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ABIM Flashcards

1
Q

Immediate angiography for UA or NSTEMI

A 
HD unstable
HF
Recurrent rest angina despite therapy
New or worse MR murmur
Sustained VT
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2
Q

UA/NSTEMI treatment

A

TIMI 0-2 low risk, 3-7 high risk (early cath)

Asa, BB, ntg, heparin, statin, plavix

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3
Q

Ddx of ST elevation

A

STEMI, pericarditis, LV aneurysm, Takotsubo, vasospasm, myocarditis, acute stroke, early repolarization

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4
Q

STEMI treatment

A

Asa, BB, P2Y12 (1 year), heparin, ACE (lifelong if HF), ntg, statin

PCI - 90 min in hospital, 2 hrs transfer (from door)

Lytics if no PCI within 2 hrs - failure if HD unstable

Emergent CABG if thrombotic PCI failure or mechanical complications

Spiro 3-14 days later - if EF <40 and HF or DM

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5
Q

Post-MI therapy

A

Asa, plavix 1 year post DES, statin, BB, ACE if DM, htn, CKD, or HF, spiro if EF <40 and HF or DM

F/u echo in 40 days (3 months if PCI or CABG), ICD if EF <35 in class 2 or 3 or <30 in class 1

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6
Q

Types of stress test

A

EKG - no in LBBB, dig, LVH, prev PCI, ST depression at baseline
Echo or spect

Dobutamine or nuc - can’t exercise, paced ventricular rhythm

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7
Q

Treatment of stable angina

A

BB
CCB if BB contraindicated (HR, AV block, asthma)
Nitrates - need washout period of 8-12 hrs to prevent tachyphylaxis
Ranolazine if still symptomatic
Asa, ACE if htn, HF, DM, or CKD, statin

PCI if still symptomatic with max medical therapy

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8
Q

Contraindicated in HF

A

Dilt and verapamil
NSAIDs
Thiazolidinediones
Don’t start BB in decompensated HF, ok to continue

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9
Q

DCM ddx

A

Myocarditis (supportive care)
EtOH (standard HF)
Drugs - cocaine, meth (standard HF, no unopposed alpha (use labetalol))
Giant cell myocarditis (immunosuppressant, transplant)
Hemochromatosis
Peripartum (ACE, ARB, spiro are teratogens) (warfarin if EF <35) (don’t get pregnant again)
Takotsubo (supportive care)
Tachycardia induced (fix arrhythmia)

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10
Q

Murmur maneuvers in HCM

A

Louder with valsalva and squatting (increased preload)

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11
Q

Migraine treatment

A

No orals in severe NV
Triptans contraindicated in CAD, stroke, brainstem aura, hemiplegic migraine
Use acute therapy 3 days per week max
Avoid OCPs in migraine bc risk of stroke

No butalbital or opioids

Prophylaxis if no response to therapy, >10 days/month, disabling >4 days/month, using meds >8 days/month — amitryptiline, metoprolol, propranolol, timolol, topiramate, valproate, venlafaxine

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12
Q

Trigeminal cephalgias

A

Cluster headache (15-120 min several times a day for weeks)- triptan or O2, prevent w verapamil

Chronic paroxysmal hemicrania (5+ times a day 2-30 min)- indomethacin

SUNCT (1-600 seconds hundreds of times per day) - no treatment

Hemicrania continua - indomethacin

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13
Q

Red flags for secondary headache

A 
Thunderclap
Physical exam abnormal
Neuro symptoms for more than an hour
New headache in older than 50
Cancer, immunosuppression, pregnancy
Level of consciousness
Triggered by exertion, sex, valsalva

MRI
CT if suspect ICH
ESR CRP if suspect giant cell arteritis
LP for suspected meningitis or increased ICP

