Aortic dissection (type A- proximal aorta) can cause what valvular problem?
(the intimal tear can cause blood to leak into the aortic valve)
Aortic dissection (type A- proximal aorta) can cause what pericardial problem?
Cardiac tamponade (the intimal tear can cause blood to fill the pericardial sac- if it surrounds the heart and restricts filling it is tamponade)
What is a prolonged PR interval on an EKG suggestive of?
P wave= atrial contraction
QRS= ventricular contraction
so P->R (PR interval)= the time it takes for the signal from the atria to get sent over to the ventricles for contraction (AV conduction delay- tells us how well the AV node is working)
What is androgenetic alopecia?
"male pattern baldness"
Causes uneven hair loss in a characteristic pattern (different in men vs. women)
What is alopecia areata?
Autoimmune dz--> patches of hair loss
What is seborrheic dermatitis?
Superficial fungus--> scaly, red skin w/ dandruff
(also called seborrheic eczema)
What is trichorrhexis nodosa?
Fragile hair w/ breaking strands (congenital or acquired- from heat, hair dyes, salt water, etc.)
Woman with a recent hx of severe postpardum depression complains of hair loss. Lots of hair comes out when washing or brushing her hair. No redness or scaling of the scalp. When you tug on her hair, >20% of fibers come out. Diagnosis?
-common cause of hair loss where you get widespread thinning of the hair (scalp and hair shafts appear normal)
-normally hair goes through 3 phases: growth-> transform-> rest/ shedding. In this condition, too much hair goes to the rest/ shedding phase
-can be triggered by stress (weight loss, pregnancy, psych issue, etc.)
**memory trick: when you're stressed you pull your hair out (hair loss assoc w/ stress) and you want to call a friend (Telogen) and be like eff...(Effluvium)
What veins are the source of most (>90%) symptomatic PE’s?
Deep veins of the proximal thigh: iliac, femoral, and popliteal
Why do we give ACE inhibitors to diabetic patients? Be specific.
They take pressure off the kidneys to prevent progression to diabetic nephropathy:
There is initial hyperfiltration (high GFR) in DM: lots of glucose in blood-> more reabsorption of glucose and therefore Na+ by the glucose/Na+ co-transporter at the PCT-> macula dense senses it is getting less Na+-> so the kidney responds by dilating the afferent and MAINLY constricting the efferent (preferential involvement of the efferent)-> this raises GFR (hyperfiltration)-> micro-albuminuria (spillage of protein into urine)-> nephrotic syndrome...(ACE inhibitors/ ARBs protect against this all)
ACE inhibitors (and ARBs) decrease renal efferent arteriole vasoconstriction, reducing glomerular hydrostatic pressure and slowing the rate of DM nephropathy progression
What is Choledocholithiasis?
When a gallstone is lodged in the common bile duct
(can present with obstructive jaundice bc bile containing conjugated bilirubin cannot flow through to be excreted)
What is SCD's (for DVT prophylaxis)?
Sequential compression device
(it is like compression stockings, but better because it applies pressure to squeeze the calf muscles and promote good circulation...when in doubt reg whether or not a patient should get DVT prophylaxis, order SCD. Anticoagulants come with bleeding side effects, this doesn't.)
What is this? How do you diagnose it? How do you treat it?
Chronic stasis dermatitis
Due to venous insufficiency
Patient who is old, obese, or hx venous thrombosis (DVT)—> failure of venous valves—> backflow of blood and leakage of fluid, plasma proteins, RBCs—> scaling, weeping, pitting edema, red/ brown discoloration, ulcers
*can appear like cellulitis, but it is bilateral & symmetric
Clinical diagnosis, but venous Doppler ultrasonography (way to evaluate blood flow) can confirm
Manage with compression stockings, leg elevation, exercise, avoid standing too long
What is this? What med can you give to treat?
Sustained monomorphic ventricular tachycardia (SMVT)
Amiodarone (class III anti-arrhythmic)
*Ventricular tachy (fast and wide QRS)-> Amiodarone
*SVT’s (fast and narrow QRS)-> Adenosine
What is a Watchman procedure/ device?
An implant that is surgically placed in the LA appendage (where clots often from from a-fib and get thrown causing stroke).
This is done in patients with a-fib who need stroke prophylaxis but cannot tolerate anticoagulants (due to bleeding risk).
