DIT crashcart notes

Question 1

Non-invasive coronary heart disease tests

Answer 1

Stress echocardiography
Stress electrocardiogram
-Stress tests by treadmill or dobutamine

radionuclide myocardial perfusion imaging
Coronary artery calcium
Cardiac computed tomography angiopgraphy

Question 2

Why are b-blockers contraindicated in pts with cocaine-induced angina and cocaine induced hypertension

Answer 2

Cocaine inhibits the reuptake of NE by the presynaptic neuron prolonging the effects of NE

NE works through the alpha and beta adrenergic receptors on vascular smooth muscle, including coronary arteries.

Beta blockers lead to unopposed alpha adrenergic activity leading to angina, MI, HTN

Question 3

How is acute DIC diagnosed?

Answer 3

CBC: Thrombocytopenia - platelets less than 100K

Elevated D-dimer: increased fibrin degradation products (FDP)

Prolonged PT and PTT (d/t consumption of coagulation factors)

Decreased fibrinogen

Reduced antithrombin, protein C and protein S

Question 4

What are the causes of DIC?

Answer 4

Sepsis or severe infections: GN or GP

Trauma

Obstetric complications

Acute pancreatitis

Malignancy

Transfusion reactions

Question 5

Ddx for RUQ pain

Answer 5

Cholecystitis, cholangitis, liver abscess

Question 6

Ddx for LUQ pain

Answer 6

splenic rupture

Question 7

Ddx for epigastrium pain

Answer 7

PUD, pancreatitis

Question 8

Ddx for RLQ pain

Answer 8

appendicitis, renal stones, ectopic pregnancy, ovarian torsion, PID

Question 9

Ddx for LLQ pain

Answer 9

Diverticulitis, renal stones, ectopic pregnancy, ovarian torsion, PID

Question 10

Clinical presentation of a spontaneous vs tension pneumothorax

Answer 10

Spontaneous: Young adults, rupture of emphysematous blebs, at rest

Tension: after blunt trauma

Question 11

Tracheal deviation in a spontaneous vs tension pneumothorax

Answer 11

Spontaneous: slight to ipsilateral side

Tension: trachea and mediastinum shifts significantly to contralateral side

Question 12

Breath sounds in a spontaneous vs tension pneumothorax

Answer 12

Spontaneous: decreased

Tension: absent

Question 13

Treatment of a spontaneous vs tension pneumothorax

Answer 13

Spontaneous: observation, supplemental O2, may need chest tube

Tension: immediate needle decompression, (thoracentesis), chest tube (thoracostomy)

Question 14

Hypertension + hypokalemia

Answer 14

Primary hyperaldosteronism (Conn's)
-aldosterone secreting adenoma

Question 15

Hyponatremia + hyperkalemia + hyperpigmentation

Answer 15

Primary adrenal insufficiency (Addison’s) - will also have hypotension

Question 16

Hypocalcemia + hyperphosphatemia + low PTH

Answer 16

Hypoparathyroidism

Question 17

Features of nephrotic syndrome

Answer 17

caused by damage to glomeruli

Proteinuria >3.5 g/24 hrs
Hypoalbuminemia
Edema
Hyperlipidemia
Hypercoagulability

Question 18

Causative pathogens associated with osteomyelitis

Answer 18

MC: Staph aureus

IV drug use: S. aureus, Pseudomonas

Sickle Cell disease: S. aureas, Salmonella spp.

Question 19

Diagnostic criteria for SLE

Answer 19

At least 4 of the 11

Malar rash
Discoid rash
Photosensitivity
Oral ulcers
Arthritis
Serositis
\+ ANA
Renal disease
Neurological d/o (seizures, psychosis)
Hematologic d/o (hemolytic anemia, leukopenia, thrombocytopenia)
Immunlogic d/o (anti-dsDNA, anti-Smith, anti-phospholipid)

Question 20

DKA lab abnormalities

Answer 20

Increased serum glucose (>250)
Increased plasma osmolality
High anion gap metabolic acidosis
\+ ketones in serum and urine
Normal or elevated serum K+ but low total body K+