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14
Q

AED side effects

A

Carbamazepine - hepatic clearance, osteoporosis, HL, hyponatremia, pancytopenia

Valproate - weight gain, HL, PCOS, teratogen, hepatotoxic

Topiramate, zonisamide - kidney stones, teratogen

All - hypersensitivity, SJS, suicidal ideation, many inactivate OCPs

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15
Q

Stroke treatment

A

tPA within 3 hours if no bleeding or BP 185/110

Tylenol for fever
NS
Asa if no lytics
DVT prophylaxis after 48 hrs

Antihypertensives in first 48 hrs only if BP 220/120 (185/110 w lytics) or aortic dissection or end organ damage

Endarterectomy after 2 weeks if stenosis ipsilateral >70

Statin, aspirin, dipyridamole, warfarin for cardioembolic

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16
Q

SAH treatment

A

CSF if CT normal but high suspicion

Clip or coil within 48-72 hrs

Keep BP under 140

Nimodipine for 21 days

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17
Q

ICH treatment

A

Surgery or angiography

Mannitol, barbiturate coma, hyperventilation for ICP

Nicardipine, labetalol to keep SBP 140-160

Reverse warfarin

No ntg or nipride bc they can increase ICP
No platelets or steroids

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18
Q

Parkinson disease ddx

A

Multiple system atrophy - ataxia and orthostatic hypotension, MRI showing necrosis of putamen, cerebellar atrophy

Supranuclear palsy - unexplained backward falls, inability to move eyes vertically

Lewy body dementia - dementia, hallucinations

Medication induced Parkinsonism - antiemetics, antipsychotics, reserpine, lithium, methyldopa

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19
Q

Myelopathy ddx

A

MS - oligoclonal bands
Neuromyelitis optica - NMO-IgG, MS wo brain lesions
Idiopathic transverse myelitis - after viral infection
B12 deficiency - check MMA and homocysteine, sensory
Copper deficiency - after bariatric surgery or taking lots of zinc
Spinal cord infarct - acute flaccid paralysis
Compressive

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20
Q

Myasthenic crisis

A

Triggered by infection, surgery, meds - aminoglycosides, quinolones, magnesium, BBs, CCBs

Treat w plasmapheresis or IVIg. No pyridostigmine alone bc it increases secretions

Regular myasthenia treated w pyridostigmine, thymectomy if thymoma

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21
Q

Drugs that cause TTP

A

Plavix, gemcitabine

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22
Q

Skin biopsy

A

Lesion for histology, perilesional for DIF

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23
Q

Milaria

A

Heat rash

Can be in fever

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24
Q

Amyopathic dermatomyositis

A

Heliotrope sign, gottrons papules, shawl sign

No muscle enzymes or decreased strength

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25
Q

Bullous pemphigoid

A

Urticarial plaques and tense bullae trunk upper legs

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26
Q

Treatment for impetigo

A

Mupirocin

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27
Q

Drug induced SLE

A 
Adalimumab
Hydralazine
Procainamide
isoniazid
Minocycline 
Annular scaly patches

