Latin Proverb
Youtube videos - link plays at curated time- and High-yield facts to allow you to learn with some context. UWQIDs are included also.
Giving furosemide to a patient with cardiorenal syndrome due to acute heart failure will reduce renal venous pressure, and improve kidney function. UWQID 12521 Curbsiders
An enlarged arteriovenous fistula, connecting arteries to veins, can decreased Systemic vascular resistance, which can lead to a response of increased CO. That then leads to increased preload, and the heart cannot keep up. UWQID 4459
Getting a low BNP or NTproBNP l for a patient with dyspnea helps you rule out acute heart failure as the cause. - ADHF unlikely if NT-proBNP <300 (NPV 98%); likely if >900 if >50yo (odds ratio 44), NT-proBNP alone is better than clinical judgment alone at diagnosing ADHF (Am J Cardiol, 2005)
Pocket Medicine ( (p. 71).
UWQID 4270
-Serial EKGs for a patient with chest pain are essential. The first EKG should be obtained in the ED wthin 10 minutes of arrival, and then repeated, especially if the pain is persistent.
-High-sens Tn (hsTn) detectable 1 h after injury, peaks ~24 h, can be elevated for >1 wk ✓ at presentation & 1–3 h later; Sabatine, Marc. Pocket Medicine (Pocket Notebook Series) (p. 31). Wolters Kluwer Health. Kindle Edition.
UWQID 19989 Wellens
-Looking at the neck veins, If you see, in intervals, a prominent and high amplitude A wave, you've spotted a cannon a wave. It happens when atria and ventricles contract at the same time.
-If the the EKG shows regular wide complex tachycardia,then the cause of the AV dissociation is probably ventricular tachycardia.
-Can be seen with complete AV block and PVC as well.
UWQID 15757
A recent MI counts as ASCVD. So a patient with recent MI does not need to have their 10 year risk calculated. They automatically get prescribed high intensity statin. -What do you do if that patient stops their statin because it's causing muscle aches? You go down to a moderate intensity statin.
UWQID 17515
-A patient who gets a stent placed because significant coronary stenosis will be put on DAPT. Compliance is Non-negotiable to avoid stent thrombosis.
-Stent thrombosis: acute clot formation in stent usually in 1st mo but can occur anytime. Typically p/w AMI. Often due to premature d/c antiplt Rx or mech prob. (stent underexpansion or unrecognized dissection, typically presents early).
Pocket Medicine(p. 38). Kindle Edition.
UWQID 2737, UWQID 19950
Predictors Dutch registry, Jama
-ST elevations in 2,3, AVF is usually due to occlusion of RCA. Can result in decrease ability for RV to pump, leading to decrease preload and severe hypotension. Can give NS bolus.
-The postero papillary muscle is supplied by RCA only, hence risk for rupture post MI.
UWQID 2156 , 2157 https://pubmed.ncbi.nlm.nih.gov/24008602/
is recommended for risk stratification and diagnosis of stable angina in patients who can exercise. They should be able to raise HR to 85% of predicted. Predicted HR= 220-age. -Need more than just EKG stress if : V-paced, WPW, St depression, LBBB.
UWQID 2742
-A patient with a large anterior stemi is at risk of developing a LV aneurysm if not reperfused promptly; a thrombus can form in that area and be more than happy to travel out. For example to the leg, causing acute limb ischemia.
-LV aneurysms can also occur as later complications from STEMI (i.e 2 months out)
UWQID 3526 ,2731
When co2 is pumped into the abdomen, that can stretch peritoneal cavity and trigger a vagal response, leading to Bradycardia.
