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175 Cards in this Set

  • Front
  • Back
What are the side effects of amiodarone?
Pulm fibrosis
Hepatotox
Hypo/hyperthy
Corneal deposits
Photosensitivity
Which protozoal/helminth:
Undercooked fish
Inflammation of biliary tract
Clonorchis
Which protozoal/helminth:
Most common protozoal infection in US
Giardia
Which protozoal/helminth:
Cause of Chagas' Dz
T cruzi
Which protozoal/helminth:
Most common helminthic infection in US
Enterobius pernicularis (Pinworm)
Which protozoal/helminth:
Snail host
Swimmer's itch
Schistosoma mansoni
Which protozoal/helminth:
Diarrhea in campers and hikers
Giardia
Which protozoal/helminth:
Raw meat
Infected cat feces
Toxoplasma
Thyroid cells with optically clear nuclei
Papillary Carcinoma of Thyroid (orphan Annie nuclei)
Anemia with hypersegmented neutrophils
Megaloblastic anemia
Branching rods on oral infection
Actinomyces israeli
Eczema
Recurrent Infections
Thrombocytopenia
Wiskott-Aldrich
Hemosiderinuria
Thrombosis
Paroxysmal nocturnal hemoglobinuria
Dermatitis
Dementia
Diarrhea
Pellagra (Niacin deficiency)
Treatment:
Trichomonas
Metro
Treatment:
Gardnerella
Metro
Treatment:
Plasmodium vivax/ovale
Chloroquine + Primaquine
Treatment:
Hookworm, pinworm, roundworm
-bendazole
Treatment:
Pediculosis capitis or pubis
Permethrin
Pyrethrin
(these are insecticides)
What are the positive and negative symptoms of schizophrenia?
pos:
Hallucinations, delusions, strange behavior, loose assocns

neg: flat affect, social withdrawal, poor motivation/grooming
Which immunodeficiency:
Neutrophils fail to respond to chemotactic stimuli
Job's syndrome (Hyper IgE) or Leukocyte adhesion deficiency syndrome
Which immunodeficiency:
Adenosine deaminase deficiency
SCID
Which immunodeficiency:
Failure of endodermal development
DiGeorge
Which immunodeficiency:
Defective tyrosine kinase gene
Bruton's agamma
Which immunodeficiency:
High levels of IgE
Hyper IgE (Job's)
Which organism:
Cat scratch
Baronella
Which organism:
Dog/cat bite
Pasturella
Which organism:
Cat feces
Toxo
Which organism:
Puppy feces
Yersinia
Which organism:
Animal urine
Leptospira (spirochete)
or
Hantavirus
Name 7 teratogens.
ACE-i
EtOH
Alkylating agents
Aminoglycosides
Cocaine
DES
Folate agonists
Iodide
Which lipid-lowering agent:
SE: Facial flushing
Niacin
Which lipid-lowering agent:
SE: elevated LFTs, myositis
Fibrates, statins
Which lipid-lowering agent:
SE: GI discomfort, bad taste
Bile acid binding resins
Which lipid-lowering agent:
Best effect on HDL
Niacin
Which lipid-lowering agent:
Best effect on TGs/VLDL
Fibrates
Which lipid-lowering agent:
Best effect on LDL/cholesterol
Statins
Which lipid-lowering agent:
Binds C. diff toxin
Cholestyramine
Diastolic murmurs
Mitral/tricuspid stenosis
Aortic/pulmonic regurgitation
Systolic murmurs
Aortic/pulmonic stenosis
Mitral/tricuspid regurgitation
These murmurs worsen with inspiration.
Tricuspid murmurs (because atria are filling upon inspiration)

RIGHT SIDED
These murmurs worsen with expiration.
Mitral murmurs

LEFT SIDED
Holosystolic murmur
Mitral regurgitation (blood flowing through valve during systole--BAD)
Murmur:
Loudest at apex
Migrates toward axilla
Mitral regurgitation
Causes of mitral regurgitation.
Mitral valve prolapse
Ischemid heart dz
Endocarditis
Rheumatic fever
Systolic murmur heart over right sternal border
Radiates to carotids
Aortic stenosis
Aortic stenosis:
Causes
Bicuspid aortic valve after age 40
Senile/degenerative calcification
Chronic rheumatic valve dz
Congenital unicuspid aortic valve
Syphilis
Bicuspid aortic valve; cause of aortic stenosis
Draw thorax and areas to place stethoscope.

