Mksap 08-28

Front 1

what drugs reduce m&m in CHF pts

Back 1

ACEi

Front 2

when to use aldosterone antagonists in CHF?

Back 2

only with NYHA class III/IV sx, and already on digoxin, diuretic, ACEi, beta blocker

Front 3

causes of dilated cardiomyopathy

Back 3

ABCD: Alcohol, Beriberi, Chronic Cocaine, Coxsacke B, Chagas, Doxorubicin, Diphtheria

Front 4

which med reduces mortality in pts with severe heart failure due to systolic fxn with sx at rest?

Back 4

spironolactone

Front 5

most useful diagnostic test in presentation of new CHF

Back 5

echocardiogram -- systolic vs diastolic failure, EF, wall motion abnormalities, valves

Front 6

what durg indicated for pts with reduced EF?

Back 6

beta-blocker, even if no hx of MI and even if asx; ACEi also proven beneficial

Front 7

when to use digoxin in HF?

Back 7

only when decompensated -- improves sx but no mortality benefit

Front 8

when to administer beta blockers in CHF?

Back 8

only in STABLE patients (use digoxin in decompensated pts); generally, need 2-4wks of stability before starting

Front 9

what renal changes suggest decreasing ACEi dose?

Back 9

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;

Front 10

what kind of cardiac hypokinesia seen in alcohol cardiomyopathy vs CAD?

Back 10

alcohol: global hypokinesia; CAD: focal

Front 11

how long do you have to take anticoagulation after first "provoked" PE (i.e. after a transient risk factor)? Which anticoagulant?

Back 11

warfarin for 3-6mos

Front 12

how much does factor V leiden (heterozygous) increase risk of thromboembolic dz?

Back 12

8x

Front 13

unprovoked episode of DVT in older pts a/w increased incidence of ___________________

Back 13

occult malignancy

Front 14

tx for symptomatic calf vein thrombosis? Risk if this tx not performed?

Back 14

tx: LMWH followed by warfarin for 3 mos; if not, 20% develop clot extension

Front 15

what are the indications for placement of IVC filter?

Back 15

inability to undergo therapeutic anticoagulation or clot extension at a therapeutic level of anticoagulation

Front 16

what renal dz a/w venous thrombosis?

Back 16

NEPHROTIC syndrome! Pathophys unkown, maybe due to renal losses of antithrombin III

Front 17

thrombolytics vs anticoagulation in newly disovered PE

Back 17

anticoagulation! Thrombolysis not indicated in absence of hemodynamic compromise -- too many risks

Front 18

what diagnostic test for PE to pursue if intermediate pretest probability + low probability VQ scan?

Back 18

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.

Hint 18

None

Front 19

what GI source of abdominal pain is often a/w menstrual cycle?

Back 19

irritible bowel syndrome

Front 20

best way to confirm diagnosis of uncomplicated GERD

Back 20

try acid suppressive tx

Front 21

when to use upper endoscopy in GERD?

Back 21

if suspect complications (warning sx: dysphagia, odynophagia, weight loss, anemia)

Front 22

when to use 24-hour esophageal pH monitoring?

Back 22

pts not responsive to acid-suppressive therapy, or who might have dx other than GERD

Front 23

what % of gastrinomas are malignant?

Back 23

65%

Front 24

most effective study for demonstrating gastrinoma? What lesions shown?

Back 24

octreotide scan; shows primary lesion + any mets to liver, lymph nodes

Front 25

what dz process do multiple duodenal ulcers suggest?

Back 25

gastrinoma

Front 26

NSAID ulcers usually found where?

Back 26

stomach, not duodenum

Front 27

alcoholic ulcers generally found where?

Back 27

superficial gastric mucosa, not duodenal

Front 28

what alarm symptoms are you worried about with dyspepsia? What would you do if you saw them?

