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366 Cards in this Set
- Front
- Back
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moa ipratropium bromide
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prevents bronchoconstriction by blocking muscarinic receptors.
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can ipratropium bromide be combined with albuterol
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yes
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problem with using theophylline
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very low therapeutic index
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what should you thinki about in a pt with recurrent pna in an elderly smoker
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bronchogenic ca
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whould would bronchogenic ca --> recurrent pna
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bronchial obx
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when are hemosiderin laden macrophages seen on bronch
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wegener's
goodpasture's |
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what is the best way to evaluate non-resolving pna or pulmonary infiltrates
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flexible bronchoscopy
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what are the indications for an ivc filter
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recurrent vte and contraind to anti-coag
h/o massive pe where recurrence of add'l pe would be life-threatening chronic pe plus h/o pulm htn |
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how to calculate minute ventilation
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resp rate x tidal volume
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what is the value of fev1/fvc in obx lung dz
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<80%
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what is the value of fev1/fvc in nml lung
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80%
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what pft abnormality do you see in restrictive lung dz
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decreased tlc
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when to tx sarcoidosis
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if there are pulm sx, cardiac, ocular or neurologic sx
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what exam finding indicates airway hyperactivity
what might this indicate |
cough induced by expiration
this is also a clinical clue to asthma |
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what is the link btwn air pollution and asthma
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there is no proven link
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what is considered a positive response to an asthma provocation test
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drop in fev1/fvc by at least 20% from baseline
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what is the #1 prognostic factor for obx lung dz
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fev1 <40% of predicted value
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how to evaluate a pulm nodule that is seen on cxr but there are no old films avail
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get a high res ct
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what are findings of a spn on ct that would indicate malignancy
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eccentric calcification patterns
reticular or punctate calcifications |
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how to evaluate an spn that has characteristics suspicious for malignancy on ct
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VATS to get bx
(FNA is not as good) |
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what is considered a favorable prognosis in sarcoidosis
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erythema nodosum without any other sx
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what pft finding would indicate that an asthma pt would need to be admitted to the hospital
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peak flow drops at least 40-50% of baseline
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criteria for ards dx
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wedge p <18
PaO2:FiO2 <200:1 diffuse bilateral infiltrates on cxr |
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vent management in ards
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keep peep high (around 9)
increase 02 concentration low tidal volume |
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t or f: a low prob v/q scan rules out pe
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false, if the clinical suspicion is high enough, get dopplers of le
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relationship btwn tb and developing pleural effusion
features of effusion how to manage |
you can get a pleural effusion during the tx of tb in pts who are recovering
effusion is usually exudative with lymphocytic predominate thoracentesis for dx and tx |
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how to manage a pt in whom you suspect osa
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first r/o hypothyroidism, then get sleep study
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clinical presentation of IgG3 deficiency
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recurrent sinopulmonary infx
recurrent gi infx |
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what is common variable deficiency associated with
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increased risk of malig
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how fast will it take for a massive pe --> death
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1-2 h
