IM essentials Flashcards
Goal SBP for a pt >60 being tx for HTN
<150/90
Echo - asymmetric basal and midseptal hypertrophy, thick septum, increased LV outflow tract gradient
Hypertrophic cardiomyopathy
high risk pts need ICD
High risk RF’s: Fhx of sudden cardiac death in first degree relative, significant LV wall thickening
Doesn’t matter if symptomatic or not
p waves not followed by QRS
Second degree AV block
Type I - Wenckeback (progressive prolongation of PR interval until beat drop)
Type II - Morbitz (constant PR interval with dropped beats)
Can be caused by combo of atenolol and diltizaem (decrease conduction w/in AV node)
acute management of afib in symptomatic but hemodynamically stable
Rate control w/ B block or CCB (diltiazem)
Pt w/ AV replacement has new dyspnea. Which PE finding would suggest prosthetic valve dysfunction?
New diastolic murmur
Suggests aortic regurg
Tx for HF s/t perpipartum cardiomyopathy
Systolic HF
ACEI (postpartum only), Bblock, spronolactone
EKG with three or more P waves morphologic patterns and variable P-R intervals in a pt with lung dz
Multifocal atrial tachycardia
Often see in lung dz or electrolyte abn
Opening snap follwed by diastolic rumble. Loud S1
Mitral stenosis
CHF w/ LV dysfunction should be tx w/?
Bblocker
What study do you order first for suspected DVT?
Ddimer
Management for symptomatic PVC’s
Bblock
HTN
HA
Palpitations
Diaphoresis
Pheo
tumor of chromaffin cells -> over produce NE, epi, DA
Originate in the adrenals
Flushing
hypotension
Carcinoid
Pt on hydrocortisone for adrenal insufficiency gets a URI. How do you manage?
Increase dose of hydrocortione during even minor intercurrent illness x 3 days
USPTF recommendaitn on DEXA scans
Women 65 +
Younger women w/ fx risk
HTN
Hypokalemia
Hyperaldosteronism
Measure aldosterone:renin activity
TSH <10
T4 WNL
Sub clinical hypothyroid
Repeat study in 6 months
Testing for incidental adrenal gland mass
O/n dexamethasone suppression test (cushing)
24 hour metanephrines (pheo)
Measure renin:aldosterone (aldosteronoma)
10% of incidentalomas are functional
Insulin therapy in hyperlgycemic hyperosmolar syndrome
IV insulin drip (not bolus)
IV faster onset than sub Q
t1/2 = 9 min
How do you manage a pt w/ hypothyroidism that is in the first trimester?
Levothyroxine requirements are increased by 30-50% in preggos w/ hypothyroidism
PT is on glyburide and metformin and having episodes of dizziness etc. A1C 6%
Stop the glyburide, she is probably having hypoglycemic episodes
high TSH
+ thyroid peroxidase
Hashimoto thyroiditis
Start levothyroxine
T1DM should have which screening after puberty?
Lipid panel
When do you start a bisphosphanate?
10 yr fx risk is 20% or >
OR risk of hip fx over the next 10 years is 3% or greater
Amenorrhea
Galactorrhea
Get a Sr prolactin
Elevated indirect bili after surgery, stress
Gilbert
Malaise
Jaundice
LFT’s up to 15x NL
Viral hepatitis