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MKSAP Flashcards

0
Q

Screen women over the age of ____ for osteoporosis with a _____. Over the age of ____ if they are at risk of fractures.

A

Age 65
DEXA scan
Age 60 with a 10-yr FRAX score of 9.3%

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1
Q

Screen all males aged ____ to _____ who have ever smoked for a ________

A

Aged 65-75.

Abdominal aortic aneurysm

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2
Q

Immunize someone with COPD against influenza with the ________ vaccine. Who else should get the flu vaccine? (pulmonary disease risk groups)

A

Killed trivalent influenza vaccine

Asthma, primary pulmonary disease or active smoker

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3
Q

Lung cancer - specific mortality has the lowest risk of bias

A

Repeat

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4
Q

Zoster vaccine is indicated at _____ years of age. It is a ______(live/killed) vaccine. It is contraindicated in ________.

A

60 years of age.
Live vaccine
Contraindicated: TB, Steroids, Immunocompromised, Chemotherapy

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5
Q

You should give a Td toxoid no matter what. Of a pt had received a booster in ___ years or if a pt has a clean, small wound and has received a booster in ___ years, there is no need to repeat the booster.

A

5 years

10 years

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6
Q

Girls aged 9-26 years should get the _____ vaccine.

A

HPV vaccine

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7
Q

Colon cancer screening should begin at age ____.

Options are:

A

50 years

Annual high sensitivity Home FOBT with sampling of 2-3 consecutive specimens
Colonoscopy every 10 years
Flex Sig every 5 years with annual high sensitivity FOBT every 3 years

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8
Q

What further testing is indicated for vasovagal syncope?

How is it defined:

A

None!

Definition: Nausea, vomiting, diaphoresis is that last for >10seconds.

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9
Q

When should a depressed pt with no response to therapy be switched to other meds or psychotherapy?

A

6 weeks

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10
Q

A patient with suicidal ideation (and a plan) should be _____

A

referred URGENTLY to mental health clinic

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11
Q

What is Zolpidem?

A

It is Ambien for insomnia

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12
Q

What is mirtazapine?

A

It is a TCA

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13
Q

How long must depression persist or with what must it be associated?

A

2 months or be associated w/significant symptoms, functional impairment, suicidal ideation, psychotic symptoms, or psychomotor retardation

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14
Q

CIWA > ____ pts indicates need for meds
CIWA > _____ pts indicates need for admission

What meds are best/1st line for alcohol withdrawal?
What meds are great for preventing seizures?

A

10 pts - requires meds
15 pts - admission

Benzos are first line for alcohol withdrawal.
Chlordiazepoxide (or diazepam) is great for preventing seizure

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15
Q 
To calm down a pt on cocaine, your should use \_\_\_\_ (drug class)
What drug for psychosis MUST YOU NOT USE?
What common cardiac class of drugs can you NOT USE?
A

Use benzo to calm down a pt on cocaine.
DO NOT EVER USE haloperidol because it lowers the seizure threshold.
DO NOT use a beta-blocker because you end up with unopposed alpha effects.

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16
Q

What drug has been shown to be the best short-term treatment of alcohol dependence? It also reduces risk of relapse.

What is it’s mechanism of action?

A

Naltrexone

Opioid receptor antagonist

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17
Q

To revert opioid intoxication effects, give_____

A

Naloxone

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18
Q

What is first line therapy for spinal stenosis?

When is a pt a candidate for surgery?

A

NSAIDs, acetaminophen, physical therapy

Surgery: When a pt has had persistent severe pain or progressive neurologic deficits for 3 months to 2 years after failing non-invasive therapy.

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19
Q

For vertebral osteomyelitis, the preferred imaging modality is a ________

What are some risk factors:
Presenting symptoms:
Work-up:
Treatment:

A

MRI of the spine

Risk factor: IVDU, endocarditis, cathether
Presenting symptoms: Pain, fever, elevated ESR (esp > 100 is very suggestive of osteomyelitis)

Work-up: Blood cultures.
Treatment: Blood cultures should be obtained before starting a targeted antibiotic therapy. There is no role for empiric Abx therapy here.

