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phase II question bank > Family Medicine > Flashcards

Family Medicine Flashcards

1
Q

Lateralized, pulsating/throbbing HA w/ N/V, photophobia and phonophobia. Lasts 4-72 hrs and is worse with physical activity. The person says the saw flashing lights prior to onset. Trx and diagnosis

A

Migraine

-resting in quiet dark room may help or simple analgesic (acetaminophen, naproxen, ibuprofen, aspirin) These should be limited to less than 15 days per month, and less than 10 if combined
Abortive:
- Triptan or Ergotamines: 5HT-1 agonists (CI if coronary artery or peripheral vasc. Disease, uncontrolled HTN)
- Dopamine blockers: IV phenothiazines, metoclopramide, promethazine, prochlorperazine (give w/ Benadryl to prevent EPS)
-ergotamines

Prophylactic: B-blocker (propranolol), CCB (verapamil), TCA, anticonvulsants (valproate, topiramate), NSAIDs , acupuncture

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2
Q

What causes a HA that is typically worse on awakening?

A

Intracranial mass or sleep apnea

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3
Q

What type of HA typically occurs at the same time each day or night?

A

Cluster HA

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4
Q

What HA signs would make you want to get a CT/MRI to r/o intracranial mass?

A

Progressive HA, new onset occurring middle/late life, HA that disturbs sleep, causes neuro/focal neuro symptoms

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5
Q

What is the MC type of HA?

A

Tension HA

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6
Q

Constant daily tight HA that is generalized, no focal deficits. Diagnosis and trx

A

Tension HA

Pretty much the same as migraine, but no triptan

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7
Q

Who gets cluster HA?

A

Middle aged men

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8
Q

Patient has recurrent bouts of a HA that last for 4-8 weeks, then go away for a while. The patient says that they when the come back is has congestion, runny nose, and a watery eye. What syndrome is a associated w/ this disease, what is the diagnosis, and what is the treatment?

A

Abortive:
100% oxygen First line
Anti migrain meds

Prophylaxis:
Verapamil First line
Lithium carbonate, topiramate, prednisone, ergotamine

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9
Q

What is the MC cause of death in young people?

A

Trauma, and head injury is almost half

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10
Q

What are signs that indicate a cranial mass?

A
  1. HA worse when lying down
  2. HA awaken patient at night
  3. HA peak in the morning
  4. New in middle or later life (key feature)
  5. Sign of malignancy: fever, night sweat, weight loss, hx of malignancy, signs of intracranial pressure (papilledema, vomiting, worsening HA, increasing disorientation, changes in LOC)
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11
Q

What meds can cause rebound HA?

A

Ergotamines, Tristan’s, opioids when taken >10 days per month

acetaminophen, acetysalicylic acid, NSAIDs when taken more than 15 days per month

These patients have HA where no effect from pain meds in 3 months

Treatment is migraine prevention therapy
(Beta blocker, CCB, TCA, anticonvulsants (topiramate/valproate)

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12
Q

When should you refer someone for a HA?

A
  1. Thunderclap onset
  2. Increasing HA unresponsive to simple measures
  3. HX of trauma, HTN, fever, visual changes
  4. Presence of neurological signs or scalp tenderness
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13
Q

When to admit for a HA?

A

Suspected subarachnoid hemorrhage, structural cranial lesion

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14
Q

Patient presents w/ sudden onset HA that they describe as a thunderclap/ worst HA of their life. In addition they have mineral sx (stiff neck, photophobia, delirium), and they are obtunded. What is most likely diagnosis, what is wrong, what imaging, and what is the treatment?

A
  1. Subarachnoid hemorrhage
  2. ARTERIAL bleed: MC berry aneurysm, AV malformation
  3. CT
  4. Admit(typ 14 days) & neuro consult, Bed rest, stool softeners, lower ICP, surgery, gradually lower ICP (nicardipine, nimodipine, labetalol)
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15
Q

79 y/o presents w/ lancinating HA on left temple. Complains of pain with chewing and sudden painless unilateral blidness, fever, and scalp tenderness. What is the lab, what is the dx, and what is the treatment?

