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Medicine Flashcards

1
Q

Three main types of ACS

A

Unstable angina (no elevated enzymes and no EKG changes), NSTEMI (elevated enzymes without EKG ST elevations), STEMI

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2
Q

Diagnostic criteria for acute pericarditis

A

At least two of the three - Pleuritic chest pain, Friction Rub, Diffuse concordant ST-segment elevation

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3
Q

Preferred therapy for STEMI

A

PTCA and stent placement

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4
Q

First step in management of a right ventricular MI

A

Volume expansion (patient will likely be hypotensive)

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5
Q

First step in management of non-cardiac chest pain

A

Empiric PPI treatment

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6
Q

Most common cause of severe bradycardia

A

3rd degree heart block

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7
Q

Which heart block is characterized by progressive prolongation of the PR interval until a dropped beat occurs?

A

Mobitz type I (Wenckebach)

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8
Q

Where are the defects in Mobitz I and Mobitz II and which progresses to 3rd degree heart block?

A

Mobitz I - in the AV node (usually), Mobitz II - in the bundles (infranodal). Type II can rapidly progress to 3rd degree heart block

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9
Q

Dosing of beta-blocker in stable angina

A

Titrate to achieve resting HR approximately 55-60 and approximately 75 percent of HR that produces angina with exertion

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10
Q

What finding excludes coronary ischemia or infarction in chest pain patients?

A

Normal wall motion on echo

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11
Q

Standard treatment for chronic stable angina

A

Aspirin, Beta blocker, ACE inhibitor, nitroglycerin, and a statin

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12
Q

Screening strategy for CAD in adults who are low risk and asymptomatic

A

None. No routine testing necessary

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13
Q

EKG findings in Wolf-Parkinson-White

A

Short PR interval, tachycardia, and a delta wave (early upshoot of the QRS complex)

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14
Q

In patients with MI, what medication reduces infarct size, decreases frequency of recurrent MI, and improves short and long term survival?

A

IV beta blockers

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15
Q

New systolic murmur and respiratory distress several days after an acute MI

A

Likely either Ventricular Septal Rupture or Mitral Regurg

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16
Q

Alternative to PTCA in STEMI and time frame

A

Thrombolytic therapy, within 12 hours of onset of chest pain

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17
Q

Features of right ventricular infarction

A

Inferior wall ST-elevation, hypotension, clear lung fields, jugular venous distention

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18
Q

Findings in SA node dysfunction

A

Sinus arrest, sinus exit block, sinus bradycardia

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19
Q

Donepezil side effects

A

Increased vagal tone, bradycardia, AV block

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20
Q

Treatment for hemodynamically unstable patients with an arrhythmia

A

Electric cardioversion

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21
Q

Most common treatment strategy for a-fib

A

Rate control and long-term anticoagulation

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22
Q

Long term sequelae of PVCs at rest

A

Little or no increased risk of CV events (if heart otherwise structurally normal)

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23
Q

Primary eligibility criterion for ICD implantation in setting of heart failure

A

LVEF less than 35 percent

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24
Q

SIRS criteria

A

Temp less than 96.8 or over 100.4, HR over 90, RR over 20 or PaCO2 less than 32, WBC less than 4, over 12, or greater than 10 percent bands

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25
Q

Criteria for diagnosing SBP

A

Greater than 250 ANC on tap, or tap grows in culture (either criteria sufficient)

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26
Q

What additions to standard post-MI care are necessary for a patient with cardiac arrest occuring within 48 hours of an acute, transmural MI?

A

None

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27
Q

Benefit to digoxin in heart failure

A

Alleviates symptoms and decreases hospitalizations, but provides no survival benefit

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28
Q

A major cardiac condition associated with pregnancy

A

Heart failure secondary to peripartum cardiomyopathy (LVEF below 45 percent 3-6 mo after delivery)

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29
Q

What treatments are indicated for all patients with systolic HF regardless of symptoms or functional status?

A

ACE-inhibitor and B-blocker

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30
Q

What medications reduce mortality in patients with NYHA class III or IV HF?

A

ACE-inhibitors, B-blockers, spironolactone

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31
Q

What valvular anomaly and arrhythmia together can be rapidly fatal?

