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226 Cards in this Set
- Front
- Back
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Barrett's esophagus refers to an abnormal change (______) in the cells of the inferior portion of the esophagus.
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Metaplasia
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The medical significance of Barrett's esophagus is its strong association with esophageal ________.
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adenocarcinoma
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What is the BEST marker for Iron Deficiency anemia?
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Ferritin
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What is the first and second diagnostic test in pts with dysphagia?
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1- barium swallow
2- endoscopy |
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Before taking a pt to surgery, what must you have?
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Tissue bx!
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Abdominal cancer mets is typically seen in the left supraclavicular node (called ________) via the thoracic duct.
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Virchow's node
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______ angina is typically brought on by exercise, relieved with rest and nitro.
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Stable
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______ angina typically has pain at rest, increased frequency, and change from previous angina.
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Unstable
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Silent ischemia/atypical symptoms are seen in which populations?
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*women
*elderly *diabetics |
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What is the treatment of angina?
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MONA -->
Morphine Oxygen Nitro ASA |
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What is the standard of care for CAD?
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PCI
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_______ is caused by coxsackie B virus and is typically seen post-MI.
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Pericarditis
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Describe the characteristics of a pericardial friction rub.
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*sharp, stabbing pain
*relieved by sitting up/leaning forward *worse with movement |
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Describe pleuritic pain.
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Sharp & severe pain worse with deep inspiration and chest wall movement.
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_______ has shearing pain, often radiating to the back.
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Aortic dissection
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______ typically presents with burning, retrosternal chest pain.
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PUD
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Acute _______ presents with sharp RUQ pain that comes and goes.
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cholecystitis
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The pain of _______ is relieved by leaning forward and pulling knees to chest. May radiate to the back and be associated with N/V.
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pancreatitis
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A large anterior MI is due to ischemia of which artery and changes will be seen in which ECG leads?
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*left main
*V1-V6 |
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An anteroseptal MI is due to ischemia of which artery and changes will be seen in which ECG leads?
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*LAD
*V1-V4 |
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An anterolateral MI is due to ischemia of which artery and ECG changes will be seen in which leads?
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*left circumflex
*I, aVL, V4-V6 |
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An inferior MI is due to ischemia of which artery and ECG changes will be seen in which leads?
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*RCA
*II, III, aVF |
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______ after an anterior MI present with pericardial effusion and eventually tamponade.
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Free wall rupture
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______ is elevated by skeletal muscle trauma & IM injections; increases 4-8 hrs after MI, and returns to normal in 48-72 hours.
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Total CK
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______ is elevated by electrical cardioversion or cardiac surgery, NOT by skeletal muscle.
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CK-MB
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Which cardiac marker is the first to rise?
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myoglobin
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______ markers rise in 3-12 hrs, return to normal in 7-10 days, and are not normally detected.
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Troponin T & I
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______ is the last cardiac enzyme to fall.
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Troponin
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What are the causes of an elevated troponin?
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*Acute infarct
*Severe PE *Heart failure *Myocarditis *Renal insufficiency |
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What are the vitamin K dependent factors?
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II, VII, IX, X
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What is the treatment for coumadin overdose?
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Vit K or FFP
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PT measures ________ factors. PTT measures _______ factors.
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PT --> extrinsic
PTT --> intrinsic (PeT & PiTT) |
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What is seen on the CXR of a pt with pulmonary edema?
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*Cardiomegaly
*Bat wing sign *Enlarged pulmonary arteries *B/L pleural effusion *Fluid in fissures *Cephalization *Kerley B lines |
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Persistent ST elevation in all leads along with depressed PR intervals is likely to be ________.
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pericarditis
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Rib notching = _______.
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Coarctation of the aorta
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What are the contraindications to beta-blocker therapy?
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*Asthma
*Heart block *COPD *DM *Electrolyte imbalance *Pregnancy *Pheochromocytoma *Cocaine user |
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What is the therapy for a pt post-MI?
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*ASA
*BB *Clopidogrel *Statin |
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Aortic stenosis presents with ______ pulse pressure. Aortic regurg presents with ______ pulse pressure.
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AS --> narrow
AR --> wide |
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What is the definition of orthostatic hypotension?
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A drop of 20 mmHg systolic or drop of 10 mmHg diastolic w/in 3 min of standing (HR increase >20 bmp or dizziness).
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BP < ____ + HR > ____ = dehydration.
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*100
*100 |
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On ophthalmological exam, a pt with recent onset HTN by show ______. A pt with months/years of HTN may have ______. A pt with severe/accelerated HTN may present with ________.
