Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Internal Medicine Flash Cards > Block 2 > Flashcards

Block 2 Flashcards

1
Q

Most accurate test for aortic dissection

A

Angiogram

*Source MTB2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which is the triad of aortoiliac disease?

A

Leriche syndrome→hip, thigh, buttock claudication; impotence; symmetric atrophy of bilateral lower extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How nitrates relieve ischemic symptoms of angina?

A

Systemic venodilation→↓cardiac preload→↓LV systolic wall stress→↓myocardial oxygen demand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

New onset hypertension in a young patient with epistaxis, tachycardia and tremor. Which test do you run?

A

Secondary hypertension due cocaine intoxication→urine drug screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Sudden posterior knee and calf pain with “crescent sign” most probably may suggest.

A

Ruptured popliteal Baker cyst

*But rule out deep venous thrombosis as well with ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Clinical presentation of anterior spinal artery syndrome

A

Motor weakness, loss of pain and temperature sensation below the lesion

*Proprioception and vibratory sensation are spared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Clinical presentation of Transverse myelitis

A

Rapidly progressive myelopathy:

  • Motor weakness→from flaccid to spastic paralysis (UMNS)
  • Autonomic dysfunction→bowel/bladder incontinence or retention, sexual dysfunction
  • Sensory dysfunction→Pain, paresthesia, numbness with distinct sensory level (Ex, lowest spinal cord level with intact sensation). Proprioception and vibration compromised.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Findings on the most useful studies for Transverse myelitis

A
  • MRI→Enhancement of =>1 contiguous spinal cord segments, usually in thoracic cord without evidence of compression
  • Lumbar puncture→CSF pleocytosis, elevated IgG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Description of clinical presentation of cluster headache

A
  • Acute onset of unilateral retro-orbital pain (excruciating, sharp, steady)
  • Paroxysms onset during sleep, awakening, rapid peak, duration 90 minutes, 8 times daily, 6-8 weeks, remission up to 1 year
  • Redness of ipsilateral eye, tearing, nasal congestion, flushing, no visual changes
  • Ipsilateral Autonomic manifestations, “Horner Sx like”→ptosis, miosis, anhidrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment of acute attacks and prophylactic treatment of cluster headache

A
  • Acute attacks: 100% Oxygen, subcutaneous sumatriptan

- Prophylactic: Verapamil, Lithium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which test you should order in an adult patient with isolated thrombocytopenia (Immune Thrombocytopenic Purpura)?

A

HIV and Hepatitis C➡most common secondary causes

*Initial presentation HIV up to 5-10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What do you have to monitor closely after initiation of Erythropoietin in a CKD patient, and why?

A
  • Blood pressure monitoring
  • Up to 30% patients develop new or worsening hypertension 2-8 wks after initiation

*Large doses or rapidly Hb increase, highest risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In addition to the classical triad of Renal cell carcinoma, what other features you may find?

A
  • Unintentional weight loss
  • Intermittent fever
  • Paraneoplastic syndromes (ectopic EPO, hypercalcemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clinical presentation of acute diverticulitis

A
  • Left lower quadrant pain
  • Nausea, vomiting
  • Bladder symptoms (urgency, dysuria, frequency) or sterile pyuria (➕leukocyte esterase, ➖nitrites/bacterias)➡bladder irritation from bowel inflammation
  • Changes bowel habits (diarrhea, constipation)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Chest radiograph findings of pulmonary embolism

A
  • Atelectasis (most common)
  • Infiltrates
  • Pleural effusions
  • Westermark’s sign➡peripheral hyperlucency due oligemia
  • Hampton’s hump➡peripheral wedge of lung opacity due pulmonary infarction
  • Fleischner sign➡enlarged pulmonary artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pathophysiology of Fanconi anemia

A

Autosomal recessive DNA repair defect, Bone-marrow failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Clinical findings of Fanconi anemia

A
  • Short stature
  • Hypo or hyper-pigmented macula on trunk
  • Genitourinary malformations
  • Absence or hypoplastic thumb
  • Polydactyly, flat thenar eminence

*Most common cause of congenital aplastic anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Treatment for Dressler’s syndrome

A
  • NSAIDs first line
  • Corticosteroids in refractory cases or NSAIDs contraindication

*Avoid anticoagulation to prevent hemorrhagic pericardial effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Physical examination and laboratory findings suggesting heavy alcohol use

A

Macrocytic anemia, AST:ALT >2:1, parotid gland enlargement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Primary prophylaxis to prevent bleeding from esophageal varicose veins

A
  • Endoscopic variceal ligation (EVL)➡preferred for larger varicose veins
  • Nonselective beta-blocker➡propranolol, nadolol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Clinical presentation of HSV retinitis in an HIV positive patient

A
  • Acute retinal necrosis syndrome➡starts keratitis and conjunctivitis with eye pain; followed by rapidly progressive visual loss
  • Fundoscopy➡widespread, pale, peripheral lesions and central necrosis of the retina.

*Might be caused by VZV as well.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Clinical presentation of CMV retinitis in HIV positive patient

A
  • Painless

- Fundoscopy➡fluffy or granular retinal lesions near retinal vessels and associated hemorrhages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What should you think in a patient with Rheumatoid arthritis history and worsening of weakness and painless sensation of 4 extremities after intubation?

