Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Internal Medicine > MKSAP > Flashcards

MKSAP Flashcards

1
Q

Acute pericarditis dx

A

1) Pleuritic chest pain
2) Friction rub (squeaky, scratchy, high pitched)
3) Diffuse concordant ST elevation (PR depression)

Also: worse lying down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Aortic dissection presentation

A

Sudden onset severe chest pain radiating to back

BP difference between R and L arms

Murmur of AR

Widened mediastinum on CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

RV MI

A

Findings: hypotension, clear lungs, elevated CVP (JVD)

Tx with normal saline then IV dobutamine if still hypotension after 1L saline

ST elevation in II, III, aVF but also V4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Medical therapy for chronic stable CAD

A

Antianginal: beta blockers, CCBs, nitrates

Vascular-protective therapy: aspirin, ACE inhibitors, statins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Workup of CAD

A

Exercise stress test is best

Adenosine nuclear perfusion stress test should NOT be done in asthma pts

Dobutamine stress echo should NOT be done in those that can exercise or those that are hypertensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

V-tach

A

After structural damage such as MI

Wide QRS (>0.12 sec)

Cannon waves (large a waves) suggest v-tach or heart block (AV dissociation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complications after MI

A

Papillary muscle rupture –> severe MR (several days later)

Ventricular free wall rupture –> CV collapse, tamponade, PEA, sudden hypotension then death (1-4 days later)

VSD –> systolic murmur, hypotension, resp distress, thrill (2-7 days after)

LV aneurysm –> intractable v-tach, septic emboli, heart failure (much later)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CHADS2

A

Whether or not pt with a-fib should be on warfarin

INR 2-3 decreases stroke risk 62%

3 or more points means YES warfarin

CHF

HTN

Age > 75

DM

Stroke (2) or TIA (1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Digoxin use

A

Used in patients with CHF for SYMPTOMS (no mortality benefit)

Use low doses (0.5-0.8 ng/mL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment of heart failure

A

All stages of systolic heart failure: beta blocker

NYHA Class III or IV: beta blocker, ACE inhibitor, spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to treat HTN or angina in pt with CHF already on beta blocker and ACE inhibitor

A

CCBs that aren’t bad in CHF: amlodipine, felodipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Antibiotic endocarditis prophylaxis

A

Prosthetic valve

Hx infective endocarditis

Cardiac transplant with valve abnormality

Unrepaired cyanotic congenital heart disease

Complex congenital heart disease w/residual abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Chronic pancreatitis

A

Clinical presentation: mid-epigastric pain, diarrhea after eating, DM 2/2 pancreatic endocrine insufficiency

Malabsorption occurs when 80% of pancreas destroyed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Serum to ascites albumin gradient (SAAG)

A

Serum albumin - ascites albumin

>1.1 means ascites is due to chronic liver disease: cirrhosis, RHF, Budd-Chiari

<1.1 means due to infection, inflammation, cancer, TB, nephrotic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hepatic encephalopathy triggers and treatment

A

Triggers: infection (SBP), dehydration, GI bleeding, diet, medications

Treatment: lactulose to 2-3 BM per day at pH < 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Precipitants of hepatorenal syndrome

A

Hepatorenal syndrome: renal failure in pt with liver disease after r/o prerenal azotemia, renal parenchymal disease, obstruction

Precipitants: SBP, vigorous diuretics, paracentesis w/o volume expansion, GI bleeding

Treatment: liver transplant

17
Q

Goals for patient with sepsis

A

Central venous oxygen saturation of at least 70%

Central venous pressure of 8-12

MAP of 65

Urine output of 0.5 mL/kg/hr

Early goal directed therapy: give 5-6L fluids within first 6 hours

18
Q

When to use activated protein C (drotrecogin alpha activated)