A

AS with a-fib

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32
Q

Short, soft, midsystolic murmur in the elderly

A

Often aortic sclerosis (benign)

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33
Q

What maneuvers increase the murmur of hypertrophic cardiomyopathy?

A

Valsalva and squat-to-stand

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34
Q

When and where is the murmur of chronic AR best heard?

A

Right after S2 with patient leaning forward, in end-expiration at the second right or third left intercostal space

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35
Q

Classic murmur of MVP

A

Midsystolic click followed by a late apical systolic murmur

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36
Q

Next step in management for a BI-RADS 1-3 mass in a woman over 30 years old

A

Ultrasound (will distinguish cystic from solid mass). If cystic aspirate, if solid biopsy by FNA, core, or excision.

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37
Q

Colorectal cancer screening in patients with first-degree relative with CRC

A

Initiate at 40 years old or 10 years earlier than age of diagnosis of youngest family member diagnosed. If normal, repeat every 3-5 years.

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38
Q

How long after diagnosis should IBD patients begin annual colorectal cancer screening?

A

8 years

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39
Q

Screening guidelines for lung cancer

A

Screening for early-stage lung cancer in asymptomatic patients is not recommended

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40
Q

When is follow up of an incidentally noted pulmonary nodule not necessary?

A

If the patient is low risk and the nodule is less than 4 mm

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41
Q

Follow up recommendations for an incidentally noted small (less than 4 mm) lung nodule in a patient at risk for lung cancer?

A

Repeat CT in 12 months. Even in at risk patients very small nodules are not likely to be malignant.

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42
Q

First line treatment for limited stage small cell lung cancer?

A

Chemotherapy (a platin and etoposide or irinotecan) and radiation. Micromets are almost always present in SCLC

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43
Q

PSA indications for a prostate biopsy

A

PSA greater than 4.0 or rise greater than 0.75 per year

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44
Q

Treatment for asymptomatic metastatic prostate cancer

A

Androgen deprivation therapy (either surgical castration or leuprolide)

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45
Q

Pap smear guidelines for each age group

A

1) Begin within 3 years of sexual activity onset or at 21, whichever is first. 2) Annually until 30, at which point every 3 years if 3 consecutive negatives, 3) After 65 no further screening if recent smears negative

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46
Q

Gradually enlarging, well-demarcated, erythematous scaly plaque

A

Bowen disease (SCC in situ). Can resemble superficial basal cell carcinoma, psoriasis, eczema

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47
Q

Dark blue or black berry like lesion, usually symmetric, elevated, and one color

A

Nodular melanoma

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48
Q

Pink pearly papule or nodule with telangiectasias and often flecks of melanin pigment

A

Basal cell carcinoma

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49
Q

Rapidly growing, nontender, firm nodules with depressed keratotic centers

A

Keratocanthoma (a type of SCC)

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50
Q

First line treatment for cancer-related dyspnea and dyspnea related to end-stage cardiopulmonary disorders

A

Morphine

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51
Q

First line treatment for delirium

A

Antipsychotics such as halodol (but there is no FDA approved treatment available for delirium)

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52
Q

Distinction between migraine and tension-type headache

A

Patients with tension-type headache are not disabled and can carry out ADLs normally. Also, migraine is often associated with other features such as aura, nausea and vomiting, etc.

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53
Q

Differential for thunderclap headache

A

SAH, migraine, venous thrombosis, diffuse cerebral vasculopathy (Call-Fleming syndrome), subdural hematoma, accelerated hypertension, pituitary apoplexy, cervical artery dissection, cocaine, serotonergic drugs, perimesencephalic hemorrhage

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54
Q

Indication for migraine prophylaxis and first line therapy

A

2 or more days of headache per week. Propanolol. Other options are timolol, topiramate, valproic acid, amitryptiline, metoprolol, relaxation therapy, biofeedback

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55
Q

Cardinal features of Parkinsons disease

A

Resting tremor, bradykinesia, rigidity, postural instability

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56
Q

First line treatment for essential tremor

A

Propanolol

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57
Q

What is not covered by the N meningitidis vaccine?

