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IM > MKSAP > Flashcards

MKSAP Flashcards

1
Q

in the tx of chronic stable angina, the BB dose should be titrated to achieve a resting HR of ___ and approximately ___% of the HR that produces angina with exertion

A

resting HR 55-60

75% of HR that produces angina with exertion

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2
Q

what is ranolazine

A

novel anti angina agent that can be used in add’n to baseline tx with BB, CCB, and a long acting nitrate

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3
Q

in the setting of continued angina despite maximal medical therapy, consider _______

A

coronary angiography

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4
Q

what finding on echo during chest pain excludes coronary ischemia

A

normal wall motion

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5
Q

chest pain, dyspnea, asymmetric leg edema, elevated central venous pressure, tachypnea, tachycardia

A

PE

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6
Q

best test to look for PE

A

CT pulmonary angiography

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7
Q

QRS tachycardia in setting of known structural heart disease (esp prior MI)

A

consider v tach until proven otherwise

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8
Q

supra ventricular tachycardia with aberrancy

A

WPW

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9
Q

an ____________ is indicated for an acute coronary syndrome with cardiogenic shock that is unresponsive to medical therapy, acute mitral regurgitation 2/2 papillary muscle dysf, ventricular septal rupture, or refractory angina

A

intra aortic balloon pump

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10
Q

in patients with MI, early IV ____ tx reduces infarct size, decreases frequency of recurrent myocardial ischemia, and improves short and long term survival

A

BB

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11
Q

an adenosine nuclear perfusion stress test is contraindicated in patients with significant ______ disease

A

bronchospastic (don’t give to patients with asthma)

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12
Q

______ stress echo is an appropriate choice in patients who are unable to exercise and are not hypertensive at rest

A

dobutamine

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13
Q

the presence of a new systolic murmur and respiratory distress several days after an acute MI indicates the possibility of either ______ or ______

A

ventricular septal rupture or mitral regurgitation 2/2 papillary muscle rupture

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14
Q

ventricular free wall rupture usually occurs ___ days after acute MI and leads to pericardial tamponade > sudden hypotension and death

A

1-4 days

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15
Q

right ventricular infarction occurs in 20% of patients with ______ wall STEMI

A

inferior

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16
Q

hypotension, clear lung fields, and jugular venous distension in setting of inferior wall STEMI

A

right ventricular infarction

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17
Q

________ following STEMI results in respiratory distress, hypotension, new systolic murmur, and a palpable thrill

A

ventricular septal defect

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18
Q

mechanical complications (such as ventricular septal defect) occur ____ days after STEMI

A

2-7 days

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19
Q

(early/late) complications following STEMI: cardiogenic shock, ventricular septal defect, mitral regurgitation, free wall rupture, left ventricular thrombosis

A

late

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20
Q

how to treat A fib with RVR in a patient who is hemodynamically unstable

A

shock (any arrhythmia with hemodynamic instability)

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21
Q

how do you treat cardiac arrest occurring within 48 hours of an acute transmural MI?

A

standard post MI care (do not need to shock a rhythm)

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22
Q

treat NY heart assoc class IV heart failure with _____

A

digoxin (alleviates symptoms and decreases hospitalizations, but provides no survival benefit)

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23
Q

patients with new onset heart failure and angina should be evaluated with:

A

cardiac cath and angiography (if they are possible candidates for CABG)

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24
Q

all patients with new onset heart failure should be evaluated with

A

echo

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25
Q

treat all systolic heart failure with ___ and ____

A

ACEi and BB

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26
Q

treat NY heart assoc functional class III or IV heart failure patients (symptoms develop with mild activity) with:

A

spironolactone (reduces mortality)

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27
Q

fixed splitting of S2 and a right ventricular heave

A

atrial septal defect

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28
Q

failure of a prosthetic aortic valve often leads to:

A

aortic insufficiency

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29
Q

transthoracic echo is indicated when a grade __/VI systolic murmur is heard on exam, in presence of any diastolic or continuous murmur, or if a new murmur is diagnosed in the interval since a normal physical

A

III

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30
Q

best test for evaluating patients with suspected asthma who have episodic symptoms and normal baseline spirometry

A

methacoline challenge test

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31
Q

what is the PC 20

A

the methacoline dose that leads to a 20% decrease in the FEV1.

