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EOR 2 Flashcards

1
Q

Dilated CM

A
  • systolic dysfunction
  • 50% idiopathic, infective myocarditis, ETOH, beriberi, chagas, doxorubicin
  • mitral regurge murmur
  • tx w/BB, ACEI, VAD to transplant
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2
Q

HOCM

A
  • diastolic dysfunction, sudden death in teens
  • (Valsalva increases sound and squatting decreases it)
  • asymptomatic tx w/BB/verapamil, severe add diuretic
  • may need myectomy, transplant
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3
Q

Restrictive CM

A
  • diastolic dysfunction
  • caused by amyloid,sarcoid, idiopathic
  • tx w/diuretic, ACEI, transplant
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4
Q

acute vs suvbacute IE cause

A

acute-S. Aureus

subacute-S. Viridans

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5
Q

Duke Criteria

A

Major:  Positive blood culture (2 separate cultures drawn >12 hours apart)  Evidence of endocardial involvement  Positive ECHO- oscillating intracardiac mass on valve or supporting structures, abscess, new partial dehiscence of prosthetic valve or new valve regurgitation
Minor Predisposing heart condition or IVDA
 Fever (38 degrees)  Vascular phenomena- major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhage, Janeway lesions  Immunologic: glomerulonephritis, Oslers nodes, Roth spots, rheumatoid factor  Microbiologic: + blood culture but not meeting major criterion
 Echo: consistent with endocarditis but not meeting major criterion

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6
Q

roth spots vs janeway lesions

A

roth spots-retinal hemorrhage

janeway-palms/soles

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7
Q

Beck;’s triad for pericarditits

A
  1. Hypotension with narrow pulse pressure
  2. JVD
  3. Muffled heart sounds
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8
Q

how does pericarditis present

A

sharp chest pain relieved leaning forward
QRD alternans from heart swinging
tx w/NSAIDS and colchicine

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9
Q

erythema multiforme

A

Acute self limiting type 4 hypersensitivity reaction. MC in young adults 20-40y/o
-Skin lesions evolve over 3-5 days and persist about 2 weeks
-Associated with HSV and meds (sulfa drugs, beta lactams, phenytoin, phenobarbital) malignancies,
autoimmune

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10
Q

how does erythema multiforme present

A

Target lesions are classic, dull, dust violet, purple/blue/red, macules/vesicles or bullae in the center surrounded by
pale edematous rim and a peripheral red halo. Often febrile.

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11
Q

SJS vs TEN

A

SJS describes cases where total body surface area of blistering and detachment are <10%
TEN is used to describe cases w/ >30% detachment

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12
Q

drugs that can cause SJS

A

sulfonamides, allopurinol, antiepileptics
(lamotrigine, phenytoin, carbamazepine), oxicam NSAIDs, beta lactam and other abx,
and nevirapine

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13
Q

Bright cherry-red, Small – pinhead size to about one quarter inch (0.5 centimeter) in diameter  Smooth, or can stick out from the skin

A

cherry angioma

no tx needed

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14
Q

dilation of small superficial vessels and capillaries that cause numerous flat
red marks on the hands, face and tongue

A

telangectiasia

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15
Q

bullous pemphigoid

A

-Chronic widespread autoimmune blistering skin disease primarily of the elderly
- Type 2 HSN autoimmune attack on the epithelial basement membrane causing subepidermal blistering
- tense bullae that don’t rupture easily, blister roof contains epidermis, NEGATIVE NIKOLSKY
tx w/steroids

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16
Q

Pemphigus Vulgaris

A

Oral mucosal membrane erosions and ulcerations before painful flaccid skin bullae, ruptures easily, leaving painful erosions that bleed easily
+ nikolsky sign
tx w/steroids

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17
Q

metformin

A

decreases hepatic production of glucose

stop if creatinine ?1.5

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18
Q

sulfonylureas

A

stimulates pancreatic beta cell insulin release

glyburide, glipizide

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19
Q

Thiazolidinediones

A

increases insulin sensitivity in peripheral receptor site adipose and muscle has no effect on pancreatic beta cells “glitazones”

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20
Q

GLP-1 agonists

A

lowers blood sugar by mimicking incretin - causes insulin secretion and
decreased glucagon and delays gastric emptying

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21
Q

DDP-4 inh

A

inhibits degradation of GLP-1 so more
circulating GLP-1
“gliptans”

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22
Q

SGLT2 inh

A

increased urinary glucose excretion

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23
Q

Cranial nerve 8- schwannoma. Benign tumor of the schwann cells, which produce myelin sheath

