

surgery for liver mets.

78
Q

What is Charcot triad and Reynolds pentad and what does it indicate

A

fever, jaundice, right upper quadrant pain
hypotension and AMS
acute cholangitis

79
Q

What is acute cholangitis

A

ascending infection due to biliary obstruction

80
Q

How do you tell the difference between a cystic duct and common bile duct obstruction

A

common bile duct obstruction will have very high alkaline phosphastase levels

81
Q

Someone with chronic diarrhea with preceding self-limited pulmonary symptoms

A

think hookworm

82
Q

Secretory diarrha

A

Due to increased secretion of ions
occurs fasting or sleep
decrease osmotic gap (<50)

83
Q

Osmotic diarrhea

A

osmotically active agents are present in the GI tract

elevated osmotic gap (>125)

84
Q

Next step of management for chronic pancreatitis

85
Q

Dupuytren contracture

A

palmar fascia thickens and shortens, deforming the hand. 4th and 5th digit

86
Q

A patient who has a pleural effusion not due to underlying cardiac or pulmonary abnormlaities?

A

hepatic hydrothrox –> fluid passage through diaphragmatic defects in pts with cirrhosis and portal hypertension

87
Q

Initial episode of C. diff treatment options

A

Vancomycin PO
OR
Fidaxomicin

88
Q

Treatment of C. Diff with someone who has hypotension/shock, ileus, megacolon?

A

Metronidazole IV

plus high-dose Vancomycin PO or PR if ileus is present

89
Q

What is the esophagram pattern for diffuse esophageal spasm

90
Q

Nutcracker esophagus

A

excessive tone at the lower esophageal sphincter and excessive contractions in the distal esophagus

91
Q

histologic changes in isoniazid heptitis

A

panolbular mononuclear infiltration and hepatic cell necrosis

92
Q

histologic changes in tubercoluous hepatitis

A

granulomas on liver biopsy

93
Q

What is the pleural fluid for esophageal rupture

A

exudative: low pH and high amylase

94
Q

Prophylactic treatment for non bleeding varices?

A

Beta blocker

Endoscopic variceal ligation –> alternative primary prevention if contraindicaions to beta blocker

95
Q

Treatment for active variceal bleeding ? what happens if they keep bleeding after that?

A

Hemodynamic support (2 IV catheters)
Octreotide
endoscopic therapy
ppx abs

Balloon tamponade

96
Q

How do you manage a patient with familial adenomatous polyposis?

A

frequent colonoscopic screening starting in childhood and elective proctocolectomy

97
Q

Clinical presentation of ischemic colitis

A

sudden onset of abdominal pain and tenderness, followed by rectal bleeding

98
Q

When do you give packed red blood cell transfusion

A

hb <7

unstable patient with acute coronary syndroome or active bleeding or hypovolemia <9 hb

99
Q

Having an upper GI bleed changes what lab values

A

increase BUN and BUN/Cr

  • increased urea production (from intestinal breakdown of hemoglobin)
  • increased urea reabsorption (due to hypovolemia )
100
Q

Clinical presentation of angiodysplasia

A

painless GI bleeding

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