5 Step 2 Dit: Heme/onc (Combined) + Endo + Cardio

Front 1

next step in mgmt:
25 y/o man dx'd with a solitary testicular mas by US

Back 1

orchiectomy

Front 2

classic findings of HSP

Back 2

palpable purpura

GI sx's (e.g. abd'l pain, vomiting, guaiac+, intussusception)

renal disease

transient arthritis/arthralgias

Front 3

What variables shift the Hb-O2 dissociation curve to the right

Back 3

"CADET-face RT"

C: incr'd
A: incr'd altitiude/acid (i.e. decr' pH)
D: incr'd DPG3
E: exercise
T: incr'd temp

Front 4

what effect does a right shift on Hb-O2 curve have

Back 4

Incr'd delivery of O2 to peripheral tissues

Front 5

what is cause of anemia that develops after taking a sulfa drug

Back 5

G6PD deficiency

Front 6

what lab markers suggest anemia due to hemolysis

Back 6

decr'd H&H with incr'd retics
normal MCV
decr'd haptoglobin
incr'd indirect bilirubin
incr'd LDH

Front 7

in hemolytic anemia, why is serum haptoglobin level der'd & serum LDH increased

Back 7

Haptoglobin binds free Hb in blood

LDH spills out of hemolyzed RBC's

Front 8

characteristic findings in hereditary spherocytosis

Back 8

jaundice & gallstones (2nd/2 elevated bilirubin)

splenomegaly

anemia with incr'd retics & MCHC

spherocytes on peripheral smear

positive osmotic fragility test

Front 9

spherocytosis is a/w higher incidence of what lab abnormality

Back 9

pseudohyperkalemia
(2nd/2 K+ spilling into blood when RBC's lyse after blood draw)

Front 10

tx of hereditary spherocytosis

Back 10

folic acid 1mg qD

splenectomy (moderate to severe cases)

RBC transfusion (extreme cases)

Front 11

Rx for diarrhea 2nd/2 E. histolytica

Back 11

metronidazole (+ hydration)

Front 12

Rx for diarrhea 2nd/2 G. Lamblia

Back 12

metronidazole (+ hydration)

Front 13

Rx for diarrhea 2nd/2 salmonella

Back 13

quinolones or TMP-SMX (+ hydration)

Front 14

Rx for diarrhea 2nd/2 shigella

Back 14

quinolones or TMP-SMX (+ hydration)

Front 15

Rx for diarrhea 2nd/2 campylobacter

Back 15

erythromycin (+ hydration)

Front 16

Rx for mild persistent asthma

Back 16

ACUTE TX:
short-acting B2-agonist (i.e. albuterol)
IV corticosteroids (for persistent sx's)

LONG-TERM CONTROL:
albuterol, prn
inhaled glucocorticoid
+/- leukotriene inhibitor (e.g. cromolyn)

Front 17

what is charcots triad indicative of & what are the components

Back 17

Dx: cholangitis

TRIAD:
jaundice
RUQ pain
Fever

Front 18

what is reynold's pentad indicative of & what are the components

Back 18

Dx: cholangitis

PENTAD:
jaundice
RUQ pain
Fever
hypotension
AMS

Front 19

Iron Def Anemia:
serum iron
ferritin
transferrin
Fe/TIBC

Back 19

serum iron: decr'd
ferritin: decr'd
transferrin: incr'd
Fe/TIBC: < 12%

Front 20

Anemia of chronic disease:
serum iron
ferritin
transferrin
Fe/TIBC

Back 20

serum iron: decr'd
ferritin: incr'd
transferrin: decr'd
Fe/TIBC: > 18%

Front 21

what is seen on blood smear of a patient with lead poisoning

Back 21

microcytic

hypochromic

basophilic stippling

Front 22

RBC disorder a/w:
schistocyte (fragmented RBC)

Back 22

hemolytic anemia
DIC
TTP
HUS

Front 23

RBC disorder a/w:
acanthocyte (spur cell)

Back 23

abetalipoproteinemia

Front 24

RBC disorder a/w:
bite cell

Back 24

G6PD def

Front 25

RBC disorder a/w:
basophilic stippling

Back 25

lead poisoning
B-thalassemia
alcohol

Front 26

RBC disorder a/w:
peripheral neuropathy and ringed sideroblastic in BM

Back 26

lead poisoning

Front 27

RBC disorder a/w:
hypersegmented neutrophils

Back 27

folate/B12 def

Front 28

RBC disorder a/w:
heinz bodies (denatured Hgb in RBC)

Back 28

G6PD def

Front 29

RBC disorder a/w:
burr cells

Back 29

uremia

Front 30

MCV & anemia a/w:
mental status changes, neuropathy, constipation

Back 30

microcytic

lead poisoning

Front 31

MCV & anemia a/w:
heavy menses, strict vegetarians, ice pica

Back 31

microcystic

iron def

Front 32

MCV & anemia a/w:
dark urine, jaundice, hepatosplenomegaly

Back 32

normocytic

hemolytic anemia

Front 33

MCV & anemia a/w:
alcoholic, malnourished

Back 33

macrocytic

folate/B12 def

Front 34

what virus can cause aplastic anemia as well as erythema infectiosum disease (i.e. "fifth disease")

Back 34

Parvovirus B19

Front 35

what test is used to rule out urethral injury

Back 35

retrograde cystourethrogram

Front 36

lipid-lowering agent:
SE = facial flushing

Back 36

niacin

Front 37

lipid-lowering agent:
SE = elevated LFT's, myositis

Back 37

statins

fibrates

Front 38

lipid-lowering agent:
SE = GI discomfort, bad taste

Back 38

bile acid sequestrants
(e.g. cholestyramine)

Front 39

lipid-lowering agent:
best effect on HDL

Back 39

niacin

Front 40

lipid-lowering agent:
best effect on TG's

Back 40

fibrates

Front 41

lipid-lowering agent:
best effect on LDL/cholesterol

Back 41

statins

Front 42

lipid-lowering agent:
binds C. Diff toxin

Back 42

cholestyramine

Front 43

which types of thalassemias are most commonly a/w pts of Mediterranean & AA/Asian descent

Back 43

MEDITERRANEAN: B-Thal

AA/ASIAN: a-Thal

Front 44

What complication occurs in 10% of pts with sideroblastic anemia

Back 44

myelodysplastic syndrome (aka "refractory anemia)
--> acute leukemia

Front 45

Besides Staph Aureus, which organism may be responsible for osteomyelitis in a sickle cell pt

Back 45

salmonella

Front 46

Which vaccines are particularly important in children with sickle cell disease

Back 46

HiB

Pneumoccal

Meningococcal

Influenza

Hep B

Front 47

What medication is used in the long-term management of sickle cell anemia

Back 47

Hydroxyurea

Front 48

drugs a/w elevated prolactin levels

Back 48

METHYLDOPA

PSYCHIATRIC DRUGS
phenothiazines
haloperidol
risperidone

Front 49

what substances cause hemolysis in px with G6PD def

Back 49

primaquin
dapsone
sulfonamides
fava beans
isoniazid
nitrofurantoin
high-dose ASA

Front 50

when would you expect eosinophillic casts in urine

Back 50

acute interstitial nephritis, AIN
(i.e. allergic interstitial nephritis)

Front 51

differential dx for eosinophilia

Back 51

"DNAAACP"

D = drugs (e.g. NSAIDS, PCN's/Ceph's)
N = neoplasms
A = allergies/asthma (churg-strauss), allergic bronchopulmonary aspergillosis
A = adrenal insufficiency (Addison's)
A = AIN (allergy-induced)
C = CVD's (e.g. PAN, dermatomyositis)
P = parasites (e.g. strongyloides, Ascaris --> Loeffler's eosinophilic pneumonitis)

Front 52

what is the management in a px with febrile neutropenia due to chemo

Back 52

admit
culture
start broad-spectrum antibiotics
(e.g. cefepime/ceftazidine)

Front 53

what type of infection causes eosiniphilia

Back 53

parasitic

Front 54

immunoglobulin a/w eosinophilia

Back 54

IgE

Front 55

what type of hypersensitivity is good pasture

Back 55

type II HSN

Front 56

what is the treatment for type II hypersensitivity

Back 56

anti-inflammatories

immunosuppressives (e.g. corticosteroids)

possibly plasmaphoresis

Front 57

most important medication for anaphylaxis

Back 57

epinephrine

Front 58

Tx for anaphylaxis

Back 58

ABC's
stop offending agent
epinephrine IM or IV (for AW obstruction)
H1/H2 blockers (for cutaneous sx's)
bronchodilators
steroids
IVF's (for hypotension)

Front 59

Dx
45 yo with acute flank pain and hematuria

Back 59

nephrolithiasis

Front 60

MCC of aortic stenosis in 50 y/o

Back 60

congenital bicuspid aortic valve

Front 61

MOA:
streptokinase

Back 61

activates tissue plasminogen --> cleaves fibrin clots

Front 62

MOA:
aspirin

Back 62

Cox-2 inhibitor --> blocks plt aggregation

Front 63

MOA:
clopidogrel

Back 63

inhibits ADP receptor

Front 64

MOA:
abciximab

Back 64

Gp2b3a Inhibitor

Front 65

MOA:
tirofiban

Back 65

Gp2b3a Inhibitor

Front 66

MOA:
ticlopidine

Back 66

inhibits ADP receptor

Front 67

MOA:
enoxaparin

Back 67

LMWH --> inhibits CF Xa

Front 68

MOA:
eptifibatide

Back 68

Gp2b3a Inhibitor

Front 69

classic triad of HUS

Back 69

hemolytic anemia
uremia
thrombocytopenia

Front 70

what is the pentad of TTP

Back 70

hemolytic anemia
uremia
thrombocytopenia
neurologic sequelea
fever

Front 71

lab test to monitor:
warfarin

Back 71

PT/INR

Front 72

lab test to monitor:
heparin

Back 72

PTT

Front 73

lab test to monitor:
LMWH

Back 73

doesn't need monitoring
(h/w it can be monitored with anti-CF Xa)

Front 74

drugs known to cause thrombocytopenia

Back 74

heparin (HIT)

abciximab (GP2b3a inhibitor)

carbamazepine, phenytoin, valproate

cimetidine

acyclovir, rifampin

sulfonamides
(e.g. sulfasalazine, TMP-SMX)

procainamide, quinidine

quinine, gold compounds

Front 75

1st line Rx for vWD

Back 75

desmopressin, DDAVP (increases vWF secretion)

Front 76

Rx for vWD that is severe or refractory

Back 76

cryoprecipitate or Factor VIII

Front 77

Rx for vWD with menorrhagia

Back 77

OCP

Front 78

MCC's of DIC

Back 78

"STOP Making Thrombi"

S = sepsis
T = trauma
O = OB complications
P = pancreatitis

M = malignancy

T = transfusions

Front 79

PLT's, BT, PT, PTT:
HUS/TTP

Back 79

PLT's: decr'd
BT: incr'd
PT: normal
PTT: normal

Front 80

PLT's, BT, PT, PTT:
hemophilia A or B

Back 80

PLT's: normal
BT: normal
PT: normal
PTT: incr'd

Front 81

PLT's, BT, PT, PTT:
vWD

Back 81

PLT's: normal
BT: incr'd
PT: normal
PTT: incr'd

Front 82

PLT's, BT, PT, PTT:
DIC

Back 82

PLT's: decr'd
BT: incr'd
PT: incr'd
PTT: incr'd

Front 83

PLT's, BT, PT, PTT:
warfarin use

Back 83

PLT's: normal
BT: normal
PT: incr'd
PTT: incr'd

Front 84

PLT's, BT, PT, PTT:
aspirin

Back 84

PLT's: normal
BT: incr'd
PT: normal
PTT: normal

Front 85

PLT's, BT, PT, PTT:
end stage liver disease

Back 85

PLT's: normal/decr'd
BT: normal/incr'd
PT: incr'd
PTT: incr'd

Front 86

what is the MC mutation that predisposes white pt's to venous thrombosis

Back 86

Factor V Leiden mutation

Front 87

Dx & Tx:
post-op pt with poor urine output, BUN 85, Cr 3 & clear lungs

Back 87

Dx: Prerenal azotemia (2nd/2 dehydration)

