Exam 3, Darrow, chest pain and fever Flashcards Preview

Year 2 CV > Exam 3, Darrow, chest pain and fever > Flashcards

Flashcards in Exam 3, Darrow, chest pain and fever Deck (52):
1

tick bite in New England 2 mo ago
biphasic high pitched squeaky sound at left sternal border, louder with expiration and leaning forward
inverted T waves on EKG
most likely Dx?

chronic pericarditis

2

firemans cap is concave or convex

convex. pericarditis is concave

3

what position makes pericarditis worse

worse laying down, relieved by sitting

4

what are common causes of pericarditis

viral (coxsackie or echo)
TB
bacterial
uremia
neoplastic
inflammtory reaction/Dresslers
radiation
drugs
myxedema

5

what cause heart block myocarditis or pericarditis or both?

myocarditis

6

do you need a pacemaker if heart block has narrow QRS

no

7

what is classic triad for early disseminated lyme disease

acute neurlologic abnormalities is meninfitis, cranial nerve neuropathy and motor or sensory radiculopathy

8

what is cardiac involvement with early disseminated lyme disease

heart block and myopericarditis

9

DM renal failure
BUN 120
creatinine 6.2
dyspnea, fatigue, neck vein distention, muffled heart sounds and BP 90/70
EKG shows electrical alterans
What does the triad suggest? EKG?

Becks triad
cardiac tamponade

10

what is pulses paradoxus indicative of

cardiac tamponade

11

a decreased y descent (more shallow) is seen in what cases

tricuspid stenosis and cardiac tamponade

12

55 female with chest trauma with fatigue, weakness, inc JVP, edema, hepatomegaly and ascites
Kussmaul sign present
These signs suggest what?

constrictive pericarditis

13

What is Kussmaul sign

vein increases in size during inspiration

14

what conditions are seen with kussmaul

COPD, pulm HTN with RV failure, rarely cardiac tamponade

15

If atrial emptying is abrupt and sharp (steep y descent on jugular curve) what does that suggest? "M configuration or W

constrictive pericarditis

16

What are other signs of constrictive pericarditis

diatolic pericardial knock (like S3) and echo from rapid early filling
square root sign- heart cath, rapid ventricular filling followed by plateau phase durine rest of diastole because of rigid pericardium

17

what are causes of constrictive pericarditis

TB
post radiation
cardiac surgery
viruses and trauma

18

what are some restrictive cardiomyopathies that may present like restrictive pericarditis

amyloidosis, endomyocardial fibrosis, hemochromatosis, sarcoidosis
decreased ventricular filling

19

how do you differentiate restrictive cardiomyopathy vs constrictive pericarditis

look at EDPressure in LV and RV, in constrictive pericarditis they are equal
BNP elevated in restrictive cardiomyopathies or LV diastolic dysfunction

20

What is Tx for constrictive pericarditis

torsemide
pericardectomy

21

homeless man iwth right hemiparesis
had fever 101F covered in lice
total 6 blood cultures had been negative
diastolic decrescendo murmur at Erbs
What is this?

fever of undetermined origin

22

What can cause a FUO fever of undetermined origin

Infection:TB, endocartis, occult abscess
Cancer:lymphoma, leukemia
Autoimmune/CTDisease: Still's, SLE, cryoglobulinemia, PAN
Mischellaneous: sarcoid, FMF, whipples thyroiditis

23

What are the main criteria for duke criteria endocarditis

two positibe blood cultures
ECHO evidence of endocardial involvement
new regurgitant murmur

24

what are the minor criteria for duke criteria endocardtitis

predisposing condition
fever of 100.4 or higher
vascular emooli: janeway lesion, splinter hemorrhages, mycotic aneurysm, conjunctival or cutaneous hemorrhage, PE, strok, MI
Immunologic phenomena with agglutinating Ab: (osler node- painful and vasculitic), roth spots, RF, GN(hematuria and proteinuria)

25

what is considered a + dukes criteria for endocarditis

2 major criteria
one major and 3 minor
5 minor

26

what are predisposing conditions to infective endocarditis

regurgitant valves, bicuspid valves, rheumatic valves, calcific valces, MVP, PDA, coarctation, VSD

27

IV drug use predominately will affect what valve

tricuspid

28

native valve endocarditis are acused by what pathogens

staph, strep viridans, bovis, Group D strep or HACEK

29

what pathogens affect prosthetic valve early on? how about after 2 mo

early- staph
late- strep or staph

30

how do you Dx endocarditis

raw 3 cultues one hour apart

31

If culture for endocarditis is negative what do you do next

think fungi
special media to grow legionella, bartonella and abiotrophia
now growth on artifical media- whipelli and psittacosis
slow growing with prolonged incubation- Brucella anareobes (HACEK + by 5 days)

32

third most common infection from human bite

eikenella

33

how can endocarditis lead to abdominal aortic aneurysm

mycotic aneurysm

34

complications of endocarditis

heart blok, CHF, emboli, mycotic aneurysms, myocardial abscess

35

Patient with cat and endocarditis was most likely what organism

coxiella burnetti

36

coxiella infection is Tx with what

doxy

37

strep endocarditis is Tx how

penicillin

38

enterococcal endocarditis is Tx how

penicillin with gentamicin

39

Staph endocarditis is Tx how

nafcillin, if MRSA- vancomycin

40

if there is staph on prosthetic valve what do you use to Tx

vancomycin
gentamycin
Rifampin-- kills foreign material

41

strep bovis endocarditis, where did it come from

GI tract
usually GI neoplasms

42

strep mutans endocarditis came from where

dental

43

enterococci endocarditis is common in what population

elderly wiht urinary problems

44

HACEK endocarditis will grow on media when

around 5 days or more

45

no growth on media from endocarditis could be what

tropheyma, Q fever

46

When do you use antibiotic endocardtisi prophylaxis

previous IE
prosthetic valves or material
cyanotic congenital heart disease (tetralogy of fallot, eisenmenger syndrome) (not so if repaired >6 mo)

47

You give prophylactic antibiotics to patients with high risk endocarditis if they are having surgery in what areas?

teeth, lungs and skin

48

what antibiotic is given for dental procedures in someone with infective endocarditis

amoxicillin

49

fever, weight loss, leukocytosis, elevated sed rate, elevated RF and episodic pulmonary edema and syncope, especially with standing
recent troke
diastolic rumble with ocassional extra sound at mitral valve area upon standint
osler node on right great toe
most likley has?

atrial myxoma which is giving off emboli that present like endocarditis with negative cultures.

50

why do you get syncope with standing with an atrial myxoma

gravity pulls myxoma down and occludes mitral or tricuspid valve

51

patient has endocrine neoplasia, pigmented skin lesions and atrial myxoma, what is this

Carney complex

52

What causes Carney complex

cAMP activated PKA with activated cell proliferation, multiple neoplasia syndrome