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Step 2 > Ramani Lecture > Flashcards

Ramani Lecture Flashcards

1
Q

Contraindications for EKG stress test vs. Echo

A

Old left branch bundle or on digoxin

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2
Q

What meds to stop for an EKG stress test?

A

Beta blockers, calcium channel blockers

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3
Q

Positive stress test

A

Pain is reproduced, ST depression, or hypotension

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4
Q

New systolic murmur 5-7 days post MI

A

Papillary muscle rupture

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5
Q

Acute severe hypotension after MI?

A

Ventricular free wall rupture “step up in oxygen from RA to RV”

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6
Q

Persistent ST elevation with mitral regurg post-MI

A

Ventricular wall aneurysm

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7
Q

bounding pulsating JVP

A

Tricuspid malfunction 2/2 AV dissociation - check for third degree heart blok

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8
Q

5-10 weeks post MI pleuritic CP and low grade temp (D/Tr)

A

Dressler’s autoimmune pericarditis, NSAIDS and aspirin

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9
Q

Vague chest pain with viral infection and murmur

A

myocarditis

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10
Q

Chest pain with rest and worse at night in person with migraine headaches, transient ST (D/BT/Tr)

A

Prinzmetal’s angina, ergonovine stim test, CCB or nitrates

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11
Q

Third degree heart block finding

A

Cannon-a waves

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12
Q

Varying PR intervals with 3 or more distinct P waves in same lead

A

Multifocal atrial tachycardia, bad prognosis, sick patients pending respiratory fialure

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13
Q

Normal complex QRS tachy and treatment

A

Vtach - unstable - cardioversion, stable - lidicoaine or amiodarone

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14
Q

Drug of choice for WPW

A

procainamide - do NOT give rate control

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15
Q

Torsades risk factors

A

Low Mg, Low K, Li, TCA OD

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16
Q

Young person with sudden onset and offset palpations normal rhythm 150-220 bpm

A

SVT - carotid massage first followed by adenosine

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17
Q

Widened QRS, short Qt after crush or burn?

A

Hyperkalemia

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18
Q

Electrical alternans? Low alternating qrs

A

Tamponade

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19
Q

Undulating baseline irregularly irregular too much synthroid, CHF valve dizease, or SOB/dizziness

A

Afib - rate control

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20
Q

Crescendo decrescenod, louder with squat, softer with valsalva +parvus et tardus

A

Aortic stenosis - replace

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21
Q

Late systolic murmur with a click, louder with valsalva, quieter with squatting

A

Mitral valve prolapse

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22
Q

Radiate to axilla, holosystolic

A

Mitral reguritation

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23
Q

Rumbling diastolic murmur with opening snap, left atrial enlargement

A

Mitral stenosis

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24
Q

Blowing diastolic murmur with widened pulse pressure and eponym parade

A

Aortic regurg

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25
Q

Suspect PE?

A

Heparin first!

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26
Q

O2 <90%

A

Give O2

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27
Q

Pneumonia?

A

CXR

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28
Q

Murmur or CHF?

A

Echo

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29
Q

Acute pulmonary edema?

A

Nitrates, lasix, and morphine

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30
Q

CHF in young person?

A

Myocarditis (coxackie B)

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31
Q

Young and no cardiomegaly on CXR

A

Right heart cath for pHTN -

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32
Q

Pulm cap wedge pressure in CHF and pHTN

A

High in CHF, normal in pHTN

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33
Q

Reversible cardiomyopathy

A

Alchol, hemochromatosis

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34
Q

Thickened peritracheal stripe and splayed carina bifurcation

A

Left atrial enlargement (mitral stenosis) and cancer

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35
Q

Transudative pleural effusion with low glucose

A

RA

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36
Q

Transudative pleural effusions with high lymphocytes

A

TB

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37
Q

Transient pleural effesuion with blood

A

Malignant or PE

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38
Q

What makes pleural effusion complicatied?