A

Worsening subluxation of the atlantoaxial joint➡cord compression➡cervical myelopathy

*Atlantoaxial instability due RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Clinical presentation of cervical myelopathy

A
  • Neck pain radiating to occipital region
  • Extremity weaknes and numbness
  • Usually first➡Gait dysfunction
  • UMN signs (legs)➡slowly progressive spastic quadriparesis, hyperreflexia, Babinski sign, Hoffman sign (corticospinal tract lesion)
  • LMN signs (arms)➡muscle atrophy, hyporeflexia
  • Sensory changes➡⬇proprioception/vibration/pain sensation in hands or feet
  • Respiratory dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the critical illness polyneuropathy?

A

Axonal injury of peripheral nerves➡weakness after prolonged stay in ICU (Ex, hyporeflexia)

*Complication of sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which etiology suggests a high anion gap metabolic acidosis with an osmolal gap?

A
  • Poisoning with:
  • Acute ethanol (most common)
  • Acute Methanol
  • Acute Ethylene glycol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Classical finding in acute ethylene glycol poisoning

A
  • Rectangular, enveloped-shaped calcium oxalate crystals on urinalysis
  • Most commonly antifreeze ingestion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Most common complication of acute ethylene glycol poisoning

A

Acute renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Two most common inherited thrombophilia in the caucasian population

A
  1. Factor V Leiden (Activated Protein C resistance)

2. Prothrombin mutation (⬆Prothrombin levels)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When do you study or test for hereditary thrombophilias?

A
  • Young age (<45) with first time unprovoked DVT/PE
  • Recurrent DVT/PE
  • Unusual sited of thrombi (cerebral, mesentery, portal veins)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Cephalosporin that can cover MRSA

A

Ceftalorine (fifth generation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which cephalosporins can cover anaerobes? Side effects of them

A
  • Cefotixin and Cefotetan (Second generation)

- ⬇Prothrombin➡⬆Risk of bleeding; disulfiram-like effect with alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the difference between ertapenem and the other carbapenems?

A

Ertapenem does not cover Pseudomonas

*All carbapenems cover gram-negative bacilli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How do you use the fluoroquinolones to treat diverticulitis and GI infections?

A
  • Ciprofloxacin, gemifloxacin, levofloxacin must be combined + metronidazole; they do not cover anaerobes
  • Moxifloxacin (exception) can be used alone; cover anaerobes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Classic side effects of quinolones

A
  • Bone growth abnormalities in children and pregnant women

- Tendonitis and Achilles tendon rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

When do you order bacterial antigen detection (Latex Agglutination Tests) in suspected bacterial meningitis?

A

Patient has received antibiotics prior to lumbar puncture➡culture may be falsely negative

*Delay in LP may happen when head CT is indicated before (Ex, confused patients)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Important feature of the CSF in a tuberculous meningitis

A

Highest protein level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

When do you suspect Listeria as the etiology of meningitis? How do you treat it?

A
  • Risk factors for Listeria:
  • Elderly
  • Neonates
  • Steroid use
  • AIDS or HIV
  • Immunocompromised, include alcoholism
  • Pregnant
  • Add Ampicillin to the Tx➡Listeria is resistant to all cephalosporins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Most common neurological deficit from untreated bacterial meningitis

A

Eighth cranial nerve deficit or deafness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Most accurate test for herpes encephalitis

A

PCR on CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Best initial test and most accurate test for bloody diarrhea

A
  • Best initial➡Stool lactoferrin

- Most accurate➡Stool culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Antibiotics that cover anaerobes in oral and GI infections

A
  • Oral: Penicillin (G, VK, ampicillin, amoxicillin), Clindamycin
  • Abdominal/GI: Metronidazole, beta-lactam/lactamase inhibitor, carbapenems, 2nd gen cephalosporins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Treatment for ESBL-producing organisms resistant to carbapenems

A
  • Ceftolozane/tazobactam
  • Ceftazidime/avibactam
  • Polymyxin (Risk for acute renal injury)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Treatment for encephalitis by aciclovir resistant herpes

A

Foscarnet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

During acute hepatitis which test correlates the best with higher mortality?

A

⬆Prothrombin time➡⬆risk of fulminant hepatic failure and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is directly correlated with the amount or quantity of active hepatitis B virus replication?

A

Hepatitis B e-antigen➡present only when there is ⬆DNA polymerase activity

*e-antigen↔PCR DNA (viral load, is more precise)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Which indicates that active infection of hepatitis B has resolved?

A

No AgHBs found

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Which is the best indication of treatment for chronic hepatitis B?

