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Clin Med Review Flashcards

1
Q 
Which of the following is a significant predictor of death in nursing homes?
A. Chlamydia
B. Unintentional weight loss
C. Asparin use
D. A only
A

B. unintentional wt loss

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2
Q

A 75 year old FTT pt is depressed and not gaining weight. What would be your 1st choice of medication?

A

Remeron

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3
Q

What is the difference between HFrEF and HRpEF?

A

HFrEF has a LV Ejection fraction of <50%

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4
Q

Which two medications improve m/m in pts with HFrEF

A

ACEI, Beta Blocker

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5
Q

Which Beta blockers improve M&M in pts w/ HFrEF? (3)

A

(carbetolol (coreg), metoprolol succinate, bisproprolol))

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6
Q

What is a recommended medication for pts with a LVEF <40%, who can’t tolerate ACEI or ARBs?

A

Hydralazine & Nitrates

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7
Q

Elequis Reversal Agent

A

Andexxa

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8
Q

What are the symptoms associated with upper motor deficiencies in als?

A

spasticity, slow rapid alternating movements, hyperreflexia, stiffness

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9
Q 
Which medication prolongs ALS life expectancy by a couple months?
A. Rilutek (riluzole)
B. Levodopa 
C. Lamotrigine 
D. Gabapentin
A

A. Rilutek

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10
Q

What is pseudo bulbar-affect in als?

A

Inappropriate emotional responses, happens as disease progresses

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11
Q

Define CHADS2

At which score should you anticoagulate?

A

CHF, HTN, Age >75, DM, Previous stroke/TIA (2 points) - over 2 anticoagulate

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12
Q

Which drug is best for rhythm control in a-fib

A

Amiodarone

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13
Q

What is the classic triad of parkinsons?

A

Pill Rolling Tremor
Bradykinesia
Cogwheel rigidity

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14
Q

Which tremor is improved with moderate alcohol consumption?

A

Benign Essential Tremor

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15
Q

What is the treatment for Benign Essential Tremor?

A

Propranolol

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16
Q

What is the most effective drug in treating symptomatic Parkinson’s patients?

A

Sinemet

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17
Q

Name the four classifications of a-fib and how long each lasts.

A

Paroxysmal (within 7 days)
Persistent (>7 days)
Longstanding persistent (>12 months)
Permanent (given up on trying to correct)

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18
Q

Name 4 potential side effects you would want to warn your parkinsons patient about before starting anticholinergics.

A 
Dilated pupils (sight impact)
Dry mouth
Confusion
Hyperthermia
Urinary retention
Flushed skin
Tachycardia
Constipation (absent bowl sounds)
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19
Q

What hormones are secreted by the posterior pituitary?

A

Oxytocin

Vasopressin

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20
Q

What ABI value is diagnostic of PAD?

A

<0.9

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21
Q

What is the treatment of choice for viral URI?

A

Supportive care

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22
Q

What are the 3 p’s of acute limb ischemia?

A

Pulseness, pain, pallor, pain, paresthesia, perishingly cold

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23
Q

What is the most common pituitary secreting hormone?

A

Prolactin

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24
Q

List two ways viral URI differs from bacterial?

A

Timeframe, maxillary pain, tooth pain, second sickening

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25
Q

What is the underlying cause of varicose veins?

A

Decreased vein compliance

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26
Q

In Alzheimer’s dementia what are the 2 common pathological feature?

A

Beta amyloid, hyperphosphorylated tau

aka plaques and tangles

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27
Q

What is the first line tx for Alzheimer’s dementia?

A

Aricept

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28
Q

Which dementia is characterized by hallucinations?

A

Lewy Body

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29
Q

What is the first line maintenance therapy for Vasospastic Angina?

A

CCBs

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30
Q

What is an EKG findings in Prinzmetal Angina?

A

NL or ST elevation during episode

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31
Q

Name 2/4 statin benefit groups

A
  1. ASCVD
    - high dose statin
  2. Pts with LDL-C ≥190mg/dl
    - high dose statin
  3. Pt 40-75 with DM and LDL-C 70-189 mg/dl
    - moderate statin
  4. Pt 40-75 w/ risk ≥7.5% and LDL-C 70-189 mg/dl
    - moderate statin
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32
Q

What test is used to monitor pts on statins?

A

Fasting lipid panel

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33
Q

What’s the first line alternative medication to use on patients who do not tolerate statins?

