BLOCK 3 FINALS REVIEW Flashcards
(199 cards)
1
Q
What EKG finding suggest acute ischemic MI?
A
New LBBB
2
Q
BNP of 52 suggests what?
A
No HF
3
Q
First test for suspected endocarditis?
A
TTE
4
Q
Negative TTE but signs of endocarditis, next step?
A
TEE
5
Q
normal telemetry in hospital, pt has flutters, whats next?
A
discharge with event monitor
6
Q
Widened mediastinum on CXR
A
Sortic dissection
7
Q
EKG shows torsades de point. Likely causes is?
A
magnesium deficiency
8
Q
interpretation of a normal stress test
A
does not rule out ischemia
9
Q
chest pain with normal troponin, what next?
A
repeat troponin in 2 hrs
10
Q
treatment for pericarditis
A
NSAIDs
11
Q
Tx afer reumatic fever in 20s
A
monthly PCN until they are 40
12
Q
Painful leg swelling post-surgery. What to order?
A
venous compression US
13
Q
Treatment for post-op DVT?
A
3-6 months anticoagulation
14
Q
difference between TAA and AAA
A
TAA is HTN
AAA is genetic
15
Q
What does a BNP level of less than 100 pg/mL indicate?
A
Normal — heart failure unlikely
16
Q
What does a BNP level between 100 and 400 pg/mL suggest?
A
Intermediate — consider other clinical factors
Could be early heart failure or other causes like pulmonary disease.
17
Q
What does a BNP level greater than 400 pg/mL indicate?
A
Abnormal — heart failure likely
18
Q
What does an NT-proBNP level of less than 300 pg/mL indicate?
A
Rules out acute heart failure in most patients
19
Q
What is the NT-proBNP threshold for chronic heart failure diagnosis in patients under 50 years?
A
<450 pg/mL
20
Q
What is the NT-proBNP threshold for chronic heart failure diagnosis in patients aged 50 to 75 years?
A
<900 pg/mL
21
Q
What is the NT-proBNP threshold for chronic heart failure diagnosis in patients over 75 years?
A
<1800 pg/mL
22
Q
Initial treatment for aortic dissection
A
CT and beta blocker
23
Q
MI in rural alaska, 4 hrs from cath lab, what to do?
A
give fibrinolytics
24
Q
ARBs MOA
A
block AT1 receptor
25
Whats the MOA of ACE inhibitors?
blocks angiotensin I --> II
26
mild sodium reabsorption inhibition
HCTZ
27
drug that decreases conduction, contractility, and HR?
Non-DHP CCB
28
already on nitroprusside for HN emergency. What is the next step?
add labetalol
29
Pt has liver disease and PUD. what lipid med is contraindicated?
nicotinic acid
30
what med inhibts triglyceride synthesis?
fenofibrate
31
severe TGs + med that causes angioedema?
fish oil (DHA/EPA)
32
stable angina best acute initial tx
nitroglycerin
33
NSTEMI with elevated troponins. Next step?
PCI
34
A patient is tachycardiac and hypotensive. What is the likely cause?
ventricles not filling properly
35
What is the function of ANP?
promotes sodium and water excretion
36
What effect does aldosterone have on the kidneys?
promotes sodium reabsorption and water retention
37
low-dose epi effect on MAP
initial decrease then increase
38
why might an elderly patient have BP 140/90
decreased vascular compliance
39
causes of orthostatic hypotension in the elderly
delayed baroreceptor response
40
What brain part controls heart rate?
medulla
41
abdominal bruit, normal aldosterone, uncontrolled HTN
renal artery stenosis
42
CKD with persistent HTN, likely causes
elevated renin
43
What structure slows HR through parasympathetic stimulation?
vagus nerve
44
why does chronic hypertension make it harder for the heart to contract effectively?
increased systemic vascular resistance
45
What would increase storke volume?
increased ventricular filling time
46
stroke volume is influenced by?
sysstmeic vascualr resistance, preload, and afterload
47
a blood pressure reading of 220/124 with papilledema and chest pain indicates?
Hypertensive emergency
48
What EKG finding is characteristic of hypokalemia?
flattened T waves and U waves
49
What rhythm is characterized by narrow QRS complexes and a rate of 160-220 bpm with sudden onset and termination?
SVT
50
an EKG with regular P waves and QRS complexes that do not correspond to each other indicates
3rd degree AV block
51
Which EKG finding is typical in a left bundle branch block
wide QRS with broad notched R waves in V5-V6
52
What EKG change suggests a posterior STEMI?