Back 28

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

Front 29

charcot's triad

Back 29

for cholangitis: 1) FEVER; 2) JAUNDICE; 3) RUQ pain

Front 30

mgmt of acute cholangitis?

Back 30

start on broad-spectrum abx, ERCP+sphincterotomy to remove stones; no surgery -- increased morbidity/mortality

Front 31

what findings diff in acute cholangitis vs cholecystitis?

Back 31

cholecystitis: no jaundice, elevated transaminases and alkphos

Front 32

position preferred by pts with peritoneal signs?

Back 32

fetal position

Front 33

what finding expected on CXR with GI perf?

Back 33

air in the peritoneum (under the diaphragm)

Front 34

what is gallstone ileus?

Back 34

large gallstone (usu >2.5 mm) into bowel lumen (usu thru fistula) --> impaction --> obstruction (usu at ileocecal valve); usu ocurs in elderly

Front 35

what can cause pneumobilia?

Back 35

either patent cystic duct or fistula involving common bile duct (or s/p TIPS procedure)

Front 36

what is esophageal manometry used for?

Back 36

diagnosing non-caridac chest pain and suspected motility disorders (measures pressure in lower part of esophagus)

Front 37

tx of suspected SBP while cultures pending?

Back 37

cephalosporin or fluoroquinolone

Front 38

strictures in the terminal ileum are a common complication of which disease?

Back 38

Crohn's (often seen as "string sign" on small bowel rads)

Front 39

what can cause a mid-esophageal stricture?

Back 39

alendronate, BARRETT'S, many others

Front 40

gi s/e of alendronate

Back 40

mid-esophageal stricture

Front 41

what to do with pt < 45yo w dyspepsia?

Back 41

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]

Front 42

typical features of henoch-schonlein purpura

Back 42

joint pain, abdominal pain, purpura on lower extremities and IgA deposition, hematuria

Front 43

complement levels in henoch-schonlein purpura

Back 43

normal (no immune complexes?, unlike SLE/post-strep GN)

Front 44

what is the universal plasma donor type (A/B/AB/O)

Back 44

AB (no antibodies in plasma)

Front 45

whole blood vs FFP for coagulopathy?

Back 45

FFP; whole blood loses labile factors during storage

Front 46

electrolyte disturbance in bulemic patients

Back 46

hypochloremia, hypokalemia

Front 47

MCC acute lower GI bleed

Back 47

DIVERTICULOSIS, neoplasm, vascular malformations

Front 48

biggest concern in postmenopausal woman with Fe defic anemia

Back 48

colorectal cancer

Front 49

what diagnostic procedure if concerned about upper GI bleed?

Back 49

upper endoscopy -- NOT upper GI series (not sensitive enough, can't be used to administer tx)

Front 50

what does bile on nasogastric aspirate tell you?

Back 50

that you're past the pylorus ==> if no blood, then upper GI bleed unlikely

Front 51

which vessels most commonly involved in pancreatitis-induced pseudoaneurysm

Back 51

splenic artery, gastroduodenal, pancreaticoduodenal

Front 52

pseudoaneurysms and pancreatitis

Back 52

pseudoaneurysms can form from autodigestion of arterial walls by elastase and pancreatic enzymes (10% of pts with acute pancreatitis)

Front 53

risk of pancreatic pseudoaneurysm? Tx?

Back 53

rupture --> life-threatening hemorrhage --> 50% mortality; tx early with transarterial embolization

Front 54

main cause of upper GI bleed in pt with hepatitis? How to confirm?

Back 54

variceal bleed -- confirm with endoscopy

Front 55

when to use TIPS procedure?

Back 55

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

Front 56

when to do colonoscopy with minimal BRBPR?

Back 56

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)

Front 57

how much blood volume lost if orthostatics correctible by IVF alone?

Back 57

10%

Front 58

when to use angiography in hematochezia? What are the advantages?

Back 58

only useful if high blood flow (0.5mL/min), but allows for embolization of vessel