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300 Cards in this Set
- Front
- Back
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What does CREST syndrome stand for?
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calcinosis, Raynaud's phenomenon, esophageal motility disorders, sclerodactyly, and telangiectasia
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What are the Rome Criteria?
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Diagnosis for IBS:
at least 12 weeks (which need not be consecutive) in the preceding 12 months of abdominal discomfort or pain that has two of the following three features: relieved with defecation; onset associated with a change in the frequency of stool; and onset associated with a change in the form (appearance) of stool. |
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What are the Manning Criteria?
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pain relief with defecation, often; looser stools at pain onset, often; more frequent stools at pain onset, often; visible abdominal distention; mucus per rectum; feeling of incomplete evacuation, often.
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What is the best test to assess for iron deficiency anemia?
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ferritin (less than 15 mcg/L, it is pathognomonic for iron deficiency)
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How does a vertebral artery stroke present?
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Horner's syndrome, dysarthria, dysphagia, decreased pain and temperature sensation, dysmetria, ataxia, and vertigo.
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How does an ACA stroke present?
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contralateral leg weakness
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How does an MCA stroke present?
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contralateral face and arm weakness greater than leg weakness, sensory loss, visual field deficit, and either aphasia due to left hemispheric stroke or hemi-inattention (neglect) due to right hemispheric stroke
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How does a PCA stroke present?
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contralateral visual field deficit
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What is the difference in skin findings between diffuse and limited systemic sclerosis?
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Limited systemic sclerosis presents with skin thickening distal to the elbows and knees; diffuse systemic sclerosis is associated with skin thickening proximal to the elbows and knees.
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What are the findings in Behçet's disease?
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recurrent aphthous oral ulcers and at least two of the following features: recurrent genital ulcers, inflammatory eye disease, cutaneous lesions, and positive findings on pathergy test (development of an erythematous papular or pustular lesion >5 mm 24 to 48 hours after skin prick by a needle)
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What are the 11 SLE classification criteria?
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SOAP BRAIN MD: Serositis (pleuritis, pericarditis); Oral or nasopharyngeal ulcerations (painless); Arthritis (nonerosive) involving more than two peripheral joints with synovitis; Photosensitivity; Blood dyscrasias (Coombs'-positive hemolytic anemia with reticulocytosis or leukopenia <4000/µL on more than two occasions, or lymphopenia <1500/µL on two occasions, or thrombocytopenia < 100,000/µL); Renal disease (persistent proteinuria >500 mg/day or cellular casts in the absence of infection); Antinuclear antibody (titer of >1:80); Immunologic disorder (anti–double-stranded DNA antibody, anti-Smith antibody, antiphospholipid antibody, positive lupus anticoagulant, or false-positive rapid plasma reagin [RPR] or VDRL test); Neurologic disorder (seizures or psychosis); Malar rash; Discoid rash (erythematous raised patches with scaling and follicular plugging).
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How does polymyalgia rheumatica present?
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typically develops in patients >50 years of age, manifests as proximal pain, sometimes is accompanied by a sense of weakness of the upper and lower extremities, and usually is associated with an elevated erythrocyte sedimentation rate
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How is PMR treated?
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corticosteroids
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How does acute interstitial nephritis present?
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classic triad of fever, rash, and arthralgias, associated with a medication exposure, urinalysis reveals sterile pyuria and occasionally eosinophiluria
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What are the lab findings in AIN?
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muddy brown casts and tubular epithelial cell casts. In an oliguric patient, high urine sodium and a fractional excretion of sodium (FENa) >1%.
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What's the equation for FENa?
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(UNa * PCr)/(PNa * UCr)*100
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How does TTP present?
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fever, renal failure, thrombocytopenia, microangiopathic hemolytic anemia, and neurologic findings
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How does acute glomerulonephritis present?
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hypertension, edema, and findings of proteinuria and glomerular hematuria on urinalysis
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What diseases are associated with low C3 and normal C4 levels?
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SLE nephritis and postinfectious glomerulonephritis
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What is the test for goodpasture's syndrome?
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anti–glomerular basement membrane antibody assay
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How do myeloma-related kidney disorders present?
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anemia, a low anion gap, and renal failure
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What is seen in Wegener's granulomatosis?
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upper and lower airway disease, glomerulonephritis, and positive findings on a proteinase-3 antineutrophil cytoplasmic antibody assay
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What is the definition of microalbuminuria?
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urine albumin–creatinine ratio of 30 to 300 mg/g
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What is the definition of macroalbuminuria?
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urine albumin–creatinine ratio of >300 mg/g on two separate urine samples performed at least 6 months apart
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What's the equation for serum osms?
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2 × [Na+] + [glucose]/18 + [BUN]/2.8
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What is an electrolyte complication of ACE-inh? What should be considered instead?
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hyperkalemia, hydralazine/nitrate combination
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What is the electrolyte imbalance seen with thiazides?
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hyponatremia
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What are the major criteria for PCV?
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elevated red blood cell mass, a normal arterial oxygen saturation, and the presence of splenomegaly
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What are the iron studies in anemia of chronic disease?
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low or low-normal iron levels and total iron-binding capacity
normal or high ferritin levels |
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What are the lab findings in hereditary spherocytosis?
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mild, Coombs'-negative hemolytic anemia, and an elevated mean corpuscular hemoglobin concentration
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What are the peripheral blood smear findings in iron deficiency anemia?
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hypochromic red blood cells, abnormalities in the size and shape of red blood cells, and occasional bizarre-shaped red blood cells
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What are the peripheral smear findings in alpha thal?