A

Does not provide protection against N meningitidis serogroup B meningitis

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58
Q

Empiric therapy for acute bacterial meningitis in an older adult

A

Third generation cephalosporin, vancomycin, ampicillin

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59
Q

When do you hold antihypertensive meds in a patient with acute stroke?

A

Uncomplicated stroke in patient without ACS, aortic dissection, or heart failure when SBP less than 220 and DBP less than 120

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60
Q

Progressive extremity weakness, parasthesia, areflexia

A

Guillain-Barre

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61
Q

Indication for zoster vaccination

A

All patients 60 and older without contraindications

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62
Q

Indications for tetanus booster and tetanus immune globulin respsectively in pts who come in with wounds

A

Booster - Last booster more than 5 years ago with clean wound or more than 10 years ago. Globulin - Pt not completed primary series or unclear immunization history

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63
Q

Ages of indication for the HPV vaccine

A

9 to 26

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64
Q

USPSTF endorsed colorectal cancer screening methods for average-risk patients

A

Annual home stool testing, colonoscopy every 10 years, flex sig every 5 years together with high-sensitivity fecal occult blood testing every 3 years

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65
Q

Prodrome of vasovagal syncope

A

Nausea, lightheadedness, diaphoresis. Keep in mind that brief myoclonic jerking during an episode of vasovagal syncope is not uncommon. Presyncopal prodrome longer than 10 seconds is highly specific for vasovagal (vs seizure for example).

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66
Q

A classic sign of syncope due to heart block (as opposed to other causes)

A

Forehead bruise (or other injuries from falls). Typically heart block produces more sudden syncope than other causes like vasovagal.

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67
Q

First line evaluation for recurrent syncope

A

Implanatable loop recorder

68
Q

Indications for pharmacologic therapy in patients with bereavement

A

Symptoms of major depression for at least 2 consecutive weeks 8 or more weeks after their loved ones death

69
Q

What medication has been shown to be useful in treating alcohol dependence?

A

Naltrexone. Disulfiram is still commonly used but there is inconclusive evidence on its efficacy.

70
Q

Components of the CAGE questionaire

A

Cut down, Annoyed, Guilty, Eye opener

71
Q

3 conditions that account for 99 percent of chronic coughs in patients who do not smoke, are not on an ACE, and have a normal chest x-ray

A

Upper airway cough syndrome (postnasal drip), asthma, and GERD. Most appropriate step in management is trial of antihistamine/decongestant

72
Q

Common cause of nausea and vomiting after bariatric surgery

A

Stomal stenosis (evaluate with upper endoscopy)

73
Q

Treatment for moderate menstrual bleeding

A

Medroxyprogesterone acetate

74
Q

Test of choice to evaluate secondary amenorrhea in the setting of negative pregnancy test, and negative tests for thyroid disorders, ovarian dysfunction, and hyperprolactinemia

A

Progestin withdrawal challenge (if normal suggests chronic anovulation with estrogen present, if abnormal suggests abnormal estrogen secretion or outflow tract obstruction)

75
Q

Test of choice for abnormal uterine bleeding in a woman over 35

A

Endometrial biopsy

76
Q

Targetoid skin lesions with mucosal involvement, sometimes related to infection such as HSV-1 or HSV-2

A

Erythema multiforme

77
Q

Treatment of choice for zoster

A

Oral famcicyclovir or valacyclovir. IV acyclovir can be used in severe zoster cases (such as zoster ophthalmicus), but PO regimens are preferred in uncomplicated cases.

78
Q

Treatment for urge incontinence

A

Oxybutynin or tolterodine (anticholinergics)

79
Q

Systemic hypertension, radial to femoral delay, rib notching on chest xray

A

Coarctation of the aorta

80
Q

Cutoff for Stage 2 hypertension and best initial therapy

A

Greater than 160 over greater than 100. Begin with two drug therapy (eg diuretic and ACEi)

81
Q

Range for prehypertension

A

Systolic 120-139, Diastolic 80-89

82
Q

Fasting glucose, random glucose, and A1C cutoffs for diabetes diagnosis

A

Fasting - Over 125, Random over 199, A1C over 6.4 percent

83
Q

Criteria for a diagnosis of DKA

A

Blood glucose less than 250, AGMA (ph less than 7.3), CO2 below 15, positive serum or urine ketones

84
Q

Target LDL for patients with zero or one CV risk factor

A

Below 160

85
Q

Is radioactive iodine uptake testing useful in evaluating hypo or hyperthyroidism?