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32
Q

a PC 20 less than __ is consistent with asthma

A

4

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33
Q

a PC 20 of ___ to ___ suggests some bronchial hyperactivity and is less specific for asthma

A

4-16

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34
Q

normal PC 20

A

above 16

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35
Q

increased residual volume/total lung capacity ratio, normal FEV1/FVC ratio, low maximum respiratory pressures, normal DLCO

A

neuromuscular respiratory failure

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36
Q

what test can you use to dx vocal cord dysf

A

laryngoscopy

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37
Q

patient with throat or neck discomfort, wheezing, stridor, anxiety, does not respond to asthma therapy, decreased lung volumes, normal oxygen sat

A

vocal cord dysf

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38
Q

patient with systemic sclerosis, worsening fatigue, DOE, clear lung fields on exam

A

pulmonary arterial hypertension

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39
Q

what does laryngoscopy show in vocal cord dysf during inspiration

A

adduction of vocal cords during inspiration

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40
Q

PFTs in patients with pulmonary arterial hypertension

A

isolated decreased DLCO in setting of normal air flow and lung volumes

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41
Q

loud P2, fixed split S2, pulmonic flow murmur, tricuspid regurgitation

A

physical signs of elevated pulmonary artery pressure

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42
Q

treat a complicated pleural effusion with:

A

chest tube drainage (antibiotics not enough)

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43
Q

what makes a pleural effusion complicated?

A

assoc with PNA, presence of located pleural fluid, pleural fluid with pH less than 7.2, glucose level less than 60, LDH greater than 1000, positive Gram stain or culture, or presence of gross pus in the pleural space

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44
Q

dullness to percussion and absent or decreased tactile fremitus and breath sounds over the affected area

A

pleural effusion

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45
Q

a patient with tuberculous pleural effusion typically presents with a _____ (cell type) predominant exudative effusion

A

lymphocyte

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46
Q

test to evaluate a tuberculous pleural effusion

A

pleural biopsy

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47
Q

manage persistent asthma during pregnancy with:

A

inhaled corticosteroids

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48
Q

treat inadequately controlled (by inhaled corticosteroids) persistent asthma with:

A

long acting beta agonist (salmetrol or formoterol)

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49
Q

abx for moderate to severe exacerbation of COPD

A

3rd gen cephalosporin + macrolide OR just a fluoroquinolone

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50
Q

patients in COPD exacerbation who have mod-severe dyspnea, use of accessory muscles, RR>25, and PH<7.35 with PCO2>45 would benefit from what type of treatment?

A

noninvasive positive pressure ventilation

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51
Q

subacute disease progression and bilateral alveolar filling opacities on CXR without environmental exposure or smoking history

A

cryptogenic organizing PNA

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52
Q

DVT ppx in hospitalized, medically ill patients

A

unfractionated heparin, LMWH, fondaparinux

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53
Q

noninvasive test to dx acute PE (esp in presence of CKD)

A

VQ scan

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54
Q

evaluate low probability DVT with:

A

D dimer test (rule out with a negative test)

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55
Q

test to evaluate for nephrolithiasis

A

helical CT scan

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56
Q

initial screening for acute abdomen

A

supine and upright abdominal X rays (look for bowel obstruction or perf)

