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from flashcardlet > MKSAP: Medicine > Flashcards

MKSAP: Medicine Flashcards

0
Q

PIP and DIP: OA or RA?

A
  • PIP = RA

- DIP = OA

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1
Q

Leukocyte count in synovial fluid of: OA? Gout & pseudogout? Septic arthritis?

A
  • OA = < 2,000
  • Gout & pseudogout = 2,000 - 50,000
  • Septic arthritis = > 50,000
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2
Q

What are postmetopausal women who use diuretics at an increased risk for?

A

-tophaceous gout of the DIP joints

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3
Q

Typical pt with patellofemoral pain syndrome?

A

-young active woman with anterior knee pain that is worsened by going down steps

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4
Q

Best screening test for pts with suspected hemochromatosis?

A

-transferrin saturation measurement

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5
Q

What 2 physical exam tests can be used to dx a meniscal tear?

A
  1. Pain along the joint line –> 76% sensitive

2. McMurray test –> 97% specific

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6
Q

2 most common cause of nongonococcal septic arthritis in adukts?

A
  • gram-positive bacteria:
    1. Strep
    2. Staph aureus –> most common
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7
Q

Typical presentation of vasculitic neuropathies?

A

-acute onset of asymmetrical weakness and sensory loss with severe pain

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8
Q

Typical age of onset of polymyalgia rheumatica?

A

> 50 yrs

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9
Q

Aa

A

Aa

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10
Q

3 Ssx of polymyalgia rheumatica?

A
  1. Pain and morning stiffness in axial joints and proximal muscles
  2. No evidence of joint inflammation or muscle weakness
  3. Elevated sed rate
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11
Q

What is calcifications of cartilage pathognomonic for?

A
  • pseudogout (AKA: calcium pyrophosphate deposition dz)
  • esp in fibrocartilage of knee meniscus, symphysis of the pubis, glenoid and acetabular labra, and the triangular cartilage of wrist
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12
Q

Tx for polymyalgia rheumatica?

A

-corticosteroids

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13
Q

Aside from “bronze diabetes” what are 4 Ssx of hemachromatosis?

A
  1. Abnormal liver chemistries
  2. Arthropathy
  3. Fatigue
  4. Impotence
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14
Q

Tx for patellofemoral pain syndrome?

A
  • rest

- NSAIDs

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15
Q

Ottawa Knee rules for obtaining an xray in a pt with acute knee pain (4)?

A
  1. Pt > 55 yrs old
  2. Tenderness in the head of the fibula or patella
  3. Inability to flex to 90*
  4. Cant bear weight immediately AND during the exam
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16
Q

What is the most common cause of knee pain in pts < 45 yrs old?

A

-patellofemoral pain syndrome

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17
Q

Tx for pts with infection of a closed space septic arthritis?

A
  1. IV antibiotics

2. Joint drainage

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18
Q

Migratory arthralgias in a sexually active pt: most likely dx? Tx?

A
  • dx: disseminated gonrrhea

- tx: ceftriaxone

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19
Q

How does a pt typically describe the injury that caused their meniscal tear injury?

A
  • twisting injury with the foot in a weight-bearing position
  • popping or tearing sensation felt that is followed by severe pain
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20
Q

DLCO in emphysema?

A

-reduced due to loss of parenchyma –> less surface area for diffusion

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21
Q

Most common cause of hemothorax

A

-trauma –> blunt or penetrating (including iatrogenic)

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22
Q

What contains isocyanates? What health consequence can they have?

A
  • found in polyurethane paints

- can be potent sensitizers in some pts with asthma

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23
Q

Tx for pt who is heterozygous for factor V Leiden mutation with recurrent thrombosis?

A

-long-term warfarin

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24
Q

DVT/PE prophylaxis in a pt who is at risk but heparin is contraindicated?

A

-intermittent pneumatic compression

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25
Q

Describe malignant pleural effusions?

A
  1. Lymphocytic

2. Exudative

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26
Q

What characteristic means that a malignant pleural effusion has poor prognosis?

A
  • pleural fluid glucose of < 60mg/dL

- means less than 6 mnth survival!

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27
Q

Dx of exercise-induced asthma?

A

-confirmed with an exercise challenge test in which there is a post exercise > 20% fall in FeV1

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28
Q

Tx for secondary pneumothorax?

A

-tube thoracostomy

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29
Q

Malignant pleural effusions: usually transudative or exudative?

A

-exudative

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30
Q

Exercise induced asthma tx?

A
  • SABA 5-10 min before exercise

- works 80% of the time

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31
Q

Maintenance Tx for a pt with a malignancy and venous thromboembolism?

A

-low-molecular-weight heparin

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32
Q

What is more serious, primary or secondary pneumothorax?

A

-secondary, becuase it is due to an underlying lung disease, so the lung function is already compromised!

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33
Q

What position should a pt with suspected hemothorax be examined in? Why?

A
  • upright

- supine position will obscure the findings

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34
Q

PCO2 in asthma attacks?

A
  • decrease in mild acute asthma exacerbations
  • normal in moderate to severe exacerbations
  • elevated in very severe exacerbations –> ominous sign, can be a sign of respiratory distress!
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35
Q

Preferred test for dx of PE?

A

-contrast-enhanced spiral CT

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36
Q

Lofgren’s syndrome?

A
  • triad of sx in the presentation of sarcoidosis:
    1. Bilateral hilar lymphadenopathy
    2. Polyarthraligias
    3. Erythema nodosum
  • triad of presenting sx is seen in 25-50% of pts with sarcoidosis, esp in females
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37
Q

Cough that occurs with sensitivity to cold is a clinical marker of? How can it be confirmed?

A
  • clinical marker of airway hyperresponsiveness

- can be confirmed via methacholine challenge test

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38
Q

Tx of acute severe asthma?

A

-bronchodilators after systemic corticosteroid tx

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39
Q

Dx of a cough-variant asthma?

A

-trail of albuterol inhaler that resolves sx

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40
Q

How many years does the pneumovax kast?

A

-about 5 yrs

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41
Q

What do you do next in a pt on low or moderate -dose inhaled corticosteroids that still has persistent asthma sx?

A

-add a LABA

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42
Q

Tx for a previously well controlled asthmatic following a respiratory tract infection?

A

-short course of oral steroids

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43
Q

3 Benefits of pulmonary rehab?

A
  1. Improves sx
  2. Improves exercise endurance
  3. Improves quality of life
    * * does NOT increase survival of pt though!
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44
Q

Methacholine test: describe

A
  • give a pt suspected to have asthma increasing doses of methacholine until they have a fall in FEV1 of > 20%
  • calculate the provocative concentration (PC20) using a dose response curve
  • a PC20 of < 4 mg/mL = asthma
  • PC20 of 4-16 = hyperreactivity
  • PC20 > 16 = normal
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45
Q

What 3 characteristics mean chest tube drainage should be used for a parapneumonic effusion?