ST depression in V1-V3
53
ST elevation in leads II, III, and aVF indicates infarction in which region?
inferior wall
54
What is the upper limit of normal for the PR interval in an adult?
200 ms
3-5 small boxes
55
What EKG finding is consistent with right atrial enlargement?
peaked P waves in lead II (>2.5mm)
56
an ECG shows hypokinesis of the anterior wall and EF of 30%. What is the likely diagnosis?
MI
56
which axis deviation is commonly seen in the left anterior fascicular block or large anterior MI?
left axis deviation
57
An ejection fraction below 35% on echo is diagnostic of
heart failure with reduced EF
58
which EKG finding best meets criteris for LVH?
S in V1 + R in V5 is over 35 mm
59
reversible ischemia on nuclear stress testing indicates
inducible ischemia with exercise
60
which is the typical axis deviation seen in a patient with anterior wall STEMI?
left axis deviation
61
What arrthymia is characterized by a wide QRS complex without a preceding P wave and a compensatroy pause?
PVC
62
What is the normal range of a QT interval for women?
<460 ms
63
What is the normal QT interval for men?
< 440 ms
64
What supplement is used for severe hypertriglyceridemia but may cause angioedema?
DHA/EPA
65
a pt with severe tremor and hypertension would benefit from which medication?
propranolo (a beta blocker)
66
what med is contraindicated in a patient taking sildenafil (viagra) due to risk of severe hypotension?
Nitroglycerin
67
what is the first line treatment for intermittent claudication?
Cilostazol
68
what medication requires caution due to risk of rhabdomyolysis?
atorvastatin
69
what class of medications is contraindicatred in asthma and COPD?
non-selective beta blockers
70
what HTN med treats both BPH and HTN?
Terazosin
71
What med treats BPH but does not lower blood pressure?
tamsulosin
72
what class of medications if sympatholytic?
beta blockers
73
What medication class is an antagonist to norepinephrine and epinephrine?
Beta blockers
74
When are prophylactic antibiotics indicated for a patient who is having a dental procedure, but also has a mechanical heart valve?
one time dose of prophylactic antibiotics
75
Which protein is used to maintain oncotic pressure and helps maintain blood pH?
albumin
76
Which white blood cell type is increased during bacterial infections?
neutrophils
77
A patient is having an asthma attack. What would you expect to see on labs?
eosinophilia
78
Which type of white blood cell is typically elevated during a parasitic infection?
eosinophils
79
Which complex involves both intrinsic and extrinsic pathways and activates factor X?
prothrombin activator
80
What leads to endothelial angiogenesis and is a target in cancer therapy?
VEGF
81
Which white blood cell releases heparin?
basophils
82
What allows blood to bypass blockages and still reach brain tissue during an ischemic stroke?
circle of willis
83
What does the liver produce that stimulates platelet production and may be deficient in cirrhosis?
thrombopoietin
84
What does poikilocytosis refer to?
variation in shape
85
Hemoglobin A2 is composed of which globin chains?
86
What is HbS?
2 alpha (α) + 2 β^S (mutant beta)
## Footnote
Seen in sickle cell disease (valine replaces glutamic acid at position 6)
87
What is HbC?
2 alpha (α) + 2 β^C
## Footnote
Another beta-chain mutation; can cause mild hemolytic anemia
88
What is HbE?
2 alpha (α) + 2 β^E
## Footnote
Common in Southeast Asia; mild symptoms or trait
89
What is HbH?
4 beta (β) chains
## Footnote
Occurs in alpha-thalassemia (3 gene deletions)
90
What is Hb Barts?
4 gamma (γ) chains
## Footnote
Severe alpha-thalassemia (4 gene deletions); incompatible with life
91
What is HbA (Adult Hemoglobin A)?
2 alpha (α) + 2 beta (β)
## Footnote
Major adult form (~96–98%)
92
What is HbA₂?
2 alpha (α) + 2 delta (δ)
## Footnote
Minor adult form (~2–3%)
93
What is HbF (Fetal Hemoglobin)?
2 alpha (α) + 2 gamma (γ)
## Footnote
Predominant in fetus; higher oxygen affinity
94
A patient has a bleeding issue but normal PT/INR and PTT. What is the best next step?
Von Willebrand factor testing
95
A patient has either elevated PT/INR or PTT (but not both). What is the next diagnostic step?
Mixing study
96
Both PT/INR and PTT are elevated. What is the most likely cause?
Factor V deficiency
97
What lab result makes you suspicious of an anticoagulation disorder?