Associated murmurs in these ares?
Systolic murmur with mid-systolic click
Mitral prolapse; only problematic if there's regurgitation
Murmurs associated with Rheumatic heart disease.
Mitral regurg/stenosis
Aortic regurg/stenosis
What heart sounds are considered benign when there is no incidence of disease?
Split S1
Split S2 on inspiration
S3 in patient under 40
Early quiet systolic murmur
Identify defect:
Crescendo-decrescendo systolic murmur heard in 2nd-3rd right interspace close to sternum
Aortic stenosis
Identify defect:
Early diastolic decrescendo murmur heard along left side of sternum
Pulmonic regurgitation
Identify defect:
Late diastolic decrescendo murmur head along left side of sternum
Tricuspid stenosis
Identify defect:
Pansystolic murmur heard at apex and radiates to left axilla
Mitral regurg
Identify defect:
Late systolic murmur preceded by mid-systolic click
Mitral prolapse
Identify defect:
Cresceno-decrescendo systolic murmur best heard in 2nd-3rd left interspaces close to sternum
Pulmonic stenosis
Identify defect:
Pansystolic murmur heard at 4th-6th left interspace
Tricuspid regurg or VSD
Identify defect:
Continuous machine-like murmur
PDA
Identify defect:
High-pitched diastolic murmur with widened pulse pressure
Aortic regurg (classic widening of pulse pressure)
Murmur heard best in left lateral decubitus position.
MR
MS
Left sided S3/S4
80 year-old man presents with systolic crescendo-decrescendo murmur.

Cause?
Aortic stenosis
Signs of right-sided heart failure.
Lower extrem edema, HSM
Signs of left-sided heart failure.
Dyspnea on exertion, orthopnea, pulmonic syx
What medications are used to treat chronic heart failure?

Acute heart failure?
Chronic: Digoxin, beta-blockers, ACE-i, diuretics (hyperact of renin)

Acute: LMNOP: Lasix, morphine, nitrates, oxygen, positioning/pressors
Signs of endocarditis
Bacterioa FROM JANE:
Fever
New murmur
Roth spots on retina (rare)
Osler's nodes (raised lesions on fingertips; painful)
Janeway lzns (non-tender lesions on palms/soles)
Splinter hemorrhages
Bacteria causing endocarditis.
75% staph aureus (rapid onset)

Strep viridens (subacute) on abnl valves (TOF, prosthesis), esp bc of dental procedures

Enterococci

Staph epidermidis (IV drug user!!)

Strep bovis (COLON CANCER)
Culture-negative endocarditis:
Causes
HACEK organisms
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella
Left-sided vs Right-sided endocarditis:
Risks
Left side: stroke
Right side: PE

(bc throw emboli)
Libman-Sacks endocarditis:
Pathophys
Sterile vegetations on both sides of heart

COMMON CAUSE = SLE; SLE CAUSES LSE
Hypovolemia effects on SVR, CO.

Treatment?
SVR inc
CO inc
Tx: IV fluid and blood
Heart failure effects on SVR, CO.

Treatment?
SVR inc
CO dec (cardiogenic shock!)
Tx: LMNOP
Sepsis/anaphylaxis effects on SVR, CO.

Treatment?
SVR low (leaky vasculature)
CO inc

Tx: Abx, iv fluids, NE
Earliest sign of sepsis.
Tachycardia
Neurogenic effects on SVR, CO.

