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PAEA Book Flashcards

1
Q

NY heart associated functional classification of heart disease

A

I-no limitation no fatigue dyspnea or angina pain
II- slight limitation of physical activity results in symptoms
III- marked limitation of physical activity; comfortable at rest but less ordinary activity causes symptoms
IV- Unable to engage in any physical activity

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2
Q

Mechanism of hypovolemic shock and 3 examples

A

Decreased iV volume

Hemorrhage
Loss of plasma
Loss of fluids and electrolytes

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3
Q

Cardiogenic shock and causes

A

Defective cardia output, cycle of output

Can be the cause of MI
Dushythmias 
HF
Defects in the septum 
Myocarditis
Hypertension
Cardiac contusion
Rupture of ventricular septum 
Cardiomyopahties
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4
Q

What is and examples of obstructive shock

A

Blockage of blood flow into or out of the heart

Tensión pneumothorax

Pericardial tamponase
Obstructive valvular disease
Pulmonary problems
Massive PE

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5
Q

Examples of distributive shock

A

Increase/excessive vasodilation

Examples include
Septic shock
SIRS
Neurogenic shock 
Anaphylaxis
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6
Q

Third space sequestration would be an example of

A

Hypovolemic shock

Also see this with loss of plasma or shock caused by hemorrhage
Loss of fluid and electrolyte Balcance

Anything that depletes intravascular volume

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7
Q

What is neurogenic shock

A

This is a type of distributive shock that is also seen with SEPSIS and anaphylaxis

Spinal cord injuries and adverse effects or spinal anesthesia

This occurs from interruption of the sympathetic vaso motor input after a high cervical spinal cord injury

Can have arteriolar dilation
Can have venodilation causes pooling in the venous system and decreases venous return and cardiac output

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8
Q

How would neurogenic shock differ from other types of shock in terms of symptoms

A

Extremities are often warm in contrast to the usual sympathetic vasoconstriction induced coolness in hypovolemic or cardiogenic shock

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9
Q

Treatment for neurogenic showcase

A

Similar to relative hypovolemic and the loss of vasomotor tone

Excessive volumes of fluid may be required to restore normal hemodynamics if given alone

Once rule out hemorrhage can use nerepi or a pure alpha adrenergic agent (phenyephrine) may be necessary to augment vascular resistance and maintain an adequate MAP

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10
Q

Hypoadrenal shock

A

The normal host response to illness, operation, or trauma requires that the adrenal glands hypersecrete cortisol in excess of that normally required

This happens in the settings in which unrecognized adrenal insufficiency complicates the host response to the stress induced by acute illness or major surgery

This can be seen with administration of chronic steroids

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11
Q

Diagnoses of adrenal insufficiency is established with

A

ACTH stimulations test

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12
Q

What is the treatment of hypoadrenal shock

A

Dexamethasone sodium phosphate 4mg IV

This agent is preferred if empiric therapy is required because, unlike hydrocortisone, it does not interfere with the ACTH stimulation test

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13
Q

Septic shock is post commonly asssociated with

A

Gram-negative and gram-positive sepsis in persons at extrémese of age and persons IC

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14
Q

Do studies for a pt is suspected shock

A 
CBC
Type cross 
Electrolytes
Glucose
Urinalysis 
Serum creatinine

These help in determining the cause

ECG, CXR, cardiac biomarkers, BNP

LACTATE

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15
Q

What level of lactic acidosis indicates hyperlactatemia

A

Metabolic acidosis

Anaerobic metabolism

2-4

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16
Q

What level of lactic acidosis comes with a 75% mortality

A

5

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17
Q

Inotropes for shock

A

Dobutamine
Dopamine
Epinephrine

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18
Q

What are the preSSRIs commonly used in shock

A

Norepinephrine
Vasopressin
Dopamine
Phenylephrine

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19
Q

Definition of orthostatic HTN

A

Greater than a 20 mm hg drop in systolic BP or a drop of greater than 10 mm Hg in diastolic between supine and sitting

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20
Q

If no change in pulse occurs with orthostatic HTN consider

A

Medication cause
Parkinson
Shy-drager syndrome
Peripheral neuropathies (diabetic autonomic neuropathy)

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21
Q

How is hypertensive urgency defined

A

Systolic BP greater than 220 or systolic greater than 125

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22
Q

How is a hypertensive urgenytreated

A

Must be treated within hours

First line is nicardipine pls esmolol
Nitroglycerin plus beta blocker (if myocardial ischemia is present)

Alternative HTn treatment 
Enalapril
Diazoxide 
Trimethaphan
Loop diuretics
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23
Q

What is the treatment for hypertension in pregnancy

A

Nicardipine or labetelol

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24
Q

What is HTN emergency

A

Strikingly elevated above 220 or above 130 with sign

Encephalopathy
Nephropathy
Intracranial hemorrhage
Aortic dissection
Pulmonary edema
Unstable angina 
MI
Preeclampsia
Eclampsia
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25
Q

When is the window of treatment for hTn emergency

A

BP must be treated within 1 hour to prevent progression of end organ damage or death

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26
Q

Malignant hypertension

A

Must also be reduced within 1 hour

Strikingly elevated

Usually seen with papilledema
Either nephropathy
Encephalopathy

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27
Q

Complications of untreated HTN

A 
Cardiovascular
Cerebrovascular
Dementia
Renal disease
Aortic dissection
Atherosclerotic complications
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28
Q

Prehypertension is defined as

A

120-139

80-90

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29
Q

What a re the loop medications

How do they work for HTN and what do you need to be careful of

A

These include

Thiazides
And hydrochlorothizide

These reduce plasma volume and peripheral resistance

Need to monitor potassium and other electrolytes

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30
Q

What are the beta adrenergic anatagonist

What a re they and how do they work

A

AKA beta blockers

These decrease heart rate
Reduce cardiac output
Reduce mortality after MI and heart failure

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31
Q

What pts would you use a beta blocker with and what medication would

A

Most effective in younger white patients use with caution in diabetes or pulmonary disease

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32
Q

How doe ACE inhibitors work?

A

Inhibit bradykinin

Degradation
Stimulates synthesis of vasodilating prostaglandins

Reduce mortality after MI in heart failure

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33
Q

Ace inhibitors are the drug of choice in

A

CKD

DM

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34
Q

CCB is the drug of choice in

A

Elderly and black patients

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35
Q

When would you use a alpha adrenergic antagonist

A

Alfuzosin

Or a alpha adrenergic anatagonist

For lowering peripheral vascular resistance

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36
Q

chronic bronchitis

A

blue bloater

cyanosis

hypoxemia
hypercapnia from the constant presence of peripheral edema
from cor pulmonale (peripheral edema)
chronic cough with large amounts of sputum

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37
Q

ephysema

A

cachectic appearance without
cyanosis

pursed lip breathing
pink puffer
use of accessory muscles for respiration
shortness of breath is manifested by the pursed lip breathing and the use of accessory muscles of respiration

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38
Q

how do you diagnose COPD

A

PFT

will see a decrease in FEV1/FVC

no reversibility

can also check a ABG if FEV1<50%

ALL pts should be screened for alpha anti triptin 1 deficiencys

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39
Q

tx copd

A

SABA PRN

add LAMA
tiotroprium
+LABA (olol)

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40
Q

whata re some of the systmic manifestations of COPD

A

hyerpcoagulability (stroke , PE, DVT, atrophy)

weight loss
osteoperosis
skin wrinkling 
anemia 
fluid retention

infarction
arrhytmia
congestive heart failure

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41
Q

ddx of COPD

A 
HF
asthma
tb
Bronchiectasis 
anemia
cystic fibrosis
neoplasm
PE
Obliterative bronchiolitis
diffuse panbrochiolitis
sleep apnea
hypothyroidism 
nueromuscular dz
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42
Q

TREATMENT

A

corticosteroids
o SpO2 88-88
prevention

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43
Q

Inhaled steroids are reserved for patients copd

A

with either ≥2 exacerbations annually or FEV 1 <50% of predicted. The role of inhaled corticosteroids (ICS) in COPD is controversial.

