Define pulmonary HTN?
Mean pulmonary artery pressure > 25 at rest or >30 with exercise
What is the best confirmatory test for AVN femoral head? i.e. if you suspect it but plain films negative
How do you tx lumbosacral strain after mechanical injury?
NSAIDs and early mobilization
What is the first line tx for central diabetes insipidus?
What is door to balloon time for STEMI? Door to needle time (fibrinolytics)? What is often given in NSTEMI?
90 min; 30 min; heparin
What stain do G6PD cells take up?
What is the empiric tx for a pt from a developing country returning to US with sx of malabsorption?
Metronidazole for Giardiasis; also keep tropical sprue in the differential
If a pt has had a mole for his whole life but it starts to change what do you do?
Excisional bx for possible melanoma
What dietary changes can help with Meniere's dz?
Low salt diet
How do you tx MALT lymphoma of the gut? What if this therapy fails?
Triple therapy for H. pylori (amoxicillin, clarithromycin, and omeprazole) if that fails then CHOP + Bleomycin
What is the main risk a pt is at when she has had a hysterectomy and is receiving tamoxifen for breast CA?
VTE; obviously not at risk for endometrial CA because had hysterectomy
What is the cause of senile purpura?
Perivascular connective tissue atrophy and there are no dangers and requires no further workup, Coags are normal
What disorder involves inability to fall alseep at normal bedtimes?
Delayed sleep phase disorder; i.e. their sleep is normal if you let them sleep in
What is the best initial step in asymptomatic hyponatremia? Symptomatic?
Fluid restriction; 3% saline (demeclocycline is rarely necessary)
When is pain with ankylosing spondylitis worse?
At night, this is classic for chronic inflammatory diseases
How may theophylline toxicity present? Dx?
CNS excitation such as HA, insomnia, and seizures with tachyarrhythmias; Check theophylline levels
What is the best tx for uncomplicated cystitis? Complicated?
Things like TMP-SMX, nitrofurantoin, fosfomycin; Quinolones like cipro
What is the cryoglobulin in mixed cryoglobulinemia?
IgM against the anti-HCV IgG! Will be assoc with hypocomplimentemia due to immune complex formation
What is "Lone Atrial Fibrillation"
Paroxysmal, persistent, or permanent AF in pts without evidence of cardiopulmonary or structural heart disease
What will damage to the lateral spinothalamic tracts present like?
CONTRALATERAL pain and sensory loss TWO LEVELS down from the lesion
What should be done in pts on Warfarin who are dizzy and have back pain?
CT scan of spine to look for retroperitoneal hematoma which can occur even without supratherapeutic INR
What is the best way to treat a microcytic anemia in RA?
Assuming it is anemia of chronic disease, i.e. not Fe def, then you should aim tx at RA so MTX, etc.
How does a dipyridamol stress test work?
Basically causes coronary steal to identify stenosed vessels
Where do the eyes deviate in a thalamic hemorrhage?
Toward the side of the lesion
What vitamin deficiency can be seen after a partial gastrectomy?
What is tachycardia-mediated cardiomyopathy
Can develop in persistent or recurrent tachyarrhythmia and prolonged periods of ventricular rate; control of the rate can improve the EF
What is the most likely cause of an elevated ALP in an elderly pt on statins?
Paget's disease; Statins increase aminotransferases not ALP
How do you manage toxic megacolon?
Prompt IV steroids, NGT decompression, antibiotics and fluids
What is the best way to diagnose Parkinson's disease?
A really solid H and P
What if a pt says something is in their eye and you do a pen light exam and see nothing?
Flourscein exam? You should be overly suspicious for foreign body in eye!
How do you tx echinococcal cysts?
First albendazole then surgery; DO NOT aspirate as this will cause anaphylaxis
What is seen in ACA strokes?
Affects the lower body more than upper and will have urinary incontinence
What should you suspect in a pt with endocarditis and focal neurologic deficit?
Septic Cerebral Embolus; Tx is IV abx and if the pt is already on abx then that would be an indication for valve replacement since embolizing after starting abx is an indication
What can you give to a pt with C. diff refractory to metronidazole (i.e. tried it twice) who cannot tolerate vanc?
What is the most appropriate empiric abx for infective endocarditis?
How do you tx Guillian Barre?
Plasmapheresis and IVIG
What screening tests should a pt with newly diagnosed cirrhosis get?
Screening endoscopy for varices and then screening US for HCC; US q6 months
What should you think if you have increased creatinine and hyperkalemia in a pt on TMP-SMX?
Worry about the K if significant because it can compete with K for excretion? The creatinine is no big deal, it selectively inhibits creatinine without affecting GFR so there is usually no actual AKI
What is the best tx for post-nasal drip?
