Medicine Flashcards Preview

Medicine > Medicine > Flashcards

Flashcards in Medicine Deck (370)
Loading flashcards...
1
Q

Psoriasis may be exacerbated by what three things

A

Strep infection, skin injury (sunburn/drug reaction), hiv

2
Q

What are the five ps of dx of lichen planus

A

Pruritic, purple, polygonal, planar, papules

3
Q

Clinical features of porphyria cutanea tarda

A

Facial hirsutism, milia, erosions, scars, tense bullae (frequently on hands)

4
Q

Porphyria cutanea tarda is associated with abuse of what substance

A

Alcohol

5
Q

Porphyria cutanea tarda is associated with hep ___ and ___ overload

A

C; iron

6
Q

Pemphigus vulgaris often involves the

A

Mouth

7
Q

Pemphigus vulgaris is diagnosed by

A

Immunofluorescent studies of perilesional skin

8
Q

Erythema nodosum, think

A

Ibs, sarcoid, strep infection, ocps

9
Q

Erythema multiforme lesions are known as

A

Target lesions

10
Q

With erythema multiforme, think

A

Hsv, drugs (penicillin, sulfa, phenytoin), or mycoplasma

11
Q

Acanthosis nigricans is associated with what malignancy

A

60% gastric

12
Q

In a younger pt with seborrheic dermatitis, think

A

Hiv

13
Q

In an older pt with seborrheic dermatitis, think

A

Parkinson’s

14
Q

Pts with alcoholic hepatitis have ast and alt levels of

A

Ast less than 300, trivial elevations of alt with an ast/alt ratio of >3

15
Q

Hemochromatosis and alcoholic liver disease share what features

A

Hepatomegaly, glucose intolerance, testicular atrophy and cardiomyopathy

16
Q

Nonalcoholic steatohepatitis occurs in

A

Middle aged women with obesity, diabetes and hypertension

17
Q

Clinical features of nonalcoholic steatohepatitis

A

Hepatomegaly and elevated transaminases (usually ast>alt)

18
Q

Causes of acute liver failure

A

Drugs (acetominophen), viral hepatitis, ischemia

19
Q

Autoimmune hepatitis usually occurs in

A

Women

20
Q

Serologically pts with autoimmune hepatitis have what antibodies

A

Antinuclear and anti smooth muscle antibodies as well as hyperglobulinemia

21
Q

What are the drugs that cause drug induced cholestasis

A

Chlorpromazine, gold, chlorpropamide, ocps, erythromycin, and amoxicillin/clavulanate

22
Q

Primary sclerosis cholangitis occurs in

A

Middle aged men with a hx of ulcerative colitis

23
Q

What are ways to control acute variceal bleeding

A

Sclerotherapy, variceal band ligation. B blockers for prophylaxis

24
Q

Spontaneous bacterial peritonitis is usually caused by

A

Gram negative rods

25
Q

How to treat spontaneous bacterial peritonitis

A

Five day course of a third gen cephalosporin

26
Q

Crohn’s disease most commonly involves the

A

Terminal ileum and cecal region

27
Q

Malabsorptive diarrhea, arthritis, fever, lymphadenopathy, clubbing, cns involvement and uveitis. Think

A

Whipples disease

28
Q

Celiac sprue is associated with what skin thing

A

Dermatitis herpetiformis

29
Q

Celiac sprue is associated with what immuno deficiency

A

Selective iga deficiency

30
Q

Celiac sprue is associated with increased risk for what kind of lymphoma

A

Small bowel lymphoma

31
Q

What serological tests help diagnose celiac sprue

A

Iga endomysial antibody, and iga tissue trans glutamine antibody

32
Q

Chronic watery diarrhea in a middle aged woman without wt loss or pain, think

A

Microscopic (collaginous) colitis

33
Q

Treatment of microscopic colitis

A

Bismuth

34
Q

Diarrhea due to pancreatic insufficiency has a ___ amount of stool fat than normal

A

Greater

35
Q

Pancreatic insufficiency have ___ small bowel absorption tests

A

Normal (d-xylose, hydrogen breath tests)

36
Q

Three top causes of acute pancreatitis

A

Alcohol consumption, gallstones, triglycerides

37
Q

Does uc involve skin lesions

A

No

38
Q

Pseudocysts develop in __ % of pts with severe acute pancreatitis. Big cysts are at risk for

A

20; perforation, infection, hemorrhage

39
Q

Read rate of ekg

A

300/# of large squares in between each consecutive r wave

40
Q

P wave

A

Atrial depolarization

41
Q

Q wave

A

Left to right depolarization of the iv septum

42
Q

R wave

A

Early ventricular depolarization

43
Q

T wave

A

Ventricular repolarization

44
Q

Pr interval

A

Reflects conduction through the av node

45
Q

Qt interval

A

Time for ventricular depolarization and repolarization

46
Q

St interval

A

Time between ventricular depolarization and repolarization

47
Q

In rbbb you see

A

Delayed r ventricular activation producing a secondary r wave (r’) in v1-v3 and a wide S wave in lateral leads (I, avl, v5-6)