A

Ezetimibe

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34
Q

ACA stroke Sx

A

cerebral-leg

UMN- Spastic paralysis

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35
Q

MCA Stroke Sx

A

cerebral- arm, hands, and head
Homonymous hemianopsia
UMN- Spastic paralysis

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36
Q

LCA Stroke Sx

A

Vision issues

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37
Q

Lacunar Infarction Sx

A

Posterior Limb of Internal Capsule (hemiparesis, ataxia), Basal Ganglia,
Thalamus (sensory deficit),
Pons (Dysarthria/CLUMSY HAND)

  • Lacumar are usually pure motor or pure sensory
  • -often assoc. w/Chronic HTN
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38
Q

Cerebellar Stroke

A

dizziness, nausea difficulty standing

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39
Q

Wells Criteria PE (7)

A
  1. Clinical findings of DVT (leg swelling, pn w/palp)
  2. Other Dx less likely than PE
  3. HR >100
  4. Immobilizatoion or surg in past 4 wks
  5. Prev. DVT/PE
  6. Hemoptysis
  7. Malignancy
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40
Q

Scores- PE likely vs PE unlikely

A

> 4 -likely

< (or equal to) 4- unlikely

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41
Q

Epidural Hematoma Vessel & finding

cross cranial sutures?

A

Middle meningeal a

lens shaped collection of blood,
does NOT cross cranial sutures

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42
Q

Subdural Hematoma Vessels & findings

cross cranial sutures?

A

tear of bridging veins
acceleraing/decelerating injuries

Crescent shaped collection of blood

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43
Q

Which vertigo-causing condition usually presents after a URI?

A

Labyrinthitis

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44
Q

Which form of nystagmus is the most concerning and why?

A

Vertical,

CNS issue

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45
Q

What anticoagulant do you prescribe for a patient with a mechanical valve?

A

Warfarin

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46
Q

Which lab do we continuously monitor for a patient on warfarin and what should the value be?

A

NL INR 2-3

Mechanical Heart Valve 2.5-3.5

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47
Q

How would you treat a patient with Afib before a scheduled cardioversion?

A

Anticoags 1mo before AND after cardioversion

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48
Q

Which test for Myasthenia Gravis will improve its symptoms?

A

Ice Pack Test

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49
Q

What can be used to differentiate between MG and botulism in terms of symptoms (not including the pattern of paralysis, ie descending paralysis)?

A

Fatigeability

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50
Q

What are the categories for CHADS2 and what does a value of 2+ signify?

A

CHF, HTN, Age > or = 75 yo, DM, Stroke (2 pts)

2+ pts = Anticoagulation indicated

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51
Q

1st test to order if growth hormone excess is suspected

A

IGF-1

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52
Q

Most common cause of acromegaly

A

Benign pituitary adenoma

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53
Q

Manifestations of Acromegaly (

A
  1. enlargement (hands, feet, jaw, internal organs)
  2. HTN
  3. DM2
  4. CHF
  5. cardiomegaly
  6. MAcroglossa
  7. deep voice
  8. OSA
  9. Spinal stenosis
  10. arthralgias
  11. wt gain
  12. hypogonadism
  13. decreased libido/ED
  14. irregular menses
  15. temporal hemianopsia
  16. HA
  17. thick skin
  18. hyperhydrosis
  19. acne/skin tags
  20. colon polyps
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54
Q

The gold standard lab test for confirming acromegaly

A

1hr glucose tolerance test

Should inhibit GH secretion in NL ppl

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55
Q

functions of GH (4)

A
  1. ↑ Ca2+ retention
  2. ↑ Muscle mass
  3. Stim growth of internal organs
  4. lipolysis
  5. homeostasis
  6. pancreatic islet cell function
  7. ↑ protein synthesis
  8. ↓ liver uptake of glucose
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56
Q

What is the middle layer of the adrenal cortex and what does it secrete?

A

Fasiculada

Glucocorticoids (cortisol)

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57
Q

Name the 3 areas you expect to see affected by tumors in MEN1

A
  1. Parathyroid
  2. Anterior pituitary
  3. Pancreas
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58
Q

Classic triad of pheochromocytoma

A

HA
Sweating
Tachycardia

59
Q

Name BOTH initial tests you could order if you suspect pheochromocytoma

A
  1. 24hr urine metanephrines/catecholamines

2. plasma fractionated metanephrines

60
Q

If a patient has bilateral adrenal hyperplasia causing hyperaldosteronism or surgery isn’t an option, what is the first line medication?