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Recent --> copper wire
Months/years --> A-V nicking Severe --> cotton wool spots, hard exudates |
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In a pt with HTN emergency, _______ may be seen on ophthalmological exam.
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papilledema
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What are some causes of Secondary HTN? (ABCDE)
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*Acromegaly, inaccuracy
*Pheochromocytoma *Cushing's, coarctation of aorta *Hyperaldosteronism |
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_______ may present with labile HTN, tachycardia, sweating, tremors. What is is caused by?
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*Pheochromocytoma
*excess epi/norepi |
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_____ is a possible complication of strep pharyngitis that is NOT prevented by treatment.
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PSGN
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What is the hallmark of peripheral vascular disease (PVD)?
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intermittent claudication (pain in calves with walking)
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What is the hallmark of renal disease?
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proteinuria
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If a pt shows LVH on EKG, what should be ordered next?
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Echo
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What are the second MCCs of CHF?
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HTN & valvular disease
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An S3 heart sound can be normal in which people?
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*children
*pregnant women |
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A fourth heart sound (S4) may be heard in pts with which conditions?
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*mitral regurg
*decreased ventricular compliance |
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What are the systolic murmurs?
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*AS
*MR *VSD |
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What are the diastolic murmurs?
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*AR
*MS |
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________ is the term for when the heart beat is weaker during inspiration.
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Pulsus paradoxus
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_______ sign occurs when left ventricular pressure drops on inspiration.
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Kussmaul's
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What are some causes of High Output Heart Failure?
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*anemia
*thyrotoxicosis *thiamine deficiency |
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Rheumatic heart disease most commonly affects which heart valve?
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*mitral
(M-A-T-P) |
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What is the MC pediatric heart problem?
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VSD
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What are the S&S of left HF?
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*SOB
*PND *Orthopnea *Rales *S3 |
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What are the S&S of right HF?
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*peripheral edema
*JVD *HJR *ascites |
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CHF has which characteristics on CXR? (ABCDE)
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*Alveolar edema (bat's wings)
*kerley B lines (interstitial edema) *Cardiomegaly *Dilated prominent upper lobe vessels (cephalization) *pleural Effusion |
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What is the diagnostic test of choice for atrial fibrillation?
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Echo
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What is the #1 cause of heart failure?
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diastolic dysfunction
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What is the #1 cause of diastolic dysfunction?
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HTN
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A fib is an irregularly _______ heart rhythm.
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irregular
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What is a major, but rare side effect of procainamide?
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drug-induced lupus
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Why might hemoptysis occur in mitral stenosis?
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b/c the recurrent laryngeal nerve is impinged by the atrium
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_______ is the tx for mitral stenosis but not for aortic stenosis.
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Balloon valvuloplasty
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If a pt develops a new murmur, it is most likely to be ________.
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mitral regurg
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A young female with atypical chest pain and a murmur most likely has ________.
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mitral valve prolapse
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A murmur in an elderly pt with syncope, angina and dyspnea is most likely to be _______.
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aortic stenosis (SAD)
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Valve replacement is required with _______.
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aortic stenosis
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Syphilis can cause which type of heart murmur?
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aortic regurg
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Bicuspid valve is susceptible to calcification and _______ later.
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aortic stenosis
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A mid-diastolic murmur with opening snap is ________.
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mitral stenosis
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A loud, holosystolic murmur that radiates to the axilla is ________.
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mitral regurg
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A mid-systolic ejection murmur best heard at the second ICS, with radiation to the carotids is _______.
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aortic stenosis
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A high-pitched diastolic blowing murmur best heard at 2nd ICS and is louder when leaning forward is ______.
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aortic regurg
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What are the characteristics of HOCM? (i.e. type of murmur, what echo shows, and which drugs to avoid).
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*systolic ejection murmur
*decreases with squatting *increases with valsalva *echo shows septal hypertrophy & LVH *avoid strenuous exercise *avoid digoxin & nitro |
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What is/are the cause/s of myocarditis?
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*Coxsackie A or B virus
*Chagas disease |
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What are some common causes of pericarditis?
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*Dressler's syndrome
*SLE *Infection *Uremia *Post-MI (24-48 hrs) |
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What are the most common S&S of pericarditis?
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*pulsus paradoxus
*friction rub *JVP *pleuritic pain *ECG changes |
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A globular heart on CXR represents _______.
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pericardial tamponade
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What is the hallmark of pericardial tamponade?
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tachycardia
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What is Beck's triad and in which conditions is it usually seen?
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*hypotension, muffled heart sounds, increased JVP
*pericardial tamponade, RV infarct |
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A rise in JVP on inspiration, aka Kussmaul's sign, may be seen in which conditions?