A
  • e-antigen or DNA polymerase (PCR DNA hepatitis B)➡strongest indicator of acute viral replication➡Degree of infectivity
  • e-antigen (qualitative)↔PCR DNA (quantitative, viral load, is more precise)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Best test to determine response to therapy or failure in therapy for chronic hepatitis B or hepatitis C

A

PCR DNA hepatitis B and PCR RNA hepatitis C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Most common method of transmission of hepatitis B

A

Perinatal transmission

  • e-antigen ➕➡90% children infected at birth
  • e-antigen ➖➡10% children infected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Best treatment for Hepatitis C genotype 1, and for any genotype

A
  • Ledipasvir + Sofosbuvir for genotype 1

- Velpatasvir for all genotypes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Goals of chronic hepatitis treatment

A
  • ⬇DNA polymerase to undetectable levels

- Convert patients from e-antigen to antibody e-antigen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Indications to treat hepatitis C

A
  • ⬆PCR-RNA viral load

- Fibrosis on biopsy (even for hepatitis B)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Sensitive and specific tests for syphilis study on CSF

A
  • FTA-ABS nearly 100% sensitive in CSF

- VDRL and PCR specific

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Which test may be useful to diagnose both chlamydia and Neisseria gonorrhoeae?

A

Nucleic acid amplification test (NAAT)

*Gram stain only detects gonorrhea, with chlamydia infection only see PMNs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is late secondary syphilis or latent infection?

A
  • Asymptomatic stage with ➕ serology
  • After chancre and rash of primary and secondary syphilis have resolved

*End or beyond the first year of infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Treatment of latent or late secondary syphilis

A

Benzathine Penicillin IM weekly for 3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Treatment of primary and secondary syphilis

A
  • One dose IM Benzathine Penicillin

- Oral Doxycycline or Tetracycline for 14 days, for penicillin allergy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Treatment of HACEK group of organisms causing endocarditis

A

Ceftriaxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Indications for prophylaxis for endocarditis

A
  • Significant cardiac defect:
  • Prosthetic valve
  • Previous endocarditis
  • Cardiac transplant recipient with valvulopathy
  • Unrepaired cyanotic heart disease
  • Risk of bacteremia:
  • Dental work with blood
  • Respiratory tract surgery that produces bacteremia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Best initial empiric therapy for endocarditis

A

Vancomycin + Gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Risk factors for endocarditis

A
  • Prosthetic valve ⬆⬆Risk
  • Regurgitant and stenotic lesions
  • Dental procedures
  • Surgery of mouth and respiratory tract + severe valvular disorder (prosthetic valve, cyanotic heart disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Most common joint, neurological and cardiac manifestations of untreated Lyme disease

A
  • Joint➡Knee arthritis
  • Neurological➡7th cranial nerve or Bell palsy (classically bilateral)
  • Cardiac➡Transient AV block
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Treatment for Lyme disease when rash, joint compromised or 7th cranial nerve palsy

A
  • Doxycycline

- Amoxicillin or Cefuroxime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Treatment for Lyme disease when cardiac or neurologic manifestations other than 7th CN palsy

A

Intravenous Ceftriaxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Prophylaxis indications for Lyme disease when tick bite and no symptoms

A

Single-dose of doxycycline within 72 hours of tick bite:

  • Ixodes scapularis clearly identified
  • Tick attachment >24 hours
  • Engorged nymph-stage tick
  • Endemic area

*Tick bite + no symptoms generally do not need prophylaxis; treat if rash shows up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What must you test before start abacavir in an HIV patient? and why?

A

HLA B5701 mutation➡⬆risk of life-threatening skin reactions (Steven-Johnson syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Most important adverse effects of Tenofovir

A
  • Renal Tubular Acidosis (RTA)
  • Bone demineralization

*Disoproxil version ⬆risk, alafenamide version is absorbed by CD4➡⬇plasma levels➡⬇adverse effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Treatment for baby from an HIV positive mother

A

Zidovudine intrapartum (to the pregnant woman) and for 6 wks (to the baby)➡prevent transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Antiretroviral to be avoided during pregnancy

A

Efavirenz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Indication for Pre-exposure prophylaxis (PrEP) for HIV and what drugs do you give?

A
  • High risk sexual and needle-stick practices with potentially HIV-infected contacts
  • Emtricitabine-Tenofovir before exposure and one month after the last exposure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Best initial and definitive treatment for Mucormycosis

A
  • Best initial: Amphotericin B
  • Surgical emergency➡resect necrotic areas

*Follow up Tx➡Posaconazole or Isavuconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Treatment for invasive Aspergillosis

A

Voriconazole, Isavuconazole, Caspofungin

  • DO NOT use Amphotericin B (is inferior)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Tests for invasive Aspergillosis

A
  • Serum Galactomannan assay
  • B-D-glucan level
  • PCR

*2 of those ➕➡>95% specificity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Treatment for Plasmodium falciparum

A

Mefloquine or Atovaquone/proguanil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Treatment for Plasmodium non-falciparum

A
  • Chloroquine

- Primaquine (vivax and ovale only)➡eradicate the hypnozoites in the liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What you should rule out first before start Primaquine?

A

G6PD deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Treatment for severe malaria

A
  • Artemisinins (Artemether, Artesunate)

- IV Quinine➡⬇Efficacy, ⬆QT prolongation toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Prophylaxis for malaria

A

Patients traveling to endemic regions➡atovaquone-proguanil or mefloquine at least 2 weeks before travel and for 4 weeks after returning

*Avoid Mefloquine in seizure, psychiatric, and
cardiac conduction disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Treatment for Babesiosis

A

Azithromycin + Atovaquone

81
Q

Which infectious diseases may show morulae in WBCs? What is the morulae in WBCs?

