Firecracker/Qbank Deck Number Three Flashcards Preview

Internal Med > Firecracker/Qbank Deck Number Three > Flashcards

Flashcards in Firecracker/Qbank Deck Number Three Deck (242):
1

serous/effusive pericarditis

transudative or exudative fluid in pericardial sac
SLE, viral, autoimmune, RA, uremia

2

fibrinous pericarditi

fibrin-rich exudate
underlying uremia, MI, acute rheumatic fever, or radiation injury

3

hemorrhagic pericarditis

gross blood
malignancy
tubercular pericarditis in endemic regions

4

pericarditis presentation

sudden onset of chest pain
worse with inspiration
better with leaning forward

5

pericarditis, pain can radiate to

trapezius muscle

6

pericarditis - PE

friction rub
distant heart sounds

7

Ewart's sign

large pericardial effusion compression LLlobe, bronchial breath sounds at left inferior scapular angle

8

pericarditis - ECG

global st segment elevation
pr depression
low voltage and elctrical alterans

9

pericarditis - c xray

usually normal
can have enlarged cardiac silhouette with >200 cc

10

pericarditis treatment

NSAIDs, steroids
cholchicine

11

purulent pericarditis treatmetn

IV antibiotics
drainage via subxiphoid pericardial windowing/pericariectomy

12

location of MR murmur

apex

13

nitroglycerin mechanism of action

dilation of capacitance vessels
decrease ventricular preload

14

drugs to hold prior to stress testing

BB, CCB, nitrates

15

test for suspected aortic dissection

TEE

16

cardiac sound that can be heard during acute phase of ACS

S4

17

EKG - post mi

PVC (wide qrs)

18

coronary artery disease

plaque formation
narrowing of arteries
mismatch in myocardial oxygen supply and demand

19

CAD modifiable risk factors

tobacco, HTN, sedentary lifestyle, obesity, DM

20

CAD nonmodifiable risk factors

age
sex (men)
family hx (less than 55 in men, less than 65 in women)

21

takayasu arteritis

cell-mediated vasculitis
affects aorta

22

initial lesion of takayasu arteritis

proximal 2/3 of left subclavian artery

23

takayasu early symptoms

constituation - fatigue, wt loss
articular - juvenile idiopathic arthritis
dermatologic - similar to erythema nodosum/pyoderma gangrenosum

24

cardiac ausculatation of takayasu

diastolic murmur of AR

25

takayasu lab findings

elevated inflamm markers

26

takayasu therapy

glucocorticoids
MTX, AZA, DMARDs

27

side effects of diuretics?

contraction alkalosis

28

myocarditis PE findings

S3 or S4 heart sound as signs of ventricular dysfunction
If severely dilated, murmurs of either tricuspid or mitral insufficiency may be present
Pericardial friction rub may be present with myopericarditis.
Edema of the extremities, dull breath sounds at the bases of the lung, and increased JVP may all be present as signs of heart failure due to dilated cardiomyopathy and ventricular dysfunction.

29

myocarditis chest xray

cardiomegaly with or without marked pulmonary vascular markings and edema.

30

side effect of IFN

depression

31

symptoms associated with viral myocarditis

heart failure and dilated cardiomyopathy with fatigue, dyspnea, and decreased exercise capacity being the first signs and symptoms.

32

drugs that can cause myocarditis

Doxorubicin
Cyclophosphamide
Chloroquine
Penicillins
Sulfonamide
Cocaine

33

myocarditis arrhythmia

atrial tach

34

What sequelae are associated with stage 2 of lyme disease?

Bell’s palsy
Aseptic meningitis
Sensory-motor neuropathies
Cardiac involvement (most commonly myocarditis and AV block)