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44
Q

what are the absolute CI to thrombolytic therapy

A

suspected AD

active bleeding

any prior cerebral hemorrhage

intracranial neoplasm

cerebral aneurysm or

arterovenus malformation

ischemic cerebrovascular
accident within 3 mo

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45
Q

relative CI to thombolytic therapy in acute MI

A

bleeding diatheses coagulopathy

major surgery within 3 wk

puncutre of noncompressible vessel or other bleeding within 2 wk

hemorrhage within 6 mo

proliferative retinopathy

active PUD

history chronic severe poorly controlled HTN (>180)

cardiopulmonary resuscitation

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46
Q

pericarditis s/p STEMI tx

A

ASA

NOT steroids

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47
Q

most common presentation of myocarditis

A

flu prodrome

dyspnea -72
chest pain -32
arrhytmias -18

chest pain is pleuritic or positional whenever the pericardium is involved

may have recent flu like syndrome

severe, diffuse and acute with sudden CHF symptoms–?> shock and death

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48
Q

etiologies of myocarditis

A

MCC IN DEVELOPED COUNTRIED VIRAL COXSAXIE B , (adeno, paro, hepatitis c, Coxs, cytomegalovirus, enterovirus)

bacterial (staph aureus, clostridium perfringens, diptheria, mycoplasma)

mycotic (candidia, aspergillus, blastomyces, histo)

parasitic (trypansoma cruzi MCC world wide)

rickettsia rickettsi

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49
Q

disease processes that can lead to myocarditis

A 
rheumatic fever
SLE
granulomatosis with polyangitis 
GCA 
drugs 
toxins
systemic and collagen vascular disease 
radiation
postpartum
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50
Q

drugs that cause myocarditis

A 
cociane
emetine
doxorubicin
sulfonamides
isoniazi
methyldopa
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51
Q

DDX OF MYOCARDITIS

A 
CLOZAPINE
ischemic caridomyopathy 
acute coronary syndromes 
valvulopathies
infiltrative disease of the myocardium 
sarcoidosis
amyloidosis
hemochromatosis
chagas
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52
Q

what is the ddx for myocarditis

A

ischemic cardiomyopathy and other cardiomyopathies

valvulopathies
ACS
infiltrative disease 
sarcardoicosis
amyloidosis 
chagas
hemacrhomatosis
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53
Q

dx workup for myocarditis

A

CXR
ECG

MRI
endomyocardial biopsy GOLD STANDARD?
(not very sensitive 10-35%)

mostly looking at cardiac troponin with 89% sensitivity

Increased CK MB
BNP if HF sxs

can do cardiac MRI

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54
Q

tx for nonpharmacological therapy

A

supportive care
restrict physcial exercise

BB for peds

IVIG
maybe inotropic drugs if severe enough

bed rest
avoid heavy use of alcohol

NSAIDs should be avoided in patients with HF generally given the risk of HF exacerbation and possible risk of icnreased mortality

antiarrhythmics therapy

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55
Q

why don’t you use NSAIDs for patients with heart failure

A

pt withs HF are dependent

upon vasodilating prostaglandins to maintain renal perfusion and salt and water balance decrease prostaglandin synthesis and, thus, may precipitate fluid retention in patients with heart failure.

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56
Q

in pts with CHF from myocarditis what is the treatment

A

ACE inhibitor
BB
possible aldosterone receptor antagonist will decrease their mortality in the long term

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57
Q

what are carcinoid tumors and how do they present

A

rare neuroendocrine tumors of the digestive tract, lungs, and less commonly of the kidneys and ovaries.

skin flushing, wheezing and diarrhea

24-hour excretion of 5-hydroxyindoleacetic acid (5-HIAA) in the patient’s urine

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58
Q

What medications are used for symptomatic control of carcinoid tumors?

A

Somatostatin analogues such as octreotide, pasireotide and lanreotide.

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59
Q

———-is the most appropriate selection to use as daily prophylaxis against the anginal pain caused by Prinzmetal (variant) angina.

A

Amlodipine

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60
Q

treatment for afibb with RVR

A

intravenous calcium channel blockers (diltiazem, verapamil) or beta-adrenergic blockers (metoprolol) are first-line rate-controlling agents for stable atrial fibrillation.

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61
Q

What agents should be avoided in patients with atrial fibrillation and Wolf-Parkinson-White (WPW) syndrome?

A

AV-nodal blocking agents such as adenosine, calcium channel blockers, beta-adrenergic blockers, and digoxin. This can lead to cardiovascular collapse due to preferential accessory pathway conduction.

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62
Q

Theophylline is recommended for…. these two dz processes

A

Theophylline is recommended for pulmonary hypertension and asthma

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63
Q

Name two steroid-sparing alternative medications used for pulmonary sarcoidosis.

A

Azathioprine and methotrexate.

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64
Q

what are the lab, CXR, and biopsy finding in sarcoidosis

A

Patient will be an African-American woman
Labs will show hypercalcemia and elevated serum ACE

CXR will show bilateral hilar adenopathy

Biopsy will show noncaseating granulomas

Treatment is steroids

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65
Q

cor pulmonale is the result of

A

cor pulmonale is the result of pulmonary hypertension associated with diseases of the lung, upper airway, pulmonary vasculature or chest wall. The disease presents as altered structure and function of the right ventricle.

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66
Q

what is the standard lab follow up for a patient on amiodarone

A

Amiodarone is a class III anti-dysrhythmic drug used to treat many common dysrhythmias. An annual chest radiograph is recommended when patients are on chronic amiodarone therapy.

Several types of pulmonary toxicity may result from chronic amiodarone therapy; however, the most common is a chronic interstitial pneumonitis.

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67
Q

what is the name and the presentation for the acute form of sarcoidosisi

A

Lofgren syndorme

hilar lymphadenopathy

erythema nodosum
arthritis

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68
Q

RF for aortic dissection>

A 
HTN
Advanced age
GCA
connective tissue disease
family hx
cocaine abuse
iatrogenic 
pregnancy
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69
Q

MCC of PNA in ED

A

acute bronchitis

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70
Q

she has been using her albuterol inhaler every 15 minutes for the last four hours without relief. What laboratory abnormality is likely to be found in this patient?

A

Hypokalemia

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71
Q

put patient therapy for DVT

A

Enoxaparin

NOT unfractionated heparin ast his requries being hospitalized

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72
Q

A 74-year-old woman presents with complaints of fever, productive cough with bloody sputum, shortness of breath, and headache. These symptoms developed and worsened drastically over the past 3 days. She recently recovered from an influenza infection 1 week ago. Her medical history otherwise includes only well-controlled hypertension. Vital signs on presentation are as follows: T 39°C, HR 106, BP 110/75, RR 30, oxygen sat 95% RA. A chest radiograph is obtained and a subsequent CT scan of the chest demonstrates multiple cavitary lung lesions. Which of the following organisms is most likely responsible for this patient’s presentation?

A

staph aureus
necrotizing pneumonia

The most common organism in necrotizing pneumonia, particularly after a viral upper respiratory infection, is S. aureus. Necrotizing pneumonia is known to be caused by a specific S. aureus strain that produces Panton-Valentine Leukocidin (PVL). Often, this infection and the ensuing pneumonia that develops, is preceded by an influenza infection. T

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73
Q

what are the HTN medications that should be given in a AA

A

thiazides and CCB

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74
Q

the treatment of choice in hemodynamically stable wide-complex tachydysrhythmias in WPW syndrome. E

A

procainamide is

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75
Q

what does legionella pneumonia look like

A 
associated with water sources
pleuritic chest apin
bradycardia
neurological symptoms
hyponatremia 
relative bradycardia
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76
Q

74-year-old woman with a history of heart failure presents to the ED with shortness of breath. Her vital signs are notable for heart rate 105 beats/minute, blood pressure 180/90 mm Hg, and oxygen saturation of 87 percent on room air. Chest X-ray shows pulmonary edema. You are considering starting nitrates. Which of the following underlying conditions puts the patient at risk of developing nitrate-induced hypotension?

