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Rosh Review Flashcards

1
Q

What is the most common cause of secondary HTN?

A

CKD

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2
Q

What is considered to be stage 1 HTN?

A

130 - 139 / 80 - 89

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3
Q

What is required to diagnose a pt with HTN?

A

2 elevated BP readings on 2 occasions

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4
Q

What are the 1st line treatment options for the general population when treating HTN?

A

Thiazides (HCTZ, chlorthalidone)
CCBs (amlodipine)

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5
Q

Patients who have HTN and CKD w/albuminuria should be treated with what?

A

ACE inhibitors (lisinopril) OR
ARB (losartan, valsartan)

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6
Q

What BP medications cannot be used together?

A

ACEi and ARB

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7
Q

What conditions would be contraindications to giving BBs for HTN?

A

Asthma and COPD

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8
Q

What are common side effects of ACEi?

A

Cough and angioedema

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9
Q

What is the difference between hypertensive urgency and hypertensive emergency?

A

There is no end-organ damage occurring in hypertensive urgency

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10
Q

What BP level is considered a hypertensive urgency/emergency?

A

> 180 / > 110 - 120

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11
Q

What is the treatment for hypertensive emergency?

A

Nicardipine +/- labetalol OR
Clevidipine +/- esmolol

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12
Q

What signs/symptoms would indicate that there is end-organ damage with an elevated BP (hypertensive emergency)?

A

CNS (dizziness, N/V)
Eyes (papilledema)
Heart (angina, MI)
Kidneys (hematuria)

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13
Q

How aggressive should treatment be during a hypertensive emergency?

A

Reduce BP by 10-20% in the 1st hr, and 5-15% in the following 23 hrs
< 180/120 (1st hr)
< 160/110 (23 hrs)

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14
Q

Are medications given PO or IV during a hypertensive emergency?

A

IV

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15
Q

What condition can present with xanthomas on skin, eyelids, and the achilles tendon area?

A

Hyperlipidemia

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16
Q

What labs are indicative of hyperlipidemia?

A

Increased serum total cholesterol
Increased LDL
Decreased HDL
Increased serum triglycerides

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17
Q

Pts with diabetes aged 45-75yo and an elevated LDL should be started on what medication?

A

Moderate intensity statin

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18
Q

What meds are commonly used for high-intensity statin therapy?

A

Atorvastatin 40-80mg
Rosuvastatin 20mg

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19
Q

What meds are commonly used for low-intensity statin therapy?

A

Simvastatin 10mg
Pravastatin 10-20mg

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20
Q

What is the 1st and 2nd line treatment for hyperlipidemia?

A

1st: statins
2nd: cholesterol absorption inhibitor (ezetimibe)

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21
Q

What medication commonly used in the treatment of hyperlipidemia is associated with causing flushing and how can this be avoided?

A

Nicotinic acid (niacin)
Reduce with giving aspirin

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22
Q

What medications are used for lowering triglycerides?

A

Fibric acids (fenofibrate, gemfibrozil)

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23
Q

What is the treatment regimen for pure hypertriglyceridemia?

A

1st line: Fibrates (fenofibrate, gemfibrozil)
2nd line: Niacin

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24
Q

What is the most common cause of stable angina pectoris?

A

Atherosclerosis

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25
Q

What is the most common risk factor for stable angina pectoris?

A

HTN

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26
Q

How does stable angina pectoris commonly present?

A

Exertional substernal chest pain that lasts < 10 mins, and is relieved with rest and/or nitro

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27
Q

What is the 1st imaging test performed on a pt who presents with stable angina pectoris?

A

EKG

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28
Q

What is the gold standard test for diagnosing stable angina pectoris?

A

Cardiac cath w/coronary angiography

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29
Q

What is the pharm treatment for stable angina pectoris?

A

Aspirin
Sublingual nitro
BBS for rate control (1st line)
CCBs (2nd line, unless brady or hypotensive)
Statin therapy

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30
Q

What is the most common cause of unstable angina pectoris?

A

Enlarged stenosis w/thrombosis, hemorrhage, or plaque rupture

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31
Q

What is the most common manifestation/presentation of unstable angina pectoris?

A

Chest pain at rest

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32
Q

What is seen on EKG in pts with unstable angina pectoris?

A

ST-depression or T-wave flattening and/or inversions

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33
Q

Which leads correlate with the anterior portion of the heart on EKG?

A

V1 - V4

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34
Q

Which leads correlate with the lateral portion of the heart on EKG?

A

5, 6, 1, AVL

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35
Q

Which leads correlate with the inferior portion of the heart on EKG?

A

2, 3, AVF

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36
Q

What is the initial pharm treatment for unstable angina?

A

O2 (sats < 90%)
Nitro
Morphine (or fentanyl)
BBs
Statin
Antiplatelet (aspirin)
Anticoagulation (heparin)

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37
Q

Pts with unstable angina who fail medication therapy and/or have EKG changes that persist after 48 hrs require what treatment?

A

Cardiac cath and revascularization

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38
Q

Pts having an NSTEMI have what elevated biomarker?

A

Troponin

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39
Q

What is the 1st line treatment for NSTEMI?

A

BB

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40
Q

What is a TIMI score?

A

Used to estimate mortality in pts with unstable angina and NSTEMI

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41
Q

Aside from ST-segment elevation, what other EKG change is suggestive of a STEMI?

A

New LBBB

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42
Q

What artery is associated with STEMI seen in the anterior (V1-V4) leads?

A

LAD

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43
Q

What artery is associated with STEMI seen in the inferior (2,3,AVF) leads?

A

RCA or left circumflex

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44
Q

What artery is associated with STEMI seen in the lateral (1,V5,V6, AVL) leads?

A

Left circumflex or diagonal of LAD

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45
Q

Pts with STEMI that require revascularization require what procedure and when should this be performed?

A

Percutaneous coronary intervention (PCI) within 90 minutes

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46
Q

What is the most common mechanical complication post MI?

A

Ventricular free wall rupture (w/i 24 hrs or 1-2 weeks)

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47
Q

How long after an MI would you be concerned about Dressler syndrome?

A

2-10 weeks

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48
Q

How does prinzmetal angina typically present?

A

Substernal chest discomfort at rest occurring between midnight and early AM

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49
Q

What is the gold standard for diagnosing prinzmetal angina?