A

Spirnolactone (Aldactone)

61
Q

Main lab abnormality you expect to see in a patient with hypoaldosteronism

A

Hyperkalemia

62
Q

Name 3 main end points or functions of aldosterone

A
  1. ↑ Na+ & H2O RESORPTION in kidneys
  2. ↑ plasma volume (BP)
  3. ↑ H+ SECRETION
  4. ↑ K+ SECRETION
63
Q

What is the other name for an adrenal adenoma that causes hyperaldosteronism?

A

Conn’s syndrome

64
Q

Name 3 classic clinical findings you’d expect to see in a patient with hyperaldosteronism

A
  1. Difficult to control HTN
  2. Hypokalemia
  3. Hypernatremia
  4. metabolic alkalosis
65
Q

If a patient has a high plasma aldosterone concentration and a high plasma renin activity, what type of hyperaldosteronism do they likely have?

A

SECONDARY HYPERALDOSTERONISM

(if the KIDNEY’S SECRETION OF RENIN IS STIMULATING HYPERALDOSTERONISM, then BOTH aldosterone and renin would be ↑)
(remember renin can be stimulated by things like CHF, cirrhosis, volume depletion, etc)

66
Q

Which is the main hormone that is underproduced in Adrenal insufficiency?

A

Cortisol

may also see ↓ aldosterone and DHEA

67
Q

What is the basic pathophysiology of tertiary adrenal insufficiency?

A

There is a lack of CRH from the hypothalamus.

68
Q

If a patient with adrenal insufficiency gets sick, what do you need to treat them with?

A 
Stress dose (↑ steroids) 
because cortisol secretion normally ↑  with stress/injury/illness
69
Q

Name 2 features that you expect to see in primary but not secondary or tertiary adrenal insufficiency

A
  1. Hyperpigmentation
  2. Hyperkalemia
  3. dehydration
  4. GI sx
70
Q

What medications are you going to maintain a patient with primary Adrenal Insufficiency on on a daily basis?

A
  1. Florinef + Hydrocortisone/prednisone

can also add DHEA

71
Q

Where is Cushing’s disease localized?

A

the anterior pituitary

oversecretes ACTH

72
Q

Name 4 common clinical manifestations of Cushing’s Syndrome

A
  1. buffalo hump
  2. moon facies
  3. striae
  4. central obesity
  5. skin atrophy
  6. fungal infections
  7. acanthosis nigricans
  8. hirsuitism
  9. increased CV dz
  10. psych manifestations
  11. increased infections
  12. proximal muscle wasting
73
Q

What is the treatment of choice in Cushing’s disease?

A

Transsphenidal resection

74
Q

Most common cause of an ectopic ACTH-producing tumor?

A

Small cell lung cancer

75
Q

Name the 3 first-line tests that can show increased cortisol

A
  1. Low dose dexamethasone suppression text
  2. late night cortisol level
  3. 24hr urinary free cortisol excretion
76
Q

eczema (atopic dermatitis), allergic rhinitis, asthma

A

Atopic Triad

77
Q

asthma, nasal polyps, and NSAID sensitivity

A

Samster’s triad

78
Q

New asthma prevention

A

SABA + ICS- just know this one.

79
Q

Copious, foul-smelling sputum
“tram tracks”-mucous lining airways, atelectasis

Gold standard: CT chest

A

Bronchiectasis

80
Q

Inhaled corticosteroids and bronchodilators

A

Bronchiectasis

81
Q

Measured FVC / Predicted FVC

If < 80% of predictive →

A

Restrictive lung dz

82
Q

Most common cause of interstitial lung disease

A

idiopathic interstitial PNA

83
Q

Lungs (90%) & lymph nodes are most common
*Bilateral Hilar Adenopathy (diagnostic)
Prednisone 20-40mg QD x 4-6wks

A

Sarcoidosis

84
Q

> 25 mmHg at rest or
30 mmHg with exertion

  1. Idiopathic –majority of cases

Definitive Dx:
Swan-Ganz Catheter

Anticoagulation
Digoxin

A

Pulm HTN

85
Q

Often a few days after a URI

Sudden onset of sharp, localized pn that is worse w/coughing, deep breathing, & mvmt

A

Pleurisy

86
Q

The most common reason for a healthcare provider visit
90% viral (Rhinoviruses 30%- 35%
Influenza and adenovirus-30%)