HCTZ causes subacute cutaneous lupus

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28
Q

Erythema multiforme

A

HSV mycoplasma pneumoniae

Tricolored targetoid papules

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29
Q

Actinic purpura

A

Age related capillary fragility

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30
Q

Epidermal inclusion cyst

A

Excise

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31
Q

Tinea treatment

A

Imidazole

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32
Q

Localized scleroderma

A

Skin hardening without systemic disease

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33
Q

Poison ivy

A

Prednisone taper

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34
Q

Lentigo maligna

A

On the face

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35
Q

Pyoderma gangrenosum treatment

A

Prednisone

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36
Q

Erythema nodosum next steps

A

CXR to look for sarcoidosis

Can be triggered by hormones

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37
Q

Pitted keratolysis

A

Small pits punctate erosions on sweaty feet, bacterial, topics antibiotics

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38
Q

Treatment of venous stasis ulcers

A

Compression

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39
Q

Dermatitis herpetiformis treatment

A

Dapsone and gluten free diet

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40
Q

Erythroderma

A

Psoriasis can flare to this w glucocorticoids

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41
Q

Inverse psoriasis

A

Itchy plaques in axillae intergluteal pannus etc

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42
Q

Heart transplant rejection

A

Biopsy

Heart failure, complete heart block

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43
Q

To decide what kind of AAA repair

A

Cta a/p to see if other vessels involved

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44
Q

Effusive constrictive pericarditis

A

Ibuprofen and colchicine

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45
Q

Intermittent claudication

A

Supervised exercise

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46
Q

Stable heart failure follow up labs

A

Electrolytes and kidney function

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47
Q

Papillary fibroelastoma

A

Independently mobile cardiac tumor stalk to left sided valvular endocardium, associated w embolization

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48
Q

Isolated anterior thigh numbness

A

Meralgia paresthetica - lateral femoral cutaneous nerve

Relieve pressure

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49
Q

Bell palsy

A

Prednisone within 72 hours

No antivirals
No imaging needed

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50
Q

Mononeuritis multiplex

A

Vasculitis, lymphoma, amyloid, sarcoidosis, Lyme, hiv, leprosy, diabetes

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51
Q

GBS

A

Areflexic
Ascending
Campylobacter
Elevated CSF protein w normal cell count

Plex or ivig
No steroids

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52
Q

CIDP

A

Proximal neuropathy over months

Prednisone, plex, IVIG

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53
Q

Steroid myopathy

A

Normal CK
Proximal weakness
Normal EMG

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54
Q

Lipophilic statins

A

Atorva simva lova

Statin myopathy more likely

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55
Q

Primary CNS lymphoma

A

Supratentorial, visual symptoms, immunocompromised

Ocular involvement

Biopsy

Radiation and chemo, start haart, no surgery

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56
Q

Meningioma

A

Enhancing dural tail

Resection, no chemo

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57
Q

Brain mets

A

Lung, breast, melanoma

Steroids, radiation

Methotrexate and cytarabine for leptomeningeal mets

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58
Q

Brain death

A

Coma, apnea, absence of brain stem reflexes

Can’t be brain death with respiratory drive or posturing

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59
Q

RA

A 
RF, CCP
Periarticular osteopenia, symmetric joint space narrowing
Cervical spine subluxation
Bronchiolitis obliterans 
Mononeuritis multiplex
Cricoarytenoid involvement
Caplan syndrome
HF
ILD
Felty syndrome
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60
Q

Treatment of RA

A

Steroids for symptoms

Methotrexate for erosive disease

Screen for osteoporosis

Methotrexate and leflunomide are teratogens

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61
Q

Erosive Inflammatory OA

A

Pain and swelling of PIP and DIP joints

ESR and CRP normal

62
Q

DISH

A

OA
Ossification along anterolateral aspect of vertebral bodies
No disk space narrowing or syndesmophytes

Complications: dysphasia, fractures, spinal stenosis, myelopathy

63
Q

Hypertrophic osteomyopathy

A

Clubbing

New periosteal bone formation

64
Q

Psoriatic arthritis

A

Check for HIV

Nsaids
Methotrexate - doesn’t prevent progression
TNF blockers

65
Q

Cutaneous T cell lymphoma treatment

A

Photophoresis

66
Q

Reactive arthritis

A

Arthritis, conjunctivitis, urethritis in 1/3

Enthesopathy
Sacroiliitis
Keratoderma blennorrhagicum (psoriasis on palms and soles)
Circinate balanitis

HIV, chlamydia, stool studies

Self limited within 6 months

67
Q

Ankylosing spondylitis

A

Worse at night, better with activity or heat

AI, uveitis, aortic aneurysm, EP problem

Cervical fracture with minor accident

NSAIDs
Glucocorticoid injections
TNF for axial
Methotrexate for peripheral
Calcium and D
68
Q

SLE criteria

A

4 of:

ANA
Malar rash
Discoid rash
Photosensitivity 
Oral ulcers
Arthritis
Serositis
Kidney disease
Neuro disease
Heme disease
Immunologic disease
69
Q

