Medicine Rocks With Rebecca Flashcards
1
Q
St elevations in v1-v4, what kind of mi? In what vessel?
A
Anterior; lad
2
Q
St elevations in I, aVL, v4-v6, what kind of mi? In what vessel?
A
Lateral; circumflex
3
Q
St elevations in II, III, aVF, what kind of mi? In what vessel?
A
Inferior; rca
4
Q
When to give thrombolytics after an MI
A
Within 6hr
5
Q
Contraindications to thrombolytics
A
If you are bleeding, if you have ever had a thrombolytic stroke, recent head trauma
6
Q
What biomarker tells you if you have a second infarction
A
Myoglobin
7
Q
3 reasons to do a bypass surgery instead of a stent after an mi
A
- Left main disease
- Three vessel disease
- Greater than 70% occlusion
8
Q
What do you discharge people on after they have had a heart attack
A
Aspirin, clopidogrel for 9-12 months if they have had a stent placed, b blocker, ace, statin
9
Q
How do you work up an nstemi
A
Exercise ekg
10
Q
When can’t you do an exercise stress test to work up an nstemi
A
If there is an old bundle branch block or if there is a baseline st elevation or on digoxin
11
Q
Post mi complication: most common cause of death?
A
Arrythmia
12
Q
Post mi complication: New systolic murmur 5-7 days post Mi
A
Mitral regurg due to papillary muscle rupture
13
Q
Imaging used to screen for lung cancer
A
Ct
14
Q
Post mi complication: acute severe hypotension
A
Free wall rupture
15
Q
Post mi complication: step up in oxygen concentration from right atrium to right ventricle
A
Septal rupture
16
Q
Post mi complication: persistent st elevation about one month later and systolic mitral regurg
A
Ventricular wall aneurysm
17
Q
Post mi complication: cannon a waves (jugular bounding waves)
A
Atrial and ventricular dissociation indicating bundle branch block (3rd deg av block)
18
Q
Post mi complication: 5-10 weeks later, pleuritic chest pain, low grade temp
A
Dressler’s syndrome (autoimmune pericarditis)
19
Q
Diffuse st elevation, worse with inspiration, better leaning forwards, indicates
A
Pericarditis
20
Q
How do you treat pericarditis
A
NSAIDs
21
Q
Chest pain that occurs at rest, worse at night, few cad risk factors, migraine headaches, transient st elevation during chest pain episodes
A
Prinzmetal angina
22
Q
Prinzmetal angina tends to occur in what population
A
Women
23
Q
Test for Prinzmetal angina
A
Ergonovine stimulation test
24
Q
Prinzmetal angina treatment
A
Ccb/nitrates
25
Varying pr interval with three or more morphologically distinct p waves in the same lead, generally in old person with chronic lung disease
Multifocal atrial tachycardia
26
What five meds are contraindicated in wpw
```
B blockers
Digoxin
Ccbs
Verapamil
Diltiazem
```
Anything that slows conduction through the av node
27
Treatment of a flutter (stable)
B blocker
| Digoxin
28
Three causes of torsades
Low mag
Low k
Overdose of tcas
29
First line tx for afib
Rate control
| B blocker or digoxin
30
What kind of murmur am I?
Holosystolic murmur with late diastolic rumble
Vsd
31
What kind of murmur am I?
Rumbling diastolic murmur with opening snap
Mitral stenosis
32
What kind of murmur am I?
Blowing diastolic murmur with widened pulse pressure and eponym parade
Aortic regurg
33
Pt comes in with sob and you suspect pe, what do you do first?
