Rosh Review Flashcards
(399 cards)
1
Q
What is the most common cause of secondary HTN?
A
CKD
2
Q
What is considered to be stage 1 HTN?
A
130 - 139 / 80 - 89
3
Q
What is required to diagnose a pt with HTN?
A
2 elevated BP readings on 2 occasions
4
Q
What are the 1st line treatment options for the general population when treating HTN?
A
Thiazides (HCTZ, chlorthalidone)
CCBs (amlodipine)
5
Q
Patients who have HTN and CKD w/albuminuria should be treated with what?
A
ACE inhibitors (lisinopril) OR
ARB (losartan, valsartan)
6
Q
What BP medications cannot be used together?
A
ACEi and ARB
7
Q
What conditions would be contraindications to giving BBs for HTN?
A
Asthma and COPD
8
Q
What are common side effects of ACEi?
A
Cough and angioedema
9
Q
What is the difference between hypertensive urgency and hypertensive emergency?
A
There is no end-organ damage occurring in hypertensive urgency
10
Q
What BP level is considered a hypertensive urgency/emergency?
A
> 180 / > 110 - 120
11
Q
What is the treatment for hypertensive emergency?
A
Nicardipine +/- labetalol OR
Clevidipine +/- esmolol
12
Q
What signs/symptoms would indicate that there is end-organ damage with an elevated BP (hypertensive emergency)?
A
CNS (dizziness, N/V)
Eyes (papilledema)
Heart (angina, MI)
Kidneys (hematuria)
13
Q
How aggressive should treatment be during a hypertensive emergency?
A
Reduce BP by 10-20% in the 1st hr, and 5-15% in the following 23 hrs
< 180/120 (1st hr)
< 160/110 (23 hrs)
14
Q
Are medications given PO or IV during a hypertensive emergency?
A
IV
15
Q
What condition can present with xanthomas on skin, eyelids, and the achilles tendon area?
A
Hyperlipidemia
16
Q
What labs are indicative of hyperlipidemia?
A
Increased serum total cholesterol
Increased LDL
Decreased HDL
Increased serum triglycerides
17
Q
Pts with diabetes aged 45-75yo and an elevated LDL should be started on what medication?
A
Moderate intensity statin
18
Q
What meds are commonly used for high-intensity statin therapy?
A
Atorvastatin 40-80mg
Rosuvastatin 20mg
19
Q
What meds are commonly used for low-intensity statin therapy?
A
Simvastatin 10mg
Pravastatin 10-20mg
20
Q
What is the 1st and 2nd line treatment for hyperlipidemia?
A
1st: statins
2nd: cholesterol absorption inhibitor (ezetimibe)
21
Q
What medication commonly used in the treatment of hyperlipidemia is associated with causing flushing and how can this be avoided?
A
Nicotinic acid (niacin)
Reduce with giving aspirin
22
Q
What medications are used for lowering triglycerides?
A
Fibric acids (fenofibrate, gemfibrozil)
23
Q
What is the treatment regimen for pure hypertriglyceridemia?
A
1st line: Fibrates (fenofibrate, gemfibrozil)
2nd line: Niacin
24
Q
What is the most common cause of stable angina pectoris?
A
Atherosclerosis
25
What is the most common risk factor for stable angina pectoris?
HTN
26
How does stable angina pectoris commonly present?
Exertional substernal chest pain that lasts < 10 mins, and is relieved with rest and/or nitro
27
What is the 1st imaging test performed on a pt who presents with stable angina pectoris?
EKG
28
What is the gold standard test for diagnosing stable angina pectoris?
Cardiac cath w/coronary angiography
29
What is the pharm treatment for stable angina pectoris?
Aspirin
Sublingual nitro
BBS for rate control (1st line)
CCBs (2nd line, unless brady or hypotensive)
Statin therapy
30
What is the most common cause of unstable angina pectoris?
Enlarged stenosis w/thrombosis, hemorrhage, or plaque rupture
31
What is the most common manifestation/presentation of unstable angina pectoris?
Chest pain at rest
32
What is seen on EKG in pts with unstable angina pectoris?
ST-depression or T-wave flattening and/or inversions
33
Which leads correlate with the anterior portion of the heart on EKG?
V1 - V4
34
Which leads correlate with the lateral portion of the heart on EKG?
5, 6, 1, AVL
35
Which leads correlate with the inferior portion of the heart on EKG?
2, 3, AVF
36
What is the initial pharm treatment for unstable angina?
O2 (sats < 90%)
Nitro
Morphine (or fentanyl)
BBs
Statin
Antiplatelet (aspirin)
Anticoagulation (heparin)
37
Pts with unstable angina who fail medication therapy and/or have EKG changes that persist after 48 hrs require what treatment?
Cardiac cath and revascularization
38
Pts having an NSTEMI have what elevated biomarker?
Troponin
39
What is the 1st line treatment for NSTEMI?
BB
40
What is a TIMI score?
Used to estimate mortality in pts with unstable angina and NSTEMI
41
Aside from ST-segment elevation, what other EKG change is suggestive of a STEMI?
New LBBB
42
What artery is associated with STEMI seen in the anterior (V1-V4) leads?
LAD
43
What artery is associated with STEMI seen in the inferior (2,3,AVF) leads?
RCA or left circumflex
44
What artery is associated with STEMI seen in the lateral (1,V5,V6, AVL) leads?
Left circumflex or diagonal of LAD
45
Pts with STEMI that require revascularization require what procedure and when should this be performed?
Percutaneous coronary intervention (PCI) within 90 minutes
46
What is the most common mechanical complication post MI?
Ventricular free wall rupture (w/i 24 hrs or 1-2 weeks)
47
How long after an MI would you be concerned about Dressler syndrome?