Tx: IVF's

Front 88

what infection causes aplastic crisis in sickle cell pt's

Back 88

Parvovirus B19

Front 89

Dx:
pt presents with glomerulonephritis plus b/l sensorineural deafness

Back 89

Alport's Syndrome

Front 90

Tx of shock

Back 90

IVF's & pressors

blood, urine, & sputum cultures (BEFORE starting antibiotics)

CXR

empiric antibiotics

insulin drip

continuous cardiac monitoring & central venous pressure measurments

Front 91

man returns from African safari c/o periodic fevers, chills, diaphoresis, muscle aches, & fatigue; how could he have avoided illness

Back 91

prophylactic anti-malarials

Front 92

Tx for infectious mononucleosis

Back 92

rest & plenty of fluids

NSAIDS or Tylenol (for fever, sore throat, & malaise)

gradual return to sports
(incr'd risk of splenic rupture):
NONCONTACT: 3 wks after sx onset
CONTACT: 4 wks after sx onset

Front 93

what is the spectrum of conditions related to blood infections

Back 93

bacteremia

SIRS

sepsis

severe sepsis

septic shock

multiple organ dysfxn syndrome

Front 94

definition:
bacteremia

Back 94

bacteria of any amount in the blood that does not meet criteria for SIRS

Front 95

definition:
SIRS

Back 95

Systemic Inflammatory Response Syndrome (SIRS) WITHOUT an identified source of infection

(NOTE: criteria may be met due to other causes independent of infection or source may never be found)

Front 96

what are the 4 categories for SIRS criteria

Back 96

temperature

tachycardia

tachypnea

WBC's

Front 97

how many of the SIRS categories must be present to meet the SIRS criteria

Back 97

2 or more

Front 98

What is the SIRS "temperature" criteria

Back 98

> 38.3C or < 36.0C

Front 99

What is the SIRS "tachycardia" criteria

Back 99

HR > 90 bpm

Front 100

What is the SIRS "tachypnea" criteria

Back 100

RR > 20 bpm or PaCO2 < 32

Front 101

What is the SIRS "WBC's" criteria

Back 101

ANY 1 OF THE FOLLOWING:

> 12,000
> 10% bands
< 4,000

Front 102

Criteria:
SIRS

Back 102

CRITERIA: 2 or more of the following:

TEMPERATURE:
> 38.3C
< 36.0C
TACHYCARDIA:
HR > 90
TACHYPNEA:
RR > 20 bpm
PaCO2 < 32
WBC'S:
> 12,000
> 10% bands
< 4,000

Front 103

definition:
sepsis

Back 103

SIRS WITH an identified source of infection;

(FYI: if SIRS criteria met & there is no obvious source of infection, w/u should include urine, blood, & sputum cultures)

Front 104

definition:
severe sepsis

Back 104

SEPSIS + 1 OF THE FOLLOWING:

organ dysfxn
hypotension
hypoperfusion

Front 105

what signs are evidence of organ dysfxn, hypotension &/or hypoperfusion seen in severe sepsis

Back 105

lactic acidosis

SBP < 90 mmHg

SBP drop > 40 mmHg

Front 106

definition:
septic shock

Back 106

SEVERE SEPSIS + hypotension , despite adequate fluid resuscitation

Front 107

definition:
multiple organ dysfxn syndrome

Back 107

SEPTIC SHOCK + evidence of 2 or more organs failing

Front 108

SUMMARIZE the spectrum of conditions related to blood infections with definition of each

Back 108

BACTEREMIA: bacteria in the blood that does not meet criteria for SIRS

SIRS: 2+ criteria met WITHOUT source of infection identified

SEPSIS: SIRS + source of infection identified

SEVERE SEPSIS: sepsis + organ dysfxn, hypotension, or hypoperfusion

SEPTIC SHOCK: severe sepsis + hypotension, despite adequate fluid resuscitation

MULTIPLE ORGAN DYSFUNCTION SYNDROME:
septic shock + evidence of 2+ organs failing

Front 109

classic EKG finding in PE

Back 109

"S1Q3T3"

wide S in Lead I

large Q in lead III

inverted T wave in lead III

Front 110

Dx:
post op px with pain presents with hyponatremia and normal volume status

Back 110

SIADH (2nd/2 stress)

Front 111

Rx for mild unconjugated hyperbilirubinemia

Back 111

phototherapy

Front 112

Rx for severe unconjugated hyperbilirubinemia

Back 112

exchange transfusion

Front 113

what is the initial HAART regimen

Back 113

2 NRTI's + EITHER:

1 protease inhibitor

1 NNRTI

may be add ritonavir

Front 114

antiretroviral a/w:
SE of lactic acidosis

Back 114

NRTI'S

Front 115

antiretroviral a/w:
SE of GI intolerance

Back 115

protease inhibitors

Front 116

antiretroviral a/w:
SE pancreatitis

Back 116

zalcitibine
didanosine
stavudine
ritonavir

Front 117

antiretroviral a/w:
SE of peripheral neuropathy

Back 117

zalcitibine
didanosine
stavudine

Front 118

antiretroviral a/w:
SE of megaloblastic anemia

Back 118

zidovudine

Front 119

antiretroviral a/w:
SE of rash

Back 119

NNRTI's

Front 120

antiretroviral a/w:
SE of hyperglycemia, DM, lipid abnormalities

Back 120

protease inhibitors
(e.g. indinavir, sequinavir, amprinavir)

Front 121

antiretroviral a/w:
SE of BM suppression

Back 121

zidovudine

Front 122

antiretroviral a/w:
given to pregnant woman with HIV

Back 122

HAART regimen with zidovudine

Front 123

antiretroviral a/w:
regimen for occupational HIV exposure

Back 123

LOW-RISK: zidovudine + lamivudine

HIGH-RISK: 3-drug HAART regimen

Front 124

what bugs are tx prophylactically in AIDS pt's with CD4+ < 200 and what is rx is given

Back 124

PCP: TMP-SMX

TOXOPLASMOSIS: TMP-SMX

MAC: Macrolide (e.g. clarithromycin or azithromycin)

Front 125

Tx for acute toxoplasmosis in AIDS pt

Back 125

pyrimethamine or sulfadiazine

Front 126

HIV prophylaxis for TB

Back 126

INH

Front 127

AIDS criteria

Back 127

ANY OF THE FOLLOWING:

HIV+ with CD4+ < 200
HIV+ with CD4+ < 15% of total lymphocytes
HIV+ with "AIDS-defining illness"

Front 128

what are some examples of "AIDS-defining illness"

Back 128

THERE ARE MANY (refer to SU p.144-145):

esophageal candidiasis
PCP
toxoplasmosis
MAC

Front 129

tumor marker:
hepatocellular carcinoma

Back 129

AFP

Front 130

tumor marker:
colon cancer

Back 130

CEA

Front 131

tumor marker:
gastric cancer

Back 131

CEA

Front 132

tumor marker:
pancreatic cancer

Back 132

CA 19-9

CEA

Front 133

tumor marker:
ovarian cancer

Back 133

CA-125

Front 134

dx:
young black man with painless hematuria

Back 134

sickle cell trait

Front 135

MCC of aortic stenosis in a 70 y/o

Back 135

senile (i.e. degenerative) calcifications

Front 136

labs in DIC

Back 136

ELEVATED:
fibrin-split products
D-dimers

DECREASED:
fibrinogen
platelets
hematocrit

Front 137

which type of RTA is a/w abnormal H+ secretion & nephrolithiasis

Back 137

RTA I

Front 138

what is the classic presentation of polycythemia vera

Back 138

thrombosis

erythromelalgia (i.e. burning pain in hands & feet)

pruritis (esp after warm bath/shower)

facial plethora

hepatosplenomegaly

visual disturbances

abnormal labs

Front 139

what visual distrubances are seen with polycythemia vera

Back 139

blurred vision

amaurosis fugax

scintillating scotoma

ophthalmic migraine

Front 140

what lab abnormalities are seen with polycythemia vera

Back 140

elevated H&H

elevated red cell mass

basophilia

leukocytosis

thrombocytosis

Front 141

what is the Rx for polycythemia vera

Back 141

phlebotomy
(FYI: induces a desirable iron def anemia --> DO NOT supplement with iron)

Front 142

what is used in px with polycythemia vera with high risk of thrombosis; which pts are considered "at risk"

Back 142

hydroxyurea

"AT RISK":
h/o thrombosis
plts > 1,500,000
CV RF+
> 70 y/o

Front 143

what is used in px with polycythemia vera with refractory pruritis or refractory erythrocytosis

Back 143

IFN-a

Front 144

what tests will help in dx of MM

Back 144

SPEP: monoclonal AB spike

UPEP: bence-jones proteins

BM BX: incr'd plasma cells

Front 145

Dx
px with weight loss, pruritis, night sweats, hepatosplenomegaly, nontender cervical lymphadenopathy

Back 145

Hodgkin's lymphoma

Front 146

Dx:
3 y/o girl presents with abd'l mass, hematuria, & HTN

Back 146

Wilm's tumor

Front 147

Dx & Tx:
recent Cuban immigrant with sx's of malabsorption is found to also have megaloblastic anemia

Back 147

Dx: Tropical sprue

Tx: folate & antibiotics (e.g. tetracycline or sulfa)

Front 148

cell pathology a/w:
EBV

Back 148

Burkitt's lymphoma

Front 149

cell pathology a/w:
reed sternberg cell, cervical lymphadenopathy, night sweats

Back 149

Hodgkin's lymphoma

Front 150

cell pathology a/w:
bence jones proteins, osteolytic lesions, high Ca2+

Back 150

MM

Front 151

cell pathology a/w:
translocation 14:18

Back 151

follicular lymphoma

Front 152

cell pathology a/w:
MC lymphoma in US

Back 152

diffuse large B cell lymphoma

Front 153

cell pathology a/w:
translocation 8:14

Back 153

burkitt's lymphoma

Front 154

cell pathology a/w:
translocations 9:22

Back 154

philadelphia (CML or ALL)

Front 155

cell pathology a/w:
MC hodgkin lymphoma

Back 155

nodular sclerosing

Front 156

cell pathology a/w:
starry sky pattern due to phagocytosis of apoptotic tumor cells

Back 156

burkitt's lymphoma

Front 157

cell pathology a/w:
high H&H, pruritis (esp after hot bath or shower), burning pain in hands or feet

Back 157

polycythemia vera

Front 158

cell pathology a/w:
white cells with hair-like projections & splenomegaly

Back 158

hairy-cell leukemia

Front 159

cell pathology a/w:
macrocytosis, hypogranular granulocytes with bilobed nuclei

Back 159

myelodysplastic syndrome

Front 160

Rx for CML

Back 160

imatinib

Front 161

leukemia a/w:
MC in children (peak age 3-4 y/o)

Back 161

ALL

Front 162

leukemia a/w:
MC in adults (avg age of onset 50 y/o)

