Uworld Flashcards
(100 cards)
1
Q
Paraneoplastic syndromes
A
- secreatory, watery diarrhea due to VIP-secreting tumors.
- carcinoid syndrome
- Gastroparesis due to autoimmune destruction of GI neurons caused by variety of tumors
2
Q
Management of first degree AV block with normal QRS duration
A
no further evaluation
3
Q
Management of first degree Av block and prolonged QRS duration
A
electrophysiology testing
4
Q
Dobutamine
A
Beta 1 receptor agonist
Increases myocardial contractility
5
Q
Recent MI, now shows up with acute limb ischemia. Next 3 steps
A
- Anticoagulation
- contact vascular surgeon
- Transthoracic echocardiography
6
Q
What is Peri-infarction pericarditis? Treatment?
A
- Post MI early onset pericardidits (Dressler is late MI complication)
- supportive treatment
7
Q
How is the diagnosis of amyloidosis confirmed
A
tissue biopsy (abdominal fat pad).
8
Q
Name 3 drugs good for heart rate and left systolic dysfunction <40% ejection fraction
A
- metoproplol succinate
- Carvedilol
- bisoproplol
9
Q
3 risk factors for aortic aneurysms
A
- large diameter
- rapid rate of expansion
- SMOKING (not htn)
10
Q
Interrupt EKG reading
1. High-voltage QRS complexes
2 Lateral ST segment depression
3. Lateral T wave inversion
A
left ventricular hypertrophy
11
Q
Risk factors for aortic dissection
A
- Hypertension
- Marfan
- Cocaine
12
Q
Suspected diagnosis of aortic dissection in patients with hemodynamic instability and renal insufficiency, next step?
A
transesophageal echocardiogram
13
Q
Pulsus parvus et tardus
A
Arterial pulse with decreased amplitude and delayed peak
Seen in aortic stenosis
14
Q
Initial diagnostic study of choice for a hemodynamically stable patient with type A aortic dissection
A
CT angiogram
15
Q
Congenital bicuspid aortic valve can turn into what murmur
A
aortic regurgitation
16
Q
What murmur is beast heard
Sitting up, leaning forward, holding breath in full expiration
A
aortic regurgitation
17
Q
Most common cause of aortic stenosis in elderly patients
A
degenerative calcification of aortic valve leaflets
18
Q
What heart sound changes in aortic stenosis
A
soft second heart sound
19
Q
Name situations where you’ll hear an S3
A
Chronic mitral regurgitation
Chronic aortic regurgitation
Heart failure
High cardiac output states (pregnancy or thyrotoxicosis)
20
Q
CYP Inducers
A
BullShit CRAP GPS: Barbituates St. John's Wart Carbamazepine Rifampin Alcohol (chronic) Phenytoin Griseofulvin Phenobarbital Sulfonylureas
21
Q
What position brings the enlarged left ventricle closer to the chest wall?
A
Left lateral decubitus position
22
Q
Laboratory findings for atheroembolism (cholesterol crystal embolism)
A
eosinophilia
23
Q
Location of cause: Atrial fibrillation
A
pulmonary veins
24
Q
Location of cause: Atrial flutter
A
Tricuspid annulus
25
Location of cause: AV nodal reentry tachycardia
AV node
26
Next step for a patient with atrial fibrilation RVR and hemodynamically unstable
Immediate synchronized electrical cardioversion
27
When is immediate debfribrillation recommended
V. fib or pulseless ventricular tachycardia
28
Location of cause: atrioventricular reentrant tachycardia
accessory atrioventricular bypass tract
29
Reversible risk factors for premature atrial contractions? treatment for symptomatic treatment?
tobacco and alcohol
| beta blockers
30
Treatment for beta blocker poisoning?
1st: fluids and atropine
2nd: glucagon
31
Why can you use Dobutamine for bradycardia but not beta blocker poisoning?
Dobutamine causes more vasodilation and worsen hypotension
32
First step in treatment for pulseless electrical activity?
fluids
33
Pulsus paradoxus
Cardiac tamponade
| SBP decrease >10 mmHg with inspiration
34
When do you hear pulsus bisferiens
aortic regurgitation
35
What is seen on EKG for cardiac tamponade
electrical alternans: amplitudes of QRS complexes vary from beat to beat
36
Classification of classic angina
1. Typical location (substernal)
2. provoked by exercise or emotional stress
3. relieved by rest or nitroglycerin
37
Valsalva
decreases preload
38
Abrupt standing
Decreases preload
39
Nitroglycercin administration
decrease preload
40
Sustained handgrip
increase afterload
41
squating
increase preload and afterload
42
passive leg raise
increase leg raise
43
If someone has pulsus paradoxus what do they likely have?
| What is pulsus paradoxus?
cardiac tamponade
asthma
COPD
fall in BP >10 mmHg during inspiration
44
What is electrical alteranans? what is this specific for?
varying amplitude of QRS complexes
| pericardial effusion
45
What pharmacologic therapy is used for persistent peripheral vascular disease despite supervised exercise therapy
cilostazol
46
What is abnormal ankle brachial index number
47
what does an ankle brachial index number of >_1.30 mean?
suggestive of calcified and incompressible vessels; additional vascular studies should be considered
48
What is the LDL level someone should start on Statin?
>190
49
Adrenal hyperplasia and adrenal adenoma both are primary causes of hyperaldosteronism? how do you differentiate the both?
adrenal vein sampling.