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when should you treat a pt with vte x12 months
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in setting of malignancy
anti-cardiolipin Ab antithrombin deficiency |
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#1 cause for bronchiectasis
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bronchitis
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define bronchiectasis
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permanent abnml dilation of the bronchial walls
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describe erythema nodosum
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red tender subq nodules over lower extremities
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is EN + hilar LAD sufficient to dx sarcoid
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yes
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indications for getting home O2
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PaO2 <55 or SaO2 <88%
or: PaO2 56-59 or SaO2 <89% if cor pulmonale, hct >55%, right heart failure is present |
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who is at risk for aspergillosis
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pts with underlying asthma
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how to dx aspergillosis
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First, check pin prick test and look for rxn to aspergillosis, then
IgE >1000 and precipitate serum AB to aspergillosis |
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how to tx aspergillosis
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oral corticosteroids
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benign calcification patterns of spn on ct
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popcorn, concentric, or laminated calcification
central calcifications diffuse homogeneous calcs |
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how does aspergillosis infx present
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asthma with eosinophilia
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what dairy product can lactose intolerant pts eat that is well-tolerated
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yoghurt
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studies/labs used to dx pancreatitis
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lfts and lipase
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which is more sensitive/specific for pancreatitis: amylase or lipase
why? |
lipase
amylase is released in parotitis, intestinal d/o, fallopian tube tz, arf, cholecystitis |
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what about getting a ruq u/s to dx pancreatitis
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pancreas is obscured in up to 1/3 of pts with pancreatitis (b/c of bowel gas) therefore this can delay the dx
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what to do if a pt with pancreatitis tha twas previously afebrile becomes febrile
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start broad spectrum abs (imepenam)
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management of a pt with ascites, fever, and abd pain
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do paracentesis to check for sbp
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what do pts with variceal bleeding have an increased risk of
how to manage |
sbp
respiratory infx aspiration pna primary bacteremia tx with proph abx (cipro, moxi, or ofloxacin) b/c infx is a greater risk than renal failure |
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why dose arf occur in variceal bleeding
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atn or hepatorenal syndrome
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what is associated with angiodysplasia
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aortic stenosis
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borhaeve syndrove
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esophageal perforation
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complication of boorhaeve's syndrome
how does that present |
acute mediastinits
dyspnea, epigastric pain, shoulder pain, pleural effusion, fever 40% mortality from mediastinitis in first 24 hours |
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best way to dx esophageal perforation
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esophagogram with water soluble contrast (barium --> more mediastinal injury)
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use of ct to dx esophageal tear
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may miss a small tear, do an esophagogram instead
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meds commonly associated with pancreatitis
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diuretics
sulfasalazine 5-asa azathioprine l-asparginine valproic acid pentamidine flagyl tetracycline |
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t or f: pts s/p chole need a low fat diet
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false, no dietary changes required
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possible explanations for anti-HCV AB
how to confirm dx |
1. persistent hcv infx
2. cleared infx 3. false positive confirm with hcv rna (positive predictive value of a+ finding in a pt who is low risk with nml lfts is very low) |
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which medicationis most commonly associated with causing c diff
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clindamycin
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how to tx c diff if recurrent
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flagyl for 1st and 2nd episode, then tx with oral vanc
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effects of smoking on ulcerative coliits
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quitting smoking can trigger flares
