QG SB3 (F) Flashcards
W3 QG blocks (38,41,44,47) Deck is full (215 cards)
1
Q
how does DiGeorge synd present?
A
CATCH-22 Cotruncal cardiac defects Abn facies Thymic hypoplasia Craniofacial abnormalities HypoCa/HypoPTH
2
Q
what cotruncal cardiac defects are seen in DiGeorge synd?
A
- TOF
- TA
- interupted aortic arch
3
Q
how does thymic hypo/aplasia present on labs?
A
T-cell def
4
Q
what craiofacial abn is seen in DiGeorge synd?
A
cleft palate
5
Q
what does PDA sound like?
A
washing machine / continuous murmur
6
Q
Down’s synd is assoc w/ cardiac defect?
A
endocardial cushion defect
7
Q
when does MVP present?
A
young females
8
Q
what should you suspect if incr Ca + kidney stones?
A
hyperparathyroidism
9
Q
where will CP of cardiac origin loacalize?
A
substernal/retrosternal
10
Q
what is supraventricular AS
A
congenital defect = L vent outflow tract obstruction 2/2 diffuse narrowing of the asc. aorta
11
Q
how does supraventricular AS present?
A
+palpable thrill (suprasternal)
+AS murmur @ 1st R intercostal space
+diff BP RUE vs LUE
12
Q
if low BP is not responding to IVF (not vol problem), what is the cause of the low BP?
A
-pump failure
13
Q
which side of the heart is the “main pump”?
A
right side
14
Q
when does the heart receive O2?
A
diastole
15
Q
SOC tx post-MI + stent placement = ?
A
- dual anticoag
- statin
- BB
- aldosterone antag
16
Q
what is dual anticoag tx?
A
- ASA
2. P2Y12 inbib = clopidogrel, prasugrel, ticagrelor
17
Q
what is the cause of anginal CP (regardless of if the pt has a murmur or not)?
A
- angina = ischemic pain!
- incr mycardial O2 demand
18
Q
what is TRALI?
A
Transfusion Related Acute lung Injury
19
Q
how does TRALI present?
A
=F, low BP, noncardiogenic pulm edema
20
Q
when does TRALI present?
A
= onset w/in 6 hrs of receiving RBC transfusion
21
Q
when/why do you hear crackles on lung ascultation?
A
LV can’t/doesn’t handle cardiac load –> fluid backs up into lungs –> pulm edema –> crackles
22
Q
pt presents s/p sx w/ low BP, incr HR, crackles on p/e, and incr PCWP when tested. what do you expect?
A
MI (–> decr LV f(x) –> incr PCWP –> pulm edema –> crackles)
23
Q
does post-sx MI always present w/ CP?
A
NO. may present w/o pain but in cardiogenic shock
24
Q
how does cardiogenic shock present?
A
AMS, low BP, incr HR, cool extremities, pulm edema (crackles, JVD), decr urination
25
what does pulm cap wedge pressure estimate?
L atrial pressure
26
pt presents w/ low BP and hx suggestive of possible bleed. Large fluid bolus is given and no/min change is seen in blood pressure. what is not causing the low BP?
-hemorrhage (this is a pump failure not a vol issue)
27
in CHF, what is the best indicator of worsening prognosis?
development of S3
28
S3 on exam + incr BNP is cause for high suspicion of what?
heart failure
29
what non cardiac conditions (not CHF) exhibit peripheral edema?
- IVC obstruction
- cirrhosis
- nephrotic synd
- LE venous insufficiency
30
why is S3 > peripheral edema @ suggesting worsening HF?
it is WAY MORE SPECIFIC
31
what are two types of syncope?
1. neurogenic
| 2. cardiogenic
32
which type of syncope presents w/ prodrome?
neurogenic
33
pt presents w/ diaphoresis. what is your ddx (general)?
1. heart problem
| 2. aorta problem
34
how does pain 2/2 AAA rupture present?
- L sided abd, flank, back, CVA pain/tenderness
- pain will range from dull --> severe
* *b/c leaked blood is irritating the retroperitoneal structures
35
how does AAA present (stable vs sudden expansion vs rupture)?
s: mostly asymp
se: dull abd/back pain; +/- distal emboli
r: sudden, severe abd/back pain; +/- shock, hematoma
36
what is Myxadematous Valve degeneration?
MCC of MVP
37
what are the 3 MCC AS in the general population?
1. senile calcification (MCC, esp age>70)
2. bicuspid aorta (MC age<70)
3. rheumatic heart dz
38
what is the most important RF for aortic dissection?
