IM Shelf Review PPT Flashcards
(251 cards)
1
Q
Which EKG leads affected in an anterior infarct?
A
V1-V4
2
Q
Which EKG leads affected in an inferior infarct?
A
II, III, aVF
3
Q
Which artery affected in an inferior infarct?
A
RCA
4
Q
Which artery affected in an anterior infarct?
A
LAD
5
Q
R ventricular infarct s/s
A
hypoTN, tachycardia, + JVD, CLEAR lungs, NO pulsus paradoxus (looks like they are in shock w JVD)
6
Q
R ventricular infarct Tx?
A
fluids; NO nitro bc lack of preload is problem, and that would make it worse
7
Q
When does myoglobin peak after an MI?
A
2h
8
Q
When does CKMB peak after an MI?
A
24h
9
Q
When does troponin peak after an MI?
A
24-48h
10
Q
What is the best test to check for a recurrent MI?
A
myoglobin
11
Q
Name 2 medications that must be d/c’d prior to a stress test.
A
beta-blockers and Ca-channel blockers
12
Q
Name 2 medications used for a chemical stress test.
A
dobutamine, adenosine
13
Q
How does dobutamine work?
A
beta1-adrenergic receptor –> increased contractility and HR
14
Q
What indicates a positive stress test?
A
+ CP, ST depression, or hypoTN
15
Q
How do adenosine work?
A
causes coronary vasodilation and increases blood flow in normal coronary arteries; Slows conduction time through the AV node, interrupting the re-entry pathways through the AV node, restoring normal sinus rhythm
16
Q
What meds do you d/c an MI pt home on?
A
aspirin/clopidogrel, beta-blocker, ace-I, statin, nitrates
17
Q
What is the most common cause of death post-MI?
A
arrhythmia
18
Q
S/p MI, new systolic murmur 5-7 days later?
A
papillary muscle rupture
19
Q
S/p MI, acute hypoTN, new murmur?
A
ventricular free wall rupture
20
Q
S/p MI, persistent ST elevation about 1 month later, with systolic MR murmur?
A
ventricular wall aneurysm
21
Q
“Cannon A-waves”
A
JVP is bounding - tricuspid valve not opening in synchrony with cardiac cycle- atria and ventricles (AV) dissociation
22
Q
S/p MI, pleuritic CP and low grade temp, 5-10 weeks later?
A
Dressler’s syndrome
23
Q
Another name for autoimmune pericarditis?
A
Dressler’s syndrome
24
Q
Dressler’s syndrome tx?
A
NSAIDs, aspirin
25
Young person, diffuse ST elevation?
pericarditis
26
CP worse with inspiration (pleuritic), improved with leaning forwards, friction rub
pericarditis
27
Tx for pericarditis?
NSAIDs
28
Vague CP + hx of viral infection + murmur?
myocarditis
29
CP at rest, worse at night, + migraines, transient ST elevation during episodes?
Prinzmetal's angina
30
Prinzmetal's angina tx?
nitrate, Ca++ channel blockers
31
Prinzmetal's angina diagnostic test?
ergonovine stimulation test
32
EKG: progressive prolongation of the PR interval, with dropped beat?
Wenckebach/Mobitz type I
33
EKG: regular P-P and R-R interval, but not associated with each other?
3rd degree heart block
34
Physical exam 3rd degree heart block?
Cannon A-waves
35
EKG: varying PR intervals with >3 morphologically distinct P waves in the same lead
multifocal atrial tachycardia (MAT)
36
EKG: >3 consecutive beats with narrow QRS and rate >120
v-tach
37
Tx v-tach?
if pt unstable = shock, if pt stable = lidocaine, amiodarone
38
EKG: delta waves
WPW
39
EKG: short PR interval, wide QRS, slurred initial deflection
WPW
40
Tx WPW?
procainamide
41
What meds are contraindicated in WPW?
anything that slows AV conduction (beta-blockers, digoxin, verapamil, diltiazem)
42
EKG: sawtooth
A-flutter
43
Tx A-flutter?
