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Board Basics Flashcards

1
Q

EKG changes seen with unstable angina and NSTEMI?

A
  1. ST segment depression
  2. T wave inversions
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2
Q

Acute coronary syndromes occur due to what pathological situations?

A
  1. Coronary blood flow was disrupted
  2. Metabolic requirements exceed supply
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3
Q

Chest pain during the peripartum period

A

Spontaneous coronary artery dissection

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4
Q

What are other presentations besides chest pain that indicate ACS?

A

HF, pulmonary edema, shock, dysrhythmias

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5
Q

What are 2 signs (PE) of cardiac ischemia?

A

New MR murmur and S4 sound

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6
Q

ST-elevation equivalents?

A
  1. New LBBB
  2. Posterior MI (tall R waves and ST depression in V1-V4)
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7
Q

Indications for immediate angiography?

A

1) Hemodynamic instability
2) HF
3) sustained VT
4) New or worsening MR murmur
5) Refractory pain

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8
Q

What of the other causes of ST elevation?

A
  1. Acute pericarditis
  2. LV aneurysm
  3. Takotsubo’s cardiomyopathy
  4. Coronary vasospasm
  5. Acute stroke
  6. Normal variant
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9
Q

What is a scoring indicate and a TIMI score?

A

0–2: Low risk, likely will need stress test
3–7: Intermediate to high risk, will need early revascularization

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10
Q

What is a tool used for restratification to determine early angiography in patients with unstable angina and NSTEMI?

A

TIMI

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11
Q

Was indication for thrombolytic agents in setting of ACS? What is a “treatable” contraindication for thrombolytic therapy?

A

If PCI not available and will not be able to be performed within under 120 minutes. BP must be below 180/110

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12
Q

What is the timeline for PCI?

A
  1. 90 minutes from first medical contact and a PCI capable Health Center
  2. 120 minutes for first medical contact if transferred from a facility that does not have PCI capabilities
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13
Q

Reportedly 2 other indications for PCI in setting of ACS?

A
  1. Failure of thrombolytic therapy
  2. Cardiogenic shock or new HF
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14
Q

When should the patient not be given thrombolytic therapy if ACS suspected?

A
  1. NSTEMI
  2. Asymptomatic patients with onset of pain greater than 24 hours ago
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15
Q

A 58-year-old man with acute chest pain has ST segment elevation in leads II, III, and aVF. Blood pressure is 82/52 mmHg, and pulse rate is 54/M IN. Physical examination shows JVD, clear lungs, and no murmur or S3.

Visit diagnosis? What is the management of this patient?

A

RV Infarction

IV Fluids, ECG lead V4R tracing, and cardiac catheterization

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16
Q

Ordered further recommendations for temporary pacing the setting of acute MI?

A
  1. Symptomatic bradycardia (including complete heart block)
  2. Alternating LBBB and RBBB
  3. New or intermediate age bifascicular block with first-degree AV block
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17
Q

Patient recently suffered an MI approximately 4 days ago and then suddenly became hypotensive and went into cardiac arrest associated with PEA

A

LV free wall rupture

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18
Q

Post MI patient developed abrupt pulmonary edema and hypotension. Patient is noted to have a loud holosystolic murmur and thrill on physical exam.

A

VSD or papillary muscle rupture

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19
Q

All complications of acute MI occur approximately 2-7 days?

A

Mechanical complications (VSD, papillary muscle rupture, and LV free wall rupture)

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20
Q

What is the management of papillary muscle rupture and VSD?

A

Stabilize patient. Intra-aortic balloon pump, afterload reduction with sodium nitroprusside, diuretics followed by emergency surgical intervention

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21
Q

Which should post MI patient’s be screened for?

A

Depression

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22
Q

ICDs are indicated PostMI patients meeting all the following criteria:

A
  1. Greater than 40 days since MI or greater than 3 months since PCI or CABG
  2. LVEF less than 35% in setting of NYHA class II or III
  3. LVEF less than 30% in setting of NYHA class I
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23
Q

Symptoms and signs that increase likelihood of HF include:

A

1) PND
2) S3 (11 fold likelihood)

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24
Q

The likelihood of HF is decreased 50% by:

A

1) absence of dyspnea on exertion
2) absence of crackles on pulmonary auscultation

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25
Q

A BNP level of what is compatible with HF? What level rules out HF?