A
  • Ehrlichiosis (Monocytic) and Anaplasmosis (Granulocytic)

- Obligate intracellular parasites➡form microcolonies in the cytoplasm of WBCs

82
Q

Best clinical clues that may suggest Legionnaires’ diseases?

A
  • Atypical community-acquired pneumonia
  • CSN features➡confusion
  • Gastrointestinal features➡abdominal pain, diarrhea, mild hepatitis
  • Hotel and cruise ships
  • Relative bradycardia (despite ⬆fever)
  • Hyponatremia
83
Q

Best initial test for Legionnaires’ disease?

A

Urine antigen testing

*Best overall➡Culture

84
Q

Treatment for cryptococcal meningitis

A

IV Amphotericin B + Flucytosine for 2 wks, then fluconazole for 8 wks

85
Q

Which vaccines are contraindicated in HIV patients?

A

Live vaccines (MMR, VZ) are contraindicated If CD4<200

*If CD4>200 there are no contraindications

86
Q

Main side effects of Isoniazid, what you should do to avoid one of them?

A
  • Drug-induced hepatitis

- Peripheral neuropathy➡Vitamin B6 (Pyridoxine) to prevent

87
Q

Diagnosis of Allergic Bronchopulmonary Aspergillosis

A
  • Previous history most commonly of Asthma or Cystic Fibrosis
  • Pulmonary infiltrates on CXR, eosinophilia, ➕skin aspergillus antigen test, antibodies to aspergillus on blood, ⬆IgE levels
88
Q

Life-threatening complication of untreated retropharyngeal abscess and treatment

A
  • Acute necrotizing mediastinitis

- Urgent surgical drainage to prevent spread to the posterior mediastinum➡lethal pleural and pericardial effusions

89
Q

Treatment to reverse Warfarin toxicity bleeding

A

Prothrombin complex concentrate➡Vitamin K dependent coagulation factors (II, VII, IX, X, Protein C and S)

  • Room temperature
  • No transmit disease
  • No excess volume
90
Q

Most common adverse effect of statins

A
  1. Liver inflammation

2. Myopathy

91
Q

Most common cause of blindness in the US in the elderly and its treatment

A
  • Macular Degeneration [Dry (80%)>Wet]
  • Dry: No treatment
  • Wet: VEGF Inhibitors➡Bevacizumab, Ranibizumab
92
Q

Frequent history clues in orbital cellulitis that you should look for

A
  • Ocular trauma or surgery

- Sinusitis

93
Q

Best initial therapy for HIV

A

Two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) + one integrase inhibitor

94
Q

Treatment for Histoplasmosis chronic cavitary lesions

A

Itraconazole for >1 year

95
Q

Treatment for Histoplasmosis severe acute pulmonary disease or disseminated disease

A

Liposomal amphotericin B or amphotericin B for 14 days followed by itraconazole for 1 year or longer

96
Q

How is the geographic distribution of the most common systemic fungal infections in the United States?

A
  • Histoplasmosis➡ Ohio and Mississippi river valleys
  • Coccidioidomycosis➡ southwestern
  • Blastomycosis➡central and southeastern, particularly the Mississippi and Ohio river valleys
97
Q

Clues on history and laboratory findings in disseminated infection of Mycobacterium Avium Complex

A
  • AIDS patients with a CD4+ < 50/mm3
  • Fever, weakness, and weight loss, night sweats, diarrhea
  • Anemia, hypoalbuminemia, ↑alkaline phosphatase, ↑LDH
98
Q

Treatment and prophylaxis for MAC disseminated infection

A
  • Tx: Clarithromycin + ethambutol, and consider HAART if drug-naïve; Rifabutin is second line. Continue for > 12 months and until CD4+ is > 100/mm3 for > 6 months
  • Prophy: Azithromycin for those with a CD4+ < 50/mm3 or AIDS-defining opportunistic infection
99
Q

Which complications of infectious mononucleosis are indicated to treat with corticosteroids?

A
  • Airway compromise caused by tonsillar enlargement
  • Severe thrombocytopenia
  • Severe autoimmune hemolytic anemia
100
Q

Complications of Infective endocarditis

A
  • Embolic strokes
  • Metastatic infection (most common cause of splenic abscess)
  • Heart failure (valvular insufficiency)
  • Glomerulonephritis
101
Q

Infective endocarditis most common microorganism based on valve status

A
  • Prosthetic valve➡Streptococcus viridans➡mitral valve (mitral regurgitation)>aortic valve (non-IV drug users, dental procedures)
  • Normal valve➡Staphylococcus aureus➡tricuspid valve>mitral valve>aortic valve (IV drug users)
102
Q

Best initial test and most accurate test for achalasia

A
  • Best initial: Barium esophagram➡”Bird’s beak sign”
  • Most accurate: Manometry➡Failure lower esophageal sphincter to relax (⬇Esophageal peristalsis, ⬆Lower esophageal sphincter tone)
103
Q

Treatments options for achalasia

A
  1. Pneumatic dilation (perforation risk <3%)
  2. Myotomy (more effective but more dangerous)
  3. Botulinum toxin (effect wear off in 3-6 mo, reinjections)
104
Q

Clinical presentation of esophageal spasm. Which are the two forms of them?

