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137 Cards in this Set
- Front
- Back
What are the common viruses that cause myocarditis?
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coxsackie virus, Echovirus, Adenovirus, EBV, CMV, Influenza
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A south American immigrant has cardiomegaly and achalasia. What is the organism likely responsible for this patient's disease?
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Chagas Disease - Trypanosoma Cruzi
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What are the major JONES criteria in the diagnosis of rheumatic heart disease?
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Joints (polyarthritis)
Heart - pancarditis & vallve damage Nodules (subcutaneous) Erythema marginatum (painless rash) Syndenham's Chorea |
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What is the mneumonic to remember the classic physical exam findings of endocarditis?
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"FROM JANE"
Fever Roth Spots Osler's Nodes Murmur Janeway Lesions Anemia Nail-bed hemorrhages Emboli |
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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?
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Janeway lesions - peripheral petechiae
Osler's nodes - tender nodules on finger & toe pads Roth's spots - retinal hemorrhages Splinter hemorrhages - sublingual petechiae |
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What is the best study to visualize a vegetation on a heart valve?
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TransEsophageal Echocardiogram (TEE)
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What is the treatment for endocarditis?
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long-term IV antibiotics (4-6wks)
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What blood pressure defines prehypertension? How should prehypertension be managed?
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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 |
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What blood pressure range is considered pre-HTN?
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SBP 120-139
DBP = 80-89 management: weight loss decrease salt intake decrease alcohol increase exercise |
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How many consecutive abnormally high readings are needed before prescribing BP medications?
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3
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What is the typical first line agent prescribed in treating newly diagnosed HTN?
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Thiazide diuretics (HCTZ & chlorthalidone)
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what is the chemical that increases as a result of ACE inhibitors, and is though to cause the adverse effects of cough & angioedema?
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bradykinin
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Which BP medication should all DM, CHF, and post-MI pts take as part of their BP regimen?
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ACE inhibitor or ARB
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Which antihypertensive can cause first dose orthostatic hypotension?
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alpha-blockers
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Which antihypertensive can cause hypertrichosis?
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minoxidil (Rogaine)
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Which antihypertensive can cause dry mouth, sedation, severe rebound hypertension?
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Clonidine
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Which antihypertensive can cause bradycardia, impotence, asthma exacerbation?
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non-selective beta-blockers
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Which antihypertensive can cause reflex tachycardia?
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Nitroprusside (vasodilator)
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Which antihypertensive can cause cough?
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ACE Inhibitors
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Which antihypertensive should be avoided in pts with sulfa allergies?
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Thiazide & loop diuretics
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Which antihypertensive can cause angioedema?
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ACE Inhibitors
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Which antihypertensive can cause drug-induced lupus?
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Hydralazine
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Which antihypertensive can cause cyanide toxicity?
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nitroprusside
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which antihypertensives can be used in pregnancy?
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labetalol, methyldopa, hydralazine, nifedipine
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What tests can be used to diagnose renal artery stenosis?
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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 |
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What is the most common cause of secondary HTN?
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Renal disease (renal artery stenosis, chronic renal disease, end stage renal disease)
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What can be offered as an alternative contraceptive to a woman whose current estrogen-containing OCPs are causing HTN?
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Progestin-only methods (progestin-only pills, DepoProvera, Implanon, Mirena)
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Hypoperfusion and resultant tissue ischemia are the concern in shock pts. What is the chemical marker of this?
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elevated lactic acid level
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What is the mechanism behind cardiogenic shock?
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failure of the pump
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What is the mechanism behind extra-cardiogenic shock?
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compression of the pump (tension pneumothorax, massive hemothorax, cardiac tamponade)
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What is the mechanism behind hypovolemic shock?
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not enough fluid to pump
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What is the mechanism behind anaphylactic shock?
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widespread vasodilation & release of vasodilatory agent in response to allergen
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What is the mechanism behind neurogenic shock?