Heparin
34
Treatment of acute pulmonary edema
Lasix
Nitrates
Morphine
35
What two kinds of cardiomyopathy are reversible
Alcoholic dilated cardiomyopathy and hemachromstosis restrictive cardiomyopathy
36
First line tx for copd
Ipratropium
37
How do ace inhibitors and b blockers improve survival in heart failure
Prevent remodeling
38
If a transudative fluid has a lot of lymphs, it’s likely
Tb
39
If transudative fluid is bloody, it likely Is one of what two things
Pe or malignancy
40
Describe lights criteria
If any of the following are present, it’s exudative
1. Pleural fluid protein to serum protein ratio >.5
2. Pleural fluid ldh to serum ldh ratio >.6
3. Ldh > 200
41
If you suspect pe what are the first three things you do, in order
1. Heparin
2. V/q scan
3. Spiral ct
42
If fev1 improves >12% with bronchodilator what is it
Asthma
43
Do copd and emphysema improve substantially with bronchodilator tx
No
44
In emphysema and ild, dlco is
Decreased
45
First line tx for copd exacerbation
Ipratropium or tiotropium
46
At what level pulse ox or blood gas do you start oxygen in copd exacerbation
Pulse ox<88%
| Blood gas<55%
47
Dx of copd exacerbation
Any change in sputum
48
Tx of copd exacerbation
Macrolides, nebs, oxygen up to 90%
49
Best prognostic indicator for copd
Fev1
50
What two things do you do to improve mortality in copd
O2 for >18h/day and quit smoking
51
Why is goal in copd only 94-95% o2
Because they are chronic co2 retainers so they need hypoxia to drive respiration
52
Copd pts need what vaccine
Pneumovax
53
New clubbing in a copd pt is called___ and is indicative of___
Hypertrophic osteoarthropathy, likely cancer. Get a cxr.
54
Tx for an asthmatic who has sx 4x/wk, night cough 2x/month and normal pfts
Albuterol and inhaled corticosteroids (moderate asthma)
55
If asthma pt has daily sx, night cough 2x/wk, and fev1 is 60-80%, tx?
Moderate-severe asthma
| Tx with albuterol, inhaled corticosteroids, and salmeterol (laba)
56
If asthma pt has daily sx, night cough 4x/wk, and fev1 is under 60%, tx?
Albuterol, inhaled corticosteroids, salmeterol (laba), and montelukast with possibly oral steroids
57
Pco2 should be ___ in an asthma exacerbation. If it is normalizing what should you worry about?
Low (tachypnic). When it rises it indicates resp distress—> intubation
58
Nodules in upper lobes with eggshell calcifications
Silicosis
59
If you have silicosis you are at higher risk for what dz?
Tb
60
Reticulonodular process in lower lobes with pleural plaques
Asbestosis
61
Patchy lower lobe infiltrate, thermophilic actinomyces
Hypersensitivity pneumonitis
62
Important referral to make for sarcoid pts
Optho due to uveitis
63
Dx and tx of sarcoid
Dx: biopsy granulomas
Tx: steroids
64
Crohns or uc?
More risk for primary sclerosing cholangitis
Uc
65
Crohns or uc?
Granulomas
Crohns
66
Crohns or uc?
Decreased risk with smoking
Uc
67
Crohns or uc?
Associated with panca
Uc
68
Crohns or uc?
Increased risk of colon cancer
Uc
69
Crohns or uc?
Pyaderma gangrenosum
Uc
| Don’t give abx it isn’t an infection
70
Crohns or uc?
Erythema nodosum
Uc
71
Alt and ast in the 1000s after surgery or hemorrhage.
| What am I?
Ischemic hepatitis (shock liver)
72
Elevated d bili indicates what liver process?
Obstruction
73
Elevated I bili indicates what liver process
Hemolysis
74
Ana and antismooth muscle antibodies indicates what liver process
Autoimmune hepatitis
75
Two causes of ischemic heart failure in a young patient
1) family history (hocm)
| 2) cocaine
76
How does cocaine affect the heart
Blocks reuptake of ne, causing vasoconstriction of coronary vessels. Leads to ischemia called contraction band necrosis.
