Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
251 Cards in this Set
- Front
- Back
|
overdose of what causes metabolic acidosis and retinal damage leading to blindness
|
methanol
|
|
|
what electrolyte abnormalities are found in hyperaldosteronism
|
metabolic alkalosis
hypokalemia mild hypernatremia |
|
|
MC coronary artery to become occluded
|
LAD
|
|
|
ECG leads that correspond to occlusion of LAD
|
V2-V4
|
|
|
in which phase of the cardiac cycle do coronary arteries fill with blood
|
diastole
|
|
|
how can you calculate mean arterial pressure
|
2/3 diastole + 1/3 systole
CO x TPR |
|
|
what electrophysiologic reason could make a QRS complex become wider
|
origin of depolarization is distal to AV node
delay along the ventricular conduction system |
|
|
Dx, Rx and MCC:
otoscopy of a child presenting with acute onset of ear pain reveals large reddish vesicles on the TM |
Dx: bullous myringitis
MCC: mycoplasma Rx: macrolides |
|
|
Dx & Rx
burn px with cherry red flushed skin, O2 sat is normal but carboxyhemogllobin is elevated |
Dx: CO2 Poisoning
Tx: 100% O2 or hyperbaric O2 |
|
|
Rx
patient with aldosterone deficiency |
fludrocortisone
|
|
|
EKG finding that is suggestive of myocardial ischemia during exercise
|
**ST depression > 1mm
ST elevation U-wave inversion |
|
|
if angina or ischemia occurs during a stress test, what test should follow
|
coronary angiography with possible angioplasty
|
|
|
how do statins reduce the incidence of myocardial infarction
|
lower LDL
anti-inflammatory effects inhibit plt thrombus formation improve coronary endothelial function |
|
|
lipid lowering agent:
SE flushing |
niacin
|
|
|
lipid lowering agent:
SE elevated LFT and myositis |
statins and fibrates
|
|
|
lipid lowering agent:
SE of GI discomfort, bad taste |
bile acid sequestrants
|
|
|
lipid lowering agent:
best for HDL |
niacin
|
|
|
lipid lowering agent:
best for TGs |
fibrates
|
|
|
lipid lowering agent:
best for LDL/cholesterol |
statins
|
|
|
lipid lowering agent:
binds to C difficile |
cholestyramine
|
|
|
LDL recommendations for px based on their CAD risk factors
|
0 - 1 RF's: LDL < 160
2+ RF's: LDL < 130 CAD/Eq: LDL <100 |
|
|
what are risks for CAD
|
tabacco use
HTN or currently on a antihypertensive HDL < 40 FHx of CAD (males < 55 & females < 65) AGE (males > 45 & females > 55) |
|
|
how can the "flushing" reaction of niacin be prevented
|
ASA (1/2 - 1 hr before taking niacin)
NSAID's (1/2 - 1 hr before taking niacin) continued use (flushing reaction will subside with time) take it in the evening take with a low-fat snack avoid hot beverages & spicy foods |
|
|
with what are chvostek and trousseau sign assoc'd
|
hypocalcemia
|
|
|
area of the brain lesioned:
contralateral hemiballismus |
subthalamic nucleus
|
|
|
area of the brain lesioned:
hemispatial neglect syndrome |
non-dominant parietal lobe
|
|
|
area of the brain lesioned:
coma |
reticular activating system, RAS (i.e. pontine lesion)
|
|
|
area of the brain lesioned:
poor repitition |
arcuate fasciculus
|
|
|
area of the brain lesioned:
poor comprehension |
Wernicke's area
|
|
|
area of the brain lesioned:
poor vocal expression |
broca's area
|
|
|
Rx for prinzmetal angina
|
**Dihydropyridine CCB's (nifedopine, amlodipine)
Non-dihydropyridine CCB's (verapamil, diltiazem) Nitrates AVOID: non-selective B-Blockers (e.g. propranolol) ASA |
