IM PEARLS Flashcards
(455 cards)
1
Q
Underlying cause of Chest Pain in Stable Angina
A
Fixed atherosclerotic stenosis of coronary arteries - Increased myocardial oxygen demand - LACTIC ACIDOSIS
2
Q
Precursor lesion of atherosclerosis
A
FATTY STREAK containing foam cells (macrophages)
3
Q
Why does pain radiate to the left arm in Stable Angina
A
Synapses shared with C4 and C5 sensory fibers
4
Q
What does pain radiating to the upper back (trapezius) indicate?
A
PERICARDIAL involvement
5
Q
Major Risk Factors for Chronic Stable Angina
A
DM, SMOKING, family history of CAD or premature CAD (M<50(F)
6
Q
Minor Risk Factor for Chronic Stable Angina
A
Age, Obesity (independent RF), Estrogen Deficiency (Males & Menopaused), Homocysteinemia
7
Q
Best initial test for Stable Angina; What are the Expected Findings?
A
ECG showing ST DEPRESSION, FLATTENING OF T WAVES sec to ischemia
8
Q
Expected Findings on Cardiac Enzymes in Stable Angina
A
Cardiac Enzymes NOT ELEVATED
9
Q
Next best step in management of Stable Angina if ECG is nondiagnostic
A
EXCERCISE STRESS TESTING or Treadmill Stress Test (for MI Risk Stratification: (+) High Risk, (-) Low Risk)
10
Q
If unable to walk, what stress test will you order in a Stable Angina patient?
A
DOBUTAMINE or DYPRIDAMOLE Stress Test (Increase Heart Rate and Contractility)
11
Q
Stable Angina patient has BASELINE ECG ABNORMALITIES, what stress test is appropriate?
A
NUCLEAR STRESS TEST (Thallium, Sestamibi)
12
Q
Most Appropriate Treatment in Stable Angina
A
LIFESTYLE MODIFICATION, OPD: Aspirin, Beta Blockers, Statins, Nitrates - Symptomatic Relief; NO Mortality Risk Reduction
13
Q
Complications associated with Stable Angina
A
ACUTE MYOCARDIAL INFARCTION, ANEURYSMS
14
Q
Patient’s chest pain unrelieved by rest or nitrates
A
UNSTABLE ANGINA (Crescendo Angina)
15
Q
If Stress Test is Positive, what is the next Best Step in Management?
A
ANGIOGRAPHY (Preventive in MI), start ANTICOAGULATION, ASPIRIN, CLOPIDOGREL, NITRATES and BETA BLOCKERS
16
Q
Underlying pathology in MI
A
RUPTURED ATHEROSCLEROTIC PLAQUE
17
Q
Blood vessel involved in Acute MI
A
LEFT ANTERIOR DESCENDING ARTERY
18
Q
Heart Wall involved in Acute MI
A
ANTEROSEPTAL WALL
19
Q
Heart Wall involved in ECG Leads V1, V2
A
SEPTAL WALL (supplied by Left Anterior Descending)
20
Q
Heart Wall involved in ECG Leads V3, V4
A
ANTERIOR WALL (supplied by Left Anterior Descending)
21
Q
Heart Wall involved in ECG Leads II, III, aVF
A
INFERIOR WALL (supplied by Right Coronary Artery)
22
Q
Heart Wall involved in ECG Leads I & aVL, V5 & V6
A
LATERAL WALL (supplied by Left Circumflex Artery)
23
Q
2 Forms of Acute MI: Distinguish the two.
A
STEMI: Q Waves, new LBBB, ST elevations in 2 or more contiguous leads or chest leads (Noncontiguous Leads=PERICARDITIS); NSTEMI: T Wave inversion, ST Depression
24
Q
Which patient population will MI present in atypical fashion?
A
ELDERLY (Autonomic Nervous System manifestations are subtle or irregular) and DIABETICS
25
Cardiac Enzymes requested in Acute MI
TROPONINS & CM-MB
26
Rise within 4 hours, detectable for 2 weeks, BEST marker for RECENT MI (artificially increased in CKD)
TROPONINS
27
Rise within 4 hours, peaks at 24 hours, normalizes in 2-3 days, BEST marker for REINFARCTION
CK-MB
28
Most Important initial intervention at the ER for Acute MI
MONA - Morphine, Oxygen, Nitrates (CI in Inferior Wall MI due to hypotension sec to decreased preload), Aspirin
29
GOLD STANDARD in treatment of Acute MI
PERCUTANEOUS CORONARY INTERVENTION (if brought to ER within 90 minutes)
30
Difference of Management in STEMI & NSTEMI
STEMI: PCI or Thrombolysis if PCI not available (most effective at 6 hours, effective up to 12 hours), anticoagulation with Heparin; NSTEMI: PCI, anticoagulation with Heparin (thrombolysis has NO benefit in NSTEMI)
31
Absolute Contraindication to Thrombolysis in Acute MI
Hemorrhagic CVD, Brain Tumor, Head Trauma, Ischemic CVD within last 1 year, Active Bleeding (exc Menses), Aortic Dissection, BP Cutoff >180/110mmHg
32
Medication shown to Improve Acute MI Survival
ASPIRIN, BETA BLOCKERS (Dec Demand), ACE(prevent CHF)/ARBs (if with LV dysfunction)
33
Acute Complications of Acute MI
PUMP FAILURE (Acute CHF; Inpatients) & ARRHYTHMIAS (Ventricular Fibrillation; Outpatients)
34
How is Extent of Pump Failure Stratified?
KILLIP CLASSIFICATION - I: No evidence of HF; II: Mild to moderate HF (S3 Gallop, Lung Rales, or JVD); III: Overt pulmonary edema; IV: Cardiogenic Shock
35
Why is there Pulmonary Edema in Acute MI
PUMP FAILURE (LV Dysfuntion) - Backflow of Blood into Pulmonary Vessels
36
Associated Complications for Acute MI
Myocardial Aneurysm, Papillary Muscle Rupture, Rupture of Interventricular Septum, Free Wall Rupture, Pericarditis (Dressler Syndrome)
37
2-7 Days post MI, MCC: Inferior Wall Ischemia, Sx: Pansystolic Murmur radiating to Axilla, Mitral Regurg Murmur, Dx: 2D Echo, Tx: Surgical Repair
PAPILLARY MUSCLE RUPTURE
38
3-5 days post MI, MCC: Anterior Wall MI, Sx: Acute R-Sided CHF, Harsh holosystolic murmur in LLSB, thrill, Tx: Balloon Catheterization, Surgical Repair
RUPTURE OF IV SEPTUM (Benign)
39
5 days-2 weeks post MI, MCC: Lateral Wall MI, Sx: Sudden chest pain, Acute HF, Hemopericardium, Tamponade, PEA, Death 90%, Tx: Pericardiocentesis, Emergency Thoracotomy
FREE WALL RUPTURE
40
1 month post MI, Sx: Persistent ST elevation, Tx: Warfarin, Surgical Repair
MYOCARDIAL ANEURYSM
41
Weeks to Months post MI, Sx: Pleuritic chest pain, Pericardial Friction Rub, Fever, Tx: High-Dose Aspirin, Ibuprofen (NSAIDS)
DRESSLER SYNDROME
42
Management for Severe Bleeding upon Heparinization of Acute MI patient
Stop Heparin. Give PROTAMINE SULFATE.