A

Coronary angiography

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50
Q

What is the treatment for prinzmetal angina?

A

CCB (1st)
Sublingual nitro
Statin

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51
Q

What is the most common cardiomyopathy in the US?

A

Dilated cardiomyopathy

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52
Q

What is the most common cause of dilated cardiomyopathy?

A

Alcohol

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53
Q

What physically happens to the heart in dilated cardiomyopathy?

A

Dilation and impaired contraction of 1 or both ventricles

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54
Q

What are common signs/symptoms of dilated cardiomyopathy?

A

Pedal edema
JVD
Hepatosplenomegaly
DOE
S3, S4 sounds
AFIB

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55
Q

What signs/symptoms can tell us whether the dilated cardiomyopathy is L or R sided?

A

L sided: dyspnea
R sided: JVD or pedal edema

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56
Q

Does L or R sided dilated cardiomyopathy typically occur first?

A

L sided first, which then causes R sided

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57
Q

An S4 heart sound is indicative of what?

A

Non-compliant L ventricle

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58
Q

What is the 1st line imaging for diagnosing dilated cardiomyopathy?

A

Echo

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59
Q

What is the 1st line pharm treatment of dilated cardiomyopathy?

A

BBs AND
ACEi or ARB

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60
Q

What is the inheritance pattern of hypertrophic cardiomyopathy?

A

Autosomal dominant

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61
Q

What murmur is indicative of hypertrophic cardiomyopathy?

A

Harsh mid-systolic crescendo-decrescendo best heard at LLSB

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62
Q

What maneuvers increase and decrease the murmur associated with hypertrophic cardiomyopathy?

A

Increase: valsalva and standing
Decrease: squatting and hand grip

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63
Q

What might been seen on the EKG of a pt with hypertrophic cardiomyopathy?

A

Tall R waves in V4 - V6

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64
Q

What is the gold standard for diagnosing hypertrophic cardiomyopathy?

A

Echo

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65
Q

What is the management for hypertrophic cardiomyopathy?

A

Avoid strenuous exercise and dehydration
BB

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66
Q

What are common causes of restrictive cardiomyopathy?

A

Amyloidosis
Sarcoidosis
Hemochromatosis

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67
Q

What common medical treatment can cause restrictive cardiomyopathy?

A

Chest radiation

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68
Q

In restrictive cardiomyopathy, which side typically fails first?

A

R side

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69
Q

What is the gold standard for diagnosing restrictive cardiomyopathy?

A

Endomyocardial biopsy

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70
Q

What is the classic triad of WPW syndrome?

A

Slurred upstroke of QRS (delta wave)
Wide QRS
Short PR interval

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71
Q

Generally speaking, heart dysrhythmias that are UNSTABLE get what treatment?

A

Tachy and unstable: synchronized cardioversion
Brady and unstable: pace

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72
Q

What pts with AFIB or atrial flutter get oral anticoagulation for long-term management

A

Pts with a CHADS-VASc score >/= 2

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73
Q

How does a RBBB appear on an EKG?

A

Rabbit ears in V1 and V2

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74
Q

How does a LBBB appear on an EKG?

A

W in V5 and V6

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75
Q

What is seen on an EKG in a pt with a 1st degree heart block?

A

Fixed, prolonged PR interval

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76
Q

What are the memory tools for 2nd and 3rd degree heart blocks?

A

Longer, longer, longer drop then you have a Wenckebach (Mobitz I)
Some Q’s don’t get through then you have a Mobitz II
P’s and Q’s don’t agree then you have a 3rd degree

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77
Q

What is the treatment for a 1st degree and Mobitz I heart block?

A

Asymptomatic: no tx
Symptomatic: atropine

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78
Q

What is the treatment for Mobitz II and 3rd degree heart block?

A

Permanent pacemaker

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79
Q

What is seen on EKG in pts with pSVT?

A

Regular rate and rhythm
HR: 160-220
P waves may not be visible
QRS usually narrow

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80
Q

What is the treatment for pSVT?

A

Vagal maneuvers
IV adenosine (or IV CCBs or BBs)
Sync. cardioversion if hemodynamically unstable (or meds aren’t working)

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81
Q

What medications can be tried if IV adenosine (1st line) does not work in a pt with pSVT?

A

Amio or procainamide

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82
Q

How is Vtach described on EKG?

A

Wide QRS tachycardia
HR: 100 - 250
All beats look the same (one beat can be replicated on the next)

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83
Q

What is the treatment for Vtach?

A

Sustained (> 30 sec): sync. cardiovert, unless pulseless arrest in which CPR and defib (unsync. cardiovert)
Nonsustained: no tx if asymptomatic; otherwise electrolyte correction +/- ICD placement

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84
Q

How is vfib described on EKG?

A

Disorganized with no associated pulse and no discernable P, T, or QRS waves

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85
Q

What is the treatment of vfib?

A

CPR + defib
Epi every 3-5 mins
Amio or lidocaine
ICD long-term

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86
Q

What commonly causes torsades?

A

Digoxin
Macrolides
Hypokalemia

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87
Q

What is the management of torsades?

A

IV mag sulfate

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88
Q

Heart failure with reduced ejection fraction (HFrEF) is classified as what?

A

Systolic HF
LVEF < 40%
Usually caused by ischemic heart disease/recent MI

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89
Q

Heart failure with preserved ejection fraction (HFpEF) is classified as what?

A

Diastolic HF
LVEF > 40%
Commonly caused by HTN, CAD, DM

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90
Q

Is L or R HF more common?

A

Left

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91
Q

Pts with R sided HF typically present with what symptoms?

A

SYSTEMIC - Roads
Fatigue
JVD
LE edema
Weight gain

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92
Q

Pts with L sided HF typically present with what symptoms?

A

PULM - Lungs
DOE
Tachypnea
Cough
Pulm crackles

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93
Q

According to the NYHA classification of HF, what symptoms are associated with class I (lowest class) and class IV (highest class)?

A

I: asymptomatic during daily activities
IV: symptoms at rest; any activity results in limitations

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94
Q

What lab is likely to be elevated on pts with HF?

A

NT-proBNP or BNP

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95
Q

Aside from HF, what other condition can also cause an elevated NT-proBNP/BNP?