48
Q

St elevations in v1-v3 means

A

Lad occlusion, anteroseptal infarct

49
Q

V1-v4 elevations means

A

Anterior infarction

50
Q

Metformin mechanism

A

Gluconeogenesis in the liver, esp creating glucose for the brain at night

51
Q

Sulfonylurea mech of action

A

Make beta cells increSe insulin production

52
Q

Sulfonylurea side effects

A

Stroke, heart attack

Burns out the B cells

53
Q

Liraglutide (victoza) and exenatide are ___. Positive ses are___

A

Glp1 agonists; delayed gastric emptying and wt loss

54
Q

Sitagliptin (januvia) mech of action

A

Dpp4 inhibitor (dpp4 breaks down glp1)

55
Q

Level of proteinuria in diabetes

A

3000 and above

56
Q

Jiardance and drugs that end in flozin are___. They cause you to___.

A

Sglt2 agonists; cause you to pee out sugar

57
Q

Side effects of sglt2 agonists

A

Infection (utis) and hypoglycemia

58
Q

Abx used to treat community acquired mrsa

A

Doxy, clinda, bactrim

59
Q

Mechanism of doxy

A

Binds to the 30s ribosomal subunit; bacteriostatic

60
Q

Mech of clindamycin

A

Binds 50s rna subunit; bacteriostatic

61
Q

Lantus (glargine)

A

Long acting basal insulin

62
Q

Humalog (lispro)

A

Fast acting short term insulin

63
Q

Levemir (detemir)

A

Long acting insulin

64
Q

Nph

A

Medium acting insulin

65
Q

Glyburide is a ___ with what serious side effect?

A

Sulfonylurea; severe hypoglycemia and stroke

66
Q

Rosiglitazone increases the risk of development of

A

Symptomatic heart failure

67
Q

Diagnosis of dka

A

Glucose 250-500 mg/dl, bicarb<18, elevated anion gap, positive serum ketones

68
Q

Why can hypercalcemia be caused by immobilization?

A

Due to increased osteoclastic bone resorption

Higher risk in younger pts

69
Q

Symptoms of hypercalcemia

A

Nausea, polyuria

70
Q

Treatment of hypercalcemia due to immobilization

A

Bisphosphonates

71
Q

What four things do amoxicillin and ampicillin cover

A

E. coli, h flu, enterococcus and listeria

72
Q

What derivative of penicillin is good at covering staphylococcus

A

Methicillin and its derivatives (doxicillin, nafcillin, diclaxicillin)

73
Q

What is zosyn/what does it cover?

A

Piptazo; covers gn Rods and gut anaerobes and pseudomonas

74
Q

What is augmentin

A

Amoxicillin and clavulanate

75
Q

Keflex is a

A

First gen cephalosporin also known as cefalexin

76
Q

What are the second gen cephalosporins?

A

Furry fox drinking tea: cefuroxine, cefoxitine, cefetetan

77
Q

What is cefipime and what does it cover?

A

Fourth gen cephalosporin: covers pseudomonas

78
Q

How is insulin cleared?

A

Renally

79
Q

With sinusitis, what do you ask about?

A

Pain, pressure, duration

80
Q

How do you tell this difference between bacterial and viral uri?

A

If it’s been over ten days and it hasn’t gone away it’s probably bacterial, give abx

81
Q

Immediate management of acute coronary syndrome

A

Aspirin, ecg, lab draw for troponins

82
Q

Benefit of aspirin in pts with acute coronary syndrome

A

Reduces risk of mi in unstable angina, prevents platelet aggregation thus reducing mortality in pts with an mi

83
Q

Mechanism of sublingual nitroglycerin

A

It’s a vasodilator used to alleviate chest pain

84
Q

What associated sx should you ask about in suspected acute coronary syndrome

A

Nausea, diaphoresis, sob, fatigue and malaise in days preceding

85
Q

Mechanism of angina

A

Imbalance between myocardial oxygen supply and demand related to atherosclerotic plaque

86
Q

Difference between stable and unstable angina

A

Unstable is when chest pain occurs at rest not just with exertion

87
Q

What is unstable angina caused by

A

Unstable plaque that has ruptured and caused a non occlusive thrombus

88
Q

Treatment of unstable angina

A

Sublingual nitroglycerin, beta blockers, aspirin, heparin, angiography with percutaneous coronary intervention, statins

89
Q

Inferior mi is associated with what coronary artery lesion

A

RCA

90
Q

Anterior infarcts are associated with what coronary artery lesion

A

Lad

91
Q

Lateral infarcts are associated with what coronary artery occlusions

A

Left circumflex

92
Q

Crackles and s3 are signs of

A

Elevated left heart pressures

93
Q

S3 heart sound is caused by

A

Large amount of blood striking a very compliant left ventricle. Often but not necessarily a sign of systolic heart failure.