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57
Q

severe abdominal pain less than 24 hours in duration

A

acute abdomen

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58
Q

abd pain, back pain, syncope

A

AAA rupture

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59
Q

dx AAA rupture

A

CT scan

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60
Q

elderly pt with atherosclerosis, crampy abdominal pain and bloody stool

A

ischemic colitis

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61
Q

finding on colonoscopy of patchy segmental ulcerations

A

ischemic colitis

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62
Q

test to evaluate for diverticulitis

A

contrast enhanced CT scan

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63
Q

LLQ pain, fever, elevated WBC

A

diverticulitis

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64
Q

dx of HUS

A

peripheral blood smear

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65
Q

tx of HUS

A

no abx, plt transfusion is controversial

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66
Q

diarrhea and tenesmus within 6 weeks of radiation therapy

A

radiation proctitis

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67
Q

dx radiation proctitis

A

flexible sigmoidoscopy

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68
Q

dx chronic pancreatitis (ab pain, malabsorption, endocrine insufficiency)

A

abdominal CT

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69
Q

management of diarrhea predominant IBS

A

high fiber diet is initial recommendation

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70
Q

tx salmonella gastritis

A

it is self limited in healthy people

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71
Q

elevation of ALT and AST, direct hyperbilirubinemia

A

hepatocellular injury

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72
Q

elevation of alk phos and minimal elevations of AST and ALT

A

cholestatic injury

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73
Q

definitive tx for patients with symptomatic gallstone disease

A

cholecystectomy

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74
Q

pattern of liver enzyme findings in primary sclerosing cholangitis

A

cholestatic pattern

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75
Q

pattern of liver enzyme findings in acute hepatitis

A

marked elevation of aminotransferases

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76
Q

how to evaluate GERG alarm symptoms

A

upper endoscopy

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77
Q

tx erosive esophagitis

A

PPI

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78
Q

linear gastric ulcers or erosions in the hiatal hernia sac

A

Cameron lesions

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79
Q

in GI bleed of obscure origin (i.e., initial work up already completed), how do you identify a bleeding source?

A

repeat upper endoscopy–will identify lesions that are difficult to see or bleed intermittently

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80
Q

pt older than 60, LLQ pain, urgent defecation, red or maroon rectal bleeding, abdominal pain out of proportion to exam

A

ischemic colitis, does not require transfusion

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81
Q

cause of painful hemtochezia, rectal outlet bleeding, pt with constipation

A

anal fissures

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82
Q

screen for HCC in patient with Hep B with what test?

A

liver u/s

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83
Q

anti smooth muscle antibody

A

autoimmune hepatitis

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84
Q

cirrhosis in patients with obesity, metabolic syndrome

A

non alcoholic steatohepatitis

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85
Q

pruritus, jaundice, autoimmune disorders, women older than 25 years, antimitochondrial antibodies

A

primary biliary cirrhosis (B for babe-women, m for mama-mitochondrial)

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86
Q

elevated alk phos, modest elevations of aminotransferases, chronic condition that presents in 4th or 5th decade of life, associated with UC

A

primary sclerosing cholangitis (more common in men than women)

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87
Q

first line therapy for hepatic encephalopathy

A

lactulose

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88
Q

management of new onset ascites

A

paracentesis

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89
Q

saag calculation

A

serum albumin level - ascitic fluid albumin level

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90
Q

saag greater than 1.1

A

portal HTN

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91
Q

saag less than 1.1

A

assoc with infection, inflammation, or low serum oncotic pressure (such as nephrotic syndrome, malignancy, tb)

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92
Q

causes of portal HTN

A

cirrhosis, constrictive pericarditis, right sided heart failure, budd chiari syndrome

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93
Q

development of kidney failure in patients with portal HTN and normal renal tubular function. intense renal vasoconstriction leads to a syndrome of AKI

A

hepatorenal syndrome (after exclusion of pre renal azotemia, renal parenchymal disease, or obstruction)

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94
Q

most effective tx for hepatorenal syndrome

A

liver transplant

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95
Q

skin finding assoc with inflammatory bowel disease which manifests as small, tender nodules on the anterior tibial surface

A

erythema nodosum

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96
Q

first line tx for induction and maintenance of remission in mild to moderate UC is

A

mesalamine or another 5-aminosalicylate agent (sulfasalazine)

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97
Q

when do you use oral prednisone in UC

A

when sxs do not respond to 5-aminosalicylates

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98
Q

when do you use azathioprine or 6-mercaptopurine in UC

A

patients who have incomplete disease remission while on corticosteroids

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99
Q

chronic watery diarrhea without bleeding, dx made by histologic examination of colonoscopic bx specimen

A

microscopic colitis

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100
Q

initial tx for microscopic colitis

A

loperamide, diphenoxylate, bismuth subsalicylate

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101
Q

for what age COPD patients would you recommend the flu vaccine

A

all ages

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102
Q

who should get screened for AAA and when?