A

Exudative with +gram or cx, pH<7.2, glc <60

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39
Q

Lights criteria

A

LDH<200
LDH eff/serum <0.6
Protein eff/serum <0.5
need all three to be transudative

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40
Q

Cancer and nephrotic syndrome dispose to PE

A

Hyperoagulable

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41
Q

PE anticoagulation

A

Heparin right away then warfarin bridge

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42
Q

When to do surgical thrombectomy

A

If immediately life threatening

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43
Q

Criteria for ARDS

A
  1. PaO2/FiO2 <200 (<300 means acute lung injury)
  2. Bilateral alveolar infiltrates on CXR
  3. PCWP <18
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44
Q

ARDS treatment

A

Mechanical ventilation w/ PEEP

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45
Q

when to start O2

A

PaO2<55 or if cor pulmonale, <59

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46
Q

Typical abx for COPD exacerbation

A

Macrolide

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47
Q

Best prognostic indicator for COPD

A

FEV1

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48
Q

New clubbing in COPDr

A

Hypertrophic ostearthropathy, get CXR for lung cancer

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49
Q

Normalizing PCO2 in asthma exacerbation

A

Impending respiratory failure, intubate

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50
Q

1 cm nodules in upper lobes with eggshell calcifications

A

Sillicosis - more predisposed to TB, INH if >10 mm

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51
Q

Reticulonodular markings in lower lobes with pleural plaques

A

Asbestosis, increased risk for bronchogenic carcinoma and mesothelemioma

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52
Q

Patchy lower lobe infiltrates (D/P)

A

Hypersensitivity pneumonitis, “farmer’s lung”

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53
Q

Hilar lymphadenopathy

A

Sarcoid

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54
Q

Sarcoid with hypercalcemia

A

Increased vit D due to macrophages in granulomas producing vit D like substance

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55
Q

Referral for sarcoid?

A

Opthalmology - uveitis conjunctivits in 25%

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56
Q

How to dx sarcoid

A

Biopsy, treat with steroids

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57
Q

First step in pulm nodule workup

A

Look for old CXR

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58
Q

Characteristics of benign pulm nodule

A 
Popcorn calcification (hamartoma)
Concentric calcification (old granuloma)
Pt<40 with well circumscribed <3 cm 0 watch with CT q2mo
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59
Q

Malignant nodule characteristics

A

Spiculated, large (>3 cm), old smoker

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60
Q

Weight loss, cough, dyspnea, hemoptysis, repeatned PNA or lung collapse

A

Cancer

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61
Q

Most common non-smoker cancer

A

Adeno - scars of old pna

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62
Q

Location and mets of adeno?

A

Periopheral cancer, liver bone brain and adrenal

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63
Q

Characteristic pleural effusion of adeno?

A

Exudative with high hylauronidase

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64
Q

Scary lung cancer symptoms with low PTH AND hypercalcemia

A

Squamous cell - PTH-rP

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65
Q

Shoulder pain, ptosis, constricted pupil, facial edema

A

Superior sulcus syndrome, small cell carcinoma

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66
Q

Cancer associated with Lamber-Eaton?

A

Small cell

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67
Q

Old smoker w/ Na=125, moist mucus membranes, no JVD

A

SIADH from small cell - euvolemic hyponatremia

68
Q

CXR with peripheral cavitation and CT with distant mets

A

Large Cell carcinoma

69
Q

Difference between small cell and Nsmall cell

A

Nsmall cell chemo, small cell resection

70
Q

Crohn’s deficiency by involving ileum?

A

Fe deficiency?

71
Q

PSC associated with which IBD?

A

UC

72
Q

Higher risk with colon cancer in crohn’s or UC?

A

UC

73
Q

Cured by colectomy?

A

UC

74
Q

Associated with p-ANA IBD?

A

UC

75
Q

Pyoderma gangrenosum with UC antibiotics?

A

No I+D, no antibiotics

76
Q

AST>ALT with high GGT

A

Alc Hep

77
Q

ALT>AST in 1000’s

A

Viral hepatitis

78
Q

AST and ALT in 1000’s after surgery?

A

Shock liver - ALT is NOT greater than AST

79
Q

Elevated alk phos AND GGT

A

Bile duct obstruction

80
Q

Elevated alk phos, normal GGT and Ca

A

Paget’s disease, hearing loss (bisphosphonates)

81
Q

Antimitochondrial Ab

A

PSC - bile resins for treatment

82
Q

ANA + antismooth muscle Ab

A

Autoimmune Hepatitis - tx w/ roids

83
Q

High Fe, low ferritin, low Fe binding capacity

A

Hemachromatosis, golden diabetes

84
Q

Low ceruloplasmin, high urinary Cu

A

Wilson’s

85
Q

Why add ampicillin for empiric meningitis treatment for old and young?

A

Lysteria coverage

86
Q

TB treatment

A

RIPE and roids

87
Q

Lyme meningitids treatment

A

IV ceftriaxone

88
Q

Best 1st step

A

Start treatment with steroids if you think bacterial

89
Q

Most common pneumoniae in healthy young people?

A

Mycoplasma - cold agglutainins

90
Q

HAP bugs?