94
Q

S1 represents

A

Shutting of tricuspid and mitral valves

95
Q

S2 represents

A

Shutting of aortic and pulmonic valves after heart is done squeezing

96
Q

Use CBC to check for

A

Blood counts e.g. Anemia

97
Q

Use a bmp to check for

A

Electrolyte abnormalities and renal function, including signs of volume depletion

98
Q

Bnp had a high negative predictive value for diagnosis of

A

Heart failure

99
Q

How to tell difference between systolic and diastolic heart failure

A

Systolic: signs and sx of hf and reduced left ventricular ejection fraction

Diastolic: signs and sx of hf with preserved lvef and a nondilated lv chamber

100
Q

Spironolactone is a ___ blocker

A

Aldosterone

101
Q

Hydralazine reduces ___

A

Afterload

102
Q

Htn plus hypokalemia, think

A

Hyperaldosteronism

103
Q

If you suspect hyperaldosteronism what do you do

A

Measure plasma renin activity and aldosterone concentration

104
Q

What is secreted in acromegaly to cause its clinical manifestations ?

A

Insulin like growth factor 1 (stimulated by growth hormone)

105
Q

Side effect of thionamide drugs for hyperthyroid (methimazole, propylthiouracil)

A

Agranulocytosis

Propylthiouracil can also cause hepatic failure

106
Q

Radioiodine ablation can cause what side effects

A

Permanent hypothyroidism, worsening of opthalmopathy

107
Q

Osteomalacia is due to

A

Defective mineralization of organic bone matrix (impaired osteoid matrix mineralization)

108
Q

Left shift means

A

There are a high number of young immature wbcs present (usually indicating infection or inflammation)

109
Q

Right shift means

A

Lack of immature (young) neutrophils…suppression of bone marrow activity

110
Q

Oral estrogen supplementation ___ need for levothyroxine in hypothyroid pts

A

Increases. Estrogen increases level of thyroxine binding globulin

111
Q

Hypothyroidism can cause what metabolic abnormalities

A

Hyperlipidemia, hyponatremia, asymptomatic increases in creatinine kinase

112
Q

Can hyperthyroidism cause proximal muscle weakness?

A

Yes

113
Q

Dx h pylori

A

Stool test>urease breath test

114
Q

Etiology of ulcers

A

NSAIDs, h pylori, etoh, burns (curling), smoking, stress, head injury (Cushing), ze syndrome (gastrinoma)

115
Q

Triple therapy treatment for ulcers

A

Clarithromycin + omeprazole + metronidazole or ampicillin

116
Q

How do you treat toxic adenoma

A

Radioactive iodine if under 2cm, lobectomy if over 2cm

117
Q

Etiology of t1dm

A

Autoimmune destruction of B cells leading to lack of insulin

118
Q

Pancoast tumors can be associated with what syndrome

A

Horner syndrome (ipsilateral ptosis, miosis, etc)

119
Q

Involvement of what nerve roots cause weakness/atrophy of hand muscles in pancoast tumors

A

C8-t2

120
Q

emphysema is associated with what dlco?

A

Low due to alveolar destruction

121
Q

Chronic bronchitis is associated with what dlco?

A

Normal

122
Q

Asthma is associated with what dlco?

A

Normal or high

123
Q

Positive bronchodilator response plus sx of wheezing, dyspnea and cough =

A

Asthma

124
Q

What lab do you see in hypovolemia

A

Decreased urine sodium

125
Q

Discordant blood pressure with higher pressure in the arms, think

A

Coarctation of the aorta

126
Q

Depth of S wave in v1 or v2 plus the height v5 or v6 is >35mm, indicates

A

Lvh

127
Q

Most common side effects of ace inhibitors

A

Cough and hyperkalemia

128
Q

Mech of thiazides

A

Blocks sodium reabsorption in the dct

129
Q

What findings on eye exam indicate hypertensive emergency

A

Papilledema and hemorrhage

130
Q

Exopthalmos in Graves’ disease is due to

A

Orbital tissue expansion

131
Q

Small fiber injury in diabetes patient causes what symptoms?

A

Positive symptoms: pain, paresthesias, allodynia

132
Q

Large fiber injury in diabetes patient causes what symptoms?

A

Negative symptoms: numbness, loss of proprioception and vibration sense, diminished ankle reflexes

133
Q

Normal lvef

A

55-70%

134
Q

Reduced lvef is suggestive of what kind of chf

A

Systolic

135
Q

In diastolic hf, lvef will be

A

Normal

136
Q

Side effect of spironolactone

A

Hyperkalemia

137
Q

Increased cardiogenic edema is due to

A

Increases hydrostatic pressure due to increased backup

138
Q

Pt presents with worsening fatigue, dyspnea, and a hx of untreated strep infection and longstanding murmur, think

A

Mitral valve stenosis

139
Q

Pt with severe dyspnea, sob, longstanding hx of uncontrolled htn , think

A

Diastolic hf

140
Q

Pt is a few days post mi and suddenly has severe dyspnea, pink frothy sputum, and new systolic murmur, think

A

Papillary muscle rupture

141
Q

Pt is very tachycardic, presents with anxiety, chest pain, and sob and has ekg that shows wide qrs complexes with no discernible p or t waves , think

A

Ventricular tachycardia

142
Q

Abcde of cxr

A

Apices, bones, cardiac shadow, diaphragm, edge of image

143
Q

What scoring system do you use for stroke?

