Cardiology
Which beta blockers are cardioprotective
Carvedilol, metoprolol succinate, bisoprolol
What class of medication is indicated to reduce proteinuria in diabetic nephropathy?
What is ACEi/ARB/NMRA
What is the most common cause of massive upper GI bleed worldwide?
Esophageal varices
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 could be causing all of this?
Small cell lung cancer
The four medication classes that comprise GDMT for HFrEF
1) ACEi/ARB/ARN-i
2) SGLT2-i (Dapagliflozin, Empagliflozin)
3) Beta-blockers
4) Mineralocorticoid receptor antagonists (spironolactone, eplerenone)
A 67-yo male presents to the ED after a mechanical fall. Initial labwork reveals a Na of 118. Further evaluation reveals a Urine Osm of 90 mOsm/kg, and a Urine Na of 10 mmol/L. What is the most likely causes of the hyponatremia?
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
Question: which test would you order next to confirm 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 3 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
What deficiency is most responsible?
ADAMTS13
List the criteria for colorectal cancer screening in a patient without any risk factors AND 4/7 ways we can screen with monitoring intervals, if the results come back normal.
Criteria: in all adults aged 45-75yo
1. High sensitivity FOBT every year
2. FIT every year
3. Cologuard/DNA-FIT every 1-3years
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?
What is papillary muscle rupture?
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 4 complications from sickle cell Vaso-occlusive Crisis.
What is
1. Acute chest
2. Pain
3. Priapism
4. Avascular necrosis
Name the 1 factor that must be present for multiple myeloma AND the "CRAB" features that indicate end-organ damage.
1. Monoclonal protein present
CRAB
C = Calcium elevation (<11)
R = Renal dysfunction (serum creatinine >2, or clearance <40)
A = Anemia (hgb <10, or a >2 decrease from baseline)
B = Bone disease (>1 osteolytic lesion detected on skeletal radiography, 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 is, cardiac amyloidosis?
There are 3 main steps in the pathophysiology of hypercalcemia causing nephrogenic DI, what are they?
Hypercalcemia:
Inhibits ADH action
Decreases aquaporin-2 expression
Impairs medullary gradient
Result:
Polyuria
Nephrogenic DI
List the at least 4 out of the 6 major criteria for hepatorenal syndrome.
What is
1. Chronic or acute liver disease with advanced liver failure and portal hypertension
2. Low GFR (kidney failure/injury)
3. Absence of shock, ongoing bacterial infection 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
6. Proteinuria <0.5g/d and no US evidence of obstruction uropathy or parenchyma disease
What is the diagnostic test of choice, treatment for methemoglobinemia, and indications for treatment?
Diagnose with co-oximeter
Treat with methylene blue
Indications: 1. if methemoglobin is greater than 20%, 2. 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