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ACP > GIM > Flashcards

GIM Flashcards

0
Q

Absolute risk reduction (ARR) =

A

EER - CER (experimental group event rate - control)

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1
Q

Absolute risk (AR) = event rate =

A

Pts w event in group/total # of pts in group

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2
Q

Number needed to treat (NNT) =

A

1/ARR

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3
Q

Relative risk reduction (RRR) =

A

EER/CER

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4
Q

Chronic cough -r/o

A

Smoking, ACEI, do a CXR

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5
Q

Chr cough - not smoker, not on ACEI, CXR-N

DDx

A
  1. Upper airway cough sy (previous post-nasal drip)
  2. GERD
  3. Asthma
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6
Q

Chr cough - not smoker, not on ACEI, CXR-N

Tx

A

In order:

  1. Antihistamine (1st gen) +decongestant
  2. Nasal steroid
  3. Tx for asthma (in young)
  4. Tx for GERD (in old)
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7
Q

Signs of upper airway cough sy (post-nasal drip)

A
  1. Throat clearing
  2. Cobble stoning at the back of the throat
  3. Tongue coated at 1/3 of the back
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8
Q

SAH - preferred investigation

A
  • first 48 hrs: Plain head CT

- after: MRI

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9
Q

Clinical presentation of SAH

A

Sudden onset unprovoked Headache w neck stiffness & n/v

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10
Q

Prodromal signs and syx in SAH

A

Syx: headache, dizziness, orbital pain, diplopia, visual loss

Signs: sensory or motor disturbance, seizure, ptosis, bruit, dysphagia

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11
Q

Prodromal signs/syx in SAH are 2ry to:

A
  1. Sentinel leaks - warning bleeds 30-50%! - sudden onset of h/a w neck pain, age>40
  2. Mass effect of aneurysm expansion
  3. Emboli
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12
Q

Headache most typical DDx in young vs old

A

Young: some form of migraine
Old: SAH, GCA, met to the brain, SDH if on Warfarin until proven otherwise

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13
Q

Migraine clinical presentation

A 
Family Hx 96%
Pulsating, worse w activity
Causes gastroparesis: n/v
Mild to severe, can be disabling
Hx of motion sickness
\+/- photo- and phonofobia
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14
Q

Migraine adjunctive Tx

A

Metoclopride taken it causes gastroparesis (all therapies are more effective)

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15
Q

Migraine trigeminal variant

A

Recurrent sinus h/a, involving the trigeminal nerve distribution, BILATERALLY!

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16
Q

Idiopathic acute neuro sensory hearing loss (N structural exam)
Tx

A 
Prednisone po x10d
Otological referral
?Mg
No benefits from acyclovir
If no response, intra-tympanic steroids
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17
Q

PVD useful physical signs

A

Absent pulses -spec 90%, LR+9-44
Femoral bruit -spec 95%, LR+5

Less helpful: cool skin, cap refill time

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18
Q

Triggers of RLS

A

Fe-deficiency
?VitD deficiency
Metoclopramide, antihistamines, neuroleptics

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19
Q

Multiple sensory deficits

A

Vague unsteadiness only w walking

Tactile input helps balancing

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20
Q

Dizziness DDx

A
  1. Vertigo
  2. Syncope/pre-syncope
  3. Disequilibrium
  4. Ill-defined lightheadedness (panic d/o, anxiety w hyperventilation
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21
Q

Acute viral labyrinthitis

  • clinical presentation &
  • Tx
A

Vertigo, movement makes it worse, but than lasts for minutes (vs BPPV)
Tx: methylprednisone 100mg x3d, then taper over 22d (NEJM)

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22
Q

Vertigo w brainstem infarct

A

Vertical nystagmus - central cause!
Non-fatiguable
Older pt w atherosclerosis
+ other brainstem or cerebellar symptoms (dysarthria, dysmetria, diplopia, motor sy)

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23
Q

Vertigo DDx

A

BPPV
vestib neuronitis
Ménière’s disease (tinnitus, hearing loss, ear fullness, vertigo)
Central cause (15%)

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24
Q

Skin manifestations of sarcoid

A

Hutchinson plaque: granulomatous skin plaques on neck/thorax
Lupus pernio: purplish plaque resembling frostbite on ears/cheeks/nose
Erythema nodosum (Lofgren)
Macular or papular sarcoidosis (most common in black ppl)
Annular sarcoid, scar&tattoo infiltration

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25
Q

Sarcoid clinical presentation

A

Lymphopenia, hyperCa, low gr fever, wt loss

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26
Q

Highest spec of this finding in sarcoid

A

Bilateral hylar lymphadenopathy

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27
Q

Sarcoid most common in this population

A 
Northern Europe (Sweden)
US: black population
28
Q

Lofgren sy

A

Self-limiting

Fever, bilat hilar lymphadenopathy, erythema nodosum, arthritis/arthralgia

29
Q

Clinical significance of lupus pernio

A

Lung and bone involvement more common

Usually more severe clinical picture

30
Q

Treatment indications for sarcoid

A

Symptomatic; if hyperCa, skin d, iritis/uveitis, arthritis, pulmonary sy, cardiac/CNS involvement (steroids, MTX, cyclosporine)