UWQID 16712
https://pubmed.ncbi.nlm.nih.gov/19371823/
https://pubmed.ncbi.nlm.nih.gov/15870416/
In the name AVNRT, focus on the N which is nodal. In that node, there will be two separate and distinct conduction pathways. A vagal maneuver works in conjunction with parasympathetic activation to slow the conduction in that AV node.UWQID 4450
Diltiazem is an option for rate control in patients presenting with rapid ventricular rate ( eg 120's 130's) who are stable. UWQID 3697
https://pubmed.ncbi.nlm.nih.gov/20825912/
If a patient has atrial fibrillation and obesity, testing for OSA is important. UWQID 21530
https://pubmed.ncbi.nlm.nih.gov/29541763/
should be suspected in a patient with a suicide attempt who is found lethargic, hypotensive, wheezing. EKG with sinus bradycardia and first degree av block. The question should mention that fluids and IV atropine do not fix the issue. -Glucagon is treatment UWQID 2663
https://pubmed.ncbi.nlm.nih.gov/16990629/
https://pubmed.ncbi.nlm.nih.gov/15898828/
Patients with vasovagal syncope should be educated on counterpressure maneuvers. UWQID 3962
In patients with abrupt onset narrow complex tachycardia, suspected to be SVT, IV adenosine can be given as the next step to slow heart down for further identification/treatment. UWQID 4920
If you see 3 or more consecutive ventricular bets faster than 100 bpm, each lasting less than 30 seconds, then that is Nonsutained vtach. The next best step is to rapidly identify if the trigger was an electrolyte imbalance. UWQID 4920
can show up in different ways on Ekg. Know the most specific one: Atrial tachycardia with AV block UWQID 3096
Look out for evidence of cyanide toxicity (confusion, agitation, metabolic acidosis...) in patients who received IV infusion of nitroprusside for HTN management.
UWQID 10763
Don't use verapamil in WPW patients with afib because that will make things go faster. You can use procainamide .UWQID 3069
-IV βB, CCB & dig contraindic. if evidence (ie, pre-excitation or WCT) of WPW (qv). *Many meds incl. amio, verapamil, quinidine, propafenone, macrolides & azole antifungals ↑ digoxin levels.
Sabatine, Marc. Pocket Medicine (Pocket Notebook Series) (p. 144). Wolters Kluwer Health. Kindle Edition.
-management of new onset atrial fibrillation in a woman with CHADSVASC2 of 2 or greater should include anticoagulation like apixaban
-Oral anticoagulation • All valvular AF because stroke risk very high
• Nonvalvular AF (NVAF): stroke risk ~4.5%/y but varies; a/c → 68% ↓ stroke but ↑ bleeding • CHA2DS2-VASc to guide Rx: CHF (1 point); HTN (1); Age ≥75 y (2); DM (1), Stroke/TIA (2); Vascular disease (eg, MI, PAD, Ao plaque) (1); Age 65–74 (1); ♀ Sex category (1) Annual risk of stroke (Lancet 2012;379:648): at low end, ~1% per point: 0 → ~0%, 1 → 1.3%, 2 → 2.2%, 3 → 3.2%, 4 → 4.0%; at higher scores, risk ↑↑ (5 → 6.7%, ≥6 → ≥10%) • Score ☐2 in ♂ or ☐3 in ♀→ anticoagulate; scores 1 in ♂ or 2 in ♀ → consider anticoag or ASA or no Rx; score 0 → reason to not Rx
• Rx options: DOAC (NVAF only) prefered over warfarin (INR 2–3); if Pt refuses anticoag, ASA + clopi or, even less effective, ASA alone (NEJM 2009;360:2066)
Pocket Medicine (p. 146). Kindle Edition.
UWQID 4452
A patient with atrial fibrillation and on fleicanide who undergoes a stress test where the heart rate increases, the fleicanide will cause the QRS to also increase because of its use dependence properties.https://pubmed.ncbi.nlm.nih.gov/24733535/
QID 4922, 4238 BB
If a patient comes in with syncope but your workup doesn't reveal any of less worrisome causes like vasovagal, then you have to evaluate outpatient for cardiac etiology with ambulatory ecg monitoring.
https://pubmed.ncbi.nlm.nih.gov/24733535/
QID 4922
Common innocent murmurs are Still murmur, pulmonic flow murmur, and venous hum. The still murmur is vibratory in quality. UWQID 3546
Inhaled nitric oxide can be an adjunct in treatment of Persistent pulmonary hypertension of the newborn, as it is a vasodilator. UWQID 19647
EKG findings of Tricuspid atresia can include large P wave and left axis deviation. UWQID 19647
When treating hypertension, if the systolic BP is 20 or more above target , or diastolic is above 10, there is a good chance you'll need combination anti-hypertensives.