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*constrictive pericarditis
*restrictive cardiomyopathy *cardiac tamponade |
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What may be seen on the CXR of a pt with an aortic dissection?
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*widened mediastinum
*prominent aortic knob |
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What is the tx of aortic dissection?
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Nitride & BB
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An aortic rupture near the carotids may be due to _______ and one near the heart is likely due to ______.
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*stroke
*MI |
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Cardiomegaly + straight moguls + prominent aortic knob + widened mediastinum = _________.
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ascending aortic aneurysm
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Which type of MI may present with bradycardia and N/V and why?
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Inferior MI due to vagal nerve compression
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A pt experiencing a right ventricular MI needs _____; NOT nitro.
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fluid
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What are the side effects of ACE-inhibitors?
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*dry cough
*facial edema *hyperkalemia |
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What is seen on the x-ray of a pt with Croup?
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Steeple sign
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What is Croup caused by and what are some S&S?
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*Parainfluenza virus
*Inspiratory stridor, barking cough |
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Epiglottitis will show ______ sign on x-ray.
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*thumbprint
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What is epiglottitis caused by mainly and what are some S&S?
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*Hemophilus influenza
*drooling, tripod position |
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Name some gram negative cocci.
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*Neisseria meningitides
*Neisseria gonorrhea |
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Give some examples of gram negative rods.
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*Legionella
*E coli *pseudomonas *Klebsiella *Bordatella *Hemophilus |
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What is Bordatella usually the culprit of?
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Pertussis (whooping cough)
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Pseudomonas is seen in kids with ______.
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CF
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Give some examples of gram positive cocci.
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*Staph aureus
*Staph epi *Strep pyogenes *Strep pneumonia |
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Name some gram positive rods.
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*Listeria
*Clostridia *Corynebacterium |
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What is the MCC of CAP?
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Strep pneumonia
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What is the MCC of atypical pneumonia?
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Mycoplasma
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What are some causes of cavitary lesions in the lung?
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*TB
*Squamous cell carcinoma *Autoimmune *Vascular *Lung abscess *Congenital |
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What are the side effects of Isoniazid (INH)?
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*hepatotoxicity
*neurotoxicity (give B6) |
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What is/are the side effect/s of Rifampin?
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hepatotoxicity
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What is/are the side effect/s of Pyrazinamide?
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hepatotoxicity
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What is/are the side effect/s of Ethambutol?
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optic neuritis
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What are the side effects of Streptomycin?
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*nephrotoxicity
*ototoxicity |
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How much induration would be considered a + test in an HIV pt and those in close contact with HIV pts? ___ mm is + in high risk populations such as health care workers, homeless, foreign-born. How much induration for all others would be positive?
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5 mm --> HIV
10 mm --> high-risk 15 mm --> all others |
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If a pt has a +PPD and a negative CXR, what should be done?
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6 months of tx with INH
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What is the dx test for the diagnosis of CF?
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Sweat chloride test
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______ increases longevity in COPD pts.
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Oxygen
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What is the MCC of hemoptysis?
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Chronic bronchitis
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What is the MCC of right-sided heart failure?
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Left-sided heart failure
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Who is Primary pulmonary hypertension most common in? What is the treatment?
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*young females with RHF
*tx is O2 and transplant |
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What is secondary pulmonary hypertension due to?
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*COPD
*CF *Hypoxemia *OSA |
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What is the treatment for Secondary pulmonary HTN?
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Treat the underlying cause & O2
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What is seen on CXR of pulmonary HTN?
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prominent pulmonary arteries
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What is the test of choice for pulmonary HTN?
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Echo
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What are the 3 parts of Virchow's triad?
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*Stasis
*Hypercoagulable state *Endothelial damage |
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_____ is the screening test of choice for a suspected DVT.
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Venous US
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What signs may be seen on the CXR of a pt with a PE?
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*Westermark sign
*Hampton's Hump |
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What is the typical pattern that may be seen on EKG of a pt with a PE?
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S1Q3
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What is the diagnostic test of choice for PE?
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Spiral CT
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What is the gold standard for dx of a PE but is rarely done?
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Pulmonary angiography
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Which marker is elevated when coagulation has started?
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D-dimer
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_______ results in pleural plaques.
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Asbestosis
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If a person has recurrent sinus infections think of ______ disease.
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Wegner's
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What are some of the granulomatous conditions?
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*TB
*Sarcoidosis *Wegner's disease |
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What are some conditions that cause erythema nodosum on the legs?
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the granulomatous conditions and OCPs
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What are some signs of pleural effusions on CXR?
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white, meniscus sign, blunting of costophrenic angles
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What are some causes of Transudative pleural effusions?