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tx of severe ulcerative colitis
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ivf
nutritional support bowel rest pain management steroids |
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complications of uc flare
how to manage |
toxic megacolon
if this develops and pt is refractory to tx x 72 h, do colectomy |
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initial evaluation of a pt with chronic diarrhea
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stool analysis (wbbcs, parasites, fat, osmotic gap)
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histologic changes seen in uc?
crohns? |
superficial mucosal inflammation with infiltration of plasma cells
transmural inflammation |
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how to manage a pt with suspected mallory weiss tear
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do endoscopy first, if no active bleeding, observe then do supportive care
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common association in pts with mallory weiss tear
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hiatal hernia
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dx of lgi bleed
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colonoscopy, however if this is not possible or if there is poor visualization, do a bleeding scan
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how to manage dysphagia in als
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it is progressive, pts will ultimately need a peg tube (peg is preferred to ngt b/c it decreases the risk of sinusitis, is more comfortable, and won't affect speech or breathing)
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what is best initial study to order in suspected stomach perforation
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axr
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how to manage h pylori/ulcer workup
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if pt <45 yo and has no warning signs (weight loss, dysphagia) thne can do non-invasive hp testing (stool ag is preferred)
if >45 yo + warning signs, do endoscopy |
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what do you see on manometry of diffuse esophageal spasm
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increased amplitue of peristaltic contractions
LES wnl |
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how to tx diffuse esophageal spasm
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anti-spasmodics
psych eval diet modifications |
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presentation of zenker's divertic
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food sticks in throat, pt p/w hallitosis, dysphagia, regurg. not painful
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when does a colon polyp not require any followup
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no further tx if:
<2cm, pedunculated and adenomatous polyp is completely excised, it is well differentiated, ther eis no vascular or lymphatic involvement, and no extension of the polyp beyond a stalk |
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how to manage a >2cm sessile colonic polyp
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f/u colonscopy 3-4 months after polypectomy
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f/u if there are multiple adenomatous polyps removed during colonoscopy
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scope in 3y
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f/u in adenoma >1cm
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scope in 3y
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f/u in villous adenoma
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scope in 3 y
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f/u if high grade dysplasia seen on polyp
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scope in 3y
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f/u if 1-2 adenomas present <1 cm each
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scope in 5y
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etiology of peptic stricture
complication |
gerd
obx dysphagia (difficulty with solids, prolonged chewing, swallowing in small portions) |
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how to manage acute cholangitis
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ercp
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what comprises triple therapy for gerd
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amox (or flagyl), clarithromycin, PPI
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how to determine if h pylori has been eradicated
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4-12 wks after completing tx do a fecal ag test (urease breath test --> false neg b/c some forms of the bacteria have decreased urease activity)
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presentation of febrile transfusion rxn
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f/c, responds to nsaids, usually no hemodynamic abnormality and no renal dysfxn
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pathophys behind febrile transfusion rxn
how to minimize this risk |
rxn of hla specific antibodies in pts plasma to donor wbcs
leuko-depletion (ex: cell washing) |
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presentation of acute hemolytic transfusion reaction
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f/c back pain
pink/red urine |
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how to confirm dx of acute hemolytic transfusion reaction
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do coombs test and measure plasma free hb
ua +Hb |
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presentation of acute ischemic colitis
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abd pain + bloody diarrhea (infarction most common at watershed areas)