A

as

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77
Q

The term sick sinus syndrome was coined to describe

A

The term sick sinus syndrome was coined to describe patients with SA node dysfunction that causes marked sinus bradycardia or sinus arrest.

may manifest in syncope and the treatment is a pacemaker IF SYMPTOMATIC

Permanent pacemaker with AICD

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78
Q

DX of pericarditis involves at least two of the following

A

typical pleuritic chest pain
pericardial friction rub
suggestive ECG
new or worsening pericardial effusion (Beck’s triad)

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79
Q

what is the treatment for pericarditis

A

high dose ASA

no NSAIDs if recent bleed MI
CHF
renal failure or
Upper GIB

colchicine secon line

dressler’s colchicineor asaparin

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80
Q

kussmaul’s sign

A

increase in JVP with inspiration

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81
Q

difference between ECG with acute pericarditis vs pericardial effusion vs constrictive pericarditis

A

diffuse ST= acute

effusion= low voltage QRS complexes

no classic ECG for contrictive but will see calcification on echo

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82
Q

difference in treatment for pericaridal effusion vs constrictive pericarditis

A

for pericardial effusion you do pericardiocentesis

for constrictive pericarditis you do a pericardiectomy

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83
Q

RF for PAD

A

smoking
DM
HTN
hypercholestrolemia

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84
Q

MC presentation of PAD

A

intermitten claudication (aching pain, cramping, weakness, numbeness, heaviness of the leg induced by exercise and relieved with rest)

critical limb ischemia (>2 weeks) rest pain, or tissue loss with nonhealing ulceration, necorsis or gangrene

acute limb ischemia i

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85
Q

what is acute limb ischemia

A

<2 weeks onset of symptoms due to poor perfusion of the extremities and further categorized by

viable
threatened
irreversible (sever sensory loss and muscle weakness)

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86
Q

physical findings in PAD

A

diminished pulse
cool skin temperature of lower extremities
bruits heard over the distal aorta
iliac or femoral arteries

changes in skin color

trophic changes like loss of hair or brittle nails

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87
Q

what is the etiology of PID

A

atherosclerotic narrowing of the arterial lumen that results in impaired blood flow to the lower extremities

symptoms manifest with exercise as metabolic demand increases

critical limb ischemia may develop gradually fro, progressive atherosclerosis or in a subacute fashion from multisegmental atherothrombosis or atheroembolization

ALI <2 week symptoms and poor profussion

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88
Q

ddx of PAD

A 
vasculitis
MSK d/o
spina stenosis or nerve root compression
peripherla neuropathy
raynaud's disease
reflex sympathetic dystrophy 
compartment syndrome
DVT
popliteal entrapment syndrome
direct vascular injury
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89
Q

acute bronchitis is MCC by

A

adenovirus

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90
Q

PE of chronic bronchitis

A 
rales
crackles 
rhonchi
wheezing
might change with location of the cough

signs of cor pulmonale (peripheral edema and cyanosis)

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91
Q

CXR of chronic bronchitis

A

increased vascular markings and enlarged right heart

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92
Q

what might you see on a ecg with chronic bronchitis

A

cor pulomanle will show right ventricular hypertrophy and right atrial enlargement

potentially MAT

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93
Q

anticholinergic use din COPD pts

what is the name and what are the side effects

A

tiotropium aka spirivia is a LAMA

it blocks acH mediated bronchoconstriction–> bronchodilation

s/e include dry mouth, blurred vision, urinary retention, difficulty swallowing

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94
Q

tiotroprium is CI in pts with

A

BPH and glaucoma (because they increase urinary retention and pupillary dilation)

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95
Q

staging of PAD

A 
I: asymptomatic
II a: mild claudication
II b: moderate severe claudication
III: ischemic rest pain
IV: ulceration or gangrene
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96
Q

first line for establishing a dx of PAD

A

ABI

calculated by dividing the highest dorsalis pedis or posterior tibial pressure by the highest brachial pressure obtained form eitherthe right or left arm

abnormal is <0.90
normal 1-1.40 at rest
non-compressible/calcified: >1.40

routine screening NOT recommended

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97
Q

PVD vs PAD

A

pvd is worse with leg dependnecy standing and prolonged sitting

PAD is worse with walking elevation of the leg and cold
better with leg dependency and rest

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98
Q

which type of PVascD has redness with dependency

A

dependent ubor is seen with PAD

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99
Q

leg ulcers with PVD are seen

A

medially

uneven margins

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100
Q

leg ulcers wtih PAD

A

lateral

clean margins

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101
Q

what is statis dermatitis

A

eczematous rash, thickening of skin and brownish pigmentation

pulses and temp usually normal

seen with PVD

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102
Q

when does rhuematic fever typically occur

A

usually 2-3 weeks but as late as 5 weeks

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103
Q

most common infection sxs seen in rheumatic fever

A

carditis 50-70%
arthritis 35-66%
chorea 10-30 %
subcutaneous nodules

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104
Q

major criteria Rheuamtic fever

A

two major

Joint
Oh my heart
Nodules
Erythema marginatum
Sydenham's chorea
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105
Q

minor criteria rheumatic fever

A

Cafe-CRP increased
A-arthralgia
F- fever
E- elevated ESR

P-prolonged PR
A- anamnesias of rehmatitis
L-leukocytosis

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106
Q

Tx for rheumatic fever

A

ASA
PNC
corticosteroids

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107
Q

Tx SSS

A

episodes of dizziness weakness and flushing of the face

pacemaker with AICD

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108
Q

TX Vtach

stbale and unstable

A

unstable–> synchronized cardiovert

stable–> amiodarone -lidocaine

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109
Q

constrictive pericarditis sxs and tx

A

right sided heart failure pericaridal knowck

tx
pericardectomy
diuretics

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110
Q

sxs of primary aldsoteronism

A

HTN
hypokalemia
hypernatremia
metbaolic alkalsosis

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111
Q

ABI for healing ulcers in DM and NOn DM

A

VENOUS STasis ulcer

.85 DM
.6-.8 NON dm

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112
Q

gold standard of acute arterial occlusion

A

arteriography
shows length location
degress of occlusion

doppler often used in er

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113
Q

holosystolic murmur heard best at apex radiation to the axilla

A

mitral valve prolapse MC reason of this (ischemia)

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114
Q

pathophysiology of WPW

A

accessory pathway that connects atria and ventricles–?electrical signals bypass AV node
short PR interval and wide QRS from DELTA WAVES

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115
Q

in what time span do you need PCI in MI pt

A

90 minutes or TPA

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116
Q

order of treatment in NSTEMI

A

1) anti-thrombotic (aspirin, heparin, ADP-inhibitors, GP IIb/IIIa inhibitors, X in)
2) adjunctive (b-blockers, nitrates)

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117
Q

what is the dx test for prinxemetal anginea

A

coronary angiogram w injection of provocative agents (ergonovine)
ST elevation only tracked while experiencing attack–>why you provac it

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118
Q

what is the PE with mitral stenosis
MCC
sxs
heart sound

A

MCC is rheumatic heart disease
Right sided heart failure, pulm htn, A-Fib, mitral facies (flushed face)

Diastolic rumble @ apex–>LLD, opening snap

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119
Q

dilated cardiomyopathy clinical presentataion

A

(ischemic*, genetic, alcohol, postpartum, chemo tox, myocarditis, endocrinopathies, viral)

systolic HF sxs
s3
fatigue
signs of left and right sided CHF lateral displaced mri

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120
Q

what is the tx for dilated cardiomyopathy

A

Tx: abstinence from alcohol, ACE-I, diuretics, digoxin, B-blockers, salt restriction

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121
Q

stasis dermatitis improves with

A

elevation and walking

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122
Q

inferior MI leads

A
  • II, III, aVF, RCA
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123
Q

posterior MI leads

A

ST depression V1, V2

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124
Q

MCC of restrictive cardiomyopathy

A

amylodosis

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125
Q

dx test with restrictive cardiomyopathy

A

ECG–>nonspecific with ST seg and T wave abnormalities

Echo–> diated atria and myocardial hypertrophy
amylodosis

CXR–>coronary vascular congestion (normal heart size)

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126
Q

restrictive cardiomyopathy tx

A

Diuretics–> may be useful if pulm vascular congestion or edema

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127
Q

Patients with ischemic colitis present with

A

Patients with ischemic colitis present with sudden onset of mild to severe cramping, often on the left side of the abdomen, along with rectal bleeding or bloody diarrhea within 24 hours of symptom onset.

