IMC 4.0

Question 1

? is the MC type of cardiomyopathy

What is the MC non-ischemic cause

What part of the heart if affected

Answer 1

Dilated

ETOH abuse
MCC- ischemic dz

All 4 chambers

Question 2

Dilated Cardiomyopathy is characterized by ?

What heart sound is present

What Sxs can this present w/

Answer 2

Dec contraction strength- systolic dysfunction

S3- ventricular gallop

Fatigue
Edema
Exertion dyspnea
Displaced apical pulse (megaly)

Question 3

? is the most definitive method to Dx Dilated Cardiomyopathy

What findings are Dx

What will be seen on EKG

Answer 3

Echo

Dilated ventricles
EF <50%, often <30%

Non-specific ST/T changes

Question 4

What will be seen on CXR of Dilated Cardiomyopathy

How is this Tx

What med is added if increased contractility is needed

Answer 4

Balloon heart- megaly and pulmonary congestion

Loop+ACEI+BB
Transplant/LVAD

Digitalis

Question 5

What medication is used in Dilated Cardiomyopathy to reduce remodeling

What medication is used to decrease the effects of excess catecholamines

Chronic use of ? street drug can lead to this

Answer 5

Angiotensin Converting Enzyme Inhibitors- ACEI

BBs

Cocaine

Question 6

Define HOCM

What type of murmur does this have

What makes murmur louder/softer

Answer 6

Ventricular hypertrophy w/ diastolic dysfunction

Medium, mid-systolic cresc-decresc w/ S4

Dec- squat, grip, raise (increased preload)
Inc- valsalva, stand (dec preload)

Question 7

How is HOCM genetically linked

This condition presents mimicking ?

What type of murmur is present

Answer 7

Autosomal dominant affect on sarcomeres

AS- angina, syncope, HF

S4 gallop w/ apical lift

Question 8

What type of JVD wave is present in HOCM

How is this Dx

What is seen on EKG

Answer 8

Prominent A-wave

Echo- LVH, thick septum
MRI

LVH
Non-specific ST/T changes

Question 9

How is HOCM Tx

What Rxs need to be avoided

What medication is c/i?

Answer 9

Diltiazem/Verapamil/Metoprolol
Exercise cessation
+syncope/arrest= ICD

Decrease preload: Diuretics ACEI Nitrates ARBs

Digoxin- increases contraction/obstruction

Question 10

How does HOCM cause death

Define Restrictive Cardiomyopathy

What Hx is in the Pts report

Answer 10

Post-exertional ventricular arrhythmia

Noncompliant ventricles (MC- LV) that resist diastolic filling

Myocardial infiltration w/ abnormal tissue-
Amyloidosis- MC

Question 11

What type of HF and sound is associated w/ Restrictive Cardiomyopathy

Half of these etiologies are ?

How is this Dx

Answer 11

Diastolic HF w/ S4

Idiopathic

Echo- normal EF, dilated atria, hypertrophy
Cath- high atrial pressure

Question 12

What is seen on EKG of Restrictive Cardiomyopathy

If a Dx is in doubt after an Echo, what is the next step?

What would be seen on CXR

Answer 12

Non-specific ST/T changes
Low voltage complexes

MRI- abnormal textures

Pulmonary vascular congestion
Normal heart size

Question 13

How is Restrictive Cardiomyopathy Tx

Why must Rxs be used cautiously

What populations are at higher risk for developing this condition

Answer 13

+edema/pulmonary congestion= diuretic
Definitive- transplant

Avoid lowering preload

Northern European men

Question 14

Define ASD

What does this defect cause to occur

How common are these defects

Answer 14

Atrial wall defect causing L to R diastolic shunt

Volume overload of RA/RV

2nd MC behind VSD

Question 15

Small ASDs can remain ASx as long as 30y/o but then ? occurs

This defect is often associated w/ ? d/t the stretching

This allows for ? event to occur

Answer 15

> 30: dyspnea, angina
50: Afib, RVF

Arrhythmia- RBBB

Paradoxical embolization- DVT causes stroke/brain abscess if septic

Question 16

What happens to the S2 in an ASD

What kind of S1/S2 is present

How is this Dx

Answer 16

Shunting of blood equalizes blood volume entering ventricles- eliminates normally wide, split S2

Loud S1
Wide fixed split- lub dub-dub

Echo w/ bubble contrast

Question 17

What is seen on EKG of ASDs

What is seen on CXR

How is this Tx

Answer 17

RAD
RVH
RBBB w/ rSR in V1

Megaly w/ dilated RA/RV

Small/central <3mm: observe
+Evidence of RV volume overload- surgical closure at 2-6y/o

Question 18

Define PDA

How do Pts present

What type of murmur is produced

Answer 18

Systolic murmur d/t persistent ductus arteriosus (aorta to L-PA) causes L-R shunt

FTT
Poor feeding
Tachy/Tachy

Continuous machinery at 2nd LICS (patent your machine)

Question 19

What are two common PE findings of PDA

What is seen on EKG

What is seen on CXR

Answer 19

Machinery murmur
Wide pulse pressure (arm>leg)

LVH, normal

LVH
Prominent LA, PA, aorta

Question 20

How are PDAs Tx

Since these may be identified at birth, especially if premature, what is the next step

? congenital infection can cause a PDA

Answer 20

Indomethacin- decreases Prostaglandin E1/E2
Fluid restriction
Surgery/Catheter

Re-eval in 24hrs

Congenital Rubella

Question 21

Define a VSD

? is this murmur the MC of

What type of murmur is created

Answer 21

Hole in septum causing L-R shunt between ventricles

MC congenital defect
MC pathological murmur of childhood

Harsh, loud holosystolic w/ systolic thrill

Question 22

How is a VSD identified on PE

How is the Dx confirmed

How is this Tx

Answer 22

Pt supine
Diaphragm at tricuspid

Echo

Watchful expectation

Infant w/ CHF + growth retardation- digoxin + diuretic

Medical failure- surgery <6mon old

Question 23

Peds w/ VSD need ? prophylaxis prior to procedures

What is being prevented

What is the MC outcome and the most UNCOMMON outcome

Answer 23

PCN/Amox
Allergy- Erythromycin

Bacterial endocarditis

MC: spontaneous closure
MUC- CHF secondary to VSD

Question 24

Define Coarctation of Aorta

What is the usual PE finding

Half of these Pts will have ? defect putting them at risk for ? sequelae

Answer 24

Narrowing of aorta, MC below origin of left subclavian artery

Arm BP > Leg BP

Bicuspid aorta;
Berry aneurysm

Question 25

What does Coarctation look like on EKG? What does it look like on CXR How is it definitively Dx

Answer 25

LVH Rib scalloping/notching Figure 3 sign TTEcho or CT/MRA

Question 26

How is Coarctation of Aorta Tx How is Tx different if seen in neonates Why would emergent surgical repair be needed

Answer 26

Balloon angioplasty w/ stent between 2-4y/o Prostaglandin E1- keeps ductus arteriosus open Shock Megaly Severe HTN/CHF

Question 27

What happens if Coarcations are left untreated Infantile Coarctation is associated w/ ? two defects Unique fact of Tetrology of Fallot

Answer 27

Death by 50y/o d/t: Rupture/dissection CVA PDA Turner Syndrome- order karyotype analysis Only cyanotic congenital heart dz on blueprint

Question 28

What are the 4 features of Tetrology of Fallot What makes this a Pentology What is the resulting shunt created?

Answer 28

PS RVH Overriding VSD ASD PS- R to L through VSD

Question 29

How is Tetrology of Fallot Dx What is seen on CXR What serial monitoring do Pts need

Answer 29

Echo Boot shaped heart EKG for QRS widening

Question 30

How is Tetrology of Fallot Tx What happens if these are left untreated What are complications that arise after surgical correction

Answer 30

Surgery Sudden cardiac death/HF <20y/o HF Outflow obstruction PR Arrhythmias

Question 31

What hereditary T-cell disorder is associated w/ Tetrology of Fallot What PE finding measures the severity of this condition Infants/Peds will have ? common PE finding

Answer 31

DiGeorge Syndrome PS Cyanosis Tet Spell= hypercyanotic

Question 32

# Define Primary HTN What are the ranges for Normal, Elevated, Stage 1 and Stage 2 According to USPSTF, Pts need HTN screening starting at ? age and how often

Answer 32

SBP 130 or > or, DBP 80 or > On two readings, on two separate visits N: <120 and <80 E: 120-29 and <80 1: 130-39 or 80-89 2: 140 or >, or 90 or > Start at 3y/o, annual at 18y/o: Normal- qYear +RFs/SBP 120-29- q6mon

Question 33

When measuring BP, Pts reasts x ?min The cuff needs to cover ? much of arm How big of width does bladder need

Answer 33

Rest >5min and >30min since tobacco/caffeine ingestion 80% of arm 40% of arm

Question 34

BP discrepancy of ? in both arms needs further eval When is anti-hypertensive therapy initiation indicated What is the target BP for PTs w/ or w/out comorbidities

Answer 34

>15mmHg All Stage 2 Stage 1 w/ ASCVDz, DM2, CKDz or 10yr risk of 10% or more 140/90 w/out comorbidiites <130/80 <60 w/ CAD/CKD/DM: <140/90 60/>: <150/90

Question 35

When Tx HTN, how much salt intake is recommended How much exercise is recommended If medication is needed, ? is used per ethnicity

Answer 35

<2.3g/day (1tsp) Mod intensity: 30min/day x 5d/wk Vigorous intensity: 30min/day x 3d/wk Non-black/DM: ACEI/ARB CCB Thzd (chlorthalidone, indapamide)

Question 36

What HTN Txs are recommended for Stage 2 HTN When are ACEI/ARB, BB, or CCBs c/i for Tx How long are therapies recommended

Answer 36

Two BP meds from different classes w/ lifestyle mod ACEI/ARB- DM w/ proteinuria BB- asthma CCB- angina pectoris F/u 1mon Goal not met- increase dose or add 2nd med

Question 37

What is done for HTN if BP is uncontrolled despite 2 anti-HTN meds What is done if one med causes to much leg edema What is done if the diuretic is not tolerated

Answer 37

ACEI/ARB and Amlodipine and Thzd-like Substitude Amlodipine w/ Verapamil/Diltiazem Use mineralcorticoid receptor agonist (Spironolactone)

Question 38

S/e of ACEI S/e of Spironolactone S/e of BB S/e of CCB S/e of hydralazine S/e of thiazides

Answer 38

Cough Angioedema HyperK (c/i- pregnant) HyperK Impotence (c/i asthma) Leg edema Lupus-syndrome (and Procainamide) Pericarditis HypoK

Question 39

What are the 5 modifications used for Tx HTN and how much of a decrease is expected ? is the initial medical therapy for DM when starting HTN Tx What EKG changes would be seen after long standing HTN

Answer 39

``` Weight loss: 5-20mm DASH diet: 8-14mm Na dec: 2-8mm PT: 4-9mm Dec ETOH: 2-4mm ``` ACEI- beneficial for neuropathy LVH

Question 40

What are two non-modifiable RFs for HTN ? anti-hypertensive agent has alpha and beta blocking activity Pt w/ BP of 135/85, what is the next step and Tx

Answer 40

Age FamHx CADz Carvedilol 10yr HDz/stroke risk: <10%- start lifestyle >10%, CVDz, DM, CKD- start meds

Question 41

# Define Secondary HTN When is this Dx suspected What is the MC cause

Answer 41

130/80 or higher w/ identifiable cause Severe BP Refractory to HTN med Primary aldosteronism- high Na, low K

Question 42

What is the MC cause of curable HTN ? sweet diet finding can increase BP readings When Tx HTN, lifestyle modification can be tried for how long before meds are used

Answer 42

Excessive ETOH and OCP combo usage Licorice 6mon

Question 43

When Tx HTN, a initial BP higher than ? indicates starting Tx w/ two med Define Cardiogenic Shock What is the MC cause

Answer 43

>160mg Pump fails, insufficient CO to maintain perfusion Acute MI

Question 44

What PE findings suggest cardiogenic shock What vitals suggest this Dx How is this Dx

Answer 44

Pulm congestion AMS Tachycardia HOTN JVD UOP <20 SBP <90 Pulmonary capillary wedge pressure >15mm

Question 45

How is Cardiogenic Shock Tx How does this Dx present post-MI What type of MI are at highest risk for this sequel

Answer 45

Fluids/Pressers: Dobutamine, NorEpi Balloon pump <72hrs post-MI as free wall rupture Q-wave transmural Lateral wall

Question 46

# Define O-HOTN What criteria is used for Dx What may be the cause in DM/older aged PTs

Answer 46

Excessive fall of BP when upright Drop of >20 SBP Drop of >10DBP Both 2-5min after supine to standing Autonomic dysfunction- HR inc <10bpm= tilt table >100bpm or inc by >30bpm= hypovolemia

Question 47

How/why does post-postprandial O-HOTN occur What is the DDx if during Bp checks Sxs present but no HOTN is present How is O-HOTN Tx

Answer 47

Insulin response to high carb meal Blood pools in GI tract Alcohol worsens HOTN POTS Dz Inc Na/fluids Fludrocortisone Midodrine

Question 48

? class of drug has the most common adverse effect of OHOTN Define NSTEMI What would be seen on EKG

Answer 48

MAOIs- inhibit enzymes that break down neurotransmitters Myocardial necrosis w/out ST elevation/Q-waves d/t incomplete block (subendocardial infarct) ST depression T-wave inversion

Question 49

What are the 3 cardiac biomarkers used during N/STEMI work ups How are NSTEMIs Tx

Answer 49

Myoglobin: 1-4hrs; 12hrs; 24hrs Troponin: most sensitive 2-4hrs; 12-24hrs; 7-10days CK/CK0MG: 4-6hrs; 12-24hrs; 48-72hrs MONA BNAH: BB ASA Reperfusion-PCI Clopidogrel Heparin ACEI NTG Statin

Question 50

# Define STEMI Since these are Tx similarly to NSTEMIs, what is done first

Answer 50

Myocardial necrosis w/ ST elevation/Q-waves d/t complete block (full wall thickness) ASA and Clopidogrel Reperfusion <12hrs of Sx onset Gold Standard: PCI <90min Thromolytic therapy <180min w/ TPA/Streptokinase

Question 51

Where on EKG would abnormal be seen: Anterior wall Inferior wall Lateral wall Posterior wall Anteroseptal

Answer 51

A: 1, aVL, V2-6; LAD I: 2, 3, aVF RCA- SA/AV nodes L: 1, aVL, V5-6 w/ reciprocal in 3, aVF; LCX P: ST depression V1-3; RCA/LCX AS: V1-V3; LAD/Septal

Question 52

What are the 6 absolute c/is for fibrinolytic therapy for STEMI Tx

Answer 52

Suspected ADissection Active bleeding/diathesis Malignant intracranial neoplasm Ischemic stroke <3mon CV lesion HTN, Intercranial

Question 53

How long after Sxs do NSTEMI/Unstable Angina need angiography Why is ASA used in N/STEMIs and TIAs What is the MC type of MI and what is the 'widow maker'

Answer 53

24-48hrs later Decreases mortality MC: Inferior (2, 3, aVF d/t RCA) WM: LAD

Question 54

What meds w/ Pts be d/c home w/ after NSTEMI What med is held until d/c and why is it started then When would BBs be with held from PTs

Answer 54

BB ACEI Ntg ASA Statin ACEI- dec LVH/remodeling to increase EF 2nd/3rd* heart blocks

Question 55

Why do Pts w/ inferior wall MIs have N/V/weakness and bradycardia Define Stable Angina Time frame for this Dx and possible presentation sign

Answer 55

Inc vagal tone SA involvement Pain/discomfort increased w/ exertion/emotion, predictable and relieved w/ rest/Nitro <15min; Levine sign

Question 56

How is Stable Angina worked up How is the Dx definitive and what wold be seen How is this Tx

Answer 56

Stress test- reversible wall abnormalities/ST depression >1mm Coronary angiography; >70% stenosis Nitro- sublingual/IV BB Angioplasty/Bypass

Question 57

Stable Angina Pts have decreased prognosis if ? What is the most sensitive clinical findings for Dx this condition What is the most useful and cost-effective non-invasive test

Answer 57

LVEF <50% Left main involved Horizontal/down sloping ST depressions on EKG Stress test: ST depression >1mm is pos

Question 58

Pts w/ ? Hx have the highest risk for/are at the same risk for CADz compared to those w/ atherosclerosis What is the most widely used test to Dx ischemic heart dz in Pts w/ classic angina Sxs What is the TxOC for HF and what class increases these benefits

Answer 58

DM Nuclear stress test ``` ACEI- dec morbidity and mortality B1 selective BBs: Bisprolol Metoprolol succinate Carvedilol ```

Question 59

What causes BNP to be released and abnormally low How is dyspnea early on in HF quantified HF is a syndrome of ?

Answer 59

Released d/t inc ventricular pressures Low- obesity Amount of activity that precipitates Sxs Ventricular dysfunction

Question 60

Systolic LHF

Answer 60

S3 w/ dilated, thin LV from CADz/MI LVEF <40% Tx: Loop ACEI BB Worse: O2 ACEI Nitro w/ IV diuretic at x2 PO dose, no BB until d/c

Question 61

Diastolic LHF

Answer 61

S4 d/t hypertophied LV Inc >55y/o w/ HTN Normal EF Tx: ACEI and BB/CCB; don't use diuretics/digoxin Exacerbation Tx- NOAL

Question 62

RV HF

Answer 62

D/t P-HTN No rales, JVD or edema Dx w/ cardiac cath

Question 63

High Output HF

Answer 63

Increased metabolic demand exceed CO Hyperthyroid Severe anemia Beriberi/thiamine deficient First- tachy, then systolic failure

Question 64

How is HF Dx What is the most important part of determining prognosis BNP levels over ? amount means CHF is likely

Answer 64

Echo EF: Norm- 55-60; <35 increased mortality >100

Question 65

What are the 4 NYHA HF classifications

Answer 65

1: no activity limitations 2: slight activity limitations; ordinary activity causes Sxs but comfortable at rest 3: marked limitation of activity; less than ordinary activity causes Sxs but comfortable at rest 4: unable to carry out activity, also have Sxs at rest

Question 66

An S3 heart sound on inspiration most likely indicates ? type of HF An S3 heart sound on expiration most likely indicates ? type of HF ? type of HF is associated w/ paroxysmal nocturnal dyspnea

Answer 66

Right sided Left sided Left sided

Question 67

? antiarrhythmic is used to Tx Afib/flutter in Pts w/ HF ? drug affects RAAS, helps limit remodeling and adds to the effects of ACEIs ? is the most effective diuretic in Tx of HF

Answer 67

Digoxin Spironolactone Furosemide

Question 68

? class medication is recommended in all stages of chronic HF ? 4 med classes are important in Tx HF because they all decrease mortality How do they accomplish this benefit?

Answer 68

BBs ACEI/ARB BB Spironolactone Inc sympathetic stimulation and aldosterone production- regulates Na/water in body

Question 69

Only valve w/ two leaflets Classic AS presentation Who gets fed during AS causing Sx

Answer 69

MV Syncope Angina Dyspnea 1- coronary artery 2- carotids 3- L subclavian (arm pain)

Question 70

Pt w/ angina is given Nitro and passes out, ? is underlying issue What type of S2 will be heard What additional heart sound may be heard

Answer 70

AS Split S2 S4

Question 71

? is the MC acquired heart valve stenosis Where can this murmur radiate to How is this best heard and what maneuvers will make this louder/softer

Answer 71

AS d/t calcification Neck, apex Leaning fwd w/ expiration; Inc w/ squat Dec w/ grip, straining

Question 72

AS w/ ? suggests a congenital origin What will be seen on PE if LVH is present What type of abnormal microscopy result can be seen

Answer 72

Ejection sound Apical impulse Helmet cells (schistocytes)- fragmented RBCs from passing through calcified stenotic AV

Question 73

What makes AS louder What makes AS quiet What is the MC cause of AS in younger PTs

Answer 73

Sit, lean fwd w/ exhale (valsalva) Squat Hand grip Stand Early onset calcification of congenital bicuspid valve

Question 74

What is the MC cause of AR What can Pts present w/ as c/c What PE finding suggests AS has caused structural changes

Answer 74

Weak valve tissue from aging, floppy flaps Aware of heart when laying down Down, displaced apex

Question 75

What term describes the pulses of the Pt w/ AR What two findings suggest a large regurg flow is present ? congenital syndrome is associated w/ AR

Answer 75

Water hammer- increased pulse pressure Mid-systolic Austin flint Marfans- MVP and AR

Question 76

What is the best initial test for Pts w/ suspected AR What does AR do to pulse pressures What is the mainstay of Tx of AR

Answer 76

TTE Widens Dec after load until surgical correction

Question 77

What is the difference in severity of mild/severe AR What is the MC cause of MS What is heard on exam

Answer 77

Severe AR- shorter murmur Rheumatic heart dz Apical opening snap (lateral decubitus) +PHTN- palpable RV impulse Loud S1 LAH- Tx w/ ACEI

Question 78

MR is the MC ? murmur What type of murmur is produced What are 4 etiologies of MR

Answer 78