43
Management of Thrombocytopenia upon Heparinization of Acute MI patient
Stop Heparin. Give LEPIRUDIN/ ARGATROBAN
44
Underlying cause of Congestive Heart Failure
VENTRICULAR DYSFUNCTION sec to CORONARY ARTERY DISEASE/ HYPERTENSION
45
Congestive Heart Failure caused by a pulmonary etiology
COR PULMONALE
46
Histopathologic change of CHF
CONCENTRIC (Inc Cardiac Muscle Width) LV HYPERTROPHY due to Pressure Overload (contrast to Eccentric {Dilation of Chamber} LVH in Hyperthyroidism) & SIDEROPHAGES (Hemosiderin-laden macrophages or HEART FAILURE CELLS)
47
Forms of CHF
SYSTOLIC (Weak LV) vs DIASTOLIC (hear unable to accommodate, does not relax enough) HF; LOW OUTPUT vs HIGH OUTPUT HF; LEFT-SIDED vs RIGHT-SIDED HF
48
Differentiaten Systolic from Diastolic Heart Failure
Systolic HF has LOW EF (40-50%)
49
Differentiate Low from High Output Heart Failure
LOW OUTPUT HF has CO 3L/MIN PER M2 (Hyperthyroidism, Anemia, Beri-Beri, Pregnancy, AV Fistula)
50
Differentiate Left from Right-Sided HF
Left-Sided HF: PULMONARY CONGESTION, ORTHOPNEA, WEAKNESS; Right-Sided HF: PERIPHERAL EDEMA, CONGESTIVE HEPATOMEGALY, SYSTEMIC VENOUS DISTENTION
51
Assessment of Functional Status of CHF
NYHA FUNCTIONAL CLASSIFICATION: I- No Limitation of Physical Activity, II- Slight Limitation of Physical Activity, III- Marked Limitation of Physical Activity, IV- Complete Limitation of Physical Activity (Symptomatic even at rest)
52
Criteria for Diagnosis of CHF
FRINGHAM CRITERIA: MAJOR (PRINCES H) - Paroxysmal nocturnal dyspnea, Rales, Increased CVP, Neck vein distention, Cardiomegaly, acute pulmonary Edema, S3 Gallop, Hepatojugular Reflux; MINOR - bipedal edema, night cough, dyspnea on exertion, hepatomegaly, pleural effusion, decreased vital capacity, tachycardia, weight loss
53
ORTHOPNEA in CHF
Redistribution of fluid from splanchic circulation and lower extremities into central during recumbency
54
PAROXYSMAL NOCTURNAL DYSPNEA in CHF
Inc Pressure in Bronchial Arteries -> Airway Compression with Interstitial Pulmonary Edema
55
Irregular Pattern of Respiration seen in CHF
CHEYNE-STOKE RESPIRATION due to Diminished Sensitivity of Respiratory Center to Arterial PCO2
56
CRACKLES in CHF
Transudation of fluid from intravascular space into he alveoli
57
ABDOMINAL PAIN In CHF
Chronic passive congestion of liver lead to distention of Glisson's Capsule (pain-sensitive)
58
Most important Diagnostic Test in CHF
2D ECHOCARDIOGRAPHY (EJECTION FRACTION)
59
Use of Brain Natreuretic Peptide in CHF
Differentiates cardiogenic from noncardiogenic pulmonary edema during shortness of breath (Normal BNP excludes CHF as cause of shortness of breath)
60
Most likely seen on Chest Xray in CHF
CARDIOMEGALY, PULMONARY CONGESTION (pulmonary vessel markings at apex), KERLEY B LINES
61
Most important treatment for pulmonary edema in CHF
LOOP DIURETICS (FUROSEMIDE)
62
Treatment modalities shown to decrease mortality in CHF
ACE-Is/ARBs (EF<35 in FC IV)
63
Drug that decreases hospitallization but has no effect on overall mortality of CHF patients
DIGOXIN
64
Heart valve involved in Infective Endocarditis
TRICUSPID VALVE
65
Most common microbial etiology in Infective Endocarditis
STAPHYLOCOCCUS AUREUS
66
Complications of Infective Endocarditis
RUPTURE OF CHORDAE TENDINAE, SEPTIC EMBOLISM
67
Virulence Factor of Causative Organism in IE that conveys Penicillin Resistance
PENICILLINASE
68
Virulence Factor of the Causative Organism in IE that conveys Complement Inactivation
PROTEIN A
69
Virulence Factor of Causative Organism in IE that conveys Ability to Cause Chordae Rupture
HYALURONIDASE
70
Most Common Cause of Acute IE? In IV Drug Abusers?
BOTH STAPHYLOCOCCUS AUREUS
71
Most Common Cause of Subacute IE? In Native-Valve IE?
BOTH VIRIDANS STREP
72
Most Common Cause of Prosthetic Valve IE
STAPHYLOCOCCUS EPIDERMIDIS
73
Most Common Cause of Culture-Negative IE
HACEK
74
Most Common Cause of IE in Colon Cancer Setting
S. BOVIS (MARANTIC ENDOCARDITIS)
75
IE in GIT Surgery
ENTEROBIUS FAECALIS
76
IE in SLE patient setting
LIBMAN-SACKS ENDOCARDITIS or VERRUCOUS ENDOCARDITIS
77
Best initial test for Infective Endocarditis
TRANSTHORACIC ECHOCARDIOGRAPHY
78
Other Diagnostic Test may be needed for Diagnosis of IE
BLOOD CULTURES from 2 NON-CONTIGUOUS SITE
79
Clinical Criteria for Diagnosis of IE
DUKE'S CRITERIA: MAJOR - 2 Positive Blood Culture, Positive Echocardiography (Vegetations); MINOR - Predisposing valve abnormality, Fever, Vascular Phenomena, Immunologic Phenomena, One Positive Culture, Suggestive Echocardiography
80
Vascular Phenomena associated with IE
MAJOR ARTERIAL EMBOLI, SEPTIC PULMONARY INFARCTS, MYCOTIC ANEURYSM, INTRACRANIAL HEMORRHAGE, CONJUNCTIVAL HEMORRHAGE, SPLINTER HEMORRHAGE, JANEWAY LESIONS
81
Immunologic Phenomena associated with IE
GLOMERULONEPHRITIS, OSLER'S NODES, ROTH'S SPOTS, RHEUMATOID FACTOR
82
Most Appropriate Empiric Therapy for IE until Culture is available
VANCOMYCIN + GENTAMICIN
83
Considered High-Risk Patiets requiring Prophylaxis before a Dental Procedure
PROSTHETIC VALVES, PRIOR IE, UNREPAIRED CYANOTIC CHD, RECENTLY-REPAIRED CHD, INCOMPLETELY-REPAIRED CHD, VALVULOPATHY POST-TRANSPLANT
84
Drug given for Standard Prophylaxis before Dental Procedures? If patient has Penicillin Allergy?
AMOXICILLIN; if WITH ALLERGY - CLINDAMYCIN or CLARITHROMYCIN
85
Underlying Cardiac Defect in RHD (Mitral Stenosis)
MITRAL VALVULAR DAMAGE DUE TO PREVIOUS RHEUMATIC FEVER
86
Histopathologic Changes in the Myocardium in RHD
"2 Russians": ASCHOFF BODIES (ANITSCHKOW MYOCYTES)
87
Hemodynamic Changes occuring in the heart in RHD
INCREASED LEFT ATRIAL DIASTOLIC PRESSURE
88
Acute Rheumatic Fever Diagnosis
JONES CRITERIA: 2 Major or 1 Major & 2 Minor: MAJOR (JONES) - migratory polyarthritis (Joints), pancarditis (Oh my heart!), subcutaneous Nodules, Erythema marginatum, Sydenham's chorea; MINOR - Arthralgia, Fever, Elevated ESR/CRP, Prolonged PR interval
89
Infection usually preceding ARF
STREPTOCOCCUS PYOGENES (GABHS) INFECTIONS - SKIN (IMPETIGO) or PHARYNGITIS
90
Pathophysiologic Mechanism of ARF
TYPE II REACTION ( IMMUNOLOGIC CROSS-REACTION due to STREPTOCOCCAL M PROTEIN)
91
Long term sequelae of repeated bouts of ARF characterized by Permanent Valvular Damage
RHEUMATIC HEART DISEASE
92
Most common Valvular Defects in ARF
MITRAL REGURGITATION
93
Most Common Valvular Defects in RHD
MITRAL STENOSIS
94
Best initial Test for RHD
2D ECHOCARDIOGRAPHY
95
Most Appropriate Treatment for RHD
SURGICAL REPAIR (VALVOTOMY, COMMISUROTOMY), ANTICOAGULATION, DIURETICS
96
Most common Valvular Heart Disease
MITRAL VALVE PROLAPSE (Most Common), MITRAL STENOSIS, MITRAL REGURGITATION, AORTIC STENOSIS, ATRIAL REGURGITATION
97
Conditions associated with MVP
EHLERS-DANLOS SYNDROME, MARFA. SYNDROME, POLYCYSTIC KIDNEY DISEASE
98
Murmur of MVP
MIDSYSTOLIC CLICK followed by MIDSYSTOLIC to LATE SYSTOLIC MURMUR at APEX
99
Murmur of Mitral Stenosis
OPENING SNAP followed by MID-DIASTOLIC RUMBLE, LOUD S1 and P2
100
Clinical Presentation of Mitral Stenosis
Usually ASYMPTOMATIC until ATRIAL FIBRILLATION or PREGNANCY develops
101
Murmur of Mitral Regurgitation
HOLOSYSTOLIC MURMUR at APEX radiating to AXILLA
102
Other signs of Mitral Regurgitation
HYPERDYNAMIC PRECORDIUM, BRISK CAROTID UPSTROKE
103
Murmur of Aortic Stenosis
EARLY SYSTOLIC EJECTION MURMUR at 2ND RIGHT ICS, radiating to CAROTIDS
104
Signs of Severe Aortic Stenosis
GALLAVARDIN PHENOMENON (Murmur disappears over sternum, reappears in apex) & PULSUS PARVUS ET TARDUS (small or weak pulse that rises slowly and delayed in occurence)
105
Murmur of Aortic Regurgitation
CORRIGAN PULSE: rapid rise and fall of carotid pulse; QUINCKE PULSE: subungual cappilary pulsations; DUROZIEZ SIGN: diastolic murmur over partially-compressed femoral artery; DE MUSSET SIGN: headbobbing with heartbeat; HILL SIGN: systolic BP >30mmHg in legs than arms; TRAUBE SIGN: pistol shot femoral pulses
106
Effect of Valsalva On murmur
INCREASES INTRATHORACIC PRESSURE, DECREASING VENOUS RETURN, DECREASING THE INTENSITY OF MURMURS
107
Effect of Squatting on Murmur
INCREASES VENOUS RETURN, INCREASING INTENSITY OF MURMURS
108
Pathophysiologic Type of Pericarditis
SEROUS, FIBRINOUS & HEMORRHAGIC
109
Most common infectious etiology of Pericarditis
COXSACKIE VIRUS TYPE B
110
Best initial test for Pericarditis? What are Expected Findings?