|
|
most likely cause of chest pain
ST segment elevation only during brief episodes of CP |
prinzmetal angina
|
|
|
most likely cause of chest pain
localized with one finger |
costochondritis
|
|
|
most likely cause of chest pain
chest wall tenderness on palpation |
musculoskeletal
|
|
|
most likely cause of chest pain
rapid onset sharp CP that radiates to the scapula |
aortic dissection
|
|
|
most likely cause of chest pain
rapid onset sharp CP in 20 y/o with assoc'd dyspnea |
spontaneous pneumothorax
|
|
|
most likely cause of chest pain
occurs after meals, improved with antacids |
GERD
esophageal spasm |
|
|
most likely cause of chest pain
sharp pain lasting hours to days and somewhat relieved by sitting forward |
pericarditis
|
|
|
most likely cause of chest pain
pain worsened by deep breathing or motion |
pleuritic or musculoskeletal
|
|
|
most likely cause of chest pain
along dermatome |
Herpes zoster (pain may appear before the rash)
|
|
|
most likely cause of chest pain
MCC of noncardiac CP |
GERD
musculoskeletal |
|
|
most likely cause of chest pain
acute onset dyspnea, tachycardia, confusion in hospitalized pt |
pulmonary embolism
|
|
|
most likely cause of chest pain
pain began a day following the start of an intense exercise program |
musculoskeletal
|
|
|
most likely cause of chest pain
widened mediastinum on CXR |
aortic dissection
|
|
|
which patient population is more likely to have atypical angina during episode of myocardial ischemia
|
diabetics
women elderly |
|
|
how does nitroglycerin work acutely in cardiac ischemic episodes
|
PERIPHERAL VENOUS VASODILATION -->
decr'd preload decr'd cardiac O2 demand NOTE: with ACUTE ISCHEMIA, coronary arteries are already maximally dilated, therefore, NTG cannot further dilate them! |
|
|
why shouldnt chest pain relieved by nitroglycerin be diagnostic of cardiac nature
|
can also relieve esophageal spasm and GERD
|
|
|
MOA:
streptokinase |
converts plasminogen --> plasmin --> degrades fibrin
|
|
|
MOA:
aspirin |
irreversibly inhibits COX 1 - 2 --> prevents plt aggregation
|
|
|
MOA:
clopidogrel |
ADP receptor blocker --> prevents plt aggregation
|
|
|
MOA:
abciximab |
GP IIb/IIIa Inhibitor --> prevents plt aggregation
|
|
|
MOA:
tirofiban |
GP IIb/IIIa Inhibitor --> prevents plt aggregation
|
|
|
MOA:
ticlopidine |
ADP receptor blocker --> prevents plt aggregation
|
|
|
MOA:
enoxaparin |
catalyzes activation of antithrombin
|
|
|
MOA:
eptifibatide |
GP IIb/IIIa Inhibitor --> prevents plt aggregation
|
|
|
cause of hyperthyroidism:
extremely tender thyroid gland |
subacute thyroiditis (i.e. De Quervain's)
|
|
|
cause of hyperthyroidism:
pretibial myxedema |
Grave's disease
|
|
|
cause of hyperthyroidism:
pride in recent wt loss, medical professional |
exogenous thyroid use
|
|
|
cause of hyperthyroidism:
palpation of single thyroid nodule |
toxic thyroid adenoma
|
|
|
cause of hyperthyroidism:
palpation of multiple thyroid nodules |
multinodular goiter
|
|
|
cause of hyperthyroidism:
recent study using IV contrast dye |
job-basedow phenomenon
|
|
|
cause of hyperthyroidism:
proptosis, ocular edema, & ocular injection |
Grave's disease
|
|
|
cause of hyperthyroidism:
h/o thyroidectomy or radioablation of thyroid |
excess thyroid hormone replacement
|
|
|
Rx of opioid overdose