Tx:
APAP/NSAIDs

A

URI

87
Q
  1. Anchor on LAMA & LABA

2. Anchor on corticosteroids (ICS)

A
  1. COPD

2. Asthma

88
Q

Measured FEV1 / Measured FVC

If <70% →

A

Obstructive process

89
Q 
Hyper or hypopigmented patches
Dx:
KOH: Spaghetti & meatballs under microscope**
Tx:
topical antifungal
A

Tinea Versicolor

90
Q
  1. AKA adjustment insomnia or acute insomnia
    Sx <3 months
    In response to an identifiable stressor
  2. Sx ≥3x/wk & persist ≥3mo
A
  1. short term insomnia

2. chronic insomnia

91
Q

Tx Longterm Insomnia

A

CBT-I 1st line

92
Q

Loss of orexin-A & orexin-B
Type 1: with cataplexy
Type 2: without cataplexy

Epworth Sleepiness Scale usually >15

A

Narcolepsy

93
Q

If Hx suggests, Dx by

Polysomnogram

A

Narcolepsy

94
Q

narcolepsy 1st line Tx

A

Modafinil (Provigil)

95
Q

Most common sleep-related breathing disorder

A

Sleep apnea

96
Q

Dx 1st line for Sleep apnea

A

in-laboratory polysomnography

97
Q

≥ 15 obstructive resp events/hr of sleep,
or
≥ 5 obstructive resp events/ hour of sleep in pt w/ ≥ 1 of the following:
1. Sleepiness, nonrestorative sleep, fatigue, or insomnia symptoms
2. Waking up with breath holding, gasping, or choking
3. Habitual snoring, breathing interruptions, or both noted by bed partner/observer
4. HTN, mood disorder, cognitive dysfunction, CAD, CVA, CHF, AF, or DM2

A

Sleep apnea Dx

98
Q

sleep apnea Tx

A

Weight loss

Continuous positive airway pressure (CPAP)

99
Q

1 cause of hepatic cellular carcinoma

A

HEP B

100
Q

Prevnar 13

A

pneumococcal

101
Q

the MOST contagious of all infectious diseases

A

Measles (2 doses)

102
Q

3 C’s of measles

A

Cough, Coryza, Conjunctivits

103
Q

HPV Bad strains

A

16 & 18

104
Q

TDaP booster dose

A

Q10y

105
Q 
Hep B 3 doses
DTaP 4 doses
Hib  3 - 4 doses*
Polio 3 doses
Prevnar 4 doses
MMR 1 dose
Varicella 1 dose
A

Vaccines by age 7

106
Q

2 newborn prophylaxis Tx

A

Erythromycin ointment- important!

Vit K

107
Q

*The greater the degree of prematurity the higher the risk of complications

A

rule of thumb

108
Q

Systemic illness due to bacteria in the bloodstream-typically w/in 1st 72hrs

most likely-Hyperthermia, Tachycardia, Respiratory Distress

A

Neonate Sepsis

109
Q

How to calculate neonate birth wt

A

(Birth Weight - Current Weight)/ Birth Weight

110
Q
  1. Have more RBC’s (delayed cord clamping)
  2. Liver is immature
  3. Body can’t clear it (no bacterial capacity to conjugate bilirubin
A

why babies get jaundice

111
Q

If it is _______ bilirubinemia- call hepatology! NOT GOOD!

A

Conjugated

112
Q

Caput succedaneum-

A

cone head

crosses suture line

113
Q

Cephalohematoma

A

Does not cross the suture line

114
Q

Ortolani & Barlow tests

A

(try to dislocate hip)

115
Q

Bilirubin-induced neurologic dysfunction

-crosses BBB and causes neuro issues.

A

BIND

116
Q

Ethical Decision Making Matrix

A
  1. Non maleficence- medical knowledge,
  2. justice- context (legal, financial, cultural, social)
  3. Beneficence- quality of life
  4. autonomy- pt preference
117
Q

rule of 7s

A

pediatric capacitance to understand.
children lack the capacity to make medical decisions

=breakdown childhood ranges every 7yrs.
0-7y, 7-14y, 14-21y

Can 15yo pt decide to withold life-saving measures? NO

118
Q

ethical principle that minors are capable of participating at some level in decision-making related to their care.