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mild microcytic anemia with prominent target cells on peripheral blood smear.
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What does ferritin measure?
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Intracellular stores (depleted in iron def, increased in ACD)
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What does TIBC measure?
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Surrogate for transferrin concentration (decreased ferritin causes transferrin to be synthesized, which increases the TIBC)
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What is increased in vWD?
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aPTT and bleeding time
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What are the anticoagulant options for individuals with HIT?
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argatroban (HIT with or without thrombosis) and lepirudin (HIT with thrombosis)
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What is the pentad of TTP?
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fever, neurologic abnormalities, thrombocytopenia, microangiopathic hemolytic anemia, and renal insufficiency
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What is the treatment of choice for TTP?
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plasmapheresis
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What are the lab findings in CML?
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elevated leukocyte count and increased numbers of granulocytic cells in all phases of development on the peripheral blood smear
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What are the lab findings in CLL?
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increased leukocyte count and increased numbers of mature lymphocytes (>5000/µL) and “smudge” cells
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What are the findings in MGUS?
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serum monoclonal γ-globulin without the clinical features of multiple myeloma, a paraprotein level <3.5 g/dL, and <10% plasmacytosis in the bone marrow
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Which cancers cause malignant pericardial effusion?
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breast and lung
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What is the treatment for extensive small cell carcinoma of the lung?
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Chemotherapy (only surgery if stage I), whole brain radiation if mets
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What is the treatment for ulcerative colitis and dysplasia of any grade detected on surveillance colonoscopy?
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colectomy
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What can be given to reduce prostate cancer risk?
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Finasteride (decreased by 25%, but many side effects)
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What should be evaluated in a pt with repeated GI and resp infections?
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Serum IgG for CVID
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What's the definition of SIRS?
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presence of two or more of the following (in the absence of a known cause): temperature >38.0 oC (100.4 °F) or <36.0 °C (96.8 °F); heart rate >90/min; respiration rate >20/min or PCO2 <32 mm Hg; leukocyte count >12,000/µL or <4000/µL, or >10% band forms.
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What's the definition of sepsis?
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SIRS in response to a confirmed infectious process.
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What's the definition of severe sepsis?
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sepsis with organ dysfunction, hypoperfusion, or hypotension.
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What's the definition of septic shock?
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sepsis-induced hypotension or hypoperfusion abnormalities despite adequate fluid resuscitation.
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What should be given for immunosuppressed patients exposed to influenza virus?
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Postexposure prophylaxis with zanamivir or oseltamivir and trivalent inactivated influenza vaccine. Not live nasal spray!
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What is the contraindication for use of zanamivir?
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asthma, b/c causes bronchospasm (use oseltamivir)
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What is the first line tx for acute bacterial rhinosinusitis?
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narrow-spectrum antibiotic, such as amoxicillin, trimethoprim–sulfamethoxazole, or doxycycline
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What is the initial therapy for acute uncomplicated urinary tract infection in a young, healthy, nonpregnant woman?
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3 days TMP-SMX (amoxicillin if culture-proven enterococcus)
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When should ARV treatment be started?
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CD4 cell count <200/µL, even if the patient is asymptomatic OR a major AIDS-related opportunistic infection
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What is a risk of inflixamab?
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increased risk of reactivation TB
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What is the recommended tx for CAP in an inpatient on the general medical floor?
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1) an intravenous β-lactam plus an intravenous or oral macrolide or doxycycline or 2) monotherapy with an intravenous fluoroquinolone
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What is the recommended tx for CAP in an inpatient in the ICU?
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intravenous β-lactam plus either an intravenous macrolide or an intravenous fluoroquinolone
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What are the options for treatment of community-acquired pneumonia in an outpatient without additional risk factors?
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advanced-generation macrolide (such as azithromycin or clarithromycin), a ketolide (telithromycin), or doxycycline
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What is empiric therapy for patients with underlying medical conditions and community-acquired pneumonia?
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macrolide and a β-lactam agent; alternatively, a fluoroquinolone alone may be used
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What are normal cholesterol, LDL and TG levels?
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choles = <200, LDL = <130, TG = <125
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What are borderline cholesterol, LDL and TG levels?
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choles = 200-240, LDL = 130-160, TG = 125-250
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What are high cholesterol, LDL and TG levels?
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choles = >240, LDL = >160, TG = >250
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What is the target LDL goal with no established CHD?
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<130
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What is the target LDL goal with CHD or diabetes?
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<100
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What are the tests for L4 root function?
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ankle dorsiflexion, sensation anteromedial leg, patellar reflex
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What are the tests for L5 root function?
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Dorsiflexion of ankle and big toe against resistance, sensation along lateral shin and dorsum of foot
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What are the tests for S1 root function?
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ankle plantar flexion, achilles reflex, sensation lateral foot and heel
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What are the Ottowa rules?
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Ankle radiographs not necessary if pt can walk 4 steps at time of injury and eval, and there is no body tenderness over distal 6 cm of either malleolus
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When do you get an echo?
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patients with cardiac symptoms, with systolic murmurs that are continuous or >3/6 in intensity, or when any diastolic murmur is present
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What drug is contraindicated in a pt who comes in with cocaine use and chest pain?
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The use of β-blockers alone to treat cocaine-induced myocardial ischemia can result in unopposed α-receptor stimulation, further increasing vascular tone and worsening the cardiovascular effects.
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When is drug therapy considered in weight loss treatment?
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patients with a BMI ≥30 or ≥27 with comorbidities
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When is bariatric surgery considered in weight loss treatment?
