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IM Uworld > 2 > Flashcards

2 Flashcards

1
Q

B-blocker OD presents how?

A

bradycardia, hypotension, wheezing, hypoglycemia, delirium, seizures, cardiogenic shock
IV fluids, atropine, IV glucagon (if profound hypotension)
glucagon ^cAMP, also helps with CCB OD

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2
Q

WPW on EKG

A

short PR <0.12 (3 boxes), delta wave (upstroke of QRS), QRS widening with ST/T wave abnormalities

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3
Q

testing with initial dx of HTN

A

UA (occult blood and PCR)
BMP/CMP
Lipid profile
EKG

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4
Q

treatment for post-MI pericarditis (Dressler’s syndrome)

A

NSAIDs, steroids if refractory

-immunologic phenomena, ^ESR

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5
Q

pulsus paradoxus

A

exaggerated decrease >10mmHg decrease in SBP with inspiration seen in cardiac tamponade, can occur in severe asthma and COPD
-inspiration decreases

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6
Q

what murmurs should always be worked up? (Echo)

A

any diastolic

>3/6 continuous systolic

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7
Q

BNP levels:
most pts with dyspnea due to CHF had BNP levels greater than ?? while levels less than ?? had a high negative predictive value for CHF as the cause of dyspnea

A

greater than 400 pg/mL

less than 100 pg/mL

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8
Q

nonselective B blockers that may trigger bronchoconstriction

A

propranolol, nadolol, sotalol, timolol (later 1/2 of alphabet)

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9
Q

cardioselective (B1) B blockers

A

metoprolol, atenolol, bisprolol, nebivolol

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10
Q

features of constrictive pericarditis

A

RHF signs: ^JVP (>8), peripheral edema/ascites
clear lung fields
pericardial knock (mid diastolic sound- filling)
pulsus paradoxus
Kussmaul’s sign
pericardial thickening and calcification on (CXR)
x and y descents on JVP tracing

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11
Q

cardiac amyloidosis features

A

increased ventricular wall thickness with normal/nondilated LV cavity on Echo
may have heavy proteinuria, periorbital purpura, hepatomegaly

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12
Q

water bottle heart on CXR
maximal apical impulse that is difficult to palpate
think??

A

pericardial effusion without tamponade

-also, diminished heart sounds

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13
Q

where do you hear an abnormal S4

A

in pts with decrease LV compliance: HTN HD, aortic stenosis, HCM, acute MI

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14
Q

what is pulses bisferiens and when is it seen

A

biphasic pulse: 2 strong systolic peaks of aortic pulse from LV ejection separated by mid systolic dip
seen in aortic regurg, HOCM, large PDA

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15
Q

murmur of mitral regurg

clinical features

A

holosystolic blowing murmur @ apex radiating to axilla

DOE, fatigue, a fib, HF signs

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16
Q

1st steps in aortic dissection

A

if stable: CT angiography for diagnosis (#2: MRA)
if unstable: emergent pericardiocentesis +/- TEE for dx
TEE especially if pt has ^Cr (renal insufficiency)

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17
Q

cyanide toxicity features

A

AMS, lactic acidosis, seizures, coma

may occur following nitropruside tx in pt with renal insufficiency

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18
Q

meds shown to improve long-term survival in pts with LV systolic dysfunction

A

B-blockers
ACE-i/ARBs
spironolactone/epleronone
Afr. Am: hydralazine + nitrates

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19
Q

medical management of aortic dissection

A

morphine for pain
IV B-blocker for target SBP of 100-120 mmHg
additional vasodilator (nitroprusside) if SBP remains^

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20
Q

digoxin toxicity can occur more rapidly with the addition of what med ?

A

amiodarone, decrease digoxin by 25-50%

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21
Q

what anti platelet therapy indicated after stent placement/post STEMI/NSTEMI

A

P2y12 receptor blockers (clopidogrel (plavix), prasugrel, ticagrelor) + ASA
in addition to B-blockers, ACE-i/ARBs, statins, spironolactone

22
Q

direct factor Xa inhibitors (apixaban) are indicated for

A

anticoagulation in nonvalvular afib and for management of DVT and PE

23
Q

normal vs elevated A-a gradient in respiratory distress

A

normal less than 15: hypoventilation is the cause

elevated is more than 30

24
Q

PE may cause pulmonary infarction leading to ?

A

hemoptysis

25
Q

what lung lesions are high probability for malignancy?
what to do next?
intermediate risk?
low risk?

A

older than 60 yrs, smoking history, large lesion i.e. more than 2 cm, irregular margins

intermed: more than 8 mm (PET) and sx excision if +
low: smaller, serial CT scans

26
Q

PE can lead to effusions that tend to be

A

small, exudative, bloody, associated with pain

27
Q

lung protective strategy for ARDS on mechanical ventilation

A

low tidal volume ventilation (LTVV) to prevent over distending alveoli

28
Q

elevated B-hCG and AFP in setting of anterior mediastinal mass

A

nonseminomatous germ cell tumor

seminomas: just B-hCG not AFP
teratomas: no markers

29
Q

thymoma is associated with systemic syndromes including ?

A

myasthenia gravis and pemphigus

30
Q

lab findings in SIADH

treatment?

