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81 Cards in this Set
- Front
- Back
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Why are there elevated TG in DKA?
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capillary lipoprotein lipase (responsible for breaking down chylomicrons) requires insulin to function-
no insulin--> no chylomicron breakdown |
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Why do patients with limited protein reserve, such as in malnutrition, get fatty liver?
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cholesterol and TG made in the liver need apoprotein carries to get them out
low protein--> no movement of cholesterol out of liver |
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What type of meds increase lipids? (5)
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birth control pills
diuretics beta blockers HIV drugs Accutane (Vit A) |
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What are some secondary causes of hyperlipidemia?
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nephrotic syndrome (loss if protein in urine causes HMG-CoA to turn on)
Hypothyroid alcohol diabetes |
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What is the cause, presentation and risk of Type 1 hyperlipidemia?
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lipoprotein lipase deficiency
seen in kids with belly ache risk of pancreatitis |
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What is the cause and presentation of Type 2 hyperlipidemia?
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familial- no LDL receptors
MI very young age (highschool) |
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What is the cause of type V hyperlipidemia and presentation?
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hyperchylomicronemia
seen in DKA |
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How much fiber is recommended a day?
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20-30 g
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Niacin- What are the side effects? What does it work on?
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SE: flushing (can pretreat with ASA), liver toxicity, glucose intolerance
Raises HDL, Lowers TG. No mortality benefit |
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Antioxidant beta carotene increases the risk of what?
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lung cancer in smokers
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What are criteria for metabolic syndrome?
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abdominal obesity
high TG low HDL HTN insulin resistance -- associated with inflammatory and prothrombotic state |
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What disease is associated with metabolic syndrome?
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PCOS
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Polyarteritis nodosa-
1.What vessels are involved? 2.What diseases is it associated with? 3.What are the symptoms? 4.What are the lab abnormalities? 5.What part of body is spared to distinguish this from Wegner's? 6.What is the treatment? |
1. medium vessels
2. Hep B, cryoglobulinemia, HIV 3. fever, weakness, weight loss, arthralgias, abdominal pain 4. p-ANCA and myeloperoxidase Ab 5. lung is spared 5. steroids and cyclophospamide |
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Kid with abdominal pain, rash, hematuria after a URI?
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henoch schonlein (IgA vasculitis)
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Wegener's (granulomatosis)
1. What vessels are involved? 2. What are the symptoms? 3. What lab abnormalities? 4.What is the treatment? |
1. Small vessels
2. Sinusitis , hemoptysis, renal failure 3. c-ANCA, anti-proteinase 3 Ab, CXR shows infiltrates 4. Cyclophosphamide and steroids |
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Temporal arteritis
1. What vessels are involved? 2. What is the presentation? 3. What dz is it associated with? 4. What is the treatment? |
1. large vessels (Giant cell arteritis)
2. woman >50 with HA, jaw claudication and optic neuritis (amaurosis fugax and blindness) 3. Polymyalgia rheumatica 4. treat with steroids. |
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1. What does CREST stand for?
2. What lab abnormalities will you have? 3. What is the treatment? |
1. calcinosis, Raynauds, esophagus, sclerodactyly, telangiectasias
2. anti-centromere Ab 3. CCB's |
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What causes Kaposi's sarcoma?
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HSV-8
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What do accentuated A2 heart sounds indicate?
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systemic HTN
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What do P2 heart sounds indicate?
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pulmonary HTN
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What does a paradoxically split S2 indicate?
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LBBB or Aortic stenosis
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what does fixed splitting of S2 indicate?
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atrial septal defect
systolic murmur |
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When will you have an S3 heart sound?
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systolic CHF
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When will you have an S4 heart sound?
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LVH (stiff ventricle)
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What does a systolic click indicate?
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mitral valve prolapse
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what murmur has a loud S1, opening snap, and diastolic rumble?
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mitral stenosis
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What is indicated by a continuous machinery murmur and how do you treat it?
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PDA- indomethacin to close it
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What murmur is associated with corrigans pulse or waterhammer?
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aortic regurg or sepsis
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What is pulsus paradoxus and when can you see it?
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drop in SBP >10mmHg on inspiration
asthma, pericardial tamponade, constrictive pericarditis |
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What are cannon "a" waves and when are they seen?
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wave seen in the jugular vein when tricuspid valve is closed and RA contracts to push blood against it)
seen in complete heart block, arrhythmias, and tricuspid stenosis |
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When do you see prominent v waves and rapid y wave descent in the jugular vein?
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TRICUSPID regurg
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What is kussmauls sign and when is it seen?
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inspiratory rise in JVP seen in constrictive/restrictive pericarditis
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What are the indications for spironolactone in CHF?
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only in systolic HF (EF <35%), in class III or IV
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What drug is good for CHF in blacks?