A
  1. Pus detected
  2. Gram-positive pleural fluid
  3. pH < 7.0
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46
Q

What 3 things can a erythrocyte count in pleural fluid of >100,000 mean?

A
  1. Trauma
  2. Pulmonary infarction
  3. Pleural malignancy
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47
Q

Pts with Hoddkin’s lymphoma who received extended-field radiation tx are at risk for?

A

-developing solid tumors

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48
Q

What is the best tx for a pt with cancer of the head of pancreas?

A
  • Whipple procedure = pancreaticoduodenectomh

- best chance of cure

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49
Q

Tx for pt with metastatic small-cell lung cancer?

A

-combo of chemo and whole brain radiation

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50
Q

What should be given to a cancer pt with pain that ceases to respond to short-term pain management?

A
  • long-acting narcotics

- morphine is better than oxycodone bc oxy is more expensive

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51
Q

What should you do for a women with an abnormal pap smear that shows atypical squamous cells?

A

-HPV testing

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52
Q

Tx for widely metastatic non-small cell lung cancer?

A

-hospice

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53
Q

What what type of pancreatic cancer causes pain and weight loss?

A

-pancreatic body or tail

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54
Q

What should be done next for a pt with a PSA > 4 ?

A

-transrectal ultrasound-guided prostate biopsy

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55
Q

Women on combination hormone replacement tx are at risk for which cancer?

A

-breast cancer

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56
Q

What are the 2 most common causes of malignant pericardial dz?

A
  1. Breast cancer

2. Lung cancer

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57
Q

Next step for an asymptomatic pt positive for fecal occult blood?

A

-colonoscopy

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58
Q

What can be done to reduce risk for squamous cell carcinoma and melanoma?

A

-avoiding direct sunlight during peak hours and other sun avoiding stratagies

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59
Q

What medication can help reduce the risk of prostate cancer?

A

-finesteride

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60
Q

Malignant v. Benign lung nodules: margins?

A
  • malignant: spiculated

- benign: smooth

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61
Q

What medication can be used to reduce the risk of breast cancer in pts who have elevated risk for breast cancer?

A

-tamoxifen

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62
Q

Malignant v. Benign lung nodules: calcification?

A
  • malignant: little or no

- benign: central, diffuse, or laminated

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63
Q

Which cancer causes obstructive jaundice and weight loss?

A

-cancers of the pancreatic head

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64
Q

Malignant v. Benign lung nodules: growth?

A
  • malignant: intermediate doubling

- benign: no or slow growth

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65
Q

Tx for hepatic encephalopathy?

A

-acyclovir

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66
Q

When should thrombolytic tx be started?

A

-must be started within 3 hrs of the onset of sx (or last time the pt was known to be well)

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67
Q

3 features of Lewy Body dementia?

A
  1. Fluctuating cognition
  2. Parkinsonism
  3. Visual hallucinations
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68
Q

5 Characteristics of toxic encephalopathy?

A
  1. Cognitive impairment
  2. Fluctuating lethargy
  3. Inattention
  4. Hallucinations
  5. Asterixis
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69
Q

7 Ssx of vertebral artery stroke?

A
  1. Horner’s syndrome
  2. Dysarthria
  3. Dysphagia
  4. Decreased pain & temp
  5. Dysmetria
  6. Ataxia
  7. Vertigo
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70
Q

5 Ssx of Demyelinating polyneuropathy?

A
  1. Symmetrical proximal muscle weakness
  2. Symmetrical distal muscle weakness
  3. Decreased deep tendon reflexes
  4. Distal loss of vibration senses
  5. Distal loss of position senses
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71
Q

When can do chronic daily headaches occur?

A
  • they can occur when a pt with migranes or tension headaches take analgesics too frequently
  • these migranes and tension headaches “transform”
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72
Q

What is the most common cause of fatal sporadic encephalitis in the US?

A

-herpes encephalitis

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73
Q

Tx for cluster headache?

A
  • prednisone

- oxygen

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74
Q

What tx can help improve sx in a pt w/ mild/moderate Alzheimer’s?

A

-cholinesterase inhibitors can have a modest effect on cognition

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75
Q

What 2 meds should be given to cover s. Pneumo and n. Meninigitis in empiric menigitis tx?

A
  1. Ceftriaxone

2. Vancomycin

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76
Q

What is alteplase?

A
  • thrombolytic agent that is a recombinant tissue-type plasminogen activator
  • must be given within 3 hrs of the onset of sx
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77
Q

4 Characteristics of vascular dementia?

A
  1. History of vascular risk factors
  2. Abrupt onset with subsequent improvement
  3. Periventricular white matter ischemia on imaging
  4. Focal neurological findings on exam
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78
Q

What is “locked in” syndrome due to?

A

-lesion in the base of the pons usually from a pontine infarction due to a basilar artery occlusion

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79
Q

What should be done in a pt with suspected subarachnoid hemorrhage but normal CT scan?

A

-do an LP to check for blood or xanthochromia

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80
Q

5 Ssx of herpes encephalitis?

A
  • rapid development of:
    1. Fever
    2. Headache
    3. Seizures
    4. Focal neurologic signs
    5. Impaired conciousness
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81
Q

What should you think of as a cause of meningitis in a transplant pt? Tx?

A
  • listeria

- penicillin

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82
Q

What are monomorphic or intact erythrocytes characteristic of when found in urine sediments?

A

-nonglomerular hematuria

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83
Q

What electrolyte imbalance can occur in a pt taking hydrochlorothiazide

A

-hyponatremia

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84
Q

Common cause of nephrotic syndrome in children and adults?

A

-minimal change disease

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85
Q

What electrolyte imbalance does sarcoidosis cause? Why?

A
  • hypercalciuria and hypercalcemia
  • the granulomatous tissue can produce 1-alpha-hydroxylase –> converts 25-hydroxyvitamin D to the active form, 1-25-dihydroxyvitamin D3 –> more absorption of calcium via vit D toxicity
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86
Q

Abdominal pain and an increasing creatinine level in an elderly man?

A

-consider acute renal failure caused by urinary tract obstruction

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87
Q

5 Characteristics of acute glomerulonephritis?

A
  1. HTN
  2. Edema
  3. Proteinuria
  4. Glomerular hematuria
  5. Erythrocyte casts in urine
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88
Q

Which comes first diabetic retinopathy or nephropathy?

A

-retinopathy!

