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137 Cards in this Set

  • Front
  • Back
What are the common viruses that cause myocarditis?
coxsackie virus, Echovirus, Adenovirus, EBV, CMV, Influenza
A south American immigrant has cardiomegaly and achalasia. What is the organism likely responsible for this patient's disease?
Chagas Disease - Trypanosoma Cruzi
What are the major JONES criteria in the diagnosis of rheumatic heart disease?
Joints (polyarthritis)
Heart - pancarditis & vallve damage
Nodules (subcutaneous)
Erythema marginatum (painless rash)
Syndenham's Chorea
What is the mneumonic to remember the classic physical exam findings of endocarditis?
Roth Spots
Osler's Nodes
Janeway Lesions
Nail-bed hemorrhages
Tiny septic emboli fly off the infected valve in endocarditis and travel to peripheral vessels, causing tiny hemorrhages. What are the names of some of these sites of micro-hemorrhages?
Janeway lesions - peripheral petechiae
Osler's nodes - tender nodules on finger & toe pads
Roth's spots - retinal hemorrhages
Splinter hemorrhages - sublingual petechiae
What is the best study to visualize a vegetation on a heart valve?
TransEsophageal Echocardiogram (TEE)
What is the treatment for endocarditis?
long-term IV antibiotics (4-6wks)
What blood pressure defines prehypertension? How should prehypertension be managed?
PreHTN = SBP 120-139, DBP 80-89

- if pts SBP is >130 or DBP >80 and has DM, Chronic Kidney Disease, end organ damage, or cardiovascular disease then medical management with an antihypertensive agent is indicated
-if none of the above comorbidities, then non-pharmacologic management with weight reduction, sodium restriction, increased physical activity, and avoidance of excess alcohol
What blood pressure range is considered pre-HTN?
SBP 120-139
DBP = 80-89

weight loss
decrease salt intake
decrease alcohol
increase exercise
How many consecutive abnormally high readings are needed before prescribing BP medications?
What is the typical first line agent prescribed in treating newly diagnosed HTN?
Thiazide diuretics (HCTZ & chlorthalidone)
what is the chemical that increases as a result of ACE inhibitors, and is though to cause the adverse effects of cough & angioedema?
Which BP medication should all DM, CHF, and post-MI pts take as part of their BP regimen?
ACE inhibitor or ARB
Which antihypertensive can cause first dose orthostatic hypotension?
Which antihypertensive can cause hypertrichosis?
minoxidil (Rogaine)
Which antihypertensive can cause dry mouth, sedation, severe rebound hypertension?
Which antihypertensive can cause bradycardia, impotence, asthma exacerbation?
non-selective beta-blockers
Which antihypertensive can cause reflex tachycardia?
Nitroprusside (vasodilator)
Which antihypertensive can cause cough?
ACE Inhibitors
Which antihypertensive should be avoided in pts with sulfa allergies?
Thiazide & loop diuretics
Which antihypertensive can cause angioedema?
ACE Inhibitors
Which antihypertensive can cause drug-induced lupus?
Which antihypertensive can cause cyanide toxicity?
which antihypertensives can be used in pregnancy?
labetalol, methyldopa, hydralazine, nifedipine
What tests can be used to diagnose renal artery stenosis?
Renal arteriogram - gold standard, but invasive
MRA of renal arteries - most freq used screening test
Renal artery duplex scan - capable of detecting bilateral renal artery stenosis (unlike CT or MRA) but time consuming (2 hrs) and must have well-trained operator
Helical CT of renal arteries with IV contrast
Captopril renal ultrasound
What is the most common cause of secondary HTN?
Renal disease (renal artery stenosis, chronic renal disease, end stage renal disease)
What can be offered as an alternative contraceptive to a woman whose current estrogen-containing OCPs are causing HTN?
Progestin-only methods (progestin-only pills, DepoProvera, Implanon, Mirena)
Hypoperfusion and resultant tissue ischemia are the concern in shock pts. What is the chemical marker of this?
elevated lactic acid level
What is the mechanism behind cardiogenic shock?
failure of the pump
What is the mechanism behind extra-cardiogenic shock?
compression of the pump (tension pneumothorax, massive hemothorax, cardiac tamponade)
What is the mechanism behind hypovolemic shock?
not enough fluid to pump
What is the mechanism behind anaphylactic shock?
widespread vasodilation & release of vasodilatory agent in response to allergen
What is the mechanism behind neurogenic shock?
widespread vasodilation & loss of autonomic regulated vascular tone
What is the mechanism behind septic shock?
widespread vasodilation & massive release of inflammatory mediators
HTN + depression + kidney stones

