deck 33

Question 1

pathophys of AVMs in the lungs

Answer 1

Shunt blood from the right to the left side of the heart, causing chronic hypoxemia and reactive polycythemia OR can present as massive or sometimes fatal hemoptysis

Question 2

treatment of homocystinuria

Answer 2

B6 (lowers homocysteine by acting as a cofactor for enzyme cystathionione beta-synthase, which metabolizes homocysteine into cystathionine)

Question 3

other features of opioid intoxication

Answer 3

• AMS + hypothermia (opioids can impair thermogenesis) + miosis (which may be absent due to co-ingestions)

Question 4

distillation of alcohol think

Answer 4

lead poisoning

Question 5

labs with vitamin K deficiency

Answer 5

prolonged PT + PTT

Question 6

management of symptomatic 3rd degree AV block

Answer 6

temporary pacemaker insertion

Question 7

viral conjunctivitis treatment

Answer 7

1) warm or cold compresses

2) +/- antihistamine/decongestant drops

Question 8

dual anti platelet therapy is…

Answer 8

aspirin + P2y12 receptor blocker (clopidogrel, prasugrel, ticagrelor)

Question 9

STEMI in patient who recently had drug-eluting stent placed think…

Answer 9

• subacute stent thrombosis from medication noncompliance
• premature discontinuation of anti platelet therapy is the strongest predictor of stent thrombosis within the first 12 months

Question 10

initial workup of HTN

Answer 10

UA (for occult hematuria and protein/creatinine ratio) + chem panel + lipid profile (risk stratification for CAD) + baseline ECG (to evaluate for CAD or LVH)

Question 11

early finding in macular degeneration

Answer 11

Distortion of straight lines such that they appear wavy (use grid test to determine)

Question 12

primary RFs for mac degeneration

Answer 12

Increasing age + smoking

Question 13

presentation of macular degeneration

Answer 13

progressive and bilateral loss of central vision

Question 14

PEA or systole management

Answer 14

• Uninterrupted CPR + vasopressors to maintain adequate cerebral and coronary perfusion
• no role for defibrillation or synchronized cardioversion

Question 15

pulseless electrical cavity (PEA)

Answer 15

Presence of an organized rhythm on cardiac monitoring without a measurable BP or palpable pulse

Question 16

cardioversion

Answer 16

delivers energy synchronized to the QRS complex

Question 17

defibrillation

Answer 17

delivers energy randomly during the cardiac cycle without synchronization to the QRS complex

Question 18

shockable rhythms

Answer 18

1) v fib

2) pulsess v tach

Question 19

Exam findings suggestive of severe AS

Answer 19

1) diminish and delayed carotid pulse (“pulses parvus and tardus”) due to blood flow obstruction
2) mid to late-peaking systolic murmur from turbulence due to stenosis
3) presence of soft and single second heart sound (thickening and calcification of aortic leaflets leads to reduced mobility and causes a soft S2, as S2 is due mainly to sudden aortic valve closure)

Question 20

presentation of spontaneous bacterial peritonitis

Answer 20

febrile + diffuse abdominal pain + AMS + hypotension + hypothermia (cirrhotics are often relatively hypothermic)

Question 21

how to determine etiology of ascites

Answer 21

calculate serum-to-ascites albumin gradient (greater than 1.1 indicates portal hypertensive etiologies)

Question 22

first question in evaluation of rectal bleeding

Answer 22

ask if low or large volume

Question 23

minimal rectal bleeding causes

Answer 23

usually due to hemorrhoids or other benign conditions

Question 24

minimal rectal bleeding evaluation

Answer 24

• if young (under 40) and no other CRC RF’s –> anoscopy (for hemorrhoids)
• if older than 50, then colonoscopy