A

Chads 2: chf, htn, age, dm, stroke hx

144
Q

What are bundle branch blocks? Do you treat them?

A

Block in bundle of his (usually due to ischemia) which interferes with the ventricular conduction pattern. Don’t treat unless symptomatic

145
Q

What is premature ventricular contraction?

A

Something In ventricle causing it to contract. Isolated, not repetitive, events

146
Q

Risk factors for premature ventricular contraction

A

Mi, digoxin tox, drugs

147
Q

If pt is hemodynamically unstable with premature ventricular contractions, treat with

A

Iv amiodarone

148
Q

What is sinus tachycardia?

A

Heart rate over 100 but otherwise normal sinus rhythm

149
Q

What is d dimer

A

Fibrin degradation product in blood after blood clot is degraded by fibrinolysis

150
Q

Mechanism of beta blockers

A

Decreases myocardial contractility and heart rate

151
Q

Mechanism of nondihydropyridine ccbs

A

Decreases myocardial contractility and heart rate

Verapamil and dilt

152
Q

Mechanism of dihydropyridine ccbs

A

Coronary artery vasodilation and decreases afterload by systemic vasodilation

153
Q

Electrical alternans is a pathognomic finding on ecg for

A

Pericardial effusion

154
Q

Electrical alternans with sinus tachy is highly specific but not very sensitive for

A

Pericardial effusion

155
Q

Stable afib patients get what treatment

A

Beta blockers, diltiazem, digoxin

156
Q

How to treat beta blocker overdose (diffuse wheezing, bradycardia, hypotension)

A

Glucagon

157
Q

Heart failure exacerbation treatment

A

Ace inhibitor (or arb), b blocker (not acutely), statin, spironolactone

158
Q

What is the heart murmur of mitral stenosis

A

Mid diastolic murmur and opening snap

159
Q

Development of av block in pt with infective endocarditis should raise suspicion for

A

Perivalvular abscess

160
Q

Murmur of tricuspid endocarditis: describe

A

Holosystolic murmur accentuated by inspiration

161
Q

Orthostatic hypotension in an old person is due to

A

Loss of baroreceptor sensitivity

Also arterial stiffness, decreases norepinephrine at nerve endings, and reduced myocardial sensitivity to sympathetic stimulation

162
Q

What meds do you stop at least 48 hours before stress testing

A

Bblockers, ccbs, nitrates

163
Q

Special quality of versed

A

Induces amnesia

164
Q

Why can massive transfusions cause hypocalcemia?

A

Packed rbcs have citrate in them, which can chelate calcium

165
Q

Chronic co toxicity is a cause of secondary ___?

A

Polycythemia

166
Q

Pica is a symptom of what anemia?

A

Iron deficiency anemia

167
Q

Anemia of lymphoproliferative disorders is due to

A

Bone marrow infiltration with cancerous cells

168
Q

Photosensitive rash and symmetric oligoarthritis in a young woman suggests

A

Sle

169
Q

Thrombosis and a hx of miscarriages in a woman with suspected sle suggest

A

Antiphospholipid syndrome

170
Q

How are encapsulated organisms eliminated from body?

A

They resist phagocytosis, so are eliminated by the humoral immune response with antibody mediated phagocytosis (opsonization) and antibody mediated compliment activation

171
Q

What is salvage therapy

A

A form of treatment for a disease when a standard treatment fails

172
Q

For combined folic acid and vit b12 deficiency, replenishing folic acid without vit b12 leads to

A

Correction of megaloblastosis but leads to rapid progression of neuro sx

173
Q

Causes of microcytic anemia

A

Iron def, anemia of chronic dz, thalassemia

174
Q

What is haptoglobin

A

A serum protein that binds free hemoglobin and promotes its excretion

175
Q

Pts with hereditary hemochromatosis have a 20x increased risk of what kind of cancer?

A

Hepatocellular

176
Q

How do you dx dvt?

A

Compression ultrasonography

177
Q

How do you treat hypercalcemia

A

Bisphosphonates

178
Q

How do bisphosphonates work?

A

Inhibit the osteoclastic activity of the bone

179
Q

What does kidney failure do to phosphorus levels?

A

Hyperphosphotemia due to inability of kidney to excrete dietary phosphorus

180
Q

Hypocalcemia causes what ekg changes?

A

Shortened pr interval

Prolonged qt interval

181
Q

What is etidronate sodium?

A

A bisphosphonate useful for reducing bone resorption in patients with bony metastasis

Good for chronic bone pain but not acute

182
Q

Method to manage bone pain in patients with prostate cancer who have undergone orchiectomy

A

Radiation therapy

183
Q

Bite cells and Heinz bodies are associated with

A

G6pd

184
Q

Head and neck cancer is primarily what kind of cancer?

A

Squamous cell carcinoma

185
Q

What cancer is associated with smudge cells and severe leukocytosis?

A

CLL

186
Q

T9:22 cancer?