A
  1. ESR >100 / temporal biopsy

2. IV methylprednisolone 40-60 mg/day then prednisone 60 mg for 6 weeks

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16
Q

Patient presents with stabbing pain near corner of mouth that radiates to their ear. They say that it’s made worse with eating, drafts, or touching their face. During the exam it appears they are trying to hold still. They have no neuro abnormalities on exam. What must you r/o, what is the diagnosis, what is the treatment?

A
  1. R/o Multiple sclerosis
  2. Trigeminal neuralgia
  3. Trx
    Carbamazepine first line (LFT and Blood count)
    Then gabapentin
    Valproate, phenytoin, topiramate
    Surgery if recalcitrant to decompress
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17
Q

Patient complains of stabbing pain in throat, around tonsils, deep in their ear. They say that it is exacerbated by swallowing, yawning, chewing, and sometimes talking. They tell you that they have even passed out. Neuro exam is normal. Diagnosis and treatement?

A
  1. Glossopharyngeal neuralgia

2. Carbamazepine, oxcarbazepine

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18
Q

what is the treatment for acute bacterial sinusitis?

A
  1. amoxicillin first line
  2. pencillin allergy: doxycycline
  3. risk for pneumococcal resistance/recent hospitalization last 5 days/ >65/ abx in last month/immunocompromised (s. pneumo MC): augmentin
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19
Q

what are the MC causes for sinusitis?

A

S. pneumo MC

H. influenza, GABHS, M. cattarrhalis

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20
Q

What test is used to evaluate epilepsy?

A

Electroencephalography (EEG)

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21
Q

What are the essentials for epilepsy?

A
  1. Recurrent unprovoked seizures,
  2. Characteristic EEG accompanying seizures
  3. Mental status abnormalities or focal neurological sx. May persist for hours postictally
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22
Q

what are red flag symptoms for GERD?

A
  1. dysphagia
  2. odynophagia
  3. weight loss
  4. bleeding
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23
Q

recurrent abdominal pain or discomfort at least 3 days per month in the last 3 months with 2 or more of the following:

  1. improvement with defecation,
  2. onset associated with a change in frequency of stool, or
  3. onset associated with a change in form (appearance) of stool
A

irritable bowel syndrome

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24
Q

indications for GI referral

A
  1. More than minimal rectal bleeding dis
  2. Weight loss
  3. Unexplained iron deficiency anemia
  4. Nocturnal symptoms
  5. Family history of selected organic diseases including colorectal cancer, inflammatory bowel disease, or celiac sprue

WABNFam

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25
Q

what is the confirmatory test for seizures activity?

A

EEG electroencephalogram, MRI is a must, but in the ER consider CT

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26
Q

what are the generalized seizures?

A
  1. absence (petit mal)
  2. tonic-clonic (tonic clonic)
  3. atonic
  4. myoclonic
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27
Q

child presents w/ brief lapse of consciousness that includes a vacant stare and lack of response. The patients teacher says that sometimes this will even happen mid sentence. At some points the patient may have mild jerking, and wetting himself. The child is unaware and does not have a post ictal phase (flaccid coma/sleep). you get an EEG and it shows bilateral symmetric 3 hz spike and wave action. What is the diagnosis and treatment?

A

absence (petit mal)
ethosuximide first line (only for absence)
valproate second line

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28
Q

what hormone is elevated in a seizure and can help you identify a difference between an actual seizure and a pseudoseizure?

A

prolactin levels

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29
Q

what labs should you monitor for a patient on anti-epileptics?

A

CBC and LFT for hematologic and hepatotoxicity

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30
Q

pt. has sudden loss of consiousness. They become rigid and falls to the ground and their respiration is arrested this (tonic phase) lasts <1 min and is followed by a jerking of the body musculature (clonic) that lasts for 2-3 min and then is followed by a flaccid coma. During the coma the patient has incontinence (attic and basement) is injured, and bit their tongue. following the attack they behave abnormally and have no awareness of the even (postictal). the EEG shows high amplitude rapid spiking that may be normal in between seizures. what is the diagnosis and treatment

A

tonic-clonic (grand mal)

valproic acid, phenytnin, carbamazepine, lamotrigine

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31
Q

auras, and automatisms (lip smacking, manual picking, patting, coordinated motor mvmt (walking)) and seizures that are associated w/ marching symptoms are what kind of seizures?

A

focal onset. they are charaterized as such because only one hemisphere has been activated. They are classified by motor or non motor, and aware vs. impaired awareness

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32
Q

what is the treatment and time frame fror status epilepticus?

