Rosh Review Things I Need to Know Flashcards
What is the ABCD2 score?
Score to predict future stroke risk
A: Age >60
B: systolic BP >140 or diastolic BP >90
C: Clinical features: unilateral weakness with or without speech impairment (2) or speech impairment without unilateral weakness (1)
D: Duration and diabetes (1): >60 mins (2), 10-59 mins (1), less than 10 mins (0)
Admit if presenting within 72 hours with score greater than or equal to 4
or if uncertainty that outpatient evaluation can be performed in 48-72 hours, or if <3 score and evidence of cerebral infarction
What is used for rate control with atrial fibrillation?
Beta-adrenergic blockers and nondihydropyridine calcium channel blockers (verapamil/diltiazem)
What is used for rhythm control in atrial fibrillation?
Cardioversion
Antidysrhythmic medications
Catheter ablation
If a patient has had atrial fibrillation for more than 48 hours, what should be initiated prior to cardioversion?
Anticoagulants for 21 days
CHADSVASC score
C: CHF
H: Hypertension
A: Age >75 +2
D: Diabetes
S: Stroke +2
Vasc: vascular disease
A: Age 65-74
Sc: Sex category (female)
If score of 2 +, start on anticoagulation such as rivaroxaban, dabigatran, or apixaban
If HAS-BLED score over 3, monitor more closely or consider risk of treatment
Treatment for giant cell arteritis
High dose corticosteroid therapy before biopsy results are finalized
IV methylprednisolone if vision loss
low-dose aspirin do decrease CVA and vision loss
How is polymyalgia rheumatica treated in the absence of temporal arteritis?
Low-dose corticosteroids
What will be positive in patients with autoimmune hypothyroidism?
Thyroid peroxidase antibodies
Diagnostic criteria for metabolic syndrome?
Waist circumference >/= 35 inches for women or 40 inches for men
triglyceride >/=150 mg/dL or on meds for hypertriglyceridemia
HDL <50 mg/dL for women or 40 for men
BP >130/85 or on antihypertensive medication
fasting blood sugar level >100 mg/dL or on medication to treat hyperglycemia
Steps in asthma management
Step 1) PRN SABA
Step 2) Daily low-dose ICS and PRN SABA OR PRN concomitant ICS and SABA
Step 3) Daily and PRN combination low-dose ICS-formoterol
Step 4) Daily and PRN combination medium-dose ICS-formoterol
Step 5) Daily medium-high dose ICS-LABA PLUS LAMA and PRN SABA
Step 6) Daily high-dose ICS LABA PLUS oral systemic corticosteroids PLUS PRN SABA
Asthma classification intermittent
Symptoms <2 days /week
<2/= nighttime awakenings/month
FEV1>80% predicted
Asthma classification mild persistent
Symptoms >2 days/week but not daily
3-4 nighttime awakenings/month
FEV1>80% of predicted
Asthma classification moderate persistent
Symptoms daily
>1 nighttime awakening/week but not nightly
FEV1 60-80% predicted
Asthma classification severe persistent
Symptoms throughout the day
Nightly awakenings common
FEV1 <60% predicted
2 MCC of hypercalcemia
Primary hyperparathyroidism
Malignancy
Symptoms of hypercalcemia
Anxiety
Depression
Cognitive dysfunction
nephrolithiasis
muscle weakness
bone pain
anorexia and nausea (moderate elevation)
Treatment of hypercalcemia if >14 mg/dL albumin corrected
Volume expansion with IV saline
Calcitonin
IV bisphosphonate
Treatment if secondary hypercalcemia to malignancy
maintenance therapy with bisphosphonate derivative
Treatment of hypercalcemia due to chronic granulomatous disease
May be due to overproduction of calcitriol
glucocorticoids to decrease calcitriol
What medication can be used instead of a bisphosphonate in patients with severe renal disease
denosumab
ECG changes in hypercalcemia
shortened QT interval
Typical symptoms associated with Dressler syndrome
Pleuritic chest pain relieved when leaning forward
Pericardial friction rub
Tachycardia
Fever and leukocytosis
ECG changes with Dressler syndrome
Diffuse concave ST segment elevation in all leads except aVR, PR depression in precordial leads, ST depression and PR segment elevation in aVR
Labs in Dressler syndrome
elevated WBC
CRP
ESR
Treatment of Dressler syndrome
Aspirin
Colchicene
Steroids if refractory
How much fluid is allowed in stage D refractory heart failure
1.5-2 L per day
Stages of heart failure
Stage A: high risk of heart failure but no structural heart disease or symptoms
Stage B: structural heart disease but no symptoms of heart failure
Stage C: structural heart disease and symptoms
Stage D: refractory heart failure
Primary symptoms of heart failure
dyspnea
orthopnea
fatigue
presenting signs and symptoms of fluid retention in heart failure
tachycardia
pleural effusions
basilar crackles
S3 gallop
JVD
ascites
hepatomegaly
pitting edema
Heart failure pharmacotherpay
ACE inhibitors or ARBs
bisoprolol, carvedilol, or metoprolol
Treatment of hypertensive urgency in ambulatory setting
captopril
labetolol
clonidine
prazosin
acute end organ damage leading to hypertensive emergency diagnosis
hemorrhagic or ischemic stroke
ACS
aortic dissection
diffuse microvascular injury
hypertensive encephalopathy
anemia
thrombocytopenia
acute kidney injury
retinopathy
how quickly to lower blood pressure in hypertensive emergency
no more than 20-25% over one hour then to 160/100 within 6 hours, and then to target blood pressure in 48 hours
unless aortic dissection, pheochromocytoma, eclampsia or preeclampsia (reduce to less than 140 in first hour and to less than 120 if aortic dissection)
antihypertensive agent for hypertensive emergency in ICU
nicardipine and labetolol
beta-blockers, nitro, nitroprusside, and hydralazine if correct clinical setting
what are the first-line antihypertensive agents in patients with acute aortic dissection
esmolol or labetolol
Confirmation of sjogren syndrome diagnosis
biopsy of lower lip mucosa showing lymphocyte infiltrate and gland fibrosis
Treatment of sjogren syndrome
Initial: artificial tears or saliva, increased oral fluid intake, and ocular and vaginal lubricants
If dry eyes, dry mouth, and other nonocular symptoms that worsen or persist: oral cholinergic agonists (pilocarpine and cevimeline), cyclosporine eye drops can improve ocular symptoms
Which medications most commonly cause hypoglycemia in diabetics
Sulfonylurea
Meglitinide
Insulin