2-10 weeks
48
How does prinzmetal angina typically present?
Substernal chest discomfort at rest occurring between midnight and early AM
49
What is the gold standard for diagnosing prinzmetal angina?
Coronary angiography
50
What is the treatment for prinzmetal angina?
CCB (1st)
Sublingual nitro
Statin
51
What is the most common cardiomyopathy in the US?
Dilated cardiomyopathy
52
What is the most common cause of dilated cardiomyopathy?
Alcohol
53
What physically happens to the heart in dilated cardiomyopathy?
Dilation and impaired contraction of 1 or both ventricles
54
What are common signs/symptoms of dilated cardiomyopathy?
Pedal edema
JVD
Hepatosplenomegaly
DOE
S3, S4 sounds
AFIB
55
What signs/symptoms can tell us whether the dilated cardiomyopathy is L or R sided?
L sided: dyspnea
R sided: JVD or pedal edema
56
Does L or R sided dilated cardiomyopathy typically occur first?
L sided first, which then causes R sided
57
An S4 heart sound is indicative of what?
Non-compliant L ventricle
58
What is the 1st line imaging for diagnosing dilated cardiomyopathy?
Echo
59
What is the 1st line pharm treatment of dilated cardiomyopathy?
BBs AND
ACEi or ARB
60
What is the inheritance pattern of hypertrophic cardiomyopathy?
Autosomal dominant
61
What murmur is indicative of hypertrophic cardiomyopathy?
Harsh mid-systolic crescendo-decrescendo best heard at LLSB
62
What maneuvers increase and decrease the murmur associated with hypertrophic cardiomyopathy?
Increase: valsalva and standing
Decrease: squatting and hand grip
63
What might been seen on the EKG of a pt with hypertrophic cardiomyopathy?
Tall R waves in V4 - V6
64
What is the gold standard for diagnosing hypertrophic cardiomyopathy?
Echo
65
What is the management for hypertrophic cardiomyopathy?
Avoid strenuous exercise and dehydration
BB
66
What are common causes of restrictive cardiomyopathy?
Amyloidosis
Sarcoidosis
Hemochromatosis
67
What common medical treatment can cause restrictive cardiomyopathy?
Chest radiation
68
In restrictive cardiomyopathy, which side typically fails first?
R side
69
What is the gold standard for diagnosing restrictive cardiomyopathy?
Endomyocardial biopsy
70
What is the classic triad of WPW syndrome?
Slurred upstroke of QRS (delta wave)
Wide QRS
Short PR interval
71
Generally speaking, heart dysrhythmias that are UNSTABLE get what treatment?
Tachy and unstable: synchronized cardioversion
Brady and unstable: pace
72
What pts with AFIB or atrial flutter get oral anticoagulation for long-term management
Pts with a CHADS-VASc score >/= 2
73
How does a RBBB appear on an EKG?
Rabbit ears in V1 and V2
74
How does a LBBB appear on an EKG?
W in V5 and V6
75
What is seen on an EKG in a pt with a 1st degree heart block?
Fixed, prolonged PR interval
76
What are the memory tools for 2nd and 3rd degree heart blocks?
Longer, longer, longer drop then you have a Wenckebach (Mobitz I)
Some Q's don't get through then you have a Mobitz II
P's and Q's don't agree then you have a 3rd degree
77
What is the treatment for a 1st degree and Mobitz I heart block?
Asymptomatic: no tx
Symptomatic: atropine
78
What is the treatment for Mobitz II and 3rd degree heart block?
Permanent pacemaker
79
What is seen on EKG in pts with pSVT?
Regular rate and rhythm
HR: 160-220
P waves may not be visible
QRS usually narrow
80
What is the treatment for pSVT?
Vagal maneuvers
IV adenosine (or IV CCBs or BBs)
Sync. cardioversion if hemodynamically unstable (or meds aren't working)
81
What medications can be tried if IV adenosine (1st line) does not work in a pt with pSVT?
Amio or procainamide
82
How is Vtach described on EKG?
Wide QRS tachycardia
HR: 100 - 250
All beats look the same (one beat can be replicated on the next)
83
What is the treatment for Vtach?
Sustained (> 30 sec): sync. cardiovert, unless pulseless arrest in which CPR and defib (unsync. cardiovert)
Nonsustained: no tx if asymptomatic; otherwise electrolyte correction +/- ICD placement
84
How is vfib described on EKG?
Disorganized with no associated pulse and no discernable P, T, or QRS waves
85
What is the treatment of vfib?
CPR + defib
Epi every 3-5 mins
Amio or lidocaine
ICD long-term
86
What commonly causes torsades?
Digoxin
Macrolides
Hypokalemia
87
What is the management of torsades?
IV mag sulfate
88
Heart failure with reduced ejection fraction (HFrEF) is classified as what?
Systolic HF
LVEF < 40%
Usually caused by ischemic heart disease/recent MI
89
Heart failure with preserved ejection fraction (HFpEF) is classified as what?
Diastolic HF
LVEF > 40%
Commonly caused by HTN, CAD, DM
90
Is L or R HF more common?
Left
91
Pts with R sided HF typically present with what symptoms?
SYSTEMIC - Roads
Fatigue
JVD
LE edema
Weight gain
92
Pts with L sided HF typically present with what symptoms?
PULM - Lungs
DOE
Tachypnea
Cough
Pulm crackles
93
According to the NYHA classification of HF, what symptoms are associated with class I (lowest class) and class IV (highest class)?
I: asymptomatic during daily activities
IV: symptoms at rest; any activity results in limitations
94
What lab is likely to be elevated on pts with HF?
NT-proBNP or BNP
95
Aside from HF, what other condition can also cause an elevated NT-proBNP/BNP?