A

> 400; <100 unlikely to be CHF

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26
Q

What would the indication for endomyocardial biopsy be in setting of CHF?

A

If you suspect, giant cell myocarditis and sarcoidosis

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27
Q

Symptomatic patients with CHF and excessive daytime sleepiness should be evaluated for?

A

OSA

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28
Q

Cardiac MRI can assess for what?

A

hemochromatosis, sarcoidosis, and amyloidosis

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29
Q

What can increase BNP?

What decreases BNP?

A

Kidney failure, age, and female sex

Obesity

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30
Q

Medications to avoid in CHF?

A

NSAIDs

Thiazides (glitazones)

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31
Q

Do not implant ICD until when?

A

3 months of guideline directed medical therapy (or 40 days after MI)

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32
Q

Preferred Beta Blocker in drug-induced cardiomyopathy?

A

Labetalol (due to alpha blocker activity to prevent coronary vasospasm); regular beta blockers can exacerbate

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33
Q

Rare disease characterized by biventricular enlargement, Refractory ventricular arrhythmias, and rapid progression to cardiogenic shock and young to middle-aged adults.

A

Giant Cell Myocarditis

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34
Q

Histologic examination of giant cell myocarditis demonstrates what?

A

Presence of multinucleated giant cells in the myocardium

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35
Q

Treatment for giant cell myocarditis?

A

Immunosuppression and/or elevated
Definitive treatment is by cardiac transplantation

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36
Q

When his peripartum cardiomyopathy diagnosed?

A

1 month for 5 months after delivery

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37
Q

What medications should be avoided in Partum cardiomyopathy?

A

ACE inhibitors, ARB, aldosterone antagonist (eplerenone)

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38
Q

What other medications are indicated in peripartum cardiomyopathy if LVEF is less than 35%?

A

Anticoagulation with heparin to warfarin

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39
Q

Should valsalva maneuver increase or decrease a murmur in HCM?

A

Increase (increase systemic resistance and afterload)

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40
Q

Screening for HCM?

A

1st degree relatives:
1) echo
2) EKG
3) genetic testing

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41
Q

medications to be avoided in HCM?

A
  1. Avoid vasodilating beta-blockers (carvedilol, labetalol, and nebivolol)
  2. Avoid digoxin, vasodilators, or diuretics which increased LV outflow obstruction for

The LV is preload dependent

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42
Q

What is the indication for surgery or septal ablation in patients with HCM?

A
  1. Outflow tract gradient of greater than 50 mmHg
  2. Continue symptoms despite maximal drug therapy
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43
Q

What medication be added if significant symptoms related to LVOT obstruction remain in hypertrophic cardiomyopathy?

A

Disopyramide

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44
Q

What are the indications for beta-blockers in patients with hypertrophic cardiomyopathy?

A

1 ejection fraction greater than 50%
2. Dyspnea
3. Chest pain

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45
Q

What findings on ECG may mimic ischemia in patients with HCM?

A

deeply inverted, symmetric T waves in leads V3 to V6; In the apical hypertrophic form of the disease

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46
Q

The two categories and etiologies of restrictive cardiomyopathy?

A

1) normal wall size

2) increased wall thickness

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47
Q

Three types of restrictive CM that have normal wall thickness?

A

1) Hemochromatosis
2) Radiation induced fibrosis
3) Eosinophilic diseases

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48
Q

Heart Failure symptoms with neuropathy and signs of proteinuria, hepatomegaly, periorbital ecchymosis, bruising, and low voltage ECG

A

AL amyloid cardiomyopathy

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49
Q

Most common extrinsic causes of sinus bradycardia or what medications?

A
  1. Beta-blockers
  2. Donepezil
  3. Neostigmine
  4. pyriDistigmine
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50
Q

Common causes of inappropriate sinus bradycardia are?

A
  1. Age-related myocardial fibrosis
  2. Hypothyroidism
  3. Inferior ischemia
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51
Q

Indications for pacemaker?

A

1) Symptomatic bradycardia
2) Permanent AF with bradycardia
3) Heart Block (Mobitz II and above)
4) Alternating LBBB and RBBB

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52
Q

What consists of the CHADSVASC score?