A

Renal failure

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96
Q

What is the gold standard imaging study for HF?

A

Echo

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97
Q

What might be seen on a CXR in a pt with HF?

A

Cardiomegaly
Pulmonary congestion (Kerley B lines)
Pleural effusion

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98
Q

What is the treatment for HFrEF (systolic dysfunction)?

A

Fluid and salt restrict
Diuretic + ACEi or ARB + BB
ICD for pts with EF < 35%

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99
Q

What medications should be avoided in pts with HF?

A

Metformin
Thiazolidinediones
NSAIDs
CCBs

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100
Q

What is the treatment for acute decompensated HF?

A

O2
IV loop diuretic
IV vasodilator (nitro)
IV inotrope (dobutamine)
+/- IV vasopressors (norepi)

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101
Q

What is the most common cause of cardiogenic shock?

A

Acute MI

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102
Q

HR increases in all types of shock except which 1?

A

Neurogenic; HR decreases

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103
Q

Mixed venous oxygen (SvO2) decreases in all types of shock except which 1?

A

Septic; increases

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104
Q

In which type of shock does cardiac output increase early on, but decrease later?

A

Septic

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105
Q

Which 2 types of shock have increased pulmonary capillary wedge pressure (PCWP)?

A

Cardiogenic and obstructive

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106
Q

What will be seen on an echo in a pt with cardiogenic shock?

A

Decreased ventricular systolic function as well as decreased stroke volume

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107
Q

What is the treatment for cardiogenic shock?

A

ABCs
Avoid aggressive IV fluids
Inotropes (dobutamine, milrinone)
Vasopressors (dopamine, norepi)
Diuretics (furosemide)

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108
Q

What size does the aorta have to be dilated to to be considered an aneurysm?

A

> 3cm

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109
Q

A true aneurysm involves what layers of the aorta?

A

All 3
Pseudo only involves tunica intima and tunica media

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110
Q

What is the most common type of aortic aneurysm?

A

Abdominal (AAA) (infrarenal)

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111
Q

What imaging is performed in a pt with suspected AAA?

A

Stable: CTA w/con
Unstable: US

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112
Q

If a CXR or KUB is done on a pt with AAA, what might be seen?

A

Widened mediastinum
Enlarged aortic knob
Calcifications

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113
Q

What AAAs get repaired?

A

Emergency repair for ruptures
> 5.5cm (men)
> 5cm (women)
Rapidly expanding (> 0.5cm in 6 mos)

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114
Q

What is the screening recommendation for AAA?

A

1 time screening US for men 65-73 with a history of smoking

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115
Q

Where do Type A and Type B aortic dissections occur?

A

Type A: ascending aorta
Type B: descending aorta

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116
Q

How are aortic dissections managed?

A

Type A: emergency surgery
Type B: medical managment

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117
Q

What is the most common cause of aortic dissection?

A

Long-standing HTN

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118
Q

What are the imaging studies used 1st line for aortic dissection?

A

Hemo stable: CTA or MRA (if CT contraindicated)
Hemo unstable: TEE

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119
Q

What are the first line meds used when treating aortic dissection?

A

IV BBs

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120
Q

What are the 6 P’s of symptoms seen in arterial embolism/thrombosis?

A

Pain
Pallor
Pulselessness
Paresthesia
Poikilothermia
Paralysis

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121
Q

What is the gold standard imaging for diagnosing arterial embolism/thrombosis?

A

Catheter based anigo

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122
Q

Arterial embolism/thrombosis is a surgical emergency. What anticoagulation should be started while awaiting surgery?

A

Heparin

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123
Q

What condition is associated with polymyalgia rheumatica?

A

Temporal (giant cell) arteritis

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124
Q

What are the signs/symptoms of temporal arteritis?

A

HA, vision changes, jaw claudication, temporal scalp tenderness, temporal artery enlargement

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125
Q

What labs are elevated in pts with temporal arteritis?

A

ESR and CRP

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126
Q

What is the gold standard for diagnosing temporal arteritis?

A

Temporal artery biopsy

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127
Q

What is the treatment for temporal arteritis?

A

Prednisone
If vision loss: IV methylprednisolone

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128
Q

What artery is most commonly affected in PAD?

A

Superficial femoral artery

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129
Q

What is the most common risk factor for PAD?

A

Tobacco use

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130
Q

Symptoms of PAD will commonly include what?

A

Symptoms improve with rest and are reproduced with ambulation

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131
Q

Severe PAD will present with what symptoms?

A

Pain at rest
Standing or hanging their foot over the side of the bed improves pain

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132
Q

What is commonly seen on PE in PAD?

A

Weak or absent pulses
Thin/shiny skin
Hair loss
Lateral malleolar ulcers

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133
Q

If an ABI is done in the workup of PAD, what level indicates the diagnosis?

A

< 0.9

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134
Q

What is the gold standard imaging for diagnosing PAD?

A

Contrast arteriography

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135
Q

What are the signs/symptoms of chronic venous insufficiency?

A

Legs that feel heavy, aching, itching
Prolonged standing aggravates symptoms
Walking and elevation of legs relieves symptoms

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136
Q

What is commonly seen on PE of chronic venous insufficiency?

A

Dependent pitting edema
Hyperpigmentation and stasis dermatitis
Shallow ulcer over medial malleolus

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137
Q

What is the 1st line imaging for chronic venous insufficiency?

A

Venous duplex US

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138
Q

What is the Virchow triad?

A

Factors contributing to developing DVT
Circulatory stasis
Endothelial injury
Hypercoagulable state

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139
Q

What is the Homan sign?

A

Pain when squeezing the calf in a DVT

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140
Q

What is used to test the probability of a DVT?

A

Wells score

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141
Q

How many days would a pt need to be bedridden to be at increased risk for DVT?

A

> 3 days

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142
Q

How does a D-dimer test rule out a DVT?

A

Only if the D-dimer is negative does it r/o a DVT

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143
Q

What is the 1st line imaging for a DVT?

A

Doppler US

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144
Q

What is the gold standard for diagnosing a DVT?

A

Contrast venography

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145
Q

What anticoagulation is used for short-term and long-term use in pts with DVT?