Question 21

Classic symptoms of Sjogren syndrome

Answer 21

dry eyes - sand in eyes

dry mouth - difficulty swallowing, tooth decay, parotid enlargement

Arthralgias

Other: Dry skin, nasal passages, vagina

Question 22

Diagnostic criteria for DM

Answer 22

One of the following criteria:

fasting plasma glucose >126 mg/dL

OGTT: Plasma glucose >= 200 mg/dL 2 hours after 75 g glucose load

Random plasma glucose >= 200 mg/dL with symptoms of hyperglycemia (polyuria, polydipsia)

hemoglobin A1c >= 6.5

Question 23

Pts that ACE inhibitors are considered first line treatments for essential htn

Answer 23

CHF or asx LV dysfunction - reduce mortality

Hx of STEMI - reduce mortality in post MI

Hx of NSTEMI w/:

• anterior infarct
• DM
• systolic dysfunction

Proteinuric CKD - slow progression of proteinuria

Question 24

Pts that ACE inhibitors are contraindicated

Answer 24

Pregnancy - teratogenic (fetal kidney problems)

Hx of angioedema from ACEI

B/l renal artery stenosis

Question 25

Profound fatigue with Heinz bodies and degmacytes (bite cells) on peripheral smear - most likely dx and cause of fatigue

Answer 25

G6PD deficiency G6PD generates NADPH - needed to reduce glutathione which neutralizes ROS and hydrogen peroxide Without G6PD - RBCs are susceptible to oxidation, which leads to hemolytic anemia

Question 26

Drugs provoking hemolytic anemia in G6PD deficiency

Answer 26

"Spleen Purges Nasty Inclusion From Damaged Cells" ``` Sulfonamides Primaquine (antimalarial) Nitrofurantoin Isoniazid (INH) Fava beans Dapsone Chloroquine (antimalarial) ```

Question 27

ST elevation in I, aVL, V5-6

Answer 27

Lateral wall MI | Circumflex artery

Question 28

ST elevation in II, III, aVF

Answer 28

Inferior wall MI Posterior descending artery, usually d/t RCA occlusion (if right dominant heart), 10% have left dominant which is off of circumflex a.

Question 29

ST elevation in V1-V4

Answer 29

Anterior wall MI | LAD

Question 30

Seronegative spondyloarthropathies

Answer 30

assoc w/ HLA-B27 ``` "PAIR" Psoriatic Ankylosing spondylitis IBD arthritis Reactive arthritis ```

Question 31

Asymmetric arthritis preceded by GI or GU infection

Answer 31

Reactive arthritis "can't see, can't pee, can't climb a tree"

Question 32

Inflammatory back pain + "bamboo spine" on x-ray

Answer 32

Ankylosing spondylitis

Question 33

Skin plaques with silvery scaling + pitting of nails + arthritis

Answer 33

Psoriatic arthritis Pencil in cup deformity on Xray of hand

Question 34

Specific gravity difference between Exudative and Transudative pleural effusion

Answer 34

Exudate: > 1.020 (high) Transudate: less than 1.012 (low)

Question 35

Protein content difference between Exudative and Transudative pleural effusion

Answer 35

Exudate: High Transudate: low

Question 36

Cellularity difference between Exudative and Transudative pleural effusion

Answer 36

Exudate: highly cellular Transudate: hypocellular

Question 37

Causes of Exudate pleural effusion

Answer 37

Exudates have "extra stuff" Infection Inflammation Cancer Lymphatic obstruction

Question 38

Causes of transudate pleural effusion

Answer 38

Transudates the fluid oozes out Na+ retention Increased hydrostatic pressure decreased oncotic pressure (low protein states)

Question 39

Organisms associated with struvite renal stones

Answer 39

Caused by urease-producing bacteria MC: Proteus mirabilis Klebsiella spp Enterobacter spp Pseudomonas spp

Question 40

Achalasia

Answer 40

Failure of LES to relax + impaired peristalsis Dysphagia to solids and liquids Regurgitation of undigested food Dx w/ esophageal manometry study Barium swallow: birds beak sign