35

causes of a hemothorax

Trauma
Aortic dissection
Tuberculosis
Malignancy

36

mitral regurg

backflow of blood into LA from LV during systole

37

MR caused by disease that dilate LV

aortic stenosis, aortic regurg

38

drugs that can cause MR

ergotamine
pergolide
cabergoline

39

MR murmur

holosystolic
apex
radiates to the axilla

40

MR EKG findings

P mitrale
notched P waves
also seen in mitral stenosis

41

other heart sounds with MR

- widely split S2
aortic valve closing before pulmonic valve
- s3

42

medical management of symptomatic MR patients - goal

reduce afterload

43

medical management of MR - how to reduce afterload

diuretics
nitrates (also reduce preload)
ACEIs
carvedilol

44

AR

blood into LV from aorta during diastole

45

acute AR cause

damage to valve - endocarditis, rheumatic fever
aortic dissection, trauma

46

chronic AR cause

dilation of aortic root: CTD, symphilis, aging

47

acute AR symptoms

severe LSHF
cardiovascular collapse
cardiogenic shock

48

chronic AR symptoms

can be asymptomatic until they can no longer compensate and get LSHF

49

AR exacerabted by

volume overload
- high salt diet
strenuous exercise

50

AR mrumur

diastolic murmur
enhanced by leaning forward

51

AR 2/2 valvular insuff

left sternal border at the third or fourth interspace

52

AR 2/2 aortic root diltation

right sternal border or the apex

53

Austin-Flint murmur

low-pitched mid- to late-diastolic rumble best heard at the apex observed in severe regurgitation which results from turbulence of the anterograde stream from the left atrium competing with retrograde flow across the insufficient aortic valve.

54

AR ECG

LV hypertrophy
LA dilation
ST depression at rest/exercise

55

chronic AR heart sound

S3

56

goal of AR medical management

reduce afterload

57

treatment for acute decompensated AR

surgery for replacement
IV afterload reduction - nitroprusside + inotropes (dobutamine)

58

medical management for which AR pts

chronic, asymptomatic, EF >50%
vasodilators, low salt diet, diuretics, CCB

59

late presentation of aortic coarctation

asymptomatic HTN
headache
epistaxis

60

Aortic coarctation - blood pressures

HTN in UE
hypotension in LE

61

Aortic coarctation - ECG

LVH

62

acute limb ischemia treatment

IV heparin + embolectomy

63

syncope due to bradycardia, look for

prolonged PR or QRS

64

PAD treatment

low dose ASA
statin
exercise therapy

65

HCM mitral valve

movement abnormality
systolic antermior motion

66

most common liver mets

GI
lung
breast

67

porcelin gallbladder - risk for

gallbladder carcinoma

68

NAFLD most likely due to

insulin resistance

69

acute bleeding in liver failure treatment

FFP

70

amebic liver mass treatment

metronidizaole

71

fulminant hep failure - def

hep encephalophy within 8 weeks

72

chronic constrictive pericarditis

chronic inflamm process involing pericardial space --> consolidation, scarring

73

dysfunction w/ constrictive pericarditis

diastolic

74

constrictive pericarditis - clinical picture

symptoms of decrease CO and increase systemic venous pressure
- fatigue, hypotension, reflex tachy
- JVD, HSM, ascites, edema

75

constrictive pericarditis can be mistaken for

cirrorsis

76

constrictive pericarditis PE

JVD
kussumal's sign
pulsus paradoxus
early diastolic knock, friction rub

77

kussmaul's sign

neck vein distention with inspiration
kussmauls sign

78

constrictive pericarditis CT

thicken pericardium >2mm

79

confirmation of constrictive pericarditis

cardiac catheterization
rapid early diastolic filling
prominent y descent on RAP tracing

80

constrictive pericarditis with calcifcation of pericardial space

accompanied by early diastolic knock

81

untreated chronic constrictive pericarditis

decreased RVEDV
rise in systemic pressue
RHF signs

82

constrictive pericarditis treatment

surgical removal of pericardium

83

causes of constrictive pericarditis

viral
cardiac surgery
radiation therapy
TB

84

Dubin JOhnson

conjugated/direct bilirubinemia
black / dark pigmented liver
benign

85

cryoglobulinemia

blood contains large amounts of proteins insoluble at cold temps
associated with Hep C, MM

86

heb B virus type

dsDNA

87

antigen associated with hep b infectivity

HBeAg

88

HBsAg

Surface antigen, indicates active infection or carrier state (HBsAg: virus is preSent)

89

HBcAb

Antibody against core antigen. Critical for diagnosis during the window phase, when HBsAg is absent but HBsAb isn't detectable yet. Doesn't confer immunity.