unstable: shock
stable: beta-blockers, digoxin (kind of like a-fib)
44
EKG: regular rhythm, ventricular rate 125-150 and atrial rate 250-300
A-flutter
45
EKG: prolonged QT interval leading to undulating rotation of the complex around the EKG w/ low Mg and K
Torsades
46
What OD causes Torsades?
tricyclics
47
EKG: regular rhythm with rate 150-220 and sudden onset and offset palpitations
SVT
48
1st line Tx SVT?
carotid massage
49
Drug tx for SVT?
adenosine
50
EKG: peaked T waves?
hyperkalemia
51
EKG: Wide QRS, short QT, prolonged PR
hyperkalemia
52
EKG: undulating, low amplitude, alternate beat variation in direction
tamponade (electrical alternans)
53
Pulsus paradoxus, hypoTN, distant heart sounds, JVD?
tamponade (electrical alternans)
54
EKG: undulating baseline, irregular R-R interval
A-fib
55
Rate control drugs for a-fib?
beta-blockers
56
SEM cresc/decressc, louder with squat, softer with valsalva, parvus et tardus
aortic stenosis
57
Causes of aortic stenosis?
old age- calcific stenosis; bicuspid aortic valve
58
Tx aortic stenosis?
valve replacement
59
SEM louder with valsalva, softer with squatting or handgrip
HOCM
60
How does valsalva affect the heart?
decreases preload
61
Late systolic murmur with a click, louder with valsalva, softer with squatting
MVP
62
Holosystolic murmur radiating to axilla
mitral regurg
63
Holosystolic murmur w late diastolic rumble in kids
VSD
64
continuous machine-like murmur
PDA
65
wide fixed and split S2
ASD
66
rumbling diastolic murmur w opening snap
mitral stenosis
67
blowing diastolic murmur with a widened pulse pressure
aortic regurg
68
If PE is highly suspected: first step?
give heparin
69
Hx of CHF and murmur present?
get echo
70
Tx acute pulm edema?
nitrates, lasix, and morphine
71
young pt, sxs of CHF w prior hx of viral infection?
myocarditis (coxsackie B)
72
Reversible causes of CHF?
EtOH, hemachromatosis
73
Tx CHF?
ace-i, beta-blocker, spironolactone, furosemide, digoxin
74
CHF tx that improve survival?
ace-i, beta-blocker, spironolactone
75
CXR: thickened peritracheal stripe and splayed carina bifurcation
LA enlargement from bad mitral stenosis; cancer
76
Name 3 transudative causes.
CHF, nephrotic syndrome, cirrhosis
77
Transudative w low glucose?
RA
78
Transudative with high lymphocytes?
TB
79
Transudative with blood?
PE or cancer
80
Name 2 exudative causes.
PNA, cancer
81
What is a complicated plural effusion?
positive bugs, low glucose, low pH
82
What is the tx for complicated plural effusion?
insert chest tube for drainage
83
Lights criteria for transudate?
1) LDH <200
2) LDH eff/serum < 0.6
3) protein eff/serum < 0.5
84
3 diagnostic criteria for ARDS?
1) PaO2/FiO2 <200
2) bilateral alveolar inf on CXR
3) pulm cap wedge pressure <18 (r/o cardiac causes)
85
ARDS tx?
PEEP
86
COPD dx?
productive cough >3mos in 2 consecutive years
87
COPD tx?
ipratroprium, beta-agonist, theophylline
88
When is O2 initiated in COPD?
pulse ox <88 or blood gas <55
89
COPD acute exasherbation dx?
any change with the sputum, increasing dyspnea
90
COPD acute exasherbation tx?
O2, nebs, corticosteroids, FQ or macrolide
91
Best prognostic indicator for COPD?