Renal failure
96
What is the gold standard imaging study for HF?
Echo
97
What might be seen on a CXR in a pt with HF?
Cardiomegaly
Pulmonary congestion (Kerley B lines)
Pleural effusion
98
What is the treatment for HFrEF (systolic dysfunction)?
Fluid and salt restrict
Diuretic + ACEi or ARB + BB
ICD for pts with EF < 35%
99
What medications should be avoided in pts with HF?
Metformin
Thiazolidinediones
NSAIDs
CCBs
100
What is the treatment for acute decompensated HF?
O2
IV loop diuretic
IV vasodilator (nitro)
IV inotrope (dobutamine)
+/- IV vasopressors (norepi)
101
What is the most common cause of cardiogenic shock?
Acute MI
102
HR increases in all types of shock except which 1?
Neurogenic; HR decreases
103
Mixed venous oxygen (SvO2) decreases in all types of shock except which 1?
Septic; increases
104
In which type of shock does cardiac output increase early on, but decrease later?
Septic
105
Which 2 types of shock have increased pulmonary capillary wedge pressure (PCWP)?
Cardiogenic and obstructive
106
What will be seen on an echo in a pt with cardiogenic shock?
Decreased ventricular systolic function as well as decreased stroke volume
107
What is the treatment for cardiogenic shock?
ABCs
Avoid aggressive IV fluids
Inotropes (dobutamine, milrinone)
Vasopressors (dopamine, norepi)
Diuretics (furosemide)
108
What size does the aorta have to be dilated to to be considered an aneurysm?
> 3cm
109
A true aneurysm involves what layers of the aorta?
All 3
Pseudo only involves tunica intima and tunica media
110
What is the most common type of aortic aneurysm?
Abdominal (AAA) (infrarenal)
111
What imaging is performed in a pt with suspected AAA?
Stable: CTA w/con
Unstable: US
112
If a CXR or KUB is done on a pt with AAA, what might be seen?
Widened mediastinum
Enlarged aortic knob
Calcifications
113
What AAAs get repaired?
Emergency repair for ruptures
> 5.5cm (men)
> 5cm (women)
Rapidly expanding (> 0.5cm in 6 mos)
114
What is the screening recommendation for AAA?
1 time screening US for men 65-73 with a history of smoking
115
Where do Type A and Type B aortic dissections occur?
Type A: ascending aorta
Type B: descending aorta
116
How are aortic dissections managed?
Type A: emergency surgery
Type B: medical managment
117
What is the most common cause of aortic dissection?
Long-standing HTN
118
What are the imaging studies used 1st line for aortic dissection?
Hemo stable: CTA or MRA (if CT contraindicated)
Hemo unstable: TEE
119
What are the first line meds used when treating aortic dissection?
IV BBs
120
What are the 6 P's of symptoms seen in arterial embolism/thrombosis?
Pain
Pallor
Pulselessness
Paresthesia
Poikilothermia
Paralysis
121
What is the gold standard imaging for diagnosing arterial embolism/thrombosis?
Catheter based anigo
122
Arterial embolism/thrombosis is a surgical emergency. What anticoagulation should be started while awaiting surgery?
Heparin
123
What condition is associated with polymyalgia rheumatica?
Temporal (giant cell) arteritis
124
What are the signs/symptoms of temporal arteritis?
HA, vision changes, jaw claudication, temporal scalp tenderness, temporal artery enlargement
125
What labs are elevated in pts with temporal arteritis?
ESR and CRP
126
What is the gold standard for diagnosing temporal arteritis?
Temporal artery biopsy
127
What is the treatment for temporal arteritis?
Prednisone
If vision loss: IV methylprednisolone
128
What artery is most commonly affected in PAD?
Superficial femoral artery
129
What is the most common risk factor for PAD?
Tobacco use
130
Symptoms of PAD will commonly include what?
Symptoms improve with rest and are reproduced with ambulation
131
Severe PAD will present with what symptoms?
Pain at rest
Standing or hanging their foot over the side of the bed improves pain
132
What is commonly seen on PE in PAD?
Weak or absent pulses
Thin/shiny skin
Hair loss
Lateral malleolar ulcers
133
If an ABI is done in the workup of PAD, what level indicates the diagnosis?
< 0.9
134
What is the gold standard imaging for diagnosing PAD?
Contrast arteriography
135
What are the signs/symptoms of chronic venous insufficiency?
Legs that feel heavy, aching, itching
Prolonged standing aggravates symptoms
Walking and elevation of legs relieves symptoms
136
What is commonly seen on PE of chronic venous insufficiency?
Dependent pitting edema
Hyperpigmentation and stasis dermatitis
Shallow ulcer over medial malleolus
137
What is the 1st line imaging for chronic venous insufficiency?
Venous duplex US
138
What is the Virchow triad?
Factors contributing to developing DVT
Circulatory stasis
Endothelial injury
Hypercoagulable state
139
What is the Homan sign?
Pain when squeezing the calf in a DVT
140
What is used to test the probability of a DVT?
Wells score
141
How many days would a pt need to be bedridden to be at increased risk for DVT?
> 3 days
142
How does a D-dimer test rule out a DVT?
Only if the D-dimer is negative does it r/o a DVT
143
What is the 1st line imaging for a DVT?
Doppler US
144
What is the gold standard for diagnosing a DVT?
Contrast venography
145
What anticoagulation is used for short-term and long-term use in pts with DVT?
Short: UFH and LMWH
Long: warfarin or NOACs (rivaroxaban or apixaban)
146
A massive iliofemoral DVT AKA phlegmasia cerulea dolens requires what treatment?
Thrombectomy or thrombolysis
147
What mnemonic is used to remember systolic and diastolic valve disorders?
