IMC-RR Flashcards by brandon lovin

? is the strongest predisposing factor to asthma

What is the triad

What test results can mean Dx

Atopy

Asthma
Allergy
Eczema

Obstructive pattern w/ FEV1 improved by 12% one second after albuterol administration

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? is the best objective test to determine asthma exacerbation severity

How is this Tx in step wise manner

Peak expiratory flow rate

Acute: Rescue SABA,
Inhaled steroid

Mod:
LABA (salmeterol) or increased ICS dose

Sev: 
High ICS dose w/ B-agonist, 
SABA- rescue
LABA- long term management
PO steroids

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? is used for first line maintenance therapy Tx for asthma

What medications target mast cell degranulation in asthmatics

What are the 5 etiology groups for P-HTN

ICS

Mast Cell Stabilizer:
Cromolyn sodium
Nedocromil

1: Pulm artery HTN
2: d/t left HDz
3: lung dz/hypoxemia
4: embolic P-HTN
5: unclear mechanism

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P-HTN is defined as ?

What is the first step for Dx

How is a Dx confirmed

Mean pulmonary arterial pressure >25mmHg

Echo

R heart cath

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How is Primary P-HTN Tx

What is heard on exam

Define Ortner’s Syndrome

CCBs
Inhaled PPD inhibitors
Prostacycins
Endothelin receptor antagonist

Ejection click after S1
Loud, narrow split S2

Compressed recurrent laryngeal d/t dilated pulm artery

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When is asterixis not observed in hepatic encephalopathy

What meds can be used to first and second lower ammonia levels

How long can first line therapy be used before combo therapy is indicated

Grade 4: comatose Pts

Lactulose- first line w/ goal fo 2-3 movements/day
Rifaximin- second line

48hrs, add Rifaximin for combo therapy

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What are the 2MC causes of cirrhosis in US

? is the MC enzyme based RBC abnormality

How is this MC inherited

Alcohol
Hep C

G6PD

X-linked, rarely affects females

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How is G6PD Dx

What results would be seen during an exacerbation

How are acute exacerbations Tx

Peripheral smear w/ bite/blister cells and Heinz bodies

Reticulocytes
Inc indirect bilirubin

D/c offender
Aggressive fluid therapy

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Define Heinz Bodies

Initial therapy for asthma attacks include ?

What is used for attacks resistant to initial therapy

What is the next step for continued Sxs

Clusters of denatured Hgb chains attached to RBC membranes

O2
Inhaled bronchodilators
Anticholinergic- allbuterol and ipratropium

Systemic CCS

IV Mg Sulfate

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Tx acronym for asthma exacerbations

? reading on peak flow is considered a severe asthma attack

BIOMES:
B-agonist
Ipratropium
O2
Mg sulfate
Epi/Terbutaline
Steroids

<50%

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SA node natural pace range
AV node natural pace range

? EKG finding signals a sinus origin of bradycardia

What two issues must be r/o when Pts present w/ bradycardia

60-100
40-60

Pos deflection 1, 2, aVL
Neg deflection aVR

Hemodynamic
Acute MI

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How does atropine help Tx bradycardia

What is the max dose used

Define Cafe Coronary Syndrome

Competitively inhibits acetylcholine from vagus nerve in the AV node

3mg or 0.04mg/kg

Asphyxiation d/t airway obstruction from poorly chewed food

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What two drugs can be used for Tx of idiopathic pulmonary fibrosis

? is the only definitive Tx

? is the MCC of digital clubbing

Nintedanib
Pirfenidone

Transplant

Lung Ca

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Define Kussmaul Sign

? BNP levels suggest restrictive cardiomyopathy

Since Restrictive Cardiomyopathy can present similar to constrictive pericarditis, how is it differentiated

Inc JVD w/ inspiration seen in restrictive cardiomyopathy

> 400pg/mL

RC- S3
CP- pericardial knock

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Normal sinus rhythms will have ? type of P-wave shapes on EKG

