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RMD Internal Med Shelf > CV > Flashcards

CV Flashcards

1
Q

What patient population are TZDs contraindicated in?

A
  • pts with Heart Assoc class III or IV heart failure
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2
Q

70yo man w hx of htn and DM2 has SOB with exertion and PND, EF = 25%. Which drug should be discontinued?

A

Pioglitazone (actos)

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3
Q

When is the use of cardiac resynchronization therapy appropriate?

A
  • in patients with medically refractory, symptomatic class III or IV disease with:
    1. QRS interval at least 130msec
    2. Left ventricular end diastolic diameter of at least 55mm
    3. Left vent EF < 30%
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4
Q

Which dietary factor decreases the rate of sudden death in CVD pts?

A

Omega 3 fats

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5
Q

What is the difference in management of an ascending vs descending aortic aneurysm?

A

Ascending: surgical emergency
Descending: intially- reduce blood pressure, beta blocker!! to reduce heart rate, if systolic remains over 100 give IV nitroprusside

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6
Q

What is the first line therapy for a descending aortic dissection?

A

Beta blocker to reduce heart rate

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7
Q

What are the screening recommendations for AAA?

A

one time screening w ultrasonography for AAA in men 65-75 yrs who have ever smoked

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8
Q

How does one treat supraventricular tachycardia that is refratory to adenosine or rapidly recurs?

A

IV verapamil or B blocker

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9
Q

What are CAD equivalent diseases? 4

A
  1. DBM
  2. PAD
  3. Symptomatic carotid artery disease
  4. AAA
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10
Q

What is the most common risk factor for frozen shoulder and what ages is it most commonly seen in?

A

Risk: diabetes mellitus

Ages 40-60

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11
Q

what are 3 physiologic differences between women and men that can affect drug metabolism?

A
  1. GI transit times are slower in women
  2. Women secrete less gastric acid
  3. Women have lower GFR
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12
Q

What is the target glucose level in critically ill pts via insulin infusion?

A

140-180mg/dL

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13
Q

What is the recommended duration of dual antiplatelet therapy following placement of a drug-eluting coronary artery stent? What drugs should you use?

A

1 year
Drugs:
1. Aspirin 162-325mg
2. Clopidogrel (75mg) or prasugrel (10mg) (or ticlopidine for pts who do not tolerate clopidogrel or prasugrel)

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14
Q

What is the most effective treatment of intrahepatic cholestasis of pregnancy?

A

Ursodiol

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15
Q

What is the reasoning of giving antibiotics for B pertussis?

A

to reduce risk of transmission to others

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16
Q

CDC recomments what for primary treatment of pertussis?

A

macrolides

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17
Q

What is tarsal coalition?

A
  • fusion of two or more tarsal bones
  • happens in mid-late adolescence
  • decreased ROM, pain on foot inversion
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18
Q

Which antidepressant is least likely to cause a pt weight gain?

A

Bupropion

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19
Q

What is the preferred method for diagnosing psychogenic nonepileptic seizures?

A

vEEG monitoring

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20
Q

What event suggests no possibility of a recovery after cardiac arrest leading to comatose?

A

myoclonic status epilepticus at 24 hours

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21
Q

What is the difference between IGRA and TST for latent TB screening?

A

IGRA differentiates between M. tb from nontuberculous mycobacteria

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22
Q

What are the first line agents for ovulation induction in PCOS?

A

Metformin and Clomiphene (clom doesnt improve hirsutism)

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23
Q

What is found on a PFT in a pt with vocal cord dysfunction?

A

normal expiratory portion but a flattened inspiratory phase (often confused with asthma- suspect in pts w exercise induced asthma who do not have a good response to beta agonists)

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24
Q

What techniques can you use to confirm or rule out a PE?

A

CT angiography & ventilation-perfusion lung scan

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25
Q

What are 4 examples of drugs that can exacerbate symptoms of restless legs syndrome?

A
  1. Antihistamines
  2. Caffeine
  3. SSRIs
  4. tricyclic antidepressants
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26
Q

What should be given for restless legs syndrome?