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BMI ≥35 with comorbidities or ≥40 without comorbidities in whom attempts at weight loss, including drug therapy, were unsuccessful
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What are the drugs for weight loss and what are their contraindications?
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Orlistat - lipase inhibitor that increases fecal fat. SE are GI. Sibutramine - appetite suppressant. Not for people with poorly controlled HTN. Fluoxetine - unclear mxn.
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What are the treatments of choice for herpes zoster?
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Famciclovir and valacyclovir, or acylovir
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What findings suggest hyperaldosteronism?
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HTN, unprovoked hypokalemia, renal potassium wasting, metabolic alkalosis
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What are the side effects of thiazide diuretics?
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hypokalemia, metabolic alkalosis, hyperglycemia
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What are the side effects of ACE inhibitors?
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ARF, hyperkalemia, cough, angioedema
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What is the target BP for pts with diabetes or renal failure?
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<130/80 mm Hg
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What are the classic symptoms of pheochromocytoma?
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hypertension, headaches, palpitations, and diaphoresis
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What symptoms are characteristic of carcinoid?
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flushes, fall in BP, rise in HR
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What medication is needed before surgery for pheochromocytoma?
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α-blockade therapy (e.g., phenoxybenzamine)
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What should be screened for in patients with HTN and episodes of pulmonary edema?
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renovascular disease (edema from episodes of hyperreninemia)
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What is the treatment of choice in scleroderma renal crisis?
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short-acting angiotensin-converting enzyme (ACE) inhibitor, such as captopril
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What is the treatment of choice for M. pneumonia?
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Erythromycin
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What should be suspected in a young, previously healthy male presents with verrucous skin
lesions, bone pain, fever, cough, and weight loss, chest x-ray shows nodular infiltrates? |
Blastomycosis - chronic resp infection, bone pain from osteolytic lesions
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What infection is associated with pancreatitis?
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mumps
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What is the most common CNS complication of varicella?
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acute cerebellar ataxia, (also sometimes a polyneuritis or transverse myelitis)
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What is a SE of imipenem?
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seizures, esp at high doses
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What is a SE of aminoglycosides?
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neuromuscular blockade (esp when given with neuromuscular blocking agents)
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What is the CXR pattern of PCP?
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diffuse perihilar infiltrates, dx'ed by silver methenamine stain
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What causes erysipelas and how do you distinguish it from cellulitis?
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S. pyogenes group A hemolytic strep, often has a preceding event (damage to skin), rapidly spreading, less likely to cause furuncles or abscesses
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What should be suspected in a pt who develops a pulmonary nodule after travel through the American Southwest?
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Coccidiomycosis (from inhalation of spores)
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What should be suspected in a previously health pt who develops pulmonary edema without known cause and has thrombocytopenia?
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Hantavirus, from aerosolized rodent urine or a bite
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What is the test and Ab for Sjogren's syndrome?
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Anti-Ro (SSA), Schirmer test (measures amount of wetness on a filter paper after 5 min on lower lid)
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What are the x-ray findings in pseudogout? What diseases are associated?
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linear calcification, hyperparathroidism, hemochromatosis
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What is seen in Felty syndrome?
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rheumatoid arthritis, splenomegaly, leukopenia (mostly from granulocytopenia), tends to occur in people who have had RA for a long time, high titers of RF and extra-articular disease
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What are side effects of gold therapy for RA?
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exfoliative dermatitis, stomatitis, nephrotic syndrome, bone marrow suppression
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What is a side effect of chloroquine therapy?
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retinitis, from deposition in the pigmented layer of retina
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What ab is found in Wegener's granulomatosis?
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c-ANCA
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What ab is found in PAN?
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p-ANCA
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What is the differential diagnosis in eosinophilic pneumonia?
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allergic bronchopulmonary aspergillosis, parasitic infections, drug reactions (eg, nitrofurantoin or sulfonamides)
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What are the findings in an empyema exudative effusion?
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very low pH, PMN predominance, drain when pH<7.20, pus or fluid shows gram positive stain/culture
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What are the findings in a rheumatoid effusion?
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exudative, lymphocytic, very low glucose leels
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How do you diagnose sarcoid?
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transbronchial biopsy (mononuclear cell granulomatous inflammatory process)
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What are the respiratory findings in PE?
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acute respiratory alkalosis
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What are the ABG findings in chronic lung disease?
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hypercapnia, compensatory increase in serum bicarb, which brings the pH close to normal
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What are the pulmonary capillary wedge pressures in ARDS and CHF?
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normal or low in ARDS, high in CHF
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What must be done after establishing a diagnosis of primary pulmonary hypertension?
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acute drug testing with pulmonary vasodilators (inhaled NO, IV adenoside or IV prostacyclin)
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What are the possible treatments for primary pulmonary hypertension?
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1) long acting CCB 2) prostacyclin 3) lung transplantation
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What is the acute treatment for unstable angina?
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O2, morphine, nitrates, ASA, B-blockers, LMWH/heparin, +/- abcixamab/tirofiban
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What are SE of lidocaine?
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confusion, tremor, convulsions, respiratory depression, bradycardia, hypotension
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What are the major Framingham criteria for CHF?
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paroxysmal nocturnal dyspnea, neck vein distension, rales, cardiomegaly, acute pulmonary edema, S3 gallop, increased venous pressure, hepatojugular reflux
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What are the two meds that should be given in post-MI LV dysfunction?
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ACE-inhibitor and diuretic (?B-blocker)
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When does radionucleotide imaging need to be used instead of stress test?
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LBBB, WPW, paced rhythm, RBBB with >1mm resting ST segment depression
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What are the classic findings in aortic stenosis?
