IM Flashcards
(116 cards)
1
Q
First and initial approach to patient presenting with chest pain?
A
Targeted history and PE
2
Q
Best dx test in chronic stable angina?
A
ECG
IF NORMAL DO STRESS TEST
3
Q
First line if treatment for reducing angina?
A
Beta blockers and CCB
4
Q
Pharmacologic agents that can be used in stress testing
A
DAD
DOBUTAMINE
Adenosine
Dipyridamole
5
Q
Definitive test for CAD
A
Coronary angiography
6
Q
Major site of atherosclerotic disease
A
Epicardial coronary artery
7
Q
Most common cause of non cardiac chest pain
A
GI disorder
8
Q
Drugs for event prevention in stable angina
A
ACSA
aspirin
Clopidogre
Statins
ACE/ARB
9
Q
Drugs for relief of angina
A
Beta blockers and CCB
10
Q
What to do in a single or two vessel disease with NORMAL LV?
A
PCI
11
Q
Indications for CABG
A
- Three vessel disease
- Two vessel disease that includes LDCA with impaired LV or diabetic
- LEFT MAIN CAD
12
Q
Next best step after diagnosing a non STE ACS?
A
Aspirin 4 tabs
13
Q
Dx test to differentiate NSTEMI and unstable angina?
A
Cardiac biomarkers
14
Q
First cardia biomarker to rise in NSTEMI?
A
Myoglobin
15
Q
Cardio biomarker to detect reinfarction
A
CKMB
16
Q
What are the ABCS of plaque stabilization?
A
Aspirin, ace, arbs
beta blockers
Clopidogrel
Statins
17
Q
Difference re pathophysiology of NSTEMI and STEMI?
A
In NSTEMI plaque rupture resulted in partial occlusion in STEMI there is sudden interruption of blood supply due to total occlusion
18
Q
Patient presented with a sense of impending doom associated with chest pain. Impression?
A
STEMI
19
Q
When can a patient perform sexual activity post MI?
A
First 1-2 weeks
20
Q
When can a patient return to work post MI?
A
2-4 weeks
21
Q
Most common out of hospital cause of death from STEMI?
A
Vfib
22
Q
Most common in hospital cause of death in STEMI?
A
Pump failure
23
Q
Patient presented with a tearing chest pain that radiates to the back. Impression?
A
Aortic dissection
24
Q
Patient presented with chest pain with dermatomal distribution. Impression?
A
Herpes zoster
25
Patient presented with chest pain that is worse in supine and is relieved when sitting upright and leaning forward. Impression?
Pericarditis
26
Patient presented with chest pain associated with dyspnea and syncope. Impression?
Aortic stenosis (⬆️ cardinal symptoms)
27
Normal levels for
TCHOL
TG
LDL
HDL
TCHOL <200
TG <150
LDL <100
HDL >40
28
DOC for hypertriglyceridemia
FIBRATES
29
DOC and with greatest mortality benefit for hyperlipidemia?
Statins
30
Drug given to patients with hypertriglyceridemia to prevent pancreatitis
Omega 3 FA
31
Given to patients with low HDL
Niacin
32
Most common etiology of HPN?
Primary or essential
33
Most common cause of secondary HPN
Primary renal disease
34
Most common cause of mortality in patients with HPN?
Heart disease
35
How do you dx HPN?
Two or more elevated BP readings in a period of over a week or so
36
Drug therapy is indicated in hypertensive patients with BP of ?
140/90 or higher
37
Patient presented with elevated bp with change in sensorium. BP is 230/140. Impression? Most urgent step?
Hypertensive EMERGENCY
START IV MEDS to decrease bp to 25% of initial bp or 160/110-100
38
Most important mechanism of dyspnea in CHF?
Pulmonary congestion
39
Most useful test to assess LV function is
2D echogram
40
Cornerstone of pharmacotherapy in CHF
Beta blockers and ACE inhibitors
41
Goals of treatment for patients with CHF
Relief of sx
Prevent progression
Reduce mortality
42
In acute decompensated HF, what is the inotropic agent of choice?
DOBUTAMINE
43
Most common cause of right sided heart failure?
