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Conrad Fischer 2 Flashcards

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1
Q

What is the cutoff for diagnosis of hypertension?

A

BP > 140/90

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2
Q

What is the next best step in management of an asymptomatic patient with a BP reading of 145/95?

A

Repeat BP in 1-2 weeks (If available, ambulatory home BP monitoring) over 3-6 measurements

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3
Q

When should hypertension meds be stopped once started?

A

Never. Therapy is indicated for life

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4
Q

What is initial therapy for an asymptomatic patient with confirmed mild hypertension?

A

Lifestyle modification (diet, exercise, weight loss)

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5
Q

What is the target LDL in patients with 1 risk factor for CAD? 2 risk factors?

A

Under 160 for 1 risk factor and under 130 for 2 risk factors

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6
Q

Which cholesterol medication has the greatest mortality reduction?

A

Statins

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7
Q

Which form of lifestyle modification is the most effective management of hypertension?

A

Weight loss

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8
Q

What is the best initial pharmacotherapy for hypertension if lifestyle modifications fail for 6 months?

A

Thiazide diuretics (hydrochlorothiazide or chlorthalidone)

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9
Q

What is the most common adverse effect of thiazide diuretic therapy?

A

Hypercalcemia

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10
Q

What is the most common adverse effect of calcium channel blockers?

A

Constipation due to inhibitory effect on smooth muscle of the bowel

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11
Q

What is the next best step in a patient whose hypertension is not controlled with thiazides?

A

Beta blocker, ACE-I, and calcium channel blockers are equal

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12
Q

What is the most important adverse side effect of hydralazine?

A

Drug induced lupus

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13
Q

What are adverse side effects of minoxidil?

A

Hair growth and edema

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14
Q

What drugs are indicated in a hypertensive patient with BPH?

A

Alpha-1 blockers (-zosin drugs)

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15
Q

How do beta blockers cause hyperkalemia?

A

Inhibition of Na/K ATPase - increased K+ extracellularly

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16
Q

What are the most notable side effects of clonidine and methyldopa?

A

Fatigue and memory loss

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17
Q

What is the most common adverse effect of alpha blockers?

A

Orthostatic hypotension

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18
Q

What is the drug of choice in a hypertensive patient with osteoporosis?

A

Thiazides b/c they prevent loss of calcium in the urine

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19
Q

Which hypertension drugs should not be used in a patient with gout?

A

Hydrochlorothiazide or furosemide

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20
Q

What are the adverse effects of spironolactone?

A

Hyperkalemia and gynecomastia (anti androgenic effect)

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21
Q

What is the most common presentation of multiple sclerosis?

A

Optic neuritis with blurring of the optic nerve head. Loses color vision and visual acuity.

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22
Q

What is the fundoscopic finding in diabetic retinopathy?

A

Proliferative retinopathy consistent with neovascularization. Treat with laser photocoagulation

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23
Q

What is the presentation of retinal detachment?

A

Not red, not tender, not painful, just blind

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24
Q

What is the fundoscopic finding in hypertensive retinopathy?

A

Cotton wool spots, papilloedema, and copper wiring

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25
What is found in the urine in hypertension?
Proteinuria
26
What are hyaline casts in the urine associated with?
Dehydration
27
What is the indicated therapy in a patient with chest pain and new LBBB?
Aspirin then thrombolytics
28
What is the best management of hypertensive crisis?
IV beta blocker, nitruprusside, or ACE-I (furosemide and diuretics do not work well in hypertensive crisis)
29
What is a psychiatric side effect of reserpine?
Depression
30
What is the cutoff of hypertensive crisis?
> 180/120
31
What is the most likely diagnosis in an IV drug user with fever and a murmur?
Endocarditis
32
What are Libman-Sacks vegetations?
Common cardiac manifestation of SLE. Non-bacterial. Affects both sides of the valve (usually mitral valve).
33
What is the best initial diagnostic test in suspected infections endocarditis?
Blood cultures (NOT echo). 95-99% of people with endocarditis have positive blood cultures
34
If a blood culture is negative, how can endocarditis be diagnosed?
Fever, risk, and embolic phenomenon (roth spots, janeway lesions, osler nodes, etc) along with visualization of vegetation on echo
35
What is the pathophysiology of a Roth spot?
Embolus containing infected material in the eye.
36
What is a splinter hemorrhage?
Thin strip of hemorrhage under the nail seen in endocarditis
37
What are Janeway lesions?
Flat, painless, lesions seen on the palms and soles of the feet in endocarditis
38
What is a coloboma?
Cat-like iris slits as a result of failure in embryonic development of the iris
39
What is a hordeolum?
Stye or infection of the sebaceous gland of the eye usually by staph. Tender to palpation. Treat with anti staph antibiotics
40
What is a chalazion?
Cyst due to blockage of the meibomian gland. Treat with warm compress to the eye.
41
What is a pterygium?
Overgrowth of conjunctiva from irritation from the environment
42
What is blepharitis?
Inflammation of the eyelid due to seborrheic dermatitis or a staph infection
43
What is the most common murmur in endocarditis?
Mitral regurgitation
44
Which cardiac conduction defect is most likely in an anti-Ro positive child of a mother with SLE?
3rd degree AV block
45
What should be given to a pregnant woman with anti-phospholipid syndrome?
Heparin and aspirin
46
What are the two types of anti-phospholipid syndrome?
Lupus anticoagulant and anti-cardiolipin antibodies
47
What syndrome is associated with spontaneous abortion, false positive VDRL, and thrombopilia?
Anti-phospholipid syndrome
48
What is the most accurate diagnostic test for lupus nephropathy?
Renal biopsy
49
What is the most common histological abnormality in lupus nephritis?
Membranous glomerulonephritis
50
What is the best therapy for membranous glomerulonephritis?
Prednisone and mycophenolate (or pred + cyclophosphamide)
51
What is the pulmonary pathology seen in SLE?
Alveolar hemorrhage
52
What is the most useful test to determine disease activity in SLE?
Complement level (decrease) and increased ds-DNA antibodies. ANA levels do not change with disease activity
53
What is the ophthalmologic finding in SLE?
Central retinal vein occulusion - no therapy for this
54
What is the most accurate test for lupus anticoagulant?
Russell viper venom
55
What is the pathology in the heart of SLE?
Libman-Sacks endocarditis
56
What is the most likely murmur heard in SLE?
Mitral regurgitation
57
What is the underlying cause of susceptibility to drug induced lupus?
Decreased acetylation rate
58
What is the treatment for drug induced lupus?
Stop the causative drug
59
What is the typical presentation of Goodpasture's Syndrome?
Hemoptysis and fever with renal findings
60
What population is most likely to have sarcoidosis?
African american females
61
What is the typical presentation of sarcoidosis?
Dry cough, shortness of breath, and rales on exam.
62
What is the most common extra-pulmonary manifestation of sarcoidosis?
Skin (liver, heart, and nervous system can also be affected but not as often as skin)
63
What is the most common skin manifestation of sarcoidosis?
Lupus pernio (raised, hardened, purple lesion usually on the face and hands) and erythema nodosum
64
What auscultatory findings will be present in interstitial lung disease?
Crackles
65
What is a typical neurological finding in sarcoidosis?
Cranial nerve VII palsy (bell's palsy)
66
Cardiac involvement of sarcoidosis leads to what type of arrhythmia?
Complete AV block. Sarcoid granulomas destroy the conduction system
67
What is the most common finding on CXR in sarcoidosis?
Bilateral hilar lymphadenopathy
68
What is the most accurate test for sarcoidosis?
Lymph node biopsy. Look for non-caseating granuloma
69
What is the treatment of choice for sarcoidosis?
Prednisone
70
What is the best initial test in suspected acromegaly?
IGF-1
71
What is the typical presentation of acromegaly?
MIddle aged patient with daytime somnolence, deep voice, and outgrowth of bony structure
72
What is the etiology of daytime somnolence in acromegaly?
Sleep apnea (neck grows thicker)
73
Why does acromegaly cause erectile dysfunction?
Alpha subunits of GH and prolactin are the same so increased GH mimics prolactin --> decreased GnRH
74
What is the best initial therapy for acromegaly?
Surgical excision
75
What is the best initial therapy for prolactinoma?
Octreotide
76
What is pegvisomant?
GH receptor antagonist. Secondary option for treatment of acromegaly
77
Why does hypothyroidism lead to GH deficiency?
Must have thyroxine for normal release of GH
78
Why is endotracheal intubation risky in a patient with RA?
Instability of C1/C2 in RA patients (risk of atlantoaxial dislocation)
79
What are the bone growths of the interphalangeal joints in OA?
Bouchard's nodes (PIP) and Heberden's nodes (DIP)
80
What is a pannus in RA?
Extra inflammatory cell buildup within the joint space. Seen on X-ray as opaque material within joint space
81
What anemia is found in RA?
Anemia of chronic disease (normal MCV, high ferritin, low TIBC) b/c macrophages use up the circulating iron
82
What is the most specific test to diagnose RA?
Anti cyclic citrulinated peptide antibodies (anti-CCP) is both sensitive and specific!
83
What is the best initial disease modifying therapy for RA?
Methotrexate
84
What is the x-ray finding of psoriatic arthritis?
Pencil in a cup
85
What is the hallmark x-ray finding of ankylosing spondylitis?
Bamboo spine
86
What is the hallmark x-ray finding of osteomyelitis?
Elevation of periosteum
87
What must be done before giving hydroxychloroquine?
Ophthalmologic exam because hydroxychloroquine can have retinal toxicity
88
When should anti-TNF drugs be used in RA?
If methotrexate and hydroxychloroquine have failed. Must do PPD test prior to using these drugs

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