Im Exam Part 1

Front 1

The ID of a saddle emboli or evidence of increased right-sided pressure is seen in what?

Back 1

pulmonary emboli

Front 2

Acute MR can result from what?

Back 2

-papillary muscle rupture

Front 3

How do you tx Prinzmetal Angina?

Back 3

CCBs and nitrates to reduce vasospasm

Front 4

What class of HF can you use Spironolactone in and how much does it decrease mortality by?

Back 4

-III-IV HF

-decreases mortality by 34%

Front 5

HCM _____ with squatting and __________ with exercise.

What do you want to avoid in HCM?

Back 5

-decreases with squatting and increases with exercise

-avoid anything that reduces preload (nitrates, diuretics, dehydration)

-tx with BB

Front 6

What are some causes of pericarditis?

Back 6

-hydralazine, procainamide, isoniazid
-post MI
-Dressler's Syndrome
-collagen vascular tissue disorders
-uremia
-radiation
-infection
-trauma
-idiopathic

Front 7

What is Beck's Triad of tamponade?

Back 7

-hypotension
-muffled heart sounds
-JVD

Front 8

Dilation of the left atrium is a major cause of what?

Back 8

A-fib

Front 9

What is the MCC of Mitral Stenosis?

Back 9

rheumatic heart disease

Front 10

What murmur has a mid-diastolic murmur with opening snap and low pitched rumble?

Back 10

MS

Front 11

Where is the murmur of MS best heard?

Back 11

LSB btw 2nd and 4th interspace

Front 12

What are the acute and chronic causes of MR?

Back 12

Acute:
-MI w/ papillary muscle rupture
-endocarditis

Chronic:
-rheumatic fever
-MVP
-LV dilation

Front 13

What murmur is a loud, holosystolic murmur that radiates to the axilla?

Back 13

MR

Front 14

What murmur is a loud systolic ejection murmur that radiates to the carotids and has a narrow pulse pressure and paradoxical split of S2?

Back 14

AS

Front 15

What is the tx for AS?

Back 15

-avoid strenuous activity
-valve replacement
-AVOID afterload reduction

Front 16

What are some conditions that cause a wide pulse pressure?

Back 16

-AR
-hyperthyroidism
-anemia
-wet beri beri
-HTN
-hypertrophic subaortic stenosis

Front 17

What murmur is a high pitched, blowing, decrescendo diastolic murmur best heard over the 2nd R interspace or 3rd L interspace?

Back 17

AR

Front 18

What is the tx for AR?>

Back 18

-tx HF
-endocarditis prophylaxis
-valve replacement

Front 19

A pt with DVT has a stroke. He has a fixed S2 split. Think what?

Back 19

ASD with right to left embolization

Front 20

BalloonValvuloplasty is an effective treatment for what murmur?

Back 20

MS

Front 21

VSD is systolic and radiates to the right

Back 21

just know that

Front 22

What murmur has a collapsing pusle?

Back 22

AR

Front 23

a 24 y/o female with preeclampsia is tx with IV drip of Mg. She c/o difficultly breathing and has diminished reflexes. What is the next step?

Back 23

-Stop Mg and give IV calcium

Front 24

Too much Mg can cause what?

Back 24

-hypotension
-flushing
-decreased reflexes
-respiratory collapse

Front 25

In AAA, when will you have unequal pulses distally?

Back 25

for descending aortic dissection

Front 26

High levels of what can cause pancreatitis?

Back 26

triglycerides

Front 27

What HTN drug can cause hyperkalemia?

Back 27

ACEi

Front 28

Etiology of DM
-80% of type 1 pts have HLA phenotypes associated with anticytoplasmic antibodies toward pancreatic beta cells (islet cell antibodies) and to GAD antibodies

Back 28

also:
-glucagon secreting alpha cells are NOT involved

Front 29

How long to you hospitalize a pt for effects from Sulfonylureas?

Back 29

24 hours

Front 30

How does a prolactinoma present?

Back 30

-galactorrhea and amenorrhea

Front 31

What are some drugs that can cause hyperprolactinemia?

Back 31

-TCAs
-prophlorperazine
-haloperidol
-methyldopa
-metoclopramide
-cimetidine

Front 32

36 y/o presents with amenorrhea for 1 year, increasingly bad HA, clumsiness and sporadic nipple discharge. Beta-HCG is negative. What is dx?

Back 32

prolactinoma

Front 33

Psychogenic polydispsia presents with what?

How is it distinguished from DI?

Back 33

-polyuria and dilute urine

-by low plasma osmolality

Front 34

What are some S/S of Grave's Disease?

Back 34

-pretibial myxedema
-exopthalamos
-apathy in the elderly

Front 35

Grave's disease has an increased or decreased radioactive iodine uptake scan?

Back 35

increased

Front 36

For Grave's disase, PTU is given for how long?

Back 36

12-24 months and usually 1/3 to 1/2 of pts remain well indefinitely

Front 37

What BB is TOC for Graves/

Back 37

propanolol

Front 38

Why are corticosteroids given in myxedema coma before thyroxine?

