1A: Dt 7 - 1

Front 1

What are the side effects of amiodarone?

Back 1

Pulm fibrosis
Hepatotox
Hypo/hyperthy
Corneal deposits
Photosensitivity

Front 2

Which protozoal/helminth:
Undercooked fish
Inflammation of biliary tract

Back 2

Clonorchis

Front 3

Which protozoal/helminth:
Most common protozoal infection in US

Back 3

Giardia

Front 4

Which protozoal/helminth:
Cause of Chagas' Dz

Back 4

T cruzi

Front 5

Which protozoal/helminth:
Most common helminthic infection in US

Back 5

Enterobius pernicularis (Pinworm)

Front 6

Which protozoal/helminth:
Snail host
Swimmer's itch

Back 6

Schistosoma mansoni

Front 7

Which protozoal/helminth:
Diarrhea in campers and hikers

Back 7

Giardia

Front 8

Which protozoal/helminth:
Raw meat
Infected cat feces

Back 8

Toxoplasma

Front 9

Thyroid cells with optically clear nuclei

Back 9

Papillary Carcinoma of Thyroid (orphan Annie nuclei)

Front 10

Anemia with hypersegmented neutrophils

Back 10

Megaloblastic anemia

Front 11

Branching rods on oral infection

Back 11

Actinomyces israeli

Front 12

Eczema
Recurrent Infections
Thrombocytopenia

Back 12

Wiskott-Aldrich

Front 13

Hemosiderinuria
Thrombosis

Back 13

Paroxysmal nocturnal hemoglobinuria

Front 14

Dermatitis
Dementia
Diarrhea

Back 14

Pellagra (Niacin deficiency)

Front 15

Treatment:
Trichomonas

Back 15

Metro

Front 16

Treatment:
Gardnerella

Back 16

Metro

Front 17

Treatment:
Plasmodium vivax/ovale

Back 17

Chloroquine + Primaquine

Front 18

Treatment:
Hookworm, pinworm, roundworm

Back 18

-bendazole

Front 19

Treatment:
Pediculosis capitis or pubis

Back 19

Permethrin
Pyrethrin
(these are insecticides)

Front 20

What are the positive and negative symptoms of schizophrenia?

Back 20

pos:
Hallucinations, delusions, strange behavior, loose assocns

neg: flat affect, social withdrawal, poor motivation/grooming

Front 21

Which immunodeficiency:
Neutrophils fail to respond to chemotactic stimuli

Back 21

Job's syndrome (Hyper IgE) or Leukocyte adhesion deficiency syndrome

Front 22

Which immunodeficiency:
Adenosine deaminase deficiency

Back 22

SCID

Front 23

Which immunodeficiency:
Failure of endodermal development

Back 23

DiGeorge

Front 24

Which immunodeficiency:
Defective tyrosine kinase gene

Back 24

Bruton's agamma

Front 25

Which immunodeficiency:
High levels of IgE

Back 25

Hyper IgE (Job's)

Front 26

Which organism:
Cat scratch

Back 26

Baronella

Front 27

Which organism:
Dog/cat bite

Back 27

Pasturella

Front 28

Which organism:
Cat feces

Back 28

Toxo

Front 29

Which organism:
Puppy feces

Back 29

Yersinia

Front 30

Which organism:
Animal urine

Back 30

Leptospira (spirochete)
or
Hantavirus

Front 31

Name 7 teratogens.

Back 31

ACE-i
EtOH
Alkylating agents
Aminoglycosides
Cocaine
DES
Folate agonists
Iodide

Front 32

Which lipid-lowering agent:
SE: Facial flushing

Back 32

Niacin

Front 33

Which lipid-lowering agent:
SE: elevated LFTs, myositis

Back 33

Fibrates, statins

Front 34

Which lipid-lowering agent:
SE: GI discomfort, bad taste

Back 34

Bile acid binding resins

Front 35

Which lipid-lowering agent:
Best effect on HDL

Back 35

Niacin

Front 36

Which lipid-lowering agent:
Best effect on TGs/VLDL

Back 36

Fibrates

Front 37

Which lipid-lowering agent:
Best effect on LDL/cholesterol

Back 37

Statins

Front 38

Which lipid-lowering agent:
Binds C. diff toxin

Back 38

Cholestyramine

Front 39

Diastolic murmurs

Back 39

Mitral/tricuspid stenosis
Aortic/pulmonic regurgitation

Front 40

Systolic murmurs

Back 40

Aortic/pulmonic stenosis
Mitral/tricuspid regurgitation

Front 41

These murmurs worsen with inspiration.