Back 162

CLL

Front 163

leukemia a/w:
philadelphia Chromosome is always present

Back 163

CML

Front 164

leukemia a/w:
smudge cells

Back 164

CLL

Front 165

leukemia a/w:
peripheral blasts are PAS+ and TdT+

Back 165

ALL

Front 166

leukemia a/w:
peripheral blasts are PAS-, MPO+ and have Auer rods

Back 166

AML

Front 167

leukemia a/w:
pancytopenia in a down syndrome px

Back 167

ALL

Front 168

lung cancer a/w:
elevated ACTH --> glucocorticoid excess --> Cushing's

Back 168

small cell lung cancer

Front 169

lung cancer a/w:
elevated PTH related peptide --> hypercalcemia

Back 169

squamous cell lung cancer

Front 170

lung cancer a/w:
elevated ADH --> SIADH --> hyponatremia

Back 170

small cell lung cancer

Front 171

lung cancer a/w:
antibodies to presynaptic Ca2+ channels --> Lambert-Eaton syndrome

Back 171

small cell lung cancer

Front 172

disease that causes glomerulonephritis with deafness

Back 172

Alport's syndrome

Front 173

MC adrenal tumor in children; lab study used to dx

Back 173

MC = neuroblastoma

Dx'c = 24-hr urine --> incr'd VMA & HVA

Front 174

Dx:
4 y/o girl with URI & dangling thumbs, short stature, & hypopigmentation of some skin areas; labs reveal pancytopenia

Back 174

fanconi's anemia

Front 175

Rx for neuroleptic malignant syndrome

Back 175

DantroleneDopamine agonists (e.g. bromocriptine)

Front 176

common complication of recurrent otitis media

Back 176

hearing loss

Front 177

Rx for DT's

Back 177

long-acting benzos (e.g. chlordiazepoxide)

Front 178

possible auto-antibodies a/w type 1 DM

Back 178

anti insulin (IAA)anti islet cell cytoplasm (ICA)anti glutamic acid decarboxylase (GAD)anti tyrosine phosphatase (IA-2)

Front 179

what lab test can be used in diabetic px to assess the adequacy of glycemic control over the last 3 months

Back 179

HbA1c

Front 180

leading cause of death in diabetics

Back 180

CV disease

Front 181

why must B-blockers be used with caution in diabetic pts

Back 181

"masks" sympathetic sx's of hypoglycemiadecreases insulin release

Front 182

what can cause hypoglycemia in a non-diabetic px

Back 182

insulinoma (B-cell tumor)exogenous insulin or sulfonylureasalcoholfastingpituitary/adrenal insufficiency

Front 183

what is the Somogyi effect

Back 183

evening insulin dose is TOO HIGH --> HYPOGLYCEMIAhypoglycemia --> release of catecholaminescatecholamines --> high glucose in the mornings

Front 184

what is the dawn phenomenon

Back 184

evening dose is TOO LOW --> diminishing insulindiminishing insulin --> rising glucose (thru the night)rising glucose --> high glucose in the mornings

Front 185

Rx other than stimulants for ADHD

Back 185

TCA's (e.g. Imipramine, desipramine, & nortriptyline)bupropiona2-agonists (e.g. clonidine)

Front 186

3 reasons for involuntary psychiatric hospitalization

Back 186

danger to selfdanger to othersgravely disabled (e.g. catatonic schizophrenic)

Front 187

what psychiatric condition occurs when a person travels a long distance and take a new name and has no memore or previous life

Back 187

dissociative fugue

Front 188

what are the DM'c drug classes

Back 188

SulfonylureasThiazolidinediones (TZD's)BiguanidesIncretin mimeticsDPP-IV inhibitorsa-glucosidase inhibitorsMeglitinides

Front 189

examples of med's within drug class:Sulfonylureas

Back 189

GlyburideGlimeperideGlipizide

Front 190

examples of med's within drug class:Thiazolidinediones (TZD's)

Back 190

PioglitazoneRosiglitazone

Front 191

examples of med's within drug class:Biguanides

Back 191

Metformin

Front 192

examples of med's within drug class:Incretin mimetics

Back 192

ExenatideLiraglutide

Front 193

examples of med's within drug class:DPP-IV inhibitors

Back 193

SitagliptinSaxagliptinLinagliptin

Front 194

examples of med's within drug class:a-glucosidase inhibitors

Back 194

Acarbose

Front 195

examples of med's within drug class:Meglitinides

Back 195

RepaglinideNateglinide

Front 196

what skin finding is a sign of insulin resistance

Back 196

acanthosis nigricans(NOTE: acanthosis nigricans is also a/w occult malignancies)

Front 197

diabetic Rx a/w:lactic acidosis

Back 197

metformin (rare, but worrisome SE)

Front 198

diabetic Rx a/w:MC SE is hypoglycemia

Back 198

sulfonylureasmetglitinides

Front 199

diabetic Rx a/w:oldest and cheapest oral agent

Back 199

sulfonylureas

Front 200

diabetic Rx a/w:often used in combination with otehr oral agents

Back 200

metformin

Front 201

diabetic Rx a/w:lowers TG and LDL

Back 201

metformin

Front 202

diabetic Rx a/w:not safe in HF

Back 202

CHF:pioglitazone (TZD)rosiglitazone (TZD)INCR'D RISK OF MI:rosiglitazone (TZD)

Front 203

diabetic Rx a/w:should not be used in px with increased Cr

Back 203

metforminsulfonylureas

Front 204

diabetic Rx a/w:avoid in px with inflammatory bowel disease

Back 204

a-glucosidase inhibitors (e.g. acarbose)

Front 205

diabetic Rx a/w:hepatic serum transaminase levels should be carefully monitored

Back 205

TZD's (glitazones)metforminsulfonylureas

Front 206

diabetic Rx a/w:no weight gain

Back 206

metforminincretin mimetics (h/w cannot be given PO)

Front 207

diabetic Rx a/w:metabolized by liver, good choice for those with renal failure

Back 207

TZD's (glitazones)

Front 208

diabetic Rx a/w:postprandial hyperglycemia

Back 208

a-glucosidase inhibitors (acarbose)

Front 209

what does GLP-1 do

Back 209

decreases glucagonincreases insulindelays gastric emptying

Front 210

what diabetic Rx increases GLP-1

Back 210

INCRETIN MIMETICS:exenatideliraglutide

Front 211

what does DPP-4 do

Back 211

Inhibit GLP-1

Front 212

what diabetic Rx inhibits DPP-4, indirectly increasing GLP-1 (i.e. inhibiting an "inhibitor)

Back 212

DPP-IV Inhibitors = "--gliptins"(e.g. Sitagliptin, Saxagliptin, Linagliptin)

Front 213

what diabetic Rx is an Amylin analog

Back 213

pramlintide

Front 214

what diabetic Rx can be used for both type 1 and type 2 DM

Back 214

pramlintide

Front 215

how can you Dx metabolic syndrome

Back 215

Any 3 of the followingABDOMINAL OBESITY (waist circ.): M > 40; F > 35PRE-HTN: > 130/85HYPERGLYCEMIA: FBSG > 100 (or 2hr post PO glucose > 140)DYSLIPIDEMIA:TG's > 150HDL: M < 40; F < 50

Front 216

what diabetic drug should be stopped before performing imaging with IV contrast

Back 216

METFORMIN:d/c for 24 hrs prior to CT with contrastre-evaluate renal fxn before re-startingrestart 48 hrs after procedure (if renal fxn is back to baseline)

Front 217

diabetic drug with MOA:decreases GI absorption or starch and disaccharides

Back 217

a-glucosidase inhibitor (e.g. acarbose)

Front 218

diabetic drug with MOA:stimulates insulin release

Back 218

sulfonylureasmeglitinides

Front 219

diabetic drug with MOA:decreases hepatic gluconeogenesis

Back 219

metforminTZD's (glitazones)

Front 220

diabetic drug with MOA:increases tissue glucose uptake and improves insulin sensitivity

Back 220

TZD's (glitazones)

Front 221

diabetic drug with MOA:mimics action of GLP-1

Back 221

INCRETIN MIMETICS:exenatideliraglutide

Front 222

diabetic drug with MOA:inhibits DPP-4

Back 222

DDP-4 INHIBITORS = "--gliptins"(e.g. Sitagliptin, Saxagliptin, Linagliptin)

Front 223

Which type of insulin is used in continuous infusion insulin pumps & in treatment of DKA

Back 223

regular Insulin (used most commonly)very rapid-acting (e.g. Lispro, Aspart, Glulisine)

Front 224

What must be kept in mind for a Type I DM'c pt that plans to begin a strenuous exercise program

Back 224

Blood sugar is likely to drop during exercise as muscles take up more glucosePts's should always have a readily available source of glucosePt's should check glucose levels regularly: before exercising every hour during exercise after exercising

Front 225

definitive tx for subdural and epidural hematoma

Back 225

evacuation with burrhole

Front 226

medication used to Dx symptomatic myasthenia gravis

Back 226

edrophonium (i.e. tensilon test)

Front 227

MCC of seizures in children 2-10 yo

Back 227

febrileinfectiontraumaideopathic

Front 228

signs and symptoms of DKA

Back 228

metabolic acididosisvomiting (WITHOUT DIARRHEA)kussmal breathingfruity odor on breathpolyuria/polydipsiamental status change

Front 229

Mgmt of DKA

Back 229

Admit to ICUIVF'sinsulin (until anion gap closes)glucose (if BG drops before AG closes)Correct electrolytes (give KCl)Tx underlying d/o

Front 230

what 2 tests can be used to confirm DKA

Back 230

ABG'surine ketone

Front 231

how to Dx diabetic gastroparesis

Back 231

gastric emptying study

Front 232

Rx for diabetic gastroparesis

Back 232

DOC = metoclopramide (reglan)2nd line = erythromycin

Front 233

Rx for proliferative diabetic retinopathy

Back 233

laser photocoagulation+ glucose control

Front 234

Rx for diabetic peripheral neuropathy

Back 234

gabapentinpregabalinduloxetine+ glucose control

Front 235

anti-HTN've that will reduce proteinuria and slow/prevent diabetic nephropathy

Back 235

ACEIs/ARBs

Front 236

what eye problems are diabetics at increased risk for developing

Back 236

cataractsglaucomaretinal detachement

Front 237

What is the equation for anion gap

Back 237

AG = [Na+] - ([Cl-] + [HCO3-])

Front 238

w/u for underlying cause of DKA

Back 238

R/O INFECTION:blood/urine culturesCXRUA & toxicology screenR/O PANCREATITIS:amylaselipaseR/O MI (in pt's > 35-40 y/o):EKGtroponins x3

Front 239

Rx for tourettes

Back 239

fluphenazine (high-potency neuroleptic)pimozidetetrabenazine

Front 240

Dxmuscle rigidity, fever and rhabdomyolysis in schizophrenic px

Back 240

neuroleptic malignant syndrome

Front 241

antidiabetic agent a.w lactic acidosis

Back 241

metformin

Front 242

Mgmt of thyroid storm

Back 242

NON-PHARM:ICU admission (25-50% mortality)r/o infection (blood/urine cultures)aggressive hydration (except overt HF)PHARMACOLOGICAL:B-blockers (to control adrenergic stimulation)PTU/methimazole (block new hormone SYNTHESIS)Iodine (to block T4/T3 RELEASE from gland)Glucocorticoids (to reduce T4 --> T3 CONVERSION)

Front 243

what Rx should be avoided in a pt with thyroid storm

Back 243

aspirin(interferes with thyroid protein binding, generating MORE free thyroid)