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exertional dyspnea, angina pectoris, syncope, narrow pulse pressure and harsh systolic crescendo-decrescendo murmur heard best at the upper right sternal border
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What is the murmur of mitral stenosis?
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diastolic rumbling apical murmur
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What is the murmur of ASD?
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A systolic murmur at the pulmonic area and a diastolic rumble along the left sternal border
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What is the murmur of VSD?
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A holosystolic murmur at the mid-left sternal border
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What is the treatment of choice for PVCs?
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If minimally symptomatic, nothing. If symptomatic, B-blocker
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What are the initial treatments of a patient with paroxysmal supraventricular tachycardia?
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vagotonic maneuvers, adenosine 2x6mg, then 2x5mg. Diltiazem and digoxin may be useful in rate control
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What is the initial treatment for Mobitz type I second-degree AV block?
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observation, benign condition
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What is the treatment for ventricular fibrillation?
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Defibrillation at 200j, 300j, 360j. Epinephrine 1mg IV push every 3-5 min. If persistent then amiodarone 300mg IV push or lidocaine 1.0-1.5mg IV push.
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What medications are used to treat hypertensive emergency?
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IV nitroprusside or IV labetalol (not not in asthma)
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What is the treatment for complete AV block?
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pacemaker placement (atropine as a temporary measure)
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What is pulsus paradoxus?
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>10mmHg inspiratory decline in systolic arterial pressure (see in pericarditis)
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What are the ECG findings in pulmonary HTN?
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tall peaked p waves in II, III, aVF (R atrial enlargement), tall R waves in V1-V3 and deep S in V6 with ST-T wave changes (from RVH), R axis deviation
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What causes paradoxical splitting of S2?
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LBBB, (or any electrical or mechnical event that delays L ventricular systole)
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What is the murmur of hypertrophic cardiomyopathy?
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Crescendo-decrescendo systolic murmur beginning well after S1,
heard best at the lower left sternal border; rapidly rising carotid arterial pulse |
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What is given for sinus bradycardia with hypotension in acute MI?
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atropine
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What is used to treat accelerated idioventricular rhythm post–myocardial
infarction? |
nothing, observation
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What is the treatment for hypertrophic cardiomyopathy?
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B-blockers (if not responding, CCBs)
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What are the SE of propranolol?
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bronchospasm, decrease HDL and raise TG
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What is the SE of clonidine?
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rebound HTN
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What is the SE of hydralazine?
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lupus-like syndrome
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What are the EKG findings in hypokalemia?
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U waves
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What are the EKG findings in hyperkalemia?
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tall, peaked T waves, then widened QRS
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What are the EKG findings in hypocalcemia?
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prolonged QT interval
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What is the upper limit of serum osms?
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serum osmolality greater than 320 mOsm/L
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What test should be done following a clinical diagnosis consistent with hypothyroidism?
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TPO Ab, present in 90-95% of people with autoimmune thyroid disease
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What are treatment options for Paget's disease?
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bisphosphonates and calcitonin
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What is the screening test for hyperaldosteronism?
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plasma aldo to renin ratio >30, can do further w/u of saline infusion test (aldo doesn't decrease after saline infusion)
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How does Addison's disease present?
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weakness, fatigue, weight loss, hypotension, extensor hyperpigmentation
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What is the treatment for Addison's disease?
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Hydrocortisone twice per day plus fludrocortisone (glucocorticoid plus mineralcorticoid)
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What is found in MEN I?
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Parathyroid hyperplasia, Pancreatic islet cell tumors, Pituitary tumors
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What is found in MEN IIa?
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Medullary thyroid carcinoma, Pheochromocytoma, Hyperparathyroidism
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What is found in MEN IIb?
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Mucosal neuromas, Medullary thyroid carcinoma, Marfinoid body habitus, Pheochromocytoma
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What provocative tests can be used to diagnose gastrinoma?
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Secretin or calcium infusion (will result in elevated gastrin levels in in gastrinoma)
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What are Ranson's criteria at presentation?
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Age greater than 55, leukocytosis greater than 16,000, glucose greater than 200 mg/dl, LDH greater than 400 IU, AST greater than 250 IU/L.
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What is the cutoff for SAAG and what does it mean?
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serum ascites albumin gradient, if >1.1 portal HTN is very likely
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Which glomerular disease: Hypertension, nephrotic syndrome, renal insufficiency, microhematuria,
sclerotic changes in juxtamedullary nephrons |
Focal segmental sclerosis
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Which glomerular disease: Mild hypertension, nephrotic syndrome, microhematuria, venous thromboses (especially renal vein thrombosis), thickened glomerular basement membrane with immunoglobulin deposition
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Membranous nephropathy
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Which glomerular disease: Normal blood pressure, anasarca, severe nephrotic syndrome, normal
light microscopy, fusion of foot processes on electron microscopy |
Minimal change disease
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Which glomerular disease: Hypertension, nephrotic syndrome, mild renal insufficiency, RBC casts
in urine, depressed third component of complement (C3), dense deposits on electron microscopy |
Membranoproliferative glomerulonephritis
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What is the definitive diagnosis for multiple myeloma?
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>10% plasma cells on bone marrow biopsy
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What does chemo start in CLL?
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Stage III or IV, which is associated with anemia and thrombocytopenia
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What are risk factors for ovarian cancer?
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infertility, frequent miscarriages, family hx. OCPs and pregnancies are protective.
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What is the classic triad for renal carcinoma?
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hematuria, flank pain, palpable flank mass. Multiple paraneoplastic syndromes
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What is the treatment for metastatic prostate cancer?