``` 2nd MC (after AS) MCC- MVP ``` Holosystolic at apex w/ dec S1, split S2 radiating to axilla, and apical S3 ``` CADz HTN Infection Rheumatic heart dz MVP ```

Question 79

What are two odd c/c Pts w/ MR may present w/ How is MR different from TR Female w/ MVP have increased issues w/ ?

Answer 79

SOB worse w/ laying/activity Inc nocturnal urination Not louder w/ inspiration Inc pulses- palpitations w/ exercise

Question 80

What maneuvers change the features of MVP What may be seen on EKG How are these Pts Tx

Answer 80

Squat- delays Standing- moves closer to S1 ST depression PVCs Early inferior repolarization QTc prolongation +palpitations: BB Avoid smoke/caffeine Surgical repair- especially w/ impaired LV systolic function

Question 81

Where is TS heard What makes murmur louder What is the MC cause of this defect

Answer 81

Diastolic rumble at LLSB Inspiration Rheumatic valve heart dz

Question 82

How is TS Tx How does TR present What is the MC cause

Answer 82

Percutaneous balloon valvotomy Holosystolic at LLSB that radiates to sternum and inc w/ inspiration RVF/dilation initiated from PHTN/LVF

Question 83

How does TR change the JVD wave How does PS present What is the MC cause

Answer 83

Inc w/ large 'V' waves Systolic murmur at pulmonic area that inc w/ inspiration Congenital malformation in kids

Question 84

What will be heard on PE of PS What type of murmur is heard in PR What causes PR

Answer 84

Widely split S2 w/ dec P2 w/ R sided S4 Diastolic decrescendo at pulmonic area that inc w/ inspiration PV annular dilation/damage/congenital malformation

Question 85

What is this murmur of PR AKA Since PR can be indistinguishable from AR, how is it differentiated How is this murmur Tx

Answer 85

Graham-Steel murmur PR inc w/ inspiration, AR does not Valve replacement

Question 86

? is the MC cardiac arrhythmia and what is it's biggest RF The prevalence of this MC increases d/t ? Why does this conduction irregularity develop

Answer 86

Afib d/t HTN- irregular, irregular w/out P-waves and narrow QRS Age SA node generation is overwhelmed/disorganized MC by pulmonary veins

Question 87

What is the most important lab ordered for Afib work up What two neurological issues can cause Afib What is the best imaging for Dx

Answer 87

TSH to measure thyroxin (inc cellular metabolic rate); Graves present w/ Afib Suabarachnoid hemorrhage CVA TTE- initial (valves, chamber/wall dimension) TEE- most accurate (thrombus)

Question 88

Where/what is the most common site of an embolus to develop during Afib How is Afib Tx and w/ ? goal How is rate control achieved w/ Rxs

Answer 88

LA appendage 1- Unstable: Cversion 2- >48hrs: anticoagulate x 21days 3- Afib + RVR= chemical conversion <110bpm: IV Diltiazem/SAME-olol Low dose digoxin, slower/inadequate rate control

Question 89

What is a s/e of using Sotalol for rate control of Afib What is the drug of choice for Tx Afib in WPW What med is best for rhythm control if there is/no CAD/CHF

Answer 89

Torsades Procainamide- security detail to AV node Flecainide: -CAD/CHF Dronedarone: +CAD, -CHF Amiodarone: +CHF

Question 90

Why are CCBs used for rate control of Afib DHP vs non-DHP CCBs If using Amiodarone/Dronedarone for rhythm control, ? drug can't also be used

Answer 90

Road block between SA/AV node (5 land to 2 lane) Pine tree- outdoor (CCBs w/ -pine, outpatient) Non-pine (non-DHP)- no out-PT; Verapamil; Diltiazem Dabigatran- DOAC for Afib d/t non-valvular d/o

Question 91

When/why would Digoxin be used in the Tx of Afib What alternatives to Warfarin are available and indication for use How does AFlutter appear on EKG

Answer 91

HF and dec LV function; Inc intracellular Ca Dabigatran- DOAC for Afib d/t non-valvular d/o Rivaro/Api-xaban: no antidote and no blood testing Irr/Regular w/ sawtooth P-waves

Question 92

How is AFlutter Tx How is rate control in Aflutter different than Afib If conversion is needed for Aflutter, how much energy is needed

Answer 92

Diltiazem Flecainide Dronedarone>Amiodarone Rate control more difficult 50-100J

Question 93

How is the need for anticoagulation for Afib/Flutter determined What DOACs can be used When/why would Warfarin be used and w/ ? goal

Answer 93

CHA2DS2-VASc: 0- none/ASA 81-325mg 1- ASA 81-325 or anticoag 2 or >- anticoagulate Dabigatran Edoxaban Apixaban Rivaroxaban ``` INR goal: 2.5: Prosthetic valves EGFR <30 Rx: Phenytoin, antiretrovirals MS ```

Question 94

What does the CHA2DS2-VASc stand for ? DOAC has a reversal agent if needed Eliquis dosage needs to be lowered if used w/ ? ABX

Answer 94

``` CHF/LVEF 40% or less HTN Age 75 or >: 2pts DM Stroke/TIA/Emboli: 2pts Vascular dz Age 65-74 Female ``` Dabigatran Clarithromycin

Question 95

# Define Paroxysmal AFib When is this Dx changed to Persistent/Permanent Afib Define Multifocal Atrial Tachycardia

Answer 95

Intermittent attacks that self resolve <7days Persist:>7d Permanent: >12mon MC in COPD Pts w/ irregular, irregular rhythm and varying P-wave morphology

Question 96

Nearly 90% of Afib PTs will present w/ ? AFlutter may develop as a sequelae to ? Aflutter Pts are more likely to present w/ ? c/c

Answer 96

ASx Open heart surgery Fatigue Exercise intolerance

Question 97

What is the main difference between Afib/Flutter Txs ? is the most rapid method to lower INR in PTs on Warfarin Define PSVT

Answer 97

Aflutter cured w/ RFA FPPlasma SVT w/ abrupt start and stop in Pts w/out other structural heart Dz

Question 98

What are the two types of PSVT How are these Dx How are these Tx

Answer 98

AVNRT: tachyarrhythmia developing above Bundle of His WPW: abnormal pathway between atria and ventricles in Bundle of Kent Holter monitor to capture episodes Stable: Vagal, Carotid massage, Valsalva Sxs: Adenosine Regular: BB/CCBs Definitive: RFA

Question 99

What meds are avoided in Tx of WPW What is the Tx oc choice for long term management Why is Adenosine used for PSVT Tx w/ fear

Answer 99

Adenosine, CCBs RFA Transient asystole d/t T1/2 of 6sec

Question 100

What are the 3 types of premature beats What abnormal beat presentation can these have

Answer 100

PVC: wide/bizarre QRS w/out P-wave PAC: abnormal P-wave, common in COPD Pts PJC: narrow QRS w/ no/inverted P-wave Trigeminy Bigeminy

Question 101

Pts w/ heart Dz and frequent PACs will soon develop ? issues What are two etiologies of PVC If Pt has palpitations, they describe them as ?

Answer 101

PSVT Afib/flutter Hypoxemia E+ imbalance In throat

Question 102

How are premature contractions Dx How are these Tx How is V-Tach Tx

Answer 102

EKG, Holter PAC: reassure PVC: BB, ablation PJC: only Tx if >10/min or multifocal w/ lidocaine/antiarrhythmic Stable: Amiodarone, Lidocaine, Procainamide Unstable monomorphic: synchronized cardioversion starting at 100J Unstable polymorphic: Dfib

Question 103

How is VTach defined This is a common complication d/t ? ? antiarrhythmic used for long term can cause hyper/hypo-thyoidism

Answer 103

3 or more consecutive premature ventricular beats Acute MI Dilated cardiomyopathy Amiodarone- similar structure to thyroxine w/ iodine

Question 104

What are the different classes of antiarrhythmic drugs? S/e of using Procainamide How is VFib Tx

Answer 104

1a: Na blocker 1b: fast Na blocker 1c: potent Na blocker 2: BB 3: K blocker 4: Ca blocker Drug induced lupus eruption CPR Defib- non-synch conversion 120 150 180 Epi Amiodarone 6mg, 12mg

Question 105

# Define VFib This MC develops d/t ? myocardial abnormal This rhythm can be caused by abusing ? two drug

Answer 105

Uncoordinated quivering of ventricle w/out useful contractions MI- ischemia increases excitability of myocardium, predisposes heat to Vfib Meth, Cocaine

Question 106

? technique can providers use to Tx VFib if no defibrillator is present Define 1* Heart Block and the Tx if needed Define the two types of 2* Heart Blocks and their Txs

Answer 106

Precordial thump PR >.20 (5 small squares): problem between SA/AV nodes; Tx w/ BBs Mobitz Type 1: Wenckebach- Long, long, drop; no Tx unless unstable- pacing Mobitz Type 2: Dropped QRS, Pwave w/out QRS; Tx w/ pacemaker

Question 107

# Define 3* Heart Block What class of drug is c/i in all heart blocks Only two blocks have constant R-Rs

Answer 107

Constant P-P, R-R interval Erratic PR; Tx w/ pacer after r/o ischemic dz CCBs 1st, 3rd degree

Question 108

? is the MC cause of AV blocks ? is the only complete AV block Why do Pts w/ Mobitz Type 2 need pacers

Answer 108

Idiopathic fibrosis/sclerosis Ischemic heart dz 3rd degree Always pathologic, almost always progress to 3rd degree blocks

Question 109

? type of Dz infection can cause a 3* heart block ? is the MC cause of 3* blocks Define Sick Sinus Syndrome

Answer 109

Lyme Dz Myocardial ischemia Dysfunction of sinus nodes automaticity and impulse generation

Question 110

# Define 4 abnormals seen in Sick Sinus Syndrome What is the MC cause of the underlying sinus node dysfunction Most PTs w/ SSS will need ? Tx

Answer 110

Sinus brady: <60bpm Pause: <3 seconds Arrest: >3 seconds Tachy-Brady: alternates; Tx w/ pacemaker Idiopathic SA fibrosis Pacemaker Use BB/CCB/Digoxin if prepared to transcutaneous pace

Question 111

# Define Acute and Subacute Endocarditis MC cause in native valves infection is ? group MC cause in IVDA MC cause in prosthetic valves

Answer 111

Acute: Staph infects normal valves Sub: Strep V infects abnormal valves HACEK Staph A w/ small vegetations Staph epidermis

Question 112

How does endocarditis of a fungal origin present What is the time frame for presentation What type of fungus will be cultured and how is it Tx

Answer 112

Contaminated line cause slowly grown, large vegetations <2mon post-valve replacement Candidia; Tx w/ Amphotericin B

Question 113

? microbe is the MC cause of infective endocarditis How does this microbe origin present What are the peripheral findings of endocarditis

Answer 113

Strep viridians Late complication of valve replacement w/ small vegetation/emboli ``` Splinter hemorrhages Roth spots Janeway- sign septic emboli Osler node- painful Spelnomegaly Hematuria ```

Question 114

How is endocarditis Dx How is this condition Tx depending on valve type

Answer 114

TEE- gold standard +Blood cultures, 3 sets, 1hr apart Native w/out IVDA: Nafcillin Ampicillin Gentamicin Prosthetic: Vanc Gentamicin Rifampin IVDA: Nafcillin PCN allergy- Vanc

Question 115

What are Pts prophylactically Tx w/ post-endocarditis Four RFs for developing infective endocarditis Pts presenting w/ ? two Sxs signal suspected Dx

Answer 115

2g Amoxicillin PCN allergy-Clinda Prosthetic valve Rheumatic heart dz IVDA Congenital defect Fever- MC Sx New murmur- TR/MR Stroke

Question 116

What are 3 possible adverse outcomes from infective endocarditis Non-IVDA endocarditis MC affects ? valve IVDA MC affects ?

Answer 116

Glomerulonephritis Septic emboli Splinter hemorrhages Mitral Tricuspid

Question 117

5 criteria for Pts to need endocarditis prophylaxis Pericarditis is MC from ? microbe and often leads to ? sequelae complication ? syndrome of pericarditis is seen 3-5d post-MI

Answer 117

Prosthetic valve Prosthetic material repair Hx endocarditis Congential heart dz Coxsackie; Pericardial effusion Dresslers

Question 118

How is pericarditis Dx What PE finding may be seen How is it Tx

Answer 118

EKG w/ diffuse, ST elevation in 1/2, V5/6 Kussmaul sign- increased CVP w/ inspiration; common in constrictive pericarditis NSAID/ASA x 7-14d Sxs >48hrs- CCS

Question 119

What are 3 autoimmune etiologies of pericarditis What 2 inflammatory Dzs can cause this What 2 medications can cause this

Answer 119

SLE RA Scleroderma Sarcoidosis Amyloidosis Hydralazine Procainamide

Question 120

How do Pericardial Effusions present What would be seen on EKGs What would be seen on Echo

Answer 120

Same as pericarditis w/ fluid accumulation around heart Low voltage QRS Alternans Tachy Swinging heart Water bottle sign

Question 121

What are the "3-Ds" of a cardiac tamponade What Triad is this AKA What are two possible complications of an effusion

Answer 121

Muffled sounds Elevated JVD w/ rapid x-descent, attenuated y-descent HOTN Beck's Triad Tamponade Constrictive pericarditis

Question 122

? is a classic finding on PE of cardiac tamponade What would be seen in PTs VS What is the gold standard of Dx

Answer 122

Pulsus paradoxus- SBP dec x 10mmHg w/ inspiration Narrow pulse pressure Echo

Question 123

How is pericardial effusion different from tamponade How is the tamponade Tx ? is the MC cause of non-traumatic tamponade

Answer 123

Effusion doesn't cause RV collapse Urgent- centesis IV fluids to inc preload Met malignancy

Question 124

How do tamponades lead to death ? is one of the most consistent tamponade findings What would make this consistent finding absent

Answer 124

IVC pressure decreases preload Pulsus paradoxus Hypovolume Low press tamponade LV

Question 125

How do AAAs present How do A-Dissections present When is screening indicated

Answer 125

Back pain Pulsatile mass HOTN Tearing pain radiating to back w/ different arm pulses Male >65 w/ +smoking history

Question 126

? is the difference between dissection and AAA in structural involvement What is the initial and gold standard Dx test of choice for AAA What is the CXR finding for aortic dissections and how are they Tx

Answer 126

AAA involves all 3 layers Dissection- one layer, intima US- initial Angiography- gold standard Widened mediastinum; Ascending- surgery Descending- BBs

Question 127

What is the Dx test of choice for aortic dissections How are AAAs managed depending on size

Answer 127

MRI angiography ``` <3cm- no more tests 3-4.4cm: annual 4.5-5cm: q6mom, refer 5-5.4cm: q3mon >5.5 or >0.5cm expansion in 6mon- immediate repair even if ASx ```

Question 128

# Define Venous Insufficiency What is a common PE finding If ulcer present, they are commonly located ?

Answer 128

Impaired venous return causing skin change, edema, pain Stasis Dermatitis Medial malleolus

Question 129

How is Chronic Venous Insufficiency Dx How are they Tx Define Varicose Veins

Answer 129

US, D-dimer Elevation, compression Ulcers- wound care, compression Dilatd superficial veins in lower extremities w/out obvious cause

Question 130

If symptomatic, what do varicose veins present w/ How are these Tx Define Acute Bronchitis

Answer 130

Pain w/ exertion Full/pressure Hyperesthesia ``` Compression Elevation Wound care Sclerotherapy Surgery ``` Cough lasting >5days

Question 131

? Sx is unusual for bronchitis and it's presence should shift Dx to ? 95% of bronchitis is d/t ? etiology If caused by bacteria, ? microbes can cause this

Answer 131

Fever; Pneumonia Viral M Catarrhalis- MC bacterial cause of acute bronchitits H influenzae Strep pneumoniae

Question 132

How is acute bronchitis Dx How are these cases Tx Acute exacerbations of chronic bronchitis d/t bacteria are Tx w/ ?

Answer 132

CXR Tx Sxs, >95% are viral: Cough: Dextromethorphan, Guaifenesin Wheeze/Pulm Dz: albuterol 1st: 2-Gen Cephalosporin 2nd: 2-Gen Macrolide or TMP/SMX

Question 133

When are ABX indicated for the Tx of Acute Bronchitis How does Acute Sinusitis present What is the MC cause

Answer 133

Elderly +CardioPulm Dz and cough x 7-10days ImmComp Sinus pain w/ drainage Sxs worsen 5-7d or do not improve >10days Strep pneumo

Question 134

What is First, Second, and Third Line Tx for Acute Sinusitis What is the gold standard and other form of imaging method if needed ? microbe is the MC cause of chronic sinusitis

Answer 134

1st: Augmentin 2nd: Doxy 3rd: Levaquin CT- gold standard X-ray w/ waters view Staph A

Question 135

Time frame for acute sinusitis When is this converted to chronic sinusitis Time frame for sub-acute sinusitis

Answer 135

<4wks w/ sudden onset >12 consecutive wks 4-12wks

Question 136

What are the indications to use ABX for Tx of Sinusitis What ABX are options for first line Tx Why would second line ABX be needed and what can be used

Answer 136

Sxs >10d w/out improving Fever >102 +purulent d/c Improvement w/ rapid worsening of Sxs Augmentin* Amoxicillin PCN allergy- Doxy, Cefixime or Cefpodoxime w/ or w/out Clindamycin ``` No improvement in 7d; Augmentin 2g BID Levofloxacin Moxifloxacin PCN allergy- Doxy, Levoflox, Moxiflox ```

Question 137

How is Chronic Sinusitis Tx How is sinusitis in Peds Tx Why do Sinusitis Pts lose sense of smell

Answer 137

3wk Tx course of: Augmentin PCN allergy- Clinda Augmentin PCN allergy: Cefpodoxime, Cefdinir Olfactory epithelium destroyed by viral infection/chronic sinusitis

Question 138

? is the MC microbe to cause acute bacterial sinusitis in adults? ? is the MC type of bacterial pneumonia that is MC seen in Pts >40y/o This MC type if common in Pts w/ ? MedHx

Answer 138

Staph A Strep pneumonia- rust colored sputum Splenectomy

Question 139

How does Staph A pneumonia present How is it Tx if MRSA is suspected Pseudomonas causes pneumonia in ? populations

Answer 139

Salmon colored sputum after influenza Vanc ``` ICU ventilator CF w/ Vit A deficiency Bronchiectasis Malignancy COPD ```

Question 140

When/where is mycoplasma pneumonia more commonly seen What two findings indicate this Dx MC microbe to cause pneumonia in drinkers w/ aspiration

Answer 140

Pts <40y/o in dorms Cold agglutinins Bullous myringitis Erythema Multiforme Klebsiella

Question 141

Strep Pneumo, H influenza induced pneumonia usually present w/ ? S/Sxs Atypicals like Mycoplasma, Chlamydia and viruses present w/ ? S/Sxs What two Pt populations are most frequently admitted for CAP

Answer 141

Productive cough Fever, high Tachy/Tachy Non-productive cough w/ fever Elderly COPD

Question 142

How do the 3 typical microbes (Hflu, Morax, Strep Pneumo) that cause pneumonia appear on CXR How do the 3 atypicals (Legion Mycoplasma C-pneumonia) appear on CXR

Answer 142

Lobar pneumonia and sicker Pt Interstitial infiltrates, Pt not as sick

Question 143

? is the MC nosocomial infection ? is the 2nd MC ? is the MC type of pneumonia in older adults and is more common in winter month

Answer 143

UTI d/t foley Pneumonia w/ Strep Pneumo Pneumococcal pneumonia d/t Strep Pneumo

Question 144

What vaccine is used to help reduce CAP What Pts should get this vaccine ? is the biggest lymph node of the body

Answer 144

PCV-13, 1 year later; PPV-23 Annual influenza ``` Age >65y/o Smokers Sickle cell dz DM Indian/Inuit Chronic liver Dz ``` Spleen- largest Ab maker in body

Question 145

How is CAP Tx outpatient w/ no ABX use x 90days How is CAP Tx outpatient if +ABX use x 90days or +comorbidities How is CAP tx in areas w/ macrolide resistance

Answer 145

Macrolide (Azith/Clarith) or, Doxy M/L/G-floxacin or, Macrolide (A/C-mycin) and Augmentin (Beta-lactam) M/L/G-floxacin or, Macrolide (A/C-mycin) and Augmentin (Beta-lactam)

Question 146

How is CAP Tx in ICU How is this Tx regiment changed it Pt has COPD ? is the MC atypical pneumonia and MC pneumonia in younger adults w/ ? outbreak trend

Answer 146

M/L/G-floxacin or Azith and Cefotax/Ceftriax or Ampicillin (antipseudomona w/ beta lactam coverage) Levofloxacin (Levaquin) becomes 1st Mycoplasma in adults <40y/o w/ summer/fall outbreaks

Question 147

How does Mycoplasma Walking Pneumonia present on CXR How is it Tx How does Legionella induced pneumonia present

Answer 147

Patchy infiltrates more extensive than exam 1- Azith/Clarith-romycin 2- Doxy/Augmentin 3- Levofloxacin (Levaquin) HypoNa Diarrhea Fever

Question 148

What is the CURB-65 scale used for How is anaerobic pneumonia Tx

Answer 148