HTN (esp age>60)
39
h/o what aside from HTN incr risk of aortic dissection?
- marfan's (MC age<40)
| - cocaine use
40
through what mechanism does reynaud's phenom occur?
vasospasm (mainly digital)
41
what is the pathophys of intermittent claudication?
PVD--> exertion induced ischemia --> m. cramps --> pain
42
CKD w/ BUN >60 sig incr risk of what complication? (hint: this is why emergent HD is done for uremia)
uremic pericarditis
43
what is apixaban?
factor Xa inhibitor
44
what are the uses of apixaban?
- nonvalvular afib
- DVT
- PE
45
how long should dual anticoag tx be used in pts w/ drug-eluting stents?
>= 12mos
46
what is the nL range for HDL?
HDL 30-70
47
what is the HDL target for therapy?
HDL > 40
48
what are the LDL targets for nonDM and DM pts w/ high cholesterol?
nonDM --> LDL < 100
| DM --> DM < 70
49
pts w/ DM btwn what ages should receive ____ + lifestyle modifications + glucose control?
- between ages 40-75
| - statins
50
what are 3 common causes of pulsus paradoxus?
- pericardial effusion/tamponade
- severe asthma
- COPD
51
BP falls by how much during insp. in pulsus paradoxus?
>10mmHg
52
pt presents w/ CP and you suspect cocaine intox. how do you manage his/her pain?
- nitroglycerin
| - CCB
53
pt presents w/ CP and you suspect cocaine intox. what do you give 1st?
IV benzos
54
why do you give IV benzos to pts w/ cocaine-associated chest pain?
1. decr psychomotor agitation
2. decr myocardial O2 demand
3. decr cardiovasc s/s
55
what do you ABSOLUTELY NOT GIVE in cocaine-associated chest pain?
BB
56
what are the lifestyle mods recommended for HTN?
1. weight loss (goal BMI <25) =BEST/MOST EFFECTIVE
2. DASH diet
3. exercise
4. limit Na intake
5. decr EtOH
57
how many mmHg will BP decr for every 10 kg weight lost?
5-10mmHg
58
what is the DASH diet?
- high fruit and veg
| - low fat and salt
59
how much exercise is recommended per week?
30 min/d x5-6 d/wk
60
how much Na should be consumed per day by HTN pts?
< 3 g/day
61
how much EtOH is acceptable per day for HTN pts?
M --> <2 drink/d
| F --> <1 drink/d
62
what lifestyle mod is most effective @ decr BP?
weight loss
63
how do AD genetic conditions generally present?
- age > 18 y/o (AD = aDults)
| - mutation --> structural abnormality
64
how do AR genetic conditions generally present?
- age < 18 y/o
| - mutation --> enzymatic abnormality
65
what type of genetic defect is hypertrophic cardiomyopathy?
AD
66
when to give nitroprusside?
HTN emergency
67
how do you medically manage aortic dissection?
control HTN & decr heart strain to decr dissection expansion:
1. IV BB
2. nitroprusside (only if BB fail)
68
why is hydralazine C/I in aortic dissection?
cause reflex tachy --> incr heart strain --> incr risk of enlarging the dissection
69
why is nitroprusside only used as 2nd line tx for aortic dissection?
can cause reflex tachy --> dissection enlargement
70
which IV BB are given as first line in aortic dissection and in what order are they given?
```
IV BB (decr HR-->decr heart strain-->decr risk enlargement)
1. labetolol
2 propranolol
3. esmolol
**in that order**
```
71
what is the most likely cause of inguinal swelling + palpable thrill + new continuous murmur s/p heart cath?
abnormal AV communication
72
palpable thrill = ?
turbulence
73
what is a complication of cardiac cath that could lead to swelling, palpable thrill, and continuous murmur?
formation of an abn AV communication
74
how will an aneurysm feel on palpation?
pulsatile mass
75
a vein is occluded. how will the affected limp look?
red
76
an artery is occluded. how will the affected limb look?
pale
77
radiation of the chest can lead to ___?
constrictive pericarditis
78
infectious endocarditis will affect which valve 1st?
tricuspid valve (--> TR)
79
which murmurs are accenuated on insp vs expiration?
Right sided (Tricuspid, pulmonic)
Inspiration --> worsens murmur
Left sided (Mitral, aortic)
Expiration --> worsens murmur
80
what are the physiologic effects of BB on the heart?
decr HR
| decr myocardial contractility
81
what are the physiologic effects of CCB on the heart?
decr HR
| decr myocardial contractility
82
why can BB and CCB generally be used to tx the same conditions?
have same physiological effect via diff mechanisms (decr HR and contractility)
83
what do nondihydrapyrimadine CCB do?