Neonatal lupus

A

Mothers have SSA or SSB

Heart block

70
Q

Lupus testing

A

ANA
Anti smith
Ds DNA correlates with disease activity
Low complements in flares

Anti Histone in drug induced lupus

71
Q

Therapy for SLE

A

Hydroxychloroquine for arthritis.
Topical glucocorticoids for rash
Life threatening disease cytoxan and MMF
Bisphosphonates for osteopenia

72
Q

Hydroxychloroquine monitoring

A

Annual eye exam

73
Q

SLE safe in pregnancy meds

A

Prednisone, hydroxychloroquine

74
Q

Diffuse cutaneous systemic sclerosis

A

Proximal to elbows and knees
ANA, SCL-70
ILD
Scleroderma renal crisis

75
Q

Limited cutaneous systemic sclerosis

A

Distal to elbows and knees
ANA, anti centromere
PH
CREST syndrome

76
Q

Systemic sclerosis test

A

Nail fold capillary destruction, dilated capillary loops

Has to have raynaud phenomenon to be SSc

77
Q

Treatment for systemic sclerosis

A

Raynaud - no smoking, amlodipine, felodipine, nifedipine, sildenafil, nitro paste

GI dysmotility - PPI, metoclopramide

Scleroderma renal crisis - ACE inhibitor

Bacterial overgrowth - antibiotics

Alveolitis - MMF or cyclophosphamide

No steroids; they cause scleroderma renal crisis

78
Q

MCTD

A

SLE, SSc, and/or polymyositis with anti U1 RNP antibodies

Mortality related to PH

79
Q

Fibromyalgia evaluation

A

CBC, BMP, TSH, ESR, CRP - normal

Don’t order ANA, RF, CCP

80
Q

Fibromyalgia treatment

A

No opioids or NSAIDs

Exercise and CBT

Pregabalin, duloxetine, milnacipran

81
Q

Gout testing

A

Monosodium urate crystals and urate tophi

Negatively birefringent

Synovial fluid WBC 2000-75000; >50000 should raise concern for septic joint

82
Q

Gout flare treatment

A

NSAIDs, colchicine, steroids

83
Q

Recurrent gout treatment

A

ACR says aim for urate <6 if tophi, <5 wo tophi

Allopurinol - start w few month course of colchicine or NSAID to prevent gout flare

Avoid allopurinol in Asians w HLA B27

Febuxostat if CKD

If nothing else works, pegloticase

84
Q

Allopurinol and HCTZ

A

Hypersensitivity syndrome

Dermatitis, fever, eosinophilia, hepatic necrosis, nephritis

85
Q

Gout and azathioprine

A

Allopurinol and febuxostat raise levels; don’t use them

86
Q

CPPD

A

Positively birefringent rhomboid shapes crystals

Linear calcification of meniscus

Screen for hemochromatosis, hypomagnesemia, hyperparathyroidism, hypothyroidism

87
Q

Disseminated gonorrhea

A

Migratory polyarthritis, fever, vesicles

Ceftriaxone for GC and doxy for chlamydia

88
Q

Polyarteritis nodosa kidney disease

A

Does not involve the glomerulus - no blood, casts, or protein

Htn, mononeuritis multiplex, livedo reticularis, purpura

Check HBV, biopsy (skin or testicle), mesenteric and renal angiography

Prednisone, cytoxan

89
Q

Giant cell arteritis

A

Fever, headache, jaw claudication

Blindness, aortic dissection and aneurysm

Diagnose with ESR and temporal artery biopsy

Treat with high dose steroids, tocilizumab, aspirin

90
Q

EGPA

A

Asthma, eosinophilia, IgE, hemoptysis

P ANCA/ MPO

Treat w prednisone, cytoxan for multi organ failure

91
Q

Takayasu arteritis

A 
Fever, malaise, weight loss, arthralgia
Arm and leg claudication
Pulse deficits
Bruits
Asymmetric BP