90

HBeAg

Core antigen. Presence indicates transmissibility (HBeAg=rEplication)

91

HBeAb

Antibody against HBeAg, indicates low transmissibility

92

chronic Hep B infection

+ HBeAg
+ HBsAg
greater than 6 months

93

inactive Hep B carriers

+HBsAg

94

Prior HBV infection

anti-HBs (IgG) and anti-HBc (IgG)

95

HBV immunization

+ anti-HBs AB

96

treatment of Hep B in unvaccinated pts

immedate Hep B vaccine + Hep B IG following expsoure

97

chronic active Hep B treatment

PEG-IFN-a
entecavir
tenofovir

98

gastrinoma stomach biopsy

multiple stomach ulcers + thickened gastric folds

99

diagnosis of gastrinoma

fasting gastrin level >1000
if less than 1000, do secretin stimulation test

100

vit d def lab values

decrease Ca + Phosphate
increased PTH

101

disseminated gonogoocal infection triad

polyarthyalgia
tenosynvitis
painless skin lesions

102

increased homocysteine treatment

pyridoxine and folate

103

increased homocystine predisposes to

thrombosis

104

massive PE echo findings

acute RV dilation and ventricular hypokinesis

105

vasovagal maneuvers in SVT - mechanism

increase vagal tone
decrease conductivity thru AV node

106

systemic scleroderma antibody

topoisomerase-I

107

2nd amyloidosis treatment and prophylaxis

colchicine

108

2ndry amyloidosis causes

inflamm arthritis, IBD, chronic infections, malignancy, vasculitis

109

complications of untreated gonorrhea in females

disseminated infection
PID
TOA
Fitz-Hugh-Curtis syndrome

110

diagnosis of gonorrhea

gram stain of urethra discharge
culture: cervix

111

resp acidosis defined as

ph <7.37 with increase in pco2

112

cause of resp acidosis

hypoventiatlion
- CNS depression
- neuromuscular failure
- decreased resp system compliance (restrictive lung dz)
- increased airway resistance (obstrutive lung dz)
- increased dead space

113

resp acidosis treatment symptoms

restlessness
headache
hyperreflexxia
asterixis
coma

114

bicarb given in pure resp acidosis?

no
hco3 + H -> co2 + h2o

115

causes of resp alkalosis

hyperventilation
- cns stimulation
- hypoxemia
- anxiety

116

resp alk general values

low h
low bicarb
low co2
compensate with decreased hco3 reabsorp

117

increased pH can cause

hypocalcemia
hypophosphatemia
hypokalemia

118

resp alkalosis on ventilators

decrease their settings

119

aortic stenosis

- calcification of valve leafets with age
- 7th decade

120

aortic stenosis presenting at an early age

congenital bicuspid aortic valves

121

symptoms of aortic stensosis

classic syncope, angina, dyspnea

122

aortic stenosis can lead to what heart pathology

LVH

123

aortic stenosis murmur

systolic cresendo-decrescendo
2ICS at RSB

124

aortic stenosis murmur radiates to

carotid arteries

125

aortic stenosis murmur decreases with

valsalva/decrease preload

126

aortic stenosis - other heart sounds

s4
weak pulse (pulsus parvus et tardus)

127

aortic stenosis CXR

LVH

128

aortic stenosis echo

possible LAE
increased pressure gradient (best assessed with cath)

129

aortic stenosis ECG

LVH
LAE
LBBB

130

cardiac insuff in aortic stenosis

leds to ischemic heart disease, heart failure

131

medical management of aortic stenosis

control HTN - diuretic, ACEI
avoid vigorous activity
avoid venodilators (nitrates)
negative inotropes (CCB/BB)

132

aortic valve replacement

only treatment for aortic stenosis
- symptoms
- asymptomatic underoing cabg
- sever with systolic failure

133

Anserine Bursitis

located anteriomedial below knee

134

anklyosing spondylitis extra-articular finding

uveitis

135

murmur in marfan's patients

AR --> diastolic

136

Rosacea symptoms

flushing, teleangiectasia

137

hypercalcemia >14 treatment

NS + calcitonin
loops only if volume overload
if chronic problem - bisphosphonates

138

Familial Hypocalciuric Hypercalecmia

high normal PTH
high, asymptomatic calcium
low urine calcium

139

viral causes of thrombocytopenia

EBV, HepC, HIV

140

achalsia symptoms

dysphagia to solids and liquids

141

villous atrophy

celiac dz

142

anti-tissue transglutaminase ab

celiac

143

anti-endomysial ab

celiac

144

foul smelling sputum

aspiriation

145

uncomplicated cystitis treatment

nitrofuratonin x5
tmp smx x 3
fosfomycin x 1

146

complicated cystitis treatment

fluro 5-14d

147

pyelonephritis treatment outpatient

fluro

148

pyelonephritis treatment inpatient

IV fluro or ceftriaxone

149

UTI during pregnancy, treatment

nitrofurantoin
amoxicillin
cephalexin

150

pityriasis rosea, most common in

older children + young adults
women

151

what is pityriasis rosea

acute inflamm skin dz
papular lesions on trunk, proximal areas of extremities
viral origin

152

What typically precedes a pityriasis rosea eruption?

single round lesions
"herald patch"

153

how is pityriasis rosea treated?

