Firecracker/Qbank Deck Number Three Flashcards
1
Q
serous/effusive pericarditis
A
transudative or exudative fluid in pericardial sac
SLE, viral, autoimmune, RA, uremia
2
Q
fibrinous pericarditi
A
fibrin-rich exudate
underlying uremia, MI, acute rheumatic fever, or radiation injury
3
Q
hemorrhagic pericarditis
A
gross blood
malignancy
tubercular pericarditis in endemic regions
4
Q
pericarditis presentation
A
sudden onset of chest pain
worse with inspiration
better with leaning forward
5
Q
pericarditis, pain can radiate to
A
trapezius muscle
6
Q
pericarditis - PE
A
friction rub
distant heart sounds
7
Q
Ewart’s sign
A
large pericardial effusion compression LLlobe, bronchial breath sounds at left inferior scapular angle
8
Q
pericarditis - ECG
A
global st segment elevation
pr depression
low voltage and elctrical alterans
9
Q
pericarditis - c xray
A
usually normal
can have enlarged cardiac silhouette with >200 cc
10
Q
pericarditis treatment
A
NSAIDs, steroids
cholchicine
11
Q
purulent pericarditis treatmetn
A
IV antibiotics
drainage via subxiphoid pericardial windowing/pericariectomy
12
Q
location of MR murmur
A
apex
13
Q
nitroglycerin mechanism of action
A
dilation of capacitance vessels
decrease ventricular preload
14
Q
drugs to hold prior to stress testing
A
BB, CCB, nitrates
15
Q
test for suspected aortic dissection
A
TEE
16
Q
cardiac sound that can be heard during acute phase of ACS
A
S4
17
Q
EKG - post mi
A
PVC (wide qrs)
18
Q
coronary artery disease
A
plaque formation
narrowing of arteries
mismatch in myocardial oxygen supply and demand
19
Q
CAD modifiable risk factors
A
tobacco, HTN, sedentary lifestyle, obesity, DM
20
Q
CAD nonmodifiable risk factors
A
age
sex (men)
family hx (less than 55 in men, less than 65 in women)
21
Q
takayasu arteritis
A
cell-mediated vasculitis
affects aorta
22
Q
initial lesion of takayasu arteritis
A
proximal 2/3 of left subclavian artery
23
Q
takayasu early symptoms
A
constituation - fatigue, wt loss
articular - juvenile idiopathic arthritis
dermatologic - similar to erythema nodosum/pyoderma gangrenosum
24
Q
cardiac ausculatation of takayasu
A
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