ECG showing DIFFUSE ST ELEVATIONS and PR DEPRESSION
111
Most appropriate treatment for Pericarditis
NSAIDS
112
Triad of Cardiac Tamponade
BECKS TRIAD: HYPOTENSION, JVD, DISTANT/MUFFLED HEART SOUNDS
113
Other Classic Signs of Cardiac Tamponade
PULSUS PARADOXUS (>10 mmHg fall in BP with inspiration), KUSSMAUL SIGN (sharp increase in JVP with inspiration), EWART SIGN (dullness, increased fremeti, egophony at left scapula), WATER BOTTLE HEART
114
ECG findings in Cardiac Tamponade
DECREASED QRS VOLTAGE AND ELECTRICAL ALTERNANS
115
Most appropriate treatment for Cardiac Tamponade
PERICARDIOCENTESIS
116
Differentiate Constrictive from Acute Pericarditis
CONSTRICTIVE PERICARDITIS PRESENTS WITH JVD, SIGNS OF RIGHT-SIDED HF and PERICARDIAL KNOCK (CALCIFIED OR CASTED PERICARDIUM)
117
Best initial step for Constrictive Pericarditis? Expected finding?
TRANSTHORACIC ECHOCARDIOGRAPHY showing INCREASED PERICARDIAL THICKNESS with CALCIFICATION
118
Most appropriate treatment for Constrictive Pericarditis
MILD CASES: Diuretics, ACE-Inhibitors SEVERE CASES: Pericardiectomy
119
Underlying cause for Acromegaly
Pituitary tumor secreting excess amount of GH
120
Important thing to compare in Acromegaly
COMPARE CURRENT APPEARANCE WITH OLD PHOTOS TO SEE DIFFERENCE IN FACI FEATURES
121
Loss of Peripheral Vision in Acromegaly
PITUITARY TUMOR compressing the OPTIC CHIASM, causing BITEMPORAL HEMIANOPSIA
122
Prone to Develop Carpal Tunnel Syndrome in Acromegaly
BONE OVERGROWTH COMPRESSES MEDIAN NERVE
123
Best initial test for Acromegaly
SERUM IGF-1 LEVELS
124
Best confirmatory Test for Acromegaly
SERUM GH after an OGTT (Glucose normally suppresses GH)
125
Most appropriate management for Acromegaly
TRANSSPHENOIDAL RESECTION OF TUMOR
126
Drug may be Given preoperatively to Shrink tumor size in Acromegaly
OCTREOTIDE (SOMATOSTATIN ANALOGUE)
127
Underlying cause for Prolactinoma
Pituitary tumor secreting excess amounts of PROLACTIN (antagonistic of GnRH)
128
Amenorrhea in Prolactinoma
DECREASED GnRH -> DEC FSH & LH -> INTERRUPTION OF MENSTRUAL CYCLE
129
Physiologic downregulators of Prolactin Secretion
DOPAMINE (antagonistic of Prolactin), ESTROGEN, PROGESTERONE, SOMATOSTATIN
130
Best initial management for Prolactinoma
Drug therapy with BROMOCRIPTINE or CABERGOLINE (DOPAMINE AGONISTS)
131
Drugs known to cause Secondary HyperProlactinemia
METOCLOPRAMIDE, AMITRYPTILINE, PHENOTHIAZINES, ANTIPSYCHOTICS
132
Underlying cause of SIADH
LUNG CANCER COMPOSED OF NEUROENDOCRINE CELLS -> AUTONOMOUS PRODUCTION OF EXCESS ADH
133
Decreased Sodium in SIADH
INCREASED WATER RETENTION -> DILUTIONAL HYPONATREMIA
134
Seizures in SIADH
Decreased Sodium creates osmotic gradient causing water movement into the brain -> CEREBRAL EDEMA
135
Underlying cause of DI
HEAD TRAUMA caused DESTRUCTION of the POSTERIOR PITUITARY GLAND
136
2 Types of DI
CENTRAL DI due to ADH Deficiency and NEPHROGENIC DI due to UNRESPONSIVENESS TO ADH
137
Distinguish between Central DI & Nephrogenic DI
WATER DEPRIVATION TEST: CENTRAL DI - Increased Urine Osmolality after ADH administration at the 6th hour of test; NEPHROGENIC DI - No increase in Urine Osmolality after ADH Administration at the 6th hour of test; PSYCHOGENIC POLYDIPSIA - increasing Urine Osmolality even if before ADH admin and further increase after ADH admin
138
Treatment for DI
CENTRAL DI: Give VASOPRESSIN; NEPHROGENIC DI: administer THIAZIDES (dec urine flow to DCT -> induce formation of functional ADH)
139
Drugs notorious for causing Nephrogenic DI
LITHIUM, DEMECLOCYCLINE
140
Underling cause for Grave's Disease
AUTOANTIBODIES STIMULATE HYPERSECRETION OF THYROID HORMONES
141
Autoantibodies present in Grave's
ANTI-TSH RECEPTOR ANTIBODIES
142
Drugs that cause similar condition as Grave's
AMIODARONE, CLOFIBRATE, METHADONE
143
Drug of Choice for Grave's? Feared Side Effect?
THIONAMIDES (PTU, MM); SE - AGRANULOCYTOSIS
144
Most Appropriate Diagnostic Test for Grave's? Expected results?
Free T4, TSH (Increased FT4, Decreased TSH)
145
Most Appropriate Treatment for Grave's
RADIOACTIVR IODINE ABLATION THERAPY
146
Expected treatment Complication of RAI used in Grave's
SECONDARY HYPOTHYROIDISM
147
Drugs given preoperatively if Surgical Intervention contemplated in Grave's
IODIDES to decrease Gland Vascularity
148
TRH Decrease, TSH Decrease, T4 Increase (Target Organs)
PRIMARY HYPERTHYROIDISM
149
TRH Decreased, TSH Increased, T4 Increased (Pituitary Problem)
SECONDARY HYPERTHYROIDISM
150
TRH Increased, TSH Increased, T4 Increased (Hypothalamic Problem)
TERTIARY HYPERTHYROIDISM
151
Weight Loss in Grave's
EXCESS T3/T4 -> Increased CATABOLISM
152
Increased Sweating, Increased Bowel Movement & Tachycardia in Grave's
EXCESS T3/T4 -> SYMPATHETIC OVERACTIVITY
153
Irregular Menses in Grave's
EXCESS T3/T4 -> Inc Sex Hormone Binding Globulin levels, Inc Total Serum Estrogen -> Inc LH and Decreasing mid-cycle LH surge
154
Exophthalmos in Grave's
Increased Volume of Retrobulbar Tissue due to Deposition of GAGs as a result of Lymphoytic Infiltration
155
Fine Finger Tremors in Grave's
EXCESS T3/T4 -> Inc Synaptic Transmission and Inc Cerebration -> Reflex Oscillation of Muscle Spindles
156
Underlying Cause of Hypothyroiditis
Antibodies against Thyroglobulin and Thyroid Peroxidase lead to Autoimmune Destruction of Thyroid Gland
157
TRH Increased, TSH Increased, T4 Decreased (Target Organ Problem)
PRIMARY HYPOTHYROIDISM
158
TRH Increased, TSH Decreased, T4 Decreased (Pituitary Problem)