Elevated lupus anticoagulant
98
Increased ALA on testing indicates what?
Lead poisoning anemia
99
Child with petechiae on legs, not sick, normal PT/INR and PTT. What's the likely diagnosis?
ITP
100
Recent UTI, now dark urine, similar episode years ago, elevated retic count. What is the diagnosis?
G6PD deficiency
101
Patient on meat/cheese low-carb diet. What deficiency may be present?
Folate deficiency
102
Blood smear with spherocytes. What is the most likely diagnosis?
Hereditary spherocytosis
103
Auer rods seen on bone marrow biopsy, what is the diagnosis?
AML
104
Painless lymph node with another in the same region- what is the most likely diagnosis?
Hodgkin's lymphoma
105
Generalized lymphadenopathy (axillary + inguinal)- what is the next best step?
lymph node biopsy
106
Patient admitted for vast-occlusive crisis develops a cough. What's the next step?
antibiotics and IV fluids
107
Patient drinks 6 beers daily- what nutritional deficiency is most likely?
folate deficiency
108
Possible cause of sideroblastic anemia?
lead poisoning
109
Congo red stain shows abnormal proteins, patient has enlarged tongue, what is the diagnosis?
amyloidosis
110
Admitted for sepsis and has blood in urine, what is the likely cause?
DIC
111
Healthy patient told he was slightly anemic in the past, now wants full workup- next best test?
Hemoglobin electrophoresis
112
Vegetarian who only eats bagels- what advice should you give?
take vitamin B12 supplement
113
Palliative care can be provided at any stage of care.
True
114
7-month old of Mediterranean descent, mom has unknown blood disorder, what test?
hemoglobin electrophoresis
115
Child with signs of ALL- what test confirms diagnosis?
bone marrow biopsy
116
Cold autoimmune hemolytic anemia can be triggered by:
scuba diving
117
Given the wrong blood transfusion- what symptoms do you expect?
back pain and renal failure
118
Bleeding disorder related to Factor VIII deficiency, what is the diagnosis?
Hemophilia A
119
Patient bleeding after dental procedure- most likely cause?
von Willebrand disease
120
What is the mechanism of action of aspirin?
inhibits COX
121
What is dipyridamole commonly used for?
cardiac stress testing
122
9 days post-hospitalization, received heparin for 3 days, toe now hypoperfused — most likely diagnosis?
HIT Type 2
123
6 days after starting heparin, now with thrombosis — what is the diagnosis?
HIT Type 2
124
Patient has CKD and needs anticoagulation — best choice?
Heparin
125
Patient on heparin now has significant bleeding — next step?
Protamine sulfate
126
What should be avoided when taking warfarin — key patient education point?
Leafy green vegetables
127
Life-threatening bleeding from warfarin — treatment?
Kcentra
128
Mild bleeding from warfarin — what can help reverse it slowly?
Vitamin K
129
Home DVT prophylaxis after surgery — appropriate agent?
Apixaban
130
DOAC reversal agent — what do you give?
Andexanet alfa (Andexxa)
131
Suspected transfusion reaction — what is the immediate response?
Stop transfusion and assess patient
132
What is the minimum recommended anticoagulation duration?
3 months
133
What is dual antiplatelet therapy composed of?
Aspirin and clopidogrel
134
Patient has low hemoglobin and is actively bleeding — next step?
Packed red blood cells
135
This drug can cause complications in cancer, CKD, and post-op patients?
Epoetin alfa
136
What imaging is needed for a man with brain abscess and HIV positive?
MRI with contrast
137
What is the empiric treatment for fungal meningitis?
Fluconazole
138
What is the NIHSS score for a patient who moved with IV, opened eyes to sternal rub, and said 'watermelon'?
9
139
What is the treatment for status epilepticus?
Lorazepam
140
What medication is given after a brain abscess is removed?
Levetiracetam
141
Where is the most common place for tumors in individuals under 15 years old?
Infratentorial
142
Is a diagnostic test needed for Parkinson's clinical diagnosis?
No
143
What medication is used for Alzheimer's disease?
Donepezil
144
What condition is indicated by food poisoning and ascending sensory issues?
Guillain Barre syndrome
145
What is the pathophysiology of vision issues that started as blurry then diplopia, with leg weakness/numbness?
Loss of myelin sheath in central nervous system
146
What is needed for a woman with TIA?
Admission for MRI and telemetry
147
What are the symptoms of a man with Huntington's disease?
Chorea, cognitive issues, and psych issues
## Footnote
Excess glutamate
148
What condition is indicated by obesity, plantar ulcers, and foot numbness?