Question 41

Anti-dsDNA

Answer 41

SLE esp active lupus nephritis

Question 42

Anti-histone

Answer 42

Drug induced lupus

Question 43

Anti-La/SSB

Answer 43

Sjogren syndrome

Question 44

Anti-Smith

Answer 44

SLE

Question 45

Anti-topoisomerase 1

Answer 45

diffuse cutaneous systemic sclerosis aka anti-SCL70 ab

Question 46

Anticentromere

Answer 46

Limited cutaneous systemic sclerosis aka CREST syndrome

Question 47

CREST syndrome

Answer 47

``` Calcinosis cutis Raynaud phenomenon Esophageal dysmotility Sclerodactyly Telangiectasias ```

Question 48

Antihypertensives safe in pregnancy

Answer 48

Methyldopa Labetalol Hydralazine Nifedipine

Question 49

Imaging study used r/i or r/o pulmonary embolism

Answer 49

CT pulmonary angiogram (contrast a concern with kidney disease) V/Q scan Traditional pulmonary angiogram

Question 50

EKG characteristics of 1st degree AV block

Answer 50

Prolonged PR interval, greater than 200 msec

Question 51

EKG characteristics of 2nd degree AV block (Mobitz I)

Answer 51

Progressive lengthening of PR interval then beat dropped (QRS not conducted)

Question 52

EKG characteristics of 2nd degree AV block (Mobitz II)

Answer 52

Dropped beat w/o progressive lengthening of the PR interval (aka normal PR interval) May progress to a 3rd degree AV block

Question 53

EKG characteristics of 3rd degree AV block

Answer 53

atria and ventricles beat independently, no correlation between P and QRS May have P on T wave or P wave on ST-T complex

Question 54

Medications used to reduce mortality in an acute exacerbation of systolic dysfunction CHF (dyspnea at rest, peripheral edema, JVD)

Answer 54

ACEI/ARBs B-blockers Aldosterone antagonists Loop diuretic - improve sx, reduce volume overload, does not impact mortality Digoxin - can decrease rate of hospitalizations, but doesn't reduce mortality

Question 55

Lab markers suggestive of hemolytic anemia

Answer 55

low H and H Normal MCV High reticulocyte count (immature blood cells) High indirect bilirubin High LDH Low haptoglobin (binds free hemoglobin, used up in hemolysis)

Question 56

Tests used to diagnose painful grouped vesicles in the groin area

Answer 56

Likely HSV-2 Require vesicular fluid of active lesion ``` Tests: Viral culture of vesicular fluid PCR of vesicular fluid Direct fluorescent Ab test Serum HSV antibodies Tzanck smear - low sensitivity/low specificity ```

Question 57

Common risk factors associated with PUD?

Answer 57

``` H. pylori chronic NSAID use Tobacco alcohol corticosteroids male gender ```

Question 58

Lab studies used to make diagnosis of PUD

Answer 58

H. pylori: Urea breath test IgG antibodies +/- biopsy

Question 59

Temporal arteritis

Answer 59

Vasculitis affecting medium and large vessels, commonly cranial branches Headache, visual disturbances, jaw claudication Permanent vision loss potential complication Diagnosis: Gold standard: temporal artery biopsy Elevated ESR (supports diagnosis)

Question 60

S/S of hypothyroidism

Answer 60

``` Fatigue Cold intolerance depression dry, coarse skin hair loss constipation wt gain Menorrhagia Bradycardia Delayed relaxation of DTRs ```

Question 61

Causes of metabolic acidosis with elevated anion gap

Answer 61

"MUDPILES" ``` Methanol Uremia (renal failure) DKA Paraldehyde, propylene glycol Isoniazid (INH), Iron tablets Lactic acidosis Ethylene glycol Salicylates ```

Question 62

S/S of infective endocarditis

Answer 62

``` MC: fever weakness fatigue anorexia new regurgitation murmur new heart failure -Right sided if IV drug user ``` ``` Septic emboli: Splinter hemorrhages Osler's nodes (painful, finger) Janeway lesions (not painful, palms/soles) Roth spots Focal neurological deficits Renal infarct and hematuria Abdominal or shoulder pain ``` Systemic immune reaction: Glomerulonephritis Arthritis