SECONDARY HYPOTHYROIDISM
159
TRH Decreased, TSH Decreased, T4 Decreased (Hypothalamic Problem)
TERTIARY HYPOTHYROIDISM
160
Fatigue and Weight Gain in Hypothyroidism
LOW T3/T4 -> DECREASED METABOLISM
161
Bradycardia in Hypothyroidism
LOW T3/T4 -> DECREASED SYMPATHETIC DRIVE
162
Coarse, Dry Skin in Hypothyroidism
LOW T3/T4 -> DECREASED HEAT PRODUCTION and DECREASED SWEATING
163
Depression in Hypothyroidism
LOW T3/T4 -> DECREASED SYNAPTIC TRANSMISSION IN BRAIN and DECREASED PRODUCTION OF NEUROTRANSMITTERS (SEROTONIN)
164
Amenorrhea in Hypothyroidism
LOW T3/T4 -> INCREASED TRH -> INC PROLACTIN, DEC GnRH, DEC FSH/LH
165
Bilateral Eyelid Edema
DEPOSITION OF GAGS as a result of LYMPHOCYTIC INFILTRATION of the CONNCECTIVE TISSUE of the SKIN
166
Underlying Cause of Hyperparathyroidism
PARATHYROID TUMOR SECRETING LARGE AMOUNTS OF PTH into BLOODSTREAM
167
*Increased PTH*, Increased s. Calcium, Decreased s. Phosphate (Target Organs Problem)
PRIMARY HYPERPARATHYROIDISM
168
Increased PTH, *Decreased s. Calcium*, Decreased s. Phosphate
SECONDARY HYPERPARATHYROIDISM (Pituitary Problem)
169
Depression and Fatigue in Hyperparathyroidism
UNKNOWN
170
Kidney Stones in Hyperparathyroidism
INCREASED URINARY CALCIUM CONCENTRATION
171
Muscle Weakness in Hyperparathyroidism
EXCESS PTH -> INCREASED PROTEIN BREAKDOWN and MUSCULAR ATROPHY
172
Other Expected Symptoms in Hyperparathyroidism
PAINFUL BONES, RENAL STONES, ABDOMINAL GROANS, PSYCHIATRIC OVERTONES
173
Most Appropriate Treatment in Hyperparathyroidism
SURGICAL PARATHYROIDECTOMY
174
Structure Injured during Surgical Treatment of Hyperparathyroidism
RECURRENT LARYNGEAL NERVE
175
Malignancy may Present Similarly with Hyperparathyroidism
HYPERCALCEMIA OF MALIGNANCY (usually SCCA OF LUNGS) due to PRODUCTION OF PTHrp (related protein)
176
Other Diseases that can Result in Secondary Forms of Hyperparathyroidism
CHRONIC KIDNEY DISEASE, CHRONIC PANCREATITIS. MALABSORPTION
177
Underlying Cause of Hypoparathyroidisn
INADVERTENT REMOVAL OF THE PARATHYROID GLAND DURING THYROID SURGERY
178
*Decreased PTH*, Decreased s. Calcium, Increased s. Phosphate
PRIMARY HYPOPARATHYROIDISIM
179
Decreased PTH, *Increased s. Calcium*, Increased s. Phosphate
SECONDARY HYPERPARATHYROIDISM
180
Muscle Twitching in Hypoparathyroidism
LOW SERUM CALCIUM -> INCREASED EXCITABILITY OF MOTOR NEURONS by DECREASING THRESHOLD POTENTIAL (HYPOCALCEMIC TETANY)
181
Underlying Cause of DM I
AUTOIMMUNE DESTRUCTION OF BETA CELLS IN PANCREAS, LEADING TO INSULIN DEFICIENCY
182
Increased Glucose, Decreased Insulin, Decreased C Peptide
TYPE 1 DM
183
Increased Glucose, Increased/Normal Insulin, Increased/Normal C Peptide
TYPE 2 DM
184
Bedwetting in DM
DUE TO OSMOTIC DIURETIC EFFECT OF GLUCOSE
185
Increased Urine Glucose in DM
TRANSPORT MAXIMA FOR GLUCOSE HAS BEEN REACHED
186
Weight Loss in DM
DECREASED INSULIN -> INCREASED PROTEIN DEGRADATION and MUSCLE WASTING
187
Polydipsia in DM
INCREASED THIRST AS A RESPONSE TO FREQUENT URINATION
188
Polyphagia in DM
DECREASED UPTAKE OF GLUCOSE INTO TARGET CELLS IN THE BODY TRIGGERS EXCESSIVE HUNGER
189
Delayed Age of Presentation in DM
RESIDUAL BETA-CELL FUNCTION (HONEYMOON PERIOD)
190
Diagnostic Test for DM
RBS with SSx, FBS >126, HbA1C >6.5, 2 HOUR 75g OGTT (most validated)
191
Most appropriate treatment
INSULIN REGIMEN, GLUCOSE MONITORING
192
Complications Expected if left Untreated
ACUTE SETTING: Diabetic Ketoacidosis CHRONIC COMPLICATIONS: Macro/Microvascular, Neuropathy, Cataracts, Nephropathy
193
Considerations in Early Morning Hyperglycemia
SOMOGYI EFFECT, DAWN PHENOMENON and WANING OF INSULIN
194
Irregular intake of meal at night with Insulin Admin cause 3 AM Hypoglycemia but Negative Feedback Mechanism cause Early Morning Hyperglycemia
SOMOGYI EFFECT
195
Controlled Sugar Level throughout the night but with Early Morning Hyperglycemia
DAWN PHENOMENON
196
Hyperglycemia at 3AM with Early Morning Hyperglycemia despite Insulin Admin
WANING OF INSULIN
197
3 AM Hyperglycemia with Very High Early Morning Hyperglycemia
WANING & DAWN PHENOMENON
198
Pathognomonic Triad of DKA
HYPERGLYCEMIA, KETONEMIA, HAGMA
199
Pathogenesis of DKA
UNCONTROLLED HYPERGLYCEMIA causes KETOACIDOSIS
200
Labs requested in DKA
URINE KETONES, ABG, SERUM GLUCOSE
201
Fruity Breath in DKA
KETONE BODIES (ACETOACETATE and BETA-HYDROXY- BUTYRATE)
202
FActors that can Incite DKA
INFECTION, ISCHEMIA, INFARCTION, IGNORANCE, INTOXICATION
203
Most Appropriate Treatment in DKA
FLUID REPLACEMENT and INSULIN DRIP
204
Underlying Cause of Pheochromocytoma
Excess Catecholamine Production from Neoplastic Chromaffin Cells in Adrenal Medulla
205
Headaches in Pheochromocytoma
DUE TO INCREASED BLOOD PRESSURE
206
Diaphoresis, Tremors, Tachycardia, and Hypertension in Pheochromocytoma
DUE TO EXCESSIVE ACTIVATION OF THE SYMPATHETIC NERVOUS SYSTEM as a result of EXCESS CATECHOLAMINES IN CIRCULATION
207
Classic Triad of Pheochromocytoma
TACHYCARDIA. SWEATING, HEADACHES
208
Most Appropriate Diagnostic Test for Pheochromocytoma
URINE VANILLYLMANDELIC ACID (URINE METANEPHRINES)
209
Most Appropriate Imaging Study for Pheochromocytoma
ABDOMINAL CT SCAN
210
Most Appropriate Treatment for Pheochromocytoma
SURGICAL RESECTION
211
Drugs Given Prior to Surgical Intervention in Pheochromocytoma
PHENOXYBENZAMINE (Irreversible Alpha Blocker), PHENTOLAMINE (Reversible Alpha Blocker) or LABETALOL (Beta Blocker)
212
Cancer Syndromes associated with Pheochromocytoma? Multiple Endocrine Neoplasia (MEN)?