|
naloxone
naltrexone |
|
|
classic presentation of aspirin overdose
|
n/v & dehydration
tinnitus hyperthermia AMS respiratory alkalosis (hyperventilation) --> mixed respiratory acidosis & metabolic acidosis with high AG |
|
|
first line treatment for growth hormone-secreting pituitary adenoma
|
transsphenoidal tumor resection
|
|
|
meds for all post-MI outpatients
|
ASA or clopidogrel
B-Blockers ACEI/ARB statin aldosterone antagonist |
|
|
Rx proven to reduce mortality following MI
|
B-Blockers
ACEI's/ARB's Statins |
|
|
what labs should be ordered in patients suspected of having an MI
|
SERIAL CARDIAC ENZYMES:
3 sets of Troponin-I q8 hrs 3 sets of CKMB q8 hrs |
|
|
MCC of death in patients with acute myocardial infarction
|
arrhythmia (V-Fib)
|
|
|
What is timeline for thrombolytics to be given in MI vs CVA
|
MI: 12 hrs after onset of sx's
CVA: 3 hrs after onset of sx's |
|
|
EKG leads & involved vessel:
anterior wall MI |
LEADS: V2 - V4
VESSEL: LAD |
|
|
EKG leads & involved vessel:
septal MI |
LEADS: V1 - V3
VESSEL: LAD |
|
|
EKG leads & involved vessel:
inferior wall MI |
LEADS: II, III, aVF
VESSEL: posterior descending |
|
|
EKG leads & involved vessel:
lateral wall MI |
LEADS: I, aVL, V5, V6
VESSEL: LAD/left circumflex |
|
|
Dx
px has HTN, mild hypernatremia, hypokalemia, metabolic alkalosis |
PRIMARY HYPERALDOSTERONISM:
Conn's Syndrome b/l adrenal hyperplasia |
|
|
antidote for:
salicylates |
activated charcoal
Na+Bicarb dialysis |
|
|
antidote for:
B-Blocker |
atropine
glucagon Ca2+ insulin & dextrose atropine |
|
|
antidote for:
digoxin |
activated charcoal
Dig Fab fragments |
|
|
antidote for:
iron |
deferoxamine
|
|
|
antidote for:
copper |
penicillamine
|
|
|
antidote for:
t-PA and Streptokinase |
aminocaproic acid
|
|
|
Rx for MI due to cocaine overdose
|
Benzo's (e.g. Lorazepam)
CCB's ** DO NOT GIVE B-BLOCKERS |
|
|
type of heart block:
PR interval is longer than .2 sec (5 small boxes) |
1st degree
|
|
|
type of heart block:
no relationship between P and QRS |
3rd degree
|
|
|
type of heart block:
PR interval becomes progressively longer until beat dropped |
2nd degree - Type I (aka Weinckebach's)
|
|
|
type of heart block:
PR interval fixed but with occasional blocked beats |
2nd degree - Type II
|
|
|
which heart block needs a pacemaker
|
2nd degree - Type II
3rd degree |
|
|
an EKG shows complete independence of P waves and QRS, what is the next best step
|
Dx: 3rd degree block
Tx: pacemaker |
|
|
pathology with EKG:
narrow QRS not a/w P waves rate of 60 bpm |
junctional rhythm
|
|
|
pathology with EKG:
narrow QRS not a/w P wave rate > 60 but < 100 |
accelerated junctional rhythm
|
|
|
pathology with EKG:
narrow QRS not a/w P wave rate > 100 |
junctional tachycardia
|
|
|
What is the tx for premature atrial contractions (PAC's)
|
observation
reduce caffeine stop smoking r/o hyperthyroidism |
|
|
px has atrial fib with rapid ventricular rate, he had a chronic atrial fib previously, what should be done before cardioversion
|
transesophageal echo (to look for atrial thrombus)
|
|
|
which endocrine disorder can cause atrial fib
|
hyperthyroidism
|
|
|
what is the drug of choice for acute onset atrial fib with rapid ventricular rate in a px with WPW
|
procainamide
electrical cardioversion |
|
|
Dx for multifocal atrial bradycardia (MFAB)
|