A

Pseudomonas, Klebsiella, E.Coli, MRSA - pit/tazo or imipenem + Vanc

91
Q

Old smokers w/ COPD

A

Hflu

92
Q

Old men with HA, confusion, diarrhea, and abd pain

A

Legionella - dx w/t urine antigents, M,FQ, doxy

93
Q

Farmers pneumonia

A

Q-fever, Coxiella burnetti, doxy

94
Q

Just skinned a rabbit in Arkansas

A

Franciella tularensis, streptamycin, gentamycin

95
Q

Order of tests in TB workup

A

PPD, CXR, sputum stain

96
Q

Who is given INH for prophylaxis

A

Kids <4TB

97
Q

+TB treatment

A

RIPE for 6 mo, 12 for meningitis, 9 if pregnant

98
Q

Rifampin side effects

A

Orange/red boddy fluids, induces CYP450

99
Q

INH side effects

A

Peripheal neuorpathy and sideroblastic anemia (prevent by giving B6(pyridoxine)), Hepatitis

100
Q

Pyrazinamide

A

Benign hyperuricemia

101
Q

Ethambutol

A

optic neuritis and impaired color vision

102
Q

Most common endocarditis bug?

A

staph aureus

103
Q

Subacute native valve

A

Viridans group strep on MV

104
Q

IVDU endocarditis?

A

Staph on tricuspid - right sided heart murmurs worse w/ inspiration

105
Q

Strep bovis bacteremia?

A

Colonoscopy

106
Q

Most common cause of death in endocarditis

A

CHF

107
Q

Prophylaxis for endocarditis

A

Prostetic valve, hx of EC, or uncorrected congenital lesion

108
Q

“travels a lot for work”

A

Code for lots of unprotected sex

109
Q

Acute retroviral syndrom 2-3 weeks after exposure symptoms? Seroconversion?

A

Mono symptoms, ELISA is negative, converts aroudn 6 weeks

110
Q

New bilateral bell’s palsy

A

Can be HIV

111
Q

young patient unexplainted thrombocytopenia

A

Can be HIV

112
Q

Zidovudine side effects? Classic and important

A

GI, leukopenia, macrocytic anemia

113
Q

Didanosine Side effects

A

Pancreatitis, peripheral neuropathy

114
Q

Abacavir side effects

A

Rash, fever, n/v, muscle aches, and SOB - never use again

115
Q

Nephrolithiasis and hyperbilirubinemia

A

Indinavir

116
Q

Efavirenz side effects

A

Sleepy, confusded, psycho

117
Q

Post-exposure prophylaxis

A

AZT, lamivudine, and nelfinavir x 4 weeks

118
Q

HIV patient with DOE, dry cough, fever, chest pain

A

Think PCP, CD4<200

119
Q

PCP blood elevation

A

LDH

120
Q

Best test for PCP after CXR?

A

Boncoscopy w/ BAL

121
Q

1st and 2nd line treatment for PCP

A

Trim-sulfa, then trim-dapsone

122
Q

When to add steroids for PCP

A

PaO2 <70, high A-a gradient

123
Q

When to start prophylaxis?

A

CD4<200, can come off after 6 mo >200

124
Q

Three major causes of diarrhea in HIV+ patient

A

CMV, MAC, cryptosporidium

125
Q

CMV dx in HIV

A

Colonoscopy with biopsy, treat with canciclovir

126
Q

Cryptosporidium dx in HIV

A

Acid fast oocysts

127
Q

Multiple ring enhancing lesions in HIV? One ring enhancing lesion?

A

Toxo multiple, CNS lymphoma if one, treat with pyramethamine sulfadiazine +folic acid then watchc for improvement, if it improves probably toxo

128
Q

HIV seizure w/ deja vu aura and 500 RBC’s in CSF

A

HSV - immediate acyclovir

129
Q

HIV with s/s of meningitis

A

Strep pneumo most common, but thinkCrypto, +india ink, ampho IV 2wks then fluconazole

130
Q

HIV hemisensory loss, visual impairmarment, Babinksi

A

PMLdue to JC virus, brain biopsy diagnosis

131
Q

HIV memory problems or gait disturbance

A

AIDS-Dementia complex, work up to find other treatable causes

132
Q

Define neutropenic fever

A

Super high temp or sustained low temp with ANC <500

133
Q

Most common cause of neutropenic fever

A

Meucositis 2/2 chemo causes bacteremia

134
Q

Most common bugs of neutropenic fever?