A

2 points: prior stroke or age >75

1 point: HTN, HF
1 point: DM, Vasc
1 point: female, ages 65-74

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53
Q

What medication is started for atrial fibrillation control if they have comorbid, WPW syndrome?

A

procainamide

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54
Q

When is warfarin indicated in AF?

A

valvular AF

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55
Q

Definitive treatment for typical atrial flutter?

A

catheter ablation

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56
Q

What is the classic ventricular rate of atrial flutter?

A

150 bpm due to 2:1 conduction ratio

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57
Q

When is VTE prophylaxis used post-discharge from hospital?

A

Postdischarge prophylaxis (up to 5 weeks)

1) Hip Fracture
2) Knee and Hip Replacement
3) Major Cancer Surgery

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58
Q

What score of zero eliminates the need for D-dimer testing or CTA?

A

PERC (Pulmonary Embolism Rule-Out) Score

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59
Q

What score from Well’s criteria indicates further testing for thrombus?

A

Well’s DVT (>1) or Well’s PE (>4) will need Duplex US or CTA, respectively

Low probability <1, <4 = D-dimer

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60
Q

Treatment of Superficial Vein Thrombophlebitis?

A

Supportive Care (Analgesia, warm compresses, and NSAIDs); if symptoms persist, image

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61
Q

When to A/C for superficial vein thrombosis?

A

> 5cm, close to deep venous system, or other risk factors exist

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62
Q

Distal Leg DVT

Asymptomatic

A
  • Monitor with serial duplex US within 1-2 weeks
  • 3-6 months of Eliquis or Xarelto
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63
Q

Proximal Leg DVT or PE

-Provoked tx duration?
-Unprovoked?
-Recurrent?

A

-3-6 months
-Extended
-Depends (whether provoked or unprovoked)

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64
Q

Indications for tPA in DVT/PE

A

1) massive DVT with either acute limb ischemia, severe edema, and/or venous insufficiency

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65
Q

Right-sided heart murmurs increase in intensity with work?

A

Inspiration

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66
Q

Hypertrophic cardiomyopathy murmurs increase intensity with what?

A

valsalva and on standing from squatting position

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67
Q

What heart murmur is described as a clinic and moves closer to S1 with a murmur lengthening with Valsalva maneuver and on standing from a squatting position?

A

Mitral valve prolapse

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68
Q

Fixed splitting occurs with ASD, VSD, and what other 2 causes?

A

RBBB, pulmonary valve stenosis

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69
Q

Paradoxical splitting occurs under what 3 manifestations?

A

LBBB, HCM, and severe AS

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70
Q

Signs of serious cardiac disease on cardiac physical exam include: (For characteristics)

A
  1. S4
  2. Murmur grade greater than 3/6 intensity
  3. Continues murmurs
  4. Any diastolic murmur
  5. Abnormal splitting of S2
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71
Q

What are the 3 different criteria that constitutes severe aortic stenosis?

A
  1. Aortic area of less than 1 cm²
  2. Aortic jet velocity (Vmax) greater than 4 m/s
  3. Mean transaortic pressure gradient greater than 40 mmHg
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72
Q

What are the 3 indications for aortic valve replacement and severe AS?

A
  1. Symptomatic: Syncope, presyncope, angina, and dyspnea
  2. Ejection fraction less than 50%
  3. A contaminant cardiac surgical procedure further indications
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73
Q

When is TAVI preferred over SAVR for symptomatic patients with severe AS?

A
  1. Age greater than 80 years
  2. Neuner patients with less than 10 years life especially
  3. Any age with a higher probability of surgical risk
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74
Q

MCC of hypercalcemia in the outpatient setting?

A

Primary Hyperparathyroidism

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75
Q

MCC of hypercalcemia in the inpatient setting?

A

Malignancy

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76
Q

Symptom presentations of hypercalcemia (non-incidental findings)?

A

1) Kidney Stones
2) Osteoporosis
3) Fractures (Osteopenia)
4) Pancreatitis

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77
Q

Hypercalcemia can also be caused with what medications?