A

Cml

187
Q

Increased reticulocyte counts suggest

A

Increased erythropoiesis

188
Q

Main categories of acute kidney injury

A

Prerenal, infrarenal, post renal

189
Q

Symptoms of hyperuremia

A

Metabolic acidosis, tachypnea, tremors, altered mental status

190
Q

Maintenance rate of iv hydration

A

4321

4: first ten kg, give 4cc/hr
3: second ten kg, give 3cc/hr
2: third ten kg, give 2cc/hr
1: every additional kilo, give 1cc/hr

191
Q

Abx can cause atn or ain. How dx?

A

See casts on UA

192
Q

Tx of stable angina for symptoms? Mortality?

A

Symptoms:
Nitroglycerin, diltiazem, metoprolol

Mortality:
Metoprolol, aspirin, acei, statin

193
Q

Is stenting helpful for symptoms or mortality or both in stable angina

A

Symptoms

194
Q

Complications of stemi anterior

A

Vtach, decompensated hf causing sob

195
Q

Use what with caution in stemi (inferior)

A

Use nitrates with caution because venodilation is going to affect preload

Also b blockers

196
Q

Wide qrs often means

A

Bbb

197
Q

New lbbb equals a

A

Stemi

198
Q

St elevation in all the leads and possibly pr depression is

A

Pericarditis

199
Q

What is the tx for dressler syndrome pericarditis

A

Aspirin

200
Q

St depressions May be sign of

A

Nstemi

Not all of the wall infarcts, just part of it

201
Q

Only diff between stemi and unstable angina is

A

Troponins

202
Q

How to tx acs

A

Mona bs
Morphine
Oxygen
Nitroglycerin* only if not hypotension or r sided infarct
Aspirin
Beta blocker * only if he isn’t already hypotensive
Statin

203
Q

Why wouldn’t you give plavix in acs management

A

You might have to give the pt a cabg soon

204
Q

Contraindications to using nitrates

A

R sided infarct, hypotension, pde inhibitor (sildenafil)

205
Q

When do you use thrombolytics in a stemi pt

A

When you can’t get to a catch lab in less than 90min

206
Q

Do you get cathed with a stemi

A

Yes

207
Q

Do you get cathed with a nstemi

A

When med management isn’t working, or really high risk, or arrythmia, or elevated trops

208
Q

Svt is a reentry loop in the ___. You might see retrograde __waves.

A

Av node; p wave

209
Q

Psvt tx

A

Valsalva, shock, ablate

B blockers prophylaxis

210
Q

Tx of acute afib (hemodynamically unstable)

A

cardiovert but know they might have a clot

Could maybe do transesophageal echo to check for clot

211
Q

Stable afib rate control

A

B blocker or digoxin

212
Q

Rate control vs Rhythm control in a young afib pt?

A

Rhythm (amiodarone)

213
Q

Afib stroke prevention scoring system?

A

Use chads2 or chads2 vasc

214
Q

Chads2 score of zero tx?

A

None

215
Q

Chads2 score of one tx?

A

Aspirin or anticoagulant

216
Q

Chads2 score of two tx?

A

Anticoagulant (warfardin or dabigatron/apixaban)

217
Q

When looking at a tachyarythmia what’s the first thing you think about

A

Wide or narrow

218
Q

Wide tachyarythmia-what are the kinds

A

Vtach, vfib, torsades

219
Q

Tx vtach?

A

Shock them

220
Q

What kind of murmur?

Blowing diastolic murmur at l sternal border with wide pulse pressure

A

Aortic regurg

221
Q

What are the chf meds that improve mortality

A

Spironolactone, ace/arbs, b blocker, for Black pts hydralazine/isosorbide

222
Q

Clopidogrel (plavix) blocks what receptor? What is it’s mech of a?

A

P2y12 receptor

Inhibits activation of platelets and eventual cross linking of fibrin

223
Q

In addition to aspirin, beta blocker, statin, and acei, what med should be used in nstemi?

A

Clopidogrel or another p2y12 receptor blocker

224
Q

Mech of a of aspirin

A

Irreversible cox inhibitor-blocks formation of thromboxane a2 in platelets producing inhibitory effect on platelet aggregation

225
Q

Decreased cardiac output in heart failure patients leads to activation of the __ system and thus __

A

Raas; increased atII levels leading to vasoconstriction of efferent glomerular arterioles

226
Q

When do you use unsynchronized cardioversion (defibrillation)?

A

In resuscitation efforts in pts with pulseless cardiac arrest who have shockable rhythm (vfib, pulseless vtach)

227
Q

Side effect of dihydropyridine ca channel antagonists like amlodipine

A

Peripheral edema

228
Q

Symmetric edema without skin changes or varicosities argues for or against venous insufficiency?

A

Against

229
Q

X-ray findings of thoracic aortic aneurysm

A

Tracheal deviation, widened mediastinum, widened aorta

230
Q

Cardiac sarcoidosis is a dz of ___ infiltration into the myocardium

A

Nomcaseating granuloma

231
Q

Aortic regurg presents with what murmur?

A

Early diastolic

232
Q

Systolic diastolic abdominal bruit has high specificity for presence of

A

Renovascular hypertension

233
Q

Symptomatic sinus bradycardia should be treated initially with

A

Iv atropine

234
Q

What do you ask to take a htn hx?