Treatment?
SVR dec
CO dec

Tx: IV fluids, high dose steroids for traumatic SC injuries
Causes of hypovolemic shock.
Trauma (blood loss)
Severe burns
Causes of cardiogenic shock.
Heart failure
MI
Life-threatening arrhythmias
PE
Tension pneumo
Cardiac contusion
Rheumatic fever:
Pathophys
Lab findings
Immune-mediated (type II hypersens) consequence of pharyngeal infection with Grab A strep (pyogenes)

Elevated ASO (anti-streptolysin O) ab's
Aschoff body-->Rheumatic heart dz
Pulsus paradoxus:
What is it?
Disease association?
Exaggerated dec in amplitude of pulse during inspiration

Seen in cardiac tamponade, asthma (exagg'd inspiration)
EKG finding of cardiac tamponade.
Electrical alternans--beat to beat variation of QRS complex
Kussmaul's sign:
What is it?
Associated disease?
Inspiration-->JVD
Due to dec'd capacity of RV
Dz: Constrictive pericarditis
Syphilitic heart disease:
Effects
Calcification of aortic root and ascending aortic arch--"tree bark" appearance of aorta

Can result in aneurysm
Most common cardiac tumor
Myxomas
Myxoma:
Most common site
Effect
Atria (mostly left atrium)
Assocd w/syncopal episodes (obstruction of valve)
Most common cardiac tumor in kids.
Rhabdomyomas--assocd w/tuberous sclerosis
Most common metastases to heart.
Melanoma
IV drug user presents with chest pain, dyspnea, tachycardia, and tachypnea.

Cause?
Bacterial endocarditis--could be right-sided with embolization to PA
Patient in MVA presents with chest pain, dyspnea, tachycardia, and tachypnea.

Cause?
Tension pneumothorax (lung collapse)
Post-op patient presents with chest pain, dyspnea, tachycardia, and tachypnea.

Cause?
Pulmonary embolism
Young girl with congenital valve disease given PCN prophylactically. In ER, bacterial endocarditis is diagnosed.

Next step in management?
IV vancomycin until culture comes back
Under what circumstances might you see pulsus paradoxus?
Tamponade
Croup
Asthma
Diffuse myocardial inflammation with necrosis and mononuclear cells
Myocarditis
Focal myocardial inflammation with multinucleate giant cells
Rheumatic fever--these are Aschkoff cells
Fever
IV drug abuse
New heart murmur
Bacterial endocarditis
Chest pain and coarse rubbing heart sounds in patient with Cr of 5.0
Uremic pericarditis
Tree-barking of aorta
Syphilis
Child with fever, joint pain, cutaneous nodules
4 weeks after throat infection
Rheumatic fever
ST elevations in all EKG leads
Pericarditis
Disordered growth of myocyte
Hypertrophic cardiomyopathy
EKG shows electrical alternans
Cardiac tamponade
Raynaud's
Treatment
ASA
Dihydropyridine CCB
Sildenafil (vasodilation)
Wegener's granulomatosis:
Presentation
Presentation
Lab-findings
Treatment
Necrotizing vasculitis
Necrotizing granulomas in lung and upper airway (even in the hard palate!)
Necrotizing glomerulonephritis

Presentation:
Hemoptysis
Hematuria
Perforation of nasal septum**

Lab: c-ANCA positive!

Tx: Steroids
Microscopic polyanitis:
Presentation
Same as Wegener's but p-ANCA positive (P! not C!)

(Necrotizing vasculitis
Necrotizing granulomas in lung and upper airway (even in the hard palate!)
Necrotizing glomerulonephritis)
Churg-Strauss Syndrome:
Presentation
Granulomatous vasculitis
Eosinophilia
Asthma, atopic dermatitis
Peripheral neuropathy (wrist/foot drop)

p-ANCA positive
c-ANCA vs p-ANCA diseases
c-ANCA: Wegener's
p-ANCA: Churg-Strauss, microscopic polyangitis, Pauci-immune crescentic glomerulonephritis, polyarteritis nodosa
Pauci-immune crescentic glomerulonephritis:
Pathophys
Vasculitis limited to kidney; paucity of antibodies
Sturge-Weber Disease:
Presentation
Port-wine stain on face
Seizures, early-onset glaucoma
Henoch-Schonlein purpura:
Presentation
Skin rash on buttocks and legs (palpable purpura)
Arthralgia
Abdominal pain/melena

