CV Flashcards
(133 cards)
1
Q
What patient population are TZDs contraindicated in?
A
- pts with Heart Assoc class III or IV heart failure
2
Q
70yo man w hx of htn and DM2 has SOB with exertion and PND, EF = 25%. Which drug should be discontinued?
A
Pioglitazone (actos)
3
Q
When is the use of cardiac resynchronization therapy appropriate?
A
- in patients with medically refractory, symptomatic class III or IV disease with:
1. QRS interval at least 130msec
2. Left ventricular end diastolic diameter of at least 55mm
3. Left vent EF < 30%
4
Q
Which dietary factor decreases the rate of sudden death in CVD pts?
A
Omega 3 fats
5
Q
What is the difference in management of an ascending vs descending aortic aneurysm?
A
Ascending: surgical emergency
Descending: intially- reduce blood pressure, beta blocker!! to reduce heart rate, if systolic remains over 100 give IV nitroprusside
6
Q
What is the first line therapy for a descending aortic dissection?
A
Beta blocker to reduce heart rate
7
Q
What are the screening recommendations for AAA?
A
one time screening w ultrasonography for AAA in men 65-75 yrs who have ever smoked
8
Q
How does one treat supraventricular tachycardia that is refratory to adenosine or rapidly recurs?
A
IV verapamil or B blocker
9
Q
What are CAD equivalent diseases? 4
A
- DBM
- PAD
- Symptomatic carotid artery disease
- AAA
10
Q
What is the most common risk factor for frozen shoulder and what ages is it most commonly seen in?
A
Risk: diabetes mellitus
Ages 40-60
11
Q
what are 3 physiologic differences between women and men that can affect drug metabolism?
A
- GI transit times are slower in women
- Women secrete less gastric acid
- Women have lower GFR
12
Q
What is the target glucose level in critically ill pts via insulin infusion?
A
140-180mg/dL
13
Q
What is the recommended duration of dual antiplatelet therapy following placement of a drug-eluting coronary artery stent? What drugs should you use?
A
1 year
Drugs:
1. Aspirin 162-325mg
2. Clopidogrel (75mg) or prasugrel (10mg) (or ticlopidine for pts who do not tolerate clopidogrel or prasugrel)
14
Q
What is the most effective treatment of intrahepatic cholestasis of pregnancy?
A
Ursodiol
15
Q
What is the reasoning of giving antibiotics for B pertussis?
A
to reduce risk of transmission to others
16
Q
CDC recomments what for primary treatment of pertussis?
A
macrolides
17
Q
What is tarsal coalition?
A
- fusion of two or more tarsal bones
- happens in mid-late adolescence
- decreased ROM, pain on foot inversion
18
Q
Which antidepressant is least likely to cause a pt weight gain?
A
Bupropion
19
Q
What is the preferred method for diagnosing psychogenic nonepileptic seizures?
A
vEEG monitoring
20
Q
What event suggests no possibility of a recovery after cardiac arrest leading to comatose?
A
myoclonic status epilepticus at 24 hours
21
Q
What is the difference between IGRA and TST for latent TB screening?
A
IGRA differentiates between M. tb from nontuberculous mycobacteria
22
Q
What are the first line agents for ovulation induction in PCOS?
A
Metformin and Clomiphene (clom doesnt improve hirsutism)
23
Q
What is found on a PFT in a pt with vocal cord dysfunction?
A
normal expiratory portion but a flattened inspiratory phase (often confused with asthma- suspect in pts w exercise induced asthma who do not have a good response to beta agonists)
24
Q
What techniques can you use to confirm or rule out a PE?
A
CT angiography & ventilation-perfusion lung scan
25
What are 4 examples of drugs that can exacerbate symptoms of restless legs syndrome?
1. Antihistamines
2. Caffeine
3. SSRIs
4. tricyclic antidepressants
26
What should be given for restless legs syndrome?
Iron supplementation if serum ferritin level is below 50ng/mL
27
What technique should be used to diagnose diverticulitis?
CT of the abdomen and pelvis
28
Why should you not perform a colonoscopy in a pt suspected to have diverticulitis?
increased risk of perforation or exacerbation of the disease is greater if performed within 6 weeks of acute process
29
what is a paient centered medical home?
a physician led team of care providers taking responsibility for the quality and safety of an individual's health
30
When do you consider a tuberculin skin test positive?
1. Induration >5mm in pts at high risk- immunocompromised, HIV, transplant, household contacts
2. Induration >15mm in pts at low risk of exposure
3. Induration >10mm in pts with increased probability of exposure (nursing home residents, homeless shelters, immigrants, IV drug users, hospital workers)
31
Which drug is FDA approved to treat hiccups?
