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Internal Medicine Flash Cards > Block 3 > Flashcards

Block 3 Flashcards

1
Q

Diagnostic and therapeutic (short-term) maneuver for cervical radiculopathy

A

Shoulder abduction test➡improve radicular symptoms when hand is placed on the top of the head

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2
Q

Most reliable sign of opioid intoxication. Which other clues you may find?

A

⬇Respiratory rate

  • Bradycardia
  • Acute change in mental status
  • Miosis
  • Hypotension
  • Hypothermia
  • Hypoactive bowel sounds

“BAM3H”

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3
Q

Ptosis, “down-and-out” gaze, diplopia and normal pupillary response in a patient with poorly controlled diabetes mellitus

A

Ischemic oculomotor (CN III) palsy [Diabetic ophthalmoplegia]

*Damage to the inner somatic nerve fibers while sparing the more peripheral parasympathetic fibers

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4
Q

Treatment for necrotizing (malignant) otitis externa

A
  • Intravenous antipseudomonal antibiotic (Ciprofloxacin)

- ±Surgical debridement

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5
Q

Reynolds pentad, and what does it suggest?

A

Acute cholangitis

  • Fever
  • Upper quadrant pain
  • Altered mental status
  • Jaundice
  • Hypotension
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6
Q

Medications that may precipitate myasthenic crisis

A
  • Antibiotics: aminioglycosides, fluoroquinolones
  • Beta-blockers
  • Calcium channel blockers
  • Magnesium
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7
Q

Ulnar nerve neuropathy differences between wrist and elbow level injury

A
  • Wrist➡numbness, paresthesia at medial side of the hand + intrinsic hand weakness (“clumsiness”) [hypothenar, medial lumbrical, adductor pollicis]
  • Elbow➡⬇grip strength [flexor carpi ulnaris, medial portion of flexor digitorum profundus]
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8
Q

How you may differentiate guillain-barré syndrome vs tick paralysis?

A
  • GBS➡Autonomic dysfunction in 70% of patients (tachycardia, urinary tract retention, arrhythmias). CSF with albuminocytologic dissociation (⬆proteins, ⬇cells). Ascending symmetrical paralysis over days to weeks.
  • Tick-borne paralysis➡Ascending paralysis over hours to days, may be localized or more pronunced on 1 extremity. Look for and find the tick (next best step)
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9
Q

Etiology of tick-borne paralysis

A

Neurotoxin release: tick needs 4-7 days for neurotoxin release

*Remove the tick➡improvement in an hour, complete recovery in several days (Dermacentor app, Ixodes holocyclus)

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10
Q

Most common organism causing deep infections following puncture wound (through the sole of a shoe)

A

Staphylococcus aureus and Pseudomonas aeruginosa

*Risk of osteomyelitis

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11
Q

Giant cell tumor of bone clinical presentation

A
  • Progressive knee pain + X-ray with eccentric lytic lesion (“soap bubbles”)
  • Benign, locally destructive neoplasm at epiphysis of long bones (young adults)
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12
Q

Giant cell tumor of bone association and prognosis

A
  • Associated with paget disease of bone

- It is benign but might have malignant transformation and pulmonary metastasis

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13
Q

Cause of Osteitis fibrosa cystica and clinical presentation

A
  • Primary Hyperparathyroidism➡⬆Resorption in cortical bone with subperiosteal thinning and cystic degeneration▶hypercalcemia (constipation, fatigue, etc)
  • Secondary hyperparathyroidism➡chronic renal failure

*X-ray: lytic lesions with multifocal involvement

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14
Q

Osteoid osteoma etiology and clinical presentation

A
  • Benign bone tumor prostaglandin-producer▶Nocturnal pain relieved by NSAIDs
  • X-ray: Small, round lucency
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15
Q

Clinical presentation of acute hemolytic transfusion reaction

A
  • Onset in minutes to 24 hours of transfusion
  • Fever, chills, hypotension
  • Renal tubular cell injury (may progress acute renal failure)▶Hemoglobinuria (dark urine), flank pain
  • Intravascular Hemolysis➡⬆LDH, ⬆Indirect bilirubin
  • DIC➡oozing intravenous site
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16
Q

Diagnosis test for acute hemolytic transfusion reaction

A

Direct coombs test➡antibody-coated RBCs

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17
Q

Clinical presentation of myopathy in Cushing syndrome

A
  • Painless progressive proximal muscle weakness, atrophy, no tenderness (may interfere with daily activities)
  • Lower extremity more involved
  • ESR and CK normal
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18
Q

Cause of myopathy in Cushing syndrome

A

Glucocorticoid-induced myopathy: Direct catabolic effects of cortisol on skeletal muscle➡muscle atrophy

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19
Q

What is the fetal hydantoin syndrome?

