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