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GnRH analogue or surgical castration
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What is the paraneoplastic syndrome of retroperitoneal sarcoma?
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Hypoglycemia due to IGF-2
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What is the paraneoplastic syndrome of pancreatic cancer?
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Trousseau syndrome - migratory superficial thrombophlebitis
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What is the paraneoplastic syndrome of squamous cancers?
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Humoral hypercalcemia of malignancy that resembles hyperparathyroidism but is caused by PTHrP
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What is the paraneoplastic syndrome of oat cell carcinoma (small cell undifferentiated)?
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Hyponatremia due to inappropriate ADH secretion (sometimes also ACTH production)
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What is the treatment for ALS?
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Riluzole, only delays death by 3-5 months
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What causes erythema multiforme?
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can follow HSV infection, or sulfa drugs, PCN, phenytoin, allopurinol, or barbiturate use
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What is the treatment for rosacea?
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low dose erythromycin, tetracycline, and metronidazole
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What is the LDL goal for people with known CAD?
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<100
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What is the LDL goal in a patient with no CAD and 0-1 risk factor?
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<160
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What is the LDL goal in a patient with no CAD and 2+ risk factors
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<130
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What is a risk of hypertriglyceridemia?
|
pancreatitis
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What are high cardiac risk indicators in the setting of noncardiac surgery?
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recent MI, unstable or advanced angina, significant arrhythmias, decompensated CHF, severe aortic stenosis
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What drug should be avoided in acute gout?
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Diuretics - predispose to hyperuricemia
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|
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What are the contraindications to nonselective B-blockers?
|
asthma, can worsen PVD, CHF, and diabetes
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What immune deficiency will give recurrent meningococcemia?
|
Complement deficiency C5–C9 - can't form MAC
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What immune deficiency will give disseminated apergillosis?
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Neutropenia - high risk of fungal and pseudomonas infections
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What immune deficiency results in disseminated mycobacteria?
|
Interleukin 12 receptor deficit - can't stimulate IFN-g production
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RTA associated with aldosterone defect? What is distinctive about it?
|
Type IV (distal), hyperkalemia and acidic urine
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Meningitis in infants. Causes? Treatment?:
|
Pneumococcus, meningococcus, H. influenzae. Treat with cefotaxime and vancomycin
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Meningitis in neonates. Causes? Treatment?:
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Group B strep, E. coli, Listeria. Treat with gentamicin and ampicillin
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HUS triad?:
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Anemia, thrombocytopenia, and acute renal failure
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Drugs that slow AV node transmission?
|
β-blockers, digoxin, calcium channel blockers
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Which arrhythmias require pacemaker implantation?
|
Second degree Mobitz type II and third degree AV block
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What are the p-450 inducers?
|
Quinidine, Barbiturates, St. John's wort, Phenytoin, Rifampin, Griseofulvin, Carbamazepine (Queen Barb Steals Phen-phen and Refuses Greasy Carbs)
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What are the p-450 inhibitors?
|
Sulfonamides, Isoniazid, Cimetidine, Ketoconazole, Erythromycin, Grapefruit juice (Inhibit drinking from a KEG because it makes you SICk)
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What is found in Fanconi’s anemia?
|
Anemia associated with absent radii and thumbs, diffuse hyperpigmentation, café-au-lait spots, microcephaly, and pancytopenia
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A patient from California or Arizona presents wutg fever, malaise, cough, and night sweats. Diagnosis? Treatment?
|
Coccidiomycosis, Amphotericin B
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What are the ankle-brachial index cutoffs for PVD and severe PVD?
|
PVD - ankle-brachial index (ABI) <0.9, and those with severe disease (rest ischemia) have an ABI <0.4.
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What does an ABI >1.3 indicate?
|
vascular calcification
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What is the initial treatment for acute viral pericarditis? If chronic?
|
high-dose nonsteroidal anti-inflammatory drug (indomethicin or ibuprofen); 7- to 10-day tapering course of corticosteroids
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|
What is the classic EKG finding in digitalis toxicity?
|
Atrial tachycardia with variable block (ectopic beats, A fib possible)
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What is recommend for a pt with multivessel CAD and diabetes mellitus?
|
better outcomes with CABG compared with percutaneous angioplasty
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Which pts with CAD merit ICD placement?
|
ejection fraction ≤30%, (but CABG if multivessel disease is present)
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What EKG finding is pathognomonic for acute pericarditis?
|
PR-segment depression (with ST segments that are upwardly concave)
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What is the CHADS2 score and what does it measure?
|
≥3 suggests
Congestive heart failure, Hypertension, Age >75 years, Diabetes, Stroke or transient ischemic attack (TIA). 2 points for a history of stroke or TIA (the strongest risk factor) and 1 point for all other risk factors. |
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What are the EKG findings in inferior infarction?
|
ST elevation in leads II, III, and aVF
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What are the EKG findings in anteroseptal infarction?
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ST elevation in leads V1–V3
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What are the EKG findings in lateral and apical infarctions?
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ST elevation V4–V6
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What are the EKG findings in acute posterior wall myocardial infarction?
|
ST depression in leads V1–V2
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What is the treatment for acute myocarditis?
|
generally, the same as CHF (ACE-i if no contraindications)
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What is the treatment for multifocal atrial tachycardia?
|
treat underlying disease! If refractory, add calcium-channel blocker such as diltiazem or verapamil
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What is the EKG of atrioventricular re-entrant tachycardia (Wolff-Parkinson-White syndrome)?
|
short PR segment, delta wave, and tachycardia.