``` Pneumonia ICU admission: Confused Urea >20 RR 30/> BP: <90/60 65 or older Each one= 1pt 0-1: low risk 2pts: mod risk, consider admit 3-5: high risk, ICU admit ``` Augmentin Amox/PCN and Metronidazole

Question 149

? PE finding is a constant finding in Legionnaires pneumonia What are the two distinct clinical presentations of this Dz What does it look like on CXR

Answer 149

Bradycardia 1st- Pontiac fever; viral-like syndrome 2nd- pneumonia Mid/lower lobe w/ patchy infiltrate Inc LDH= pleural effusion

Question 150

How is Legionairres Pneumonia Dx How is this form of pneumonia Tx Define Pneumocystic Carinii Pneumonia

Answer 150

IFA and ELISA Sputum DFA Legionella urine Ag 1- Azithromycin 2- Levofloxacin (Levaquin) 3- Doxy Pneumocystis jiroveci- unicellular fungi in ImmComp Pts (AIDS CD4 <200)

Question 151

How does Pneumocystis jiroveci present How does it appear on CXR How is this type Dx

Answer 151

F/C Dyspnea, low PO2 Dry cough x wks Bilateral, perihilar infiltrates w/ inflamed alveolar cells Bronchial lavage/biopsy

Question 152

How is the degree of lung injury in Pneumocystis Jiroveci measured How is this Tx What s/e may be seen d/t this medication

Answer 152

LDH level TMP/SMX (+ Dapsone) Allergy- Pentamidine Pancreatitis Renal failure Prolong QT

Question 153

Chlamydia pneumonia is associated w/ ? Hx but lacks ? presenting Sx What 3 forms are pathogenic to humans How is it passed along

Answer 153

Birds; Afebrile Pneumoniae Psittaci Trachomatis Inhalation of dried feces

Question 154

How is Chlamydia Psittaci Tx ? are the 3 MC causes of viral pneumonia

Answer 154

1- Doxy 2- Azithromycin Influenza Adenovirus Parainfluenza

Question 155

How is Viral Pneumonia in Peds Dx How is an RSV etiology tested for How will they present

Answer 155

PCR testing for Adenovirus Nasal wash Tachypneic w/ wheeze

Question 156

How is RSV pneumonia Tx What will these Pts be at risk for later in life Pts w/ pneumonia and Tx w/ Macrolides but bounce back now need to be Tx w/?

Answer 156

1- Ribavirin 2- Palivizumab Reactive airway dzs Levofloxacin (Levaquin)

Question 157

Peds w/ CAP are Tx w/ ? How is CAP Tx outpatient w/ no comorbidities, recent ABX use and low resistance rate What is the s/e of using Macrolide or Fluoroquinolone class ABXs

Answer 157

1st- Amoxicillin, <5y/o 2nd- Azithromycin, >5y/o 1- Azith/Erythromycin 2- Clarithromycin/Doxy Prolonged QT interval

Question 158

MC cause of viral pneumonia in adults MC cause of viral pneumonia in kids MC cause of fungal pneumonia in western states

Answer 158

Influenza RSV Valley Fever d/t Coccidioides

Question 159

MC cause of fungal pneumonia from caves/zoos in Ohio/MS river valley ? fungal spore is found in soil and can lead to meningitis MC fungal pneumonia etiology in COPD/TB

Answer 159

Histoplasma capsulatum Cryptococcus Pulmonary aspergillosis

Question 160

? is a major RF for CAP ? microbe is a tag along but exacerbator of H Influenza pneumonia Histoplasma Capsulatum looks like ? on CXR

Answer 160

Recent hospitalization M Catarrhalis Sarcoidosis

Question 161

What are 3 positive PE findings seen in pneumonia Poor dental hygiene can cause pneumonia from ? type of microbes ? beta-lactam ABX is used in the Tx of CAP

Answer 161

Tactile fremitus Egophony: spoken 'ee' heard as 'ay' Dull percussion Anaerobes Ceftriaxone

Question 162

How is Klebsiella Pneumonia Tx Pneumovax can be given to Pts w/ increased risk of pneumococcal dz starting at ? age ? is the TxOC for Peds w/ Chlamydial Pneumonia

Answer 162

3rd Gen: Cefotaxime 23mon Erythromycin/Sulfisoxazole

Question 163

What is seen on CXR of hypersensitivity pneumonitis How is Coccidioides Pneumonia Dx How Coccidioides and Aspergillosis Tx ?

Answer 163

Diffuse nodular densities EIA for IgG/IgM C/A: Flu/Itra-conazole

Question 164

How is Crypto/Histoplasma capsulatum pneumonia Tx When/what is used in AIDS Pts for daily prophylaxis against Jiroveci

Answer 164

Amphotericin B and Flucytosine TMP/SMX; Hx of PJP infection CD4 <200

Question 165

How is Viral Pneumonia differentiated from Mycoplasma Pneumonia How is Viral Pneumonia Dx If Sxs <48hrs, what is used for Tx depending on strain of influenza

Answer 165

Adeno- fast onset w/ GI Sxs x7days Myco- slow, insidious Rapid Influenza Ag RSV nasal swab Neg agglutinin titer A/B: Zan/Oselt-amivir A only: Ama/Riman-tadine

Question 166

? is the MC cause of lower respiratory tract infections in kids worldwide This is the leading cause of ? two Dxs in infants ? is the MC pathogen of Bronchiolitis

Answer 166

RSV, almost all will have it by 3y/o Bronchiolitis Pneumonia RSV

Question 167

How is RSV Dx What is seen on PE What does this look like on CXR How is it Tx

Answer 167

Nasal RSV Ag test Fever Wheezing cough Rhinorrhea Flaring nares Diffuse infiltrates Steroids

Question 168

When does Pt w/ RSV need to be admitted When is prophylaxis indicated What is used for prophylaxis

Answer 168

Feeding difficulty O2 desat Retractions Tachypnea ``` 28wk, 6 day or < and <12mon at start of RSV season <12mon w/ CH/LDz, Congenital airway abnormality ImmComp <24mon w/ CF ``` Palivizumab

Question 169

What organism causes TB How is it transmitted What are the classic findings on PE

Answer 169

Mycobacterium tuberculosis Respiratory droplet Fever Anorexia Weight Loss Night sweat

Question 170

When are TB PPDs read as positive

Answer 170

Induration= raised area ``` >5mm: +CXR ImmComp/HIV Pred equivalent of 15mg/day >1mon Close contacts ``` ``` >10mm: IVDA High prevelance immigrant High risk living Bypass surgery Medical employees ``` >15mm: No RFs

Question 171

How is TB Dx What would be seen on CXR What would be seen on biopsy results

Answer 171

Sputum smear/culture for Acid Fast Bacilli and staining Upper cavitary lesion Apical Ghon complex Caseating granuloma

Question 172

What is the name of TB spread out of the lungs What are two types

Answer 172

Miliary Potts- TB to spine Scrofula- TB to cervical nodes

Question 173

How is TB Tx How long is Tx done per med type

Answer 173

+PPD= CXR Neg CXR= Isoniazid x 9mon w/ B6 (Pyridoxine) to prevent neuropathy or sideblastic anemia ``` Active TB= RIPE w/ baselines prior to Tx: Rifampin Isonizid Pyrazinamide Ethambutol ``` RIPE x 2mon IR x 4mon

Question 174

What are the s/e of RIPE Tx drugs When is a Pt w/ active TB considered for therapy cessation What is used for prophylaxis for PTs living w/ +TB

Answer 174

Rif: orange fluids INH: neuropathy Pyra: gout Emb: optic neuritis, red/green blindness Neg AFB x 2 in a row Isoniazid x 12mon

Question 175

What part of RIPE Tx needs to be adjusted if CrCl is <30mL/min What PT education is given w/ RIPE Tx Which meds can cause hepatotoxicity

Answer 175

E/P to 3x/wk Take meds on empty stomach RIP

Question 176

RIPE Tx can interact w/ ? other Tx method CXR finding of a Ghon complex indicated ? Dx What part of the lung is MC involved w/ these complexes

Answer 176

Raltegravir for HIV, double dose for HIV Tx Primary TB Lower lobes

Question 177

How is L-TB Tx Administration of ? drug can reactivate a latent infection Mycobacterium MC affects ? part of lung

Answer 177

INH x 9mon or, Rifampin x 4mon or, RIF and PZA x 2mon w/ infected contact Exogenous CCS Upper lobes

Question 178

TB is the MC cause of ? endocrine d/o in the world PPDs need to be read w/in ? time frame Why do Pts w/ Rheumatoid Arthritis need TB tests prior to Tx

Answer 178

Addisons Dz 48-72hrs Etanercept: anti-cytokine agent, can reactivate dormant TB

Question 179

+HIV Pt w/ positive PPD is Tx how Define Asthma What PE finding indicates emergency

Answer 179

INH and RFN Chronic, reversible, inflammatory airway dz Lack of wheezing

Question 180

How is Asthma Dx Define FEV Define FVC

Answer 180

Peak expiratory flow rate (Dec FEV1:FVC ratio) Forced Expiratory Volume- measures how much air exhaled w/ forced breath Total amount exhaled during FEV test

Question 181

What are the 4 asthma classifications and Ts

Answer 181

Intermittent: Sx <2x/wk or 2/< wake up/wk Tx: SABA PRN ``` Mild: Sx >2/wk or 3-4 wake up/mon SABA >2d/wk Minor limitations Tx: Low ICS daily ``` ``` Moderate: Daily Sxs >1 waking >wk Daily SABA use Some activity limits Tx 3: Low ICS+LABA daily Tx 4: Med ICS+ LABA daily ``` ``` Severe: Daily Sxs Wake 7x/wk Multiple SABA daily Extremely limited activity Tx 5: High ICS+LABA daily Tx 6: High ICS+LABA+PO CCS ```

Question 182

How is an asthma exacerbation Tx When Tx Asthma, considered SQ allergen immunotherapy for ? Steps Consider consult at ? step

Answer 182

PO CCS Iprtropium bromide Nebulized SABA O2 2-4 Step 3

Question 183

How is exercise induced asthma prophylactically Tx What is the ICS used for Asthma Txs ? PE finding suggests improvement of an asthma attack after Tx

Answer 183

Albuterol- B2 agonist Nedocromil Beclomethasone Cromolyn Inc FEV1

Question 184

What is the MOA of Salmeterol for Asthma Tx COPD is umbrella term for what two Dxs What causes the risk for infection and loss of lung recoil to occur

Answer 184

Relaxation of bronchial smooth muscles Chronic bronchitis Emphysema Dec ciliary/WBC function Frayed elastin fibers

Question 185

How is COPD Dx What is the criteria for chronic bronchitis Dx What are common findings seen in these Pts

Answer 185

PFT: FEV1/FVC 50% Productive cough >3mon x 2yrs Inc Hgb/Hct (polycythemia) P-HTN

Question 186

How is COPD Tx What is the single most important medication fro Tx What vaccines are highly recommended

Answer 186

Mild: SABA (FEV1>80) Mod: LABA (Tiotropium) + ICS (Fluticasone, Salmeterol) Low O2- too much removed respiratory drive PaO2 <55mmHg/ PaCO2>55mmHg SpO2 <88% or 89% w/ CorPulmonale Flu Pneumoccocal

Question 187

? is the inhaler of choice for COPD Pts Define Emphysema Why are Blue Bloaters blue and why are Pink Puffers pink