A

Iron supplementation if serum ferritin level is below 50ng/mL

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27
Q

What technique should be used to diagnose diverticulitis?

A

CT of the abdomen and pelvis

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28
Q

Why should you not perform a colonoscopy in a pt suspected to have diverticulitis?

A

increased risk of perforation or exacerbation of the disease is greater if performed within 6 weeks of acute process

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29
Q

what is a paient centered medical home?

A

a physician led team of care providers taking responsibility for the quality and safety of an individual’s health

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30
Q

When do you consider a tuberculin skin test positive?

A
  1. Induration >5mm in pts at high risk- immunocompromised, HIV, transplant, household contacts
  2. Induration >15mm in pts at low risk of exposure
  3. Induration >10mm in pts with increased probability of exposure (nursing home residents, homeless shelters, immigrants, IV drug users, hospital workers)
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31
Q

Which drug is FDA approved to treat hiccups?

A

Chlorpromazine

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32
Q

How do you determine a pt’s risk of stroke and if they should be anticoagulated?

A

CHADS2:
One point for: history of CHF, HTN, Age (75), and DBM
two points for: previous stroke or TIA
- initiate warfarin in pts w/ score >2 or a fibb

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33
Q

in hypertensive pts with DBM, the blood pressure goal should be below a threshold of what?

A

130/80

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34
Q

What compound in cough and cold remedies can be associated with serotonin syndrome?

A

Dextromethorphan

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35
Q

What is a marker for hear failure?

A

BNP- synthesized, stored and released by the ventricular myocardium in response to volume expansion and pressure overload

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36
Q

What class of HTN medications reduces risk of death?

A

thiazide diuretic with or without an ACE inhibitor

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37
Q

What initial test rules out adrenal insufficiency?

A

A morning serum cortisol

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38
Q

Which criterion is necessary to make a diagnosis of polymyalgia rheumatica?

A

bilateral shoulder or hip stiffness and aching for at least one month

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39
Q

The CDC recommends that all pts between 13-64 be screened for

A

HIV infection

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40
Q

Which anticholinergic agent can be used to reduce respiratory secretions and is LEAST likely to cause CNS effects like sedation?

A

Glycopyrrolate

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41
Q

PVCs should not be suppressed with what??

A

antiarrhythmic agnents- may increase mortality

ie) encainide or flecainide

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42
Q

What is the only hypoglycemic agent shown to reduce mortality rates in patients with type 2 DBM?

A

metformin

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43
Q

What is a screening test or primary hyperaldosteronism? What values diagnose it?

A

morning aldosterone-to-renin ratio

- diagnosed via a ratio >20:1 with an aldosterone level >15ng/dL

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44
Q

What is an acceptable increase in ASTs and ALTs for pts on statins?

A

A 3 fold increase above the upper limit of normal

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45
Q

In pts with chronic hep B, what measured level suggests that the infection is in the active phase?

A

Elevated levels of ALT

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46
Q

What are the three major phases of chronic hepatitis B?

A
  1. Immune-tolerant
  2. Immune-active (elevated liver enzmes and presence of HBeAg)
  3. Inactive carrier (anti-HBeAg)
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47
Q

What is the treatment for painful subacute thyroiditis?

A

Prednisone

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48
Q

In pts with chronic hep B, what measured level suggests that the infection is in the active phase?

A

Elevated levels of ALT

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48
Q

In pts with chronic hep B, what measured level suggests that the infection is in the active phase?

A

Elevated levels of ALT

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49
Q

What are the three major phases of chronic hepatitis B?

A
  1. Immune-tolerant
  2. Immune-active (elevated liver enzmes and presence of HBeAg)
  3. Inactive carrier (anti-HBeAg)
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49
Q

What are the three major phases of chronic hepatitis B?

A
  1. Immune-tolerant
  2. Immune-active (elevated liver enzmes and presence of HBeAg)
  3. Inactive carrier (anti-HBeAg)
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50
Q

What is the treatment for painful subacute thyroiditis?

A

Prednisone

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50
Q

What is the treatment for painful subacute thyroiditis?