Diabetic peripheral neuropathy
149
What additional finding would be expected in a person with left facial droop and arm paralysis?
Left sided neglect
150
What does the anterior cerebral artery supply?
Anterior and frontal medial lobes
151
Where would you expect a stroke in a person with right arm symptoms and bilateral right visual field defect?
Left middle cerebral artery
152
What are the symptoms of an anterior cord injury?
Complete motor paralysis and loss of pain/temp but could still feel pressure
153
What test is needed for a 7-year-old with absence seizures?
EEG
154
What is Cushing reflex?
Bradycardia, HTN, respiratory depression with increased ICP
155
What does benzodiazepine withdrawal cause?
Seizures
156
What should be done for a woman with worsening headaches, waking up with them, and aura?
Needed MRI brain
157
What does a changing headache pattern indicate?
Tumor
158
What is the treatment for a 16-year-old girl with bilateral headache?
Sumatriptan
159
What are the symptoms of a man with pain behind his eye, ptosis, and miosis?
Cluster headache
160
In whom is a lumbar puncture contraindicated?
Kid with epidural hematoma
161
What injury occurs when a guy gets hit in the head during an armed robbery?
Epidural hematoma
## Footnote
Middle meningeal artery injured
162
What is the mechanism of action for an alcoholic dad who fell?
Bridging veins
163
What does a hyperdense crescent shape in the occipital lobe indicate?
Subdural hematoma
164
What layers are involved in an epidural hematoma?
Between skull and dura
165
What would a biopsy find in a middle-aged man with a tumor under the temporal region?
Meningioma
166
What should be done for a volleyball player who got hit in the head and has a GCS of 3?
Observe, she likely has a concussion
167
What is used to lower blood pressure from a brain abscess?
Dexamethasone
168
What medication is used for secondary stroke prevention?
Furosemide for HTN
## Footnote
Apparently the answer is aspirin
169
What is the patient education for post concussive syndrome?
Will likely resolve within 3 months
170
What is the difference between focal and generalized seizures?
Focal originates in one hemisphere and generalized originates in both hemispheres
171
What is the definitive diagnostic test for meningitis?
Either blood cultures or CSF analysis
172
What should be done for a little girl who fell from 3 ft and hit her head but is acting fine?
Discharge home or observe for a few hours
173
What was missed in a woman who was sent home with a bad headache and found dead?
Subarachnoid hemorrhage
174
What is the most common cause of a non-traumatic intracranial hemorrhage?
Hypertension
175
What condition is associated with lipohyalinosis?
Lacunar strokes
176
What is the most concerning physical exam finding for a football player with a concussion?
Bruising behind the left ear
177
What indicates a basilar skull fracture?
Ecchymosis around mastoid
178
What medication is used to lower ICP?
Mannitol
179
What is the contraindication for tPA?
Less than 100,000
180
What would be found in a man with frontotemporal dementia on MRI?
Atrophy on frontal and temporal lobes
181
What should be given to a man with Bell’s palsy?
Prednisone for 5 days and then reevaluate
182
What would a CT show for a man with symptoms of Bell’s palsy?
Normal
183
What is the most common finding during a stroke on CT?
No acute abnormalities
184
What medication is used for a woman with tremor that gets better with alcohol?
Propranolol
185
What is needed for a pacemaker man with diabetes and leg numbness?
CTA
186
What are the symptoms of upper motor neuron disease?
Difficulty swallowing, change in voice, and sensory intact
## Footnote
ALS
187
What condition did an old man with a UTI likely develop?
Delirium
188
What is the pathology associated with Alzheimer's disease?
Neurofibrillary tangle
189
What should be done for a 9-month-old that can sit up?
Suspicious for CP, refer to developmental specialist
190
What additional finding would be expected in a man with a 1cm mass in the right cerebellar hemisphere?
Ataxia
191
What type of headache is worse when laying down?
Most risk for brain tumor
192
What condition is indicated by low back pain, distal weakness, and a respiratory rate of 12?
Guillain Barre syndrome
193
What is the most common cause of bacterial meningitis in an 8-month-old?
Group B strep
194
What is the most likely cause of Bell’s palsy?
Herpes simplex 1
195
What would be another physical exam finding of Parkinson’s disease?
Bradykinesia
196
What medication is used for a woman with a crawling sensation in her leg?
Gabapentin
197
What type of tumor is commonly seen in children?
Medulloblastoma
198
What condition is indicated by a PA student with tension headaches?
Tension headaches