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widespread vasodilation & loss of autonomic regulated vascular tone
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What is the mechanism behind septic shock?
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widespread vasodilation & massive release of inflammatory mediators
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HTN + depression + kidney stones
Dx? |
hyperparathyroidism
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What complication can arise from the use of vasopressors such as norepinephrine (NE) in treating shock?
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peripheral vasoconstriction & ischemia (finers & toes, mesenteric ischemia, renal failure)
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What intervention is most effective at reducing blood pressure?
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weight loss
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What is the preferred initial antihypertensive in a pt with no comorbidities?
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Thiazide diuretic
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Which anti-HTN is first line in pts with diabetes
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ACE inhibitor/ ARB
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Which anti-HTN is first line in pts with BPH
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alpha-blockers
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Which anti-HTN is first line in pts with heart failure
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ACE Inhibitor/ ARB,
beta-blocker Aldosterone Antagonists |
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Which anti-HTN is first line in pts with left ventricular hypertrophy
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ACE inhibitor/ ARB
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Which anti-HTN is first line in pts with hyperthyroidism
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Propanolol
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Which anti-HTN is first line in pts with osteoporosis
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Thiazide diuretics
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Which anti-HTN is first line in pts with benign essential tremor
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beta-blocker
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Which anti-HTN is first line in post-menopausal females?
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thiazide diuretics
loops lose Calcium, thiazides dont |
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Which anti-HTN is first line in pts with migraines?
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beta-blockers
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HTN measures in arms but low BP in lower extremity
What is the most likely cause of HTN? |
coarctation of aorta
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What is the most likely cause of HTN?
pt found to have proteinuria |
renal disease
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What is the most likely cause of secondary HTN with the follow finding:
hypokalemia |
hyperaldosteronism
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tachycardia + diarrhea + heat intolerance
What is the most likely cause of HTN? |
hyperthyroidism
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What is the most likely cause of secondary HTN with the follow finding:
hyperkalemia |
renal failure or renal artery stenosis
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pt has episodes of excessive sweating + tachycardia
What is the most likely cause of HTN? |
pheochromocytoma
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oompare the vasodilating effects of:
Nitroglycerin Dihydropyridine CCBs Hydralazine Nitroprusside |
Nitroglycerin = venous vasodilator
Dihydropyridine CCBs = dilates both arteries & veins Hydralazine = arterial vasodilator Nitroprusside = dilates both arteries & veins |
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What are the HACEK bacteria?
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Haemophilus
Actinobacillus Cardiobacterium Eikenella Kingella |
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What are the indications for the repair of AAA to prevent future rupture?
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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) |
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What is the w/u for a pt with peripheral artery disease (PAD) considering surgical corrections?
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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 |
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What are the components of medical, conservative management of peripheral artery disease (PAD)?
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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 |
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What options are available to treat varicose veins?
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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 |
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What is an Unna boot, and when is its used indication?
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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 |
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What are the different methods available for the primary prevention of DVT?
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What is the treatment for superficial thrombophlebitis?
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What study should be ordered for a pt suspected of having an Abdominal aortic aneurysm (AAA)?
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Ultrasound of the abdomen
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What are recommendations for screening for AAA with u/s?
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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
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What are the first recommendations to pts with claudication besides medication optimization?
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Stop smoking, ↑ exercise/walking
If these fail, consider surgical option |
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What are several methods to prevent DVTs in hospitalized pts?
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Place SCDs
Ambulate Anticoagulate – Enoxaparin/ Heparin or warfarin |
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What should be ordered in a pt suspected of having a DVT?
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D-dimer (good for ruling out)
Bilateral lower extremity duplex U/S |
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A pt comes to the ER following a MVC and CXR reveals a widened mediastinum. What imaging would confirm dx?
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Contrast CT scan of the chest
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How is Kawasaki’s disease diagnosed?
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“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 |
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How is Kawasaki’s disease treated?
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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 |
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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?