Front 244

Rx with MOA:decrease TH synthesis

Back 244

PTU methimazole

Front 245

Rx with MOA:decreases release of T4 & T3 from the gland

Back 245

Iodine

Front 246

Rx with MOA:decreases T4 conversion

Back 246

PTUglucocorticoids

Front 247

what thyroid abnormalities would you expect to find during pregnancy

Back 247

incr'd TBG --> incr'd total T3 & T4normal free T3 & free T4

Front 248

Dxpx with exophthalmos

Back 248

graves

Front 249

Rx for graves

Back 249

PHARMACOLOGICAL:Methimazole or PTUDEFINITIVE TX'S:radioactive iodine/ablationsubtotal thyroidectomy

Front 250

which thyroid dysfunction will radioactive iodine most likely result in hypothyroidism

Back 250

GRAVE'S DISEASE:radioactive iodine is taken up by fxn'l tissue& in Grave's, the entire gland is hyperfxn'lNOTE: likely to happen in many thyroid d/o's tx'd with radioactive iodine, but Grave's is most likely b/c hyperfxn'l thyroid

Front 251

what is the FIRST step in a pt with a palpable thyroid nodule

Back 251

Check TSH, FT4Thyroid US (to measure size and assess for other nodules)

Front 252

what should be done in a pt with a palpable thyroid nodule who's labs reveal hyperthyroid

Back 252

radionucleotide uptake scan

Front 253

what should be done in a pt with a palpable thyroid nodule who's labs reveal euthyroid

Back 253

FNA

Front 254

what should be done in a pt with a palpable thyroid nodule who's labs reveal hypothyroid

Back 254

thyroid replacementmonitor for decrease in nodule size (if nodule persists after thyroid replacement --> FNA)

Front 255

what should be done in a hyperthyroid px with cold radionucleotide uptake scan

Back 255

FNA

Front 256

what should be done in a hyperthyroid px with hot radionucleotide uptake scan

Back 256

tx as hyperthyroidism (i.e. B-blocker, PTU/Methimazole, Iodide, Glucocorticoids)

Front 257

what should be done if a FNA of thyroid nodule is malignant

Back 257

surgery

Front 258

what should be done if FNA of thyroid nodule is benign

Back 258

repeat US every 6 monthsif increase in size --> repeat FNA

Front 259

what should be done if FNA of thyroid nodule is intermediate

Back 259

repeat US every 6 monthsif increase in size --> repeat FNA

Front 260

what should be done if FNA of thyroid nodule is nondiagnostic

Back 260

repeat FNA

Front 261

what lab abnormalities necessitate obtaining a thyroid function test to rule out thyroid disease

Back 261

hyperlipidemia (hypothyroid incr's LDL & total ch'ol)hyponatremiaelevated CPK

Front 262

hyperthyroidism a/w:tender thyroid

Back 262

Subacute thyroiditis (aka De Quervain Thyroiditis)

Front 263

hyperthyroidism a/w:pretibial myxedema

Back 263

graves

Front 264

hyperthyroidism a/w:pride in recent weight loss

Back 264

exogenous abuse

Front 265

hyperthyroidism a/w:palpation of single thyroid nodule

Back 265

toxic thyroid adenoma (aka Plummer Ds)

Front 266

hyperthyroidism a/w:palpation of multiple thyroid nodules

Back 266

multinodular goiter

Front 267

hyperthyroidism a/w:recent iodine IV contrast study

Back 267

Jod Basedow Phenomenon(aka iodine-induced hyperthyroidism)

Front 268

hyperthyroidism a/w:eye changes

Back 268

graves

Front 269

hyperthyroidism a/w:history or thyroidectomy

Back 269

excess TH replacement

Front 270

lab abnormality a/w bacterial meningitis

Back 270

incr'd WBCs WITH POSSIBLE:left shift on CBC (bandemia)leukopeniamild hyponatremia

Front 271

RX for DKA

Back 271

IVF'sIV insulin (until AG closes & NO ketones)IV glucose (prevent hypoglycemia)Replace electrolytes (Mg2+, Ca2+, K+, & phosphate)

Front 272

disorder a/w child who has history of theft, vandalism and violence

Back 272

conduct disorder

Front 273

How do you tx a px who has hyperPTH who refuses or cant have surgery

Back 273

ADEQUATE HYDRATION (to avoid renal stones)MINIMIZE BONE RESORPTION:exercisebisphosphonatesCa2+ (1000mg/day)Vit D (400 - 600 IU/day)PREVENT WORSENING HYPERCALCEMIA BY AVOIDING:thiazide diureticslithiumvolume depletionprolonged bed rest Ca2+ ingestion (>1000mg/day)ROUTINE MONITORING:serum Ca2+ q6 mosserum Cr q12 mos BMD of hip, L-spine, & forearm q12 mos

Front 274

what are oral phosphate binders for px with hyperphosphatemia 2nd/2 hyperPTH

Back 274

Ca2+ carbonate Ca2+ acetate

Front 275

MCC's of hyperPTH

Back 275

adenoma (single PT gland)hyperplasia (x4 PT glands)

Front 276

how will vit D def affect Ca, PTH, P

Back 276

decr'd Caincr'd PTHdecr'd P

Front 277

why might PTH be increased in renal disease

Back 277

renal ds --> decr'd vit D conversion --> decr'd Ca absorption (gut) --> incr'd PTH

Front 278

what happens to phosphate in px with hyperPTH and renal disease

Back 278

increases

Front 279

likely cause of increased PTH, decreased Ca and increased P

Back 279

renal failure

Front 280

Ca2+, Phos, Alk phos, PTH in:pagets

Back 280

Ca2+: normalPhos: normalAlk phos: incr'dPTH: normal

Front 281

Ca2+, Phos, Alk phos, PTH in:osteomalacia/rickets

Back 281

Ca2+: decr'dPhos: decr'dAlk phos: nl/incr'dPTH: incr'd

Front 282

Ca2+, Phos, Alk phos, PTH in:chronic renal failure

Back 282

Ca2+: decr'dPhos: incr'dAlk phos: nl/incr'dPTH: incr'd

Front 283

Ca2+, Phos, Alk phos, PTH in:osteoporosis

Back 283

Ca2+: normalPhos: normalAlk phos: normalPTH: normal

Front 284

Ca2+, Phos, Alk phos, PTH in:osteopetrosis

Back 284

Ca2+: normalPhos: normalAlk phos: normalPTH: normal

Front 285

Ca2+, Phos, Alk phos, PTH in:primary hyperPTH

Back 285

Ca2+: incr'dPhos: decr'dAlk phos: incr'dPTH: incr'd

Front 286

Ca2+, Phos, Alk phos, PTH in:hypoPTH

Back 286

Ca2+: decr'dPhos: incr'dAlk phos: normalPTH: decr'd

Front 287

Ca2+, Phos, Alk phos, PTH in:pseudohypoPTH

Back 287

Ca2+: decr'dPhos: incr'dAlk phos: normalPTH: incr'd

Front 288

what is the disease a/w shortened 4th and 5th digits

Back 288

albrights hereditary osteodystrophy

Front 289

what are the indications for surgical parathyroidectomy

Back 289

SYMPTOMATIC:bonesstonesgroanspsychiatric overtonesINCR'D [Ca2+]:> 1.0 mg/dl above upper limits of nlDECR'D Cr Cl (reduced by 30%) --> incr'd CrAGE < 50 y/oBMD:T-score < -2.5 (at any site)

Front 290

If parathyroid adenoma is found & surgery is indicated, what is removed

Back 290

REMOVAL of ONLY the gland containing adenomaBIOPSY of 1 - 3 other glands

Front 291

If parathyroid hyperplasia is found & surgery is indicated, what is removed

Back 291

REMOVAL of 3 & 1/2 glands SURGICALLY "CLIP" the remaining 1/2 (or forearm autotrasplantation in cases of high recurrence e.g. Men type 1 & IIa)

Front 292

what happens to phosphate in pts with hyperPTH caused by renal ds

Back 292

HYPERPHOSPHATEMIA (2nd/2 kidney's inability to excrete phosphate)

Front 293

Dxpx with exophthalmos, pretibial myxedema and decreased TSH

Back 293

graves

Front 294

worrisome SE of ADHD Rx, Atomoxetine

Back 294

incr'd suicidal ideationhepatic injury

Front 295

what are common SE or atypical antipsychotics

Back 295

fewer mvmt SE'sfewer anticholinergic SE'sWt gain --> DM/DKA (esp, Olanzapine)

Front 296

Rx for prolactinoma

Back 296

DOPAMINE AGONISTS:cabergolinebromocriptine or pergolide

Front 297

Rx for female with prolactinoma > 3cm with desire to be pregnant

Back 297

withhold DA agonisttransphenoidal surgery (even if DA agonist is effective)

Front 298

what are common complications of acromegaly

Back 298

cardiac failureDMspinal cord compressionoptic nerve compressionarthropathy

Front 299

screening test for acromegaly

Back 299

IGF-1 levels

Front 300

confirmatory test for acromegaly

Back 300

oral glucose suppression test(75g glucose --> measure GH at 1hr & 2hr;[GH] > 1ng/mL = acromegaly)

Front 301

what should be done if a px tests positive for acromegaly

Back 301

pituitary MRI to evaluate for mass or empty sella (MCC of acromegaly = pituitary adenoma)

Front 302

what should be done in empty sella syndrome

Back 302

nothing/reassurance

Front 303

Rx for acromegaly

Back 303

1ST LINE = OCTREOTIDE(somatostatin analog: inhibits GH secretion)2ND LINE = CABERGOLINE (DA agonist: inhibits PRL & GH secretion)3RD LINE = PEGVISOMANT (GH receptor antagonist)DEFINITIVE TX: transphenoidal resection

Front 304

What is typical hyperprolactinoma presentation

Back 304

MALES:incr'd PRL --> decr'd LH/FSH --> decr'd Testosteronedecr'd LH/FSH --> HYPOGONADISMdecr'd Testosterone --> FATIGUE, LOW LIBIDOFEMALES:incr'd PRL --> decr'd LH/FSH --> decr'd E2/Progesterone --> AMENORRHEA GALACTORRHEA

Front 305

what Rx cause elevated prolactin levels

Back 305

PHENOTHIAZINES:thioridazineprochlorperazinepromothiazineOTHER ANTIPSYCHOTICS:risperidonehaloperidolMETHYLDOPAVERAPAMIL

Front 306

next step in management of a px with non-drug-induced hyperprolactinemia

Back 306

MRI of brain (r/o pituitary adenoma)TSH levels (r/o hypothyroidism)

Front 307

what visual field deficit is a/w prolactinoma

Back 307

bitemporal hemianopsia

Front 308

what is a lactotroph adenoma

Back 308

prolactinoma

Front 309

what is a somatotroph adenoma

Back 309

growth hormone secreting adenoma

Front 310

Rx for hypercalcemia

Back 310

IVF's --> urinate Ca2+ outloops (e.g. furosemide)

Front 311

Dxpx with hearing loss and vertigo, examination shows a greyish white pearly lesion involving the TM

Back 311

cholesteatoma

Front 312

what marker is most accurate to Dx an androgen-producing tumor in a woman

Back 312

DHEA-S (NOTE: DHEA-S made ONLY by adrenals;DHEA & testosterone made by adrenals & ovaries)

Front 313

what are the elctrolyte abnormalities found in hyperaldosteronism

Back 313

hypokalemiamildly elevated Na+metabolic alkalosis

Front 314

what is the hyperaldosteronism triad

Back 314

TRIAD:HTNhypokalemiametabolic alkalosis

Front 315

what is the most specific lab finding in making the Dx of primary hyperaldosteronism