Define Boerhaave Syndrome

What is an abnormal/rare PE finding

Upright in Lead 2
Biphasic V1

Transmural perf d/t inc esophageal and negative chest pressures

Hematemesis

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What is the MC location for Boerhaaves to develop

What is the name of the Triad for this presentation

How are varicose veins defined by size

Left posterolateral aspect of distal esophagus

Mackler- vomitting, lower thoracic pain, subcutaneous emphysema

> 3mm diameter

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How are varicose veins Tx

What are the 4 categories for varicose classifications

What meds can be used to help heal stasis ulcers induced by varicose veins

Compression/lifestyle x 3mon
Sclerotherapy
Ablation- deep > superficial

Clinical
Etiologic
Anatomic
Pathophysiological

Rheologic-
ASA, Pentoxifylline

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Time frames for HTN Emergency Tx

Define Masked HTN

? is the MC PE finding in Pts w/ constrictive pericarditis

Goal <180/120 in first hour-
Dec x 25-30% in first 2hrs

Goal <160/110 in next 23hrs-
Dec 5-15% in 23hrs

Normally elevated but appears normal at office appointments

Inc JVP

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What two conditions cause Kussmaul Sign

? is the MC type of pre-Ca cell type seen in PTs w/ Barretts

Barrett’s can progress into ? type of Ca

Constrictive Pericarditis
Severe TV Dz

Specialized intestinal epithelium- only type w/ clear malignant potential

Adeno

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What Rx combo can prevent Barretts progression into Adenocarcioma

? underlying Dx is protective against Barrett’s progression

Native valve endocarditis is caused by ? while prosthetic/IVDA infections are caused by ?

ASA+Statin

H Pylori

Native: Strep viridians
Prosthetic: Staph epidermis
IVD: Staph aureus

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? is the MC neurological presentation of endocarditis

What is needed per Duke’s for Dx

Focal neuro deficits d/t vegetation breaking off of valves

Two major
One major, 3 minor
Five minor

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Duke Major criteria

Duke Minor criteria

? is the imaging modality of choice

Two + blood cultures w/ +Echo vegetation
New valve regurgitation

Vascular phenomenon
Immune phenomenon
Prev heart Dx/IVDA
\+Culture atypical for endocarditis
Fever

TEE

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? is the MC cause of traumatic aortic dissections

? is the biggest RF for a traumatic and atraumatic dissection

? part of the aorta is most likely to tear

MVC

Trauma: rapid deceleration
Atrauma: HTN

Isthmus- distal to left subclavian

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Aortic dissection present w/ murmurs similar to ?

How are these Pts assessed w/ imaging pending hemodynamic status

? drugs can and can’t be used to lower HTN in cocaine use

Aortic regurgitation

Stable: CT
Unstable: bedside Echo

Yes: Esmolol, Labetolol
No: non-selective BBs

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3 etiologies for Secondary Pneumothorax Why do these occur How are these Tx

Trauma Infection Malignancy Apical blebs rupture Unstable: Needle-D, thoracostomy Stable: observe Secondary: thoracostomy

# Define Pulsul Parvus et Tardus What are the 4 types of drug allergy eruptions

Delayed carotid artery pulse w/ plateaued peak and decreased amplitude during Aortic Stenosis 1: anaphylactic, IgE mediated mast cell degranulation 2: cytotoxic, IgG/IgM activate complement 3: immune, IgG/IgM activate complement 4: delayed cell mediated, activated T-cells against surface Ags

Examples of Class 1 hypersensitivity reactions Examples of Class 2 hypersensitivity reactions Examples of Class 3 hypersensitivity reactions Examples of Class 4 hypersensitivity reactions

Anaphylaxis Urticaria Angioedema Autoimmune hemolytic anemia Goodpasture Erythroblastalis fetalis PostStrep nephritis Lupus Serum sickness PPD Rejection, transplant Dermatitis, contact

IgE mediated reactions cause ? two cells to release ? substances What are the 4 MC etiologies for drug mediated hypersensitivity reactions Respiratory Distress Syndrome is AKA ?