A

Short: UFH and LMWH
Long: warfarin or NOACs (rivaroxaban or apixaban)

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146
Q

A massive iliofemoral DVT AKA phlegmasia cerulea dolens requires what treatment?

A

Thrombectomy or thrombolysis

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147
Q

What mnemonic is used to remember systolic and diastolic valve disorders?

A

PASS: pulmonic and aortic stenosis = systolic
PAID: pulmonic and aortic insufficiency = diastolic

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148
Q

What type of murmur is heard in aortic stenosis?

A

Harsh crescendo-decrescendo systolic ejection murmur heard best in the 2nd R ICS

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149
Q

What is the treatment for aortic stenosis and what meds should be avoided?

A

Aortic valve replacement
Avoid: diuretics, BBs, vasodilators

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150
Q

What type of murmur is heard in aortic regurg?

A

Diastolic decrescendo that is high-pitched and blowing heard best at LSB when the pt is sitting up and leaning forward

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151
Q

What might be used to describe a patient’s pulse pressure in aortic regurg?

A

Widened arterial pulse pressure
AKA Corrigan pulse or Quincke pulse

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152
Q

What is the most common cause of mitral stenosis?

A

Rheumatic fever (strep pharyngitis)

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153
Q

What is the murmur heard with mitral stenosis?

A

“The operating system is Microsoft”
Opening snap
Low-pitched rumbling heard best lying on L side

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154
Q

What is the murmur heard in mitral regurg?

A

Holosystolic that is loud and blowing best heard at the apex and radiates to the axilla

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155
Q

Mitral valve prolapse is commonly seen in what disorders?

A

Ehler-Danlos and Marfan

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156
Q

What is the murmur heard with mitral valve prolapse?

A

“In order to be MVP, team must click”
Systolic click best heard at the apex

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157
Q

What is the murmur heard in pulmonary stenosis?

A

Crescendo-decrescendo systolic murmur at 2nd L ICS

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158
Q

What is the most common cause of tricuspid regurg?

A

L sided HF

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159
Q

What is the murmur heard in tricuspid regurg?

A

Blowing holosystolic that increases with inspiration best heard at the LLSB

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160
Q

All valvular disorders are diagnosed with what gold standard imaging?

161
Q

What valves are commonly affected in infective endocarditis?

A

Mitral valve (MC)
Tricuspid (IVDU)

162
Q

What are the most common causes of infective endocardititis?

A

Native valves: strep viridans
Prosthetic valves: staph epi
IVDU: staph aureus

163
Q

What are signs/symptoms of infective endocarditis?

A

Fever, CP, dyspnea, cough
PE: new heart murmur, splinter hemorrhages, Janeway lesions, osler nodes, roth spots (eyes)

164
Q

What is the gold standard imaging for diagnosis infective endocarditis?

165
Q

What is the modified Duke criteria?

A

Used in diagnosing infective endocarditis
Must have 2 major, 1 major & 3 minor, or 5 minor criteria

166
Q

What is the treatment for infective endocarditis?

A

Native valve: nafcillin, oxacillin OR cephalosporin (ceftriaxone, cefepime) AND vanc
Prosthetic valve: vanc + gent + rifampin
Both for 4-6 weeks

167
Q

What medication is commonly used as prophylaxis for endocarditis prior to procedures?

A

PO Amoxicillin 2g 30-60 mins prior to procedure

168
Q

What is seen on EKG in pts with acute pericarditis?

A

Diffuse ST elevations

169
Q

What are common causes of acute pericadititis?

A

Infection (viral, TB, bacterial)
Post MI (Dressler)
Uremia (CKD)

170
Q

What are signs/symptoms of acute pericarditis?

A

CP that improves with sitting up and leaning forward
Pericardial friction rub on exam

171
Q

What is the treatment of acute pericarditis in most adult patients?

A

Aspirin or ibuprofen or indomethacin AND colchicine

172
Q

In what situation of acute pericarditis would you NOT recommend ibuprofen or indomethacin as part of the treatment?

173
Q

If a pt has acute pericarditis and has a contraindication to NSAIDs, what is the treatment regiment?

A

Prednisone AND colchicine

174
Q

What is Beck’s triad?

A

Physical exam findings in cardiac tamponade
Hypotension, JVD, muffled heart sounds

175
Q

What is seen on EKG in cardiac tamponade?

A

Electrical alternans (QRS looks different with each beat)

176
Q

What is the treatment for cardiac tamponade?

A

Normal saline IV fluids
Pericardiocentesis
Pericardial window

177
Q

What measurement of induration on a TB skin test is positive?

A

No risk factors: > 15mm
High risk (health care, IVDU): > 10mm
Immunocomp. (HIV): > 5mm

178
Q

What is the gold standard diagnostic imaging for pulmonary nodules?

A

CT w/o contrast

179
Q

What is the most common malignant and benign pulmonary nodule?

A

Malignant: adenocarcinoma
Benign: granuloma

180
Q

When should pulmonary nodules be followed up?

A

< 6mm: no f/u if low risk; optional CT at 12 mos if high risk
6-8mm: CT at 6-12 mos
> 8mm: CT at 3, 9, 24 mos if low risk; PET, biopsy if high risk

181
Q

What is the USPSTF lung cancer screening recommendation?

A

Adults 50 - 80 yo with a 20 pack year smoking history and currently smoke, or who have quit within the past 15 years should get a yearly low dose CT unless they have not smoked for 15 years

182
Q

What is seen on PFTs of a patient with chronic bronchitis?

A

Decreased FEV1 and FEV1/FVC (< 0.7 or 70%)
Normal or increased TLC and RV
Normal DLCO

183
Q

Emphysema is characterized by what lung abnormality?

A

Loss of recoil and alveolar surface area

184
Q

What can cause COPD in patients who have never smoked?

A

Alpha-1 antitrypsin deficiency

185
Q

What is seen on PFTs in emphysema?

A

Decreased FEV1 and FEV1/FVC (< 0.7 or 70%)
Normal or increased TLC and RV
Decreased DLCO

186
Q

Patients with idiopathic pulmonary fibrosis show what on PFTs?

A

Normal to increased FEV1
Normal to decreased FEV1/FVC
Decreased DLCO

187
Q

What intervention improves survival in pts with COPD?

188
Q

If a pt with COPD has pneumonia, what is the most likely causative agent?