A
Home bp readings
Salt intake
Alcohol intake
Exercise
Meds
235
Q

Workup of htn

A

Ekg (lvh)
UA (proteinuria-will tell you whether esrd is present)
BMP (ckd, baseline cr, k)

236
Q

What are first line for garden variety htn?

A

Aces, ca channel blockers, thiazides diuretics

NOT bblockers

237
Q

Side effects of the pines (ca channel blockers)

A

Le edema, constipation

238
Q

Side effects of thiazide diuretics

A

Hypokalemia, hyponatremia, gout flares

239
Q

What is cor pulmonale

A

Impaired function of the right ventricle caused by pulm htn that occurs due to underlying diseases of the lung (copd), pulm vasculature Or osa

240
Q

Constrictive pericarditis is a potential late complication of

A

Radiation therapy

241
Q

Constrictive pericarditis occurs as a result of

A

Scarring and subsequent loss of normal elasticity of the pericardial sac

242
Q

What is pulsus paradoxus

A

Abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration

243
Q

Class I antiarrhythmic drugs block

A

Sodium channels, inhibiting initial depolarization channels

244
Q

What are the class Ic antiarrhythmics

A

Flecanide and propafenone

245
Q

Use dependence, aka widening of the qrs complex in faster heart rates, can be due to what drugs?

A

Class Ic antiarrhythmics (flecanide)

246
Q

Imaging modality for abdominal aortic aneurysm

A

Ultrasound

247
Q

Stemi in a pt with a recent drug eluting stent is likely due to

A

Medication noncompliance (premature discontinuation of antiplatelet therapy)

248
Q

What drugs when used with digoxin causes digoxin tox

A

Amiodarone, verapamil, propafenone

249
Q

What should you use within 90min of stemi

A

Percutaneous intervention (pci) to restore coronary blood flow

250
Q

6 ps of acute arterial occlusion

A
Pain
Pallor
Poikilothermia (cool extremity)
Paresthesia
Pulselessness
Paralysis
251
Q

Pts with acute arterial occlusions leading to immediately threatened limb should be started on

A

Heparin

252
Q

Can hyperthyroidism cause new onset afib

A

Yes

253
Q

What testing should you perform on a pt newly diagnosed with htn

A

UA for occult hematuria and urine protein/creatinine ratio

Chemistry panel

Lipid profile

Baseline ecg

254
Q

Are diastolic and continuous murmurs usually due to pathological cause?

A

Yup

255
Q

What is supravalvular aortic stenosis

A

Second most common type of as

Congenital lv outflow tract obstruction due to narrowing of ascending aorta

256
Q

Pe findings of supravalvular aortic stenosis

A

Systolic murmur best heard at first right intercostal space, higher than normal as; unequal carotid pulses; differential bp in upper extremities; palpable thrill in suprasternal notch; may develop coronary artery stenosis

257
Q

Acute limb ischemia after MI suggests

A

Possible arterial embolus from left ventricular thrombus

258
Q

Side effect of niacin

A

Cutaneous flushing and pruritus due to prostaglandin induced peripheral vasodilation

259
Q

Initial tx of hcm

A

Beta blockers

260
Q

Lab findings with a cholesterol embolism

A

Elevated serum creatinine, eosinophilia, hypocomplementemia

261
Q

Most common causes of positive hepatojugular reflux

A

Constrictive pericarditis
Rv infarction
Restrictive cardiomyopathy

262
Q

Tx of afib + hyperthyroidism

A

B blocker

Controls hr and hyperadrenergic sx, also decreases conversion of t4 to t3 in peripheral tissues

263
Q

Progressive dyspnea on exertion, fatigue and exertional syncope are suggestive of ___ obstruction

A

Outflow

264
Q

Delayed and diminished carotid pulse (pulsus parvus and tardus), soft second heart sound, and murmur, are suggestive of severe ___

A

As

265
Q

Exertional syncope usually portends to what pathological causes?

A

Ventricular arrythmias and outflow obstruction

266
Q

Fourth heart sound is due to

A

Blood is forced into a stiff ventricle

267
Q

Causes of fourth heart sound?

A

Ventricular hypertrophy (as, hocm) and also during the acute phase of MI due to ischemia

268
Q

Displaced apical impulse, holosystolic murmur and third heart sound are consistent with severe

A

Mitral regurg

269
Q

What is the most common cause of chronic MR in developed countries

A

Mitral valve prolapse

270
Q

Pathophys of mvp

A

Myxomatous degeneration of mitral valve leaflets and chordae causing a mid systolic click

271
Q

Why do you get hyponatremia in heart failure?