- cause coronary artery vasodilation
| - decr afterload
84
how do nitrates work?
vasodilation --> decr preload and decr END diastolic vol
85
chronic refractory/peristent angina should be treated w/ what?
1. nitrates
| 2. ranolazine
86
what does ranolazine do?
incr myocardial Ca influx
87
what is the 1st line tx of chronic stable angina?
BB
88
what drugs are 2nd line tx of chronic stable angina?
diltiazem and verapamil
89
what meds can be added to BB to tx stable angina?
dihydropyrimadine CCB (=dipines)
90
what drugs prolonge QT interval and incr risk of torsades de pointes?
```
ABCDEs
anti-Arrhythmics (class 1a and 3)
antiBiotics
anti-psyChotics
anti-Depressants and Diuretics
anti-Emetics (ondansetron)
```
91
what anti-Arrhythmics cause QT prolongation?
- amiodarone
- flecanide
- sotolol
- ranolazine
92
what ABX cause QT prolongation?
- macrolides
- fluoroquinolones
- anti-fungals (=azoles)
93
what anti-psyChotics cause QT prolongation?
- haloperidol
- risperidone
- quetiapine
94
what anti-Depressants cause QT prolongation?
TCAs (esp. amitriptyline)
| -SSRI (esp. citalopram)
95
aortic dissection is suspected but pt is unstable and/or has CKD. how do you confirm dx?
TEE
96
young pt presents w/ intermittent retrosternal CP. what should you suspect?
drugs
97
which drugs cause pupillary dilation?
- cocaine
- methamphetamines
- bath salts
98
which drugs cause pupillary constriction?
opioids
99
how to tx cocaine chest pain?
-IV Benzos (aggitation)
-nitroglycerin (pain)
NO BB!!!
100
in rheumatic heart dz what valve is most commonly affected?
mitral > aortic
101
in rheumatic heart dz what murmurs might you hear?
MC: early = MR --> MS = late
LC: early = AR --> AS = late
102
AR progresses to AS. what condition should you suspect?
1. bicuspid aortic valve
| 2. h/o rheumatic heart dz
103
combo of irreg irreg rhythm + hemoptysis suggests what?
L atrial problem (enlargement)
104
L atrium is enlarged. what 2 symp may develop?
1. dysphagia
| 2. hoarseness
105
pain is parasternal. where is the problem?
MSK or chest cavity
106
pt presents w/ sharp parasternal CP that is reproducible and pleuritic. dx = ?
costochondritis (MSK pain)
107
what is the mitral valve issue seen in HOCM?
abn mitral leaflet motion (=ant displacement --> obstr)
108
what is cor pulmonale?
enlargement of the R heart 2/2 lung dz
109
what causes cor pulmonale?
lung dz (COPD/PE) --> pulm HTN --> cor pulmonale
110
where can TB cause calcifications?
lung, kidney, bladder, spine, pericardium
111
how to tx TB infx of the bladder?
BCG vaccine
112
what two conditions cause distant heart sounds?
1. tamponade
| 2. pericarditis
113
jugular venous pressure tracings show prominent x and y descents. what is this?
pulsus paradoxus
114
what are the MCC of cor pulmonale?
- COPD
| - PE
115
trypanosoma cruzi causes what?
chagas dz
116
how does chagas dz present?
- megacolon
- megaesophagus
- cardiac dz
117
what cardiac problems are caused by chagas dz?
- systolic and diastolic HF
- MR and TR
- arrhythmias
118
CHF leads to third spacing which results in decr BP. how does the body respond?
incr RAAS --> constrict efferent arteriole --> incr filtration
119
what are the surgical options for AAA repair?
- unstable = open or EVAR
| - stable = laprascopic
120
what might you hear on auscultation during acute phase of MI?
S4 gallop
121
fixed S2 splitting = ?
ASD
122
what is S4?
atrial gallop
123
how does fibromuscular dysplasia present?
- F age > 50yo
- refractory HTN starting age < 35yo
- sudden inc HTN from baseline
- Cr incr > 0.5-1 after starting an ACEi/ARB
- abd bruit
124
what is the timeline for PCI of STEMI?
door --> cath time =< 90 min
125
renal stones smaller than what size will pass spontaneously?