A
  • Sudden onset of severe chest pain not related to exertion, can be precipitated by drinking cold liquids
  • Diffuse esophageal spasm (DES) and Nutcracker esophagus

*Both forms clinically indistinguishable. Hard to differentiate at the beginning with coronary disease. EKG and stress test normal

105
Q

Most accurate test for Diffuse esophageal spasm (DES) and Nutcracker esophagus

A

Manometry➡Different pattern of abnormal contraction

106
Q

Treatment for esophageal spastic disorders

A

Calcium channel blockers and nitrates (similar Prinzmetal angina)

*PPIs can improve some cases

107
Q

Important history clue and best initial test for eosinophilic esophagitis

A
  • Asthma and allergic diseases

- Endoscopy➡Multiple concentric rings

108
Q

Most accurate test for eosinophilic esophagitis

A

Biopsy➡Eosinophilic infiltration of esophageal mucosa

109
Q

Best initial and most effective therapy for eosinophilic esophagitis

A
  • PPIs and eliminate allergenic food

- Swallow steroid inhalers (topical effect of steroids)

110
Q

Difference between Schatzki ring and Plummer-Vinson syndrome esophageal lesions

A
  • Schatzki ring➡from acid reflux, associated with hiatal hernia. Scarring or tightening (also called peptic stricture) of the distal esophagus.
  • Plummer-Vinson syndrome➡associated with iron deficiency anemia, rarely transforms into squamous cell cancer. More proximal.
111
Q

Treatment of Schatzki ring and Plummer-Vinson syndrome esophageal lesions

A
  • Schatzki ring➡pneumatic dilation in an endoscopic procedure
  • Plummer-Vinson syndrome➡ iron replacement at first▶may lead to resolution of the lesion
112
Q

Best diagnostic test for Zenker diverticulum

A

Barium studies

*Do not answer nasogastric tube placement or upper endoscopy➡dangerous, may cause perforation

113
Q

Finding on the most accurate test for the scleroderma esophagus compromised

A

Manometry➡inability to close the lower esophageal sphincter▶⬇LES pressure

114
Q

Most common cause of epigastric pain

A

Non-ulcer dyspepsia

115
Q

Treatment for cannabinoid hyperemesis syndrome

A
  • Hot shower or bath

- Antiemetics (ondansetron) or benzodiazepines (lorazepam)

116
Q

Most common cause of peptic ulcer disease

A
  1. Helicobacter pylori

2. NSAIDs

117
Q

Treatment for GERD for whose do not respond to the medical management

A
  • Nissen fundoplication➡wrapping the stomach around the lower esophageal sphincter
  • Endocinch➡suture around the LES
  • Local heat or radiation of LES➡scarring

*About 5% of GERD patients do not respond to medical therapies

118
Q

Indication for stress ulcer prophylaxis

A
  • Mechanical ventilation
  • Burns
  • Head trauma
  • Sepsis with coagulopathy
119
Q

Most common cause of upper GI bleeding

A

Peptic ulcer disease

120
Q

Clinical presentation of gastritis

A
  • Bleeding without pain➡“coffee-ground” emesis, large hematemesis, melena, Heme (guaiac) positive stool
  • Severe, erosive gastritis➡epigastric pain
  • Nausea, vomiting
  • Asymptomatic
121
Q

What you must always rule out in a patient with a gastric ulcer?

A

Gastric cancer is present in 4% of those with GU but in none of those with DU

122
Q

Best next step when you suspect persistent helicobacter pylori infection with a duodenal ulcer and gastric ulcer

A
  • DU: Think antibiotic resistance➡urea breath testing, stool antigen detection, or a repeat endoscopy for biopsy➡if ➕➡switching to metronidazole + tetracycline + PPIs + bismuth
  • GU: repeat endoscopy to exclude cancer
123
Q

What is Non-ulcer dyspepsia?

A

Epigastric pain with a normal endoscopy

124
Q

Clues on clinical presentation that makes you suspect gastrinoma

A

Peptic ulcer disease symptoms + diarrhea (acid inactivates lipase)

125
Q

How are the ulcers from gastrinoma?

A
  • Large (>1–2 cm)
  • Recurrent after Helicobacter eradication
  • Distal in the duodenum
  • Multiple
126
Q

How do you confirm gastrinoma (Zollinger-Ellison syndrome)?

A

Any of them:

  • ⬆Gastrin off antisecretory therapy (PPIs or H2 blockers) with high gastric acidity
  • ⬆Gastrin despite a high gastric acid output
  • Persistent ⬆Gastrin despite injecting secretin
127
Q

What is the most accurate test to identify metastases from gastrinoma?

A

Somatostatin receptor scintigraphy (nuclear octreotide scan) + endoscopic ultrasound
(Always do first CT and MRI)

*Gastrinoma is associated with a massive increase in the number of somatostatin receptors in the abdomen

128
Q

Best initial treatment for diabetic gastroparesis

A

Dietary modifications➡Blenderize foods, Restore fluids, Correct potassium and glucose levels

*Not always have to confirm diagnose to start treatment

129
Q

Most accurate test to confirm diabetic gastroparesis

A

Nuclear gastric emptying study➡Bolus of food tagged with technetium▶delay in the emptying of food

130
Q

Best initial test for diabetic gastroparesis

A

Upper endoscopy or abdominal CT scan➡ excludes luminal gastric mass or abdominal mass compressing the stomach

131
Q

Which treatments can you give if the best initial therapy for diabetic gastroparesis fails?

