HTN
A 60-year-old female with newly diagnosed hypertension has an average BP of 146/88 mmHg. She has type 2 diabetes and microalbuminuria. What is the best first-line antihypertensive medication for her?
ACE/ARB - Lisinopril
What lipid medication lowers triglycerides most effectively and is used to treat hypertriglyceridemia >500 mg/dL?
Fibrates
A 65-year-old man presents with exertional dyspnea and angina. On exam, you hear a harsh systolic crescendo-decrescendo murmur best heard at the right upper sternal border and radiating to the carotids. What is the most likely diagnosis?
Aortic Stenosis
A newborn has a continuous “machine-like” murmur at the left infraclavicular area. What is the most likely diagnosis?
Patent Ductus Arteriosus (PDA)
What is the MCC of coronary artery diseases?
Atherosclerosis
A 35-year-old woman has hypertension resistant to three medications. On exam, she has abdominal bruits. What secondary cause should you suspect?
Renal artery stenosis
When triglycerides exceed 400 mg/dL, what value cannot be calculated on a standard lipid panel?
LDL
A 35-year-old woman with a history of rheumatic fever presents with fatigue and palpitations. You hear a diastolic murmur with an opening snap best heard at the apex. What is the diagnosis?
A 22-year-old healthy male collapses during a basketball game. He has a systolic murmur that increases with Valsalva. What is the most likely underlying condition?
Hypertrophic obstructive cardiomyopathy (HOCM)
A child with cyanosis, clubbing, and a harsh systolic murmur has a boot-shaped heart on chest X-ray. What congenital defect is most likely?
Tetralogy of Fallot
A patient with a history of MI should be started on which medications to reduce mortality?
Beta-blocker & ACE inhibitor
Which drug is considered #1 choice for uncomplicated HTN... Name 3 big side effects?
Thiazides/Diuretics - HYPOnatremia, HYPOkalemia, HYPERglycemia
cross reference with MSK: Thiazides/diuretics can cause HYPERuricemia which can trigger GOUT
A 55-year-old male with history of peripheral artery disease and LDL of 130 mg/dL comes into your clinic. What is the best next step for management?
High intensity statin
Atorvastatin or Rosuvastatin
A 35-year-old woman with a history of rheumatic fever presents with fatigue and palpitations. You hear a diastolic murmur with an opening snap best heard at the apex. What is the diagnosis?
Mitral Stenosis
A child has a wide fixed splitting of S2, and the MC type is ostium secundum. What is the most likely diagnosis?
Atrial Septal Defect (ASD)
What are the reversal agents for these medications Unfractionated Heparin, Warfarin, and Rivaroxaban (Factor Xa inhibitor)?
Protamine sulfate, Phytonadione (Vit K), and Andexanet alfa
A 62-year-old male with hypertension is found to have a BP of 210/130 mmHg and bilateral papilledema on fundoscopy and kidney dysfunction. What is the most appropriate next step management in lowering the BP?
Admit ICU - Lower BP 25% within 1st hr (goal is below 180/120) -- Next 23 hrs lower 5-15% (goal 160/100), Meds - Nicardipine
A patient with familial hypercholesterolemia is already on a high-dose statin but LDL-C remains >100 mg/dL. What is the next best step?
Add ezetimibe
You are measuring blood pressure in a patient with aortic regurgitation. You find that the femoral systolic pressure exceeds brachial systolic pressure by more than 20 mmHg. What is this finding called?
Hill's Sign
A 4-day-old infant with poor feeding has no palpable femoral pulses. CXR reveals notching or moth-eaten ribs. What condition should you suspect?
Coarctation of the aorta
A 60-year-old male presents to the primary care clinic to establish care. No pertinent PMHx. He used to play tennis daily, but has recently stopped because he “can’t keep up anymore”. He also reports that over the past few months he has noticed shortness of breath while walking up 2 flights of stairs to his apartment. ROS is otherwise negative. Vital signs include a HR: 75 bpm and BP: 145/68 mmHg while sitting. Auscultation reveals a blowing diastolic decrescendo murmur heard at the left upper sternal border. A “pistol shot” sound is noted over the femoral arteries. Where would this murmur most likely radiate to on physical exam?
Aortic Regurgitation- Radiate to the left lower sternal border
A 62-year-old male presents with persistent headaches, facial redness, and pruritus after hot showers. His vitals show a BP:165/95 mmHg. Labs reveal an elevated hemoglobin of 20 g/dL and hematocrit of 61%. What is the most likely diagnosis and treatment?
Polycythemia Vera - Serial phlebotomy
A 22-year-old male with a history of sickle cell disease presents to the emergency department with right-sided weakness and slurred speech that began one hour ago. He also reports recent episodes of chest pain and abdominal pain. His vitals include BP:142/92 mmHg, and neurologic exam confirms right-sided hemiparesis. Labs reveal low HDL, elevated LDL, and elevated triglycerides. What is the most likely underlying cause of his current symptoms?
Ischemic stroke 2/2 vaso-occlusive crisis and ASCVD from dyslipidemia
explanation: pts with sickle cell are at inc risk of strokes causing vaso-occlusive crisis symps -- since dyslipidemia is a contributing factor for ASCVD a pt with sickle cell + dyslipidemia inc overall risk for ischemic stroke
A 52-year-old woman comes in with a blowing holosystolic murmur, what two conditions should you suspect, if so where does it radiate?
Mitral Regurgitation - Radiates to axilla
Tricuspid Regurgitation - rare no raditation
A newborn with cyanosis improves with prostaglandin E1. What condition is this medication used to treat?
Transposition of the great arteries
A 65-year-old male presents complaining of low back pain. He has a PMHx of HTN and dyslipidemia. He is currently taking Pravastatin 20mg and HCTZ 25 mg daily. He has tried ibuprofen, stretching, rest, and ice for his back pain but it continues to get worse. An x-ray of his lumbar spine is completed and reveals lytic lesions throughout the lumbar spine. Blood work reveals anemia and hypercalcemia. Rouleaux formation is noted on peripheral smear. Urine analysis reveals Bence-Jones proteins. Which of the following is the most likely diagnosis?
Multiple myeloma