A

Hyperthyroidism

86
Q

Guidelines for biopsy of a thyroid nodule

A

Biopsy any nodule greater than 1 cm in diameter or if patient has cancer risk factors

87
Q

Use of thyroid scan and radioactive iodine uptake testing in evaluating thyroid nodules

A

Order if TSH level is suppressed. If the nodule is found to be hyperfunctional it makes cancer very unlikely

88
Q

Changes in levothyroxine requirements during pregnancy in hypothyroid patients

A

Needs may increase 30 to 50 percent, primarily during first trimester

89
Q

Best tests to evaluate hypothyroid pregnant patients

A

TSH and total T4 (free T4 not as accurate). Keep total T4 at around 1.5 times normal and TSH in lower end of normal range

90
Q

First line treatment for Graves disease

A

Atenolol and methimazole

91
Q

Euthyroid sick syndrome

A

Seen in ICU patients, will have low TSH, T3, and T4. Manage with repeat TFTs in 6-8 weeks

92
Q

Evaluation of an adrenal incidentaloma

A

Metanephrine levels and overnight dexamethasone suppression test (even if patient is asymptomatic)

93
Q

Best screening test for primary hyperaldosteronism

A

Serum aldosterone to plasma renin ratio. If greater than 20 it is consistent with primary hyperaldosteronism

94
Q

Best test to diagnose pheochromocytoma

A

Abdominal CT scan. Next best test is MIBG scan (more specific but less sensitive)

95
Q

First line therapy for osteoporosis

A

Bisphosphonates, vitamin D, and calcium

96
Q

Recommendations for DEXA scans as screening tests

A

Women age 65 and older and women 60-64 at increased risk of osteoporosis (weight below 154 lbs)

97
Q

Test of choice for nephrolithiasis

A

Abdominal CT (x-ray works as well but has low sensitivity and specificity)

98
Q

First test in acute abdomen

A

Supine and upright abdominal radiographs to look for obstruction

99
Q

Test for diagnosing radiation proctitis

A

Flex sig

100
Q

Indications for upper endoscopy in patient with dyspepsia

A

Over 55 or alarm features (unexplained IDA, unintentional weight loss, dysphagia, odynophagia, palpable abdominal mass, jaundice)

101
Q

Classic finding of mesenteric ischemia

A

Pain out of proportion to exam

102
Q

First line therapy for UC

A

Mesalamine (or other 5-ASA). Next line is corticosteroids, then Azathioprine or 6-MP or Infliximab

103
Q

Chronic watery diarrhea without bleeding. Onset in 6th decade of life, more common in women

A

Microscopic colitis. Diagnosis made by histologic examination of biopsy

104
Q

Two ways to distinguish vWF disease from Hemophilia A

A

Hemophilia A does not include prolonged bleeding time (no platelet dysfunction), and cannot be transmitted from father to son (because it is X-linked)

105
Q

Transient aplastic crisis in patients with chronic hemolytic anemia

A

Parvovirus B19 (most commonly)

106
Q

Cardiovascular abnormality which is a common cause of morbidity and mortality in patients with sickle cell

A

Pulmonary hypertension

107
Q

Treatment for sickle cell acute chest syndrome

A

Exchange transfusion

108
Q

Test of choice for osteonecrosis

A

MRI

109
Q

Triad of TTP

A

Microangiopathic hemolytic anemia, thombocytopenia with normal coagulation, CNS symptoms

110
Q

First line treatment for ITP

A

Corticosteroids. Splenectomy can be considered if patient fails steroids and other therapies

111
Q

Anemia, proteinuria, hypercalcemia, renal failure, and decreased anion gap

A

Multiple myeloma

112
Q

Criteria for MGUS

A

Serum monoclonal protein level less than 3.0 g per dL without overt clinical features of myeloma and less than 10 percent plasma cells in marrow

113
Q

Young woman with unusual fever pattern including very high spikes and rapid defervescence without chills. Normal physical and lab findings

A

Factitious fever

114
Q

What improves survival in patients with severe sepsis and an APACHE score of 25 or greater?

