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1
Q

Primary HTN is defined by ? readings

Ranges for Normal, Elevated, Stage 1 and Stage 2 HTN

What are the ACC/AHA HTN targets
What are the JNC-8 HTN targets

A

SBP ≥130/ ≥DBP 80

N: <120/80 and <80
E: 120-129 and <80
1: 130-39 or 80-89
2: ≥140/≥90

A: <130/80
J: <60y/o/CKDz/DM: <140/90
≥60y/o: <150/90

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2
Q

When does ACC/AHA suggest starting Rx management for HTN

How is OHOTN Tx

What is the earliest stage of an atherosclerotic plaque

A

All Stage 2
Stage 1 w/: DMT2
ASCVDz/≥10% CKDz

Inc Na/Fluids, Fludrocortisone, Midodrine

Inflammation induced foam cell (lipid laden macrophage) w/ fatty streak

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3
Q

Absolute c/is for fibrinolytic therapy for STEMI Tx

A 
Suspect dissection
Active bleed/diathesis
Malignant intracranial neoplasm
Ischemic stroke <3mon 
Cerebral vascular lesion
Hemorrhage, cranial
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4
Q

? medication is used for chronic angina and safe for the above c/i but w/ ? s/e

? is the only drug class shown to be antianginal and prolong life in Pts w/ CADz

? medication is used during CHF to reduce morbidity and mortality

A

Ranolazine; QTc prolongation

BBs

ACEI

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5
Q

What are the 3 beta-1 selective used to reduce mortality from HF

Why do ventricles release BNP in response to inc volume

What can cause this to be artificially low

A

Bisprolol
Metoprolol succinate
Carvedilol

Dec RAAS, Inc Na excretion

Obesity, Constrictive pericardial dz

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6
Q

HF w/ EF of ? is a sign of increased mortality and need for ? next step

What are the 4 NYHA HF Classificaitons

? scoring system is used to estimate risk of major bleeding in Pts on anticoag meds

A

<35; defib placement

1: ASx, no limitations
2: Sx w/ mod activity
3: Sx w/ mild activity
4: Sx at rest

HAS-BLED:
HTN Abnormal Kid/Liv function Stroke
Bleeding Labile INR Elder >65y/o Drugs/ETOH
0-1: low 2: mod 3-6: high

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7
Q

AR

MS

PR

TS

AS

PS

HOCM

MVP

MR

TR

VSD

A

Sit, lean fwd; Diaphragm at Erbs

L lat-decubits; Bell at mitral

Sit, lean fwd: Diaphragm at Pulmonic

Supine; Bell at Tricuspid

Sit; Diaphragm at Aortic

Supine; Bell at Tricuspid

Supine; Diaphragm at Mitral

Supine, Diaphragm at Mitral

Supine, Diaphragm at Mitral apex

Supine, Diaphragm at Tricuspid

Supine; Diaphragm at Tricuspid LLSB

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8
Q

MCC of AR

What is a rare seronegative cause

What will be seen on PE in this condition

A

Aging process makes leaflets weak/floppy

Ankylosing

Wide pulse pressure, Water hammer/Corrigan pulse heard at LSB

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9
Q

What 5 other signs are seen when AR is present

What extra murmur can be present w/ AR

What is the indication after load reduction is needed and what class is preferred

A 
Hill: leg > arm BP
Musset- head bob
Quinke- nail bed
Duroziez- to-and-fro
Traubes: pistol sound over femoral/radial pulses

Austin-Flint: diastolic murmur from blood hitting anterior mitral leaflet

SBP >140 w/ ARBs

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10
Q

MCC of MS

What is heard w/ this murmur

MC Sx of MS

A

Rheumatic fever

Opening snap after S2

Dyspnea

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11
Q

What will be heard on PE of MR

? maneuver intensifies MR murmur

MC murmur associated w/ Marfans

A

Soft S1, wide split S2 w/ loud P2

Hand grip

MVP

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12
Q

? part of the valve is MC involved in MVP

? unique presentation in females can indicate underlying MVP

How is MVP defined by Echo

A

Middle cusp of posterior leaflet (both= Barlow Syndr.)

POTS

Billowing leaflet 2mm/> above annular plane

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13
Q

When is medical Tx for MVP indicated and ? is used

In the USA, TS is MC d/t ? etiologies

TS is characterized by ? four PE findings

A

Palpitations= BBs

Rheumatic fever-MC
Prior regurge
Carcinoid syndrome

Hepatomegaly
Ascites
Right HF
Dependent edema

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14
Q

Tricuspid stenosis will cause ? type of JVP finding

Since this valvulopathy can mimic ?, it’s differentiated by ?

? is the mainstay of Tx, particularly ? one is considerable bowel ischemia is present

A

Giant a-wave

MS;
Increases w/ inhalation

Loop diuretics;
Tosemide, Bumetanide

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15
Q

How is TS Tx if liver is engorged/ascites is present

? congenital and iatrogenic etiology can cause TR

? JVP wave is altered w/ TR

A

Aldosterone inhibitors

Ebstein Anomaly: septal, posterior leaflets into the RV
Pacemaker lead injury

X-descent fades w/ inc regurg
Large V-wave w/ rapid descent

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16
Q

MCC of TR

PS is usually d/t ? and found in ? population

What type of PE finding is heard w/ PR

A

RVF and dilation d/t P-HTN or LVF

Congenital- Peds

Widely split S2 w/ pulmonic ejection sound
Right sided S4

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17
Q

What secondary murmur is also heard w/ PR

? is a common EKG finding in these Pts

What is the MC c/c of PR

A

Graham Steel- diastolic pulmonary murmur d/t dilated annulus; mis-Dx as AR

RBBB

Dyspnea w/ exertion

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18
Q

Define Ortner’s Syndrome

? leaflet is affected by age and calcification the most

? is the most important lab ordered for Afib work up and ? is the MC site for thrombus to develop

A

Hoarse voice d/t PR

Posterior

TSH (thyroxine)- inc cellular basal metabolic rate; LA

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19
Q

How is the Anticoagulation need for Tx of Afib/flutter determined

When is Warfarin used and w/ ? INR goal

A 
CHF/LVEF <40%
HTN
Age >75
DM
Stroke/TIA/Embolis
Vasc Dz
Age 65-74y/o
Female

INR 2.5:
Prosthetic valve
EGFR <30
Rx: phenytoin, antiretroviral
Mitral stenosis
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20
Q

Mnemonic for BBBs

What do these look like on EKG

What are the two types of PSVT

A

WiLLiaM MoRRoW:
V1- W and M in V6= LBBB
V1- M and W in V6- RBBB

LBBB: up bunny ears V4-6
RBBB: up bunny ears V1-3

AVNRT: arrhythmia from above BoHis
WPW: arrhythmia from BoKent

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21
Q

3 EKG characteristics of WPW

What two medications can be used to manage WPW

How are PSVTs definitively Dx

A

D-wave c/ slow ventricular activation
Narrow tachycardia
Short PR interval

Procainamide, Quinidine

Holter monitor

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22
Q

How are PSVTs Tx

What can not be used for Tx in WPW

What are the 3 types of premature beats

A

Carotid massage/valsalva
Adenosine for Sxs
BBs/CCBs if regular
Definitive: ablation

Adenosine or CCBs

PAC: abnormal P-wave
PJC: narrow QRS
PVC: wide QRS

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23
Q

Premature Atrial Contractions are common in ? population

Pts w/ heart Dz and frequent PACs may soon develop ?