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*CHF
*Cirrhosis |
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What are some causes of Exudative pleural effusions?
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*PNA
*CA *TB *Collagen vascular disease *Viruses *CABG |
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What does Light's Criteria state about exudative pleural effusions?
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*Pleural fluid protein : serum protein >0.5
*Pleural fluid LDH : serum LDH >0.6 *Pleural fluid LDH >2/3 upper limit of normal serum LDH |
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What is the gold standard for diagnosis of Sarcoidosis? Who is it more common in?
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*tissue bx
*AA females |
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In a pt with sarcoidosis, what would PFTs show? A CXR?
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PFT --> restrictive lung disease
CXR --> bilateral hilar adenopathy |
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What is the treatment for a PTX?
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Thoracocentesis in 5th ICS
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How is a PTX seen on CXR?
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black (full of air)
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What is the MCC of fever after surgery? Which other pt population is prone to getting the same condition?
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*Atelectasis
*Newborns |
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How is atelectasis seen on CXR?
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white (airless)
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How might atelectasis be prevented after surgery?
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incentive spirometry
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What are some of the tx options for influenza?
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*Zanamivir (Relenza)
*Oseltamivir (Tamiflu) |
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Hypoventilation and increased CO2 causes respiratory _______.
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acidosis
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Hyperventilation and decreased CO2 causes respiratory _______.
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alkalosis
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Diarrhea causes _______ pH imbalance. Vomiting causes _______.
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*Diarrhea --> metabolic acidosis
*Vomiting --> metabolic alkalosis |
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What are the three parts of Horner's Syndrome?
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*miosis
*partial ptosis *anhidrosis |
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The characteristic physical sign of a _______ may be seen in pts with CO2 retention (resp failure).
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flapping tremor
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Where might breast CA spread to?
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*axillary & supraclavicular nodes
*spine *ribs *lungs |
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What are Cheyne-Stokes respirations?
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periodic breathing near death (i.e. heart failure, coma, neuro damage)
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What are Kussmaul's respirations? Which conditions may it be noted in?
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*fast, deep breathing
*metabolic acidosis, DKA, kidney or liver dz |
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What may be seen on the CXR of a COPD pt?
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*hyperinflation
*flat diaphragm *tubular heart *increased retrosternal space |
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Interstitial lung disease has a _______ appearance on CXR.
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ground glass
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LVH may show ______ on CXR.
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kerley B lines
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How might bronchopneumonia show on CXR? Causes?
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patchy infiltrates (mycoplasma, viral)
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How might interstitial PNA be seen on CXR? Causes?
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*fine diffuse infiltrates
*influenza, CMV, p. jirovecii |
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How does lobar PNA present on CXR? Causes?
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*dense lobar consolidation
*S. pneumonia, h. flu, legionella |
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How does silicosis present on CXR?
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egg shell appearance
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What are the treatments for anemia, hypocalcemia, and hyperphosphatemia in the chronic renal failure pt?
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*anemia --> EPO injections
*hypocalcemia --> Ca & vit D *hyperphosphatemia --> dialysis |
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What is the hallmark of renal failure?
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proteinuria
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The serum creatinine may still be normal with <___% kidney damage.
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60
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Where is renin produced? How does renin affect BP?
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*in the juxtogloberular apparatus (JGA) of the kidney
*renin release causes HTN |
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What are the 3 main functions of angiotensin?
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1- constrict the arterioles
2- secrete ADH 3- secrete aldosterone |
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Where is ADH secreted from?
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posterior pituitary gland
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Where is aldosterone secreted from?
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glomerulosa cells of the adrenal cortex in the adrenal gland
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What effect does ADH have on BP?
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ADH causes water retention which elevates BP
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How does aldosterone affect BP?
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Aldosterone retains sodium, which causes water retention, which elevates BP
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What are the contents of the adrenal medulla?
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Catecholamines (epi & norepi)
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What are the contents of the adrenal cortex?
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salt, sugar, sex
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Primary aldosteronism causes secondary _____.
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HTN
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What is the tx of severe hyperkalemia?
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*Ca gluconate
*insulin & glucose |
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What is aldosterone release dependent on?
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An increase in angiotensin II concentration & an increase in plasma (K+).
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What condition causes excess ADH and in turn results in a decrease in serum osmolarity?
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SIADH
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What condition causes a decrease in ADH, an increase in urine output, and an increase in serum osmolarity?
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DI
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What is it called when the pituitary gland doesn't release ADH?
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Central DI
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What is the condition called when the collecting ducts of the kidneys are unable to respond to ADH?
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Nephrogenic DI
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Excess secretion of ADH = _________.