A

30 min, dextrose then lorazepam or diazepam (repeated at 10min) then phenytoin then phenobarbital

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33
Q

patient has sudden brief, sporadic muscle twitching and no loss of consiousness

A

myoclonus valproic acid, clonazepam

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34
Q

what kind of seizure is called a drop attack?

A

sudden loss of postural tone

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35
Q

what is a common side effect of valproic acid?

A

tremor, but also try and remember hepatotoxicity, thrombocytopenia, and pancreatitis

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36
Q

what kind of tremor does someone with essential tremor have?

A

an INTENTIONAL TREMOR (upper extremities>lower extremities) increased w/ stress and intentional MVMT, you will see it on finger to nose test. RELIEVED W/ ALCOHOL

treatment is propanolol
Autosomal dominant disorder

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37
Q

initial treatment for hypertension in african americans?

A

CCB then thiazide diuretics, then add on ACEI/ARB

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38
Q

what are non pharm recommendations for treatment of HTN?

A

weight loss
decrease ETOH
exercise
DASH: increase fruits and veges and dec. fats and sodim

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39
Q

what should be the initial hypertensive medication treatment for someone w/ DM or CKD?

A

ACEI or ARB

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40
Q

what is are the initial meds that are used for uncomplicated HTN in non-blacks?

A

In no particular order

  1. thiazide diuretics
  2. ACEI
  3. ARB
  4. CCB
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41
Q

what are side effect of thiazide-type diuretics and mech of action?

A

prevent NA reabsorption in distal convoluted tubule

hypercalcemia, hyperuricemia, hyperglycemia (careful DM and gout)

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42
Q

what are side effect of loop diuretics and mech of action (furosemide, bumetanide)?

A

inhibits H2O at loop of henle

hypokalemia, ototoxicity

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43
Q

what is the renal trifecta?

A

diuretics and acei/arb and nsaids

essentially starving the kidneys

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44
Q

what population groups are good candidates for ACEI?

A

post MI, HF, stroke, DM, high CAD risk

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45
Q

mech of action of ACEI and side effects?

A

cardioprotective syndergitic effect w/ used w/ thiazides

angioedema, cough, hyperkalemia

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46
Q

what is the first line agent for HTN in pregnancy?

A

methyldopa

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47
Q

side effect of abrupt clonidine stoppage?

A

hypertensive crisis

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48
Q

when are non-dihydropyridine CCB used to treat htn?

A

AFIB when a B blocker can’t be tolerated

verapamil, diltiazem

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49
Q

why are dihydropyridines (nifedipine and amlodipine) used more than non-dihydropyridines when treating HTN?

A

dihydropyridines are potent vasodilators and do not affect contractility or conduction

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50
Q

sde effects of CCB?

A

peripheral edema

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51
Q

MC cause of CAD?

A

atherosclerosis

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52
Q

risk factors for CAD?

A 
DM (worst)
smoking
hyperlipidemia
HTN
males
age (45 m, 55 w)
fam hx
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53
Q

what is angina?

A

substernal chest pain brought on by exertion

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54
Q

what is levine’s sign?

A

clenched fist over chest

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55
Q

substernal chest pain, poorly localized, may radiate, less than 20 min that is relieved w/ rest/nitro and precipitated by exertion/anxiety?

A

angina

consider sx of dyspnea, epigastric pain/ shoulder pain anginal equivalent

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56
Q

what will you see on ECG during angina typically?

A

st depression, f/u w/ stress test for angina because 50% have normal ECG

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57
Q

when do you use a myocardial perfusion imaging stress test when diagnosing ischemic heart disease?

A

when patient has baseline ECG abnormalites

can be stress or pharm w/ thallium 201 or 99m. localize regions of ischemia.

pharm agents: adenosine or dipyridamole when patients cant tolerate exercese.

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58
Q

what is the definitive managment of angina?

A
  1. percutaneous transluminal coronary angioplasty: if 1 or 2 vessel dieseae not involving the L main coronary artery and in whom ventricular function is normal/near normal
  2. Coronary Artery bypass graft CABG: if L main coronary artery disease, symptomatic or critical stenotic 3 vessel disease or decreased L ventricular ejection fraction <40%
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59
Q

contraindications for using NITRo?