Back 315

HIGH PAC:PRC RatioPAC is incPRC is dec(NOTE:PAC = plasma aldosterone concentrationPRC = plasma renin concentration)

Front 316

what steroid is used to replace aldosterone

Back 316

fludracortisone (100 x stronger than aldosterone)

Front 317

what steroid is most like cortisol

Back 317

Hydrocodone (has glucocorticoid & mineralcorticoid action)

Front 318

What is the MC pituitary tumor & what is the rx

Back 318

MC = ProlactinomaTx = bromocriptine, cabergoline, or pergolide

Front 319

Dx:16 y/o with left arm paralysis (no medical cause is found) after her boyfriend dies in a MVA

Back 319

Conversion d/o

Front 320

What effect would giving a B-Blocker have on a pt with HTN due to pheochromacytoma

Back 320

Worsen HTN due to unopposed a1-activity

Front 321

What is the likely condition of a female infant with virilization of the genitalia & hypotension

Back 321

21a-hydroxylase def --> CAH

Front 322

What serum lab abnormalities would you see in 17a-hydroxylase deficiency & in 21a-hydroxylase deficiency

Back 322

17a-HYDROXYLASE DEFICIENCY:hypokalemiamild hypernatremia+ HTN21a-HYDROXYLASE DEFICIENCY:hyperkalemiahyponatremia+ hypotension

Front 323

Dx:A pt with acromegaly is found to have elevated Ca2+ on a blood draw during a w/u of his peptic ulcer

Back 323

DX: MEN I ("3 P's"):acromegaly = pituitary d/oelevated Ca2+ = hyperparathyroidismpeptic ulcer = gastrin-secreting tumor (ZES)

Front 324

What is involved in MEN I Syndrome

Back 324

Mnemonic: "3 P's"parathyroid hyperplasiapituitarypancrease (islet) or GI

Front 325

What is involved in MEN IIa Syndrome

Back 325

Mnemonic: "1M + 2 P's"medullary thyroid carcinomaparathyroid hyperplasiapheochromacytoma

Front 326

What is involved in MEN IIb Syndrome

Back 326

Mnemonic: "2 M's + 1P"medullary thyroid carcinomamucosal neuromaspheochromacytoma

Front 327

What oncogene is involved with the MEN Syndromes & with which type is it associated

Back 327

RET Proto-Oncogenea/w Men IIa & Men IIb

Front 328

What are the MCC's of eosinophilia

Back 328

Mnemonic: "DN-AAA-CP" (D-N triple-A C-P):DrugsNeoplasmsAllergic causes (allergies, asthma, Churg-Strauss)Addison's DsAcute Interstitial NephritisCVD'sParasitic Infections (including Loeffler's Eosinophilic Pneumonitis 2nd/2 Ascaris Lumbricoides)

Front 329

causes of secondary HTN

Back 329

pheochromacytomahyperaldosteronismexcess glucocorticoidscushing's syndromerenal artery stenosisCAH (11a-OH & 17a-OH def's)CKDOCPcoarctation of aorta

Front 330

The most common cause of hypothyroidism.

Back 330

Hashimoto's thyroiditis

Front 331

Lab findings in Hashimoto's thyroiditis.

Back 331

high TSH, low T4,antimicrosomal antibodies

Front 332

Exophalamos, pretibial myxedema, & ⇩TSH

Back 332

Grave's disease

Front 333

The most common cause of Cushing's syndrome.

Back 333

Iatrogenic steroid administration. (2nd most common is Cushing's disease)

Front 334

A patient presents w/ signs of hypocalcemia, high phosphorus, & low PTH.

Back 334

Hypoparathyroidism

Front 335

"Stones, bones, groans, psychiatric overtones."

Back 335

Signs & symptoms of hypercalcemia.

Front 336

A patient complains of headache, weakness, & polyuria; exam reveals hypertension & tetany. Labs reveal hypernatremia, hypokalemia, & metabolic alkalosis.

Back 336

Primary hyperaldosteronism (due to Conn's syndrome or bilateral adrenal hyperplasia)

Front 337

A patients presents with tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, & a sense of panic.

Back 337

Pheochromocytoma

Front 338

Should α- or β-antagonists be used first in treating pheochromocytoma?

Back 338

α-antagonists(phentolamine & phenoxybenzamine)

Front 339

A patient w/ a history of lithium use presents with copious amounts of dilute urine.

Back 339

Nephrogenic diabetes insipidus (DI)

Front 340

Treatment of central diabetes insipidus.

Back 340

Administration of DDAVP ⇩serum osmolality & free water restriction

Front 341

A postoperative patient w/ significant pain presents with hyponatremia & normal volume status.

Back 341

SIADH due to stress

Front 342

An antidiabetic agent associated w/ lactic acidosis.

Back 342

Metformin

Front 343

A patient presents w/ weakness, nausea, vomiting, weight loss, & new skin pigmentation. Labs show hyponatremia & hyperkalemia. Treatment?

Back 343

Primary adrenal insufficiency (Addison's disease).Treat with replacement glucocorticoids, mineralcorticids, & IV fluids.

Front 344

Goal hemoglobin A1c for a patient w/ DM.

Back 344

<7.0

Front 345

Treatment of DKA.

Back 345

Fluids, insulin, & aggressive replacement of electrolytes (e.g. K+)

Front 346

What are β-blockers contraindicated in diabetics?

Back 346

They can mask symptoms of hypoglycemia. (How?)

Front 347

overdose of what causes metabolic acidosis and retinal damage leading to blindness

Back 347

methanol

Front 348

what electrolyte abnormalities are found in hyperaldosteronism

Back 348

metabolic alkalosishypokalemiamild hypernatremia

Front 349

MC coronary artery to become occluded

Back 349

LAD

Front 350

ECG leads that correspond to occlusion of LAD

Back 350

V2-V4

Front 351

in which phase of the cardiac cycle do coronary arteries fill with blood

Back 351

diastole

Front 352

how can you calculate mean arterial pressure

Back 352

2/3 diastole + 1/3 systoleCO x TPR

Front 353

what electrophysiologic reason could make a QRS complex become wider

Back 353

origin of depolarization is distal to AV nodedelay along the ventricular conduction system

Front 354

Dx, Rx and MCC:otoscopy of a child presenting with acute onset of ear pain reveals large reddish vesicles on the TM

Back 354

Dx: bullous myringitisMCC: mycoplasmaRx: macrolides

Front 355

Dx & Rxburn px with cherry red flushed skin, O2 sat is normal but carboxyhemogllobin is elevated

Back 355

Dx: CO2 PoisoningTx: 100% O2 or hyperbaric O2

Front 356

Rxpatient with aldosterone deficiency

Back 356

fludrocortisone

Front 357

EKG finding that is suggestive of myocardial ischemia during exercise

Back 357

**ST depression > 1mmST elevationU-wave inversion

Front 358

if angina or ischemia occurs during a stress test, what test should follow

Back 358

coronary angiography with possible angioplasty

Front 359

how do statins reduce the incidence of myocardial infarction

Back 359

lower LDLanti-inflammatory effectsinhibit plt thrombus formationimprove coronary endothelial function

Front 360

lipid lowering agent:SE flushing

Back 360

niacin

Front 361

lipid lowering agent:SE elevated LFT and myositis

Back 361

statins and fibrates

Front 362

lipid lowering agent:SE of GI discomfort, bad taste

Back 362

bile acid sequestrants

Front 363

lipid lowering agent:best for HDL

Back 363

niacin

Front 364

lipid lowering agent:best for TGs

Back 364

fibrates

Front 365

lipid lowering agent:best for LDL/cholesterol

Back 365

statins

Front 366

lipid lowering agent:binds to C difficile

Back 366

cholestyramine

Front 367

LDL recommendations for px based on their CAD risk factors

Back 367

0 - 1 RF's: LDL < 1602+ RF's: LDL < 130CAD/Eq: LDL <100

Front 368

what are risks for CAD

Back 368

tabacco useHTN or currently on a antihypertensiveHDL < 40FHx of CAD (males < 55 & females < 65)AGE (males > 45 & females > 55)

Front 369

how can the "flushing" reaction of niacin be prevented

Back 369

ASA (1/2 - 1 hr before taking niacin)NSAID's (1/2 - 1 hr before taking niacin)continued use(flushing reaction will subside with time)take it in the eveningtake with a low-fat snackavoid hot beverages & spicy foods

Front 370

with what are chvostek and trousseau sign assoc'd

Back 370

hypocalcemia

Front 371

area of the brain lesioned:contralateral hemiballismus

Back 371

subthalamic nucleus

Front 372

area of the brain lesioned:hemispatial neglect syndrome

Back 372

non-dominant parietal lobe

Front 373

area of the brain lesioned:coma

Back 373

reticular activating system, RAS (i.e. pontine lesion)

Front 374

area of the brain lesioned:poor repitition

Back 374

arcuate fasciculus

Front 375

area of the brain lesioned:poor comprehension

Back 375

Wernicke's area

Front 376

area of the brain lesioned:poor vocal expression

Back 376

broca's area

Front 377

Rx for prinzmetal angina

Back 377

**Dihydropyridine CCB's (nifedopine, amlodipine)Non-dihydropyridine CCB's (verapamil, diltiazem)NitratesAVOID: non-selective B-Blockers (e.g. propranolol)ASA

Front 378

most likely cause of chest painST segment elevation only during brief episodes of CP

Back 378

prinzmetal angina

Front 379

most likely cause of chest painlocalized with one finger

Back 379

costochondritis

Front 380

most likely cause of chest painchest wall tenderness on palpation

Back 380

musculoskeletal

Front 381

most likely cause of chest painrapid onset sharp CP that radiates to the scapula

Back 381

aortic dissection

Front 382

most likely cause of chest painrapid onset sharp CP in 20 y/o with assoc'd dyspnea

Back 382

spontaneous pneumothorax

Front 383

most likely cause of chest painoccurs after meals, improved with antacids

Back 383

GERDesophageal spasm

Front 384

most likely cause of chest painsharp pain lasting hours to days and somewhat relieved by sitting forward

Back 384

pericarditis

Front 385

most likely cause of chest painpain worsened by deep breathing or motion

Back 385

pleuritic or musculoskeletal

Front 386

most likely cause of chest painalong dermatome

Back 386

Herpes zoster (pain may appear before the rash)

Front 387

most likely cause of chest painMCC of noncardiac CP

Back 387

GERDmusculoskeletal

Front 388

most likely cause of chest painacute onset dyspnea, tachycardia, confusion in hospitalized pt

Back 388

pulmonary embolism

Front 389

most likely cause of chest painpain began a day following the start of an intense exercise program

Back 389

musculoskeletal

Front 390

most likely cause of chest painwidened mediastinum on CXR

Back 390

aortic dissection

Front 391

which patient population is more likely to have atypical angina during episode of myocardial ischemia

Back 391

diabeticswomenelderly

Front 392

how does nitroglycerin work acutely in cardiac ischemic episodes

Back 392

PERIPHERAL VENOUS VASODILATION -->decr'd preloaddecr'd cardiac O2 demandNOTE: with ACUTE ISCHEMIA, coronary arteries are already maximally dilated, therefore, NTG cannot further dilate them!