Left sided heart failure
44
Patient presented with SYNCOPE, ANGINA and DYSPNEA. Auscultation showede a MIDSYSTOLIC MURMUR. Dx? What is the best INITIAL test?
```
Dx: AS
Transthoracic echocardiogram (TEE)
```
45
Patient presented with SYNCOPE, ANGINA and DYSPNEA. What is the most ACCURATE DX test?
Left heart catheterization
46
Patient presented with SYNCOPE, ANGINA and DYSPNEA. What is the treatment of choice for symptomatic patients?
Aortic valve replacement surgery
47
Patient presented with a high pitched blowing diastolic murmur over the left sternal border. Dx? Initial dignostic? Tx?
Aortic regurgitation
TEE
SURGICAL AORTIC VALVE REPLACEMENT
48
Patient presented with a hx of RHD with a low pitched diastolic murmur at the apex. Dx? Chest X-ray finding? Common cause?
Dx: mitral stenosis
Cxr: straightening of the left upper border of cardiac silhouette
MC CAUSE : RHEUMATIC FEVER
49
Patient diagnosed with Mitral stenosis. What is the most effective treatment?
Balloon valvuloplasty
50
MS patient presented with onset of ATRIAL FIBRILLATION which is a HALLMARK OF DISEASE PROGRESSION was started with WARFARIN. What is the target INR?
INR 2-3
51
Patient presented with hpn and a holosystolic murmur at the apex that radiates to the axilla. Dx?
Mitral regurgitation
52
Patient is a case of MARFAN's that presented with MIDSYSTOLIC click and systolic murmur that is increased by standing and valsalva. Dx?
Mitral valve prolapse
53
Patient is a IV DRUG USER presented with a BLOWING HOLOSYSTOLIC MURMUR at the left sternal border. DX?
Tricuspid regurgitation
54
Most common type of cardiomyopathy
Dilated cardiomyopathy
55
Leading cause of death in young healthy athletes
Hypertrophic cardiomyopathy
56
Echocardiography showed a glittering hyperrefractile myocardium. This is typical of?
An amyloid infiltration in restrictive cardiomyopathy
57
What is a characteristic echocardiographic finding in HYPERTROPHIC CARDIOMYOPATHY?
Systolic anterior motion (SAM)
58
Features in pericarditis?
Chest pain that is positional
Rub (pericardial friction- pathognomonic)
Effusion that is pericardial
ST segment elevation that is diffuse
(+)etiology -TANS
59
Management of pericarditis?
Aspirin + omeprazole
NSAIDs or steroids as anti inflammatory
AVOID ANTICOAGULATANTS
60
Becks triad
Jugular venous distention
Muffled heart sounds
Hypotension
61
Most urgent step in a diagnosis of CARDIAC TAMPONADE
Echo-guided pericardiocentesis
62
Best INITIAL test when considering a PAD?
Ankle brachial index (ABI)
Diagnostic is ABI of <0.9
normal >1
PAD <0.9
Severe ischemia <0.5
63
Gold standard for diagnosis of PAD
Arteriography
64
First line for symptom improvement if PAD?
Cilostazol
2nd line is PENTOXIFYLINE
65
Beta blockers that showed evidence for lowering mortality in Heart failure
Metoprolol succinate
Bisoprolol
Carvedilol
66
Most common cause of chronic cough in a patient who is a non smoker, and not on ACE inhibitors with normal PE and CXR
PAG ang cough >8weeks
Postnasal drip
Asthma
GERD
67
Samter's triad
ANA
Aspirin
Nasal polyps
Asthma
68
Best test to determine reactive airway disease
Metacholine stimulation test
69
Target SPO2 in asthma?
>90%
70
First line of treatment for acute asthma attack
SABA
71
First line of controller treatment
Low dose ICS
72
When to step up in asthma control?
2-3 months of uncontrolled or persistent asthma
73
When to step down asthma mgt?
When asthma attacks are controlled for 3 months
74
When is it time to start giving ICS in a person dx with asthma
If attacks occur more than 2x a month and the person wakes up from sleep due to an attack more than once a month
75
Test that CONFIRMS asthma
Spirometry
76
Best INITIAL test for COPD
Soirometry
77
Best diagnostic test for COPD in acute exacerbations?