Answer 187

Ipratropium bromide- anticholinergic blocks constrictive effect of Ach on airway muscles Enlarged air spaces d/t destruction of alveolar septae Blue: Chronic hypoxia Pink: CO2 retention

Question 188

? CXR finding is pathognemonic for Emphysema Pts <40y/o w/ COPD need ? test Hallmark of blue bloater

Answer 188

Parenchymal Bullae (subpleural blebs) Alpha-1 antitrypsin Productive cough

Question 189

3 parts of PFT that are decreased in COPD 2 parts that are increased ? drugs is used in COPD Tx for preventing nocturnal bronchospasms

Answer 189

Max vent volume Tidal volume Vital capacity Total lung capacity Residual volume Theophylline- xanthing drug prevents spasms and prolongs dilation

Question 190

What microbes cause infections in COPD PTs What ABX are used during COPD exacerbation ? are the indications to use these ABX

Answer 190

H influenza Strep Pneumo Moraxella Strep Viridians 1- macrolide 2- Cefuroxime Cefpodoxime, Fefdinir 3- Doxy Inc quantity and purulence

Question 191

COPD Pts >65y/o are predisposed to infections by ? How are these Pts Tx w/ ABX Blue Bloater is common in ? smoking Hx

Answer 191

Pseudomonas 1- Cipro/Levofloxacin 2- Augmentin 3- Doxy >40pk/year

Question 192

Difference in CXR between Blue Bloater and Pink Puffer ? is the most effective Tx for COPD What will ABGs of chronic bronchitis show

Answer 192

Blue: diaphragm not flat Cessation Resp acidosis

Question 193

COPD Gold Categories

Answer 193

A: breathless if hurrying on level ground; less Sxs, 0-1 exacerbation past 12mon w/ no admission Tx: SABA/SAMA B: walks slower than others; more Sxs, 0-1 exacerbation past 12mon w/ no admission Tx: LABA/LAMA w/ SABA C: breathless if hurrying on level ground; less Sxs 2/> exacerbation/year w/ 1 or more admission Tx: LAMA, SABA D: walks slower than others; more Sxs; 2/> exacerbation/year w/ 1 or more admission Tx: LAMA+LABA+SABA

Question 194

# Define Centriacinar Emphysema This form of emphysema is associated w/ ? What part of the lung is affected

Answer 194

Morphological pattern of destruction to bronchioles and central acini Smoking Upper lobe

Question 195

COPD Pts w/ ? other Dx have increased risk for mortality Why do emphysema PTs breathe through pursed lips COPD exacerbation are managed w/ ? 3 meds

Answer 195

Bronchiectasis Inc pressure in airway prevents collapse Systemic steroids ABX Antivirals

Question 196

SABAs for COPD Tx SAMAs for COPD Tx LABAs for COPD Tx LAMAs for COPD Tx

Answer 196

Levabuterol Albuterol Pirbuterol Ipratropium Bromide Salmeterol Olodaterol Formoterol Arformoterol Aclidinum bromide Tiotropiium Bromide Umeclidinium Glycopyronium bromide

Question 197

Interstitial lung Dzs Which one is MC of the interstitial dzs This is MC caused by four etiologies

Answer 197

-Pulmonary alveolar proteinosis -Eosinophilic Pulm -Syndrome Interstitial pneumonia -Diffuse interstitial pneumonia Sarcoidosis Interstitial pneumonia Medication Environment Occupation Infection

Question 198

What is the MC type of interstitial pneumonia What histological pattern is seen What is no pattern is seen by the lab

Answer 198

Pulmonary fibrosis Usual Interstitial Pneumonia IPF

Question 199

3 criteria used to Dx Pts >65y/o w/ IPF/UIP What are the three methods to Dx this condition How are these Pts Tx as long as they don't have IPF

Answer 199

Inspiratory crackles Restrictive PFT CXR findgins Pleural honey combing BAL- esp P Jirovecii Lung biopsy- standard Transbronchial biopsy Pred: 1-2mg/kg/day x 2mon

Question 200

How are PTs w/ IPF Tx What is the only definitive Tx fo IPF How is sarcoidosis Dx and Tx

Answer 200

Nintedanib and Pirfenidone Transplant Biopsy w/ non-caseating granulomas Tx: Pred 1mg/kg/day

Question 201

How is Sarcoidosis Tx if refractory to steroid Tx What is a good/poor prognosis for these PTs

Answer 201

Methotrexate Azathioprine Infliximab Good: only hilar adenopathy Bad: lung parenchyma involvement

Question 202

# Define Pulmonary Alveolar Proteinosis MC presenting c/c CXR findings How is this Tx

Answer 202

Phospholipid accumulation in alveolar spaces Dyspnea Bilateral alveolar infiltrates Whole lung lavage GM-CSF: granulocyte macrophage colony stimulating factor

Question 203

What can cause Eosinophilic Pulm Syndromes What syndrome can be seen here One third of cases are idiopathic d/t ? How is this Tx

Answer 203

Helminth infection Filariae infecition Loffler: helminthe larva infiltrate into pulmonary passage Chronic: female w/ asthma Acute: febrile illness w/ cough/dyspnea Pred

Question 204

What are the 7 types of Occupational Pulmonary Dzs

Answer 204

Pneumoconioses Hypersenstivity Pneumonitis Obstructive airway d/o Toxic lung injury Cancer Pleural Dz Other

Question 205

# Define Pneumoconioses What are the 3 types of Penumoconiose Dzs How are all Tx

Answer 205

Fibrotic lung dz from inhaled inorganic dusts Coal Worker: Silicosis Asbestosis Supportive

Question 206

How does Coal Worker Pneumoconiosis appear on CXR ? RF does not play into this conditions severity Complicated Coal Workers is AKA ? Coal Workers + Rheumatoid Arthritis causes ?

Answer 206

Diffuse opacities in upper lobes Smoking Progressive Massive Fibrosis- contraction of upper lobes, similar to Complicated Silicosis Caplan Syndrome

Question 207

How does Silicosis appear on CXR These PTs are at increased risk for ? future Dx Asbestosis Pts usually don't seek Tx until ? long after exposure

Answer 207

Egg shell calcification throughout lungs Pulmonary TB >15yrs

Question 208

How is Asbestosis best Dx ? tissue finding suggests significant exposure What finding characterizes Hypersensitivity Pneumonitis

Answer 208

CT- detects parenchymal fibrosis Ferruginous body Interstitial infiltrates of lymphocytes and plasma cells w/ noncaseating granulomas

Question 209

What causes Farmers Lung What causes Humidifier Lung What causes Bird Fancier Lung

Answer 209

Moldy Hay Contaminated humidifier/heating systems Bird serum/excretions

Question 210

What causes Bagassosis What causes Sequoisis What causes Maple Bark Stripper Dz

Answer 210

Moldy sugar cane Modly redwood dust Rotting maple tree bark

Question 211

What causes Mushroom Picker Dx What causes Suberosis What causes Detergent Workers Dz

Answer 211

Moldy compost Moldy cork dust Enzyme additives

Question 212

What are the 3 Occupational Obstructive Airway Dzs

Answer 212

Occupational Asthma- Dx w/ bronchial provocation Industrial Bronchitis- exposured coal dust, hemp, cotton, flax Byssinosis- textile worker; Sxs worse on first day back to work; leads to Chronic Bronchitis

Question 213

Example of Toxic Lung Injury What is a later complication experienced and how can this be prevented ? flavoring can cause a Toxic Lung Injury

Answer 213

Silo Filler- inhaled Nitrogen Dioxide Bronchiolitis obliterans; Early CCS Tx Diacetyl- butter flavored popcorn

Question 214

What three toxic inhalations lead to the development of bronchogenic carcinomas ? inhalation causes small-cell carcinomas Pleural Dzs can develop d/t exposure to ? two inhalants

Answer 214

Cigarette, Asbestos, Radon gas Chloromethyl methyl ether Asbestos Talc

Question 215

# Define Berylliosis Systemic Sxs manifest mimicking ? Size requirements for pulmonary nodule or mass

Answer 215

Pulmonary d/o from mining materal for fluorescent lamps Sarcoidosis <3cm- nodule >3cm- mass

Question 216

Pulmonary nodules are AKA ? What are the steps for work up

Answer 216

Coin lesions 1- Incidental CXR 2- CT 3- Suspicious (ill-defined border, lobular, spiculated)- biopsy 4- non-suspicious (calcified, smooth edges) <1cm: f/u 3mon, 6mon and yearly x 2yrs

Question 217

Coin lesion that has not grown in ? time is considered benign What CXR finding is suspicious What diameter is suggestive of benign/malignant

Answer 217

2yrs or more Volume doubling from 21-40 days <1.5cm: benign >5.3cm: Ca Exception: Abscess, Wegener, Hydatid cyst

Question 218

PTs <35y/o, nonsmoking w/ incidental lung nodule finding needs ? next step if no prior CXRs are avail Non-small cell lung Ca has ? four sub-types ? is the MC type seen in non-smoking females

Answer 218

CT scan of chest Adeno- MC lung Ca Squamous- MC in smoker Large- Dx of exclusion, rapid grower Carcinoid Bronchogenic Adenocarcinoma-

Question 219

MC presentation of adenocarcinoma What CXR finding indicates Squamous Cell Ca What CXR finding suggest adenocarcinoma

Answer 219

Pleural effusion w/ inc LDH Central mass w/ hemoptysis Peripheral mass

Question 220

What CXR finding suggests large/carcinoid What is Small Cell Lung Ca so deadly What lab findings signal Small Cell Lung Ca

Answer 220

Throughout lung Almost always in smoker Mets early/at Dx Rarely surgical ``` ADH= SIADH: HypoNa, HyperCa ACTH= Cushing Synd. ```

Question 221

What syndrome can Small Cell Lung Ca cause How are lung Cas Dx Pancoast tumor of lung are most likely ? type

Answer 221

Lambert Eaton Myasthenic Syndrome- muscle weakness d/t ACTH/ADH Bronchoscopy w/ biopsy (central) or, Fine needle transthoracic Squamous Adenocarcinoma

Question 222

Pt presents w/ facial/arm swelling means a Pancoast Tumor is causing ? Pancoast Syndrome is ? trifecta How is Non-Small Cell Ca Tx

Answer 222

Superior Vena Cava Syndrome Shoulder pain Horners Bone destruction (PTH from squamous Ca) Stage 1-2: surgery Stage 3: chemo then surgery Stage 4: palliative

Question 223

How is Small Cell Ca Tx Small Cell Ca is AKA ? How is Carcinoid Syndromes Dx

Answer 223

Non-surgical= Chemo Oat Cell Carcinoma CT scan w/ Octreoscan UA- inc 5-HIAA CXR- pedunculated sessile growth in central bronchi

Question 224

Squamous Cell and Small Cell both start ? ? type of lung Ca starts in the pleura

Answer 224

Centrally (SCs start central; all others start peripheral) Mesothelioma (asbestosis), not a bronchogenic carcinoma

Question 225

# Define Carcinoid Syndrome Why is there a hormonal excess Where are the tumors located

Answer 225

Specific to carcinoids- serotonin increases bronchoconstriction (asthma), peristalsis (diarrhea) and facial flushing* Tryptophan converted into serotonin instead of niacin/proteins Colon Appendix- Peds pts Bronchials Small intestine

Question 226

What lab result indicates Pt has Carcinoid Syndrome What other lab result is elevated and decreased ? nutritional dz may be c/c presentation

Answer 226

5-HIAA- serotonin elevated in urine Inc: chromogranin A, protein of carcinoid Ca Dec: tryptophan Pellagra- niacin deficiency

Question 227

What heart valve lesions may be present during Carcinoid Syndromes How are these Tx What is the MC site for these tumors to mets to

Answer 227

TIPS: Tricuspid insufficiency Pulmonic Stenosis Surgical excision (resistant to Chemo/Rad) Octerotide- somatostatin analogue to decrease serotonin secretion Niacin (Vit B3) Liver to lungs

Question 228

What is the mnemonic for Carcinoid Syndrome and why is this Normal pulmonary BP is ? so P-HTN is then defined as ? What is the MC of P-HTN

Answer 228

FDR: Flushing: inc histamine/bradykinin Diarrhea: pellagra R-sided valves: collagen thickens d/t inc serotonin 15/5; >25mmHg at rest MS

Question 229

How is P-HTN Dx What would be seen on EKG How is this Tx depending on the etiology

Answer 229

Right heart cath- gold standard T-wave inversion V1-V4, 2, 3, aVF 2* LVF: Diuretic Anticoagulant Digoxin Cardiogenic- (pulm artery HTN) Prostanoids, Phosphodiesterase inhibitor, Endothelin antagonist

Question 230

What structural changes does P-HTN cause ? respiratory drug is used for P-HTN Tx O2 saturation of 90% correlates to ? PO2 value

Answer 230

Smooth muscle hypertrophy Initmal fibrosis in Pulm Arteries Bosentan- endothelin antagonist to decrease vascular resistance 60mmHg

Question 231

DVT presents w/ ? PE finding Females older than 35y/o should have ? birth control d/t inc risk How are these Dx

Answer 231

Homan- extend leg, push foot to head, +pain Progestin only D-Dimer Venography w/ Duplex US- gold standard

Question 232

How are DVTs Tx If Pt has recurrent DVTs, how is Tx changed Where are DVTs more commonly developed

Answer 232

LMWH Fondaparinux Lifetime anticoagulation Left iliac- compressed by aortic bifurcation

Question 233

How do PEs present How are these Dx How are they Tx

Answer 233

SOB w/ tachycardia*- MC Sx of PE ``` Spiral CT VQ scan (pregnant) ``` Heparin w/ Xa inhib (Riva/Apixa/Edoxaban) then Dabigatran (DOAC) Renal insuff- Warfarin (INR 2-3) Heme-unstable: thrombolytic

Question 234

? part of the lung is more commonly affected by PEs If PE is a fat emboli from long bone Fx, how does the Pt present How is the probability of a PE calculated

Answer 234

Lower lobes Hypoxemia Neuro abnormals Petechial rash Wells Score: >4- PE likely, image =4- unlikely, D-dimer

Question 235

What do ABGs during PEs show What would be seen on EKG What CXR terms may be seen

Answer 235

Respiratory alkalosis S1Q3T3 Westermark Hampton hump

Question 236

Where does the obstruction in OSA tend to occur What are the RFs for OSA How can this present

Answer 236

Ooropharynx ``` Alcohol Hypothyroidism Sedatives Obesity FamHx Anatomical obstruction ``` ``` Personality change Dec intellect Dec libido Monring HAs Polycythemia ```

Question 237

How is OSA Dx and differentiated from CSA What is an alternative test for Pts w/ high suspicion but no medical comorbidity How is this Tx by severity

Answer 237

Polysomnography w/: >5 apneas w/ comorbidity 15/> regardless of comorbidity Home sleep apnea test Mild-Mod: PO appliance Pos pressure therapy Sev: CPAP Uvulopalatopharyngoplasty Tracheostomy- life threatening OSA

Question 238

During OSA work ups, Cheyne Stokes respiration are commonly seen in PTs w/ ? Dx How is the severity of sleep-disordered breathing measured What are the 3 categories of severity

Answer 238

CHF Apneic + hypopneic episodes/hr Normal AHI <5 Mild: 5-15 Mod: 15-30 Sev: >30

Question 239

When is OSA Tx indicated ? class medication is c/i in these Pts What are the different types of pneumothorax

Answer 239

Sx w/ AHI >5 All AHI >15 Benzos Spot- ruptured bleb Secondary Spot- cough/lung dz Traumatic Tension- leads to shock

Question 240

What will be seen on PE of Pneumothorax How are these Tx How do Pts w/ Sarcoidosis present

Answer 240

Dec sounds Dec tactile fremitus <20% diameter self resolve Needle aspiration Chest tube CXR q24hrs Spiking fever Erythema Nodosum

Question 241

How is Sarcoidosis Dx What lab result will be elevated What would be seen on a PFT How is it Tx

Answer 241

Tissue biopsy- noncaseating granulomas HyperCa ACE higher 4x normal Restrictive pattern PO Pred and ACEI

Question 242

# Define Sarcoidosis What is the hallmark CXR finding What are 3 DDxs for this hallmark finding

Answer 242

Systemic granulomatous dz w/ noncaseating granulomas Mediastinal adenopathy Young female: sarcoidosis Ohio kid/zookeeper w/ fever- Histo Old ceramic worker- beryllosis

Question 243

What is used for assessing Sarcoidosis progression and Tx guides How is this Tx What is the leading cause of death for this population

Answer 243

Serial PFTs CCS ACEI for HTN Methotrexate Pulmonary fibrosis

Question 244

What are the 4 organs MC involved in sarcoidosis in sequence What are the 4 stages of this Dz

Answer 244

Lung Nodes Skin Eye 1- bilat adenopathy 2- bilat adenopathy and reticular opacities 3- reticular opacities 4- opacities w/ volume loss and fibrosis

Question 245

# Define Transudate What is the MC cause What are other possible causes

Answer 245

"Transient" thin water fluid from pulmonary circulation back pressure/dec osmotic pressure CHF Cirrhosis w/ ascites Hypoalbumin- nephrotic syndrome

Question 246

# Define Exudate What is the MC cause What are other possible causes

Answer 246

Thicker fluid from tissue infection, damage, inflammation allowing blood protein/water to escape Pneumonia Ca PE TB Pancreatitis