A

hyponatremia
serum osm less than 275 (hypotonic)
urine osm more than 100 (concentrated)
urine Na+ more than 40 mEq/L (salt wasting)
*seen in small cell lung cancer
tx: fluid restriction +/- salt tablets, demeclocycline only if unresponsive (decr. response to ADH)
do not use NS or LR as may cause water retention; useful in hypovolemic hyponatremic patients

31
Q

what levels of PaCO2 are worrisome in an asthma exacerbation?

A

elevated or even normal (i.e. 50) as they should be low due to the hyperventilation
implies inability to meet increased respiratory demands and impending respiratory failure

32
Q

inability to correct hypoxemia with increased FiO2 is seen in ?

A

intrapulmonary shunting- seen in decreased alveolar ventilation, a form of V/Q mismatch where V is 0 in certain areas (pneumonia, ARDS/atelectasis, severe PE, pulm. edema)
(also seen in i
in contrast, emphysema, interstitial lung disease, and PE(sometimes) are V/Q mismatches where V is greater than 0 so ^FiO2 will improve hypoxemia

33
Q

what disease?
-bronchial thickening and dilation due to recurrent infection/inflammation
-cough + mucopurulent sputum, hemoptysis, dyspnea
how to diagnose?

A

bronchiectasis

high-resolution CT of chest

34
Q

pleural effusion shows what breath sounds, tactile fremitus, and percussion? in contrast to consolidation

A

decreased breath sounds and DECREASED tactile fremitus- fluid outside lung insulate sounds/vibrations inside the lung
dullness to percussion

In contrast, consolidation i.e. pna is fluid inside the lung which will result in increased breath sounds and tactile fremitus but still dullness to percussion

35
Q

outpatient empiric tx of CAP

A

healthy: macrolide (azithromycin) or doxycyline
comorbidities: FQ (levaquin or moxifloxacin NOT cipro) + macrolide

36
Q

inpatient non-ICU empiric tx of CAP

A 
IV FQ (levaquin or moxifloxacin) IV 
IV B-lactam + macrolide (ceftriaxone + azithromycin)
37
Q

ICU empiric tx of CAP

A

IV B-lactam + macrolide (rocephin + azithromycin)

IV B-lactam + FQ (rocephin + levaquin)

38
Q

score to help determine hospitalization in pneumonia

A 
CURB-65: 1 pt for each
Confusion
Urea 20+
RR 30+
SBP less than 90 or DBP less than 60
Age 65+
0: outpt tx, 1-2: possible inpt tx, 3-4: inpt, ICU if 4
39
Q

how to treat bradycardia associated with hypothermia?

A

active rewarming and warmed IVF

atropine and cardiac pacing is NOT effective!

40
Q

decreased airflow rate during inspiration AND expiration is seen in ?

A

fixed upper-airway obstructions

41
Q

PE anticoagulation in pt with severe renal insufficiency (GFR less than 30)

A

unfractionated heparin over LMWH (lovenox) or fondaparinux, rivaroxaban
reduced renal clearance increases anti-Xa activity levels and bleeding risk

42
Q

when to give abx for AE COPD

A

if 2+ cardinal symptoms: increased dyspneal, cough, sputum production
or if requires mechanical ventilation

43
Q

ABG levels when to intubate

A

PaO2 less than 70, PaCO2 50+, pH less than 7.2 + hypercapnia

acceptable ranges on mech. vent: PaO2 50-60 with PaCO2 40-50 with pH btw 7.35-7.50

44
Q

ABG in PE

A

PaO2 and PaCO2 low, high pH (respiratory alkalosis)

A-a gradient typically elevated

45
Q

Well’s criteria

A
  1. 0 -s/s of DVT
  2. 0 -alt. dx less likely than PE
  3. 5 -HR 100+
  4. 5 -immob. 3+ days or sx in prev. 4 wks
  5. 5 -prev. DVT/PE
  6. 0 -hemoptysis
  7. 0 -malignancy prev. 6 mo or palliative

4+ PE is likely

46
Q

PE tx

A

O2
LMWH (lovenox) better than unfractionated UNLESS renal insufficiency, for 5-10 days, INR 2-3
warfarin or NOACs start day 1 with hep then 3-6 months+
tPA not well defined, massive PE + hemodyn. unstable, or RHF
catheter-directed thrombolysis
IVC filter
surgical thrombectomy (hemodyn. compr., lg prox thrombus, poor candidate for tPA)

47
Q

indications for IVC filter

A

CI to anticoag in pt with documented PE/DVT
complication of current anticoag
failure of adequate anticoag (i.e. DVT/PE while on tx)
low pulm reserve at high risk of death from PE

48
Q

when higher INR indicated (2.5-3.5)

A

prosthetic mechanical heart valves, ppx of recurrent MI, tx of antiphospholipid Ab syndrome

49
Q

what makes a PE submassive?

tx?

A

evidence of right heart strain: elevated troponin OR elevated BNP OR increased RA/RV size on 2D Echo
tx: heparin gtt–>coumadin

50
Q

what makes a PE massive?

tx?

A 
submassive criteria (RH strain) + hypotension
tx: tPA, thrombectomy if CI (otherwise thrombectomy used in CTEPH -chronic tromboembolic pulm. HTN)
51
Q

causes of hemoptysis

A

bronchitis (50%), lung cancer, TB, bronchiectasis, pneumonia

more rare: Goodpasture, PE w. pulm infarct, aspergilloma within cavities, mitral stenosis with ^PVP, hemophilia

IM Uworld (16 decks)

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