A

Activated Protein C administration. Do not give however, if patient is bleeding or platelet count is below 30,000.

115
Q

Difference between SIRS and sepsis

A

Sepsis is SIRS plus a documented infection

116
Q

First line treatment for otitis media in adults

A

Amoxicillin

117
Q

Centor criteria

A

Fever, tonsillar exudates, tender anterior cervical lymphadenopathy, abscence of cough. Higher scores suggest strep pharyngitis

118
Q

First line treatment for acute sinusitis

A

Symptomatic management (antibiotics are rarely helpful)

119
Q

First line treatment for asymptomatic bacteriuria in pregnant patient

A

Ampicillin, amoxicillin, or nitrofurantoin (cipro and trimethoprim are both category C)

120
Q

What should you suspect in a patient who has a UTI susceptible to their antibiotic that fails to clear?

A

Prostatic abscess (if of course its a male patient). There are many other causes of failure to clear UTI, but this one is easy to forget

121
Q

First line treatment for pyelonephritis

A

Quinolones (usually cipro)

122
Q

Treatment of choice for ambulatory patient with PID

A

IM ceftriaxone and oral doxycycline

123
Q

Initial TB therapy

A

Isoniazid, rifampin, pyrazinamide, ethambutol

124
Q

Management of a patient about to go on TNF-a inhibitor therapy who is found to have a positive PPD

A

Treat with isoniazid for 9 months and then reapproach beginning TNF-a inhibitor therapy

125
Q

Treatment of choice for patient with lung abscess related to aspiration

A

Ampicillin-sulbactam (provides good coverage of b-lactamase oral anaerobes)

126
Q

Patients who require infective endocarditis prophylaxis before dental procedures

A

Prosthetic valves, hx of endocarditis, unrepaired cyanotic congenital heart disease, repaired cyanotic congenital heart dz within 6 months of repair or with residual defects or abnormalities, cardiac transplant recipient. Do not ppx other patients

127
Q

Treatments of choice for infective endocarditis prophylaxis

A

1st line - amoxicillin. If cant take PO - amp, cefazolin, or ceftriaxone IM or IV. If PCN allergic - clinda, azithro, or clarithro

128
Q

Management of suspected osteomyelitis

A

Bone biopsy and culture

129
Q

In what type of infection are fever and leukocytosis frequently absent

A

Prosthetic joint infection. Pain is often the predominant or only symptom

130
Q

Treatment of an acute gout attack

A

NSAIDs, corticosteroids, or colchicine

131
Q

Goal uric acid levels in patient with gout

A

Less than 6.0

132
Q

First line uric acid lowering therapy

A

Low-dose colchicine and allopurinol

133
Q

Pain in what location is particularly characteristic of osteoarthritis?

A

Base of the thumb

134
Q

X-ray findings in RA

A

Erosions of cartilage and bone

135
Q

What test do you need to conduct in a patient with newly diagnosed psoriatic arthritis?

A

HIV test. Untreated HIV is associated with explosive-onset widely distributed psoriasis, which may progress to psoriatic arthritis

136
Q

How do you differentiate the uveitis in ankylosing spondylitis and that in sarcoid or vasculitis?

A

In AS it is an anterior uveitis, and the eye is red and painful. Sarcoid and vasculitities usually have posteior uveitis with the eye not red or painful

137
Q

Best test for diagnosing ankylosing spondylitis

A

MRI of the sacroiliac joints. It is more sensitive and specific than HLA-B27 testing

138
Q

Treatment for suspected lupus glomerulonephritis

A

High dose corticosteroids

139
Q

Pulmonary condition associated with dermatomyositis and polymyositis

A

Interstitial lung disease with progressive pulmonary fibrosis and secondary pulmonary arterial hypertension. One of the leading causes of death in poly and dermatomyositis