How do you treat asymptomatic PVC's? Symptomatic? What is a run of 3 or more PVC's called?
No tx; BB; Ventricular tachycardia
What antibiotic may decrease the excretion rate of theophylline?
What is a good DM II drug to add to metformin if there is suboptimal glycemic control?
GLP-1 agonists such as liraglutide and exanetide
Who should be screened for C. trachomatis?
All sexually active femals under 24
What is Type I HIT?
A nonimmune response that occurs in the first 48 hours of heparin and is a transient effect in which the platelet count does not drop below 100,000
What is Type II HIT?
An immune-mediated response due to PF-4 abs that typically occurs 5-10 days after starting heparin and leads to drops > 50% in platelet count with venous and arterial thromboses
What is the best way to initially tx metabolic alkalosis?
IV NS but note that there are saline-responsive alkaloses and saline-unresponsive alkaloses; unresponsive ones have high urinary Cl
What is the most SENSITIVE test for nephropathy in DM
Random urine for albumin:creatinine ratio (done 1x per year along with ophtho exam and neuropathy screen)
What is the best tx for fibromuscular dysplasia
Stent placement via angiography in the renal; note renal artery stenosis due to atherosclerosis does not respond as well to stenting
What is the regimen for Hodgkin Lymphoma?
ABVD = Doxorubicin, Bleomycin, Vincristine, and Dacarbazine? If lymphocyte predominant then add rituximab, for other 3 just ABVD
A pinkish red hue to the skin is common in pts with what toxicity
Carbone monoxide (100% O2 via nonrebreather and check carboxyhemoglobin if greater than 20 then do HBO)
In whom is HIV screening recommended?
Pts 15-65 regardless of risk factors; p24 antigen and antibody testing (ELISA)
When should women be screened for osteoporosis?
When at age 65 or up or if have suggestive hx
What is porphyria cutanea tarda assoc with? What is deficient? How do you tx?
HCV; Uroporphyrinogen decarboxylase; Plasma exchange, hydroxychloroquine or IFN alpha
What ppx abx should a post transplant pt be on?
What is a concern when someone has been seizing greater than 5 min?
There is an increased risk of cortical necrosis due to excitotoxicity; MRI can confirm dx
What is the way to titrate chronic pain mgmt i.e. in CA pts? (General principle)
Start with short-acting pain medications and titrate them up to an effective dose, then transition that dose over to a long acting and give short acting for breakthrough pain
Why do ppl with CHF exacerbations have tachypnea?
LV dysfunction causes pulmonary edema which widens the A-a gradient leading to hypoxemia with increased central respiratory drive (resp. alkalosis)
What is a scleroderma renal crisis?
Acute renal failure with malignant HTN and shistocytes (MAHA) with thrombocytopenia as well.
How does pneumoccocal vaccination work in adults over 65?
PCV13 first then followed by the 23 valent one 6-12 months later
Which type of contrast agents have lower incidence of nephropathy?
Non-ionic contrast agents (Adequate IV hydration with NS or isotonic bicarb or acetylcysteine also good)
When should HPV vaccines be given in women and men?
9-26 and 9-21, respectively
What is the size limit for a pituitary microadenoma?
10 mm; if less than this you tx the biochemical sx i.e. cabergoline for prolactinoma; if larger you c/s neurosurgery
How do you manage a pt with PE and renal insufficiency?
Start with UFH because renal insufficiency will increase anti-xa levels so don?t want to use LMWH; then do a V/Q scan rather than contrast CT (i.e. this is in GFR
Why is there a metabolic alkalosis in Conn's?
Aldosterone causes H secretion in DCT
What should you suspect in a pt in the ICU who was just resuscitated from PEA, now in sinus rhythm with duskiness and coolness of the fingers and toes?
Distal ischemia from pressors; suspect in ICU pt who codes or in trauma pt who needs pressors
How do you dx CMV colitis? What is the usual CD4 count?
Colonscopy with Bx showing cytomegalic cells with inclusion bodies; under 50
What can you say about the prognostic utility of hyponatremia in the setting of CHF?
It parallels the severity of the heart failure and is an independent risk factor of clinical outcomes (due to increased ADH)
What is "Upper Respiratory Cough Syndrome"?
Post nasal drip best initial tx is antihistamine
What is the best way to dx CLL
Flow cytometry to show clonality
Why would a pt with an acute GI bleed have increased BUN:Creatinine?
Reabsorption of blood in the GI tract can cause increased nitrogenous load
What do you do if a pt is stable in a blunt abdominal trauma setting and FAST is inconclusive?