Other DSA Stuff

Question 1

stage 1 radiographic findings sarcoidosis

Answer 1

hilar adenopathy alone

Question 2

stage 2 radiographic findings sarcoidosis

Answer 2

hilar adenopathy w/ parechymal involvement

Question 3

stage 3 radiographic findings sarcoidosis

Answer 3

parenchymal involvement alone

Question 4

stage 4 radiographic findings sarcoidosis

Answer 4

advanced fibrotic changes principally in the upper lobes

Question 5

most prominent sx of IPF

Answer 5

progressive dyspnea

Question 6

hallmark features on lung biopsy of IPF

Answer 6

heterogenous distribution of parenchymal fibrosis against background of mild inflammation

Question 7

first tx in pts with UA/NSTEMI

Answer 7

aspirin

- clopidogrel if aspirin intolerant

Question 8

initial conservative tx in pts with UA/NSTEMI

Answer 8

anticoag therapy

• enoxaparin
• fondaparinux (less common)

Question 9

after initiating enoxaparin, what tx for pts w/ UA/STEMI in conservative tx

Answer 9

clopidogrel

Question 10

initial invasive strategy in pts with UA/NSTEMI

Answer 10

anticoag thearpy

• enoxaparin
• bivalirudin

Question 11

after initiating enoxaparin, what tx for pts w/ UA/STEMI in invasive tx

Answer 11

add second anticoag for precatheterization

• clopidogrel
• GP IIb/IIIa inhibitor (eptifibatide or tirofiban)

Question 12

3 P2Y12 inhibitor antiplatelet therapies

Answer 12

clopidogrel
prasugrel
ticagrelor

Question 13

3 GP IIB/IIIA inhibitors

Answer 13

tirofiban
epitifibatide
abciximab

Question 14

MOA fondaparinus

Answer 14

Xa inhibitor

Question 15

MOA bivalirudin

Answer 15

direct thrombin inhibitor

Question 16

do you treat unstable angina with CCB

Answer 16

NO, third line therapy only

Question 17

Killip classification 1-4 (part of GRACE score)

Answer 17

1: absence of rales and S3
2: rales that do not clear w/ coughing over 1/3 or less lung fields, or presence of S3
3: rales that do not clear w/ coughing more than 2/3 lung fields
4: cardiogenic shock (rales, hypotension, signs of hypoperfusion)

Question 18

GRACE risk score

Answer 18

measure risk stratification for coronary angiography in pts w/ or w/o ST elevation

Question 19

TIMI risk score is based on what factors

Answer 19

• age 65 or older
• 3 or more cardiac risk factors
• prior coronary stenosis 50% or more
• ST segment deviation
• 2 anginal events in prior 24 hours
• aspirin in prior 7 days
• elevated cardiac markers

Question 20

what type of shock is associated w/ pulmonary edema

Answer 20

cardiogenic

Question 21

tension pneumothorax, cardiac tamponade, PE, and severe pulmonary HTN cause what type of shock

Answer 21

obstructive

Question 22

elevated serum lactate is associated with what type of shock

Answer 22

septic shock

Question 23

GI effects of hypotension

Answer 23

splanchnic vasoconstriction –>

• oliguria
• bowel ischemia
• hepatic dysfunction
• multiorgan failure

Question 24

CNS effects hypotension

Answer 24

• restlessness
• agitation
• confusion
• lethargy
• coma

Question 25

what to do with shock patients who become unresponsive

Answer 25

check glucose and if levels are low give 50% dextrose IV

Question 26

central venous pressure < 5 mmHg indicates | CVP > 18 mmHg indicates

Answer 26

hypovolemia | volume overload, cardiac failure, tamponade, pulm HTN

Question 27

PACs measure what

Answer 27

- pulmonary artery pressure - left sided filling pressure - PCWP

Question 28

what can you use to distinguish b/w cardiogenic and septic shock

Answer 28

pulmonary artery catheters

Question 29

what does POCUS look at

Answer 29

inferior vena cava (intravascular volume status)