Front 393

why shouldnt chest pain relieved by nitroglycerin be diagnostic of cardiac nature

Back 393

can also relieve esophageal spasm and GERD

Front 394

MOA:streptokinase

Back 394

converts plasminogen --> plasmin --> degrades fibrin

Front 395

MOA:aspirin

Back 395

irreversibly inhibits COX 1 - 2 --> prevents plt aggregation

Front 396

MOA:clopidogrel

Back 396

ADP receptor blocker --> prevents plt aggregation

Front 397

MOA:abciximab

Back 397

GP IIb/IIIa Inhibitor --> prevents plt aggregation

Front 398

MOA:tirofiban

Back 398

GP IIb/IIIa Inhibitor --> prevents plt aggregation

Front 399

MOA:ticlopidine

Back 399

ADP receptor blocker --> prevents plt aggregation

Front 400

MOA:enoxaparin

Back 400

catalyzes activation of antithrombin

Front 401

MOA:eptifibatide

Back 401

GP IIb/IIIa Inhibitor --> prevents plt aggregation

Front 402

cause of hyperthyroidism: extremely tender thyroid gland

Back 402

subacute thyroiditis (i.e. De Quervain's)

Front 403

cause of hyperthyroidism:pretibial myxedema

Back 403

Grave's disease

Front 404

cause of hyperthyroidism:pride in recent wt loss, medical professional

Back 404

exogenous thyroid use

Front 405

cause of hyperthyroidism:palpation of single thyroid nodule

Back 405

toxic thyroid adenoma

Front 406

cause of hyperthyroidism:palpation of multiple thyroid nodules

Back 406

multinodular goiter

Front 407

cause of hyperthyroidism:recent study using IV contrast dye

Back 407

job-basedow phenomenon

Front 408

cause of hyperthyroidism:proptosis, ocular edema, & ocular injection

Back 408

Grave's disease

Front 409

cause of hyperthyroidism:h/o thyroidectomy or radioablation of thyroid

Back 409

excess thyroid hormone replacement

Front 410

Rx of opioid overdose

Back 410

naloxonenaltrexone

Front 411

classic presentation of aspirin overdose

Back 411

n/v & dehydrationtinnitushyperthermiaAMSrespiratory alkalosis (hyperventilation) --> mixed respiratory acidosis & metabolic acidosis with high AG

Front 412

first line treatment for growth hormone-secreting pituitary adenoma

Back 412

transsphenoidal tumor resection

Front 413

meds for all post-MI outpatients

Back 413

ASA or clopidogrelB-BlockersACEI/ARBstatinaldosterone antagonist

Front 414

Rx proven to reduce mortality following MI

Back 414

B-BlockersACEI's/ARB'sStatins

Front 415

what labs should be ordered in patients suspected of having an MI

Back 415

SERIAL CARDIAC ENZYMES:3 sets of Troponin-I q8 hrs3 sets of CKMB q8 hrs

Front 416

MCC of death in patients with acute myocardial infarction

Back 416

arrhythmia (V-Fib)

Front 417

What is timeline for thrombolytics to be given in MI vs CVA

Back 417

MI: 12 hrs after onset of sx'sCVA: 3 hrs after onset of sx's

Front 418

EKG leads & involved vessel:anterior wall MI

Back 418

LEADS: V2 - V4VESSEL: LAD

Front 419

EKG leads & involved vessel:septal MI

Back 419

LEADS: V1 - V3VESSEL: LAD

Front 420

EKG leads & involved vessel:inferior wall MI

Back 420

LEADS: II, III, aVFVESSEL: posterior descending

Front 421

EKG leads & involved vessel:lateral wall MI

Back 421

LEADS: I, aVL, V5, V6VESSEL: LAD/left circumflex

Front 422

Dxpx has HTN, mild hypernatremia, hypokalemia, metabolic alkalosis

Back 422

PRIMARY HYPERALDOSTERONISM:Conn's Syndromeb/l adrenal hyperplasia

Front 423

antidote for:salicylates

Back 423

activated charcoalNa+Bicarbdialysis

Front 424

antidote for:B-Blocker

Back 424

atropineglucagonCa2+insulin & dextroseatropine

Front 425

antidote for:digoxin

Back 425

activated charcoalDig Fab fragments

Front 426

antidote for:iron

Back 426

deferoxamine

Front 427

antidote for:copper

Back 427

penicillamine

Front 428

antidote for:t-PA and Streptokinase

Back 428

aminocaproic acid

Front 429

Rx for MI due to cocaine overdose

Back 429

Benzo's (e.g. Lorazepam)CCB's** DO NOT GIVE B-BLOCKERS

Front 430

type of heart block:PR interval is longer than .2 sec (5 small boxes)

Back 430

1st degree

Front 431

type of heart block:no relationship between P and QRS

Back 431

3rd degree

Front 432

type of heart block:PR interval becomes progressively longer until beat dropped

Back 432

2nd degree - Type I (aka Weinckebach's)

Front 433

type of heart block:PR interval fixed but with occasional blocked beats

Back 433

2nd degree - Type II

Front 434

which heart block needs a pacemaker

Back 434

2nd degree - Type II3rd degree

Front 435

an EKG shows complete independence of P waves and QRS, what is the next best step

Back 435

Dx: 3rd degree blockTx: pacemaker

Front 436

pathology with EKG:narrow QRS not a/w P wavesrate of 60 bpm

Back 436

junctional rhythm

Front 437

pathology with EKG:narrow QRS not a/w P waverate > 60 but < 100

Back 437

accelerated junctional rhythm

Front 438

pathology with EKG:narrow QRS not a/w P waverate > 100

Back 438

junctional tachycardia

Front 439

What is the tx for premature atrial contractions (PAC's)

Back 439

observationreduce caffeinestop smokingr/o hyperthyroidism

Front 440

px has atrial fib with rapid ventricular rate, he had a chronic atrial fib previously, what should be done before cardioversion

Back 440

transesophageal echo (to look for atrial thrombus)

Front 441

which endocrine disorder can cause atrial fib

Back 441

hyperthyroidism

Front 442

what is the drug of choice for acute onset atrial fib with rapid ventricular rate in a px with WPW

Back 442

procainamideelectrical cardioversion

Front 443

Dx for multifocal atrial bradycardia (MFAB)

Back 443

3+ different P wave morphologies< 60 bpm

Front 444

Dx for wandering pacemaker (aka multifocal atrial rhythm)

Back 444

3+ different P wave morphologies< 100 bpm

Front 445

Dx for multifocal atrial tachycardia (MFAT)

Back 445

3+ different P wave morphologies> 100 bpm

Front 446

what is the drug of choice for paroxysmal supraventricular tachycardia

Back 446

carotid massageIV adenosine

Front 447

pathology with EKG:wide QRS not a/w P wavesrate 20-40

Back 447

ventricular rhythm

Front 448

pathology with EKG:wide QRS not a/w P waves rate > 40 but < 100

Back 448

accelerated ventricular rhythm

Front 449

pathology with EKG:wide QRS not a/w P waverate > 100

Back 449

ventricular tachy

Front 450

pathology with EKG:chaotic, no p-waves, no QRS

Back 450

V fib

Front 451

pathology with EKG:erratic QRS that varies in amplitude in a repeating pattern (sinusoidal)

Back 451

torsades

Front 452

antiarrhythmic that should be avoided in px with preexisting lung disease

Back 452

Amiodarone

Front 453

What are some common SE's with the use of amiodarone & what should be monitored

Back 453

Pulmonary fibrosis (monitor PFT's & diffusion capacity before starting & q 6 months)Liver damage (monitor LFT's)Hyper/hypothyroidism (monitor TFT's)

Front 454

what are the classes of anti-arrhythmics

Back 454

"SoBe PoCa"CLASS I: Na+ channel blockers ("So" = sodium)CLASS II: B-Blockers ("Be" = Beta)CLASS III: K+ channel blockers ("Po" = potassium)CLASS IV: CCB's ("Ca" = calcium)OTHER: Adenosine

Front 455

generally, what arrhythmias do each anti-arrhythmic class tx

Back 455

CLASS I: V-Tach (lidocaine)CLASS II:PVC'sA-fib/flutterMATV-TachCLASS III:A-fib/flutterCLASS IV:A-fib/flutterPSVTMATADENOSINE:PSVT (unless 2nd/2 WPW)

Front 456

What is Rx for SVT vs SVT 2nd/2 WPW

Back 456

SVT: AdenosineSVT 2ND/2 WPW:amiodaroneprocainamidecatheter ablation of accessory pathway**DO NOT GIVE ADENOSINE

Front 457

area of the brain lesioned:resting tremor

Back 457

basal ganglia

Front 458

area of the brain lesioned:intention tremor

Back 458

cerebellar hemisphere

Front 459

area of the brain lesioned:hyperorality, hypersexuality, disinhibited behavior

Back 459

b/l amygdala

Front 460

area of the brain lesioned:personality changes

Back 460

frontal lobe

Front 461

area of the brain lesioned:dysarthria

Back 461

cerebellar vermis

Front 462

area of the brain lesioned:agraphia, acalculia, & finger agnosia

Back 462

L parietal (dominant)

Front 463

organism a/w with causing infection in burn px

Back 463

pseudomonas aeruginosa

Front 464

Rx for atrial fib of unknown duration

Back 464

RATE CONTROL:B-BlockerNon-DHP CCB (e.g. verapamil)DigoxinANTICOAGULATE:WarfarinHeparin

Front 465

what are Kerley B lines and what are they associated with

Back 465

subpleural interstitial (interlobular septa) thickeningseen on CXR in periphery of the lower lung zones2nd/2 pulmonary edemaETIOLOGIES:LV failure, mitral valve diseaselymphatic obstruction, lymphangitis, carcinomatosisasbestosis, sarcoidosis

Front 466

what is the normal range for the ejection fractionwhat EF is considered HF

Back 466

nl = 55-75 %HF < 55%

Front 467

what two cardiovascular diseases have the biggest risk factors for CHF

Back 467

HTNCAD

Front 468

what ECG finding may indicate a very early stage HF

Back 468

LVH

Front 469

what lab markers are used to help Dx acute exacerbations of CHF

Back 469

BNP

Front 470

what medications are important in the outpatient Rx for chronic congestive heart failure

Back 470

**ACEI's (& certain ARB's)**B-Blockers (bisoprol, carvedilol, metoprolol XR)**Aldosterone Antagonist (e.g. spironolactone)Loop diuretics (e.g. furosemide)Digoxinloopsaldosterone -digoxin

Front 471

Rx for acute exacerbations of CHF

Back 471

DISCONTINUE B-BLOCKERS (during exacerbation)"LMNOP"loopsmorphinenitratesoxygenposition/pressors (e.g. dobutamine)

Front 472

in which population are triptans contraindicated

Back 472

CADprinzmetal anginapregnancy

Front 473

what drugs block transmission through AV node

Back 473

B-BlockersNon-DHP CCB's (e.g. verapamil, diltiazem)digoxin

Front 474

what causes stones, bones, groans and psychic overtones

Back 474

hypercalcemia (MCC = hyperparathyroidism)

Front 475

what valves have blood flowing during systole

Back 475

aortic & pulmonic valves

Front 476

what valves have blood flowing during diastole

Back 476

mitral & tricuspid valves

Front 477

what are the systolic heart murmurs

Back 477

AS/PSMR/TRVSD/MVP

Front 478

what are the diastolic heart murmurs

Back 478

MS/TSAR/PR

Front 479

what is next step in mgmt in w/u of a low-grade systolic murmur in an otherwise healthy, asx'c pt

Back 479

no further w/u

Front 480

what is next step in mgmt in w/u of a diastolic murmur in an otherwise healthy, asx'c pt

Back 480

echocardiogram

Front 481

type of heart murmur:diastolic murmur heard best at LLSB, that increases with inspiration

Back 481

tricuspid stenosis

Front 482

type of heart murmur:late diastolic murmur with an opening snap (no change with inspiration)

Back 482

mitral stenosis

Front 483

type of heart murmur:systolic murmur heard best in the 2nd RICS, parasternal

Back 483

aortic stenosis

Front 484

type of heart murmur:systolic murmur heard best in the 2nd LICS, parasternal

Back 484

pulmonic stenosis

Front 485

type of heart murmur:late systolic murmur best heard at the apex

Back 485

MVP

Front 486

type of heart murmur:diastolic murmur with widened pulse pressure

Back 486

aortic regurg

Front 487

type of heart murmur:holosystolic murmur that is louder with inspiration at the LLSB

Back 487

tricuspid regurgVSD

Front 488

type of heart murmur:holosystolic murmur heard at the apex and radiates to the axilla

Back 488

mitral regurg

Front 489

what is the MCC of CP in a pt with sudden tearing CP radiating to the back

Back 489

aortic dissection

Front 490

increased skin pigmentation is seen in pts with which kind of adrenal insufficiency

Back 490

primary adrenal insufficiency (aka Addison's)

Front 491

what are the classic sx's of Parkinson's

Back 491

resting tremor ("pill rolling")cog-wheel rigiditymask-like faciesshuffling gaitpostural instability

Front 492

What is Kussmaul sign

Back 492

Definition: JVD with inspirationPathology: decr'd capacity of RVDiseases: constrictive pericarditis >> tamponade

Front 493

What is Pulsus Paradoxus

Back 493

Definition: decr'd SBP with inspiration ( > 10 mmHg) Pathology: decr'd capacity of LVDiseases: tamponade >> pericarditis

Front 494

What is Beck's Triad & when is it seen

Back 494

Seen with TAMPONADEJVD (decr'd capacity of RV)hypotension (decr'd capacity of LV)distant heart sounds

Front 495

What is the classic appearance of the heart on CXR of a pt with pericardial effusion

Back 495

enlarged, globular heart ("water bottle" shaped)

Front 496

What is the tx for cardiac tamponade

Back 496

immediate pericardiocentesis

Front 497

What disease has signs of heart failure + DM + elevated LFT's

Back 497

HEMOCHROMATOSIS:Fe2+ deposition in heart --> dilated/restrictive cardiomyopathyFe2+ deposition in pancrease --> DMFe2+ deposition in liver --> incr'd LFT's

Front 498

in what scenarios might you see kussmaul sign

Back 498

Kussmaul sign = incr'd JVD with inspirationconstrictive pericarditisrestrictive cardiomyopathycardiac tamponadeRV infarctmassive PE

Front 499

what are the symptoms of neuroleptic malignant syndrome

Back 499

AMSmuscle rigidityhyperthermiaautonomic instabilityrhabdomyolysis

Front 500

what is the treatment of neuroleptic malignant syndrome

Back 500

d/c neurolepticcooling (for hyperthermia)dantrolene (or bromocriptine or amantadine)IVF's (to prevent rhabdomyolysis)

Front 501

what are the common viruses of myocarditis

Back 501

echovirusadenovirusEBV/CMVcoxsackieinfluenza

Front 502

Dx:S. american with cardiomegaly and achalasia

Back 502

chagas disease (trypanosoma cruzi)

Front 503

what is the bug that causes Chagas Ds & what are the common findings

Back 503

Bug: trypanosoma cruziSx's: cardiomegaly, mega-esophagus (a/w achalasia), mega-colon

Front 504

what are the major jones criteria for rheumatic heart disease

Back 504

joint pain (arthropathy)heart (pancarditis)subcutaneous noduleserythema marginatumsydenham chorea

Front 505

What bugs should be considered with high suspicion of endocarditis but cultures are negative

Back 505

"HACEK" organisims:haemophilusactinobacilluscardiobacteriumeikenellakingella

Front 506

what study is used to visualize a vegetation in a heart valve

Back 506

TEE

Front 507

Describe the 4 peripheral signs of endocarditis:

Back 507

JANEWAY LESIONS:PAINLESS petechiae on palm/solesOSLER'S NODES:PAINFUL nodules on fingers/toesROTH SPOTS:retinal hemorrhagesSPLINTER HEMORRHAGES:petechiae under the nails

Front 508

Dx:hypocalcemia, high phosphorus, & low PTH

Back 508

hypoparathyroidism

Front 509

what is the classic EKG finding in pericarditis

Back 509

Global ST elevation (i.e. seen in all leads)PR interval depression

Front 510

what commonly causes heart failure in young patients

Back 510

myocarditis

Front 511

What is pre-HTN

Back 511

120-139/80-89

Front 512

when should pre-HTN be tx'd

Back 512

H/O OF COMORBIDITY:CV diseaseDMCKDend-organ damage

Front 513

what is the most effective in reducing BP

Back 513

Weight loss

Front 514

what is the MCC of renal artery stenosis

Back 514

fibromuscular dysplasia

Front 515

screening test for renal artery stenosis

Back 515

MRA of renal arteries

Front 516

gold standard to Dx renal artery stenosis

Back 516

renal arteriogram

Front 517

what does renal artery stenosis show on radiologicimaging

Back 517

"beads-on-a-string" appearance

Front 518

MCC of secondary HTN

Back 518

renal disease (CKD, ESRD, RAS)

Front 519

most likely cause of secondary HTN:HTN in arms but low BP in legs

Back 519

coarctation of aorta

Front 520

most likely cause of secondary HTN:proteinuria

Back 520

renal disease

Front 521

most likely cause of secondary HTN:hypokalemia

Back 521

primary hyperaldosteronismRAS

Front 522

most likely cause of secondary HTN:tachycardia, diarrhea, heat intolerance

Back 522

hyperthyroidism

Front 523

most likely cause of secondary HTN:hyperkalemia

Back 523

renal failure

Front 524

most likely cause of secondary HTN:episodic sweating and tachycardia

Back 524

pheochromocytoma

Front 525

what lab marker is used to help dx acute CHF exacerbation

Back 525

BNP

Front 526

w/u for underlying cause of DKA

Back 526

R/O INFECTION:blood/urine cultures, UA, CXRR/O DRUGS:tox screenR/O PANCREATITIS:amylase/lipaseR/O MI:EKGcardiac enzymes x 3

Front 527

what is the preferred initial antihypertensive in a px with no comorbidities

Back 527

thiazide

Front 528

first line antihypertensive:diabetes

Back 528

ACEI's/ARB's

Front 529

first line antihypertensive:heart failure

Back 529

ACEI'sB-BlockersAldosterone antagonist

Front 530

first line antihypertensive:BPH

Back 530

a1-Blocker

Front 531

first line antihypertensive:LV hypertrophy

Back 531

ACEI's/ARB's

Front 532

first line antihypertensive:hyperthyroidism

Back 532

B-Blocker (e.g. propranolol)

Front 533

first line antihypertensive:osteoporosis

Back 533

thiazides

Front 534

first line antihypertensive:benign essential tremor

Back 534

B-Blocker (e.g. propranolol)

Front 535

first line antihypertensive:post-menopausal woman

Back 535

thiazides

Front 536

first line antihypertensive:migraines

Back 536

B-BlockersCCB's (e.g. verapamil)

Front 537

SE of antihypertensive:first dose orthostatic hypotension

Back 537

a-Blockers

Front 538

SE of antihypertensive:hypertrichosis

Back 538

minoxidil

Front 539

SE of antihypertensive:dry mouth, sedation, severe rebound HTN

Back 539

clonidine (a2-agonist)

Front 540

SE of antihypertensive:bradycardia, impotence, asthma exacerbation

Back 540

non-selective B-Blocker

Front 541

SE of antihypertensive:reflex tachycardia

Back 541

vasodilators (eg. hydralazine, nitrates)

Front 542

SE of antihypertensive:cough

Back 542

ACEI's

Front 543

SE of antihypertensive:avoid in px with sulfa allergy

Back 543

loopsthiazides

Front 544

SE of antihypertensive:angioedema

Back 544

ACEI's

Front 545

SE of antihypertensive:development of drug-induced lupus (anti-histone AB's)

Back 545

hydralazine

Front 546

SE of antihypertensive:cyanide toxicity

Back 546

Na+ nitroprusside

Front 547

what is dilated by:hydralazine

Back 547

arteries

Front 548

what is dilated by:CCB

Back 548

arteries & veins

Front 549

what is dilated by:nitroprusside

Back 549

arteries & veins

Front 550

what is dilated by:nitroglycerin

Back 550

venodilation

Front 551

what is the MCC of cushings syndrome

Back 551

#1 exogenous glucocorticoids#2 pituitary ACTH-secreting tumor (i.e. Cushing's Ds)

Front 552

what is the Parkland burn formula

Back 552

4mL x body wt in kg x %BSA:1/2 given in 1st 8 hrs1/2 given over following 16 hrs

Front 553

what is becks triad for cardiac tamponade

Back 553

JVD (decr'd capacity of RV)hypotension (decr'd capacity of LV)distant heart sounds

Front 554

hypoperfusion and resultant tissue ischemia are the concern in shock pt'swhat is the chemical marker for this

Back 554

lactate

Front 555

what complications can arise from the use of vasopressors such as NE in treating shock

Back 555

ischemia/necrosis of fingertips/toesmesenteric ischemiarenal failure

Front 556

pathophysiology of shock:cardiogenic

Back 556

failure of the pump

Front 557

pathophysiology of shock:extracardiogenic

Back 557

compression of the pump

Front 558

pathophysiology of shock:hypovolemic

Back 558

not enough fluid to pump

Front 559

pathophysiology of shock:anaphylactic

Back 559

widespread vasodilation in response to allergen

Front 560

pathophysiology of shock:neurogenic

Back 560

widespread vasodilation due to loss of autonomic-regulated vascular tone

Front 561

pathophysiology of shock:septic

Back 561

widespread vasodilation due to massive release of inflammatory mediators

Front 562

CO, SVR, PCWP:cardiogenic shock

Back 562

CO: decr'dSVR: incr'dPCWP: incr'd(source: Step-Up-to-Med, 2nd ed)

Front 563

CO, SVR, PCWP:hypovolemic shock

Back 563

CO: decr'dSVR: incr'dPCWP: decr'd(source: Step-Up-to-Med, 2nd ed)

Front 564

CO, SVR, PCWP:neurogenic

Back 564

CO: decr'dSVR: decr'dPCWP: decr'd(source: Step-Up-to-Med, 2nd ed)

Front 565

CO, SVR, PCWP:septic

Back 565

CO: incr'dSVR: decr'dPCWP: decr'd(source: Step-Up-to-Med, 2nd ed)

Front 566

what are the 2 MC SE's of statin use & assoc'd labs

Back 566

hepatotoxicity: elevated LFTsmyositis: elevated CPK

Front 567

which BP medication should be avoided in px with ischemic stroke or SAH b/c of the increase in ICP

Back 567

nitroprussidenitroglycerin

Front 568

what are the indications for surgical repair of aortic aneurysm

Back 568

diameter > 5.5 cm for mendiameter > 5.0 cm for womendiameter increase by more than 5 mm in 6 monthssx'c (e.g. tenderness, pain in abdomen or back)

Front 569

What are the components of management of peripheral artery disease (PAD)

Back 569

smoking cessationexercise (to increase collateral flow)glucose & BP controlcilastozol (improve flow to LE & decr claudication)ASA or clopidogrel + statin (to reduce CV events)