3+ different P wave morphologies
< 60 bpm |
|
|
Dx for wandering pacemaker (aka multifocal atrial rhythm)
|
3+ different P wave morphologies
< 100 bpm |
|
|
Dx for multifocal atrial tachycardia (MFAT)
|
3+ different P wave morphologies
> 100 bpm |
|
|
what is the drug of choice for paroxysmal supraventricular tachycardia
|
carotid massage
IV adenosine |
|
|
pathology with EKG:
wide QRS not a/w P waves rate 20-40 |
ventricular rhythm
|
|
|
pathology with EKG:
wide QRS not a/w P waves rate > 40 but < 100 |
accelerated ventricular rhythm
|
|
|
pathology with EKG:
wide QRS not a/w P wave rate > 100 |
ventricular tachy
|
|
|
pathology with EKG:
chaotic, no p-waves, no QRS |
V fib
|
|
|
pathology with EKG:
erratic QRS that varies in amplitude in a repeating pattern (sinusoidal) |
torsades
|
|
|
antiarrhythmic that should be avoided in px with preexisting lung disease
|
Amiodarone
|
|
|
What are some common SE's with the use of amiodarone & what should be monitored
|
Pulmonary fibrosis (monitor PFT's & diffusion capacity before starting & q 6 months)
Liver damage (monitor LFT's) Hyper/hypothyroidism (monitor TFT's) |
|
|
what are the classes of anti-arrhythmics
|
"SoBe PoCa"
CLASS I: Na+ channel blockers ("So" = sodium) CLASS II: B-Blockers ("Be" = Beta) CLASS III: K+ channel blockers ("Po" = potassium) CLASS IV: CCB's ("Ca" = calcium) OTHER: Adenosine |
|
|
generally, what arrhythmias do each anti-arrhythmic class tx
|
CLASS I:
V-Tach (lidocaine) CLASS II: PVC's A-fib/flutter MAT V-Tach CLASS III: A-fib/flutter CLASS IV: A-fib/flutter PSVT MAT ADENOSINE: PSVT (unless 2nd/2 WPW) |
|
|
What is Rx for SVT vs SVT 2nd/2 WPW
|
SVT: Adenosine
SVT 2ND/2 WPW: amiodarone procainamide catheter ablation of accessory pathway **DO NOT GIVE ADENOSINE |
|
|
area of the brain lesioned:
resting tremor |
basal ganglia
|
|
|
area of the brain lesioned:
intention tremor |
cerebellar hemisphere
|
|
|
area of the brain lesioned:
hyperorality, hypersexuality, disinhibited behavior |
b/l amygdala
|
|
|
area of the brain lesioned:
personality changes |
frontal lobe
|
|
|
area of the brain lesioned:
dysarthria |
cerebellar vermis
|
|
|
area of the brain lesioned:
agraphia, acalculia, & finger agnosia |
L parietal (dominant)
|
|
|
organism a/w with causing infection in burn px
|
pseudomonas aeruginosa
|
|
|
Rx for atrial fib of unknown duration
|
RATE CONTROL:
B-Blocker Non-DHP CCB (e.g. verapamil) Digoxin ANTICOAGULATE: Warfarin Heparin |
|
|
what are Kerley B lines and what are they associated with
|
subpleural interstitial (interlobular septa) thickening
seen on CXR in periphery of the lower lung zones 2nd/2 pulmonary edema ETIOLOGIES: LV failure, mitral valve disease lymphatic obstruction, lymphangitis, carcinomatosis asbestosis, sarcoidosis |
|
|
what is the normal range for the ejection fraction
what EF is considered HF |
nl = 55-75 %
HF < 55% |
|
|
what two cardiovascular diseases have the biggest risk factors for CHF
|
HTN
CAD |
|
|
what ECG finding may indicate a very early stage HF
|
LVH
|
|
|
what lab markers are used to help Dx acute exacerbations of CHF
|
BNP
|
|
|
what medications are important in the outpatient Rx for chronic congestive heart failure
|
**ACEI's (& certain ARB's)
**B-Blockers (bisoprol, carvedilol, metoprolol XR) **Aldosterone Antagonist (e.g. spironolactone) Loop diuretics (e.g. furosemide) Digoxin loops aldosterone - digoxin |
|