FEV1
92
What improves COPD mortality?
long-term O2, d/c smoking
93
COPD pt with clubbing?
lung cancer! get CXR (hypertrophic osteoarthropathy)
94
Name a long acting beta-agonist.
salmetrol
95
PCO2 in the middle of an asthma attack?
low
96
CXR: 1cm nodules in upper lobes with eggshell calcifications?
silicosis
97
Silicosis predisposes to ___.
TB
98
Asbestosis predisposes the patient to ____.
cancer
99
CXR: reticulonodular process in lower lobe with pleural plaques.
asbestosis
100
CXR: patchy lower lobe infiltrates, thermophyilic actinomyces
hypersensitivity pneumonitis (farmer's lung)
101
CXR: hilar lymphadenopathy, increase ACE, erythema nodosum
sarcoidosis
102
Why hypercalcemia in sarcoid?
microphages make vitamin D
103
Tx sarcoid?
steroids
104
Benign lung nodule characteristics?
popcorn calcification (hamartoma), concentric calcification (old granuloma)
105
Malignant lung nodule characteristics?
>3cm, eccentric calcification, older pt, smoker
106
Most common lung cancer in nonsmokers?
adenocarcinoma
107
Where does adenocarcinoma of the lung arise?
peripheral
108
Where does adenocarcinoma of the lung metastasize?
liver, bone, brain, adrenals
109
Plural effusion of adenocarcinoma of the lung?
exudative with high hyaluronidase
110
kidney stones, constipation, + malaise with low PTH and central lung mass?
paraneoplastic syndrome of squamous cell carcinoma (PTH RH)
111
shoulder pain, ptosis, constricted pupil, facial edema
pancoast tumor/superior sulcus syndrome- from small cell carcinoma
112
ptosis better after 1 min of upward gaze
Lambert-Eaton (small cell lung ca)
113
old smoker, low Na+, moist mucous membranes, no JVD
SIADH from small cell carcinoma
114
IBD with p-ANCA?
UC
115
Tx IBD?
ASA, sulfasalazine, corticosteroids
116
2 liver markers in EtOH?
AST, GGT
117
ALT>AST and in the 1000s?
viral hepatitis
118
ALT and AST and in the 1000s
ischemic hepatitis/shock liver
119
elevated D-bili?
obstruction (biliary tract, gallbladder, Dubin-Johnson, Rotor)
120
elevated indirect bili?
hemolysis, Gilbert, Criglar-Najar
121
elevated alk phos and GGT?
obstruction in biliary ducts
122
elevated alk phos, normal GGT, normal Ca++?
Paget's disease
123
ANA+, antismoothmuscle Ab with liver dz?
autoimmune hepatitis
124
high Fe, low ferritin, low Fe binding capacity, liver problems?
hemachromatosis
125
low ceruloplasmin, urinary Cu++ high
Wilsons
126
Tx Paget's disease?
bisphosphonates
127
meningitis in young and old bug? tx?
listeria- add ampicillin
128
meningitis in brain surg bug? tx?
staph- vanc
129
meningeal Tb tx?
add steroids to RIPE therapy
130
Lime dz meningitis?
IV ceftriaxone
131
Most common PNA bug in young, healthy people? tx?
mycoplasma- tx = macrolide
132
HAP bugs?
Pseudomonas
Klebsiella
E. coli
133
old smoker with COPD. PNA?
H. influenza- 2nd/3rd generation cephalosporin
134
PNA after the flu?
Staph
135
PNA after delivering a baby cow?
Q fever (coxiella)
136
PNA after skinning a rabbit?
tularemia
137
Who gets Tb exposure prophylaxis? With what?
kids <4yo with INH
138
SE rifampin?
red/orange body fluids; CYP450 inducer
139
SE INH?
neuropathy- give B6 (pyridoxine)
140
SE pyrazinamide?
hyperuricemia
141
SE ethambutol?
optic neuritis
142
most common bug endocarditis of ?
Staph
143
most common valve endocarditis?
mitral valve
144
IV drug user endocardidits valve?
tricuspid
145
What murmur is worse with inspiration?
right-sided
146
Endocarditis complication?
emboli, CHF
147
Strep bovis bacteremia?
colonoscopy looking for colon cancer
148
Strep bovis bacteremia?
colonoscopy looking for colon cancer
149
When do you start HAART?
