Clinic TBL

Question 1

Mixedema coma

Management

Answer 1

Stress dose steroids
Levothyroxine
Rewarming

Question 2

Secondary hypothyroidism

How is TSH, T4?

Answer 2

TRH low
TSH inappropriately normal or low
T4 low

Question 3

Condition w/ normal TSH and Low T4

Answer 3

Central hypothyroidism

Question 4

Relationship between prolactin and TRH

Answer 4

TRH stimulates PRL production

Question 5

Chronic HF
With clear lungs
Explained by?

Answer 5

Lymphatic hypertrophy

Does not mean pt does not require diuresis

Question 6

ProBNP

Answer 6

Use to exclude HF in a pt with unsure dx

Question 7

Coronary perfusion

Answer 7

Determined by diastolic pressure and LVEDP

Question 8

ED admission w Acute HF exacerbation

What to do w BB meds

Answer 8

If pt has not received BB, don’t start BB

If pt is already on BB - > Continue BB Unless there is shock or severe Brady

Question 9

CCB

Amlodipine more used as outpatient why?

Answer 9

Onset of action 2 to 3 days

Question 10

S3 gallop

Answer 10

Sign of volume overload

Normal in athletes and pregnant pts

Question 11

LBBB

Answer 11

V1 W

V6 M

Question 12

Right sided MI

Management

Answer 12

Preload dependent

Management fluids

Question 13

Serotonin Sx

Clinical features

Answer 13

1 Mental status changes (anxiety, agitation, delirium)
2 Autonomic dysregulation (diaphoresis, HTN, tachy, hyperthermia, vomiting, diarrhea)
3 Neuromuscular hyperactivity (tremor, myoclonus, hyperreflexia)

Question 14

Neuroleptic Malignant Syndrome
VS
Serotonin Syndrome

Answer 14

NMS does not involve neuromuscular hyperactivity (tremor, hyperreflexia, clonus). In addition, it is characterized by bradykinesia and generalized “lead pipe” muscular rigidity, which differs from the hyperkinesia of SS.

Question 15

Resuscitation fluids

Answer 15

30 ml/kg

Question 16

Maintenance fluids

Answer 16

First 10kg -> 4ml/kg
Next 10kg - > 2ml/kg
The rest - > 1ml/kg

Question 17

Granulomatous disease

Answer 17

Mycobacteria

Sarcoid

Question 18

HIV, fever, pneumothorax

Answer 18

PCP

Question 19

Genvoya and statins

Answer 19

Cobicistat increases statin concentration and needs to be adjusted

Question 20

IV acyclovir in herpes zóster ophtalmicus

Answer 20

Indicated when lesion crosses midline or >2 dermatomes compromised

Question 21

Uveitis workup

Answer 21

TB
Syphilis
Sarcoid

Question 22

Steroids > 30 days

Answer 22

Requires PCP prophylaxis

Question 23

Hx of thyroid ca

TSH goals?

Answer 23

< 0.1

Question 24

Cosyntropin

Answer 24

best to dx 1ry adrenal insufficiency and chronic 2ry adrenal insufficiency (adrenals atrophy and loose the ability to respond to external/internal ACTH)

Question 25

Non functioning adenoma | Prolactin increases

Answer 25

Is in continuous inhibition by dopamine

Question 26

Hyperthyroidism in pregnancy

Answer 26

1st T PTU | 2nd and 3rd T Methimazol due to risk of fetal anomalies

Question 27

Obesity and testosterone

Answer 27

Obesity decreases sex hormone binding globulin Free testosterone is decreased Total testosterone can be normal in obesity

Question 28

DKA and HHS

Answer 28

Aggressive IVF K replacement Do not stop IV insulin until GAP is closed Only bicarb if pH < 7

Question 29

Afib | Eval for

Answer 29

OSA

Question 30

Afib

Answer 30

Rate BB, CCB, Digoxin Rhythm Amio, Sotalol, Dofetilide (watch QT) Synchronized cardioversion Ablation