50
Medication treatment for supraventricular complex narrow-QRS complex
Adenosine
51
Medication of choice for hemodynamically stable patients with wide-QRS complex tachycardia
Amiodarone or lidocaine
52
When do you see Target cells
thalassemia or chronic liver disease
53
What is peripheral smear for scleroderma renal crisis
Schistocytes and thrombocytopenia
54
Treatment for Takayasu arteritis
steroids
55
What can happen to the heart following an implantable pacemaker or cardioverter-defrillator placement?
right sided heart failure due to tricuspid regurgitation
| - transvenous lead placement through tricuspid valve can lead to direct valve damage or inadequate leaflet coaptation.
56
Palpable thrill is usually associated with what murmur
VSD
57
First line treatment for ventricular tachycardia
amiodarone
58
frist line treatment for torsades de pointes
Mg in stable patient
| Defibrillation in unstable patient
59
Defibrillation
unsynchronized
60
Treatment for Wolf-Parkinson-White Syndrome
procainamide
61
Achalasia has dysphagia to what
solids and liquids
62
what is used to diagnose achalasia
manometry
63
Clues pointing to pseudoachalaisa
weight loss
rapid symptom onset
presentation <60
64
What is pseudoachalaisa
narrowing of distal esophagus secondary to causes other than denervation (esophageal cancer)
65
Polymyositis impacts what part of the esophagus
upper third of esophagus
66
Define acute liver failure? treatment?
1. AST & ALT >1,000
2. hepatic encephalopathy
3. INR >1.5
Liver transplant
67
What lab value indicates biliary pancreatitis?
ALT >150
68
Ascites: SAAG >_1.1
indicates portal hypertension
| cardiac ascites, cirrhosis, Budd-Chiari syndrome
69
Ascites: protein >_2.5
High protein ascites
| CHF, TB,
70
Acities: <2.5
Low protein ascites
| Cirrhosis, nephrotic syndrome
71
How do you calculate SAAG
[peritoneal fluid albumin] - [serum albumin]
72
Initial step in management for oropharyngeal dysphagia
videofluroscopic modified barium swallow
73
Difference between oropharyngeal dysphagia and esophageal dysphagia?
esophageal dysphagia = a few seconds after swallowing but does not cause difficulty initiating swallowing (oropharyngeal dysphagia)
74
Next step in management for oropharyngeal dysphagia
videofluoroscopic modified barium swallow
75
Next step in management for esophageal dysphagia with both solids and liquids
Barium swallow followed by possible manometry
76
esophageal dysphagia with solids progressing to liquids most likely cause? what is the next question you should ask?
mechanical obstruction
h/o radiation, caustic injury, stricture
yes: barium swallow
no: upper endoscopy
77
treatment of Carcinoid tumors
Octreotide
| surgery for liver mets.
78
What is Charcot triad and Reynolds pentad and what does it indicate
fever, jaundice, right upper quadrant pain
hypotension and AMS
acute cholangitis
79
What is acute cholangitis
ascending infection due to biliary obstruction
80
How do you tell the difference between a cystic duct and common bile duct obstruction
common bile duct obstruction will have very high alkaline phosphastase levels
81
Someone with chronic diarrhea with preceding self-limited pulmonary symptoms
think hookworm
82
Secretory diarrha
Due to increased secretion of ions
occurs fasting or sleep
decrease osmotic gap (<50)
83
Osmotic diarrhea
osmotically active agents are present in the GI tract
| elevated osmotic gap (>125)
84
Next step of management for chronic pancreatitis
CT scan
85
Dupuytren contracture
palmar fascia thickens and shortens, deforming the hand. 4th and 5th digit
86
A patient who has a pleural effusion not due to underlying cardiac or pulmonary abnormlaities?
hepatic hydrothrox --> fluid passage through diaphragmatic defects in pts with cirrhosis and portal hypertension
87
Initial episode of C. diff treatment options
Vancomycin PO
OR
Fidaxomicin
88
Treatment of C. Diff with someone who has hypotension/shock, ileus, megacolon?
Metronidazole IV
| plus high-dose Vancomycin PO or PR if ileus is present
89
What is the esophagram pattern for diffuse esophageal spasm
corkscrew
90
Nutcracker esophagus
excessive tone at the lower esophageal sphincter and excessive contractions in the distal esophagus
91
histologic changes in isoniazid heptitis
panolbular mononuclear infiltration and hepatic cell necrosis
92
histologic changes in tubercoluous hepatitis
granulomas on liver biopsy
93
What is the pleural fluid for esophageal rupture
exudative: low pH and high amylase
94
Prophylactic treatment for non bleeding varices?
Beta blocker
| Endoscopic variceal ligation --> alternative primary prevention if contraindicaions to beta blocker
95
Treatment for active variceal bleeding ? what happens if they keep bleeding after that?
Hemodynamic support (2 IV catheters)
Octreotide
endoscopic therapy
ppx abs
Balloon tamponade
96
How do you manage a patient with familial adenomatous polyposis?
frequent colonoscopic screening starting in childhood and elective proctocolectomy
97
Clinical presentation of ischemic colitis
sudden onset of abdominal pain and tenderness, followed by rectal bleeding
98
When do you give packed red blood cell transfusion
hb <7
| unstable patient with acute coronary syndroome or active bleeding or hypovolemia <9 hb
99
Having an upper GI bleed changes what lab values
increase BUN and BUN/Cr
- increased urea production (from intestinal breakdown of hemoglobin)
- increased urea reabsorption (due to hypovolemia )
100
Clinical presentation of angiodysplasia
painless GI bleeding