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89
Q

4 Characteristics of nephrotic syndrome?

A
  1. Urine protein excretion > 3.5 g/day
  2. Hyperlipidemia
  3. Hypoalbuminemia
  4. Edema
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90
Q

Electrolytes in primary hyperparathyroidism?

A
  • elevated serum calcium
  • low phosphorus
  • elevated hypercalcemia
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91
Q

Tx and prognosis of atheroembolic acute renal failure?

A

-no tx and the renal function does not usually return

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92
Q

What acid/base disturbance often develops in a pt with ESLD? Why?

A
  • respiratory alkalosis
  • the liver normally metabolizes steroid hormones, the elevated prostaglandin levels in ESLD cause a stimulation of the respiratory drive –> primary resp alkalosis
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93
Q

Formula to calculate osmolality?

A

2*[Na]+[glucose]/18+[BUN]/2.8

-normal gap < 10

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94
Q

What electrolyte abnormality can be caused by ACEi? What drug should be used instead in these pts?

A
  • hyperkalemia

- instead use: hydralazine/nitrate combo to control the BP

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95
Q

What can hypomagnesium in pts with alcoholism mimic? Why?

A
  • can mimic hypoparathyroidism with hypocalcemia
  • hypomagnesium can cause suppression of parathyroid hormone secretion and resistance to PTH action
  • so magnesium needs to be corrected in order to correct the calcium
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96
Q

4 Characteristics of hypertensive nephrosclerosis?

A
  1. HTN
  2. Non-nephrotic proteinuria
  3. Bland urine sediments
  4. Slowly progressive loss of kidney function
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97
Q

Which pathogen is associated with HUS?

A

-E. Coli O157:H7 shiga toxin

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98
Q

What rash is characteristic of atheroembolic acute renal failure?

A
  • fine reticular rash, livedo reticularis

- red, lacy rash

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99
Q

Why does hypomagensium occur in alcoholics?

A

-acute alcohol ingestion induces magnesium loss via urine

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100
Q

Acetazolamide: what is it? What acid/base disturbance can it cause? Why?

A
  • carbonic anhydrase inhibitor

- can cause a non-ion gap metabolic acidosis –> prevents the reabsorption of bicarb in the proximal tubule

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101
Q

Classic triad of sx for acute interstitial nephritis?

A
  1. Fever
  2. Rash
  3. Arthralgias
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102
Q

What classifies as ACEi-induced prerenal acute renal failure? Tx?

A
  • increase of creatinine >30% after the initiation of an ACEi or ARB (less than 30% is tolerable, an increase in creatinine is expected with these drugs)
  • tx: stop the ACEi or ARB
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103
Q

Low anion gap? Common cause?

A
  • less than 6

- hypoalbuminemia

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104
Q

Muddy brown casts?

A

-acute tubular necrosis

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105
Q

Anion Gap formula?

A

= [Na+] - ([Cl-] + [HCO3-])

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106
Q

How long after an arterial catheter can atheroembolic acute renal failure occur?

A

-1-4 weeks afterwards

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107
Q

4 Characteristics of multiple myelomma?

A
  1. Calcium is elevated
  2. Anemia
  3. Renal failure
  4. Bone lesions
    * *“CRAB”
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108
Q

General characteristic of SIADH?

A

-patient is unable to make dilute urine

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109
Q

3 features of ethylene glycol poisoning?

A
  1. Elevated Anion gap metabolic acidosis
  2. Elevated osmolar gap
  3. Calcium oxalate crystals in urine
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110
Q

Decreased pH and bicarb?

A

-metabolic acidosis!

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111
Q

Osmolar gap?

A
  • difference btwn the calculated and measured osmolality

- normal < 10

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112
Q

What are dysmorphic erythrocytes associated with when they are found in urine sediments?

A

-glomerular hematuria

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113
Q

Mechanism for how NSAIDs can cause prerenal acute renal failure?

A

-inhibition of prostaglandin synthesis causes vasoconstriction –> decreased glomerular capillary pressure –> acute renal failure

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114
Q

Normal anion gap

A
  • = 6-11
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115
Q

Common cause of mixed anion gap metabolic acidosis and respiratory alkalosis?

A

-salicylate toxicity

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116
Q

Oval fat bodies in urine?

A

-hallmark of proteinuria

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117
Q

C3 and C4 levels in SLE nephritis?

A

-C3 and C4 will be really low!

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118
Q

5 Characteristics of minimal change disease?

A
  1. Edema
  2. Hypoalbuminemia
  3. Hyoercholesterolemia
  4. Urine protein excretion of >3.5 g/24hrs
  5. Numerous oval fat bodies in urine –> “ maltese cross”
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119
Q

In what kidney disease are ACEi contraindicated? Why?

A
  • bilateral renal artery stenosis bc in these pts the GFR is maintained by an angII-induced vasoconstriction at the efferent arterioles
  • *switching to an ARB will NOT solve this problem!
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120
Q

Best screening test for diabetic nephropathy?

A

-measurement of microalbumin

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121
Q

Dipstick-positive hematuria, but no intact eyrthrocytes on microscopic analysis of urine sediments?

A

-think: rhabdomyolysis-associated acute renal failure

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122
Q

C3 and C4 levels in postinfectious glomerulonephritis?

A
  • low C3

- normal C4

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123
Q

What is the normal response to a fluid deprivation test?

A

-increasing urine osmolarity

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124
Q

What does an elevated osmolar gal mean? Common causes?

A
  • means there is a presence of an unmeasured osmole

- causes: ethylene glycol or methanol

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125
Q

What type of casts are seen in acute interstitial nephritis?

A

-leukocyte casts

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126
Q

Winter’s formula?

A

-Expected PCO2 = 1.5*[HCO3-]+ 8

+/-2

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127
Q

Primary metabolic acidosis plus a PCO2 higher than expected?

A

-mixed metabolic and respiratory acidosis

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128
Q

4 Characteristics if Wegener’s granulomatosis?

A
  1. Upper respiratory dz
  2. Lower respiratory dz
  3. Glomerulonephritis
  4. C-ANCA
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129
Q

Glomerular nephritis + alveolar hemorrhage?

A

-Goodpasture’s syndrome

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130
Q

Three most common causes of vaginal discharge?

A
  1. Candidal infection
  2. Trichomonias
  3. Bacterial vaginosis
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131
Q

Definition of sepsis?

A

-SIRS in response to confirmed infectious process

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132
Q

What tx has shown to have the most impact on survival in a pt with severe sepsis?

A

-aggressive fluid resuscitation within 6 hrs!

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133
Q

What post surgery sx means the pt is more likely to have a periprosthetic infection?

