PACKRAT 2 misses Flashcards

(59 cards)

1
Q

Essential HTN

A

Normal: <120/80
Pre-HTN: 120-139/80-89
Stage 1 HTN: 140-159/90-99
Stage 2 HTN: >160/100

Essential: idiopathic etiology, + fhx
Secondary: 2/2 identifiable and correctable cause; suspect if refractory to anti-HTNs (renal artery stenosis / fibromuscular dysplasia or hyperaldosteronisim, coarctation)

Complications:
CV: CAD, HF
Neuro: TIA, CVA, aneurysm rupture, encephalopathy
Nephropathy
Optic: retinal hemorrhage, blindness, retinopathy

Exam:
fundo: 1)arterial narrowing, 2) AV nicking, 3) added hemorrhages and soft exudates, 4) Papilledema = malignant HTN

Tx: 
lifestyle modifications
-wt loss: BMI 18.5-24.9, smoking cessation, Na restriction <2.4g/day
-dash diet
exercise >30min / day for most of week
-limit alcohol consumption

Pharm:
-diuretics, ACE, ARB, CCB, BB, A-Blockers

HTN urgency: inc BP but no end-organ damage
Tx: dec BP (MAP) 25% in first 24-48 hrs with PO agents

HTN emergency: >220/120 and acute end-organ damage
Tx: decrease BP (MAP) by 10% first hour and additional 15% next 2-3 hrs using IV agents

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2
Q

Thiazide diuretics

A

HCTZ, chlorthalidone

Ind: initial TOC in uncomplicated HTN (then add ACE/ARB, CCB, or BB)

Mech: dec bl volume / pressure by decreasing Na/H2O reabsorption at distal diluting tubule and lowers Ca excretion

ADRs: Hyponatremia, Hypokalemia, hyperuricemia and hyperglycemia (Caution in DM and gout)

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3
Q

Loop Diuretics

A

Furosemide, Bumetanide

Ind: HTN, CHF, hypercalcemia, severe edema, mild renal dz

Mech: inhibit water transport across Loop of Henle –> increased H2O, Na, Cl, and K excretion

ADRs: volume depletion, hypokalemia/natremia/calcemia, hyperuricemia, hypochloremic metabolic alkalosis, hyperglycemia

CI in sulfa allergy

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4
Q

K-Sparking diuretics

A

Spironolactone, Amiloride, Eplerenone

Mech: inhibit aldosterone-mediated Na/H2O absorption

ADRs: hyperkalemia (gynecomastia with spironolactone)

CI renal failure and hyponatremia

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5
Q

Thrombophlebitis

A

Inflammation of superficial vein / thrombus; benign and self-limiting

CM assoc with IV cath, trauma, preg, varicose veins

Trousseau’s sign: migratory thrombophlebitis assoc with malig or vasculitis

S/s: tenderness, pain, induration, edema, erythema along course of superficial vein +/- palpable cord

Dx: US –> noncompressible vein with clot and vein wall thickening

Workup:

  • hypercoag state
  • migratory phlebitis: CA

Tx: supportive- elevation and warm compresses, NSAIDs, TEDs
Septic: IV PCN and AMG

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6
Q

Prinzmetal’s angina

A

coronary spasm –> transient ST elevations without MI

Pt: F >50 smoker +/- other vasospastic dz (migraines, Raynaud’s)

Sx: CP at rest in morning, with hyperventilation, emotional stress, or cold exposure

Dx:
EKG: +/- transient ST elevations, rapidly resolve with CCB and NTG
Angiography: no fixed stenotic lesion

Tx: CCB = DOC; nitrates PRN

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7
Q

stable angina

A

substernal CP d/t exertion 2/2 CAD

RFs: DM (CAD equivalent), Hyperlipidemia, smoking, HTN, male, >65 yo, fhx CAD, obese

Sx: substernal nonpleuritic CP +/- radiation lasting <30 min and relieved with rest or nitrates; d/t fixed artery stenosis

Angina equivalent: dyspnea, epigastric pain, shoulder pain

Dx:
EKG: St depression with exertion, T wave inversion, poor R wave progression, or normal
Stress test
Coronary angiography: GOLD STANDARD for definitive dx

Tx:
Pharm: nitrates, BB, CCB, ASA
Revascularization: PTCA, PCI, CABG

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8
Q

mitral valve prolapse

A

MC in young F with Marfan / Ehlers Danlos

Sx: 
MC asx
-autonomic dysfct: CP, panic attacks; arrhythmia --> fatigue, palpitaitons, syncope, dizziness
-progression: fatigue, dyspnea, PND, CHF
-stroke, endocarditis, PVCs

Murmur: midsystolic ejection click at apex; may have midsystolic murmur of MR too

PE:
-narrow AP diameter, thin, HoTN, scoliosis, pectus excacatum

Tx: BB for autonomic dysfct, reasurrance in asx or mild sx

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9
Q

CHF

A

Acute decompensated HF with worsening of baseline sx characterized by pulmonary congestion, sympathetic activation, or CXR findings

CXR findings:

  • cephalization of flow: increased vascular flow –> inc pulmonary venous pressure; seen when Pul capillary wedge pressure (PCWP) 12-18 mmHg (normal 6-12)
  • Kerley B lines: linear markings in periphery of lower lung fields when PCWP 18-25 mmHg

Tx:
LMNOP: Lasix, Morphine, Nitrates, Oxygen, Position

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10
Q

rosacea

A

Et: unclear; persistent vasomotor instability with lesion formation

Triggers: EtOH, increased temp, hot drinks; hot / cold weather, hot baths, spicy food

Sx:

  • acne-like rash with erythema, flushing, telengiectasia, skin thickening, papulopustules with burning and stinging
  • absence of comedones distinguishes it from acne!

Tx: topical flagyl 1st line +/- clinidine for flushing; avoid triggers

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11
Q

Basal cell carcinoma

A

MC skin cancer; MC in fair-skinned with prolonged sun exposure, xeroderma

Slow growing with low invidence of mets

Sx:
flat firm airea with small raised translucent / pearly / waxy papule with central ulceration and raised rolled borders; friable +/- telengiectasia

Dx: punch / shave biopsy –> basophilic cells

Tx: electric desiccation / curettage = TOC or Mohs

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12
Q

Oral Candidiasis

A

dd

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13
Q

Lice

A

LL

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14
Q

Kaposi Sarcoma

A

KK

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15
Q

Psoriasis

A

PP

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16
Q

Contact Dermatitis

A

CC

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17
Q

Diabetic Ketoacidosis

A

DK

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18
Q

Pseudogou

A

PP

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19
Q

Subacute Thyroiditis

A

ST

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20
Q

Pituitary adenoma

A

PA

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21
Q

Diabetes Insipidus

A

DI

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22
Q

Serous Otitis Media

A

SOM

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23
Q

Optic Neuritis

A

ON

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24
Q

Allergic Rhinitis

25
Cerumen Impaction
CI
26
Retinal Detachment
RD
27
Anal Fissure
AF
28
Esophageal Achalasia
EA
29
Stomach CA
SCA
30
Acute Pancreatitis
AP
31
Alcoholic Liver dz
ALD
32
Cirrhosis
C
33
B12 Deficiency
B12
34
Infectious Diarrhea
ID
35
Intracranial Hemorrhage
ICH
36
MS
MS
37
CVA
CVA
38
Metabolic Encephalopathy
ME
39
Neurocysticercosis
NC
40
Menopause
M
41
Trichomonas
Trich
42
Fibromyalgia
F
43
Osteoarthritis
OA
44
Rheumatoid Arthritis
RA
45
Tobacco Cessation
TC
46
Aspiration Pneumonia
AP
47
CO Poisoning
CO
48
Chronic Bronchitis
CB
49
Influenza
I
50
Sarcoidosis
S
51
Bacterial Pneumonia
BP
52
PE
PE
53
TB
TB
54
Cheyne-Stokes Respirations
CSR
55
Prostate CA
PCA
56
BPH
BPH
57
Cystitis
cys
58
ARF
ARF
59
Nephrolithiasis
Ne