A

one time between ages 65-75, men who have smoked

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103
Q

at what age would you recommend the zoster vaccine

A

60 years, regardless of h/o prior infection

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104
Q

when can you omit the tetanus booster in a patient with an injury

A

received tetanus booster within 5 years and in patients with clean minor wounds who received the vaccination within 10 years

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105
Q

how often should you do sigmoidoscopy for colon cancer screening

A

q5y

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106
Q

how often should you do FOBT

A

q3y

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107
Q

syncopal episode in patient with advanced systolic heart failure and underlying ischemic heart disease

A

vtach

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108
Q

defn of orthostatic hypoTN

A

systolic drops by 20 or diastolic drops by 10 within 3 minutes of standing

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109
Q

sudden loss of consciousness irrespective of body position and lack of preceding symptoms

A

consider intermittent complete heart block as a cause of recurrent syncope

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110
Q

initial tx in management of patient with cocaine induced agitation

A

benzos

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111
Q

how to tx spinal stenosis

A

surgery

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112
Q

how to test for vertebral osteomyelitis (red flags include history of IV drug use, fever, elevated ESR)

A

urgent spine MRI

113
Q

tx acute nonspecific back pain

A

acetaminophen (not bed rest!)

114
Q

back pain, muscle weakness, loss of bowel/bladder control

A

spinal cord compression

115
Q

how to dx spinal cord compression due to bone metastases

A

MRI

116
Q

how to dx cough variant asthma (chronic cough not due to GERD, post nasal drip)

A

trial of inhaled albuterol (cough resolves)

117
Q

all patients with hemoptysis should have a:

A

CXR

118
Q

patients with hemoptysis and at high risk for lung cancer should have a:

A

Chest CT and fiberoptic bronchoscopy, even in CXR is normal

119
Q

tx acute bronchitis

A

symptomatic measures, no abx

120
Q

at what BMI do you consider bariatric surgery

A

35 with obesity related morbidities or 40 without morbidities if medical management has been unsuccessful

121
Q

in all patients with a BMI greater than __, obtain a blood glucose level, serum creatinine level, fasting lipid profile to assess for comorbidities

A

25

122
Q

manage a patient with involuntary weight loss, no focal sxs, no abnormal labs, negative CXR

A

reevaluate in 6 months (then search for malignancy if no cause can be found for weight loss)

123
Q

well demarcated, rapidly spreading area of warmth, swelling, tenderness, and erythema that may be accompanied by fever

A

cellulitis

124
Q

screening for hearing impairment

A

whispered voice test or handheld audioscopy

125
Q

anticholinergic agents that are effective for treating urge urinary incontinence

A

oxybutynin and tolterodine

126
Q

elderly patient with HTN

A

add a thiazide diuretic (more effective than ACEi/ARB)

127
Q

defn of stage 2 HTN

A

160/100

128
Q

tx stage 2 HTN

A

2 drug therapy

129
Q

pancytopenia, low retic count, hypo plastic bone marrow

A

aplastic anemia

130
Q

in _____, accumulated oxidized hemoglobin remains adherent to the erythrocyte membrane, which creates an adjacent membrane-bound clear zone

A

G6PD deficiency (bite cells)

131
Q

low mean cellular volume, target cells, normal results on iron studies

A

thalassemia

132
Q

peripheral blood smear finding in patient with prosthetic valve

A

schistocytes

133
Q

spherocytes on blood smear, complication of lymphoid malignancies

A

warm antibody mediated hemolytic anemia

134
Q

prolonged PT, PTT, high D dimer, reduced serum fibrinogen and plt count, microangiopathic hemolytic anemia