PASS: pulmonic and aortic stenosis = systolic
PAID: pulmonic and aortic insufficiency = diastolic
148
What type of murmur is heard in aortic stenosis?
Harsh crescendo-decrescendo systolic ejection murmur heard best in the 2nd R ICS
149
What is the treatment for aortic stenosis and what meds should be avoided?
Aortic valve replacement
Avoid: diuretics, BBs, vasodilators
150
What type of murmur is heard in aortic regurg?
Diastolic decrescendo that is high-pitched and blowing heard best at LSB when the pt is sitting up and leaning forward
151
What might be used to describe a patient's pulse pressure in aortic regurg?
Widened arterial pulse pressure
AKA Corrigan pulse or Quincke pulse
152
What is the most common cause of mitral stenosis?
Rheumatic fever (strep pharyngitis)
153
What is the murmur heard with mitral stenosis?
"The operating system is Microsoft"
Opening snap
Low-pitched rumbling heard best lying on L side
154
What is the murmur heard in mitral regurg?
Holosystolic that is loud and blowing best heard at the apex and radiates to the axilla
155
Mitral valve prolapse is commonly seen in what disorders?
Ehler-Danlos and Marfan
156
What is the murmur heard with mitral valve prolapse?
"In order to be MVP, team must click"
Systolic click best heard at the apex
157
What is the murmur heard in pulmonary stenosis?
Crescendo-decrescendo systolic murmur at 2nd L ICS
158
What is the most common cause of tricuspid regurg?
L sided HF
159
What is the murmur heard in tricuspid regurg?
Blowing holosystolic that increases with inspiration best heard at the LLSB
160
All valvular disorders are diagnosed with what gold standard imaging?
Echo
161
What valves are commonly affected in infective endocarditis?
Mitral valve (MC)
Tricuspid (IVDU)
162
What are the most common causes of infective endocardititis?
Native valves: strep viridans
Prosthetic valves: staph epi
IVDU: staph aureus
163
What are signs/symptoms of infective endocarditis?
Fever, CP, dyspnea, cough
PE: new heart murmur, splinter hemorrhages, Janeway lesions, osler nodes, roth spots (eyes)
164
What is the gold standard imaging for diagnosis infective endocarditis?
TEE
165
What is the modified Duke criteria?
Used in diagnosing infective endocarditis
Must have 2 major, 1 major & 3 minor, or 5 minor criteria
166
What is the treatment for infective endocarditis?
Native valve: nafcillin, oxacillin OR cephalosporin (ceftriaxone, cefepime) AND vanc
Prosthetic valve: vanc + gent + rifampin
Both for 4-6 weeks
167
What medication is commonly used as prophylaxis for endocarditis prior to procedures?
PO Amoxicillin 2g 30-60 mins prior to procedure
168
What is seen on EKG in pts with acute pericarditis?
Diffuse ST elevations
169
What are common causes of acute pericadititis?
Infection (viral, TB, bacterial)
Post MI (Dressler)
Uremia (CKD)
170
What are signs/symptoms of acute pericarditis?
CP that improves with sitting up and leaning forward
Pericardial friction rub on exam
171
What is the treatment of acute pericarditis in most adult patients?
Aspirin or ibuprofen or indomethacin AND colchicine
172
In what situation of acute pericarditis would you NOT recommend ibuprofen or indomethacin as part of the treatment?
Post MI
173
If a pt has acute pericarditis and has a contraindication to NSAIDs, what is the treatment regiment?
Prednisone AND colchicine
174
What is Beck's triad?
Physical exam findings in cardiac tamponade
Hypotension, JVD, muffled heart sounds
175
What is seen on EKG in cardiac tamponade?
Electrical alternans (QRS looks different with each beat)
176
What is the treatment for cardiac tamponade?
Normal saline IV fluids
Pericardiocentesis
Pericardial window
177
What measurement of induration on a TB skin test is positive?
No risk factors: > 15mm
High risk (health care, IVDU): > 10mm
Immunocomp. (HIV): > 5mm
178
What is the gold standard diagnostic imaging for pulmonary nodules?
CT w/o contrast
179
What is the most common malignant and benign pulmonary nodule?
Malignant: adenocarcinoma
Benign: granuloma
180
When should pulmonary nodules be followed up?
< 6mm: no f/u if low risk; optional CT at 12 mos if high risk
6-8mm: CT at 6-12 mos
> 8mm: CT at 3, 9, 24 mos if low risk; PET, biopsy if high risk
181
What is the USPSTF lung cancer screening recommendation?
Adults 50 - 80 yo with a 20 pack year smoking history and currently smoke, or who have quit within the past 15 years should get a yearly low dose CT unless they have not smoked for 15 years
182
What is seen on PFTs of a patient with chronic bronchitis?
Decreased FEV1 and FEV1/FVC (< 0.7 or 70%)
Normal or increased TLC and RV
Normal DLCO
183
Emphysema is characterized by what lung abnormality?
Loss of recoil and alveolar surface area
184
What can cause COPD in patients who have never smoked?
Alpha-1 antitrypsin deficiency
185
What is seen on PFTs in emphysema?
Decreased FEV1 and FEV1/FVC (< 0.7 or 70%)
Normal or increased TLC and RV
Decreased DLCO
186
Patients with idiopathic pulmonary fibrosis show what on PFTs?
Normal to increased FEV1
Normal to decreased FEV1/FVC
Decreased DLCO
187
What intervention improves survival in pts with COPD?
O2
188
If a pt with COPD has pneumonia, what is the most likely causative agent?
H. flu
189
Most COPD pts are treated with a regimen of what?
LABA + LAMA
190
What is the management of an acute COPD exacerbation?
