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PGY1 > Clinic TBL > Flashcards

Clinic TBL Flashcards

1
Q

Mixedema coma

Management

A

Stress dose steroids
Levothyroxine
Rewarming

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2
Q

Secondary hypothyroidism

How is TSH, T4?

A

TRH low
TSH inappropriately normal or low
T4 low

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3
Q

Condition w/ normal TSH and Low T4

A

Central hypothyroidism

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4
Q

Relationship between prolactin and TRH

A

TRH stimulates PRL production

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5
Q

Chronic HF
With clear lungs
Explained by?

A

Lymphatic hypertrophy

Does not mean pt does not require diuresis

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6
Q

ProBNP

A

Use to exclude HF in a pt with unsure dx

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7
Q

Coronary perfusion

A

Determined by diastolic pressure and LVEDP

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8
Q

ED admission w Acute HF exacerbation

What to do w BB meds

A

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

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9
Q

CCB

Amlodipine more used as outpatient why?

A

Onset of action 2 to 3 days

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10
Q

S3 gallop

A

Sign of volume overload

Normal in athletes and pregnant pts

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11
Q

LBBB

A

V1 W

V6 M

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12
Q

Right sided MI

Management

A

Preload dependent

Management fluids

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13
Q

Serotonin Sx

Clinical features

A

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

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14
Q

Neuroleptic Malignant Syndrome
VS
Serotonin Syndrome

A

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.

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15
Q

Resuscitation fluids

A

30 ml/kg

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16
Q

Maintenance fluids

A

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

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17
Q

Granulomatous disease

A

Mycobacteria

Sarcoid

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18
Q

HIV, fever, pneumothorax

A

PCP

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19
Q

Genvoya and statins

A

Cobicistat increases statin concentration and needs to be adjusted

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20
Q

IV acyclovir in herpes zóster ophtalmicus

A

Indicated when lesion crosses midline or >2 dermatomes compromised

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21
Q

Uveitis workup

A

TB
Syphilis
Sarcoid

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22
Q

Steroids > 30 days

A

Requires PCP prophylaxis

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23
Q

Hx of thyroid ca

TSH goals?

A

< 0.1

24
Q

Cosyntropin

A

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

25
Q

Non functioning adenoma

Prolactin increases

A

Is in continuous inhibition by dopamine

26
Q

Hyperthyroidism in pregnancy

A

1st T PTU

2nd and 3rd T Methimazol due to risk of fetal anomalies

27
Q

Obesity and testosterone

A

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

28
Q

DKA and HHS

A

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

29
Q

Afib

Eval for

A

OSA

30
Q

Afib

A

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

31
Q

Signs of cardiogenic shock

No BB instead

A

Amio or Digoxin

32
Q

Cardioversion (drug, electrical, ablation)

A

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

33
Q

Antidotes

Dabigatran

A

Idarucizumab

34
Q

Antidote

Xa inhibitors

A

Andexanet alpha

35
Q

Coronary calcium Score

A

Done in Asymptomatic pts

36
Q

preop TTE indications

A

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

37
Q

COPD dx

A

Spirometry

38
Q

Gold standard for bronchiectasis

A

High resolution CT

39
Q

Management for unexplained chronic cough

A

Gabapentin

Multimodal speech therapy

40
Q

Sarcoidosis dx

A

Bronchoscopic biopsy - > noncaseating granulomas

41
Q

2 sarcoidosis pattern do not need bx for dx

A

Lofgren Sx

Heerfordt Sx

42
Q

Lofgren Sx

Triad and treatment

A

Hilar lymphadenopathy, acute oligoarthritis and erithema nodosum

NSAIDs

43
Q

Heerfordt Sx

Triad

A

Uveitis, parotid gland enlargement and fever

44
Q

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

A

Cortisol affected by estradiol, low protein state

45
Q

To rule out pheo

A

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

46
Q

Shift work sleep disorder

Tx

A

1) CBT

2) modafinil

47
Q

In lab polysomnography indications (vs at home)

A

Risk for central sleep apnea
HF
Advanced pulmonary disease

48
Q

Lungs fluoroquinolones

A

Levo, moxi, gatiflox

49
Q

Aminotransferase > 1000

Etiologies

A

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

50
Q

Autoimmune hepatitis

Dx

A

ANA
Anti smooth muscle ab
IgG

51
Q

Wilson’s disease

A 
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
52
Q

Difference between MRCP and ERCP

A

MRCP dx only done by radio

ERCP dx and therapeutic done by GI

53
Q

Acute liver injury VS Acute hepatic failure

A 
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
54
Q

When to admit acute elevation of AST ALT

A

SIRS
Prolonged PT INR
AMS asterixis
No tolerance to oral fluids

55
Q

Celiac disease

A

Cause:
elevation of liver enzymes
Iron deficiency

56
Q

Liver pattern

Cholestatic VS hepatocellular

A

Hepatocellular
AST/ALT elevated, normal Alkphos

Cholestatic
AST/ALT normal, Elevated Alkphos

57
Q

Cholestatic pattern of injury in hospitalized pts Etiologies

A

Medication, sepsis, TPN

PGY1 (2 decks)

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