Last Minute Flashcards
1
Q
PE Work-up?
A
Wells criteria
0-1 low
2-6 intermediate
7+ high
> 4 likely
<4 unlikely
If low risk -> PERC
- If 0 - stop
- If 1+ - D-Dimer
If intermediate - D-Dimer
-If positive - CT-PE
If high - CT-PE
If CT-PE is negative with high pre-test probability, get another study (LE doppler or VQ scan)
Use VQ scan in high or intermediate risk with contraindication to CT
2
Q
Wells criteria?
A
Symptoms +3 P# #1 on DDx +3 Tachycardic +1.5 Immobilization +1.5 Previous DVT/PE +1.5 Hemoptysis +1 Malignancy \+1
3
Q
PERC?
A
0 points if:
<50 HR <100 OT sat >94% on RA No unilateral leg swelling No hemoptysis No surgery/trauma within 4 weeks No hx VTE No estrogen
4
Q
Rx options for VTE?
A
Heparin drip
LMWH
Warfarin
NOACs
5
Q
Rx VTE?
A
NOACs (dabigatran, rivaroxaban, apixaban, edoxaban)
6
Q
Rx VTE + cancer?
A
LMWH
7
Q
Rx VTE if once daily oral therapy preferred?
A
NOAC or Warfarin
8
Q
Rx VTE with liver disease causing coagulopathy?
A
LMWH
9
Q
Rx VTE with renal disease?
A
Warfarin (NOAC, LMWH contraindicated)
10
Q
Rx VTE with CAD?
A
NOAC (NOT dabigatran) or Warfarin
11
Q
Rx VTE if pregnant?
A
LMWH
12
Q
When is thrombolysis indicated in DVT/PE?
A
Patients who are hemodynamically unstable and at risk for death
13
Q
Indications for IVC filter?
A
Major contraindication to anticoagulation
Recurrent VTE despite therapeutic anticoagulation
Chronic reucrrent VTE with pulmonary HTN
14
Q
Most common cause of major upper GI bleed?
A
PUD
15
Q
Most common cause of major lower GI bleed?
A
Diverticulosis
16
Q
Manage pt with GI bleed?
A
Protect the airway
2 large bore IVsIV fluids
Order blood/transfuse if needed
Consult GI for upper endoscopy
17
Q
Dx HIV?
A
- ELISA - screens for Ab. If positive ->
- Western plot
- Quantitative PCR
18
Q
In HIV, what i the best indicator of the status of the immune system/risk of OI and disease progression?
A
CD4 count
19
Q
Risks of OI at 200-500 CD4?
A
Zoster TB Lymphoma Bacterial pneumonia Kaposi
20
Q
OI at CD4 <200
A
PJP
21
Q
OI at CD4<100
A
Candidiasis
CMV
HSV
22
Q
OI at CD4 <50
A
CM
MAC
23
Q
What is used to assess response to therapy in HIV?
A
Viral load
24
Q
Rx HIV?
A
Triple HAART therapy:
2 NRTs + EITHER a NNRT or Protease inhibitor
25
Prophylaxis/timing for PJP in HIV?
<200
| TMP/SMX
26
Prophylaxis for TB in HIV?
Yearly screening with PPD
| If positive, isoniazid + pyridoxine
27
Prophylaxis/timing for MAC in HIV?
<200
| Clarithro and azithro
28
Prophylaxis/timing for Toxo in HIV?
<100
| TMP/SMX
29
Rx PJP in HIV?
TMP-SMX for 3 weeks, steroids if hypoxic or elevated A-a graident
30
Rx candidiasis in HIV?
Oral/esophageal - nystatin swish and spit
Local - azoles
Disseminated - amphotericin
31
Dx cryptococcus neoformans?
CSF cryptotococcal antigen
| India ink
32
Rx cryptococcus neofrmans?
Amphotericin B for 10-14 days
| Oral fluconazole 8-10 weeks + forever
33
Rx CMV in HIV?