A
  1. Metoclopramide➡⬆gastrointestinal motility (Do not use permanently: Dystonia and hyperprolactinemia)
  2. Erythromycin + antiemetics➡⬆gastrointestinal motility
  3. Gastric electrical stimulation (gastric pacemaker)
132
Q

Most common cause of lower GI bleeding

A

Diverticulosis

133
Q

What is the most important next step in the management of GI bleeding?

A

Fluid replacement with high volumes (normal saline or Ringer lactate)

134
Q

Initial medical treatment for esophageal and gastric varices

A

Octreotide (somatostatin)➡⬇portal pressure

135
Q

Best initial therapy for clostridium difficile colitis. Next best step if there is NO RESPONSE and if there is RECURRENCE.

A
  • Oral Vancomycin
  • NO RESPONSE➡Fidaxomicin
  • RECURRENCE (there was resolution)➡tapered dose of vancomycin (another course) or fidaxomicin
136
Q

What is fulminant clostridium difficile infection? Treatment.

A
  • ⬆WBC, Metabolic acidosis, ⬆lactate, ⬆creatinine

- Vancomycin and metronidazole

137
Q

Most accurate test for chronic pancreatitis

A

Secretin stimulation testing

138
Q

Sensible and specific finding on imaging in chronic pancreatitis

A
  • Abdominal x-ray➡calcification of the pancreas

- Abdominal CT scan➡pancreatic calcification (80% to 90% sensitive)

139
Q

Hemoglobin electrophoresis pattern of Beta-thalassemia major

A
  • HbA2 ⬆⬆ (2 alpha + 2 delta)
  • HbF ⬆⬆ (2 alpha + 2 gamma)
  • Mutation in both beta-globin genes
  • HbS absent, HbA absent
140
Q

Treatment of Beta-thalassemia major

A

Transfusion-dependent➡⬆Risk of iron overload➡Iron chelation therapy▶avoid damage on liver, kidneys, endocrine glands

141
Q

Most sensitive predictor of anastomotic leak after bariatric surgery (Roux-en-Y gastric bypass). What other manifestations you may find?

A
  • HR>120/min most sensitive predictor

- Fever, abdominal pain, tachypnea

142
Q

Why do patients with fat malabsorption (Ex, Chron disease, small intestinal disease) have a high risk of nephrolithiasis?

A

Hyperoxaluria

  • Normally Calcium binds Oxalate in gut➡❌Oxalate absorption
  • Fat malabsorption➡Calcium is bound by fat➡Oxalate is absorbed; ❌absorb bile salts➡⬇bile salts reabsorption in small intestine➡⬆⬆bile salts damage colonic mucosa➡⬆Oxalate absorption
143
Q

Findings on laryngoscopy of laryngeal squamous cell carcinoma in a patient with hoarseness

A

Fungating, irregular white/red mass on vocal cord with/without blood crusting (ulcer)

144
Q

How do you expect to find the urinary sodium, fractional excretion of sodium, urine sediment, urine WBC and BUN/creatinine ratio in a patient with sepsis?

A
  • Renal hypoperfusion➡activation of RAAS➡⬆Na reabsorption➡⬇Urinary sodium (<20mEq/mL), ⬇Fractional excretion of Na (<1%)
  • No intrinsic kidney damage➡urine sediment bland (acellular, no WBC or RBC)
  • Urea follows reabsorption of Na and water➡⬆BUN/creatinine ratio >20:1
145
Q

How are the urinary sodium, urine osmolality and urine sediment in acute tubular necrosis?

A
  • ❌reabsorption of Na by the injured tubules➡⬆Urinary Na (>20mEq/mL)
  • ⬇Urine Osmolality (300-350)
  • Muddy brown granular urinary casts
  • BUN/creatinine ratio 10-15:1
  • FENa>2%

*Contrast-induced ATN may have ⬇Urinary Na (<20mEq/mL)

146
Q

Urine sodium and urine sediment on glomerulonephritis

A
  • RBC casts, mild ⬆WBC, hematuria
  • ⬇Urine Na (<20mEq/mL)

*Hypertension

147
Q

Which conditions may present with very high urinary sodium levels?

A
  • Syndrome of inappropriate antidiuretic hormone (SIADH)

- Diuretics

148
Q

When do you suspect carcinoid syndrome?

A

Intermittent diarrhea + episodic flushing (85%) + cutaneous telangiectasias + bronchoespasm (wheezing) + cardiac abnormalities (right heart HF, tricuspid regurgitation)

149
Q

Best initial diagnostic test for carcinoid syndrome

A

Urinary 5-hydroxyindolacetic acid (5-HIAA)

*Degradation product of Serotonin

150
Q

Treatment for carcinoid syndrome

A

Octreotide

151
Q

Serologic testing to differentiate Crohn disease from Ulcerative colitis

A
  • CD➡ANCA➖, Anti-Saccharomyces cerevisiae antibody (ASCA)➕

- UC➡ANCA➕, ASCA➖

152
Q

Which procedure you must avoid in a patient with diverticulitis and why?