Back 41

Tricuspid murmurs (because atria are filling upon inspiration)

RIGHT SIDED

Front 42

These murmurs worsen with expiration.

Back 42

Mitral murmurs

LEFT SIDED

Front 43

Holosystolic murmur

Back 43

Mitral regurgitation (blood flowing through valve during systole--BAD)

Front 44

Murmur:
Loudest at apex
Migrates toward axilla

Back 44

Mitral regurgitation

Front 45

Causes of mitral regurgitation.

Back 45

Mitral valve prolapse
Ischemid heart dz
Endocarditis
Rheumatic fever

Front 46

Systolic murmur heart over right sternal border
Radiates to carotids

Back 46

Aortic stenosis

Front 47

Aortic stenosis:
Causes

Back 47

Bicuspid aortic valve after age 40
Senile/degenerative calcification
Chronic rheumatic valve dz
Congenital unicuspid aortic valve
Syphilis

Front 48

Back 48

Bicuspid aortic valve; cause of aortic stenosis

Front 49

Draw thorax and areas to place stethoscope.

Associated murmurs in these ares?

Back 49

Front 50

Systolic murmur with mid-systolic click

Back 50

Mitral prolapse; only problematic if there's regurgitation

Front 51

Murmurs associated with Rheumatic heart disease.

Back 51

Mitral regurg/stenosis
Aortic regurg/stenosis

Front 52

What heart sounds are considered benign when there is no incidence of disease?

Back 52

Split S1
Split S2 on inspiration
S3 in patient under 40
Early quiet systolic murmur

Front 53

Identify defect:
Crescendo-decrescendo systolic murmur heard in 2nd-3rd right interspace close to sternum

Back 53

Aortic stenosis

Front 54

Identify defect:
Early diastolic decrescendo murmur heard along left side of sternum

Back 54

Pulmonic regurgitation

Front 55

Identify defect:
Late diastolic decrescendo murmur head along left side of sternum

Back 55

Tricuspid stenosis

Front 56

Identify defect:
Pansystolic murmur heard at apex and radiates to left axilla

Back 56

Mitral regurg

Front 57

Identify defect:
Late systolic murmur preceded by mid-systolic click

Back 57

Mitral prolapse

Front 58

Identify defect:
Cresceno-decrescendo systolic murmur best heard in 2nd-3rd left interspaces close to sternum

Back 58

Pulmonic stenosis

Front 59

Identify defect:
Pansystolic murmur heard at 4th-6th left interspace

Back 59

Tricuspid regurg or VSD

Front 60

Identify defect:
Continuous machine-like murmur

Back 60

PDA

Front 61

Identify defect:
High-pitched diastolic murmur with widened pulse pressure

Back 61

Aortic regurg (classic widening of pulse pressure)

Front 62

Murmur heard best in left lateral decubitus position.

Back 62

MR
MS
Left sided S3/S4

Front 63

80 year-old man presents with systolic crescendo-decrescendo murmur.

Cause?

Back 63

Aortic stenosis

Front 64

Signs of right-sided heart failure.

Back 64

Lower extrem edema, HSM

Front 65

Signs of left-sided heart failure.

Back 65

Dyspnea on exertion, orthopnea, pulmonic syx

Front 66

What medications are used to treat chronic heart failure?

Acute heart failure?

Back 66

Chronic: Digoxin, beta-blockers, ACE-i, diuretics (hyperact of renin)

Acute: LMNOP: Lasix, morphine, nitrates, oxygen, positioning/pressors

Front 67

Signs of endocarditis

Back 67

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

Front 68

Bacteria causing endocarditis.

Back 68

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)

Front 69

Culture-negative endocarditis:
Causes

Back 69

HACEK organisms
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella

Front 70

Left-sided vs Right-sided endocarditis:
Risks

Back 70

Left side: stroke
Right side: PE

(bc throw emboli)

Front 71

Libman-Sacks endocarditis:
Pathophys

Back 71

Sterile vegetations on both sides of heart

COMMON CAUSE = SLE; SLE CAUSES LSE

Front 72

Hypovolemia effects on SVR, CO.

Treatment?

Back 72

SVR inc
CO inc
Tx: IV fluid and blood

Front 73

Heart failure effects on SVR, CO.

Treatment?