A

SBP <90
RV infarction
sildenafil other PDE-5 inhibitor

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60
Q

first line drug therapy for chronic management of stable angina?

A

beta blocker: reduces mortality

B1 selective: metoprolol, atenolol

nonselective: propranolol, nadolol

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61
Q

anterior wall infarction: ECG and artery?

A

V1-V4 LAD

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62
Q

lateral wall infarction: ECG and artery?

A

I, aVL, V5, V6 Circumflex

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63
Q

anterolateral wall infarctoin: ECG and artery?

A

I, avl, V4, V5, V6 LAD and circumflex

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64
Q

inferior infarction: ECG and artery?

A

II, III, aVF right coronary artery

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65
Q

posterior wall infarction: EC and artery?

A

ST depression V1 and V2 RCA, circumflex

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66
Q

what is the treatment for prinzmetals angina?

A

CCBs,

occurs at rest, vasospasm of coronary arteries

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67
Q

rate and treatment for sinus tachycardia?

A

> 100, USUALLLY NONE

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68
Q

rate for sinus bradycardia and treatment?

A

<60

atropine

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69
Q

what is sinus arrhythmia?

A

HR increases during inspiration

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70
Q

what does sick sinus syndrome look like and treatment??

A

sinus arrest w/ alternating paroxysms of atrial tachyarrhythmias and bradyarrhythmias.
secondary to SA node disease

trx: pacemaker

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71
Q

what is first degree av block and management?

A

constant prolonged PRI (>.20), P for every QRS

observation

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72
Q

what is key about second degree heart blocks

A

not all SA node make it to ventricles so some P have no QRS

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73
Q

what is second degree MOBITZ I (wenckebach)?

A

PROGRESSIVE PRI lengthening then dropped QRS (going going gone).

if symptomatic atropine

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74
Q

what is second degree mobitz II?

A

CONSTANT prolonged PRI w/ dropped QRS

management atropine and pacing then definitive treatment is permanent pacemaker because 3rd degree will develop

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75
Q

what is third degree heart block?

A

AV dissociation: P waves not related to QRS

P waves are not followed by qrs (leads to dec. cardiac output)

trx: temporary pacing then permanent pacemaker.

76
Q

what is atrial flutter

A

saw tooth

250-350 bpm (no p waves)

rate usually regular

trx:
stable vagal, B-blocker, CCB

unstable: direct current (synchronized) cardioversion
definitive: radio frequency ablation

77
Q

what is a. fib?

A

irregularly irregular w/ narrow QRS

NO Pwaves
350-600(atrial)
80-140(vent)

stable trx:
1. RATE CONTROL
B-blocker (metoprolol, esmolol)
CCB (diltazem, verapamil)
digoxin (preferred if hypotension or CHF)
  1. RHYTHM CONTROL
    cardioversion: <48 hrs or 3-4 wks anticoag
    pharm: ibutilide, flecainide, sotalol, amiodarone
    radiofrequency: perm pacemaker
unstable
direct current (synchronized) cardioversion

anticoagulation:

  • assess for embolization risk: CHAD2DS2-VASc (>=2 give oral anticoagulation) recommend
  • determination of the benefits vs. risk of anticoagulation: embolization vs. bleeding risk

anticoags:
non vit K antagonist oral anticoags
- dabigatran: direct thrombin
- rivaroxaban, apixaban, edoxaban: factor Xa inhibitors

warfarin: preferred for severe chronic kidney disease goal INR2-3

78
Q

what is the CHA2DS2-VASc criteria for anticoag?

A 
CHF
HTN
A2ge >=75
DM
S2 stroke, TIA, thrombus
Vascular disease (MI, aortic plaque, PAD)
Age 65-74
Sex
79
Q

what is the treatment for stable SupraVentricularTachycardia?

A

adenosine

HR>100
regular rhythm w/ narrow QRS

80
Q

what is the for wolff-parkinson- white?

A

procainamide

81
Q

what is the treatment for unstable SVT?

A

direct current (synchronized) cardioversion

definitive: radiofrequncy ablation

82
Q

what are the 2 rhythms that you can defibrillate?

A
  1. vfib

2. pulseless vtach

83
Q

what is wandering atrial pacemaker?

A

<100 bpm and 3 p wave morphologies

84
Q

what is multifocal atrial tachycardia?