A

acoustic neuroma

- Unilateral sensorineural hearing loss is an acoustic neuroma until proven otherwise

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24
Q

Vestibular neuritis & hearing loss/tinnitus (cochlear involvement)

A

labyrinthitis, MC from a viral infection

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25
Celiac
-Small bowel Autoimmune disorder to rye, wheat, and barley -dermatitis herpetiformis is seen
26
how to test for Celiac
Serum immunoglobulin A (IgA) endomysial antibodies and IgA tissue transglutaminase (tTG) antibodies. Sensitivity and specificity > 95%
27
intussusception
- common 6-18 months - preceded often by viral syndrome - vomiting, abdominal pain, passage of blood per rectum
28
how to dx/tx intussception
- barium enema | - may show spring-coil sign
29
MCC LBO
adhesions | colon cancer in older folks
30
Most common cause of painless rectal bleeding in the pediatric population
polyps
31
how to tx cryptorchidism
orchiopexy ideally before 1 year old  hCG or GRH hormones can be used to induce descension. May be used prior to surgery but not often done
32
is a condition in which urine flows retrograde, or backward, from the bladder into the ureters/kidneys
vesicoureteral reflux
33
This results from autoimmune antibody formation against host platelets. Occurs in acute form and chronic form. Clinical features:  Petechiae and ecchymosis on the skin Bleeding of mucus membranes  No splenomegaly
immune thrombocytopenia purpura Plt <20K tx w/steroids, IVIG
34
- rare disorder of platelet consumption | - hemolytic anemia, thrombocytopenia, acute renal failure, fever, fluctuating, transient neurologic signs
thrombotic thrombocyopenia purpura
35
↓ Platelets + anemia + renal failure
HUS
36
VWD
missing or defective von Willebrand factor (VWF), a clotting protein. VWF binds factor VIII, a key clotting protein
37
hemophila A
factor VIII deficiency x-linked recessive prolonged PTT
38
hemophilia B aka christmas disease
factor IX deficiency
39
hemophilia C
factor XI deficiency comon in AJ
40
how to tx botulism
hospitalization | antitoxin does not treat, but prevents further damage
41
From contaminated water, fish, shellfish, street vendor food  Clinical features: diarrhea RICE WATER
vibrio cholera
42
BLOOD AND MUCUS (PUS) IN STOOL
shigella | tx w/bactrim
43
Infection occurs from consuming food products with organisms: poultry, reptiles and amphibians (pet turtle)
salmonella
44
how to tx diphtheria
diphtheria equine antitoxin, removal membrane direct laryngoscopy, PCN or erythromycin, isolation
45
JONES criteria for rheumatic fever | requires 2 major or 1 major plus 2 minor
``` Major ● Carditis ● Chorea ● Erythema marginatum ● Polyarthritis ● Subcutaneous nodules Minor ● Arthralgia ● Elevated ESR or C-reactive protein ● Fever ● Prolonged PR interval (on ECG) ```
46
group of clinical syndromes characterized by motor and postural dysfunction due to permanent and non-progressive disruptions in the developing fetal brain
cerebral palsy MC type is spastic syndrome dx via cranial MRI
47
Autoimmune, inflammatory demyelinating disease of the CNS of idiopathic origin with axon degeneration
MS, MC type is relaxing remitting | Slow nerve impulses weakness numbness pain and vision loss
48
LLhermites
lightning shock pain
49
pulfrich effect
sense of disorientation in moving traffic
50
uhthoffs
worsening of symptoms with heat
51
Autoimmune disorder causes decrease in acetylcholine receptors at post synaptic junction MUSCLE WEAKNESS AND FATIGABILITY IMPROVES WITH REST,
Myasthenia Gravis
52
how to tx MG
ACHase inhibitors like pyridiostigmine and neostigmine
53
Excessive anxiety and worry about daily events and activities (job, school, work, marriage) for at least 6 months
GAD
54
Period of extreme anxiety that peaks 10 minutes declines within 30 minutes, RARELY LASTS FOR LONGER than 1 HOUR
panic attack
55
MC mental disorder
phobia
56
``` Chronic progressive interstitial scarring from persistent inflammation resulting in loss of pulmonary function w/ restrictive component ```
idiopathic pulmonary fibrosis -CXR: bilateral reticular opacities in periphery and lower lobes- honeycombing
57
PFT of IPF
normal to increased FEV1/FVC ratio; RV decreased; VC decreased;
58
Multisystem disorder characterized by alveolitis followed by epithelioid granulomas • Associated with inclusion bodies such as Schaumann’s bodies and asteroid bodies • NON-CASEATING GRANULOMAS, HILAR ADENOPATHY • Most common African Americans; young people (< 40 y/o); females
Sarcoidosis
59
Chronic progressive disease with multisystem involvement of pulmonary and GI tract which ultimately results in death  Autosomal recessive on chromosome 7 o Defect of the CFTR gene amusing alterations of salt and water movements across membranes --> abnormally thick secretions
cystic fibrosis
60
how to tx cystic fibrosis
o aimed at pulmonary, GI, nutritional, infectious disease o Exacerbations: antibiotics with augmented airway clearing  Pseudomonas infections: tobramycin or aztreonam and Azithromycin o Enzyme replacement for pancreatic insufficiency o High fat diet
61
hyaline membrane disease
Surfactant production begins 24-48 weeks- by 35 weeks, enough surfactant is produced -CXR will demonstrate diffuse bilateral atelectasis causing a “ground glass appearance” and air bronchograms
62
nephrotic syndrome
Heavy proteinuria >3.5 g/14 hours | Hypoalbuminemia <3 g/dl
63
Minimal change disease aka Nil's
M/C Cause of NS in KIDS <10 and can follow a viral URI In adults, its M/C associated with NSAIDs proteinuria w/no hematuria
64
membranous nephropathy
M/C primary cause of NS in adults,
65
M/C/C of ESRD in USA(second being HTN)
diabetic nephropathy
66
acute renal failure
Low GFR with accumulation of nitrogenous wastes
67
HPV strains
16 and 18 cause cancer | 6 and 11 cause warts
68
cervical cancer screening guidelines
 First PAP at the age of 21 regardless of sexual activity (no pap indicated prior to that)  Age less than 30: do not screen with HPV testing  Age 21-65: Screen with PAP every 3 years  Age 30-65: Screen with PAP and Cytology every 5 years  Age > 65: Screen with adequate prior screening: do not screen
69
when to start HPV vaccine
11-12
70
Pregnant woman + trauma + PAIN =
abruptio placentae
71
Bright red vaginal bleeding that PAINLESS, 3rd trimester
placenta previa
72
Beta hcg level above which IUP should be visualized on US
 1000-1500 on transvaginal  4000-6500 on transabdominal Methotrexate in patients with <5000 hcg and ectopic mass <3-4 cm
73
Premature cervical dilation especially in the 2 nd trimester that leads to spontaneous abortions
incompetent cervix painless dilation of cervix tx w/Weekly injection of 17-alpha-hydroxyprogesterone
74
postpartum hemmorhage
Blood loss > 500 mL in vaginal delivery > 1,000 for C-section following delivery (difficult to quantify)
75
MCC pospartum hemorrhage
uterine atony because normally the uterus should contract therefore compressing blood vessels and preventing bleeding, over distension, Oxytocin use during labor, uterine exhaustion, retained placenta or blood clots, full bladder, uterine infection, cervical or vulvar or vaginal lacerations, and coagulopathy
76
PROM
Premature rupture denotes spontaneous rupture of fetal membranes before the onset of labor -alkaline ph is amniotic fluid
77
PPROM
Preterm (<37 weeks) premature rupture of membranes | -risk of oligohydramnios
78
prolonged rupture of membranes
Rupture of membranes that lasts > 18 hours | -risk of chorioamnionitis
79
how to manage PROM
-tocolytics (terbutaline, nifedipine, indomethacin, Mg Sulfate) < 34 weeks give steroids
80
give rhogam to...
RH - moms at 28-30 weeks
81
HTN meds for AA
thiazide or CCB
82
HTN meds for DM or chronic kidney disease
ACE/ARB
83
tx of choice in uncomplicated HTN
thiazide diuretic | prevents kidney water/Na reabsorption at DCT
84
dihydropyridines
``` potent vasodilators (little effect on cardiac contractility) -nifedipine/amlodipine ```
85
non-dihydropyridines
affect contractility and conduction - verapamil/diltiazem - used for prinzmetal angina also
86
A1 blockers
"azosin" | good for HTN w/BPH
87
nitroglycerin
-increase blood supply -decrease cardiac work, deny preload C/I w/PDE5 inhibitors
88
1st line tx for chronic angina
BB
89
ASA inhibits
thromboxane A2

EOR 2 (1 decks)

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