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Dx: Temporal artery biopsy
Tx: steroids & aspirin |
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Why should steroids be started immediately in pts in which you have a high suspicion of temporal arteritis?
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Prevent vision loss
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35 yo Japanese-American F has fever, malaise, and ↓ carotid & limb pulses. What will be seen on radiology? Biopsy?
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Radiology: defects along the aorta & its branches
Biopsy: fibrosis, giant cells, plasma cells & lymphocytes w/in the media & adventitia of affected vessels |
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A known asthmatic develops ↑ fatigue, fever & rash. What vasculitis might she have? What might be seen on blood tests?
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Dx: Churgg-Strauss
Blood tests: ↑ serum eosinophils, ↑ ESR, (+) pANCA |
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What are the signs & symptoms of Kawasaki disease?
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“CRASH & burn”
Conjunctivitis, Rash, Adenopathy, Strawberry tongue Hands & feet have edema with induration, erythema & desquamation Fever > 5 days |
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What is the tx for Kawasaki disease? What complication is the treatment trying to prevent?
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Tx: Aspirin + IVIG, trying to prevent aneurysms
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What is the treatment for ventricular septal defects?
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What are the characteristics of Ebstein’s Anomaly?
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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 |
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What are the unique structures of the fetal circulation that close after birth?
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Umbilical vein, umbilical arteries (2)
Ductus arteriosus, ductus venosus Foramen ovale |
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HYQ: What medication is used to close a PDA?
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Indomethacin
Note: Prostaglandin E keeps it open think: to open the door, you gotta "push it, push it real good" (Push/Prost) |
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A newbown is found to have a congenital heart disease that causes early cyanosis. What drug does this newborn need?
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Prostaglandin E
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What is the most common congenital heart defect?
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VSD
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Describe briefly the sequence of events in Eisenmenger’s syndrome:
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L to R shunt → ↑ blood in pulmonary vasculature, ↑ resistance → shunt reverses R to L
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What are the abnormalities a/w Tetrology of Fallot?
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VSD, overriding aorta, RVH, RV outflow obstruction/stenosis of pulmonary artery
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What heart defect are Down syndrome pts at higher risk for?
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Endocardial cushion defect
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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?
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Anomalous origin of the left coronary artery
Arises from the pulmonary artery rather than the aorta & carries deoxygenated blood |
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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?
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β-blockers (propanolol)
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What type of vasculitis:
Weak pulses in upper extremity |
Takayasu’s
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Necrotizing granulomas of lung & necrotizing glomerulonephritis
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Wegener's
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Necrotizing immune complex inflammation of visceral/ renal vessels in young male smokers
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Buerger’s
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What type of vasculitis is seen with young asthmatics?
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Churg-Strauss
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What type of vasculitis is seen in Infants & young children; involves coronary arteries
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Kawasaki
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Most common vasculitis
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Temporal (Giant cell) arteritis
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what type of vasculitis is assoc with hep B infection
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Polyarteritis nodosa
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In which type of vasculitis can you see occlusion of ophthalmic artery that can lead to blindness?
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Temporal (giant cell) arteritis
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Perforation of nasal septum
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Wegener's
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Unilateral headache, jaw claudication
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Temporal (giant cell) arteritis
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What is the next step in the management of a pt with a DVT that has a high likelihood of falling?
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IVC filter
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What are the components of the medical management of peripheral artery disease (PAD)?
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Smoking cessation
↑ exercise glucose control diet BP control Cilostazol |
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What are the indications for operating on an AAA?
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Size >5.5 cm
Rate of increase > 0.5cm in 6 mos Symptomatic |
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Who should be screened for an abdominal aortic aneurysm?
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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
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What are some of the complications/ reactions that can arise from blood transfusions?
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In a Swan-Ganz catheter (pulmonary artery catheter), the wedge pressure is equal to what?
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Left atrial pressure
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Which blood products replace clotting factors?
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FFP, Cryoprecipitate, Whole blood
Clotting factors from donors Recombinant factors, Autologus blood |
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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?