A

Thiazide diuretics (non-PTH mediated)

Lithium (PTH-mediated)

78
Q

What other rheumatological condition is associated with hypercalcemia (10%) and hypercalciuria (50%)

A

Sarcoidosis (mediastinal lymphadenopathy)

79
Q

Calcium: Elevated
PTH: Elevated
Phosphorus: Low

Imaging: Chondrocalcinosis

A

Primary Hyperparathyroidism

80
Q

Calcium: Markedly elevated
PTH: Suppressed
Phosphorus: Normal/Low

Imaging: Lung Cancer

A

Humoral Hypercalcemia of Malignancy

may or may not be mediated by PTH-related protein (PTHrP)

81
Q

Calcium: Elevated
PTH: Suppressed
Phosphorus: Normal/Low

Imaging: Bone Mets in a known prostate cancer patient

A

Local Osteolytic Lesions

Lytic Bone Metastasis (Prostate, Breast, Lung, Renal) can release calcium from the broken down bone

82
Q

Calcium: Elevated
PTH: Suppressed
Phosphorus: Elevated

Labs: Elevated Cr/Decreased eGFR, Anemia

A

MM: low phosphate = Fanconi syndrome

high phosphate = renal dysfunction from MM

Confirm with serum and urine electrophoresis

83
Q

Calcium: Elevated
PTH: Suppressed
Phosphorus: Elevated

Calcitonin: Elevated

A

Granulomas (TB, Sarcoid)

Malignancy: B-cell Lymphoma

Elevated Vitamin D = high calcium = negative feedback to PTH = high phosophate

84
Q

C4 elevated

A

Hereditary angioedema

85
Q

Calcium: Elevated
PTH: Suppressed
Phosphorus: Elevated
Creatinine: Elevated
Bicarbonate: Elevated
CBC: Normal

History of osteoporosis

A

Milk-Alkali Syndrome: excessive ingestion of calcium carbonate to treat osteoporosis

Metabolic alkalosis
Calcium elevated
AKI

86
Q

Other indirect cause of hypercalcemia (Endocrinological cause)?

A

Hyperthyroidism (direct stimulation of osteoclasts)

87
Q

Two indications for acute treatment of hypercalcemia in the inpatient setting?

A

1) Acute increase in calcium with symptoms (Clinical: AMS, coma)
2) Ca levels greater than 14 (most likely Humoral Hypercalcemia of Malignancy)

88
Q

Calcium: Elevated
PTH: Normal

What test should be included with initial workup in addition to: phosphorus, Vitamin D levels?

A

Urinary calcium level

Familial Hypocalciuric Hypercalcemia

89
Q

Hyperparathyroidism is most common manifestation of what MEN syndrome?

90
Q

What other workup is indicated with hyperparathyroidism when surgery is indicated?

A

Imaging: MRI, CT, sestamibi scan, U/S

91
Q

Tx of acute hypercalcemia in inpatient setting?

A

IV Fluids NS

IV Bisphosphonates

(Steroids if MM, Lymphoma, or Sarcoid)

92
Q

Indications for parathyroidectomy in asymptomatic patients?

A

Calcium >1 of ULN
Age <50
CrCl <60
T <-2.5 or vertebral fracture

93
Q

MEN1

A

MC: Hyperparathyroidism

Pituitary

Pancreas

MEN has 1 Penis (P)

94
Q

MEN2

A

MC: Medullary thyroid cancer

Pheochromocytoma

Hyperparathyroidism

95
Q

MCC of hypocalcemia

A

Low albumin

Albumin 1: 0.8 Total Ca

Check ionized calcium

96
Q

Calcium: Low
PTH: Low
Phosphate: High
Vit D Levels: Variable

A

Hypo-parathyroid

97
Q

Calcium: Low
PTH: High
Phosphate: High
1,25 Vitamin D: Low

98
Q

Recent parathyroidectomy and hypocalcemia

A

Hungry Bone syndrome

99
Q

Imparied PTH secretion and PTH resistance associated with what electrolyte abnormality?

A

Low Magnesium (Alcoholic, diarrhea, diuretics)

100
Q

How to supplement Vit D in Kidney disease?

A

1,25 dihydroxy D

101
Q

How to supplement Vit D in Liver disease?

A

25-hydroxy D

102
Q

USPSTF osteoporosis screening?