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SIADH
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What is the first line tx for enuresis?
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Behavioral tx then DDAVP
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A drug reaction rash will be ______.
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systemic (not on just one arm)
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If a pt has a Steven-Johnsons reaction to a drug, do not give them a ______ medication.
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sulfa
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What is the most important intracellular buffer? Extracellular?
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*Hgb
*bicarb |
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If a pt presents with cola-colored urine and HTN, think of _______.
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PSGN
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What are some causes of an elevated BUN?
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*high protein diet
*hypovolemia/dehydration *upper GI bleed |
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A low flow rate is when ___% of urea is reabsorbed into blood.
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50
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What are some conditions with high ammonia levels?
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*Liver failure
*End-stage cirrhosis |
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FeNa <1% = _______.
FeNa >2% = ________. |
* Pre-renal failure (hypovolemia)
*renal failure |
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What is a normal GFR?
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at least >60
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A pt with N/V, headache, cherry red face, confusion, and fatigue along with other family members with similar symptoms = ______.
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CO poisoning
|
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What is a screening test for nephrolithiasis?
|
KUB
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What is the diagnostic test of choice for a pt with suspected nephrolithiasis?
|
CT
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What should be done with a pt on metformin that needs to undergo a CT scan with contrast? Why?
|
Stop the metformin before systemic contrast due to risk of lactic acidosis.
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A renal failure pt with elevated phosphate and decreased calcium = secondary _________.
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hyperparathyroidism
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Oliguria is a urine output < _____ cc/24 hrs. Anuria is a urine output < ____ cc/24 hrs.
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Oliguria --> 500
Anuria --> 50 |
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An elevation of serum creatinine and urea = ________.
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Azotemia
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______ is azotemia that leads to confusion and drowsiness.
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Uremia
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For acute renal failure due to interstitial nephritis from abx, what should be ordered?
|
urine eosinophils
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_______ casts are common and can be normal due to intense exercise.
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Hyaline
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RBC casts are seen in ________. WBC casts are seen in _______.
|
RBC --> GN
WBC --> pyelo |
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Granular/waxy casts are seen in ________.
Broad casts are seen in _______. |
Granular --> ARF
Broad --> CRF |
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_______ is seen in nephritic syndrome.
|
Maltese cross
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Which meds may cause pre-renal failure?
|
*ACE-inhibitors
*NSAIDs |
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If lactate is present, think ______.
|
sepsis
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What type of anemia do renal failure pts get? Why?
|
Normocytic anemia -- EPO production slows & bone marrow becomes depressed
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What is the first sign of ARF?
|
oliguria
|
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What are some common causes of CRF?
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*Analgesic nephropathy --> get serum ASA levels
*Polycystic disease *Interstitial nephritis *Diabetes *HTN *Renal artery stenosis *Kidney stones *BPH |
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What is an important diabetic lab test that should be done every 6-12 months?
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microalbumin
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Athletic pseudo-nephritis will show which type of casts in the urine?
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hyaline and granular
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Nephritic syndrome (inflammatory) is characterized by.... ?
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*hematuria
*RBC casts *HTN *oliguria |
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What is the triad of Nephrotic syndrome (leaky)?
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*proteinuria
*edema *hypoalbuminemia |
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The inability of the kidney to concentrate urine is called ______.
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uremic syndrome
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Minimal change disease in children is classified by....?
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*proteinuria
*hematuria *fat, casts, & crystals |
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What is the tx of minimal change disease?
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*low salt diet
*steroids |
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What is the tx for PSGN?
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*tx HTN aggressively
*AVOID steroids! *Decrease protein & Na in diet |
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Broad casts seen in the urine of a renal failure pt = _______.
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poor prognosis-- aka renal failure casts
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Which immunizations should be given to renal failure pts?
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*pneumovax
*prevnar *influenza |
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What are some of the common organisms to cause UTIs?
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*E. coli, proteus, enterobacter
*in hospital -- pseudomonas |
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What is the UTI drug of choice? In the pregnant pt?
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*Cipro
*Keflex |
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What are the S&S of pyelonephritis?
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*fever/chills
*flank tenderness |
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What is the pyelo drug of choice?
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Cipro
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In a male with prostatitis a DRE should not be performed. Why?
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It could cause bacteremia
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What is/are the prostatitis drug/s of choice?
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*Bactrim of cipro for 21 days +
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What is the MC type of kidney stone? 2nd? 3rd?
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1- calcium oxylate stones
2- uric acid stones 3- struvite stones (infection) |
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How are uric acid kidney stones treated?
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*low purine diet
*potassium citrate or allopurinol |
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How are struvite kidney stones treated?
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abx
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