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Deck Kat > IM > Flashcards

IM Flashcards

1
Q

First and initial approach to patient presenting with chest pain?

A

Targeted history and PE

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2
Q

Best dx test in chronic stable angina?

A

ECG

IF NORMAL DO STRESS TEST

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3
Q

First line if treatment for reducing angina?

A

Beta blockers and CCB

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4
Q

Pharmacologic agents that can be used in stress testing

A

DAD

DOBUTAMINE
Adenosine
Dipyridamole

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5
Q

Definitive test for CAD

A

Coronary angiography

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6
Q

Major site of atherosclerotic disease

A

Epicardial coronary artery

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7
Q

Most common cause of non cardiac chest pain

A

GI disorder

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8
Q

Drugs for event prevention in stable angina

A

ACSA

aspirin
Clopidogre
Statins
ACE/ARB

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9
Q

Drugs for relief of angina

A

Beta blockers and CCB

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10
Q

What to do in a single or two vessel disease with NORMAL LV?

A

PCI

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11
Q

Indications for CABG

A
  • Three vessel disease
  • Two vessel disease that includes LDCA with impaired LV or diabetic
  • LEFT MAIN CAD
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12
Q

Next best step after diagnosing a non STE ACS?

A

Aspirin 4 tabs

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13
Q

Dx test to differentiate NSTEMI and unstable angina?

A

Cardiac biomarkers

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14
Q

First cardia biomarker to rise in NSTEMI?

A

Myoglobin

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15
Q

Cardio biomarker to detect reinfarction

A

CKMB

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16
Q

What are the ABCS of plaque stabilization?

A

Aspirin, ace, arbs
beta blockers
Clopidogrel
Statins

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17
Q

Difference re pathophysiology of NSTEMI and STEMI?

A

In NSTEMI plaque rupture resulted in partial occlusion in STEMI there is sudden interruption of blood supply due to total occlusion

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18
Q

Patient presented with a sense of impending doom associated with chest pain. Impression?

A

STEMI

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19
Q

When can a patient perform sexual activity post MI?

A

First 1-2 weeks

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20
Q

When can a patient return to work post MI?

A

2-4 weeks

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21
Q

Most common out of hospital cause of death from STEMI?

A

Vfib

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22
Q

Most common in hospital cause of death in STEMI?

A

Pump failure

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23
Q

Patient presented with a tearing chest pain that radiates to the back. Impression?

A

Aortic dissection

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24
Q

Patient presented with chest pain with dermatomal distribution. Impression?

A

Herpes zoster

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25
Q

Patient presented with chest pain that is worse in supine and is relieved when sitting upright and leaning forward. Impression?

A

Pericarditis

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26
Q

Patient presented with chest pain associated with dyspnea and syncope. Impression?

A

Aortic stenosis (⬆️ cardinal symptoms)

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27
Q

Normal levels for

TCHOL
TG
LDL
HDL

A

TCHOL <200
TG <150
LDL <100
HDL >40

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28
Q

DOC for hypertriglyceridemia

A

FIBRATES

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29
Q

DOC and with greatest mortality benefit for hyperlipidemia?

A

Statins

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30
Q

Drug given to patients with hypertriglyceridemia to prevent pancreatitis

A

Omega 3 FA

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31
Q

Given to patients with low HDL

A

Niacin

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32
Q

Most common etiology of HPN?

A

Primary or essential

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33
Q

Most common cause of secondary HPN

A

Primary renal disease

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34
Q

Most common cause of mortality in patients with HPN?

A

Heart disease

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35
Q

How do you dx HPN?

A

Two or more elevated BP readings in a period of over a week or so

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36
Q

Drug therapy is indicated in hypertensive patients with BP of ?

A

140/90 or higher

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37
Q

Patient presented with elevated bp with change in sensorium. BP is 230/140. Impression? Most urgent step?

A

Hypertensive EMERGENCY

START IV MEDS to decrease bp to 25% of initial bp or 160/110-100

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38
Q

Most important mechanism of dyspnea in CHF?

A

Pulmonary congestion

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39
Q

Most useful test to assess LV function is

A

2D echogram

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40
Q

Cornerstone of pharmacotherapy in CHF

A

Beta blockers and ACE inhibitors

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41
Q

Goals of treatment for patients with CHF

A

Relief of sx
Prevent progression
Reduce mortality

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42
Q

In acute decompensated HF, what is the inotropic agent of choice?

A

DOBUTAMINE

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43
Q

Most common cause of right sided heart failure?