Question 31

Signs of cardiogenic shock | No BB instead

Answer 31

Amio or Digoxin

Question 32

Cardioversion (drug, electrical, ablation)

Answer 32

Any cardioversion after 48 of symptoms onset there is an increase risk of thrombus Requires TEE or cardiac CT to rule out LAA

Question 33

Antidotes | Dabigatran

Answer 33

Idarucizumab

Question 34

Antidote | Xa inhibitors

Answer 34

Andexanet alpha

Question 35

Coronary calcium Score

Answer 35

Done in Asymptomatic pts

Question 36

preop TTE indications

Answer 36

Mod-severe AS-AI Dyspnea HF w change in clinical status Known LV dysfunction

Question 37

COPD dx

Answer 37

Spirometry

Question 38

Gold standard for bronchiectasis

Answer 38

High resolution CT

Question 39

Management for unexplained chronic cough

Answer 39

Gabapentin | Multimodal speech therapy

Question 40

Sarcoidosis dx

Answer 40

Bronchoscopic biopsy - > noncaseating granulomas

Question 41

2 sarcoidosis pattern do not need bx for dx

Answer 41

Lofgren Sx | Heerfordt Sx

Question 42

Lofgren Sx | Triad and treatment

Answer 42

Hilar lymphadenopathy, acute oligoarthritis and erithema nodosum NSAIDs

Question 43

Heerfordt Sx | Triad

Answer 43

Uveitis, parotid gland enlargement and fever

Question 44

Cortisol unreliable in pt taking estadiol given that estradiol increases cortisol binding protein

Answer 44

Cortisol affected by estradiol, low protein state

Question 45

To rule out pheo

Answer 45

Stop antidepressants (TCA) for at least 2 weeks before testing antidepressants

Question 46

Shift work sleep disorder | Tx

Answer 46

1) CBT | 2) modafinil

Question 47

In lab polysomnography indications (vs at home)

Answer 47

Risk for central sleep apnea HF Advanced pulmonary disease

Question 48

Lungs fluoroquinolones

Answer 48

Levo, moxi, gatiflox

Question 49

Aminotransferase > 1000 | Etiologies

Answer 49

Autoimmune hepatitis Acute viral hepatitis Ischemic or toxic hepatopathy - > hypotension Wilson's disease Acute Budd Chiari Sx - > hepatic vein thrombosis Fulminant Wilson disease Acute biliary obstruction

Question 50

Autoimmune hepatitis | Dx

Answer 50

ANA Anti smooth muscle ab IgG

Question 51

Wilson's disease

Answer 51

``` Ceruloplasmin < 20 (also an acute phase reactant that may be normal to elevated in disease) - young patient - neuropsychiatric condition - AST/ALT 1000 - Alk phos low normal ```

Question 52

Difference between MRCP and ERCP

Answer 52

MRCP dx only done by radio | ERCP dx and therapeutic done by GI

Question 53

Acute liver injury VS Acute hepatic failure

Answer 53

``` ALI Elevated transaminases W or w/o Jaundice W or w/o Coagulopathy NO encephalopathy ``` ``` AHF Liver injury Coagulopathy INR >= 1.5 ENCEPHALOPATHY duration of illness < 26 wks ```

Question 54

When to admit acute elevation of AST ALT

Answer 54

SIRS Prolonged PT INR AMS asterixis No tolerance to oral fluids

Question 55

Celiac disease

Answer 55

Cause: elevation of liver enzymes Iron deficiency

Question 56

Liver pattern | Cholestatic VS hepatocellular

Answer 56

Hepatocellular AST/ALT elevated, normal Alkphos Cholestatic AST/ALT normal, Elevated Alkphos

Question 57

Cholestatic pattern of injury in hospitalized pts Etiologies

Answer 57

Medication, sepsis, TPN