Ganciclovir or foscarnet
34
Rx Toxo in HIV?
Sulfadiazone + pyrimethamine
35
Dx autoimmune hepatitis
Anti-smooth muscle antibodies, liver/kidney microsomal antibodies
36
Rx autoimmune hepatitis
Steroids
37
What is PBC?
Autoimmune disease seen in middle-aged women, destruction of bile ducts with portal inflammation and scaring
Elevated alk phos
+AMA
38
Rx PBC?
Symptomatic with ursodeoxycholic acid to slow progression
39
What is PSC?
Men
Thickening of bile duct walls, narrows lumen
Dx - ERCP/PTC (beading)
40
Rx PSC?
Symptomatic with cholestyramine (itching)
41
Dx cholecystitis?
#1 RUQ U/S
CT - as accurate as U/S, more sensitive for complications
HIDA if U/S inconclusive
If normal, rule out cholecystitis. + means gallbladder not visualized. If not visualized after 4 hours, dx confirmed
42
DDx - conjugated hyperbilirubinemia?
1. Decreased intrahepatic excretion of bilirubin (hepatocellular disease, DJ/Rotor, drug-induced, PBC, PSC)
2. Extrahepatic biliary obstruction (gallstones, cholangiocarinoma, etc.)
43
DDx - unconjugated hyperbilirubinemia
1. Excess bilirubin production (hemolytic anemia)
2. Reduced hepatic uptake of bilirubin or impaired conjugation (Gilbert's, drugs, Crigler-Najjar, diffuse liver disease - hepatitis, cirrhosis)
44
If unconjugated what labs?
CBC, reticulocyte count, haptoglobin, LDH, peripheral smear (hemolysis?)
45
If conjugated what labs?
LFTs
46
Work-up for lung nodule?
1. Compare with past imaging
Options:
- Observation (serial imaging with CT)
- Biopsy (FNA)
- Removal (gold standard/definitive Rx for malignant)
47
Paraneoplastic syndrome - ACTH/SIADH/Lambert Eaton - what type of cancer?
Small cell carcinoma
48
Paraneoplastic syndrome - Hypercalcemia via PTHrP - what type of cancer?
Squamous cell carcinoma
49
Paraneoplastic syndrome - carcinoid syndrome - what type of cancer?
Bronchial carcinoid tumor
50
Rx NSCLC
Surgery (gold standard)
Radiation very good
Chemo bad
51
Rx small cell lung cancer
Chemo + radiation
| Surgery bad
52
Minimum PFT requirement for lung cancer resection
Pre-op
| FEV1 >2 L or >1.5 L if lobectomy
53
Walk through acid-base disorders
1. [H+] = 24 x (pCO2/HCO3)
7.10 -> 70, 7.20 -> 60 etc
2. pH?
>7.4 - alkalosis
<7.4 - acidosis
3. pCO2?
If alkalosis, pCO2 <40 - respiratory, pCO2>40 - metabolic
4. If acidosis, pCO2 <40 - metabolic, pCO2 >40 - respiratory
5. Primary metabolic:
-Alkalosis - pCO2 should be 40-55
-Acidosis - calculate predicted pCO2 (1.5 x HCO3) + 8 +/-2
-If actual too high - resp acidosis
-Ifa ctual too low -a ddl resp alk
6. AG?
7. Correct the bicarb (AG - 12 + HCO3)
If >30 - addl metabolic alk
If <23 - addl non-AG metabolic acidosis
54
DDx - AG metabolic acidosis
```
Methanol/metformin
Uremia
DKA/alcoholic ketoacidosis
Paraldehyde
Isoniazid/Iron
Lactic acidosis
EtOH/Ethylene glcyol
Rhabdo/renal failure
Salicylates
```
55
DDx - non-AG metabolic acidosis
```
Hyperalimentation (TPN)
Acetaloamide
RTA
Diarrhea
Uretero-pelvic shunt
Post-hypocapnia
Spironolactone
```
56
DDx - metabolic alkalosis?
