Term
| Never patch an injured eye for longer than? |
|
Definition
|
|
Term
| A patient presents with eye irritation. Fluorescein stain with Wood's lamp exam reveals a rust ring? What is the appropriate management? |
|
Definition
| Metallic foreign body- attempt to remove large foreign body with cotton swab and refer to optho for full removal with rotating burr. |
|
|
Term
| A patient presents with facial pain and swelling after a blunt trauma to the eye. they are unable to look up. subcutaneous emphysema and exophthalmos are present. what is the appropriate management. |
|
Definition
| Blow out fracture- Start abx and analgesics. get CT head. refer to ophthalmology/sugery. |
|
|
Term
1) A patient presents with eye pain and photophobia. they typically wear contact lenses. Flueroscein stain reveals a dendritic lesion. What is the underlying pathogen?
2) A patient presents with eye pain and photophobia. they typically wear contact lenses. Fluorescein stain reveals visible pooling. what is the underlying pathogen and treatment? |
|
Definition
1) herpes keratitis
2) bacterial keratitis due to pseudomonas - Q1hr fluoroquinolone drop |
|
|
Term
| Retinal detachments most commonly begin in what quadrant? |
|
Definition
| superior temporal area (like a curtain being torn downward) |
|
|
Term
| Leading cause of irreversible central visual loss in patients >65 y/o |
|
Definition
|
|
Term
| A patient has been experiencing gradual loss of central vision. metamorphopsia is present when the patient is presented with an amsler grid. Drusen deposits are present on retinal exam. what is the diagnosis? |
|
Definition
|
|
Term
| A patient presents with sudden, painless, unilateral vision loss. Retinal exam reveals retinal pallor, box-carring of arterial flow, and a cherry red spot. What should you do? |
|
Definition
| Central retinal artery occlusion - Have pain remain recumbent and try gentle ocular massage. refer to ophto. |
|
|
Term
| A 62 year old male with T2DM presents with sudden, painless, unilateral vision loss. Fundoscopy reveals afferent pupillary defect and a "blood and thunder" appearance of the retina. What is the diagnosis? |
|
Definition
Central retinal vein occlusion
better prognosis than artery occlusion
refer to ophtho |
|
|
Term
| Leading cause of blindness in adults in the US in patients <65 y/o |
|
Definition
|
|
Term
| A patient presents with sudden, painful, unilateral vision loss that started while seeing a movie. Exam reveals a fixed, mid-dilated pupil. The patient is diaphoretic and nauseated. What is the appropriate treatment? |
|
Definition
| Acute angle-closure glaucoma- start IV acetazolamide, topical beta blocker, and refer urgently to ophtho. |
|
|
Term
| A 54 year old African American male with PMH of T2DM is found to have increased cup to disc ratio on fundoscopy. What is the diagnosis? |
|
Definition
| Open angle glaucoma - most common cause of blindness in AA |
|
|
Term
A 9 year old female with 1 week history of sinusitis presents with swelling around the eye, ptosis, and fever.
What workup should be done? |
|
Definition
Orbital cellulitis-
get CBC, blood cultures, culture of any drainage, and CT to determine extent |
|
|
Term
| Treatment and most common organisms of orbital cellulitis? |
|
Definition
Strep pneumo, Staph aureus, H Flu
This is a medical emergency requiring IV abx- nafcillin and metronidazole
OR clinday, cephalosporin, and fluoroquinolone |
|
|
Term
| If MRSA is suspected in orbital cellulitis, what is the recommended treatment? |
|
Definition
|
|
Term
| Common problem of the newborn in which the lacrimal duct does not open |
|
Definition
|
|
Term
| inflammation of the meiobian gland, or glands of Moll or zeis, resulting in a small, mildly painful nodule or pustule. usually caused by staph |
|
Definition
hordeolum (stye)
tx: warm compress |
|
|
Term
Eye issues:
1) relatively painless, indurated lesion deep from the palpebral margin, caused by chronic inflammation of the meiobian gland
2) When the lid lashes are turned inward due to scar tissue or spasm of the eye muscles
3) When lid lashes are turned outward due to age, trauma, or facial nerve palsy
4) elevated, yellowish, fleshy conjunctival mass found on the sclera adjacent to the cornea, typically on the nasal side. results of chronic exposure.
