U World Flashcards Preview

Internal Medicine > U World > Flashcards

Flashcards in U World Deck (38):

Aortic valve replacement indications:

1. Symptomatic (SAD) - syncope, angina, dyspnea
2. Severe AS in pts undergoing CABG or other valvular surgery
3. A symptomatic pts with severe AS and either poor LV systolic fx, LV hypertrophy >15mm, valve area


Phase 1a ventricular arrhythmias

within 10 mins of coronary occlusion; acute ischemia causes heterogeneity in conduction, delayed conduction increases the chance of re-entry.


Phase 1b ventricular arrhythmias

10-60 mins after MI; due to abnormal automaticity


Mitral regurgitation

seen in dilated and ischemic cardiomyopathy; holosystolic murmur at apex with radiation to the axilla


Causes of outflow obstruction in hypertrophic cardiomyopathy

1. Bulging of the interventricular septum
2. systolic anterior motion (SAM) of mitral valve leaflets


Bronchiectasis appearance on CT and potential complication

tubular airways with thickened walls; hemoptysis


Treatment for infective endocarditis due to strep mutans

IV antibiotics (aqueous pencillin G or IV ceftriaxone) for 4 wks


Myasthenia gravis (paraneoplastic syndrome) involved site and clinical features:

acetylcholine receptor in postsynaptic membrane; fluctuating muscle weakness - ocular (ptosis and diplopia), bulbar (dysphagia, dysarthria) and facial, neck, and limb muscles


Lambert-Eaton syndrome (paraneoplastic syndrome) involved site and clinical features:

presynaptic membrane voltage-gated calcium channels; proximal muscle weakness, autonomic dysfunction (dry mouth), cranial nerve involvement (ptosis), diminished or absent DTRs


Dermatomyositis/polymyositis (paraneoplatic syndrome) involved sites and clinical features:

muscle fiber injury; symmetrical and proximal muscle weakness, interstitial lung disease, Raynaud's, and esophageal dysmotility, polyarthritis, skin findings (Gottron's papules and heliotrope rash)


Female athlete triad

1. decreased caloric intake
2. oligo-amenorrhea
3. osteoporosis


Morton's neuroma

pain btwn the 3rd and 4th toes on the plantar surface w/ clicking sensation (Mulder's sign)


Tarsal tunnel syndrome

compression of the tibial nerve that causes numbness, burning, and aching of the distal plantar surface of the foot and toes


Isolated systolic hypertension (ISH)

decreased compliance of the arteries with age that causes isolated systolic pressure increase and widened pulse pressure; treat with thiazides, CCBs, or ACE inhbitor


Pulmonary HTN

pulmonary artery pressure >25 mm at rest or >30 mm w/ exercise


Causes of pulmonary HTN

1. Disorders of the respiratory system, hypoxemia
2. Pulmonary venous HTN (LV disease, mitral valve disease, pulmonary veno-occlusive disease)
3. chronic thromboembolic disease
4. Pulmonary arterial HTN (primary or associated with vasculopathy)
5. Pulmonary capillary hemangiomatosis


Modified Wells criteria for pretest probability of PE

- Clinical signs of DVT (+3)
- Alternate diagnosis less likely (+3)
- Previous PE or DVT (+1.5)
- HR >100 (+1.5)
- Recent surgery or immobilization (+1.5)
- Hemoptysis (+1)
- Cancer (+1)

Total score: > or = to 4, PE likely


Cardiac index

CO/body surface area


Normal hemodynamic measurements

Right atrial pressure (preload) - 4mmHg
Pulmonary capillary wedge pressure (preload) - 9mmHg
Cardiac index (pump function) - 2.8 to 4.2 L/min/m2
Systemic vascular resistance (after load) - 1150 dynes*sec/cm5
Mixed venous oxygen saturation - 60-80%


Hypovolemic shock

Decreased right atrial pressure, pulmonary capillary wedge pressure, cardiac index, and mixed venous O2 saturation

Increased systemic vascular resistance


Cardiogenic shock

Increased right atrial pressure, pulmonary capillary wedge pressure, systemic vascular resistance

Decreased cardiac index and mixed venous O2 saturation


Septic shock

Normal to decreased right atrial pressure and pulmonary capillary wedge pressure

Increased cardiac index and mixed venous O2 saturation

Decreased systemic vascular resistance


Avascular necrosis

Progressive hip pain w/o restriction of ROM or abnormality of radiographs.
MRI is diagnostic.



Doesn't cover pseudomonas



Inhibits dihydrofolate reductase


Nonallergic rhinitis

Nasal congestion, rhinorrhea, sneezing, postnasal drainage w/o specific etiology.
- routine allergy testing not necessary prior to empiric therapy.
-treat with intranasal antihistamine, intranasal glucocorticoids.


Esophageal chest pain

- Prolonged pain lasting more than an hour


Medications causing diabetes insipidus

lithium, demeclocycline, foscarnet, cidofovir, and amphotericin


Giant cell tumor of bone

-"soap bubble" appearance
- Benign tumor of young adults that an lead to pain, swelling, and decreased ROM as well as potential fractures
- Located in the epiphyseal region of long bones
- Osteoclasts
- Treat with surgery.


Osteoid osteoma

- sclerotic cortical lesion w/ central lucency
- Pain that's worse at night and relieved by nonsteroidal anti-inflammatory medications.


CYP 450 inhibitors

- Increase Warfarin's effect

1. Acetaminophen/NSAIDS
2. Antibiotics/antifungals
3. Amiodarone
4. Cimetidine
5. Cranberry juice, Ginko balboa, vitamin E
6. Omeprazole
7. Thyroid hormone
8. SSRIs


CYP 450 Inducers

-Decrease Warfarin's effects

1. Carbamazapine
2. Ginseng
3. Green vegetables
4. oral contraceptives
5. Phenobarbital
6. Rifampin
7. St. john's wart


Crystal-induced AKI

Common etiology:
1. acyclovir
2. sulfonamides
3. methotrexate
4. ethylene glycol
5. protease inhibitors

- Increase risk with volume depletion and CKD


Hereditary telangiectasia (Osler-Weber-Rendu syndrome)

- Autosomal dominant
- Diffuse telangiectasias, recurrent epistaxis, and widespread AV malformations (usually in the mucous membranes, skin and GI tract, but also liver, brain and lung)
- Pulmonary AVMs can shunt blood from the right to the left side of the heart causing chronic hypoxemia and reactive polycythemia; can also cause massive hemoptysis)


Vitamin K deficiency

- Vitamin K is a cofactor in the carboxylation of glutamic acid residues on PT complex proteins
- Decreases all PT complex proteins (II, VII, IX, X, proteins C and S)
-Increases both PT and PTT
- Due to inadequate intake, intestinal malabsorption, or hepatocellular disease.


Prophylaxis for splenectomy

daily oral penicillin prophylaxis for 3-5 yrs following splenectomy


DVT algorithim

Proximal lower extremity DVT -----> PE w/ hemodynamic instability or massive DVT w/ severe swelling or threatened ischemia -----> if no contraindications to anticoagulation, start thrombolytic therapy. If contraindications exist, consider mechanical thrombectomy, iliac stenting, or surgical thrombectomy

- Less severe DVT -----> treat with anticoagulation unless contraindicated in which IVC filter placement is indicated


Aquired sideroblastic anemia

- Defective heme synthesis
- Often due to pyrodoxine-dependent impairment in early steps of protoporphyrin synthesis
- Isoniazid is a pyrodoxine inhibitor.
- Dimorphic RBC populations (normocytic and hypochromic)
- Increased serum iron and decreased TIBC