Cardiology
Which beta blockers are cardioprotective
Carvedilol, metoprolol succinate, bisoprolol
What classes of medications are indicated to reduce proteinuria in diabetic nephropathy?
What is ACE-i/ARB/NMRA
What is the most common cause of massive upper GI bleed worldwide?
Peptic Ulcer Disease
What is the diagnosis based on the following iron panel:
- Iron: Low
- TIBC: Low
- Ferritin: High
Anemia of chronic disease
A 65yo male with a 40 pack-year history presents with confusion. Initial lab workup is remarkable for Na 118.
Labs:
Serum osmolality: 260 mOsm/kg
Urine sodium: 50 mmol/L
Urine osmolality: 550 mOsm/kg
Chest CT shows a 4 cm right hilar mass.
Which type of lung cancer is the most likely cause?
Small cell lung cancer
The four medication classes that comprise GDMT for HFrEF
1) ACE-i/ARB/ARN-i
2) SGLT2-i (Dapagliflozin, Empagliflozin)
3) Beta-blockers
4) Mineralocorticoid receptor antagonists (spironolactone, eplerenone)
What is, primary polydipsia
What is the strongest predictor of severity in acute pancreatitis?
BUN elevation
What is the most specific test for diagnosing HIIT?
Serotonin release assay
A 70-year-old woman with metastatic squamous cell carcinoma of the lung presents with weakness and constipation.
Labs:
Serum calcium: 13.2 mg/dL
PTH: low
Which test would you order next to confirm the diagnosis?
PTHrP secretion
In symptomatic patients with aortic stenosis, what 3 ECHO findings warrant valve replacement?
What is as aortic valve area ≤1.0 cm², peak velocity ≥4.0 m/s, or mean gradient ≥40 mm Hg?
A 67-year-old man presents with hematuria and rapidly rising creatinine. Complement levels are normal. ANCA negative. Anti-GBM negative. Kidney biopsy shows crescentic GN with linear IgG staining absent; there is granular deposition of IgG and C3. What is the most likely diagnosis?
What is infection related glomerulonephritis
A 58-year-old woman with alcohol-use disorder presents with abdominal distension and weight loss.
Paracentesis results:
Serum albumin: 3.0 g/dL
Ascitic albumin: 2.2 g/dL
Ascitic total protein: 3.6 g/dL
Ascitic fluid cytology: pending
Name three potential causes of this patient's ascites.
What is TB, malignancy (ex: peritoneal carcinomatosis), pancreatic ascites/pancreatitis, nephrotic syndrome, intestinal perforations?
A 45yo female presents with fatigue, petechiae, and confusion. Labs reveal:
Hb: 8.1 g/dL
Platelets: 22,000
LDH: 1,200 U/L
Haptoglobin: undetectable
Creatinine: 1.1
Peripheral smear: schistocytes
Coagulation studies: normal PT/PTT
Which deficiency is most responsible?
ADAMTS13
List the criteria for colorectal cancer screening in a patient without any risk factors AND 3/7 ways we can screen with monitoring
Criteria: in all adults aged 45-75 years old
1) High sensitivity FOBT annually
2) FIT annually
3) Cologuard/DNA-FIT every 1-3 years
4) CT colonography every 5 years
5) Flexible sigmoidoscopy every 5 years
6) Flexible sigmoidoscopy with FIT every 10 years with FIT yearly
7) Colonoscopy every 10 years
Three days after STEMI with PCI to the LAD, a patient develops sudden-onset hypoxia, with audible crackles on auscultation, and a holosystolic murmur at the apex. What is the most likely diagnosis?
Which condition causes:
1) Hypokalemia
2) Metabolic alkalosis
3) Hypocalciuria
Gitelman
Why do cirrhotic patients develop hyponatremia?
Excess ADH due to low effective arterial volume, leads to water retention, and subsequent hyponatremia
Mechanism:
Cirrhosis --> splanchnic vasodilation --> decreased ECV --> increased ADH release --> increased water retention
Name four complications of sickle cell vaso-occlusive crisis.
What is:
1) Acute chest syndrome
2) Pain
3) Priapism
4) Avascular necrosis
Name the one criteria that MUST be present to diagnose multiple myeloma. ALSO name the "CRAB" features that indicate end-organ damage.
Criteria that must be present: monoclonal protein present
CRAB:
C = calcium elevation (> 11)
R = renal dysfunction (serum creatinine > 2, or clearance < 40)
A = Anemia (Hgb < 10, or a change of greater than 2 points from baseline)
B = bone disease (> 1 osteolytic lesion detected on skeletal radiograph, WBLC CT, or PET/CT)
A 72yo male with HFpEF, peripheral neuropathy, and carpal tunnel syndrome, presents with worsening edema. TTE is completed which demonstrates concentric LV thickening with preserved EF. Strain imaging shows apical sparing. What is the most likely diagnosis?
What are the three main steps in the pathophysiology of hypercalcemia causing nephrogenic DI?
Hypercalcemia:
Inhibits ADH action
Decreases aquaporin-2 expression
Impairs medullary gradient
Result:
Polyuria
Nephrogenic DI
List at least four out of the six major criteria for hepatorenal syndrome.
What is:
1) chronic or acute liver disease with advanced liver failure and portal hypertension
2) low GFR (renal failure/injury)
3) Absence of shock, ongoing bacterial infections, or treatment with nephrotoxic drugs
4) Absence of gastrointestinal or renal fluid losses
5) No sustained improvement in renal function following diuretic withdrawal and expansion of plasma volume with 1.5L of isotonic saline (albumin challenge)
6) Proteinuria <0.5g/d and no US evidence of obstructive uropathy or parenchymal disease
What is the diagnostic test of choice AND treatment for methemoglobinemia (what are the indications for treatment)?
What is:
1) Diagnosis with co-oximeter
2) Treatment with Methylene blue
Indications for treatment: if methemoglobin is greater than 20% and if patient is symptomatic
A patient receives cisplatin for testicular cancer. He develops creatinine rise, hypomagnesemia, and ototoxicity. Which mechanism explains his nephrotoxicity?
Tubular oxidative damage