Back 73

SVR inc
CO dec (cardiogenic shock!)
Tx: LMNOP

Front 74

Sepsis/anaphylaxis effects on SVR, CO.

Treatment?

Back 74

SVR low (leaky vasculature)
CO inc

Tx: Abx, iv fluids, NE

Front 75

Earliest sign of sepsis.

Back 75

Tachycardia

Front 76

Neurogenic effects on SVR, CO.

Treatment?

Back 76

SVR dec
CO dec

Tx: IV fluids, high dose steroids for traumatic SC injuries

Front 77

Causes of hypovolemic shock.

Back 77

Trauma (blood loss)
Severe burns

Front 78

Causes of cardiogenic shock.

Back 78

Heart failure
MI
Life-threatening arrhythmias
PE
Tension pneumo
Cardiac contusion

Front 79

Rheumatic fever:
Pathophys
Lab findings

Back 79

Immune-mediated (type II hypersens) consequence of pharyngeal infection with Grab A strep (pyogenes)

Elevated ASO (anti-streptolysin O) ab's

Front 80

Back 80

Aschoff body-->Rheumatic heart dz

Front 81

Pulsus paradoxus:
What is it?
Disease association?

Back 81

Exaggerated dec in amplitude of pulse during inspiration

Seen in cardiac tamponade, asthma (exagg'd inspiration)

Front 82

EKG finding of cardiac tamponade.

Back 82

Electrical alternans--beat to beat variation of QRS complex

Front 83

Kussmaul's sign:
What is it?
Associated disease?

Back 83

Inspiration-->JVD
Due to dec'd capacity of RV
Dz: Constrictive pericarditis

Front 84

Syphilitic heart disease:
Effects

Back 84

Calcification of aortic root and ascending aortic arch--"tree bark" appearance of aorta

Can result in aneurysm

Front 85

Most common cardiac tumor

Back 85

Myxomas

Front 86

Myxoma:
Most common site
Effect

Back 86

Atria (mostly left atrium)
Assocd w/syncopal episodes (obstruction of valve)

Front 87

Most common cardiac tumor in kids.

Back 87

Rhabdomyomas--assocd w/tuberous sclerosis

Front 88

Most common metastases to heart.

Back 88

Melanoma

Front 89

IV drug user presents with chest pain, dyspnea, tachycardia, and tachypnea.

Cause?

Back 89

Bacterial endocarditis--could be right-sided with embolization to PA

Front 90

Patient in MVA presents with chest pain, dyspnea, tachycardia, and tachypnea.

Cause?

Back 90

Tension pneumothorax (lung collapse)

Front 91

Post-op patient presents with chest pain, dyspnea, tachycardia, and tachypnea.

Cause?

Back 91

Pulmonary embolism

Front 92

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

Next step in management?

Back 92

IV vancomycin until culture comes back

Front 93

Under what circumstances might you see pulsus paradoxus?

Back 93

Tamponade
Croup
Asthma

Front 94

Diffuse myocardial inflammation with necrosis and mononuclear cells

Back 94

Myocarditis

Front 95

Focal myocardial inflammation with multinucleate giant cells

Back 95

Rheumatic fever--these are Aschkoff cells

Front 96

Fever
IV drug abuse
New heart murmur

Back 96

Bacterial endocarditis

Front 97

Chest pain and coarse rubbing heart sounds in patient with Cr of 5.0

Back 97

Uremic pericarditis

Front 98

Tree-barking of aorta

Back 98

Syphilis

Front 99

Child with fever, joint pain, cutaneous nodules
4 weeks after throat infection

Back 99

Rheumatic fever

Front 100

ST elevations in all EKG leads

Back 100

Pericarditis

Front 101

Disordered growth of myocyte

Back 101

Hypertrophic cardiomyopathy

Front 102

EKG shows electrical alternans

Back 102

Cardiac tamponade

Front 103

Raynaud's
Treatment

Back 103

ASA
Dihydropyridine CCB
Sildenafil (vasodilation)

Front 104

Wegener's granulomatosis:
Presentation
Presentation
Lab-findings
Treatment

Back 104

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

Front 105

Microscopic polyanitis:
Presentation

Back 105

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)

Front 106

Churg-Strauss Syndrome:
Presentation

Back 106

Granulomatous vasculitis
Eosinophilia
Asthma, atopic dermatitis
Peripheral neuropathy (wrist/foot drop)

p-ANCA positive

Front 107

c-ANCA vs p-ANCA diseases

Back 107

c-ANCA: Wegener's
p-ANCA: Churg-Strauss, microscopic polyangitis, Pauci-immune crescentic glomerulonephritis, polyarteritis nodosa