? type of premature beats are common in healthy adults

A

COPD

PSVT, Afib/Flutter

PVCs

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24
Q

If PVCs are symptomatic, what is described

What causes PJCs

How are premature beats Dx

A

Palpitations in throat

Irritable site in AV node fires before SA node

EKG, Holter monitor

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25
How are premature beats Tx How is wide and regular V-tach Tx
PAC: reassure PJC: only if >10/min or multifocal= lidocaine/antiarrhythmic PVC: only if Sxs, BBs/ablation Stable: amiodarone, procainamide Unstable: cardiovert Pulseless: defib
26
V-tach rhythm is a frequent complication of ? heart conditions How is Stable V-Tach Tx How is unstable Pts w/ monomorphic VTach Tx
MI, Dilated myopathy In sequence: Amiodarone Lidocaine Procainamide Synchronized conversion
27
? valvulopathies can predispose Pts to VFib SSS may also manifest and present as ? What are the 4 possible presentations of SSS
AS/PS Chronotropic Incompetence- inappropriate HR response to exercise/stress Brady: sinus <60bpm Pause: <3 seconds Arrest: >3 seconds Tachy-Brady syndrome
28
How is IE in native valves w/out IVDA Tx How is prosthetic valve IE Tx How is IVDA IE Tx
Genta Naficillin Ceftriaxone Vanc Genta Rifampin Cefepime and Vanc
29
Who needs Infective Endocarditis prophylaxis What is used for IE prophylaxis Heart valves w/ ? d/o are more likely to become infected w/ endocarditis
Prosthetic material Previous Dx IE Unrepaired cyanotic heart dz Transplant w/ regurg 2g Amox/Clinda Regurgitation
30
? microbe can cause culture-negative Endocarditis How can endocarditis be prophylactic Tx while cultures are pending Rheumatic fever MC affects ? valve and follows ? but is technically not a ?
Bartonella quintana Vanc and Ceftriax Mitral; Strep throat infection; Inflammatory reaction
31
How is Rheumatic Fever Tx When is AB prophylaxis indicated for Peds Acute pericarditis can often progress into developing ? issue
CCS ASA/NSAID Pen G Benzathine PCN allergy: Erythromycin W/out carditis: for 5yrs or until 21y/o Carditis, no residual damage: 10yrs Carditis and residual damage: >10yrs Pericardial effusion
32
How does a pericardial effusion present How is it Dx How is it Tx
Low voltage QRS Alternans Distant sounds EKG: low voltage w/ alternans Echo: swinging heart Centesis Window if recurrent
33
? triad is seen in Cardiac Effusion w/ Tamponades ? is a classic finding for this condition ? is the gold standard for Dx
Becks: HOTN Inc JVD Muffled Pulsus paradoxus- inhale dec SBP >20mm Echo w/ RV collapse during diastole
34
When does USPSTF recommend screenings for AAA How are Aortic Aneurysms screened for ? is the gold standard for screening
65-75y/o w/ +smoking Hx Initial: US CT- test of choice for thoracic aneurysms/eval of known AAA Angiography
35
What medical therapy is used for AAAs until surgical correction How do Aortic Dissections present to ED What is the gold standard for Dx
BBs Tearing chest pain radiating to scapuas and decreased pulses MRI angiography
36
How are aortic dissections Tx What are the 5 Ps of arterial occlusions What are common causes of the thrombus formation
Ascending: surgery Descending: LEP-olol, morphine/dilaudid ``` Pallor Pulselessness Paresthesia Paralysis Poikilothermia ``` Afib, MS
37
? is the gold standard for Dx or arterial occlusions ? is done for Tx until surgery is needed AV malformations are more likely to be located ?, Dx by ? and Tx w/ ?
Angiography IV heparin Brain Lungs Spine; Angiography; Surgical excision
38
How does Peripheral Artery Dz present If ulcers are present how do they appear on PE How are these Dx
Intermittent claudication and ABI <0.9 Well circumscribed, lateral/distal Angiography- gold standard Doppler US
39
? is the definitive Tx of peripheral artery dz ? medical management is used What PE finding suggests thrombo/phlebitis
Arterial bypass Anti-platelet/lipid Cilostazol ASA Clopidogrel Palpable cord
40
How are thrombo/phlebitis Dx How is phlebitis Tx How is thrombophlebitis Tx
Venous duplex US- noncompressable vein indicates clot NSAID Elevate Compress Anticoagulation
41
How does Venous Insufficiency appear on PE Where do ulcers appear in this condition How does a Venous Thrombosis present
Hyperpigmentation Atrophic skin Stasis dermatitis Superior to medial/lateral malleolus Unilateral, asymmetrical swelling of lower extremity
42
? is first line imaging for DVTs How are these Tx Define Acute Bronchitis
Duplex US Venography- gold standard LMWH or, Fondaparinux or, Factor Xa inhibitors Afebrile cough x 5 days (fever- think pneumonia)
43
MCC of acute bronchitis What are other possible etiologies How is this Tx
Viral HFlu, M catarrhalis*, Strep pneumo Support, Dextrmethorphan, Guaifenesin
44
When are ABX indicated for acute bronchitis Define Sinusitis Criteria for Acute, Chronic
ImmSupp/Elderly w/ CardioPulm Dz and cough x 7-10days Sxs worsening over 5-7d or don't improve >10d A: <4wks, quick onset C: >12wks
45
Gold standard method to Dx sinusitis Indications to use ABX What is used for adults
Sinus CT Fever >102 Rapid worsening after improvement Nasal d/c Sxs >10d Amox/Augmentin Doxy/Clinda if allergic
46
When/Why are second line ABX used for sinusitis What meds are used now What meds are used for chronic sinusitis
Sxs don't improve x 7d 2g BID Augmentin Moxi/Levo-floxacin 3rd gen Cephalo Augmentin, Clinda
47
What is used for Peds w/ sinusitis When is f/u needed How do Pts w/ bacterial pneumonia present
Augmentin 72hrs: no improvement, switch meds Cough Dyspnea Tachy/Tachy Fever
48
How does Strep Pneumo pneumonia present How does Staph A pneumonia present How does Mycoplasma pneumonia present
Rust colored sputum, common in asplenics Salmom sputum after influenza Walking pneumo w/ bullous myringitis
49
How does Histoplasmosis pneumonia present ? is AKA Valley Fever What are 3 common PE findings for Pts w/ pneumonia
Bat dropping contact mimicking sarcoidosis on CXR Coccidioides- unremitting cough despite Txs Tactile fremitus Egophony Dull percussion
50
How is bacterial pneumonia Tx When are the admitted What ABX are used
Doxy, Marcolides >50y/o w/ comorbidities AMS Dehydrated Cefrtiax + Azith/Flqn
51
How is Coccidioides Pneumonia Dx What Pts does Aspergillus infect and how is it Tx How are both Tx
EIA for IgM/IgG TB/COPD Pts w/ healthy immune system Flu/Itra-conazole
52
Cryptococcus pneumonia can also cause ? ? form of pneumonia is apical and mimics TB How are both Tx
Meningitis Histoplasma from bird/bat droppings in Ohio River valley w/ hilar adenopathy Amphotericin B
53
How is P Jirovici Dx What is a common PE finding How are they Tx and what is used if allergic to primary med
Bronchoalveolar lavage Low O2 despite supplemental O2 TMP-SMX; Pentamidine
54
MCC of pneumonia in adults MCC of pneumonia in Peds How is viral pneumonia Dx
Influenza RSV Rapid Ag- flu; Nasal swab- RSV
55
? two meds can be used to Tx influenza A and B What two can only treat Influenza A How is RSV pneumonia Tx
Zanamivir, Oseltamivir Amantadine, Rimantadine Ribavirin
56
What are the classic findings of TB on PE Define Drug Resistant TB Define Multiple Drug Resistant TB
Fever Anorexia Weight loss Night sweats Resistant to one: I/R Resistant to I and R
57
How is TB Dx What is seen on CXR What is seen on biopsy results
Acid fast smears and Mycobacterium cultures Apical Ghon complexes w/ cavitary lesions Caseating granulomas
58
What are the two forms of miliary TB How is TB Tx What are the s/e of RIPE therapy
Potts Dz: spine Scrofula: cervical lymph nodes + PPD= CXR Neg CXR: latent, Tx w/ Isoniazid/B6 x 9mon Active CXR: Baseline LFTs- RIPE x 8wks; RI x 16wks R: orange fluids I: neuropathy P: hyperuricemia E: red-green blindness
59
What is used for prophylaxis for household members When are Pts considered fully Tx
Isoniazid x 12mon Two negative AFB smears and cultures
60
Why do Pts need to be tested prior to Tx w/ Etanercept for RA What part of RIPE needs to be adjusted if CrCl is <30 ? RIPE adjustment is needed if Pt is also on HIV meds
Activates latent TB P/E- 3 x/wk Raltegravir, double dose when w/ Rifampin
61
What are the 4 indications to test for TB w/ NAAT ? is the traditional test for latent TB Define Ranke Complex
HIV Endemic resident MDR contact Previously Tx for TB TST via Mantoux method Calcified hilar lymph node
62
How are pregnant Pts w/ TB Tx and w/ ? educational piece How is asthma Dx What type of improvement result helps w/ Dx
R/I/E x 4-8wks, R/I x 7months Breast feeding not c/i Peak expiratory flow: FEV1/FVC 75-80% >10% inc of FEV1
63
# Define Intermittent Asthma Define Mild Define Moderate Define Severe
Sx/SABA ≤2 days/wk Awake ≤2 x/month No activity interference Sxs/SABA ≥3day/wk Awake 3-4x/mon Minor limitations Daily Sxs/SABA w/ ≥1 awakening/wk Some limitations Daily Sxs Nightly awakenings SABA several x/day Extreme limitations
64
Step 1 Asthma Tx Step 2 Asthma Tx Step 3 Asthma Tx Step 4 Asthma Tx Step 5 Asthma Tx Step 6 Asthma Tx
1- Intermittent; SABA PRN 2- Mild; Low ICS daily 3- Moderate; Low ICS + LABA daily 4- Moderate; Med ICS + LABA daily 5- Persistent; High ICS + LABA daily 6- Persist; High ICS+LABA+PO CCS daily
65
What is used for acute Tx of asthma exacerbation MC inhaled precipitant Define Samter Syndrome and Atopic Triad
Nebulized SABA O2 PO CCS Ipratropium bromide Cigarette smoke Samter: Asthma ASA Polyps Atopic: Asthma Rhinitis Eczema
66
What defines Chronic Bronchitis What defines Emphysema Most smokers will be Dx w/ ? and termed ?
Productive cough x 3mon/year x 2yrs Structural changes Chronic bronchitis, blue bloater
67
What is the single best variable for predicting which Pt will develop COPD How is Chronic Bronchitis Dx What is seen on CXR
Hx 40 pack/year smoker Lung biopsy w/ inc Reid index (gland layer >50% of bronchial wall) Inc interstitial markings and non-flat diaphragm
68
What will be seen on PFT in chronic bronchitis What is the most effective therapy for Tx Pts w/ chronic bronchitis When is supplemental O2 indicated
FEV/FVC ratio <0.7 Cessation SaO2 <89% or, Rest PaO2 <55mmH
69
How are COPD exacerbation Tx If ABX are used, ? ones and w/ ? indication What will probably develop in these Pts d/t chronic hypoxic vasoconstriction
O2 (goal 88-92%) Nebulized albuteral and Ipratropium PO Prednisone Inc dyspnea, sputum/purlence; Azith/Cefur/Doxy Cor pulmonale
70
COPD Gold Categories
A: Less Sx, Low risk; Breathless w/ hustle on flat ground, 0-1 exacerbation, 0 admission; SABA/SAMA B: more Sx, low risk; Breathless w/ walking slower than peers, 0-1 exacerbations, 0 admission; LAMA/LABA C: less Sx, High risk Breathless w/ hustle on flat ground, ≥2 exacerbations, ≥1 admissions; LAMA and SABA D: more Sxs, High risk; Breathless w/ walking slower than peers, ≥2 exacerbation, ≥1 hospitalizations LAMA+LABA w/ SABA
71
What causes structural changes seen in emphysema What type of breathing habit do these Pts develop What term is used for these Pts
Destruction of alveolar septae d/t lost elastin Purse lip, keeps airway from collapsing Pink puffer- retained CO2
72
What is different between Blue Bloaters and Pink Puffers on CBC results ? is the MC of all interstitial lung dzs How is this MC Dx
BB- Inc H/H PP- normal Hct Idiopathic pulmonary fibrosis CXR w/ diffuse, patchy fibrosis and pleural base honeycomb
73
What type of PFT results are seen in Idiopathic Pulmonary Fibrosis How is this Tx Define Pneumoconiosis
Restrictive pattern- dec volume, normal/inc FEV1/FVC CCS O2 Transplant Pulmonay fibrosis w/ known cause; Exposure to mining/dust causing dec lung volume/FVC (restrictive dz)
74
Asbestosis CXR findings Coal Workers CXR findings Sillicosis CXR findings
Linear pattern w/ basilar predominance, opacities and honeycomb Nodular opacities in upper fields and less prominent hilar adenopathy Egg shell classifications of hilar nodes
75
Berylliosis CXR findings ? restrictive lung dz makes Pts at increased risk for TB ? restrictive lung dz needs tobacco cessation more than others
Difuse infiltrates w/ hilar adenopathy Sillicosis- need serial TST/CXRs Asbestosis
76
? tissue finding indicates significant exposure to asbestos ? size lung mass is a nodule or a mass How are incidental CXR findings of pulmonary nodules managed
Ferruginous body <3cm- coin lesion, nodule (<30mm) >3cm- mass CT w/out contrast- Ill defined, lobular, spiculated= biopsy <1cm, calcified, smooth/defined border= f/u 3mon, 6mon, annual x 2yrs
77
What are the two categories of lung cancer What are the 4 subtypes of one of these categories
Small cell Non-Small cell: Adeno: non-smoker w/ small peripheral lesion; MC bronchogenic Ca SCC: central, solitary mass in smokers w/ hemoptysis Large: fast growth that rarely responds to surgery Carcinoid- lack differentiation
78
How does Small Cell Lung Ca present What lab results would be seen What syndrome can this Ca cause
Aggressive and almost always in smokers; more likely to spread early ACTH/ADH: HypoNa/HyperCa Lamber Eaton- limb weakness
79
How are lung Ca Dx Pancoast tumors are more likely to be ? types What makes up the Pancoast Syndrome
Bronchoscopy w/ biopsy if central or, Fine Needle Transthoracic aspiration (most useful) Adeno/SCC Shoulder pain Horners Bone destruction
80
How is Non-Small Cell lung Ca Tx How is Small Cell Ca Tx ? measurement means PHTN
Stage 1-2: surgery Stage 3: chemo then surgery Stage 4: palliative Chemo, no surgery option >25mmHg at rest
81
? is the MCC of PHTN How is this Dx How is this Tx depending on the origin
MS Right sided catheterization LVF: diuretic, digoxin, anticoagulate Cardiogenic: prostanoids, PD5 inhibitors, endothlin antagonists Pulm Artery HTN: endothelin antagonists, prostanoids
82
Lab result showing s/e of prolonged rescue inhaler B-2 agonist use Preferred fluid used for aortic dissections ? artery supplies LV and if occluded will cause a loss of ejection fraction?
HypoK Crystalloids LAD
83
Why do Tet Spells lead to cyanosis What does squatting help w/ Tet Spells Tetrology of Fallot is associated w/ ? chromosomal abnormalities
Worsened pulmonary outflow obstruction Increases systemic vascular resistance #22 deletions, DiGeorge Syndrome
84
What valves are MC affected by Rheumatic Fever in descending order ? is cardiotoxicity d/t BB/CCBs Tx How is sinus bradycardia Tx if atropine is ineffective
M>A>T Glucagon Dopamine, Epi
85
Most PEs arise from where in the body What are the 4 specific RFs What triad would be seen if a fat emboli is the cause
Iliofemoral DVTs Cancer OCPs Pregnancy Surgery Hypoxemia Neuro abnormals Petechial rash
86
How are PEs Tx How long is medical therapy used for What are the indications for embolectomy
Acute phase: Heparin Then: ARE-aban and Dabigatran 3mon minimum Unstable w/ c/i for thrombolytic therapy
87
What are the 5 RFs for OSA For a Dx, ? sleep study or lab results are needed How is mild/mod/sev OSA Tx
Obesity Anatomy FamHx ETOH/Sedative Hypothyroid ≥5 events/hr w/ Sxs ≥15 events/hr PCO2 > 45mmHg Mild/Mod: CPAP, PO piece Sev: CPAP Uvuloplasty Tracheostomy
88
What is the hallmark CXR finding for almost all pulmonary sarcoidosis What other 3 DDx need to be considered though if this hallmark is seen How is pulmonary sarcoidosis Dx How is this Tx
Mediastinal adenopathy Young female: sarcoidosis Kid from Ohio/zookeeper: histo 60y/o ceremics: berylliosis HyperCa; Inc ACE 4x CCS ACEI Methotrexate w/ serial PFTs
89
# Define ARDS What 3 events account for 75% of all ARDS cases What 3 things can be seen on PE
Resp failure d/t fluid in lungs from inc alveolar capillary permeability Sepsis syndrome- MC Sev/mulitple trauma Aspiration/inhalation Tachypnea Pink sputum Crackle
90
What would be seen on CXR of ARDS How is it Dx How is ARDS Tx
Bronchogram, Bilat infiltrates Bilateral infiltrates Non-CHF Sxs PaO2:FiO2 <300 Sxs developing <7d Intubate w/ lowest level of PEEP to maintain PaO2 >60mm/SaO2 >90
91
How is the mortality of septic shock predicted ? is an indirect marker of tissue perfusion used in sepsis Tx ? is the MCC of sepsis and ? is the MC manifestation
qSOFA Lactate Pneumonia; Fever
92
A Dx of sepsis should be considered if Pt presents w/ two of ? three Sxs What causes gram positive shock What causes gram negative shock
Worsening mentation RR ≥22/min SBP ≤100mmHg Exotoxins from staph/strep Endotoxins from EColi Klebsiella Proteus or Pseudomonas
93
MCC of anaphylaxis ? type of reaction is the usually What does this reaction cause to happen
Ingested foods MC a Type 1 IgE mediated reaction Mast cells/basophils cause HOTN, shock, angioedema from fluid shift from intravascular space
94
What is usually the first sign of anaphylaxis Acronym for acute asthma exacerbation Tx
Cutaneous pruritus/urticaria/angioedema BIOMES: Bagonist Ipratropium O2 Mg sulfate Epi/Terbutaline Steroids
95
Mod/High suspicion for DVT needs ? next steps
Duplex US: Pos= anticoagulate Neg= repeat US in 5-7d ``` D-Dimer: Pos: Duplex US Pos US- anticoagulate Neg US- repeat in 5-7d Neg D-dimer: DVT excluded ```
96
Kawasakis mnemonic GCA is associated w/ ? other Dx
``` Crash and Burn: Conjunctivitis Rash Adenopathy Strawberry tongue Hand/feet swelling Burning fever >5d ``` Polymyalgia rheumatica
97
? is the MC primary cardiac tumor ? genetic condition is this MC associated w/ When do ASx AAAs need to be refereed for elective repair
Atrial myxoma in LA Carney syndrome ≥5.5cm or expands ≥0.6cm/6mon
98
Janeway lesions are more common w/ ? form of endocarditis Ebstein's Anomaly is associated w/ ? arrhythmia ? three defects make up this condition
Subacute WPW Small ASD/PFO Dilated RA, small RV TV insufficiency
99
? features are associated w/ an innocent murmur Define Leriche Syndrome ? heart condition has a pericardial knock
``` ≤2 intensity Minimal radiation Softer w/ sitting Musical/vibratory Short systolic duration ``` Claudication in thigh/butt d/t atherosclerosis in aortoiliac system Constrictive pericarditis
100
MOA for Adenosine This is the first line drug used to Tx ? Preferred anticoagulant for pregnancy
Inhibits AV node conduction PSVT LMWH
101
What two anticoagulants can be used during breast feeding What labs are ordered for Secondary HTN work up What is the next step in work up after a suspected Dx of infectious endocarditis is suspected
LMWH< Warfarin CBC/CMP Lipid UA ECH Blood culture x 3, then empiric ABX
102
How are hemodynamically unstable Pts w/ WPW Tx What is the first step in Tx of orthodromic AVRT in stable Pts What is the definitive Tx for these Pts
Conversion Vagal then adenosine then BB/CCBs Ablation
103
What are the Hs and Ts for PEA
Hypovolemia Hypoxia Hypothermia HyperK Tension pneumo Thrombus Toxicologic Tamponade
104
What is the most specific finding on stress test for myocardial ischemia What drugs need to be avoided in 2* Type 2 and 3 AV blocks What causes the PDA to close after birth
2mm down sloping ST depressions Adenosine BBs CCBs Digoxin Pulm vasculature resistance dec= bradykinin release
105
PDA defects are associated w/ ? two conditions When would Pts benefit from Palivizumab administration What type of murmur exists w/ AS
Downs, Maternal rubella Cyanotic heart defect Mod/Sev P-HTN Congenital HF w/ meds Paradoxically split S2 w/ narrow pulse pressures
106
What are the 5 cyanotic congenital heart Dzs Why do Pts w/ Brugadas have inc risk for sudden death Define Brugadas and how is this acquired and Tx
``` Truncus arteriosus Transposition of great vessels Tricuspid atresia Tetrology Total anomalous pulm vascu ``` Inc risk for Vfib Pseudo-RBBB w/ ST elevation in V1-2; Autosomal dominant; ICD
107
How are stable Pts w/ monomorphic V-tach Tx What are the s/e of the first line med MCC of V-tach
Procainamide or Amiodarone then Sotalol Pro: HOTN, prolonged QTc Structural heart Dz
108
How are unstable Pts in V-tach Tx Mnemonic for s/e of loop diuretics What are the loop diuretics
Synch'd conversion ``` Ototoxicity HypoK/Mg Dehydrate Allergy to sulfa Alkalosis, metabolic Nephritis Gout ``` Furosem/Torem/Bumetan-ide
109
What adverse outcome of MI appears 2-7d after w/ mid-systolic murmur and rapid onset of pulm edema How does a Klebsiella induced lung abscess appear on CXR Although Klebsiella and alcohol is common, ? microbe is more common cause of pneumonia
Acute MR w/ sinus tachy R sided infiltrate in upper love w/ bulging fissure Strep pneumonia
110
CXR w/ decreased vascularity d/t suspected PE is called ? What causes Croup What is heard on PE and what is seen on CXR
Westermark's sign Parainfluenza virus Inspiratory stridor, Steeple sign
111
Two MCC of Ventilator Associated Pneumonia What causes Pertussis What are the three stages of this condition
Staph A, Pseudomonas Bordatella Catarrhal: lacrimation Paroxysmal: whoop Convalescent: resolution
112
How is Whooping Cough Tx Pancreatitis induced pleural effusion would have ? inc lab result What does surfactant expression begin during development
Pertussis: Azithromycin or TMP/SMX Amylase 20wks; gradual increase until 36wks
113
What is the MC presenting S/Sx and finding of a PE Define Esophageal Ring What syndrome can this develop
S: tachypnea Sx: dyspnea at rest/exertion F: normal CXR Schatzki- distal stricture at B-ring junction; almost always w/ hiatal hernias Steakhouse: progressive dysphagia to solids
114
# Define Esophageal Web ? syndrome can develop w/ esophageal webs Pts that develop the above syndrome are at increased risk for developing ?
Membrane across mid/upper esophagus MC d/t GERD Plummer Vinson: iron deficient anemia Dysphagia Cervical-web Glossitis Cheilosis SCC
115
How are esophageal strictures Dx How are these Tx When do umbilical hernias need surgical referral
Initial: barium swallow, upper endoscopy H2 antagonist, Omeprazole, Endoscopy w/ dilation; PPI dec recurrence Persists >2yrs of life
116
# Define Strangulated hernia Define Obstructed Hernia Define Incarcerated
Blood supply has been impaired Irreducible hernia w/ intact blood supply Occluded and irreducible, can progress to strangulated
117
? is the main RF for esophagitis Endoscopy for esophagitis work up shows multiple, shallow ulcers meaning ? etiology Two MC meds that cause medication induced esophagitis
ImmComp HSV NSAIDs, Bisophosphonates
118
When is Eosinophilic Esophagitis a considered Dx What would be seen on barium swallow and how is it definitively dx Radiation exposure exceeding ? much puts these Pts at risk for ?
