Systemic Disorders

Question 1

target BP prior to administration of IV alteplase

Answer 1

<185/110

Question 2

Metabolic syndrome definition

Treatment

Answer 2

3 of the Ff: abdominal obesity (waist circumference in men≥102 cm or ≥88 cm in women),
elevated triglycerides (>175 mg/dL),
low high-density lipoprotein (<40 mg/dL in men or <50 mg/dL in women),
elevated BP ≥130/85 mm Hg, and
elevated fasting plasma glucose (≥100 mg/dL).

Aggressive lifestyle mod

Question 3

Acute physiologic effects of nicotine

Answer 3

Stimulation of the sympathetic nervous system
Elevated HR and BP

headache, insomnia, and depression
Coronary vasoconstriction

Question 4

Prior to TPA for stroke

Answer 4

Get glucose and CT non con of head

Question 5

primary aldosteronism

Diagnosis

Answer 5

Hypertension and hypo kale Mia, metabolic alkalosis

Plasma aldo and renin (ratio >30)
Confirm with oral sodium loading test, saline infusion test, fludrocortisone suppression, or captopril challenge

Adrenal CT->adrenal vein sampling-> adrenalectomy

Question 6

Hyper kale Mia ECG

Answer 6

peaked T waves->decreased P-wave amplitude-> PR interval prolongation-> and QRS interval widening. In severe hyperkalemia, these changes manifest as a “sine wave” morphology.

Question 7

Bio marker of recent tobacco smoke exposure

Answer 7

Cotinine

hair, saliva, urine, and serum

Half life of 16 hours

Question 8

Nicotine withdrawal in ACS (hospitalized patients)

Answer 8

nicotine patch or combination nicotine replacement therapy (NRT

Question 9

Coarctation

Answer 9

prominent to-and-fro machinery murmur

Question 10

Cigarette smoking vs smokeless tobacco

Answer 10

Increased risk of afib, platelet activation, inflammation

Question 11

Orthostatic syncope in chronic steroid use

Diagnosis

Answer 11

Due to steroids

Morning cortisol level, or cosyntropin stimulation

Question 12

Immune mediated anaphylaxis

hypertension after induction of anesthesia

Answer 12

Histamine and tryptase will be elevated

Pheo

Question 13

ACEI induced angioedema

Further testing if

Answer 13

Clinical diagnosis
Due to bradykinin

there were family history of angioedema, personal history of malignancy, or prior angioedema event)

Question 14

Treatment of allergic reaction

Answer 14

IM epinephrine
1:1000
Repeat every 5-15 minutes if needed

Question 15

Fish oil

Answer 15

Only indicated in very high triglycerides

Question 16

primary hyperparathyroidism

Hctz calcium

Answer 16

elevated calcium and low-normal phosphorus and low-normal magnesium

High

Question 17

Post TIA, incident with highest risk

Answer 17

Stroke

Question 18

High Risk of stroke after TIA

Answer 18

Age > 60 (1 point)

2) BP: systolic BP >140 or diastolic BP >90 (1 point)
3) Clinical symptoms: focal weakness (1 point), focal weakness + speech disturbance (2 points)
4) Duration: 10-59 minutes, 60 minutes or longer (2 points)
5) Diabetes mellitus: diabetes mellitus present (1 point)

Question 19

Statin for ASCVD risk

Answer 19

> 7.5%

Question 20

Cardiac masses including thrombi and tumors

Primary cardiac tumor differential
Benign
Malignant

Single tumor with central calcification, associated with colon polyps

Answer 20

Get cardiac MRI

myxomas, fibroelastomas, lipomas, fibromas, and rhabdomyomas
angiosarcomas and rhabdomyosarcomas

Fibroma

Question 21

Hypotension+ cushingoid features+ hyponatremia + hyperkalemia

Diagnosis

Answer 21

Adrenal crisis

Morning cortisol-> ACTH stim test