A

Assent

119
Q

Best Interest Standard
Parents are obligated to make decisions that best maximize the well-being of their children
Rests on value judgments

Harm Principle
Parents cannot make decisions that will harm their children

A

Pediatric Ethic principles

120
Q

Most common cause of intermittent stridor in infants

A

Laryngomalacia

121
Q

gold standard Tx for FB upper airway

A

Bronchoscopy

122
Q 
Viral croup 
Laryngotracheobronchitis
Epiglottitis 
Supraglotittis
Bacterial tracheitis
A

Croup syndromes

123
Q

Most common: Parainfluenza

Steeple Sign

A

croup

124
Q

Medical emergency

Haemophilus influenzae

Cherry- red and swollen epiglottis

Thumb Sign

A

epiglottitis

125
Q

Most common pediatric airway emergency requiring PICU admission

Subglottic narrowing
Copious purulent tracheal secretions and membranes

A

Bacterial Tracheitis

126
Q

Most common serious acute respiratory illness in infants & young children

Most common organism:
RSV

A

Bronchiolitis

127
Q

Acute onset**
1-2d fever, rhinorrhea, cough, then…
Tachypnea
Expiratory Wheezing

Will see with a preceding illness

A

Bronchiolitis

128
Q

Suxygen
Maintain hydration
Albuterol and racemic epi should NOT be used

A

Bronchiolitis Tx

129
Q

70% cases of bronchiolitis

40% cases of pneumonia

A

RSV

130
Q 
Complications
Otitis media: most common
Typical onset 3-4 days after onset
Pneumonia *****
Coinfection with Staph aureus (the PNA causes death)
A

Influenza

131
Q

Oseltamivir (Tamiflu®) A & B

DO NOT GIVE AMANTIDINE & RIMANTIDINE
-Flu is resistant

A

Flu Tx

132
Q

Annual vaccination is best way to prevent influenza!***

A

Best way to prevent flu

133
Q

which flu vaccine?

not for use in pts:
prengnacy
cochlear implant
immunocompromised

A

Nasal spray, (live attenuated)

134
Q

Highly communicable

Organism:
Bordetella pertussis

Severe bronchitis

50% of children <12mo are hospitalized

A

Pertussis

135
Q

Stages of Pertussis

A 
Cataharral: 7-10d
coryza, irritating cough
Paroxysmal: 1-6wks
Vomiting coughing
"whoop" cough on inspiration
Convalescent: 7-10d
136
Q

the single greatest cause of death in otherwise healthy children***
>2 million children die

Lung exam
Crackles
↓ breath sounds (bronchophony, tactile fremitus)
Consolidation
Wheezing
Viral and atypical

First 2 years of life, up to 80% viral

A

Pneumonia

137
Q

15% of newborns with CF present with:
____ _____
Diagnostic of CF

A

Meconium Ileus

138
Q

15-month-old male present with inspiratory stridor audible without a stethoscope and RR of 40 bpm. There are moderate intercostal retractions, and no cyanosis. After one course of racemic epinephrine, which is the next best management plan?
A. Cool mist room humidification (not recomm)
B. Dexamethasone IM, one dose
C. Aerosolized ribavirin
D. Chest physical therapy

A

B. Dexamethasone IM, one dose

139
Q 
A 10-month-old presents for evaluation of noisy breathing and barking cough that gets worse at night.  There is a one week history of rhinorrhea, low-grade fever, and cough.  The cough has progressively worsened over the past 3 days.  On exam: RR 50bpm, T 100.6, inspiratory stridor, barking cough.  Remainder of exam unremarkable.  What is the most likely diagnosis?
A. Croup
B. Epiglottitis
C. Foreign Body in trachea
D. Pneumonia
A

A. Croup

140
Q 
A 4-month-old infant presents with acute onset of tachypnea, cough, rhinorrhea, expiratory wheezing.  Which is the most likely cause?
A. Influenza
B. Adenovirus (looks like kawasaki)
C. Streptococcus pneumoniae
D. Bronchiolitis
A

D. Bronchiolitis

141
Q

Most common EKG finding for PE is ____

Can also see ______

A

NSR

S1Q3T3

142
Q

QT longer than _____sec (_____sec always long)

2.5 large boxes long

A

longer than 0.47sec

143
Q

Q waves >2mm

A

pathological Q waves

144
Q

EKG: LVH, deep Q waves without h/o prior heart disease, large inverted T Waves
Present all the time

A

HOCM

Finals (24 decks)

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