Question 247

What criteria is used for pleural effusions as an exudate

Answer 247

``` Lights Criteria: one of three= (Inc Protein, Inc LDH) 1- pleural protein:serum protein >0.5 2- pleural LDH:serum LDH >0.6 3- pleural LDH >2/3 upper limit of lab's normal serum LDH ```

Question 248

Isolated L-sided pleural effusion is most likely a ? Isolated R-sided pleural effusion is most likely as ? How are these Tx

Answer 248

Exudate Transudate Thoracentesis Chronic/recurrent: pleurodesis or indwelling cath

Question 249

# Define Empyema Usually these are Tx how Define Decortication

Answer 249

infected pleural effusion Chest tube Thoracotomy and removal of infected fibrous rings from around lung

Question 250

# Define ARDS What is the MC cause Usually ? other organs will fail too How is this Tx

Answer 250

Respiratory failure d/t Inflammation of lungs and fluid accumulation in alveoli decrease O2 sats 1-Sepsis (2- trauma, 3- aspiration/near-drown) Kidney Liver Intubate for mechanical PEEP, PaO2 >60/SaO2 >90

Question 251

What physiological process causes ARDS This process allows for ? to develop How is this Dx

Answer 251

Inc alveolar-capillary membrane permeability Non-cardiogenic pulmonary edema (protein rich) CXR w/ air bronchograms and bilateral fluffy infiltrates

Question 252

# Define Delirium This is common in hospitalized PTs d/t ? What is the 4 criteria needed for Dx

Answer 252

Acute onset of temporary AMS Drugs Infection Dehydration Dec consciousness Cognitive change Rapid onset Evidence physical condition

Question 253

Testing to Dx Delirium includes ? How is this Tx ? are the MC type of hallucinations experienced by these Pts

Answer 253

CT/MRI Tx cause Supportive care Sedation Visual

Question 254

? antipsychotic is used for delirium Tx What is the MC cause of delirium What is the saying for anticholinergic ODs

Answer 254

Haloperidol ETOH abuse ``` Hot as Hades Mad as a hatter Dry as a bone Red as a beet Blind as a bat ```

Question 255

How do Cluster HAs present What will Pt look like How are these Tx

Answer 255

Unilateral eye pain w/ lacrimation and nasal congestion x 15-180min Same time, every day attack causing pacing/rubbing head O2 12-15L via non-rebreather Sumatriptan

Question 256

What is used of Cluster HA prophylaxis How do Migraine HAs present How is this Tx in order

Answer 256

Lithium Divalproex Verapamil Topiramate Unilateral throb/pulsating HA w/ photo/phono-phobia and N/V ``` NSAID 5-HT1 agonist (Triptan- constrict dilated vessels) Atenolol Ergotamine Reglan + Benadryl ```

Question 257

When are migraine Tx c/i How are these Dx When is neuroimaging indicated

Answer 257

Cardiac dz Cerebrovasc dz PVDz PIN: Photophobia Impairment, job/life Nausea New onset >50y/o Changed pattern Atypical/unremitting Prolonged/bizarre aura

Question 258

When is migraine prophylaxis indicated What is used for prophylaxis

Answer 258

4/> HA/mon 8/> HA days/mon 1st line: Divalproex Topiramate PMT-olol 2nd: Amytriptyline Venlafaxine A/N-olol 3rd: Botox CHRP monoclonal Abs

Question 259

? is the MC form of aura w/ migraines Define Migraine Equivalent When are these Dx as Chronic Migraines

Answer 259

Ophthalmic Migraine aura w/out HA >15d/mon x 3mon

Question 260

How do Tension HAs present How are they Tx What are two categories of these HAs

Answer 260

Bilateral front/occipital HA in 'band-like' pattern 1st: NSAID 2nd: ASA/caffeine Ergotamine Episodic: <15d/mon Chronic: 15/>d/mon

Question 261

What is used for Tension HA prophylaxis Medication overuse HAs must be avoided by limiting abortive agent use to ? How does an esophageal stricture tend to present

Answer 261

TCA: amytriptyline CBTherapy No more than 2d/wk Dysphagia to solids w/ gradual progression

Question 262

MCC of esophogeal strictures is d/t ? Define Esophageal Web Define Schatzki Ring

Answer 262

Benign peptic strictures from GERD Thin mucosal membrane growing across lumen Eosphageal ring at B-junction, MC from hiatal hernia

Question 263

# Define Plummer-Vinson Syndrome Define Steakhouse Syndrome How are esophageal strictures Dx

Answer 263

Dysphagia Iron deficient anemia Cheilosis Esophageal webs Progressive dysphagia to solids, worse after heavy meal that was wolfed down Initial- barium swallow Dx- Upper Endoscopy

Question 264

How are esophageal strictures Tx ? esophageal stricture is PROXIMAL/MID and not distal What are the 3 types of hernias

Answer 264

Endoscopy w/ dilation H2 antagonist PPI Infectious esophagitis Diaphragmatic Ventral Umbilical- refer >2y/o

Question 265

How are hernias Dx Define Direct Hernia Define Indirect Hernia

Answer 265

US/Clinical Intestine goes through external ring at Hesselbach Triangle, rarely into scrotum; felt on side of finger MC; intestine goes through inguinal ring into canal; felt on tip of finger; congenital/<1y/o Pt ("i" indirect through "i" of inguinal)

Question 266

? type of hernia have high incidence of strangulation What are the 5 types of non-infectious esophagitis What is the hallmark Sx of infectious esophigitis

Answer 266

Femoral d/t femoral ring rigidity ``` Medication Eosinophilic Radiation Corrosive Reflux ``` Odynophagia- pain w/ swallowing liquid or solid

Question 267

How does Fungal Esophagitis present How does HSV Esophagitis present How does CMV esophagitis present How does Eosinophilic Esophagitis present

Answer 267

Linear white/yellow plaques; Tx Fluconazole Mulitiple punched out lesions on EGD; Tx Acyclovir Solitary ulcer/erosion on EGD; Tx Ganciclovir MedHx of asthma and multiple corrugated rings on swallow; Tx inhaled steroid

Question 268

How is Esophagitis Dx How is Corrosive Esophagitis Tx How is Bisphosphonate induced esophagitis Tx

Answer 268

Endoscopy w/ biopsy and culture CCS Take w/ 4oz of water, avoid laying down x60min

Question 269

? is the MCC of esophagitis Esophagitis induced from chemo/rad is expected after ? much radiation What are these PTs at risk for developing

Answer 269

GERD 5000cGy Strictures

Question 270

What are the two main types of esophageal Ca How are these Cas Tx How do these usually present

Answer 270

SCC, MC world- d/t smoking and ETOH Adeno, MC in US- d/t Barrett's esophagus Resection-no mets Rad/Chemo w/ 5-FU Dysphagia to solids progressing to liquids w/ adenopathy

Question 271

Adenocardinoma of the esophagus is usually found in ? area and d/t ? progression How are esophageal Ca Dx and staged Barretts Esophagitis need endoscopic screenings ? often

Answer 271

Distal esophagus: GERD to Barretts Dx: upper endoscopy Stage: CT q3-5yrs

Question 272

How is GERD Dx What is an upper GI study used for ? presenting GERD c/c is often overlooked

Answer 272

pH probe: Gold Standard Endoscoyp w/ cytologic washing Anatomy, not reflux Chronic cough

Question 273

How is GERD Tx What are 5 meds that can cause LES relaxation What is an uncommon Sx seen in GERD

Answer 273

H2 antagonist BID Persistent Sxs- switch to PPI (most effective) Once Sxs stop, continue x 8wks ``` CCBx Diazepam Theophylline Meperidine Morphine ``` Odynophagia

Question 274

Two common presenting Sxs of gastritis What are the two types of gastritis

Answer 274

Dyspepsia Abdominal pain Acute: rapid developed lesion in gastric antrum Chronic: Type A- slow lesions in fundus d/t Ab w/ risk for adenocarcinoma Type B- ASx slow lesions in antrum from NSAID/Pylori w/ PUD risk

Question 275

How is gastritis Dx How is this Tx What are four s/e of medical therapy

Answer 275

Endoscopy w/ four biopsies H2RA: Famotidine, Cimetidine, Omeprazole- D/c when ASx x 8wks ``` PPI causes: Hypochloride Dec Ca (hip Fxs) Dec serum B12 Dec Mg ```

Question 276

Gastritits Tx can make Pts at increased risk for ? What two infections can cause gastritis ? is the MCC

Answer 276

Pneumonia C Diff HSV CMV H Pylori

Question 277

Microscopic shape of H Pylori What are the two types of ulcers seen in PUDz How can the location be hinted at on PE

Answer 277

Gram-neg spiral bacillus Duodenal Gastric Food decreases pain of duodenal ulcer

Question 278

What type of PUD ulcer is more common Both types of ulcers are MC caused by ? What anatomic plane are these usually found on

Answer 278

Duodenal > Gastric H Pylori Anterior duodenum

Question 279

Rarely, duodenal ulcers can be caused by ? syndrome PUD is the MC cause of ? How does this MC usually present

Answer 279

Zollinger-Ellison: gastrinoma tumor of pancreas causing excess gastrin to be produced; Dx w/ serum gastrin >200pg Non-hemorrhagic GI bleeds Melena

Question 280

How is PUDz Dx How is PUD Tx w/ Triple Therapy What is the next step if H Pylori was suspected

Answer 280

Upper endoscopy w/ biopsy ``` PPI +H Pylori= Omeprazole Amoxicillin Metronidazole/Clarithromycin Quad therapy: add Bismuth ``` Eradication confirmation in 4wks

Question 281

How are NSAID induced PUD Tx How is Zollinger Ellison Tx When is PPI Tx used w/ caution

Answer 281

D/c NSAID PPI x 8wks minimum PPI Tumor resection Hepatic impairment

Question 282

4 RFs for gastric Ca How are these Dx How are they Tx

Answer 282

FamHx Ulcers H Pylori Pernicous anemia Guiac CBC- micro/hypo EGD w/ biopsy Gastrectomy

Question 283

What are the MC Sxs of gastric Ca ? is the most important RF What are two metastatic signs

Answer 283

Early: pain, indigestion MC: Weight loss H Pylori Virchow node- L-supraclavicular Mary Joseph- umbilical

Question 284

What EGD finding indicates a gastric Ca Dx What does the mnemonic WEAPON stand for

Answer 284

Linitis Plastic- thickening of stomach wall ``` Weight loss Emesis Anorexia Pain Obstruction Nausea ```

Question 285

Virchows node is associated w/ L-supraclavicular, what is associated w/ the R side What causes Celiac Dz What does this Dz cause to occur

Answer 285

Hodgkin's lymphoma: right nodule drains mediastinum, a common origin site Autosomal recessive inheritance of an immunologic response to gluten Injury to proximal intestine mucosa

Question 286

? is a dermatological manifestation of Celiac Dz How is this Dx How is a Dx confirmed after a positive Dx test

Answer 286

Derm. herpetiformis- European male w/ painful, pruritic bilateral extensor lesions Dx: punch biopsy Tx: Dapsone, diet IgA endomysial Ab- inc spec, lower sense IgA transglutaminase AB- + in most Pts on gluten free diet Endoscopic intestinal biopsy

Question 287

Why are Pts sensitive to gluten in Celiac Dz What causes lactose intolerance How is this Dx

Answer 287

Sensitivity to gliadins- alcohol-water soluble fraction of gluten No lactase enzyme: digests lactose into glucose/galactose Hydrogen breath test >20ppm <90min Stool acidity- E Coli/Rotavirus

Question 288

What is the difference in appearance of Crohns and UC What is the difference in areas involved

Answer 288

Crohns- transmural cobblestone, skip lesions UC- limited to sub/mucosa crypt abscess Crohns- spares rectum, +abdominal pain

Question 289

? radiographic findings are pathognemonic fo Crohns and UC ? one is protected by smoking ? Ab test is used for UC

Answer 289

Crohns: Terminal ileum string sign UC: lead pipe d/t loss of haustra UC p-ANCA

Question 290

What upper GI Sx can indicate Crohns What is the MC site What Ab test is used

Answer 290

Aphthous ulcer Terminal ileum ASCA

Question 291

How is UC and Crohns Tx w/ 5-ASAs What Rx is used if there is no response What is the next step if there is still no response

Answer 291

Sulfasalazine w/ supplemental folate Mesalamine Metronidazole Azathioprine 6-Mercaptopurine

Question 292

Which IBDz can be cured w/ surgery What medical therapy needs to be avoided in these PTs What are 3 extraintestinal manifestations of IBDz

Answer 292

UC Anti-diarrheals- induces ileus Uveitis Erythema nodosum Arthritis

Question 293

How is IBS standardized by Sx-based criteria What are labs not needed for Dx What med is used for Tx as an anti-spasmodic

Answer 293

``` Rome criteria: Pain 3d/mon x 3mon w/ two of: Improved w/ BM Changed frequency Changed consistency ``` Routine studies are normal in IBS Hyoscycamine- anticholinergic

Question 294

IBS is a ? d/o ? infection leads to increased prevalence of IBS ? is the MC vessel blocked leading to intestinal ischemia

Answer 294

Functional, not organic Giardia lamblia Superior mesenteric artery

Question 295

Mesenteric ischemia presents as pain after ? and relieved by ? What will be seen on x-ray How is this Dx How is it Tx

Answer 295

<30min after eating; Relief w/ laying/squat Thumb-printing of small bowel Mesenteric angiography- gold standard Colonoscopy Revascularization

Question 296

What meds can help prevent future poly growth after polypectomy Colonic polys are the MC cause of ? in Peds Where are adenomatous polyps commonly found

Answer 296

ASA Cox-2 inhibitors Painless rectal bleeding Distal colon/rectum

Question 297

Polyps located ? are more likely to be malignant What type of polyp has a 30-70% chance of malignant transformation How are these Dx

Answer 297

Proximal colon Villous adenoma Colonoscopy for Dx and therapeutic q/ f/u q3-5yrs

Question 298

# Define Familial Adenomatous Polyposis What screening is needed for first degree relatives When is a sigmoidoscope recommended

Answer 298

>100 polyps by 15y/o and Ca by 40y/o Genetic screen at 10y/o 12y/o

Question 299

What two RFs trigger the start to colon Ca screenings What types of screening are recommended for Pts that have no Sxs/RFs Under routine circumstances, when should Pts start and stop getting screening colonoscopies

Answer 299

Adenomatous polyp or 1st* relative w/ Dx- start at 40y/o or 10yrs younger than age of Dx >50: Colon- q10yrs Flex sig, contrast enema, tumor cells- q5yrs 45y/o - 75y/o

Question 300

Colon Ca is the ? leading cause of death How is colon Ca Dx How are these Tx

Answer 300

3rd Lung, skin, colon Colonoscopy w/ biopsy Enema= apple core lesion Resection Chemo w/ 5-FU

Question 301

What lab result is monitored in colon Ca Pts during Tx Where is Diverticulitis MC found How is this Dx

Answer 301

CEA- carcinoembryonic antigen Descending colon Western society- sigmoid CT w/out contrast- fat stranding w/ wall thickening NO colonoscopy

Question 302

Diverticulitis is the MC cause of ? How is diverticulitis Tx What 3 PE findings is suggestive of positive Diverticuosis Dx

Answer 302

Painless, massive lower GI bleeds Cipro or, Augmentin + Metronidazole No vomit Inc CRP >5mg LLQ pain

Question 303

? is NOT a complication of Diverticulosis ? two microbes cause the inflammatory process of diverticulitis ? criteria is used to define constipation

Answer 303

Colon Ca E Coli Bacteroides fragilis Rome 3

Question 304

Pts >50y/o w/ constipation need ? r/o How much fiber is recommended during Tx

Answer 304

Ca 20-25g/day

Question 305

What are the bulking laxatives What are the osmotic laxatives What are the softener suppositories

Answer 305

Psyllium seed Methycellulose Ca polycarbophil Wheat dextrin Polyethylene glycol Glycerin Bisacodyl

Question 306

Constipation lasting longer than ? long needs further work up ? anti-HTN med class doesn't cause constipation ? is the MC organic cause of constipation in Peds

Answer 306

>14days BBs Hirschprung dz

Question 307

# Define Hep A Where does this cause outbreaks How is it Dx

Answer 307

RNA virus transmitted via fecal-oral Military Enclosed environment Daycare Early: anti-HAV IgM Late: anti-HAV IgG, remains elevated for life

Question 308

How is Hep A Tx When are vaccines given Define Hep B

Answer 308

IgG globulin no more than 14d after exposure <24mon, just as effective as immune globulin injections DNA virus 'Dane" particle via blood, IVDA, intercourse

Question 309

When can pregnant females get Hep B vaccine ? is the first sign of infection What is the 2nd sign What is the 3rd sign

Answer 309

27-36wks HBsAg- subway, serological hallmark of HBV infection HBeAg- egg= replication and infectious HBcAg- intracellular Ag in liver cell

Question 310

? lab result means Dx of acute Hep B ? lab result means decreased viral replication ? lab result appears after clearance of the HBsAg or indicates vaccination

Answer 310

anti-HBc (Ab IgM) anti-HBe (Ab IgM) anti-HBs (Ab IgM) anti-HBs

Question 311

How does Chronic Hep B develop ? test is used to differentiate from passive and active Hep B immunity What lab result will indicate health care worker is Hep B immunized

Answer 311

HBsAg is always positive, 'e' can occasionally develop >6mon after infection Core Abs IVDA: +cAbs Healthcare: -cAbs anti-HBs (we never exposed to the core)

Question 312

How is Hep B Tx Define Hep C Incubation period and these Pts are at risk for ?

Answer 312

Hep B DNA vaccine Single strand RNA in post-transfusion/transplant/IVDA Pts 2wks-6mon; Hepatocellular Ca

Question 313

How is Hep C Dx How is Hep C Tx Define Hep D How is D transmitted

Answer 313

anti-HCV Abs in serum Interferon, controls chronic Hep C RNA virus requiring HBsAg for infection Clotting factors Drug users

Question 314

? infection causes 50% of fulminate hepatitis infections This infection puts Pts at increased risk for ?