CD4<350 or viral load >55,000 (unless pregnant)
150
What HIV drug causes leukopenia, GI sx, and macrocytic anemia?
zidovudine (AZT)
151
What HIV drug causes pancreatitis, peripheral neuropathy?
didanosine
152
Post-exposure HIV prophylaxis?
AZT + lamivudine + nelfinavir for 4 weeks
153
HIV pt with DOE, dry cough, fever, CP?
pneumocystic pna
154
Blood test PCP?
elevated LDH
155
1st line tx PCP?
tmp-smx
156
2nd line tx PCP?
dapsone, pentamiadine
157
PCP prophylaxis indicated when? What is used?
CD4<200
| tmp-smx
158
3 bugs causing diarrhea in HIV+ pt?
CMV
MAC
cryptosporidium
159
HIV+, one ring enhancing brain lesion?
primary CNS lymphoma
160
Tx toxo?
pyramethamine-sulfadiazine
161
HIV+ pt with sz and dejavu aura? Tx?
HSV encephalitis- acyclovir
162
What virus goes to the temporal lobe?
HSV
163
Most common cause of meningitis in an HIV+ pt? What else is worrysome?
strep pneumo, cryptococcus
164
Tx Cryptococcus?
amphotericin IV
165
HIV+ with hemisensory loss, visual impairment, Babinski?
PML from JC polyomavirus
166
HIV+ with memory problems or gait disturbance?
aids dementia complex
167
Most common bugs in neutropenic fever?
pseudomonas, MRSA
168
Target rash, fever, CN7 palsy, AV block, meningitis dx? tx?
Lyme dz
| doxycycline (if under 8, give amox)
169
Rash @ wrists, palms, soles, ankles, fever, HA. Dx and tx?
Rocky Mountain Spotted Fever (Rickettsia); doxy for everyone
170
Tick bite tx?
doxycycline
171
gram + branching, partially acid fast?
nocardia
172
Nocardia tx?
tmp-smx
173
Numbness, Chvostek or Trousseau, prolonged QT interval?
hypocalcemia
174
Bones, stones, groans, psycho, short QT?
hypercalcemia
175
Paralysis, constipated, ST depression and U waves?
hypokalemia
176
Peaked T waves, prolonged PR and QRS, sine waves?
hyperkalemia
177
Tx hyperkalemia?
1) calcium gluconate to stabilize cardiac memb
2) insulin + glucose, or kayexalate, diuretics, albuterol, sodium bicarb
3) dialysis
178
Tx Type 1 renal tubule acidosis?
bicarb
179
BUN/Cr ration >20:1?
prerenal azotemia
180
if FENA <1%?
prerenal azotemia
181
Muddy brown casts?
ATN
182
protein, blood, and eos in urine + fever and rash 1-2 weeks ago?
AIN
183
Tx ATN?
fluids, stop drugs
184
CPK 50,000?
rhabdo
185
What is the first test in suspected rhabdo?
check K+ or get EKG
186
envelope-shape crystals on UA?
ethylene glycol intox (antifreeze)
187
increased Cr s/p cardiac cath or contrast CT?
contrast-induced nephropathy
188
AEIOU dialysis?
```
acidosis
electrolytes
intoxication
overload volume
uremia
```
189
painless hematuria dx?
cancer
190
terminal hematuria with tiny clots?
bladder CA
191
dysmorphic RBCs in UA?
glomerular problems
192
blood in urine 1-2 days after runny nose, sore throat, cough?
IgA nephropathy (Bergers)
193
hematuria + deafness?
Alport
194
kid with arthralgias, purpura, abd pain, blood in urine?
Henoch-Schonlein Purpura (IgA)
195
Tx HSP?
steroids
196
Tx TTP?
plasmapheresis
197
DIC-looking but normal PT/PTT?