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What meds are indicated for all pts with systolic dysfunction, regardless of symptoms?
|
angiotensin-converting enzyme inhibitor and a β-blocker
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What are the criteria for using spironolactone in CHF?
|
Severe heart failure, left ventricular ejection fraction ≤35%, serum creatinine ≤2.5 mg/dL, and serum potassium ≤5 meq/L
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What is the treatment for patients with sustained ventricular tachycardia in the setting of significant structural heart disease?
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ICD placement
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What is the treatment for a stable patient with v-tach?
|
lidocaine, procainamide, or amiodarone
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What is the treatment for an unstable patient with v-tach?
|
direct-current cardioversion
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What maneuvers increase and decrease the murmur of hypertrophic cardiomyopathy?
|
increases after a Valsalva maneuver and decreases with standing to squatting.
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What happens with Valsalva maneuver or the squat-to-stand maneuver?
|
venous return is transiently decreased, left ventricular chamber size decreases and the septum and mitral leaflet are brought closer together.
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What happens with the stand-to-squat maneuver and passive leg lift?
|
transiently increase venous return (preload) and therefore increase left ventricular chamber size and volume, the end-systolic dimension of the left ventricle increases
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What do isometric handgrip exercises do?
|
Increase afterload (increase regurgitrant murmurs)
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What are the findings of mitral prolapse?
|
midsystolic click followed by a late systolic murmur, Valsalva maneuver and standing from a squatting position move the click-murmur complex closer to S1
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When should chest tube drainage (tube thoracostomy) of a parapneumonic effusion should be instituted?
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if pus or gram-positive pleural fluid is detected or if the pleural fluid pH is <7.0.
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In the setting of pneumonia, when is thoracentesis indicated?
|
presence of free-flowing pleural fluid >10 mm in height on a lateral decubitus chest radiograph
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What is indicated for asthma control in previously well-controlled patients following a respiratory tract infection?
|
short course of oral corticosteroids
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What is indicated for a pt who presents with acute severe asthma?
|
IV corticosteroids, Prompt administration of bronchodilators and anticholinergics, magnesium sulfate (intravenous or inhaled)
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What should be done in patients with persistent asthma not adequately controlled with daily low- or moderate-dose inhaled corticosteroids?
|
adding a long-acting β-agonist improves asthma control and quality of life.
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What underlying conditions merit treatment in acute bronchitis?
|
COPD, or if it is B. pertussis
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|
What is Löfgren's syndrome?
|
sarcoidosis, presenting acutely with bilateral hilar lymphadenopathy, polyarthralgias, and erythema nodosum
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What do flat neck veins tell you?
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No right sided circulatory collapse (as in massive PE)
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What is the treatment for patients with acute venous thromboembolism in association with metastatic cancer?
|
Chronic low-molecular-weight heparin at therapeutic doses reduces the risk for recurrent venous thromboembolism compared with standard-intensity warfarin
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|
What is the long term treatment for patients heterozygous for factor V Leiden mutation with recurrent thrombosis?
|
anticoagulation therapy with warfarin
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|
What PFTs are found in obstructuvve lung disease?
|
FEV1/FVC ratio <70%
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|
What is the difference between Wegener's and Goodpasture's syndromes?
|
Goodpasture's syndrome is a renal-pulmonary vasculitis syndrome; it usually affects young men and does not cause upper respiratory tract disease. Wegener's = proteinase-3 antineutrophil cytoplasmic antibody assay. Goodpasture's = anti-GBM ab
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What is the acid base disorder associated with severe liver failure?
|
AG metabolic acidosis, decreased clearance of lactate from the circulation can lead to lactic acidosis
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What acid base disturbance does acetazolamide cause?
|
non–anion gap metabolic acidosis
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What does a low pH and decreased bicarbonate level tell you?
|
metabolic acidosis
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What is the serum sodium correction for glucose?
|
correcting the serum sodium by 1.6 to 2.4 meq/L for each 100 mg/dL increase in plasma glucose concentration above 100 mg/dL
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What's the cause of hyperphosphatemia in chronic kidney disease?
|
low glomerular filtration rate
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What presents like hypoparathyroidism in alcoholic pts?
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Hypomagnesemia in a patient with alcoholism can mimic hypoparathyroidism, including severe hypocalcemia and hyperphosphatemia
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What is indicated for empiric treatment of a highly compliant, nonpregnant patient with acute pyelonephritis who can eat and drink?
|
Oral levofloxacin
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|
What is the CV finding in endocarditis?
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Worry about perivalvular abscess, causing conduction abnormaliities
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|
|
What is the biliary disease associated with UC?
|
Sclerosing cholangitis
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|
|
What is the biliary disease of young women?
|
primary biliary sclerosis
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|
What are spherocytes seen in?
|
WAIHA, and hereditary spherocytosis
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|
TTP pentad (other)
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fever, neuro abnl, thrombocytopenia, anemia, schistocytes, elevated LDH
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Who fits the category for cut-off threshold of >5 mm for PPD?
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persons at highest risk of developing active tuberculosis (e.g., HIV-infected patients, immunosuppressed patients, persons with close contact with anyone with active tuberculosis, or those with a chest radiograph consistent with prior tuberculosis)
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Who fits the category for cut-off threshold of >10 mm for PPD?