A

Prednisone

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51
Q

In pts with chronic hep B, what measured level suggests that the infection is in the active phase?

A

Elevated levels of ALT

52
Q

What are the three major phases of chronic hepatitis B?

A
  1. Immune-tolerant
  2. Immune-active (elevated liver enzmes and presence of HBeAg)
  3. Inactive carrier (anti-HBeAg)
56
Q

What is the treatment for painful subacute thyroiditis?

A

Prednisone

57
Q

What is the most useful predictive factor in distinguishing uncomplicated pyelonephritis from perinephric abscess?

A

persistence of fever more than 4 days after initiating antibiotics

58
Q

What does a CT scan usually show in perinephric abscess?

A
  • perirenal fluid
  • enlagement of psoas muscle
  • perirenal gas (diagnostic)
59
Q

When do you not need to do routine preoperative testing?

A
  • in asymptomatic patients undergoing low-risk procedures (eg cataract procedures)
60
Q

How do you classify mild persistent asthma?

A
  • occurs more than 2 days per week (but not daily)

- uses albuterol inhaler more than 2 days per week (not daily)

61
Q

When does the ADA recommend screening for diabetes?

A

all asymptomatic adults w a BMI >25.0 kg/ who have one or more additional risk factors
- screening for all adults with no risk factors every 3 yrs beginning at age 45

62
Q

What is euthyroid sick syndrome?

A

alterations in thyroid function tests seen frequently in hospitalized patients
- decreased thyroid fxn may be seen early in sepsis

63
Q

How do you evaluate a child w possible septic arthritis?

A

Ultrasonography (detects an effusion)

64
Q

What is the female athlete triad?

A

Amenorrhea
Osteoporosis
Disordered eating
- should have a bone density test

65
Q

What is the most common cause of recurrent and persistent acute otitis media in children?

A

Penicillin-resistant Strep pneumo

66
Q

what are the recommendations for a Td vaccine?

A

at least every 10 years, and a one time TdaP booster for adults aged >18 years

67
Q

when should you give the IM influenza vaccine versus intranasal?

A

Intranasal (live attenuated): all adults

IM (inactivated): all adults > 50 yrs and those with certain comorbid conditions

68
Q

what are the guidelines for cervical cancer screening?

A
  • begin at age 21 regardless of when they start having sex, perform every 2 years
  • for women >30yrs, who have had three consecutive normal smears, can switch to every 3 years
69
Q

Who should get the HPV vaccine?

A

both males and females aged 9-26 years given before initiation of sexual activity

70
Q

what are the CHD risk equivalents? (4)

A
  • Diabetes
  • Symptomatic CAD
  • Peripheral Artery Disease
  • AAA
71
Q

what are the risk factors for CHD? (5)

A
  1. Cigarette smoking
  2. BP> 140/90
  3. Premature CHD in family members (45 men, >55 women
    - high HDL (>60) is a negative risk factor
72
Q

What are the high risk countries for hep A?

A

asia and africa!!

73
Q

Who should get a yellow fever vaccine?

A

those traveling to sub-saharan africa and equatorial south american countries

74
Q

Who should get the meningococcal vaccination?

A

some asian countries and sub-saharan Africa (legally required for those who make pilgrimage to Mecca Saudi-arabia

75
Q

Who should be screened for chlamydia?

A

sexually active women age 24 and asymptomatic women at increased risk for STIs (those with other STIs or with new/numerous partners)

76
Q

When do you start routine screening for lipid disorders?

A

men >35 yrs, and women >45yrs
- begin at age 20 for patients with diabetes, FHx of premature CAD, familial hyperlipidemia, or numerous risk factors for CHD

77
Q

What type of immunity does the pneumococcal vaccine produce?

A

T cell independent B cell response

78
Q

In general HIV pts shouldnt get live vaccines, what are the two exceptions?

A

MMR & Varicella

79
Q

In pts with Peripheral Vascular disease, what is the most useful intervention to improve function and reduce symptoms of claudication?

A

Supervised graded exercise program & Antiplatelet agents like aspirin or clopidogrel

80
Q

Who should be screened for bladder cancer?

A

no one yet- low incidence and poor positive predictive value

81
Q

Who should be screened for AAA?

A

men aged 65-75 who have smoked cigarettes via abdominal ultrasound

82
Q

what are the T scores of osteopenia versus osteoporosis?

A

Osteopenia: -1.5 to -2.5
Osteoporosis: <-2.5

83
Q

What are the most common sites of disk herniation?

A

L5-S1 and L4-5

84
Q

What are the deficits seen in L4-5 impingement?

A
  • extensor of great toes

- sensory loss on dorsum of foot/base of first toe

85
Q

What are the deficits seen in L5-S1 impingement?

A
  • ankle jerk reflex impaired (plantar flexion)

- sensory deficit in buttocks, posterior thigh, calf, lateral ankle, and foot

86
Q

what are some indications for x rays in pts with back pain?

A
  • lasting mroe than 6 weeks
  • age >60
  • history of significant trauma
  • neurologic deficit
  • systemic symptoms
  • history of drug or alcohol abuse
87
Q

CT and MRI should be used when you suspect what low back conditions?

A
  1. Spinal infections
  2. Cancers
  3. Herniated disks
  4. Spinal stenosis
88
Q

You should use caution in telling which patient populations to use acetaminophen?

A
  1. Hx of gastritis or ulcers
  2. HTN
  3. Chronic renal failure
  4. CHF
89
Q

Colonic motility can be inhibited by which medical conditions and electrolyte imbalances?

A
  1. hypothyroidism
  2. hypercalcemia
  3. hypokalemia
  4. scleroderma
  5. diabetes
  6. neurologic disorders (parkinsons, MS, paraplegia)
90
Q

What medications can cause constipation?

A
  1. Verapamil- Ca Channel blockers
  2. Narcotics
  3. Anticholinergics
91
Q

When is anoscopy useful?

A

questions about internal hemorrhoids and anal fissures

92
Q

Magnesium salts are contraindicated in what type of patients?

A
  • renal failure!
93
Q

what is the most common presenting sign of urinary tract malignancy?

A
  • painless hematuria
94
Q

hemoptysis + hematuria =

A

goodpastures

95
Q

what medications can cause interstitial nephritis (hematuria, fever, skin rash)?

A
  1. NSAIDs
  2. Cephalosporins
  3. Ciprofloxacin
96
Q

which medications can cause hemorrhagic cystitis?

A
  1. Cyclophosphamide!
97
Q

blindness, deafness, hematuria

A

alport syndrome

98
Q

what will you find in microscopic examination of interstitial neohritis?

A

eosinophilia

99
Q

What is an IVP used for?

A

detecting kidney stones, masses, cysts and hydronephrosis
- use an ultrasound in individuals who are allergic to contrast media, at risk for contrast nephropathy, or have renal insufficiency

100
Q

If find suspicious lesions on IVP or US, what should you do next?

A
  • CT or MRI and possible biopsy
101
Q

whats the next step in someone with an uncertain diagnosis of lymphadenopathy?

A

CBC and serology

- then a CXR in pt with pulm symptoms, suprcalvicular lymphadenopathy, or severely ill pts

102
Q

When should you consider a lymph node biopsy? when do you need to do an early biopsy?

A
  • when there is clinical suspicion of neoplasm or illness such as TB or sarcoidosis, LN remaining for 4-12 weeks
  • early: LN size and irregularity, presence of weight loss, or an enlarged liver or spleen, supraclavicular nodes
103
Q

what are the symptoms of meniere disease?

A

recurring vertigo + tinnitus + vomiting

104
Q

Diabetes + nausea and vomiting

A

consider DKA

105
Q

persistent early-morning nausea in the absence of a pregnancy or metabolic disease

A

-possibility of increased ICP, so perform CT or MRI of head

106
Q

what medication is helpful in patients with vestibular related nausea and/or vomiting?

A

antihistamine: meclizine (antivert)

107
Q

Which medications are commonly known to cause nausea?