189
Q

Most COPD pts are treated with a regimen of what?

A

LABA + LAMA

190
Q

What is the management of an acute COPD exacerbation?

A

Albuterol
Ipratropium (anticholinergic)
Prednisone
Resp support
Abx

191
Q

What is the most common cause of a transudative pleural effusion?

192
Q

What is shown in the light criteria for transudative pleural effusions?

A

Protein: < 0.5
LDH: < 0.6

193
Q

What is shown in the light criteria for exudative pleural effusions?

A

Protein: > 0.5
LDH: > 0.6

194
Q

What commonly causes an exudative pleural effusion?

A

Malignancy

195
Q

What is the treatment for a pleural effusion?

A

Thoracentesis

196
Q

What signs/symptoms would be concerning for a PE?

A

HAD CLOTS
Hormones (estrogen)
Age (> 50)
DVT/PE Hx
Coughing blood
Leg swelling
O2 < 95%
Tachy
Surgery w/i last 4 weeks

197
Q

If a patient is suspected of having a PE and cannot get a CTA (pregnancy, CKD/AKI) what test should be ordered?

198
Q

What is commonly seen on EKG in a PE?

A

Sinus tach
S1Q3T3 pattern

199
Q

What is the gold standard definitive diagnostic test for pulmonary HTN?

A

R heart cath

200
Q

What is the management for pulmonary HTN?

A

CCBs
PDE-5 inhibitors
O2
Anticoagulate

201
Q

What is the most common cause of cor pulmonale?

A

Acute: PE
Chronic: COPD

202
Q

What is seen on physical exam in idiopathic pulmonary fibrosis that is not seen in conditions like asthma and COPD?

A

Digital clubbing

203
Q

What is the gold standard diagnostic imaging for idiopathic pulmonary fibrosis?

A

High-resolution CT

204
Q

What is seen on CT of a pt with IPF?

A

Honeycombing

205
Q

What is the treatment of IPF?

A

O2
Antifibrotics (nintedanib, pirfenidone)
Lung transplant (definitive)

206
Q

What are the pathologies of penumoconiosis?

A

Coal worker lung: coal mining
Berylliosis: aerospace, fluorescent bulbs
Silicosis: mining
Siderosis: arc welding
Stannosis: tin welding
Asbestosis: ships, demolition

207
Q

What is seen on CXR in silicosis?

A

Hilar lymphadenopathy
Egg shell calcifications

208
Q

What is seen on imaging in asbestosis?

A

Lower lobe predominant reticular opacities
Pleural plaques

209
Q

What complication can arise from pneumoconiosis?

A

Malignant mesothelioma

210
Q

What extrapulmonary symptoms are seen in sarcoidosis?

A

Lupus pernio
Erythema nodosum
Anterior uveitis

211
Q

What lab level is only seen in sarcoidosis?

A

Elevated serum ACE levels

212
Q

What is seen on CXR in sarcoidosis?

A

Bilateral hilar adenopathy

213
Q

What is seen on histology in sarcoidosis?

A

Noncaseating granulomas

214
Q

What is the atopic triad?

A

Asthma
Atopic dermatitis
Allergic rhinitis

215
Q

What is Samter’s triad?

A

Aspirin/NSAID sensitivity
Nasal polyps
Asthma

216
Q

Does the obstruction caused by asthma get better or stay the same when given bronchodilators?

A

Gets better

217
Q

What would be considered moderate-persistant asthma?

A

Day time symptoms daily
Night time symptoms > 1x/week but not nightly
FEV1 > 60% but < 80%
Some activity limitations

218
Q

What is the step-wise approach to asthma treatment?

A

1: PRN SABA
2: PRN SABA + low-dose ICS
3: daily and PRN combo low-dose ICS (formoterol)
4: increase to medium dose combo ICS
5: medium-high dose ICS (LABA) + LAMA and PRN SABA
6: high dose ICS + oral steroids + PRN SABA

219
Q

What is the most common cause of ARDS?

220
Q

What is seen on CXR in ARDS?

A

Complete white out

221
Q

What is the gold standard diagnostic test for GERD?

A

Ambulatory pH monitoring

222
Q

What occurs in pts with Barrett esophagus?

A

Normal squamous epithelium changes to metaplastic columnar epithelium

223
Q

What is primarily an idiopathic motility disorder that is characterized by decreased peristalsis and progressive dysphagia?

224
Q

What is the 1st imaging study and gold standard diagnostic study for achalasia?

A

1st: barium esophagram (bird beak appearance)
GS: esophageal manometry

225
Q

What is the most common treatment for achalasia?

A

Pneumatic balloon dilation of LES

226
Q

What is the treatment of acute bleeding in esophageal varices?

A

Octreotide
Emergent EGD for banding

227
Q

What medication is used as prevention of esophageal varices?

A

Non-selective BBs

228
Q

What is the definitive treatment for esophageal varices?

229
Q

What is the most common type of esophageal cancer?

A

Adenocarcinoma (in the US)
SCC (worldwide)

230
Q

What are the biggest risk factors for esophageal cancer?

A

GERD and Barrett’s
Smoking
ETOH use

231
Q

What are common causes of acute gastritis?

A

H. pylori (MC)
NSAIDs/aspirin

232
Q

What is the gold standard for diagnosing gastritis?

A

Endoscopy w/biopsy

233
Q

How can H. pylori be detected?

A

Serology
Stool antigen test
Urea breath test

234
Q

What is the quadruple treatment for H. pylori?

A

PPI
Bismuth
Metronidazole
Tetracycline (doxy)
x 14 days

235
Q

How does food help differentiate where ulcers may be in the GI system?

A

Decreased pain w/food = duodenal ulcer
Increased pain w/food = gastric ulcer

236
Q

What is increased in Zollinger-Ellison syndrome?

237
Q

What needs to be done following 14 days of quad therapy for H. pylori?

A

Urea breath test to confirm eradication

238
Q

What physical exam findings are indicative of metastatic gastric cancer?

A

Virchow node (supraclavicular)
Sister Mary Joseph nodule (at umbilicus)

239
Q

What is the gold standard diagnostic imaging for a SBO?

A

Abdominal CT w/oral and IV contrast

240
Q

What medication can be used for pts with gallstones that are symptomatic but do not wish to pursue surgery?