A
  • periosthetic pain

- those who are pain-free aftery surgery are less likely to become infected

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134
Q

What imaging is preferred for the dx of osteomyelitis?

A

-MRI (best) or CT

135
Q

Oral antiviral agent used to tx uncomplicated genital herpes simplex virus?

A

-oral valacyclovir

136
Q

Prophylaxtic tx for an immunocomp, nonvaccinated pt exposed to the flu?

A
  1. Zanamivir or oseltamivir

2. Inactivated flu vaccine

137
Q

What is the best solution to use to clean a catheter insertion site?

A

-chlorhexidine

138
Q

What PPD cutt-off range are adolescents who are exposed to adults in high-risk category in?

A

-> 10

139
Q

Which heart valve is the most susceptible to an abscess formation?

A

-the aortic valve and its adjacent ring

140
Q

Tx for orthopedic implant-associated osteomyelitis?

A
  • surgical debridement and removal of infected implant

- plus IV antibiotic

141
Q

Tx of acute pyelonephritis in a pt who is: compliant, can eat and drink, and not pregnant?

A

-oral levofloxacin

142
Q

Definition of severe sepsis?

A

-sepsis with organ dysfunction, hypoperfusion, or hypotension

143
Q

What contact precautions should a suspected or confirmed TB patient be tx with?

A

-airborne isolation + personal respirators for the hospital staff

144
Q

What extrapulmonary manifestations are common with legionella pneumonia?

A
  1. Hyponatremia
  2. Azotemia
  3. Elevated live enzymes
  4. Elevated creatine kinase
145
Q

What is the best way to decrease the risk of UTIs from catheters?

A
  • remove the catheter

- no other method (prophylactic antibiotics, disinfecting wash, etc) has been useful

146
Q

Latent TB tx?

A

-isoniazid for 9 mnths

147
Q

5 Ssx of bacterial vaginosis?

A
  1. Homogenous white discharge
  2. Absence of vaginal erythema
  3. Presence of clue cells
  4. Vaginal pH > 4.5
  5. Vaginal discharge with malodorous “fishy” odor
148
Q

What kind of drugs are oseltamivir and zanamivir? What are they used for?

A
  • neuraminidase inhibitors
  • both active against influenza A and B
  • zanamivir can cause bronchospasm –> CONTRAINDICATED IN ASTHMA!!
149
Q

Pt with recurrent GI and resp infections, what disease should you think about? Dx?

A
  • think: common variable immunodeficiency (AKA acquired hypogammaglobulinemia)
  • dx: measure serum IgG levels
  • *recurrent GI infections especially with giardiasis!
150
Q

Septic shock definition?

A
  • sepsis-induced hypotension or hypoperfusion abnormalities despite adequate fluid resuscitation
  • this dx cannot be made until fluid resuscitation has been administered and the response has been evaluated!!
151
Q

What helps prevent ventilator-associated pneumonia?

A

-keeping mechanically ventilated pts at 45* angle

152
Q

How does a prior vaccination with bCG affect the interpretation of a PPD?

A
  • it does NOT change it!

- test is read as if the person does not have the vaccine!

153
Q

What IV catheter site is associated with a lower risk of infection?

A

-subclavian

154
Q

Name 2 neuraminidase inhibitors that can be used for influenza?

A
  1. Oseltamivir

2. Zanamivir

155
Q

What should be done first in a pt with a contiguous foot ulcer and possible bone involvement?

A

-bone bx with cultures before starting antibiotics!

156
Q

What is drug fever and which commonly cause it?

A
  • a prolonged fever caused by a medication, with no other obvious signs of inflammation
  • antibiotics can cause this, esp beta-lactams
157
Q

What influenza medication is contraindicated in asthmatic pts? Why?

A
  • zanamivir

- may induce bronchospasm!

158
Q

What is the most sensitive test to do in an HIV infection during the acute (early) stage?

A

-HIV viral load

159
Q

3 Cut-offs for induration from TB test? Who is in each group?

A
  1. > 5 mm –> highest risk, immunosuppresed, TB contacts, chest xray shows TB
  2. > 10 mm –> mid risk, immigrants, IV drug users, prisoners, health care workers, pts with chronic disease/malignancy
  3. > 15 mm –> lowest risk, “normal” people
160
Q

What could happen if an infected orthopedic implant is not removed?

A

-a biofilm can form & the bug will escape the hosts defenses!

161
Q

Best way to stop the spread of c. Diff from an infected pt?

A
  • put the pt in contact isolation

- ALCOHOL RUBS are NOT effective for killing c. Diff!

162
Q

Tx for acute bacterial rhinosinusitis?

A
  • 3 - 10 day course of narrow-spectrum antibiotics, such as:
    1) amoxicillin
    2) TMP-SMZ
    3) doxycycline
163
Q

Which two common infections cause cervicitis rather than vaginitis?

A
  1. Chlaymidia

2. Gonorrhea

164
Q

What is the Tx for an uncomplicated UTI in a compliant, young, healthy, nonpregnant female?

A

-TMP-SMZ

165
Q

4 Ssx of bacterial rhinosinusitis?

A
  1. Duration of the sx –> greater than 1 week + worsening sx after an initial improvement
  2. Maxillary tenderness
  3. Purulent drainage
  4. Poor response to decongestants
166
Q

What bug is likely to be the cause if there are extrapulmonary manifestations too?

A

-legionella

167
Q

A

A

A

168
Q

Progressive multifocal leukoencephalopathy: what is it? What is it caused by? What dies it lead to? Tx?

A
  • opportunistic infection
  • caused by polyomavirus JC
  • leads to demyelination of the CNS –> causes progressive neurologic deficits
  • tx: HAART tx
169
Q

What is the best antibiotic tx for aspirate pneumonia? What are the common bugs involved?

A
  • use: clindamycin

- bugs: anaerobes

170
Q

How does prednisone effect a PPD test?

A
  • can cause a false-negative result!

- so test pt with PPD BEFORE starting prednisone!

171
Q

Rhinitis medicamentosa? Tx?

A
  • persistent rhinitis sx in a pt with chronic nasal decongestant spray use
  • due to the rebound phenomenon
  • tx: withdraw the decongestant and give nasal corticosteroid spray
172
Q

Reccomended tx for a pt with CAP who is being hospitalized?

A

Either:

1) IV beta-lactam plus IV or oral macrolide or doxy
2) IV fluoroquinolones

173
Q

What is the initial antiTB tx regime?

A
  • 4 antiTB drugs (Rifampin, Isoniazide, Pyraznamide, Ethambutol)
  • the fourth drug may be stopped when the sensitivity results are back
174
Q

Definition of systemic inflammatory response syndrome (SIRS)?

A
  • presence of 2 or more of (in absence of a known cause):
    a) temp > 100F or < 96.8F
    b) heart rate > 90/min
    c) resp rate > 20/min, or PCO2 < 32
    d) leukocyte count > 12,000 or < 4,000 or > 10% bands
175
Q

2 Tx options for candida vaginitis?

A
  1. Intravaginal clotrimazole cream

2. Single oral dose of fluconazole

176
Q

5 Ssx of TTP?

A
  1. Fever
  2. Neurologic abnormalities
  3. Thrombocytopenia
  4. Microangiopathic hemolytic anemia –> see: anemia, schistocytes, and elevated lactate dehydrogenase concentration
  5. Renal insufficiency
177
Q

What is the most common cause of thrombocytopenia during pregnancy? Tx?

A
  • incidental thrombocytopenia of pregnancy

- tx: none, its a benign condition, just monitor the pt and platelet levels

178
Q

What is required for the dx of myelodysplastic syndrome?

A

-cytopenia of at least one of the cell lines

179
Q

What is seen on the peripheral blood smear in a pt with alpha-thal trait?

A

-target cells

180
Q

In what 2 situations are protein C & S concentrations decreased in patients?

A
  1. Pregnancy

2. When they are on oral anti-coagulants

181
Q

Tx for Philadelphia chromosome positive CML?

A

-imantinib mesylate –> targets BCR-ABL

182
Q

Tx of HIT?

A
  • stop heparin immediately

- use an alternative anticoagulation tx = direct thrombin inhibitor

183
Q

4 Common ssx of multiple myleoma?

A
  1. Hypercalcemia
  2. Bone pain
  3. Anemia
  4. Clusters of Large plasma cells on bone marrow aspirate
184
Q

What happens to iron levels during an infection? Why?

A
  • the iron levels decrease during an infection bc there is an increase in hepcidin and bacterial lactoferrin binds to the iron (bacteria use iron to support their growth)
  • cytokine levels also increase, which affects transferrin and ferritin expression = low total iron binding capacity & low transferrin levels & high ferritin levels
185
Q

2 Most common mutations that predispose to venous thrombosis? What ethnicities are they most common in?

A
  1. Factor V Leiden
  2. Prothrombin G20210A
    - most common in whites, rare in Asian and black populations
186
Q

What is the leading cause of death in a pt with sickle cell anemia?

A

-acute chest syndrome

187
Q

What drug should be used to prevent renal dz in sickle cell pts that show signs of developing kidney dysfunction?

A

-ACEi

188
Q

What does HELLP stand for?

A
  • Hemolysis with microangiopathic blood smear
  • Elevated Liver enzymes
  • Low Platelets
189
Q

Dx for an acquired factor VIII inhibitor coagulopathy?

A
  • mixing study
  • patient’s plasma and normal plasma are mixed in 1:1 ratio & the abnormal test is repeated –> if the abnormality is due to a factor VIII deficiency, the abnormality will correct with mixing, but if the abnormality is due to an inhibition, the abnormality will not correct with mixing!
190
Q

2 Micro bio signs of Chronic myeloid leukemia?

A
  1. Elevated leukocyte count

2. Increased numbers of granulocytic cells in all phases of development on peripheral blood smear

191
Q

3 Major criteria for dx of polycythemia vera?

A
  1. Elevated RBC mass
  2. Normal arterial oxygen saturation
  3. Splenomegaly
192
Q

What 2 proteins are decreased during pregnancy? When else are they decreased?

A

-protein C and protein S are decreased during pregnancy and when using oral anticoagulants

193
Q

3 Features of Autoimmune hemolytic anemia?

A
  1. Anemia
  2. Elevated reticulocyte count
  3. Microspherocytes on peripheral blood smear
194
Q

5 Ssx of acute chest syndrome?

A
  1. Fever
  2. Chest pain
  3. Shortness of breath
  4. Hypoxia
  5. Radiographically detected pulmonary infiltrate
    * * in a pt with a sickling disorder (SS)
195
Q

What is seen in the CBC and bone marrow in aplastic anemia?

A
  • CBC = pancytopenia

- bone marrow = hypocellular hone marrow

196
Q

Tx for TTP

A

-plasma exchange ASAP

197
Q

2 Most common infectious causes of acute chest syndrome?

A
  1. Chlamydia

2. Mycoplasma

198
Q

2 Microbio signs of Acute Myeloid Leukemia?

A
  1. Pancytopenia

2. Increased myeloid blasts

199
Q

Initial tx in pts with warm-antibody autoimmune hemolytic anemia?

A

-corticosteroid tx

200
Q

What is the mean corpuscular hemoglobin concentration in hereditary sphereocytosis?

A

-elevated

201
Q

Serum methylmalonic acid and homocysteine concentrations in vitamin B12 deficiency v. Folate deficiency?

A
  • B12: both methylmalonic acid and homocysteine concentrations are elevated
  • Folate: only homocysteine concentrations are elevated, not methylmalonic acid
202
Q

4 Signs of DIC?

A
  1. Elevated prothrombin time
  2. Elevated activated partial thromboplastin time
  3. Low fibrinogen levels
  4. Thrombocytopenia
203
Q

In what 3 settings can an acquired factor VIII inhibitor coagulopathy occur?

A
  1. Some malignancies –> ex lymphomas
  2. Some autoimmune diseases
  3. Postpartum
204
Q

3 Ssx of HUS?

A
  1. Thrombocytopenia
  2. Microangiopathic hemolytic anemia
  3. Renal disease
205
Q

3 Hematologic findings in iron deficiency anemia on the peripheral blood smear?

A
  1. Hypochromatic RBCs
  2. Abnormalities in the size and shape of RBCs
  3. Occasional bizarre shaped (ex cigar) RBCs
206
Q

What are patients with refractory anemia and an excessive amount of blasts at risk for?

A

-transforming into an acute leukemia during their lifetime

207
Q

Ssx of ITP?

A
  1. Severe thrombocytopenia
  2. Normal hemoglobin
  3. Normal leukocytes
  4. Absence of other sx, such as fever, headache, other constitutional manifestations
208
Q

Tx of choice for heroes zoster?

A

-famciclovir (replaced acyclovir as the top choice)

209
Q

Tx of scabies?

A

-topical permethrin

210
Q

What 2 drugs are the tx of choice for HtN in chronic kidney dz?

A
  1. ACEi

2. ARBs

211
Q

Phenoxybenzamine: what is it?

A

-alpha blocker

212
Q

Initial tx for common warts?

A

-topical tx containing salicylic acid

213
Q

What does tinea versicolor look like on KOH prep? Tx?

A
  • KOH: spaghetti and meatballs

- tx: topical ketoconazole cream

214
Q

What ankle-brachial index indicates leg ischemia?

A
  • <0.9 & decreases 20% or greater with exercise
215
Q

Corticosteroids and acne?

A

-nit used for tx and can even cause acne!

216
Q

What 3 cardiovascular findings are normal in pregnancy?

A
  1. Systolic murmur
  2. S3 gallop
  3. Mild peripheral edema
217
Q

When can a multidrug antihypertensive regimen be considered ineffective?

A

-only if it contains a diuretic

218
Q

What can significantly increase the accuracy of a breast exam?

A
  • the duration

- the examiner should spend 3 minutes per breast

219
Q

What medication should be added for a pt with uncontrolled HTN who is already on an ACEi and beta-blocker?

A

-thiazide diuretic

220
Q

What are the colon cancer screening recommendations for a person with a familial hx of colon cancer? What does it mean by familial risk?

A
  • familial risk = multiple first degree relatives or a first degree relative < 60 yrs old
  • screening: every 5 yrs starting at age 40, or 10 yrs before the youngest diagnosis!
221
Q

Orlistat: MOA? Results? Sfx?

A
  • MOA: lipase inhibitor, increases fecal fat loss
  • results: average of 6.3 lbs lost in 12 mnths
  • sfx: related to malabsorption of fat
222
Q

How long does it typically take for a girl’s menses to regulate? What does it mean if it doesnt?

A
  • usually takes a year

- can suggest PCOS if it doesnt regulate

223
Q

Tx of what is the best way to preserve renal fctn in a pt with diabetic nephropathy?

A

-HTN

224
Q

What has been shown to prevent pelvic inflammatory disease?

A

-annual chlamydial screening of sexually active women < 24 yrs old and other women who are at increased risk

225
Q

What BMI indicates obesity tx with medications? Surgical tx?

A
  • medications: > 27 with comorbidities or > 30

- surgery: > 35 with comorbidities or > 40

226
Q

What imbalance can thiazide diuretics cause? How? Tx?

A
  • thiazide diuretics can cause hypercalcemia bc they stimulate renal tubular calcium reabsorption
  • tx: stop the diuretic & it should self correct
227
Q

What common medication can cause HTN that is resistant to tx? Why?

A
  • NSAIDs, esp in elderly

- bc they effect sodium excretion

228
Q

What is the tx of choice for scleroderma renal crisis?

A

-shirt acting ACEi

229
Q

What is considered hazardous drinking in young men (< 65 yrs)? In older men ( > 65 yrs)?

A
  • young = more than 4 drinks on a given day, or more than 14 drinks per week
  • old = more than 3 on a given day, or more than 7 drinks per week
230
Q

Tx for comedonal-only acne?

A

-topical retinoids

231
Q

What is an aphthous ulcer?

A
  • one of the most common oral ulcers in north america
  • painful lesions that are localized, shallow, round, can be whitish in appearance
  • can begin to occur in teenagers and recur often
  • cause unknown
232
Q

What are the recommendations for abdominal aortic aneurysm screening?

A

-men ages 65-70 yrs who are, or have ever been smokers should be screened via an abdominal ultrasound once

233
Q

What can unprovoked hypokalemia suggest?

A

-hypoaldosteronism

234
Q

Sibutramine: MOA? Results? Sfx?

A
  • MOA: appetite suppressant that works through combine NE and serotonin reuptake inhibition
  • results: 9.8 lbs at 12 mnths
  • sfx: increase in HR, BP, nervousness, dry mouth, headache, insomnia
235
Q

What cardio med is contraindicated with cocaine use? Why?

A

-Beta-blockers –> bc cocaine causes both alpha and beta stimulation, so using a beta blocker would cause unopposed stimulation of alpha receptors!

236
Q

Tx for poison ivy?

A

-oral prednisone

237
Q

ACEi and ARBs in pregnancy?

A

-contraindicated, can cause adverse effects on fetal renal function esp in 2nd and 3rd trimesters

238
Q

When should oral antibiotics be used for acne treatment? How long does it take to determine efficacy? Which are the best to use?

A
  • used: when the combination of a topical comedolytic agent (ex retinoid) plus a topical antibiotic have not worked
  • duration: takes 6-8 wks to determine efficacy
  • which: use an oral tetracycline + an additional topical antibiotic
239
Q

What 2 dugs are preferred for tx of chronic HTN in pregnant pts?

A
  1. Labetalol

2. Methyldopa

240
Q

What is the most common cause of acute mesenteric artery ischemia?

A

-arterial embolism originating from the heart, most often due to afib

241
Q

4 Ssx of primary biliary cirrhosis?

A
  1. Puritis
  2. Hypercholesterolemia
  3. Cholestatic liver dz
  4. Positive antimicrobial antibody titer
242
Q

What liver dz are pts with inflammatory bowel dz at higher risk for developing?

A

-primary sclerosing cholangitis

243
Q

Tx for acetaminophen toxicity?

A

-N-acetylcysteine

244
Q

How do pts with severe cholangitis usually present (4)?

A
  1. Fever
  2. Jaundice
  3. Altered mental status
  4. Abdominal pain
245
Q

3 Most common causes of aminotransferase values of > 5000 U/L?

A
  1. Acetaminophen hepatotox
  2. Hepatic ischemia
  3. Viral hepatitis (ex. Herpes simplex)
246
Q

6 “Alarm sx” of abdominal pts?

A
  1. Hematochezia
  2. Weight loss
  3. Family Hx of colon cancer
  4. Fever
  5. Anemia
  6. Chronic severe diarrhea
    * *require careful evaluation
247
Q

Pseudoachalasia: what is it?

A
  • sx of achalasia caused by a tumor

- usually seen in pts >60 yrs –> do an endoscopy on elderly pts that present with sx of achalasia!

248
Q

Tx for HELLP syndrome?

A
  • delivery of fetus

- usually resolves within 48 hrs of delivery

249
Q

When should repeat endoscopies be done for pts with barrett’s esopagitis?

A

-endoscope with bx every 3 yrs

250
Q

What 3 situations would make you suspicious of a gastrinoma in a pt?

A
  1. Multiple ulcers
  2. Ulcers in unusual locations
  3. Ulcers that recur frequently, esp in absence of NSAID use!

**zollinger-ellison syndrome

251
Q

What is a common cause of self-limited, mild pain, hematochezia in eldery pts?

A

-ischemic colitis

252
Q

5 Ssx of achalasia?

A
  1. Dysphagia
  2. Regurgitation
  3. Weight loss
  4. Chest discomfort
  5. “Bird beak” sign on barium swallow = dilated esophageal lumen and smooth muscle narrowing at esophageal outlet
253
Q

Serologic testing for H. Pylori

A
  • can be done if the pt doesnt have any alarm sx (if they do, they need an endoscopy!)
  • test blood, serum, &/or saliva for IgG antibody to H. Pylori –> will remain positive for months
254
Q

Aminotransferase values in a pt with hepatic ischemia?

A

-will be high (>5000), but then will rapidly improve over a few days

255
Q

Why are alcoholics at a higher risk of developing acetaminophen hepatotoxicity?

A

-chronic alcohol use causes a depletion in the stores of glutathione (used for metabolism of alcohol) –> also needed for the metabolism of acetaminophen –> so they can develop toxicity at lower doses

256
Q

How does uncomplicated diverticulitis present?

A

-left lower quadrant abdominal pain and fever

257
Q

Grey-Turner’s sign?

A
  • ecchymosis of the flanks
  • suggests pancreatitc hemorrhage due to pancreatic necrosis
  • very rare presentation of acute pancreatitis
258
Q

What is the best initial imaging study for a pt with possible pancreatic adenocarcinoma?

A

-helical CT scan of abdomen

259
Q

5 alarm features for gastric malignancy with dyspepsia?

A
  1. Weight loss
  2. Bleeding
  3. Early satiety
  4. Vomiting
  5. Anemia
260
Q

What is elevated in Gilbert’s syndrome?

A

-indirect (unconjugated) bilirubin

261
Q

Dx of diverticulitis?

A
  • abdominal CT
  • colonoscopy should be done several weeks after resolution –> do not do colonoscopy during acute flare up bc complications such as: can occur
    1. Abscess
    2. Fistula
    3. Obstruction
262
Q

What is the most common cause of occult gastrointestinal bleeding in pts > 60yrs?

A

-angiodysplasia = vascular malformations

263
Q

Tx for diarrhea predominant IBS?

A

-loperamide

264
Q

How often should a lt with pan-colitis (for more than 10 yrs) undergo a colonoscopy with bx?

A

-every 1-2yrs for cancer surveillance

265
Q

What 2 groups of pts is herpes hepatitis seen most often in?

A
  1. Pregnant pts

2. Immunocomp pts

266
Q

Relationship of nausea and vomiting in relationship to the pain of acute appendicitis?

A

-n/v follow the onset of pain

267
Q

Ssx of acute cholecystitis (4)?

A
  1. Prolonged right upper quadrant abdominal pain
  2. Fever
  3. Leukocytosis
  4. Hyperbilirubinemia
268
Q

What is fulminant hepatic failure? What is the first thing that should be done?

A
  • clinical syndrome of severe acute liver failure and encephalopathy in a pt w/out a hx of liver dz
  • immediate evaluation for liver transplant should be done!
269
Q

What prophylaxtic tx should pts with large esophageal varicies undergo?

A

-nonselective beta-blocker –> decrease splanchnic blood flow

270
Q

What does the acronym HELLP syndrome stand for?

A
  • Hemolysis
  • Elevated Liver enzymes
  • Low Platelets
271
Q

How does acute mesenteric artery ischemia usually present?

A

-sudden, severe, generalized abdominal pain

272
Q

What creatinine levels should metformin not be used in?

A
  • men > 1.5

- women > 1.4

273
Q

4 features of myxedema coma? What is it typically preceded by?

A
  1. Progressive obtundation
  2. Hypothermia
  3. Hypotension
  4. Bradycardia
274
Q

Definition of subclinical hyperTH?

A

-low or undetectable TSH level with free T4 and free T3 are within reference range

275
Q

4 Recommendations to prevent cortico-steroid induced osteoporosis?

A
  1. Calcium supplementation
  2. Vit D supplememntation
  3. DEXA scan before tx
  4. Bisphosphanates if tx will be >3 mnths
276
Q

Name 6 coronary artery dz equivalents? What should they be treated for?

A
  1. Clinical coronary artery dz
  2. Symptomatic carotid artery dz
  3. Peripheral artery dz
  4. Abdominal aortic aneurysm
  5. Diabetes mellitus
  6. Framingham risk score of > 20%
    - should be tx with lipid-lowering therapy
277
Q

2 criteria for predibetic glycemic states?

A
  1. 2-hour glucose tolerance test of 140-199 = impaired fasting glucose
  2. Fasting glucose of 100-125 = impaired fasting glucose
278
Q

What is the main tx for symptomatic thyroiditis?

A

-beta blocker –> for tachy or palpitations that may occur during the thyrotoxic phase

279
Q

What bone mineral density is diagnostic for osteoporosis?

A
  • <-2.5 SD below the young adult mean
280
Q

What is usually the level of prolactin in a nonpregnant female with a prolactinoma?

A

> 200 ng/mL

281
Q

Which pts are thiazolidinediones contraindicated in? Why?

A
  • type II DM pts with heart failure

- thiazolidinediones increase fluid retention and can cause decompensated heart failure

282
Q

What happens to the thyroid hormone requirement during pregnancy?

A

-increases by 30-40%

283
Q

What are women with subclinical hyperthyroidism at an increased risk for?

A

-atrial fibrillation (3-fold increased risk!)

284
Q

What is the recommended 2-hour postprandial glucose for diabetics?

A
  • < 180
285
Q

Hyperfunctioning adenomatous thyroid nodule: physical exam findings of thyroid? Radioactive iodine uptake? Uptake of tracer?

A
  • PE: palpable nodule
  • increased iodine uptake
  • “hot” nodule on tracer uptake
286
Q

Grave’s dz: physical exam findings of thyroid? Radioactive iodine uptake? Uptake of tracer?

A
  • PE: diffusely enlarged thyroid gland
  • elevated iodine uptake
  • homogenous uptake of tracer
287
Q

5 Major risk factors for osteoporosis?

A
  1. Personal hx of a fracture as an adult
  2. History if fragility fracture in a first-degree relative
  3. Low body weight (<127 lbs)
  4. Current smoker
  5. Oral corticosteroid use for > 3 mnths
288
Q

What should the dose of metformin be held on the day that a pt has radiographic procedure that will be using contrast? When should it be restarted?

A
  • bc metformin will accumulate in a pt that has renal insufficiency and cause lactic acidosis
  • radiocontrast can be nephrotoxic and cause renal insufficiency
  • resume once renal fctn normalizes
289
Q

3 Criteria for dx Diabetes?

A
  1. Fasting glucose on 2 occasions > 126
  2. Glucose tolerance test of > 200
  3. Random glucose of > 200 + symptoms
290
Q

Alcoholic ketoacidosis v. DKA?

A
  • have similar sx and can mimic DKA

- blood glucose conc is the key difference –> it will be normal or low in setting of ketoacidosis

291
Q

Toxic multinodular goiter: physical exam findings of thyroid? Radioactive iodine uptake? Uptake of tracer?