5) slowly growing thickening of the bulbar conjunctiva, highly vascular triangular mass growing from the nasal side |
|
Definition
1) Chalazion
2) entropion
3) ectropion
4) pinguecula
5) Pterygium |
|
|
Term
Eye terms:
1) inward misalignment of gaze
2) outward misalignment of gaze
3) reduce visual acuity not correctable by refractive means
4) blood in the anterior chamber of the eye |
|
Definition
1) esotropia (form of strabismus)
2) exotropia (form of strabismus)
3) amblyopia
4) hyphema |
|
|
Term
|
Definition
|
|
Term
What type of hearing loss and in which ear?
Weber test lateralizes to left
Rinne test shows BC>AC on left and AC>BC on right. |
|
Definition
|
|
Term
What type of hearing loss and in which ear?
Weber test lateralizes to right
Rinnes test shows BC>AC on rihgt and AC>BC on left |
|
Definition
|
|
Term
| Most common cause of SNHL? Due to increasing age |
|
Definition
|
|
Term
| Syndrome involving recurrent vertigo lasting minutes to hour, low range hearing loss, tinnitus, and lack of nystagmus on impaired side. |
|
Definition
|
|
Term
|
Definition
aminoglycosides
loop diuretics
chemo agents |
|
|
Term
| What one ophthalmologic test should be done first on all eye complaints except for chemical splash? |
|
Definition
|
|
Term
| swinging flashlight test is looking for? |
|
Definition
relative afferent pupillary defect
AKA Marcus Gunn Pupil |
|
|
Term
| What will the slit lamp exam show you? |
|
Definition
| anterior chamber of the eye- not retina, etc |
|
|
Term
| Patient presents with a tender, swollen, erythematous eye lid following a minor trauma. there is no proptosis or relative afferent pupillary defect. Vision is normal. Dx and treatment? |
|
Definition
preseptal cellulitis
oral augmentin or clindamycin |
|
|
Term
| For ENT/optho infections in diabetics or generally sick patients, consider what etiology? |
|
Definition
|
|
Term
| General treatment for any mild infection/irritation involving the eye lids? |
|
Definition
| Warm compression, baby shampoo scrub |
|
|
Term
Conjunctivitis:
1) Term that should make you think viral
2) Term that should make you think bacterial |
|
Definition
1) pre-auricular adenopathy
2) purulent discharge |
|
|
Term
Amaurosis Fugax:
30% chance of ____ within 7 days
always check _____ |
|
Definition
|
|
Term
| Cotton wool spots on retinal exam. think ? |
|
Definition
|
|
Term
| A 42 y/o female presents with rapid, progress central vision loss associated with loss of color vision. She reports pain with eye movement and exam reveals RAPD and optic disc swelling? Dx? |
|
Definition
Optic neuritis - usually associated with MS
Tx with IV steroids |
|
|
Term
_____ uveitis presents wtih painless vision loss, is typically bilateral, and is most commonly associated with sarcoid
____ uveitis presents with painful vision loss, photophobia, decreased VA. pain increases with eye movement and it is associated with infection and autoimmune conditions |
|
Definition
|
|
Term
|
Definition
1- olfactory - smell
2- optic - vision
3, 4, 6- occularmotor - eye movements
5- trigeminal
7- facial
8- vestibulocochlear
9- glossopharyngeal (taste)
10- vagus - lots of functions including swallowing and voice
11- accessory nerve - shoulder shrug
12- hypoglossal - tongue movement |
|
|
Term
| Most common pathogens in otitis externa |
|
Definition
|
|
Term
| Patient presents with fever, post-auricular adenoapthy/erythema/tenderness, and a downward, posteriorly displaced auricle. they were treated for acute otitis media 5 days ago. dx and treatment? |
|
Definition
mastoiditis
IV abx and myringotomy |
|
|
Term
| A patient presents with slowly progressive conductive hearing loss associated with tinnitus. they report family history of hearing loss. dx? |
|
Definition
| otosclerosis - refer to ent |
|
|
Term
| When a patient presents with pulsatile tinnitus, think ? |
|
Definition
| vascular issue - get MRA or CTA |