An abdominal CT may demonstrate findings of thickening of bowel wall or free peritoneal fluid

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128
Q

bronchitis symptoms but with fever

A

think PNA

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129
Q

MCC of bronchitis

A

viral
cough can be productive or not

do fluids antypyretics 
rest 
antitussices
bronchodilators 
Anbx are beneficial in elderly or COPD or IC >7-10
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130
Q

Tx for acute exacerbations of chronic bronchitis

A

azithromyocin

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131
Q

hypercalcemia and cavitary lesions

A

squamous cell

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132
Q

Gynecomastia MC with what type of lung cancer

A

Gynecomastia MC with adenocarcinoma.

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133
Q

Lambert-Eaton Syndrome

A

associated with small cell. Antibodies against calcium-gated channels @ the neuromuscular junction => weakness similar to myasthenia gravis but in Lambert-Eaton, the weakness IMPROVES with continued use.

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134
Q

pulmonary nodule

Age <30, lesions stable more than 2y

A

Low prob of malignancy (<5%)–> monitor with CT 3 months

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135
Q

intermediate probability of CA with solid lung nodule

A

Intermediate prob of malignancy (5-60%)–>

biopsy
(transthoracic needle for peripheral lesions or bronchoscopy for central lesions)

PET+–> high CA
VATS

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136
Q

high probability of malignancy

A

go straight to staging and resection

no bx

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137
Q

gram stain of strep pneumoniae

A

Strep pneumoniae, gram + cocci in pairs

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138
Q

cam PNA sxs

A

Sudden onset of Fever, productive cough, purulent, tachycardia/pnea
Bronchial breath sounds, dullness to percussion, increase tactile fremitus, increase egophony

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139
Q

tx of out pt CAM

A

Tx: outpatient
Primary Options
azithromycin : 500 mg orally once daily on day one, followed by 250 mg once daily for 4 days
clarithromycin : 500 mg orally twice daily
erythromycin base : 500 mg orally four times daily

Secondary Options
doxycycline : 100 mg orally twice daily

(doxycycline or macrolide )

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140
Q

in patient tx of CAM

A

B-lactam + macrolide or broad spectrum FQ

azithromycin : 500 mg intravenously once daily
– AND –
ampicillin : 1000 mg intravenously every 6 hours or
cefotaxime : 1 g intravenously every 8 hours or
ceftriaxone : 1 g intravenously once daily

OR
levofloxacin : 750 mg orally/intravenously once daily
moxifloxacin : 400 mg orally/intravenously once daily

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141
Q

ICU non pseudomonal

A

B-lactam + macrolide or B-lactam + broad spectrum FQ

ampicillin/sulbactam : 1.5 to 3 g intravenously every 6 hours more
or
cefotaxime : 1 g intravenously every 8 hours or
ceftriaxone : 1 g intravenously once daily
– AND –
levofloxacin : 750 mg intravenously once daily or
moxifloxacin : 400 mg intravenously once daily or
azithromycin : 500 mg intravenously once daily

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142
Q

is pseudomonal PNA suspected

A

antipneumococcal, antipseudomonal beta-lactam

(e.g., piperacillin/tazobactam, cefepime, meropenem)

PLUS
ciprofloxacin or levofloxacin.

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143
Q

PNA related to Related to AC and cooling vacs, contaminated water

A

legionella
CAM
- Add Levofloxacin or Azithromycin if Legionella is suspected.

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144
Q

what symptoms would you expect to see with legionella

A

GI sxs: anorexia, N/V/D, increased LFTs, hyponatremia

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145
Q

Chronic fibrotic disease 2ry to inhalation of mineral dust (ingested by alveolar macrophages)

A

Pneumoconiosis


Restrictive lung disease, decreased lung compliance

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146
Q

progressive massive fibrosis; CXR shows small upper lobe nodules and hyperinflation. May have obstructive pattern on PFT.

A

“coal workers lung

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147
Q

Caplan syndrome

A

(RA) and pneumoconiosis that manifests as intrapulmonary nodules,

148
Q

mining, sand blasting, quarry, stone increase risk TB;

A

silicosis

149
Q

silicosis CXR

A

CXR: multiple small (<10mm) round nodular opacities primarily in the upper lobes. Bilateral nodular densities progress from the periphery to the hilum. + egg shell calcifications of the hilar & mediastinal nodes (only seen in 5%). Lung Biopsy

150
Q

berylliosis

A

 aerospace, nuclear, ceramics requires chronic steroids; CXR: normal 50%, hilar lymphadenopathy, increased interstitial lung markings.

151
Q

Byssinosis:

A

Byssinosis: brown lung diseases, Monday fever, d/t cotton exposure
asbestosis increased risk of CA, mesothelioma; CXR: pleural plaques (pleural

152
Q

ABG with asthma

A

respiratory alkalosis* classic with exacerbation

153
Q

when should you admit a pt for asthma exacerbation

A

PEFR <50% predicted, AMS

154
Q

when can you discharge a pt with a asthma exacerbation?

A

Discharge—>PEFR >70%, improvement for >1 hour

155
Q

LABA examples

A

salmetrol, symbicort(budesonide/formoterol) Advair)

156
Q

improves resp muscle endurance, narrow therapeutic window

A

Theophylline

157
Q

heliox works by

A

decreases airway resistence)

158
Q

chronic Bronchitis

CXR

A

increased vascular markings, enlarged right heart border

ECG: cor pulmonale, multifocal atrial tachycardia

159
Q

emphysema CXR

A

hyperinflation,
decreased vascular markings
+/- bullae

160
Q

Tx for COPD exacerbation

A

Tx: bronchodilators: combo with B2agonist + anticholinergic

B2= albuterol, terbutaline, salmeterol (long acting)

Anticholinergic= tiotropium(Spiriva), ipratropium (atrovent)

161
Q

when would you use corticosteroids in COPD exacerbation

when would you use theophylline

A

not monotherapy, may be added to LABA (salmeterol + fluticasone)

162
Q

when would you use O2 in a COPD exacerbation

A

Use if cor pulmonale,

02sat <88% or

Pa02 <55mm Hg.

163
Q

gold standard for TB dx

A

Acid fast smear & sputum cultures x 3 days (AFB cultures GOLD STANDARD

164
Q

treatment for latent TB

A

INH + pyridoxine 9 months (12 mon if CXR granulation or HIV +)

165
Q

TB treatment for people that have had contact with infected persons

A

If in contact: RIF + PZA 4 months (consult ID specialist)

166
Q

treatment for active TB

A

RIPE

(rifampin, INH, pyrazinamide, ethambutol).

Total tx of active is 6 months (or 3 months after negative sputum culture).

if culture shows sensitivity to INH and RIF —> stop other two

167
Q

rifampin adverse side effects

A

Thrombocytopenia,* flu-like symptoms. Orange colored secretions* [ex tears, urine]. GI upset, hypersensitivity, fever, hepatitis.

168
Q

isoniazid adverse side effects

A

Hepatitis* (especially >35y ofage). Peripheral neuropathy.*
Drug-induced lupus, rash.
Abdominal pain, high anion gap acidosis. Cytochrome P450 inhibition.____________

MUST TAKE WITH PYRIDOXINE . B6

169
Q

Pyrazinamide adverse side effects

A

Hepatitis & hyperuricemia.
GI symptoms, arthritis.
Photosensitive dermatologic rash

170
Q

etambutol EMB adverse side effects

A

optic neuritis

red green

171
Q

3 criteria for latent tB

A

asymptomatic person

PPD +

No evidence of active infection on CXR or CT (NOT contagious)

172
Q

why do you use Bronchoalveolar lavage in TB

A

Bronchoalveolar lavage: used to r/o infectious causes. Sarcoid: incr. CD4:CD8 (increased CD4, decreased CD8)

173
Q

Tx for sarcoidosis

A

Oral corticosteroids TOC*
Methotrexate (steroid alternative) watch for toxicity though
Hydroxychloroquine: may be good for chronic disfiguring skin lesions.
NSAIDs for musculoskeletal symptoms & erythema nodosum
Single lung transplant in severe cases.