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20
Q

A positive straight leg test indicated…

A

Disk herniation (esp L5)

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21
Q

Acute, non-specific low back pain (someone pulling their back) should be treated with…

What do studies say about bed rest in this setting:

A

Acetaminophen or NSAIDS

Studies say bed rest does not help and it may actually impair recovery time,

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22
Q

Back pain, muscle weakness, and loss of bowel/bladder control is concerning for…

Imaging:

A

Spinal cord compression.

Imaging: MRI of the spine

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23
Q

Most common causes of chronic cough are…

If the concern is cough-variant asthma, try a trial therapy of ____

A

Asthma
GERD
Post-Nasal Drip (chronic sinusitis-rhinitis)

Cough-variant asthma: albuterol

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24
Q

So how do you treat a post-nasal drip which usually happens in the setting of a chronic cough (>8wks) in the absence of ACE-I, smoking, and normal CXR?

DDx

A

Antihistamine/decongestant combination

DDx: Post-nasal drip (upper airway cough syndrome), GERD, asthma

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25
Q

All pts with hemoptysis should have a _____ (imaging). If they are at high risk of cancer, it should be a _______ and ______ even if the initial imaging modality requested above is normal.

A

All patients w/hemoptysis: CXR

If high risk for cancer: Chest CT and fiber optic bronchoscopy even if a CXR is normal.

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26
Q

Quitting smoking improved both lung function and reduces the rate of decline in COPD.

A

Repeat

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27
Q

Women who smoke have a 3x higher risk of a Cardiovascular event

A

Whoa!

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28
Q

For smoking cessation, varenicline is the most effective (3x better than placebo). Side effect is nausea. Bupropion and nortriptyline are of equal efficacy to each other but less effective than varenicline.

A

Repeat

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29
Q

Daytime fatigue, somnolence, HTN or history of snoring are concerning for ______.
Work-up: ____

A

Sleep apnea

Sleep study

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30
Q

In pts with BMI > 25, obtain what tests to screen for co-morbidities?

A

Fasting glucose, Lipid panel (HDL, LDL, triglycerides), serum Cr

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31
Q

Define metabolic syndrome:

What is first line therapy for it:

A 
Fasting Glucose >= 110mg/dL
Waist Circumference > 40 in. (men) > 35in (women)
BP > 130/85
HDL < 40
Triglycerides > 150

First line: lifestyle modification (diet, smoking, physical activity, weight loss)

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32
Q

Orlistat causes local lipase inhibition in the GI Tract. It is appropriate to use in the setting of failed weight loss therapy that relied on diet and exercise alone.

A

Repeat

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33
Q

Persistent nausea/vomiting occurring after a gastric bypass is concerning for _______?

Work-Up:
Treatment:

A

Stomal stenosis

Work-up: endoscopy
Treatment: Dilation during endoscopy

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34
Q

Severe COPD can cause unintentional weight loss, skeletal muscle dysfunction, increased CV disease, osteoporosis and depression.

A

Repeat

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35
Q

Treat heavy menstrual bleeding with _______

A

Oral medroxyprogesterone acetate

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36
Q

Raloxifene is approved for prevention of post menopausal bone mass loss.

A

Repeat

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37
Q

Secondary amenorrhea (loss of menstrual cycle) should be worked up with progesterone withdrawal challenge. If a withdrawal bleed occurs then ______. If there is no withdrawal bleed then, _______

A

Anatomic defects and low estradiol levels are NOT responsible.

If a withdrawal bleed fails to occur that means low estrogen, endometrial non-reactiveness, HPA axis dysfunction or anatomic defects are responsible.

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38
Q

What are the new guidelines?

A

See the ACC article.

High intensity statin = Atorvastatin 80mg?

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39
Q

In all patients, abnormal uterine bleeding should be worked up with: _________.

In a patient >____ yrs, abnormal uterine bleeding should be worked up with ________ in addition to above.

A

Pelvic examination and pap smear.

35 years; endometrial biopsy to rule out endometrial hyperplasia or endometrial cancer.

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40
Q

A well demarcated, rapidly spreading warm, tender and erythematous rash is concerning for…

A

Cellulitis. (affects the dermis)

Pathogen: Staph, strep

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41
Q

Itchy, red, edematous, weepy, crusted sometimes with vesicles and bullae rash is concerning for…

A

Allergic contact dermatitis

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42
Q

A recurrent itchy erythematous rash involving the eyebrows and cheeks is concerning for …. In the absence of Photosensitivity, arthralgias, muscle weakness.