Question 30

cardiac index < 2L/min/m2 means | cardiac index > 4L/min/m2 in hypotensive pt means

Answer 30

<2: needs inotropic support | >4: early septic shock

Question 31

``` systemic vascular resistance low (<800): SVR high (>1500): ```

Answer 31

low: sepsis and neurogenic shock high: hypovolemic and cardiogenic shock

Question 32

what fluid is used for volume replacement in shock

Answer 32

crystalloid solution

Question 33

compare fluid replacement in cardiogenic and septic shock

Answer 33

cardiogenic: smaller fluid challenges in increments of 250 mL septic: large volumes of fluid (usually more than 2L)

Question 34

compare vasoactive therapy in: pt w/ hypotension and high CO after volume resuscitation pt with low CO w/ high filling pressure

Answer 34

pt 1: vasopressor support to improve vasomotor tone pt 2: inotropic support to improve contractility

Question 35

what vasoactive therapy to give in pts with vasodilatory shock

Answer 35

NE and E

Question 36

vasopressor of choice in septic shock

Answer 36

NE | - phenylephrine can also be used

Question 37

1st line vasopressor agents in cardiogenic shock

Answer 37

NE or dopamine

Question 38

tx of choice for pts with shock secondary to adrenal insufficiency

Answer 38

corticoteroids

Question 39

what endogenous pyrogens mediate fever

Answer 39

IL-1, TNF, interferon a

Question 40

elevation of temperature related to inability of body to dissipate heat

Answer 40

hyperthermia

Question 41

5 categories of fever

Answer 41

``` hypersensitivity rxns altered thermoregulatory mechanisms related to administration of drug direct extensions of pharmacologic action of drug idiosyncratic (we don't know) ```

Question 42

near universal agreement that core body temp of ___ represents a fever

Answer 42

38.3 (100.9)

Question 43

most common causes of fever of unknown origin

Answer 43

tuberculosis and intra-abdominal abscesses

Question 44

malignancies associated with fever of unknown origin

Answer 44

hodgkin's dz, non-hodgkin's lymphoma

Question 45

inflammatory conditions associated w/ fever of unknown origin

Answer 45

SLE giant cell arteritis IBD

Question 46

very high fever, consider --->

Answer 46

CNS infections NMS heat stroke

Question 47

fever w/ rash, consider -->

Answer 47

meningitis bacteremia w/ septic shock rickettsial dz bacterial endocarditis

Question 48

fever w/ change in mental status, consider -->

Answer 48

``` meningitis encaphlitis NMS heat stroke bacterial infections w/ septic shock ```

Question 49

fever w/ dizziness or light-headedness, consider -->

Answer 49

bacterial infection w/ septic shock adrenal insufficiency PE

Question 50

fever w/ recent chemotherapy, consider -->

Answer 50

nosocomial infection w/ neutropenia

Question 51

fever w/ SOB and CP, consider -->

Answer 51

PE, pneumonia, empyema

Question 52

tertian fever and quartan fever are associated w/:

Answer 52

tertian: malaria due to plasmodium vivas or ovale quartan: malaria due to plasmodium malariae

Question 53

DUKE criteria for infectious endocarditis

Answer 53

- positive blood culture - persistent positive blood culture - echo positive for IE minor criteria: - fever

Question 54

criteria for fever of unknown origin:

Answer 54

fever >101 on at least two occasions | illness duration of > 3 weeks

Question 55

maculopapular rash in a sparse distribution over the anterior trunk in the groin and upper legs - intermittent fever

Answer 55

rickettsial infection

Question 56

sx of human monocytotropic erlichiosis (HME)

Answer 56

- fever - headache - myalgia - malaise - 8 day illness - thrombocytopenia, leukopenia, elevated serum aminotransferases

Question 57

sx rocky mountain spotted fever

Answer 57

- fever, rash, hx of tick exposure | - rash characterized by macules appearing on wrists and ankles and then spreading to rest of extremities and trunk

Question 58

sx lyme dz

Answer 58

erythema marginatum, fever, chills, myalgia