A

dic

135
Q

personal and family h/o bleeding, prolonged bleeding time, borderline elevated activated partial thromboplastin time, low factor 8 level

A

von willebrand disease

136
Q

right sided heart failure and peripheral edema, abnormal venous waveforms, fixed splitting of S2, loud or palpable pulmonic valve closure, tricuspid regurgitation, right ventricular heave, clear lungs (in patient with sickle cell)

A

pulmonary HTN

137
Q

management of acute chest syndrome in patient with sickle cell

A

exchange transfusion

138
Q

how to dx osteonecrosis of the hip if x rays are normal

A

MRI

139
Q

when does HIT occur

A

5-10 days after starting heparin therapy (t1/2 of coag factors)

140
Q

first line tx ITP

A

corticosteroids

141
Q

for how long should you anticoagulate a patient with antiphospholipid syndrome after a first DVT?

A

lifelong

142
Q

h/o thrombotic event (including recurrent fetal loss), assoc with lupus anticoagulant or persistently elevated levels of anticardiolipin or beta 2 glycoprotein I antibodies

A

antiphospholipid syndrome

143
Q

decreased anion gap in the presence of anemia, proteinuria, hypercalcemia, and renal failure

A

multiple myeloma

144
Q

monoclonal gammopathy of undetermined significance is characterized by a serum monoclonal protein level less than __g/dL with the overt clinical features of myeloma and less than __% plasma cells in the bone marrow

A

3g/dL, 10%

145
Q

myeloblasts that contain Auer rods

A

AML

146
Q

presence of BCR/ABL oncogene, smear showing increased granulocytes with marked left shift, hyper cellular bone marrow with marked myeloid proliferation

A

CML

147
Q

worsening sore throat despite abx tx, fever, dysphagia, pooling of saliva, muffled voice

A

peritonsillar abscess complication of Group A beta hemolytic strep

148
Q

abx of choice for tx acute otitis media in adults

A

amoxicillin

149
Q

tx asx bacteriuria in pregnant patients with

A

ampicillin, amoxicillin, or nitrofurantoin

150
Q

outpt management for pyelo

A

oral fluoroquinolone

151
Q

tx PJP w/ hypoxia (arterial PO2 < 70)

A

bactrim and corticosteroids

152
Q

most sensitive test for dx HIV in acute stage

A

HIV RNA viral load

153
Q

how can you reduce the risk of ventilator assoc PNA

A

semi erect positioning

154
Q

severe, rapidly progressive PNA, esp during flu season, in those with cavitary infiltrates on CXR

A

consider MRSA–add vancomycin or linezolid to CAP regimen of cefotaxime and levofloxacin

155
Q

tx CAP in pt with no comorbidities with

A

azithro

156
Q

long term outcome of Meniere disease

A

resolution of vertigo, continued hearing loss

157
Q

most specific autoantibody for SLE

A

anti smith (anti-Sm)

158
Q

tx raynaud

A

nifedipine (vessel specific)

159
Q

how do you correct the serum sodium in a diabetic?

A

(glucose creates osmotic force that pulls water out of cells and into intravascular space) measured sodium + (glucose - 100)/100 x 1.6

160
Q

management in patients older than 45 with increase in heartburn sxs and ab pain

A

EGD

161
Q

Hep A follow up

A

report to public health dept

162
Q

a cause of hyper coagulability and hemolytic anemia that is intermittent, caused by a defect in hemopoietic cells that renders them vulnerable to complement mediated lysis

A

paroxysmal nocturnal hemoglobinuria (sleep causes a mild acidosis)

163
Q

test to evaluate for paroxysmal nocturnal hemoglobinuria

A

Ham’s acidification test

164
Q

treatment for a stable, supra ventricular tachycardia

A
  1. vagal maneuver, 2. small bolus of adenosine (can use digoxin as chronic treatment)
165
Q

dermatitis, dementia, diarrhea

A

pellagra (niacin def)