|
|
Term
| A patient presents with severe vertigo and hearing loss that lasts several days to a week. dx? |
|
Definition
labyrinthitis
as opposed to Meneier's which lasts minutes to hours at a time |
|
|
Term
| Patient presents with unilateral SNHL and tinnitus. what needs to be ruled out? |
|
Definition
| acoustic neuroma (aka vestibular schwannoma) |
|
|
Term
Bacterial sinusitis treatment
1) typical
2) PCN allergy |
|
Definition
if it mentions purulent drainage, use abx
Augmentin
doxy or resp fluoroquinolone (levoquin or moxifloxaicin) if PCN allergy
NOT azithromycin |
|
|
Term
| Treatment algorithm: allergic rhinitis |
|
Definition
1) intranasal glucocorticoids (mainstay)
2) oral antihistamines and/or antihistamine sprays (azelastine or olopatadine)
3) monteleukast |
|
|
Term
| A 3 year old presents with unilateral purulent nasal discharge and no other associated ENT symptoms. Think ? |
|
Definition
|
|
Term
Mouth/throat terms:
1) white patches of oral mucosa that cannot be removed by scraping. 1-20% progress to cancer within 10 years.
2) Red mucosal plaques with very high malignant transformation rate
3) small, painful, round ulcerations with yellow-gray fibrinoid centers with surrounding red halo
4) ginigival redness and swelling
5) gingival inflammation accompanied by loss of supportive connective tissues |
|
Definition
1) leukoplakia
2) erythroplakia
3) apthous ulcer
4) gingivitis
5) periodontitis |
|
|
Term
Most common causes of acute sialadenitits
1) bacterial
2) viral
3) other |
|
Definition
1) staph aureus
2) Mumps
3) suppurative - from underlying issue like anticholinergc meds. pus can be expressed on PE. |
|
|
Term
| 4 Systolic murmurs and 2 Diastolic murmurs |
|
Definition
Systolic:
1) Mitral regurg
2) Aortic stenosis
3) Tricuspid regurg
4) Pulmonic stenosis
Diastolic:
1) Aortic regurg
2) Mitral stenosis |
|
|
Term
Holosystolic murmur heard best at apex and radiates to axilla
associated with CHF and dyspnea due to blood flow backing up in to the lungs |
|
Definition
|
|
Term
systolic crescendo-decrescendo murmur with harsh quality heard at the RSB and may radiate to carotid
associated with syncope on exertion, angia with exertion |
|
Definition
|
|
Term
pansystolic murmur accentuated with inspiration. heard at the left lower sternal border
associated with pulmonary hypertension and ebsteins anomaly. can be seenw ith JVD, pulmonary edema, ascites |
|
Definition
|
|
Term
| Systolic murmur heard at the left 2nd ICS associated with JVD or RV hypertrophy with heave |
|
Definition
|
|
Term
blowing decrescendo diastolic murmur heard loudest at the RSB
Associated with widened pulse pressure or bounding pulses. sometimes seen in CHF.
AKA Austin-Flint Murmur |
|
Definition
|
|
Term
| low pitched, diastolic rumble heard at the apex. associated with opening snap. seen in rheumatic heart disease. |
|
Definition
|
|
Term
| a 17 year old football player comes in for a sports physical. you note a systolic murmur on exam. what would make you think this is HOCM and not a benign murmur? |
|
Definition
| HOCM: worsens with valsalva and standing. better with squatting. |
|
|
Term
| A 46 year old female presents with palpitations. exam reveals a mid systolic click. dx and treatment? |
|
Definition
MVP
Beta blocker and avoidace of triggers (caffeine, dehydration) |
|
|
Term
| A patient presents with fever & sharp chest pain that worsens with inspiration. Exam reveals a friction rub. EKG shows concave, upsloping ST elevation. What is the dx and tx? |
|
Definition
|
|
Term
| Most common causes (2) of viral pericarditis |
|
Definition
|
|
Term
A patient presents with hypotension, JVD< and muffled heart sounds. The JVP seems to get worse with inspiration (kussmaul's sign), their blood pressure drops with inspiration (pulsus paradoxus). they have a narrow pulse pressure and are tachycardic. EKG shows electrical alternans.
