IMC-RR Flashcards
? 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
? 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
? 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
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
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
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
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
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
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
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%
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
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
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
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
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
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
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
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
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
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
? 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
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
? 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
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
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