A

Left sided heart failure

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44
Q

Patient presented with SYNCOPE, ANGINA and DYSPNEA. Auscultation showede a MIDSYSTOLIC MURMUR. Dx? What is the best INITIAL test?

A 
Dx: AS
Transthoracic echocardiogram (TEE)
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45
Q

Patient presented with SYNCOPE, ANGINA and DYSPNEA. What is the most ACCURATE DX test?

A

Left heart catheterization

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46
Q

Patient presented with SYNCOPE, ANGINA and DYSPNEA. What is the treatment of choice for symptomatic patients?

A

Aortic valve replacement surgery

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47
Q

Patient presented with a high pitched blowing diastolic murmur over the left sternal border. Dx? Initial dignostic? Tx?

A

Aortic regurgitation

TEE

SURGICAL AORTIC VALVE REPLACEMENT

48
Q

Patient presented with a hx of RHD with a low pitched diastolic murmur at the apex. Dx? Chest X-ray finding? Common cause?

A

Dx: mitral stenosis

Cxr: straightening of the left upper border of cardiac silhouette

MC CAUSE : RHEUMATIC FEVER

49
Q

Patient diagnosed with Mitral stenosis. What is the most effective treatment?

A

Balloon valvuloplasty

50
Q

MS patient presented with onset of ATRIAL FIBRILLATION which is a HALLMARK OF DISEASE PROGRESSION was started with WARFARIN. What is the target INR?

A

INR 2-3

51
Q

Patient presented with hpn and a holosystolic murmur at the apex that radiates to the axilla. Dx?

A

Mitral regurgitation

52
Q

Patient is a case of MARFAN’s that presented with MIDSYSTOLIC click and systolic murmur that is increased by standing and valsalva. Dx?

A

Mitral valve prolapse

53
Q

Patient is a IV DRUG USER presented with a BLOWING HOLOSYSTOLIC MURMUR at the left sternal border. DX?

A

Tricuspid regurgitation

54
Q

Most common type of cardiomyopathy

A

Dilated cardiomyopathy

55
Q

Leading cause of death in young healthy athletes

A

Hypertrophic cardiomyopathy

56
Q

Echocardiography showed a glittering hyperrefractile myocardium. This is typical of?

A

An amyloid infiltration in restrictive cardiomyopathy

57
Q

What is a characteristic echocardiographic finding in HYPERTROPHIC CARDIOMYOPATHY?

A

Systolic anterior motion (SAM)

58
Q

Features in pericarditis?

A

Chest pain that is positional
Rub (pericardial friction- pathognomonic)
Effusion that is pericardial
ST segment elevation that is diffuse

(+)etiology -TANS

59
Q

Management of pericarditis?

A

Aspirin + omeprazole
NSAIDs or steroids as anti inflammatory

AVOID ANTICOAGULATANTS

60
Q

Becks triad

A

Jugular venous distention
Muffled heart sounds
Hypotension

61
Q

Most urgent step in a diagnosis of CARDIAC TAMPONADE

A

Echo-guided pericardiocentesis

62
Q

Best INITIAL test when considering a PAD?

A

Ankle brachial index (ABI)
Diagnostic is ABI of <0.9

normal >1
PAD <0.9
Severe ischemia <0.5

63
Q

Gold standard for diagnosis of PAD

A

Arteriography

64
Q

First line for symptom improvement if PAD?

A

Cilostazol

2nd line is PENTOXIFYLINE

65
Q

Beta blockers that showed evidence for lowering mortality in Heart failure

A

Metoprolol succinate
Bisoprolol
Carvedilol

66
Q

Most common cause of chronic cough in a patient who is a non smoker, and not on ACE inhibitors with normal PE and CXR

A

PAG ang cough >8weeks

Postnasal drip
Asthma
GERD

67
Q

Samter’s triad

A

ANA

Aspirin
Nasal polyps
Asthma

68
Q

Best test to determine reactive airway disease

A

Metacholine stimulation test

69
Q

Target SPO2 in asthma?

A

> 90%

70
Q

First line of treatment for acute asthma attack

A

SABA

71
Q

First line of controller treatment

A

Low dose ICS

72
Q

When to step up in asthma control?

A

2-3 months of uncontrolled or persistent asthma

73
Q

When to step down asthma mgt?

A

When asthma attacks are controlled for 3 months

74
Q

When is it time to start giving ICS in a person dx with asthma

A

If attacks occur more than 2x a month and the person wakes up from sleep due to an attack more than once a month

75
Q

Test that CONFIRMS asthma

A

Spirometry

76
Q

Best INITIAL test for COPD

A

Soirometry

77
Q

Best diagnostic test for COPD in acute exacerbations?