dx and tx? |
|
Definition
cardiac tamponade
tx: IV fluids (increase pressure pushing against heart) and pericardiocentesis |
|
|
Term
What drug?
an antiarrhythmic that is associated with prolonged QT interval, thyroid and liver toxicity, ILD |
|
Definition
|
|
Term
Heart sounds:
1) Never normal. caused by conditions that cause a stiff ventricle including longstanding HTN and acute MI
2) Normal in some pts during inspiration but indicates atrial septal defect if present during both inspiration and expiration
2) can be normal in healthy young athletes or can indicate CHF |
|
Definition
|
|
Term
Which side is the heart failure?
S3 noted on exam
Enlarged/displaced apical pulse
orthopnea, PND
rales
exertional dyspnea |
|
Definition
Left
"Left = Lungs" - due to blood backing up into lungs |
|
|
Term
which side is the heart failure?
JVD
Hepatojugular reflux
hepatomegaly, RUQ pain, anorexia
pleural effusion
pitting edema |
|
Definition
Right
due to blood backing up everywhere in the body (not just lungs) |
|
|
Term
CHF classifications vs stages
what do I need to know? |
|
Definition
calssifications get better, stages do not.
Class I- no symptoms
Class II- symptoms w/ vigorous physical activity
Class III- symptoms with minimal activity
Class IV- symptoms at rest
Stages:
A- no structural dysfunction
B- structural dysfunction but no symptoms
C- previous or current CHF symptoms
D- Advanced disease requiring hospitalization, transplant, or palliative care |
|
|
Term
| what is the most common cause of right sided heart failure? |
|
Definition
|
|
Term
| General treatment algorithm for systolic CHF? 3 drug classes |
|
Definition
1) ACE OR ARB FOR EVERYONE
2) Loop diuretic
3) Beta-blocker, specifically metoprolol succinate, carvediolol, or bisprolol
Can use nitrate + hydralazine if cannot take ACE/ARB
add spironolactone in class II-IV |
|
|
Term
| Controlling _______ is the mainstay of therapy in diastolic heart failure. |
|
Definition
|
|
Term
| echo shows normal LVEF but incomplete filling of the ventricles and a "speckling" pattern. dx and underlying etiology? |
|
Definition
restrictive cardiomyopathy
caused by things that scar/infiltrate myocardium like sarcoid, amyloid, hemochromatosis (iron) |
|
|
Term
| What does a LOW (<0.9) ankle brachial index indicate? |
|
Definition
| PAD (arterial obstruction) |
|
|
Term
| inflammatory vasoocclusive disease that can cause distal ischemia. related to tobacco use and most commonly seen in men <45 y/o |
|
Definition
| Buerger Disease (thromboangiitis obliterans) |
|
|
Term
| Who should be screened for AAA? |
|
Definition
men age 65-75 who have EVER smoked (100 cigs or more in their life)
smoking is most important risk factor |
|
|
Term
| Typical medication choice for any vasospastic dz? |
|
Definition
|
|
Term
| Treatment vs monitoring for AAA based on size |
|
Definition
<3cm, no f/u needed
3-4cm - US yearly
4-5.4cm - US q6 months
>5.5cm - surgery |
|
|
Term
Thoracic aortic aneurysm:
1) ____ is the most common condition associated with dissection
2) Treatment |
|
Definition
1) HTN
2) Type A dissection: Ascending Aorta or Aortic Arch (all A's) - immediate surgery
Type B: any other spot - treated with Beta Blocker (all B's) |
|
|
Term
Syncope:
1) Most common cause of syncope in young adults. includes vasovagal syncope and situational syncope (from coughing, defecating, etc)
2) most common cause of syncope in older adults |
|
Definition
1) Reflex syncope
2) Orthostatic syncope |
|
|
Term
Types of secondary htn:
1) Recent-onset HTN in a young woman with FMD. may have abd bruit. may have hx of recurrent flash pulmonary edema
2) Conn's syndrome. caused by an adrenal adenoma. associated with hypokalemia, elevated aldosterone:renin ratio
3) difference in BP between upper and lower extremities. radial-femoral pulse delay |
|
Definition
1) Due to renal artery stenosis
2) primary hyperaldosteronism
3) Coarctation of aorta |
|
|
Term
Catecholamine-secreting adrenal tumor associated with life-threatening HTN
classically presents with episodic htn, diaphoresis, and HA in a young pt.