174
Q

Ear pain, bullous myringitis*(eardrum), non-productive cough, erythematous pharynx (pharyngitis), URI sx

A

mycoplasma pneumonia

age <50 years
persistent cough
dry cough
long duration of symptoms
Other Factors
recent community exposure
fever
headache
diarrhea
bullous myringitis
lung rales/crepitations
throat involvement
rash
175
Q

mycoplasma pneumonia dx

A

Send serum cold agglutinins for Dx

176
Q

mycoplasma pneumonia tx

A

Doesn’t respond to B-lactam, lacks cell wall. Use macrolide

azithromycin : 500 mg orally once daily on the first day, followed by 250 mg once daily for 4 days; 500 mg intravenously once daily for at least 5 days
clarithromycin : 500 mg orally (immediate-release) twice daily for 14-21 days
erythromycin base : 500 mg orally four times daily for 14-21 days; 1000 mg intravenously four times daily for 14-21 days

177
Q

pickwickian syndrome

A

obesity hypoventilation syndrome—condition in which severely overweight people fail to breathe rapidly or deeply enough, resulting in low blood O2 and high CO2 levels.

alveolar hypoventilation results from blunted ventilatory drive and increased mechanical load imposed by obesity

can lead to heart failure symptoms
hypoxemia during sleep .

get polysomnography and screen TSH and cbc

178
Q

HBsAg

A

Infected
>6 months chonric

1st evidence

179
Q

HBsAb

A

vaccination of distant resovled infection

if this doesn’t exist than you can assume chronic infection

180
Q

HBcAb

A

if IgM then acute

if IgG than chronic or immune through exposure

181
Q

HBeAg

A

increase in viral replication

increased infectivity

182
Q

charcot’s triad sx

A

Most patients have fever, jaundice, and right upper quadrant pain (Charcot triad).

183
Q

biliary colic

A

occurs after a fatty meal in which the gallbladder contracts and pushes stones into the cystic duct; when the duct relaxes, the stone retreats back into the gallbladder causing visceral pain.

184
Q

Cholecystitis is..

A

Cholecystitis—obstruction of the cystic duct resulting in acute inflammation of the gallbladder wall.

185
Q

Choledocholithiasis is..

A

Choledocholithiasis—gallstones located in the common bile duct.

186
Q

cholangitis is ..

A

gallstones in the ampulla of vater

187
Q

dx cholestasis aka biliary colic

A

high alk phos
juanidce
dark urine

188
Q

cholelithiasis

A

RUQ ultrasound high sensitivity
(IF >2MM)
can also get MRI or CT

189
Q

what is boas sign

A

referred right subscapular pain with cholelithiasis

190
Q

acute cholecysitis sx

A

pain lasts days
RUQ
epigastrium
nausea, vomiting, anorexia

MURPHY sign
GET HIDA WHEN ULS inconclusive

will see elevated ALK-Pand GGT

191
Q

tx for acute cholecysitis

A 
IV fluids
bowel rest
IV abnx 
analgesics
cholecystecomy within 48 hrs 
but timing depends on severity
192
Q

choledocholithiasis

A

stones in the common bile duct (CBD)

primary:
originate in CBD

secondary: originates in GB passes to CBD

193
Q

choledocholithiasis sxs

A

RUQ or epigastric pain
jaundice

NO FEVER

194
Q

dx test for choledocholithiasis

A

RUQ ULS first but not sensitive

ERCP -GOLD STANDARD

195
Q

TX FOR choledocholithiasis

A

ERCP with sphincterectomy and stone extraction with stent placement

lap choledocholithotomy

can complicate and turn into cholangitis

196
Q

cholangitis dx tests

A

infection of biliary tract seocndary to obstruction and bacterial overgrowth

ULS first
ERCP after

blood culture

197
Q

PSC

A

ERCP decompression or can progress to hepatic abscess chornic idopathic progressive
disease of intraheptatic or extrahepatic bile ducts

thickening
and narrowing of lumen
liekly triggered by immune mediated bile duct injury (STRONG ASSOCIATION WITH ULCERATIVE COLITIS)

198
Q

What is the sxs associated with PSC

A

insidious onset
chronic cholestasis

progressive to jaundice and itching

fatigue
malaise
weight loss

199
Q

dx test for PSC

A

ERCP

LFTS

200
Q

PSC tx

A

liver transplant

cholestyramine should give sx relief of itching

201
Q

primary biliary cirrhosis

A

chronic and progressive cholestatic disease with destruction of intraheptic bile ducts with portal inflammation and scaring
autoimmune

fatigue
itching
many asxs
hyperpigmentation
jaundice
ascites

need liver biopsy
abdominal ULS to rule out obstruction

202
Q

primary biliary cirrhosis

A

symptomatic and transplant

203
Q

Hemochromatosis

A

Bronze diabetes
Autosomal recessive
HFE gene

Increased iron storage absorption
MC among Caucasian makes

Progressive iron absorption in the GI tract
Increase deposits in the liver heart,
Pancreases
And pituitary

204
Q

What sus do you see with hemochromatosis

A 
Liver disease
Skin pigmentation
DM
Arthropathy
Impotence
Cardiomyopathy
205
Q

Bets screening test for hemochromatosis

A

Transferrin saturation
(Values greater than 45%) indicate further testing

Elevated serum ferritin is good evidence over overload

Liver box is gold standard but not needed

Might seem hyperglycmemia
Elevated LFTs

206
Q

Tx for hemochromatosis

A

Phlebotomy
Goal to bring ferreting level below 50

The cheating agent deferoxamine has to be given daily as a9-12 hr IV or SC infusion and complaisance is difficult

Oral cheating deferasirox is effective but should not be given in pts with high risk myelodysplastic syndrome because it can cause renal impar EENT, hepatic impairment or GI hemorrhage

207
Q

Te for pt with diarrhea
Abdominal distensión

And vesicular lesión found on extensor surfaces of arms and legs

A

Celiacs

Get anti endometrial antibodies or anti trans glutaminase Ab

Bx of small bowel revelas villus and atrophy blunting 
Megaloblastic anemia (poor folic acid B12 absoption)

Will increase risk of cirrhosis

Vitamin supplementation corticosteroids may be needed in refractory

208
Q

IBD with watery diarrhea what is the dx test and what would you see

A

Skip lesions on endoscopy of sigmoid or colonoscopy will reversal cobblestoning appearance

Rectal sparring

Will probably need CT and will show inflammation throughout the bowel wall at the ileso e al junction and mesenterio fat wrapping

209
Q

Tx Crohn’s

A

5-ASA mesalmine for maintenance

Prednisone for acute

Metronidazole if not responding to 5 ASA or perineal disease fistula or dfissure

I uno suppressing drugs might be needed like azathioprine or 6-mercaptopurine

Supplement b12 FOLATE Vitamin D

210
Q

Gold standard dx for pr with epigastric pain
Dyspepsia
Abdominal pain

A

Get endoscopy

211
Q

Gastritis tx

A

If H pylori

NSAIDs empiric therapy with acid suppression

4-8 Wk PPI

If no response then test for H pylori

PPI+ 2 antibiotics for 2 wk or quad therapy

Clarithro+amoxicillin+PPI
(CAP)
Metronidazole if PNC allegory

212
Q

Flapping tremor
Musty breath
AMS

Te

A

Hepatic encephalopathy

Lactulose or Rifazimin, lactitol

Neomycin is 2nd line
Protein restriction

213
Q

RUQ
Jaundice
Fever

MCC and dx

What is the test

A

Choledocolithiasis is MCC

But cholangitis is the dx
Get ERCP or PTC

Get CBC
Increase in ALK with GGT

214
Q

Tx of Cholangitis

A

Antibiotics and ERCP common bile duct decompression

215
Q

ROME CRITERIA for IBS

A

BOUTS OF DIARRHEA for at least 3 months

Associated with at least 2 of the following 3

  1. Related to defecation
  2. Onset associated with stool frequency
  3. Onset associated with change in stool form

Improvement with defection
Change in consistency
PP urgency
If no alarm symptoms just reassurance and life style changes

216
Q

Dx studie for diverticulitis

A

CT scan increased WBC
Guiac +

Diverticulitis —> inflamed diverticula
Secondary to obstruction/ info.