MEN IIa: PCC, Medullary Thyroid Cancer, PTH; MEN IIb: PCC, Medullary Thyroid Cancer, Neuromas
213
Rule of 10s for Pheochromocytoma
10% bilateral, 10% extra-adrenal, 10% malignant, 10% familial, 10% pediatric, 10% without BP elevation
214
Underlying Cause for Conn Syndrome (Primary HyperAldosteronism)
EXCESS ALDOSTERONE PRODUCTION from ADRENAL CORTEX TUMOR
215
Increased Aldosterone, Decreased Renin, Increased ECF Volume, No Change in Sodium Excretion, Absent Edema, Etiology - Adrenal Tumor (Conn Syndrome)
PRIMARY HYPERALDOSTERONISM
216
Increased Aldosterone, Increased Renin, Increased ECF Volume, Decreased Sodium Excretion, Presence of Edema, Etiology - RENIN-SECRETING TUMOR, RENAL ARTERY STENOSIS
SECONDARY HYPERALDOSTERONISM
217
Persistent Hypertension in Conn Syndrome
DUE TO EXCESSIVE ALDOSTERONE PRODUCTION
218
Normal Sodium Excretion and No Edema despite of Increased ECF Volume
due to SODIUM ESCAPE PHENOMENON (Increased BP -> Inc ANP production -> Normalization of Sodium Excretion and Prevents Edema)
219
Fatigue and Muscle Weakness in Conn Syndrome
due to DECREASED POTASSIUM LEVELS
220
Polyuria in Conn Syndrome
DECREASED POTASSIUM IMPAIRS URINE CONCENTRATING ABILITY (Counter Current Multiplier Uses Na-K-Cl Co-Transport)
221
Metabolic Alkalosis in Conn Syndrome
1. Hydrogen ion loss into urine and migration into potassium-depleted cells 2. Potassium deficiency increases capacity of Proximal Convoluted Tubule to Reabsorb Filtered Bicarbonate
222
Most appropriate Treatment in Conn Syndrome
SURGICAL REMOVAL OF ADRENAL MASS
223
Management for Unresectable Tumor in Conn Syndrome
ALDOSTERONE ANTAGONISTS (SPINOROLACTONE and EPLERENONE)
224
Underlying Cause of Cushing's Syndrome
EXCESS CORTISOL PRODUCTION FROM ADRENAL CORTEX TUMOR
225
Most common Cause of Cushing Syndrome
IATROGENIC (EXCESS STEROID INTAKE)
226
*Increased Cortisol*, Decreased ACTH, No effect on High-Dose Dexa Suppression, Eti: CORTISOL PRODUCING ADRENAL TUMOR
ADRENAL CUSHING SYNDROME
227
Increased Cortisol, *Increased ACTH*, Suppressed High-Dose Dexa Suppression, Eti: ACTH-Producing Pituitary Tumor
PITUITARY CUSHING SYNDROME
228
Increased Cortisol, *Increased ACTH*, No effect on High-Dose Dexa Suppression, Etio: ACTH-Producing Lung Tumor
ECTOPIC CUSHING SYNDROME
229
Hypertension in Cushing Syndrome
1. Excess cortisol -> Inc Vascular Responsiveness to Catecholamines -> Inc Total Peripheral Resistance 2. At High Doses, Glucocorticoids display mineralocorticoid effects -> SALT and WATER RETENTION
230
Central Obesity in Cushing Syndrome
Catabolism of Skin Proteins lead to Weakening and Rupture of Collagen Fibers in the Dermis
231
Easy Bruising and Violaceous Abdominal Striae in Cushing Syndrome
EXCESS CORTISOL LEADS TO INSULIN RESISTANCE and ADIPOSE TISSUE DEPOSITION at CHARACTERISTIC SITES (MOON FACIES, BUFFALO HUMP)
232
Acne and Hirsutism in Cushing's Syndrome
1. Excess adrenal androgens 2. Excess insulin stimulates ovarian theca cells to produce androgens
233
Proximal Weakness and Edema in Cushing's
Due to EXCESS PROTEIN CATABOLISM and PROTEIN DEPLETION
234
Most appropriate treatment in Cushing's
SURGICAL RESECTION of the ADRENAL MASS
235
Management for Surgically Unresectable Tumors
KETOCONAZOLE, METYRAPONE
236
Underlying Cause of Addison's Disease
AUTOIMMUNE DESTRUCTION OF ADRENAL GLANDS
237
Increased CRH, Increased ACTH, Decreased Cortisol, Decreased Aldosterone, Decreased Androgens, (+) Hypotension, Dark Skin Color, Etio: AUTOIMMUNE ADRENALITIS
PRIMARY ADRENAL INSUFFICIENCY
238
Increased CRH, *Decreased ACTH*, Decreased Cortisol, Normal Aldosterone, Decreased Androgens, (-) Hypotension, Pale Skin Color, Etio: PITUITARY NOT SECRETING ACTH
SECONDARY ADRENAL INSUFFICIENCY
239
*Decreased CRH*, Decreased ACTH, Decreased Cortisol, Normal Aldosterone, Decreased Androgen, (-) Hypotension, Pale Skin Color, Etio: STEROID WITHDRAWAL
TERTIARY ADRENAL INSUFFICIENCY
240
Muscle Weakness, Weight Loss and Anorexia in Adrenal Insufficiency
DECREASED ENERGY MOBILIZATION DUE TO DECREASED CORTISOL
241
Skin Darkening in Adrenal Insufficiency
INCREASED ACTH SECRETION LEADS TO EXCESS POMC-DERIVED HORMONES (a-MSH, b-MSH)
242
Orthostatic Hypotension in Adrenal Insufficiency
Decreased Aldosterone -> DECREASED RESPONSIVENESS OF RAA
243
Decreased Sodium and Increased Potassium Levels in Adrenal Insufficiency
DECREASED ALDOSTERONE ACTIVITY
244
Decreased Glucose Level in Adrenal Insufficiency
DECREASED CORTISOL causes INCREASED INSULIN SENSITIVITY
245
Decreased Pubic Hair in Adrenal Insufficiency
DUE TO ADRENAL ANDROGEN DEFICIENCY
246
Signs of Androgen Deficiency more seen in Females with Adrenal Insufficiency
ADRENALS are MAIN SOURCE OF ANDROGENS IN FEMALES (TESTIS in MALES)
247
Occurence of severe hypotension (shock) as a result of extreme adrenal hormone deficiency (in patients with Depressed HPA axis)
ADRENAL CRISIS
248
Adrenal Crisis in setting of Fulminant Meningococcemia
WATERHOUSE-FRIDERICHSEN SYNDROME (due to BILATERAL ADRENAL HEMORRHAGE)
249
Most Appropriate Diagnostic Test Adrenal Insufficiency
ACTH STIMULATION TEST (COSYNTROPIN TEST)
250
Interpretation of ACTH STIMULATION TEST (COSYNTROPIN TEST)
PRIMARY AI: Low Cortisol + Low ACTH; SECONDARY/TERTIARY AI: Low Cortisol + High ACTH
251
Most Appropriate Treatment in Adrenal Insufficiency
GLUCOCORTICOID and MINERALOCORTICOID REPLACEMENT, AGGRESSIVE HYDRATION
252
Most common Cause of Acute Pancreatitis
GALLSTONES > ALCOHOLIC BINGE DRINKING
253
Other important Cause of Acute Pancreatitis
Trauma, Steroids, Mumps, Autoimmune, Scorpion Bites, Hyperlipidemia, Drugs (Antivirals)
254
Characteristic Signs on PE of Acute Pancreatitis
GRAY TURNER (FLANK) & CULLEN (PERIUMBILICAL)
255
Most Common Appropriate Diagnostic Test
SERUM AMYLASE (MORE SENSITIVE) & SERUM LIPASE (MORE SPECIFIC)
256
Important Imaging Study in Acute Pancreatitis
ABDOMINAL CT SCAN (SENTINEL LOOPS)
257
Most Appropriate Treatment for Acute Pancreatitis
BOWEL REST (NPO), HYDRATION, ANALGESICS
258
Most Appropriate Analgesic for Treatment of Acute Pancreatitis
MEPERIDINE (DOES NOT CAUSE SO DYSFUNCTION)
259
Complications of Acute Pancreatitis
Hemorrhage, Pseudocyst, Chronic Pancreatitis
260
Criteria used for Prognostication in Acute Pancreatitis
RANSON'S CRITERIA: AT PRESENTATION (GALAW) - Glucose >200mg/dL, Age >55, LDH >250u/L, AST >250u/L, WBC >16,000/mm3; AT 48 HOURS (CHOBBS) - Calcium 10%, pO2 5mg/dL, Base deficit >5mg/dL, Sequestration of Fluid ls >6L
261
Prognostication of Acute Pancreatitis using Ranson's Criteria
0-2: 2% mortality, 3-4: 15% mortality, 5-6: 40% mortality, 7-8: 100% mortality
262
Antibiotics indicated for Acute Pancreatitis
ONLY INDICATED IN SEVERE PANCREATITIS WHEN >30% NECROSIS ON CT SCAN
263
Indication for Surgery in Acute Pancreatitis
PSEUDOCYST, ABSCESS, BILIARY PANCREATITIS
264
Clinical Presentation of Chronic Pancreatitis
ABDOMINAL PAIN WITH SIGNS OF MALABSORPTION DUE TO PANCREATIC INSUFFICIENCY
265
Most Common Cause of Chronic Pancreatitis
LONG TERM ALCOHOL ABUSE
266
Treatment for Chronic Pancreatitis
DIETARY MODIFICATION (SMALL, LOW-FAT MEALS), ENZYME REPLACEMENT (PANCRELIPASE)
267
Risk Factors for Esophageal Adenocarcinoma
ACHALASIA, BARRETT ESOPHAGUS, CIGARETTE SMOKING, DIVERTICULA, ETHANOL, FAMILIAL
268
Most Appropriate Diagnostic Test for Esophageal Adenocarcinoma
BARIUM SWALLOW, followed by EGD with BIOPSY
269
Seen on Biopsy in Esophageal Adenocarcinoma
SQUAMOCOLUMNAR METAPLASIA (BARRETT ESOPHAGUS) and NEOPLASTIC CHANGES (INVASION)
270
Most Appropriate Treatment for Esophageal Adenocarcinoma
ESOPHAGECTOMY with GASTRIC PULL-UP with or without CHEMORADIATION (Controversial)