Mast cell, Basophils- Histamine Leukotriene Prostaglandins B-lactam ABX ASA NSAIDs Sulfas Hyaline Membrane Dz

# Define Hyaline Membrane Dz What cells are responsible for making what is lacking in this condition When are these cells normally seen in gestation

D/o of decreased surfactant Type 2 pneumocytes 20wks, Maxed at 34-36wks

? is used for a screening tool for RDS What CXR finding is seen How is this prevented and how is it Tx

Phosphatidylglycerol via amniotic fluid test Ground glass w/ visible air in bronchograms ``` Prevent: Betameth/Dexamethasone 48hrs prior to delivery Tx: Intratracheal surfactant O2/Vent ```

Infants Tx for RSD w/ prolonged ventilation are at risk for ? What causes diverticulosis to develop ? type of liver Ca accounts for >85% of liver Ca

Bronchopulmonary dysplasia Weak point in colon from inc pressure where vasa recta penetrate muscular layer Hepatocellular carcinoma

? is the MCC of painless lower GI bleeds What is the biggest RF for hepatocellular Ca ? lab result is elevated in 90% of Pts

LLQ Diverticulosis Cirrhosis Gamma carboxy prothrombin

? is the prognosis predtor for Pts w/ hepatocellular Ca ? is the MC malignant liver tumor in infant/children How does P Jiroveci appear on CXR

AFP levels at Dx: >200 at Dx or, Inc >15ng/mon= poor Hepatoblastoma Difuse interstitial/alveolar infiltrate (bat wing)

How is P Jiroveci Tx if Pts has severe sulfa allergy ? is the serological hallmark of an active Hep B infection

Clindamycin-primaquine or, Trimethoprim-dapson HBsAg

Use of HBsAG Use of Anti-HBs

Screen/Detect/Dx acute/chronic infection First indicator acute HBV IDs chronic infection/HBV carrier Detects previous exposure Proves vaccination Hx/need Presence= immune

Use of Anti-HBc Use of Anti-HBc IgM

Helps detect acute/chronic HBV infection IgM- produced first IgG- produced later and lasts for life Detects acute infections

Use of HBeAG Use of Anti-HBe

Marker of infectivity Screens Tx efficacy Monitoring acute infection

What are the two MC s/e of Verapamil use How is TB screened and Dx How are HIV negative Pts Tx

Gingival hyperplasia Constipation Screen: PPD Dx: acid-fast sputum stain RIPE x 2mon w/ B6 (pyridoxine) RI x 4mon

? is the 2nd MC cause of infectious death in adults world wide What types of tumors are lung carcinoma tumors What is the MC location of carcinoid tumor

TB Neuroendocrine- secrete serotonin GI

? is the MC lung neoplasm of children How does this present What doe these look like on CXR

Lung carcinoid tumor Wheeze Hemoptysis Recurrent pneuonia Small, round apacities w/out cavitation

How are lung carcinoids Dx w/ imaging ? method can Dx and detect mets How are these Tx

CT then lung biopsy Somatostatin receptor scintograpy Resection

? hyper secreted hormone is associated w/ lung carcinoid tumor Hypertriglyceridemia is defined as ? When is medical intervention indicated and what is used

ACTH leading to Cushing's Syndrome Fasting TG >150mg MIld: 150-400 Mod: 500-886 Sev: >886 >886: Fibrates: Gemfibrozil, Fenofibrate Nicotinic acid Fish oil

? 4 classes of meds lower TG levels and by ? much ? is the MC manifestation of TB

Fibrates: 30-50% Niacin: 30-50% Omega-3: 30-50% Lova/Atorvastatin: 20-40% Pulmonary tB

What makes a PPD positive at 5mm What makes a PPD positive at 10mm ? size is positive if Pt has no RFs

Active HIV CXR w/ TB granuloma Organ transplant Close contact w/ TB ``` Homeless IVDA Medical employees Endemic area immigrant <4y/o ``` 15mm