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initial management of fecal impaction
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initally tx with enemas and suppositories
if this fails, may have to do colonoscopy |
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inications for a rectal tube
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used to tx pseudoobx of colon, with dilated colon and abd distention
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how to initially manage a pt with dysphagia
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barium swallow is best initial test - it's better than doing endoscopy blindly --> perforation
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f/u for pts with barrett's esophagus
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if no dysplasia, do endoscopy q1-3y
with low grade dysplasia, endoscopy q6-12 mo with high grade dysplasia, q3 mo or surgery |
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how to manage mild gerd
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tx with h2 blockers and lifestyle changes, if this fails switch to ppi
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chronic dietary management for chronic pancreatitis
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low fat diet to prevent malabsorption of fat
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what is psyllium used for
|
chronic constipation
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indication for prophylactic abx in pancreatitis
which abx should be used |
if they have severe sx, large fluid collections
pancreatic necrosis with >30% glandular involvement imepenam |
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contraindication to alpha1 blockers
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chf
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benefits of alpha1 blockers other than bp control and bph
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may increase insulin sensitivity
can lower ldl and raise hdl |
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what type of bp med should be used to tx all pts with ckd
why |
ace-i
b/c it decreases intraglomerular pressure, prevents the progression of renal dz and decreases proteinuria |
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complications of proximal ureteral obx
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hydronephrosis, infx, and hemodynamic instability (can be life-threatening)
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how to tx a complicated ureteral obx
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percutaneous nephrostomy, abx
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when can shock wave lithotripsy be used
|
for uncomplicated kidney stones
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presentation of hepatorenal syndrome
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decresaed renal output, change in ms, elevated cr
suspect if no improvement of renal failure despite volume expansion |
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how to dx hepatorenal syndrome as the cause for renal failure
|
check urine na (<10)
incresaed urine osm |
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presentation of aspiratio pneumonitis
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severely obtunded pt with h/o vomiting
sx develop within 2-5 hrs after aspiration |
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how to manage aspiration pneumonitis
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no abx, supportive tx only
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presentation of aspiration pna
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pna occuring 1-5d after aspiration
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organisms involved in aspiration pna
|
gpc
gnr anaerobes |
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tx of aspiration pna
|
clinda
|
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lab findings in non-bacterial prostatitis
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urine shows >20 wbc/hpf
negative cx |
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tx of non-bacterial prostatitis
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sitz bath
anti-inflammatories |
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ua findings in analgesic induced nephropathy
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nephrotic range proteinuria
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t or f:
the protein seen in multiple myeloma can be picked up on ua |
false
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tx of autosomal dominant polycystic kidney dz (ADPKD)
|
ace inhibitor to prevent renal decline
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how to manage a pt with mild ADPKD
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routine bp checks only, no invasive testing needed if pt has mild dz
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t or f:
all pts with ADPKD should get mri to evaluate for berry aneurysms |
false, only pts with fhx of sah need to be evaluated
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#1 extrarenal manifestation of ADPKD
|
hepatic cysts
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describe pathophysiology of htn in pts with ADPKD
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intrarenal vasculature is compressed --> renal ischemia --> activation of RAS
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what is the best way to screen pts who have fhx of ADPKD
|
renal u/s (need 3-5 cysts in each kidney to make dx)
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presentation of schistosomiasis
|
microhematuria and anemia (often seen in immigrants)
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how to dx renal artery stenosis
|
mra (if contraindicated, do cta)
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contraindications of metformin
|
