PIMP Internal Medicine

Question 1

Criteria for HIT (Heparin Induced thrombocytopenia)

Answer 1

• Heparin exposure greater than five days
• Drop in platelets to less than 100-150 or drop >50% of baseline
• Confirmed by lab testing
• Platelets return to normal when heparin discontinued
• Development of new thrombosis on heparin
• Absenceo f other causes of thrombocytopenia

Question 2

What is the diagnostic test of choice for HIT?

Answer 2

Serotonin release assay and heparin induced platelet antibody

Question 3

Signs of cardiac tamponade?

Answer 3

Beck’s triad: jugular venous distention, muffled heart sounds, and low blood pressure

*likekly see tachycardia, decreased voltage EKG, and sometimes pulsus paradoxus

Question 4

Stages of chronic kidney diases

Answer 4

Stage 1: GFR > 90 mL/min (normal)
Stage 2: GFR  60-89 
Stage 3A: GFR 45-59 
Stage 3B: 30-44
Stage 4: 15-29
Stage 5:

Question 5

Causes of exudative vs transudative pleural fluid?

Answer 5

Exudative: malignancy, abscess or infection, chylothorax

Transudative: heart failure, hypoalbuminemia, nephrotic syndrome

Question 6

Criteria for exudative vs transucative pleural fluid (Light’s criteria)

Answer 6

Pleural effusion is likely exudative if:

1. Protein/serum protein ratio greater than 0.5
2. Effusion LDH/serum LDH ratio greater than 0.6
3. Effusion LDH levle >2/3 upper limit of laboratory normal for serum LDH

Question 7

At what point in DKA can the insulin drip be turned off?

Answer 7

Generally wait until the anion gap closes (less than 12) before DCing hte insulin drip

Question 8

What levels for vancomyocin trough?

Answer 8

For most infections, a trouhg of 10-15 is appropariate. For infections involving the lung or brain, vanc levels should be 15-20. Check levels immediately prior to the next dose

Question 9

Which test for recurrent myocardial infarction?

Answer 9

CKMB

• CKMB rises within hours and peaks after 24 hours, normalizing around 48 hours
• Troponins on the other hand begin to rise after a couple hours, peak at 12 hours, and then remain elevated for up to 7 days

Question 10

Test for rheumatoid arthritis?

Answer 10

1. Rheumatoid factor
2. Anti-CCP
3. ESR

*ESR and RF are inflammatory markers and often elevated in other conditions making their specificity low

Question 11

Treatment for uremic platelet dysfunction?

Answer 11

IV or intranasal DDAVP - lasts only minutes and is best used during procedures due to short half life
-Estradiol patch as estrogensh elp restore platelet function