166
Q

1st line tx COPD together with smoking cessation and pulmonary rehab

A

inhaled anticholinergics (ipratropium)

167
Q

tx infectious arthritis in a 25 year old

A

ceftriaxone

168
Q

ceruloplasmin levels in Wilson

A

decreased

169
Q

urinary copper levels in Wilson

A

increased

170
Q

treatment of choice for CNS toxoplasmosis

A

pyrimethamine, sulfadiazine, leucovorin

171
Q

affect of edrophonium in patient with MG

A

transient increase in strength of handgrip, upward gaze (quick on/off)

172
Q

ppx tx for portal HTN

A

beta blockers (block mesenteric artery dilatation, resulting in reduced portal inflow)

173
Q

drug in elderly that can cause a hypokalemia that manifests as weakness and muscle cramps, or a hyponatremia that presents as lethargy/confusion/weakness (also, increased uric acid, increased LDL, hyperglycemia)

A

HCTZ

174
Q

first line tx for ITP

A

trial of oral corticosteroids

175
Q

dysfunctional collagen results in capillary fragility, poor wound healing, abnormal hair development, gum disease

A

Vit C def

176
Q

tx of neurosyphilis

A

penicillin G, 3 million units, q4h for 10-14 days

177
Q

management of progressive, unstable angina

A

cardiac cath and coronary angiogram

178
Q

tx GBS

A

plasmapheresis or IVIG

179
Q

bacterial meningitis of gram positive cocci in pairs in a 20 year old

A

strep pneumo

180
Q

tx for acute MI with ST segment elevations of more than 2mm in two contiguous leads or a new LBBB

A

immediate repercussion with IV thrombolytics or coronary balloon angioplasty

181
Q

how to reduce duration of flu if they have been sick for less than 2 days

A

amantadine and inhaled oseltamivir (do not base off viral antibody titers as they do not rise during acute phase of the illness)

182
Q

type _ RTA is assoc with sjogren, SLE

A

I-distal

183
Q

type _ RTA is assoc with diabetic nephropathy

A

IV-hyporenin, hypoaldosterone

184
Q

type _ RTA is assoc with nephrolithiasis

A

I-distal

185
Q

type _ RTA is assoc with bone disease

A

II-proximal

186
Q

type _ RTA is assoc with hyperkalemia

A

IV

187
Q

type _ RTA has urine pH > 5.5

A

I-distal

188
Q

urine pH in hyperchloremic metab acidosis due to diarrhea (GI bicarb loss)

A

urine pH <5.5

189
Q

RTA type _ assoc with multiple myeloma

A

II

190
Q

effect of handgrip on afterload and volume of regurgitation murmurs and VSD

A

increases afterload, increases murmur volume in regurg murmurs and VSD

191
Q

valsalva (increases/decreases) venous return

A

decreases

192
Q

drug to treat vfib and vtach

A

amiodarone

193
Q

drug to treat torsades

A

mag

194
Q

drug to treat 1st degree AV block and 2nd Degree type I

A

atropine

195
Q

most common bacterial cause of diarrhea

A

campylobacter

196
Q

travel diarrhea

A

ETEC

197
Q

AEIOU mnemonic

A

when to give dialysis: acidosis, electrolytes (na/k), ingestion (toxins), overload (chf, edema), uremia (pericarditis)

198
Q

rbc urine casts

A

glomerulonephritis

199
Q

wbc urine casts

A

acute interstitial nephritis, pyelo, interactions with drugs (Bactrim, pcn, cephalosporins)

200
Q

muddy brown urine casts

A

ATN

201
Q

waxy urine casts

A

CKD

202
Q

plt disorder, glycol IIb-IIIa

A

Glanzmann’s

203
Q

plt disorder, glycoprotein Ib

A

Bernard Soulier

204
Q

meds (2) for prolactinoma (first line tx)