Back 38

to prevent an Addisonian crisis

Front 39

Hoshimoto's Thyroiditis. Just know these

Back 39

-CD4 lymphocyte mediated destruction of thyroid
-thyroid is nontender**
-diffuse firm enlargement of thyroid gland, or normal size if disease has progressed
-antimicrosomal antibodies are present in >90%
-decreased radioactive iodine uptake scan

Front 40

Know these 4 things about subacute thyroiditis

Back 40

-NOT autoimmune*****
-post viral condition
-neck pain
-tender enlarged thyroid gland, hyperthyroid signs are initially present, then hypothyroid may develop

Front 41

A 72 y/o male w/ hx of afib, is on dig, complains of ab pain out of proportion to exam. What do you think?

Back 41

acute mesenteric ischemia

Front 42

A 75 y/o female w/ hx of MI complains of gnawing ab pain after eating. She has lost 15 lbs in past month Think what?

Back 42

chronic mesenteric ischemia

Front 43

What are some causes of mesenteric ischemia?

Back 43

-atherosclerosis
-a fib
-hypotension
-poor cardiac output
-hypercoagulability

Front 44

What are some S/S of mesenteric ischemia?

Back 44

-severe ab pain out of proportion to exam
-hx of gnawing ab pain after eating
-hx of sudden onset of ab pain and hx of a fib or hypercoagulable state
-labs may show increased lactate or metabolic acidosis

Front 45

What are some causes of delayed gastric emptying?

Back 45

-DM
-gastroparesis
-gastric outlet obstruction
-anticholinergic use****
-fatty foods

Front 46

Gastritis pain is worsened by food and relieved by what?

Back 46

antacids

Front 47

What is Charcot's Triad for ascending cholangitis?

Back 47

-RUQ pain
-fever
-jaundice

Front 48

A 34 y/o male w/ hx of UC, jaundice, elevated GGT and alk phos. THink what?

Back 48

Primary sclerosing cholangitis

Front 49

Primary biliary cirrhosis is associated with what sex?

Back 49

women and autoimmune

(antimitochondrial antibodies)

Front 50

What is the MCC of massive lower GI bleeding in pts over 60?

Back 50

diverticulosis

Front 51

How do you tx Whipple's Disease?

Back 51

1 year of bactrim or tetracycline

Front 52

What is the triad of ZE?

Back 52

-PUD
-gastric hypersectrion
-elevated gastrin levels

Front 53

Hepatic encephalopathy is precipitated by what?

Back 53

-GI bleed
-increased dietary protein
-infection

Front 54

Pernicious Anemia:
1-absence of IF that causes what?
2-antibodies against what?

Back 54

1-B12 deficiency

2-antibodies against parietal cells

Front 55

What are some causes of normochromic, normocytic anemia?

Back 55

-bone marrow problems (aplastic anemia, myelodysplastic syndrome)
-anemia of chronic disease
-early Fe, B12, and folate deficiency

Front 56

What is the most common metabolic disorder of RBCs?

Back 56

G6PD deficiency

Front 57

Anemia of chronic disease; increase or decrease:
1-ferritin
2-serum Fe
3-TIBC
4-transferring

Back 57

1-normal to increased
2-decreased
3-decreased
4-decreased

Front 58

Pts with SCA are prone to infection with what?

Back 58

encapsulated organisms and salmonella is MC

Front 59

In Primary Polycythemia Vera erythropoetin is high or low?

Back 59

low

Front 60

What are some disorders in which bleeding time is elevated?

Back 60

-thrombocytopenia
-qualitative platelet disorders (renal failure**)
-von Willenbrand's Disease

Front 61

TT is elevated in what disorders. 4 of them

Back 61

-DIC
-liver disease
-heparin therapy
-hypofibrinogenemia

Front 62

27 y/o HIV+ female with fever, waxing and waxing mental status, and hematuria. CBC shows pancytopenia. Think what?

Back 62

TTP and tx iwth plasmaphoresis NOT platelets

Front 63

Know these things about TTP

Back 63

-evidenc eof hemolysis: shistocytes on peripheral smear, decreased haptoglobin, elevated LDH and elevated total bilirubin
-renal failure
-fever and confusion
-NORMAL PT AND PTT

Front 64

The liver is enlarged in which stage of CML?

Back 64

chronic phase

Front 65

How does the nodular sclerosing type of Hodgkin's lymphoma present?

Back 65

with cervical lymph node enlargement or mediastinal mass (also Reed-Sternberg cells)

Front 66

In Non-Hodgkin's Lymphoma, involvement of what is more common?

Back 66

mesenteric nodes and extranodal disease

Front 67

What is the MC leukemia in the Western world?

Back 67

CLL

Front 68

What leukemia is mostly found on accident?

Back 68

CLL

Front 69

MM is most common in what race?

Back 69

blacks

Front 70

Bence Jones proteins is seen on what disease?

Back 70

MM