What is cephalization on x-ray?
Enlarged/ more prominent pulmonary vessels
What is a hydropneumothorax?
Air + fluid in the lung (pleural space)
What does CABG stand for?
Coronary artery bypass grafting (CABG)
*Patients with multiple narrowed coronary arteries may have a better outcome with a CABG as opposed to placement of a stent (PCI)
**Although we learned to load a patient up with Clopidogrel + ASA (2 antiplatelet agents) prior to getting a stent, many doctors in real life do not do this- just use 1. Why? If they go in there (w/ angiogram) and decide a CABG is best for the patient instead of a stent, they wouldn't be able to do it then and there if the patient was loaded up on antiplatelet agents (bleeding risk)- would have to wait a few weeks. If the patient was just on 1 they could do it.
2 shockable rhythms?
2 non-shockable rhythms?
1. V-fib (ventricular fibrillation)
2. V-tach (ventricular tachycardia)
**note: Torsades is a subcategory of ventricular tachycardia- shock it.
2. Pulseless electrical activity (PEA)- abnormal rhythm (ex: a-fib) is going on where you expect a pulse, but you don't have one
Rap song: “Defib for V-fib and pulseless V-tach. Don’t defib asystole, you won’t get them back!”
What do the P waves look like in a-fib?
Absent P waves replaced by chaotic fibrillatory waves
(remember P wave= atrial depol, and in a-fib the atria are contracting abnormally)
What anatomic site is the origin of a-fib?
The pulmonary veins
(most common site of the ectopic foci responsible for a-fib)
Lifeguard with multiple sexual partners comes in with this rash. Diagnosis?
(Fungal skin infection that grows in humidity. Causes areas of hypopigmentation or hyperpigmentation. Diagnose by "spaghetti and meatball" appearance of KOH preparation of skin scrapings. Treat with selenium sulfide/ Selsun blue or Ketoconazole.)
Anoscopy vs. Sigmoidoscopy vs. Colonoscopy?
Anoscopy- an anal speculum
Sigmoidoscopy- flexible scope that looks at the sigmoid colon
Colonoscopy- flexible scope that looks at the entire colon
Patient has hyperthyroidism (high T4, low TSH). No obvious signs of Graves’ disease. What test should you do next in your work-up and how do you interpret the results?
Radioactive iodine uptake (RAIU) scan
-If uptake is HIGH—> this means the thyroid gland is actively making TH so it is either Graves’ disease (if it’s diffuse uptake) or nodular disease (if it’s nodular uptake)
-If uptake is LOW—> this means even though you have high TH, the thyroid gland is NOT actively making that excess TH so it is either thyroiditis (preformed TH released) (if Tg is high) or exogenous TH intake (if Tg is low)
What is this?
(Chronic inherited skin disorder caused by mutations in the filaggrin gene where you get diffuse dermal scaling)
Obese teen girl has a dull ache in her left thigh, worse with activity and better with rest and NSAIDs. Her left hip has decreased range of motion upon internal rotation. Most likely cause of her symptoms?
Slipped capital femoral epiphysis
-Can occur in obese teens who are still growing
-The femoral head is posteriorly displaced (The ball at the head of the femur (thighbone) slips off the neck of the bone in a backwards direction)
-presents with dull pain/ ache of the hip, thigh, or knee
-foot is externally rotated (foot pointed out/ laterally)
-altered gait and internal rotation due to pain
What is this?
(Infection of the lacrimal sac, usually due to staph or strep- presents with tenderness, edema, redness)
What do you do for a patient with an asymptomatic hiatal hernia?
Watch and wait
(If GERD symptoms--> medically manage. If refractory GERD--> consider for surgery.)
ST elevation in leads V4-V6. What artery is occluded?
LCX (left circumflex)
Remember the following:
- II, III, aVF--> RCA occluded (inferior MI)
- V1-V4--> LAD occluded (anterolateral MI)
- I, aVL or V4-V6--> LCX occluded (lateral MI)
*V4 all the way through aVL is LCX territory!
What is this?
Central retinal VEIN occlusion
“Blood and thunder” on fundoscopy exam
-Blood drainage from the eye is blocked off, so the veins going away from the eye get so backed up-> scattered and diffuse hemorrhages