A

> 65 with DEXA

<65 with risk factors based on FRAX score

103
Q

If patient is receiving long-term steroids (>3 months), what testing should be done?

A

DEXA scan within 6 months if:

> 40
<40 if fracture or elevated FRAX

104
Q

isolated increase in alkaline phosphatase?

A

liver disease or

PAGET’S

105
Q

MCC of osteoporosis in men and women?

A

Women: estradiol deficiency

Men: testosterone deficiency

106
Q

Secondary Causes of osteoporosis?

A

Endo: hyper-thyroid, hyper-parathyroid, Cushing’s (high steroids)

Malabsorption: Celiac, intestinal resection, Chron’s

107
Q

Osteoporosis diagnosis confirmation (besides DEXA score)

A

1) DEXA <-2.5
2) Fragility Fracture (Fracture from standing height or lower)

108
Q

Paget’s disease is a focal disorder of what?

A

Bone remodeling:
-greatly accelerated rates of bone turnover
-disruption of normal architecture of bone
-gross deformities of bone

109
Q

Most patients that suffer from Paget’s are asymptomatic and the disease is suspected with what lab abnormality?

A

Elevated alk phos

110
Q

Signs and symptoms associated with Paget’s Disease?

A

1) Bone pain, fractures
2) CN compression syndromes, spinal stenosis, nerve root syndromes
3) High-output cardiac failure

111
Q

Diagnostic modality of Paget’s disease?

A

X-ray

1) asymptomatic - order bone scan and then X-ray areas with increase radionuclide uptake

2) symptomatic - order X-ray of painful area

112
Q

Imaging findings of Paget’s?

A

1) Cotton wool skull
2) Cortical thickening
3) Focal osteolysis with coarsening of the trabecular pattern

113
Q

When is treatment indicated in Paget’s?

A

1) Symptomatic - bone pain, fractures, radiculopathy
2) Involvement of a weight bearing bone or joint - even if asymptomatic

114
Q

Tx of Paget’s Disease?

A

One time dose of IV Zoledronic acid

115
Q

What specific type of Vitamin D do you test for?

A

25-hydroxyvitamin D

Vit D Level greater than 20

116
Q

Osteomalacia is the failure of what?

A

Bone matrix to adequately mineralize; typically due to lack of calcium and phosphorus; most of time 2/2 Vit D deficiency

117
Q

Workup of osteomalacia (labs and possible underlying causes)

A

Low calcium and low phosphorus

Intestinal malabsorption (celiac)
Metabolism - Liver issues
Kidney issues

118
Q

Osteomalacia tx if Vit D deficiency is cause?

A

Ergocalciferol 1000-2000 U/daily
Calcium 1g/d

119
Q

Most common cause of osteoporosis of women and men respectively?

A

Women: estrogen deficiency
Men: testosterone deficiency

120
Q

Secondary causes of osteoporosis (two categories)?

A

Endo: Cushing’s (steroids), hyperthyroidism, hyperparathyroidism

Intestinal Absorption: celiac, Chron’s disease, intestinal resection)

121
Q

What medications are associated with osteoporosis?

A

Thyroid hormone, steroids

phenobarbitol, phenytoin

thiazolidinediones

122
Q

Encourage all patients with osteoporosis to do what?

A
  1. Stop tobacco and alcohol
  2. resistance exercise
  3. Calcium and Vit D supplementation
123
Q

First Line therapy for anti-resorptive therapy?

Indications?

A

Alendronate or Risedronate (oral-bisphosphonates)

Osteoporosis
Osteopenia (high risk factors)

Fragility fracture
Vertebral fracture or hip fracture

124
Q

When are oral bisphosphonates contraindicated?

A

CKD

Esophageal disease

choose IV zoledronate acid (once yearly)

125
Q

What medication is preferred in patient’s with CKD stage IV or higher?

A

Denosumab (monoclonal antibody inhibits osteoclast activation)

not tolerant to bisphosphonates

126
Q

When are IV bisphosphonates contraindicated?

A

CKD and severe hypocalcemia

127
Q

What are primary causes of hypocalcemia?

A

Primary Autoimmune hypoparathyroidism

128
Q

When is parathyroidectomy indicated?