```
Contraction
Licorice
Endocrine (Conn's, Cushing's, Bartter's)
Vomiting/NG suction
Excess alkali
Refeeding
Post-hypercapnea
Diuretics
```
57
Which alkalosis acidosis have high urine chloride?
```
Licorice
Endo
Excess alkali
Refeeding
Diureitcs
```
58
DDx - acute respiratory acidosis?
Hypoventilation
59
Chronic respiratory acidosis?
COPD/Restrcitve lung dsiease
60
Ddx - resp alkalosis?
Hyperventilation
61
Calculate the osmolar gap?
Predicted osmolality = Na + (glucose/18) + BUN/2.8
Compare with serum osm
Indicates toxic ingestion
62
Walk through hyponatremia
1. Plasma osmolality
(Calculate effective = measured - BUN/2.8)
If low (<280) - true hyponatremia
if normal (280-285) - pseduohyponatremia
if high (>285) - hypertonic (hyperglycemia, mannitol, sorbitol, contrast)
2. If hypotonic, assess volume status
-Low - hypovolemic
-Normal - euvolemic
-High - hypervolemic
3. Urine Na
-Expected to be low
-If >20, this indicates salt-wasting nephropathy, diuretics, hypoaldosteronism
4. Urine Osm
<100 - indicates appropriate dilution of urine
>100 - SIADH, CHF, hypothyroidism, adrenal insufficiency
63
DDx - euvolemic hypotonic hypernatremia
SIADH
Psychogenic polydipsia
Post-op
Hypothyroidism
64
DDx - hypervolemic hypotonic hypernatremia
CHF, nephrotic, liver disease
65
Joints NOT seen in OA?
Wrists and ankles
66
Rx acute gout?
NSAIDs
2nd line - colchicine (contra in renal insufficiency)
3rd line - steroids
67
Long term gout rx?
Allopurinol/febuxostat if increased production
Probenecid if decreased excretion
68
Prevention for gout?
Colchcine, low dose pred, NSAIDs
69
Key findings in joint fluid analysis?
WBC >50000 = septic
PMNs >75% = septic
WBC >2000 = inflammatory
70
Correct ESR for age/gender?
```
M = age/2
F = age+10/2
```
71
Correct CRP for age/ggender?
```
M = age/5
F = age+30/5
```
72
Ab for RA?
+RF (sensitive, not specific)
| anti-CCP (sensitive/specific, poor prognostic factor)
73
Rx RA: short-term, mild, mod/severe
Short-term: prednisone
Mild: NSAIDs or hydroxychloroquine or sulfasalazine
Mod/Severe: oral weekly MTX (#1)
Leflunomide
Anti-TNF alpha
other biologics
74
Rx spondylos?
Similar to RA, but no hydroxychloroquine in psoriasis (can worsen), use TNF-alpha if axial involvement
75
Dx SLE?
4+
```
Serositis
Oral ulcers
Arthritis
Photosensitivity
Blood disorders (penias)
Renal involvement
ANA
Immunological phenomena (Ab)
Neurologic
Malar rash
Discoid rash
```
76
Ab in SLE?
ANA (sensitive)
anti-ds-DNA (specific)
anti-smith (specifiic)
77
SLE Ab to monitor flares?
anti-dsDNA
78
Rx SLE?
Short-term - prednisone
Mild/cutaneous - hydroxychloroquine
Mod/severe - azathioprine/MMF
Severe - MMF/ritoximab, cyclophos
79
Ab in systemic sclerosis?
CREST - anti-centromere
| Diffuse - anti-scl70
80
Ab in Sjogren's?
SS-A
SS-B
Often ANA, RF
81
Ab in polymyositis?
Anti-Jo-1
82
Rx COPD Stages 1-4
1 - SABA
2 - + LABA or LACA
3 - + inhaled cort
4 + O2