A

> 100 BPM and 3 p wave morphologies

85
Q

MAT is associated w/ what disease?

A

COPD

86
Q

signs of wolf parkinson white?

A

delta wave, wide qrs, short PR interval

trx: procainamide

avoid use of AV node blocker (ABCD)
adenosine, betablocker, CCB, digoxin

87
Q

what is the rate for a junctional rhythm?

A

40-60

pwaves inverted or not present, w/ narrow QRS

88
Q

what is premature ventricular contaction?

A

wide, bizarre QRS earlier than expected, t wave typically opposite direction of QRS

no treatment

89
Q

what is vtach?

A

> =3 consecutive PVCs at a rate of >100 BPM (sustained if >30 sec.)

stable sustained VT: antiarrhythmics (amiodarone, lidocaine, procainamide)

unstable VT w/ pulse: synchronized cardioversion

VT w/ no pulse: defib, adn CPR

90
Q

what is the cause and treatment for torsades?

A

IV magnesium, commonly due to hypomagnesium, and hyperkalemia

91
Q

what is a common predisposing factor for vtach?

A

prolonged QT interval

92
Q

treatment for Vfib?

A

defibrillatin

93
Q

treatment for asystole and pulseless electrical activity?

A

CPR + epinephrine + shockable rhythm q 2 min

94
Q

treatment for unstable bradycardia?

A

atropine

95
Q

treatment for unstable tachycardia?

A

synchronized cardioversion

96
Q

treatment for unstable wide QRS tachycardia

A

antiarrhythmia

97
Q

what does acute pericarditis look like on EKG?

A

diffuse ST elevations in V1-V6

PR depression in the same leads at ST elevations

98
Q

what test should be used to monitor palpitations?

A

holter monitor (continuous ECG testing worn 24-48 hrs)

think arrhythmia
Non cardiac: stimulant use, caffeine, ETOH, hyperthyroidism

99
Q

what is brugada and what is it associated w/?

A

V1, V2 RBBB
V1-V3 ST elevation

sudden cardiac death

get automated implantable cardiac defibrillator

100
Q

what will be low in hyperaldosteronism?

A

K

101
Q

effects of angiotensin II?

A
  1. inc. aldosterone: Na
  2. inc. ADH: inc H2O
  3. vasoconstriction
    4 inc sympathetic tone
102
Q

what is the gold standard for diagnosing coronary artery disease, renal artery stenosis, peripheral artery disease, and abdominal aortic aneurysms?

A

angiography

103
Q

what test is most useful to diagnose HF?

A

echocardiogram

(transthoracic echo TTE: primary noninvasive test for cardiac anatomy and function)

(transesophageal echo TEE)

104
Q

when is a treadmill test CI?

A

patient is unable to excercise or has baseline ECG abnomalities

105
Q

what is a positive treadmill stress test?

A

st depression

  1. exercise induced hyper/hypo tension
  2. smptoms or HR abnormalities with normal resting ECG
106
Q

what test can localize the region of ischemia?

A

radionuclide myocardial perfusion imaging

107
Q

what are the vasodilators in pharmacologic stress testing?

A

adenosine or dipyridamole

preferred in patients w/ baseline ECG abn. and can localize region of ischemia

108
Q

when is pharmacologic stress testing contraindicated?

A

bronchospastic disease (asthma, COPD)

2nd/3rd degree HB

sick sinus syndrome

109
Q

what is a stress echo able to visualize and when is CI?

A

localizes the regions of ischemia, depicts wall mostion abnormalities, visualizes the structure and function of the heart (assess LV and valvular function)

110
Q

what are AMI protocol?

A

ECG w/in 10 min

door to thrombolytics 30 min

door to PCI 90 min

MONA: 
morphine
oxygen
nitrates
asprin

STEMI: B blocker, NTG, aspirin, heparin, ACEI, reperfusion

Nstemi, unstable angina: b blocker, NTG, aspirin, heparin

cocaine induced MI: ASA, NTG, heparin, anxiolytics (no B blockers!! unopposed alpha vasoconstriction)

R ventricular wall and inferior wall: must be careful because IV nitrates and morphine will reduce the preload.

if viagra: no nitrates (decreases preload)

111
Q

what is conservative management for chest pain?

