U World

Question 1

Aortic valve replacement indications:

Answer 1

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

Question 2

Phase 1a ventricular arrhythmias

Answer 2

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

Question 3

Phase 1b ventricular arrhythmias

Answer 3

10-60 mins after MI; due to abnormal automaticity

Question 4

Mitral regurgitation

Answer 4

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

Question 5

Causes of outflow obstruction in hypertrophic cardiomyopathy

Answer 5

1. Bulging of the interventricular septum

2. systolic anterior motion (SAM) of mitral valve leaflets

Question 6

Bronchiectasis appearance on CT and potential complication

Answer 6

tubular airways with thickened walls; hemoptysis

Question 7

Treatment for infective endocarditis due to strep mutans

Answer 7

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

Question 8

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

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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)

Question 11

Female athlete triad

Answer 11

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

Question 12

Morton’s neuroma

Answer 12

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

Question 13

Tarsal tunnel syndrome

Answer 13

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

Question 14

Isolated systolic hypertension (ISH)

Answer 14

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

Question 15

Pulmonary HTN

Answer 15

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

Question 16

Causes of pulmonary HTN

Answer 16

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

Question 17

Modified Wells criteria for pretest probability of PE

Answer 17

• 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

Question 18

Cardiac index

Answer 18

CO/body surface area

Question 19

Normal hemodynamic measurements

Answer 19

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%

Question 20

Hypovolemic shock

Answer 20

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

Increased systemic vascular resistance

Question 21

Cardiogenic shock

Answer 21

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

Decreased cardiac index and mixed venous O2 saturation

Question 22

Septic shock

Answer 22

Normal to decreased right atrial pressure and pulmonary capillary wedge pressure

Increased cardiac index and mixed venous O2 saturation

Decreased systemic vascular resistance

Question 23

Avascular necrosis

Answer 23

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

Question 24

Ertapenem

Answer 24

Doesn’t cover pseudomonas

Question 25

Methotrexate

Answer 25

Inhibits dihydrofolate reductase

Question 26

Nonallergic rhinitis

Answer 26

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.

Question 27

Esophageal chest pain

Answer 27

- Prolonged pain lasting more than an hour

Question 28

Medications causing diabetes insipidus

Answer 28

lithium, demeclocycline, foscarnet, cidofovir, and amphotericin

Question 29

Giant cell tumor of bone

Answer 29

- "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.

Question 30

Osteoid osteoma

Answer 30

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

Question 31

CYP 450 inhibitors

Answer 31

- 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

Question 32

CYP 450 Inducers

Answer 32

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

Question 33

Crystal-induced AKI

Answer 33

Common etiology: 1. acyclovir 2. sulfonamides 3. methotrexate 4. ethylene glycol 5. protease inhibitors - Increase risk with volume depletion and CKD

Question 34

Hereditary telangiectasia (Osler-Weber-Rendu syndrome)

Answer 34

- 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)

Question 35

Vitamin K deficiency

Answer 35

- 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.

Question 36

Prophylaxis for splenectomy

Answer 36

daily oral penicillin prophylaxis for 3-5 yrs following splenectomy

Question 37

DVT algorithim

Answer 37

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

Question 38

Aquired sideroblastic anemia

Answer 38

- 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