Fever LLQ pain

N/V/D/C flatulance

217
Q

Acute cholecysitis dx test

A

HIDA

218
Q

Pathophysiology of PUD

A

Decrease mucosal protective factors
Mucus, bicarbonate, PG, and blood flow

  1. Increasing damaging factors like acid and pepsin

DU more common than GU

2-5 hrs—> duodenal

1-2 hrs after—> gastric

219
Q

Copious watery
Non blood diarrhea with flecks of mucus and low grade fever

No fecal orador

Dx test

A

Rice water stool chokers do rapid dipstick testing

Fluid replacement is mainstay and tetracycline antibiotiotics or FQ or macrolides

220
Q

Hepatitis d REQUIRES

A

HEPATITIS b

221
Q

DX test GERD

A

Usually endoscopy often used 1st but the gold standard is 24 hour ambulatory pH monitor is GOLD STANDARD

222
Q

Gastroenteritis when do you use anbx

A

Travelers diarrhea and SHigella both have bloody stool

ETEC

Give cirpofloxacin
If preganant azithromyocin

SHigella - largest amount of fecal leukocytes

TMP.SMX

Cholera - shellfish rice water—>FQ

223
Q

MC type of hepatocellular carcinoma

A

Non-fibrolamellar
Associated with hep B/C

Unresectable with short survival time

Fibromalar is respectable and not seen with HEP, occurs in younger pts.

Get alpha 1 FP and do LR biopsy

224
Q

diagnostic test for RA

A

+ rheumatoid factor, +
Anti-citrullinated protein antibodies (ACPAs)

CCP- cyclic citrullinated peptides contian these antibodies

225
Q

what is the presentation of lumbar stenosis and how does it present

A

pseudoclaudication, neurogenic
Narrowing of spinal canal impingement of the nerve roots & cauda equine
Back Pain with paresthesias
Worse with extension (prolonged standing/walking)
RELIEVED with flexion (sitting/walking uphill)
Lumbar epidural injection of steroids

226
Q

worsening of OA

A

MC in weight bearing joints
Narrowed joint space, sclerosis, osteophyte formation
Evening joint stiffness (worsens throughout the day)

227
Q

Heberden’s nodes are present on the

A

Heberden’s nodes

DIP

228
Q

treatment of OA

A

Acetaminophen NSAIDS corticosteroid injections

229
Q

tx of morton’s neuroma

A

Steroids, wide shoes, surgery if persists

Wide shoes, glucocorticoid injection* , surgical resection leaves patient with perm. Numbness

230
Q

what tests would you see with polyarteritis nodosa

A

Increased ESR, ANCA negative
Angiography microaneurysm with abrupt cut-off of small arteries
Steroids

231
Q

what is polyarteritis nodosa and what are the associated sxs

A

systemic vasculitis of medium/small arteries –?necrotizing
Ass with hep B & C*
Increased microaneurysms, muscular arteries involved

constitutional symtomns and abdominal pain

HTN, renal failure, neuropathy, livedo reticularis (lungs spared*)

232
Q

allupurinol should not be given with

A

Allopurinol reduces uric acid production by inhibiting xanthine oxidase
AVOID DIURETICS!!!

233
Q

what is pseudo gout

A

accumulatin of crystals of calcium pyrophosphate dehydrate (CPPD) in connective tissues

chondrocalcinosis

234
Q

MC location of pseudogout

A

Knee

235
Q

polymalgia rheumatica

A

Idiopathic inflam condition, synovitis, bursitis, tenosynovitis
aching/stiffness of proximal joints, bilateral
difficulty brushing hair, putting on coat, getting out of chair
Hips, shoulder, neck

236
Q

polymalgia rheumatica has a stonrg association with what other dx

A

Closely related to Giant cell arteritis

237
Q

tx for polymyalgia rheumatica

A

corticosteroids taper after 4-6 weeks stop in 1-2 years

self limiting

238
Q

what is morton’s neuroma and how do you diagnose it

A

Painful mass near plantar surface of foot, radiates to 3rd,4th toe, pain on ambulation
Reproduce pain by squeezing foot forcing met heads together
MRI needed for diagnosis
Steroids, wide shoes, surgery if persists

239
Q

jobes test is for

A

Jobes test or Empty can test isolated examination of supraspinatus muscle
this muscle from the deltoid
Jobes bring arm up and to the front, with arm internally rotated (thumb to floor), downward force and try to resist the force.
If it drops then could mean rotator cuff tear

240
Q

MC location for SAH

A

arterial bleed between arachnoid and pia

MC Berry aneurysm rupture (AVM)

241
Q

other than worst headache of life what are some common sxs seen with SAH

A

Stiff neck, photophobia, delirium

worst head of life

242
Q

what would you do if CT was negative but you suspected SAH

what would you see

A

LP —> xanthochromia

243
Q

tx for SAH

A

Supportive, Bedrest, antianxiety meds

244
Q

Uhthoff’s phenomenom

A

MS

Uhthoff’s phenomenom worse with heat

245
Q

Lhermitte’s sign

A

neck flexion causes lightning-shock pain from spine to leg

MS

246
Q

MS diagnosis

A

increase IgG in CSF (oligoclonal bands)

MRI with gadolinium: MRI test ofchoice in helping to confirm MS.*

247
Q

long term medications for MS

A

fi-interferon* or Glatiramer acetate (Copaxone) decrease #/severity of relapses.

248
Q

guillan barre LP reuslts n

A

high protein with normal WBC count

This is know n as albuminocytological
dissociation.

May be due to altered neuronal capillary-CSF barrier defect.

249
Q

RF for Bell’s pa;sy

A

Diabetes mellitus, pregnancy (esp 3rdtrimester), post URI, dental nerve block.

250
Q

treatment for guillan barre

what is CI

A

lasmapheresis best if
done early.

MOA:removes harmful circulating auto-antibodies that
cause demyelination. Equally as effective as IVIG. Patients are usually hospitalized.

DO NOT GIVE PREDNISONE

251
Q

CNI

A

olfactory

252
Q

CN II

A

optic
VA
PLR

253
Q

III

A

oculomotor EOM (inferior rectus, ciliary body)

254
Q

IV

A

TROCHLEAR

EOM superior oblique

255
Q

VI

A

abducens

lateral gaze

256
Q

VII

A

facial motor of the face

257
Q

VIII

A

acoutise of vestibulocochlear hearing and balance

258
Q

IX

A

glossopharyngeal

taste posterior 1/3 of the tongue

259
Q

X

A

Vaguse
gag reflex
voice
soft palate

260
Q

XI

A

accessory motor neck and shoulder

261
Q

XIII

A

hypoglossal
tongue deviation
fasiculation

262
Q

decerebrate

A

arms adducted to side
damage to upper brain stem

E
E
E hands for E extensor

This is 2 points on the GCS

263
Q

decorticate

A

arms flexed and on chest damage to corticospinal tract

decor
c
c
c 
FLEX

THIS IS 3 POINTS ON THE GCS

264
Q

genetics of huntington’s

what is the pathophysiology

A

autosomal dominant
neurodegenetive disorder caused by a gene mutation

neurotoxicity as well as cerebral, putamen & caudate nucleus atrophy.

265
Q

progression of huntington’s disease

A

r 30-50y ofage. Initial O behavioral => Q chorea* & © dementia.

266
Q

diagnosis of huntington’s disease

A

CT
cerebral &
CAUDATENUCLEUSATROPHY.* MRI shows similar findings. Genetic testing.

  1. PET scan: decreased glucose metabolism in the caudate nucleus & putamen.
267
Q

symptoms of parkinson’s

A

tremor
resting pill roll
wrosen at rest and with emotional stress

lessoned with voluntary activity and intention usually confinded to one limg

268
Q

tx for parkinson’s

A

if young use dopamine agonists like bromocrptine or more recently ropinarole
can also use anticholinergics like benzotropine in younger pts

if older than 70 go straight to carvidopa levadopa

269
Q

absolute CI to anticholirgics like trihexyphenadyl and . benzotropine

A

nstipation, dry mouth, blurred vision, tachycardia, urinary retention. CL BPH, glaucoma.

270
Q

Selegiline, Rasagiline how do they work

A

increases dopamine in the striatum (MAO-B normally breaks down dopamine).

271
Q

how do entacapone, Tolcapone. work

A

Catechol-O-Methyltransferase (COMT) inhibitors

entacapone, Tolcapone. Adjunctive tx. MOA: prevents dopamine breakdown. Ex. S/E: GI sx, brown discoloration of urine.