Topical steroids
Phototherapy
Erythromycin
Recent studies have also found antiviral treatment with acyclovir to be effective in accelerating improvement.

154

How can pityriasis rosea be differentiated from tinea corporis?

negative potassium scrape (not fungus)

155

What is the typical presentation of pityriasis rosea?

pruritic, oval erythematous papules that are covered by white scale. T

156

thrombocytopenia =

less than 150,000
less than 10,000 spontaneous bleeding
less than 50,000 surgical bleeding

157

broad categories of thrombocytepenia due to

platelet underproduction
platelet destruction
dilutation
sequestration

158

diagnosis of thrombocytopenia

repeat cbc
peripheral smear to r/o pseudothrombocytopenia

159

TB, positive with 5+ induring

TB contacts
HIV
immunosuppression/organ transplant
CXR changes

160

meningitis prophylaxis 2-50 yr

vanc + 3 degree cephalopsorin

161

meningitis prophylaxis greater than 50 yr

vanc + 3 degree cephalosporin + ampicllin

162

meningitis prophylaxis immunosuppresion

vanc + amp + cefepime

163

cryptococcal meningitis treatment

amphotericine + flucytosine

164

UTI - pyruia

>10 leukocytes

165

HIV dysphagia

CMV, HSV, candida

166

CMV colitis in AIDs pts

owl's eyes - inclusion bodys
mouth ulcers

167

CMV treatment

ganciclovir

168

HIV needle stick

draw serologies and start 3 drug regimen

169

Bartonella treatment

azithromycin

170

aspergillus -- invasive

immunocompromised
bilateral lung infiltrates
fungal ball
pulmonary nodule with halo sign

171

adverse effect of fluroquinolones

achilles tendinopathy

172

oseltamivir use within

48 hrs of symptoms

173

food poisoning from rice

bacillus cereus

174

Histoplasmosis location

central and southern US (ohio and miss river valleys)

175

Coccidioidomycosis symptoms

nonspecific: joint pains, chest pain, etc

176

Nocardia - type of organism

gram positive, acid fast

177

Nocardia symptoms

lung nodules
brain abscesses

178

Nocardia treatment

tmp-smx for long duration

179

exudative =

increased capillary permeability

180

lung symptoms + pain in arm

pancoast

181

COPD air trapping during

expiratory phase

182

bronchogenic cyst

middle mediastinum

183

pulmonary fibrosis, A-A gradient

increased alevolar-arterial gradient

184

most common cause of inherited hypercoagulability

factor V leiden

185

hodgkin's lymphoma treated when less than 30, at risk for

secondary malignacy

186

What are examples of disease states that can cause an increased A-a gradient?

pulmonary edema
PE
R to L vascular shunts

187

What can cause a falsely normal A-a gradient?

hypoventilation
high altitudes

188

definitive diagnosis of Histoplasma

tissue biopsy of lung
lymph nodes that demonstrate granulomas

189

splenic and liver calcifications

histo

190

On microscopy, how does Histoplasma capsulatum appear at varying temperatures

mold at ambient temps
yeast at body temps

191

Where are Histoplasma capsulatum cells found on microscopy?

facultative intracellular yeast (2 - 4 microns in diameter) found inside macrophages.

192

populations predisposed to diseeminated histo

infants or immunocompromised

193

two general manifestations of histo?

pulmonary infection or disseminated

194

What causes erythema nodosum

delayed hypersensitivity reaction to antigens

195

What is erythema nodosum?

inflammation of subcutaneous fat that results in painful erythematous nodules, usually in a pretibial location.

196

What is the single most frequent condition associated with the development of erythema nodosum?

streptococcal pharyngitis

197

What is the typical presentation of erythema nodosum?

the typical presentation of erythema nodosum involves painful erythematous nodules, usually on the anterior portion of the tibia with possible malaise, fatigue, and polyarthralgia.

198

Amongst whom is erythema nodosum most common?

women ages 15-40

199

What laboratory findings are associated with erythema nodosum?

antistreptolysin o ab
ESR

200

Rx treatment of erythema nodosum

nsaids
potassium iodide
corticosteroids

201

What are two causes of failure of muscle relaxation in achalasia?

dysfunction of NO synthase producing neurons
denervation of esophageal muscle

202

diagnosis of achlasia

barium swallow
esophageal manometry

203

What is the cause of achalasia?

failure of LES to relax

204

What three things does manometry demonstrate in achalasia?