HUS or TTP
198
c-ANCA, kidney, lung, sinus involvement, peeing blood
Wegeners
199
p-ANCA, renal failure, asthma, eos
Churg-Strauss
200
tx Wegeners?
steroids, cyclophosphamide
201
tx Churg-Strauss?
cyclophosphamide
202
p-ANCA, no lung involve, Hep B
polyarteritis nodosa
203
tx polyarteritis nodosa?
cyclophosphamide
204
Most common type of kidney stone?
calcium oxalate
205
Fam hx kidney stones?
cysteine stones
206
Kidney stones with a chronic indwelling foley?
struvite stones (proteus, pseudo, kleb, staph)
207
leukemia + kidney stones?
uric acid stones
208
kidney stone s/p bowel resection?
pure oxylate stone (ca++ not reabsorbed by gut and pooped out)
209
Best first test for protinurea?
repeat the test
210
most common cause nephrotic syndrome in kids?
minimal change
211
most common cause nephrotic syndrome in adults?
membranous
212
fusion of foot processes?
minimal change dz
213
minimal change dz tx?
steroids
214
thick capillary walls with subepi spikes?
membranous
215
nephrotic syndrome in heroin, HIV?
FSGS
216
nephrotic syndrome in chronic hepatitis and low complement?
membranoproliferative
217
nephrotic syndrome with sudden flank pain?
renal vein thrombosis bc peeing out clotting factors
218
mesangial IgM deposits?
FSGS
219
tram-tracking basement membrane with subendothelial deposits?
membranoproliferative
220
unique proteins in multiple myeloma?
Bence-Jones
221
MCV 70, low Fe, high TIBC, low retic, high RDW, low ferritin.
Fe deficiency anemia
222
MCV 70, low Fe, low TIBC, low retic, high RDW, low ferritin.
anemia of chronic dz
223
MCV 60, low RDW
thalassemia
224
MCV 70, high Fe, high ferritin, low TIBC
sideroblastic anemia
225
INH for Tb blood SE?
sideroblastic anemia
226
MCV 100, low retics, high homocysteine, normal methylmelonic acid
folate defic
227
MCV high with acanthocyte?
liver dz
228
MCV 100, low retics, high homocysteine, high methylmelonic acid
B12 deficiency
229
normal MCV, high LDH, high indirect bili, low haptoglobin
hemolysis
230
sickle cell kid with sudden drop in Hct?
aplastic crisis
231
hemolysis with cyanosis of fingers, ears, nose, and recent Mycoplasma PNA?
cold agglutinins (IgM mediated)
232
sudden onset hemolysis after PCN?
warm agglutinins (igG mediated)
233
dark urine in the morning?
paroxysmal nocturnal hemoglobinuria
234
sudden onset hemolytic anemia after primiquine, sulfas, or fava beans?
G6PD deficiency
235
young female, recurrent epistaxis, heavy menses, only CBC abnormal is low plates
ITP
236
Tx ITP?
prednisone, splenectomy, IVIG
237
young female, recurrent epistaxis, heavy menses, bleeding time and PTT high?
von-Willebrands
238
von-Willebrands tx?
replace factor 8
239
mixing study corrects PTT?
hemophilia- give factor
240
1st clotting factor depleted in liver dz?
VII (high PT)
241
Which 2 clotting are made by the endothelium?
VIII, von Willebrands
242
PT and PTT high, fibrinogen low, d-dimer and split products high?
DIC
243
Tx DIC?
FFP, plates, correct underlying problem
244
PT and PTT normal, fibrinogen low, d-dimer and split products high?
TTP or HUS
245
Tx TTP or HUS?
plasmapheresis
246
7 days post op, arterial clot, low plates. Dx?
HIT
247
Mechanism of HIT?
Ab that binds to heparin and PF4
248
Tx HIT?
stop heparin, start lepirudin
249
Warfarin, then skin necrosis?
protein C/S deficiency
250
factor V leiden?
hypercoag state
251
Clotting on heparin?
ATIII deficiency