Asthma and GERD non-responsive to antacids Ribbed esophagus w/ multiple corrugated rings; Biopsy 5000 cGy; Stricture
119
What is the hallmark sign of infectious esophagitis Since esophagitis primarily occurs in ImmComp Pts, what are the MC microbes What would be seen on exam if etiology was fungal
Odynophagia- pain w/ swallow C albicans HSV CMV Linear yellow/white plaques w/ odynophagia
120
What would be seen on PE if etiology of esophagitis was viral and how they're Tx How is esophagitis Dx How is esophagitis Tx depending on cause
HSV- shallow punched out lesions; Acyclovir CMV- large, solitary ulcer; Ganciclovir Biopsy Culture Endoscopy Double contract esophogram Candida: Fluconazole HSV: acyclovir CMV: ganciclovir Corrosive: steroid
121
Chronic GERD puts Pts at risk for ? Dz What are Pts at risk for if the above issue develops What is the gold standard and test of choice for Dx
Barretts; f/u screening q3-5yrs Adenocarcinoma Gold: 24hr pH monior w/ manometry confirmation TxoC: endoscopy w/ cytologic washing
122
? meds lower LES pressure and worsen GERD Sxs Pts w/ GERD Sxs and ? RFs are considered high risk and need endoscopy
``` Progesterone Anticholinergic/histamines Nitrates TCAs CCBs ``` ``` Hematemesis Age >50 Weight loss Anemia/melena Recurrent vomiting Dysphagia ```
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How is GERD Tx H2 antagonist class ending PPI class ending
H2 antagonist, Qd then BID Sxs persist- switch to PPI Continue x 8wk after Sx control - tidine - prazole
124
# Define Achalasia What will be seen on swallow studies What is the best study for Dx How is achalasia Tx
Motility d/o in distal esophagus d/t loss of auerbach plexus- no peristalsis and weight loss Bird beak/Rat tail Manometry EGD dilation or mytomy CCBs, Nitro, PPIs prevent stricture return
125
# Define Diffuse Esophageal Spasm What would be seen on a barium swallow What is the best method to confirm a Dx of esophageal spasm after a barium swallow and how is this Tx
Non-peristaltic, painful contractions after ingesting hot/cold food Corkscrew appearance Manometry; w/ Nitrates/CCB/Botox
126
How does esophageal cancer present What is the MC type of esophageal Ca What part of the esophagus is MC affected and by ? RFs
Dysphagia to solids progressing to liquids w/ adenopathy World: SCC USA: Adeno d/t GERD/Barretts Distal; men who smoke
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How is esophageal Ca Dx How is this Tx How often are Pt w/ Barretts f/u and screened
Endoscopy w/ biopsy- test of choice; CT for staging Resection, Radiation, Chemo w/ 5-FU q3-5hrs
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Rosh Pulm- #19 | Rosh Cards- #70
GI- Gastritis
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What happens if achalasia is left untreated ? infectious Dz can cause Achalsia Sxs Candidiasis esophagitis not responding to itraconazole needs ? Tx adjustment
Sigmoid esophagus Chagas Itraconazole suspension of Voriconazole
130
Refractory candidiasis esophagitis infections are Tx w/ ? How is CMV esophagitis Tx but is limited d/t ? s/e Pts intolerant or unresponsive to the above Tx are then Tx w/ ?
IV Caspofungin Ganciclovir; neutropenia IV Foscarnet
131
How is herpetic esophagitis Tx Pts that are intolerant/unresponsive to the above Tx are then Tx w/ ? Normal LES pressure ranges
A/F/V-cyclovir IV Foscarnet 10-35mmHg
132
Most GERD reflux is induced by ? What two autoimmune Dzs can have worse GERD Sxs ? Dx study needs to be avoided during a GERD work up
Gastric distension by vasovagal reflex Sjogrens, Scleroderma Barium study
133
When Tx GERD w/ H2 antagonists (-tidine), Pt education for pill use ? medication is the preferred initial med for Tx of GERD What two Sxs are common indicators of gastritis
Take prior to eating PPIs: -prazole Inflammation of stomach lining- Dyspepsia, Abdominal pain
134
Acute Gastritis usually develops in ? part of stomach What are the two types of Chronic Gastritis
Antrum Type A- in fundus d/t anti-parietal Abs, associated w/ Pernicious Anemia; risk for AdenoCa Type B- in antrum d/t NSAIDs, Pylori and often ASx; risk to develop PUD
135
How is Gastritis Dx What are 3 methods to detect H Pylori if a suspected DDx How is this Tx
Endoscopy w/ 4 biopsies Fecal Ag, Serology, Urea breath test Mild: Famot/Cime-tidine Sev: Omeprazole taper, d/c when ASx x 8wks
136
What is the next step for gastritis if Sxs return ≤3mon of d/c acid suppression meds What are the s/e of PPI use What RF increases incidence of gastric ulcers and dec healing time
Upper endoscopy HypoCl/B12/Mg Dec Ca absorption Pneumonia C D-ff Cigarette smoke
137
What type of PUD ulcer are MC The MC is MCC by ? How do Pts present
Duodenal > Gastric H pylori Dec pain w/ food
138
Duodenal ulcers are MC located ? If located elsewhere, ? is the increased risk PUD can rarely be caused by ? syndrome
Anterior duodenum Posterior= bleeding from gastroduodenal artery/acute pancreatitis Zollinger Ellison- gastrinoma of pancrease releasing excess gastrin; >200=Dx
139
Gastric ulcers are MC found located ? ? is the MCC of non-hemorrhagic GI bleed This MC typically presents as ?
Lesser curvature of antrum PUD Melena
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What is the most accurate Dx test for PUD All Pts undergoing this test need ? additional test What would be seen on labs/rads if an ulcer ruptured
Upper endoscopy H pylori biopsy Inc serum amylase, Pneumo-diaphragm
141
How is PUD Tx When is Pylori eradication testing performed How are Pts w/ NSAID induced PUD Tx
All Pts- PPI H Pylori: Metro/Clarithromycin Amox PPI ≥4 weeks after completing therapy PPI for minimum of 8wks
142
# Define Functional Dyspepsia Functional dyspepsia is the MCC of ? How can this be managed
Dyspepsia w/out etiology on scope/studies Chronic dyspepsia Desipramine, Nortriptyline Buspirone- dec bloat/fullness
143
What are the 4 RFs for gastric Ca How does this form present How is this Dx
FamHx Anemia, pernicious Gastric ulcers H pylori**- most important Vague fullness/early w/ meal Anorexia N/V w/ weight loss EGD w/ biopsy; Pos guiac
144
What lab results may be seen in Pts w/ gastric Ca How is this Tx What mnemonic is used for gastric Ca suspicion
Microcytic/Hypochromic Gastrectomy w/ rad/chemo WEAPON: Weight loss Emesis Anorexia Pain Obstruction Nausea
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What is the MC early Sx of gastric Ca Overall, what is the MC Sx What lymph nodes will be involved
Epigastric discomfort/indigestion Weight loss L-side virchows node (r-side= HL) Sister Mary, Joseph- umbilical
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What is the MC type of gastric cancer worldwide What EGD finding suggests gastric Ca presence Define Celiac Dz
Adeno Linitis Plastica- diffuse thickening of stomach wall Immune response to gluten causing injury to proximal end mucosa
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What blood test is used to Dx Celiac Dz How is the Dx confirmed after ? positive test Celiac Pts may need correction of ? deficiencies
IgA endomysial and transglutaminase Ab + endymysial Ab: mucosal biopsy from duodenal bulb B12 Ca D, Vit Fe Folate
148
What lab test has a higher spec but lower sense for Celiac testing What causes lactose intolerance Pts may need ? supplementation
EMA-IgA No lactase= dec conversion of lactose in glucose/galactose Ca
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How is a presumptive Dx of lactose intolerance made How is the Dx confirmed Fecal pH test can also be performed w/ ? being normal
Mild Sxs w/ lactose ingestion that resolve 5-67d after eliminating from diet Lactose breath H test += 20ppm over baseline Normally alkaline; Abnormal- intolerance, Rotavirus/EColi infection
150
How is lactose intolerance Tx Crohns involvement Appearance on colonoscopy
Lactase supplements; Lactose avoidance Global GI tract, spares rectum Skip lesions, cobble stone
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? type of diarrhea does Crohns have Risk for fistula development Appearance on x-ray
Non-bloody w/ frequent abdominal pain Yes Terminal ileum string sign
152
Crohns histological findings Effect of smoking on condition What serology marker is used for this
Transmural, non-caseating granuloma Worsens Dz ASCA and Perinuclear antineutrophil cytoplasmic Ab
153
UC area of involvement Appearance on colonoscopy ? type of diarrhea do Pts have
Colon, usually w/ rectum Continuous lesions Non-painful, bloody
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UC risk for fistula development Appearance on x-rays Histological findings
No Erythematous, friable ulcers w/ lead pipe appearance d/t loss of haustral folds Mucosa only crypts abscess
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Effect of smoking w/ UC ? serology marker is used How is this Dx
Protective p-ANCA Barium enema- lead pipe Flex sigmoid- dec risk for perf
156
? complications can arise from UC Pts need ? nutritional screening q1-2yrs How are UC and Crohns Tx
Toxic megacolon, Ca Vit D, B12 Sulfasalazine/Mesalamine- block prostaglandin release; UC > Crohns
157
What is the next step in Tx if Pts w/ UC/Crohns don't respond to 5-ASA Tx What med is used during exacerbation What meds can be used in conjunction w/ the above if no response is achieved
Metronidazole Systemic CCS Azathioprine, 6-Mercaptopurine
158
What bile acid sequestrants are used during UC/Crohns Tx Which one can be Tx w/ surgery What do asthma exacerbations get upon d/c
Cholestyramine, Colestipol UC w/ total colectomy Beta agonist, CCS
159
? antihypertensive med can cause prolonged HOTN when used w/ Sildenafil ? P2Y12 inhibitor is c/i in Pts w/ MEdHx of TIA <12mon What criteria is used for Dx IBS
A-blockers Prasugrelor Rome: Pain x 3d/mon x 3 mon w/ ≥2 of: Improved w/ BM Changed freq/consistency
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Pts w/ IBS report w/ ? c/c and ? relieving fact What red flags make the Rome Criteria for Dx invalid What is the next step if red flags are present
N/V, bloat relieved w/ defecation Hematochezia Weight loss Fever Imaging or colonoscopy; no labs- normal during IBS
161
How is IBS Tx Toxic megacolon is a complication of ? How do Pts present
Hyoscyamine before meals for antispasmotic effect IBS: UC > Crohns ``` Shock Abdominal distension Fever Enlarge colon >6cm Peritonitis ```
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Criteria used w/ radiology to Dx Toxic Megacolon How is this Tx
Three of: Fever Leukocytosis >10.5K Anemia Tachy >120bpm One of: HOTN E+ imbalance AMS Dehydration Ceftriax+Metro, Decompression, Resection
163
? is the MC vessel blocked during intestinal ischemia What would be seen on x-rays How is it Dx by gold standards and how is it Tx
Superior Mesenteric artery Thumb printing Angiography; Revascularization
164
How does chronic mesenteric ischemia present What MedHx do Pts usually have ? two meds can help prevent formation of new polyps
Post-prandial pain w/in 60min of eating, resolves <3hrs PVDz Smoker DM ASA, Cox-2 inhibitors
165
Polyp growths are the MCC of ? in Peds These tend to be more malignant w/ ? association Define Familial Adenomatous Polyposis
Painless rectal bleeding More superior in intestine they are Thousands of polyps by 15y/o, Ca by 40y/o
166
When do first degree relatives need screening w/ FamHx for Familial Adenomatous Polyposis ? types of polyps are common in the distal colon/rectum What types of plyps have a higher risk for Ca transformation
Genetic screening after 10y/o Adenomatous: MC tubular type, least risk Villous adenomas
167
When do Pts start routine screening colonoscopies How can this form of Ca be screened for How often are scopes performed
45y/o, ending at 75y/o Guiac q12mon Fecal q12mon FIT DNA q 1-3yrs Flex Sigmoid: q5yrs or, q10yrs w/ FIT every year Colonoscopy: q10yrs CT colonography q5yrs
168
What is seen on barium study if colon cancer is present How is this Tx ? is the MCC of lower GI bleeds and how does this MC present
Apple core lesion Resection w/ 5-FU chemo Diverticulosis- painless rectal bleeding in Pt w/ LLQ pain
169
Where are diverticuli MC found How does diverticulitis w/ macroperforation present ? triad is considered a pos Dx
Descending colon; Western society- sigmoid Constipation LLQ pain Inc WBC/CRP Fever No vomit, CRP >5mg, LLQ tenderness
170
How is diverticulosis Dx What ABX are used for Tx When is admission indicated
Noncontrast CT: fat stranding w/ thick wall X-ray r/o free air Avoid colonoscopy Cipro or Augmentin w/ Metronidazol Complicated Uncomplicated w/ fever >102.5, Septic, ImmSupp, NPO
171
What are the bulk-forming laxative What are the osmotic laxatives What are the suppositories used for constipation Tx
Psyllium Ca polycarbophil Methylcellulose Dextrin Lactulose Mg Polyethylene glycol Sorbitol Glycerin Bisacodyl Senna
172
? Pt presentation w/ constipation needs to have colon Ca r/o Constipation lasting more than ? and refractory to Tx needs further work up What causes Traveler's Diarrhea
>50y/o w/ new onset constipation >2wks E Coli
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Diarrhea after picnic/egg salad Diarrhea after shellfish Diarrhea after pork/poultry
Staph A Vibrio cholerae Salmonella
174
Diarrhea after poorly preserved canned foods ? lab result indicates inflammatory diarrhea How can the frequency of diarrhea be decreased
C perfringens WBCs in stool Loperamide Diphenoxylate Codeine Paregoric
175
Hep A virus type and mode of transmission Where are epidemics seen What vectors can also carry this virus
RNA virus transmitted via ATM Daycare/Barracks Water, Milk, Shellfish
176
What labs are seen during Hep A during early/late phase How is this Tx When are vaccinations given
Acute: anti-HAV IgM Later: anti-HAV IgG Immune globulin IgG <2wks since exposure 12-23mon
177
Hep B virus type and mode of transmission What lab result is seen first and is the first sign of infection What lab result is seen w/ viral replication and indicates infectiousness Where is the Ag core going to be found
DNA virus w/ Dane particle from sex/blood products HBsAg HBeAg HBcAg- intracellular, liver- Pt now 'has' Hep B
178
What is the first response seen to Hep B infections How is acute Hep B Dx What is the second response seen in response to Hep B What is the last response seen to Hep B infections
HBcAb IgM; x3mon- IgG HBcAb HBeAb IgM; x3mon- IgG HBsAb IgM; x3mon- IgG
179
What lab result suggests Pt is immune to Hep B How do you differ active from passive Hep B immunity How do you Dx Chronic Hep B
anti-HBs IgM/IgG ABcAg; anti-HBc Ab HBsAg is always Pos
180
Hep C virus type and mode of transmission What is different between Hep C and B How is Hep C Dx
Single RNA strand in transfusion recipients and IVDA Hep C more likely to be chronic Anti-HCV Abs
181
How is Chronic Hep C managed Hep D virus type and mode of transmission Hep D will cause >50% of all ? cases
Interferon RNA virus transmitted w/ HBsAG Fulminate hepatitis
182
Hep E infection resembles ? and is transmitted by ? MC infectious cause of dilated cardiomyopathy What are the 3 phases of acute heptatitis
Hep A; via ATM Enterovirus: Coxsackie B Prodromal: dec smoking, spiking fever- Hep A Icteric: jaundice after fever Fulminant: encephalopathy, coagulopathy
183
What lab results are seen w/ acute hepatitis Only ? etiologies of hepatitis can become chronic Define Fulminant Hepatitis
Inc ALT/AST: Acute >500, Chronic <500 B, C, D Acute liver failure in Pts w/ hepatitis
184
What are 3 etiologies for Fulminant hepatitis How does this form of hepatitis appear on PE
Tylenol OD- MC in USA Viral infection Reye syndrome- kids w/ ASA use after viral infection Encephalopathy w/ astrix Coagulopathy- INR ≥1.5 Reye syndrome- uncontrollable N/V w/ hand/foot rash
185
How is Fulminant Hepatitis managed What is definitive Tx What lab result suggest alcoholic liver dz
IV fluid/E+ Mannitol- inc ICP PPI- stress ulcer prophylaxis Liver transplant AST>ALT x 2 AST- normally in mitochondria, ETOH induces injury/release
186
What are the etiologies for non-alcoholic fatty liver dz What are the two types
HyperLipid Obese GCCS DM NAFL: benign, no fibrosis or malignant potential NA Steatohepatitis- inflammation and fibrosis w/ premalignant potential
187
How is NAFL Dz Dx Define Cirrhosis What is the MCC
Biopsy- fatty deposits w/out alcoholic Hx Irreversible fibrosis w/ nodular regeneration 2/2 chronic liver dz Chronic Hep C > alcohol
188
What may be seen on PE of cirrhosis How is this Dx and managed definitively What type of f/u surveillance do these Pts need
Telangiectasis Ascites Gynecomastia Confusion Lethargy Asterixis Medusa Spider angioma Liver biopsy; Transplant RUQ US q6mon
189
How is cirrhosis encephalopathy managed How is cirrhosis ascites managed How is cirrhosis pruritus managed
1st: Lactulose/Rifampin 2nd: Neomycin Na restriction Spironolactone Furosemide Cholestyramine
190
How is cirrhosis staging done ? autoimmune d/o can cause cirrhosis ? lab/rads are ordered at Dx
``` Child-Pugh: Serum albumin Encephalopathy Ascites Total bili PT INR A: 5-6pts B: 7-9pts C: 10-15pts ``` Wilson's Dz- inc copper, dec ceruloplasmin w/ +FamHx A-fetoprotein- high= MRI EGD
191
Pt w/ cirrhosis presenting w/ ? two Sxs suggest spontaneous peritonitis What marker is used to see if Pts convert to cancer ? vascular issue can develop and present in a triad
Fever, Abd pain A-fetoprotein Budd Chiari- hepatic vein thrombosis: Pain Ascites Megaly- lver
192
? is the MCC of portal HTN in peds What are the two types How is this Dx
Budd Chiari 1*: hepatic vein thrombisis (MC) 2*: hepatic/IVC occlusion RUQ Us- screening Venography- test of choice
193
# Define 'Nutmeg Liver' How is Budd Chiari Tx How is autoimmune hepatitis Tx
Congestive hepatopathy, DDx for Budd Chiari Dx Shunt decompression Diuretics for ascites CCS
194
How is Wilson's Dz induced cirrhosis Tx What is used for prophylaxis against variceal hemorrhage/esophageal bleeds Define Hepatocellular Carcinoma
Penicillamine- chelation therapy Nadolol, Propranolol Tumor developing d/t chronic liver dz and cirrhosis
195
Hepatocellular Carcinomas work up once lesion <1cm is found What sizes have a good prognosis w/ transplant Tx Define Cholelithiasis
Contrast MRI; Neg- f/u US q3mon No rad findings- biopsy Single tumor <5cm ≤3 tumors all ≤3cm Gallstones (cholesterol > pigment) w/out inflammation
196
What are the RFs for cholelithiasis ? is the cardinal Sx of cholelithiasis How is this Dx
5 Fs: Fat Fertile Female Flatulent Forty Biliary colic RUQ US after 8hrs of fasting
197
What lab result is elevated when there is obstructed bile flow in cholelithiasis What lab result is decreased What clotting factors are made in the liver and how are they assessed
ALK-P, confirmed w/ GGT Albumin 1 2 5 7 9 10 12 13 w/ PT
198
How is cholelithiasis Tx Black gallstones mean ? Brown gallstones mean ?
Ursodeoxycholic- dissolves stones over 6-9mon; Cholecystectomy Hemolysis, ETOH related cirrhosis Asian, parasite/bacterial infection
199
# Define cholecystitis What PE finding aids w/ Dx What ABX are used for cholecystitis prior to ? surgical procedures
Cystic duct obstruction leading to EColi infection/inflammation Murphy- pain w/ inspiration Boas- pain to R shoulder; US then HIDA- most specific Ceftriax and Metronidazole; Cholecystostomy- percutaneous drainage
200
? pre-malignant condition can develop from chronic cholecystitis Define Choledocholithiasis and what this can lead to What PE finding is more suggestive of choledocholithiasis and what is the Dx test of choice
Porcelain GB Gallstone in common bile duct; cholestasis- inc ALP w/ GGT Jaundice; ERCP
201
# Define Cholangitis What triad presents w/ ascending cholangitis and what additional Sxs makes this into a pentad How is this Dx
Biliary tract infection 2/2 obstructed common bile duct and EColi/Klebsiella Charcot: F/C, RUQ pain and jaundice; HOTN/shock and AMS US then cholangiography via E/MRCP
202
How is pulmonary wedge pressure measured HyperK EKG changes S1/S2 sounds
Swan Ganz cath Peaked T, Dropped P, Wide QRS, Sine wave S1: MT S2: AP
203
What is the classic presentation for pancreatic cancer What is the imaging study of choice for this What PE sign may be seen
Painless jaundice and pruritus w/ mass compressing bile duct w/ jaundice Abdominal CT: Neg: endoscopic US w/ biopsy Pos: resection w/ biopsy Courvoisier sign- palpable gallbladder
204
What is the worst type of pancreatic cancer w/ the lowest prognosis What is the MC s/e after PUD surgery What is the MCC of pediatric intestinal obstruction
Ductal adenocarcinoma Weight loss d/t early satiety Intussusception- colicky pain, vomit and bloody stool
205
How is intussusception Dx MCC of small bowel obstruction MCC of large bowel obstructions
US or pneumatic enema- Dx and therapeutic Adhesions Neoplasms
206
? is the MC location for primary anal fissures to develop and what would be seen on PE of chronic fissures How are these Tx in order What part of the cardiac system has the slowed electrical conduction
Posterior to midline; skin tags WASH, Topical nifedipine/Nitro, Botox, Lateral internal sphincterotomy AV node
207
What causes Primary Anal fissures posterior to midline What causes Secondary anal fissures lateral to midline What type of cells make surfactant
Trauma Constipation Vaginal delivery Crohns Malignancy Communicable/Granulomatous Dzs Type 2 pneumocytes
208
What criteria allows for Tetrology Pts to play in sports after surgical correction What mnemonic is used for DDxs for pancreatitis
R ventricular pressure <50mmHg GET SMASHED Gallstone Ethanol Trauma Steroid Mumps Autoimmune Scorpions HyperCa Hyperlipid ERCP Drug
209
How is chronic pancreatitis' presentation different from acute What is the classic triad for chronic pancreatitis What anatomical variant may be seen w/ chronic cases
Steatorrhea, Fat malabsorbed Pancreatic calcification Steatorrhea DM Pancreatic pseudocyst
210
? lab result is more specific for pancreatitis What is the Dx test of choice How is this x if biliary sepsis is present
Serum lipase 3x higher Initial: CT or MRCP Dx: CT** or Xray: sentinel loop w/ dec bowel sounds; colon cut off sign ERCP
211