What complication can arise from the use of vasopressors such as norepinephrine (NE) in treating shock?
peripheral vasoconstriction & ischemia (finers & toes, mesenteric ischemia, renal failure)
What intervention is most effective at reducing blood pressure?
weight loss
What is the preferred initial antihypertensive in a pt with no comorbidities?
Thiazide diuretic
Which anti-HTN is first line in pts with diabetes
ACE inhibitor/ ARB
Which anti-HTN is first line in pts with BPH
Which anti-HTN is first line in pts with heart failure
ACE Inhibitor/ ARB,
Aldosterone Antagonists
Which anti-HTN is first line in pts with left ventricular hypertrophy
ACE inhibitor/ ARB
Which anti-HTN is first line in pts with hyperthyroidism
Which anti-HTN is first line in pts with osteoporosis
Thiazide diuretics
Which anti-HTN is first line in pts with benign essential tremor
Which anti-HTN is first line in post-menopausal females?
thiazide diuretics

loops lose Calcium, thiazides dont
Which anti-HTN is first line in pts with migraines?
HTN measures in arms but low BP in lower extremity

What is the most likely cause of HTN?
coarctation of aorta
What is the most likely cause of HTN?

pt found to have proteinuria
renal disease
What is the most likely cause of secondary HTN with the follow finding:

tachycardia + diarrhea + heat intolerance

What is the most likely cause of HTN?
What is the most likely cause of secondary HTN with the follow finding:
renal failure or renal artery stenosis
pt has episodes of excessive sweating + tachycardia