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persons who have immigrated to the United States from high-risk countries within the past 5 years, injection drug users, prisoners, health care workers, and patients with silicosis, diabetes mellitus, chronic renal failure, leukemia and lymphoma, carcinoma of the head and neck or lung, recent significant weight loss, and a history of gastrectomy or jejunoileal bypass, healthy adolescents exposed to high-risk adults
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|
|
What is the treatment of choice for aspiration pneumonia?
|
Clindamycin
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What should be considered in a patient with hyponatremia, azotemia, and elevated liver enzymes or creatine kinase?
|
Legionella, tx with azithromycin and cefuroxime
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|
What are the goal uric acid levels in patients with tophaceous gout?
|
Uric acid levels should be reduced to 6 mg/dL to dissolve tophi and other urate deposits in the tissue.
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How do patients with hereditary hemochromatosis present? with abnormal liver chemistry test results, arthropathy, fatigue, and impotence.
|
with abnormal liver chemistry test results, arthropathy, fatigue, and impotence
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|
What disease is associated with a synovial fluid leukocyte count of <2000/µL?
|
osteoarthritis
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What disease is associated with a synovial fluid leukocyte count of 2000/µL and 50,000/µL?
|
Gout and calcium pyrophosphate deposition disease (pseudogout)
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What disease is associated with a synovial fluid leukocyte count of 10,000/µL and 50,000/µL?
|
septic arthritis
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|
What should be done in a patient with a diagnosis of polymyositis, dermatomyositis, or inclusion-body myositis?
|
careful evaluation for an occult malignancy, beginning with routine age- and sex-appropriate screening tests
|
|
|
What is the difference between polymyalgia rheumatica and polymyositis?
|
PMR - hip and should pain and stiffness, significantly elevated erythrocyte sedimentation rate but a normal creatine kinase level. Polymyositis - high creatine kinase level and proximal muscle weakness (less likely to be painful)
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|
How does peripheral nervous system vasculitis usually present? with asymmetrical weakness and sensory loss in specific nerve distributions
|
with asymmetrical weakness and sensory loss in specific nerve distributions
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|
What is the treatment for PMR?
|
Corticosteroid therapy often resolves polymyalgia rheumatica symptoms within 24 hours.
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|
What disease has pancytopenia and hypocellular bone marrow?
|
aplastic anemia
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|
What disease is characterized by anemia, an elevated reticulocyte count, and microspherocytes on the peripheral blood smear?
|
Autoimmune hemolytic anemia
|
|
|
What are the best lab tests to diagnose vitamin B12 deficiency?
|
elevated serum methylmalonic acid and homocysteine concentrations. (methylmalonic acid distinguishes from folate deficiency)
|
|
|
What are the best lab tests to diagnose folate deficency?
|
elevated homocysteine concentration only
|
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|
What are basic labs distinguishing Hereditary spherocytosis?
|
mild, Coombs'-negative hemolytic anemia, and an elevated mean corpuscular hemoglobin concentration (occurs because spherocytes contain more hemoglobin per unit of volume than normal red blood cells)
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|
|
What is the initial treatment in warm-antibody autoimmune hemolytic anemia?
|
corticosteroid therapy
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|
What is the treatment for CML and what is the mechanism?
|
Imatinib mesylate treatment, specifically targets and inhibits BCR-ABL tyrosine kinase activity and leads to suppression of the CML clone
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|
What is the treatment for MGUS?
|
A routine follow-up examination to identify any signs and symptoms of progression to multiple myeloma and periodic measurement of monoclonal protein concentration are sufficient
|
|
|
What is empiric therapy for Streptococcus pneumoniae meningitis?
|
vancomycin plus ceftriaxone and dexamethasone
|
|
|
What is the presentation of locked-in syndrome?
|
quadriplegic, have paralysis of horizontal eye movements and bulbar muscles, and can communicate only by moving their eyes vertically or blinking
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|
|
What is the presentation of a vertebral artery stroke?
|
Horner's syndrome, dysarthria, dysphagia, decreased pain and temperature sensation, dysmetria, ataxia, and vertigo
|
|
|
What is the treatment for stroke not eligable for TPA?
|
Early administration of aspirin, 160 to 325 mg daily, results in a modest reduction in the risk of recurrent stroke in the short term and slightly less death and disability in the long term.
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|
|
What is the treatment for stroke presenting w/in 3 hrs of onset?
|
tPA, antiplatelet agents and anticoagulants should be withheld for 24 to 48 hours following thrombolysis
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|
|
When is alteplase contraindicated?
|
in patients with mean arterial pressure >130 mm Hg or blood pressure >185/110 mm Hg
|
|
|
What are the indications for carotid endarterectomy in symptomatic pts?
|
carotid artery ultrasonography showing a >50% stenosis of the internal carotid artery
|
|
|
What is characteristic of a demyelinating polyneuropathy?
|
symmetric proximal and distal muscle weakness, decreased deep tendon reflexes, and distal loss of vibration and position senses
|
|
|
Which medication should be avoided when using IV contrast?
|
metformin, which accumulates in patients with renal insufficiency, worry for lactic acidosis
|
|
|
What are the ADA guidelines for a DM diagnosis?
|
fasting plasma glucose ≥126 mg/dL, a 2-hour plasma glucose ≥200 mg/dL after a 75-g oral glucose load, or a random plasma glucose ≥200 mg/dL plus symptoms of diabetes. If any abnl, must be confirmed by a second test.
|
|
|
What are the cutoffs for impaired glucose tolerance?
|
2-hour glucose level of 140–199 mg/dL during an oral glucose tolerance test, and impaired fasting glucose, defined as a fasting glucose level of 100–125 mg/dL
|
|
|
What are desirable postprandial excursions?
|
30 to 50 mg/dL
|
|
|
What are recommended treatment goals in DM?