Front 570

how do confirm Dx of aortic dissection

Back 570

CT - chest with contrast

Front 571

Who should be screened for an AAA

Back 571

MEN 65-75 y/o with h/o smokingSX'C PT's (e.g. pulsatile abdominal mass)

Front 572

What study should be ordered for a pt suspected of having a AAA

Back 572

ultrasound

Front 573

what is the next best step in the management of a px with a DVT that has a high likelihood of falling

Back 573

IVC filter

Front 574

How is Kawasaki's dx'd

Back 574

Fever + 4/5 "CRASH" sx'sConjuctivitis (b/l, non-exudative, painless)Rash (truncal)Adenopathy (cervical LN's)Strawberry tongue + diffuse mucous membrane erythemaHands and Feet: edema with induration, erythema, or desquamation

Front 575

how is kawasaki treated

Back 575

IVIGhigh-dose aspirin (acute phase)low-dose aspirin (48-hrs after fever resolution)echocardiogram(during acute phase + 6-8 wks later)

Front 576

vasculitis a/w:weak pulse on upper extremity

Back 576

takayasu's

Front 577

vasculitis a/w:necotizing immune complex inflammation of visceral/renal vessels

Back 577

PAN

Front 578

vasculitis a/w:young male smokers

Back 578

buerger's

Front 579

vasculitis a/w:young asian women

Back 579

takayasu's

Front 580

vasculitis a/w:young asthmatics

Back 580

churg-strauss

Front 581

vasculitis a/w:infants and young children, involves coronary arteries

Back 581

kawasaki

Front 582

vasculitis a/w:MCC of vasculitis

Back 582

temporal arteritis

Front 583

vasculitis a/w:a/w Hep B infection

Back 583

PAN

Front 584

vasculitis a/w:occlusion of opthalmic artery that leads to blindness

Back 584

temporal arteritis

Front 585

vasculitis a/w:unilateral headache, jaw claudication

Back 585

temporal arteritis

Front 586

what autoimmune complication occurs 2-4 weeks post-MI

Back 586

dressler syndrome --> pericarditis (fever, incr'd ESR)

Front 587

what type of psychotherapy is used to treat phobias, obsessive compulsive disorders and panic disorders

Back 587

cognitive behavioral therapy

Front 588

ebsteins anomoly is a/w

Back 588

maternal lithium use

Front 589

what is found in ebsteins anomaly

Back 589

tricuspid leaflets are displaced into RVhypoplastic RV & dilated RAtricuspid regurg, wide split S2patent foramen ovale (80%)

Front 590

for which arrhythmias are pt's with ebstein's anomaly at incr'd risk; what causes this incr'd risk

Back 590

SVT & WPW2nd/2 dilated right atrium

Front 591

Dx:6 week old infant present to ER with irritability and signs of L sided heart failureEKG finds a left sided MI

Back 591

Dx: anomolous origin of the L main coronary artery(arises from pulmonary artery rather than the aorta)

Front 592

MC congenital heart defect

Back 592

VSD

Front 593

what is used to close a PDA

Back 593

indomethacin

Front 594

what is used to keep PDA open in px with TOGV

Back 594

prostaglandin E

Front 595

what are the abnormalities a/w tetrology of fallot

Back 595

VSDoverriding aortapulmonary stenosis (RV outflow obstruction)RVH

Front 596

what heart defect are down syndrome patients higher risk of getting

Back 596

endocardial cushion defect

Front 597

What are the unique structures of the fetal circulation that close after birth

Back 597

umbilical vein & 2 umbilical arteries ductus venosus foreman ovale ductus arteriosus

Front 598

Primary/Essential HTN

Back 598

>140/>90 on 3 separate occasions. obesity, tobacco, salt diet. Retinal-arterovenous nicking, cotton wool spots, retinal hemorrhages. Tx 1-Wt loss, salt restriction, alcohol reduction 2- Diuretic (thiazide) then add drug to affect the comorbid condition (ACEI/BB-CAD, ACEI-DM, CCB-vasospasms)

Front 599

DM

Back 599

ACEI C: Thiazides-inc glucoseC: BB-mask hypoglycemia

Front 600

CHF

Back 600

ACEI/Diuretics C: CCB may exacerbate HF

Front 601

Post MI

Back 601

BB/ACEI decreae mortality

Front 602

BPH

Back 602

alpha-1 adrenergic blockers - Prazosin or Terazosin (Tamsulosin least effect on HTN but least side effects overall)

Front 603

Migranes

Back 603

BB

Front 604

Osteoporosis

Back 604

Thiazides

Front 605

Ashtma/COPD

Back 605

C:BB

Front 606

Pregnancy

Back 606

C: Thiazides-decrease blood volume, ACEI/ARB-Teratogenic

Front 607

Gout

Back 607

C: Diuretic increase UA

Front 608

Depression

Back 608

C: BB may worsten symptoms

Front 609

Secondary HTN

Back 609

Identify the cause and treat

Front 610

Hypertensive Urgency

Back 610

high BP with mild symptoms lower in 24hrs Tx Captopril PO, Clonodine PO

Front 611

HTN Emergency

Back 611

high BP with end organ damage lower bp in 1 hr Tx Labetalol Nitroprusside

Front 612

Malignant HTN

Back 612

high BP with progressive RF, encephalopathy/papiledema

Front 613

normal systemic vascular resistance

Back 613

~1000-1600 dyne*sec/cm

Front 614

CVP

Back 614

3-5cc

Front 615

RA

Back 615

0-8

Front 616

Pulmonary

Back 616

32-48/16-24

Front 617

LA PCWP

Back 617

8-10

Front 618

LV

Back 618

140/8-10

Front 619

Aorta

Back 619

120/80

Front 620

systolic RA RV Pul LA LV

Back 620

RA3-Pul25/10-LA10-LV140/10-A120/80

Front 621

Shock

Back 621

general rule all have low CO except septic shock

Front 622

Cardiogenic

Back 622

MI, Arrythmias

Front 623

Right

Back 623

inc CVP PCWP dec CO inc TPR, responds to IVF inc CWP

Front 624

Left

Back 624

inc CVP dec PCWP CO TPR, responds to IVF inc CWP

Front 625

Tamponade

Back 625

inc CVP PCWP dec CO inc TPR, no response

Front 626

Lung (PE, Air Embolus, Pn Thx, ARDS

Back 626

inc CVP dec PCWP CO inc TPR, no reponse

Front 627

Hypovolemic

Back 627

everything low except TPR, responds to IVF inc CWP

Front 628

Septic

Back 628

everthing low excetp CO, responds to IVF -only one with a high mixed V-O2 body is using lactic acid not O2

Front 629

Neurogenic

Back 629

everything low, no responce to IVF

Front 630

Aortic Aneurysm

Back 630

MC Atherosclerosis Connective tissue dz - cystic medial necrosis Syphillis - vasovasorum inflammation.

Front 631

AAA

Back 631

screen >65 who ever smoked. pulsating, abdominal mass, abd bruits. US, CT/MRI for accurate localization and size. TX <5 follow symptomatic or >6 surgery. Complication Ischemic colitis, stroke, paraplegia, renal insufficiency

Front 632

Aortic Dissection

Back 632

ripping chest pain , decreased peripheral pulses, CXR/Echo/CT Gold St:Angiogram wide mediastinum, A-ascending aorta tx surgery : B: distal to subclavian decrease bp treat medically

Front 633

Leg pain that improves with rest, resting leg pain if severe, dry skin, ulcers.

Back 633

Peripheral Vascular Dz: HTN, DM, CAD. Ankle Brachial Index <1, <0.4 severe. US for locating stenosis, Arteriogram, Tx Exercise, foot exams, ASA, pentoxifyllin or cilostazol, bypass if severe (resting pain, necrotic foot) Prolonged ischemia - amputation dont be afraid to choose it

Front 634

tortuosity of veins, edema, ulcerations.

Back 634

Tx exercise, compression hosiery, leg elevation.

Front 635

palpable, warm, pulsating masses

Back 635

AVM, risk of thrombus, surgical removal if symptomatic

Front 636

deep leg pain, swelling warmth

Back 636

DVT, rf prolonged inactivity, pregnancy, OCP, tobacco. inflammation-thombophlebitis Radio: US or Contrast venography. Tx leg elevations, heparin-warfarin, comp: PE 40% mortality

Front 637

palpable purpura or ulcers on skin, hematuria, HTN, joint pain

Back 637

PAN, rf: HepB/C young, everything but lungs involved, LAB: inc WBC ESR, Dec Hgb, protienuria, hematuria, p-ANCA, Dx biopsy artery. Radio: angiogram with numerous aneurysms. Tx corticosteroids

Front 638

new onset headache, jaw claudication, scalp pain, temporal tenderness

Back 638

Temporal Arteritis, women >50, inc ESR, temp artery bpx: inflammation in vessel media and lymphocytes, giant cell in adventitia. Elevated ESR, tx Prednisone

Front 639

decrease carotid and limb pulses

Back 639

Takayasu's arteritis, inflammation of aorta, bpx plasma lymphocytes in adventitia. tx corticosteroids Comp: cerebrovascular or MI

Front 640

Asthmatic symptoms older px, fatigue, malaise

Back 640

Churge Strauss allergic angiitis, eosinophils in biopsy and cbc. Tx Corticosteroids

Front 641

recent upper respiratory infection, arthritis, palpable purpura, abdominal pain

Back 641

children, IgA vasculitis, Tx self limiting or Corticosteroids for GI symptoms

Front 642

desquamation of hands and feet, lymphadenopathy, conjunctival lesions, maculopapular rash

Back 642

Kawasaki's necrotizing inflamation, young children, coronary vasculitis- aneurysm, MI sudden death. Tx ASA IVIg

Front 643

CRASH and Burn

Back 643

Conjunctivits, Rash, Adenopathy, Strawberry tongue, Hand and Foot, Burn >40-5d

Front 644

pansystolic murmur at lower left sternal border

Back 644

VSD, most common cong disease. Echo, small follow large-close before eisenmenger's

Front 645

wide fixed S2 systolic ejection murmur at upper left border

Back 645

ASD, untreated ASD, surgery when pulmonary blood flow is twice that of systemic. Comp: Eisenmenger's, RV dysfunction, Pul HTN, arrythmias

Front 646

machinery murmer 2nd intercostal space, bounding pulses

Back 646

PDA; rf prematurity, high altitude, rubella, maternal prostaglandins. CXR: cardiomegaly, Echo: LA and LV, DX: Angiogram Tx: Indomethacin closure, surgical if unrespnsive

Front 647

cyanosis worsens with closure of PDA, loud S2

Back 647

Transposition of GV, incompatidble with life-PDA or VSD, apert's syndrome, CXR: narrow heart base, abnormal pulmonary markings, Dx: Echo for dx, Tx: Prosta E2 to keep open. Balloon atrial septostomy to widen VSD, promp surgical correction

Front 648

cyanosis, failure to thrive, HF, systolic murmur at lower left sternal border, loud S1 S2 bounding pulses

Back 648

Persitent Truncus Arteriousis, CXR: Boot shaped heart, Dx: angio or echo for dx. Tx Surgery

Front 649

downs syndrome

Back 649

Endocardial cushion defect, ASD/VSD and single atrio Dx:Echo. Tx surgery

Front 650

cyanosis, dysnea, fatigue, child squates to releive hypoxemic event

Back 650

Teratology of Fallot, rf trisomies and cri du chat, PROV Pul stenosis, RVH, Overiding aorta, VSD. CXR boot shaped heart, Tx PG E2, O2, propanolol, fluids and morphine knee to chest for acute episode. Surgical correction