A

Ursodeoxycholic acid

241
Q

What is a boas sign?

A

Referred shoulder pain from gallbladder infection

242
Q

What is the gold standard diagnostic test for cholecystitis?

A

HIDA
AKA cholescintigraphy or hepatobiliary scintigraphy

243
Q

What is the gold standard diagnostic and therapeutic imaging study for choledocholithiasis?

244
Q

What is cholangitis?

A

A biliary tract infection that occurs 2/2 gallstone obstruction in the common bile duct

245
Q

What symptoms make up Charcot’s triad?

A

RUQ pain
Fever
Jaundice

246
Q

What symptoms make up Reynolds pentad?

A

RUQ pain
Fever
Jaundice
Confusion
Hypotension

247
Q

What is the only Hepatitis that is a DNA instead of an RNA type?

248
Q

Which hepatitis’ transmit via oral-fecal route?

A

Hep A and E

249
Q

Which hepatitis’ are co-dependent?

A

Hep D and B (can’t have D w/o B)

250
Q

In acute hepatitis, which liver enzyme is usually more elevated?

251
Q

Acute and chronic Hep B have what positive serologic markers?

252
Q

What Hep B serologic markers would indicate that a patient has recovered from Hep B or was immunized?

A

Positive anti-HBs

253
Q

What do IgG and IgM represent on serologic markers related to hepatitis?

A

IgG = gone/recovered
IgM = right meow

254
Q

Which hepatitis is the only one that is treated with direct acting antiviral medications and not supportive care?

255
Q

Which hepatitis’ do not become chronic?

A

Hep A and E

256
Q

What are common causes of cirrhosis?

A

Chronic Hep C (MC)
ETOH

257
Q

What lab studies are seen in cirrhosis?

A

Macrocytic anemia (decreased B12 or folate)
Thrombocytopenia
Increased LFTs
Decreased albumin
Increased ammonia

258
Q

What is the treatment for hepatic encephalopathy?

A

Lactulose or rifaximin

259
Q

What is the most common cause of deaths due to cancer worldwide?

A

Hepatocellular carcinoma

260
Q

An increase in what lab is suspicious/diagnostic for hepatocellular carcinoma?

A

AFP > 20 = suspicious
AFP > 400 = diagnostic

261
Q

What is the protocol for screening for hepatocellular carcinoma?

A

US every 6 mos +/- AFP in high risk patients

262
Q

What is used to determine prognosis of acute pancreatitis?

A

Ranson criteria

263
Q

What labs are elevated in acute pancreatitis?

A

Serum lipase (more specific)
Amylase

264
Q

What is the test of choice for acute pancreatitis?

A

CT of the abdomen w/contrast

265
Q

What is the most common cause of chronic pancreatitis?

266
Q

What is the triad of symptoms seen in chronic pancreatitis?

A

Calcifications
Steatorrhea
DM

267
Q

What is a difference between acute and chronic pancreatitis related to labs?

A

Lipase and amylase may be normal in chronic

268
Q

What is the most sensitive imaging study in chronic pancreatitis?

269
Q

What is the most common type of pancreatic cancer?

A

Adenocarcinoma

270
Q

What is a physical exam finding seen in pancreatic cancer?

A

Courvoisier sign (palpable nontender gallbladder)
Trousseau syndrome (migratory thrombophlebitis)

271
Q

What tumor marker is used for monitoring after treatment of pancreatic cancer?

272
Q

Where is diverticulosis most commonly found?

A

In the sigmoid colon

273
Q

What procedure is contraindicated in patients with diverticulitis?

A

Colonoscopy due to risk of perf

274
Q

What is the gold standard diagnostic imaging for diverticulitis?

A

CT of the abdomen/pelvis w/oral and IV contrast

275
Q

What is the outpt and inpt treatment for diverticulitis?

A

Outpt: ciprofloxain + metronidazole OR amoxicillin-clavulanate w/follow up in 48 hrs
Inpt: IV abx 3-5 days with switch to PO to complete 10-14 day course

276
Q

When should pts with diverticulitis have a colonoscopy?

A

6-8 weeks after resolution of clinical symptoms

277
Q

What conditions are associated with HLA-B27?

A

PAIR
Psoriatic arthritis
Ankylosing spondylitis
IBD
Reactive arthritis

278
Q

What condition presents as recurrent, dull abdominal pain that occurs 10-30 mins after eating?

A

Chronic mesenteric ischemia

279
Q

What is the gold standard imaging for mesenteric ischemia?

280
Q

What artery is most commonly involved in acute mesenteric ischemia?

281
Q

What is a common presentation of acute mesenteric ischemia?

A

Sudden onset of diffuse severe pain that is out of proportion to exam

282
Q

What is the most common cause of a large bowel obstruction?

A

Colon cancer
Volvulus (MC non-cancer)

283
Q

What are the most common causes of toxic megacolon?

A

IBD or C. diff

284
Q

What colonic dilation is indicative of toxic megacolon?

285
Q

At what age do you start colon cancer screening for average risk patients?

286
Q

What is the tumor marker associated with colon cancer?

287
Q

What is the most common inheritable thrombophilia and what is the genetic inheritability pattern?

A

Factor V leiden
Autosomal dominant

288
Q

Pts with factor V leiden commonly develop what?

A

DVT
PE
Miscarriages

289
Q

What is seen on labs in pts with ITP?

A

Isolated thrombocytopenia (platelet count < 100,000)
Megakaryocytes on peripheral smear
Normal coagulation studies

290
Q

What platelet count is considered critical thrombocytopenia?

291
Q

What is the treatment for ITP that has minor bleeding or severe thrombocytopenia (< 30,000) w/o bleeding?

A

Glucocorticoids
IVIG

292
Q

What is the classic pentad for TTP?

A

FAT RN
Fever
Anemia
Thrombocytopenia
Renal injury
Neuro findings

293
Q

What is seen on labs in TTP?

A

Severe thrombocytopenia
Microangiopathic hemolytic anemia
Schistocytes on peripheral blood smear
Normal coagulation studies

294
Q

What is the treatment for TTP?

A

Plasma exchange therapy

295
Q

What is the most common inherited bleeding disorder?

A

Von Willebrand Disease

296
Q

What is a common clinical manifestation of vWD?