What is the most likely cause of HTN?
oompare the vasodilating effects of:
Dihydropyridine CCBs
Nitroglycerin = venous vasodilator
Dihydropyridine CCBs = dilates both arteries & veins
Hydralazine = arterial vasodilator
Nitroprusside = dilates both arteries & veins
What are the HACEK bacteria?
What are the indications for the repair of AAA to prevent future rupture?
Diameter > 5.5cm
↑ in diameter by more than .5cm in a 6mo interval (should be receiving abd sono q 6mos)
symptomatic (ie tenderness, pain in abdomen or back)
What is the w/u for a pt with peripheral artery disease (PAD) considering surgical corrections?
Generally the steps of surgical evaluation for PVD are as follows: physical exam → ankle-brachial index (ABI) (to confirm diagnosis) → segmental pressures and/or LE duplex/Doppler (to determine lesion location, morphology) → lower extremity arteriogram (to map the disease extent and locations in order to determine the best tx option) → surgery
Cardiac stress test prior to surgery b/c pts are likely to also have CAD needing intervention prior to PAD surgery
What are the components of medical, conservative management of peripheral artery disease (PAD)?
Smoking cessation; Glucose & BP control
Daily exercise to ↑ collateral flow
Cilostazol (pletal) 100mg BID to improve flow to LE and ↓claudication. It is better than pentoxifylline (Trental) 400mg tid. Contraindicated if any heart failure due to ↑mortality.
Aspirin or Plavix qd to ↓ cardiovascular events
Statin therapy to ↓ cardio events and ↑ pain-free walking distance
Other possibly effective therapies: Trental (2nd line to Pletal) Ginko biloba
Not Effective: Vit E
What options are available to treat varicose veins?
Weight reduction, avoidance of prolonged stockings, leg elevation
Compression stockings: OTC support stockings, Class I stockings (20-30mmHg), or Class II stockings (30-40mmHg)
Sclerotherapy: injection of substance directly into the vein that causes injury & thrombosis
Surgery: involving ligation of the long sphenous vein or short saphenous vein
What is an Unna boot, and when is its used indication?
Inelastic banadage that is impregnanted with zinc oxide paste + calamine lotion + glycerine + gelatin
Indicated for ulcer arising from chronic venous insufficiency
Pts preder to use hydrocolloid dressing that can be changed at home q5-7 days instead of the Unna boot which must be placed by trained personnel q1-3wks. The effectiveness in ulcer healing is the same for both
What are the different methods available for the primary prevention of DVT?
What is the treatment for superficial thrombophlebitis?
What study should be ordered for a pt suspected of having an Abdominal aortic aneurysm (AAA)?
Ultrasound of the abdomen
What are recommendations for screening for AAA with u/s?
All males btw the ages of 65-75yrs with any h/o smoking & men ages 65-75 yrs who have never smoked but who have a 1st degree relative who required repair of AAA or died from ruptured AAA
What are the first recommendations to pts with claudication besides medication optimization?
Stop smoking, ↑ exercise/walking
If these fail, consider surgical option
What are several methods to prevent DVTs in hospitalized pts?
Place SCDs
Anticoagulate – Enoxaparin/ Heparin or warfarin
What should be ordered in a pt suspected of having a DVT?
D-dimer (good for ruling out)
Bilateral lower extremity duplex U/S
A pt comes to the ER following a MVC and CXR reveals a widened mediastinum. What imaging would confirm dx?
Contrast CT scan of the chest
How is Kawasaki’s disease diagnosed?
“CRASH & burn”
Conjunctivitis – bilateral, nonexudative, painless
Rash - truncal
Adenopathy- of the cervical lymph nodes
Strawberry tongue – and diffuse mucus membrane erythema
Hands & feet have edema with induration, erythema & desquamation
Fever > 5 days (>40C or 104°F)
Note: coronary artery aneurysms can occur w/in weeks of the illness onset, but are not indicated in diagnostic criteria
How is Kawasaki’s disease treated?
IVIG (2g/kg over 8-12 hrs) – ideally w/in the first 10 days
High-dose aspirin (80-100mg/kg/day in 4 divided doses) in the acute phase of the illness continued until 48hrs after fever resolution, followed by low-dose aspirin (3-5 mg/kg/day) until inflammatory markers (ESR, platelets) return to normal (usually 6 weeks)
(steroids are not indicated and are of no proven benefit)
Echocardiogram in the acute phase & 6-8 wks later
A 55yo F presents with c/o new headache, jaw claudication, and tenderness of the temporal artery. What test will reveal dx? What is the treatment?
Dx: Temporal artery biopsy
Tx: steroids & aspirin
Why should steroids be started immediately in pts in which you have a high suspicion of temporal arteritis?
Prevent vision loss
35 yo Japanese-American F has fever, malaise, and ↓ carotid & limb pulses. What will be seen on radiology? Biopsy?
Radiology: defects along the aorta & its branches
Biopsy: fibrosis, giant cells, plasma cells & lymphocytes w/in the media & adventitia of affected vessels
A known asthmatic develops ↑ fatigue, fever & rash. What vasculitis might she have? What might be seen on blood tests?
Dx: Churgg-Strauss
Blood tests: ↑ serum eosinophils, ↑ ESR, (+) pANCA
What are the signs & symptoms of Kawasaki disease?
“CRASH & burn”
Conjunctivitis, Rash, Adenopathy, Strawberry tongue
Hands & feet have edema with induration, erythema & desquamation
Fever > 5 days
What is the tx for Kawasaki disease? What complication is the treatment trying to prevent?
Tx: Aspirin + IVIG, trying to prevent aneurysms
What is the treatment for ventricular septal defects?
What are the characteristics of Ebstein’s Anomaly?
a/w maternal Lithium use
Tricuspid Leaflets are displaced into right ventricle, hypoplastic right ventricle, tricuspid regurg or stenosis
80% have a patent foramen ovale with R → L shunt
Dilated right atrium = ↑ risk of SVT & WPW
Exam: widely split S2, tricuspid regurgitation
Tx: PGE, digoxin, diuresis, propanolol for SVT
What are the unique structures of the fetal circulation that close after birth?
Umbilical vein, umbilical arteries (2)
Ductus arteriosus, ductus venosus
Foramen ovale
HYQ: What medication is used to close a PDA?
Note: Prostaglandin E keeps it open
think: to open the door, you gotta "push it, push it real good" (Push/Prost)
A newbown is found to have a congenital heart disease that causes early cyanosis. What drug does this newborn need?
Prostaglandin E
What is the most common congenital heart defect?
Describe briefly the sequence of events in Eisenmenger’s syndrome:
L to R shunt → ↑ blood in pulmonary vasculature, ↑ resistance → shunt reverses R to L
What are the abnormalities a/w Tetrology of Fallot?
VSD, overriding aorta, RVH, RV outflow obstruction/stenosis of pulmonary artery
What heart defect are Down syndrome pts at higher risk for?
Endocardial cushion defect
HYQ: 6wk old infant presents to the pediatric ER for irritability & is found to have signs of left-sided heart failure. An EKG is interpreted as a left-sided MI. What is the most likely dx?
Anomalous origin of the left coronary artery
Arises from the pulmonary artery rather than the aorta & carries deoxygenated blood
HYQ: What class of medications is indicated in pts with a hereditary prolongation of the QT interval in order to prevent episode of ventricular fibrillation?
β-blockers (propanolol)
What type of vasculitis:
Weak pulses in upper extremity
Necrotizing granulomas of lung & necrotizing glomerulonephritis
Necrotizing immune complex inflammation of visceral/ renal vessels in young male smokers
What type of vasculitis is seen with young asthmatics?
What type of vasculitis is seen in Infants & young children; involves coronary arteries
Most common vasculitis
Temporal (Giant cell) arteritis
what type of vasculitis is assoc with hep B infection
Polyarteritis nodosa
In which type of vasculitis can you see occlusion of ophthalmic artery that can lead to blindness?
Temporal (giant cell) arteritis
Perforation of nasal septum
Unilateral headache, jaw claudication
Temporal (giant cell) arteritis
What is the next step in the management of a pt with a DVT that has a high likelihood of falling?
IVC filter
What are the components of the medical management of peripheral artery disease (PAD)?
Smoking cessation
↑ exercise
glucose control
BP control
What are the indications for operating on an AAA?
Size >5.5 cm
Rate of increase > 0.5cm in 6 mos
Who should be screened for an abdominal aortic aneurysm?
All males btw the ages of 65-75yrs with any h/o smoking & men ages 65-75 yrs who have never smoked but who have a 1st degree relative who required repair of AAA or died from ruptured AAA
What are some of the complications/ reactions that can arise from blood transfusions?
In a Swan-Ganz catheter (pulmonary artery catheter), the wedge pressure is equal to what?
Left atrial pressure
Which blood products replace clotting factors?
FFP, Cryoprecipitate, Whole blood
Clotting factors from donors
Recombinant factors, Autologus blood
A pt is brought to the ER s/p MVA. It appears he has sustained blunt trauma & is hypOtensive. You immediately order a type & cross and start IVF. The pt is found to be type O neg so the lab sends up 6units of AB+ pRBCs. What is the next step?
Send it back! He needs O neg blood
For what indications would you use the following?
What is the cause of acute hemolytic transfusion reaction? Anaphylactic reaction?
Acute hemorlytic: ABO incompatibility