Treat with:

A

Seborrheic dermatitis.

Treatment
Face: low-dose corticosteroid or ketoconazole
Scalp: shampoo with tar, ketoconazole, and selenium sulfide

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43
Q

An erythematous rash affecting the cheeks and nose that includes the nasolabial folds (smile limes) and presents with pustules or papules or telangiectasias without comedomes after age 30 is concerning for…

A

Rosacea

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44
Q

Cutaneous candidiasis presents with sharply demarcated, bright red patch with an infection that begins with pustules on a red base that become confluent. The key is local _________. In addition, small pustular lesions at the periphery (______) are usually present.

If in the groin, the ______ is often involved.

A

Local altered immunity - increased moisture, diabetes, altered systemic immunity.

Satellite lesions

Scrotum

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45
Q

Light pink to red papules and thin plaques with scaling and active borders and central clearing in the groin is concerning for…

Diagnosis:

A

Tinea cruris

Diagnosis: KOH slide prep showing fungi (if needed)

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46
Q

Fine, pink, blanching macules and papules on the wrists and ankles that spread centripetal to the arms and soles are concerning for…

A

Rocky mountain spotted fever (rickettsia ricketsii)

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47
Q

Chronic urticaria lasts ____ hrs occurs at least ____ times/wk for up to ___ wks.

Acute urticaria lasts ____

A

Chronic urticaria lasts greater than 24 hrs and occurs at least 2 times a week for up to 6 weeks.

Acute urticaria lasts less than 24 hrs. It can be recurrent but each episode lasts less than 24 hours.

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48
Q

Only investigate painless generalized non-tender lymphadenopathy in a young person if the lymph nodes is >2cm, progressively enlarging or there are systemic symptoms that persist for over 2-3 weeks. Note: inguinal nodes a frequently reactive and least preferred for biopsy.

If further work-up were warranted, the following could be ordered:

A

Work-up: CBC with diff and CXR

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49
Q

The acronym for evaluating new onset urinary incontinence is DIAPERS. It stands for ________. It identifies reversible causes of incontinence.

A 
Drugs
Infection
Atrophic vaginitis
Psychological (Depression, Dementia, Delirium)
Endocrine (hyperglycemia, hypercalcemia)
Restricted mobility
Stool impaction
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50
Q

The best way to screen an elderly person for hearing impairment is ____

A

Whispered voice test

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51
Q

To treat isolated urinary incontinence in an elderly male patient, treat with

A

Anti-cholinergic agents (oxybutynin, tolterodine)

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52
Q

If you can, start a hypertensive patient who is significantly goal on a low dose chlorthalidone (thiazide diuretic) as first anti-hypertensive.

A

Repeat

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53
Q

Aortic coarctation is associated with ______ and ______ on CXR. Other findings include: _________

A

Rib notching, 3 sign.

Other findings: reduced and delayed lower extremity pulse

54
Q

What is the gold standard, imaging modality of choice for nephrolithiasis?

A

Noncontrast helical abdominal CT

55
Q

Severe abdominal or back pain associated with syncope that is then followed by persistent abdominal discomfort is concerning for ____________

Work-up:

A

Ruptured AAA

Work-up: CT scan, then surgery

56
Q

Chronic abdominal pain with pain relieved on defecation, onset of symptoms associated with change in stool frequency/consistency in a young female is concerning for ____________.

Treatment:

A

Irritable bowel syndrome.

Treatment: reassurance and polyethylene glycol

57
Q

Ischemic colitis can present with the following symptoms/demographic:

It can present as ________ on colonoscopy.
On CT it presents as:

Treatment:

A

Elderly patient (over 60) with LLQ pain urgent defecation and maroon/red rectal bleeding that does not require transfusion.

Patchy, segmental ulcerations, hemorrhagic nodules, gangrene
CT: segmental thickening of bowel

Treatment: Supportive; IV Fluids and bowel rest. Most symptoms resolve in 48 hours.

58
Q

What imaging modality is most appropriate to evaluate acute diverticulitis?

Complications:

A

Contrast enhanced CT of the abdomen and pelvis.