A

Body senses low cardiac output and secretes adh. Adh promotes water reabsorption which leads to dilutional hyponatremia

272
Q

Treatment of stable vtach

A

Iv amiodarone

273
Q

Lung and heart major side effects of amiodarone

A

Chronic interstitial pneumonitis that can cause ards, torsades

274
Q

Ocular side effects of amiodarone

A

Corneal microdeposits, optic neuropathy

275
Q

Dermatological side effects of amiodarone

A

Blue gray skin discoloration

276
Q

What is becks triad

A

Becks triad of cardiac tamponade: hypotension, distended neck veins, muffled heart sounds

Pulsus paradoxus is also a common finding

277
Q

Why is there decreased stroke volume and cardiac output in cardiac tamponade

A

Decreased ventricular preload

278
Q

Bun>60 and pericarditis-etiology?

A

Uremic pericarditis

279
Q

Most effective treatment for uremic pericarditis

A

Dialysis

280
Q

Tx for pts with viral or idiopathic pericarditis

A

NSAIDs, colchicine

281
Q

What is more specific for chf, third heart sound or peripheral edema?

A

S3

282
Q

In pts with manifestations of chf, ecg findings of concentric lv hypertrophy and non dilated lv cavity, in absence of htn, suspect

A

Restrictive cardiomyopathy esp due to cardiac amyloidosis

283
Q

Restrictive cardiomyopathy (r hf sx), proteinuria, waxy skin, anemia, easy bruising, neuropathy may be signs of

A

Amyloidosis

284
Q

Tx for vfib

A

Defibrillation

285
Q

Define cardioversion

A

Any process that aims to convert an arrhythmia back to sinus rhythm

286
Q

___ is a common trigger for bronchoconstriction in pts with asthma, especially those with concurrent rhinitis and nasal polyps

A

Aspirin

Also nonselective B.Blockers (propranolol)

287
Q

Can cardiac myxoma cause fever, wt loss, and raynauds

A

Yes

288
Q

What is pulseless electrical activity? How to tx?

A

Presence of organized rhythm on cardiac monitoring without a measurable bp or palpable pulse in cardiac arrest pt

Tx-cpr

289
Q

Mitral valve abnormality in hocm pts?

A

Abnormal mitral leaflet motion

290
Q

Do pts in septic shock have decreased preload or afterload

A

Both

291
Q

Why do septic shock pts have elevated mixed venous oxygen?

A

Increased cardiac output in response to reduced svr to maintain peripheral tissue perfusion with inability of tissues to adequately extract oxygen

292
Q

What are the most frequent location of ectopic Foci that cause afib?

A

Pulmonary veins

293
Q

Bounding pulses are associated with what murmur?

A

Aortic regurg

294
Q

Pulsus parvus and tardus is associated with what murmur?

A

Aortic stenosis

295
Q

Tx for chronic venous insufficiency?

A

Frequent leg elevation and compression therapy and exercise

296
Q

Genetic inheritance in hocm

A

Autosomal dominant

297
Q

Side effect of amoxicillin

A

Rash

298
Q

Major complication of gas

A

Pign

299
Q

With an esr over 100 in an older woman, what are the three things it could be

A

Vasculitis (temporal arteritis), endocarditis, malignancy

300
Q

Temporal arteritis goes hand and hand with what diagnosis?

A

Pmr

301
Q

Levaquin is what kind of antibiotic?

A

Fluoroquinolone

302
Q

Side effect of fluoroquinolones

A

Tendon rupture, diarrhea

303
Q

Notching of third to eighth ribs in the back may be due to what cardiac cause?

A

Coarctation of the aorta

304
Q

What arrythmia is associated with digitalis toxicity?

A

Atrial tachycardia with av block

305
Q

Can fluconazole and moxifloxacin give you qt prolongation

A

Yes

306
Q

Treatment of torsades

A

Mag sulfate for stable pts; defibrillation for unstable pts

307
Q

Can asthma/copd cause pulsus paradoxus

A

Yes

308
Q

Can aortic regurg cause pulsus paradoxus

A

No it prevents it

309
Q

Define bronchiectasis

A

Abnormal permanent airway dilation.

310
Q

Non massive hemoptysis work up

A

Hpi, cxr, labs=chem panel, coags, ua

311
Q

What four questions should you ask in non massive hemoptysis work up?

A

Age <40?
Non smoker?
Neg cxr?
<1 wk hemoptysis?

If reassuring answers you can send Home

312
Q

With chronic dyspnea what should you order?

A

Pfts

313
Q

Increased tlc means

A

Hyperinflation

314
Q

Increased residual volume means

A

Air trapping

315
Q

If flow vol loop looks like a squashed oval, what does it mean?

A

Obstruction in the upper airway

316
Q

Most likely causes of cough for under three weeks

A

Viral/bacterial URI

Post infectious

317
Q

Most likely causes of cough for 3-8 weeks

A

Post infectious

Pertussis

318
Q

Most likely causes of cough for over eight weeks

A

Upper airway cough syndrome
Asthma
GERD

Get cxr

319
Q

Define platypnea

A

Dyspnea worse in upright than supine position

320
Q

Acute dyspnea work up

A
Pulse ox
CBC
Chem 7
Abg
Bnp
Cxr
Ecg
321
Q

Differential of dyspnea in a young patient

A

Asthma
Deconditioning
Paradoxical vocal cord motion
Psych disorder

322
Q

Diff dx of orthopnea

A

Hf, diaphragmatic paralysis, asthma, sleep apnea, obesity

323
Q

Diff dx of platypnea

A

Intrapulmonary shunt (avm)
Intracardiac shunt
Hepatopulm syndrome

324
Q

Chronic dyspnea workup

A

Cxr
Pulse ox
Spirometry
Cardiopulm exercise testing

325
Q

Leading causes for transudative pleural fluid

A
HF
Hepatic hydrothorax
Atelectasis
Nephrotic syndrome
Hypoalbuminemia
326
Q

What is levofloxacin?