Chlorpromazine
32
How do you determine a pt's risk of stroke and if they should be anticoagulated?
CHADS2:
One point for: history of CHF, HTN, Age (75), and DBM
two points for: previous stroke or TIA
- initiate warfarin in pts w/ score >2 or a fibb
33
in hypertensive pts with DBM, the blood pressure goal should be below a threshold of what?
130/80
34
What compound in cough and cold remedies can be associated with serotonin syndrome?
Dextromethorphan
35
What is a marker for hear failure?
BNP- synthesized, stored and released by the ventricular myocardium in response to volume expansion and pressure overload
36
What class of HTN medications reduces risk of death?
thiazide diuretic with or without an ACE inhibitor
37
What initial test rules out adrenal insufficiency?
A morning serum cortisol
38
Which criterion is necessary to make a diagnosis of polymyalgia rheumatica?
bilateral shoulder or hip stiffness and aching for at least one month
39
The CDC recommends that all pts between 13-64 be screened for
HIV infection
40
Which anticholinergic agent can be used to reduce respiratory secretions and is LEAST likely to cause CNS effects like sedation?
Glycopyrrolate
41
PVCs should not be suppressed with what??
antiarrhythmic agnents- may increase mortality
| ie) encainide or flecainide
42
What is the only hypoglycemic agent shown to reduce mortality rates in patients with type 2 DBM?
metformin
43
What is a screening test or primary hyperaldosteronism? What values diagnose it?
morning aldosterone-to-renin ratio
| - diagnosed via a ratio >20:1 with an aldosterone level >15ng/dL
44
What is an acceptable increase in ASTs and ALTs for pts on statins?
A 3 fold increase above the upper limit of normal
45
In pts with chronic hep B, what measured level suggests that the infection is in the active phase?
Elevated levels of ALT
46
What are the three major phases of chronic hepatitis B?
1. Immune-tolerant
2. Immune-active (elevated liver enzmes and presence of HBeAg)
3. Inactive carrier (anti-HBeAg)
47
What is the treatment for painful subacute thyroiditis?
Prednisone
48
In pts with chronic hep B, what measured level suggests that the infection is in the active phase?
Elevated levels of ALT
48
In pts with chronic hep B, what measured level suggests that the infection is in the active phase?
Elevated levels of ALT
49
What are the three major phases of chronic hepatitis B?
1. Immune-tolerant
2. Immune-active (elevated liver enzmes and presence of HBeAg)
3. Inactive carrier (anti-HBeAg)
49
What are the three major phases of chronic hepatitis B?
1. Immune-tolerant
2. Immune-active (elevated liver enzmes and presence of HBeAg)
3. Inactive carrier (anti-HBeAg)
50
What is the treatment for painful subacute thyroiditis?
Prednisone
50
What is the treatment for painful subacute thyroiditis?
Prednisone
51
In pts with chronic hep B, what measured level suggests that the infection is in the active phase?
Elevated levels of ALT
52
What are the three major phases of chronic hepatitis B?
1. Immune-tolerant
2. Immune-active (elevated liver enzmes and presence of HBeAg)
3. Inactive carrier (anti-HBeAg)
56
What is the treatment for painful subacute thyroiditis?
Prednisone
57
What is the most useful predictive factor in distinguishing uncomplicated pyelonephritis from perinephric abscess?
persistence of fever more than 4 days after initiating antibiotics
58
What does a CT scan usually show in perinephric abscess?
- perirenal fluid
- enlagement of psoas muscle
- perirenal gas (diagnostic)
59
When do you not need to do routine preoperative testing?
- in asymptomatic patients undergoing low-risk procedures (eg cataract procedures)
60
How do you classify mild persistent asthma?
- occurs more than 2 days per week (but not daily)
| - uses albuterol inhaler more than 2 days per week (not daily)
61
When does the ADA recommend screening for diabetes?
all asymptomatic adults w a BMI >25.0 kg/ who have one or more additional risk factors
- screening for all adults with no risk factors every 3 yrs beginning at age 45
62
What is euthyroid sick syndrome?
alterations in thyroid function tests seen frequently in hospitalized patients
- decreased thyroid fxn may be seen early in sepsis
63
How do you evaluate a child w possible septic arthritis?
Ultrasonography (detects an effusion)
64
What is the female athlete triad?
Amenorrhea
Osteoporosis
Disordered eating
- should have a bone density test
65
What is the most common cause of recurrent and persistent acute otitis media in children?
Penicillin-resistant Strep pneumo
66
what are the recommendations for a Td vaccine?
at least every 10 years, and a one time TdaP booster for adults aged >18 years
67
when should you give the IM influenza vaccine versus intranasal?
Intranasal (live attenuated): all adults
| IM (inactivated): all adults > 50 yrs and those with certain comorbid conditions
68
what are the guidelines for cervical cancer screening?
- begin at age 21 regardless of when they start having sex, perform every 2 years
- for women >30yrs, who have had three consecutive normal smears, can switch to every 3 years
69
Who should get the HPV vaccine?
both males and females aged 9-26 years given before initiation of sexual activity
70
what are the CHD risk equivalents? (4)
- Diabetes
- Symptomatic CAD
- Peripheral Artery Disease
- AAA
71
what are the risk factors for CHD? (5)
1. Cigarette smoking
2. BP> 140/90
3. Premature CHD in family members (45 men, >55 women
- high HDL (>60) is a negative risk factor
72
What are the high risk countries for hep A?
asia and africa!!
73
Who should get a yellow fever vaccine?
those traveling to sub-saharan africa and equatorial south american countries
74
Who should get the meningococcal vaccination?
some asian countries and sub-saharan Africa (legally required for those who make pilgrimage to Mecca Saudi-arabia
75
Who should be screened for chlamydia?
sexually active women age 24 and asymptomatic women at increased risk for STIs (those with other STIs or with new/numerous partners)
76
When do you start routine screening for lipid disorders?
men >35 yrs, and women >45yrs
- begin at age 20 for patients with diabetes, FHx of premature CAD, familial hyperlipidemia, or numerous risk factors for CHD
77
What type of immunity does the pneumococcal vaccine produce?
T cell independent B cell response
78
In general HIV pts shouldnt get live vaccines, what are the two exceptions?
MMR & Varicella
79
In pts with Peripheral Vascular disease, what is the most useful intervention to improve function and reduce symptoms of claudication?
Supervised graded exercise program & Antiplatelet agents like aspirin or clopidogrel
80
Who should be screened for bladder cancer?
no one yet- low incidence and poor positive predictive value
81
Who should be screened for AAA?
men aged 65-75 who have smoked cigarettes via abdominal ultrasound
82
what are the T scores of osteopenia versus osteoporosis?
Osteopenia: -1.5 to -2.5
Osteoporosis: <-2.5
83
What are the most common sites of disk herniation?
L5-S1 and L4-5
84
What are the deficits seen in L4-5 impingement?
- extensor of great toes
| - sensory loss on dorsum of foot/base of first toe
85
What are the deficits seen in L5-S1 impingement?
- ankle jerk reflex impaired (plantar flexion)
| - sensory deficit in buttocks, posterior thigh, calf, lateral ankle, and foot
86
what are some indications for x rays in pts with back pain?
- lasting mroe than 6 weeks
- age >60
- history of significant trauma
- neurologic deficit
- systemic symptoms
- history of drug or alcohol abuse
87
CT and MRI should be used when you suspect what low back conditions?
1. Spinal infections
2. Cancers
3. Herniated disks
4. Spinal stenosis
88
You should use caution in telling which patient populations to use acetaminophen?
1. Hx of gastritis or ulcers
2. HTN
3. Chronic renal failure
4. CHF
89
Colonic motility can be inhibited by which medical conditions and electrolyte imbalances?
1. hypothyroidism
2. hypercalcemia
3. hypokalemia
4. scleroderma
5. diabetes
6. neurologic disorders (parkinsons, MS, paraplegia)
90
What medications can cause constipation?
1. Verapamil- Ca Channel blockers
2. Narcotics
3. Anticholinergics
91
When is anoscopy useful?
questions about internal hemorrhoids and anal fissures
92
Magnesium salts are contraindicated in what type of patients?
- renal failure!
93
what is the most common presenting sign of urinary tract malignancy?
- painless hematuria
94
hemoptysis + hematuria =
goodpastures
95
what medications can cause interstitial nephritis (hematuria, fever, skin rash)?
1. NSAIDs
2. Cephalosporins
3. Ciprofloxacin
96
which medications can cause hemorrhagic cystitis?
1. Cyclophosphamide!
97
blindness, deafness, hematuria
alport syndrome
98
what will you find in microscopic examination of interstitial neohritis?
eosinophilia
99
What is an IVP used for?
detecting kidney stones, masses, cysts and hydronephrosis
- use an ultrasound in individuals who are allergic to contrast media, at risk for contrast nephropathy, or have renal insufficiency
100
If find suspicious lesions on IVP or US, what should you do next?
- CT or MRI and possible biopsy
101
whats the next step in someone with an uncertain diagnosis of lymphadenopathy?
CBC and serology
| - then a CXR in pt with pulm symptoms, suprcalvicular lymphadenopathy, or severely ill pts
102
When should you consider a lymph node biopsy? when do you need to do an early biopsy?
- when there is clinical suspicion of neoplasm or illness such as TB or sarcoidosis, LN remaining for 4-12 weeks
- early: LN size and irregularity, presence of weight loss, or an enlarged liver or spleen, supraclavicular nodes
103
what are the symptoms of meniere disease?
recurring vertigo + tinnitus + vomiting
104
Diabetes + nausea and vomiting
consider DKA
105
persistent early-morning nausea in the absence of a pregnancy or metabolic disease
-possibility of increased ICP, so perform CT or MRI of head
106
what medication is helpful in patients with vestibular related nausea and/or vomiting?
antihistamine: meclizine (antivert)
107
Which medications are commonly known to cause nausea?
1. Macrolide antibiotics
2. Metronidazole
3. Opiates
4. NSAIDs
5. Estrogen
6. Digitalis
7. Theophylline
108
what medication class is used for nausea?
phenothiazines
109
what are the micvovascular complications of DBM? Macrovascular?
Micro: retinopathy, neuropathy, nephropathy
Macro: premature atherosclerosis leading to CV, cerebrovascular and PVD.
110
What are some causes of TRANSIENT hyperglycemia?
- stresses like infection or heart attack
111
What are some causes of elevated blood sugar that are NOT from diabetes?
- pancreatitis, pancreatic cancer, pancreatic resection
| - hemochromatosis (bronze diabetes)
112
What medications can cause elevated blood sugars?
- high dose steroids
- beta blockers
- OCPs
- phenytoin
- hydrochlorothiazide
113
what are the ADA's recommendations for screening for diabetes?
everyone over the age of 45, every 3 years via a fasting glucose
114
The diagnosis of diabetes can be established by one of the 3 criteria?
1. Fasting BG >126mg/dL on two or more separate occasions
2. Random blood glucose greater than 200mg/dL with polyuria, polydypsia, and polyphagia
3. A 2-hour postprandial glucose greater than 200mg/dL
115
who is considered prediabetic?
fasting BG 100-125mg/dL
116
who and when should you screen for microalbuminuria
- for DBM patients over 30 years of age or those with DBM more than 5 years duration
- screening done annually
117
what are the contraindications of sulfonylureas?
- allergy
- pregnancy
- significant renal dysfunction
118
side effects of sulfonylureas?
- weight gain and hypoglycemia
119
MOA of metformin?
biguanide- inhibits hepatic gluconeogenesis and increasing glucose uptake in the peripheral tissues
120
SE of metformin?
- diarrhea, nausea, dyspepsia
- lactic acidosis!!! avoid in pts with renal dysfunction (Cr >1.5)m CHF, acute or chronic acidosis, or hepatic dysfunction
121
MOA of TZDs?
use in caution w cardiac conditions- can cause MI and icnrease risk of CHF
- MOA: decreasing insulin resistance in skeletal muscle and the liver
122
what is the most commonly used diabetes medication combination?
metformin (biguanide) and sulfonylurea
123
what should the BP and LDL levels be in a diabetic patient?
BP: 130/80 (use ACE inhibitor)
LDL: 50yrs
124
Meds used to tx diabetic neuropathy?
- TCAs
- Carbamazepine
- Gabapentin
125
how do you distinguish between bacterial vaginosis and candida vaginitis?
pH! candid pH 4.5
126
what role does squatting play in hypertrophic cardiomyopathy?
increases venous return, thus decreases the murmur whereas standing decreases return and increaes the obstruction/murmur
127
what is rhinitis medicamentosa?
condition caused by chronic use of cocaine or nasal nasal decongestants
128
what is vasomotor rhinitis?
chronic nasal congestion with pink nasal mucosa that is brought on by sudden changes in temp, humidity, or odor
129
how much calcium should patients be given w osteoporosis?
premenopausal: 1000mg/day
postmenopausal: 1200mg/day
130
How do you diagnose diverticulitis?
CT scan!! do not do colonoscopy or barium enema bc of risk of perforation
131
What are the indications for hospitalization in pts with pneumonia?
1. Systolic BP 140
3. O2 sat less than 90%
4. presence of abscess or pleural effusion
5. Marked metabolic abnormality
6. Age >65
7. Unreliable social situation
132
How do you evaluate for multiple sclerosis?
MRI of the brain
133
what is blepharitis?
chronic lid margin erythema, scaling and loss of eyelashes