dx by: elevated plasma metanephrines
dx and tx? |
|
Definition
pheochromocytoma
tx: resection of tumor.
phentolamine or nitroprusside for HTN (blocks catecholamines) |
|
|
Term
Blood pressure goals:
>60 y/o
<60 y/o
CKD or DM |
|
Definition
1) <150/90
2) <140/90
3) <140/90 |
|
|
Term
HTN Treatment guidelines:
1) Non-black
2) Black
3) CKD (all races) |
|
Definition
1) HCTZ, CCB, ACE/ARB - alone or in combination
2) HCTZ or CCB alone or in combo
3) ACE or ARB
Only add another class of medication (INCLUDING BB) once all first line drugs have been added and maximized |
|
|
Term
BP meds to avoid in certain populations:
1) pregnancy
2) asthmatics
3) gout |
|
Definition
1) ACE/ARBs
2) BB
3) diuretics |
|
|
Term
| HTN Treatment in pregnancy |
|
Definition
|
|
Term
| Hypertensive Urgency vs Emergency |
|
Definition
Urgency: Systolic >180 or diastolic > 120 with NO evidence of end organ damage.
-lower BP by 25% over 24 hrs. no need to treat emergently
Emergency:
1) Accelerated HTN: Recent significant increase over baseline BP with target organ damage (HA, TIA, renal insuff)
2) Malignant HTN: elevated BP associated with PAPILLEDEMA
-Tx: Admit to ICU and lower BP by 25% over 1 hr with IV nitroprusside, labetaolol, nicardipine, or hydralazine |
|
|
Term
| Lipid screening recommendatiosn |
|
Definition
| everyone at 21 years old then every 5 years |
|
|
Term
| 4 groups of patients who should be on statins: |
|
Definition
1) people who've had CVA, TIA, PAD, MI
2) Pts with LDL >190
3) Diabetics with LDL 70-189
4) Pts with LDL 70-189 and ASCVD risk >7.5% |
|
|
Term
| Meds that can increase statin myopathy |
|
Definition
Gemfibrozile
Clarithromycin/erythromycin
amiodarone
verapamil
protease inhibitors
ketoconazole |
|
|
Term
2 high intensity statins (lower LDL 50%)
4 moderate intensity statins (lower LDL 30-50%) |
|
Definition
High intensity:
Atorvastatin 40-80mg
Rosuvastatin 20-40mg
Moderate intensity:
Atorvastatin 10mg
Rosuvastatin 10mg
Simvastatin 20-40mg
Pravastatin 40mg |
|
|
Term
Non-statin cholesterol drugs:
1) useful as adjunct to statin in pts with familial hypercholesterolemia. may raise trigs
2) helpful for lowering trigs
3) Lowers trig, LDL, and raises HDl. cannot be used in combo w/ statin due to risk of rhabdo |
|
Definition
1) cholestyramine (bile acid sequestrant)
2) fish oil (lovaza)
3) fibrates |
|
|
Term
| A patient has a stress echo that indicates wall motion abnormality. what does this indicate? |
|
Definition
|
|
Term
| A drop in BP > ____ mmHg indicates a positive tilt table test |
|
Definition
|
|
Term
Coronary arteries, MI location, and EKG leads
1) RCA
2) LAD
3) Circumflex |
|
Definition
1) RCA - inferior - Leads II, III, AvF
2) LAD - anterior - Leads V3 and V4
3) circumflex - lateral - V5, V6, I, AvL |
|
|
Term
Chest pain terms:
1) a sign of myocardial ischemia that causes chest pain, heaviness, squeezing, choking, burning, etc.
