Hypertension
Which affordable ARB (30 tabs for $9 and 90 tabs for $24 at Walmart) is more effective at lowering BP than Losartan and Valsartan?
Irbesartan, according to one meta-analysis
Which state causes an increased prolactin level?
Hypothyroidism (leads to increased secretion of TRH which stimulates TSH and prolactin from the pituitary, so can see galactorrhea/lactation from hypothyroidism)
Posterior epistaxis usually originates from what artery?
Sphenopalatine artery
Which first line medicine used in alcohol use disorder should not be given when patient is still drinking alcohol?
Acamprosate (Campral)
When looking at the lower extremities when doing a physical exam, what should you always do?
Inspect both sides, even if the issue is on one side
OSA is a common cause of secondary hypertension. What are all of the components of the STOP-BANG score?
Snore, Tired, Observed apnea, Pressure/HTN, BMI >35, Age >50, Neck circumference >40cm, gender/male
Which medicine should pregnant patients in their first trimester use for Grave’s disease?
Propylthiouracil (PTU), methimazole teratogenic
According to Aidan, who is a very nice ortho surgeon we can send referrals to?
Dr. Saif Zaman
What medicine can “give you an Asian flush” type reaction if you use with something like mouthwash?
Disulfiram (Antabuse)
According to Sharul, what is a cause of falls that you must be mindful of?
Polypharmacy
According to the 2017 ACA/AHA HTN guidelines, what labs should you get on first diagnosis of hypertension? Name 6.
BMP (check for glucose, creatinine, sodium, potassium, calcium), CBC, Lipid profile, TSH, urinalysis, EKG (look for LVH). Optional: echo, uric acid, urinary albumin to creatinine ratio
In patients with subclinical hypothyroidism (elevated TSH with normal T3 and T4 levels), what level of TSH should you start treatment for even if asymptomatic?
Greater than 10. Also treat with elevated TPO antibody titers or if pregnant trying to conceive (bring TSH under 2.5)
In patients with restless leg syndrome, supplementation with what can improve symptoms?
Iron
Which anti-hypertensive can be used to prevent migraine?
Candesartan
What type of cream works well for shoulder pain?
Capsaicin
DASH diet is estimated to be able to lower systolic blood pressure by how many mmHg?
~11mmHg
This condition leaves a very tender thyroid, especially after a flu-like viral infection. Can start hyperthyroid early then goes hypothyroid. Has increased ESR, jaw pain
Subacute granulomatous thyroiditis (de Quervain)
Which physical exam test has a 7.2 to 28 positive likelihood ratio for shoulder pathology (mainly rotator cuff tear)
Internal rotation lag sign (be sure to know how to perform it!)
What is the criteria used to diagnosis multiple sclerosis?
McDonald Criteria
Young patient with emphysema on CT with no smoking history. What else should you check?
Alpha-1 antitrypsin. Not all emphysema is smoking related
Primary aldosteronism/Conn syndrome is a cause of secondary hypertension. What is the cutoff for likely diagnosis of this in the PAC/PRA ratio? (Plasma aldosterone concentration/Plasma renin activity)
Ratio greater than 20, the aldosterone is high and the renin will be low. Make sure off aldosterone antagonists for 4-6 weeks.
What lab should you monitor for Levothyroxine dose adjustment in patients with secondary hypothyroidism?
Free T4. TSH is unreliable
The NOSTONE 2022 Trial tested different doses of which medication for recurrence/prevention of calcium-containing kidney stones?
HCTZ, found high dose no better than low dose
Name all components of the POUND mnemonic for migraine (and for fun, write the time frame the specific way Richard used)
Pulsatile, one day (4-72 hrs) duration, unilateral, nausea (aura), disabling
For short-term treatment of complete heart block, what is a medication that can be used? Example during ambulance transport.
Isoprenaline/isoproterenol (non-selective Beta agonist, usually used for bradycardia)