|
Rx for acute exacerbations of CHF
|
DISCONTINUE B-BLOCKERS (during exacerbation)
"LMNOP" loops morphine nitrates oxygen position/pressors (e.g. dobutamine) |
|
|
in which population are triptans contraindicated
|
CAD
prinzmetal angina pregnancy |
|
|
what drugs block transmission through AV node
|
B-Blockers
Non-DHP CCB's (e.g. verapamil, diltiazem) digoxin |
|
|
what causes stones, bones, groans and psychic overtones
|
hypercalcemia (MCC = hyperparathyroidism)
|
|
|
what valves have blood flowing during systole
|
aortic & pulmonic valves
|
|
|
what valves have blood flowing during diastole
|
mitral & tricuspid valves
|
|
|
what are the systolic heart murmurs
|
AS/PS
MR/TR VSD/MVP |
|
|
what are the diastolic heart murmurs
|
MS/TS
AR/PR |
|
|
what is next step in mgmt in w/u of a low-grade systolic murmur in an otherwise healthy, asx'c pt
|
no further w/u
|
|
|
what is next step in mgmt in w/u of a diastolic murmur in an otherwise healthy, asx'c pt
|
echocardiogram
|
|
|
type of heart murmur:
diastolic murmur heard best at LLSB, that increases with inspiration |
tricuspid stenosis
|
|
|
type of heart murmur:
late diastolic murmur with an opening snap (no change with inspiration) |
mitral stenosis
|
|
|
type of heart murmur:
systolic murmur heard best in the 2nd RICS, parasternal |
aortic stenosis
|
|
|
type of heart murmur:
systolic murmur heard best in the 2nd LICS, parasternal |
pulmonic stenosis
|
|
|
type of heart murmur:
late systolic murmur best heard at the apex |
MVP
|
|
|
type of heart murmur:
diastolic murmur with widened pulse pressure |
aortic regurg
|
|
|
type of heart murmur:
holosystolic murmur that is louder with inspiration at the LLSB |
tricuspid regurg
VSD |
|
|
type of heart murmur:
holosystolic murmur heard at the apex and radiates to the axilla |
mitral regurg
|
|
|
what is the MCC of CP in a pt with sudden tearing CP radiating to the back
|
aortic dissection
|
|
|
increased skin pigmentation is seen in pts with which kind of adrenal insufficiency
|
primary adrenal insufficiency (aka Addison's)
|
|
|
what are the classic sx's of Parkinson's
|
resting tremor ("pill rolling")
cog-wheel rigidity mask-like facies shuffling gait postural instability |
|
|
What is Kussmaul sign
|
Definition: JVD with inspiration
Pathology: decr'd capacity of RV Diseases: constrictive pericarditis >> tamponade |
|
|
What is Pulsus Paradoxus
|
Definition: decr'd SBP with inspiration ( > 10 mmHg)
Pathology: decr'd capacity of LV Diseases: tamponade >> pericarditis |
|
|
What is Beck's Triad & when is it seen
|
Seen with TAMPONADE
JVD (decr'd capacity of RV) hypotension (decr'd capacity of LV) distant heart sounds |
|
|
What is the classic appearance of the heart on CXR of a pt with pericardial effusion
|
enlarged, globular heart ("water bottle" shaped)
|
|
|
What is the tx for cardiac tamponade
|
immediate pericardiocentesis
|
|
|
What disease has signs of heart failure + DM + elevated LFT's
|
HEMOCHROMATOSIS:
Fe2+ deposition in heart --> dilated/restrictive cardiomyopathy Fe2+ deposition in pancrease --> DM Fe2+ deposition in liver --> incr'd LFT's |
|
|
in what scenarios might you see kussmaul sign
|
Kussmaul sign = incr'd JVD with inspiration
constrictive pericarditis restrictive cardiomyopathy cardiac tamponade RV infarct massive PE |