Aortography

Prednisone

92
Q

Relapsing polychondritis

A

Red hot painful ears
Strider caused by tracheal collapse
Saddle nose deformity

Cartilage biopsy

NSAIDs, colchicine, dapsone for mild
Steroids for severe

93
Q

Familial Mediterranean fever

A

Recurrent fever and serositis, arthritis, rashes

ESR CRP
Serum amyloid AA
Proteinuria
Genetic testing

Colchicine

94
Q

Adult onset Still disease

A

Daily fever, myalgia, proteinuria, serositis, evanescent pink rash, arthritis

Ferritin >2500

Steroids
Mtx, TNF inhibitor, anakinra

95
Q

Complex regional pain syndrome

A

Abnormal bone metabolism and osteoporosis
Follows injury, surgery, MI, or stroke
Hair loss, movement disorder, swelling, autonomic dysfunction

Physical therapy, steroids, bisphosphonates even if no osteoporosis

96
Q

Primary adrenal insufficiency

A

Low aldo, hyperpigmentation

Autoimmune adrenalitis - hydrocortisone and fludrocortisone
Bilateral adrenal hemorrhage
TB
Addison disease
Neisseria 
HIV
Histo
Mets
97
Q

Primary adrenal insufficiency testing

A

Morning serum cortisol low, diagnosed <3. Normal >15
If borderline, cosyntropin stim test
ACTH to see primary vs secondary

Stress dose steroids if they are sick

98
Q

Secondary adrenal insufficiency

A

ACTH deficiency
Pituitary apoplexy
Steroids
Long term opioid use - long acting

99
Q

Adrenal crisis

A

Shock, fever, abdominal pain, tachycardia

Usually primary because that causes hypotension

100
Q

Hypercortisolism testing

A

24 hour urine, nighttime salivary cortisol
Low dose suppression test - 1 mg dex doesn’t suppress

ACTH low - Cushing syndrome - CT MRI adrenals

ACTH high - high dose suppression test - 8 mg
If suppresses, pituitary. If not, ectopic production (small cell lung cancer)

101
Q

Pheochromocytoma treatment

A

Phenoxybenzamine

No contrast - can cause crisis. Make sure treated before imaging.