272
Q

sxs of constrictive pericarditis

A

Dsypnea, Right sided heart failure (JVD during inspiration, periph edema, hepatojugular reflux) , **pericardial Knock (high pitched 3rd heart sound from sudden cessation of ventricular filling from thickened inelastic pericardium)

273
Q

tx of constrictive pericarditis

A

Tx: pericardectomy, diuretics (for symptoms)

274
Q

, Primary aldosteronism sxs

A

HTN, hypokalemia, hypernatremia, metabolic alkalosis

headaches, flushing of the face.

275
Q

what is primary hyper aldosteronism

A

is RenIn-independent (autonomous).

  • Idiopathic or idiopathic bilateral adrenal hyperplasia (60%). MC in women.
  • Conn’s syndrome:adrenal aldosteronoma*(40%) located in the zona glomerulosa.

Unilateral adrenal hyperplasia (rare).

276
Q

initial labs if suspecting hyperaldosteronism,

A

Labs:

Hypokalemia
WITH
METABOLICALKALOSIS*(dueto dumping of K+&H+in exchange for Na+).

277
Q

if pt has hypokalemia and HTN

what is the workup on this pt

A

suspect hyperaldosteronism
inital test would be a aldosteron: renin ratio showing >20

then a salt supression (saline infusion) test if non reactive would suggest primary aldosteneronism or conn’s syndrome

then CT MRI

278
Q

dx and MCC of scrotal pain erythema and swelling

A

MCC= chlamydia men >35, enteric organism in children & men >35
Scrotal pain, erythema, swelling

279
Q

dx tests and pysical exam of epidiydimitis

A

Prehn’s sign (relief of pain with elevation of affected scrotum
US—> increased testicular blood flow, UA—>pyuria or bacteremia

280
Q

tx for epidyditmitis

A

Bed rest, scrotal elevation, cool compress, NSAIDs
Gon/chlamydia—> azithromycin & ceftriaxone
Fluoroquinalones

281
Q

MCC of pyelonephrotos

A

lower UTI

E. coli, Proteus sp, Klebsiella, Enterobacter sp, pseudomonas
Fever, flank pain, irritative voiding, CVA tenderness

282
Q

UA of pyelonephritis

A

UA
pyuria, bacteremia, hematuria, WBC casts

remember this is one of the causes of AIN

283
Q

outpatient and inpatient treatment of pyelonephritis

A

Ciprofloxacin, Bactrim (1-2 weeks)

Inpatient—> IV fluoroquinolones, Ampicillin + gentamycin

Then oral ABX 2 weeks after dc

284
Q

if treatment for pyelonephritis fails

A

probably obstruction

If fails look for obstruction/abscess

285
Q

MC organism for UTI

for sexually active women

A

women MC to have UTI
E. coli MC organism,

staph saprophyticus with sexually active women

286
Q

dx of UTI

A

Dx: urinalysis: pyuria (increase WBC (>10 hpf), +leukocyte esterase + nitrates +hematuria)

287
Q

genetic variations of polcystic kidney disease

A

cystc replace the mass of kidney, reducing function & leading to kidney failure

AR–> begins in utero, leads to neonatal death
AD–>bilateral

288
Q

symptoms and sign of PCKD

A

Back and flank pain, headaches, nocturia

U/S* (fluid filled cysts)

289
Q

ultrasound ULS

A

U/S* (fluid filled cysts)

Supportive to ease sxs and prolong life (control HTN, high fluid intake, low-protein diet)

290
Q

Treatment Polycystic kidney disease

A

Infections—>Bactrim, fluoro, chloramphenicol, vanco

Dialysis, renal transplant

291
Q

damage to renal glomeruli by inflammatory proteins in glomerular membranes

focal

A

Focal—> IgA nephropathy, hereditary nephritis, SLE

292
Q

damage to renal glomeruli by inflammatory proteins in glomerular membranes

A

Diffuse—>SLE, vasculitis

293
Q

signs and sxs of glomerular nephritis

A

Hematuria, anuria/oliguria, edema of face/eyes/ankles/feet

Steroids, immunosuppressive drugs

control inflame

294
Q

MC type of bladder cancer and MC risk factor

A

90% transitional cell (TCC)

smoking MC ris factor

295
Q

dx of bladder CA made wiht

A

Dx: cystoscopy with biopsy (diagnostic and curative if able to do excision)

296
Q

local bladder CA tx

A

Tx: local–>resection with electrocautery

297
Q

Invasive bladder CA tx

A

cystectomy, chemo, XRT

298
Q

Recurrent bladder CA tx

A

BCG immune therapy (bacillus Calmette-Guerin)

299
Q

stage 1 ckd GFR

A

Stage 1 GFR normal (>90)

300
Q

Stage 2 CKD GFR

A

GFR 60-89

301
Q

Stage 3 GFR

A

Stage 3 GFR 30-59

302
Q

Stage 4 GFR

A

Stage 4 GFR 15-29

303
Q

Stage 5 GFR

A

Stage 5 GFR <15 End stage renal failure

304
Q

presentation of post infectious glomerulonephritis

A

MC after GABHS*
2-14 year old boys, puffy eyelids, facial edema up to 3 weeks post strep
scanty/cola colored urine (hematuria/oliguria)

305
Q

dx of glomerulonephritis

A

increase antistreptolysin titers, low serum complement (C3)

306
Q

tx of post stre glomerulonephritis

A

Tx: supportive, antibiotics

307
Q

FIND THIS OUT

A

If you have a supraspinatus injury, what ROM will have pain?

308
Q

Anatomical landmark of upper vs lower GI bleed

A

Anatomical landmark of upper vs lower GI bleed- ligament of Treitz

309
Q

Auer rods

A

Auer rods are AML

310
Q

MC adult leukemia

A

CLL is most common adult leukemia

311
Q

What do you do for asystole?

A

What do you do for asystole? Shock, unsynchronized

312
Q

What type of cell is affected in peptic ulcer disease?

A

What type of cell is affected in peptic ulcer disease?

313
Q

holosystolic low pitch blowing murmur, heard best at apex, radiation to the axilla

A

Mitral regurgitation

314
Q

Wolff-Parkinson-White syndrome

A

Electrical signals bypass AV node

short PR interval and wide QRS from DELTA WAVES

315
Q

Myocardial infarction

A

STEMI:

1) reperfusion* (PCI within 90 minutes or thrombolytic–>TPA (alteplase, streptokinase)
2) antithrombotic (aspirin, heparin)
3) adjunctive (ACE-I*, b-blockers, nitrates, morphine, statin)

-new onset LBBB considered STEMI equivalent

NSTEMI: 1) anti-thrombotic (aspirin, heparin, ADP-inhibitors, GP IIb/IIIa inhibitors, X in)
2)adjunctive (b-blockers, nitrates)

316
Q

how do you diagnose Prinzmetal angina

A

coronary angiogram w injection of provocative agents (ergonovine)

ST elevation only tracked while experiencing attack

why you provac it

317
Q

what is the difference between HFrEF and congestive heart failure

A

with LVEF ≤40 percent, known as HFrEF

Congestivedecompensated heart failure with worsening baseline

318
Q

MCC of mitral stenosis

A

MCC rheumatic heart disease

319
Q

mitral stenosis leads to

A

Right sided heart failure, pulm htn, A-Fib, mitral facies (flushed face)

320
Q

sxs of dilated cardiomyopathy

A

AKA congestive HF

increased JVD

narrow pulse pressure

pulmonary rales, hepatomegaly,

peripheral edema

S3 and S4

mitral regurg, tricuspid regurg (less common)

321
Q

echo for dilated cardiomyopathy will show

A

Echo

LV dilation, high diastolic pressure, low cardiac output

322
Q

Tx for diastolic HF

A

Tx:
abstinence from alcohol,
ACE-I,
diuretics (spironilactone)

digoxin (NO MORTALITY)
B-blockers Only carvedilol, long-acting metoprolol succinate, and bisoprolol have shown

. Elsevier Health Sciences. Kindle Edition.
salt restriction

323
Q

what is venous insufficiency and how does it present

A

Vascular incompetency of either deep and/or superficial veins

Superficial thrombophlebitis, DVT or trauma

Leg pain (improves with elevation/walking), leg edema, stasis dermatitis, brownish hyperpigmentation, ulcer (medial malleolus), atrophie blanche