|
hemoglobin A1c <7.0%, preprandial glucose 90–130 mg/dL, 2-hour postprandial glucose <180 mg/dL, blood pressure <130/80 mm Hg, triglycerides <150 mg/dL, HDL cholesterol >40 mg/dL, and LDL cholesterol <100 mg/dL.
|
|
|
Which DM meds shouldn't be used in patients with New York Heart Association class III congestive heart failure?
|
Metformin and thiazolidinediones
|
|
|
What is contraindicated in contraindicated in patients with type 2 diabetes mellitus and heart failure?
|
Thiazolidinediones
|
|
|
What is contraindicated in contraindicated in patients with type 2 diabetes mellitus and renal insufficiency?
|
Metformin
|
|
|
What is seen in myxedema coma?
|
progressive obtundation, hypothermia, hypotension, and bradycardia
|
|
|
How do you identify a hyperfunctioning adenomatous thyroid nodule?
|
palpable on thyroid examination, is associated with increased iodine uptake, and a thyroid scan that localizes the adenoma as a “hot” focus.
|
|
|
How do you identidy toxic multinodular goiter?
|
a goiter that is nodular to palpation, an elevated iodine uptake, and a thyroid scan demonstrating heterogeneous uptake of the tracer
|
|
|
How do you identify Graves disease?
|
diffusely enlarged thyroid gland, elevated iodine uptake, and a thyroid scan demonstrating homogeneous uptake of the tracer.
|
|
|
where would a lesion cause the classic cape distribution?
|
central cervical cord lesion (C5-C6 is the lateral arm):
Bilateral loss due to destruction of ventral commisure, damages spinothalamic fibers crossing. |
|
|
What is Schmidt's syndrome?
|
concurrence of autoimmune thyroid disease and Addison's disease (An isolated elevation in TSH has also been described in patients with adrenal insufficiency as a result of an absence of the suppressive effect of cortisol upon TSH synthesis and release from the anterior pituitary.)
|
|
|
What are the 2 screening tests for Cushings?
|
measurement of urine free cortisol (increased) and the overnight dexamethasone suppression test (not suppresssable)
|
|
|
When is osteoporosis screening initiated?
|
all women ≥65 years and women <65 years who have one or more risk factors for osteoporosis.
|
|
|
Which LN require immediate excision?
|
rapid onset of enlarged lymph nodes and size >2 cm
|
|
|
What is seen in primary sclerosing cholangitis?
|
laboratory results compatible with cholestatic liver disease (high alkaline phosphatase concentration, normal or minimally elevated bilirubin level, and modestly elevated aminotransferase values) Dilatation of the peripheral bile ducts on ultrasonography without evidence of apparent obstruction in the common bile duct
|
|
|
What is seen in cholangiocarcinoma?
|
a moderate dilatation of the intrahepatic bile ducts
|
|
|
What treatment is indicated for early-stage breast cancer?
|
Breast-conserving surgery with radiation therapy results in similar and sometimes superior survival in patients with early-stage breast cancer regardless of patient age compared with mastectomy. Consider adjuvant systemic therapy with hormonal therapy, chemotherapy, or both
|
|
|
What are the characteristics of malignant lung lesions?
|
spiculated margins, little or no calcification, and intermediate doubling times (between 30 and 500 days)
|
|
|
أَنشَأَ - يُنشِىء - الإنْشاء
|
to found, erect, establish
|
|
|
What are the cancer associations with combination hormone replacement therapy?
|
increases the risk for breast cancer
|
|
|
What are the most common causes of aminotransferase values >5000 U/L?
|
acetaminophen hepatotoxicity, hepatic ischemia, and hepatitis due to unusual viruses such as herpes simplex virus
|
|
|
Which two syndromes are associated with an indirect hyperbilirubinemia?
|
Gilbert's and Crigler-Najjar
|
|
|
What lab values are seen in hepatic ischemia?
|
marked elevations in aminotransferase values that rapidly improve within several days.
|
|
|
What is the treatment for uncomplicated diverticulitis?
|
broad-spectrum antibiotics such as ciprofloxacin and metronidazole for 7 to 10 days and a soft, low-residue diet
|
|
|
What are treatments for IBS?
|
TCAs and SSRIs; diarrhea-predominant irritable bowel syndrome (IBS) - loperamide (alosetron if severe)
|
|
|
What biliary disease are IBD patients at high risk of developing?
|
primary sclerosing cholangitis
|
|
|
What is fulminent liver failure and how is it treated?
|
clinical syndrome of severe acute liver failure and hepatic encephalopathy (asterixis and depressed consciousness) in a patient without pre-existing liver disease, immediate eval for transplant
|
|
|
What should be done for patients with a positive assay for antibodies to hepatitis C virus (anti-HCV)?
|
test for HCV RNA to determine if viremia is present.
|
|
|
How does autoimmune hepatitis present? What is the Ab test?
|
Autoimmune hepatitis can manifest as acute hepatitis with elevated aminotransferase values and jaundice; the AST:ALT ratio is typically <2.0. Antinuclear antibody and anti–smooth muscle antibody titers ≥1:80 support a diagnosis of autoimmune hepatitis.
|
|
|
What findings suggest primary biliary cirrhosis?
|
Pruritus, hypercholesterolemia, laboratory evidence of cholestatic liver disease, and a positive antimitochondrial antibody titer
|
|
|
What is the preferred initial evaluation for patients with suspected abdominal aortic aneurysm?
|
Abdominal ultrasonography
|
|
|
What is the treatment for comedonal-only acne?
|
topical retinoids are the mainstay of treatment
|
|
|
Which diuretics stimulate renal tubular calcium reabsorption and may lead to a mild hypercalcemia?
|
thiazide diuretics
|