A

cabergoline, bromocriptine

205
Q

indications for CABG

A

L main dz, 3 vessel dz (2 vessel dz + DM), >70% occlusion, pain despite maximum medical tx, or post-infarction angina

206
Q

can’t do EKG stress test if:

A

old LBBB or baseline ST elevation OR on digoxin. do exercise echo instead

207
Q

avoid what before MUGA nuclear medicine test that shows perfusion of heart

A

theophylline, caffeine

208
Q

new systolic murmur 5-7 days post MI

A

papillary muscle rupture

209
Q

cannon A waves post MI

A

AV dissociation, either V fib or 3rd degree block

210
Q

step up in O2 concentration from RA to RV after MI

A

ventricular septal rupture

211
Q

acute severe hypoTN post MI

A

ventricular free wall rupture

212
Q

5-10 weeks post MI, pleuritic CP, low grade temp

A

Dresslers, autoimmune pericarditiis, tx with NSAIDs and ASA

213
Q

CP that occurs with rest, worse at night, migraine headaches, worse with ergonovine stimulation test

A

prinzmetal’s angina, tx with CCB or nitrates

214
Q

SEM cresc/decresc, louder w/ squatting, softer w/ valsalva. + parvus et tardus

A

aortic stenosis

215
Q

SEM louder w/ valsalva, softer w/ squatting or handgrip.

A

HOCM

216
Q

Late systolic murmur w/ click louder w/ valsalva and handgrip, softer w/ squatting

A

MVP

217
Q

holosystolic murmur radiates to axilla w/ LAE

A

mitral regurg

218
Q

Holosystolic murmur w/ late diastolic rumble in kids

A

VSD

219
Q

Continuous machine like murmur-

A

PDA

220
Q

wide and fixed split S2

A

ASD

221
Q

Rumbling diastolic murmur with an opening snap, LAE and A-fib

A

mitral stenosis

222
Q

Blowing diastolic murmur with widened pulse pressure and eponym parade.

A

aortic regurg

223
Q

if patient is young, comes in with SOB, no cardiomegaly on CXR, consider ___

A

primary pulmonary HTN

224
Q

young pt with SOB with sxs of CHF w/ prior h/o viral infection

A

myocarditis, coxsackie B

225
Q

PCWP in CHF

A

elevated (estimates the pressure of the left atrium)

226
Q

Pulmonary artery pressure in pulmonary HTN

A

elevated

227
Q

CHF: EF < __%

A

55%

228
Q

digoxin’s role in CHF

A

decreases sxs and hospitalization, does not improve survival

229
Q

transudative pleural effusion

A

CHF, nephrotic, cirrhotic

230
Q

low pleural glucose, transudative pleural effusion

A

rheumatoid arthritis

231
Q

high lymphocytes in transudative pleural effusion

A

TB

232
Q

bloody transudative pleural effusion

A

malignant or PE

233
Q

exudative pleural effusion

A

cancer, parapneumonic

234
Q

light’s criteria for transudative pleural effusion

A

LDH<200, LDH eff/serum

235
Q

first step if you suspect PE

A

give heparin first, then VQ scan or spiral CT, pulmonary angiography is gold standard

236
Q

tx ARDS

A

mechanical ventilation with PEEp

237
Q
  1. ) PaO2/FiO2 < 200 (<300 means acute lung injury) 2.) Bilateral alveolar infiltrates on CXR
  2. ) PCWP is <18 (means pulmonary edema is non cardiogenic
A

ARDS

238
Q

new clubbing in a COPDer

A

hypertrophic osteoarthropathy, get a CXR bc likely lung cancer

239
Q

1cm nodues in upper lobes w/ eggshell calcifications.

A

silicosis

240
Q

important preventative measure in silicosis

A

yearly TB test

241
Q

Reticulonodular process in lower lobes w/ pleural plaques.

A

asbestosis

242
Q

Patchy lower lobe infiltrates, thermophilic actinomyces.