Anaphylactic: anti-IgA IgG Abs react in IgA deficient pts
What are some agents used to treat shock due to a weakly beating heart?
Dopamine, Dobutamine, Epinephrine, Isoproterenol, Norepinephrine
What commonly used agents cause peripheral vasoconstriction?
Norepinephrine, Vasopressin, Epinephrine, Phenylephrine
What medications are used to treat febrile & urticarial transfusion reactions?
Acetominophen & Diphenhydramine
What is the typical ER lab work-up for a pt with acute abdominal pain?
CBC with differential
Chem 14
β-hCG if female
amylase, lipase
stool guaiac
What are the signs & symptoms of acute mesenteric ischemia?
Sudden onset of severe abdominal pain (periumbilical) that is OUT OF PROPORTION TO THE EXAM
Vomiting & diarrhea
Condition that could cause emboli formation (ie atrial fibrillation)
Early exam: mostly normal, abdominal distention +/- occult blood on stool
Late exam (bowel infarction): abdominal distention, absent bowel sounds, peritoneal signs, feculent odor to the breath
What is the treatment for acute mesenteric ischemia?
What are the classic signs/symptoms of chronic mesenteric ischemia?
Aka intestinal angina
Dull, crampy, postprandial epigastric pain within the first hour after eating then subsiding over 2 hrs
Weight loss (due to food aversion to avoid postprandial pain)
Possibly nausea, vomiting, and early satiety
Abdominal bruit (50%)
What are the treatment option for chronic mesenteric ischemia?
Bypass, endarterectomy, angioplasty
Which oral hypoglycemia medicine should NOT be given when a pt is to have a radiologic procedure in which he will need IV contrast?
Note: metformin + contrast dye → lactic acidosis
A patient taking warfarin chronically for a h/o thromboembolism requires surgery. What can be given in the perioperative period to keep the patient anticoagulated?
Heparin or LMWH
What are the 5 W’s of post-operative fever? To what do they refer?
Wind – atelectasis / pneumonia
Water – UTI (foley catheter)
Walking – DVT / PE
Wound – wound infection
Wonder drugs – drug reaction
“Wein” (Vein) – thrombophlebitis, DVT
also think sinusitis if NG tube in place
What studies are ordered to evaluate the cause of a fever in a postop patient?
CXR, UA, urine culture, blood cultures
Sputum culture, wound culture
What is used to evaluate patients that may have a lower extremity DVT?
D-dimer and/or bilateral lower extremity ultrasound
What should be prescribed to abdominal post-op patients to help reduce atelectasis?
Incentive spirometry
Deep breathing exercises
Physical therapy
+/- bronchodilators & inhaled steroids
Other notes:
LMWH should NOT be restarted until at least 2 hrs after removal of epidural catheter to avoid epidural hematoma