Albuterol
Ipratropium (anticholinergic)
Prednisone
Resp support
Abx
191
What is the most common cause of a transudative pleural effusion?
CHF
192
What is shown in the light criteria for transudative pleural effusions?
Protein: < 0.5
LDH: < 0.6
193
What is shown in the light criteria for exudative pleural effusions?
Protein: > 0.5
LDH: > 0.6
194
What commonly causes an exudative pleural effusion?
Malignancy
195
What is the treatment for a pleural effusion?
Thoracentesis
196
What signs/symptoms would be concerning for a PE?
HAD CLOTS
Hormones (estrogen)
Age (> 50)
DVT/PE Hx
Coughing blood
Leg swelling
O2 < 95%
Tachy
Surgery w/i last 4 weeks
197
If a patient is suspected of having a PE and cannot get a CTA (pregnancy, CKD/AKI) what test should be ordered?
V/Q scan
198
What is commonly seen on EKG in a PE?
Sinus tach
S1Q3T3 pattern
199
What is the gold standard definitive diagnostic test for pulmonary HTN?
R heart cath
200
What is the management for pulmonary HTN?
CCBs
PDE-5 inhibitors
O2
Anticoagulate
201
What is the most common cause of cor pulmonale?
Acute: PE
Chronic: COPD
202
What is seen on physical exam in idiopathic pulmonary fibrosis that is not seen in conditions like asthma and COPD?
Digital clubbing
203
What is the gold standard diagnostic imaging for idiopathic pulmonary fibrosis?
High-resolution CT
204
What is seen on CT of a pt with IPF?
Honeycombing
205
What is the treatment of IPF?
O2
Antifibrotics (nintedanib, pirfenidone)
Lung transplant (definitive)
206
What are the pathologies of penumoconiosis?
Coal worker lung: coal mining
Berylliosis: aerospace, fluorescent bulbs
Silicosis: mining
Siderosis: arc welding
Stannosis: tin welding
Asbestosis: ships, demolition
207
What is seen on CXR in silicosis?
Hilar lymphadenopathy
Egg shell calcifications
208
What is seen on imaging in asbestosis?
Lower lobe predominant reticular opacities
Pleural plaques
209
What complication can arise from pneumoconiosis?
Malignant mesothelioma
210
What extrapulmonary symptoms are seen in sarcoidosis?
Lupus pernio
Erythema nodosum
Anterior uveitis
211
What lab level is only seen in sarcoidosis?
Elevated serum ACE levels
212
What is seen on CXR in sarcoidosis?
Bilateral hilar adenopathy
213
What is seen on histology in sarcoidosis?
Noncaseating granulomas
214
What is the atopic triad?
Asthma
Atopic dermatitis
Allergic rhinitis
215
What is Samter's triad?
Aspirin/NSAID sensitivity
Nasal polyps
Asthma
216
Does the obstruction caused by asthma get better or stay the same when given bronchodilators?
Gets better
217
What would be considered moderate-persistant asthma?
Day time symptoms daily
Night time symptoms > 1x/week but not nightly
FEV1 > 60% but < 80%
Some activity limitations
218
What is the step-wise approach to asthma treatment?
1: PRN SABA
2: PRN SABA + low-dose ICS
3: daily and PRN combo low-dose ICS (formoterol)
4: increase to medium dose combo ICS
5: medium-high dose ICS (LABA) + LAMA and PRN SABA
6: high dose ICS + oral steroids + PRN SABA
219
What is the most common cause of ARDS?
Sepsis
220
What is seen on CXR in ARDS?
Complete white out
221
What is the gold standard diagnostic test for GERD?
Ambulatory pH monitoring
222
What occurs in pts with Barrett esophagus?
Normal squamous epithelium changes to metaplastic columnar epithelium
223
What is primarily an idiopathic motility disorder that is characterized by decreased peristalsis and progressive dysphagia?
Achalasia
224
What is the 1st imaging study and gold standard diagnostic study for achalasia?
1st: barium esophagram (bird beak appearance)
GS: esophageal manometry
225
What is the most common treatment for achalasia?
Pneumatic balloon dilation of LES
226
What is the treatment of acute bleeding in esophageal varices?
Octreotide
Emergent EGD for banding
227
What medication is used as prevention of esophageal varices?
Non-selective BBs
228
What is the definitive treatment for esophageal varices?
TIPS
229
What is the most common type of esophageal cancer?
Adenocarcinoma (in the US)
SCC (worldwide)
230
What are the biggest risk factors for esophageal cancer?
GERD and Barrett's
Smoking
ETOH use
231
What are common causes of acute gastritis?
H. pylori (MC)
NSAIDs/aspirin
232
What is the gold standard for diagnosing gastritis?
Endoscopy w/biopsy
233
How can H. pylori be detected?
Serology
Stool antigen test
Urea breath test
234
What is the quadruple treatment for H. pylori?
PPI
Bismuth
Metronidazole
Tetracycline (doxy)
x 14 days
235
How does food help differentiate where ulcers may be in the GI system?
Decreased pain w/food = duodenal ulcer
Increased pain w/food = gastric ulcer
236
What is increased in Zollinger-Ellison syndrome?
Gastrin
237
What needs to be done following 14 days of quad therapy for H. pylori?
Urea breath test to confirm eradication
238
What physical exam findings are indicative of metastatic gastric cancer?
Virchow node (supraclavicular)
Sister Mary Joseph nodule (at umbilicus)
239
What is the gold standard diagnostic imaging for a SBO?
Abdominal CT w/oral and IV contrast
240
What medication can be used for pts with gallstones that are symptomatic but do not wish to pursue surgery?
Ursodeoxycholic acid
241
What is a boas sign?