What lab result is highly suspicious for gallstone induced pancreatitis What lab result will be seen on BMP Once admitted, how are Pts managed
ALT 3x higher than normal HypoCa- necrotic fat binds to Ca via soponification LR w/ Meperidine and Imipenem
212
What is the most sensitive and specific test for pancreatic function w/ chronic pancreatitis What tumor marker is used to track PTs after pancreatic cancer Tx Name of surgical procedure
Fecal elastase CA 19-9 Pancreaticoduodenectomy- whipple
213
How is pancreatic cancer managed if Pt is inoperable MC Sx of anorectal Ca What is the MC type
ERCP w/ stent Hemaochezia w/ tenesmus Adenocarcinoma
214
What studies are ordered for hemorrhoids How are hemorrhoids classified
Anoscopy- benign PE Colon/Sigmoidoscopy- >40y/o w/ RFs for cancer Degree of prolapse: 1: none below dentate line 2: spot reduction 3: manual reduction 4: irreducible, may strangulate
215
How are internal hemorrhoids Tx Hemorrhoidectomy is used for Tx of ? stages What is the MC microbe and location for anal fistula/abscess
Docusate/Psylliumw/ sitz baths Lidocaine/witch hazel Rubber band ligation +bleeding= sclerotherapy Stage 4 and medical failures Staph A; posterior wall
216
How are anorectal abscess and fistulas Tx Define anal fissure
InD then WASH: Warm water cleanse Analgesic Sitz bath High fiber Painful linear tear/crack along distal canal
217
How are anal fissures Tx Define Vit C deficiency What condition develops d/t the deficiency
First: Sitz bath, inc water/fiber 2nd; Nitro, Nifedipine 3rd: botox to internal sphincter 4th: internal sphincterotomy Ascorbic acid Scurvy: tooth loss w/ 3 Hs- Hyperkeratosis: hyper hair follicles w/ curled hair Hemorrhage: gun/skin/joint bleeding and dec healing Heme: anemia w/ glossitis
218
How is Vit C deficiency Dx How does Vit D deficiency appear on PE What would be seen on x-rays
Leukocyte ascorbic levels > serum levels Bone pain Prox muscle weakness Bowing of long bones Looser lines- pseudo Fxs
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How is Vit D deficiency Tx What is the other name for Vit D and it's role in the body Viatmin A deficiency/toxicity
Ergocalciferol 1,25 Dihydroxycalciferol- needed to absorb Ca from intestine Inc: idiopathic intracranial HTN Dec: night blindness
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What is seen on PE if Vit A deficiency is present B2 deficiency syndrome name B1 Deficeincy
Bitot's spots: white spot in conjunctiva Riboflavin- Oral: magenta colored tongue Ocular: photophobia Genital: scrotal dermatitis Thiamine: d/t alcoholism
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What are the two forms of B1 Thiamine Deficiency What form of encephalopathy can form Why is this such a concern
Dry Beriberi: symmetric peripheral neuropathy Wet Beriberi: high output HF w/ dilated myopathy Wernicke: ataxia, confusion, ophthalmoplegia Neuro emergency commonly seen in alcoholics
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? form of dementia can form w/ B1 Thiamine deficiency What are the etiologies of B3 Deficiency What condition does this present as
Korsakoff: short term loss w/ confabulation d/t Wernickes Untreated corn lacking tryptophan Carcinoid syndrome: inc tryptophan metabolism w/ serotonin production Hartnup dz: dec tryptophan absorption Pellagra: Dermatitis (sun exposed) Diarrhea Dementia
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How does B6 deficiency present How is B12 absorbed into the gut What is the MCC of this deficiency
Peripheral neuropahty and anemia W/ intrinsic factor in distal ileum Pernicious anemia- dec IF d/t parietal cell Abs
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How does B12 deficiency appear on PE How is this Dx Since this presents similarly to folate deficiency, what lab results are used to differ the two
Initial Sx: symmetric paresthesia in legs Lat/Post spinal cord demyelination: loss of vibratory/proprioception, dec DTRs CBC w/ peripheral smear: macrocytic w/ hypersegmented neutrophils and macro ovalocytes Inc LDH, homocysteine, methylmalonic acid
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# Define RA How does this present on exam What two syndromes can be seen w/ this Dz
Chronic autoimmune inflammatory dz w/ persistent symmetric polyarthritis AM stiffness improving through day, affects DIP and PIP Felty: RA + splenomegaly + dec WBC Caplan: coal worker lung and RA
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What are the two hand deformities seen w/ rheumatoid arthritis How is RA Dx How is RA Tx w/ DMARDs
Boutonniere: PIP flexion, hyperextend DIP Swan neck: DIP flexion, hyperextend PIP Rheum factor: sens, not spec Anti citrullinated peptide Abs: most spec NSAIDs w/ CCS Hydroxychloroquine Methotrexate* Sulfasalazine
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How is RA Tx w/ Biologics Lab results seen w/ OA What DDx can occur w/ OA in the knee
IL-1 antagonist: Anakinra Anti-TNF: Etanercept Infliximab Adalimumab Normal ESR/CRP Bakers Cyst
228
What are four meds that can induce lupus Define SLE What lab result is usually pos in these Pts
Procainamide Isoniazid Quinidine Hydralazine Autoimmune dz w/ rash (maculopapular butterfly), joint pain, fever ANA and anti-histone Abs, normal complement
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What are the three types of SLE How is this Dx What lab result means Pt is at increased risk for thrombosis
Fixed erythematous: rash on cheeks/nose bridge Discoid: annular, erythematous patches Systemic: Renal Alopecia CNS Eye CV Initial: ANA Anti-double DNA/AntiSmith- 100% spec Antiphospholipid Ab syndrome
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What lab result can indicated females w/ SLE will have frequent miscarriage/livedo reticularis What complement levels are dec during flares ? lab results suggest increased risk for neonatal lupus erythematosus during pregnancy
B-2 glycoprotein 1 Ab C3,4 CH50 Anti Ro/La
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? lab result has high sensitivity for an etiology for drug induced lupus How is SLE managed Define Scleroderma
Antihistone Ab Hydroxychloroquine NSAID/Acetaminophen Sun protection CT d/o w/ thickened skin (sclerodactyly)
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Limited Cutaneous Systemic Sclerosis is AKA ? syndrome How is the vascular phenomenon Tx How is Scleroderma Dx
CREST: Carlcinosis Raynauds gErd, Sclerodactyly Telangiectasis Raynauds- CCB and prostcyclin Anti-centromere Ab- limited crest, better Anti-SCL 70 Ab- diffuse Dz w/ multiple organ involvement
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How is Scleroderma Tx to prevent progression/if pulm system is involved What meds are used if P-HTN develops What is the drug of choice for renal crisis
Methotrexate Mycophenolate Cyclophosphamide Ambrisentan and Tadalafil Captopril
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# Define Ankylosing Spondylitis This Dx is also associated w/ ? other four Dx How is this condition Dx
Seronegative arthropathy affecting sacroiliac joints Psoriasis IBDz Anterior uveitis AR CRP/ESR, HLA-B27 X-ray: gold standard
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How is Ankylosing Spondylitis managed What meds can be used for relieving joint Sxs What lab result will be Pos in >80% of Reitters Pts
PT w/ NSAIDs Refractory: a-TNF Etanercept/Infliximab Sulfasalazine, Methotrexate HLA-B27
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# Define Reitters Syndrome What GI infections can cause this Other than + HLA-B27, what other lab result aids w/ Dx
Autoimmune response to infection, MC G > C Salmonella/Shigella Campylobacter Yersinia Aseptic synovial fluid
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How is Reitters Tx Define Gout How is this Dx if the attack is in great toe
NSAIDs/ABX No response: methotrexate, a-TNF, CCS Uric acid accumulation in joints/tissue Podagra
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How does acute gouty arthritis present How does chronic gout present Define Pseudogout
Podagra, monoarthropathy Tophi deposition Ca pyrophosphate crystal in tissues, MC knee, wrist
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What will be seen on x-rays of pseudogout How is gout Dx How is pseudogout Dx
Chondrocalcinosis- linear radiodensities Neg birefringent needles Rat bite/punched out erosion on x-ray Inc serum uric acid/ESR/WBCs Pos birefringent, rhomboid crystals
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How is acute gout Tx/managed What is avoided When/How is chronic gout considered for managed
1st: Indomethacin, Naprosyn 2nd: colchicine, steroid ASA- inc serum uric acid Tophi or ≥2 attacks/year: Allopurinol: red uric acid production Probenecid: inc uric acid secretion NSAID or Colchicine
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How is Pseudogout Tx What is used for prophylaxis Define Polymyositis
CCS then NSAID Colchine Chronic, idiopathic inflammation causing symmetric, proximal weakness/pain
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What would be seen on PE in Pts w/ Polymyositis What parts of the body are MC affected How is Polymyositis different from Dermatomyositis and Polymyalgia Rheumatica
Early fatigue Inability to rise from seated Shoulders, Hips Derm: skin changes PR: lack of joint pain Polymyositis:` inc muscle enzymes/CrK
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# Define Dermatomyositis What differentiators may be seen on exam
Autoimmune myopathy w/ symmetric proximal weakness AND cutaneous findings Gottrons: raised purple, scaling plaques on bone prominences Shawl/V-sign: pink rash on neck/trunk Heliotrope rash: purple/red rash around eyes/on lids
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What would be seen on muscle biopsy results in Dermatomyositis Pts What serology result is specific for Dermatomyositis What marker is specific for interstitial lung fibrosis
Endomysial inflammation Anti-Mi-2 Ab Anti-Jo 1 Ab
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How is Polymyositis/Dermatomyositis Tx What two presenting factors are unique for fibromyalgia How is this Dx
Suppress w/ CCS Long term management- Methotrexate Sleep disturbances, Sxs worse w/ stress Pain w/ 4kgs of force in 11 of 18 sites
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How is fibromyalgia managed What is the only FDA approved med for Tx What is the preferred method of PT
TCAS Pregabalin Swimming
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What part of the body is attacked during Sjogrens How is it Dx What test can be done in office for Dx How is Sjogrens Tx
Exocrine glands: Xerostomia, Keratoconjunctivitis sicca ANA, Anti-SS A/B (anti-RO/La) Schirmers: pos if <5mm lacrimation in 5min Pilocarpine- cholinergic for xerostomia Cevimeline
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What is the Rule of 50 for GCA What causes this to occur What branches of the carotid artery are affected by GCA
Steroids ESR Age >50 Viral infection causing monocyte activation and cytokine production Post-Ciliary Occipital Ophthalmic Temporal
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GCA prevalence is closely linked w/ ? other Dx What type of vision loss can occur
Polymylagia Rheumatica- inflammatory condition causing synovitis, bursitis and tenosynovitis Amaurosis fugax- temporal monocular d/t ischemic optic neuritis
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What do Pts present w/ as c/c w/ polymyalgia rheumatica How are Pts w/ this condition managed Define Polyarteritis Nodosa and w/ co-Dx may exist w/ this
AM stiffness/joint swelling w/ normal strength CCS, Methotrexate Vasculitis of med/small arteries; Hep B/C
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Two abnormal c/c making Polyarteritis Nodosa a possible dx What PE finding supports this How is a Dx confirmed
New foot/wrist drop Rapidly inc HTN Tender lumps on thigh/lower legs Biopsy- necrotizing arteries Ateriography- arterial aneurysms
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What rheum factor is usually negative in Pts w/ Polyarteritis Nodosa How is this Tx ? is the MCC of hyperthyroidism
ANCA neg Steroids w/ cyclophosphamide Hep B: plasmapheresis Graves dz
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What will lab results show in hyperthyroidism How is this Dx How is this Tx
Low TSH, high T3 and FT4 (graves- only T3 is elevated) Anti-thyrotropin Abs via TSI/TBII Methimazole- mild cases PTU- pregnancy Cards Sx: Atenolol
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? is the MCC of hypothyroidism What will be seen on lab results How is this form of thyroid d/o Dx
Autoimmune Hashimoto High TSH, low FT4 Anti-thyroid peroxidase (TPO) Abs
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Lab results for Primary Hypothyroidism Lab results for Secondary Hypothyroidism How is this Tx
Inc TSH, low T4 w/ high cholesterol Low TSH and low T4 w/ low cholesterol Thyroxine/Synthroid- synthetic free T4
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What presentation shift DDx from Hashimotos thyroiditis to subacute thyroiditis ? is the MCC of thyroid pain What path does this follow and w/ ? lab result
Neck tenderness/goiter w/ recent viral illness Subacute thyroiditis (Quervains) Hyper to hypo-thyroid; Inc ESR
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Two meds that cause thyroiditis Infectious thyroiditis are usually d/t ? microbes How is Subacute/Postpartum thyroiditis Tx
Lithium Amiodarone Staph/Strep BBs, ASA
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? is the MC RF for thyroid Ca ? is the MC type ? is the MC benign thyroid nodule
Radiation Papillary in females 40-60y/o Thyroid adenoma
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Thyroid nodules must be bigger than ? size to be palpable What are the RFs for thyroid Ca How are thyroid Ca Dx
>1cm diameter FamHx Age >65/<20 Radiation US >1cm- biopsy
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How to tell if thyroid nodules are malignant or not How is thryoid Ca Tx What Tx step is different for ? type of Ca
Thyroid uptake: Ca- cold, no uptake; next step= FNA Benign- hot (uptake) Thyroidectomy w/ chemo External beam radiation- anaplastic Ca
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First line Tx for tinea corporis How does this appear on PE What other DDx appears similarly
Topical clotrimazole Red, itching scaly patch w/ scaly edges and central clearing Granuloma annulare- benign inflammatory condition w/out scaling
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? is the MC overlooked DDx when assessing isolated pleural effusions What is the MCC of isolated effusions Define Lymphogranuloma venereum
PE HF STD from Chlamydia trachomatis in MSM- painless genital ulcers resolving <3days
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What PE finding may be seen w/ Lymphogranuloma venereum How is this Tx How are scabies Tx in adults/infants or in nursing home populations
Groove sign- adneopathy above and below inguinal ligament Doxy Permethrin 5%; PO Ivermectin
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Common s/e to IV delivered chemo Txs What two atypicals have the least amount of weight gain associated w/ use Define DI and what lab results are seen
`Irritative voiding Sxs Aripiprazole, Ziprasidone Dec ADH secretion= Inc serum Na/Osm, dec urine Osm
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Medical management for chronic barotrauma/pain w/ flying How does Primary Immune Thrombocytopenia present How are Pts managed
Pseudophedrine (decongestants) Petechiae, gingival bleeding after viral illness Platelets <10K: IVIG, steroids transfuse Platelets >20K: observe
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How is life threatening HypoMg Tx Histology results of psoriasis biopsy S/e of lidocaine toxicity
IV CaCl or Ca gluconate w/ dialysis hyerpkeratosis, parakeratosis, acanthosis Bradycardia, heart blocks
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Max doses of lidocaine w/ or w/out epi Pts w/ open skull Fxs need ? ABX prophylaxis When do hyperCa Sxs begin in pts w/ hyperparathyroidism
3-5mg/kg w/out; 5-7mg/kg w/ Vanc w/ Ceftriax >12
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What causes Primary and Secondary Hyperparathyroidism What saying goes w/ the presentation of hyperparathyroidism How is this Tx
P: parathyroid adenoma S: CKDz induce hypoCa/D Bone pain Stone, kidney Groan, ab cramps Psychic depression, irritability, psychosis Parathyroidectomy
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How is hyperparathyroidism induced hypreCa Tx How is osteoprorosis induced by hyperparathyroidism Tx How does hypoparathyroidism present
Furosemide/Calcitonin Bisphosphonates Dec PTH= dec Ca levels
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What are the two MCC of hypoparathyroidism What two PE findings suggest this Dx How is hypoparathyroidism Tx immediately
Damaged parathyroid Autoimmune destruction Trousseaus: carpal Inc DTRs Chvosteks: facial Vit D, Ca Tetany: IV Ca gluconate
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How is hypoparathyroidism managed long term What triad is Dx for hypoparathyroidism ? bone Ca is most associated w/ Paget's Dz
Recombinant PTH replacement Dec Ca/PTH, Inc phosphate Osterosarcoma (Paget's Sarcoma)
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# Define Paget's Dz ? infection can cause this dz What parts of the body are MC involved w/ Paget's Dz
Bone remodeling d/o leading to less compact/weaker bones Measles Femur Lumbar Pelvis Skull
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What PE finding can be seen in Paget's Dz Pts How is Paget's Dz Dx How is this condition Tx
Excessive skin warmth, Deafness Inc ALP CXR- lytic lesion, thick cortex Bisphosphonates, Calcitonin
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What are the two MC types of dyslipidemias What are normal fasting triglyceride levels
Combined, 2b: elevated total, LDL and Tgl HyperTrigly- 4; normal total/LDL, inc Trigly Norm: <150 Mod: 150-499 Mod/Sev: 500-999 Sev: ≥1000
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What risks present w/ mod/sev hypertriglyceridemia >500 What risks present when levels exceed >2000mg What can be seen on PE in Pts w/ Type 3 hyperlipidemia
Pancreatitis, Eruptive xanthomas, Lipidemia retinalis Chylomicronemia syndrome: recurrent abd pain, N/V, pancreatitis Palmar xanthomas- yellow palmar creases
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What are fasting lipid panel screening started If results are found to be over ? what is the next step What meds are used to reduce levels and prevent pancreatitis
20y/o, repeat q5yrs; +RFs= q12mon >150mg, 12-16hrs later after fasting >1000- B-quant Niacin/Fish oil Fenofibrate*/gemfibrozil Lipitor
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How often is Pt f/u needed when Tx hypertriglyceridemia Define Dawn Phenomenon Define Somogyi effect
Sev: q3d Mod/Mod-Sev: q6-8wks Down Insulin: Early AM increase d/t insulin sensitivity/nightly surge of regulatory hormones; Inc bedtime NPH dose/dec snak So much insulin: Hyperglycemia rebound d/t GH surge; dec bedtime dose/inc snack
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? type of fluid should be used in the Tx of DKA What lab results Dx DMT1 All DMT1 are Tx w/ ? and ? f/u sequence
NS Fasting ≥126 A1c ≥6.5% Random ≥200 w/ Sxs Insulin w/ Basal/pre-meal A1c rechecks q3mon
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What test is used to differ Type 1 or 2 DM When does ASA become part of DMT1 Tx What 2 diuretics and ? CCB are used in Tx
C-peptide test:- T1: low, T2: inc Men >50y/o or Women >60y/o w/ CVD, HTN, HyperLipid/Albumin Thzd: Chlorthiazide, Indapamide; Amlodipine
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All DM of ? age need additional meds added What is the MCC of gynecomastia in infants/boys What is the MCC of gynecomastia in men
40-75= statin Physiologic gynecomastia Drug: spironolactone, anabolics, antiandrogens Idiopathic Pubertal gynecomastia
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Onset, Peak and Duration of insulin
Novolog/Apidra/Humalog: 10-15m 60-90m 4-5hrs Regular: 30-60m 2-4hr 5-8hrs NPH 1-3h 5-8hrs 12-18hrs Levemir 90min no peak 12-24hrs Lantus 90min no peak 24hrs
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How is Osteoporosis Dx What are the T-scores This is Tx w/ but w/ ? s/e
DEXA at ≥65y/o or Confirmed fragility Fx Penia: -1 - 2.4 Porosis: ≤2.5 Sev: ≤-2.5 w/ Fx Bisphos (Alen/Rise-dronate), jaw osteonecrosis Sev/continue Fxs: Teriparatide
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When do DEXA screenings begin younger than 65y/o Primary, Secondary, Tertiary adrenal d/o Define Primary Adrenal Insufficiency
FamHx osteroporosis Weight <127lbs Tobacco CCS P: adrenal gland destruction, low cortisol, aldosterone) S: pituitary fails to secrete ACTH, low ACTH/cortisol T: hypothalamus fails to release CRH Dec aldosterone/cortisol, inc ACTH
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# Define Secondary Adrenal Insufficiency What can cause this form How is Primary/Secondary Adrenal Insufficiency Dx
Dec ACTH/cortisol, normal aldosterone MCC: d/c steroid w/out taper, Pituitary adenoma 1*: Inc ACTH, Low cortisol 2*: low ACTH and Cortisol
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What will lab results look like in Primary Insufficiency How is Primary/Secondary adrenal insufficiency Tx How are these Pts managed during surgery
HyperK, HpoNa, HypoGlyc, non-gap metabolic acidosis d/t dec aldosterone 1*: Hydro*/Fludro-cortisone (only ad Fludro in Primary) 2*: resection Normal response= 3x inc cortisol: IV GCSS and Isotonic fluids
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How are Addisonian Crisis Tx Define Pheos What other Dxs are these associated w/?
NS/D5 w/ Hydrocortisone- Dx Addisons or, NS/D5 w/ Dexameth- unknown Dx Fludro: reverses E+ d/o Catecholamine secreting adrenal tumor releasing Epi/NorEpi/Dopa (MC adrenal adult tumor) NF-1, MEN 2A/2b, Von Hippel Dz
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What are the 5 Ps of Pheo Sxs How are Pheos Dx How are these Tx