A

Teratogenic effect of phenytoin: orofacial clefts, microcephaly, nail/digit hypoplasia, cardiac defects, dysmorphic facial features

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20
Q

Radiologic feature of invasive aspergillosis in the lungs

A

Chest CT scan: Pulmonary nodules with surrounding ground-glass opacities (“halo sign”)

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21
Q

How do you suspect inhalant abuse acute intoxication?

A
  • Brief transient euphoria and loss consciousness
  • Highly lipid soluble➡immediate effects (typically last 15-45 minutes)
  • Dermatitis due chemical exposure around the mouth or nostrils▶”glue sniffer’s rash”
  • Chronic abuse of nitrous oxide➡vitamin B12 deficiency▶polyneuropathy
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22
Q

What is the most likely diagnosis in a patient with gallstone pancreatitis and fever, RUQ pain, jaundice altered mental status and hypotension? What should be the management?

A
  • Acute cholangitis
  • After strenous IV fluid resucitation and antibiotics, Endoscopic retrograde cholangiopancreatography➡relieve the biliary obstruction
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23
Q

Most common adolescent- and adult-onset muscular dystrophy and mode of genetic transmision

A
  • Classic myotonic dystrophy

- Autosomal dominant➡CTG repeat expansion on the DMPK gene

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24
Q

Main clinical presentation of classic myotonic dystrophy

A
  • Pogressive skeletal muscle weakness➡face and distal extremities (forearms, hands, ankle flexors)▶muscle wasting➡ptosis, temporal wasting, limb muscle atrophy
  • Grip myotonia (hand)
  • Dysphagia
  • Conduction anomalies
  • Testicular atrophy/infertility
25
Q

Primary mechanism underlying the most common cytopenias in SLE

A

Autoantibodies➡Immune-mediated peripheral destruction (in all 3 cell lines)

26
Q

Which clinical manifestations might raise suspicion of cervical myelopathy?

A
  • Lower motor neuron (LMN) signs (Ex, weakness and atrophy) at the level of the lesion (arms)
  • Upper motor neuron (UMN) signs (Ex, hyperreflexia) below the level of the lesion (legs)
27
Q

Most common cause of cervical myelopathy in older adults

A

Spondylosis➡canal narrowing➡spinal cord compression

28
Q

Most common metals alloys that trigger allergic contact dermatitis. Mechanism of the reaction.

A
  • Nickel (jewerly or clothing fastener)➡neck, wrists, ear lobes, umbilicus; cobalt, chromium, beryllium, zinc
  • Corrosion by electrolytes in sweat releases soluble metal ions➡type IV (cell-mediated) hypersensitivity reaction
29
Q

Pulmonary function test results in a patient with amyotrophic lateral sclerosis (ALS)

A
  • Restrictive pattern (normal or ⬆FEV1/FVC, ⬇VC)➡extrinsic limitation of lung expansion
  • Diaphragmatic involvement (weakness)➡⬇FVC, ⬇Maximal inspiratory pressure (reflect diaphragmatic strength), DLCO normal (pulmonar parenchyma and alveoli unaffected)
30
Q

Best predictors of postoperative outcomes following lung resection surgery

A

FEV1 and DLCO

31
Q

Screening for abdominal aortic aneurysm

A

Abdominal ultrasound for men age 65-75 who have ever smoked (lifetime tobacco use>100 cigarettes)

32
Q

Ocular manifestations of Neurofibromatosis type 1

A
  • Optic pathway glioma (15% of patients, age<6)➡asymptomatic or grow large to compress optic nerve▶⬇visual acuity, ❌color vision, optic nerve atrophy, proptosis, esotropia, optic disc pallor
  • Lisch nodules➡pigmented iris hamartomas
33
Q

Primary dose-limiting side effect of first-line treatment for Sickle cell anemia with recurrent vaso-occlusive crisis

A

Myelosuppression (neutropenia, anemia, thrombocytopenia)

*Hydroxyurea➡⬆fetal hemoglobin➡⬇sickled hb➡⬇polymerization of RBC▶⬇vaso-occlusion episodes

34
Q

Most common site of colon cancer metastasis

A

Liver

35
Q

Important difference in clinical presentation between paralytic ileus and bowel obstruction

A
  • Paralytic ileus: hypoactive bowel sounds

- Bowel obstruction: hyperactive “tinkling” bowel sounds. Peristaltic waves on the abdominal wall

36
Q

Musculoskeletal presentation of hereditary hemochromatosis

A

Arthralgia, arthropathy, chondrocalcinosis (Pseudogout)

37
Q

How you may differentiate small cell carcinoma vs squamous cell carcinoma of the lung?