IgA immune complexes
Burger's disease:
Presentation
Vasculitis fo small and medium peripheral vessels in HEAVY SMOKERS
Kawasaki disease:
Presentation
Acute vasculitis in Asian children/infants (self-limiting)

Fever, conjunctivitis, strawberry tongue, peeling of skin/desquamation of skin on palms/soles

Coronary aneurysms

Treat with high dose ASA, forget Reye's!
Polyarteritis nodosa:
Presentation
Immune-complex mediated vasculitis in patients with Hep B
Temporal arteritis:
Presentation
Diagnosis
Treatment
MOST COMMON VASCULITIS

Elderly females with unilateral headache, jaw claudication (hurts so much to chew)
Impaired vision, irreversible blinndess

Elevated ESR to screen
Temporal biopsy for confirmatory

Tx: high dose steroids
Which vasculitis:
Weak pulses in upper extremities
Takiyasu's
Which vasculitis:
Necrotizing granulomas of lung and necrotizing glomerulonephritis
Wegener's
Which vasculitis:
Necrotizing immune complex inflamman of visceral/renal vessels
Wegener's
Which vasculitis:
Young male smokers
Buerger's
Which vasculitis:
Young Asian women
Takiyasu's
Which vasculitis:
Asthmatics
Churg-Strauss
Which vasculitis:
Infants and young children
Involved coronary arteries
Kawasaki
Most common vasculitis
Giant cell (Temporal) arteritis
Which vasculitis:
Associated with Hepatitis B infection
Polyarteritis nodosa
Which vasculitis:
Occlusion of ophthalmic artery can lead to blindness
Temporal arteritis
Which vasculitis:
Perforation of nasal septum
Wegener's
Which vasculitis:
Unilateral headache
Jaw claudication
Temporal arteritis
Which vascular tumor:
Benign raised red lesion about size of mole in older patients
Cherry hemangioma
Which vascular tumor:
Raised, red area present at birth, increases in size initially, regresses over months to years
Strawberry hemangioma
Which vascular tumor:
Lesion caused by lymphoangiogenic growth factors in infected HIV patient
Kaposi's sarcoma
Which vascular tumor:
Polypoid red lesion found in pregnancy or after trauma
Pyogenic granuloma
Which vascular tumor:
Benign, painful, red-blue tumor under fingernails
Glomus tumor
Which vascular tumor:
Cavernous lymphangioma associated with Turner's Syndrome
Cystic hygroma
What is the classic presentation of a patient with temporal arteritis?

What lab findings help diagnose temporal arteritis?
Jaw claudication
Unilateral HA
Blindness/impaired vision

ESR would help
Temporal bx is definitive
Which vascular tumor:
Skin papule in AIDS patient caused by Bartonella
Bacillary angiomatosis
Hypochromic, microcytic anemia
Fe def anemia
Pb poinoning
Thalassemia
Anemia of chronid disease
(micro CLIT)
What are the differences between acute and subacute bacterial endocarditis?
Acute: staph aureus; rapid onset, can affect normal valves

