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Conrad Fischer 2 Flashcards

1
Q

What is the cutoff for diagnosis of hypertension?

A

BP > 140/90

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2
Q

What is the next best step in management of an asymptomatic patient with a BP reading of 145/95?

A

Repeat BP in 1-2 weeks (If available, ambulatory home BP monitoring) over 3-6 measurements

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3
Q

When should hypertension meds be stopped once started?

A

Never. Therapy is indicated for life

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4
Q

What is initial therapy for an asymptomatic patient with confirmed mild hypertension?

A

Lifestyle modification (diet, exercise, weight loss)

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5
Q

What is the target LDL in patients with 1 risk factor for CAD? 2 risk factors?

A

Under 160 for 1 risk factor and under 130 for 2 risk factors

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6
Q

Which cholesterol medication has the greatest mortality reduction?

A

Statins

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7
Q

Which form of lifestyle modification is the most effective management of hypertension?

A

Weight loss

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8
Q

What is the best initial pharmacotherapy for hypertension if lifestyle modifications fail for 6 months?

A

Thiazide diuretics (hydrochlorothiazide or chlorthalidone)

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9
Q

What is the most common adverse effect of thiazide diuretic therapy?

A

Hypercalcemia

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10
Q

What is the most common adverse effect of calcium channel blockers?

A

Constipation due to inhibitory effect on smooth muscle of the bowel

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11
Q

What is the next best step in a patient whose hypertension is not controlled with thiazides?

A

Beta blocker, ACE-I, and calcium channel blockers are equal

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12
Q

What is the most important adverse side effect of hydralazine?

A

Drug induced lupus

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13
Q

What are adverse side effects of minoxidil?

A

Hair growth and edema

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14
Q

What drugs are indicated in a hypertensive patient with BPH?

A

Alpha-1 blockers (-zosin drugs)

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15
Q

How do beta blockers cause hyperkalemia?

A

Inhibition of Na/K ATPase - increased K+ extracellularly

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16
Q

What are the most notable side effects of clonidine and methyldopa?

A

Fatigue and memory loss

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17
Q

What is the most common adverse effect of alpha blockers?

A

Orthostatic hypotension

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18
Q

What is the drug of choice in a hypertensive patient with osteoporosis?

A

Thiazides b/c they prevent loss of calcium in the urine

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19
Q

Which hypertension drugs should not be used in a patient with gout?

A

Hydrochlorothiazide or furosemide

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20
Q

What are the adverse effects of spironolactone?

A

Hyperkalemia and gynecomastia (anti androgenic effect)

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21
Q

What is the most common presentation of multiple sclerosis?

A

Optic neuritis with blurring of the optic nerve head. Loses color vision and visual acuity.

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22
Q

What is the fundoscopic finding in diabetic retinopathy?

A

Proliferative retinopathy consistent with neovascularization. Treat with laser photocoagulation

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23
Q

What is the presentation of retinal detachment?

A

Not red, not tender, not painful, just blind

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24
Q

What is the fundoscopic finding in hypertensive retinopathy?

A

Cotton wool spots, papilloedema, and copper wiring

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25
Q

What is found in the urine in hypertension?

A

Proteinuria

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26
Q

What are hyaline casts in the urine associated with?

A

Dehydration

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27
Q

What is the indicated therapy in a patient with chest pain and new LBBB?

A

Aspirin then thrombolytics

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28
Q

What is the best management of hypertensive crisis?

A

IV beta blocker, nitruprusside, or ACE-I (furosemide and diuretics do not work well in hypertensive crisis)

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29
Q

What is a psychiatric side effect of reserpine?

A

Depression

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30
Q

What is the cutoff of hypertensive crisis?

A

> 180/120

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31
Q

What is the most likely diagnosis in an IV drug user with fever and a murmur?

A

Endocarditis

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32
Q

What are Libman-Sacks vegetations?

A

Common cardiac manifestation of SLE. Non-bacterial. Affects both sides of the valve (usually mitral valve).

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33
Q

What is the best initial diagnostic test in suspected infections endocarditis?

A

Blood cultures (NOT echo). 95-99% of people with endocarditis have positive blood cultures

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34
Q

If a blood culture is negative, how can endocarditis be diagnosed?

A

Fever, risk, and embolic phenomenon (roth spots, janeway lesions, osler nodes, etc) along with visualization of vegetation on echo

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35
Q

What is the pathophysiology of a Roth spot?

A

Embolus containing infected material in the eye.

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36
Q

What is a splinter hemorrhage?

A

Thin strip of hemorrhage under the nail seen in endocarditis

37
Q

What are Janeway lesions?

A

Flat, painless, lesions seen on the palms and soles of the feet in endocarditis

38
Q

What is a coloboma?

A

Cat-like iris slits as a result of failure in embryonic development of the iris

39
Q

What is a hordeolum?

A

Stye or infection of the sebaceous gland of the eye usually by staph. Tender to palpation. Treat with anti staph antibiotics

40
Q

What is a chalazion?

A

Cyst due to blockage of the meibomian gland. Treat with warm compress to the eye.

41
Q

What is a pterygium?

A

Overgrowth of conjunctiva from irritation from the environment

42
Q

What is blepharitis?

A

Inflammation of the eyelid due to seborrheic dermatitis or a staph infection

43
Q

What is the most common murmur in endocarditis?