140
Q

Test of choice for polyarteritis nodosa as the cause of renal failure

A

Angiography of the renal arteries

141
Q

Reduced FEV1 and FVC, normal FEV1 to FVC ratio, reduced TLC and decreased DLCO

A

Interstitial lung disease

142
Q

Portal hypertension, dyspnea, platypnea, hypoxemia with orthdeoxia, cyanosis, and clubbing

A

Hepatopulmonary syndrome

143
Q

Primary cause of morbidity in patients with systemic sclerosis

A

Pulmonary artery hypertension

144
Q

Lights criteria

A

A pleural effusion is exudative if 1 of the following is true. 1) Pleural protein to serum protein ratio is greater than 0.5. 2) Pleural fluid LDH to serum LDH is greater than 0.6. 3) Pleural fluid LDH is over 0.6 or two-thirds upper limit normal

145
Q

Pneumonia associated pleural effusions that need chest tube drainage

A

Any of the following. 1) Loculated, 2) pH less than 7.2, 3) glucose less than 60, 4) LDH over 1000, 5) positive gram stain or culture, or 6) gross pus

146
Q

Differential physical exam findings in pleural effusion versus lobar pneumonia

A

Effusion - decreased tactile fremitus, Pneumonia - increased tactile fremitus. Both have decreased breath sounds and dullness to percussion

147
Q

Treatment for acute COPD exacerbation

A

Oral or IV corticosteroids, short-acting bronchodilator, supplemental oxygen, AND antibiotics (usually fluoroquinolone or third-gen ceph with a macrolide)

148
Q

In a COPD exacerbation you should titrate oxygen flow rate to reach what O2 sat goal?

A

Around 90 percent (being overly aggressive with supplemental oxygen can lead to CO2 retention)

149
Q

Bilateral basilar emphysema in a patient younger than 45

A

Rule out alpha-1-antitrypsin deficiency

150
Q

Subacute pulmonary disease with bilateral alveolar-filling opacities on chest x-ray

A

Cryptogenic organizing pneumonia

151
Q

Most common known causes of diffuse parenchymal lung disease

A

Connective tissue diseases, drugs, environmental

152
Q

When heparin is bridged to warfarin, what is the minimum duration of the heparin therapy?

A

Minimum three days from when warfarin is started, and you must have one INR in goal range (usually over 2) before stopping heparin

153
Q

Benign cause of proteinuria in young adults

A

Orthostatic proteinuria. Etiology unknown, usually resolves on its own

154
Q

Acute kidney injury, sterile pyuria, leukocyte casts

A

Acute interstitial nephritis

155
Q

Between ATN and AIN which usually includes systemic symptoms and what are they?

A

AIN. Rash, pruritis, eosinophilia, fever

156
Q

Common drugs for ATN and AIN respsectively

A

ATN - cisplatin, aminoglycosides, radiocontrast. AIN - bactrim, pencillins, cephalosporins

157
Q

Absolute indications for kidney replacement in patients with stage 5 CKD (GFR less than 15 or on dialysis)

A

Uncontrollable hyperkalemia or hypervolemia, AMS, pericarditis, bleeding-diathesis secondary to uremic platelet dysfunction

158
Q

Winters formula

A

Expected PCO2 equals (1.5 x Bicarb + 8) +- 2

159
Q

Bicarb compensation in respiratory acidosis

A

Acute - Bicarb increases 1 for every 10 of PaCO2. Chronic - Bicarb increases 1 for every 4 of PaCO2

160
Q

Urine anion gap calculation

A

Urine Na + Urine K - Urine Cl

161
Q

Urine Anion Gap (UAG) interpretation

A

Normal is 30-50. NAGMA of extrarenal origin will have a large negative UAG. Renal NAGMA (such as RTA) will have a positive (even if below normal range) UAG.

162
Q

Type of acid base disturbance in DKA

A

AGMA

163
Q

What type of acid base disorder does ethylene glycol poisoning cause?

A

AGMA

164
Q

What lab may be normal on admission for a patient with severe alcoholism but become abnormal 12-24 hours into hospitalization?

A

Phosphate. They can develop severe hypophosphatemia which leads to restlessness, agitation, and weakness

165
Q

Test of choice for intussusception

A

Air contrast enema

166
Q

Treatment for cephalohematoma

A

Usually none required, most resorb within 2 weeks to 3 months

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