Complications: perforation, abscess, fistula, obstruction

59
Q

Hemolytic uremic syndrome presents with _________ and _______
Pathogen:
Diagnosis

A

Microangiopathic hemolytic anemia and thrombocytopenia.
Pathogen: EO157:H7

Diagnosis: peripheral blood smear (schistocytes)

60
Q

Treatment for TTP is:

A

Plasmapheresis

61
Q

Diarrhea and tenesmus within 6 weeks of receiving radiation are concerning for _______
Work-up:

A

Radiation proctitis

Work-up: Flex sigmoidoscopy

62
Q

Treat severe C.diff by:

A
  1. Stop antibiotic

2. IV metronidazole, oral vancomycin

63
Q

What is the treatment for most Salmonella gastroenteritis?

A

None. For most healthy people, Salmonella gastroenteritis is usually a self-limited illness.

Treatment is recommended only for: children less than 2 years or adults greater than 50 years, severe illness requiring hospitalization, people with atherosclerotic plaques or endovascular or bone prostheses, immunocompromised. If treating, treat with ciprofloxacin.

64
Q

Elevations in ____ (ALT vs AST) are more specific for liver disease.

A

Repeat

65
Q

In hepatocellular injury, what pattern is seen:

A

Elevated ALT, AST, and then a conjugated (direct) hyperbilirubinemia where direct bilirubin is greater than 50% of the total bilirubin.

66
Q

Cholestatic liver injury presents as:

Does cholestasis occur with or without jaundice?
Work-up:

A

Elevated alkaline phosphatase, conjugated hyperbilirubinemia (direct) and a mild transaminitis.

Jaundice: Either with or without

Work-Up: Ultrasound study to determine if it is intrahepatic or extrahepatic.

67
Q

What are examples of liver diseases that sometimes present as a mixed liver injury pattern?

What is a mixed liver injury pattern:

A

Hep B, Hep C

Mixed liver injury: Highly elevated: ALT, AST, Alkaline phosphatase, and bilirubin.

68
Q

Non-hepatic liver injury like in the setting of muscle injury would present with: (liver enzymes)

A

Marked elevation of AST, lesser elevation of ALT, and no associated elevation of conjugated bilirubin.

69
Q

In Gilbert’s you see asymptomatic elevation in total bilirubin due to increased ______(indirect vs direct) bilirubin. The total bilirubin in Gilbert’s can be elevated up to 3.0mg/dL. There is NO evidence of hemolysis.

A

Indirect bilirubin is elevated in Gilbert’s.

You must confirm by looking at the Hgb that there is no hemolysis component resulting in the increased indirect bilirubin.

70
Q

Acute Cholangitis should be treated with:

A

Treatment: broad spectrum antibiotics, ERCP with sphincterotomy

71
Q

In the setting of a patient with GI bleeding of obscure cause even after performing an endoscopy and colonoscopy, the appropriate next step is ______

A

Repeat upper endoscopy - identifies source in significant number of patients.

After the repeat endoscopy, then one can consider repeat colonoscopy or capsule endoscopy. double balloon endoscopy is to evaluate findings seen on capsule endoscopy.

Never use a barium swallow to work-up GI bleeding.

72
Q

Do NOT perform a colonoscopy in acute diverticulitis because of the risk of perforation.

A

Repeat

73
Q

Patients with serum triglycerides over 1000 are the ones who develop acute pancreatitis from hypertriglyceridemia.

A

Repeat

74
Q

Screen a pt with chronic Hep B infection for hepatocellular carcinoma without cirrhosis with ________

Biggest risk factor for HCC?

A

Ultrasonography.

If a pt with Hep B has a compatible ultrasound and an AFP greater than 500ng/mL, they can be diagnosed with HCC without a biopsy.

The biggest risk factor for HCC is cirrhosis.

75
Q

Anti-smooth muscle antibody is NOT positive in drug-induced hepatitis.

A

Repeat

76
Q

Non alcoholic steatohepatitis is associated with ________ (risk factors)

A

Type 2 DM, obesity, Hyperlipidemia

77
Q

Any patient with new onset cirrhosis should have a diagnostic ________

A

Paracentesis

78
Q

Hepatorenal syndrome is _____

Treatment:

A

Development of kidney failure in the setting of portal HTN (esp cirrhosis) and normal kidney function. The cirrhotic liver is thought to alter bloodflow so that intense vasoconstriction happens at the kidney.