A

Mitral regurgitation

44
Q

Which cardiac conduction defect is most likely in an anti-Ro positive child of a mother with SLE?

A

3rd degree AV block

45
Q

What should be given to a pregnant woman with anti-phospholipid syndrome?

A

Heparin and aspirin

46
Q

What are the two types of anti-phospholipid syndrome?

A

Lupus anticoagulant and anti-cardiolipin antibodies

47
Q

What syndrome is associated with spontaneous abortion, false positive VDRL, and thrombopilia?

A

Anti-phospholipid syndrome

48
Q

What is the most accurate diagnostic test for lupus nephropathy?

A

Renal biopsy

49
Q

What is the most common histological abnormality in lupus nephritis?

A

Membranous glomerulonephritis

50
Q

What is the best therapy for membranous glomerulonephritis?

A

Prednisone and mycophenolate (or pred + cyclophosphamide)

51
Q

What is the pulmonary pathology seen in SLE?

A

Alveolar hemorrhage

52
Q

What is the most useful test to determine disease activity in SLE?

A

Complement level (decrease) and increased ds-DNA antibodies. ANA levels do not change with disease activity

53
Q

What is the ophthalmologic finding in SLE?

A

Central retinal vein occulusion - no therapy for this

54
Q

What is the most accurate test for lupus anticoagulant?

A

Russell viper venom

55
Q

What is the pathology in the heart of SLE?

A

Libman-Sacks endocarditis

56
Q

What is the most likely murmur heard in SLE?

A

Mitral regurgitation

57
Q

What is the underlying cause of susceptibility to drug induced lupus?

A

Decreased acetylation rate

58
Q

What is the treatment for drug induced lupus?

A

Stop the causative drug

59
Q

What is the typical presentation of Goodpasture’s Syndrome?

A

Hemoptysis and fever with renal findings

60
Q

What population is most likely to have sarcoidosis?

A

African american females

61
Q

What is the typical presentation of sarcoidosis?

A

Dry cough, shortness of breath, and rales on exam.

62
Q

What is the most common extra-pulmonary manifestation of sarcoidosis?

A

Skin (liver, heart, and nervous system can also be affected but not as often as skin)

63
Q

What is the most common skin manifestation of sarcoidosis?

A

Lupus pernio (raised, hardened, purple lesion usually on the face and hands) and erythema nodosum

64
Q

What auscultatory findings will be present in interstitial lung disease?

65
Q

What is a typical neurological finding in sarcoidosis?

A

Cranial nerve VII palsy (bell’s palsy)

66
Q

Cardiac involvement of sarcoidosis leads to what type of arrhythmia?

A

Complete AV block. Sarcoid granulomas destroy the conduction system

67
Q

What is the most common finding on CXR in sarcoidosis?

A

Bilateral hilar lymphadenopathy

68
Q

What is the most accurate test for sarcoidosis?

A

Lymph node biopsy. Look for non-caseating granuloma

69
Q

What is the treatment of choice for sarcoidosis?

A

Prednisone

70
Q

What is the best initial test in suspected acromegaly?

71
Q

What is the typical presentation of acromegaly?

A

MIddle aged patient with daytime somnolence, deep voice, and outgrowth of bony structure

72
Q

What is the etiology of daytime somnolence in acromegaly?

A

Sleep apnea (neck grows thicker)

73
Q

Why does acromegaly cause erectile dysfunction?

A

Alpha subunits of GH and prolactin are the same so increased GH mimics prolactin –> decreased GnRH

74
Q

What is the best initial therapy for acromegaly?

A

Surgical excision

75
Q

What is the best initial therapy for prolactinoma?

A

Octreotide

76
Q

What is pegvisomant?

A

GH receptor antagonist. Secondary option for treatment of acromegaly

77
Q

Why does hypothyroidism lead to GH deficiency?

A

Must have thyroxine for normal release of GH

78
Q

Why is endotracheal intubation risky in a patient with RA?

A

Instability of C1/C2 in RA patients (risk of atlantoaxial dislocation)

79
Q

What are the bone growths of the interphalangeal joints in OA?

A

Bouchard’s nodes (PIP) and Heberden’s nodes (DIP)

80
Q

What is a pannus in RA?

A

Extra inflammatory cell buildup within the joint space. Seen on X-ray as opaque material within joint space

81
Q

What anemia is found in RA?

A

Anemia of chronic disease (normal MCV, high ferritin, low TIBC) b/c macrophages use up the circulating iron

82
Q

What is the most specific test to diagnose RA?

A

Anti cyclic citrulinated peptide antibodies (anti-CCP) is both sensitive and specific!

83
Q

What is the best initial disease modifying therapy for RA?

A

Methotrexate

84
Q

What is the x-ray finding of psoriatic arthritis?

A

Pencil in a cup

85
Q

What is the hallmark x-ray finding of ankylosing spondylitis?

A

Bamboo spine

86
Q

What is the hallmark x-ray finding of osteomyelitis?

A

Elevation of periosteum

87
Q

What must be done before giving hydroxychloroquine?

A

Ophthalmologic exam because hydroxychloroquine can have retinal toxicity

88
Q

When should anti-TNF drugs be used in RA?

A

If methotrexate and hydroxychloroquine have failed. Must do PPD test prior to using these drugs

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