Referred shoulder pain from gallbladder infection
242
What is the gold standard diagnostic test for cholecystitis?
HIDA
AKA cholescintigraphy or hepatobiliary scintigraphy
243
What is the gold standard diagnostic and therapeutic imaging study for choledocholithiasis?
ERCP
244
What is cholangitis?
A biliary tract infection that occurs 2/2 gallstone obstruction in the common bile duct
245
What symptoms make up Charcot's triad?
RUQ pain
Fever
Jaundice
246
What symptoms make up Reynolds pentad?
RUQ pain
Fever
Jaundice
Confusion
Hypotension
247
What is the only Hepatitis that is a DNA instead of an RNA type?
Hep B
248
Which hepatitis' transmit via oral-fecal route?
Hep A and E
249
Which hepatitis' are co-dependent?
Hep D and B (can't have D w/o B)
250
In acute hepatitis, which liver enzyme is usually more elevated?
ALT > AST
251
Acute and chronic Hep B have what positive serologic markers?
HBsAg
252
What Hep B serologic markers would indicate that a patient has recovered from Hep B or was immunized?
Positive anti-HBs
253
What do IgG and IgM represent on serologic markers related to hepatitis?
IgG = gone/recovered
IgM = right meow
254
Which hepatitis is the only one that is treated with direct acting antiviral medications and not supportive care?
Hep C
255
Which hepatitis' do not become chronic?
Hep A and E
256
What are common causes of cirrhosis?
Chronic Hep C (MC)
ETOH
257
What lab studies are seen in cirrhosis?
Macrocytic anemia (decreased B12 or folate)
Thrombocytopenia
Increased LFTs
Decreased albumin
Increased ammonia
258
What is the treatment for hepatic encephalopathy?
Lactulose or rifaximin
259
What is the most common cause of deaths due to cancer worldwide?
Hepatocellular carcinoma
260
An increase in what lab is suspicious/diagnostic for hepatocellular carcinoma?
AFP > 20 = suspicious
AFP > 400 = diagnostic
261
What is the protocol for screening for hepatocellular carcinoma?
US every 6 mos +/- AFP in high risk patients
262
What is used to determine prognosis of acute pancreatitis?
Ranson criteria
263
What labs are elevated in acute pancreatitis?
Serum lipase (more specific)
Amylase
264
What is the test of choice for acute pancreatitis?
CT of the abdomen w/contrast
265
What is the most common cause of chronic pancreatitis?
Alcohol
266
What is the triad of symptoms seen in chronic pancreatitis?
Calcifications
Steatorrhea
DM
267
What is a difference between acute and chronic pancreatitis related to labs?
Lipase and amylase may be normal in chronic
268
What is the most sensitive imaging study in chronic pancreatitis?
ERCP
269
What is the most common type of pancreatic cancer?
Adenocarcinoma
270
What is a physical exam finding seen in pancreatic cancer?
Courvoisier sign (palpable nontender gallbladder)
Trousseau syndrome (migratory thrombophlebitis)
271
What tumor marker is used for monitoring after treatment of pancreatic cancer?
CA 19-9
272
Where is diverticulosis most commonly found?
In the sigmoid colon
273
What procedure is contraindicated in patients with diverticulitis?
Colonoscopy due to risk of perf
274
What is the gold standard diagnostic imaging for diverticulitis?
CT of the abdomen/pelvis w/oral and IV contrast
275
What is the outpt and inpt treatment for diverticulitis?
Outpt: ciprofloxain + metronidazole OR amoxicillin-clavulanate w/follow up in 48 hrs
Inpt: IV abx 3-5 days with switch to PO to complete 10-14 day course
276
When should pts with diverticulitis have a colonoscopy?
6-8 weeks after resolution of clinical symptoms
277
What conditions are associated with HLA-B27?
PAIR
Psoriatic arthritis
Ankylosing spondylitis
IBD
Reactive arthritis
278
What condition presents as recurrent, dull abdominal pain that occurs 10-30 mins after eating?
Chronic mesenteric ischemia
279
What is the gold standard imaging for mesenteric ischemia?
CTA
280
What artery is most commonly involved in acute mesenteric ischemia?
SMA
281
What is a common presentation of acute mesenteric ischemia?
Sudden onset of diffuse severe pain that is out of proportion to exam
282
What is the most common cause of a large bowel obstruction?
Colon cancer
Volvulus (MC non-cancer)
283
What are the most common causes of toxic megacolon?
IBD or C. diff
284
What colonic dilation is indicative of toxic megacolon?
> 6 cm
285
At what age do you start colon cancer screening for average risk patients?
45
286
What is the tumor marker associated with colon cancer?
CEA
287
What is the most common inheritable thrombophilia and what is the genetic inheritability pattern?
Factor V leiden
Autosomal dominant
288
Pts with factor V leiden commonly develop what?
DVT
PE
Miscarriages
289
What is seen on labs in pts with ITP?
Isolated thrombocytopenia (platelet count < 100,000)
Megakaryocytes on peripheral smear
Normal coagulation studies
290
What platelet count is considered critical thrombocytopenia?
< 20,000
291
What is the treatment for ITP that has minor bleeding or severe thrombocytopenia (< 30,000) w/o bleeding?
Glucocorticoids
IVIG
292
What is the classic pentad for TTP?
FAT RN
Fever
Anemia
Thrombocytopenia
Renal injury
Neuro findings
293
What is seen on labs in TTP?
Severe thrombocytopenia
Microangiopathic hemolytic anemia
Schistocytes on peripheral blood smear
Normal coagulation studies
294
What is the treatment for TTP?
Plasma exchange therapy
295
What is the most common inherited bleeding disorder?
Von Willebrand Disease
296
What is a common clinical manifestation of vWD?