A

Mucocutaneous bleeding (nose, gums)

297
Q

What is seen on coagulation studies in pts with vWD?

A

Normal PT
Prolonged PTT

298
Q

What is the management of vWD?

A

Major surgery/bleeding: vWF concentrate
Minor procedure/bleeding: desmopressin

299
Q

Both hemophilia A and B have what coagulation studies?

A

Normal platelet function
Normal PT
Prolonged PTT
Normal bleeding time

300
Q

What factor is deficient in hemophilia A and B?

A

A: factor VIII
B: factor IX

301
Q

What symptoms are associated with severe IDA?

A

Pallor
Koilonychia (dents in nails)
Atrophic glossitis
Angular cheilosis

302
Q

What lab findings are seen in IDA?

A

Low MCV
Low iron
Low ferritin
High TIBC
High transferrin

303
Q

What labs are seen in anemia of chronic disease?

A

Low MCV
Low iron
Low TIBC
Normal/high ferritin
Normal transferrin

304
Q

What labs are seen in thalassemia?

A

Low MCV
Low TIBC
Low transferrin
Normal iron
Normal ferritin

305
Q

What is seen on peripheral blood smear in IDA?

A

Hypochromic microcytic blood cells

306
Q

What are common causes of folate deficiency?

A

Meds (methotrexate, trimethoprim)
Chronic ETOH
Pregnancy

307
Q

What labs are seen in folate deficiency?

A

MCV > 100
Increased homocysteine
Normal MMA

308
Q

Vitamin B12 can be differentiated from folate deficiency/IDA by what?

A

Neurologic symptoms

309
Q

What labs are seen in B12 deficiency?

A

MCV > 100
Increased MMA and homocysteine

310
Q

What is the inheritance pattern of G6PD deficiency?

A

X-linked recessive

311
Q

What is seen on peripheral smear in pts with G6PD deficiency?

A

Bite cells and Heinz bodies

312
Q

What labs are elevated in polycythemia vera?

A

Hct and Hgb

313
Q

What is the primary treatment for polycythemia vera?

A

Phlebotomy

314
Q

What is seen on peripheral blood smear in pts with sickle cell?

A

Sickled red blood cells
Howell-Jolly bodies

315
Q

What medication is used in sickle cell pts to reduce vaso-occlusive episodes?

A

Hydroxyurea

316
Q

What condition shows target cells on peripheral smear?

A

Beta thalassemia

317
Q

What is the most common cancer in children?

318
Q

What is seen on bone biopsy in a pt with ALL?

A

Hypercellular w/ > 20% blasts

319
Q

What presents with painless lymphadenopathy, hepatosplenomegaly, and has smudge cells on peripheral blood smear?

320
Q

What presents with auer rods on bone marrow biopsy?

321
Q

What condition is associated with the Philadelphia chromosome (BCR-ABL1 gene)?

322
Q

What condition shows Reed-Sternberg cells (owl’s eyes) on tissue biopsy?

A

Hodgkin lymphoma

323
Q

Which type of lymphoma has a worse prognosis (hodgkin or non-hodgkin)?

A

Non-hodgkin

324
Q

What condition has rouleaux formations on blood smear and Bence Jones proteinuria on UA?

A

Multiple myeloma

325
Q

What is seen on radiographs in pts with multiple myeloma?

A

Lytic lesions

326
Q

What is seen on physical exam in Grave’s disease?

A

Diffusely enlarged nontender thyroid
Exophthalmos
Pretibial myxedema
Increased DTRs

327
Q

What lab studies are seen in Grave’s?

A

Decreased TSH
Increased T4 and T3

328
Q

Does Grave’s have high or low uptake on thyroid radioisotope scanning?

329
Q

What meds are used to treat hyperthyroidism?

A

PTU
Methimazole

330
Q

What med is used to treat hyperthyroidism in pregnancy?

A

PTU in 1st trimester then switch to methimazole in 2nd

331
Q

What is the treatment for thyroid storm?

A

BB
PTU or methimazole
Iodine
Steroids

332
Q

What are 2 commonly used medications that can cause hypothyroidism?

A

Amio
Lithium

333
Q

What labs are seen in primary hypothyroidism?

A

Increased TSH
low or normal free T4

334
Q

What labs are seen in secondary hypothyroidism?

A

Decreased TSH
Decreased or normal free T4

335
Q

How long does it take levothyroxine to increase T4 levels?

336
Q

Subacute thyroiditis is usually preceded by what?

337
Q

What does hot and cold nodule on a radionuclide thyroid scan indicate?

A

Hot = benign
cold = malignant

338
Q

What is the most common type of thyroid cancer?

A

Papillary carcinoma

339
Q

What type of thyroid cancer produces calcitonin?

A

Medullary carcinoma

340
Q

What is commonly injured during a total thyroidectomy?

A

Recurrent laryngeal nerve

341
Q

How is primary hyperparathyroidism classified?

A

Excess PTH leads to hypercalcemia
Caused by parathyroid adenoma (MC)

342
Q

What labs are seen in primary hyperparathyroidism?

A

Increased PTH
Increased Ca+
Increased Vit D
Decreased PO4

343
Q

How is secondary hyperparathyroidism classified?

A

Caused by CKD which leads to decreased production of calcitriol leading to increased PTH secretion

344
Q

What labs are seen in secondary hyperparathyroidism?

A

Increased PTH
Normal Ca+
Decreased Vit D
Normal PO4

345
Q

What symptoms are associated with hyperparathyroidism?

A

Bones
Stones
Groans
Psychiatric overtones

346
Q

What is the treatment for primary hyperparathyroidism?

A

Increase fluids
Decrease calcium
Vit D
Parathyroidectomy

347
Q

What is the treatment for severe hypercalcemia?

A

IV fluids
Bisphosphonates, calcitonin
Furosemide

348
Q

What is the treatment for secondary hyperparathyroidism?

A

Due to Vit D def: Vit D
Due to CKD: calcitriol

349
Q

What physical exam signs are seen in hypoparathyroidism?

A

Chvostek sign (cheek tap)
Trousseau (hand spasm with BP cuff)
Increased DTRs

350
Q

Chvostek and trousseau sign are associated with what in hypoparathyroidism?