A

hypersensitivity pneumonitis (farmer’s lung)

243
Q

Hilar lymphadenopathy, ↑ACE erythema nodosum

A

sarcoidosis

244
Q

MC lung cancer in non smokers

A

adenocarcinoma–in scars of old PNA

245
Q

patient with kidney stones, constipation, malaise, low PTH and central lung mass

A

squamous cell carcinoma, paraneoplastic syndrome 2/2 PTH-rp

246
Q

CXR showing peripheral cavitation and

CT showing distant mets?

A

large cell carcinoma

247
Q

patient with shoulder pain, ptosis, constricted pupil, facial edema

A

superior sulcus syndrome from small cell carcinoma

248
Q

SIADH paraneoplastic

A

from small cell

249
Q

lambert eaton paraneoplastic

A

from small cell

250
Q

AST and ALT in 1000s after surgery or hemorrhage

A

shock liver ischemic hepatitis

251
Q

causes of elevated D bilirubin

A

obstructive, dubins-j, rotor

252
Q

causes of elevated I-bilirubin

A

hemolysis, gilbert, criggler-najjar

253
Q

elevated alk phos, normal GGT, normal Ca

A

page’s disease (tx with bisphosphonates)

254
Q

HIV drug with SE GI, leukopenia, microcytic anemia

A

ziduvodine

255
Q

post exposure ppx HIV

A

AZT, lamivudine, nelfinavir for four weeks

256
Q

tx pcp in sulfa allergic patient

A

trim-dapsone or primaquine-clinda

257
Q

pcp ppx in pt who is allergic to sulfa

A

dapsone, or atovaquone

258
Q

never do a ___ on a neutropenic fever patient

A

Digital rectal exam

259
Q

Tick bite, no rash, myalgia, fever, HA,

↓plts and WBC, ↑ALT

A

Ehrlichiosis! Can dx w/ morulae

260
Q

(hypo/hyper) Ca: prolonged QT

A

hypo (also Chvostek, Trousseau)

261
Q

(hypo/hyper) Ca: shortened QT

A

hyper

262
Q

paralysis, ileus, ST depression, U waves

A

hypokalemia

263
Q

BUN/Cr ratioif >20/1

A

pre-renal azotemia

264
Q

1 cause of death in CKD

A

CVD so keep LDL<100

265
Q

tx normochromic normocytic anemia in CKD

A

give EPO

266
Q

dx DM2

A

fasting over 126, random over 200, 2hr glucose tolerance test over 200, or venous HbA1c over 6.5%

267
Q

how to manage hyperglycemia in a hospitalized patient

A

basal and rapid acting preprandial insulin administration

268
Q

tx diabetic retinopathy

A

pan retinal photocoagulation

269
Q

tests to dx DKA

A

blood glucose less than 250, arterial pH<7.3, serum CO2<15, positive serum or urine ketones

270
Q

tx hyperglycemic hyperosmolar syndrome

A

IV fluids and tx predisposing factor such as infection, MI, new kidney insufficiency

271
Q

tx DKA

A

insulin drip

272
Q

LDL goal in patient with zero or one risk factor

A

160 or below

273
Q

when is fibrate therapy indicated

A

triglycerides over 200 in setting of elevated non HDL cholesterol levels

274
Q

how to confirm dx of hashimoto

A

look for TPO antibodies (but not necessary if you’re merely diagnosing hypothyroidism, then you just do the T4 and TSH)

275
Q

when do you do an FNA on a thyroid nodule

A

when it is greater than 1cm or if the patient has cancer risk factors

276
Q

management of pregnant woman with hypothyroidism

A

recheck TSH, keep it in the lower range of normal. pregnancy increases levothyroxine requirements by 30-50% in the first trimester

277
Q

medical tx graves dz

A

atenolol and methimazole

278
Q

when would you pursue further testing of an incidentaloma

A

hyper secretion of glucocorticoids and catecholamines

279
Q

best screening test for hyperaldosteronism

A

ratio of serum aldo to plasma renin activity (ratio greater than 20 is consistent with the disease)

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