31
Q

Obstructive PFTs

A

decreased FEV1, N or incr FVC, incr TLC

DLCO: asthma - N, COPD - decr

32
Q

Restrictive PFTs

A

Decr FEV1, FVC, TLC, DLCO

33
Q

Postprandial abdo pain DDx

A

GERD, SBO, mensenteric ischaemia, chilecystitis, pancreatitis, IBS

34
Q

Chr mesenteric ischaemia clinical presentation

A

Post-prandial abdo pain, wt loss, decr appetite, diarrhea - FOB positive, malabsorption, evidence of PVD/CAD

35
Q

Mesenteric ischemia - small bowel vs colitis

A

SB: wt loss, abdo pain, diarrhea
Colitis: bloody diarrhea, not painful, positive c-scope, thumbprinting in Ba-studies

36
Q

Acute mesenteric ischemia

A

Severe abdo pain, out-of proportion, nausea/vomiting, diarrhea, incr WBC, lactic acidosis
RFs: MI/CHF/arrhythmia (A.fib)

37
Q

Thyroid hormones binding to

A

Fe, antacids, Ca, cholestyramine, sucralfate

38
Q

Thyroid hormone absorption

A

Absorbs better at night, PPI and H2 blocker interferes w absorption

39
Q

PPI interferes w

A

Ca, Fe, ketokonazole, itraconazole absorption

40
Q

PPI is risk for

A

C. Diff and it’s recurrence

Hip#

41
Q

Osteoporosis is ass w following meds

A

Steroids, long-term heparin (LMWH too), thiazolisendions, SSRIs, PPIs, loop diuretics

42
Q

Warfarin most severe interactions

A 
TMP/Sulfa
Erythromycin
Amiodarone
Propafenone
Metronidazole
Itraconazole/ketokonazole/fluconazole
43
Q

Warfarin possible interactions

A

Quinolones
Omeprazole
Clarythromycin
Azithromycin

44
Q

ABx ok w Warfarin

A

Penicillins
Cephalosporins
Nitrofurantoin

45
Q

Tylenol and Warfarin

A

Regular Tylenol >2 g/d effects INR at 2-5 days

46
Q

Prednisone and warfarin

A

Prednisone effects INR at D6

47
Q

Simvastatin + gemfibrozil?

A

Avoid b/o rhabdo

Rather statin + fenofibrate

48
Q

Clarithro + macrolide:

A

Clarithro: CYP3A4 inhibitor

49
Q

CCB + simvastatin

A

Diltiazem and Verapamil raises simvastatin levels

50
Q

Simvastatin and lovastatin

A

Similar metabolism

51
Q

Increased risk for statin toxicity

A

Fibrates, azoles, amiodarone, erythro/clarithro, protease inhibitors, verapamil/diltiazem

52
Q

Muscle toxicity of statins:

Fluvastatin, pravastatin, atorvastatin, simvastatin

A

Fluvastatin<simvastatin

53
Q

The least muscle-toxic statin

A

Fluvastatin

54
Q

The most muscle toxic statin

A

Simvastatin

55
Q

Myalgias & statins

A

Dose & drug dependent
Correct hypothyroidism!
More in: Asians & small body mass

56
Q

Bx w statin myopathy

A

Positive even if CK normal, but they are in myalgia

Muscles are damaged in asymptomatic pts

57
Q

Approach to myalgia if on statin

A
  • check CK and TSH
  • if severe, stop statin, restart at a lower dose, or
  • change to another statin or use only on alternate days
  • if sy persist, stop statin, use zee timing, colesevelam, red yeast rice (active ingredient: lovastatin)
58
Q

TMP/Sulfa and MTX interaction

A

Septra displaces MTX from plasma protein binding and competes w it’s renal elimination => incr MTX levels (and toxicity)

59
Q

Penicillins and MTX

A

Penicillins compete w MTX renal elimination

60
Q

Grapefruit juice (naringin) metabolic activity

A

CYP3A4 inhibitor

61
Q

Grapefruit juice drug interactions

A

CCB (nifedipine was the first described food-drug interaction)
Statins (simva, lova)
Cyclosporine
BZD
Saquinavir (anti-HIV proteinase inhibitor)

62
Q

Simvastatin

A 
Warfarin
Amiodarone
Fibrates
Clarithro
Azoles
63
Q

HyperK 2ry to these drugs

A 
ACEI/ARB
K-sparing diuretics
TMP-Sulfa
NSAIDS
Salt substitute (Kcl!)
64
Q

No Septra for pts on:

A

Warfarin
MTX
Sulfa-allergy
Elderly, renal insuff

65
Q

Topiramate mechanism and side effect

A

Carbonic anhydrase inhibitor, causing NAGMA

66
Q

Bisphosphonates and MSK pain

A

5-20% on weekly doses

67
Q

SSRIs side effects

A

UGIB (more so if on NSAIDS, make sure pt on PPI)
HypoNa
Sexual dysfunction (20-40%, delayed ejaculation/orgasm)

68
Q

Drugs provoking CHF

A

NSAIDS
Pioglitazone, rosiglitazone
Kayexalate
Dihydropyridinee

ACP (6 decks)

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