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hydralzine and nitrate combo (BilDil)
decreases mortality |
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What is the number one cause of death in US
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MI
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What is the procedure of choice (on boards) to r/o CAD in atypical CP with normal EKG
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exercise stress test
stress thallium test useful in those who cant exercise of those who have baseline abnormal EKGs |
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What is prinzmetals angina, who commonly presents with this and what is the tx?
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coronary vasospasms in women. Tx with CCB
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what is the number one cause of sudden cardiac death?
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arrhythmias
also consider PE, HOCM, MVP, AS, congenital long QT |
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When is exercise treadmill test contraindicated?
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if known HOCM or aortic stenosis
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What is different about inferior MIs than other MIs?
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hits right coronary and may affect SA/AV nodes causing vagal symptoms and bradycardias so have to give IVFs
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If EKG shows persistent ST elevation >2weeks s/p MI what should you think about?
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ventricular aneurysm
give warfarin |
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Pt presents with fever, malaise, pericarditis, leukocytosis weeks to months after an MI.
Dx? Tx? |
dresslers syndrome
give ASA |
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Drug of choice in recurrent pericarditis?
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colchicine
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EKG shows large R wave adn ST depression in V1 and V2?
Dx? and Tx? |
posterior MI
BB, ASa, statins, and ACe-I |
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When is CABG indicated?
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Left main dz or 3 vessel dz
2 vessel dz in DM |
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What is the number one cause of death in HTN?
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MI (not stroke)
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What cardiac abnormalities are seen in Marfans?
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MVP and aortic dissections
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What cardiac abnormalities are seen in Down's?
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ASD
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What cardiac abnormalites are seen in Turners syndrome?
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coarctation of aorta
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Transposition of vessels in baby is associated with what disease in mom?
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DM
#50 on cardiac section, not sure if that is what he means |
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If mom has lupus, baby is at risk for what cardiac abnormality?
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complete heart block
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What is the most common congenital heart defect?
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VSD( will have harsh systolic murmur)
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What is the only condition with equal A and V waves?
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ASD
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What findings are associated with coarctation?
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berry aneurysms, rib notching, upper body HTN
fix to prevent stroke |
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What is the number 1 cyanotic heart condition?
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tetrology
overriding aorta, pulm stenosis, VSD, RVH |
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What are the JONES criteria and what do they diagnose?
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Joints, carditis, nodules, erythema marginatum, Sydenhams chorea for rheumatic fever
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What is austin flint murmur and what is is associated iwth?
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sound of blood hitting MV while opening seen in AR
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What is deMusset sign and when is it seen?
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head bobbing with systole seen in AR
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what murmur is associated with Quincke's pulse?
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AR
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what is traubes sign and when is it seen?
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"pistol shot sound" over femorals in AR
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What is the Graham steel murmur?
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pulm regurg
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Infective endocarditis organisms
1. MC in acute? 2. subacute 3. IVDU 4. prosthetic valves? 5. colon cancer? |
1. staph aureus
2. strep viridans 3. staph aureus 4. staph epidermis 5. strep bovis |
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What is the number one cause of myocarditis, pericarditis and pleuritis?
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coxsackie N
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what are classic amyloid findings
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restrictive symptoms (RHF), low voltage on EKG, prolonged "Y" descent, carpal tunnel, speckled pattern of muscle on ECHO,
need endometrial bx |
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What increases murmur in HOCM?
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valsalva or decreasing venous return
tx with BB |
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how to differentiate pericardial tamponade vs constrictive pericarditis?
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both have equaliztion of left and right ventricular diastolic pressures BUT
constrictive also has the "square root sign" or a dip and plateau pattern |
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what is PCWP like in left heart failure?
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high
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what will SVR and CO be in sepsis?
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low SVR and high CO
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What are causes of sinus tachy?
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panic
hyperthyroid PE |
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What is the treatment for asymptomatic PVCs and PAcs?
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nothing!
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Tx of SVT?
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vagal stimulation and the adenosine
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hwo does dabigatran work?
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direct thrombin inhibitor
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how does rivaroxaban work?
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a factor Xa inhibitor
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What are risks of prolonged QT?
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"R on T" on ECG
torsades and V fib |
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What is treatment of torsades?
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magnesium
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What is treatment of congenital long QT and how is it passed?
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beta blockers
autosomal dominant aka Romano ward syndrome |
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What are classic findings in brugagda syndrome?
2. Who is it seen in ? 3. What are the risks? |
1. See ST seg elevation in V1-V3 (saddle back appearance or sail sign) and a pseudo RBBB
2. Asians 3. Risk of sudden cardiac death |
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What changes are seen on EKG of WPW and what is the treatment
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see SVT, short PR, delta wave
tx with procainamide and then catheter ablation --> dont give dig or verapamil |
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u waves seen with?
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hypokalemia
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peaked T waves with?
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hyperkalemia
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long QT causes by what electrolyte?
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hypocalcemia
-watch out for quinolones |