A

APACHE II score >25

Septic shock requiring vasopressors

Sepsis-induced ARDS requiring mechanical ventilation

2+ sepsis induced organ dysfunctions

Do NOT use if: platelets < 30, active bleeding, surgery <12 hours agowha

19
Q

Glomerular vs nonglomerular hematuria

A

Glomerular hematuria: dysmorphic RBCs, RBC casts, proteinuria; do kidney biopsy to eval glomeruli

Nonglomerular hematuria: do cystoscopy to eval for malignancy if increased risk for bladder cancer (male, >50, smoking, exposure to cyclophosphamide/radiation, etc)

20
Q

HUS

A

Presents as AKI, thrombocytopenia, MAHA (schistocytes on smear), bloody diarrhea

Caused by shiga toxin producing E. coli: shiga toxin binds platelets, glomerular capillary endothelial cells, mesangial cells, and glomerular and tubular epithelial cells, causes platelet aggregation, can also cause release of large vWF multimers from endothelial cells causing more platelet aggregation

Caused by familial deficiency of factor H: factor H is complement component that usually protects cells from damage by alternative complement system so when deficient, C3 potentiates damage to glomerular cells and exposes subendothelium which causes activation of platelets and coagulation

21
Q

Indications for chest tube drainage of parapneumonic effusion

A

Loculated

pH <7.2

Glucose <60

LDH >1000

Positive gram stain or culture

Pus

22
Q

When to intubate in asthma exacerbation

A

Resp acidosis

Hypoxemia

Fatigue

23
Q

Wells criteria for PE

A

Cancer w/tx within 6 months or palliative

Paralysis or recent cast

Recent immobilization or surgery

Tenderness along deep veins

Swelling

Greater than 3cm circumference difference

Pitting edema

Collateral superficial veins

-2 if suspect a different dx

24
Q

Urine anion gap

A

UAG = Na + K - Cl

Should be 30-50

If very negative, have increased urine ammonium secretion and extrarenal cause of metabolic acidosis (GI, pancreatic, biliary, ureter losses)

If positive UAG, have decreased urine ammonium secretion and kidney cause of metabolic acidosis (RTA)

25
Q

Gap metabolic acidosis

A

MUD PILERS

Methanol

Uremia

DKA

Propylene glycol

INH, iron, infection

Lactic acidosis

Ethylene glycol

Renal failure

Salicylates (late)

26
Q

Non-gap metabolic acidosis

A

USED CARPH

Ureterosigmoidoscopy

Saline (with DKA)

Endocrine (Addison’s, spironolactone, trimterine, amiloride, primary hyperpara)

Diarrhea

Carbonic anhydrase inhibitors

Ammonium chloride

RTA (drugs: topiramate, tenofovir, imatinib, valproate, ifosfamide, cisplatin)

Pancreatitis

Hyperalimentation

27
Q

Causes of respiratory alkalosis

A

Hyperventilation

Pregnancy

Pulmonary HTN

PE

PNA

Pulmonary fibrosis

Heart failure

Sepsis

Cirrhosis

28
Q

Types of hyponatremia

A

Hypo-osmolar hyponatremia: heart failure, cirrhosis, nephrotic syndrome

True hyponatremia: high glucose

Pseudo-hyponatremia: hyperglobulinemia, hyperTG

29
Q

TTP Pentad

A

1) MAHA (schistocytes)
2) Thrombocytopenia with normal coags
3) CNS symptoms
4) Fever
5) Renal failure

ADAMTS13 deficiency

Tx with plasma exchange

30
Q

Multiple Myeloma

A

HyperCalcemia

Renal failure

Anemia

Bone (osteopenia)

Leukopenia

Present with encapsulated organism pneumonia

M- protein (IgG, IgA), Bence Jones protein

31
Q

Transudative vs exudative effusion

A

Transudative: Heart failure, hypoalbuminemia

Exudative: protein fluid/serum >0.5; LDH >0.6 or >2/3 upper limit of serum; pneumonia, drug-induced Lupus, PE (75%)

Internal Medicine (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions