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ABIM Flashcards

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1
Q

Immediate angiography for UA or NSTEMI

A 
HD unstable
HF
Recurrent rest angina despite therapy
New or worse MR murmur
Sustained VT
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2
Q

UA/NSTEMI treatment

A

TIMI 0-2 low risk, 3-7 high risk (early cath)

Asa, BB, ntg, heparin, statin, plavix

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3
Q

Ddx of ST elevation

A

STEMI, pericarditis, LV aneurysm, Takotsubo, vasospasm, myocarditis, acute stroke, early repolarization

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4
Q

STEMI treatment

A

Asa, BB, P2Y12 (1 year), heparin, ACE (lifelong if HF), ntg, statin

PCI - 90 min in hospital, 2 hrs transfer (from door)

Lytics if no PCI within 2 hrs - failure if HD unstable

Emergent CABG if thrombotic PCI failure or mechanical complications

Spiro 3-14 days later - if EF <40 and HF or DM

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5
Q

Post-MI therapy

A

Asa, plavix 1 year post DES, statin, BB, ACE if DM, htn, CKD, or HF, spiro if EF <40 and HF or DM

F/u echo in 40 days (3 months if PCI or CABG), ICD if EF <35 in class 2 or 3 or <30 in class 1

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6
Q

Types of stress test

A

EKG - no in LBBB, dig, LVH, prev PCI, ST depression at baseline
Echo or spect

Dobutamine or nuc - can’t exercise, paced ventricular rhythm

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7
Q

Treatment of stable angina

A

BB
CCB if BB contraindicated (HR, AV block, asthma)
Nitrates - need washout period of 8-12 hrs to prevent tachyphylaxis
Ranolazine if still symptomatic
Asa, ACE if htn, HF, DM, or CKD, statin

PCI if still symptomatic with max medical therapy

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8
Q

Contraindicated in HF

A

Dilt and verapamil
NSAIDs
Thiazolidinediones
Don’t start BB in decompensated HF, ok to continue

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9
Q

DCM ddx

A

Myocarditis (supportive care)
EtOH (standard HF)
Drugs - cocaine, meth (standard HF, no unopposed alpha (use labetalol))
Giant cell myocarditis (immunosuppressant, transplant)
Hemochromatosis
Peripartum (ACE, ARB, spiro are teratogens) (warfarin if EF <35) (don’t get pregnant again)
Takotsubo (supportive care)
Tachycardia induced (fix arrhythmia)

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10
Q

Murmur maneuvers in HCM

A

Louder with valsalva and squatting (increased preload)

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11
Q

Migraine treatment

A

No orals in severe NV
Triptans contraindicated in CAD, stroke, brainstem aura, hemiplegic migraine
Use acute therapy 3 days per week max
Avoid OCPs in migraine bc risk of stroke

No butalbital or opioids

Prophylaxis if no response to therapy, >10 days/month, disabling >4 days/month, using meds >8 days/month — amitryptiline, metoprolol, propranolol, timolol, topiramate, valproate, venlafaxine

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12
Q

Trigeminal cephalgias

A

Cluster headache (15-120 min several times a day for weeks)- triptan or O2, prevent w verapamil

Chronic paroxysmal hemicrania (5+ times a day 2-30 min)- indomethacin

SUNCT (1-600 seconds hundreds of times per day) - no treatment

Hemicrania continua - indomethacin

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13
Q

Red flags for secondary headache

A 
Thunderclap
Physical exam abnormal
Neuro symptoms for more than an hour
New headache in older than 50
Cancer, immunosuppression, pregnancy
Level of consciousness
Triggered by exertion, sex, valsalva

MRI
CT if suspect ICH
ESR CRP if suspect giant cell arteritis
LP for suspected meningitis or increased ICP

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14
Q

AED side effects

A

Carbamazepine - hepatic clearance, osteoporosis, HL, hyponatremia, pancytopenia

Valproate - weight gain, HL, PCOS, teratogen, hepatotoxic

Topiramate, zonisamide - kidney stones, teratogen

All - hypersensitivity, SJS, suicidal ideation, many inactivate OCPs

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15
Q

Stroke treatment

A

tPA within 3 hours if no bleeding or BP 185/110

Tylenol for fever
NS
Asa if no lytics
DVT prophylaxis after 48 hrs

Antihypertensives in first 48 hrs only if BP 220/120 (185/110 w lytics) or aortic dissection or end organ damage

Endarterectomy after 2 weeks if stenosis ipsilateral >70

Statin, aspirin, dipyridamole, warfarin for cardioembolic

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16
Q

SAH treatment

A

CSF if CT normal but high suspicion

Clip or coil within 48-72 hrs

Keep BP under 140

Nimodipine for 21 days

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17
Q

ICH treatment

A

Surgery or angiography

Mannitol, barbiturate coma, hyperventilation for ICP

Nicardipine, labetalol to keep SBP 140-160

Reverse warfarin

No ntg or nipride bc they can increase ICP
No platelets or steroids

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18
Q

Parkinson disease ddx

A

Multiple system atrophy - ataxia and orthostatic hypotension, MRI showing necrosis of putamen, cerebellar atrophy

Supranuclear palsy - unexplained backward falls, inability to move eyes vertically

Lewy body dementia - dementia, hallucinations

Medication induced Parkinsonism - antiemetics, antipsychotics, reserpine, lithium, methyldopa

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19
Q

Myelopathy ddx

A

MS - oligoclonal bands
Neuromyelitis optica - NMO-IgG, MS wo brain lesions
Idiopathic transverse myelitis - after viral infection
B12 deficiency - check MMA and homocysteine, sensory
Copper deficiency - after bariatric surgery or taking lots of zinc
Spinal cord infarct - acute flaccid paralysis
Compressive

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20
Q

Myasthenic crisis

A

Triggered by infection, surgery, meds - aminoglycosides, quinolones, magnesium, BBs, CCBs

Treat w plasmapheresis or IVIg. No pyridostigmine alone bc it increases secretions

Regular myasthenia treated w pyridostigmine, thymectomy if thymoma

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21
Q

Drugs that cause TTP

A

Plavix, gemcitabine

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22
Q

Skin biopsy

A

Lesion for histology, perilesional for DIF

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23
Q

Milaria

A

Heat rash

Can be in fever

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24
Q

Amyopathic dermatomyositis

A

Heliotrope sign, gottrons papules, shawl sign

No muscle enzymes or decreased strength

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25
Bullous pemphigoid
Urticarial plaques and tense bullae trunk upper legs
26
Treatment for impetigo
Mupirocin
27
Drug induced SLE
``` Adalimumab Hydralazine Procainamide isoniazid Minocycline Annular scaly patches ``` HCTZ causes subacute cutaneous lupus
28
Erythema multiforme
HSV mycoplasma pneumoniae Tricolored targetoid papules
29
Actinic purpura
Age related capillary fragility
30
Epidermal inclusion cyst
Excise
31
Tinea treatment
Imidazole
32
Localized scleroderma
Skin hardening without systemic disease
33
Poison ivy
Prednisone taper
34
Lentigo maligna
On the face
35
Pyoderma gangrenosum treatment
Prednisone
36
Erythema nodosum next steps
CXR to look for sarcoidosis | Can be triggered by hormones
37
Pitted keratolysis
Small pits punctate erosions on sweaty feet, bacterial, topics antibiotics
38
Treatment of venous stasis ulcers
Compression
39
Dermatitis herpetiformis treatment
Dapsone and gluten free diet
40
Erythroderma
Psoriasis can flare to this w glucocorticoids
41
Inverse psoriasis
Itchy plaques in axillae intergluteal pannus etc
42
Heart transplant rejection
Biopsy | Heart failure, complete heart block
43
To decide what kind of AAA repair
Cta a/p to see if other vessels involved
44
Effusive constrictive pericarditis
Ibuprofen and colchicine
45
Intermittent claudication
Supervised exercise
46
Stable heart failure follow up labs
Electrolytes and kidney function
47
Papillary fibroelastoma
Independently mobile cardiac tumor stalk to left sided valvular endocardium, associated w embolization
48
Isolated anterior thigh numbness
Meralgia paresthetica - lateral femoral cutaneous nerve Relieve pressure
49
Bell palsy
Prednisone within 72 hours No antivirals No imaging needed
50
Mononeuritis multiplex
Vasculitis, lymphoma, amyloid, sarcoidosis, Lyme, hiv, leprosy, diabetes
51
GBS
Areflexic Ascending Campylobacter Elevated CSF protein w normal cell count Plex or ivig No steroids
52
CIDP
Proximal neuropathy over months Prednisone, plex, IVIG
53
Steroid myopathy
Normal CK Proximal weakness Normal EMG
54
Lipophilic statins
Atorva simva lova Statin myopathy more likely
55
Primary CNS lymphoma
Supratentorial, visual symptoms, immunocompromised Ocular involvement Biopsy Radiation and chemo, start haart, no surgery
56
Meningioma
Enhancing dural tail Resection, no chemo
57
Brain mets
Lung, breast, melanoma Steroids, radiation Methotrexate and cytarabine for leptomeningeal mets
58
Brain death
Coma, apnea, absence of brain stem reflexes Can’t be brain death with respiratory drive or posturing
59
RA
``` RF, CCP Periarticular osteopenia, symmetric joint space narrowing Cervical spine subluxation Bronchiolitis obliterans Mononeuritis multiplex Cricoarytenoid involvement Caplan syndrome HF ILD Felty syndrome ```
60
Treatment of RA
Steroids for symptoms Methotrexate for erosive disease Screen for osteoporosis Methotrexate and leflunomide are teratogens
61
Erosive Inflammatory OA
Pain and swelling of PIP and DIP joints | ESR and CRP normal
62
DISH
OA Ossification along anterolateral aspect of vertebral bodies No disk space narrowing or syndesmophytes Complications: dysphasia, fractures, spinal stenosis, myelopathy
63
Hypertrophic osteomyopathy
Clubbing | New periosteal bone formation
64
Psoriatic arthritis
Check for HIV Nsaids Methotrexate - doesn’t prevent progression TNF blockers
65
Cutaneous T cell lymphoma treatment
Photophoresis
66
Reactive arthritis
Arthritis, conjunctivitis, urethritis in 1/3 Enthesopathy Sacroiliitis Keratoderma blennorrhagicum (psoriasis on palms and soles) Circinate balanitis HIV, chlamydia, stool studies Self limited within 6 months
67
Ankylosing spondylitis
Worse at night, better with activity or heat AI, uveitis, aortic aneurysm, EP problem Cervical fracture with minor accident ``` NSAIDs Glucocorticoid injections TNF for axial Methotrexate for peripheral Calcium and D ```
68
SLE criteria
4 of: ``` ANA Malar rash Discoid rash Photosensitivity Oral ulcers Arthritis Serositis Kidney disease Neuro disease Heme disease Immunologic disease ```
69
Neonatal lupus
Mothers have SSA or SSB Heart block
70
Lupus testing
ANA Anti smith Ds DNA correlates with disease activity Low complements in flares Anti Histone in drug induced lupus
71
Therapy for SLE
Hydroxychloroquine for arthritis. Topical glucocorticoids for rash Life threatening disease cytoxan and MMF Bisphosphonates for osteopenia
72
Hydroxychloroquine monitoring
Annual eye exam
73
SLE safe in pregnancy meds
Prednisone, hydroxychloroquine
74
Diffuse cutaneous systemic sclerosis
Proximal to elbows and knees ANA, SCL-70 ILD Scleroderma renal crisis
75
Limited cutaneous systemic sclerosis
Distal to elbows and knees ANA, anti centromere PH CREST syndrome
76
Systemic sclerosis test
Nail fold capillary destruction, dilated capillary loops Has to have raynaud phenomenon to be SSc
77
Treatment for systemic sclerosis
Raynaud - no smoking, amlodipine, felodipine, nifedipine, sildenafil, nitro paste GI dysmotility - PPI, metoclopramide Scleroderma renal crisis - ACE inhibitor Bacterial overgrowth - antibiotics Alveolitis - MMF or cyclophosphamide No steroids; they cause scleroderma renal crisis
78
MCTD
SLE, SSc, and/or polymyositis with anti U1 RNP antibodies Mortality related to PH
79
Fibromyalgia evaluation
CBC, BMP, TSH, ESR, CRP - normal Don’t order ANA, RF, CCP
80
Fibromyalgia treatment
No opioids or NSAIDs Exercise and CBT Pregabalin, duloxetine, milnacipran
81
Gout testing
Monosodium urate crystals and urate tophi Negatively birefringent Synovial fluid WBC 2000-75000; >50000 should raise concern for septic joint
82
Gout flare treatment
NSAIDs, colchicine, steroids
83
Recurrent gout treatment
ACR says aim for urate <6 if tophi, <5 wo tophi Allopurinol - start w few month course of colchicine or NSAID to prevent gout flare Avoid allopurinol in Asians w HLA B27 Febuxostat if CKD If nothing else works, pegloticase
84
Allopurinol and HCTZ
Hypersensitivity syndrome Dermatitis, fever, eosinophilia, hepatic necrosis, nephritis
85
Gout and azathioprine
Allopurinol and febuxostat raise levels; don’t use them
86
CPPD
Positively birefringent rhomboid shapes crystals Linear calcification of meniscus Screen for hemochromatosis, hypomagnesemia, hyperparathyroidism, hypothyroidism
87
Disseminated gonorrhea
Migratory polyarthritis, fever, vesicles Ceftriaxone for GC and doxy for chlamydia
88
Polyarteritis nodosa kidney disease
Does not involve the glomerulus - no blood, casts, or protein Htn, mononeuritis multiplex, livedo reticularis, purpura Check HBV, biopsy (skin or testicle), mesenteric and renal angiography Prednisone, cytoxan
89
Giant cell arteritis
Fever, headache, jaw claudication Blindness, aortic dissection and aneurysm Diagnose with ESR and temporal artery biopsy Treat with high dose steroids, tocilizumab, aspirin
90
EGPA
Asthma, eosinophilia, IgE, hemoptysis P ANCA/ MPO Treat w prednisone, cytoxan for multi organ failure
91
Takayasu arteritis
``` Fever, malaise, weight loss, arthralgia Arm and leg claudication Pulse deficits Bruits Asymmetric BP ``` Aortography Prednisone
92
Relapsing polychondritis
Red hot painful ears Strider caused by tracheal collapse Saddle nose deformity Cartilage biopsy NSAIDs, colchicine, dapsone for mild Steroids for severe
93
Familial Mediterranean fever
Recurrent fever and serositis, arthritis, rashes ESR CRP Serum amyloid AA Proteinuria Genetic testing Colchicine
94
Adult onset Still disease
Daily fever, myalgia, proteinuria, serositis, evanescent pink rash, arthritis Ferritin >2500 Steroids Mtx, TNF inhibitor, anakinra
95
Complex regional pain syndrome
Abnormal bone metabolism and osteoporosis Follows injury, surgery, MI, or stroke Hair loss, movement disorder, swelling, autonomic dysfunction Physical therapy, steroids, bisphosphonates even if no osteoporosis
96
Primary adrenal insufficiency
Low aldo, hyperpigmentation ``` Autoimmune adrenalitis - hydrocortisone and fludrocortisone Bilateral adrenal hemorrhage TB Addison disease Neisseria HIV Histo Mets ```
97
Primary adrenal insufficiency testing
Morning serum cortisol low, diagnosed <3. Normal >15 If borderline, cosyntropin stim test ACTH to see primary vs secondary Stress dose steroids if they are sick
98
Secondary adrenal insufficiency
ACTH deficiency Pituitary apoplexy Steroids Long term opioid use - long acting
99
Adrenal crisis
Shock, fever, abdominal pain, tachycardia | Usually primary because that causes hypotension
100
Hypercortisolism testing
24 hour urine, nighttime salivary cortisol Low dose suppression test - 1 mg dex doesn’t suppress ACTH low - Cushing syndrome - CT MRI adrenals ACTH high - high dose suppression test - 8 mg If suppresses, pituitary. If not, ectopic production (small cell lung cancer)