2) characterized by the patient's fist clenched over the sternum when describing dicsomfort
3) a variant of angina that occurs at night while the pt is recumbant
4) inadequate myocardial microvasculature flow. causes angina and abnormal stress test but coronary arteries are normal on cath.
5) When patients (esp elderly) present w/ atypical symptoms of myocardial ischemia including abdominal pain, syncope, SOB, or "just don't feel right" |
|
Definition
1) angina
2) Levine sign
3) Angina decubitus
4) Syndrome X
5) Angina equivalent |
|
|
Term
Angina terms:
1) episodic pain lasting 5-15 min. provoked by exertion and relieved by rest or nitro
2) ST segment elevation caused by focal coronary artery spasm. usually seen in women <50 in the morning
3) A form of ACS. chest pain iTwth little exertion or at rest, lasting >20 min
4) A form of ACS. chest pain with little exertion or at rest, lasting >20 min AND associated with abnormal troponins
5) A form of ACS. chest pain lasting >20 min with little exertion or at rest, associated with abnormal troponins AND ST elevation on EKG |
|
Definition
1) stable angina
2) Prinzmetal's angina
3) Unstable angina
4) NSTEMI
5) STEMI |
|
|
Term
| Workup and treatment for stable angina |
|
Definition
Stress test (ideally exercise)
treatment:
Aspirin
Beta Blocker (first line)
CCB (2nd line)
Nitrates
Statin
Ranolazine (can be used in place of BB if pt has low BP or low HR) |
|
|
Term
| Treatment and common trigger for Prinzmetal's angina |
|
Definition
Treatment: nifedipine, amlodipine, or nitrates
Triggers: triptans (migraine medicine),smoking, cocaine |
|
|
Term
| Contraindications for treadmill stress test |
|
Definition
Aortic dissection
Severe Aortic stenosis
MI within the past 2 days
BBB
Uncontrolled CHF
Acute PE
Acute myocarditis or pericarditis |
|
|
Term
| what is a myocardial perfusion scintigraphy? |
|
Definition
| another name for stress test |
|
|
Term
| ____ on EKG indicates an old MI |
|
Definition
|
|
Term
| Immediate management of ACS |
|
Definition
MONA-BAH
Morphine
Oxygen
Nitro
Aspirin
Beta Blocker
Ace/ARB
Heparin (or other anticoagulant)
Get to cath lab or fibrinolytic if unable to be cathed |
|
|
Term
| Indications for fibrinolytic |
|
Definition
ST elevation in at least 2 contiguous leads or new BBB
AND
Signs of actue MI
AND
Time of onset <12 hours
Never give someone a thrombolytic if they have risk of acute systemic bleed
-active bleed w/in 3 months
-stroke w/in 3 months
-major surgery or trauma w/in 14 days
etc
thrombolytics all end in "-plase" |
|
|
Term
| indications for cardiac cath (percutaneous intervention) |
|
Definition
Treatment of choice in most patients with acute MI, assuming it's been <90 min (or less than 120 min if being transported)
-also treatment of coice in cardiogenic shock |
|
|
Term
|
Definition
1) >50% stenosis of left main artery
2) >70% stenosis of LAD and circumflex
3) any 3 vessels involved
4) Multivessel CAD in diabetic |
|
|
Term
Complications of acute MI:
1) acute mitral valve regurgitation caused by ______ presents with acute CHF days to weeks after MI and requries surgical repair
2) happens most commonly after anterior innfart. is an emergency and has poor prognosis |
|
Definition
1) papillary muscle rupture
2) LV free wall rupture |
|
|
Term
Reversal agent for each
1) coumadin
2) heparin
3) fibrinolytic |
|
Definition
1) vitamin K
2) protamine sulfate
3) aminocaproic acid |
|
|
Term
a 45 y/o male presents with substernal chest pressure and is foudn to have elevated troponin consistent w/ MI. Which of the following can best decrease myocardial oxygen demand and potentially reduce the size of the infarct?
1) Nitro
2) BB
3) ASA
4) Loop diuretic
5) ACE |
|
Definition
|
|
Term
a 45 y/o male w/ severe asthma is having an MI. wich of the following beta blockers is most cardioselective while causing minimal brochconstriction?