|
|
what are the symptoms of neuroleptic malignant syndrome
|
AMS
muscle rigidity hyperthermia autonomic instability rhabdomyolysis |
|
|
what is the treatment of neuroleptic malignant syndrome
|
d/c neuroleptic
cooling (for hyperthermia) dantrolene (or bromocriptine or amantadine) IVF's (to prevent rhabdomyolysis) |
|
|
what are the common viruses of myocarditis
|
echovirus
adenovirus EBV/CMV coxsackie influenza |
|
|
Dx:
S. american with cardiomegaly and achalasia |
chagas disease (trypanosoma cruzi)
|
|
|
what is the bug that causes Chagas Ds & what are the common findings
|
Bug: trypanosoma cruzi
Sx's: cardiomegaly, mega-esophagus (a/w achalasia), mega-colon |
|
|
what are the major jones criteria for rheumatic heart disease
|
joint pain (arthropathy)
heart (pancarditis) subcutaneous nodules erythema marginatum sydenham chorea |
|
|
What bugs should be considered with high suspicion of endocarditis but cultures are negative
|
"HACEK" organisims:
haemophilus actinobacillus cardiobacterium eikenella kingella |
|
|
what study is used to visualize a vegetation in a heart valve
|
TEE
|
|
|
Describe the 4 peripheral signs of endocarditis:
|
JANEWAY LESIONS:
PAINLESS petechiae on palm/soles OSLER'S NODES: PAINFUL nodules on fingers/toes ROTH SPOTS: retinal hemorrhages SPLINTER HEMORRHAGES: petechiae under the nails |
|
|
Dx:
hypocalcemia, high phosphorus, & low PTH |
hypoparathyroidism
|
|
|
what is the classic EKG finding in pericarditis
|
Global ST elevation (i.e. seen in all leads)
PR interval depression |
|
|
what commonly causes heart failure in young patients
|
myocarditis
|
|
|
What is pre-HTN
|
120-139/80-89
|
|
|
when should pre-HTN be tx'd
|
H/O OF COMORBIDITY:
CV disease DM CKD end-organ damage |
|
|
what is the most effective in reducing BP
|
Weight loss
|
|
|
what is the MCC of renal artery stenosis
|
fibromuscular dysplasia
|
|
|
screening test for renal artery stenosis
|
MRA of renal arteries
|
|
|
gold standard to Dx renal artery stenosis
|
renal arteriogram
|
|
|
what does renal artery stenosis show on radiologic
imaging |
"beads-on-a-string" appearance
|
|
|
MCC of secondary HTN
|
renal disease (CKD, ESRD, RAS)
|
|
|
most likely cause of secondary HTN:
HTN in arms but low BP in legs |
coarctation of aorta
|
|
|
most likely cause of secondary HTN:
proteinuria |
renal disease
|
|
|
most likely cause of secondary HTN:
hypokalemia |
primary hyperaldosteronism
RAS |
|
|
most likely cause of secondary HTN:
tachycardia, diarrhea, heat intolerance |
hyperthyroidism
|
|
|
most likely cause of secondary HTN:
hyperkalemia |
renal failure
|
|
|
most likely cause of secondary HTN:
episodic sweating and tachycardia |
pheochromocytoma
|
|
|
what lab marker is used to help dx acute CHF exacerbation
|
BNP
|
|
|
w/u for underlying cause of DKA
|
R/O INFECTION:
blood/urine cultures, UA, CXR R/O DRUGS: tox screen R/O PANCREATITIS: amylase/lipase R/O MI: EKG cardiac enzymes x 3 |
|
|
what is the preferred initial antihypertensive in a px with no comorbidities
|
thiazide
|
|
|
first line antihypertensive:
diabetes |
ACEI's/ARB's
|
|
|
first line antihypertensive:
heart failure |
ACEI's
B-Blockers Aldosterone antagonist |
|
|
first line antihypertensive:
BPH |
a1-Blocker
|
|
|
first line antihypertensive:
LV hypertrophy |
ACEI's/ARB's
|
|
|