A

began >12 hrs prior (w/o current chest pain) or low TIMI

aspirin 9 months
statin
B-blocker
ACEI
Nitroglycerin PRN
112
Q

what are the absolute contraindications to fibrinolytics?

A
  • previous intracranial hemorrohage
  • non hemorrhagic stroke w/in 6 months or closed head/facial trauma w/in 3 months
  • intracranial neoplasm, aneurysm, AVM
  • active internal bleeding
  • suspected aortic dissection
113
Q

MC cause of heart failure?

A

coronary artery disease

114
Q

inability of the heart to pump sufficient blood to meet the metabolic demands of the body at normal filling pressures?

A

heart failure

115
Q

MC causes of R side HF?

A

L side HF and pulmonary disease

116
Q

what is the MC cause of L side HF?

A

coronary artery disease and HTN

117
Q

what is more common systolic or diastolic HF?

A

systolic

118
Q

HF w/ decreased ejection fraction, S3 gallop, and is usually secondary to MI, and dilated cardiomyopathy?

A

systolic HF

119
Q

HF with normal/inc. EF, S4 gallop (forced atrial contraction into a stiff ventricle), typically caused by HTN, LVH, elderly

A

diastolic HF

120
Q

NYHA classes w/ HF?

A

I: no sy or limitation of activity

II: mild sx (dyspnea/angina) w/ slight limitation

III: moderate symptoms cause marked limitation in activity even with minimal exertion, but comforatble at rest

IV: sx at rest, severe limitations

121
Q

what are compensatory mechansims in HF?

A

sympathetic activation

myocyte hypertrophy remodeling

RAAS activation

122
Q

what is the MC symptom of L side HF?

A

dyspnea

123
Q

signs of L side HF

A

dyspnea, orthopnea, paraoxysmal nocturnal dyspnea, rales/rhonchi, chronic non productive cough, PINK FROTHY SPUTUM, S3, S4, MC cause of transudative pleural effusions, hypertension, cheyenne stokes breathing, cool extremities, dusk pale skin

124
Q

signs of R sided failure

A

peripheral edema, JVD, GI /hepatic congestion (N/V, anorexia, RUQ tenderness, hepatojugular reflex)

125
Q

what score from patient health questionnaire 9 (PHQ-9) is concerning for depression?

A

> =10

126
Q

what do ARBs end w/?

A

-artan

127
Q

what is the initial management for HF?

A

ACEI (and diuretic for symptomsL loop diurectics are most effective: furosemide, bumetanide, toresmide). Add on BB. Consider K sparing diruetic spironolactone (decreases mortality)

digoxin if HF + afib, but no mortality benefit

consider hydralazine + nitrates if unable to tolerate ACEI or BB. Good for african americans

128
Q

what treatment is indicated in patients with HF and EF <35%?

A

Implantable cardioverter defibrillator

129
Q

what treatment is indicated in patients with HF and EF <35%?

A

Implantable cardioverter defibrillator

130
Q

what are findings indicative of CHF on CXR?

A

cephalization

kerley B lines, butterfly/batwing pattern, pulmonary edema, peribronchial cuffing, perihilar congestion, and cardiomegaly

131
Q

what is the treatment for CHF?

A

LMNOP

Lasix (loop diruetic furosemide), morphine, nitrates, oxygen, position

morphine reduces preload

132
Q

what is the treatment for diastolic HF?

A

HR control, BP control, relief os ischemia

BB
ACEI
CCB

133
Q

acute fibrinous inflamation of the pericardium

A

acute pericarditis

134
Q

clinical manifestations of pericarditis?

A

pleuritic chest pain, and positional chest pain that relieves when leaning fwd. and friction rub best heard at end respiration while upright and leaning fwd. fever typically present

135
Q

what are 2 most common causes of pericarditis

A

idiopathic and viral ( enteroviruses, coxsackie, echovirus)

also consider dressler syndrome (post MI pericarditis)

136
Q

what is the treatment for pericarditis?

A

aspirin/nsaids first line

colchicine second line

corticosteroids if sx >48 hrs and refractory

137
Q

PE for pericardial effusion, ECG, treatment?

A

muffled heart sounds, electrical alternans/low voltage ecg

trx: observation if small
bigger: pericardiocentesis/ pericardial window

138
Q

PE for pericardial effusion, ECG, treatment?

