Rosh Review Things I Need to Know

Question 1

What is the ABCD2 score?

Answer 1

Score to predict future stroke risk
A: Age >60
B: systolic BP >140 or diastolic BP >90
C: Clinical features: unilateral weakness with or without speech impairment (2) or speech impairment without unilateral weakness (1)
D: Duration and diabetes (1): >60 mins (2), 10-59 mins (1), less than 10 mins (0)

Admit if presenting within 72 hours with score greater than or equal to 4
or if uncertainty that outpatient evaluation can be performed in 48-72 hours, or if <3 score and evidence of cerebral infarction

Question 2

What is used for rate control with atrial fibrillation?

Answer 2

Beta-adrenergic blockers and nondihydropyridine calcium channel blockers (verapamil/diltiazem)

Question 3

What is used for rhythm control in atrial fibrillation?

Answer 3

Cardioversion
Antidysrhythmic medications
Catheter ablation

Question 4

If a patient has had atrial fibrillation for more than 48 hours, what should be initiated prior to cardioversion?

Answer 4

Anticoagulants for 21 days

Question 5

CHADSVASC score

Answer 5

C: CHF
H: Hypertension
A: Age >75 +2
D: Diabetes
S: Stroke +2
Vasc: vascular disease
A: Age 65-74
Sc: Sex category (female)

If score of 2 +, start on anticoagulation such as rivaroxaban, dabigatran, or apixaban
If HAS-BLED score over 3, monitor more closely or consider risk of treatment

Question 6

Treatment for giant cell arteritis

Answer 6

High dose corticosteroid therapy before biopsy results are finalized
IV methylprednisolone if vision loss
low-dose aspirin do decrease CVA and vision loss

Question 7

How is polymyalgia rheumatica treated in the absence of temporal arteritis?

Answer 7

Low-dose corticosteroids

Question 8

What will be positive in patients with autoimmune hypothyroidism?

Answer 8

Thyroid peroxidase antibodies

Question 9

Diagnostic criteria for metabolic syndrome?

Answer 9

Waist circumference >/= 35 inches for women or 40 inches for men
triglyceride >/=150 mg/dL or on meds for hypertriglyceridemia
HDL <50 mg/dL for women or 40 for men
BP >130/85 or on antihypertensive medication
fasting blood sugar level >100 mg/dL or on medication to treat hyperglycemia

Question 10

Steps in asthma management

Answer 10

Step 1) PRN SABA
Step 2) Daily low-dose ICS and PRN SABA OR PRN concomitant ICS and SABA
Step 3) Daily and PRN combination low-dose ICS-formoterol
Step 4) Daily and PRN combination medium-dose ICS-formoterol
Step 5) Daily medium-high dose ICS-LABA PLUS LAMA and PRN SABA
Step 6) Daily high-dose ICS LABA PLUS oral systemic corticosteroids PLUS PRN SABA

Question 11

Asthma classification intermittent

Answer 11

Symptoms <2 days /week
<2/= nighttime awakenings/month
FEV1>80% predicted

Question 12

Asthma classification mild persistent

Answer 12

Symptoms >2 days/week but not daily
3-4 nighttime awakenings/month
FEV1>80% of predicted

Question 13

Asthma classification moderate persistent

Answer 13

Symptoms daily
>1 nighttime awakening/week but not nightly
FEV1 60-80% predicted

Question 14

Asthma classification severe persistent

Answer 14

Symptoms throughout the day
Nightly awakenings common
FEV1 <60% predicted

Question 15

2 MCC of hypercalcemia

Answer 15

Primary hyperparathyroidism
Malignancy

Question 16

Symptoms of hypercalcemia

Answer 16

Anxiety
Depression
Cognitive dysfunction
nephrolithiasis
muscle weakness
bone pain
anorexia and nausea (moderate elevation)

Question 17

Treatment of hypercalcemia if >14 mg/dL albumin corrected

Answer 17

Volume expansion with IV saline
Calcitonin
IV bisphosphonate

Question 18

Treatment if secondary hypercalcemia to malignancy

Answer 18

maintenance therapy with bisphosphonate derivative

Question 19

Treatment of hypercalcemia due to chronic granulomatous disease

Answer 19

May be due to overproduction of calcitriol
glucocorticoids to decrease calcitriol

Question 20

What medication can be used instead of a bisphosphonate in patients with severe renal disease

Answer 20

denosumab

Question 21

ECG changes in hypercalcemia

Answer 21

shortened QT interval

Question 22

Typical symptoms associated with Dressler syndrome

Answer 22

Pleuritic chest pain relieved when leaning forward
Pericardial friction rub
Tachycardia
Fever and leukocytosis

Question 23

ECG changes with Dressler syndrome

Answer 23

Diffuse concave ST segment elevation in all leads except aVR, PR depression in precordial leads, ST depression and PR segment elevation in aVR

Question 24

Labs in Dressler syndrome

Answer 24

elevated WBC
CRP
ESR

Question 25

Treatment of Dressler syndrome

Answer 25

Aspirin Colchicene Steroids if refractory

Question 26

How much fluid is allowed in stage D refractory heart failure

Answer 26

1.5-2 L per day

Question 27

Stages of heart failure

Answer 27

Stage A: high risk of heart failure but no structural heart disease or symptoms Stage B: structural heart disease but no symptoms of heart failure Stage C: structural heart disease and symptoms Stage D: refractory heart failure

Question 28

Primary symptoms of heart failure

Answer 28

dyspnea orthopnea fatigue

Question 29

presenting signs and symptoms of fluid retention in heart failure

Answer 29

tachycardia pleural effusions basilar crackles S3 gallop JVD ascites hepatomegaly pitting edema

Question 30

Heart failure pharmacotherpay

Answer 30

ACE inhibitors or ARBs bisoprolol, carvedilol, or metoprolol

Question 31

Treatment of hypertensive urgency in ambulatory setting

Answer 31

captopril labetolol clonidine prazosin

Question 32

acute end organ damage leading to hypertensive emergency diagnosis

Answer 32

hemorrhagic or ischemic stroke ACS aortic dissection diffuse microvascular injury hypertensive encephalopathy anemia thrombocytopenia acute kidney injury retinopathy

Question 33

how quickly to lower blood pressure in hypertensive emergency

Answer 33

no more than 20-25% over one hour then to 160/100 within 6 hours, and then to target blood pressure in 48 hours unless aortic dissection, pheochromocytoma, eclampsia or preeclampsia (reduce to less than 140 in first hour and to less than 120 if aortic dissection)

Question 34

antihypertensive agent for hypertensive emergency in ICU

Answer 34

nicardipine and labetolol beta-blockers, nitro, nitroprusside, and hydralazine if correct clinical setting

Question 35

what are the first-line antihypertensive agents in patients with acute aortic dissection

Answer 35

esmolol or labetolol

Question 36

Confirmation of sjogren syndrome diagnosis

Answer 36

biopsy of lower lip mucosa showing lymphocyte infiltrate and gland fibrosis

Question 37

Treatment of sjogren syndrome

Answer 37

Initial: artificial tears or saliva, increased oral fluid intake, and ocular and vaginal lubricants If dry eyes, dry mouth, and other nonocular symptoms that worsen or persist: oral cholinergic agonists (pilocarpine and cevimeline), cyclosporine eye drops can improve ocular symptoms

Question 38

Which medications most commonly cause hypoglycemia in diabetics

Answer 38

Sulfonylurea Meglitinide Insulin