A
  • PE: nodular to palpation
  • elevated iodine uptake
  • heterogenous uptake of tracer
292
Q

What is the recommended prepradial glucose for diabetics?

A

-glucose 90-130

293
Q

What 3 leads are inferior?

A
  1. Lead II
  2. Lead III
  3. Lead aVF
294
Q

What hypertensive medication should be avoided in pregnancy? Why?

A

-ACEi –> can cause fetal renal agenesis

295
Q

Initial tx of acute viral pericarditis?

A

-high-dose NSAID, such as indomethacin or ibuprofen

296
Q

Peripheral ischemia after an arterial catheterization?

A

-think: cholesterol embolism syndrome

297
Q

Which heart condition can go undiagnosed until pregnancy and why?

A
  • mitral stenosis

- can be asymptomatic until the body is hemodynamically stressed, as in pregnancy

298
Q

Most common artery to be involved with ascending aortic dissection?

A

-right coronary artery

299
Q

What are the 4 main benefits of using a Beta-blocker post MI?

A
  1. Reduces size of infarct
  2. Reduces frequency of recurrent MI
  3. Improves short-term survival
  4. Improves long-term survival
300
Q

What is the one drug that is indicated for all pts with systolic heart failure, regaurdless of ejection feaction?

A

-ACEi

301
Q

Tx for tachycardic pts who are unstable?

A

-immediate direct-current cardioversion

302
Q

What is one physical exam finding that can help exclude the dx of severe aortic stenosis? Why?

A
  • a physiologically split S2

- with severe stenosis the valve leaflets do not “snap” shut, so the aortic component will be absent

303
Q

For an acute MI, if fibrinolytics are indicated, when should they be given?

A
  • within 30min of arrival to hospital

- not after 12 hrs of sx!

304
Q

What is the most important determinant of survival in cardiac arrests? Why?

A
  • time to defibrillation

- most adults go into cardiac arrest bc of a ventricular arrhythmia

305
Q

What 3 things are seen on EKG for a Wolff-Parkinson-White syndrome pt?

A
  1. Short PR segment
  2. Delta wave
  3. Tachycardia
306
Q

Inferior leads

A

Leads II, III, and aVF

307
Q

Tx for life threatening Dig toxicity?

A

-digitoxin-specific antibody fragments

308
Q

What is pathognomonic for acute pericarditis on EKG?

A

-PR-segment depression

309
Q

How to dx diastolic heart failure?

A

-made when the ssx of systolic heart failure are present, but there is normal left ventricular ejection fraction and an absence of significant valvular abnormalities

310
Q

Lack of pericardial effusion on echo?

A
  • does not exclude pericarditis

- 40% of pts w/ pericarditis lack effusion

311
Q

What 2 medications are indicated in all pts with systolic heart failure?

A
  1. ACEi

2. Beta-blocker

312
Q

Which pts does CABG improve the survival in?

A
  • w/ obstructive left main and/or 3-vessel CAD

- reduced EF

313
Q

Lateral and apical leads?

A

-V4-6

314
Q

What is pathognomonic for acute pericarditis on EKG?

A

-PR-segment depression

315
Q

What increases the murmur of hypertrophic cardiomyopathy? What decreases it?

A
  • increases w/ valsalva maneuver

- decreases w/ squatting from standing

316
Q

Atrial tachycardia with variable block?

A

-think: digitalis toxicity

317
Q

Tx for ventricular fibrillation or sustained ventricular tachy?

A

-implantable cardioverter-defibrillator

318
Q

Ankle-brachial index for pts with peripheral vascular dz? For severe cases? For vascular calcification?

A
  • ABI < 0.9 = peripheral vascular dz
  • severe < 0.4
  • calcification > 1.3
319
Q

What 2 things can an ascending aortic dissection lead to?

A
  1. Aortic regurg

2. Obstruction of right coronary a.

320
Q

Pt with prosthetic heart valve and unexplained fever?

A

-think: bacterial endocarditis

321
Q

What 3 cardiac problems can give you an ST elevation?

A
  1. MI
  2. Variant angina
  3. Acute pericarditis
322
Q

Pulmonary capillary wedge pressure and CO in cardiogenic shock?

A
  • PCWP = elevated

- CO = low

323
Q

EKG finding of digitalis toxicity?

A

-atrial tachy with variable block

324
Q

Tx of monophasic ventricular tachy in a hemodynamically stable pt? Unstable pt?

A
  • stable: IV
    1. Lidocaine
    2. Procainamide
    3. Amioderone
  • unstable: direct-current cardioversion
325
Q

Anteroseptal leads?

A

-leads V1-3

326
Q

Dosage of beta-blockers in pt with systolic HF?

A

-should be titrated to pts heart rate

327
Q

Short term and long term tx of coronary artery vasospasm?

A
  • short term = nitrates

- long term = CCBs

328
Q

List 4 physical findings of severe aortic stenosis?

A
  1. Small and late carotid pulses
  2. Late peaking systolic murmur
  3. Absence of splitting of S2
  4. Sustained apical pulse
329
Q

Alcoholic cardiomyopathy: describe changes in heart? Tx?

A
  • both ventricles are dilated and globally hypokinetic

- tx: abstaining from alcohol may reverse the cardiomyopathy in pts with less advanced dz + tx for heart failure

330
Q

Cardiac amyloidosis: describe changes in heart? How dies it typically present?

A
  • changes: left ventricular wall thickness increased –> due to amyloid deposition
  • presentation: restrictive cardiomyopathy w/ diastolic dysfunction (rather than systolic dysfunction)
331
Q

How to determine which pts with afib should be on warfarin v aspirin?

A
  • determine the CHADS2 score:
    1. CHF –> 1 pt
    2. HTN –> 1 pt
    3. Age >/= 75 –> 1 pt
    4. Diabetes –> 1 pt
    5. Stroke or TIA hx –> 2 pts
  • score of >/= 3 –> give warfarin
  • score of 1 or 2 –> give aspirin
332
Q

What is meconium ileus almost always associated with?

A

-CF

333
Q

Meconium illeus: what is it? What is it thought to be caused by?

A
  • congealed meconium that obstructs the distal ileum
  • thought to be caused by a deficiency of proteolytic enzymes
  • obstruction begins in utero –> results in under development of distal lumina
334
Q

Meconium ileus: tx? 2 Possible complications?

A
  1. Volvulus

2. Perforation peritonitis

335
Q

What can cause the bulging fontanelle in an infant as the presenting sign of CF?

A

-inability of vitamin A metabolism –> vitamin A excess

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