A
  1. Primary hyperparathyroidism
  2. Symptoms - disease related to hypercalcemia
  3. Asymptomatic - Numbers (1, 2.5, 50, 60)
129
Q

What medications can cause gynecomastia?

A

OPIOIDS!

Spironolactone, Cimetidine (H2 blocker), Anti-androgens

5-alpha reductase inhibitors (BPH and hair loss), protease inhibitors

130
Q

What are other causes of gynecomastia? What should the initial workup include if there is no obvious cause?

A

Cirrhosis, CKD

Hyperthyroidism, Hypogonadism

Germ Cell Tumors

hCG, 8 AM fasting testosterone, estradiol levels

131
Q

Treatment of gynecomastia in confirmed hypogonadism?

A

Testosterone (gel)

132
Q

Treatment of gynecomastia with no hypogonadism?

A

Estrogen receptor modulators

aromatase inhibitors

133
Q

What is an alternative renal marker that can estimate GFR, which is less influenced by age, sex, muscle mass, and body weight?

A

Serum cystatin C

134
Q

What conditions can overestimate GFR with a falsely low/normal creatinine?

A

Old age, malnutrition

Liver disease

135
Q

Protein detected on UA should always be followed up with what?

A

24 hour urine protein collection

protein-creatinine ratio

albumin-creatinine ratio

136
Q

What test is used to evaluate diabetic kidney disease?

A

Urine Microalbumin (albumin-creatinine ratio)

30 to 300 = moderately increased albuminuria

> 300 = severely increased albuminuria

137
Q

What is an abnormal protein-creatinine ratio defined as?

A

> 150 mg/g

138
Q

Proteinuria is a maker of what structural (portion of the kidney) renal disease

A

Renal parenchyma

glomerular disease

139
Q

Proteinuria is an independent marker for what?

A

CVD, PVD, and progressive kidney disease

140
Q

Positional (orthostatic) proteinuria is diagnosed how?

A

Daytime (standing) urine collection

Nighttime (supine) urine collection

141
Q

Hematuria is classified into what two categories?

A

Glomerular

Extraglomerular

142
Q

Hematuria + proteinuria = ?

A

Glomerular Hematuria (even with no casts)

142
Q

What are the qualifications of Extraglomerular hematuria?

A
  1. Normal erythrocyte morphology
  2. No presence of casts
  3. No presence of proteinuria
142
Q

What microscopic findings or the urine indicate glomerular causes of hematuria?

A
  1. Erythrocyte- casts
  2. Dysmorphic erythrocytes (Mickey Mouse ears, acanthocytes (spiculated))
142
Q

Should patients be evaluated for hematuria even if they take anti-platelets and/or anticoagulants?

142
Q

DDx of extraglomerular hematuria?

A

GU Cancer until proven otherwise

Infection, Drugs, Kidney stone, trauma

142
Q

Sterile pyuria indicates what?

A

TB

Interstitial nephritis/cystitis

142
Q

Urine Eosinophils indicates what?

A

AIN

postinfectious GN, atheroembolic disease of the kidney, small vessel vasculitis, septic emboli

143
Q

Leukocytes in the urine generally indicate what?

A

Glomerular/Tubulointerstitial inflammation

infection, or an allergic reaction

144
Q

Positive for blood on dipstick but, negative microscopic erythrocytes?

A

Hemolysis and Rhabdomyolysis

145
Q

Urine lipids and fat generally indicate what?

A

severe proteinuria or nephrotic syndrome

146
Q

What are renal casts?

A

Cylindrical aggregates of Tamm-Horsfall mucoproteins that trap the intraluminal contents, which appear in the urine.

147
Q

Erythrocyte casts

A

Glomerular disease (glomerulonephritis)

148
Q

Leukocyte Casts

A

Inflammation or infection of

Renal parenchyma

149
Q

Muddy Brown casts

150
Q

Broad casts

151
Q

Causes of SIADH?

A

Cancer (SCLC)
Intracranial pathology
Medications

152
Q

What medications are associated with SIADH?

A

thiazide diuretics
SSRIs
tricyclic antidepressants
opioids
phenothiazines
carbamazepine

153
Q

tx for hypovolemic hypotonic hyponatremia?