Question 63

Microcytic anemia ddx

Answer 63

Iron deficiency Anemia of chronic disease Lead poisoning

Question 64

Megaloblastic anemia

Answer 64

Macrocytic anemia with hypersegmented neutrophils B12 deficiency: neurological deficits, peripheral neuropathy - Dorsal column and lateral spinal column problems - symmetrical loss of vibration/sensation of feet - severe: cognitive problems, dementia Folate deficiency

Question 65

Labs to differentiate B12 vs folate deficiency as cause of megaloblastic anemia

Answer 65

B12: high homocysteine and high methylmalonic acid Folate: high homocysteine

Question 66

Small cell lung cancer paraneoplastic syndrome

Answer 66

ADH release: SIADH ACTH release: Cushing syndrome Lambert-Eaton myasthenic syndrome: Ab against presynaptic Ca2+ at NMJ causing weakness that improves with use

Question 67

Squamous cell lung cancer paraneoplastic syndrome

Answer 67

PTHrP secretion: Hypercalcemia

Question 68

Celiac disease antibodies

Answer 68

Anti-endomysial antibodies, bind to tissue transglutaminase Anti-gliadin Ab - low positive predictive value

Question 69

Celiac disease intestinal biopsy

Answer 69

Blunting of duodenal and jejunal villi

Question 70

Mechanism and cause of cardiogenic shock

Answer 70

Failure of myocardial pump MI, arrhythmias, cardiac tamponade, PE, cardiac contusion following trauma

Question 71

Mechanism and cause of septic shock

Answer 71

Decreased total peripheral resistance d/t peripheral dilation GN bacteria, DIC, endotoxins

Question 72

Mechanism and cause of hypovolemic shock

Answer 72

Inadequate blood or plasma volume Hemorrhage, severe burns, trauma

Question 73

Mechanism and cause of anaphylactic shock

Answer 73

Generalized hypersensitivity type 1 rxn Mast cell degranulation leads to vasodilation Allergic reaction

Question 74

Mechanism and cause of neurogenic shock

Answer 74

Autonomic dysfunction, peripheral vasodilation, bradycardia CNS or spinal injury

Question 75

Lab result seen in pt's successfully treated for syphilis

Answer 75

RPR and VDRL become negative (nontreponemal) | FTA-ABs remains positive for life (treponemal)

Question 76

Most common causes of acute pancreatitis

Answer 76

"PANCREATITIS" ``` hyperParathyroidism Alcohol - chronic -MC Neoplasm - blocking CBD Cholelithiasis - MC Rx - drugs (Ritonavir, reverse transcriptase inhibitors, sulfa drugs) ERCP Abdominal surgery hyperTriglyceridemia Infection (mumps) Trauma Idiopathic (20 percent) Scorpion sting ```

Question 77

S/S of acute pancreatitis

Answer 77

severe epigastric pain, radiates to back N/V sitophobia Cullen's or Grey-turner's sign

Question 78

Medications with highest risk of causing drug-induced lupus

Answer 78

SHIPP ``` Sulfonamides Hydralazine Isoniazid Phenytoin Procainamide ```

Question 79

Tumors associated with MENI

Answer 79

3 Ps Parathyroid adenomas Pancreatic tumors - endocrine Pituitary adenomas

Question 80

Tumors associated with MENIIA

Answer 80

2P 1M Pheochromocytoma Medullary thyroid cancer Parathyroid hyperplasia

Question 81

Tumors associated with MENIIB

Answer 81

1P 2M Pheochromocytoma Medullary thyroid cancer Mucosal neuromas

Question 82

Acute Kidney Injury

Answer 82

aka acute renal failure At least 1 of the following: Increase in serum creatinine > 0.3 mg/dL within 48 hours Increase in serum creatinine >50 percent within 7 days Urine output less than 0.5 mL/kg/hr for at least 6 hours

Question 83

Chronic kidney disease

Answer 83

At least 1 of the following for >= 3 mo eGFR less than 60 ml/min/1.73 m2 urinary abnormalities (proteinuria, microscopic hematuria, WBC or RBC casts)