UWQID 15975
Don't forget to check for comorbid conditions when first evaluating hypertension. Lipid panel and Urinalysis should be ordered. UWQID 2159
-Remember the P's to diagnose acute limb ischemia clinicallly. The 6P's are pain, pallor, parasthesia, paralysis, poikylothermia,pulselessness. -Start an IV heparin as soon as possible and call vascular surgery consultants. UWQID 2666
https://pubmed.ncbi.nlm.nih.gov/28987435/
Initial management of aortic dissection is with IV Beta Blocker with end goal of decreasing the stress on aorta's wall.
UWQID 3056
https://pubmed.ncbi.nlm.nih.gov/11511117/
If a patient has ever smoked and is 65, then they should get a screening ultrasound, according to USPSTF.
UWQID 4532
If a patient has pain in their LE when they walk, and that happens intermittently, then the initial treatment is supervised exercise program for their PAD.UWQID 8928
When a marfan patient presents with sudden-onset chest pain, be wary for aortic dissection. Since aortic root is affected in Marfan, also look out for an early diastolic murmur.
UWQID 4484
Frequently used regimens range from prednisone 30 to 60 mg, once daily, to methylprednisolone 60 to 125 mg, two to four times daily, depending on the severity of the exacerbation
UWQID 4730 Uptodate
Peak flow testing where there is more than 10% worsenign from baseline suggests exacerbation.
UWQID 4105, 4771
Demyelinating plaque perfectly located in the pons can lead to shar shooting pain to areas of cheeks and jaw , seen in trigeminal neuralgia UWQID 3462
IF a noncon Head CT shows a thalamic hemorrhage in a young healthy person, you can consider getting a urine tox screen, to rule out or rule in cocaine as a cause. UWQID 19403 , UWQID 2672
Duration in Primary stabbing headache is a few seconds, and also without autonomic symptoms. UWQID 114669
Can be secondary to dissection of left vertebral artery.
Mnemonic Nostradamus in a taxi shaped like a trojan horse, gets a burger to go, puts the cucumbers on one side of his face ,gags on burger , he loses control and airbags made of spinach deploy.
UWQID 17492
In a young woman with a P/E showing mildly enlarged thyroid gland, mobile and nontender+ plus thyrotoxicosis labs+ Radioactive iodine uptake less than 5%, suspect silent thyroiditis. Painless/Silent thyroiditis is a variant of Hashimoto, though it won't lead to chronic hypothyroid.
-Silent (postpartum, autoimmune including Hashimoto’s, or lymphocytic): painless, ⊕ TPO Abs; if postpartum, can recur with subsequent pregnancies
Pocket Medicine (p. 617). Kindle Edition.
UWQID 2191
https://pubmed.ncbi.nlm.nih.gov/31929534/
After having detected a thyroid nodule on physical exam, the next step is an ultrasound and getting serum TSH. You don't want to jump to RAIU scan before knowing TSH, because it's only for those with low TSH. -For normal tsh, you get a FNA under ultrasound guidance.
UWQID 3484
https://pubmed.ncbi.nlm.nih.gov/31929534/
Radioactive iodine should be avoided as a treatment in a patient with Graves disease that has moderate or severe eye disease. For example if : bilateral proptosis, lid lag, periorbital puffiness and diploplia and discomfort on lateral gazeUWQID 4415
https://pubmed.ncbi.nlm.nih.gov/31929534/
If a patient has normal fasting glucose levels but discordantly has elevated A1C, they may be having episodes of postprandial hyperglycemia. If already on a long acting basal insulin, then a rapid-acting premeal insulin can help.
UWQID 12366
-Your body has mechanisms to make you aware when your sugar is low- It activates the autonomic nervous system. That response can become blunted in patients with long standing diabetes and previous episodes of severe hypotension. -Exercise-induced hypoglycemia can occur in CKD patients taking insulin.
UWQID 19233 UWQID 7010
is a type of microvascular complication of diabetes mellitus. So is diabetic nephropathy. Unlike for macrovascular outcomes (stroke, MI) and mortality, intensive blood glucose control reduces the risk of microvascular complications. UWQID 11367
Total body potassium deficit will be seen in both DKA and HHS because of glycosuria-induced osmotic diuresis. Aggressive fluid replaement is essential.