154
Q

What should the target treatment range be for chronic symptomatic isovolemic hypotonic hyponatremia?

A

4.0 6.0 in 24 hours

155
Q

Acute true hyponatremia should be treated with what?

A

3% to raise Na level by 2.0 to 3.0

156
Q

Indication to use 3% normal saline bolus?

A

Neurological symptoms including seizures/coma

correct by 2.0-4.0 as long as total increase does not go above 10.0 in 24 hours

157
Q

Treatment to give patient with overcorrected serum sodium to prevent central pontine myelinosis?

A

Desmopressin and IV 5% Dextrose

You give ADH therapy to lower back the sodium levels

158
Q

Treatment for chronic SIADH? (3 options)

A

fluid restriction

Demeclocycline

V1 and V2 receptor anatagonists Conivaptan and Tolvaptan

159
Q

Most common causes of hyperkalemia?

A

Acute and Chronic Kidney Failure

Type IV RTA

Medications

Potassium shifts

Low urine flow states

160
Q

What medications can cause hyperkalemia? (x4)

A

ACE/ARBs, potassium sparing diuretics, Sulfas, pentamidine

161
Q

Significant hyperkalemia with a normal ECG suggests what?

A

Pseudohyperkalemia

162
Q

Absolute levels of potassium cannot reliably determine whether a life threatening condition exists in setting of hyperkalemia. What can?

A

ECG changes

163
Q

The most common causes of hypokalemia?

A

Pee and Poop (GI)

Diuretics

Vomiting/Diarrhea

164
Q

Spot urine potassium-creatinine ratio of what confirms hypokalemia?

A

less than 13

165
Q

Flaccid generalized weakness with hypokalemia in Mexican/Asian descent who have eaten a high carb meal or done physical exercise?

A

Hypokalemic periodic paralysis

166
Q

What is hypokalemic periodic paralysis associated with?

A

thyrotoxicosis (treatment involves treating hyperthyroidism)

167
Q

What test obviates the need for brain biopsy in PCNSLymphoma?

A

Vitreous biopsy when lymphoma is involved in the vitreous

168
Q

Treatment for PCNSL?

A

HIV - start ART
Immunocompromised - stop Immunosuppression

Responds well to whole brain radiation and chemotherapy

avoid steroids

169
Q

CTH with a homogeneously enhancing extra axial mass adherent to the dura and an enhancing dural “tail”

A

Meningioma

170
Q

MRI shows multiple ring enhancing lesions with central necrosis; has significant surrounding edema and mass effect

A

Brain Mets

if new finding, assess for lung, breast, and melanoma

171
Q

First line treatment for parenchymal and leptomeningeal tumors?

A

Glucocorticoids

Chemo for leptominengeal

Radiation/Resection for parenchymal

172
Q

Central vertigo with dysarthria, diplopia, weakness, ataxia, or gait instability

A

Vertebrobasilar stroke

173
Q

Exam for acute, persistent vertigo

A

HINTS

Head Impulse: catch up saccades late

Nystagmus: Bidirectional nystagmus (back and forth)

Test of Skew: Presence of vertical skew when hand is placed over eye

174
Q

Non-stroke, severe, longer lasting vertigo (days), nausea and vomiting. Dx?

A

Vestibular neuronitis

175
Q

Hearing loss with vestibular neuronitis

A

Labrynthritis

176
Q

Vertigo hearing loss tinnitus

A

Meniere’s dz

177
Q

Healing loss, tinnitus, unsteadiness, facial nerve involvement

A

Acoustic neuroma

178
Q

Herpes Zoster with facial involvement and peripheral vertio

A

Ramsay Hunt Syndrome

179
Q

BPPV tx

A

Epley’s maneuver

180
Q

Meniere’s tx

A

Vestibular rehab and/or diuretics

181
Q

Short term relief of vertigo

A

Benzo, antihistamines, antiemetics

182
Q

*** Key treatment in vertigo, disequilibrium, and nonspecific dizziness

A

Vestibular and balance rehab

183
Q

Unexplained fatigue lasting more than 6 consecutive months that impairs the ability to perform desired activity. Unrefreshing sleep, cognitive impairment, orthostatic intolerance

A

SEID

Systemic Exertion Intolerance Disease

Medicine (7 decks)

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