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Send it back! He needs O neg blood
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For what indications would you use the following?
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What is the cause of acute hemolytic transfusion reaction? Anaphylactic reaction?
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Acute hemorlytic: ABO incompatibility
Anaphylactic: anti-IgA IgG Abs react in IgA deficient pts |
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What are some agents used to treat shock due to a weakly beating heart?
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Dopamine, Dobutamine, Epinephrine, Isoproterenol, Norepinephrine
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What commonly used agents cause peripheral vasoconstriction?
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Norepinephrine, Vasopressin, Epinephrine, Phenylephrine
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What medications are used to treat febrile & urticarial transfusion reactions?
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Acetominophen & Diphenhydramine
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What is the typical ER lab work-up for a pt with acute abdominal pain?
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CBC with differential
Chem 14 β-hCG if female urinalysis amylase, lipase stool guaiac |
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What are the signs & symptoms of acute mesenteric ischemia?
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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 |
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What is the treatment for acute mesenteric ischemia?
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What are the classic signs/symptoms of chronic mesenteric ischemia?
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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%) |
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What are the treatment option for chronic mesenteric ischemia?
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Bypass, endarterectomy, angioplasty
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Which oral hypoglycemia medicine should NOT be given when a pt is to have a radiologic procedure in which he will need IV contrast?
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Metformin
Note: metformin + contrast dye → lactic acidosis |
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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?
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Heparin or LMWH
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What are the 5 W’s of post-operative fever? To what do they refer?
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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 |
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What studies are ordered to evaluate the cause of a fever in a postop patient?
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CXR, UA, urine culture, blood cultures
Sputum culture, wound culture |
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What is used to evaluate patients that may have a lower extremity DVT?
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D-dimer and/or bilateral lower extremity ultrasound
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What should be prescribed to abdominal post-op patients to help reduce atelectasis?
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Incentive spirometry
Deep breathing exercises Physical therapy +/- bronchodilators & inhaled steroids |
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Other notes:
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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) |
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Clean-contaminated wounds involve an incision through disinfected skin & would involve one or more of the following structures?
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GI tract, respiratory tract, vagina
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What is seen on abdominal x-ray or CT scan that indicates a ruptured viscus?
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Free air (radiolucent/ black)
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What is the classic finding in the abdominal exam of a patient with mesenteric ischemia?
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Pain out of proportion to the exam
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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?
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Dantrolene (think malignant hyperthermia)
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What are a few contraindications to the transplant of the following organs?
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Heart – smoking, pulmonary hypertension
Lung – smoking, poor cardiac/liver/renal failure Liver – alcoholism, multiple suicide attempts |
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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?
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Acute rejection
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What is the usual lab panel ordered in a pt presenting to the ER with generalized abdominal pain?
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CBC with differential, Chem 8 / BMP, LFTs, Urine analysis
β-hCG (if female) stool guaiac amylase, lipase EKG & cardiac enzymes if > 45 yrs old |
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What is the usual time frame for stopping warfarin prior to surgery?
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3 – 4 days prior to surgery
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What interventions are helpful in optimizing lung function in the post-op period in patients with pre-existing lung disease?
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Incentive spirometry
Pain control Deep breathing Physical therapy Bronchodilators Inhaled steroids |
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What type of immunodeficiency increases the risk of anaphylactic transfusion reaction?
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IgA deficiency
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What lab findings suggest hepatic disease during a pre-op work-up?
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↑ PT/PTT
↓ platelets ↑ bilirubin ↑ or ↓ transaminases ↓ albumin |
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What are the preferred vessels in the placement of a Swan-Ganz catheter?
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Right IJ or Left Subclavian
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When is the greatest risk for a post-operative MI? What is recommended perioperatively for pts with known CAD?
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With in first 48 hrs
Telemetry monitoring |
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Which vasopressor matches the following statement?
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you forgot to fill this in
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Which blood product is most appropriate in the following scenarios?
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you forgot to fill this in
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