A

Paraneoplastic syndromes:

  • Small CC: ⬆ACTH (Cushing sx), ⬆ADH (SIADH), ⬆Antibodies against presynaptic Ca+2 channels (Lambert-Eaton myasthenic sx)
  • Squamous CC: ⬆PTHrP (hypercalcemia)
  • Sca++mous
38
Q

Which conditions you must study in a patient with pseudogout?

A
  • Hyperparathyroidism
  • Hypothyroidism
  • Hemochromatosis
39
Q

Definition of severe aortic stenosis

A
  • Aortic jet velocity >=4 m/sec
  • Mean transvalvular pressure gradient >=40 mmHg
  • Valve area usually <=1 cm2, but NO required
40
Q

Indications of aortic valve replacement

A

Severe AS and >= of the following:

  • Onset of symptoms (angina, syncope)
  • Left ventricular ejection fraction <50%
  • Undergoing other cardiac surgery (CABG)
41
Q

Common findings of chronic primary adrenal insufficiency

A
  • Hyponatremia: hypovolemia-induced antidiuretic hormone secretion
  • Hypoglycemia: cortisol deficiency
  • Peripheral eosinophilia: normally inhibited by corticosteroids

*History of weakness, fatigue, anorexia, weight loss

42
Q

Management of small spontaneous pneumothorax

A
  • Observation

- Supplemental oxygen (regardless of oxygen saturation)➡⬆speed of resorption

43
Q

Best treatment for cancer-related anorexia/cachexia syndrome (CACS)

A

Progesterone analogs (megestrol acetate medroxyprogesterone acetate)>corticosteroids

44
Q

Treatment for HIV cachexia

A

Synthetic cannabinoids (dronabinol)

45
Q

Pathophysiologic mechanism of membranoproliferative glomerulonephritis

A
  • Dense intramembranous deposits that stain for C3
  • Deposit disease▶IgG antibodies (C3 nephritic factor) against C3 convertase➡persistent activation of the alternative complement pathway▶kidney damage
46
Q

Most important side effects of phenytoin

A
  • Phenytoin➡❌folic acid absorption in jejunum▶folic acid deficiency over weeks or months
  • Megaloblastic anemia
  • Gingival overgrowth/hyperplasia
  • Phenytoin➡❌bone and mineral metabolism (⬇bone density): calcium and vitamin D supplementation
47
Q

Symptoms of papilledema due to increased intracranial pressure

A
  • Momentary vision loss that varies according to changes in head position
  • Large blind spot in visual fields
48
Q

Markers of Nonclassic congenital adrenal hyperplasia

A
  • Hyperandrogenism
  • ⬆ 17-hydroxyprogesterone

*Cause by partial ⬇ 21-hydroxylase activity

49
Q

Most common psychiatric complication of multiple sclerosis

A

Depression

50
Q

Treatment of triglyceride-induced pancreatitis

A
  • If Glucose≥500 mg/dL: consider insulin infusion▶limits fatty-acid release from adipocytes)
  • If Glucose≤500 mg/dL or severe pancreatitis (lactic acidosis, hypocalcemia, etc): apheresis▶removes triglyceride-rich plasma

*Always IV fluids and pain control

51
Q

What is the difference between heat exhaustion vs exertional heat stroke?

A

Exertional heat stroke has CNS dysfunction, heat exhaustion not

52
Q

Most common form of paroxysmal supraventricular tachycardia (PSVT)

A

Atrioventricular nodal reentrant tachycardia (AVNRT)➡reentry mechanism▶slow and fast pathways form a looped circuit

*Impulses traveling in antegrade direction through the slow pathway and returning through the fast pathway

53
Q

Most common cause of chronic mitral regurgitation in developed countries

A

Mitral valve prolapse: myxomatous degeneration of the mitral valve leaflets and chordae

54
Q

How do you confirm benign paroxysmal positional vertigo (BPPV)?

A

Dix-Hallpike maneuver➡vertigo and nystagmus on quickly lying back into a supine position with the head rotated 45 degrees

55
Q

Treatment for Alopecia areata

A
  • Mild/moderate hair loss: topical or intralesional corticosteroids
  • Extensive hair loss: topical immunotherapy (diphenylcyclopropenone), oral corticosteroids

*Autoimmune disorder involving the hair bulb cells

56
Q

Major driver of AKI in cardiorenal syndrome?

A

Elevated central venous pressure

*Reduced effective arterial blood volume (EABV)➡Heart failure, cirrhosis

57
Q

Antibiotic indicated for patients undergoing splenectomy and develop fever

A

Amoxicillin-clavulanate

*Levofloxacin (for penicillin allergy)

58
Q

First step in evaluating solitary pulmonary nodule (SPN)

A

Comparison with previous x-ray➡stable lesion in 2-3 years▶malignancy ruled out, no further testing

Internal Medicine Flash Cards (3 decks)

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