first line antihypertensive:
hyperthyroidism |
B-Blocker (e.g. propranolol)
|
|
|
first line antihypertensive:
osteoporosis |
thiazides
|
|
|
first line antihypertensive:
benign essential tremor |
B-Blocker (e.g. propranolol)
|
|
|
first line antihypertensive:
post-menopausal woman |
thiazides
|
|
|
first line antihypertensive:
migraines |
B-Blockers
CCB's (e.g. verapamil) |
|
|
SE of antihypertensive:
first dose orthostatic hypotension |
a-Blockers
|
|
|
SE of antihypertensive:
hypertrichosis |
minoxidil
|
|
|
SE of antihypertensive:
dry mouth, sedation, severe rebound HTN |
clonidine (a2-agonist)
|
|
|
SE of antihypertensive:
bradycardia, impotence, asthma exacerbation |
non-selective B-Blocker
|
|
|
SE of antihypertensive:
reflex tachycardia |
vasodilators (eg. hydralazine, nitrates)
|
|
|
SE of antihypertensive:
cough |
ACEI's
|
|
|
SE of antihypertensive:
avoid in px with sulfa allergy |
loops
thiazides |
|
|
SE of antihypertensive:
angioedema |
ACEI's
|
|
|
SE of antihypertensive:
development of drug-induced lupus (anti-histone AB's) |
hydralazine
|
|
|
SE of antihypertensive:
cyanide toxicity |
Na+ nitroprusside
|
|
|
what is dilated by:
hydralazine |
arteries
|
|
|
what is dilated by:
CCB |
arteries & veins
|
|
|
what is dilated by:
nitroprusside |
arteries & veins
|
|
|
what is dilated by:
nitroglycerin |
venodilation
|
|
|
what is the MCC of cushings syndrome
|
#1 exogenous glucocorticoids
#2 pituitary ACTH-secreting tumor (i.e. Cushing's Ds) |
|
|
what is the Parkland burn formula
|
4mL x body wt in kg x %BSA:
1/2 given in 1st 8 hrs 1/2 given over following 16 hrs |
|
|
what is becks triad for cardiac tamponade
|
JVD (decr'd capacity of RV)
hypotension (decr'd capacity of LV) distant heart sounds |
|
|
hypoperfusion and resultant tissue ischemia are the concern in shock pt's
what is the chemical marker for this |
lactate
|
|
|
what complications can arise from the use of vasopressors such as NE in treating shock
|
ischemia/necrosis of fingertips/toes
mesenteric ischemia renal failure |
|
|
pathophysiology of shock:
cardiogenic |
failure of the pump
|
|
|
pathophysiology of shock:
extracardiogenic |
compression of the pump
|
|
|
pathophysiology of shock:
hypovolemic |
not enough fluid to pump
|
|
|
pathophysiology of shock:
anaphylactic |
widespread vasodilation in response to allergen
|
|
|
pathophysiology of shock:
neurogenic |
widespread vasodilation due to loss of autonomic-regulated vascular tone
|
|
|
pathophysiology of shock:
septic |
widespread vasodilation due to massive release of inflammatory mediators
|
|
|
CO, SVR, PCWP:
cardiogenic shock |
CO: decr'd
SVR: incr'd PCWP: incr'd (source: Step-Up-to-Med, 2nd ed) |
|
|
CO, SVR, PCWP:
hypovolemic shock |
CO: decr'd
SVR: incr'd PCWP: decr'd (source: Step-Up-to-Med, 2nd ed) |
|
|
CO, SVR, PCWP:
neurogenic |
CO: decr'd
SVR: decr'd PCWP: decr'd (source: Step-Up-to-Med, 2nd ed) |
|
|
CO, SVR, PCWP:
septic |
CO: incr'd
SVR: decr'd PCWP: decr'd (source: Step-Up-to-Med, 2nd ed) |
|
|
what are the 2 MC SE's of statin use & assoc'd labs
|
hepatotoxicity: elevated LFTs
myositis: elevated CPK |
|
|
which BP medication should be avoided in px with ischemic stroke or SAH b/c of the increase in ICP
|
nitroprusside
nitroglycerin |
|
|
what are the indications for surgical repair of aortic aneurysm
|
diameter > 5.5 cm for men