271
2 Types of Esophageal Cancer? Associated conditions?
BARRETT'S ESOPHAGUS = ESOPHAGEAL ADENOCARCINOMA; PLUMMER-VINSON SYNDROME = SCCA
272
Localization and Incidence for Esophageal AdenoCarcinoma and SCCA
NOW EQUAL IN INCIDENCE; ESOPHAGEAL ADENOCARCINOMA in Distal 3rd, ESOPHAGEAL SCCA in Middle 3rd
273
Differentiate Esophageal Cancer from Achalasia clinically
ACHALASIA: dysphagia to solids and liquids simultaneously; ESOPHAGEAL CA: dysphagia first to solids progressing to liquids
274
Alcoholic who had Frequent Retching and Vomiting leading to Severe Hematemesis
ESOPHAGEAL RUPTURE
275
Differentiate 2 Most Likely Cause of Esophageal Rupture
MALLORY-WEISS SYNDROME: Partial Thickness tearing at GEJ; BOERHAAVE'S SYNDROME: ANTIBIOTICS, SURGERY, IV HYDRATION (almost 100% mortality)
276
Underlying Pathology in PUD
GASTRIC and HYPERSECRETION LEADING TO ULCERS
277
Most Appropriate Diagnostic Test for PUD
ENDOSCOPY with BIOPSY
278
Conditions encompassed by PUD
GASTRIC ULCERS and DUODENAL ULCERS
279
Most common location of PUD
DUODENAL BULB
280
Differentiate Gastric Ulcer and Peptic Ulcer
GASTRIC ULCER: Pain worse on food intake, no nocturnal pains; PEPTIC ULCER: Pain relieved with food intake, awakens patient at night
281
Most appropriate treatment for PUD
PROTON PUMP INHIBITORS; if (+) H Pylori: OMEPRAZOLE + CLARITHROMYCIN + AMOXICILLIN
282
Possible Complications for PUD
HEMORRHAGE > PERFORATION > GASTRIC OUTLET OBSTRUCTION
283
Treatment of PUD when Refractory to Medical Management
DUODENAL ULCER: Truncal Vagotomy with Pyloroplasty; GASTRIC ULCER: Bilroth I or II Reconstruction
284
PUD patient continues to be Refractory to Management. Pancreatic mass on CT scan
GASTRINOMA (ZOLLINGER-ELLISON SYNDROME)
285
Most common anatomic location of Gastrinomas
PASSARO'S TRIANGLE: junctions of cystic duct/ CBD, 2nd/3rd portion of duodenum, head/ neck of pancreas)
286
Most Appropriate Diagnostic Test for Gastrinomas
PENTAGASTRIN STIMULATION TEST, SECRETIN STIMULATION TEST
287
Usual Location of Ulcers in Zollinger-Ellison Syndrome
Simultaneous, recurrent gastric and duodenal ulcers (postbulbar)
288
Underlying pathology in Chronic Liver Disease
ADVANCED LIVER CIRRHOSIS COMPLICATED by PORTOSYSTEMIC SHUNTING
289
Most common cause of Chronic Liver Disease
ALCOHOLISM and VIRAL HEPATITIS
290
Differentiate among Common Causes of Chronic Liver Disease
AST/ALT RATIO > 2 in ALCOHOLIC LIVER DISEASE = 1 in VIRAL HEPATITIS
291
Histopathologic Hallmark seen in Alcoholic Liver Disease compared to Viral Hepatitis
MALLORY BODIES (Malloy Lasingero) = ALD, COUNCILMAN BODIES (Councillor Manyakis) = VIRAL HEPATITIS
292
3 Stages of Alcoholic Liver Disease
STEATOSIS, HEPATITIS, CIRRHOSIS
293
Other Signs and Symptoms of Liver Disease
CLD: palmar erythema, testicular atrophy, spider angioma, Duputyren contracture; PH: hemorrhoids, caput medusae, varices ruptured esophageal varices
294
Gynecomastia, Spider Angiomata and Palmar Erythema in Chronic Liver Disease
Due to High Circulating Estrogen Levels
295
Muehrcke Nails, Peripheral Edema and Prolonged Bleeding Time in Chronic Liver Disease
Due to HYPOALBUMINEMIA, HYPOPROTEINEMIA
296
Thrombocytopenia, Anemia and Leukopenia in Chronic Liver Disease
Due to HYPERSPLENISM
297
Ruling Out Other Causes of Ascites other than Portal Hypertension
SERUM ASCITES ALBUMIN GRADIENT (SAAG): >1.1 - Portal Hypertension, <1.1 - Malignancy or Infection
298
Most Appropriate Treatment for Chronic Liver Disease
TIPS PROCEDURE
299
Definitive Treatment for Chronic Liver Disease
LIVER TRANSPLANT
300
Complications if Chronic Liver Disease is Left Untreated
Massive UGIB, hepatic encephalopathy, hepatorenal syndrome, hepatopulmonary syndrome, bacterial peritonitis
301
Signs if Hepatic Failure
HYPERAMMONEMIA, FETOR HEPATICUS
302
Hepatic Encephalopathy and Asterixis in Chronic Liver Disease
ACCUMULATION OF AMMONIA IN CNS
303
Responsible for Fetor Hepaticus
MUSTY, FECAL SMELL due to ACCUMULATION OF MERCAPTANS
304
Treatment of Hepatic Encephalopathy
LACTULOSE (promotes bowel movement and excretion of Ammonia, acidification of colon, deactivation of colonic bacteria), Protein restriction (branched-chain amino acid), Neomycin
305
Underlying pathology in Ulcerative Colitis
INFLAMMATORY BOWEL DISEASE
306
Types of Ulcerative Colitis
ULCERATIVE COLITIS & CROHN DISEASE
307
Can be ANYWHERE in GIT, with SKIP LESIONS and RECTAL SPARING, TRANSMURAL inflammation, COBBLESTONE MUCOSA, NONCASEATING GRANULOMAS
CROHN's DISEASE
308
Found in COLON only, MUCOSAL inflammation, LEAD PIPE colon, PSEUDOPOLYPS, CRYPT ABSCESSES
ULCERATIVE COLITIS
309
Extracolonic Manifestation associated with Ulcerative Colitis
Arthritis, Episcleritis, Uveitis, Pyoderma Gangrenosum
310
Increased Risk of Malignancy in Ulcerative Colitis
COLON CANCER
311
Bacterial Infection causing Flare-Ups in Ulcerative Colitis
CLOSTRIDIUM DIFFICILE
312
Complications of Ulcerative Colitis? Definitive treatment?
EXSANGUINATION, TOXIC MEGACOLON; Definitive Tx - TOTAL COLECTOMY
313
Most Likely Cause of Acute Tubular Necrosis
RENAL HYPOPERFUSION due to HYPOVOLEMIA (hemorrhage), RHABDOMYOLYSIS
314
Other Laboratory Tests requested in ATN
SERUM ELECTROLYTES, BUN, CREA
315
Differentiate Azotemia from Uremia
AZOTEMIA: Biochemical (Inc Urea); UREMIA: Clinical Signs and Symptoms
316
3 Important Causes of Azotemia
PRERENAL DISEASE, INTRINSIC RENAL DISEASE and POSTRENAL DISEASE (OBSTRUCTIVE UROPATHY)
317
BUN/Crea ratio >20, Fe Sodium <1%, due to Hypovolemia, Hemorrhage
PRERENAL AZOTEMIA
318
BUN/Crea Ratio 2%, due to PSGN, Drugs, HTN
INTRINSIC RENAL
319
BUN/Crea ratio 10-20, Fe Sodium Intermediate, due to Prostate, Cervical Cancer
OBSTRUCTIVE UROPATHY
320
Continuing significant irreversible reduction in nephron number
CHRONIC KIDNEY DISEASE
321
Most common cause of Chronic Kidney Disease
DIABETES MELLITUS
322
Staging for Chronic Kidney Disease
Stage 0: with Risk Factor, Stage 1: GFR >90, Stage 2: GFR 60-89, Stage 3: GFR 30-59, Stage 4: GFR 15-29, Stage 5: GFR <15 (ESRD)
323
Indications for Dialysis in CKD
ACIDOSIS, ELECTROLYTES (Hyperkalemia), Ingestion of Toxins, Overload, Uremia
324
2 Modes of Dialysis
HEMODIALYSIS (Tesio Catheter and AV graft) & PERITONEAL DIALYSIS (Tenchkoff Catheter)
325
Anemia in CKD? Type of Anemia?