Treatment: liver transplantation

79
Q

As far as cutaneous manifestations of IBD are concerned, Crohn’s tends to be associated with ________. Ulcerative colitis with _______.

A

Crohn’s - erythema nodusum - exquisitely tender nodules on anterior tibial surface.

Ulcerative colitis - pyoderma gangrenosum (neutrophilic skin disease)

80
Q

Dermatititis herpetiformis is associated with ________ (GI disease). It presents as grouped, pruiritic, erythematous papulovesicles on _______ (extensor vs flexor) surfaces.

A

Celiac disease

Extensor surfaces.

81
Q

To treat ulcerative colitis:

A

Mild proctitis/distal disease: start with topical mesalamine or corticosteroid suppositories.
For non-responsive proctitis or a pancolitis: use oral 5-ASA’s like Sulfasalazine, mesalamine, balsalazise, olsalazine.
If still no response, add corticosteroids. If still no response, add Azathioprine or 6-MP.

82
Q

In the setting of inflammation, ferritin should be higher than normal. Specifically at least _____. Ferritin lower than this level may suggest iron deficiency in the setting of inflammation.

A

100 to 120ng/mL.

83
Q

Bleeding time is a measure of _________ function.

A

Platelet. Bleeding time can prolonged in the setting of platelet disease, Von Willebrand’s disease, DIC, and thrombocytopenia.

84
Q

The best way to screen for a bleeding disorder is a _______.

What tests should be done if the initial screen is concerning for bleeding disorder:

A

Clinical history.

Work-up if clinical history is concerning for bleeding: Prothrombin time (PT/INR), PTT, Platelet count

85
Q

Acute chest syndrome in sickle cell should be managed with ______

A

Red blood cell exchange transfusion - increases amount of Hgb A in pt.

86
Q

Thrombocytopenia with normal coagulation, microangiopathic hemolytic anemia (schistocytes), and CNS symptoms are concerning for _____. Adding renal failure and fever makes the pentad.

A

TTP

87
Q

Seeing large platelet clumps on a peripheral blood smear is concerning for _______.

Treatment

A

Pseudothrombocytopenia

Treatment: use an alternative anticoagulant to EDTA like sodium citrate.

88
Q

Gestational thrombocytopenia usually occurs in the _______ trimester and is associated with platelet counts between _____ and ______.

Treatment:

A

Late in gestation.

Platelet counts between 70,000 and 150,000.
Treatment: None required

89
Q

Screening for thrombophilia should’ve performed not at the onset of the event or during anticoagulant therapy but ______

A

After a few weeks of patient completing anticoagulant therapy.

90
Q

To diagnose anti phospholipid syndrome, you need a history of _________ with persistent ________, ________, or ________ antibodies.

A

History of thrombotic event including recurrent fetal loss
Persistent Lupus anticoagulant, or persistently elevated levels of anti-cardiolipidin or beta-2-glycoprotein I antibodies.

91
Q

A decreased anion gap in the setting of anemia, renal failure, and proteinuria suggests _________

A

Multiple myeloma

92
Q

Auer rods suggest what disease?

Seeing a fever in this disease almost always signals _____ and prompt work-up and initiation of _______ (treatment) are indicated.

A

Acute myelogenous leukemia

Signals infection. Prompt work-up and initiation of broad-spectrum antibiotics are indicated.

93
Q

Acute promeyeloid leukemia is a subtype of AML that responds very well to _______ therapy.

A

ATRA - all-trans retinoic acid.

94
Q

Familial Mediterranean fever is marked by:

Pattern of inheritance:

Lab abnormalities

A

1-3 days of fever with serositis (pleuritis, synvotis, abdominal pain) usually occurring before the age of 10 in people of middle eastern, Turkish, Jewish descent.

Autosomal recessive

Lab abnormalities: Leukocytosis, elevated ESR

95
Q

A patient coming in with muscle rigidity, hyperthermia, cognitive changes, autonomic instability, diaphoresis, sialorhhea, seizures, arrythmias, and RHABDOMYOLYSIS within 2 weeks of getting an anti-psychotic (haloperidol or fluphenazine), they have _______

A

Neuroleptic malignant syndrome

Treatment: ABCs, stabilize, any patient with altered mental status in the field should first receive trial of dextrose, thiamine, and naloxone to r/o other causes of altered mental status, then remove offending (NMS-inducing) agent.