Impaired peristalsis
↓ Relaxation of lower esophageal sphincter (LES) after swallowing
↑ Resting tone of LES

205

achalasia treatments

esophagomyotomy, botulinum toxin injections, nitrates and calcium channel blockers.

206

Patients with achalasia have an increased risk of what condition?

esophageal squamous cell carcinoma

207

What is seen on barium swallow in a patient with achalasia?

Classic “Bird’s beak” appearance at the lower esophageal sphincter (LES)
Proximal esophageal dilation

208

What are some causes of “secondary” achalasia?

cancer
chagas
diabetic neuropathy
amyloidosis, sarcoidosis

209

What complication can result from balloon dilation treatment in a patient with achalasia?

esophageal rupture

210

What are three ways to biochemically reduce LES tone in patients with achalasia?

botox
nitrates
CCB

211

What is the presentation of diffuse esophageal spasm?

chest pain and dysphagia
precipitants: rapid eating, extreme food temps, heart burn, stress

212

What is diffuse esophageal spasm?

abnormal (non-peristaltic) contractions of esophagus

213

What is seen on manometry in diffuse esophageal spasm?

uncoordinated, nonperistaltic contractions

214

diffuse esophageal spasm treatment

CCB, Nitrates, TCAs

215

esophageal spasm imaging

corkscrew pattern

216

OSA - increased hematocrit

hypoxemia --> increased EPO from kidneys

217

spherocytes w/o central pallor + positive coombs test

autoimmune hemolytic anemia

218

Hairy Cell Leukemia

positive tartrate resistance acid phosphatase

219

diarrhea for >2 weeks

cryptosporiduium
cyclopsora
giardia

220

Baker's cysts

inflammed synovium from RA/OA/cartilage tears
popliteal fossa

221

ABG on CHF pt in resp distress

resp alkalosis
hypocapnia

222

sporotrichosis

gardener's dz

223

treatment of cocaine related chest pain

benzos, aspirin, nitroglycerin, CCB
do not give BB

224

hydatid cyst

cyst with eggshell calcifications
associated with echinococcus granulosis (dogs!)

225

itching after hot bath

polycythemia vera

226

uremic coagulopathy due to

platelet dysfxn
BT is prolonged
treat with DDAVP

227

What interventional studies may be used in the evaluation of hematuria?

cytoscopy - bladder cancer
retrograde pyelogram - ureteral malignancy
kidney biopsy - GN or vasuculitis

228

What imaging studies may be used in the evaluation of hematuria?

xray - kidney stone
ultrasound - renal masses
CT - renal malignancy

229

What do you suspect with painful hematuria? Painless hematuria?

painless - bladder cancer, renal cell carcinoma
pain - kidney stone, renal infarction, cystitis/kidney infection

230

ultrasound in hematuria

cystic vs solid masses

231

In general, what is the cause of hematuria?

whole RBCs leak into urine

232

If a patient has grossly bloody-appearing urine but a urine dipstick negative for blood, what does this mean?

substances from food/beets
no follow up needed

233

What is the treatment for myoglobinuria secondary to rhabdomyolysis?

Start IV normal saline to help preserve kidney function, and correct electrolyte abnormalities

234

What is the role of abdominal x-ray in the evaluation of hematuria?

kidney stones

235

What are some specific causes of hematuria?

malignancy (bladder and renal cell carcinoma), infection, stones, glomerulonephritis, vasculitis, and trauma.

236

What is the main focus of the treatment of hematuria?

underlying cause

237

What does a urine dipstick positive for blood tell you? What is the next step?

detects heme
could also be from hemoglobinuria or myoglobinuria
need urine microscopy to detect RBC

238

What is the treatment for hemoglobinuria secondary to intravascular hemolysis?

start intravenous saline to preserve kidney function and correct electrolyte abnormalities (eg, hyperkalemia) if present.

239

What is the difference between gross hematuria and microscopic hematuria?

gross - urine is pink/red
micro - >3 RBC

240

What would you expect to find on urine microscopy in all cases of true hematuria?

greater than 3 rbcs

241

tests for hemoglobinuria

ldh
indirect bilirubin

242

tests for rhabdomyolysis

CPK
hyperkalemia
hyperuricemia
renal failure