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58 Cards in this Set

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what drugs reduce m&m in CHF pts
ACEi
when to use aldosterone antagonists in CHF?
only with NYHA class III/IV sx, and already on digoxin, diuretic, ACEi, beta blocker
causes of dilated cardiomyopathy
ABCD: Alcohol, Beriberi, Chronic Cocaine, Coxsacke B, Chagas, Doxorubicin, Diphtheria
which med reduces mortality in pts with severe heart failure due to systolic fxn with sx at rest?
spironolactone
most useful diagnostic test in presentation of new CHF
echocardiogram -- systolic vs diastolic failure, EF, wall motion abnormalities, valves
what durg indicated for pts with reduced EF?
beta-blocker, even if no hx of MI and even if asx; ACEi also proven beneficial
when to use digoxin in HF?
only when decompensated -- improves sx but no mortality benefit
when to administer beta blockers in CHF?
only in STABLE patients (use digoxin in decompensated pts); generally, need 2-4wks of stability before starting
what renal changes suggest decreasing ACEi dose?
if greater than 30% increase in baseline Cr, or sustained elevation for 2-4 wks, OR k>5.0; transient Cr elevation expected with ACEi initiation;
what kind of cardiac hypokinesia seen in alcohol cardiomyopathy vs CAD?
alcohol: global hypokinesia; CAD: focal
how long do you have to take anticoagulation after first "provoked" PE (i.e. after a transient risk factor)? Which anticoagulant?
warfarin for 3-6mos
how much does factor V leiden (heterozygous) increase risk of thromboembolic dz?
8x
unprovoked episode of DVT in older pts a/w increased incidence of ___________________
occult malignancy
tx for symptomatic calf vein thrombosis? Risk if this tx not performed?
tx: LMWH followed by warfarin for 3 mos; if not, 20% develop clot extension
what are the indications for placement of IVC filter?
inability to undergo therapeutic anticoagulation or clot extension at a therapeutic level of anticoagulation
what renal dz a/w venous thrombosis?
NEPHROTIC syndrome! Pathophys unkown, maybe due to renal losses of antithrombin III
thrombolytics vs anticoagulation in newly disovered PE
anticoagulation! Thrombolysis not indicated in absence of hemodynamic compromise -- too many risks
what diagnostic test for PE to pursue if intermediate pretest probability + low probability VQ scan?
low prob VQ scan doesn't eliminate risk of PE. Need to do d-dimer to r/o DVT. If d-dimer positive (not sensitive), do LENI.
None
what GI source of abdominal pain is often a/w menstrual cycle?
irritible bowel syndrome
best way to confirm diagnosis of uncomplicated GERD
try acid suppressive tx
when to use upper endoscopy in GERD?
if suspect complications (warning sx: dysphagia, odynophagia, weight loss, anemia)
when to use 24-hour esophageal pH monitoring?
pts not responsive to acid-suppressive therapy, or who might have dx other than GERD
what % of gastrinomas are malignant?
65%
most effective study for demonstrating gastrinoma? What lesions shown?
octreotide scan; shows primary lesion + any mets to liver, lymph nodes
what dz process do multiple duodenal ulcers suggest?
gastrinoma
NSAID ulcers usually found where?
stomach, not duodenum
alcoholic ulcers generally found where?
superficial gastric mucosa, not duodenal
what alarm symptoms are you worried about with dyspepsia? What would you do if you saw them?
age>50, weight loss, anorexia, dysphagia, GI bleeding, unexplained anemia, vomiting; if seen, need to do upper endoscopy to r/o ulcer complication and malignancy
charcot's triad
for cholangitis: 1) FEVER; 2) JAUNDICE; 3) RUQ pain
mgmt of acute cholangitis?
start on broad-spectrum abx, ERCP+sphincterotomy to remove stones; no surgery -- increased morbidity/mortality
what findings diff in acute cholangitis vs cholecystitis?
cholecystitis: no jaundice, elevated transaminases and alkphos
position preferred by pts with peritoneal signs?
fetal position
what finding expected on CXR with GI perf?
air in the peritoneum (under the diaphragm)
what is gallstone ileus?
large gallstone (usu >2.5 mm) into bowel lumen (usu thru fistula) --> impaction --> obstruction (usu at ileocecal valve); usu ocurs in elderly
what can cause pneumobilia?
either patent cystic duct or fistula involving common bile duct (or s/p TIPS procedure)
what is esophageal manometry used for?
diagnosing non-caridac chest pain and suspected motility disorders (measures pressure in lower part of esophagus)
tx of suspected SBP while cultures pending?
cephalosporin or fluoroquinolone
strictures in the terminal ileum are a common complication of which disease?
Crohn's (often seen as "string sign" on small bowel rads)
what can cause a mid-esophageal stricture?
alendronate, BARRETT'S, many others
gi s/e of alendronate
mid-esophageal stricture
what to do with pt < 45yo w dyspepsia?
if no alarm sx, test for h.pylori and try PPI; if alarm sx present, upper endoscopy needs to be done quickly to r/o malignancy [alarm sx include anemia, anorexia, dysphagia, vomiting, bleeding, wt loss]
typical features of henoch-schonlein purpura
joint pain, abdominal pain, purpura on lower extremities and IgA deposition, hematuria
complement levels in henoch-schonlein purpura
normal (no immune complexes?, unlike SLE/post-strep GN)
what is the universal plasma donor type (A/B/AB/O)
AB (no antibodies in plasma)
whole blood vs FFP for coagulopathy?
FFP; whole blood loses labile factors during storage
electrolyte disturbance in bulemic patients
hypochloremia, hypokalemia
MCC acute lower GI bleed
DIVERTICULOSIS, neoplasm, vascular malformations
biggest concern in postmenopausal woman with Fe defic anemia
colorectal cancer
what diagnostic procedure if concerned about upper GI bleed?
upper endoscopy -- NOT upper GI series (not sensitive enough, can't be used to administer tx)
what does bile on nasogastric aspirate tell you?
that you're past the pylorus ==> if no blood, then upper GI bleed unlikely
which vessels most commonly involved in pancreatitis-induced pseudoaneurysm
splenic artery, gastroduodenal, pancreaticoduodenal
pseudoaneurysms and pancreatitis
pseudoaneurysms can form from autodigestion of arterial walls by elastase and pancreatic enzymes (10% of pts with acute pancreatitis)
risk of pancreatic pseudoaneurysm? Tx?
rupture --> life-threatening hemorrhage --> 50% mortality; tx early with transarterial embolization
main cause of upper GI bleed in pt with hepatitis? How to confirm?
variceal bleed -- confirm with endoscopy
when to use TIPS procedure?
only when medical therapy and tx of symptoms (eg banding of varices) has failed; major complication risk including infection, encephalopathy, and liver failure -- require transplant
when to do colonoscopy with minimal BRBPR?
AGE > 50; if h/o melena, DRBPR, or orthostatics, do UPPER GI first, THEN colonoscopy; if suspicion of malignancy, fecal occult blood positive stools (doesn't happen with hemorrhoids), Fhx of polyposis / HNPCC, pts without colonoscopy after BRBPR who dev new sx or change in bowel habits)
how much blood volume lost if orthostatics correctible by IVF alone?
10%
when to use angiography in hematochezia? What are the advantages?
only useful if high blood flow (0.5mL/min), but allows for embolization of vessel