How is latent TB Tx ? type of reaction is the PPD test ? TB tx needs to be used w/ supplemental nutrition

Rifampin x 4mon INH x 9mon Type 4- mediated by T-lymphocytes INH w/ B6 pyridoxine to prevent peripheral neuropathy

# Define Cheyne-Stokes respiration What causes this respiratory pattern How is this type of breathing Dx

Apnea followed by faster/deeper breathing followed by decreasing depth/frequency until apena again Delayed arterial CO2 detection Delayed ventilation Sleep study, polysomnogram

Cheyne Stokes breathing can be seen during ? five times ? gas is responsible for controlling respiration C Diff is MCC by ? ABX

``` Prematurity Altitude acclimation Neuro dz CHF End of life ``` CO2 Flqn- Cipro Clindamycin Cephalosporin PCNs

? colonoscopy finding suggests C Diff What three ABX are used for Tx What are the 3 RFs for C Diff

Pseudomembranous colitis PO Vanc PO Fidaxomicin Metronidazole ABX Hospitalization Inc age

? is the cardinal Sx of bronchitis ? PE finding is rare and it's presence should change the Dx How is this Tx

Cough x 5days Fever- pneumonia, flu Dextromethophan Guaifanesin Codein Wheeze/Pulm Dz- albuterol

? is the first line ABX therapy for pertussis ? lab result indicated a perforated appendix ? ABX is used pre-operatively

MacrolideL ACE-mycin Elevated total serum bilirubin 2g Cefoxitin PCN allergy: Clinda w/ Cipro or Levo

+ psoas sign indictes appendix is located ? + obturator sign indicates appendix is located ? + McBurney's indicates appendix is located ?

Retro-cecal/peritoneum Retrocecal Pelvis Iliac fossa

? causes Torsades ? is the MCC of chronic gastritis What is used for Triple and Quad Therapy

QT prolongation H Pylori in antrum/body- Gram neg rod 3: Clarithromycin Omeprazole Amox (Metro) 4: Omeprazole Tetracycline Metro Bismuth

? is the MC RF seen in esophageal adenocarcinomas Biggest RF for Adenocarcinoma Biggest RF for SCC

GERD Barretts Smoke and ETOH

What two parts of the colon are most susceptible to ischemic colitis ? is the gold standard for Dx What are the two 'watershed' areas of this condition

Splenic flexure Rectosigmoid junction Colonoscopy Superior/Inferior mesenteric artery area Inferior/Hypogastric artery area

? is the proposed mechanism for developing non-alcohol fatty liver dz ? has proven to be the best Tx What vaccines do they need

Insulin resistance Weight loss Hep A/B

? amount of alcohol consumption is estimated to increase health risks ? is the MC systemic vasculitis What causes the Sxs associated w/ this MC

Men: >14 drinks/wk Women: >7 drinks/wk GCA Intima hyperplasia

? is the two biggest RF for GCA ? other rheumatological dx is associated w/ this condition What are two common lab results

Age, almost never <50 Scandanavian descent Polymyalgia rheumatica- morning stiffness/ache in pelvis/shoulder girdles Normochromic anemia Normal leukocytes

How is GCA Tx in Pts who can't tolerate CCS ? is the best antiplatelet regiment for PTs having urgent PCI How does this change if Pt is having nonurgent/elective PCI

Tocilizumab Methotrexate ASA and Prasugrel/Ticagrelor ASA and Clopidogrel

Bulk forming laxatives Softener laxatives Stimulant laxatives Lubricant laxatives Prokinetic laxatives

Psyllium Methylcellulose Docusate Senna Bisacodyl Castor oil Mineral oil Lactulose Sorbitol Polyethylene glycol Tegaserod Metoclopramide

Identified inferior MI, next best step? ? type of respiratory noises heard during asthma attack How is pneumonia Tx if Pt has had ABX <90days

Repeat EKG w/ right sided leads Expiatory wheeze Fluroquinolone or, Macrolide and Beta-lactam