A

Colonoscopy➡infection weakens the colonic wall➡risk of perforation

153
Q

Best test for diverticulitis

A

CT scan

154
Q

Worst prognosis marker in acute pancreatitis

A

Low calcium

155
Q

When you must rule out infection in pancreatitis? How do you do it?

A
  • Severe necrosis➡>30% necrosis on CT or MRI

- Needle biopsy➡only way to confirm infection

156
Q

Best initial test for spontaneous bacterial peritonitis

A

Ascitic fluid study➡cell count >250 neutrophils

157
Q

Which symptom is very important to ask for when suspect hepatopulmonary syndrome?

A

Orthodeoxia➡hypoxia upon sitting upright

158
Q

Most accurate blood test for primary biliary cholangitis

A

Antimitochondrial antibody

159
Q

From the patient history, how you may distinguish primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC)?

A

80% of PSC occurs in association with IBD

160
Q

Which test may help you distinguish PBC and PSC?

A
  • PBC➡antimitochondrial antibody and liver biopsy (most accurate)
  • PSC➡MRCP or ERCP▶beading, narrowing, strictures in biliary system (most accurate). Bx is not essential for Dx. (ONLY cause of cirrhosis for which Bx is the not most the accurate)
161
Q

Most likely diagnosis in a nonsmoker young patient with liver disease + emphysema (COPD). Treatment.

A
  • Alpha 1-antitrypsin deficiency

- Replace enzyme

162
Q

Findings in the iron studies profile on hemochromatosis

A

⬆serum Iron, ⬆Ferritin, ⬇Iron binding capacity

*Best initial test for hemochromatosis

163
Q

Besides the liver biopsy, which studies are enough to confirm hemochromatosis?

A

MRI➡⬆iron deposition in the liver
➕
Hemochromatosis gene (HFE; mutation C282y) testing

164
Q

Hemochromatosis treatment

A

Phlebotomy

165
Q

How is the clinical presentation of Wilson disease in other organs than the liver compromise?

A
  • CNS➡Psychosis, tremor, dysarthria, ataxia, seizures
  • RBCs➡Coombs negative hemolytic anemia
  • Kidneys➡Renal tubular acidosis, nephrolithiasis
166
Q

Best initial test and most accurate test for Wilson disease

A
  • Best initial➡Slit-lamp examination▶Kayser-Fleischer rings
  • Most accurate➡abnormally ⬆copper excretion into urine after giving penicillamine
  • ⬇Ceruplasmin is NOT the most accurate
  • Liver Bx is sensitive and specific
167
Q

Key findings on imaging and serum when suspect autoimmune pancreatitis

A
  • CT scan➡enlarged, “sausage-shaped” pancreas
  • ⬆serum IgG4 (IgG4-related pancreatitis), ➕ANA and rheumatoid factor

*Associated with Sjögren syndrome, autoimmune thyroiditis, interstitial nephritis, sclerosing cholangitis

168
Q

Treatment options for Wilson disease

A
  • Penicillamine➡chelate copper, removes it from body
  • Zinc➡❌intestinal copper absorption
  • Trientine➡copper-chelating

*Penicillamine cannot be used with allergy to penicillin➡zinc or trientine.

169
Q

How do you assess for severe exocrine pancreas insufficiency? For which diagnosis is it useful?

A
  • ⬇Fecal elastase
  • ⬇serum Trypsinogen
  • Chronic pancreatitis
170
Q

Which findings on feces you may find high on inflammatory bowel disease?

A

⬆️Calprotectin or Lactoferrin

⬆️Fecal leukocytes

171
Q

In a patient with liver disease, which is the indication to receive prophylaxis for SBP?

A

Cirrhosis with ascites + variceal bleeding

172
Q

Classic clinical presentation of pellagra and its cause

A
  • Niacin deficiency
  • Clinical presentation, “3 Ds”:
  • Dermatitis - sun-exposed areas, rough, hyperpigmented, scaly
  • Diarrhea - watery, loss appetite, nausea, abd pain
  • Dementia - memory loss, affective symptoms (depression), psychosis
173
Q

Why you may have niacin deficiency? Which is the disease?

A

Pellagra

  • Diet based on corn products (developing countries)
  • Impaired nutritional intake (developed countries; alcoholics, chronic illness)
  • Carcinoid syndrome➡⬇tryptophan
  • Hartnup disease➡❌tryptophan absorption
  • Prolonged Isoniazid therapy➡❌tryptophan metabolism
174
Q

Potential complications of infectious mononucleosis

A
  • Splenic rupture
  • Acute airway obstruction
  • Autoimmune hemolytic anemia and thrombocytopenia
175
Q

How do you differentiate central vs nephrogenic diabetes insipidus?

A

Vasopressin stimulation test

  • Central➡⬇urine volume, ⬆urine osmolality
  • Nephrogenic➡no effect on urine volume or osmolality
176
Q

Treatment for hyperprolactinemia

A
  • Dopamine agonists: Cabergoline>Bromocriptine
  • Transsphenoidal surgery when not responding to medications
  • Radiation (rarely needed)
  • Asymptomatic does not need treatment
177
Q

What is the Kallman syndrome and which is the etiology?