Answer 314

Hep D Inc severity of Hep B attacks Chronic hepatitis Cirrhosis

Question 315

# Define Hep E How is this transmitted Pt wants to be tested to see if they have Hep A, ? lab is ordered

Answer 315

Similar to Hep A d/t trasmission and prevalence in young adults Fecal-oral Anti-HAV IgM

Question 316

What Hep B lab result would a PA-C and IVDA have in common What lab test says Pt is actively infectious What lab result would be positive in chronic Hep B Pt

Answer 316

Anti-HBs HBeAg HBsAg

Question 317

Hep D needs / part of Hep B to exist What is the first evidence of infection w/ Hep B What is the lab result needed for Dx of Hep B What lab result indicated Hep B virus replication and infection

Answer 317

HBsAg Anti-HBs Anti-HBc HBeAg

Question 318

What Hx does Hep A present w/ What are two PE findings How long are they contagious

Answer 318

Travel to Asia Hepatomegaly and jaundice 1wk of jaundice

Question 319

How are Hep A Pts Dx What Pt education goes w/ Dx What do family members get for Tx

Answer 319

IgM anti-HAV Immune for life IV-IGg

Question 320

How does Hep B present to clinic What lab result means Pt is immune ? lab result means Pt is positive for infection

Answer 320

Flu-like w/ jaundice anti-HBs HBsAg

Question 321

? lab result mean acute Hep B ? lab result means chronic Hep B Hep E outbreaks is associated w/ ? How is it Dx

Answer 321

Anti-HBc IgM Anti-HBc IgG Waterborne outbreaks IgM anti-HEV

Question 322

When are Hep C screenings recommended What anti-virals are used for tx How is Chronic Hep E Tx

Answer 322

18-79y/o Sofosbu-vir Velpatas Daclatas Glecapre Ribavirin

Question 323

# Define Cirrhosis What PE findings may present late in the Dz process What skin changes can be seen

Answer 323

Hepatic fibrosis d/t regenerative nodules surrounded by fibrotic tissue preventing regeneration Terrys nail- white bed Ascites Gynecomastia Palmar erythema Caput medusae Spider angioma

Question 324

How is Cirrhosis Dx Once Dx, all PTs need ? f/u imaging What abnormal lab results will be seen

Answer 324

Gold Standard: biopsy EGD ``` AST > ALT Anemia Dec platelets Inc unconjugated bili Inc PTT ```

Question 325

What scoring system is used for Cirrhosis Mortality What meds are sued for prophylaxis against variceal hemorrhage What is used if encephalopathy is present and what is avoided

Answer 325

Child-Pugh: Class A: 5-6pts Class B: 7-9pts Class C: 10-15pts Non-selective BBs: Nadolol Propranolol Lactulose+Neomycin; Sedatives

Question 326

What is used in cirrhosis if pruritis is present Cirrhosis Pts w/ sudden onset fever and abdominal pain need ? Dx r/o Why can cirrhosis Pts present w/ foul breath

Answer 326

Cholestyramine Bacterial peritonitis Fetor Hepaticus- musty breath d/t sulfur in blood passing into lungs

Question 327

What are 3 features of decompensated liver cirrhosis Define Palm Tree Sign ? tumor marker is used for liver Ca

Answer 327

Jaundice Encephalopathy Ascites Caput Medusae: enlarged superficial epigastric veins in umbilicus alpha-Fetoprotein

Question 328

Hepatocellular carcinoma occurs in the setting of ? two Dxs How are these worked up if <1cm Inc alpha-fetoprotein in ? two populations should raise concern

Answer 328

Chronic liver dz Cirrhosis MRI Neg= US q3mon Cirrhosis Hep B

Question 329

How are liver Cas Tx What Tx option is not attempted d/t ineffectiveness What are the 5 F's of Cholelithiasis

Answer 329

Transplant if tumor is <5cm or, | 3/< tumors, all 3/

Question 330

# Define Cholelithiasis What is the best test to Dx Cholelithiasis What is the cardinal Sxs

Answer 330

Stones in gallbladder w/out inflammation RUQ US, best after NPO x 8hrs to fill/distend gallbladder Biliary colic d/t temporary obstruction

Question 331

# Define Boas Sign What are the 3 potential complications that can arise from this condition

Answer 331

Right subscapular pain d/t biliary colic Cholecystitis- cystic duct obstruction Choledocholithiasis- gallstones in biliary tree Cholangitis- biliary tract infection d/t obstructed stones

Question 332

How is Choledocholithiasis Tx How is Cholangitis Dx What lab result will be elevated if bile flow is obstructed, specific to the biliary tree, and what Dx is then likely What lab result is used to confirm this lab elevation

Answer 332

ERCP stone extraction ERCP Alkaline phosphatase (ALK-P)- cholestasis GGT

Question 333

The liver's ability to synthesize clotting factors is reflected by ? lab result What clotting factors does it make How is Cholelithiasis Tx

Answer 333

Prothrombin time 1 2 5 8 9 10 12 13 Cholecystectomy

Question 334

? ABX is a major cause of biliary sludge This ABX can cause ? type of stones to be formed Define Cholecystitis

Answer 334

Ceftriaxone- binds Ca in bile w/in gallbladder Frank stones Inflamed gallbladder d/t obstruction of biliary duct

Question 335

What is the most specific test to Dx cholecystitis What PE finding helps w/ Dx How is this Dx

Answer 335

HIDA Scan Murphy's Sign RUQ US then, HIDA

Question 336

How is cholecystitis Tx Define Cholangitis What is the MC microbe involved

Answer 336

Lap Cholecystectomy Infected obstruction in bile duct E Coli

Question 337

# Define Charcots Triad Define Reynold's Pentad How is Cholangitis Dx

Answer 337

RUQ pain Jaundice Fever HOTN Confusion RUQ US then, ERCP for Dx and Tx

Question 338

? is the top 3 MCC of acute cholangitis What are the 3 products secreted by the pancreas What is the MCC of acute and chronic pancreatitis

Answer 338

Choledocholithiasis ERCP Tumor Amylase Insulin Glucagon Acute: gallstone Chronic- ETOH

Question 339

How is pancreatitis Dx How is this Tx ? RF increases the risk for pancreatic Ca

Answer 339

Abdominal CT Analgesia Bowel rest IV fluids Smoking

Question 340

What tumor marker is used to track pancreatic Ca How does pancreatitis present What is the mnemonic for causes of pancreatitis

Answer 340

CA 19-9 Steatorrhea Pain radiating to back, better w/ leaning fwd ``` GET SMASHED: Gallstone Ethanol Trauma Steroid Mumps Autoimmune Scorpion HyperCa HyperLipid ERCP Drugs ```

Question 341

What criteria is used to predict the severity of pancreatitis What are the indications at admission What are the indications at 48hrs

Answer 341

Ranson's criteria ``` Glucose >200 Age >55y/o Leukocyte >16K LDH >350 AST >250 ``` ``` Arterial PAO2 <60 BiCarb <20 Ca <8 BUN inc x 1.8 Hct dec x 10% Sequestered >6L ```

Question 342

What is the triad of chronic pancreatitis What extra finding may be seen on imaging ? lab result is sens and spec for Dx

Answer 342

Pancreatic calcification Steatorrhea DM Pseudocyst- Pt will have palpable mass and jaundice Lipase > 3x normal

Question 343

How is Pancreatitis Dx What would be seen on x-ray How is Chronic Pancreatitis Dx

Answer 343

Abdominal CT w/ contrast Sentinal loops CT MRI w/ MRCP

Question 344

How is pancreatitis Tx What is the best part of Tx When are hemorrhoids more prevalent

Answer 344

NPO IV analgesia, fluid bowel rest Fluids Pregnancy Post-child birth

Question 345

How are hemorrhoids Tx What are the 3 types

Answer 345

Stool softener CCS sitz bath Internal- rubber band ligation External: distal to dentate Internal: prox to dentate Mixed; prox and distal

Question 346

What are the 4 degrees of hemorrhoids Pts w/ anal fistulas need ? other Dx considered What is an uncommon PE finding in anorectal abscesses

Answer 346

1: no prolapse 2: prolapse, spot reduction 3: prolapse, need manual reduction 4: irreducible, risk for strangulation Crohns Fevers- more likely in deep abscesses

Question 347

# Define Anorectal Fistula When/why is imaging needed for abscesses How is anal fistula Dx

Answer 347

Tract between two areas d/t deep anorectal abscess CT if recurrent Anoscopy

Question 348

How are anorectal abscess/fistulas Tx Vit B3 deficiency is AKA ? What would be seen on PE

Answer 348

InD Softener w/ inc fiber Fistula- surgery Niacin- Pellagra; 4 D's: dermatitis diarrhea dementia death Bright red tongue

Question 349

What populations are at risk for Vit B3/niacin deficiency What Rx can cause Niacin/Vit B3 deficiency What is VitB1 deficiency

Answer 349

ETOH Mal-absorption syndrome INH therapy BerBeri- burning feet syndrome

Question 350

What is the MCC of VitB1 deficiency What issue can present in these populations What is VitB2 deficiency and what does it present w/

Answer 350

Alcoholics Wernickes encephalopathy- abnormal eye movement, abnormal stance/gait, AMS Riboflavin- cheilosis, angular stomatitis, magenta tongue

Question 351

What is VitB6 deficiency What does this deficiency present w/ How is this Tx

Answer 351

Pyidoxine- Seb Derm-like eruption Atrophic glossitis w/ ulcers Conjunctivitis Neuorpathy INH OD Tx

Question 352

What is the first sign of Vit A deficiency Who does this present in How does Vit C deficiency present

Answer 352

Night blindness CF Mal-absorption Spruce/pancreatic d/o Scuvy- easily bleeds/bruises, hair/tooth loss, joint pain/swelling

Question 353

Prolonged Vit D deficiency leads to What other chronic Dz can lead to this deficiency Where is Vit K synthesized and what does it control

Answer 353

Rickets End stage renal dz- can't activate Vit D to absorb Ca in intestine Liver; any Dz impacting liver- dec K PT and PTT

Question 354

What population is at inc risk for Vit K deficiency Define Phenylketonuria This is the MC ? and w/out Tx ? develops

Answer 354

Exclusively breast fed infants Genetic d/o preventing normal use of protein Inborn error or protein metabolism; Brain development

Question 355

First vaccine given to infant Second shot given is ? What is the 3rd test

Answer 355

Hep B Vit K PKU

Question 356

# Define Kwashiorkor Deficiency Define Marasmus Folate deficiency can cause ?

Answer 356

Inadequate intake of protein leading to edema Inadequate intake of ALL energy forms Neural tube defect

Question 357

Vit B12 deficiency can lead to ? ? is the MC type of kidney stone and what prevention can dec incidence If the stone is infected, most likely a ? stone infected by ?

Answer 357

Cobalamin- degeneration of spinal cord Calcium oxylate- grapefruit juice Struvite- Proteus Klebsiella Pseudomonas Staph

Question 358

Kidney stones larger than ? will probably need surgical help What is the MC location for these to get lodged Best method to Dx is ?

Answer 358

>5mm- need lithotripsy UVJ Abdominal/pelvic CT w/out contrast

Question 359

How are kidney stones Tx What are the 4 types of kidney stone and what are they associated w/ All of these are radiopaque except for ? type

Answer 359

1st: toradol 2nd morphine 3rd: opiate 4: Tamsulosin/CCB Ca Oxalate- MC Struvite- chronic UTI w/ Klebsiella/Proteus Uric Acid- acidic urine d/t meat/alcohol/gout Cystine- genetic Cystine- lucent

Question 360

When do kidney stones need to be admitted What Tx method is best for stones >5mm but <2cm What Tx method is best if the above method fails and is best for stones >2cm

Answer 360

Uncontrolled pain Anuria Renal colic and UTI/fever Lithotripsy Percutaneous nephrolithotomy

Question 361

? is the primary intervention of choice for struvite kidney stones ? is the MC and 2nd MC microbe to cause cystitis How is this Tx w/ 1st, 2nd line meds and during pregnancy

Answer 361

Percutaneous nephrolithotomy 1st- E Coli 2nd- Enterococcus/Saprophytics (sexually active female) 1st: TMP/SMX 2nd: Cipro Pregnant- Nitrofurantoin/Cephalexin Pain- Phenazopyridine Complicated- Cipro

Question 362

# Define Cystitis How can this present in Peds ? is the MC cause of recurrent cystitis in men

Answer 362

Infection of bladder causing dysuria w/out d/c New onset incontinence in previously toilet trained Pt Chronic bacterial prostatits

Question 363

How is cystitis Dx What lab results indicated Dx When/why would imaging be needed

Answer 363

Urine culture- gold standard Urine dipstick w/ + nitrites, luekocyte esterase >100K CFU women >1K CFU men/cath Pts Pyelo Recurrent Anatomic abnormals

Question 364

When would ASx cystitis in geriatric need Tx How are postcoidal UTIs Tx How is Pediatric Cystitis Tx depending on renal involvement

Answer 364

DM + structure abnormals TMPSMX Cephalexin Low risk- Keflex High risk- 3rd gen (Cefix, Cefdinir, Ceftibuten)

Question 365

When working up female cystitis, squamous cells are seen on UA. What is the next step Define Pyelonephritis How does this present

Answer 365

Repeat UA w/ clean catch, squamous epithelial cells indicate vaginal flora Ascending UTI that reaches renal pelvis CVA tenderness w/ F/C/N/V

Question 366

What is the MC microbe that causes Pyelonephritis What lab result is pathognomonic for dx How is this Tx outpatient, admitted and pregnant

Answer 366

E Coli WBC casts Cipro/Levo/Cephalexin IV Ceftriax Preg: IV Ceftriax

Question 367

# Define Nephrotic Syndrome Pts w/ this syndrome are at increased risk for ? What is the MCC in adults and Peds

Answer 367

Protieinuria >3.5g/24hrs Hypoalbuminemia Hypercholesterol Normal renal function DVT- hypercoagulable Adult: DM Peds: post-viral infection

Question 368

How is nephritic syndrome different from nephrotic syndrome What are the two classifications of nephrotic syndrome Why is there proteinuria in nephrotic syndrome What two lab results suggest a Dx of Nephrotic Syndrome

Answer 368

Neph: Hematuria 1-3g/day proteinuria HTN Oliguria Primary: kidney biopsy Secondary: systemic dz Podocytes damaged by IgG Abs Fatty cast w/ maltese cross Oval fat bodies

Question 369

What are the MC primary cause of Nephrotic Syndrome

Answer 369

Membranous Nephropathy- MC in non-DM w/ malignancy/infection w/ Hep B Minimal Change- MCC in kids; assume Dx w/ idiopathic nephrotic syndrome improved w/ CCS Focal Segmental Glomerulosclerosis: occurs in obese, heroine, AfAm w/ HIV

Question 370

What are the MC secondary causes of Nephrotic Syndrome How is Nephrotic Syndrome Dx How is this Tx

Answer 370

Lupus DM Pre-eclampsia Amyloidosis 24hr urine w/ >3.5g of protein ``` Statin Angiotensiin inhibition Na restriction Diuretic Steroids/Cyclosporine ```

Question 371

MC first Sx of nephrotic syndrome in Peds is seen as ? What does HyperK look like on EKG How is it Tx

Answer 371

Facial swelling Peak T Prolonged QRS Muscle fatigue Bicarb Insulin Gluconate

Question 372

What does HypoK look like on EKG How is this Tx What needs to be avoided

Answer 372

Flat/inverted T wave U-wave Replete K and Mg Avoid Dextrose fluids

Question 373

What can cause HyperVolemic, HypoNa What can cause Euvolemic HypoNa What can cause HypoVolemic NypoNa

Answer 373

CHF Nephrotic syndrome RF Cirrhosis SIADS Steroids Hypothyroid Na loss

Question 374

How is ASx HypoNa Tx How is Moderate HypoNa Tx How is severe HypoNa Tx Correcting serum Na should be done how fast in order to prevent ?

Answer 374

Water restriction IV NS, Loop diuretic 50mL bolus w/ 3% NS = 10mEq.L over 24hrs; Osmotic demyelination syndrome

Question 375

What lab result indicates underlying How is this Tx What adverse outcomes can occur from Tx What lab results indicates HyperNa d/t Diabetes Insipidus

Answer 375

BUN/Cr >20:1 d/t decreased flow to kidneys, more urea remains in blood D5W Cerebral edema Pontine herniation Urine osmolality <250 w/ HyperNa

Question 376

MCC of HypoCa What EKG/PE findings can be seen How is HypoCa Tx

Answer 376

Hypoparathyroidism QT prolongation Traousseaus Chvosteks Calcium gluconate Calcium chloride

Question 377

MCCC of HyperCa What 'saying' goes with this condition What does EKG look like How is this Tx

Answer 377

Hyperparathyroid Stone Bones Groans Moans Shortened QT interval NS w/ Furosemide

Question 378

What is the 3 step approach to Acid-Base d/os DDx for metabolic acidosis How is anion gap calculated

Answer 378

pH: 7.35-7.45 PCO2: 35-45 HCO3: 20-26 ``` MUDPILES: Methanol Uremia DKA Paraldehyde Infection Lactive acidosis Ethylene glycol Salicylates ``` Na - (Cl+HCO3)= 10-16

Question 379

DDx for low anion gap <16 Define Orchitis Since this is usually d/t a virus, bacterial orchitis is MC d/t?

Answer 379

Loss of BiCarb d/t: Pancreatic/biliary drainage Renal tubular acidosis Diarrhea Unilateral testicular inflammation d/t mumps Concurrent epididymitis

Question 380

How is Orchitis Dx How is this Tx When/why would ABX be used

Answer 380

UA w/ culture Pyuria Bacteruria NSAIDs Scrotal support ABX Ice/Rest <35/sexually active post-puberty male: Ceftriax and Doxy or, Azith and Doxy (PCN allergy) >35w/out STI suspected: Levofloxacin or TMP/SMX

Question 381

Where is the epididymis located and what does it do In Pts <35y/o this is usually d/t ? and Tx w/ In Pts >35y/o this is usually d/t ? and Tx w/?