< 1cm
126
what pharm tx can be used to help pass small kidney stones?
a-blockers = tamulosin
| causes ureteral m. to relax --> ureters dilate --> stone passes more easily
127
how do you w/u metabolic derrangements?
1. look @ pH
2. look @ paCO2
3. look @ HCO3
128
what is nL pH?
= 7.45
129
what is nL paCO2?
= 40
130
what will paCO2 be in the 2 types of alkalosis?
resp alk - paCO2 decr
| met alk - paCO2 incr (comp)
131
what will paCO2 be in the 2 types of acidosis?
resp acidosis - paCO2 incr
| met acidosis - paCO2 decr (comp)
132
what is the first line tx for renovasc HTN?
ACEi
133
what is the earliest sign of kidney damage seen in DM?
hyperfiltration --> microalbuminuria
134
what is the MC complication in nephrotic synd?
renal vein thrombosis 2/2 loss of anti-thrombin 3
135
muddy brown casts = ?
ATN
136
broad, waxy casts = ?
chronic renal failure
137
RBC casts = ?
nephritis (1. glomerular dz 2. vasculitis)
138
WBC casts = ?
1. AIN
| 2. pyelonephritis
139
fatty casts = ?
nephrotic synd
140
hyaline casts = ?
-prerenal azotemia
141
chron's is associated w/ which type of kidney stone?
CaOxalate stones
142
what factors do you look at to determine the cause of vaginitis?
color, pH, pmHx, pSocialHx
143
when would you get a voiding cystogram on a kid?
- high suspicion of anatomical defect/abn
| - U/S +
144
HCV is associated w/ which nephritis?
mixed cryoglobulinemia
145
Cl is decr. what do you suspect?
incr vomiting or diarrhea
146
pt presents w/ recent h/o of ABX + WBC casts. Dx = ?
AIN
147
what is seen later on in diabetic kidney damage?
nodular sclerosis (kimmel-wilson bodies)
148
general principle: the "most appropriate" test = what?
-quickest, cheapest, "best initial" test
149
pt presents w/ F + incr WBC + new mitral murmur + h/o recent viral infec. what do you suspect?
infectious endocarditis
150
how will renal infarct present?
- flank pain, n/v
| - U/A + RBC + protein - (NO) casts
151
what is a complication of endocarditis?
septic emboli
152
anion gap is > 12. what could be the cause?
```
MUDPILES
Methanol
Uremia
Diabetic ketoacidosis
Paraaldehyde
Iron, isoniazid
Lactic acid
Ethylene glycol
Salicylates
```
153
pt presents w/ bilat flank pain + HTN + famHx. what should you suspect?
PCKD (AD)
154
when do PCKD pts start to exhibit s/s of dz?
age 30-40s
155
why is urine dark in rhabdo?
myoglobin in the urine
156
what are the common causes of rhabdo?
- trauma
- crush/compression injury
- dehydration
- excessive exercise
- uncontrolled shivering
- NEMS
157
what is nL BUN?
12-18
158
what is pathomneumonic for interstitial cystitis?
bladder pain relieved w/ urination
159
what will the U/A findings be w/ interstitial cystitis?
nL
160
interstitial cystitis tx = ?
- amitriptyline
- pentosan polysulfate
- analgesics
161
when might pre-eclampsia, gestational DM, and gestational HTN present?
@ >= 20 wks gestation w/o prior hx of complaint
162
levofloxacin doesn't cause actute renal failure. but what can it cause?
AIN
163
amikacin = aminoglycoside that causes what?
acute renal failure
164
what drug is used to tx MDR pyelonephritis but can cause acute renal failure?
amikacin
165
when should stenting be used to tx HTN 2/2 RAS?
- ACEi intolerant
- failed pharm tx
- recurrent flash pulm edema
- refractory CHF 2/2 HTN
166
what is the dx when a sickle cell pt has reticulocyte count < 1%
-aplastic crisis
167
how do you differentiate btwn a mixed germ cell tumor and a seminoma via labs?
```
mixed = incr B-hCG + incr alpha-fetoprotein (APF)
seminoma = incr B-hCG + nL AFP
```
168
pt presents w/ a mediastinal mass. what is your ddx?
Terrible Ts
1. Thymoma
2. Terrible lymphoma
3. Thyroid
4. Teratoma
169
when a lymph node is tender, what do you suspect?
infx
170
when a lymph node is non-tender, what do you suspect?
malignancy
171
what might head and neck cancer present w/ ear pain + nL ear exam?
mass can put pressure on CN 9 afferent fibers
172
what is the MC head and neck Ca?