cr >1.5 (1.4 in females)
etoh abuse liver dz chf --> lactic acidosis |
|
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which medications can cause decreased tubular secretions of cr
|
tmp
cimetidine probenecid |
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organisms associated with emphysematous pyelo
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e coli
klebsiella |
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tx of emphysematous pyelo
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nephrectomy if abscess with gas extension into perinephric space
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how to manage mild pyelo
|
precutaneous drainage
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organisms associated with emphysematous cholecystitis
|
e coli
clostridium |
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|
most common immediate complication of turp (transurethral resection of prostate)
|
hyponatremia secondary to large amts of isotonic fluid used in procedure
Na can approach <100 |
|
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complication of trazadone
|
priapism secondary to alpha blockade or serotonin receptor stimulation
|
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tx of priapism caused by medication
|
phenylephrine or epinephrine
|
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tx of priapism in sickle cell crisis
|
ivf
|
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complications of splenic sequestration
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severely decreased hb --> hypovolemic shock
pts MUST have transfusion |
|
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clincal features of mastocytoma
|
sclerotic bone lesions, diarrhea, eosinophilia, pud, gib
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tx of mastocytoma
|
h1 antagonist, ppi, or cromolyn sodium
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type of bone lesions seen in mm
|
lytic
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most common primary ca to metastasize to brain
|
lung > breast > unk primary > melanoma > colon
|
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t or f:
unilateal ureteric calculi --> arf |
false
|
|
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clinical features of cryoglobulinemia
|
arthralgias
palpable purpura lad hepatosplenomegaly peripheral neuropathy asx hematuria, proteinuria, renal failure |
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dz associated with cryoglobulenemia
|
hcv
|
|
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complement lvls in cryoglobulinemia
|
low
|
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complement levels in post-streptococcal glomerulonephritis
|
low
|
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what is c-anca associated with
|
wegeners
goodpasture's |
|
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age --> relative contraindication for kidney donation
|
<18, >65 yo
|
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how does survival compare with an organ from a living person compared with a cadaveric organ
|
donor from living person has greater chance of survival compared with cadaver, even if not a perfect hla match
|
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clinical features of iga nephropathy
|
gross hematuria after uri
|
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complement level in iga nephropathy
|
wnl
|
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time frame for hematuria after strep infx
|
7-10 days
|
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timeframe for hematuria in thin membrane dz
|
usually doesn't follow uri
|
|
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how to differentiate post-streptococcal glomerulonephritis from thin membrane dz
|
if you can't tell clinically, do bx
|
|
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tx of mixed cryoglobulinemia
|
ribaviron (can't be used in renal failure) or ifn alpha
|
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complement level in pan
|
wnl
|
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complement lvl in wegener's
|
wnl
|
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|
#1 complication of turp procedure
|
retrograde ejaculation b/c the bladder neck doesn't close post-procedure
|
|
|
vision side effect of viagra
|
loss of blue-green differentiation
|
|
|
clinical features of urethral diverticula
|
post-void dribbling
dysuria dyspareunia --> infx, hematuria, stress incontinence |
|
|
exam findings of urethral diverticula
|
vaginal wall fullness, when compressed --> blood and purulent drainage from urethra
|
|
|
how is definitive dx of uretrhal diverticula made
|
cystoscopy
|
|
|
stage 1 renal cell carcinoma
management |
malignancy confined to the capsule
partial nephrectomy |
|
|
extension of rcc into fascia
|
total nephrectomy
|
|
|
paraneoplastic syndrome associated with rcc
|
increased hb/hg secondary to increased epo release by hypernephroma --> rbc mass
|
|
|
gold standard to dx bladder or prostate ca
|
cystoscopy
|
|
|
moa metoclopramide
adverse effects use in chemo |
da antagonis
--> akasthisia, dystonia, eps used to prevent chemo-induced emesis |
|
|
#1 hereditary thrombophilia
|
factor v leiden
|
|
|
pancoast tumor
|
nsclc that arises from superior sulcus --> horner's syndrome and hoarseness
|
|
|
pathophys of horner's syndrome
|
invastion of paravertebral sympathetic chain
--> hoarseness if there is extension into recurrent laryngeal nerve |
|
|
management of pancoast tumor
|
surgery and radiation unless there are distant mets, in that case just radiation
|
|
|
tx options for cml
|
bmt
oral chemo (hydroxyurea or busulfan) ifn alpha tyrosine kinase inhibitors |
|
|
who is candidate for bmt in cml
|
pts in the chronic phase of dz, <50yo, stable
|
|
|
drawbacks to the oral chemotherapy agents used in cml
|
busulfan and hydroxyurea --> recurrence b/c they cause a cytologic remission, but not a metabolic remission
busulfan --> lung toxicity |
|
|
management of lcis
|
since lcis is not considered a direct precursor to breast cancer, just makes a pt at increased risk for breast ca
close observation is usually the best option, but pts can be managed with tamoxifen or prophylactic b/l mastectomy |
|
|
t or f:
lcis must be surgically exised |
false
|
|
|
most common initial presentation of pancoast tumor
|
shoulder pain
|
|
|
complication of tamoxifen
how to manage |
associated with endometrial hyperplasia
nothing special, just regular h&p, annual pap |
|
|
secondary polycythemia
|
results from high epo levels usually to compensate for high altitude, copd, cardiac shunt
|
|
|
how to test for secondary polycythemia
|
check o2 sat
|
|
|
lab findings in polycythemia vera
|
elevated rbc, wbc, and plts
|
|
|
how to manage pt with multiple brain mets
|
steroids and whole brain radiation
(prolongs life by 2-5 months) |
|
|
clinical features of svc syndrome
|
sob
cough fascial fullness neck pain hoarseness, dysphagia, cp, syncope |
|
|
association with svc syndrome
|
bronchogenic ca
|
|
|
when to use thrombolytics in dvt
|
only if there is signifiant swelling leading to arterial compromise
|
|
|
how much should 1 unit of plts increase a pts plt count
|
5000
|
|
|
when should plt response be seen after transfusion
what if there is no increase |
10-60 mins
then, autoimmune destruction from alloimmunization |
|
|
what if there is a nml response to plt transfusion in first hour, but then within 24 hrs, the plts decrease again
|
think dic
bleeding sepsis |
|
|
protective factors in colon ca
|
high fiber diet
long-term nsaid use hrt |
|
|
pathophys of eaton lambert syndrome
|
antibodies against presynaptic ca channels --> defective ACh release --> muscle weakness
|
|
|
how to dx eaton lambert syndrome
|
when doing an emg, repeat stimulation of muscle --> increased muscle response (opposite is true in myasthenia gravis)
|
|
|
pathophysiology of myasthenia gravis
|
antibodies against the ACh receptors
repeat stimulation of a nerve --> fatiguability |
|
|
acute tx of anemia of chronic dz
|
epo transfusions (if pts epo <500)
otherwise, frequent blood transfusions |
|
|
what is the best way to confirm anemia of chronic dz if diagnosis is in question
|
bone marrow bx to look for iron stores
|
|
|
when is primary cns lymphoma seen
|
in hiv pts with cd4 <50
|
|
|
etiology of primary cns lymphoma
|
ebv
|
|
|
t or f:
primary cns lymphoma commonly metastasizes |
false, rarely mets outside of cns
|
|
|
how to tx epidural spinal cord compression secondary to malignancy
|
tx w steroids then immediately get mri to confirm dx, then start radiation tx
|
|
|
tx of supraventricular tachycardia
|
adenosine
|
|
|
best initial tx for head and neck ca
|
first give chemo and radiation. this may make the tumor operable
|
|
|
tx of hit
|
stop all heparin products
give argatroban or lepirudin (direct thrombin inhibitors) |
|
|
t or f:
primary cns lymphoma commonly metastasizes |
false, rarely mets outside of cns
|
|
|
how to tx epidural spinal cord compression secondary to malignancy
|
tx w steroids then immediately get mri to confirm dx, then start radiation tx
|
|
|
tx of supraventricular tachycardia
|
adenosine
|
|
|
best initial tx for head and neck ca
|
first give chemo and radiation. this may make the tumor operable
|
|
|
tx of hit
|
stop all heparin products
give argatroban or lepirudin (direct thrombin inhibitors) |
|
|
contraindication for lepirudin
|
caution with renal insuff
|
|
|
contraindication of aragtroban
|
caution with hepatic dysfxn
|
|
|
how to minimize risk of hit
|
minimize use of heparin products to 5 days
|
|
|
how to tx itp
|
steroids then ivig if steroids fail
splenectomy is a last resort, rarely required |
|
|
how to manage horomne sensitive prostate ca with bony mets
|
palliative tx with leuprolide
|
|
|
moa leuprolide
|
leutinizing hormone releasing hormone antagonist --> binds to lhrh in pituitary
lh initially increases --> increased fsh --> increased testosterone, but then after 1 wk, the receptors are downregulated --> lower lh --> lower fsh/testosterone |
|
|
when is leuprolide contraindicated as a monotherapy
what is combined iwht it |
when there are severe vertebral mets
if leuprolide is used alone, sx can get much worse, in these pts, give flutamide x1 wk prior to starting leuprolide |
|
|
moa flutamide
|
anti-adronergic
|
|
|
tx of choice for scc of skin
|
local excision
(radiation if pt is not surgical candidate) |
|
|
tx of cholangiocarcinoma
|
palliative ercp with stent placement
dz has usually met by the time dx is made |
|
|
tx of acute hemolytic transfusion rxn
|
stop transfusion
give nss +/- DA infusion to maintain kidney perfusion |
|
|
intial test of choice for pernicious anemia
if negative, but still suspect |
anti-IF testing
if negative, but still suspect dx, do schilling test |
|
|
association with pernicious anemia
|
associated with autoimmune metaplastic atrophic gastritis (autoimmune dz vs gastric mucosa) --> glandular atrophy and intestinal metaplasia
|
|
|
how to dx mm
|
spep
upep skeletal survey (plain films) bone marrow bx |
|
|
what type of bony lesions are missed on bone scan
|
sclerotic
|
|
|
t or f:
alk phos is elevated in mm |
false
|
|
|
t or f:
alk phos is elevated in mm |
false
|
|
|
#1 cause of vision loss in elderly
|
macular degeneration + cortical cataracts
|
|
|
will pts benefit from cataract surgery if they have cataracts + macular degen
|
no
|
|
|
ophtho finding associated with diabetes
|
proliferative retinopathy
|
|
|
what is endophthalmitis
presentation? |
infx of vitreous fluid
12-24 h of mild eye pain and decreased visual acuity. swollen eyelids, edema, red conjnctiva, can't visualize retinal bv |
|
|
how to confirm dx of endophthalmitis
|
aspiration and vitreous/aqueous humor cultures
|
|
|
how to tx endophthalmitis
|
vitreal abx
|
|
|
most common organisms associated with foreign body eye infx
|
staph
strep h flu pseudomonas |
|
|
how to tx eye foreign body
|
remove foreign body, then
erythromycin sulfacetamide cipro or ofloxacin |
|
|
who gets eye pseudomonas infx
|
contact lens wearers
|
|
|
what is seen in severe non-proliferative diabetic retinopathy
|
multiple retinal hemorrhages and cotton wool spots --> macular edema and impaired retinal circulation
|
|
|
how to manage severe non-prliferative diabetic retinopathy
|
there is no change in chance of visual loss in pts who get immediate laser photocoagulation than those who don't, so before tx, do detailed retinoscopic study to check for macular edema
|
|
|
what is seen in proliferative diabetic retinpathy
how to manage |
disc neovascularization
immediate laser photocoagulation |
|
|
how to manage vitreal hemorhage
|
vitrectomy
|
|
|
how to manage retinal detachment
|
vitrectomy
|
|
|
when to operate on a aaa
|
if >5 cm or if there is rapid growth
|
|
|
how to follow aaa
|
annual imaging
|
|
|
what is the major risk factor that contributes to aaa growth
|
smoking
|
|
|
tx of torsades
|
defibrillation
|
|
|
tx of vtach with hemodynamic compromise
|
defibrillation
|
|
|
how to manage torsades in a stable pt
|
first try mgso4, then temporary overdrive pacing, then cardioversion
|
|
|
when can sychronized cardioversion be done
|
\stable vtach, a fib, a flutter or svt
|
|
|
causes of acute heart failure
|
chordae tendonae rupture
chest wall trauma with compromise of valvular apparatus |
|
|
sequelae of chrodae tendonae rupture
|
flash pulmonary edema and acute mitral regurg
|
|
|
effects of ehlers danlos syndrome on the heart
|
myxomatous degeneration of mitral valve --> chordae tendonae rupture
|
|
|
sx of tca overdose
|
hypotension
anticholinergic effects cns manifestations arrhythmias (qrs prolong, torsades, vtach, vfib) |
|
|
how to manage cardiotox of tca o/d
|
nahco3
tx arrhythmias with lidocaine |
|
|
what bv supplies the rv
|
rca
|
|
|
what bv supplies the ant wall of the lv
|
lad
|
|
|
what bv supplies the anterolateral wall of the lv
|
diagonal branches of the lad
|
|
|
what bv supplies the posterior-lateral wall of the lv
|
left circumflex
|
|
|
what complications occur 2-7 days post mi
|
chordae tendonae rupture
papillary muscle rupture |
|
|
dressler's syndrome
|
leukocytosis
pleuritic cp fever pericardial rub (autoimmune related) |
|
|
tx of dressler's syndrome
|
first use nsaids
may also need steroids |
|
|
what is the worst risk factor for cardiovascular death
|
dm
|
|
|
what cardiac med should be avoided in pts with ami
|
ccbs
|
|
|
murmur of mvp
|
mid-systolic click then late systolic murmur
|
|
|
apical holosystolic murmur
|
mitral regurg
|
|
|
cresc-decresc ejection murmur at lusb
|
pulmonic stenosis
|
|
|
murmur of mitral stenosis
|
low pitched rumbling, diastolic murmur at apex
|
|
|
when to use flecainide
|
to maintain nsr in pts without structural dz
|
|
|
complications associated with flecainide
|
--> fatal arrhythmias if used in structural heart dz
|
|
|
etiology of MAT
|
hypoxia
copd hypokalemia hypomag cad htn valvular dz meds |
|
|
management of mat
|
correct underlying problem
if that doesn't work or if there is no correctable cause, tx with verapamil or bb |
|
|
when is cabg preferred over angioplasty
|
better lt survival in dm with multi-bv disease or recent q wave infarct
|
|
|
pathophys of cocaine induced mi
|
--> vasospasm --> coronary artery thrombus
|
|
|
management of cocaine induced mi
|
need to get cath if there is no response to medical management
|
|
|
can you treat a pt who has severe angioedema with ace with an arb
|
no
|
|
|
etiologies for chf
|
CAD > HTN > valvular dz
|
|
|
murmur of aortic stenosis
|
cresc-decresc
|
|
|
which htn med --> photosensitivity
|
hctz
|
|
|
skin complication associated with lisinopril
|
aggravates psoriasis
|
|
|
skin complication associated with lasix
|
steven-johnson syndrome, urticaria
|
|
|
what is the first thing you should think of in horner's syndrome + unilateral ha
how to dx how to tx |
carotid dissection
get MRA tx with anticoagulation |
|
|
which class of medications are contraindicated in acute chf exacerbation
|
beta blockers
|
|
|
pathophys of aortic dissection
|
separation of intima and media
|
|
|
how to manage aortic dissection
|
tx with rapidly lowering bp by using beta blockrs
if still high, add nitroprusside sbp goal 100-120, hr <60 |
|
|
initial drug of choice to tx htn
|
hctz
|
|
|
what is the most concerning cardiac risk factor pre-operatively
|
critical aortic stenosis
unstable angina |
|
|
how to manage PAT
|
ccbs
metoprolol esmolol |
|
|
what study should be done before tx with the -rubicin chemotx
|
muga scan (aka radionuclide ventriculography or radionuclide angiography)
|
|
|
exam findings in tamponade
|
inspiratory decrease in bp >20
|
|
|
which rhythm has absent p waves and narrow qrs morphology
|
svt
|
|
|
how can wpw present
what happens if ccbs or bb are given |
svt
conduction will be slowed at the av node and conduction through accessory pathway increases --> v-fib and death |
|
|
most common cause for flash pulmonary edema
|
hypertensive crisis
|
|
|
tx of flash pulmonary edema secondary to htn crisis
|
lower bp with nitroglycerin or nitroprusside
|
|
|
1st test of choice in flash pulm edema
|
echo to evaluate valvular dz
|
|
|
when to order an exercise technetium 99 test
|
pts with lbbb or pacemaker
wpw >1 mm ST depression at rest inability to exercsie prior h/o revascularization |
|
|
when to order exercise ekg
|
1st test of choice in pts with indeterminant probability and nml resting ekg
|
|
|
when is asynchronous cardioversion used
|
vfib
|
|
|
when is synchronous cardioversion used
|
a-fib
|
|
|
which a-fib pt scan be managed with asa alone
|
<60 yo
no structural or functional cardiac abnormalities |
|
|
etiology of non-sustained vtach
|
scarred myocardium from prior mi, cad, lvh
|
|
|
first test of choice in non-sustained vtach
|
2d echo
stress test |
|
|
which medications increase dig levels
|
verapamil
amiodarone quinidine spironolactone |
|
|
how to manage a pt with inr 5-9, no active bleeding
|
hold coumadin and give one small dose of vital k (oral)
|
|
|
how to manage pt with inr 9-20 without active bleeding