Answer 381

Posterior testis; Connect efferent duct w/ vas deferens Chlamydia/Gonorrhea; Ceftriax and Doxy E-Coli/Pseudomonas; Cipro

Question 382

What PE sign is seen in epididymitis MCC for ED How is this Tx and when is this drug class c/i

Answer 382

Prehns: elevation brings relief Psychogenic Sildenafil- empty stomach 1hr prior, lasts 8hrs Tadalafil- 2hrs prios, lasts 36hrs Verdenafil- take w/ non-fatty food, lasts 8hrs CAD/CVA

Question 383

What is the biggest RF for ED What are 3 common causes of priapisms How are these Tx

Answer 383

Atherosclerosis Trazadone Cocaine Sickle Cell Dz Stair climbing Sudafed

Question 384

If Pt experiences erection during sleep, cause of ED is most likely d/t? What causes the Sxs of BPH This is Tx w/ any drug w/ ? class

Answer 384

Psychogenic Residual volume d/t increased cell numbers increasing urinary resistance -sin: a- blockers Prazosin Terazosin Tamulosin -ride: Finasteride- 5a reductase, inhibits T converted to DHT; dec size of prostate

Question 385

What 3 classes of drugs need to be avoided when Tx BPH How is BPH Dx What lab marker for Ca is usually elevated and needs to be checked

Answer 385

Anticholinergics Sympathomimetics Opioids DRE- uniform, large, firm and rubbery prostate PSA: <4 normal >4 w/ BPH- prostatitis/Ca

Question 386

How is BPH Tx if refractory to meds ? is the MC non-cutaneous Ca among males When does screening begin for this MC

Answer 386

TURP- transurethral resection of prostate Prostate PSA test at 50 +1st* relative/AfAM at 40

Question 387

What type of Ca is prostate Ca What is the MC site this Ca will mets to What RF leads to an increased risk while ? may be protective

Answer 387

Adenocarcinoma Bone High fat diet increases risk; Soy decreases risk

Question 388

When is a transrectal biopsy for prostate Ca indicated What presenting c/c indicates prostate Ca has metastesized What will be felt on PE

Answer 388

PSA >10 Abnormal transrectal US Back pain Hard, nodular and asymmetric

Question 389

PSA >4 next step PSA >10 next step How is prostate Ca Tx but w/ ? adverse outcome

Answer 389

US w/ needle biopsy Bone scan r/o mets Protatectomy- ED

Question 390

How is prostate Ca w/ mets Tx What monitoring is needed ? is the MC type of bladder Ca in the USA

Answer 390

Androgen deprivation therapy- Leuprolide PSA <0.1 Urothelial carcinoma- AKA transitional cell carcinoma

Question 391

SCC bladder Ca is associated w/ ? infection How does bladder Ca present How is it Dx How is it Tx

Answer 391

Schistosoma haematobium Painless hematuria w/ +smoking Hx Cystoscopy w/ biopsy- gold standard Chemo, surgery, cystoscopy q3mon

Question 392

What are the 5 types of incontinence

Answer 392

Urge: detrusor overactivity; MC elderly, nursing home Dx: urodynamic study Stress: weak floor after delivery; r/o infection w/ UA Overflow: impaired detrusor contractility; high postvoid volume/nocturnal wetting, common in DM/neuro d/os Functional: can't reach toilet in time d/t physical/mental blockades Mixed: stress and urge- MC

Question 393

How is urinary incontinence Dx

Answer 393

UA- r/o UTI (only mandatory study for Peds w/ enuresis) Postvoid residual: overflow= high PVR stress/urge- low/norm PVR Urodynamic- stress- normal contraction urge- inc contraction during filling US w/ cystoscope- anatomic abnormals

Question 394

How is Urge incontinence Tx How is stress Tx How is Overflow Tx

Answer 394

Bladder training Anticholinergics (oxybutynin) TCA (Imipramine) Kegels Estrogen Pessary Sling, mid-urethral Intermittent self-cath Cholinergic- Bethanechol, inc contractions A-blocker- Tera/Doxazosin- dec sphincter resistance

Question 395

How is functional incontinence tx How is Mixed incontinence Tx ? is the most definitive Tx for primary enuresis

Answer 395

Scheduled voidings Lifestyle mod w/ pelvic floor exercises Desmopressin

Question 396

How does prostatitis present How is this Tx

Answer 396

Hesitency w/ dec flow Saddle tenderness <35: C/G >35: Ecoli, pseudomonas; Doxy/Ofloxacin/Ceftriax >35: EColi/Pseudo; Cipro/TMPSMX

Question 397

How does acute bacterial prostatits present on DRE ? is the MC form of prostatitis How are acute and chronic cases Tx

Answer 397

Boggy, warm and tender- do not massage (sepsis) Chronic bacterial w/ enlarged, nontender prostate Acute: <35: Ceftriax and Doxy >35: Flqln/TMP-SMX Chronic- Flqnln or TMP-SMX

Question 398

? is the MC type of renal malignancy ? does this originate This is more common in ? population

Answer 398

Renal Cell Ca Proximal renal tubular epithelium AfAm

Question 399

How does Renal Cell Ca present What labs would be abnormal What are the 1st and 2nd MC types

Answer 399

Weight loss Hematuria Palpable mass Normo/Normo anemia (EPO flare) HTN w/ hyperCa Clear cell carcinoma Transitional cell

Question 400

What is the biggest RF for Renal Cell Ca How is this Dx How is it Tx

Answer 400

Smoking Abdominal CT or US Surgery w/ nephrectomy

Question 401

? is the MC type of testicular Ca and the two types When does this tend to appear What is seen on PE

Answer 401

Germ cell: Seminoma Non-seminomatous 20-34y/o w/ cryptorchidism/orchitis Painless, swollen and hard testi

Question 402

What are the 3 most important tumor markers for Dx testicular Ca ? lab result isolates Dx to NSGCT testicular tumor What lab result is sen in both Seminomas and NSGCT

Answer 402

bHCG AFP LDH AFP HCG

Question 403

What does LDH indicate for testicular Ca How is testicular Ca Tx ? tumor marker is used to monitor for relapse

Answer 403

High burden- seminoma, recurrence of NSGCT Orchiectomy Seminomatous- radiation NSGCT- radioresistant AFP

Question 404

How does Acute RF look on lab results What can cause this What is the first and second MC cause of Chronic RF

Answer 404

Inc Cr/BUN Dec GFR ``` ACEI w/ bilat stenosis Hypovolemia Infection Nephritic syndrome Tubular necrosis ``` 1st: DM 2nd: HTN

Question 405

What type of UA results is seen in Chronic RF What are the 3 mechanisms of Acute RF

Answer 405

Broad Waxy Casts Prerenal: perfusion Renal: glomerular, tubular, interstistial Postrenal: obstruction

Question 406

Prerenal SpecGrav, BUN, Osmolality and FENA Renal SpecGrav, BUN, Osmolality and FENA

Answer 406

>1.030 >20 >500 <1 <10.10 <10 <300 >1

Question 407

What types of casts are seen on UA during acute tubular necrosis What other lab result is seen d/t this damage What 3 lab results make this Dx likely

Answer 407

Muddy borwn Unable to concentrate urine- high FENa FENa >2% Muddy casts High osmolality

Question 408

What lab results suggest Interstitial Nephritis What results are seen in Glomerulonephritis Why does CKDz develop Vit D deficiency and Hyperphosphate

Answer 408

WBC casts Eosinophils Oliguria Hematuria RBC casts Vit D cant be made into Calcitriol Dec excretion

Question 409

How is CKDz defined ? is the MC cause What are the 5 stages

Answer 409

``` eGFR <60ml x 3mon or any 3: Albuminuria >30mg Proteinuria >0.2 Hematuria Structural abnormals ``` HTN 1: GFR 90mL or > w/ albuminuria or hreditary dz 2: 60-89 3: 30-59 4: 15-29 5: <15

Question 410

How is CKDz Dx ? is the marker for kidney damage What meds are used to slow Dx progression

Answer 410

Cockcroft Gault formula for GFR Proteinuria ACEI/ARB w/ pneumococcal vaccine

Question 411

How does RA present What joints does it primarily affect What syndromes can these Pts develop

Answer 411

Warm, swollen and symmetrically stiff joints x 1hr every morning MCP PIP Wrist Felty- RA, Splenomegaly, and Neutropenia Caplan- pneumoconiosis and RA

Question 412

What type of effusion is seen in RA PTs ? rheum lab results will be positive in most PTs and which one is more specific What type of anemia could be seen

Answer 412

Exudative RF, C1M; Anti-CCP more spec for RA Normo/Normo

Question 413

? monotherapy is the best initial Tx medication for early RA w/ poor prognosis ? is used 2nd line for Tx What is the s/e of using this 2nd line Tx

Answer 413

Methotrexate Hydroxychloroquine Eye toxicity

Question 414

What drugs are used 1st through 4th line for Tx of RA What is the pathophysiologic reason for RA Dz What two PE findings suggest OA Dx

Answer 414

Methotrexate Hydroxychloroquine Sulfasalzine (HMS- triple therapy) Infliximab Synovial inflammation PIP Bouchard DIP Heberden

Question 415

What is the first medication elderly PTs w/ OA are Tx w/ What three x-ray findings aid w/ Dx OA in the knee commonly causs ?

Answer 415

Tylenol Narrowing Oseophyte Sclerosis Baker's cyst

Question 416

How does SLE present ? syndrome do these Pts have that put them at risk for DVTs How is this Tx ? monoclonal Ab can be used to inhibit B-cell factors

Answer 416

Fatigue Hand/wrist joint pain Malar rash

Question 417

What are 4 medications that can cause lupus Define Discoid Lupus What two tests are 100% specific for SLE Dx

Answer 417

Procainamide Isoniazid Quinidine Hydralazine Annular, erythematous patches on face/scalp that heal w/ scars Antidouble strand DNA (dsDNA) and, Anti-Smit Ab (anti-SM)

Question 418

Why do women w/ SLE have increased risk for miscarriages What lab results will be decreased during flares What two lab positives put neonates at higher risk for neonate lupus

Answer 418

B2 glycoprotein 1 Ab Complement- C3, C4, CH50 Anti-Ro, Anti-La

Question 419

? lab result positive is highly sensitive for drug induced lupus How is SLE Dx confirmed

Answer 419

Antihistone Ab ``` 4 or more RASHNIA4 Renal d/o Arthralgia Serositis Heme d/o Neuro d/o Imm derangement ANA 4 rashes: malar, discoid, photosensitive mucosal ```

Question 420

How is SLE Tx ? is the MC constitutional Sx associated w/ SLE ? is the most specific Ab for SLE and ? has the most sensitivity for screening

Answer 420

Sun protection Hydroxychloroquine* NSAIDs/Tyelenol Fatigue Anti-Smith; ANA

Question 421

How is Systemic Sclerosis characterized on PE What syndrome do these PTs develop ? is the MC GI Sx

Answer 421

Thickened skin from accumulation of collagen ``` CREST- Calcinosis Raynauds Esophageal dysfunt Sclerdactyly Telangiectasis ``` GERD

Question 422

How is Scleroderma Dx How is it Tx during renal crisis or Raynauds crisis

Answer 422

Anti-centromere A- limited crest but better prognosis Antiscl70- diffuse/multiple organs involved Anti-tropoisomerase Ab ACEI- Captopril CCB/Prostacyclin

Question 423

How is Scleroderma induced P-HTN Tx ? three GI infection can stimulate Retiers How is Ankylosing Tx

Answer 423

Ambrisentan and Tadalafil Shigella Salmonella Campylobacter ``` PT w/: Indomethacin Methotrexate/Sulfasalazine Pred- flares Etanercept/Infliximab ```

Question 424

# Define Ankylosing How does this present What 4 systemic issues can this present w/

Answer 424

Seronegative spondyloarthropathy affecting SI joint and spine Morning back pain that dec w/ activity Psoriasis IBDz Anterior uveitis Aortic regurg

Question 425

? is the gold standard to Dx Ankylosing How is Reiters Tx What would be seen on a synovial aspiration result

Answer 425

X-ray Indometh/Diclofenac Doxy for Chlamydia Sulfasal/Methotrex Etanercept/Infliximab Aseptic w/ negative bacterial culture

Question 426

? is the MC form of inflammatory arthritis This MC is a d/o of ? ? is the underlying physiologic issue

Answer 426

Gout Purine metabolism Hyperuricemia

Question 427

? medication can induce gout How is this Dx How is this Tx How does Tx change if cause is pseudogout

Answer 427

Thiazides Needle shaped monosodium urate crystals w/ negative biregringence (pos fringence/rhomboid- pseudo) 1st: Indomethicin/Naproxen/Ibuprofen 2nd: Colchicine Steroids

Question 428

? is usually the first sign of gout attack What x-ray findings signal pseudogout When is gout prophylaxis indicated

Answer 428

Podagra- MTP of great toe Chondrocalcinosis- linear radiodensities 2 or more flares/year: Allopurinol- dec uric acid production Probenecid- inc urine excretion

Question 429

How is Firbomyalgia Tx ? is the preferred method of exercise PT ? is the Sjogrens Dx test and ? lab result is Dx

Answer 429

TCA Pregabalin- only FDA approved Tx Swimming Schirmers tear test: <5mm of lacrimation in 5min Anti-RO and antiLA (Anti-SSA, Anti-SSB)

Question 430

? part of the body does Sjogrens affect How is this Tx Define Giant Cell Arteritis

Answer 430

Exocrine glands- salivary/lacrimal w/ parotid enlargement Tears Pilocarpine- cholinergic Cevimeline- muscarinic stimulation Autoimmune viral infection causes monocyte activation/cytokine production leading to tissue destruction

Question 431

The vasculitis of GCA affects ? structures This is MC in ? population w/ ? Dx How is this Dx

Answer 431

``` Extracranial branch of carotid: Posterior ciliary Occipital Ophthalmic Temporal ``` Female >50 w/ Polyalgia Rheumatica ESR >100 Biopsy

Question 432

# Define Polymyalgic Rheumatica ? other Dx is closely related w/ this population How is this Tx

Answer 432

Idiopathic inflammation of synovitis, bursitis, tenosynovitis causing proximal joint stiffness GCA Methotrexate, CCS

Question 433

# Define Polyarteritis Nodosa One quarter of Pts will have ? underlying Dx How is this Dx

Answer 433

Systemic vasculitis of arteries in men 40-50y/o Hep B/C Biopsy- necrotizing arteritis

Question 434

? lab result is seen in Polyarteritis Nodosa How is this Tx and ? is done if refractory How is this Tx if underlying Hep B is present

Answer 434

ANCA negative Steroids; Cyclophosphamide Plasmapheresis

Question 435

Cephalosporin Generation endings

Answer 435

1st: Fa/Pha 2nd: everything else 3rd: one/ten/me 4th: Pi 5th: Rol

Question 436

# Define Hyperthyroidism What is the preferred method for Tx hyperthyroidism during pregnancy How can Pts present

Answer 436

PTU Excess production of thyroxine hormone Weight loss Anxiety Tachycardia/PVCs

Question 437

? is the MCCC of hyperthyroidism What lab result will be seen and what will be seen if condition is causes by the MCC How is it Tx

Answer 437

Graves dz- antithyrotropin Ab (TSHR-Ab) against TSH receptor Low TSH, inc F-T4/T3 Graves Dz: low TSH, inc T3 Methimazole Propylthiouracil

Question 438

Thyroid storm occur in ? two populations How does this lead to death How is Graves Abs tested for

Answer 438

Graves Dz Toxic Multinodular goiter Cardiogenic shock CV collapse TSI, TBII

Question 439

How are the cardiac Sxs of Graves Dz Tx Define Hypothyroidism What is the MCC and what would be seen on lab results

Answer 439

Atenolol Thyroid gland doesn't produce enough thyroid hormone Hashimotos- Inc TSH, low FT4

Question 440

What does Primary Hypothyroidism look like on lab results What does Secondary Hypothyroidism look like ? lab result is not sensitive for the Dx of hypothyroidism

Answer 440

Inc TSH, low FT4 Low TSH, low FT4 T3

Question 441

How is a Dx of Hashimoto's confirmed Anemia is often present, ? type ? other CMP lab result will be high in primary hypothyroidism

Answer 441

Anti-TPO Abs Normo/Normo Cholesterol

Question 442

How is Hypothyroidism Tx ? is a severe form of hypothyroidism seen nondiagnosed/under Tx cases ? presentation should suggest a Dx of Hashimotos Thyroiditis

Answer 442

L-Thyroxine/Synthroid Myxedema Coma Goiter w/ tenderness +MedHx recent viral illness

Question 443

What lab result would be elevated during Hashimotos Thyroiditis ? type of thyroid activity is seen in postpartum thyroiditis Define Quevains Thyroiditis

Answer 443

Anti-TPO Abs Hyper x 5-7mon MCC of thyroid pain after infection; starts hyper, progresses to hypo

Question 444

What are two drugs that can cause drug induced thyroiditis ? causes Bacterial Thyroiditis ? lab result should indicate Pt w/ heat, pain, swelling has a bacterial form

Answer 444

Lithium Amiodarone Staph, Strep Inc WBC

Question 445

4 etiologies of a painful thyroiditis 3 etiologies of a nonpainful thyroiditis

Answer 445

DeQuervains/Granulomatous Infectious Radiation Trauma Postpartum Drug induced Hashimotos

Question 446

How is Hashimotos' Thyroiditis Tx How is Subacute/Postpartum Thyroiditis Tx How is Drug induced Thyroiditis Tx How is Bacterial Thyroiditis Tx

Answer 446

Chronic hypo- T4 substitution BBs and ASA D/c offender Surgical drainage of abscess and specific ABX

Question 447

? is the MC RF for thyroid carcinoma ? is the MC form ? is the MC beign nodule

Answer 447

Radiation exposure Papillary Adenoma

Question 448

? PE findings suggest thyroid Ca What Lab/US results also suggest a Dx How is thyroid Ca Dx

Answer 448

Firm/hard Fixed w/ swallowing Swollen lymph nodes Microcalcification Irregular margin Size >1cm Solid US w/ biopsy if >1cm

Question 449

How is a thyroid nodule determined to be benign or malignant What is the next step if uptake shows Ca How is this Tx

Answer 449

Cold- no iodine uptake, Ca Hot, takes up iodine, non-Ca Fine needle aspiration Removal of thyroid Anaplastic Ca- Tx w/ chemo/rad

Question 450

# Define Hyperparathyroidism When do PTs become symptomatic What causes primary and secondary hyperparathyroidism

Answer 450

Aver active, secretes PTH, leads to hypercalcemia Ca >12 Primary: parathyroid adenoma Secondary: CKDz

Question 451

What is the saying for hyperparathyroidism How is this condition Tx Define Hypoparathyroidism

Answer 451

Bones Stones Groans Psychic moans Ectomy Furosemide/Calcitonin Bisphosphonates Dec PTH causing low Ca levels

Question 452

What do Pts w/ hypoparathyroidism present w/ What triad is used for Dx What is seen on EKG

Answer 452

Chvosteks's sign Trousseaus sign Dec Ca Inc DTRs Dec PTH Inc Phosphate Prolonged QTc

Question 453

How is hypoparathyroidism Tx short term How is this Tx if tetany is present How is this Tx long term

Answer 453

Vit D, Ca IV Ca gluconate Recombinant human PTH

Question 454

# Define Paget's Dz What form of bone Ca is most associated w/ this condition ? parts of the body are most affected

Answer 454

Bone remodeling d/o causing weaker bone Osterosearcoma Femur Lumber Pelvis* Skull*

Question 455

How can Pts w/ Paget's Dz present How is this Dx How is it Tx

Answer 455

Arthritis Bone pain Excessive warmth Deafness Inc Alk Phos Lytic lesions/thickened cortices on x-ray Bisphosphonates Calcitonin

Question 456

Total cholesterol is desired to be below ? LDL is desired to be below ? HLD is desired to be below? ?