A

Hypocalcemia

351
Q

What labs are seen in hypothyroidism?

A

Decreased PTH
Decreased Ca+
Increased PO4

352
Q

What is the treatment for symptomatic hypocalcemia?

A

IV calcium gluconate

353
Q

What has hyperpigmentation and orthostatic hypotension on physical exam?

A

Primary adrenal insufficiency (Addisons)

354
Q

What labs are seen in primary adrenal insufficiency (Addisons)?

A

Decreased serum cortisol
Increased ACTH
Hyponatremia
Hyperkalemia
Decreased aldosterone

355
Q

What lab difference is seen in secondary adrenal insufficiency compared to primary?

A

ACTH is decreased on secondary

356
Q

Is hyper or hypokalemia seen in Cushing syndrome?

A

Hypokalemia

357
Q

How do you determine where the issue is when doing the workup for Cushings?

A

Both have increased cortisol
ACTH is low/has no response to desmopressin test = adrenal issue
ACTH is high/has response to desmopressin test = pituitary tumor

358
Q

What labs are seen in SIADH?

A

Decreased serum Na+
Decreased serum osmo (< 280)
Increased urine osmo (> 100)

359
Q

What is the treatment for SIADH?

A

Water restrict
Correct Na+

360
Q

Nephrogenic DI is commonly caused by what medication?

361
Q

What labs are seen in DI?

A

Increased Na+
Increased serum osmo
Decreased urine osmo

362
Q

What test is required to make a diagnosis of DI?

A

Water deprivation test

363
Q

How is central vs nephrogenic DI determined?

A

Desmopressin (synthetic ADH) given
Minimal/no increase in urine osmo = nephrogenic
Increase in urine osmo = central

364
Q

What is the treatment for central DI?

A

Desmopressin

365
Q

What vision change is commonly reported with a pituitary adenoma?

A

Bitemporal hemianopsia

366
Q

What is the imaging modality of choice for suspected pituitary adenoma?

A

MRI w/contrast

367
Q

What is the treatment of a functional pituitary adenoma?

A

Transsphenoidal resection

368
Q

What symptoms are commonly seen in post-strep glomerulonephritis?

A

Usually in kids
Recent strep or impetigo (1-6 wks prior)
Edema (face, hands, feet)
Coca cola colored urine

369
Q

What is seen on UA in pts with post-strep glomerulonephritis?

A

Hematuria
RBC casts
Proteinuria < 3.5

370
Q

What is the most common glomerulonephritis worldwide?

A

IgA nephropathy (Berger disease)

371
Q

How can you tell the difference between IgA nephropathy and post-strep glomerulonephritis?

A

IgA nephropathy presents with hematuria 1-2 DAYS after a URI, not weeks

372
Q

What test will be positive in pts with post-strep glomerulonephritis?

A

Antistreptolysin O titer

373
Q

What is the most common secondary cause of nephrotic syndrome in adults?

374
Q

What is the most common nephrotic syndrome seen in children?

A

Minimal change

375
Q

How do you tell the difference between a nephrotic and a nephritic syndrome?

A

By the proteinuria
NephrOtic: > 3.5
Nephritis: < 3.5

376
Q

What type of casts are seen on a UA in nephrotic syndrome?

A

Fatty casts
Maltese cross pattern under polarized light

377
Q

How does the BUN/Cr ratio help you identify where an AKI is?

A

BUN:Cr < 20 = intra/post renal
BUN:Cr > 20 = pre-renal

378
Q

How does FENa tell you where an AKI is?

A

< 1 = pre-renal
> 1 = post renal

379
Q

What is the most common intrinsic renal disease?

380
Q

What are causes of pre-renal, renal, and post renal AKIs?

A

Pre: hypoperfusion (cardiogenic shock, hemorrhage, sepsis)
Renal: direct damage (toxins, drugs, infx)
Post: obstruction (stone, tumor, trauma)

381
Q

What is a good amount of urine output?

382
Q

What symptoms are seen pre, renal, and post renal AKI?

A

Pre: hypotension, decreased skin turgor
Renal: fever, rash, joint pain
Post: dysuria, diminished stream, hypertension

383
Q

ATN has what kind of casts on UA?

A

Muddy brown casts

384
Q

What kind of casts are seen on UA in AIN?

A

WBC casts and eosinophils

385
Q

What are the indications for dialysis?

A

AEIOU
Acidosis
Electrolytes (K+ > 6.5)
Ingestions
Overload
Uremia

386
Q

What are the most common causes of end-stage kidney failure?

387
Q

How is CKD classified?

A

GFR stages
Stage 1: > 90 = normal
Stage 3a: 45-59 = mild to mod decrease
Stage 3b: 30-44 = mod to severe
Stage 5: < 15 = kidney failure

388
Q

What is seen on US of a pt with CKD?

A

Small, echogenic kidneys bilaterally

389
Q

What medication is used as part of the treatment regimen for PKD?

A

Vasopressin V2-receptor antagonist (Tolvaptan)

390
Q

What screening needs to be done for pts with PKD?

A

Screening MRA of the brain for cerebral aneurysms

391
Q

What is the equation to calculate anion gap?

A

Na - [Cl + HCO3]
> 12 = elevated

392
Q

What can present as both a respiratory alkalosis and a metabolic acidosis?

A

Salicylate toxicity

393
Q

What EKG change can indicate a severe hypokalemia?

394
Q

How much K is needed to change a hypokalemia?

A

10meq = change of 0.1
If K is 3.0 - 3.5, give 50meq

395
Q

What drugs are common causes of hyperkalemia?

A

Digoxin
K sparing diuretics
ACEi, ARBs

396
Q

What should be given 1st when treating hyperkalemia?

A

Calcium gluconate

397
Q

What are causes of hypotonic hyponatremia?

A

Hypovolemic: GI loss, diuretics
Euvolemic: SIADH
Hypervolemic: CHF, cirrhosis, AKI, CKD

398
Q

What is the classic triad for renal cell carcinoma?

A

Flank pain
Gross hematuria
Palpable abdominal renal mass

399
Q

What is WAGR syndrome?

A

Symptoms associated with Wilms tumor
Wilms tumor
Aniridia (no iris)
GU abnormalities
Range of developmental delays

PANCE Prep (1 decks)

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