Renal protective measures:
Hydration, IV bicarb, NAC (n-acetylcysteine)
Clean-contaminated wounds involve an incision through disinfected skin & would involve one or more of the following structures?
GI tract, respiratory tract, vagina
What is seen on abdominal x-ray or CT scan that indicates a ruptured viscus?
Free air (radiolucent/ black)
What is the classic finding in the abdominal exam of a patient with mesenteric ischemia?
Pain out of proportion to the exam
During a surgical procedure, the anesthesiologist notices that the patient’s temperature has climbed quickly and her muscles are rigid. Recognizing this feared complication, the doctor should administer which medicine?
Dantrolene (think malignant hyperthermia)
What are a few contraindications to the transplant of the following organs?
Heart – smoking, pulmonary hypertension
Lung – smoking, poor cardiac/liver/renal failure
Liver – alcoholism, multiple suicide attempts
What is the type of rejection that is treatable with immunosuppressive agents? What is the mechanism of this rejection? Within what time frame may it show up?
Acute rejection
What is the usual lab panel ordered in a pt presenting to the ER with generalized abdominal pain?
CBC with differential, Chem 8 / BMP, LFTs, Urine analysis
β-hCG (if female)
stool guaiac
amylase, lipase
EKG & cardiac enzymes if > 45 yrs old
What is the usual time frame for stopping warfarin prior to surgery?
3 – 4 days prior to surgery
What interventions are helpful in optimizing lung function in the post-op period in patients with pre-existing lung disease?
Incentive spirometry
Pain control
Deep breathing
Physical therapy
Inhaled steroids
What type of immunodeficiency increases the risk of anaphylactic transfusion reaction?
IgA deficiency
What lab findings suggest hepatic disease during a pre-op work-up?
↓ platelets
↑ bilirubin
↑ or ↓ transaminases
↓ albumin
What are the preferred vessels in the placement of a Swan-Ganz catheter?
Right IJ or Left Subclavian
When is the greatest risk for a post-operative MI? What is recommended perioperatively for pts with known CAD?
With in first 48 hrs
Telemetry monitoring
Which vasopressor matches the following statement?
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Which blood product is most appropriate in the following scenarios?
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