77
Common causes of chest pain in young people
Reflux, msk, post viral pericarditis, anxiety
78
If someone can’t exercise what kind of echo do you do
Dobutamine stress test
79
Two drugs that prolong life in pp who have had cad
Aspirin and statin
80
If a young pt comes in and it looks like hf, think about
Viral myocarditis (cocaine, alcohol)
81
Three drugs that increase mortality in heart failure pts
Acei, b blocker, spironolactone
82
Tx for afib (1st line)
Anticoagulation (warfarin or 10a inhibitors (-xabans))
83
What is Chads vasc
Estimates stroke risk in pts with afib, includes: chf, htn, age>75, dm, prior stroke
84
Two main causes of atn (but there are many more)
Prerenal, contrast dye
85
Increased creatinine and blood on dip but not on sed is indicative of
Rhabdo
86
Two drugs causing hyponatremia
Thiazides, ssri
87
Diabetics who get really hyperkalemic when you put them on an acei. Think of
rta type iv
88
When should correction of sodium be fast
When they are in seizure or coma, otherwise be cautious in pts who look ok but have scary sx
89
First, second and third line tx for hyperkalemia
1. Calcium gluconate
2. Insulin and bicarb
3. Kayexalate and dialysis
90
Most common post renal cause
Bph
91
Aces and NSAIDs cause what
Prerenal disease
| Both at same time is bad
92
When do you usually give long acting insulin
At night
93
If a type I diabetic comes in with fatigue, think of what four things
1. Hashimoto
2. Addison’s
3. Anemic (pernicious anemia)
4. Celiacs/vit d def
94
If you suspect adrenal insufficiency what do you do first? Second?
First: plasma cortisol level, if low, check
Second: acth
95
Acth, aldosterone, and renin will be high or low in primary adrenal insufficiency? Secondary ai?
Primary: high acth and renin, low aldo
Secondary: low acth, renin and Aldo normal
96
Anti Dsdna is associated with
Sle (drugs)
97
Anti Smith is associated with
Sle
98
Anti ro and anti la
Sjogrens
99
Anticentromere
Crest
100
Anti jo 1
Polymyositis
101
Anti histone
Sle (drugs)
102
Hip hurts when you start walking (older person)
Trochanteric bursitis
103
Tx oa
First line Tylenol
| Second line NSAIDs
104
Tx sle
Hydroxychloroquine
105
Sjogrens is associated with what cancer
Lymphomas
106
Dermatomyositis and polymyositis increase your risk for
Cancer. Make sure you’re up to date on screening
107
Polyarteritis nodosa is associated with what virus
Hep b
108
Three mc bugs for meningitis. What do you add for young and old pts?
S pneumo, n meningitidis, h flu
Add ampicillin to cover listeria
109
Three things to do if you suspect meningitis, in order
1. Abx
2. Check intracranial pressure
3. Lp
110
First step if you suspect pneumonia
Cxr
111
Mc bug in general for pneumonia? How do you treat?
S pneumo, treat with macrolide (can also do fluoroquinolone or third gen cephalosporin)
112
Mc bug for pneumonia in young healthy person. Tx?
M pneumo, macrolide
113
Mc pneumonia:
Hospitalized
Tx?
Pseudomonas
Klebsiella
E. coli
Tx zosyn or imipenem+vanc
114
Mc pneumonia:
| Old smokers with copd
H flu
115
Mc pneumonia:
Alcoholics with current jelly sputum
Tx?