Front 108

Pauci-immune crescentic glomerulonephritis:
Pathophys

Back 108

Vasculitis limited to kidney; paucity of antibodies

Front 109

Sturge-Weber Disease:
Presentation

Back 109

Port-wine stain on face
Seizures, early-onset glaucoma

Front 110

Henoch-Schonlein purpura:
Presentation

Back 110

Skin rash on buttocks and legs (palpable purpura)
Arthralgia
Abdominal pain/melena

IgA immune complexes

Front 111

Burger's disease:
Presentation

Back 111

Vasculitis fo small and medium peripheral vessels in HEAVY SMOKERS

Front 112

Kawasaki disease:
Presentation

Back 112

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!

Front 113

Polyarteritis nodosa:
Presentation

Back 113

Immune-complex mediated vasculitis in patients with Hep B

Front 114

Temporal arteritis:
Presentation
Diagnosis
Treatment

Back 114

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

Front 115

Which vasculitis:
Weak pulses in upper extremities

Back 115

Takiyasu's

Front 116

Which vasculitis:
Necrotizing granulomas of lung and necrotizing glomerulonephritis

Back 116

Wegener's

Front 117

Which vasculitis:
Necrotizing immune complex inflamman of visceral/renal vessels

Back 117

Wegener's

Front 118

Which vasculitis:
Young male smokers

Back 118

Buerger's

Front 119

Which vasculitis:
Young Asian women

Back 119

Takiyasu's

Front 120

Which vasculitis:
Asthmatics

Back 120

Churg-Strauss

Front 121

Which vasculitis:
Infants and young children
Involved coronary arteries

Back 121

Kawasaki

Front 122

Most common vasculitis

Back 122

Giant cell (Temporal) arteritis

Front 123

Which vasculitis:
Associated with Hepatitis B infection

Back 123

Polyarteritis nodosa

Front 124

Which vasculitis:
Occlusion of ophthalmic artery can lead to blindness

Back 124

Temporal arteritis

Front 125

Which vasculitis:
Perforation of nasal septum

Back 125

Wegener's

Front 126

Which vasculitis:
Unilateral headache
Jaw claudication

Back 126

Temporal arteritis

Front 127

Which vascular tumor:
Benign raised red lesion about size of mole in older patients

Back 127

Cherry hemangioma

Front 128

Which vascular tumor:
Raised, red area present at birth, increases in size initially, regresses over months to years

Back 128

Strawberry hemangioma

Front 129

Which vascular tumor:
Lesion caused by lymphoangiogenic growth factors in infected HIV patient

Back 129

Kaposi's sarcoma

Front 130

Which vascular tumor:
Polypoid red lesion found in pregnancy or after trauma

Back 130

Pyogenic granuloma

Front 131

Which vascular tumor:
Benign, painful, red-blue tumor under fingernails

Back 131

Glomus tumor

Front 132

Which vascular tumor:
Cavernous lymphangioma associated with Turner's Syndrome

Back 132

Cystic hygroma

Front 133

What is the classic presentation of a patient with temporal arteritis?

What lab findings help diagnose temporal arteritis?

Back 133

Jaw claudication
Unilateral HA
Blindness/impaired vision

ESR would help
Temporal bx is definitive

Front 134

Which vascular tumor:
Skin papule in AIDS patient caused by Bartonella

Back 134

Bacillary angiomatosis

Front 135

Hypochromic, microcytic anemia

Back 135

Fe def anemia
Pb poinoning
Thalassemia
Anemia of chronid disease
(micro CLIT)

Front 136

What are the differences between acute and subacute bacterial endocarditis?

Back 136

Acute: staph aureus; rapid onset, can affect normal valves

Subacute: Strep viridans with pre-existing damage; insidious onset

Front 137

Increased alpha-fetoprotein in amniotic fluid/maternal serum

Back 137

Anencephaly
Spina bifida (NT defects)

Front 138

What are the Jones criteria for the diagnosis of acute rheumatic fever?

Back 138

JONES:
Joints--polyarteritis
O (<3): Pancarditis--endo/myo/pericarditis
N: nodules subcut
E: Erythema marginatum
S: Sydenham's chorea

Front 139

Increased uric acid levels

Back 139

Gout
Lesch-Nyhan syndrome
Tumor lysis syndrome
Loop, thiazide diuretics

Front 140

Why do the kidneys retain fluid in CHF patients?