Pressure, HTN Pain, HA Perspiration Palpitations Pallor 24hr catecholamine UA for metanephrine/vanillylmandelic acid Adrenalectomy w/ phenoxybenzamine or phentolamine then BB/CCB
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# Define Cushings Syndrome What two Cas can produce Cushings Syndrome Why do Cushing's Dz Pts gain weight
Inc cortisol/BP w/ dec K d/t excess aldosteronism Carcinoid tumor, Small cell Ca Cortisol stims fat/carb metabolism= Insulin release= Increased appetite
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How is Cushings Syndrome Dx How do ACTH levels indicated etiology of Cushings w/ high dose DexaMeth suppression test
24hr urine cortisol: most spec 11pm salivary cortisol Low_dexa suppression test- inc cortisol/no suppression= Cushings syndrome Inc ACTH, Dec cortisol- pituitary tumor (CDz only etiology suppressed w/ DexaMeth) Inc ACTH, no supp: ectopic Dec ACTH, no supp: adrenal
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How is Cushings Dz Tx How is Cushings Synd Tx What is the difference between gigantism and acromegaly
Transsphenoid surgery; Radiation or Pasireotide, Mifepristone Tumor resection or, Ketoconazole, Metyrapone Ketoconazole, Giant: inc GH in childhood, epiphyses open Acro: inc GF secretion in adulthood
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How is Acromegaly Dx If surgery is not a Tx option, how are Pts Tx Define Diabetes Insipidus and the two types
Serum IG-F1 d/t dec fluctuation compared to GH Oct/Lan-reotide Deficient/resistant to vasopressin: Central: MC; no production Nephrogenic: insensitivity
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What drugs can cause Nephrogenic Diabetes Insipidus What electrolyte abnormalities can cause DI How is Diabetes Insipidus Dx w/ lab results
Lithium, Amphoterrible HyperCa, HypoK High serum osmolality Low urine osmolality
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How is DI Dx How is a Dx differentiated from Central and Nephrogenic How is Central Diabetes Insipidus Tx How is Nephrogenic Diabetes Insipidus Tx
Water deprivation test: DI continues to produce diluted urine Desmopressin stim test: Central: dec (no production) Nephro: continued ( resistant) Desmopressin/DDAVP Hydrochlorothiazide, Amiloride
294
What are the four types of stones seen in Nephrolithiasis Which ones are radiolucent and radiopaque
Ca Oxalate- MC; grapefruit inc production Struvite: MC infected d/e chronic UTIs w/ Klebsiella, Proteus Uric acid- acidic urine Cystine- genetic difficiency; Paque: oxalate, struvite Lucent: cystine, uric acid
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How is Nephro/Urolithiasis Dx What are the indications to admit How are these Tx based on size
CT w/out contrast Uncontrolled pain Anuria Renal Colic and UTI/Fever <5mm: spont passage >5-10mm: elective lithotripsy >10mm: nephrostomy/stent
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Extracorporeal lithotripsy is good for Tx stones ? size Percutaneous nephrolitotomy is indicated for stones ? size MC microbe causing pyelonephritis
>5mm - <2cm >2cm diameter E Coli
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What UA result is pathognomonic for pyelonephritis What other Dx is this pathognemonic for How is this Tx
WBC casts Interstitial nephritis Cipro/Levo/Cephalexin Preg= admit w/ Ceftriax
298
What is the most important RF for ED Priapism is associated w/ ? 3 etiologies How is ED Tx
Artherosclerosis of cavernous arteries d/ smoking/DM Trazodone Coaine Sickle cell Phosphodiesterase inhibitor- Inc cGMP to increase NO release
299
What ED Txs need to be taken w/ or w/out food Which one has the longest effect of 24-36hrs How are med induced priapisms Tx
Sildenafil- w/ Vardenafil- w/out Tadalafil Stair climber, Sudafed
300
What are the 5 types of incontinence
Mixed- MC; stress and urge Urge- detrusor over activity; MC elderly/nursing homes Dx: urodynamic study Functional- physical/mental disabled Overflow- dec contraction- high post-void volume; common in DM/neuro d/os Stress- weak pelvic floor; post-pregnancy
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How is urinary incontinence Dx ? is the only mandatory lab needed for Peds w/ enuresis
Post-void residual; Overflow: high Stress/Urge: norm/low Urodynamic study: Stress: normal Urge: inc during filling UA
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How is incontinence Tx depending on etiology
Mixed- lifestyle mod and floor exercises Urge- training, Oxybutynin, Imipramine- TCA Functional- schedule Overflow- self-cath, Bethanechol, -zosin) Stress- kegels, vaginal estrogen, pessary, mid-urethral sling surgery
303
Epididymitis is characterized by ? triad How is the microbe etiology differed by age What PE finding is classic for this Dx
Dysuria Unilateral pain, posterior testis Swelling <35: G/C >35: EColi Prehns- relief w/ elevation
304
How is Epididymitis Tx How is this Tx in Pts that practice insertive anal sex Define Orchitis
<35y/o: Ceftriax and Doxy ≥35y/o: Levoflox or TMP-SMX Ceftriaxone and Levoflox Ascending bacterial infection from urinary tract to testes
305
How is Orchitis Dx How is this Tx What is the MC form of prostatitis
UA w/ culture: Py/Bacter-uria <35y/o: Ceftriax + Doxy or Azithromycin + Doxy ≥35 Levofloxacin (x21 days if w/ prostatitis) Chronic: enlarged, nontender on DRE
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How does acute bacterial prostatitis present on DRE What needs to be avoided on exam How are acute/chronic prostatitis Dx
Boggy, warm and tender w/ F/C/malaise and urine Sxs Prostate massage Acute: UA w/ WBC, +cultures Chronic- negative cultures
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How is prostatitis Tx Pts w/ BPH need to avoid ? three classes of drugs How does BPH present on DRE
<35y/o: Ceftriax and Doxy >35y/o: Flqnln or Bactrim Anticholinergic Sympathomimetic Opioid Uniformly large, firm/rubbery
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How is BPH Tx How is this Tx if Pt is refractory to meds How does prostate Ca present on DRE
Tamsulosin 5-a reductase- dec size: Finasteride/Dutasteride TURP; transurethral resection of prostate Hard, nodular and asymmetric
309
What PSA levels indicate suspected prostate Ca What are the two RFs for prostate Ca When is screening done
PSA >4: US w/ needle biopsy PSA >10: bone scan Age, FamHx >50y/o 40y/o w/ 1* FamHx/AfAm
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Prostate Ca Tx is accomplished w/ ? and w/ ? s/e How is this Tx if mets is present How is this Tx if no mets are present
Prostatectomy- ED Ieuprolide- androgen deprivation therapy Castration
311
? is the MC type of bladder Ca What is the 'classic' presentation How is this definitively Dx
Transitional cell Ca Painless hematuria in smoker Cystoscopy w/ biopsy
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How is bladder Ca Tx What is the classic triad for renal cell carcinoma What are the MC type of renal cell carcinoma and w/ ? RF
Endoscopic resection w/ cystoscopy q3mon Flank pain w/ mass Hematuria Clear cell; smoking > transitional
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What are the first tests for Dx renal cell carcinoma How is this Tx How does testicular cancer present
Abdominal CT/US Radical Nephrectomy Firm, painless mass in 15-40y/o
314
? is the MC type of testicular Ca What are the two types of this MC What is the RF for this type of Ca
Germ cell tumor Seminoma- classic/spermatocytic Non-seminomatous Cryptorchidism
315
How is testicular Ca Dx What are the 3 most likely locations for mets What tumor markers are used
US Lung Abdomen Brain AFP- NSGCT only HCH- both
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What lab result indicates a higher tumor burden during testicular Ca How is testicular Ca Tx ? is the most convenient marker for assessing acute RF
LDH Orchiectomy Seminoma- radiosensitive NSGCT- radioresistant Creatinine
317
What do UA results look like in pre-renal acute RF What do UA results look like in renal acute RF
Spec Grav: >1.030 BUN/Cr >20 Osmolality >500 FENA <1 Spec Grav <1.010 BUN/CR <10 Osmolality <300 FENA >1
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During renal failure work ups, what doe the following mean RBC casts WBC casts Muddy casts Hyaline casts Waxy casts Inc osmolality FENA >2%
RBC: glomerulonephritis WBC: pyelonephritis Muddy: tubular necrosis Hyaline: normal Waxy: chronic renal dz O-FENA: tubular necrosis
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What are the 3 MC causes of acute renal failure in order What causes acute tubular necrosis What is the MCC
Tubular necrosis Interstitial nephriti Glomerulonephritis Kidney ischemia Toxins Pre-renal fialure
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What causes Interstitial Nephritis What will be seen on UA results How is it Tx
Immune mediated response WBC casts, Hematuria Eosinophils D/c offender CCS Dialysis
321
What are the 3 etiologies of Glomerulonephritis What will be seen on UA results What criteria is needed for Dx of CKDz
IGA nephropathy (bergers dz) Post-infectious Membranoproliferative Hematuria RBC casts ``` eGFR <60mL x 3mon or, Albuminuria >30mg/day Proteinuria/Cr >0.2 Hematuria Structural abnormals ```
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? is the MCC of CKDz How is CKDz staged What stag is considered "symptomatic stage"
DM 1: normal GFR w/ persistent albuminuria/structural dz 2: GFR 60-89 3: GFR 30-59 4: GFR 15-29 5: GFR <15 Stage 4: HyperK/Ph, HypoCa
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Criteria needed to Dx CKDz Pts w/ CKDz need to avoid ? compound ? UA result is a specific finding to CKDz
``` eGFR <60mL x 3mon or: Albuminuria >30mg/day Proteinuria/Cr ratio >0.2 hematuira Structural abnormalities ``` Mg Broad waxy casts
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? is CKDz Dx What marker is used to find damage w/ ? appearing first Other than E+ abnormalities, ? other lab result will be low
GFR Proteinuria, microalbuminuria Epo
325
How is CKDz Tx What is the JNC-8 BP and A1c goal range What vaccine do Pts need
ACEI/ARB <140/90, 11-12g Pneumococcal
326
# Define Glomerulonephritis There are two types and are based on ?
Inflamed glomeruli causing protein/RBC leakage into urine d/t immune response 24hr protein: Nephritis <3.5g/day Nephrotic >3.5g/day
327
What is the classic presentation of Nephritic Syndrome ? infection can cause this syndrome How is this post-infectious etiology Dx
HTN Edema RBC casts Proteinuria <3.5g/day Group A strep +ASO titer w/ low complement
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? is the MCC of anute glomerulonephritis worldwide How do Pts present How is this Dx
IgA Nephropathy- Berger Dz Gross hematuria and flank pain after URI/GI infection IgA deposits in mesangium
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# Define Alports Syndrome What non-renal exam needs to be done How is this Dx
Ped w/ isolated, persistent hematuria and hearing loss Ophth exam: anterior lenticonus C3/4 levels
330
What causes Membranoproliferative Glomerulonephritis How is this form Dx What lab result is Dx of Rapidly Progressing Glomerulonephritis
SLE, Hep C Low C4, C4 Crescent formation of biopsy d/t fibrin/plasma proteins
331
Rapidly Progressing Glomerulonephritis is AKA ? ? type of Abs are found How is it Tx
Goodpastures Anti-GBM Steroids Plasmapheresis Cyclophosphamide
332
What type of Abs are seen in Rapidly Progressing Glomerulonephritis induced vasculitis Glomerulonephritis as a group usually has ? decreased lab result and needs / for Dx How is Glomerulonephritis Tx
ANCA Abs: Micro polyangitis: P-ANCA Granulomatosis w/ polyangitis: C-ANCA (Wegners) Dec C3, Renal biopsy- gold standard Enalapril/Losartan Post-Strep: Nifedipine Nephropathy- GCCS
333
How does Nephrotic Syndrome present on PE What would be seen on lab results What are the two classifications of nephrotic syndrome by etiology
Edema Ascites Effusion HTN Proteinuria >3.5g HypoAlbumin, Hyperlipid Primary: kidney biopsy Secondary: SLE DM Pre-E
334
What UA results suggest a Dx of nephrotic syndrome w/ protein >3.5g/day What are the 3 MCC primary causes of this syndrome
Fatty cast w/ maltese cross Oval fat body Membrane nephropathy- MC in non-DM w/ Ca and Hep B Minimal Change: MCC in kids; Tx w/ CCS Focal Segment: obese heroin users w/ HIV/Sickle
335
How is Minimal Change Dz and Focal Segmental Glomerulosclerosis Tx How is Membranous Nephropathy Tx based of risk how is Focal Segmental Glomerulosclerosis Tx if resistant to primary Tx
Pred w/ ACEI Low: ACEI Mod/Sev: GCCS w/ Cyclophosphamide Cyclosporine
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What makes the cysts in PCKDz ? MC stat does this Dx own What cardiac abnormalities can these Pts have
Epithelial cells from renal tubules MC autosomal dom d/o MCP, LVH
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How is PCKDz Dx What genetic studies are needed How are these Pts managed until transplant is possible
US PKD-1 and 2 ACE/ARB
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? is the MC E+ d/o ? level is Dx What is the MCC
HypoNa <135 Hypotonic fluids
339
What are the 4 types of HypoNa
HypoVol HypoNa: volume contraction HyperVol HypoNa: volume expanded SIADH: volume expansion w/out edema HypoNa w/ Euvol: GCSS, hypothyroid
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How is HypoNa Tx How fast is Tx limited to If severely hypoNa, don't Tx faster than ?
0.9% NS w/ Loop diuretics <0.5mEq/L/hr 3% NS; <10mEq q24hrs to avoid demyelination syndrome
341
What lab result suggest HyperNa How is this Tx What happens if Tx is too fast
BUN/CR >20:1 w/ Na >145 D5W Cerebral edema Pontine herniation
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HyperK level What can cause this What does this look like on EKG
>5 mEq KF stage 5 ACEI/Spironolactone Peaked T Prolonged QRS Muscle fatigue
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How is HyperK Tx When is HypoK seen What does HypoK look like on EKG
Na bicarb Insulin Glucose Diuretics, Cushing Syndrome Flat/Invert T wave U-waves
344
What is avoided while replacing K MCC of hypo/hyperCa How are these Tx
Destrose- stimulates insulin and will cause K shift into cells Hypo: Hypoparathyroidism Hyper: hyperparathyroidism Hypo: Ca gluconate/chloride Hyper: NS w/ Furosemide
345
How does HypoMg present How is this Tx How is HyperMg Tx
Weak, Hyper-reflex, Widened EKG Acute: IV Mg Chronic: PO Mg Isotonic saline Loop diuretics
346
What are the two rules to calculate maintenance of fluids
``` 100/50/20: 100mL/kd first 10kg 50mL for next 10kg 20mL for every 1kg over 20 Divide by 24 for hourly rate ``` 4/2/1 Rule: 4mL first 10kg 2mL for next 10kg 1ml/kg for every kg over 20
347
What is the average value rule for Acid-Base d/os What is the 3 step approach to assessing acid/base d/ox Metabolic Acidosis w/ low anion gap suggests ?
24/7 40/40 Bicarb: 24 pH 7.40 Co2- 40 pH PCO2 Bicarb Diarrhea Pancreatic/biliary drainage Renal tubular acidosis
348
DDx for metabolic acidosis
``` Anion gap: Na - (Cl+BiCarb)= 10-16 >16: MUDPILES Methanol Uremia DKA Paraldehyde Infection Lactic acidosis Ethylene glycol Salicylates ```
349
What is the first sign of Fe Deficient Anemia What are later findings This owns ? MC stat
Low ferritin Indices change: micro/hypo MCC of anemia
350
Anemia d/t lead poisoning presents w/ ? lab result How is this Tx How is Fe Deficient Anemia Tx
Basophilic stippling EDTA Ferrous sulfate w/ juice: 6wks corrects anemia 6mon repletes stores F/u q3mon x 12mon
351
What are the two MCC of Anemia of Chronic Dz How are the two differed How is this form Tx
Chronic RF, CT d/os Dec epo w/ RF EPO and Fe supplements
352
How does B12 deficiency anemia present This is laboratory similar to ? other deficiency How are the two differed
Macrocytic w/ hypersegmented neutrophils Loss of proprioception Dec vibratory sense Folate, only other macrocytic anemias Folate- no neuro Sxs
353
What lab results suggest Hemolytic anemia What test is positive if hemolytic anemia is d/t autoimmune etiology How is this form of anemia Tx based on etiology
Inc LDH, Dec Haptoglobin + Direct Coombs Autoimm: steroids, splenectomy Hereditary Spherocytosis: splenectomy
354
What does Aplastic Anemia look like What is unique about this types lab results How is this Dx
Loss of blood cell precursors= anemia w/out reticulocytosis All 3 cell lines dec'd RBC WBC Platelet Marrow biopsy: hypocellular w/ fatty infiltrates
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? medication may be used in Aplastic Anemia to reduce incidence of infections Sickle Cell Dz and Trait lab results How is Sickle Dx
G-CSF: Filgrastim HbSS: Dz HbSA: Trait HgbS on electrophoresis
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? buzz work is used w/ Sickle Cell lab findings These Pts are at risk for ? microbe of osteomyelitis How is Thalassemia anemia differed from Fe Deficient Anemia
Howell Jolly Bodies: non-phagocytosed nuclear remnants Salmonella Fe: low RBCs Thal: normal/high RBCs
357
How does peripheral vertigo present How does central vertigo present Vertigo w/ syncope= ? DDx
Sudden onset N/V w/ tinniuts and HL w/ horizontal nystagmus w/ rotation Sudden onset w/ vertical nystagmus and w/out auditory changes Vertebrobasilar insufficency
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BPPV Sx, Tx and Dx Vestibular neuritis Sx and Tx Labrynthitis Sxs, Dx and Tx
Sx; positional vertigo w/out auditory manifestations Dx: Dix-Hallspike Tx: Epley and Meclizine Sx: Vertigo despite position, no auditory, MedHx URI Tx: Meclizine Vertigo w/ HL, tinnitus and URI MRI, Meclizine w/ steroids
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Meniere's Dz Sx, and Tx Acoustic neuroma Sx, Dx and Tx Define Delerium
Episodic vertigo w/ HL and NO recent URI Diuretics, Na restriction, CN8 ablation Vertigo, Unilateral HL, tinnitus and ataxia MRI, surgery Acute, short and reversible alteration in mental status
360
How are Cluster HAs Tx What meds can be used for propylaxis What are the two types of migraines
100% O2 at 12-15mL/min x 15-20min via NRB w/ Sumatriptann Verapamil then Lithium Common: no aura > Classic: aura
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What criteria provide a 93% probability of migraine dx MC type of aura How miraines Tx
Last 3mon has Pt had 2/3: Photophobia Impairment Nausea Visual Mild/Mod: NSAIDs, Excedrin 2nd line: Sumatriptan Ergomar Metoclopramide w/ Benadryl
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When is prophylaxis indicated for migraines What is used for first, second and third line meds Define TIA
≥4 HA/mon or ≥HA days/mon Divalproex Topiramate PMT-olol Amitriptyline Venlafaxine AN-olol Botox, CGRP Abs Transient neuro dysfunction d/t ischemia w/ infarct
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What presentation can indicate Pt has TIA What are the two types What scoring system is used to estimate a stroke after a TIA
Wrinkling of forehead Large artery low flow d/t stenosis Embolic d/t Afib ABCD2: Age BP Clinical Duration DM
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How are TIAs Tx Lab result seen in amyloidosis induced restrictive myopathy What other two conditions can present w/ myocarditis
ASA w/ Clopidogrel x 21days Apple green birefringence w/ Congo-red stain Megacolon, Pericarditis
365
How Pts w/ myocarditis managed for Tx How is a sinus rhythm determined on EKG How is atrial enlargement determined
Support w/ Loops ACEI BBs Pos P-wave in lead 1, 2 aVF Neg P-wave in aVR L: m-shaped p-wave in lead 2; biphasic P-wave in V1 w/ larger terminal component R: P-wave in lead 3 ≥3mm; biphasic P-wave in V1 w/ larger initial component
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EKG criteria for right ventricular hypertrophy What are the two methods for EKG criteria for left ventricular hypertrophy EKG vector movement in relation to hypertrophy or ischemia
V1 R > S or R>7mm Soklow lyone: V1 S + V5/6 R= >35mm (men) or >30mm (fem) Cornell: aVL R + V3 S >28mm (men) or >20mm (fem) Towards hypertrophy, away from ischemia
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What is the quadrant method for determining axis deviation on EKGs Inferior or Lateral MIs causes ? deviation
LAD based on Lead 1 and aVF, check Lead 2, neg QRS= deviation Inf: left, Lat: right
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Brady cardia Tx algorithm What is the exception to this rule How is SSS Tx if unstable
Unstable w/ Sxs, HOTN, AMS, refractory chest pain or acute HF: Atropine then: Epi or Dopamine the transcutaneous pace Atropine then Dopamine, Epi and TransCu pacing
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Tachycardia Tx algorithm
Unstable: sync'd conversion Unstable w/ regular narrow QRS: Adenosine Not unstable: QRS ≥12sec wide: Yes, wide QRS complex: Amiodarone Lidocaine Procainamide Yes, monomorphic: Adenosine No wide QRS: Vagal Adenosine BB CCB
370
How are the 3 different stable, narrow complex tachycardias Tx How is sinus tachycardia Tx during acute MIs What is the most important/helpful aspect of determining if AV blocks are present
Afib/flutter: BB or CCBs WPW: procainamide or Amiodarone, avoid ABCDs SVT: vagal, Adenosine Metoprolol PR intervals
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Mobitz Type 2-2 is commonly located where Stable Aflutter Tx Unstable Aflutter Tx
BoHis Vagal Rate: MAE-olol or Diltia/Verapa Definitive: ablation Synch'd conversion
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What phenomenon may be seen on EKG during Afib How are stable Pts managed How are unstable Pts managed
Ashmans: aberrant conduction w/ wide QRS after short R-R cylcles Rate: MAE-olol or Diltia/Verapa (Digoxin if BB/CCB c/i) Synch'd conversion
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Saying to help ID SVT rhythms how are stable w/ regular, narrow complexes Tx What is the definitive Tx
Cant tell if bump is T or P, must be SVT Vagal then Adenosine then BB/CCB/Digoxin Ablation
374
How is WAP vs MAT differed MAT is associated w/ ? Dz and managed w/ ? meds Define Orthodromic and Antidrome PSVTs