A

ABG

78
Q

Target SPO2 in COPD

A

90% or more

79
Q

Common risk factor in COPD

A

Tobacco smoking

80
Q

Characteristic of asthma

A

Airway hyper responsiveness

81
Q

Characteristic of COPD

A

Airflow limitation/ obstruction

82
Q

Definitive diagnostic test for COPD

A

Pulmonary function test or spirometry with FEV1/FVC ratio of <0.7

83
Q

When to start O2 therapy in COPD?

A

If SP02 is less than 88% or if 90% with signs if pulmonary hypertension or right sided heart failure

84
Q

Bacteria more commonly implicated in COPD exacerbations

A

S. Pneumoniae
H. Influenzae
M. Catarrhalis

85
Q

Most common atypical pathogens in pneumonia

A

MCL

Mycoplasma
Chlamydia
Legionella

86
Q

Most common extra pulmonary TB

A

TB lymphadenitis

87
Q

Pott’s disease commonly affects what part of the spine?

A

Lower thoracic upper lumbar

88
Q

Tb drug related to peripheral neuropathy

A

Isoniazid

89
Q

Tb drugs related to visual impairment

A

Ethambutol

90
Q

Cornerstone in diagnosing TB MENINGITIS

A

Lumbar tap

91
Q

Gold standard in diagnosing TB MENINGITIS

A

CSF CULTURE

92
Q

Most common cause of pleural effusion

A

LV HEART FAILURE

93
Q

MC cause of exudative PE

A

TB

MALIGNANCY IS THE 2nd MC cause

94
Q

Light criteria

A

PF:serum protein = >0.5
PF: serum LDH = >0.6
PF LDH > 2/3 upper normal serum limit

Yes = exudative

95
Q

Patient who worked in ship building came in for annual CXR. Results showed CALCIFIED PLEURAL PLAQUES. Impression?

A

Asbestosis

*also in tile and brake lining

96
Q

Patient who worked in the mining industry came in for annual CXR. Results showed EGGSHELL CALCIFICATION . Impression?

A

SILICOSIS

*also in stone and glass cutting, sandblasting and quarrying

97
Q

Patient who is an aerospace engineer came in for annual CXR. Results showed nodlues along septal line. Impression?

A

Berylliosis

*also in nuclear and electronic plants

98
Q

Patient who worked in a cotton manufacturing company came in for annual CXR. Results showed diffuse infiltrates with hilar adenopathy. Impression?

A

Byssinosis

99
Q

A coal worker came in for annual CXR. Results showed progressive fibrosis. Impression?

A

Coal worker’s pneumoconiosis

100
Q

DOC for CAP due to a LEGIONELLA infection

A

Clarithromycin

101
Q

Features of ARDS

A

A cute in onset
R ratio of Pa02/FiO2
D iffuse bilateral CXR
S sawn ganz pressure is less than 18mmHg

102
Q

Most patients are liberated from the mech vent after ARDS when?

A

From day 7-21

104
Q

Best initial diagnostic test in an assessment of ARF

A

ABG

105
Q

How do you correct hypoxemia in an intubated patient?

A

adjust mech vent settings to increase oxygenation by increasing FiO2 and increasing PEEP

106
Q

How do you correct hypercarbia in an intubated patient?

A

Increase ventilation by increasing RR and increase in tidal volume

107
Q

What mech vent strategy has shown to improve survival in ARDS?

A

Low tidal volume

108
Q

Most appropriate diagnostic test for pulmonary embolism?

A

Chest ct with contrast

109
Q

Gold standard in the diagnosis of PE

A

Invasive pulmonary angiogram

110
Q

Initial test to rule in or our a PE or a DVT

A

D-dimer

113
Q

What is the most urgent step in a cardiogenic shock?

A

FLUID RESUSCITATION with crystalloids with at least 30cc/kg within 3hours

114
Q

Vasopressor of choice in shock

A

Norepinephrine

2nd line = epinephrine

115
Q

Inotropic agent of choice for shock

A

DOBUTAMINE

116
Q

Most serious complication of fluid infusion

A

Pulmonary edema

117
Q

Features of tension pneumothorax

A

P-Thorax

Pleuritic chest pain
Tracheal deviation
Hyperresonance
Onset is sudden
Reduced breath sounds and dyspnea 
Absent fremitus
Xray shows collapase
118
Q

MC sx of DVT

A

Cramps

119
Q

Hallmarks of massive PE

A

Dyspnea
Syncope
Hypotension

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