Final - Student/Jeopardy Questions Flashcards
which dizziness condition usually presents after a URI
labyrinthitis
A 75 yo is depressed and not gaining wt. What would your first choice med be?
Remeron (Mirtazapene)
difference btw HFrEF and HFpEF
less than or equal to 50% ejection fraction
what two medications improve morbidity and mortality in HFrEF
ACEI
beta blockers
med for pt w. LVEF less than or equal to 40% who can’t tolerate ACEI and ARBS
hydralazine and nitrate
Eliquis reversal agent
Andexanet alfa (Andexxa)
symptoms associated w. UMN lesion
- spasticity
- slow RAM
- hyperreflexia
- stiffness
which med prolongs ALS life expectancy
Rilutek (Riluzole)
Pseudobulbar affect in ALS
- inappropriate emotional response
CHADS
- CHF
- HTN
- age >75
- DM
- previous stroke/TIA (2 pt)
2 or higher = anticoagulate
what drug is best for rhythm control in afib
Amiodarone
which tremor is improved w. moderate etoh
benign essential
most effective drug in symptomatic Parkinson’s
Sinemet (Carbidopa/Levodopa)
tx for benign essential tremor
Propranolol
posterior pituitary hormones (2)
- oxytocin
- vasopressin
ABI diagnostic of PAD
<0.9
most common pituitary screening hormone
prolactin
tx for Alzheimer’s
Aricept
first line maintenance therapy for vasospastic angina
CCB
EKG for vasospastic angina during episode
ST elevations
statin benefit groups
- ASCVD
- LDL>190
- 40-75 yo w. DM
- 10 year risk for ASCVD 7.5% or higher
first line alternative med for pt who do not tolerate statins (or used as adjunctive to statins)
Ezitimibe
which type of nystagmus is the most concerning why?
vertigal; CNS
which anticoagulant do you prescribe to a pt w. a mechanical valve
Warfarin (Coumadin)
which lab is continuously monitored for pt on Warfarin
INR
nl INR
2.0-3.0
nl INR for mechanical heart valve
2.5-3.5
tx for Afib pt with scheduled cardioversion
anticoags 30 days before AND after cardioversion
test for myasthenia gravis that improves symptoms
ice pack
single most sensitive test for MG
single fiber electromyography
differentiating factor between MG and botulism
- descending paralysis in botulism
- fatigabillity in MG
1st test to order if GH excess is suspected
IFG-1
most common cause of acromegaly
benign pituitary adenoma
manifestations of acromegaly
enlargement of hands, feet, jaw, internal organs
HTN; DM2; CHF
cardiomegaly, macroglossia
deep voice
OSA; spinal stenosis; arthralgias; wt gain; hypogonadism
decreased libido; ED; irregular menses; temporal hemianopsia
HA; thick skin; hyperhidrosis; acne; skin tags; colon polyps
gold standard lab test for confirming acromegaly
1 hour glucose tolerance test → should stop GH from being released
fxns of GH
increase calcium retention
increase muscle mass
stimulate growth of all internal organs except brain
decrease liver uptake of glucose
promote lipolysis
promote gluconeogenesis
maintain homeostasis
maintain fxn of pancreatic islets
increase protein synthesis
layers of the adrenal gland
zona glomerulosa → mineralocorticoids
zona fasiculata → glucocorticoids
zona reticularis → sex hormones
mineralocorticoid examples
steroid hormones that regulate salt and water → aldosterone
glucocorticoid examples
fight inflammation → cortisol; cortisone; dexamethasone; hydrocortisone; prednisone; methylprednisone
examples of sex hormones released by adrenal gland
androgens
estrogens
MEN 1 tumors affect
parathyroid
anterior pituitary
pancreas
PAP
pheochromocytoma triad
HA
sweating
tachycardia
2 tests if you suspect pheochromocytoma
24 hr urine fractionated metanephrines and catecholamines
plasma fractionated metanephrines
first line tx for a pt w. bilateral adrenal hyperplasia causing hyperaldosteronism if surgery is not an option
spironolactone (Aldactone)
main lab abnormality in hypoaldosteronism
hyperkalemia
3 fxns of aldosterone
water resorption
Na+ resorption
increased bp
K+ secretion
H+ secretion
adrenal adenoma that causes hyperaldosteronism
Conn’s syndrome
3 clinical findings i pt w. hyperaldosteronism
hypokalemia
hypernatremia
metabolic alkalosis
difficult to control HTN
elevated PAC and elevated PRA = what type of hyperaldosteronism
secondary → kidney’s secretion of renin is stimulating aldosterone → negative feedback is not working on kidney to stop PRA secretion
factors that can trigger renin secretion
CHF
cirrhosis
volume depletion
main hormone underproduced in adrenal insufficiency
cortisol
pathology of tertiary adrenal insufficiency
lack of CRH from hypothalamus
tx for sick pt who has adrenal insufficiency
high dose steroids
2 features seen in primary but not secondary or tertiary adrenal insufficiency
hyperpigmentation
hyperkalemia
dehydration
GI symptoms
what meds should you give to pt w. primary adrenal insufficiency on a daily basis
corticosteroids:
florinef
hydrocortisone or prednisone
+/- DHEA
where is Cushing’s dz localized
pituitary → tumor oversecreting ACTH
clinical manifestations of Cushing’s
hyperglycemia
hyperpigmentation
moon facies
buffalo hump
fungal infxns
acanthosis nigricans
tx for cushing’s dz
transphenoidal resection
most common cause of ACTH-producing tumor
small cell lung cancer
3 first line tests to show increased cortisol
dexamethasone suppression
late night salivary cortisol
24 hr urinary free cortisol excretion