Question 25

general manifestations of hyperthyroidism

Answer 25

``` anxiety and insomnia palpitations heat intolerance increased perspiration weight loss without decreased appetite goiter ```

Question 26

important cause of proximal muscle weakness with atrophy to think about

Answer 26

chronic hyperthyroid myopathy

Question 27

cause of zenker diverticulum

Answer 27

sphincter dysfunction + esophageal dysmotility

Question 28

evaluation of subclinical hypothyroidism

Answer 28

antithyroid peroxidase antibodies (patients with hashimoto's can have subclinical hypothyroidism preceding overt hypothyroidism)

Question 29

other impt cause of recurrent miscarriage

Answer 29

Hashimotos

Question 30

most common presentation of primary hyperparathyroidism

Answer 30

asymptomatic hypercalcemia with elevated parathyroid hormone level

Question 31

initial step in evaluation of cushing syndrome

Answer 31

Confirm hypercortisolism with a late-night salivary cortisol assay, 24-hour urine free cortisol measurement, and/or overnight low-dose dexamethasone test. If confirmed, then differentiate ACTH-dependent from ACTH-independent causes.

Question 32

first step in evaluation of hypogonadism

Answer 32

1) determine if primary or secondary (if primary, LH/FSH should be elevated)

Question 33

evaluation of secondary hypogonadism

Answer 33

- Measure serum prolactin + screen for other pituitary hormone deficiencies

Question 34

causes of secondary hypogonadism

Answer 34

mass lesion in hypothalamus or pituitary, hyperprolactinemia, long-term use of glucocorticoids or opiates, severe systemic illness

Question 35

prolactin relevance to hypogonadism

Answer 35

high prolactin can suppress testosterone production

Question 36

euthyroid sick syndrome labs

Answer 36

fall in total and free T3 with normal T4 and TSH levels

Question 37

irritant contact dermatitis of hand presentation

Answer 37

pruritus, erythema, vesicles, hyperkeratosis and fissuring of skin

Question 38

DASH diet

Answer 38

diet high in fruits and vegetables and low in saturated fat and total fat

Question 39

lifestyle modification with greatest efficacy

Answer 39

DASH diet then exercise then dietary sodium then alcohol

Question 40

other promotility agent

Answer 40

erythromycin

Question 41

diabetes drug category that induces weight loss

Answer 41

GLP-1 agonists (eg eventide, liraglutide)

Question 42

aortic regurgitation presentation

Answer 42

exertional dyspnea + pounding heart sensation + widened pulse pressure

Question 43

chronic aortic regurg pathophys

Answer 43

- portion of LV output leaks back into the LV, causing an increase in LV end-diastolic volume, myocardial hypertrophy, and chamber enlargement - this increase in LV size brings the apex close to the chest wall, causing a pounding sensation and uncomfortable awareness of heartbeat, especially in the left lateral decubitus position.

Question 44

chest pain with aortic stenosis

Answer 44

aortic outflow obstruction from supravalvular aortic stenosis can lead to LVH and exertional angina due to subendorcadial ischemia with increased myocardial oxygen demand during exercise

Question 45

peri-infection pericarditis presentation

Answer 45

pleuritic chest pain + pericardial friction rub + diffuse ST-segmeent elevations on ECG less than 4 days following MI

Question 46

renovascular HTN setting

Answer 46

1) resistant, severe HTN + diffuse atherosclerosis 2) also suspect if asymmetric kidney size, recurrent flash pulmonary edema or elevation in serum creatinine after starting ACE or ARB

Question 47

clinical features of primary aldosteronism

Answer 47

1) easily provoked hypokalemia 2) slight hypernatremia 3) HTN w/ adrenal incidentaloma

Question 48

important confounder of serum calcium

Answer 48

albumin (hypoalbuminemia)

Question 49

ambulatory blood pressure monitoring (ABPM)

Answer 49

- pt wears BP cuff throughout a 24-hour period and BP is measured and recorded at routine intervals. - used for masked HTN

Question 50

masked HTN

Answer 50

- normal BP readings in clinic but elevated average BP throughout the day. Suggested by signs of hypertensive end-organ damage

Question 51

signs of HTN end-organ damage

Answer 51

1) retinal arteriovenous nicking consistent with HTN retinopathy 2) increased QRS-complex voltage consistent with LV hypertrophy

Question 52

signs of RV failure

Answer 52

1) elevated JVP 2) RV 3rd heart sound 3) tricuspid regurgitation murmur 4) hepatomegaly with pulsatile liver 5) lower-extremity edema + ascites + pleural effusions

Question 53

right heart catheterization with cor pulmonale

Answer 53

elevated pulmonary systolic pressure

Question 54

feature of edema that suggests nephrotic syndrome

Answer 54

periorbital/facial edema and pedal edema

Question 55

when is wedge pressure elevated?

Answer 55

LV systolic or diastolic dysfunction

Question 56

major COPD heart sequela

Answer 56

cor pulmonale