Klebsiella. Tx-3rd gen cephalosporin
116
Mc pneumonia:
| Old men with headache, confusion, diarrhea and abdo pain
Legionella
117
Dx legionella
Urine antigen
118
Mc pneumonia:
| Just had flu
Staph
119
Mc pneumonia:
| Just delivered a baby cow and has vomiting/diarrhea
Coxsiella Burnetti (q fever)
120
Mc pneumonia:
| Just skinned a rabbit
Tularemia
121
Drug side effects:
| Rifampin
Orange
122
Drug side effects:
| Isoniazid
Peripheral neuropathy and sideroblastic anemia, prevent by giving vit b6
123
Drug side effects:
| Ethambutol
Optic neuritis
124
Mc bug endocarditis:
| Acute
Staph
125
Mc bug endocarditis subacute
Viridans on the mitral valve
126
Ivdu and endocarditis, think what two things
Staph and tricuspid valve
127
Strep bovis is associated with what cancer
Crc
128
At what cd4 count do you start haart
350
129
Side effect of zidovudine
Gi, leukopenia, macrocytic anemia
130
Post exposure prophylaxis against hiv
Azt, lamivudine, nelfinavir for 4 weeks
131
Dx pjp
Cxr then bal
132
Tx for pjp
Bactrim or pentamidine
133
Hiv pt with diarrhea, think what three things?
Cmv, mac, cryptosporidium
134
Dx cmv
Colonoscopy or biopsy
135
Tx cmv
Ganciclovir or foscarnet
136
Se of ganciclovir
Neutropenia
137
Side effect of foscarnet
Renal tox
138
Four basic sx of mac
Diarrhea, wasting, fevers, night sweats
139
Tx mac
Clarithromycin and ethambutol +/- rifampin
140
Cryptosporidium is transmitted via
Dog poop and swimming pools
141
What is diarrhea in cryptosporidium like?
Watery diarrhea with mucus, Oocysts are acid fast
142
Hiv with neuro sx and multiple ring enhancing lesions
Toxo
143
Tx of toxo
Paramethamine sulfadiazine
144
Hiv with neuro sx and just one ring enhancing lesion
Primary cns lymphoma
145
Hiv with neuro sx and seizure with deja vu aura (temporal lobe) and rbcs In csf
Hsv encephalitis, tx with acyclovir
146
Hiv with neuro sx and signs of meningitis
S pneumo , also worry about cryptococcus
147
Hiv with neuro sx and hemisensory loss, visual impairment and pos babinski
Pml (Jc polyomavirus)
| Brain biopsy is gold standard
148
Hiv with neuro sx and memory problems or gait disturbance
Aids dementia complex
149
Rash at wrists and ankles, palms and soles, fever and headache. What is it and how do you treat?
Rocky mt spotted fever, doxy
150
Tick bite, no rash, myalgia, fever, headache, low plts and wbcs but high alt. What is it and how tx?
Ehrlichiosis, treat with doxy
151
Immunosuppressed, cavitary lung dz, wt loss, fever. What is it and how tx?
Nocardia, bactrim
152
How do you treat hyponatremia, not seizing, vol down
Normal saline
153
How do you treat hyponatremia, not seizing, euvolemic or hypervolemic?
Fluid restrict
154
How to tx hypernatremia
D5w, don’t correct too fast due to cerebral edema
155
Bones stones groans psych
Hypercalcemia/hyperparathyroid
156
Paralysis, ileus, st depression, u waves
Hypokalemia
157
Tx rhabdo
Bicarb
158
Envelop shaped crystals on ua. What is it and how to tx?
Ethylene glycol intox, tx with dialysis or bicarb if ph<7.2
159
Bump in creatinine s/p cardiac cath or ct scan, think
Contrast nephropathy
160
Pt is peeing blood. First test?
UA
161
Painless hematuria likely indicates
Cancer of bladder or kidney until proven otherwise
162
Terminal hematuria + tiny clots=
Bladder cancer
163
Hematuria and hemoptysis think
Goodpastures
164
Hematuria + deafness=
Alports
165
Kid s/p viral uri w/renal failure and abdo pain, arthralgia and purpura
Henoch schlonlein
166
C anca, kidney, lung and sinus involvement
Wegners
167
P anca, renal failure, asthma, eosinophilia
Egpa (churg Strauss)
168
P anca, no lung involvement, hep b. What am I and how to tx?
Polyarteritis nodosa, tx with cyclophosphamide
169
Dx kidney stone
Ct
170
Most common type of kidney stones
Calcium oxalate
171
Kid with fam hx-what kind of kidney stones
Cysteine
172
Chronic indwelling catheter with alkaline pee-what kind of stones?