1) metoprolol
2) Proanolol
3) Carvedilol
4) Nadolol |
|
Definition
|
|
Term
____ a type of drug that increases cardiac output and contractility. includes dobutamine and milrinone. used in cardiac shock.
_____ suppresses heart rate. includes BB, CCB, and dig |
|
Definition
inotrope
negative chronotrope |
|
|
Term
| Patient present with hypotension, tacycardia, S3 gallop, appears ill. swan-ganz catheter reveals low CO index. treatment? |
|
Definition
Cardiogenic shock- pump failure that leads to decreased perfusion of organs
tx: vasopressors, intraarotic balloon pump, dobutamine/milrinone. ICU monitoring w/ swan-ganz catheter to monitor cardiac output |
|
|
Term
patient presents wtih hypotensino, AMS, weak pulse, oligouria, and tachycardia. May have recently had trauma, dehydration, burns, ruptured ectopic, or GI bleed.
Tx? |
|
Definition
Hypovolemic shock
Tx: Rapipd volume repletion w/ 2 L NS or LR
For hypovolemic shock- the answer is NOT pressors until after volume repletion |
|
|
Term
| Patient presents wtih hypotension, tachycardia, confusion, hypoxemia, oligouria int he setting of recent infection. labs show elevated lactic acid level and leukocytosis. Dx and tx? |
|
Definition
Septic shock
Broad spectrum abx w/in the first hour
IV fludis- 30 ml/kg int he first 3 hours
Pressors |
|
|
Term
What class of medicine?
dobutamine
Norepinephrine
Vasopressin |
|
Definition
|
|
Term
56 y/o male presents w/ intermittent CP at rest that does not become worse w/ exertion. he has hx of HTN, elevated LDL, OA. His EKG shows LBBB that is unchanged from previous EKGs. he is pain free today. what is the most appropriate next step?
1) cardiology consutl for cath
2) pharmacologic stress test with nuclear imaging
3) exercise stress test wtih echo
4) exercise stress test with nuclear imaging |
|
Definition
pharmacologic stress test.
BBB precludes an exercise stress test |
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Term
A 42 y/o Female wtih hx of migraines is awakened with acute onset of substernal chest pain. on arrival to the ER, EKG shows ST elevations c/w acute MI. Coronary angiography is performed and is normal. Which of the following medications could have caused this?
1) nifedipine
2) sumatriptan
3) estrogen
4) ibuprofen
5) ACE inhibitor |
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Definition
sumatriptan -- prinzmetal's angina
treatment: nifedipine |
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Term
A 72 y/o female w/ hx of DM presents to the ER with CP at rest intermittently for 4 hours. she has associated SOB. HR 59, BP 134/72, RR 20, O2 sat 95%. EKG shows T wave inversion in Leads v1, V2, V3. troponins are elevated. what is her dx?
1) stable angina
2) unstable angina
3) NSTEMI
4) STEMI |
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Definition
| NSTEMI - elevated troponins but no ST elevation |
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Term
77 y/o woman presents wtih syncope during her daily exercise routine. her hx includes several other episodes of syncope over the l ast 6 months. she has sysstolic murmur heard best at the RUS border with radiation to the neck. which is the most probably dx?
1) mitral stenosis
2) Mitral regurg
3) Tricuspid regurg
4) AS
5) Aortic insufficiency |
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Definition
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Term
76 y/o female with hx of CAD and prior inferior wall MI presents w/ 2 months of increased SOB on exertion and lower extremity swelling. her PE shows IV/VI holosystolic murmur at the 5th ICSradiation to axilla. Which si the most likley cause?
1) Mitral regurg
2) Mitral stenosis
3) tricuspid regurg
4) VSD
5) Left ventricular aneurysm |
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Definition
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Term
a 35 y/o female with hx of anxiety and panice attacks presents for routine PE. she intermittently experiences palpitations but in general feels well. PE reveals mid systolic click. no murmur is present. Which is most likely?