A
  1. Macrolide antibiotics
  2. Metronidazole
  3. Opiates
  4. NSAIDs
  5. Estrogen
  6. Digitalis
  7. Theophylline
108
Q

what medication class is used for nausea?

A

phenothiazines

109
Q

what are the micvovascular complications of DBM? Macrovascular?

A

Micro: retinopathy, neuropathy, nephropathy
Macro: premature atherosclerosis leading to CV, cerebrovascular and PVD.

110
Q

What are some causes of TRANSIENT hyperglycemia?

A
  • stresses like infection or heart attack
111
Q

What are some causes of elevated blood sugar that are NOT from diabetes?

A
  • pancreatitis, pancreatic cancer, pancreatic resection

- hemochromatosis (bronze diabetes)

112
Q

What medications can cause elevated blood sugars?

A
  • high dose steroids
  • beta blockers
  • OCPs
  • phenytoin
  • hydrochlorothiazide
113
Q

what are the ADA’s recommendations for screening for diabetes?

A

everyone over the age of 45, every 3 years via a fasting glucose

114
Q

The diagnosis of diabetes can be established by one of the 3 criteria?

A
  1. Fasting BG >126mg/dL on two or more separate occasions
  2. Random blood glucose greater than 200mg/dL with polyuria, polydypsia, and polyphagia
  3. A 2-hour postprandial glucose greater than 200mg/dL
115
Q

who is considered prediabetic?

A

fasting BG 100-125mg/dL

116
Q

who and when should you screen for microalbuminuria

A
  • for DBM patients over 30 years of age or those with DBM more than 5 years duration
  • screening done annually
117
Q

what are the contraindications of sulfonylureas?

A
  • allergy
  • pregnancy
  • significant renal dysfunction
118
Q

side effects of sulfonylureas?

A
  • weight gain and hypoglycemia
119
Q

MOA of metformin?

A

biguanide- inhibits hepatic gluconeogenesis and increasing glucose uptake in the peripheral tissues

120
Q

SE of metformin?

A
  • diarrhea, nausea, dyspepsia
  • lactic acidosis!!! avoid in pts with renal dysfunction (Cr >1.5)m CHF, acute or chronic acidosis, or hepatic dysfunction
121
Q

MOA of TZDs?

A

use in caution w cardiac conditions- can cause MI and icnrease risk of CHF
- MOA: decreasing insulin resistance in skeletal muscle and the liver

122
Q

what is the most commonly used diabetes medication combination?

A

metformin (biguanide) and sulfonylurea

123
Q

what should the BP and LDL levels be in a diabetic patient?

A

BP: 130/80 (use ACE inhibitor)
LDL: 50yrs

124
Q

Meds used to tx diabetic neuropathy?

A
  • TCAs
  • Carbamazepine
  • Gabapentin
125
Q

how do you distinguish between bacterial vaginosis and candida vaginitis?

A

pH! candid pH 4.5

126
Q

what role does squatting play in hypertrophic cardiomyopathy?

A

increases venous return, thus decreases the murmur whereas standing decreases return and increaes the obstruction/murmur

127
Q

what is rhinitis medicamentosa?

A

condition caused by chronic use of cocaine or nasal nasal decongestants

128
Q

what is vasomotor rhinitis?

A

chronic nasal congestion with pink nasal mucosa that is brought on by sudden changes in temp, humidity, or odor

129
Q

how much calcium should patients be given w osteoporosis?

A

premenopausal: 1000mg/day
postmenopausal: 1200mg/day

130
Q

How do you diagnose diverticulitis?

A

CT scan!! do not do colonoscopy or barium enema bc of risk of perforation

131
Q

What are the indications for hospitalization in pts with pneumonia?

A
  1. Systolic BP 140
  2. O2 sat less than 90%
  3. presence of abscess or pleural effusion
  4. Marked metabolic abnormality
  5. Age >65
  6. Unreliable social situation
132
Q

How do you evaluate for multiple sclerosis?

A

MRI of the brain

133
Q

what is blepharitis?

A

chronic lid margin erythema, scaling and loss of eyelashes

RMD Internal Med Shelf (1 decks)

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