A

muffled heart sounds, electrical alternans/low voltage ecg

trx: observation if small
bigger: pericardiocentesis/ pericardial window

139
Q

clinical manifestations of pericardial tamponade (so much fluid that filling is compromised and decrease output)?

A

beck’s triad

  1. JVD
  2. muffled heart tones
  3. hypotension

pulsus paradoxus: >10 mmHg decrease in systolic BP w/ inspiration

dyspeana fatigue, peripheral edema, shock: hypotension, reflex tachycardia, cool extremities

Immediate pericardiocentesis

140
Q

what is the treatment for cardiac tamponade?

A

pericardiocentesis

141
Q

what is the treatment for constrictive pericarditis?

A

pericardiectomy

142
Q

ejection click is associated w/ what pathology?

A

MVP: chordae tendinae abruptly pulls the mitral valve tight

143
Q

fixed split of s2 is heard w/ what?

A

ASD, VSD, pulmonary HTN and mitral regurgitation

144
Q

opening snap is what pathology?

A

opening of a stenotic mitral valve

145
Q

treatment for systolic crescendo-decrescendo murmur best heard at RUSB that radiates to neck?

A

surgery: valve replacement

aortic stenosis makes LVH

146
Q

what are the modified duke criteria for infective endocarditis?

A

2 major or 1 maj and 3 minor or 5 minor

Bacterial Endcarditis FIVE PM

147
Q

what are the diagnostic techniques for someone with peripheral artery disease? signs: claudication, acute arterial embolism, gangrene

A

arteriography (GOLD STANDARD), Ankle-brachial index (+

148
Q

what are the diagnostic tests for aortic aneurysm?

A
  1. abdominal ultrasound (initial test)
  2. CT chest: thoracic aneurysms
  3. angiography: gold standard
149
Q

what are the treatments for aortic aneurysm?

A

> 5.5 cm or >.5 cm in 6 months: immediate surgical repair (even if asymptomatic)

3-4 cm q 12 months
4-4.5 cm q 6 months
>4.5 cm vascular surgeon repair

150
Q

pain in stomach/back. tender abdomen with palpable mass. syncope and hypotension. +/- flank ecchymosis

A

abdominal aortic aneurysm

151
Q

what is the most important predisposing factor for aortic dissection?

A

hypertension

152
Q

chest pain (sudden onset feels like ripping, tearing, knife like) chest/upper back. Decreased peripheral pulses w/ >20 mmHg between L and R arm. +/- Hyper/hypo-tension. acute new onset artic regurge (diastolic decresendo).

A

aortic dissection

153
Q

what is the diagnosis of aortic dissection?

A
  1. MRI angiography gold standard (time consuming)
  2. CT scan with contrast (becoming test of choice)
  3. TEE echo (may be used initially if unstable)
  4. CXR (widening of the mediastinum)
154
Q

what is the management of aortic dissection?

A

surgery (stanford A (all or ascending)/ debakeys I/II)

medical management: Descending
Esmolol, labetalol 1st Line
Sodium nitroprusside PRN

155
Q

diagnosis of superficial thrombophlebitis (tenderness, pain, induration edema, erythema following superficial vein. Consider especially if hx of IV cath, trauma, pregnancy, varicose veins).

A

venous duplex ultrasound: noncompressible vein w/ clot

156
Q

what are the diagnostic studies for DVT?

A

venous duplex ultrasound (first line non-invasive)

D-dimer: can r/o it low risk patient (wells <1), in high risk patients w/ NEGATIVE U/S can help decide if serial US are requeired.

Venography (GOLD STANDARD)

157
Q

what is the treatment for DVT?

A

think LMWH/Unfractionated heparin to bridge gap to warfarin INR-2-3 and AT LEAST 5 DAYS. Vit K is antidote for warfarin. protamine sulfate is antidote for heparin

heparin: monitor CBC because of thrombocytopenia

1st DVT cause of surgery/trauma/OCP: 3 months
idiopathic proximal DVT: indefinite
idiopathic distal: 3 months
pregnancy: LMWH
malignancy: LMWH

IVC filter if contraindication/failed anticoag treatment

158
Q

treatment for varicose veins?

A
  1. conservative: compression, elevation, avoid long standing

2. sclerotherapy, radiofrequency, laser ablation, ambulatory phlebectomy

159
Q

what is the gold standard test for diagnosing asthma?