Back 140

Kidneys sense poor perfusion-->Renin via JGA-->AgII-->Aldosterone-->Na+ and H2O retention

Front 141

Intranuclear eosinophilic droplet-like bodies

Back 141

Cowdry type A (HSV or yellow fever)

Front 142

Which defect:
Crescendo-decrescendo systolic murmur best heard in 2nd-3rd right interspace close to sternum

Back 142

Aortic stenosis

Front 143

Large lysosomal vesicles in phagocytes
Immunodeficiency

Back 143

Chediak-Higashi dz

Front 144

Which defect:
Rumbling late diastolic murmur with opening snap

Back 144

MS

Front 145

Low serum ceruloplasmin

Back 145

Wilson's dz

Front 146

Which defect:
Pansystolic murmur best heard at 4th-6th left intercostal spaces

Back 146

TR or VSD

Front 147

Lumpy-bumpy appearance of glomeruli on immunofluorescence

Back 147

Poststrepp GN (immune complex deposn)

Front 148

Which defect:
Continuous machine-like murmur

Back 148

PDA

Front 149

Lytic bone (hole-punched) lesions on x-ray

Back 149

Multiple myeloma

Front 150

What are the common causes of restrictive cardiomyopathy?

Back 150

Sarcoid
Amyloid
Hemochromatosis
Laughler's Dz
Post-radiation fibrosis

Front 151

Mammary gland (blue-domed) cyst

Back 151

Fibrocystic change of breast

Front 152

What is Dressler's syndrome?

Back 152

Pericarditis following MI/heart surgery (though to be auto-immune process)

Front 153

Monoclonal antibody spike

Back 153

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

Front 154

What are the most common complications after an MI?

Back 154

Arrhythmia (Vfib = deadly)
LVF-->pulm edema

Front 155

Monoclonal globulin protein in blood/urine

Back 155

Bence Jone proteins (multiple myeloma--kappa or lambda Ig light chains in urine); Waldenstrom's macroglobulinemia

Front 156

Evolution of an MI:
0-4 hours
4-24 hours
2-4 days
5-10 days
10+ days

Back 156

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

Front 157

Mucin-filled cell with peripheral nucleus

Back 157

Signet ring (gastric carcinoma)

Front 158

What are the most common locations for atherosclerosis?

Back 158

Abdominal aorta
Coronary arteries
Popliteal arteries
Carotid arteries (TIAs, Strokes, dementia)

Front 159

Narrowing of bowel lumen on barium radiograph

Back 159

String sign--Crohn's dz

Front 160

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?

Back 160

Aortic dissection causing widening of mediastinum

Front 161

Needle-shaped, negatively birefringent crystals

Back 161

Gout (hyperuricemia)

Front 162

On auscultation of a patient, you hear a pansystolic murmur at the apex with radiation to the axilla.

Cause?

Back 162

MR

Front 163

Nodular hyaline deposits in glomeruli

Back 163

Kimmelstiel-Wilson nodules (diabetic nephropathy)

Front 164

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?

Back 164

Compression of inferior vena cava, less pre-load to heart, less stroke volume out of heart

Front 165

Nutmeg appearance of liver

Back 165

Chronic passive congestion of liver due to RHF

Front 166

Onion-skin periosteal reaction

Back 166

Ewing sarcoma of bone

Front 167

Onion skin periosteal reaction

Back 167

Ewing's sarcoma (malignant round-cell tumor)

Front 168

Pseudopalisading tumor cell arragnement

Back 168

Glioblastoma multiforme (most common brain tumor)

Front 169

Periosteum raised from bone, creating triangular area

Back 169

Codman's triangle on x-ray (osterosarcoma, Ewing's sarcoma, pyogenic osteomyelitis)

Front 170

Elevated serum uric acid

Back 170

Gaut
L-N syndrome
Diuretics (loop, thiazides)

Front 171

Podocyte fusion on EM

Back 171

Minimal change dz (child w/nephrotic syndrome)

Front 172

Polished, ivory-like appearance of bone at cartilage erosion

Back 172

Eburnation (osteoarthritis resulting in bony sclerosis)

Front 173

Protein aggregates in neurons from hyperphosphorylation of protein tau

Back 173

Neurofibrillary tangles (AD, CJD)

Front 174

Pseudopalisading tumor cells on brain biopsy

Back 174

Glioblastoma multiforme

Front 175

RBC casts in urine

Back 175

Acute GN