Struvite (proteus, klebsiella, staph)
173
If leukemia is being treated with chemo, what kind of kidney stones?
Uric acid
174
If s/p bowel resection for volvulus, what kind of kidney stones
Oxalate stones
175
Tx for kidney stones:
1. Under 5mm
2. Over 2cm
3. Between 5mm and 2cm
1. Fluids
2. Cut out
3. Extracorporeal shock lithotripsy
176
Mc proteinuria:
| In kids
Minimal change
177
Mc proteinuria:
| In adults
Membranous nephropathy
178
Mc proteinuria:
| Associated with heroin and hiv
Fsgn
179
Mc proteinuria:
| Associated with chronic hepatitis and low complement
Membranoproliferative gn
180
If a nephrotic pt suddenly develops flank pain, think
Renal vein thrombosis (they are peeing out clotting factors)
181
Mcv=60, low rdw, target cells think
Thalassemia
182
Mcv=70, high fe, low tibc, high ferritin think
Sideroblastic anemia (can be caused by inh)
183
Young woman, recurrent epistaxis, heavy menses, Petechiae, and low platelets . What is it and what is tx?
Itp
| Prednisone
184
What antibody if neg rules out sle
Ana
185
Most sensitive for sle (antibodies)
Anti dsdna or anti smith
186
Two antibody tests for ra
Rf and anti ccp
187
Polydipsia, polyuria, hypernatremia, low urine osm responsive to desmopressin indicates
Central di
188
Polydipsia, polyuria, hypernatremia, low urine osm not responsive to desmopressin indicates
Nephrogenic di
189
Workup of a thyroid nodule
1. Check tsh
2. Do raiu to find “hot nodule”
3. If hot, excise, if normal do fna
4. If malignant, excise
190
Mc type of thyroid cancer
Papillary
191
Psammoma bodies associated with what thyroid cancer
Papillary
192
Tx of follicular thyroid cancer
Excision of thyroid (whole thing)
193
What thyroid cancer is associated with men II
Medullary
194
Osteoporosis, central fat, dm, hirsutism, what am I?
Cushing
195
Dx cushing
1mg on dexa suppression test or 24h urine cortisol
196
Weakness, hypotension, wt loss, hyperkalemia, hyponatremia, low ph. Suspect? Test?
Adrenal insufficiency, cosyntropin stimulation test
197
Tx of Addison dz
Nacl resus and long term replacement of dexamethasone and fludrocortisone
198
Perioral numbness, chvostek, trousseau s/p thyroidectomy
Hypocalcemia and hypoparathyroidism
199
Parathyroid nodules, what do you do?
Fna and sestamibi scan
200
Pituitary adenoma, parathyroid hyperplasia, pancreatic islet cell tumor
Men I
201
Parathyroid hyperplasia, medullary thyroid cancer, pheochromocytoma
Men 2a
202
Medullary thyroid cancer, pheochromocytoma, marfanoid
Men2b
203
N/v, abdo pain, kussmaul respirations, coma with bgl=400
Dka
204
Tx dka
Fluids and insulin drip, add k once peeing
205
Polydipsia, polyuria, profound dehydration, confusion and coma with bgl=1000? Tx?
HHS
| Tx with fluids and electrolytes
206
First step in case of stroke? Most accurate test?
1. Non contrast ct to rule out hemorrhage
| 2. Most accurate is diffusion weighted mri for ischemic stroke (ct can be neg in the first 48h)
207
Tx of stroke within the first 3-4 h?