A

pulmonary function test, (dec FEV1, dec FEV1/FVC)

160
Q

rash that begins following an itch?

A

atopic dermatitis

161
Q

what is the MC inflammatory skin disease?

A

eczema

162
Q

what are the characteristics of eczema?

A

erythema, scale, vesicles

163
Q

symmetric vesicular hand lesions (tapioca) and foot dermatitis w/ itch that precedes rash. associated w/ increased hand washing. vesicles slowly resolve then progresses to lichenificiation. at that point pain replaces pruritis. diagnosis and treatment?

itch-> vesicles-> lichenification/cracking/scaling->pain

A

dyshidrotic eczema (pomphylox)

potent steroid then wean
avoid excessive hand washing
\+/- abx for secondary infection
elimination diet
hydroxyzine for itch
164
Q

dry skin and scaling rash that develops on lower anterolateral legs. Has cracked red lines that resemble porcelain. more itch than rash. associated w/ long hot showers and worse in winter. diagnosis and treatment?

A

asteatotic eczema (eczema craquele)

decrease freq of bathing and water temp
apply emollients often and immediately after bath
steroids: III-IV

165
Q

red, round, coin shaped lesions(plaque) that commonly occur on the back of elderly persons hands every winter. They may flake and can be misdiagnosed as tinea. diagnosis and treatment?

A

Nummular eczema

potent steroids for 4-6 weeks, group III-V (TAC MC)
antipruritic PRN

166
Q

what are the 2 kinds of contact dermatitis?

A
  1. irritant

2. allergic

167
Q

how do you diagnose contact dermatitis?

A

patch testing to ID causative agent

168
Q

what are the 2 most common types of irritant dermatitis?

A

occupational (hand dermatitis)

diaper dermatitis

169
Q
  • brush field spots (small, white, grayish/brown spots on the periphery of the iris)
  • heart defects
  • large tongue
  • poor muscle tone
  • sandal toe deformity
  • single palmer crease
  • upward slanting eye
  • epicanthal fold
A

trisomy 21 (down syndrome)

170
Q

mc site for fixed drug eruption

A

glans penis

171
Q

what do you never do a shave on?

A

melanoma

172
Q

where do you not use anesthesia?

A

ears, fingers, nose, toes, hose (penis)

173
Q

greasy, stuck on appearnace?

A

seborrheic keraotsis

174
Q

leser-trelat sign

A

associated w/ seborrheic keratosis, could be an indication of internal malignancy if many SKs appear all at once

175
Q

dermatosis papulosis nigra

A

think morgan freeman, benign, smilar to S. MC africans and hispanics

176
Q

stucco keratosis

A

white stuck on appearnce, associated w/ vasc. insufficiency so dont fix

177
Q

acrochordon

A

skin tag

178
Q

pink brown, slightly raised lesion that restracts beneath the surface w/ compression: retracts downward when squeezing around the lesion w/ thumb and index finger.

A

dermatofibromas

remove w/ punch biopsy or excision

179
Q

tumor with central umbilication

A

sebaceous hyperplasia

180
Q

lower eyelid/undereye, 1-3 mm small, firm flesh colored papules.

A

syringoma

181
Q

button hole sign. pinkish white pedunculated tumor that invaginated through skin with pressure.

A

neurofibroma, look for axillary freckling and cafe-au-lait spots (von recklinhausen, NF1): if so consult neuro for cancer

182
Q

what is the difference between hypertrophic scar and keloid?

A

keloid goes beyond borders of wounds site, starts later, and is stable. while a hypertrophic scar is confined to the wound site, starts early and regresses over time

183
Q

this is a precursor to squamous cell carcinoma?

A

actinic keratosis

184
Q

what’s bowens diease?

A

carcinoma in situ, f/u q6 months, cryo, could become SCC

185
Q

what is erythroplasia of queyrat?

A

SCC in situ on mucous membranes MC penis. red, moist, slightly raised plaque, associated w/ HPV-8. trx 5-fu or imiquod

186
Q

treatment for bartonella henslae??

A

azithromycin

187
Q

normal range of calcium, and what does hypo/hyper look like on ecg?

A
  • 8.5 and 10.5 mg/dL
    hypocalcemia will prolong the qt interval
    hypercalcemia will shorten the qt interval

phase II question bank (3 decks)

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