Inability to produce EPO causes NORMOCYTIC, NORMOCHROMIC ANEMIA
326
Secondary Hyperparathyroidism in CKD
Failing kidneys FAIL TO REABSORB CALCIUM -> HYPOCALCEMIA
327
Vitamin D supplementation in CKD
Inability to form active Vitamin D (1,25-DHCC) due to kidney damage
328
Clinical Effect of Hypocalcemia, Hyperphosphatemia and Low Vitamin D in CKD
RENAL OSTEODYSTROPHY (CHONDROCALCINOSIS, OSTEOPENIA)
329
Most common Cause of Death in CKD
CAD/MI (ESRD is a CAD equivalent)
330
Medications Given to Prevent Cardiac Complications in CKD
BETA-BLOCKERS, ACE-Inhibitors, STATINS
331
Most common cause of Acute Pyrlonephritis
ESCHERICHIA COLI
332
Most Appropriate Treatment for Acute Pyelonephritis
EMPIRIC ANTIBIOTIC THERAPY (QUINOLONES)
333
Complication of Acute Pyelonephritis in Diabetics
RENAL PAPILLARY NECROSIS
334
Facultative Gram-Negative Rods with Swarming Motility in Urine Culture in Acute Pylonephritis
PROTEUS MIRABILIS
335
Infections more common on Females in Acute Pyelonephritis
Females have SHORTER URETHRA
336
Underlying pathology in Nephrotic Syndrome
IN SITU IMMUNE COMPLEX FORMATION/ DEPOSITION
337
Most Common Cause of Nephrotic Syndrome in Adults
MEMBRANOUS NEPHROPATHY
338
Most Common Cause of Nephrotic Syndrome in Children
MINIMAL CHANGE DISEASE
339
Renal Biopsy in Nephrotic Syndrome
LM: Diffuse capillary wall thickening, EM: Subepithelial deposits, IF: Granular deposits
340
Nephrotic Range Proteinuria
>3.5g protein in 24H urine collection
341
Most Appropriate Treatment for Nephrotic Syndrome
STEROIDS (PREDNISONE): Better response in Minimal Change Disease
342
Complications arising from Nephrotic Syndrome
SPONTANEOUS BACTERIAL PERITONITIS, THROMBOMBOLIC EVENTS, HYPERLIPIDEMIA
343
If Nephrotic Syndrome patient Unresponsive to Steroids after 2 Months
FOCAL SEGMENTAL GLOMERULOSCLEROSIS
344
Most Common Cause of Nephrotic Syndrome in Children
MINIMAL CHANGE DISEASE (LIPOID NEPHROSIS)
345
Types of Renal Tubular Acidosis
TYPE I RTA, TYPE II RTA, TYPE IV RTA
346
Most Common Cause of RTA
TYPE I RTA: Sporadic, Hep B or Hep C; TYPE II RTA: Multiple Myeloma, Amyloidosis; TYPE IV RTA: DM, Hypoaldosteronism
347
Pathophysiologic Mechanism for RTA
TYPE I RTA: Inability to secrete H+ in DCT; TYPE II RTA: Inability to reabsorb HCO3 in PCT; TYPE IV RTA: Decreased Aldosterone
348
High Urine pH (Basic), (+) STONES, Low Potassium, Diagnosis by Acid Load (give NH4Cl), Tx via HCO3 + K tabs
TYPE I RTA (Distal)
349
Low Urine pH (Acidic), (-) Stones, Low Potassium, Diagnosis by HCO3 LOAD (Give HCO3), Tx via HCO3 + K tabs + diuretics (HCTZ)
TYPE II RTA (PROXIMAL)
350
Low Urine pH (Acidic), (-) Stones, HIGH POTASSIUM, Diagnosis by Na Restriction (High Urine Na), Tx via Fludrocortisone
TYPE IV RTA (DM)
351
Defect at Thick Ascending Loop, Na-K-2Cl Symport Channel, more on Children, Normal/ Increased Urine Ca2+ (Stones), Impaired Concentrating Ability, Dec GFR (AS IF LOOP DIURETIC ABUSER, MORE SEVERE)
BARTERR'S SYNDROME
352
Defect at Distal Convoluted Tubule, Na-Cl Symport Channel, more on Adults, Dec Urine Ca2+ (No Stones), Normal Concentrating Ability, Normal GFR (AS IF THIAZIDE DIURETIC ABUSER)
GITELMAN'S SYNDROME
353
Underlying Pathology in SLE
CHRONIC MULTISYSTEM AUTOIMMUNE DISEASE
354
Type of Hypersensitivity in SLE
TYPE III HYPERSENSITIVITY
355
Most Sensitive and Specific Serologic Tests for SLE
MOST SENSITIVE: ANA; MOST SPECIFIC: anti-dsDNA or anti-Smith
356
Diagnostic Criteria for SLE
AT LEAST 4/11: Serositis, Oral Ulcers, ANA, Photosensitivity, Blood, Renal, Arthritis, Immunologic, Neuropsychiatric, Malar Rash, Discoid Rash
357
Most Common Criterion for SLE
HEMATOLOGIC CHANGES (LEUKOPENIA)
358
Drugs causing Similar Presentation as SLE? Auto- antibodies associated?
HYDRALAZINE, ISONIAZID, PROCAINAMIDE, PENICILLAMINE; ANTI-HISTONE ANTIBODIES
359
False Positive Syphilis Test in SLE
Anti- Cardiolipin Antibodies; RPR is embedded in Cardiolipin
360
Complications in Pregnant SLE patient? Pathogenesis?
RECURRENT ABORTIONS due to APAS (due to Lupus Anticoagulant and AntiCardiolipin Antibodies)
361
Most Appropriate Treatment for Acute Flare-Ups in SLE
CORTICOSTEROIDS
362
Most Appropriate Treatment for Cutaneous Lesions
ANTIMALARIALS with or without CORTICOSTEROIDS (Low Dose)
363
Most Appropriate Treatment to Induce Disease Remission in SLE
IMMUNOSUPPRESSIVES (CYCLOPHOSPHAMIDE) + CORTICOSTEROIDS
364
Management for Development of Unexplained Proteinuria and Hematuria
RENAL BIOPSY
365
Most Catastrophic Organ Involvement in SLE
SLE NEPHRITIS
366
Various Forms of Renal Involvement
I: Minimal Mesangial 10-25%, II: Mesangial Proliferative, III: Focal Proliferative 20-35%, IV: Diffuse Proliferative 35-60% (Most Common/ Most Severe; HP- Wire-Loop Lesions), V: Membranous 10-15% (Nephrotic Change Proteinuria)
367
Underlying Pathology in Osteoarthritis
CHRONIC, SLOWLY PROGRESSIVE, EROSIVE DAMAGE TO JOINT SURFACES -> LOSS OF ARTICULAR CARTILAGE
368
Etiology of Osteoarthritis
DIRECTLY PROPORTIONAL to INCREASING AGE and TRAUMA to the JOINT (Most Common Cause of Joint Disease)
369
Most Appropriate Diagnostic Test in Osteoarthritis
XRAY OF AFFECTED JOINTS (Joint Space Narrowing, Osteophytes, Bone Cysts)
370
Most Appropriate Treatment in Osteoarthritis
WEIGHT LOSS, MODERATE EXERCISE, ACETAMINOPHEN (Best Initial Analgesic), INTRAARTICULAR STEROIDS IF THERE IS NO PAIN CONTROL, JOINT REPLACEMENT for SEVERE DISEASE
371
Differentiate Rheumatoid Arthritis from Osteoarthritis
RHEUMATOID ARTHRITIS: Bilateral, Symmetrical Joint Involvement (usually MCP joints), Morning Stiffness >30min, Autoimmune Phenomena (Rheumatoid Nodules, Episcleritis, Vasculitis)
372
Underlying Pathology in Gout
Defect in Urate Metabolism due to Overproduction (Idiopathic, Increased turnover of cells, enzyme deficiency) or underexcretion (Renal Insufficiency, Acidosis, Thiazides, Aspirin)
373
Most Acurate Diagnostic Test in Gout
Joint Aspiration (Needle-Shaped Crystals with Negative Bifringence on Polarized Light Microscopy)
374
Most appropriate treatment of Gout in ER
NSAIDS and COLCHICINE
375
Safe Drug for Chronic Gout with Renal Insufficiency
ALLOPURINOL
376
Calcium pyrophosphate deposition disease
PSEUDOGOUT
377
Finding on Joint Aspiration in Gout
POSITIVELY BIFRINGENT RHOMBOID-SHAPED CRYSTALS
378
Most Common Cause of Atypical Pneumonia
Mycoplasma (Most Common), Legionella, Chlamydia
379
Diagnostic Test to Confirm Clinical Impression
MYCOPLASMA: IgM Titer or Cold Agglutinin Test; LEGIONELLA: Urinary Antigen Test; CHLAMYDIA: Serology or Antigen Detection
380
Most Likely Cause of Disease in Atypical Pneumonia
MYCOPLASMA (Skin Rash, Hemolysis, Arthralgia)
381
Other Clinical Clinical Cues to Rule Out Other Causes of Atypical Pneumonia
LEGIONELLA: Hyponatremia, Diarrhea; CHLAMYDIA: Atherosclerosis
382
Most Appropriate Treatment in Atypical Pneumonia
Empiric Therapy with AZITHROMYCIN
383
Most Common Cause of High Grade Fever, Rusty Sputum, and Lobar Pneumonia
STREPTOCOCCUS PNEUMONIAE
384
Most Common Cause of Pneumonia with Currant Jelly Sputum
KLEBSIELLA PNEUMONIAE
385
Pathologic Stages of Typical Bacterial Pneumonia
CONGESTION, RED HEPATIZATION, GREY HEPATIZATION, RESOLUTION
386
Indication for Pseudomonas Coverage in CAP
PROLONGED BROAD-SPECTRUM ANTIBIOTIC THERAPY, BRONCHIECTASIS, MALNUTRITION, STEROID THERAPY
387
Admission Criteria for patient with CAP
Confusion, Uremia, RR>30, low BP, Age >65 (CURB-65 CRITERIA, If 2 or more present, ADMIT)
388
Light's Criteria: LDH >200, LDH/Serum Ratio >0.6, Protein/Serum Ratio >0.5, Ex: Pneumonia, Cancer, Infections, RHD
EXUDATE
389
Light's Criteria: LDH <0.5, Ex: CHF, Cirrhosis, Renal Failure
TRANSUDATE
390
Underlying pathology in COPD
Destruction of Normal Alveoli-Capillary structures and enlargement of Airspace
391
2 Disease Components in Spectrum of COPD
EMPHYSEMA and CHRONIC BRONCHITIS
392
Most Important Risk Factor of COPD
SMOKING
393
Other Important Diagnostic Test for COPD? Expected Findings?
PULMONARY FUNCTION TEST showing DECREASED FEV1 and FEV1/FVC ratio
394
Most Common Pattern of Involvement in COPD
CENTRIACINAR EMPHYSEMA OF UPPER LOBES
395
Congenital Enzyme Deficiency associated with COPD? Morphologic pattern?
ALPHA-1 ANTITRYPSIN DEFICIENCY, with BIBASILAR PANACINAR EMPHYSEMA and LIVER CIRRHOSIS
396
Drug of Choice for COPD
INHALED BRONCHODILATOR + ANTICHOLINERGIC; INHALED CORTICOSTEROIDS
397
Only Treatments shown to Improve Survival in COPD
SMOKING CESSATION and HOME OXYGEN THERAPY
398
Right-Sided CHF in COPD
COR PULMONALE (COPD STAGE V)
399
Most Common Cause of Exacerbation in COPD
INFECTIONS (H. Influenzae, Influenza virus)
400
Preventive Measures for COPD patients? Level of Prevention?
PNEUMOCOCCAL, Hib and INFLUENZA VACCINATIONS (PRIMARY PREVENTION)
401
Drug of Choice for COPD with Comorbid Cardiac Conditions
IPRATROPIUM (BETA-AGONISTS cause TACHYCARDIA and ARRHYTHMIAS)
402
Underlying Pathology in PE
DVT travels to LUNGS and OBSTRUCTS PULMONARY VASCULATURE
403
Risk Factors for PE
HYPERCOAGULABILITY: Estrogens, Malignancy, Genetic Diseases; STASIS: Prolonged Immobilization; ENDOTHELIAL INJURY: Trauma, previous DVT (VIRCHOW's TRIAD)
404
Most Appropriate Diagnostic Test for PE? Expected Finding?
VENTILATION-PERFUSION SCAN (V/Q scan); Multiple Perfusion Defects with Normal Ventilation (V/Q ratio)
405
Gold Standard for Diagnosis of PE
PULMONARY ANGIOGRAPHY (SPIRAL CT?)
406
Most Common Acid-Base Disorder associated with PE
RESPIRATORY ALKALOSIS
407
Most Common ECG finding in PE
SINUS TACHYCARDIA (also NSSTTWC or S1Q3T3 strain pattern)
408
Most Appropriate Treatment for PE
ANTICOAGULATION
409
Most Appropriate Treatment for PE patients with Contraindications
IVC FILTER
410
Most Common Cause of Death in PE
PROGRESSIVE RIGHT-SIDED HEART FAILURE
411
Causative Agent of TB
MYCOBACTERIUM TUBERCULOSIS
412
Most Appropriate Diagnostic Test for TB
SPUTUM AFB x 3
413
Phases of Infection of TB?
PRIMARY COMPLEX and REACTIVATION TB
414
Mode of Transmission for TB
AIRBORNE DROPLETS
415
Asymptomatic Case Detection for TB
PPD or MANTOUX test
416
Chest XRay Findings in TB
SIMON'S FOCUS, CICATRICIAL CHANGES, CAVITATION at LUNG APEX
417
Most Appropriate Treatment for TB
2 HRZE/ 4HR in 6 months
418
Most Effective Treatment Strategy
DOTS
419
Adverse Effects associated with TB Treatment
INH: Neuro/Hepatotoxicity, RMP: RO urine, PZA: Arthralgia, Hepatotoxicity, EMB: Retrobulbar Neuritis
420
Underlying Pathology in BAIAE
REVERSIBLE AIRWAY INFLAMMATION and OBSTRUCTION
421
Type of Immune Reaction causing BAIAE
TYPE I REACTION (IgE Mediated)
422
Bronchospasm in BAIAE
IgE-mediated degranulation of Mast Cells causing HISTAMINE RELEASE
423
HP Hallmarks in BAIAE
CURSCHMANN's SPIRALS, CHARCOT-LEYDEN CRYSTALS
424
Best Initial Test for Diagnosis of BAIAE
PULMONARY FUNCTION TEST: 12% improvement with FEV1 after Beta-Agonist)
425
Next best Diagnostic Test if Asthma patient is Not in Exacerbation
METHACOLINE CHALLENGE: >20% decrease in FEV1
426
Poor Prognostic Factors for Asthma
PULSUS PARADOXUS, RESPIRATORY FATIGUE, CYANOSIS
427
ABG in BAIAE
EARLY STAGE: Repiratory Alkalosis, Normal pO2, LATE STAGE: Respiratory Acidosis, IMPENDING RESPIRATORY FAILURE: Normal ABG
428
Acute Exacerbation of Asthma Not Responding to Standard Treatments
STATUS ASTHMATICUS
429
Treatment of Status Asthmaticus
IV HYDROCORTISONE, NEBULIZED EPINEPHRINE or ALBUTEROL, THEOPHYLLINE, MgSO4
430
Types of Medication in Asthma Management
RELIEVERS (Reduce Bronchospasm): SABA, Ipratropium, Theophylline, IV Hydrocortisone; CONTROLLERS (Reduce Inflammation): Steroids, LABA, Leukotriene Antagonists, Mast Cell Stabilizers, anti-IgE antibodies
431
2 Main Morphologic Forms of Lung Cancer
SMALL CELL LUNG CANCER, NON-SMALL CELL LUNG CANCER
432
Most Significant Risk Factor for Lung Cancer
CIGARETTE SMOKING
433
Next Step in Management of Lung Cancer
CHEST XRAY
434
Gynecomastia, Clubbing and Acanthosis Nigricans in Lung Cancer
PARANEOPLASTIC SYNDROMES
435
Most Appropriate Diagnostic Test after Imaging Studies
LUNG BIOPSY
436
Centrally-Located Lung Mass upon CXray in Lung Cancer
SMALL CELL LUNG CANCER, SQUAMOUS CELL LUNG CANCER
437
Differentiate Lung Cancer on Basis of Paraneoplastic Syndromes
SMALL CELL LUNG CANCER: Ectopic Cushing Syndrome, SIADH, Lambert-Eaton Myasthenia; SQUAMOUS CELL LUNG CANCER: Hypercalcemia, Clubbing, Gynecomastia
438
Most Appropriate Treatment for Lung Cancer
CHEMOTHERAPY with or without RADIOTHERAPY
439
Complications of Lung Cancer
SUPERIOR VENA CAVA SYNDROME, PANCOAST TUMOR leading to HORNER SYNDROME, AIRWAY OBSTRUCTION, HOARSENESS
440
Prognosis for Lung Cancer
POOR (5-Year Survival Rate 10%)
441
Underlying Pathology for Colorectal Cancer
BLEEDING COLORECTAL MASS causing OBSTRUCTION
442
Most Appropriate Diagnostic Test for Colorectal Cancer
COLONOSCOPY with BIOPSY
443
Appropriate Screening Test for those at Risk for Colorectal Cancer
FOBT (Yearly), SIGMOIDOSCOPY (Every 5 years), COLONOSCOPY (Every 10 years)
444
Familial Colon Cancer Syndrome associated with Mutation of APC gene
FAMILIAL ADENOMATOUS POLYPOSIS
445
Diagnosis for Colorectal Cancer
VISUALIZING: 100 Polyps during Colonoscopy
446
FAP plus Brain Tumors (Medulloblastoma), Café-au-lait spots and Basal Cell Carcinoma
TURCOT SYNDROME
447
FAP plus extraintestinal tumors: Osteomas, Nasopharyngeal Fibroma, Lipoma
GARDNER SYNDROME
448
Hyperpigmented spots on Lips/ Bucc Mucosa and Hamartomatous Polyps (Not Premalignant)
PEUTZ-JEGHERS SYNDROME
449
Hereditary Non-Polyposis Cancer due to Defective Mismatch Repair (Colon Cancer + Endometrial Cancer)
LYNCH SYNDROME
450
Differentiate Right-Sided and Left-Sided Colon Cancer
RIGHT-SIDED: Fatigue and weakness due to Iron Deficiency Anemia; LEFT-SIDED: Occult Bleeding, Changes in Bowel Habits or Cramping Left Lower Quadrant discomfort
451
Most Important Risk Factor for Colorectal Cancer
DIETARY HABITS (Low Fiber, High Refined Carbohydrates/ Fat)
452
Most Important Prognostic Factor of Colorectal Cancer
Depth of Invasion, Presence or Absence of Lymph Node Metastases
453
Describe Treatment for Colorectal Cancer
LOCALIZED DISEASE: Surgery; METASTATIC DISEASE: Chemotherapy
454
Most Common Site of Metastasis
LIVER
455
Surgical Treatment Modalities based on Anatomic Location of Colorectal Cancer Tumor
CECUM, RIGHT COLON & PROXIMAL/ MID-TRANSVERSE: Right Hemicolectomy, SPLENIC FLEXURE and LEFT COLON: Left Hemicolectomy, SIGMOID/ RECTOSIGMOID: Sigmoid Colectomy, PROXIMAL RECTUM: Low Anterior Resection, DISTAL RECTUM: Abdomino Perineal Resection