A

Defective migration of neurons and failure of olfactory bulbs to develop➡⬇GnRH➡⬇FSH, LH, testosterone▶hyposmia/anosmia, Infertility, 50% Renal agenesis

*Failure to complete puberty; a form of hypogonadotropic hypogonadism

178
Q

Best initial test for GH deficiency

A

Injecting GHRH➡normal response is ⬆GH

179
Q

Treatment options for acromegaly

A
  • Surgery: transsphenoidal resection (responds in 70% of cases)
  • Medications:
  • Cabergoline: Dopamine agonist➡❌GH release
  • Octreotide or lanreotide: Somatostatin agonist➡❌GH release
  • Pegvisomant: GH receptor antagonist➡❌IGF release from the liver
  • Radiotherapy: for no response to surgery or medications
180
Q

What is Euthyroid sick syndrome?

A

⬇T3,⬆reverse T3 (rT3), ⬇T4, TSH does not rise

*Clinically euthyroid patients with nonthyroidal systemic illness have low serum levels of thyroid hormones

181
Q

Most common cause of hypercalcemia

A

Primary hyperparathyroidism and cancer 90% of cases

182
Q

First-line treatment for acute hypercalcemia

A
  • Saline hydration at high volume

- Bisphosphonate: Pamidronate, zoledronic acid (take several days to work)

183
Q

Treatment for acute hypercalcemia when the first option does not work

A

Calcitonin➡❌Osteoclasts, onset of action is very rapid

184
Q

What treatment you should add to treat hypercalcemia from sarcoidosis or any granulomatous disease?

A

Prednisone

185
Q

Causes of primary hyperparathyroidism

A
  • Solitary adenoma (80%-85%)
  • Hyperplasia of all 4 glands (15%-20%)
  • Parathyroid malignancy (1%)
186
Q

Possible clinical presentation of primary hyperparathyroidism

A
  • Asymptomatic
  • Acute severe hypercalcemia
  • Slower o chronic presentation➡Osteoporosis; Nephrolithiasis and renal insufficiency; muscle weakness, anorexia, nausea, vomiting, abdominal pain; Peptic ulcer disease (calcium ⬆gastrin)
187
Q

Standard of care for primary hyperparathyroidism and which are the indications?

A

Surgical removal of involved parathyroid glands

  • Bone disease (Ex, Osteoporosis)
  • Renal involvement, including stones
  • Age <50 yrs
  • Calcium consistently 1 point above normal
188
Q

Most common cause of hypocalcemia. Other causes.

A
  • Primary hypoparathyroidism prior neck surgery (Ex, thyroidectomy)
  • Other causes:
  • Hypomagnesemia➡Mg is needed to release PTH
  • Renal failure➡kidney 25 OH-D▶1,25 OH-D
  • Vitamin D deficiency➡inadequate sunlight exposure or insufficient intake; Rickets and Osteomalacia
  • Genetic disorders
  • Fat malabsorption
  • Hypoalbuminemia (no symptoms because free Ca is normal)
189
Q

Treatment for primary hyperparathyroidism when the first line of management is not possible

A

Cinacalcet➡❌release of PTH

190
Q

Most accurate test for Paget disease of bone. Best initial test.

A
  • Radionuclide (technetium) bone scan
  • Best initial: Plain film x-rays (lytic and sclerotic lesions, depending on disease stage)

*⬆Alkaline phosphatase and normal GGTP, Bilirrubin aid in diagnosis

191
Q

Best initial test for hypercortisolism. What other options to rule out it?

A
  • 24-hour urine cortisol (also more specific)

- 1 mg dexamethasone suppression test (sensitive, might be false positive)➡normally suppress morning cortisol level

192
Q

Best initial test to determine the cause (source) or location of hypercortisolism

A

ACTH level

193
Q

Treatment options for endogenous hypercortisolism when surgically removing the source (pituitary, adrenal or cancer) is not possible

A
  • Pasireotide: somatostatin analog➡❌levels and activity of ACTH (for ACTH dependent Cushing sx)
  • Mifepristone: ❌cortisol receptors throughout the body
  • Mitotane: ❌steroidogenesis, also cytotoxic to adrenal tissue (for adrenal cancer cannot be fully resected or metastatic disease can’t be identified)
194
Q

Most specific test of adrenal function (mainly for hypoadrenalism)

A

Cosyntropin test: measure cortisol before and after administration➡normally ⬆cortisol after give it

195
Q

Most common classic presentation of primary hyperaldosteronism

A

High blood pressure + Hypokalemia

196
Q

Best initial test for primary hyperaldosteronism

A

Ratio of plasma aldosterone to plasma renin >20:1

197
Q

Most accurate test to confirm unilateral adrenal adenoma

A

Sample of venous blood draining the adrenal➡⬆Aldosterone

198
Q

Most common cause of primary hyperaldosteronism

A
  1. Solitary adenoma

2. Bilateral hyperplasia

199
Q

Treatment for bilateral adrenal hyperplasia in primary hyperaldosteronism

A

Eplerenone or Spironolactone

Internal Medicine Flash Cards (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions