Mksap 08-25

Front 1

Management of exercise-induced (asthma/bronchospasm)

Back 1

if severe, use prophylactic inhaled beta-2 agonist (eg albuterol) 5-10min before exercise

Front 2

results of methacholine challenge testing in exercise-induced asthma

Back 2

equivocal -- exercise-induced asthma not necessarily correlated with allergic asthma

Front 3

classic presentation of interstitial lung disease

Back 3

crackles, clubbing, chest radiograph changes

Front 4

causes of interstitial lung disease

Back 4

pneumoconiosis (from occupational exposures to dust, asbestos, coal mining, etc.); hypersensitivity pneumonitis (from birds, molds, etc.); medications (eg cytotoxic drugs, abx, antiarrythmics)

Front 5

defn and mgmt of mild intermittent vs mild persistent asthma

Back 5

mild intermittent: <= 2 days of sx/wk, <= 2 nocturnal events / month; both treated with albuterol prn, mild persistent also tx with corticosteroid

Front 6

use of ipratropium bromide in asthma control

Back 6

only for acute exacerbation in emergency situation; not useful for longterm management

Front 7

what to do in moderate persistent asthma if steroids are not sufficient?

Back 7

add long-acting beta agonist

Hint 7

None

Front 8

does myesthenia gravis better or worsen as the day progresses?

Back 8

worsens (unlike lambert eaton)

Front 9

vocal cord dysfunction vs asthma

Back 9

difficult to distinguish; vocal cord dysfunction: not responsive to asthma tx, nl spirometry, no nocturnal sx, difficulty with INSPIRATION > EXPIRATION; Tx of vocal cord dysfunction: speech therapy

Front 10

DOE with nocturnal cough suggestive of what etiology

Back 10

heart failure

Front 11

why don’t you always hear rales with chronic heart failure?

Back 11

dilation of pulmonary lymphatics ==> no pulmonary edema at baseline

Front 12

what test to rule out heart failure?

Back 12

BNP: if < 100, HF unlikely

Front 13

carotid upstrokes in MR vs PDA

Back 13

brisk in PDA (increased stroke volume); not brisk in MR b/c decreased forward flow

Front 14

changes to pulse pressure with PDA

Back 14

widened b/c of diastolic runoff into pulmonary artery

Front 15

risk factors for stroke in pt with afib

Back 15

hx of stroke, hx of MI, hx of HTN, age > 65, DM, LAE, LV dysfunction

Front 16

tx of afib

Back 16

warfarin + betablocker/amiodarone

Front 17

pathophys and tx of peripartum cardiomyopathy

Back 17

in 3rd trimester, increased volume load --> failure (pulm edema, SOB, tachy); tx with delivery (vaginal if possible), no ARB/ACEi (teratogenic)

Front 18

risk factors for peripartum cardiomyopathy

Back 18

black women, multi gestations/parity, >30yo, hx

Front 19

characteristics of mitral stenosis

Back 19

1) opening snap; 2) diastolic rumble; 3) pre-systolic accentuation (atrial kick)

Front 20

easy way to tell if pulmonary hypertension is 2/2 ASD or VSD

Back 20

cyanosis

Front 21

how to prevent influenza in a high risk pt?

Back 21

vaccination + amantadine/rimantadine x 2wk (only bc high risk) for Influenza A, oseltamivir for Influ A and B

Front 22

prophy for influenza B

Back 22

oseltamivir

Front 23

only tx proven to prolong life in hypoxemic COPD pts

Back 23

O2 (also smoking cessation, lung-volume-reduction surgery)

Front 24

nasal O2 prescribed at what PaO2?

Back 24

<55, or if cor pulmonale, < 60

Hint 24

None

Front 25

what causes morning headaches in COPD?

Back 25

CO2 retention

Front 26

indications for pulmonary rehabilitation

Back 26

pts with chronic resp impairment who are dyspneic despite optimal medical management

Front 27

tx of acute COPD exacerbation

Back 27

bronchodilators (eg albuterol -- not most effective, but v few s/e)

Front 28

effectiveness of influenza vax in preventing hospitalization of elderly for PNA / influenza

Back 28

good! 30-70%

Front 29

how often does elderly person at risk need to get vax for influenza/pneumococcus?

Back 29

influenza: yearly; pneumococcus: once

Front 30

what kind of surgeries pose greatest risk to COPD pts?

Back 30

upper abdominal / thoracic surgeries

Front 31

reasons to use ACEi or ARB in hypertension

Back 31

1) DM; 2) renal failure (elev Cre) -- also beta-blockers; 3)

Front 32

target BP in diabetics with HTN

Back 32

135/80

Front 33

what is characteristic of BP in hyperthyroidism?

Back 33

elevated SYSTOLIC ONLY (nl diastolic)

Front 34

lifestyle changes that decrease blood pressure

Back 34

AEROBIC EXERCISE, also weight loss (1kg --> 1mmHg), reduced salt intake, decreased alcohol / smoking

Front 35

hypertension at young age with hypokalemia

Back 35

look for hyperaldosteronism by measuring serum renin:aldo ratio; alt: herbal supplements, black licorice, beta agonist inhaler

Front 36

obstructive sleep apnea a/w what chronic condition?

Back 36

hypertension (independent of obesity)

Front 37

tx of gestational hypertension

Back 37

methyldopa -- doesn't decrease risk of preeclampsia, but also does not affect neonatal outcomes

Front 38

Cr changes after initiation of ACEi

Back 38

slight elevation common after BP normalized (kidneys adjusting to lowered renal perfusion pressure); still, need to be vigilant due to potential occult bilateral RAS (usu see >20% inc in Cre)

Front 39

antihypertension efficacy in african americans

Back 39

beta blockers, ACEi, and ARBs LESS EFFECTIVE; thiazides, CCBs MORE effective (only when considering monotherapy -- no racial difference with combo therapy)

Front 40

what to look for if suspect glomerulnephritis?

Back 40

1) urine microscopy -- look for RBC casts and dysmorphic RBCs; 2) Serum Cre

Front 41

how to approximate 24hr protein excretion?

Back 41

spot urinary protein:creatinine ratio

Front 42

use of alpha-blockers in hypertension

Back 42

usually not a good idea -- shown by ALLHAT trial to increase risk of cardiovascular events, especially CHF

Front 43

normal plasma aldo values

Back 43

<10 ng/dL

Front 44

plasma aldo:renin ratio in primary hyperaldosteronism

Back 44

>20-25

Front 45

classic sites of cerebral hypertensive hemorrhages

Back 45

basal ganglia, thalamus/internal capsule, pons, cerebellum

Front 46

location of cerebral hypertensive hemorrhage vs amyloid angiopathy

Back 46

amyloid angiopathy usu closer to cortex; hypertensive in BG, thalamus, internal capsule, pons, cerebellum