Tpa
208
Tx of stroke after first four hours
Aspirin (heparin only for those with afib)
209
Tx if someone has had a stroke while on aspirin
Dipyridamole or switch to clopidogrel
210
When to clip an aneurysm
Within days of rupture or when <10mm
211
When to do an endarterectomy
When occlusion >70% and is symptomatic
212
EEG buzzwords:
| 3hz spike and wave
Absence seizure, tx with ethosuxamide
213
EEG buzzwords:
| Triphasic bursts
Creutzfeldt jacob. Dementia+ myoclonus
214
EEG buzzwords:
| Diffuse background slowing
Delirium. Contrast with psychosis, which has no eeg changes
215
EEG buzzwords:
| Hypoarrhythmia
Infantile spasms, tx with acth.
216
New onset headache, deep pain that wakes them up at night, worse with coughing or bending forward
Brain tumor
217
Fat lady on minocycline or who takes isotreintoin w/abducens nerve palsy/diplopia
Pseudotumor cerebri
218
Tx of guillain barre
Ivig, plasmaphoreses
219
Nasal voice, ptosis, dysphasia, resp acidosis think ___. Acute tx? Chronic tx?
Myasthenia gravis.
Acute tx: ivig or plasmaphoresis
Chronic tx: pyridostigmine
220
Stroke in what vessel?
Contralateral lower extremity and face
Aca
221
Stroke in what vessel?
| Aphasia, contralateral hemoparesis
Mca
222
Stroke in what vessel?
Ipsilateral ataxia, diplopia, dysphagia, vertigo
Contralateral homonymous hemianopsia
Vertebral/basilar
223
Stroke in what vessel?
| Left hemiplegia/hemisensory loss, left homonomous hemianopsia with eyes deviated towards right and apraxia
Right mca stroke
224
Stroke in what vessel?
Left hemiplegia and hemisensory loss in leg>arm. Confusion and behavioral disturbance
R Aca
225
Stroke in what vessel?
Left hemisensory loss and horners and right facial sensory loss
R Wallenberg (pica)
226
Tx of status epilepticus
Lorazepam + low dose phenytoin
227
Dizziness, headache, hearing/vision problems, monoclonal IgM m spike
Waldenstrom macroglobulinemia
228
Hemochromatosis and alcoholic liver disease share what four features
Hepatomegaly
Glucose intolerance
Testicular atrophy
Cardiomyopathy
229
Sbp is caused by ___ and should be treated with ___
Gram negative rods; third gen cephalosporin
230
If you suspect chronic pancreatitis what should you do
Plain abdominal X-ray
231
H pylori is present in 90% of ___ ulcers and 75% of ___ ulcers
Duodenal; gastric
232
Pt with dvt plus stroke think
Foramen ovale
233
Statins decrease stroke risk by what percent
20-30%
234
Why are pts with nephrotic syndrome at increased risk for infections
Due to loss of igg and complement through urine
235
Flank pain, hematuria and enlarged kidney on us, think
Renal vein thrombosis
236
Hematuria within 48hrs of a uri and is the Mc nephritis in world
Iga nephropathy
237
Four causes of ain
B lactams (esp penicillins), NSAIDs, Dilantin (phenytoin) and allopurinol
238
Martha’s Vineyard, think
Babesiosis
239
Erythema Migrans rash 7-10 days after a tick bite think
Lyme disease
240
Good therapy for a dog or cat bite
Augmentin (amox clav)
241
Metformin can cause a ___ acidosis
Gap
242
When should hiv pts with oral candidiasis receive pcp prophylaxis
Always irrespective of cd4 count
243
Besides cough, what’s another hypersensitivity rxn to acei?
Angioedema esp of face/lips/tongue
244
Triad of aspirin allergy
Asthma, nasal polyps, sinusitis
245
Positive ppd and neg cxr means __. What do you do?
Latent tb, 9 months of isoniazid
246
Eosinophils in the urine is specific for
Ain
247
Granular casts are pathopneumonic for
Atn
248
Dilation of what occurs I’m dilated cardiomyopathy
Both ventricles
249
Osteomalacia (aka bowing of legs, bone pain, high alk phos) is due to what process
Inadequate bone mineralization
250
Dude with type I diabetes collapses. What do you think of and what do you do?
Hypoglycemia
| Give dextrose