UWQID 2186 UWQID 4247 https://pubmed.ncbi.nlm.nih.gov/29431405/
Early. morning cortisol is not done for evaluation of Cushing. Rather 2 of those 3 : late night salivary, 24 hr urine free cortisol, and/or low dose dexamethasone supprssion test.
UWQID 2592, UWQID 4419 https://pubmed.ncbi.nlm.nih.gov/29431405/
will be painful, proximal muscles will be weak, and labs will show high ck levels. On P/E, look for delayed tendon reflexes consistent with hypothyroid. Muscle biopsy is not needed for dx. You can rule out polymyositis where pain is absent and tendon reflexes are normal.Uworld
A patient with primary adrenal insufficiency discharged with hydrocortisone might not have all replacements it needs. It needs replacement for. mineralocorticoid activity as well, so you would add fludrocortisone. CoreIM
ACTH stim test should be performed at the initial evaluation for adrenal insufficiency.
IV normal saline at 200-300 ml/hour initially is part of the management.UWQID 2169
is a urease producing organism. A patient can present with weeks of episodic epigastric pain. Can wake patients at night, and bloating sensations after meals. UWQID 3588, UWQID 4363 Pointofcare
If a patient with Upper GI bleed is not responding to your commands (altered), continues to throw up blood, then next step is to intubate to protect airway. Then you go ahead with your endoscopic ligation or sclerotherapy to stop the bleed.https://pubmed.ncbi.nlm.nih.gov/25177367/
For esophageal varices secondary to cirrhosis, a medication that can reduce portal pressure should be given. Nonselective beta blockers can do that. UWQID 2921 , 4386 https://pubmed.ncbi.nlm.nih.gov/35355838/
In a patient with RUQ and fever, hypotension, you can start suspecting acute cholangitis. It's an infection that occurs because bile stops moving. The Ultrasound can help you identify dilation. An ERCP can be used to relieve the obstruction.Dynamed, Uptodatehttps
Be mindful that cholecystitis can still happen without gallstones. Acalculous cholecystitis usually happens in critically ill patients. UWQID 2245Dynamed, Uptodatehttps
Be mindful of extra-GI, autoimmune related symptoms that can present with Celiac disease.UWQID : 20396
is due to a brush border enzyme deficiency. A lactose hydrogen breath test can confirm the diagnosis when unclear.UWQID : 12406, 3605
Recurrent right lower lung pneumonia in an elderly should prompt you to evaluate swallowoing mechanics.UWQID : 2212
along with history of diarrhea, hypokalemia and metabolic alkalosis- think laxative abuse. UWQID : 3593
can occur in hypercoagulable states such as SLE. -In the youtube video, the source was from infective endocarditis. UWQID : 16255
Colorectal cancer is the most common source of mets to the liver. Multiple liver masses would be seen. -Prostate cancer can also mets to liver.UWQID : 4389, 12403
-Leukocyte alkaline phosphate is low in CML, can help differentiate from Leukemoid reaction, where both have elevate leukocyte count. -Like in this patient, fatigue, weight loss can be symptoms. On P/E splenomegaly can be felt. UWQID 2885 https://pubmed.ncbi.nlm.nih.gov/24729196/
carries a high risk for catastrophic hemorrhage secondary to tumor-induced consumptive coagulopathy.UWQID 12465
IF a chest xray shows a large anterior mediastinal mass which is in fact T ALL, then the physical can also show large liver and testicular enlargement. Labs would show pancytopenia.https://pubmed.ncbi.nlm.nih.gov/25435111/
, Excisional lymph node biopsy is used to establish the diagnosis of Hodgkin lymphoma.UWQID 16585, 16134
Most cases of Posttransplant Lymphoproliferative disorders are du to EBV. You can see proliferation of immortal B cells. UWQID 20935
One cause of drug-induced neutropenia is sulfasalazine.UWQID 20935
Flow cytometry is used to diagnose CLLUWQID 2887
HIV patients are at greater risk of developoing lymphoma. If it occurs due to EBV reactivation, then it can be NHL. UWQID 16776
Removing white cells from blood products, aka leukoreduction, helps prevent febrile nonhemolytic transfusion reaactions. UWQID 4160
Salvage radiotherapy in prostate cancer UWQID 4940, 12403
Ondansetron vs droperidol RCT
UWQID 2623
UWQID 2597
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