SCC
173
how does polycythemia vera present?
- AQUAGENIC PRURITIS
- facial plethora
- INCR HCT
174
pt presents w/ s/s of polycythemia vera + incr LFTs. what do you suspect?
Budd-Chiari synd
175
what is a common cause of Budd-Chiari synd?
hepatic vein thrombosis 2/2 polycythemia vera
176
how does Budd-Chiari synd present?
- vague progressive abd pain
- ascites
- hepatosplenomegaly
177
what mutation is assoc w/ polycythemia vera?
JAK2v617F
178
what is nL MCHC?
< 35%
179
what MCHC should you expect in hereditary spherocytosis?
> 35% (cells are smaller but contain same amount of Hgb)
180
which microcytic anemia is often asymp?
thalassemia
181
what are the uses of hemoglobin electrophoresis?
- distinguish btwn Hgb E or C
- dx thalassemia A/B
- dx sickle cell dz
182
what are the coag studies in hemophelia A vs B?
Hem A: plt-nL aPTT-incr PT-nL F8-decr F9-nL
| Hem B: plt-nL aPTT-incr PT-nL F8-nL F9-decr
183
what is the tx for mild hemophilia?
desmopressin (DDAVP)
184
what is the tx for mod/severe hemophilia?
replace missing factor (cryoprecipitate)
185
what is a normal anti-D Ab titer level?
=< 1 : 8
1 = amount baby has
8 = amount mom has
186
Eosin-5-maleimide binding is what kind of test?
flow cytometry
187
what is another name for the acidified glycerol lysis test?
osmotic fragility test
188
what dz is diagnosed w/ either the osmotic fragility test (acidified glycerol lysis test) or Eosin-5-maleimide binding flow cytometry?
hereditary spherocytosis
189
what are 4 common leukemias?
- ALL
- AML
- CML
- CLL
190
which leukemias present w/ >=25% BLASTS on BM bx?
ALL and AML
191
which leukemia is seen predominantly in kids?
ALL
192
which leukemia is seen predominantly in the elderly?
CLL
193
which leukemias are seen predominantly in middle-aged adults
AML and CML
| M = middle aged
194
which leukemia presents w/ auer rods?
AML
| A = Auer rods = AML
195
which leukemia presents w/ smudge cells?
CLL
| elderly are waiting for kids to call but the phone# got smudged
196
which leukemia is PAS+ and Tdt+ ?
ALL
197
which specific variant of AML has Auer rods?
APL variant = (t 15:17)
198
which gene mutation is CML associated w/ ?
(t 9:22) = bcr-abl fusion protein
199
if pt presents w/ pancytopenia, what must you do?
BM bx
200
what condition is assoc w/ ALL and AML?
Down's synd
201
a pt w/ down's synd presents to the ED. what must you want out for?
alanto-axial insufficiency
202
pt presents w/ >50K WBC + incr LAP. dx = ?
leukemoid rxn
203
what is LAP?
= leukocyte alkaline phosphatase
| -elevated in leukemoid rxns
204
pt presents w/ >50k WBC + nL LAP. dx = ?
CML
205
what are the stages of granulocyte development?
1. myeloblast
2. promyelocyte
3. myelocyte
4. metamyelocyte
5. band form
6. neutrophil
206
which presents w/ more mature precursors CML or leukemoid rxn?
```
Leukemoid = More mature (L so has More)
cMl = Less mature (M so has Less)
```
207
will leukemoid rxn have more metamyelocytes or myelocytes?
metamyelocytes > myelocytes
208
will CML have more metamyelocytes or myelocytes?
myelocytes > metamyelocytes
209
what causes CML?
philadelphia chromosome = (t 9:22) --> bcr-abl fusion protein
210
what causes leukemoid rxn?
severe infx
211
pt presents w/ h/o prostate ca + LE neuro issues + back pain. what do you suspect?
bone mets
212
when do you suspect epidural spinal cord compression?
- h/o malig + new back pain + motor/sensory abnormalities
| - loss of bowel and/or bladder control = late s/s
213
how do you tx suspected epidural spinal cord compression?
1. IV glucocorticoids
2. emergent MRI
3. rad-onc/ neuro-sx consults
214
what bone marrow problem can cause anemia?
infiltration w/ Ca cells
215
what are the common renal tubular acidosis associations?
type 1 = AI conditions
type 2 = mult. myeloma, osteomalacia, Ricketts
type 4 = DM2