|
give higher dose of oral vit k k
|
|
|
when can sexual activity resume after mi
|
6 wks
|
|
|
how to tx bradycardia after inferior wall mi
|
sx are transient, but atropine should be given anyway
if sx persist or there is hemodynamic compromise, then tx with temporary cardiac pacing |
|
|
nrti medications
|
-vudine
|
|
|
nnrti medications
|
efavirenz
nevirapie delavidine |
|
|
protease inhibitor medications
|
-navir
|
|
|
most effective haart tx
|
2nrti + 1nnrti or 1protease inhibitor
|
|
|
adequate response to haart
|
90% decrease in viral load in 8 wks, and undetectable in 4-6 months
cd4 count increases by 50 in 4-8 wks, then 50-100 each year |
|
|
which hiv med is likely teratogenic
|
efavirenz
|
|
|
findings that indicate exudative pleural effusion
|
LD pleural fluid: serum >0.6
protein pleural fluid: serum >0.5 |
|
|
mechanism behind rash seen in mono pts tx with antibiotics
|
IgG and IgM against PCN derivatives
|
|
|
what are the different types fo nec fasc
|
type i: seen in pts with dm or pvd, usually involves staph, b. fragilis, e coli, gas, etc)
type ii: seen in healthy pts, usually after an injury, almost always involving gas |
|
|
findings in type ii nec fasc
|
blisters
erythema bullae fever malaise rapid decline |
|
|
what is nec fasc
|
infx of subq tissue that spreads along the fascial planes
|
|
|
management of type ii nec faisc
|
surgical debridement and clinda
|
|
|
immunocompromised pt with systemic infx, pulm and sinus sx, what infx do you think of
|
aspergillosis
|
|
|
why are pts with dka at risk for infx with mucormycosis
|
the acidic environment and high iron content are a great place for mucormycosis to grow
|
|
|
management of mucormycosis infx
|
tx with amphoterecin b and debridemetn
|
|
|
presentation of diphtheria
|
gray-brown pseudomembrane
pharyngitis cervical lad fever |
|
|
how to dx diphtheria
|
loeffler's agar
|
|
|
how to tx diptheria
complications |
antitoxin
--> anaphylaxis or serum sickness |
|
|
eosinophilia + diarrhea
|
think helminths
|
|
|
hiv lipodystrophy
what is it which med implicated |
elevated ldl, tg, lfts
secondary to protease inhibitors |
|
|
how to tx hiv lipodystrophy
|
gemfibrozil (if tg are the most elevated)
|
|
|
which medications penetrate the prostate the best
|
quinolones
bactrim |
|
|
how long to tx prostatitis
|
6-12 wks
|
|
|
side effect of
didanosine |
pancreatitis
|
|
|
side effect of
abacavir |
hypersensitivity
|
|
|
side effect of
nrtis |
lactic acidosis
|
|
|
side effect of
nevirapine |
liver failure
|
|
|
side effect of
protease inhibitors |
crystal induced nephropathy
|
|
|
who should be treated for salmonella enteritis
|
pts <12 mo
immunocompromised >50 yo |
|
|
how to tx salmonella
|
cipro
bactrim ceftriaxone |
|
|
what can often co-exist with lyme dz
|
systemic ehrlichosis
|
|
|
how to tx endophthalamitis
|
viterctomy and abx
|
|
|
how to manage a pt with fibrotic lung dz and +ppd
|
inh x 9 mo
|
|
|
pathology of pml
|
oligodendrocytes with intranuclear inclusions, demyelination and gliosis
|
|
|
pathophys of pml
|
reactivation of jc virus
|
|
|
presentation of pml
|
cognitive impairment
hemiparesis aphasia ataxia |
|
|
natural course of pml, if no tx given
|
death within 3-6 mo
|
|
|
what are the centor criteria
|
way of determining management of sore throat
cirteria: 1. fever 2. tonsillar exudate 3. tender cervical lad 4. no cough if one of two of the sx present, do rapid ag testing if 3-4 are met, tx empirically |
|
|
presentation of roseola
|
fever, which resolves, which is followed by rash from trunk -> extremities
|
|
|
presentation of rubeola
|
conugh, conjunctivitis, coryza
rash from head down pts look very sick |
|
|
presentation of rubella
|
similar to rubeola, but pts are less sick
|
|
|
when should mri be used to dx osteomyelitis
|
when spine is involved, or diabetic foot ulcer
|
|
|
how to manage an hbv vaccine non-responder when they are exposed to hbv
|
get HBiG
|
|
|
which heart valve is involved if the conduction system is not working well
|
aortic
|
|
|
when NOT to tx bacteruria in elderly
|
if pts are asx do not treat unless wbc >20/hpf
|
|
|
clinical features of erysipelas
|
red, painful, swollen elevated skin
fever, chills, malaise |
|
|
incubation for non-gonococcal urethritis
incubation period for gonococcal urethritis |
5-10 days
2-7 days |
|
|
d/c in non-gonococcal urethritis
d/c in gonococcal urethritis |
watery
purulent |
|
|
how to tx non-gonococcal urethritis
|
azithro or doxy
if no response, add flagyl +/- erythromycin to cover for trich |
|
|
tx of community acquired pna
|
azithro (or clarithro) + ceftriaxone
|
|
|
org responsible for tss
|
staph
|
|
|
tx of tss
|
IVF (pts may require up to 20L/d)
clinda +/- nafcillin |
|
|
lp diagnostic clues for cryptococcal meningitis
|
opening pressure >200
WBC <50 with lymphocyte predominance high protein, low glucose +india ink |
|
|
how to manage cryptococcal meningitis
|
amphoterecin b or flucytosine
serial lps to manage sx |
|
|
how often should hiv viral load and cd4 count be monitored
|
q3-4 mo
|
|
|
at what cd4 level should haart tx be initiated
viral load |
cd4 201-350
>55,000 |
|
|
how to determine hiv status if initial elisa is negative
|
if initial hiv elisa is negative, but hiv dx is still suspected, check hiv rna or p24 antigen
(seen in acute retroviral syndrome) |
|
|
how to manage frequent post-coital uti's
|
post-coital antibiotic prophylaxis
|
|
|
tx of endometritis
|
clinda + gent
|
|
|
organisms responsible for endometritis
|
gbs, chlamydia, mycoplasm
|
|
|
inpt tx of pid
|
cefotetan + doxy
OR gent + clinda |
|
|
tx of lgv
|
doxy or erythro
|
|
|
organism in lgv
|
chlamydia
|
|
|
organisms in neonatal meningitis
|
gbs
e coli listeria |
|
|
tx fo neonatal meningitis
|
cefotaxime, amp, vanc
|
|
|
orgs of adult meningitis
|
n meningitidis
strep pneumo h flu |
|
|
management of adult meningitis
|
ceftriaxone + vanc
|
|
|
organisms of meningitis in adults >50
|
strep pneumo
n meningitidis listeria |
|
|
management fo meningitis in adults >50
|
ceftriaxone
vanc amp |