Answer 456

<200 <100 <40: low >60: high

Question 457

What are the LDL goals if <1RF, 2RFs, DM/CADz, 10yr risk of >20%

Answer 457

<160- normal population, 1RF <130 for 2RFs <100- DM, CADz <70- 10yrs risk of 20%, recent MI, CAD w/ DM/current smoking

Question 458

How is hypercholesterol Tx What is a s/e of Tx, especially over ? dose When are lipid screening began depending on organization recommending

Answer 458

1st: lifestyle 2nd: statin Rhabdo, >80mg- check serum creatine kinase USAPSTF: 35y/o NCEP: 20y/o

Question 459

How is hypertriglycerides Tx What bile sequestrant is used for DM w/ hypertriglyceride

Answer 459

1st: Fibrates (gemfibrozil) 2nd: Niacin, Omega-3, Bile sequestrant (Resin) Colesevelam hydrochloride

Question 460

Pts w/ LDL of 190/> are Tx w/ ? How is DM between 40-75y/o Tx

Answer 460

High intensity statin: Atorva: 40-80 Rosuva: 20mg ``` ASCVD 7.5/>: high intensity ASCVD <7.5: moderate intensity Atorva- 10mg Rosuva- 10mg Simva- 20-40mg Prava- 40-80mg Lova- 40mg Flu XL- 80mg Flu- 40mg BID Pita- 2-4mg ```

Question 461

How are non-DM w/ LDL >190 Tx What are the two types of hypertriglycerides

Answer 461

ASCVD 7.5/>: moderate intensity ASCVD <7.5: lifestyle Combines- 2b; total, LDL and Tgd all elevated Familial hyper- 4; normal LDL, elevated Tgd

Question 462

Hypertriglycerides >500 put PTs at risk for ? Levels over 2000 put Pts at risk for ? ? type of hypertriglyceride causes palmar xanthomas

Answer 462

Pancreatitis Xanthomas Lipemia retinalis Chlomicronemia- N/V/pain/pancreatitis Type 3

Question 463

How often are fasting lipid panels needed What is the next step if triglycerides are found to be >150mg What is the next step if levels are found to be >1000

Answer 463

Start at 20y/o, No comorbiditeis- repeat q5yrs + comorbidities- repeat q12mon Fast x 12-16hr and recheck Beta-quantification and electrophoresis

Question 464

? 3 meds are used to lower triglyceride levels What causes Type 1 DM to emerge

Answer 464

Statins Fibrates Niacin Fish oil B-cells fail to respond and are destroyed

Question 465

# Define Dawn Phenomenon Define Somogyi effect

Answer 465

Dec insulin sensitivity and surge of regulator hormones during fasting; Tx inc night time insulin Nocturnal hypoglycemia w/ rebound hyperglycemia d/t GH surge; Tx w/ dec nighttime insulin

Question 466

How is DM Dx How is this Tx ? vaccines do these Pts need

Answer 466

Random >200 w/ Sxs Fasting 126 or > A1c 6.5% or > A1c goal <7 Basal (Glargine) Rapid (Humalog) Flu Tdap PCV12 Pneumococcal

Question 467

Bolus-rapid insulin Bolus short acting insulin Basal-immediate Basal-long acting

Answer 467

Post-prandial control: Lispro Aspart Glulisine Fasting control: Regular: Humulin-R, Novolin-R NPH: Humulin-N, Novolin-N Glargine Detemir

Question 468

MOA and S/e of Metformin

Answer 468

Dec liver glucose production, peripheral glucose utilization, and intestinal absorption Lactic acidosis

Question 469

MOA and s/e of Sulfonylureas

Answer 469

Stimulate pancreatic B-cells to release insulin Hypoglycemia Weight gain

Question 470

MOA and s/e of thiazolidinediones

Answer 470

Inc insulin sensitivity at peripheral receptor sites Fluid retention/edema

Question 471

MOA and s/e of a-glucosidase inhibitor

Answer 471

Delays glucose absorption in intestine Inc LFT/hepatitis

Question 472

MOA and s/e of Meglitinides

Answer 472

Stimulate b-cell insulin release Hypglycemia

Question 473

MOA and s/e of GLP-1 agonists

Answer 473

Mimicks incretin to cause insulin secretion, decreases glucagon and delays gastric emptying Hypoglycemia Gastroparesis

Question 474

MOA and s/e of DDP-4 inhibitors

Answer 474

Inhibits degradation of GLP-1 Pancreatitis RF

Question 475

MOA and s/e of SGLT2 inhibitors

Answer 475

Dec renal glucose threshold to increase urinary eexcretion UTIs

Question 476

Normal fasting glucose is ? Criteria for DM Dx Criteria for Pre-DM Dx

Answer 476

70-100 A1c 6.5/> Fasting 126/> 2hr 200/> Random 200/> w/ Sxs A1c 5.7-6.4 Fasting 100-125 2hr w/ 75g- 140-199

Question 477

How often is A1c checked for controlled and uncontrolled DM MCC of gynecomastia in infant/boys MCC of gynecomastia in men

Answer 477

Control: q6mon Uncontrol: q2mon Physiologic gynecomastia Drugs (spironolactone) Idiopathic Persistent pubertal gynecomastia

Question 478

How is Osteoporosis Dx What scores mean porotic/penic How are these Tx and w/ ? Pt education

Answer 478

DEXA on all females 65/> Porotic: T-score -2.5 or < Penia: T-score -1 - 2.4 ``` PO Bisphosphonates (Alendronate, Risedronate) Take w/ water, remain upright x 30min to avoid jaw necrosis ```

Question 479

How often are f/u DEXA scans needed depending on T-scores How is this Tx if PT can't tolerate PO Bisphosphonates What medication is sued for Tx in PTx w/ very high risk of Fx (-3.5/>)

Answer 479

-1 - -1.5: q5yrs -1.5 - -2: q3-5yrs >-2; q1-2yrs IV Zoledronic Acid Teriparatide- recombinant PTH

Question 480

How to remember Addisons Dz What E+ findings are seen on lab results

Answer 480

ADrenal Down ADD hormone for Tx HyperK HypoNa

Question 481

Primary adrenocortical insufficiency is AKA and d/t? What lab results will be seen Define secondary adrenocortical insufficiency and lab results seen

Answer 481

Addisons Dz- adrenal destruction causing dec cortisol/aldosterone Inc ACTH Dec cortisol Dec aldosterone Pituitary failure; Dec ACTH Dec cortisol Normal aldosterone

Question 482

? are the two etiologies of secondary adrenocortical insufficiency How is this Dx

Answer 482

Exogenous steroids- MCC Hypopituitarism 8AM ACTH w/ ACTH stimulation test Inc ATCH and low cortisol= primary Dx Low ACTH, low cortisol= secondary Dx

Question 483

? two stimulation tests are used toDx adrenal insufficiency

Answer 483

ACTH Cosyntropin: IM ACTH given Normal: cortisol levels rise Insufficiency: little/no increase CRH stimulation- differs the cuase of the insufficiency Primary- high ACTH, low cortisol Secondary- low ACTH, low cortisol

Question 484

How is Addison's Tx How is Secondary Insufficiency Tx What lab results suggest Cushings Syndrome

Answer 484

Cortisol replacement Hydrocortisone Fludrocortison Inc cortisol Inc BP Dec K+

Question 485

Cushings Dz is MCC by ? ? body types is seen here How is Cushings Syndrome Dx

Answer 485

Pituitary adenoma Buffalo hump Moon facies Pigmented striae Low dose Dexamethasone suppression and, 24hr urine cortisol (gold standard)

Question 486

How is the cause of Cushing Syndrome differentiated

Answer 486

High dose dexamethasonze suppression test- Suppressed cortisol- pituitary ACTH secreting tumor ACTH level: dec ACTH= adrenal tumor Norm/Inc ACTH: ectopic ACTH tumor

Question 487

How is Cushings Dz Tx What med is used for Pts ineligible for the primary Tx Adrenal neoplastic Dz is AKA ?

Answer 487

Transsphenoidal surgery Ketoconazole Pheochromocytoma

Question 488

# Define Pheochromocytoma This Dx is associated in ? other d/os What are the 5Ps of episodic Sxs

Answer 488

Catecholamine (Epi, NorEpi) secreting adrenal tumor NF-1 MEN2A/2B Von Hippel Lindau Dz ``` Pressure, Inc BP Pain, HA Persipiration Palpation, tachy Pallor ```

Question 489

How is a Pheo Dx How is this Tx What must be doe prior to Tx

Answer 489

24hr catecholamine w/ metabolites (metanephrine and vanilymandelic acid) Complete adrenalectomy Non-sel A-block: phenoxybenzamine/phentolamine Then, BBs

Question 490

Gigantism and Acromegaly are both caused by ? What are these rarely caused by What is the difference between Gigantism and Acromegaly

Answer 490

Pituitary adenomas secreting excess GH Non-pituitary tumor secreting GHRH G: GH hypersecretion begins in childhood, before epiphyses closure A: hypersecretion in adulthood

Question 491

How is Acromegaly/Gigantism Dx What lab result is used to track therapy response How are both cases Tx

Answer 491

IGF-, 2-10x normal IGF-1 Surgery/radiation Non-surgical= Octreotide/Lanreotide to suppress HG

Question 492

# Define Diabetes Insipidus What are the two types

Answer 492

Deficient/resistant ADH resulting in massive polyuria Central- no ADH production Nephrogenic- partial, complete insensitivity to ADH

Question 493

How is Diabetes Insipidus Dx How is the etiology of the Dx determined

Answer 493

Water Deprivation test- pos- diluted urine production despite water restriction Desmopressin stimulation test: Central= dec urine output Nephrogenic= continued production of diluted urine

Question 494

How is Diabetes Insipidus Tx depending on the etiology Define Glomerulonephritis What is the MCC

Answer 494

Central: Desmopressin Nephro: Na/Protein restriction w/ Hydrochlorothiazide or indomethacine Sudden onset of hematuria, proteinuria and RBC casts d/ glomeruli inflammation Post-infection GABHS/Strep species World: Beurgers Dz

Question 495

How is Post-Infectious Glomerulonephritis Dx ? is the MCC of this worldwide How does the worldwide MC present

Answer 495

ASO titer and, Low C3/C4 IgA Nephropathy- Bergers Dz Hematuria URI Flank pain

Question 496

How is IgA Nephropathy/Berer's Dx Define Alports Syndrome How is this Dx

Answer 496

IgA deposits in mesangium on staining Isolated, persistent hematuria in kids w/ RF, HL and anterior lenticonus on Opto exam C3/C4 levels

Question 497

What causes Membranoproliferative Glomerulonephritis How is this Dx What lab result suggests a Dx of Rapidly Progressive Glomerulonephritis

Answer 497

SLE/Viral hepatitis induced damage to glomerulus Low C3,C4 levels Crescent formation on biopsy d/t fibrin/plasma protein deposition

Question 498

How is Goodpastures Syndrome Dx How is it Tx What is seen on vasculitis induced glomerulonephritis

Answer 498

+anti-GM Abs Linear IgG deposits Steroids Plasmapheresis w/ cyclophosphamide ANCA Abs

Question 499

How is glomerulonephritis Dx What lab is needed if Pt has recent strep infection What is the gold standard for Dx

Answer 499

Hematuria (>3RBCs/field) RBC casts Proteinuria Antistreptolysin-o titer Renal biopsy

Question 500

What lab result is often decreased in glomerulonephritis How is this Tx What are the cysts in Polycystic KDz made of

Answer 500

C3 ACE/ARB is protective Post-strep- use Nifedipine Steroids/Na/Fluid restriction Epithelial cells from renal tubules

Question 501

? is one of the MC human genetic d/os What ER c/c can these Pts have What Cardiac issues can they have

Answer 501

Autosomal dominant PCKDz Brain aneurysm induced worst HA ever MVP, LVH

Question 502

How is PCKDz Dx Genetic studies for ? can be done prior to Sx onset How is this condition Tx

Answer 502

US PDK1/PKD2 ACEI/ARB Transplant

Question 503

? is the MC form of anemia What type of anemia is seen What are the two MCCs

Answer 503

Fe deficient Micro/Hypo ``` Dyfunctional uterine bleeding GI bleed (men) ```

Question 504

How is Fe Deficient Anemia Tx What is the first, second and last sing of this condition developing What lab result suggest lead poisoning and how is it Tx

Answer 504

Ferrous sulfate 1st: low ferritin 2nd: rising TIBC 3rd: micro/hypo Pt w/ neuro Sxs- Basophilic stippling, Sideroblastic anemia Thalassemia; Tx EDTA

Question 505

What is seen on a peripheral smear of Fe Defficient anemia How long does Tx take How often do these Pts need f/u

Answer 505

Poikilocytes- pencil/cigar shaped 6wks corrects anemia 6mon replaces Fe stores q3mon x 12mon

Question 506

When Tx Fe Deficient anemia, taking meds w/ ? can increase absorption ? lab result suggests Tx is working ? are the MCC of Anemia of Chornic Dz

Answer 506

Vit C Inc reticulocyte counts Chronic RF CT d/o

Question 507

How is Anemia d/t Renal Failure Dx How is this Tx What does B12 Deficiency anemia look like

Answer 507

+RF and dec EPO levels Recombinant EPO- Procrit, Epogen when Hgb <10 Fe supplements Hypersegmented neutrophils Neuropathy- loss of vibratory/proprioception Inc Methylmalonic acid

Question 508

B12 Anemia leading to pernicious anemia is d/t ? How is B12 Anemia Dx What other lab results are elevated

Answer 508

Dec intrinsic factor Macrocytosis and, Hypersegmented neutrophils MMA Homocysteine

Question 509

What is seen in Folate Deficient Anemia Of the two macro anemias (B12/Folate) hos does Folate appear differently What is the risk if mother has tthis during pregnancy

Answer 509

Dec folate Inc MCV- macro Folate- no Neuro Sxs Inc risk neural tube defects

Question 510

How is Folate Deficient Anemia Dx How is this Tx What causes hemolytic anemia

Answer 510

Magaloblastic Folate <3 Normal MMA 400-1000ug/day of Folate Premature RBC breakdown

Question 511

What are the two etiologies of the premature RBC breakdown of Hemolytic Anemia

Answer 511

Intracorpuscular: RBC membrane defects (spherocytosis) Extracorpuscular: Autoimmune (+Coombs, Tx Pred) G6PD Chemo s/e

Question 512

How does Hemolytic Anemia present What test will be positive if cause is autoimmune What four results indicated the other causes

Answer 512

Splenomegaly Inc indirect bili Inc LDH Direct Coombs (Abs to RBCs, Indirect- Abs in serum) Spherocytosis- fragility test G6PD- Heinz body Sickle- inc retic count w/ pain Thalassemia: very low MCV w/ normal TIBC/Ferritin

Question 513

? lab result pentad is the hallmark of hemolytic anemia How are these Tx Define Aplastic Anemia

Answer 513

Corrected Retic >2 Falling Hgb Inc indirect bili Inc LDH Autoimmune: steroids Spherocytosis: splenectomy Normo/Normo from loss of blood cell precursors causing anemia w/out reticulocytes

Question 514

Unique fact about Aplastic Anemia When is this Dx suspected What is the most accurate test

Answer 514

Only one where all 3 lines are dec: WBC RBC Platelet WBC <1500 Platelet <50K Marrow biopsy- hypocellular marrow w/ fatty infiltrates

Question 515

How is Aplastic Anemia Tx How is Tx changed in PTs ?50y/o What med is used to decrease risk of infections

Answer 515

RBC transfusion w/ leuko-reduced, platelet transfusion Anti-thymocyte globulin + cyclosporine/Pred Figrastim- G-CSF

Question 516

How is Sickle Cell inherited ? lab result is used to track crisis progress What does the punnet square look like

Answer 516

Homozygous of HgbS Retic count HbSS- Dz HbSA- trait Two parents w/ trait= 1/4 chance of kid w/ HbSS

Question 517

How is Sickle Cell Dx ? bodies are seen in lab results ? med is used to decrease frequency of crisis

Answer 517

HgbSS on electrophoresis Howell Jolly- nuclear remains not phagocytosed Hydroxyurea

Question 518

# Define Thalassemia Thalassemia and Fe Deficient are both micro/hypo, how is Thalassemia different What other lab finding helps w/ Dx

Answer 518

Autosomal recessive blood d/o w/ abnormal Hgb formation Higher RBC count More micro/hypo than Fe deficient Nucleated erythroblasts

Question 519

Stopped on B-Thalassemia

Answer 519

b