Mucocutaneous bleeding (nose, gums)
297
What is seen on coagulation studies in pts with vWD?
Normal PT
Prolonged PTT
298
What is the management of vWD?
Major surgery/bleeding: vWF concentrate
Minor procedure/bleeding: desmopressin
299
Both hemophilia A and B have what coagulation studies?
Normal platelet function
Normal PT
Prolonged PTT
Normal bleeding time
300
What factor is deficient in hemophilia A and B?
A: factor VIII
B: factor IX
301
What symptoms are associated with severe IDA?
Pallor
Koilonychia (dents in nails)
Atrophic glossitis
Angular cheilosis
302
What lab findings are seen in IDA?
Low MCV
Low iron
Low ferritin
High TIBC
High transferrin
303
What labs are seen in anemia of chronic disease?
Low MCV
Low iron
Low TIBC
Normal/high ferritin
Normal transferrin
304
What labs are seen in thalassemia?
Low MCV
Low TIBC
Low transferrin
Normal iron
Normal ferritin
305
What is seen on peripheral blood smear in IDA?
Hypochromic microcytic blood cells
306
What are common causes of folate deficiency?
Meds (methotrexate, trimethoprim)
Chronic ETOH
Pregnancy
307
What labs are seen in folate deficiency?
MCV > 100
Increased homocysteine
Normal MMA
308
Vitamin B12 can be differentiated from folate deficiency/IDA by what?
Neurologic symptoms
309
What labs are seen in B12 deficiency?
MCV > 100
Increased MMA and homocysteine
310
What is the inheritance pattern of G6PD deficiency?
X-linked recessive
311
What is seen on peripheral smear in pts with G6PD deficiency?
Bite cells and Heinz bodies
312
What labs are elevated in polycythemia vera?
Hct and Hgb
313
What is the primary treatment for polycythemia vera?
Phlebotomy
314
What is seen on peripheral blood smear in pts with sickle cell?
Sickled red blood cells
Howell-Jolly bodies
315
What medication is used in sickle cell pts to reduce vaso-occlusive episodes?
Hydroxyurea
316
What condition shows target cells on peripheral smear?
Beta thalassemia
317
What is the most common cancer in children?
ALL
318
What is seen on bone biopsy in a pt with ALL?
Hypercellular w/ > 20% blasts
319
What presents with painless lymphadenopathy, hepatosplenomegaly, and has smudge cells on peripheral blood smear?
CLL
320
What presents with auer rods on bone marrow biopsy?
AML
321
What condition is associated with the Philadelphia chromosome (BCR-ABL1 gene)?
CML
322
What condition shows Reed-Sternberg cells (owl's eyes) on tissue biopsy?
Hodgkin lymphoma
323
Which type of lymphoma has a worse prognosis (hodgkin or non-hodgkin)?
Non-hodgkin
324
What condition has rouleaux formations on blood smear and Bence Jones proteinuria on UA?
Multiple myeloma
325
What is seen on radiographs in pts with multiple myeloma?
Lytic lesions
326
What is seen on physical exam in Grave's disease?
Diffusely enlarged nontender thyroid
Exophthalmos
Pretibial myxedema
Increased DTRs
327
What lab studies are seen in Grave's?
Decreased TSH
Increased T4 and T3
328
Does Grave's have high or low uptake on thyroid radioisotope scanning?
High
329
What meds are used to treat hyperthyroidism?
PTU
Methimazole
330
What med is used to treat hyperthyroidism in pregnancy?
PTU in 1st trimester then switch to methimazole in 2nd
331
What is the treatment for thyroid storm?
BB
PTU or methimazole
Iodine
Steroids
332
What are 2 commonly used medications that can cause hypothyroidism?
Amio
Lithium
333
What labs are seen in primary hypothyroidism?
Increased TSH
low or normal free T4
334
What labs are seen in secondary hypothyroidism?
Decreased TSH
Decreased or normal free T4
335
How long does it take levothyroxine to increase T4 levels?
4-6 weeks
336
Subacute thyroiditis is usually preceded by what?
Viral URI
337
What does hot and cold nodule on a radionuclide thyroid scan indicate?
Hot = benign
cold = malignant
338
What is the most common type of thyroid cancer?
Papillary carcinoma
339
What type of thyroid cancer produces calcitonin?
Medullary carcinoma
340
What is commonly injured during a total thyroidectomy?
Recurrent laryngeal nerve
341
How is primary hyperparathyroidism classified?
Excess PTH leads to hypercalcemia
Caused by parathyroid adenoma (MC)
342
What labs are seen in primary hyperparathyroidism?
Increased PTH
Increased Ca+
Increased Vit D
Decreased PO4
343
How is secondary hyperparathyroidism classified?
Caused by CKD which leads to decreased production of calcitriol leading to increased PTH secretion
344
What labs are seen in secondary hyperparathyroidism?
Increased PTH
Normal Ca+
Decreased Vit D
Normal PO4
345
What symptoms are associated with hyperparathyroidism?
Bones
Stones
Groans
Psychiatric overtones
346
What is the treatment for primary hyperparathyroidism?
Increase fluids
Decrease calcium
Vit D
Parathyroidectomy
347
What is the treatment for severe hypercalcemia?
IV fluids
Bisphosphonates, calcitonin
Furosemide
348
What is the treatment for secondary hyperparathyroidism?
Due to Vit D def: Vit D
Due to CKD: calcitriol
349
What physical exam signs are seen in hypoparathyroidism?
Chvostek sign (cheek tap)
Trousseau (hand spasm with BP cuff)
Increased DTRs
350
Chvostek and trousseau sign are associated with what in hypoparathyroidism?