Post op fluids, might need pressors

Long term monitor for mets

102
Q

Men 2A

A

Pheo, medullary thyroid cancer, pituitary adenoma

103
Q

Prolactinoma treatment

A

Cabergoline or bromocriptine - dopamine agonist. Shrinks it

Surgery if it fails

104
Q

Hypothyroidism and prolactin

A

TSH can elevate prolactin mildly

Other causes : risperdone,

105
Q

Bartter syndrome

A

High urine cl na ca

Like loop diuretic effect

106
Q

CKD and chronic metabolic acidosis

A

Give bicarb if bicarb <22

107
Q

Minimal change disease treatment

A

Prednisone

Ace, diuretics, statin

108
Q

IgA nephropathy treatment

A

ACE inhibitor

109
Q

Multiple myeloma diagnosis

A

Aki, anemia, hypercalcemia, bone pain, nagma

110
Q

Antihypertensive regimen adjustment

A

Add another agent instead of increasing dose once at 50% max dose

111
Q

Ethylene glycol toxicity treatment

A

Fomipazole, fluid, dialysis

112
Q

Membranous glomerulonephropathy management

A

Eval for secondary causes - cancer screening, hepatitis, syphilis, lupus

Prior to immunosuppression

113
Q

Balkan endemic nephropathy

A

Aristolochic acid
Tubulointerstitial

Associated w upper urinary tract urothelial cancer
Cystoscopy

114
Q

DI diagnosis and treatment

A

High sodium w low urine osm

Try desmopressin, if it doesn’t work it’s nephrogenic - HCTZ

115
Q

Hypoaldosteronism sources causing hyperK

A

Heparin, RAAS inhibition, type 4 RTA, primary adrenal disease

116
Q

Pyroglutamic acidosis

A

Chronic acetaminophen if chronically ill, CKD, poor nutrition, vegetarian

Mental status changes, agma

117
Q

Previously treated GPA with hematuria

A

Cystoscopy to look for bladder cancer - both GPA and cytoxan increase risk

118
Q

Hematuria workup

A

Cystoscopy to look for bladder cancer in age >35

119
Q

Acute hyponatremia treatment

A

3% saline

120
Q

Sarcoidosis renal involvement

A

Nephrocalcinosis, hypercalcemia, hypercalcuria

Interstitial nephritis w granulomas

121
Q

Hyperlipidemia in CKD treatment

A

Statin

Though triglycerides are primary problem

122
Q

Assess high creatinine in patients with high muscle mass

A

Cystatin C - produced by all cells, not just muscle cells, so it’s clearance may be better indicator

123
Q

Kidney stone prevention

A

If hypercalcuria, add a thiazide

124
Q

Membranous GN antibody

A

Anti PLA2

125
Q

Treatment of renal artery stenosis

A

Atherosclerosis treatment including ACE, check to see that cr doesn’t increase >25%

126
Q

Type 1 RTA

A

Distal tubule

Can’t acidify urine
HypoK
Nagma
Positive urine anion gap

127
Q

FSGS associations

A

Premature birth
Solitary kidney
Obesity
Black

128
Q

Fabry disease

A 
X linked
Lisosomal storage disorder
Burning hands and feet
Nephritis
Angiokeratomas
Corneal and lens opacities
Heart infiltration
Neuro involvement
129
Q

Struvite stone treatment

A

Remove stones - Nidus for infection

130
Q

Adynamic bone disease

A

ESRD

Normal pth and vitamin d

131
Q

CKD anemia treatment

A

Supplemental iron with goal of tsat >30 and ferritin >500

Epo if normal iron stores

132
Q

Calcineurin inhibitor aki and hyperkalemia treatment

A

Thiazide diuretic

133
Q

Hypermagnesemia treatment

A

Calcium

134
Q

Topamax kidney stone

A

Calcium phosphate

135
Q

Cisplatin renal toxicity

A

Tubular injury
Fanconi syndrome
Hypomagnesemia
Polyuria

136
Q

Liraglutide

A

Diabetes and weight loss

137
Q

Autoimmune adrenalitis testing

A

21 hydroxylase antibodies

138
Q

Prolactin and antipsychotics

A

If prolactin is <50, probably medication side effect

But if >200, get pituitary mri

139
Q

Pager disease of bone

A

After diagnosis with X-ray

Need alk phos. If normal, disease is burnt out and needs no treatment

140
Q

Antiresorptive drug hypocalcemia

A

Caused by low vitamin D

141
Q

Monitoring labs chronic hypoparathyroidism

A

24 hr urine calcium
If over 300, have to decrease calcium and vitamin D replacement
Thiazide diuretics decrease calcium excretion, can be used to meet calcium goals

142
Q

False negative metanephrines

A

Norepinephrine uptake meds

Like amitryptiline

143
Q

Metformin GFR

A

> 45

144
Q

Toxic adenoma treatment

A

Radioactive iodine or surgery

145
Q

Parathyroidectomy indications

A

Ca >1 over ULN, gfr <60, urine ca >400, kidney stones, T score

146
Q

Hypoglycemic unawareness

A

Decrease all insulin doses

147
Q

Methimazole side effect

A

Agranulocytosis, comes with sore throat and fever

148
Q

Myxedema coma treatment

A

Hydrocortisone before thyroid hormones

149
Q

Amiodarone induced thyrotoxicosis treatment

A

Prednisone taper
Methimazole if just hyperthyroidism without destruction
Stop amio

150
Q

Osteomalacia

A 
Low vit d
Low ca
Low phos 
High PTH
High ALP
151
Q

Colonoscopy and aspirin

A

No need to discontinue

152
Q

Hyperplastic polyps

A

Repeat colonoscopy in 10 years

All (3 decks)

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