1) Mitral regurg
2) mitral stenosis
3) MVP
4) Normal mitral valve |
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Definition
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Term
A 23 y/o male presents to the ER with sharp chest pains radiation to his left neck and AMS. for the past 3 days he had severe n/v attributed to viral gastroenteritis. PE reveals a loud scratching sound in the end systole and all of diastole located near the cardiac apex. CXR is normal. Which is most likely?
1) mi
2) Aortic dissection
3) esophageal rupture
4) pericarditis |
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Definition
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Term
82 y/o male w/ h of persistent a fib and hypertension presents w/ increased DOE. CXR shows honeycombing and PFT shows a restrictive defect. Which is most likely causing his symptoms?
1) CHF
2) Amiodarone
3) ramipril
4) Sotalol
5) lisinopril |
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Definition
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Term
a 67 y/o female w/ hx of breast cancer and tobacco use complains of dizzines and DOE. her heart sounds are distant and her systolic BP is noted to markedly decrease w/ inspiration. which is most likely?
1) MI
2) mitral regurg
3) PE
4) Aortic regurg
5) cardiac tamponade |
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Definition
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Term
22 y/o college student w/ no prior PMH presents to the ER with complains of palpitations and dizziness that started 8 hr ago. he states he was drinking heavily at a party last night. no CP or syncope. His BP is 80/50, HR 160, resp 24, O2 sat 94%. What is your initial tx?
1) anticoagulate for 3 weeks then plan for DCCV
2) immediate synchronized cardioversion
3) IV diltiazem
4) Await echo to eval for thrombus |
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Definition
Immediate cardioversion
BP and HR --> unstable |
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Term
35 y/o male is admitted w/ recent onset of predominately right heart failure sx. echo shows pulmonary HTN and endomyocardial biopsy confirms amyloidosis. with is the most likely diagnosis?
1) dilated cardiomyopathy
2) aortic stenosis
3) restrictive cardiomyopathy
4) AAA |
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Definition
| restrictive cardiomyopathy |
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Term
58 y/o female has been dx with systolic CHF with an EF of 25%. she currently takes lisinopril and lasix. which ofo the following should be added to improve her sx and reduce her mortality long term?
1) carvedilol
2) nitro
3) amlodipine
4) verapamil
5) dig |
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Definition
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Term
67 y/o male presents w/ increasing fatigue over the last 3 months. he complains of decreased appetite, abdominal fullness. PE reveals S3 gallow, lungs w/ decrased breath sounds a tthe bases and hepatomegaly with Jvp. he has BL lower extremity 3+ pitting edema. labs show serum creat of 1.6, BUN 40, LFTs mildly elevated. which is most likely?
1) cirrhosis
2) RV dysfunction
3) acute hepatitis
4) COPD exacerbation |
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Definition
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Term
84 y/o male with hx of severe emphysema and prior MI has dyspnea with minimal exertion that has progressed to orthopnea over the past 2 days. PE shows III/VI holosystlic murmmur athte apex, S3 heart sound, and rales in the lower lungs. No LE edema is present his symptoms correlate wtih which of these?
1) cor pulmonale
2) Left sided CHF
3) Right sided CHF
4) Left and right CHF |
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Definition
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Term
39 y/o AA non-smoking female recently dx wtih HTN. her labs are all wnl. you have counseled her on lifestyle and are now ready to start meds. what would you recommend as initial therapy?
1) Lisinopril 10mg qd
2) HCTZ 12.5mg qd
3) Metoprolol succinate 25mg bid
4) hydralazine 10mg qd
5) irbesartan 150mg qd |
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Definition
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Term
61 y/o female w/ hx of HTN presents w/ jaundice and generalized fatigue. labs show elevated indirect bili, normal creatinine, low HGB, undetectable haptoglobin. which drug could be responsible?
1) lisinopril
2) Minoxidil
3) clonidine
4) methyldopa
5) valsartan |
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Definition
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Term
a 56 y/o obese female presents for routine PE. her lipid profile reveals significantly increased trigs at 355. which of the folowing meds can act to lower her trigs by stimmulating the synthesis of lipoprotein lipase?
1) gemfibrozil
2) rosuvastatin
3) cholestyramine
4) ezetizimibe
5) ketoconazole |
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Definition
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