WAP: <100bpm w/ 3 different P-wave morphologies MAT: >100bpm w/ 3 different P-wave morphologies COPD: Verapamil or BBs Ortho: regular, narrow complex w/out P-waves Anti: regular, wide tachy mimicking Vtach
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How do PVCs appear on EKG Torsades can be caused by ? med if all E+ are normal ? anti-arrhythmic can enhance the above meds toxicity
Wide, bizarre QRS w/ T wave in opposite direction of QRS w/ compensatory pause beat Digoxin Quinidine
376
Class 1 Anti-arrythmic drugs
Na channel blockers: dec Na conduction and AV node automaticity leading to membrane stabilization 1A: Procainamide Quinidine Disopyramide; Prolong repolarization and action potential 1b: Lidocaine, Tocainide; Dec conduction velocity and shortens repolarization; C/i: narrow SVT 1c: Flecainide Propafenone Ecainide; Inc QRS prolongation and dec conduction velocity w/ affecting action potential
377
Class 2 Anti-arrhythmic drugs
Cardio sel: AME-olol Non-Sel B1, B2: PS-olol Non-sel A, B1,2: LC-olol Dec SA/AV node conduction Non-sels can cause bronchospasms in asthma/COPD Toxicity Tx w/ glucagon
378
Class 3 anti-arrhythmics
Sotalol Amiodarone Ibutilide Dofetilide Prolongs action potential Amiodarone: characteristics of Class 1-4 meds w/ s/e of pulm fibrosis and thyroid d/o
379
Class 4 anti-arrhythmics Class 5 anti-arrhythmics
Verapamil, Diltiazem Slows SA/AV conduction to inc PR interval and refractory period Digoxin- cardiac glycoside, dec ATP-ase
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Class 1 and 3 antiarrhythmics are used for while Class 2 and 4 are used for Intracranial hemorrhage can cause Pts to present w/ ? How are the categorized by size
1/3: rhythm 2/4: rate Subarachnoid hemorrhage Small: <15mm Large: 15-25mm Giant: 25-50mm Super: >50mm
381
? is the MC type of brain aneurym and is the MCC of ? Cerebral aneurysms are associated w/ Coarctation and ? What are the key features of these on presentation
Saccular/Berry- MCC of atraumatic SAH PCKDz Sudden, unilateral HA w/ N/V/AMS
382
How are brain aneurysms screened for What would be seen on LP results How are these Tx
Non-contrast CT Inc opening pressure w/ gross blood Xanthorchromia- blood in CSF >2hrs Surgical clipping, Endovascular coiling
383
What defines a seizure as general or partial What are the two types of partial seizures Partial seizures originate from ? and are the MC ?
Gen: LoC Part: partial preservation of consciousness Simple: consciousness maintained Complex: impaired consciousness Temporal lobe; MC seizure of elderly PTs
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# Define Todd's Paralysis Define Generalized Seizure What would be seen on EEGs during absence seizures and how are these managed
Hemiparalysis last <24hrs after simple partial seizure Seizure start midbrain and spread to both cortices Symmetric 3Hz spikes; Ethosuximide
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What would be seen on EEG during Tonic Clonic seizures how are these managed What characterizes tonic clonic seizures
High amplitude, rapid spiking Phenytoin Facial/truncal spasms Flex/Extension of extremities Impaired consciousness
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Febrile seizure lasting longer than ? need to be Tx w/ ? Define Status Epilepticus What are the two types
>5min w/ Diazepam/Lorazepam Single seizure >5min or ≥2 seizures w/ 5min w/out returning to baseline Non/Convulsive
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Withdrawal from anticonvulsant meds can lead to ? type of seizures Brain damage can occur if these last longer than ? How are these Tx
Generalized convulsive status epilepticus >60min Lorazepam then Phenytoin
388
# Define Essential Tremor How can these be acquired What can help reduce the tremor
Bilateral tremor during purposeful/voluntary movements w/out a resting component Autosomal dominant Alcohol
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Resting tremors indicates ? and not ? Intention tremor suggest ? issues Postural tremor suggests ? issue
Parkinsons, essential tremor Cerebral d/o or MS/Wilson's Dz Toxic/Metabolic d/o
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How are essential Tremors Tx What is done for drug resistant cases What are the 3 cardinal features of Parkinsons
Propranolol, Primidone Deep brain stimulation Resting tremor, Cogwheel, Bradykinesia
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What is the most specific clinical sign for Parkinsons What causes this Dz What are the TRAP Sxs commonly associated with this
Pill rolling tremor that disappears w/ voluntary movement Degeneration of basal ganglia in substantia nigra Tremor: asymmetric resting tremor, disappears w/ movement Rigidity: cogwheel/lead pipe Akinesia: slow/less movement Postural instability: late feature
392
# Define Myerson sign What reflex is this called What Dx is this sign/reflex associated w/
Reflexive eye blinking d/t repetitive tapping above nasal bridge Glabellar Parkinsons
393
What is the gold standard to Dx Parkinsons How is this Tx in younger Pts What is used for Pts >65y/o
Neuropathologic exam Dopamine agonist: Pramipexole Bromocriptine Ropinirole Sinemet: levodopa/carbidopa
394
What are the classic signs of Huntingtons What is the Dx test for Huntingtons What would be seen on MRI results
Chorea Rigidity Dementia w/ seizures CAG repeats Atrophy of caudate nucleus
395
How is Huntingtons Tx How are peripheral neuropathies Tx Define Myasthenia Gravis
Chorea: Tertrabenazine Risperidone Haloperidol Gaba Amytriptyline SNRI Topiramate Autoimmune attack of Acth receptors at neuromuscular junctions causing hallmark Sx: fatigability
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What Pt presentation indicates Myasthenia Gravis How to Sxs spread What is the MC and gold standard Dx method
Weakness w/ everyday activities Prox to Dist: Ptosis Weak chewing Limb fatigue MC: Tensilon test; prevents Acth breakdown, +MG when Pt becomes stronger w/ injection GS: single fiber electromyography
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How is Myasthenia Gravis Tx Define Myasthenic Crisis How are these PTs Tx
Pyridostigmine/Neostigmine- prevents Acth breakdown Pred- dec production of autoAbs Thymectomy <60y/o: curative Neuromuscular resp failure from dysphagia/aspiration IVIG, plasma exchange
398
# Define Polycythemia Vera What is a classic Sx of this condition What causes Secondary Polycythemia Vera
Marrow malignancy leading to over production of cells Pruritus after hot baths, Gout Artificial increased cell production d/t inc Epo (high altitude living)
399
What are the 4 'H's' of Polycythemia Vera What cell mutation do these Pts have How is this Dx
Hypervoemia, Hyperhistonemia, Hyperviscosity, Hyperuricemia Jak 2 tyrosine kinase mutation Marrow biopsy
400
How is Polycythemia Vera Tx Pts >60y/o and Pts w/ prior thrombosis can be Tx w/ ? meyelosuppressive agent What med is used to decrease platelet count specifically
Phlebotomy to keep Hct ≤42% Hydoxyurea w/ ASA Anagrelide
401
# Define Primary Thrombocytosis What Sx/presentation can this have What would be seen on smear results
Platelets <600K Erythromelalgia- burning/erythema d/t micro occlusions Hypogranular, abnormally shaped platelets
402
How is Essential Thrombocytosis managed Define TRALI Define TACO
Anagrelide, Hydroxyurea Transfusion Related Acute Lung Injury- donor Abs attack PTs WBCs leading to resp distress/pulm edema <6hrs Transfusion Associated Circulatory Overload- fluid overload in Pts w/ CHF/CKD; differed by TRALI by inc pulm wedge pressure
403
How is TRALI Tx How is TACO Tx Define Von Willebrand Dz and the two types
Mechanical ventilation Diuretics Missing protein for platelet function; A: dec Factor 8; B: dec Factor 9
404
? is the MC genetic bleeding d/o How does this MC present How is it Tx
VWB Dz- Autosonal dominant No hemarthrosis, Petechiae, Bleed w/ minor injury DDAVp
405
# Define Hemophilia What are the two types How does this present
X-linked recessive (almost always affects males) A: Factor 8; B: Factor 9 (Xmas Dz) Hemarthrosis, Bruises, Bleeds
406
How is Hemophilia A/B Dx What is the most specific method to Dx How are these d/os Tx
Inc PTT w/ normal platelets and correct w/ mixing (uncorrected= lupus, factor inhibition) Functional factor assay Factor replacement
407
How does ALL present ? MC stat does ALL own How are most cases Tx
Child w/ adenopathy, bone pain, bleeding and fever MC childhood malignancy Chemo; stem cell transplant if relapse
408
How does CLL present What MC stat does this own How is this Dx How is this MC Tx
Middle age Pt w/ fatigue, adenopathy and splenomegaly MC leukemia in adults Smudge cells, mature lymphocytes Lymphocytes >100K or Sxs= chemo
409
How is ALL Dx How is CLL Dx How does AMl present
Bone marrow w/ >20% blast cells Peripheral smear w/ fragile B cells that smudge during prep Blast cells w/ Auer rods in adult w/ dec blood levels
410
How is AML Tx How does CML present Most CML Pts will be ASx until ?
Chemo w/ marrow transplant WBC >100K w/ hyperuricemia and elevated blood levels Blastic crisis- acute leukemia
411
How is CML Dx How is this form Tx and turned into a chronic condition What is an adverse s/e of AML Tx
Philadelphia chromosmoe: translocation of chrom 9, 22 Gleevec (Imtanib) Tumor Lysis Syndrome: release of K, Ph; Tx w/ Allopurinl and manage RF
412
How does HL present What MC stat does this own What PE finding is indicative
Painless adenopathy, Reed-Sternberg cells in bimodal age distribution MC type of lymphoma Painless cervical nodule w/out change x 30d
413
Half of HL cases are implicated w/ ? MedHx infection How is HL Tx How does N-HL present
Epstein barr Chemo and Rad HIV Pt w/ GI Sxs and painless adenopathy
414
HL affects ? nodes MC while NHL affects ? nodes MC How is NHL Tx ? form of lymphoma has a geographical aspect to it's prevalence
HL: upper body; NHL: peripheal nodes Rituximab and chemo Burkitt- Central Africa w/ association w/ EBV and AIDS
415
? is the name of chemo regiment HL Pts receive Define Multiple Myeloma What MC stat does this form own
ABVD: Adriamycin Bleomycin Vinblastine Dacarbazine Monoclonal plasma cell Ca producing IgG > IgA MC primary tumor of bone/marrow
416
How does MM present How is this Dx Marrow biopsy results would show ?
Bone pain (low back/ribs) Anemia Infection Serum protein electrophoresis- M-protein spike UA: Bence Jones proteins (IgG light chain) Peripheral smear: Rouleaux formation Xray: pumched out lytic lesion Fried egg appearance- proliferation of monoclonal plasma cells
417
How is MM Tx What meds can be used during Tx Define Meningitis
Marrow transplant Melphalan: nitrogen mustard alkylating Tha/Lena-lidomide: immune modulator Bortezomib: proteasome inhibitor Chemokine induced inflammation of leptomeninges, membranes around brain and spinal cord
418
How is Meningitis and Encephalitis differed on PE When does Crypto become an opportunistic infection and cause of meningitis ? parasite can cause meningitis
Enc: altered brain function, petechiae (N meningitis) CD4 <100 P Falciparum
419
MCC of meningitis in newborns MCC of meningitis in children/teens MCC of meningitis in adults/elderly
GBS, EColi, LIsteria N meningitidis, Strep pneumo Strep pneumo, Listeria
420
Bacterial meningitis LP results Viral meningitis LP results How is meningitis Tx based on etiology
Inc Protein/Opening pressure, dec glucose Norm pressure, Inc WBCs Aseptic: Acyclovir Bacterial: Dexameth w/ Cephalosporin/Vanc Bacterial >50: Vanc Rocephin Ampicillin Contact: Rifampin
421
MCC of Encephalitis Define Reye Syndrome What would be seen on PE during Reye's
HSV; ImmCOmp= CMV Rapid encephalopathy w/ hepatic dysfunction Pos Babinski, HyperReflexia
422
What would be seen on LP results of encephalitis How is Encephalitis Tx Define MS
Inc WBCs predominantly lymphocytes Norm glucose, proteins Support and Acyclovir Autoinflammatory Dz w/ demyelination, neuron loss and scarring of white matter
423
What are the MC Sxs seen w/ MS What PE sign is seen early in this Dz What is the MC form of MS
Paresthesia Optic neuritis Weakness Sensory loss Lhermittte- electric shock in limb/torso from neck flexion Relapsing Remitting MS: episodic flare ups Secondary Progressive: progressive deterioration Primary progressive: declining neuro function w/out flares Progressive Relapse: declining neuro function w/ flares
424
What is the next Dx step for MS if MRI is inconclusive MS targets ? cells particularly resulting in demyelination What MRI criteria is used for Dx
Oligocloncal bands Oligodendrocytes McDonald dx criteria
425
How is MS Tx How is MS incontinence Tx AIDS is defined as ?
CCS for attacks, Interferon betas Oxybutynin: incontinence CD4 <200
426
How is HIV Dx When is medical HAART therapy indicated
ELISA w/ confirmation by Western blot CD4 <350 or Viral load PCR >55K
427
? opportunistic infection is present regardless of CD4 levels ? opportunistic infection is present w/ CD4 count of ≤250 ? opportunistic infection is present w/ CD4 count of ≤200 ? opportunistic infection is present w/ CD4 count of <150 ? opportunistic infection is present w/ CD4 count of <100 ? opportunistic infection is present w/ CD4 count of <50
All: TB 250: Coccidio 200: Pneumocystis 150: Histo 100: Toxoplasmosis/Crypto <50: mycobacterium ovium complex
428
Post-HIV exposure prophylaxis should be started w/in ? time frame When are retestings done How is neonatal acne Tx
<72hrs 6wks, 3mon, 6mon Topical Ketoconazole 2%
429
What are the 4 stages of acne What are the 4 DDxs and how could each be r/o
1: comedonal 2: papular, little scarring 3: pustular; >25 lesions w/ mod scarring 4: nodulocystic, severe scars CCS acne: no comedone, pustules all in same stage Rosacea: no comedones Perioral: distribution Acneiform drug eruption
430
How are each grade of acne Tx
1: topical retinoid 2: topical retinoid and benzoyl peroxide; add Clascoterone/Minocycline if no response 3: systemic ABX (Doxy, Mino, Sare) + grade 2 regiment 4: Isotretinoin
431
Any case of acne that is more than mild is Tx w/ ? first line Tx regiment What birth control options are available for Tx What type of reaction is Erythema Multiform and is usually associated w/ ?
Topical retinoid Topical antimicrobial Ethinyl estradiol norgestimate Estrostep Yaz Type 4; HSV, Sulfa drugs
432
How does Erythema Multiforme present on PE What are the two types of EM How is EM differed from SJS
Target lesion w/ dusky center on palms, soles, and extensors that blanch, but don't itch or Nikolsky Major: two mucus sites and widespread skin Minor: limited skin, one mucosal EM: extremity/mouth SJS: trunk
433
How is EM Tx Define SJS What is this commonly caused by
PO antihistamine Acyclovir if +HSV Topical CCS Milder TEN, ≤10% BSA w/ +Nikolsky's Gout meds Anticonvulsants Sulfa drugs
434
How is SJS and TEN Dx How is this Tx Define TEN
Biopsy- necrotic epithelium D/c offender IVIG Consult derm/ophth ≥30% BSA affected
435
TEN can present in Peds mimicking SSS, how is it differed on exam How is TEN Tx Define Urticaria
Sparing of mucous membranes Admit Consult Cyclosporine Blanchable papules/wheals that disappear <24hrs
436
What sign is associated w/ urticaria What is a painless, deeper form or urticaria What type of hypersensitivity reaction is this
Darier's Sign- localized urticaria occurring where skin is rubbed d/t histamine release Angioedema Type 1, IgE: mast cell degranulation releases inflammatory reactants
437
General measure for Tx urticaria What two factors can exacerbate Sxs How is urticaria Tx
Calamine or 1% menthol NSAIDs, ETOH 2ng Gen AntiHist: Fexofenadine Des/Loratadine Cetirizine
438
How is Urticaria Tx in Pts w/ disrupted sleep d/t itching What TCA can be used too What med is safe for chronic, unresponsive cases
First Gen: Hydroxyzine Diphenhydramine Doxepin Leukotriene antagonists
439
# Define Acanthosis Nigricans The presence of this indicated ? two issues What are these Pts at risk for developing
Velvety, hyperpigmented plqaues Hyperinsulinemia Insulin resistance Metabolic Syndrome
440
How is Acanthosis Nigricans Tx What can be done for cosmetic Tx How does BCC present
Weight loss Metformin Vit D analogs Topical retinoids Pearly rolled border, telangiectasis w/ central ulcer
441
How is BCC Dx How is this Tx What is Kaposi Sarcoma associated w/ and is a ? defining Ca
Shave/Punch biopsy Surgical; Fluorouracil, Imiquimod HHV-8; AIDS
442
What is the hallmark of Kaposi Sarcoma used for Dx What lab result will be seen in these Pts How is it Tx
Biopsy- vascular proliferation d/t angiogenic inflammation CD4 <100 Chemo/Radiation HAART for all Pts w/ AIDS related cases
443
What are the ABCDEs of moles Define Melanoma What is the MC site of this in wo/men
Asymmetry Borders Color Diameter Evolving Tumor growth d/t malignant transformations in melanocytic system M: back W: calves
444
Malignant melanoma is the MC tumor responsible for mets to ? What acronym is for the most important independent factors for increased likelihood of melanoma How is this Dx
Heart ``` HARMM: Prior Hx of melanoma Age >50 Absent regular Derm evals Changing mole Male ``` Biopsy
445
How is malignant melanomas staged Prognosis is associated w/ ? How are these Tx
Clark Classification: 1: epidermis 2: papillary dermis 3: papilary reticular 4: reticular dermis 5: penetrates SQ fat Lesion depth 1-3: excision, 4: chemo
446
# Define SCC What do they look like on PE These usually arise within preexisting ?
Malignant epithelial tumor from epidermal keratinocytes Enlarged hyperkeratonic macule w/ scales/crusted lumps Actinic keratosis Intraepidermal carcinoma
447
How are BCC and SCC differed on exam How is SCC Dx How are they Tx
BCC: telangiectasia, central ulcer, rolled border SCC: scaly papules Biopsy Excision w/ Mohs
448
Two areas MC affected by pressure ulcers and how can they be avoided What are the 4 stages How are pressure ulcers Tx
Sacrum, Hip; Reposition q2hrs 1- Non-blanching 2- pink ulcer, lost dermal layer 3- dermal loss, SQ/fat visible 4: exposed bone/tendon 1: prevention, thin dressing 2: occlusive dressing 3-4: necrotic debridment
449
? is a common inflammatory dermatosis of the lower extremities Where are these MC seen How is this MC Tx
Stasis dermatitis: chronic venous insufficiency w/ varicose veins Medial ankle Compress, CCS, ABX if cellulitis present
450
# Define AKs, which are synonyms for ? These are precursors for ? Ca How are they Tx
Solar Keratosis- pink/yellow lesions w/ sand paper texture SCC Cryo Imiquimod 5-Fu
451
# Define SKs What are these commonly referred to as? How are they Tx if desired
MC benign skin tumor; dark plaques w/ stuck on appearance Barnacles of old age Cryo, Electrodissection, Curettage
452
What MCC cellulitis in adults What MCC cellulitis in kids How are these Dx and w/ ? education
Staph, Strep pyogenes HFlu, Strep pneumo Cultures; F/u <48hrs
453
How is cellulitis Tx
Mild: Cephalexin Cefuroxime PCN allergy: Clinda ``` Purulent/MRSA: TMP-SMX Clinda Doxy IV Vanc or Linezolid ```
454
Erysipelas is always caused by ? microbe How is this type of infection defined How is it Dx
GAS: Strep pyogenes Superficial cellulitis w/ dermal lymphatic involvement Culture Antistreptolysin titer
455
How is Erysipelas Tx
Mild: Pen G PCN-All: Erythro/Clinda Mod: TMP-MSX and Pen VK Cephalexin Severe: Vanc and Daptomycin
456
How does dermal candidiasis present on PE What is seen on KOH preps How is vaginal candidiasis Tx
Diffuse, beefy red erythema w/ sharp margins and satellite lesions Budding yeast, hyphae and pseudohyphae Micon/Clotrim/Flucaon-azole
457
How is oropharyngeal dandidiasis Tx How is esophageal candidiasis Tx How is diaper cadidiasis Tx
Clotrimazole, Nystatin Flucon/Itracon-azole Nystatin Clotrim/Micon/Ketocon-azole
458
How is symptomatic candidiasis induced vulvovaginitis during pregnancy Tx What type of herpes is Varicella Zoster How is Shingles Dx
Topical Clotrim/Micon-azole HHV-3 PCR/Tzanck prep: multi-nucleated giant cells
459
What PE finding w/ shingles is an Ophtho referral How is Zoster Tx How is this Tx during pregnancy
Hutchinson Antivirals, Sxs <72hrs FAV-ciclovir Acyclovir
460
How is chicken pos (varicella) Tx What needs to be avoided in Peds and why When can Peds be vaccinated from chicken pox
<12y/o: none, >13: acyclovir Salicylates; Reyes syndrome 12-15mon and 4-6yrs
461
When should Pts get Shingles vaccine Warts are AKA ? and all caused by ?
50y/o x two 2-6mon apart Verrucae; HPV
462
Verruca Vulgaris Verruca Plana Verruca Plantaris
Common warts from HPV 1 2 4 7; grow on areas of trauma Flat warts from HPV 3 10 26 29 41; grow on face, scratch marks Plantar warts D/t HPV 2 4 on weight bearing surfaces of feet
463
Condyloma Acuminatum Filiform Wart Epidermodysplasia verruciformis
Veneral warts d/t HPV 6 11 Frond-like narrow growths on face; variant of common wart Hereditary d/o of chronic HPV infections
464
Cardinal sign of warts is ? on PE How are these Tx How are anogenital warts x
Absent skin lines Pin-point black dots Bleeds when shaved Cryo Salicylic acid Interferon- refractory Trichloroacetic acid, Podophylin
465
HPV vaccine is effective against ? strains Define GAD/o What meds can be used for Tx
6 11 16 18 Excessive worry about multiple things x 6mon SSRI: Paroxetine Escitalopra Buspirone SNRI: Venlafaxine Kava herb: liver damage
466
# Define Panic D/o How is this Tx Define OCD
Intense fear/discomfort w/ Sxs peaking <10min causing altered behavior x 1mon Benzo if SSRI too slow SSRI: Paroxetine Sertraline Fluoxetine CBT Repetitive, disabling thoughts (obsession) or behaviors (compulsion)
467
What is the primary goal of OCD's actions This d/o is labeled as ? What other Dx is associated w/ OCD
Not lose control Ego-dystonic: behavior is inconsistent w/ beliefs/attitudes Tourettes
468
How is OCD Tx Define Body Dysmorphic D/o What other Dxs commonly co-exist in these Ptx
Psychotherapy SSRI/Clomipramine Imagined defect in physical appearance d/t stereotype of beauty Psychotic and OCD
469
How is BDD/o Tx Define Hoarding D/o How is this d/o Tx
SSRIs w/ CBT Difficulty discarding items regardless of value Paroxetine w/ CBT
470
# Define Trichotillomania What is used first in Tx and what can be used as adjuncts Define Excoriation D/o and how is this Tx
Intentional hair pulling w/ pleasure/relief after completing task CBT- 1st then SSRI/TCA Picking of skin causing distress; CBT w/ Fluoxetine