diameter > 5.0 cm for women diameter increase by more than 5 mm in 6 months sx'c (e.g. tenderness, pain in abdomen or back) |
|
|
What are the components of management of peripheral artery disease (PAD)
|
smoking cessation
exercise (to increase collateral flow) glucose & BP control cilastozol (improve flow to LE & decr claudication) ASA or clopidogrel + statin (to reduce CV events) |
|
|
how do confirm Dx of aortic dissection
|
CT - chest with contrast
|
|
|
Who should be screened for an AAA
|
MEN 65-75 y/o with h/o smoking
SX'C PT's (e.g. pulsatile abdominal mass) |
|
|
What study should be ordered for a pt suspected of having a AAA
|
ultrasound
|
|
|
what is the next best step in the management of a px with a DVT that has a high likelihood of falling
|
IVC filter
|
|
|
How is Kawasaki's dx'd
|
Fever + 4/5 "CRASH" sx's
Conjuctivitis (b/l, non-exudative, painless) Rash (truncal) Adenopathy (cervical LN's) Strawberry tongue + diffuse mucous membrane erythema Hands and Feet: edema with induration, erythema, or desquamation |
|
|
how is kawasaki treated
|
IVIG
high-dose aspirin (acute phase) low-dose aspirin (48-hrs after fever resolution) echocardiogram (during acute phase + 6-8 wks later) |
|
|
vasculitis a/w:
weak pulse on upper extremity |
takayasu's
|
|
|
vasculitis a/w:
necotizing immune complex inflammation of visceral/renal vessels |
PAN
|
|
|
vasculitis a/w:
young male smokers |
buerger's
|
|
|
vasculitis a/w:
young asian women |
takayasu's
|
|
|
vasculitis a/w:
young asthmatics |
churg-strauss
|
|
|
vasculitis a/w:
infants and young children, involves coronary arteries |
kawasaki
|
|
|
vasculitis a/w:
MCC of vasculitis |
temporal arteritis
|
|
|
vasculitis a/w:
a/w Hep B infection |
PAN
|
|
|
vasculitis a/w:
occlusion of opthalmic artery that leads to blindness |
temporal arteritis
|
|
|
vasculitis a/w:
unilateral headache, jaw claudication |
temporal arteritis
|
|
|
what autoimmune complication occurs 2-4 weeks post-MI
|
dressler syndrome --> pericarditis (fever, incr'd ESR)
|
|
|
what type of psychotherapy is used to treat phobias, obsessive compulsive disorders and panic disorders
|
cognitive behavioral therapy
|
|
|
ebsteins anomoly is a/w
|
maternal lithium use
|
|
|
what is found in ebsteins anomaly
|
tricuspid leaflets are displaced into RV
hypoplastic RV & dilated RA tricuspid regurg, wide split S2 patent foramen ovale (80%) |
|
|
for which arrhythmias are pt's with ebstein's anomaly at incr'd risk; what causes this incr'd risk
|
SVT & WPW
2nd/2 dilated right atrium |
|
|
Dx:
6 week old infant present to ER with irritability and signs of L sided heart failure EKG finds a left sided MI |
Dx: anomolous origin of the L main coronary artery
(arises from pulmonary artery rather than the aorta) |
|
|
MC congenital heart defect
|
VSD
|
|
|
what is used to close a PDA
|
indomethacin
|
|
|
what is used to keep PDA open in px with TOGV
|
prostaglandin E
|
|
|
what are the abnormalities a/w tetrology of fallot
|
VSD
overriding aorta pulmonary stenosis (RV outflow obstruction) RVH |
|
|
what heart defect are down syndrome patients higher risk of getting
|
endocardial cushion defect
|
|
|
What are the unique structures of the fetal circulation that close after birth
|
umbilical vein & 2 umbilical arteries
ductus venosus foreman ovale ductus arteriosus |