101
Pheochromocytoma treatment
Phenoxybenzamine No contrast - can cause crisis. Make sure treated before imaging. Post op fluids, might need pressors Long term monitor for mets
102
Men 2A
Pheo, medullary thyroid cancer, pituitary adenoma
103
Prolactinoma treatment
Cabergoline or bromocriptine - dopamine agonist. Shrinks it Surgery if it fails
104
Hypothyroidism and prolactin
TSH can elevate prolactin mildly Other causes : risperdone,
105
Bartter syndrome
High urine cl na ca Like loop diuretic effect
106
CKD and chronic metabolic acidosis
Give bicarb if bicarb <22
107
Minimal change disease treatment
Prednisone Ace, diuretics, statin
108
IgA nephropathy treatment
ACE inhibitor
109
Multiple myeloma diagnosis
Aki, anemia, hypercalcemia, bone pain, nagma
110
Antihypertensive regimen adjustment
Add another agent instead of increasing dose once at 50% max dose
111
Ethylene glycol toxicity treatment
Fomipazole, fluid, dialysis
112
Membranous glomerulonephropathy management
Eval for secondary causes - cancer screening, hepatitis, syphilis, lupus Prior to immunosuppression
113
Balkan endemic nephropathy
Aristolochic acid Tubulointerstitial Associated w upper urinary tract urothelial cancer Cystoscopy
114
DI diagnosis and treatment
High sodium w low urine osm Try desmopressin, if it doesn’t work it’s nephrogenic - HCTZ
115
Hypoaldosteronism sources causing hyperK
Heparin, RAAS inhibition, type 4 RTA, primary adrenal disease
116
Pyroglutamic acidosis
Chronic acetaminophen if chronically ill, CKD, poor nutrition, vegetarian Mental status changes, agma
117
Previously treated GPA with hematuria
Cystoscopy to look for bladder cancer - both GPA and cytoxan increase risk
118
Hematuria workup
Cystoscopy to look for bladder cancer in age >35
119
Acute hyponatremia treatment
3% saline
120
Sarcoidosis renal involvement
Nephrocalcinosis, hypercalcemia, hypercalcuria Interstitial nephritis w granulomas
121
Hyperlipidemia in CKD treatment
Statin Though triglycerides are primary problem
122
Assess high creatinine in patients with high muscle mass
Cystatin C - produced by all cells, not just muscle cells, so it’s clearance may be better indicator
123
Kidney stone prevention
If hypercalcuria, add a thiazide
124
Membranous GN antibody
Anti PLA2
125
Treatment of renal artery stenosis
Atherosclerosis treatment including ACE, check to see that cr doesn’t increase >25%
126
Type 1 RTA
Distal tubule Can’t acidify urine HypoK Nagma Positive urine anion gap
127
FSGS associations
Premature birth Solitary kidney Obesity Black
128
Fabry disease
``` X linked Lisosomal storage disorder Burning hands and feet Nephritis Angiokeratomas Corneal and lens opacities Heart infiltration Neuro involvement ```
129
Struvite stone treatment
Remove stones - Nidus for infection
130
Adynamic bone disease
ESRD | Normal pth and vitamin d
131
CKD anemia treatment
Supplemental iron with goal of tsat >30 and ferritin >500 Epo if normal iron stores
132
Calcineurin inhibitor aki and hyperkalemia treatment
Thiazide diuretic
133
Hypermagnesemia treatment
Calcium
134
Topamax kidney stone
Calcium phosphate
135
Cisplatin renal toxicity
Tubular injury Fanconi syndrome Hypomagnesemia Polyuria
136
Liraglutide
Diabetes and weight loss
137
Autoimmune adrenalitis testing
21 hydroxylase antibodies
138
Prolactin and antipsychotics
If prolactin is <50, probably medication side effect But if >200, get pituitary mri
139
Pager disease of bone
After diagnosis with X-ray | Need alk phos. If normal, disease is burnt out and needs no treatment
140
Antiresorptive drug hypocalcemia
Caused by low vitamin D
141
Monitoring labs chronic hypoparathyroidism
24 hr urine calcium If over 300, have to decrease calcium and vitamin D replacement Thiazide diuretics decrease calcium excretion, can be used to meet calcium goals
142
False negative metanephrines
Norepinephrine uptake meds Like amitryptiline
143
Metformin GFR
>45
144
Toxic adenoma treatment
Radioactive iodine or surgery
145
Parathyroidectomy indications
Ca >1 over ULN, gfr <60, urine ca >400, kidney stones, T score
146
Hypoglycemic unawareness
Decrease all insulin doses
147
Methimazole side effect
Agranulocytosis, comes with sore throat and fever
148
Myxedema coma treatment
Hydrocortisone before thyroid hormones
149
Amiodarone induced thyrotoxicosis treatment
Prednisone taper Methimazole if just hyperthyroidism without destruction Stop amio
150
Osteomalacia
``` Low vit d Low ca Low phos High PTH High ALP ```
151
Colonoscopy and aspirin
No need to discontinue
152
Hyperplastic polyps
Repeat colonoscopy in 10 years

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