471
# Define PTSD How can this be Tx Criteria for Adjustment D/o
Traumatic exposure leaving Sxs >1mon SSRI w/ CBT Prazosin for nightmares Benzos x first 2wks Sxs emerge <3mon of stressor and end <6mon after stressor is resolved
472
# Define Major Depressive D/o and what is first line Tx What is a major cause of depression How is the severity of depression measured
5 or more SIGECAPS ≥2wks; SSRIs Unemployment Beck depression inventory
473
# Define Dysthymia How is this Tx How does BP1 present
Depressive Sxs >2yrs w/out being Sx free for >2mon at a time SSRI w/ therapy and PT Destroys relationships Neglects work Spending life savings
474
What class of medication needs to be avoided in BP1 How does BP2 present How can these PTs be managed
SSRIs Sadness, distracted and dec need for sleep SSRIs Quetiapine Olanzapine w/ Fluoxetine
475
# Define Cyclothymic D/o How are these Pts managed and Tx Criteria for ADHD
Hypomaniac episodes w/ low mood state x 2yrs Lithium Valproate Carbamazepine w/ therapy Hyper, impulsive and inattentive <12y/o and in more than 1 environment
476
? is one of the most inheritable psych d/os Who is more likely to have this Define Autism
ADHD First born son Dec social communication/ interactions w/ restricted, repetitive movements and adherence to routines
477
What meds can be used for Autism Define Narcolepsy What can be presenting c/c
2G: Risperidone, Aripiprazole SSRI: sterotype/repetitive behavior Recurrent sleeping/napping w/ intense urge to sleep 3x/wk x 3mon Cateplexy: bilateral loss of muscle tone w/ retained consciousness
478
What causes narcolepsy How are PTs managed Define Insomnia
Hypocretin deficiency in CSF Modanafil, Methyphenidate Insufficient quality/quantity of sleep 3x/wk x 3mon
479
What would be seen on PE during alcohol withdrawal What needs to be given during withdrawals along w/ benzos What med is used for ingestion aversion
``` Anxiety Hyper autonomic- tachy, sweating Insomnia N/V Tremor ``` Dextrose Mg Thiamine Disulfiram- inhibits acetaldehyde dehydrogenase
480
What med is used for alcoholics to change brain chemistry and decrease restlessness during sobriety What drug is used w/ equal efficacy as the above drug and naltrexone ? presentation suggests PCP ingestion
Acamprosate, 666mg TID Topiramate Aggressive w/ enraged response to loud noises/sudden movements, horizontal nystagmus
481
What is the MOA of PCP How is this form of ingestion Tx What is the MOA of LSD
NMDA antagonist Haloperidol, Benzos 5-HT action
482
How is LSD ingestion Tx MOA of opium What does ingestion cause to occur
Haloperidol, Benzos Mu receptor agonist Constipation Resp-depression Pin-point pupils
483
How are opioid withdrawals Tx What is the MOA of Benzos What is seen during withdrawals
Clonidine, Methadone, Buprenorphine w/ Naloxone Inc frequency by opening GABA receptors Anxiety Seizure Tremor- MC if short acting abuse
484
How are Benzo ODs Tx MOA of barbituates Why are barbituate ODs more dangerous than benzos
Flumazenil- competetive GABA antagonist Clonazepam- long acting w/ taper Inc open duration of GABA channels No depression ceiling
485
MOA of cocaine What is seen w/ ingestion What is used during intoxication
Prevent amine (Dopamine NorEpi Serotonin) reuptake Sympathetic activation: Anorexia Tachycardic Dilated pupils HTN Haloperidol Vit C: promotes excretion
486
What needs to be avoided when Tx cocaine intoxication What meds can be used for withdrawal MOA of amphetamines
BBs, restraints- risk developing rhabdo Buproprion, Bromocriptine, SSRIs Promotes DNS release w/ dec reuptake
487
How are amphetamine ingestion Tx MOA of ectasy What is seen during use
Haloperidol Benzos Vit C 5HT > dopamine effects Hyperthermia, hyponatremia
488
When are smokers screened for lung cancer How are screenings completed What meds are used during cessation
50-80y/o w/ 20ppy Hx w/ current use/quit <15yrs Annual low dose CT Buproprion Varenicline
489
# Define Conversion D/o These PTs can present w/ ? odd factor How is this Tx
Neuro Sxs that can't be Dx/explained La belle indifference Therapy w/ anxiolytics
490
# Define Somatic Sx d/o How are these Pts best managed Define Hypochondriasis
Pre-occupation w/ serious illness ≥6mon Single clinician for monthly visits/therapy Illness Anxiety D/o: obsession w/ idea but no Dx'd illness x 6mon
491
How is Illness Anxiety D/o managed What are the two types of Anorexia Nervosa How is Anorexia Nervosa differed from Bulemia nervosa
Therapy w/ SSRIs Restricted, Bing/purge BMI <17, weight <85% of ideal
492
When does Anorexia Nervosa need to be admitted How are these Pts Tx What metabolic disequalibrium is caused by bulimia nervosa
Weight <75% expected body weight Therapy w/ SSRIs Met alkalosis
493
How is Bulimia Nervosa Tx Define Binge Eating D/o How is this managed for Tx
Fluoxetine w/ therapy Lack of control over eating despite being full/not hungry Therapy, behavioral Tx
494
What causes Pityriasis Rosea How is this Tx Define Blepharitis
HSV 7 Steroids w/ antihistamines Painless inflammation of eyelid d/t dysfunctional meibomian gland or staph infection
495
Blepharitis is associated w/ what two conditions What will Pts complain of How is this Dx and Tx
Seborrhea, Rosacea Crusty eyelids in AM Slip lamp; Compress, massage, ABX
496
# Define Chalazion How are these Tx Define Hordeolum
Painless infected meibomian gland in middle section of eye lid Warm compress, CCS, Incision w/ curettage Painful, warm lump on eye lid w/ photophobia/foreign body sensation d/t Staph A
497
How are Hordeolums Tx How are corneal abrasions Dx How are these Pts Tx
Warm compress w/ topical ABX; Non-response: InD Fluorescein stain Bacitracin/Polymyxin B or Cipro Contacts= Ciproflox
498
How does Cauda Equina present How is this Dx How is this Tx
Compressed lumbrosacral nerve roots below conus medularis MRI of L4-5 Surgical emergency
499
How is spinal stenosis differed from lumbar rediculopathy What sign may be seen in these Pts What PE test is negative
Stenosis: worse w/ walking/exercise, relieved w/ hip flexion/leaning forward Kemp: unilateral radicular pain from stenosis made worse w/ extension Straight leg raise
500
How is spinal stenosis Dx Criteria for this Dx Define Secondary Amenorrhea and the MCC
CT myelogram if MRI c/i No menses or secondary features at 13yrs No menses at 15yrs w/ secondary features No menses x3mon or 6mon w/ Hx of irregular cycles; pregnancy
501
? syndrome can cause Secondary Amenorrhea How is Amenorrhea Dx How is this Tx
Ashermans: endometrial atrophy d/t scarring/radiation Sheehan: dysfunctional pituitary d/t posterior stalk bleed Quant hCG OCP: cyclic progesterone 10mg x 10days
502
What are the three MCC of hearing loss Define CHL Define SNHL
Presbycusis Impaction ET dysfunction Lesion on EAC, TM or middle ear preventing conduction Lesion in inner ear or on CN8
503
SNHL d/t brain tumor will be MC located ? How is HL Dx ETD is the primary cause of ? two Dxs
Cerebellopontine angle Weber: sound to affected ear= CHL unaffected= SNHL Rinne: BC > AC= CHL, AC > BC= SNHL AOM, OME
504
All children under 7y/o have ? ENT issue How is this issue Dx How are these Pts managed
ETD Tympanogram Ibuprofen Steroids Pseudophedrine Tympanostomy tubes
505
How is barotrauma Tx prophylactically Barotrauma can present w/ SNHL and vertigo if ? develops AOM is AKA ?
Afrin- risk for medicamentosa Perilymph fistula: torn membrane separating middle and inner ear Suppurative OM
506
MC microbe for AOM Criteria for Acute, Chronic and Recurrent AOM What would be seen on PE during AOM
Strep pneumo then Hflu, Moraxella Acute: <3wks Chronic: >3wks Recurernt: 3x in 6mon, 4 in 12mon Bulging TM w/ loss of landmarks and limited mobility w/ pneumatoscopy
507
How is AOM in children and adults Tx What is used for kids w/ immediate hypersensitivity to first line Txs How is Chronic Otitis Media Tx
Peds: Amox Adult: Augmentin or Doxy/Azith/Clarithromycin Azith/Clarith-romycin Myringotomy
508
How does Otitis Externa present on exam What is the MC microbe What variant is seen in the DM population
Itching canal w/ pain during movement, Weber lateralizes to blocked canal Pseudomonas Malignant OE:
509
Fungal Otitis is d/t ? microbes How is OE Tx if TM can't be visualized How is fungal otitis externa Tx
Aspergillus niger or Candida Cipro and Dexamethason, Ofloxacin, Cortisporin suspension Acetic acid, Clotrimazole, Itraconazole PO
510
What is the MCC of CHL How is this MC Tx What three PE findings suggest Allergic Rhinitis
Cerumen impaction: Weber to clogged side, abnormal Rinnie (BC>AC) Cabamide peroxide or Triethanolamine Boggy turbinates Allergic shiner/salutes
511
How is non-allergic rhinitis Tx How is cold air induced rhinitis best Tx MC site for anterior and posterior nose bleeds
Intranasal steroids, antihistamines, Ipratropium Ipratropium A: Kiesselbach plexus/Little's area P: Woodruff d/t sphenopalatine artery
512
How are persistent epistaxis Tx MCC of Acute Sinusitis MCC of Chronic Sinusitis
Pressure x 10min while leaning fwd Oxymetazoline/Cocaine Anterior packing w/ cephalosporin Petroleum jelly/ABX ointment Strep pneumo Hflu Moraxella Staph A, Anaerobes, Gram-neg
513
What are the indications to prescribe ABX for sinusitis How are these Pts Tx What is used if Pt fails to improve in 7d
Duration >10d w/out improvement Fever >102 Purulent d/c Improvement then rapid worsening Amox the Augmentin Allergy: Clinda/Doxy/Cephalosporin Augmentin 2g Levo/Moxi-floxacin
514
How is Chronic Rhinosinusitis Tx Define Leukoplakia What are the two RFs that put these Pts at risk to develop ?
Augmentin, Clinda if allergic White pre-cancerous patches on mucosa that can't be wiped off Tobacco use, HPV; SCC
515
What PE finding of leukoplakia makes the risk for dysplasia or Ca higher This mouth condition presents mimicking ? other Dz How are Pts Tx for leukoplakia
Erythematous appearance- erythroplakia Hairy luekoplakia: EBV associated lesion in HIV Pts w/out pre-malignancy risk Surgical excision, d/c tobacco
516
How is Hairy leukoplakia Tx When does an aphtous ulcer need to be considered for biopsy
``` Zidovudine A/G-clovir Foscarnet Podophyllin Isotretinoin ``` Lasts >3wks
517
How are aphthous ulcers Tx How is Strep Throat Tx in Pts w/ PCN allergy MCC of viral pharyngitis
Diphenhydramine hydrochloride Mg hydroxide Viscous lidocaine Erythromycin, 1st gen cephalosporin Adenovirus
518
How is Mono Dx How is fungal pharyngitis Tx in HIV Pts How many Centor criteria for rapid testing
Heterophile agglutination test: Monospot PO Fluconazole 3 of 4; neg= culture is Gold Standard
519
How long are athletes benched after having Mono How is Ghonorrhea pharyngitis Tx Peritonsillar abscess AKA ? and MC d/t ?
3wks from Sx onset Ceftriaxone Quincy's abscess; Strep/Staph or Bacteroides
520
What ABX are used for PTAs MCC of epiglottitis How do Pts present on PE
Amox Amp-Sulbactam Clinda HIB Drooling Dysphagia Distress while sitting w/ neck hyperextended/chin protruding
521
What ABX are used to Tx epiglottitis When is laryngitis cancer a considered Dx How is laryngitis Dx
Ceftriax w/ Clinda and CCS SCC if persists >2wks w/ ETOH/smoking Hx Laryngoscopy
522
How are vocal performers w/ pharyngitis Tx What is the MC thyroid neoplastic dz MC type of PO Cancer
CCS Papillary SCC
523
# Define Brachial Cleft Cyst These Cysts own ? MC stat Define Thyroglossal cyst
Cyst appearing after URI anterior to SCM MC lateral neck mass Soft mass rising w/ tongue protrusion; MC midline mass
524
AV node blocking drugs How long after conversion are Afib Pts anticoagulated What two med classes can have first dose HOTN
Digoxin 4wks ACEI, A-blockers**
525
MCCC of sudden cardiac death/arrest ? med dec mortality in CHF the most ? med does not increase mortality after MI
Ischemic heart dz ACEI Nitro
526
Most modifiable RF for CADz ? med decreases mortality from acute MI LVH criteria
Smoking ASA On EKG?
527
? atypical beat causes inverted P-waves on EKG ? PE finding suggests CHF as the most likely cause of a Pts dyspnea High output cardiac failure
Junctional beats Third heart sound PE: warm skin, bulging eyes, wide pulse pressures
528
Post-CHF exacerbation d/c education to prevent readmissions BNP can be artificially low d/t ? two things TIMI RFs
Daily weights Obesity, Pericardial constriction Criteria/indications
529
MOA of statins Two possible adverse outcomes Pt education for taking these meds
Inhibit HMG-CoA reductase, inc LDL clearance Rhabdo, Myositis Take at night (Atorva/Rosuva- anytime of day)
530
MOA of Niacin Adverse effect of use C/i to use
Inc HDL levels by decreasing clearance Inc prostaglandins= flushing/warm skin; Pre-Tx w/ NSAID/ASA 30min prior PUD, Liver Dz
531
MOA of Fibrates Adverse effects of use C/i to use
Dec triglyceride synthesis w/ inc lipoprotein catabolism Increased gallstones Hepatobiliary Dz, Breastfeeding
532
What is the only Fibrate approved for co-use w/ a Statin Genfibrozil can't be used w/ ? meglitinide How is the pruritus associated w/ biliary obstruction Tx
Fenofibric acid Repaglinide Cholestyramine
533
MOA of Bile Acid Sequestrants Adverse effects of use C/i to use
Binds to bile acids preventing absorption and dec LDL Inc triglycerides Impairs medication/fat soluble vitamin absorption Sev hypertriglycerides, Complete biliary obstruction
534
MOA of Ezetimibe What are the indications for use What are the adverse effects of use
Inhibits intestinal cholesterol absorption Combo use w/ statin to dec LDLs Inc LFTs, HA/D
535
? are the two MCC of end stage renal dz in USA ? is the only ARB that doesn't cause hyperuricemia MOA of Thiazide diuretics (including Metolazone) S/e of use
DM then HTN Losartan Dec reabsorption and Ca excretion at distal tubule HypoNa/K, HyperUr/Ca/Glucose
536
MOA of Loop Diuretics Adverse effects of use C/i in ? population
Inhibit water transport across LoH HypoK/Na/Ca Sulfa allergy
537
MOA of K-sparing diuretics S/e of use C/i to use
Inhibit Na/water absorption, most useful combo use w/ Loops HyperK, metabolic acidosis Renal failure, HypoNa
538
MOA of ACEI Adverse effects of use C/i to use
Dec pre/after load, inc vasodilation and insulin action 1st dose HOTN, HyperK Cough Angioedema Pregnancy
539
MOA of ARBS Adverse effect of use C/i to use
Binds/blocks angiotensin two receptors w/out increasing bradykinin levels HyperK Pregnancy
540
MOA of Non-Dihydro CCBs MOA of Dihydro CCBs S/e of use C/i to use
Vasodilators w/out cardiac effect Affect contractility/conduction along w/ vasodilation HA Edema Consitpaion- Verapamil CHF, 2*/3* blocks
541
How are Coarctations repaired What do Pts need prior to surgery MC cyanotic congential heart Dz
Surgery/Transcatheter Prostaglandin E1- Alprostadil Tetrology: PROV
542
Tetrology is associated w/ ? genetic defect What is the MC presentation How is this Dx
Chrom 22 deletion Blue Baby Syndrome; tet spell relieved w/ squatting Echo
543
What are the two revascularization techniques for Tx angina and what determines the method What two meds are used for a chemical stress test for Pts unable to exercise Pts need to d/c ? two meds prior to test
PCI: 1 or 2 vessel Dz in non-DM w/out LAD involvement and normal EF CABG: L-main or 3 vessel Dz, or two vessel Dz in diabetics, or Pts w/ EF <40% Adenosine: dec AV conduction Dipyridamole: dec platelet aggregation, coronary artery dilation Theophylline: adenosine receptor antagonist Caffeine
544
What can trigger Rest Angina What medication may be used during angiography to aid w/ Dx How are these Pts managed and what is avoided
rinzmetal: cocaine, pseudophedrine Ergonovine CCBs, then Nitro; No BBs
545
Check ? leads for P-wave morphology How is a sinus rhythm determined Normal PR interval
2, V1 Upright 1, 2, aVF; Neg in aVR .12-.2 (3-5 boxes)
546
How is L atria enlargement assessed How is R atria enlargement assessed Normal QRS length is ? but if shortened ? step is
M-shaped in lead 2 Biphasic in V1 w/ larger terminal component Tall in lead two ≥3mm Biphasic in V1 w/ larger initial component
547
What iis the typical outpatient medical regiment for angina What are the two procedures done for Tx and what determined each one MCC of HF
BB ASA Nitro Statin PCI: 1-2 vessel dz w/out L-main involvement and normal EF CABG: L-main stenosis or 3 vessel dz (2 vessel if diabetic) of LVEF <40% CADz
548
# Define Sinus Arrhythmia If Sx, how are these Pts Tx
Beat to beat variation: inc w/ inspiration, dec w/ expiration Brady w/ Atropine first, then: Trans-pace, Epi, Dopamine
549
Criteria for Sinus Tach What med is used for persistent sinus tach during ACS Criteria for Sinus Brady and how are Pts w/ Sxs Tx
>100bpm w/ P-waves Metoprolol <60bpm w/ P-waves; Atropine then Epi/Trans-pacing
550
How does A-flutter appear on EKG How are stable Pts managed How are unstable Pts managed
Identical saw-tooth waves at 250-350 bpms Vagal, Rate: BB/CCBs Sync'd conversion
551
Definitive Tx for A-flutter ? class anti-arrhythmics can be used What are the four types of Afib
Ablation 1A, 1C or 3 Paroxysmal: <7days Persistent: >7days Permanent: >12mon, refractory to conversion or no attempts Lone: no heart Dz
552
? syndrome can occur during Afib How are stable Pts Tx How are unstable Pts Tx
Ashman: aberrant conduction beats w/ wide QRS after short R-R cycles Rate: BB or Non-Di CCBs, Digoxin if BB/CCB c/i Synch'd conversion
553
What class medication is avoided during systolic HF Harsh rumbling murmur means ? and lead to ? Rumbling murmurs mean ? and lead to ?
CCBs Stenosis- pressure overload Regurgitation- volume overload
554
What are the two different EKG presentations of PSVTs How are the two Tx
Orthodromic: narrow complex tachycardia Antidromic: regular, wide complex tachycardia Stable, narrow: vagal, Adenosine, BB CCB Digoxin Stable, Wide: Amiodarone, Procainamide Unstable: Synch'd conversion
555
What is the difference between WAP and MAT MAT frequently co-exists w/ ? other d/o How is MAT Tx in this population
WAP: <100bpm MAP: >100bpm COPD Verapamil; BB if LV function preserved
556
WPW is a AVRT variant w/ accessory pathway located ? What are the 3 EKG findings How is this wide complex Tx
Bundle of Kent Short PR Wide QRS D-wave Procainamide/Amiodarone Synch'd conversion Ablation
557
What EKG finding suggest AV junctional rhythms What EKG finding suggest PVCs MCC of Vtach
Inverted P-wave 1, 2, aVF Post P-wave aVR T-wave opposite direction of QRS w/ compensatory pause Ischemic heart dz
558
Along w/ low E+, what medication toxicity can cause V-tach How is stable, sustained Vtach Tx MCC of Vfib
Digoxin Amiodarone Lidocaine Procainamide ischemic heart Dz
559
MCC of syncope Harsh/Rumbling murmur indicates ? Blowing murmur indicates ?
Vasovagal: prodrome of dizzy, light headed, tunnel vision Stenosis Regurg
560
Increasing venous return to the heart increases the intensity of ALL murmurs except ? two What two murmurs radiate What positions accentuate aortic and mitral murmurs
HOCM, MVP MR: axilla AS: carotid Aortic: sit, lean forward Mitral: lay on side
561
What does hand grip do for heart murmurs This murmur increases ? murmurs What effect does Amyl nitrate have on murmurs
Inc after load, dec LV emptying Outflow: AS, HOCM, MVP Dec afterload, inc LV emptying; inc AR/MR murmurs; this is why after load reducers (ACEI) are used
562
? is the MC valvular Dz What are the two MCC by age What would be seen on PE indicating this murmur
AS- preload depended >70: age degeneration <70: bicuspid valve Pulsus parvus et tardus: weak, delayed carotid pulse w/ narrow pulse pressure
563
How are Pts w/ AS managed until surgical correction What additional murmur can be heard w/ AR What two additional PE findings aid w/ Dx AR
Avoid exertion and neg inotropes: BBs, CCBs Austin Flint: Mid-late diastolic rumble at apex d/t regurg from LA into LV Bounding pulses, Wide pulse pressure
564
What are the 8 types of wide pulse pressures seen w/ AR
Water Hammer: rapid up/down of radial pulse Corrigan: water hammer in carotid artery Hill's: SBP popliteal > brachial, most sensitive Duroziez: femoral artery pressure= bruit Traubes: double sound at femoral w/ compression De Musset: head bob w/ pulse Muller's: pulsations seen in uvula Quincke's: finger nail pulsations
565
How is AR Dx How are Pts managed until surgery MCC of MS
Echo w/ cath Dec afterload: ACEI/ARB Rheumatic heart dz
566
What facial changes are seen on PE in Pts w/ MS What ENT syndrome can this cause What will be heard on exam
Mitral facies: flushed cheeks w/ facial pallor d/t hypoxia Ortners- recurrent nerve plasy d/t LA dilation Loud S1 (MV closure) w/ opening snap
567
MCC of MVP What does this sound like on PE What makes this click occur sooner/later
USA: MVP Developing: rheumatic heart dz Widely split S2 w/ displaced PMI Soon: dec preload, Late: inc preload
568
What med is used during MVP w/ Sxs Do Pts need endocarditis prophylaxis What causes PS
BBs No Congenital Rubella Syndrome
569
What additional murmur is heard w/ PR Define Carvallos Sign ? lab result makes a Dx of CHF more likely
Graham Steel: early diastolic decrescendo at LUSB, accentuated w/ inc venous return/dec w/ dec return Inc murmur w/ inspiration w/ pulsatile liver= TR BNP >100; LMOP: Fuorsemide Morphine Nitrates O2 Position- sit and dangle legs over bed to dec preload/venous return
570
What are the two MCC of pericarditis How is pericarditis Dx How is this Tx based on etiology
Infection: Coxsackie, Echovirus Dresslers EKG: diffuse, precordial ST elevation/PR depression, opposite in aVR NSAID/ASA; Dressler: ASA/Colchicine (avoid NSAID)
571
? size of abdominal aorta is considered an aneurysm What is the MC location How do un/ruptured aneurysms present
>3cm Infrarenal Un: Flank pain, abdominal bruit, pulsatile mass Rup: Flank pain w/ echymosis, HOTN, mass
572
How are AAA Dx When are screenings performed What sizes are indicative of repair/referral
Stable: CT w/ contrast Unstable: bedside US All men 65-75y/o w/ smoking Hx >5.4 or expands >0.5cm/6mon >4.5cm: refer 4-4.5cm: US q6mon 3-4cm: US q12mon
573
What is the MC Sx of PADz How can the location of Sxs determine the side of occlusion What type of ulcers does this condition develop
LE claudication Aortic bifurcation/Common iliac: butt, hip, groin Femoral artery/branch: thigh/upper calf Popliteal: lower calf, ankle/foot Lateral malleolus