96
Q

Thyroid storm does NOT cause muscle rigidity or elevations in CK.

A

Repeat

97
Q

Give activated protein C to a patient in severe sepsis with a platelet count between 30 K and 50K who had surgery over 12 hrs ago. Do NOT give to someone who is actively bleeding.

A

Improves mortality in a patient at high risk of death.

98
Q

Treat a Tonsillar abscess with:

A

Antibiotics: Ampicillin-Sulbactam, Penicillin G + Metronidazole. Only use Clindamycin in PCN allergy.
If not responding to antibiotics: ENT consult

99
Q

Treat asymptomatic bacteriuria in pregnant women with _______

A

Ampicillin or nitrofurantoin or amoxicillin

Never use ciprofloxacin or Bactrim in pregnancy. They are contraindicated.

100
Q

What is the treatment for pyelonephritis?

A

Floroquinolone

101
Q

Screen ______ (demographic groups) for syphilis.

A 
All pregnant women
Commercial sex workers
Former prisoners
Anyone with another STD
MSM
102
Q

HIV prophylaxis:
At what CD4 count should you begin PCP prophylaxis? What is it?
At what CD4 count should you begin Toxo prophylaxis? What is it?
At what CD4 count should MAC prophylaxis begin?

A

Begin PCP prophylaxis at CD4 count of 200. It is TMP-SMX.
Begin Toxo prophylaxis at CD4 count of 100. It is TMP-SMX.
Begin MAC prophylaxis at CD4 count of 50. It is Azithromycin.

103
Q

Toxoplasmosis appears as _________

Treatment:

A

Ring enhancing lesions with mass effect on MRI.

Treatment: Sulfadiazine + pyrimethamine and folinic acid. Then follow-up with MRI to assess treatment response after 14 days.

104
Q

Progressive multifocal leukoencephalopathy presents as __________________ on MRI.

A

T2 MRI: hyperintense

T1: hypo intense

105
Q

Semi erect positioning reduces the risk of ventilator associated pneumonias

A

Repeat

106
Q

What are appropriate precautions (droplet vs airborne) for meningitis, varicella, TB, measles?

A

Meningitis - droplet precautions
Measles - airborne precautions
TB - airborne precautions
Varicella - airborne precautions

107
Q

For a patient on immunosuppression like prednisone, the PPD cut off is ____ for latent TB in the absence of significant prior exposure. Treatment:

The same cutoff of ___mm is used in the setting of all patients who are about to undergo transplant or get started on a TNF-alpha inhibitor.

A

5mm
Treatment: Isoniazid for 9 months.

5mm. If positive, treat with isoniazid for at least 2 months.

108
Q

What is the season for Flu in the northern hemisphere?

A

November to April

109
Q

What is the treatment for mild community acquired pneumonia?

Pathogens:

A

Azithromycin or Clarithromycin.

Pathogens: Strep pneumoniae, Mycoplasma pneumonia, Chlamydophila pneumoniae

110
Q

Lung abscess typically shows ____ on Chest X-ray?

Treatment:

A

Air-fluid levels

Treatment: Ampicillin-Sulbactam

111
Q

Prophylaxis for endocarditis just prior to a dental procedure is ___________ or _________ if they are allergic.

A

Amoxicillin - endocarditis prophylaxis

Clindamycin - for prophylaxis in the setting of a PCN allergy.

112
Q

A patient with hematuria (more than 2 erythrocytes/hpf), no dysmorphic erythrocytes, and no proteinuria suggests non-glomerular GU bleeding which in the right clinical context = painless hematuria.

A

Repeat

113
Q

In respiratory acidosis, compensation is as follows:

For every 10mmHg increase in CO2, there is:
Acute - ____ incr in bicarbonate
Chronic - ____ incr in bicarbonate

A

In respiratory acidosis, compensation is as follows

For every 10mmHg increase in CO2, there is:
Acute - 1mEq/L incr in bicarbonate
Chronic - 3.5mEq/L incr in bicarbonate

114
Q

Light’s criteria for pleural effusions:

What does it tell you?

A

Light’s criteria:

Fluid protein/serum protein > 0.5
Fluid LDH/serum LDH > 0.6
Plerual fluid LDH greater than 2/3 upper limit of normal LDH.

FLUID IS EXUDATIVE if one of above is met.
DDx for exudative effusion: Inflammatory vs infectious vs malignancy vs rheumatologic

115
Q

A Loud P2, fixed split S2, pulmonic flow murmur, and tricuspid regurgitation are most suggestive of _______

A

Increased pulmonary arterial pressure. I.e. Pulm HTN

116
Q

What are the parameters for pleural fluid that MUST be drained?

How do you drain it?

A 
Loculated pleural fluid
pH less than 7.20
Glucose less than 60mg/dL
LDH greater than 1000U/L
Positive gram stain or culture
Gross pus
(These are usually parapneumonic effusions or malignancy)

Method of drainage: Drain with a chest tube or cathether

117
Q

If young patient presents with inspiratory AND expiratory wheezing and is shown not to have asthma or their asthma was well controlled, ___________ disease should be suspected.
Other helpful signs:

Work up:
Treatment:

A

Vocal chord dysfunction
Other signs: Reduced volume on CXR despite incr volume expected in a pt with asthma. In flow volume loops, inspiratory limb is flattened.

Work up: Laryngoscopy (adduction of vocal chords when symptomatic)
Treatment: speech therapy, relaxation techniques

118
Q

The beauty of a meta choline challenge in asthma is that it induces bronchoconstriction even when the patient is asymptomatic and spirometry is normal.

A

Repeat

119
Q

A lymphocyte predominant exudative effusion suggests _________?

Work-up:

A

TB

Work up: Pleural biopsy

120
Q

The appropriate addition for an asthma patient that was previously controlled and then loses control secondary to a URI is:

A

Add a short-course ORAL corticosteroids

121
Q

Inhaled corticosteroids are ______ (safe/not safe) to manage asthma in pregnancy.

A

SAFE! Stick with their regimen.

122
Q

In patients with persistent asthma (2 or more days per week or 2 or more nights a month), not adequately controlled by an inhaled corticosteroid and a SABA, add a ___________

A

Long acting beta agonist.

123
Q

Only consider adding a Leukotriene antagonist once a long-acting beta agonist and an inhaled corticosteroid have been demonstrated to be inadequate.

A

Repeat.

124
Q

The appropriate antibiotic therapy for a COPD patient with an exacerbation is:

A

Cephalosporin + macrolide

Alternative: Floroquinolone monotherapy

125
Q

A COPD patient has to have an FEV1 less than ____% with homogenous disease or a DLCO less than ___% to qualify for a LUNG TRANSPLANT.

A

Less than 20% FEV1; less than 20% DLCO

126
Q

A COPD patient with severe disease who does not yet qualify for a lung transplant is a great candidate for __________ (intervention).

A

Pulmonary rehabilitation

127
Q

Nocturnal ventilation is equivalent to ______

A

CPAP

128
Q

An obese patient with low oxygen saturation while AWAKE, has _______ (diagnosis)

Work-up:

A

Obesity hypoventilation syndrome

Work up: Polysomnography, ABG (diagnosis is made with PCO2 greater than 45 while awake)

129
Q

Bilateral filling alveolar opacities on CXR with varied distribution in a subacute presentation of pneumonia-like symptoms but with a low grade fever and over the course of weeks is concerning for: _________.
What clue about the opacities helps to make this diagnosis:

A

Cryptogenic organizing pneumonia

Clue: opacities tend to migrate to different areas of the lung in serial examinations.

130
Q

A patient with systemic sclerosis who develops anti-topoisomerase I antibodies (I.e. Anti-Scl-70) and presents with decrease exercise tolerance and reduced DLCO is concerning for:
_________________ (diagnosis)

Work-up:

A

Diffuse parenchymal lung disease

Work-up: CT chest (demonstrate ground glass and reticular opacities, sub pleural cysts, honey combing)

131
Q

Fatigue, low-grade fever, cough, and peripheral blood eosinophilia can be seen in ____________ (diagnosis).

Treatment:

A

Drug-induced lung toxicity

Treatment: stop offending drug

132
Q

What is the appropriate non-invasive (preferred) test to diagnose an acute PE especially in the setting of increase Creatinine or chronic kidney disease?

A

V/Q scan.

Recall that the alternative test requires a large amount of contrast.

Medicine Shelf (4 decks)

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