A

Pseudomonas and MRSA

135
Q

Lyme disease treatment for <8

A

amoxacillin

136
Q

Rash at wrists and ankles, fevers, and headache

A

Rikettsia, everyone get doxy

137
Q

Tick bite w/o rash but myalgias, fever, headaches, low plts and WBC, up ALT

A

Ehrlichiosis, Can dx with morulae intracell inclusion, tx w/ doxy

138
Q

Immune suppressed pt with cavitary lung dz, wegith loss, fever, gram +aerobic branching bugs

A

Nocardia - tx w/ trim-sulfa

139
Q

Numbness, Chvostek, prolonged QT

A

Hypocalcemia

140
Q

Paralysis, ileus, ST depression, U waves

A

Hypokalcemia

141
Q

Treatment for hyperkalemia

A

Ca-gluconate, insulin +glc, kayexalate, albuterol, and NaBicarb - last resort diuretics then dialysis

142
Q

Best test for metabolic alkalosis

A

Urine chloride - high urine chloride? hyperaldo, barters, gittlemans. Cl low, vomitting, NG suction, antacids, diuretics

143
Q

RTA Type I (proximal or distal, cause, presentation, treatment)

A

Distal
Lithium/AmphB, analgesics
Urine pH>5.4 with hypoK and stones, cannot secrete H+
Give K and oral bicarb

144
Q

RTA Type II (proximal or distal), cause, presentation, treatment

A

Proximal
Fanconi’s syndrome, myeloma, amyloid
Hypokalemia, osteomalacia, cannot reabsorb HCO3
Bicarb won’t help (because they can’t reabsorb), replete K

145
Q

RTA Type IV

A

Hyperrenin hypoaldo - Mostly caused by diabetes, HyperK, high urine NA even with salt, treat with fludrocortisone

146
Q

what to use for urine concentration if on diuretic

A

FENurea

147
Q

Muddy brown casts in ampho, aminocglycosides, cisplatin, or prolonged ischemia?

A

ATN

148
Q

Protein, blood and eosinophils in urine plus fever and rush after trim-sula?

A

AIN. stop offending agent

149
Q

Treatment for rhabdo

A

Deal with hyperkalemia nad bicarb to alkalinize urine and prevent precipitation

150
Q

Enveloped shaped crystals in UA

A

Ethylene glycol (AGMA), Tx w/ dialysis or bicarb if low pH

151
Q

Cr up 48-72 hrs post cardiac ccath or CT scan

A

Contrast nephropathy, hydrate before and give bicarb or NAC

152
Q

Indications for emergent dialysis

A 
A - acidosis
E-Electrolye impalance (high K)
I- Intoxication - antifreeze, Li
O- Overload of volume, CHF or Pulmonary edema
U-uremia -> pericarditis, AMS
153
Q

Most common CKD complications

A

Cardiovascular dizease - LDL <100

154
Q

Complications of CKD

A

HTN - up aldo
Anemia of chronic disease - loss of Epo
Hyper K, hyper phos, low calcium -> 2nd HPTH, renal osteodystrophy from Ca into tissues, calciphylaxis (skin necrosis)
Uremia

155
Q

Peeing blood 1-2 days after runny nose, sore throat, and cough

A

Berger’s Dz, IgA neprhopathy

156
Q

1-2 weeks after sore throat

A

Post-strep CN

157
Q

Hematuria + hemoptysis

A

Goodpastures - Abs to collagen IV

158
Q

Heamturia + deafness

A

Alport, XLR collagen IV

159
Q

Kid s/p viral URI with renal fialure, abdominal pain, arthralgia, and purpura

A

HS purpura, IgA, steroids

160
Q

Kiddo after beef ingestion with diarrhea and renal failure, MAHA and petechiae

A

HUS E. Coli - no ABX - more toxin

161
Q

Cardiac patient after ticlopidine w/t renal failure, MAHA, low plts, fever, and AMS

A

TTP - plasmapheresis, no platelets, differentiate from HUS/TTP by PT and PTT

162
Q

c-ANCA kidney, lung, and sinus

A

Wegener’s Granulomatosis - need biopsy

163
Q

p-Anca, renal failure, asthma, eosinophilia

A

Churg strausss - lung bx, steroid

164
Q

P-anca, no lung involvement, Hep B

A

PAN, small/med arteries everywhere but lung

165
Q

Kid w/t family hx of stones

A

Cysteine stones

166
Q

Chronic indwelling foley stones and alkaline pee

A

Struvite stones with bacteria

167
Q

Nephrotic patient suddenly develops flank pain

A

Renal vein thrombosis - peeins out AT III, protein Cand S, stat CT or U/S

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