574
# Define the triad for Leriche Syndrome How is PADz pain at rest relieved How is PADz Dx
Claudication Impotence Dec femoral pulses Foot dependency (hanging off of bed) ABI <0.9, pain at rest suggests ABI <0.4
575
How is PADz Tx What is the name of the first line revascularization procedure Acute Arterial Occlusion is most likely to occur where
Exercise w/ smoking cessation Clostazol > ASA/Clopidogrel Percutaneous transluminal angioplasty Superficial Fermolr/Popliteal artery d/t thrombotic occlusion
576
What is an early and late sign for Arterial Occlusion Define Thromboangitis Obliterans How is this condition Dx
Paresthesia, Paralysis Buerger's Dz: non-atherosclerotic vasculitis Abnormal Allens test, Corkscrew arterioles on aortography
577
How is Thromboangitis Obliterans Tx Where is the MC primary cardiac tumor found This MC can present mimicking ? valvulopathy
Cessation w/ Iloprost (prostaglandin analog) and CCB LA near fossa ovalis MVP
578
How are Atrial Myxomas Dx How is GCA Tx if steroid-sparing/refractory agents are needed What PE sign can be seen w/ superficial thrombophlebitis
TEE: ball-valve obstruction on MV Methotrexate, Azathioprine Trousseaus: migratory thrombophlebitis w/ malignancy
579
Most specific sign for DVT 3 indication for IVC filter w/ DVTs How long are Pts anticoagulated for
Swelling/edema >3cm Recurrent despite anticoagulation C/i to anticoagulation RV dysfunction/enlargement x3mon
580
PVDz stats PADz stats
Pain worse w/ leg dependency/rest Pain improves w/ activity/elevation Cyanosis w/ dependency Medial ulcers Better w/ dependency/rest Lateral ulcers Worse w/ activity/elevation Redness w/ dependency
581
What does Chronic Vein Insufficiency have hyperpigmented skin changed How are ulcers dressed What medication can be used to improve healing time
Hemosiderin deposition Zinc gauze w/ MC site on medial malleolus ASA
582
# Define Wheeze Define Rhochi Define Crackle/Rales Define Stridor
Louder expiration d/t narrow/obstructed airway Low pitch rumble/rattle cleared w/ coughing High pitched noises w/ inspiration NOT cleared by cough Narrowing in larynx/trachea hear throughout cycles
583
MC type of cardiomyopathy What are the two MCCs What is the hallmark PE finding
Dilated: systolic dysfunction Idiopathic, Coxsackie/Echovirus S3 gallop
584
How is Dilated Cardiomyopathy Dx How are these Pts Tx When is an ICD warranted
Echo w/ dec EF and LV dilation/thin walls Loops ACEI BB Spironolactone EF <35%
585
# Define Restrictive Cardiomyopathy What is the MCC What sign may be seen on PE
Diastolic dysfunction d/t dec filling compliance Amyloidosis Kussmaul: inc JVP w/ inspiration
586
How is Restrictive Cardiomyopathy Dx How are Pts Tx Define HOCM
Definitive: biopsy Echo: non-dilated ventricles w/ normal wall thickness and diastolic dysfunction Chelation: hemochromatosis GCCS: sarcoidosis Autosomal dominant d/o causing hypertrophy w/ diastolic dysfunction
587
What causes the obstruction during HOCM What makes the murmur worse How is this Dx
Septal hypertrophy w/ anterior MV motion during systole Inc contraction: B-agonist Exerise Digoxin Dec LV volume: Valsalva, dehydration Echo: 15mm wall thickness w/ LVH
588
How is HOCM Tx MC type of ASD What is the other type and the valvulopathy associated w/ it
BB then CCBs/Disopyramide Young and refractory: myomectomy or alcohol ablation Ostium Secundum, mid-septum Ostium premium: MV abnormalities
589
What does ASD sound like on PE How is this Dx and what EKG sign may be present These can be Tx w/ observation but surgery is indicated when
Wide, Fixed Split S2 w/out vary w/ inspiration Def: Cath Echo; Crochetage: R-wave notching in inferior leads >1cm or Sxs via percutaneous transcatheter
590
# Define PDA What population is more likely for this defect What allows this defect to continue after birth
Continuous connection between descending aorta and pulm arteries Premature female Continued prostaglandin E1 production and low O2
591
What syndrome can develop out of PDAs What does this sound like on PE How is this condition Dx
Eisenmenger: P-HTN w/ cyanosis and feet clubbing Continuous 'to-and-fro" machinery murmur w/ wide, bounding peripheral pulses Initial: Echo, Def: Cath
592
How are PDAs Tx What is the MC congenital heart Dz of childhood What EKG phenomenon may be seen w/ this MC
Indomethacin; Surgical if non-responsive by 1-3y/o VSDs, MC type: Perimembranous Katz-Watchel: LVH + RVH
593
When are VSDs Tx w/ surgery Why is surgical intervention done prior to 2y/o Where are aortic coarctations MC located
Symptomatic infant Uncontrolled CHF Delayed growth Recurrent resp infections Prevent P-HTN Insertion of ductus arteriosus distal to L subclavian origin
594
How does aortic coarctations present What are the two types What is the Gold Standard and Confirmatory Dx test
Arm BP > Leg BP (bilateral claudication) Post-ductal: adults, narrowing distal to ductus Pre-ductal: infantile, narrowing prox to ductus Confirm: Echo, Gold: Angiography
595
How are Coarctations repaired What do Pts need prior to surgery
Surgery/Transcatheter Prostaglandin E1- Alprostadil
596
Tetrology is associated w/ ? genetic defect What is the MC presentation How is this Dx
Chrom 22 deletion Blue Baby Syndrome; tet spell relieved w/ squatting Echo
597
Ranges for Normal, Elevated, Stage 1 and Stage 2 HTN What is the MCC of Primary and Secondary What are the two MCC of end stage renal dz
N: <120/80 and <80 E: 120-129 and <80 1: 130-39 or 80-89 2: ≥140/≥90 P: idiopathic, S: renovascular dz DM then HTN
598
? is the only type of shock where large amounts of fluid are avoided What drugs are used instead What is the first line medical therapy for O-HTON
Cardiogenic- capillary wedge pressure >15mmHg Dobutamine Epi Amrinone- PPD-3 inhibitor Fludrocortisone then Midodrine- A-1 agonist or Droxidopa- pressore
599
What is the worst RF for CADz What is the most important modifiable RF How long does angina pectoris last
DM Smoking <30min or <5min w/ rest/Nitro
600
Initial test of choice for Angina and classic finding What is the most important non-invasive test What is the definitive test
EKG: ST-depression Stress test Angiography
601
What iis the typical outpatient medical regiment for angina What are the two procedures done for Tx and what determined each one
BB ASA Nitro Statin PCI: 1-2 vessel dz w/out L-main involvement and normal EF CABG: L-main stenosis or 3 vessel dz (2 vessel if diabetic) of LVEF <40%
602
MCC of L-sided HF MCC of R-sided HF MC form of HF
CADz and HTn L-sided HF (Pulm Dz, MS) Systolic: Dec EF w/ S3
603
What causes High Output HF What are the 3 parts leading to HF
``` Wet BeriBeri Anemia Pagets Thyrotoxicosis Shunts, AV ``` Sympathetic activation Hypertrophy/remodel RAAS activation w/ ventricular remodel
604
What is the most important prognostic factor of HF What are the two initial tests ordered for suspected CHF What medication class is the single most effective med for mortality benefit in HF w/ reduced EF
EF: <35% inc morality and ICD indication CXR w/ BNP >100 ACEI
605
Indications to use Ivabradine for HF ? med has decreased hospitalizations but offers no benefit for mortality
Chronic, stable HF w/ LVEF ≤35% and HR ≥70bpm and already maxed out/unable to take BBs Digoxin
606
What are the LMOPs of CHF Tx What CXR finding suggests CWP of 18-25mmHg What CXR findings suggest CWP of >25mmHg
Lasix (Furosemide) Nitrate O2 Poistion- sit and dangle legs Kerley Bs Butterfly/Batwing
607
What class medication is avoided during systolic HF Define Acute Bacterial Endocarditis Define Subacute Bacterial Endocarditis Prosthetic valve endocarditis is MC d/t ?
CCBs Normal valve infected w/ Staph A Abnormal valve infected w/ Strep V Staph Epidermis
608
What organisms cause endocarditis w/ negative blooc cultures What are two microbes that cause endocarditis in Pts w/ colon Ca/UC What is the MC Sx of infective endocarditis
``` Haeomophilus aphrophilus Actinobacillus Cardiobacterium hominis Eikenella corrodens Kingella kingae ``` Strep bovis Fever
609
What are the clinical manifestations of Infective Endocarditis How long is Fungal Endocarditis Tx What valve is most likely to be affected by infective endocarditis
FROM Jane: Fever Roth Osler Megaly, speen Janeway lesions Amphotericin x 6-8wks M>A>T>P
610
What are the major criteria What are the minor criteria for Rheumatic Fever Rheumatic valvular dz is most likely to affect ? valves
``` Joint polyarthritis Oh no, carditis Nodules, SQ Erythema marginatum: macular, non-pruritic annualr rash w/ sharp demarcation borders on trunk/extremity Sydenhams chorea ``` Arthralgia Fever Inc ESR/CRP Prolonged PR M>A>T>P
611
Gold standard for Dx myocarditis How are these Pts Tx MCC of pericardial effusions
Biopsy Systolic failure: Loops ACEI BBs Lung Ca then Breast Ca
612
Most important RF for aortic dissection How can the location of pain predict the type of dissection What two meds are used for Type B dissections
HTN Ascending: anterior pain, type A Arch: neck/jaw Descending: interscapular pain, type B Non-Sel: labetalol w/ Na nitroprusside
613
How quickly is BP lowered during aortic dissections Define COPD and what is the MC RF What is the only genetic dz linked to COPD
100-120 <20min Smoking Alpha-1 antitrypsin deficiency
614
# Define Emphysema What are the 3 types of emphysema What is the hallmark of emphysema
Enlarged terminal airspace (distal to terminal bronchioles) Centrilobar: smoking Panacinar: a-1 antitrypsin Paraseptal: Spot Pneumos Dyspnea
615
How is emphysema Dz Define Chronic Bronchitis What is the MC etiology
PFT: irreversible restrictive pattern w/ FEV1/FVC <70% Productive cough x 3mon x 2yrs Smoking
616
What are the 3 cardinal Sxs of chronic bronchitis How is Chronic Bronchitis Dx ? arrhythmia is seen in these Pts
Chronic cough, Sputum, Dyspnea PFT: FEV1/FVC <70% w/ dec FVC MAT: >100bpm w/ 3 different P-wave morphologies; Tx- Verapamil
617
What lab result differs Chronic Bronchitis from Emphysema Most important step in Pt management along w/ ? vaccines When is O2 supplementation needed
Inc H/H w/ resp acidosis Cessation, Pneumococcal/Influenza PaO2 >55, SpO2 88% or less Cor Pulmonale
618
Emphysema Chronic bronchitis
``` Dyspnea- MC Sx Hyperinflated lunged/flat diaphragm Hyperresonance Matched V/Q defect Hypoxic ``` ``` Productive cough- hallmark Rales, Rhonchi, Wheeze Resp acidosis w/ inc H/H V/Q mistmatch Hypercapnea ```
619
What ABX classes are used during COPD exacerbations How are Pts Tx by GOLD Class
Macrolide: Azith/Clarith-romycin Cephalosporin Augmentin Fluroquinolones A: SABA (Albuterol) or SAMA (Ipratropium) B: LAMA>BA (Tiotropium>Sal/For-meterol) C: LAMA (Tiotropium) D: LAMA+LABA or LABA+inhaled GCSS
620
Why doe COPD Pts develop P-HTN and Cor Pulmonale Define Bronchiectassis What is the MCC and what infections are Pts vulnerable to
Hypoxic constriction inc R-sided atrial pressures Permanent dilation of bronchials CF w/ Pseudomonas infections; Non-CF: HFlu
621
How is CF Dx and w/ ? two findings What are the three components of Asthma What is the strongest RF
CT: tram-track and signet ring sign Airway hyperactivity Bronchoconstriction Inflammation Atopy
622
# Define Samter's Triad Define Atopic Triad How is Asthma Dx
ASA, Rhinosinusitis, Polyps Asthma Dermatitis Rhinitis PFT: reversed obstruction w/ dec FEV1/FVC
623
How is Asthma Dx via bronchoprovocation test How is an exacerbation best assessed What criteria are needed for discharge after exacerbation
Methacholine challenge: 20% or more dec of FEV1 followed by bronchodilator challenge w/ FEV1 inc 12% or more Peak expiratory flow rate PEFR >70% or >15% improvement
624
# Define Sarcoidosis What do Pts present w/ What lab results would be seen
Idiopathic, multi-system inflammatory granulomatous dz Lupus pernia- most specific Erythema Nadosum (classic) Dry cough Hyper ACE, Ca, Vit D
625
# Define Lofgren Syndrome seen w/ Sarcoidosis What is the best initial test and what would be seen
Polyarthralgias w/ fever Erythema Nadosum Bilateral hilar adenopathy CXR: 1: BHL w/out pulm Sxs 2: BHL w/ ILDz 3: ILDz only 4: fibrosis w/ restrictive dz
626
What is the most accurate Dx method for sarcoidosis How are these Pts Tx What meds can be used for cutaneous manifestations
Tissue biopsy: non-caseating granulomas PO CCS Methotrexate, Hydroxychloroquine
627
What are two poor prognostic factors for Sarcoidosis MCC of typical pneumonia and CAP What would be seen on PE for this MC
Lupus pernio, Interstitial lung Dz Strep pneumo Tactile fremitus Egophony Dull w/ percussion
628
How does pneumonia d/t Strep Pneumo appear What would be seen on lab results What is the 2nd MCC of CAP
Chills/Rigors w/ rusty (blood-tinged) sputum Gram-pos diplococci H-Influ: Gram-neg rod in ImmComp or Pts w/ Pulm Dzs
629
Pneumonia d/t Staph A is commonly seen after ? and causes ? What stain pattern does this have ? microbe causes pneumonia in alcoholics
Influenza, HAP Clustered gram-pos cocci Klebsiella: purple (currant jelly) sputum w/ cavitary lesions on CXR; Gram-neg rods
630
? is the MCC of Atypical pneumonia What two non-pulm manifestations can this cause How is this MC Dx
Mycoplasma pneu. Bullous myringitis Cold Autoimmune Hemolytic Anemia CXR: Reticulonodular pattern, PCR (test of choice)- cold agglutinins
631
What ABX are used for pneumonia Tx What class of ABX is this naturally resistant to How is Legionella Dx and Tx
Azith/Clarith-romycin, Doxy Lacks cell wall= B-lactams PCR > Urine Ag; Azith/Clarith-romycin or Levofloxacin
632
How is aspiration induced pneumonia Tx How is the need to admit pneumonia Pt determined ? additional PE finding suggests aspiration pneumonia
IV Amp-Sulbactam, PO Augmentin CURB65: Confusion Uremia >30 Resp >29 BP <90/<60, Age >65 Foul smelling sputum d/t accumulation in R-lower lobe
633
How is Histoplasmosis transmitted This can also be an AIDS defining illness if CD4 is below ? How is this Dx
Bird/bat droppings in Mississippi/Ohio River Valley 150/< Sputum culture > PCR Inc ALK-P, LDH w/ pancytopenia
634
How is Histoplasmosis Tx ? is the MC opportunistic infection of HIV How do Pts present w/ this MC
Mild/Mod: Itraconazole Sev: Amphotericin P jirovecii Dyspnea/dec O2 sat w/ exertion
635
How is P jirovecii pneumonia Dx How is the normal course of TMP-SMX adjusted w/ add on meds What IV med is used for severe cases
Diffuse bilateral interstitial infiltrates w/ LDH >200 Broncho lavage for fluorescent Ab stain Definitive: biopsy HIV w/ Hypoxia: add Prednisone Pentamidine
636
How is P jirovecii Tx in Pts w/ G6PD ? forms of TB are infectious Two forms of extrapulm TB
Atovaquone or Pentamidine (avoid Dapsone, Primaquine) Primary, Secondary (reactivated) Scrofulla: cervical nodes Pott's: vertebral
637
What are the two granuloma complexes seen w/ TB How is TB Dx and when is a Pt considered Tx How is this Dx if primary Dx methods are c/i
Ghons: calcified lymph node Rankes: healed, calcified Ghons complex One pos acid fast= pos NAAT: more sensitive than sputum 3 consecutive neg acid fast= neg Gastric specimen
638
MOA/adverse of Rifampin MOA/adverse Isoniazid MOA/adverse of Pyrazinamide MOA/adverse of Ethambutol MOA/adverse of Streptomycin
RNA synthesis inhibitor; orange secretion Inhibits myclonic acid synthesis; peripheral neuropathy Gout/liver Dz Color vision changes Aminoglycoside, CN8 toxicity
639
Pos PPD criteria >5mm Pos PPD criteria >10mm Pos PPD criteria >15mm
Close contact w/ ATB HIV/ImmSupp 15mg/day x 1mon or equivalent of Pred Pox CXR w/ calcified granuloma High risk, dense populus, Immigrant IVDA GI surgery Induration inc x 10mm x 2yrs No RFs
640
# Define Silicosis This condition puts Pts at risk for ? What is seen on CXR for Dx How are Pts Tx
Pulm Dz d/t inhaled silicone dioxide from quarrys/sand blasting TB/mycobacterium infection Nodular opacities in upper lobes w/ eggshell calcifications CCS w/ O2
641
Coal Worker's Lung CXR resembles ? and has ? PFT pattern How is Berryllium exposure made How is this Dx made
Emphysema, Obstructive Nickel, Copper, Aluminum in aerospace/electronics Lymphocyte proliferation test- assess thymidine uptake
642
How is Berylliosis Dx How are PTs Tx This lung condition puts Pts at increased risk for ?
Restrictive lung patter and non-caseating nodule biopsy CCS w/ O2 then Methotrexate Colon Lung Stomach Ca
643
Name of lung Dz from cotton exposure What occupational hazard puts Pts at risk What c/c do Pts present w/
Byssinosis Textile: flax/hemp seed exposure Sxs better at end of work week, restart when work resumes
644
MC complication from Asbestosis Most specific complication from Asbestosis Define Silo Filler Dz
Bronchogenic Carcinoma Mesothelioma of pleura Hypersensitivity pneumonitis from nitrogen dioxide release; N95 mask helps
645
Pertussis is most contagious during ? phase When is the whoop/emesis seen How are Pts Tx
Catarrhal Paroxysmal Azithromycin or TMP-SMX
646
What med is used for prophylaxis Tx of close contacts w/ epiglottitis What meds are used for Pt Tx after intubation is established How is Croup d/t parainfluenza Tx
Rifampin Ceftriax/Cefotax or -cillin Dexamethasone w/ nebulized Epi
647
MCC of Solitary Pulm Nodules What characteristics make these increased risk for malignancy What characteristics make these more likely to be benign
Infectiours Granulomas Lobulated Age >40 Irregular Diameter Size >2cm Circumscribed Smooth <1cm <30y/o
648
What are the two MC sites for carcinoid tumors What do these look like on bronchoscopy How can the location of the tumor be identified
GI > Lungs Pink/Purple centrally located tumor w/ vascularization CT or Octreotide scintigraphy
649
Bronchial carcinoid tumors are made of ? type of cells What do these tumors secrete What is the strongest association for SCLC
Enterochromaffin Serotonin ACTH ADH MSH Smoking
650
? is the MC solid tumor to present w/ paraneoplastic syndromes Mesothelioma tumors arise MC from ? and 2nd MC from ? Criteria for Pulm-HTN and ? genetic association
Small cell carcinoma (oat cell) Pleura, Peritoneum Pulm arterial pressure ≥20mmHg; BMPR2 defect
651
What are the four classifications of P-HTN If vasoreactive condition, ? class med is first line Tx ? combo findings on PE are suspicious for PEs
1: idiopathic 2: d/t left heart dz 3: hypoxemia/chronic lung dz 4: thromboembolic dz CCBs Normal CXR w/ hypoxia
652
What is the MC abnormal CXR finding of PEs What are two classic but rare findings How are Pts Tx if un/stable
Atelectasis Westermark: avascular marking distal to PE Hampton: wedge shape infiltrate d/t infarct Stable: Heparin w/ Warfarin bridge Un: SBP <90/RV dysfunction: thrombolysis w/ LMWH
653
Well's Criteria for PE What is done if the above stratification method shows a score of 0-1
``` 3pts: Clinical S/Sxs of DVT or PE likely 1.5pts: HR >100, Immobile x 3d/surgery <4wks, Prev PE/DVT Dx 1pts: hemoptysis, malignancy w/ Tx <6mon ``` ``` PERC Rule: Hormone Age >50 DVT/PE Hx Coughing blood Leg swelling O2 <95% Tachy >100bpm Surgery/Trauma <28days ```
654
What steps are used for PE prophylaxis in low, mod, and high risk Pts MCC of ARDS and w/ ? presentation Mimicks CHF on CXR, how are they differed
<40y/o/low risk early ambulation Mod: stockings, pneumatics Sev: LMWH (Ortho/Neuro surgery) Gram-neg sepsis: hypoxemia w/out hypercarb ARDS spares CV angles
655
# Define Central Sleep Apnea Define Cheyne Stokes breathing pattern Define Biots Breathing pattern
Dec CNS drive causes dec respiratory effort Response to hypercapnia d/t dec brain blood flow Quick, shallow breaths of equal depth w/ irregular apnic periods (medulla damage, opioid use)
656
# Define Kussmauls Respirations What are the two types of pleural effusion and their etiologies
Hyperpnea; deep, rapid breaths d/t metabolic acidosis (body tries to blow off excess Co2) w/out pauses Transudate: CHF** Cirrhosis Hypoalbumin Atelectasis Nephrotic (inc hydrostatic, dec oncotic press) Exudate: infection/inflammation- Pneumonia Emboli TB Ca
657
What is the initial test of choice for pleural effusions What is the best type of image What is the Dx Gold Standard
CXR: blunting of angles (meniscus sign) Lateral decubitus films Thoracentesis for Light's Criteria; Protein:Serum >0.5 LDH:serum >0.6 LDH >2/3 upper limit of normal
658
Max amount to be removed by throacentesis during therapeutic procedure What lab results suggest fluid is empyema How are effusions Tx if recurrent, chronic or d/t malignancy
1.5L pH <7.2, glucose <40, +Gram stain Pleurodesis w/ Talc or Doxy/Mino-cycline
659
# Define Anaphylactic Shock How are Pts Tx How long is observation mandated
IgE mediated hypersensitivity Epi, Airway, Antihistamines 4-6hrs d/t biphasic phenomenon
660
MCC of infectious esophagitis Hallmark of GERD What are the 4 red flags of GERD
Candidis: empiric Tx w/ Fluconazole Pyrosis Bleeding Odynophagia Weight-loss Dysphagia
661
What are the two MCCs of gastritis H Pylori quad therapy Concomitant therapy
1: H pylori 2: NSAID/ASA Bismuth subsalicylate Tetracycline Metronidazole w/ PPIs Clarithromycin Amox Metro PPI
662
? medication is good for preventing NSAID induced gastric ulcers What is the MC site for extranodal N-HL MCC of acute/chronic pancreatitis
Misoprostol Stomach A: Gallstones, C: ETOH
663
What two lab results suggest cholestasis is present MCC upper GI bleeds MCC lower GI bleeds
Inc ALP w/ GGT PUD Diverticulosis Dx by colonoscopy
664
? ABX are used for Diverticulitis Tx What anti-Ab indicated Crohns MCC acute mesenteric ischemia
OutPt/Uncomp: Metro and Cipro/Levo or TMP Anti-Saccharomyces cerevisiae Afib emoblus
665
What two 'water shed' locations are MC affected by ischemic colitis MC non-neoplastic polyp in colon MC tumor marker screened during colon Ca
Splenic flexure, Rectosignmoid junction Hyperplastic CEA
666
TCA over dose antidote Amphetamine over dose antidote Benzos antidote
Na bicarb Ammonium chloride Flumazenil
667
Theophylline antidote Digoxin antidote Methemoglobin antidote
BBs Digibind w/ Mg Methylene blue w/ Vit C
668
Ethylene glycol antidote What is used to Tx fecal impaction after manual removal When is diverticulitis considered to be complicated
Ethanol infusion, Fomepizole Polyethylene glycol Fistual, Obstruction, Perforation, Abscess

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