A

Also levaquin

A fluroquinolone

327
Q

Tx of cap outpt

A

In previously healthy pt, macrolide or doxy

In comorbid pt, fluroquinolone (not cipro) or b-lactam + macrolide

328
Q

Do cap pts have rhinorrhea or sore throat?

A

No

329
Q

Tx of cap inpt (not icu)

A

In comorbid pt, fluroquinolone (not cipro) or b-lactam + macrolide

330
Q

Cxr of idiopathic pulm fibrosis

A

Reticular opacities, opacities have a basilar predominance

331
Q

Describe alveolar opacities

A

More white than black
Opacities are “fluffy” like cotton wool
Opacities obscure underlying structures

332
Q

Describe interstitial opacities

A

More black than white (alveoli are open)

Reticular appearance

333
Q

Ideal scan for pe

A

Ct pulm angio

334
Q

Ideal scan for aortic dissection

A

Ct aortic dissection protocol

335
Q

Ideal scan for mediastinum, pleural space, questionable malignancy

A

Plain contrast ct

336
Q

Ideal scan for lung parenchyma (interstitial diseases)

A

Non contrast ct

337
Q

On us what color is fluid

A

Black

338
Q

Exudative pleural fluid means

A

Inflammation, infection

339
Q

Serum LDH ratio in exudate

A

> 0.6

340
Q

Dx of active tb

A

Afb smears of sputum

341
Q

Se of isoniazid

A

Peripheral neuropathy (prevent with pyroxidine), and hepatitis

342
Q

Se of rifampin

A

Hepatits, high drug interactions with haart, ocp, warfarin

343
Q

Se of pyrazinamide

A

Hepatotox

Hyperurecemia

344
Q

Se of ethambutol

A

Optic neuritis

345
Q

Criteria for dx of pulm htn

A

Mean pa pressure >25mmhg at rest

346
Q

How to describe visual sx in temporal arteritis

A

Window shade blinders

347
Q

What does bile do

A

Emulsifies fats

348
Q

Cough lasting >5 days to 3 weeks with no fever or chills, but with wheezing or ronchi and chest wall tenderness

A

Acute bronchitis

349
Q

Can you have small amounts of hemoptysis in acute bronchitis

A

Yes

350
Q

Tx for acute bronchitis

A

Generally symptomatic only

351
Q

Most common three causes of secondary nail clubbing

A

Lung malignancies
Cystic fibrosis
Right to left cardiac shunts

352
Q

Is hypoxemia in copd (in absence of malignancy) associated with clubbing?

A

No

353
Q

Tx of anaphylaxis

A

Epinephrine

354
Q

How do you dx upper airway cough syndrome

A

Elimination of nasal discharge and cough with h1 histamine receptor antagonists (chlorpheniramine)

355
Q

Pts with asthma exacerbation usually have respiratory ____ with a ___ paco2

A

Alkalosis; low due to hyperventilation

356
Q

Normal or elevated paco2 in acute asthma exacerbation is concerning for

A

respiratory failure

357
Q

Suspect what kind of lung cancer in a pt with significant smoking hx, hypercalcemia and a hilar mass

A

Squamous cell carcinoma

358
Q

Atelectasis causes respiratory ___

A

Alkalosis due to compensatory tachypnea

359
Q

PE and pleural effusion cause respiratory ___

A

Alkalosis due to compensatory tachypnea

360
Q

Hypoventilation is associated with a ___ aa gradient and respiratory ___

A

Normal; acidosis

361
Q

Dry cough and malaise for two months with bilateral hilar adenopathy is suggestive of

A

Sarcoidosis (noncaseating granulomatous inflammation)

362
Q

Are breath sounds increased in consolidation? How about in pleural effusion?

A

Yes; no

363
Q

In pulmonary fibrosis, you have ___ lung volumes, ___ fev1, ___dlco, and ___ aa gradient

A

Decreased
Normal or increased
Decreased
Increased

364
Q

Lifespan of platelets

A

One week

365
Q

How long does aspirin last

A

Forever it’s irreversible

366
Q

Left atrial pressure equals what pressure?

A

Lv end diastolic pressure

367
Q

Fick equation

A

Cardiac output=(oxygen consumption)/(arteriovenous oxygen difference)

368
Q

Mammary artery

A

Also internal Thoracic artery. Branches off subclavian and goes down inside of rib cage.

369
Q

Bivalirudin (angiomax)-what is it

A

Direct thrombin inhibitor

Reversible

370
Q

Bivalirudin (angiomax)-when is it used?

A

Used as an anticoagulant during coronary angioplasty or pci

Or for pts with hit syndrome