ABG
78
Target SPO2 in COPD
90% or more
79
Common risk factor in COPD
Tobacco smoking
80
Characteristic of asthma
Airway hyper responsiveness
81
Characteristic of COPD
Airflow limitation/ obstruction
82
Definitive diagnostic test for COPD
Pulmonary function test or spirometry with FEV1/FVC ratio of <0.7
83
When to start O2 therapy in COPD?
If SP02 is less than 88% or if 90% with signs if pulmonary hypertension or right sided heart failure
84
Bacteria more commonly implicated in COPD exacerbations
S. Pneumoniae
H. Influenzae
M. Catarrhalis
85
Most common atypical pathogens in pneumonia
MCL
Mycoplasma
Chlamydia
Legionella
86
Most common extra pulmonary TB
TB lymphadenitis
87
Pott's disease commonly affects what part of the spine?
Lower thoracic upper lumbar
88
Tb drug related to peripheral neuropathy
Isoniazid
89
Tb drugs related to visual impairment
Ethambutol
90
Cornerstone in diagnosing TB MENINGITIS
Lumbar tap
91
Gold standard in diagnosing TB MENINGITIS
CSF CULTURE
92
Most common cause of pleural effusion
LV HEART FAILURE
93
MC cause of exudative PE
TB
MALIGNANCY IS THE 2nd MC cause
94
Light criteria
PF:serum protein = >0.5
PF: serum LDH = >0.6
PF LDH > 2/3 upper normal serum limit
Yes = exudative
95
Patient who worked in ship building came in for annual CXR. Results showed CALCIFIED PLEURAL PLAQUES. Impression?
Asbestosis
*also in tile and brake lining
96
Patient who worked in the mining industry came in for annual CXR. Results showed EGGSHELL CALCIFICATION . Impression?
SILICOSIS
*also in stone and glass cutting, sandblasting and quarrying
97
Patient who is an aerospace engineer came in for annual CXR. Results showed nodlues along septal line. Impression?
Berylliosis
*also in nuclear and electronic plants
98
Patient who worked in a cotton manufacturing company came in for annual CXR. Results showed diffuse infiltrates with hilar adenopathy. Impression?
Byssinosis
99
A coal worker came in for annual CXR. Results showed progressive fibrosis. Impression?
Coal worker's pneumoconiosis
100
DOC for CAP due to a LEGIONELLA infection
Clarithromycin
101
Features of ARDS
A cute in onset
R ratio of Pa02/FiO2
D iffuse bilateral CXR
S sawn ganz pressure is less than 18mmHg
102
Most patients are liberated from the mech vent after ARDS when?
From day 7-21
104
Best initial diagnostic test in an assessment of ARF
ABG
105
How do you correct hypoxemia in an intubated patient?
adjust mech vent settings to increase oxygenation by increasing FiO2 and increasing PEEP
106
How do you correct hypercarbia in an intubated patient?
Increase ventilation by increasing RR and increase in tidal volume
107
What mech vent strategy has shown to improve survival in ARDS?
Low tidal volume
108
Most appropriate diagnostic test for pulmonary embolism?
Chest ct with contrast
109
Gold standard in the diagnosis of PE
Invasive pulmonary angiogram
110
Initial test to rule in or our a PE or a DVT
D-dimer
113
What is the most urgent step in a cardiogenic shock?
FLUID RESUSCITATION with crystalloids with at least 30cc/kg within 3hours
114
Vasopressor of choice in shock
Norepinephrine
2nd line = epinephrine
115
Inotropic agent of choice for shock
DOBUTAMINE
116
Most serious complication of fluid infusion
Pulmonary edema
117
Features of tension pneumothorax
P-Thorax
```
Pleuritic chest pain
Tracheal deviation
Hyperresonance
Onset is sudden
Reduced breath sounds and dyspnea
Absent fremitus
Xray shows collapase
```
118
MC sx of DVT
Cramps
119
Hallmarks of massive PE
Dyspnea
Syncope
Hypotension