Hypocalcemia
351
What labs are seen in hypothyroidism?
Decreased PTH
Decreased Ca+
Increased PO4
352
What is the treatment for symptomatic hypocalcemia?
IV calcium gluconate
353
What has hyperpigmentation and orthostatic hypotension on physical exam?
Primary adrenal insufficiency (Addisons)
354
What labs are seen in primary adrenal insufficiency (Addisons)?
Decreased serum cortisol
Increased ACTH
Hyponatremia
Hyperkalemia
Decreased aldosterone
355
What lab difference is seen in secondary adrenal insufficiency compared to primary?
ACTH is decreased on secondary
356
Is hyper or hypokalemia seen in Cushing syndrome?
Hypokalemia
357
How do you determine where the issue is when doing the workup for Cushings?
Both have increased cortisol
ACTH is low/has no response to desmopressin test = adrenal issue
ACTH is high/has response to desmopressin test = pituitary tumor
358
What labs are seen in SIADH?
Decreased serum Na+
Decreased serum osmo (< 280)
Increased urine osmo (> 100)
359
What is the treatment for SIADH?
Water restrict
Correct Na+
360
Nephrogenic DI is commonly caused by what medication?
Lithium
361
What labs are seen in DI?
Increased Na+
Increased serum osmo
Decreased urine osmo
362
What test is required to make a diagnosis of DI?
Water deprivation test
363
How is central vs nephrogenic DI determined?
Desmopressin (synthetic ADH) given
Minimal/no increase in urine osmo = nephrogenic
Increase in urine osmo = central
364
What is the treatment for central DI?
Desmopressin
365
What vision change is commonly reported with a pituitary adenoma?
Bitemporal hemianopsia
366
What is the imaging modality of choice for suspected pituitary adenoma?
MRI w/contrast
367
What is the treatment of a functional pituitary adenoma?
Transsphenoidal resection
368
What symptoms are commonly seen in post-strep glomerulonephritis?
Usually in kids
Recent strep or impetigo (1-6 wks prior)
Edema (face, hands, feet)
Coca cola colored urine
369
What is seen on UA in pts with post-strep glomerulonephritis?
Hematuria
RBC casts
Proteinuria < 3.5
370
What is the most common glomerulonephritis worldwide?
IgA nephropathy (Berger disease)
371
How can you tell the difference between IgA nephropathy and post-strep glomerulonephritis?
IgA nephropathy presents with hematuria 1-2 DAYS after a URI, not weeks
372
What test will be positive in pts with post-strep glomerulonephritis?
Antistreptolysin O titer
373
What is the most common secondary cause of nephrotic syndrome in adults?
DM
374
What is the most common nephrotic syndrome seen in children?
Minimal change
375
How do you tell the difference between a nephrotic and a nephritic syndrome?
By the proteinuria
NephrOtic: > 3.5
Nephritis: < 3.5
376
What type of casts are seen on a UA in nephrotic syndrome?
Fatty casts
Maltese cross pattern under polarized light
377
How does the BUN/Cr ratio help you identify where an AKI is?
BUN:Cr < 20 = intra/post renal
BUN:Cr > 20 = pre-renal
378
How does FENa tell you where an AKI is?
< 1 = pre-renal
> 1 = post renal
379
What is the most common intrinsic renal disease?
ATN
380
What are causes of pre-renal, renal, and post renal AKIs?
Pre: hypoperfusion (cardiogenic shock, hemorrhage, sepsis)
Renal: direct damage (toxins, drugs, infx)
Post: obstruction (stone, tumor, trauma)
381
What is a good amount of urine output?
25 cc/hr
382
What symptoms are seen pre, renal, and post renal AKI?
Pre: hypotension, decreased skin turgor
Renal: fever, rash, joint pain
Post: dysuria, diminished stream, hypertension
383
ATN has what kind of casts on UA?
Muddy brown casts
384
What kind of casts are seen on UA in AIN?
WBC casts and eosinophils
385
What are the indications for dialysis?
AEIOU
Acidosis
Electrolytes (K+ > 6.5)
Ingestions
Overload
Uremia
386
What are the most common causes of end-stage kidney failure?
DM
HTN
387
How is CKD classified?
GFR stages
Stage 1: > 90 = normal
Stage 3a: 45-59 = mild to mod decrease
Stage 3b: 30-44 = mod to severe
Stage 5: < 15 = kidney failure
388
What is seen on US of a pt with CKD?
Small, echogenic kidneys bilaterally
389
What medication is used as part of the treatment regimen for PKD?
Vasopressin V2-receptor antagonist (Tolvaptan)
390
What screening needs to be done for pts with PKD?
Screening MRA of the brain for cerebral aneurysms
391
What is the equation to calculate anion gap?
Na - [Cl + HCO3]
> 12 = elevated
392
What can present as both a respiratory alkalosis and a metabolic acidosis?
Salicylate toxicity
393
What EKG change can indicate a severe hypokalemia?
U waves
394
How much K is needed to change a hypokalemia?
10meq = change of 0.1
If K is 3.0 - 3.5, give 50meq
395
What drugs are common causes of hyperkalemia?
Digoxin
K sparing diuretics
ACEi, ARBs
396
What should be given 1st when treating hyperkalemia?
Calcium gluconate
397
What are causes of hypotonic hyponatremia?
Hypovolemic: GI loss, diuretics
Euvolemic: SIADH
Hypervolemic: CHF, cirrhosis, AKI, CKD
398
What is the classic triad for renal cell carcinoma?
Flank pain
Gross hematuria
Palpable abdominal renal mass
399
What is WAGR syndrome?
Symptoms associated with Wilms tumor
Wilms tumor
Aniridia (no iris)
GU abnormalities
Range of developmental delays