324
Q

MCC of pericarditis

A

Inflammation of pericardium
Persistent, pleuritic, postural (better sitting/leaning forward), pericardial friction rub

MCC–>viral (enterovirus coxsackie, echovirus)

325
Q

pericarditis can lead to

A

Leads to pericardial effusion—>tamponade (pericardiocentesis*)

326
Q

anterior wall

A

V1-V4, LAD

327
Q

lateral wall

A

V5, V6, aVL, circumflex

328
Q

Anterolateral

A
  • aVL, V4, V5,V6, LAD or circumflex
329
Q

Inferior

A
  • II, III, aVF, RCA
330
Q

Posterior

A

ST depression V1, V2

331
Q

diagnosis of LVH

A

Echo–> asymmetrical wall thickness (septal) >15 mm, systolic anterior motion of mitral valve

EKG–> LVH

332
Q

tx of LVH

A

Tx: b-blockers* first line, surgical, alcohol septal ablation(ethanol)

333
Q

EKG

A

Amplitude of largest R or S in limb leads ≥ 20 mm = 3 points

Amplitude of S in V1 or V2 ≥ 30
mm = 3 points

Amplitude of R in V5 or V6 ≥ 30 mm = 3 points

334
Q

dressler’’s syndrome usually occurs how soon after an MI

A

Pericarditis 2-5 s/p MI
Chest pain (pleuritic), persistent, postural (worse lying down), fever, pericardial friction rub
EKG: diffuse ST elevations
Tx: aspirin or cochicine

335
Q

restrictive cardiomyopathy aka

A

restrictive cardiomyopathy

H/O amyloidosis, hemachromatosis, sarcoidosis, fibrosis, ca

336
Q

what are the diagnostic tests for restrictive cardiomyopathy

A

ECG–> nonspecific with ST seg and T wave abnormalities

Echo–> diated atria and myocardial hypertrophy

CXR–>coronary vascular congestion (normal heart size)

337
Q

dx work up of

40 yr old man with clubbing of the fingers bi basilar crackles +/- cyanosis non productive cough

A

decreased lung volume, honeycombing, ground glass opacities
bx: honeycombing (large cystic airspaces)

CXR/CT scan: diffuse reticular opacities (honeycombing),* ground glass opacities. Biopsy: honeycombing (large cystic airspacesfrom cysticfibrotic alveolitis).

PFT: decreased lung volumes decreased TLC, RV

338
Q

Red maculopapular rash on wrists and ankle

A

Red maculopapular rash on wrists and ankles central 2-3 days (face spared)

Rickettsia rickettsia, dog tick, 2-14 days post bite

339
Q

when do you see RMSF

A

Red maculopapular rash on wrists and ankles–> central 2-3 days (face spared)

can present with seizure
Fever + rash + h/o bite (camping, trip)

340
Q

DX of RMSF

A

Clinical diagnosis (don’t wait for serologies) - fever, rash, history of tick bite.

Serologies: indirect immunofluorescent antibody test for IgM and IgG antibodies

CSF: low glucose & pleocytosis (increased cell count).

341
Q

mnmgt RMSF

A

doxycycline–> even in kids

chloramphenicol 2nd line –> PREGNANCY

342
Q

reaction sixe TB

A

> 5 IC
10 all other high risk populations
15 everyone else

343
Q

tetanus dx and management

A

Neurotoxin blocks neuron inhibition—> severe muscle spasm
Blocks the release of ACH

mgmt: metronidazole

344
Q

gram-negative rod transmitted via contaminated food & water. Outbreaks may
occur during poor sanitation & overcrowding conditions (especially abroad).

what is the management

A

cholera

  1. Supportive:fluid replacement mainstay.* Often self-limited.
  2. Antibiotics: tetracyclines,
    fluoroquinolones or macrolides may shorten the disease course in
    patients who are severely ill, other comorbid conditions or with high fever.
345
Q

most sensitive test for VZV

A

PCR most sensitive test for VZV
Vesicles on an erythematous base “dew drops on a rose petal”
treat symptoms

346
Q

Most are asymptomatic (often incidental finding of leukocytosis on routine blood testing], 2. Fatigue MC, dyspnea on exertion, (infections. Lymphadenopathy, hepatosplenomegaly.

A

Dx: peripheral smear (well-differentiated lymphocytes with scattered SMUDGE CELLS*)

(fragile B cells that often smudge during slide preparation]. Lymphocytosis >20,000/pL.

Pancytopenia: thrombocytopenia, anemia.

347
Q

MCV >115 almost exclusively seen in …..

especially if hypersegmented neutrophils* arepresent

A

MCV >115 almost exclusively seen in B12 or Folate deficiency

cobalamine

348
Q

When replacing the B12 need to check for

A

Watch for hypokalemia* (replacement leads to cells taking up large amounts of potassium)

Watch for hypokalemia–> replacement leads to reticulocytosis with new cells taking up large amounts of potassium

<3.5, muscle cramps, constipation
flat T waves, U waves

349
Q

ekg of pericardial effusion

A

low voltage QRS, electrical alternans

350
Q

Painful, loss of vision, N/V/diaphoresis
PE: “steamy cornea”, fixed-mid-dilated pupil, decreased visual acuity, injected

tx

A

TX: immediate referral*, IV carbonic anhydrase inhibitor (acetazolamide)

351
Q

Classic: come in with stab wound, now hypotensive, distant heart sounds and increased

A

JVP, narrow puse pressure, pulsus paradoxus…..

Cardiac tamponade

Echo** test of choice diastolic collapse of cardiac chambers*
“water bottle heart” on CXR
EKG: electrical alternans

352
Q

cardiac tamponade tx

A

IV fluids to improve hemodynamics, pericardiocentesis* (diagnostic and therapeutic)

353
Q

post-op with tachypnea

A

Pulmonary embolism

354
Q

staus epilepticus tx

A

Airway—>hyperthermia (cooling blanket)
IV diazepam/lorazepam (until stops)
phenytoin/fosphenytoin

355
Q

2nd Type I(Wenckenbach) tx

A

observe, atropine, epi

356
Q

a-fib tx

A

RATE control*, vagal, CCB, BB, rhythm- DCC, digoxin

prevent stroke warfarin, aspirin

357
Q

CMV sxs

A

Primary disease: most asymptomatic. Mononucleosis-like illness* (if symptomatic).

RETINITIS
ESOPHAGITIS

mostly in IC

358
Q

CMV retinitis

A

hemorrhage with soft exudates: scrambled eggs/ketchup appearance (pizza pie)*
appearance on funduscopy if CD4 <50;* Pneumonitis, Encephalitis; Colitis (CD4 <100).

359
Q

dx of MCV

A

serologies (Antigen tests, IgM, IgG titers).

PCR.
Biopsy of tissues: Owl’s eye* appearance (epithelial cells with enlarged nuclei surrounded by
clear zone & cytoplasmic inclusions).

360
Q

tx of CMV

A

Ganciclovir* treatm ent o f choice. 2 nd line: Foscarnet, Cidofovir. Valacyclovir.

361
Q

tx for toxoplasmosis

A

Sulfadiazene (or Clindamycin) + Pyrimethamine (with folinic acid/leucovorin to prevent bone marrow suppression & reduce nephrotoxicity). Spiramycin if pregnant.

362
Q

sxs of gonococcal urethritis

A

brupt onset of symptoms (especially within 3-4 days). Opaque, yellow,
white or clear thick discharge, pruritus. Up to 20% of patients are asymptomatic.

363
Q

posterior electrocardiogram (C) would be appropriate to evaluate for posterior ST segment elevation if you saw

A

osterior electrocardiogram (C) would be appropriate to evaluate for posterior ST segment elevation if you saw deep depression in leads V1 and V2 with prominent R waves.

364
Q

what ECG findings are suggestive of an inferior wall infarct. This patient is suffering from hypotension and bradycardia as well, which suggest a potential right ventricular infarct

A

ST segment elevation in leads II, III, and aVF is suggestive of an inferior wall infarct. This patient is suffering from hypotension and bradycardia as well, which suggest a potential right ventricular infarct

365
Q

Which of the following is the treatment of choice in antidromic atrioventricular reciprocating tachycardia in a hemodynamically stable patient?

A

Procainamide

My IM EOR Cards (2 decks)

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