Subacute: Strep viridans with pre-existing damage; insidious onset
Increased alpha-fetoprotein in amniotic fluid/maternal serum
Anencephaly
Spina bifida (NT defects)
What are the Jones criteria for the diagnosis of acute rheumatic fever?
JONES:
Joints--polyarteritis
O (<3): Pancarditis--endo/myo/pericarditis
N: nodules subcut
E: Erythema marginatum
S: Sydenham's chorea
Increased uric acid levels
Gout
Lesch-Nyhan syndrome
Tumor lysis syndrome
Loop, thiazide diuretics
Why do the kidneys retain fluid in CHF patients?
Kidneys sense poor perfusion-->Renin via JGA-->AgII-->Aldosterone-->Na+ and H2O retention
Intranuclear eosinophilic droplet-like bodies
Cowdry type A (HSV or yellow fever)
Which defect:
Crescendo-decrescendo systolic murmur best heard in 2nd-3rd right interspace close to sternum
Aortic stenosis
Large lysosomal vesicles in phagocytes
Immunodeficiency
Chediak-Higashi dz
Which defect:
Rumbling late diastolic murmur with opening snap
MS
Low serum ceruloplasmin
Wilson's dz
Which defect:
Pansystolic murmur best heard at 4th-6th left intercostal spaces
TR or VSD
Lumpy-bumpy appearance of glomeruli on immunofluorescence
Poststrepp GN (immune complex deposn)
Which defect:
Continuous machine-like murmur
PDA
Lytic bone (hole-punched) lesions on x-ray
Multiple myeloma
What are the common causes of restrictive cardiomyopathy?
Sarcoid
Amyloid
Hemochromatosis
Laughler's Dz
Post-radiation fibrosis
Mammary gland (blue-domed) cyst
Fibrocystic change of breast
What is Dressler's syndrome?
Pericarditis following MI/heart surgery (though to be auto-immune process)
Monoclonal antibody spike
1. Multiple myeloma (M protein--usually IgG or IgA)
2. Monoclonal gamopathy of undet'd significance (MGUS)
3. Waldenstrom's (M protein = IgM) macroglobulinemia
4. Primary amyloidosis
What are the most common complications after an MI?
Arrhythmia (Vfib = deadly)
LVF-->pulm edema
Monoclonal globulin protein in blood/urine
Bence Jone proteins (multiple myeloma--kappa or lambda Ig light chains in urine); Waldenstrom's macroglobulinemia
Evolution of an MI:
0-4 hours
4-24 hours
2-4 days
5-10 days
10+ days
0-4 hours: no visible change
4-24 hours: contraction bands, necrotic cells, enzymes spill
2-4 days: acute inflamn, nphils, dilated vessels, hyperemia
5-10 days: macs, risk of free wall rupture, pap mm rupture, septal rupture
10+ days: contracted scar, absence of myocytes; risk of aneurysms
Mucin-filled cell with peripheral nucleus
Signet ring (gastric carcinoma)
What are the most common locations for atherosclerosis?
Abdominal aorta
Coronary arteries
Popliteal arteries
Carotid arteries (TIAs, Strokes, dementia)
Narrowing of bowel lumen on barium radiograph
String sign--Crohn's dz
An adult patient with a history of hypertension presents with sudden sharp, tearing pain radiating to the back.

What do you expect to see on CXR?
Aortic dissection causing widening of mediastinum
Needle-shaped, negatively birefringent crystals
Gout (hyperuricemia)
On auscultation of a patient, you hear a pansystolic murmur at the apex with radiation to the axilla.

Cause?
MR
Nodular hyaline deposits in glomeruli
Kimmelstiel-Wilson nodules (diabetic nephropathy)
A 25 year-old pregnant woman in her 3rd trimester has a normal BP when standing and sitting.

When supine, her BP drops to 90/50.

Diagnosis?
Compression of inferior vena cava, less pre-load to heart, less stroke volume out of heart
Nutmeg appearance of liver
Chronic passive congestion of liver due to RHF
Onion-skin periosteal reaction
Ewing sarcoma of bone
Onion skin periosteal reaction
Ewing's sarcoma (malignant round-cell tumor)
Pseudopalisading tumor cell arragnement
Glioblastoma multiforme (most common brain tumor)
Periosteum raised from bone, creating triangular area
Codman's triangle on x-ray (osterosarcoma, Ewing's sarcoma, pyogenic osteomyelitis)
Elevated serum uric acid
Gaut
L-N syndrome
Diuretics (loop, thiazides)
Podocyte fusion on EM
Minimal change dz (child w/nephrotic syndrome)
Polished, ivory-like appearance of bone at cartilage erosion
Eburnation (osteoarthritis resulting in bony sclerosis)
Protein aggregates in neurons from hyperphosphorylation of protein tau
Neurofibrillary tangles (AD, CJD)
Pseudopalisading tumor cells on brain biopsy
Glioblastoma multiforme
RBC casts in urine
Acute GN