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Internal Medicine > Deck 1 > Flashcards

Deck 1 Flashcards

1
Q

what labratory abnormality is seen in antiphospholipid syndrome

A

prolonged PTT

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2
Q

signs of antiphospholipid syndrome

A

recurrent fetal loss, recurrent thromboembolism

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3
Q

what si the mechanism of acetazolamide

A

this increases urinary excretion of bicarb by inhibiting carbonic anhydrase which combines H and HCO3, meaning more bicarb is excreted

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4
Q

effect of altitude on acid base status

A

you develop a respiratory alkalosis because you increase your respiratory drive which blows off CO2

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5
Q

HSV encephalitis signs

A

cognitive/personality changes, focal neurologic deficits, and/or seizures due to temporal lobe involvement (often seen on brain imaging).

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6
Q

typical manifestations of CMV in HIV patients

A

typically a retinitis

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7
Q

manifestations of JC virus in HIV patients

A

PML- focal neuro signs, and cognitive changes

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8
Q

manifestations of toxo in hiv patients

A

focal neuro deficits, seen on imaging

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9
Q

lab abnormalities in acute tubular necrosis

A

high urine sodium, normal BUN:Cr, often casts

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10
Q

what type of AKI is ATN

A

intrarenal

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11
Q

what will be seen on UA/BMP of a patient with multiple myeloma

A

bence-jones proteins, elevated urinary calcium, elevated Cr, elevated Ca

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12
Q

what the common cause of dilutional hyponatremia

A

primary polydipsia

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13
Q

clinical features of chronic mesenteric ischemia

A

postprandial pain, weightloss, nausea/diarrhea, food aversion

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14
Q

what is associated with MEN1

A

pituitary (adenomas), Parathyroid (adenomas or hyperplasia), pancreas (VIPoma, glucagonoma, somatostatinoma, insulinoma, gastrinoma)

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15
Q

signs of babesiosis

A

flu like sx to severe DIC, ARDS, CHF, splenic rupture

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16
Q

what transmits babesia and region

A

ixodes tick, northeast

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17
Q

what is associated with better outcomes in SCA outside a hospital

A

faster time to rhythm analysis and defibrillaiton

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18
Q

machism of pharmacologic stress test

A

typically its adenosine used and this increases blood flow to all the coronary vessels by causing dilation which then shows varying flow of the contrast because obstructed vessels dont dilate as much

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19
Q

manfestations of refeeding syndrome

A

muscle weakness, hyporeflexia, rhabdomyolysis, hemolysis, arrhythmias, and congestive heart failure

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20
Q

labratory findings of refeeding syndrome

A

hypophosphatemia

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21
Q

whats in the TTP pentad

A

low platelets, neuro changes, signs of hemolytic anemia, renal insufficiency, +/- fever

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22
Q

what deficiency can be seen in carcinoid syndrome

A

niacin

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23
Q

what are the clinical features of carcinoid syndrome

A

flushing, valvular heart disease, diarrhea, cramping, telangectasias, bronchospasm,

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24
Q

which antibiotic can cause phototoxicity

A

doxy

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25
Q

signs of CMV infection

A

fever, fatigue, malaise, lymphocytosis (atyptical lymphocytes), elevated LFTs

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26
Q

initial lab testing for non sustained SVT

A

bmp to check electrolytes

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27
Q

effects of a bicuspid aortic valve

A

these can cause aortic stenosis and aortic regurg

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28
Q

where do you hear aortic regurg

A

you hear it on the left sternal border

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29
Q

what type of murmur is aortic regurg

A

early diastolic decrescendo

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30
Q

what is cardiac index

A

cardiac index is the measure of cardiac output to BSA

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31
Q

what is the cardiac index and PCWP in obstructive shock

A

low cardiac index because heart cannot pump out, and low PCWP because the heart is not getting filled (nothing in LA)

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32
Q

what is the cardiac index and PCWP in cardiogenic shock

A

low cardiac index because heart is not pumping well but high PCWP because it is filling and filling just cant pump

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33
Q

what shape are calcium pyrophosphate crystals

A

rhomboid shaped

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34
Q

what causes CPP crystal deposition

A

this is pseudogout and can be bc of elevated Ca, due to hyperparathyroidism, hypothyroidism, or hemachromatosis

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35
Q

what is the hamman sign and what is it associated with

A

crunching sound on auscultation of chest and this is associated with esophageal perf or pneumothorax

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36
Q

where is adenoCA in the lung

A

peripherally located

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37
Q

does gonorrhea cause ulcers

A

NO

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38
Q

what two things cause painful penile lesions

A

H ducryi and HSV

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39
Q

common complication due to nephrotic syndrome

A

renal vein thrombosis due to loss of anti-clotting proteins (ATIII etc)

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40
Q

what drugs to people need to be on post MI

A

aspirin, clopidegrel (P2Y12 blocker), beta blocker, ACE, statin, mineralicorticoid antagonist

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41
Q

treatment of 1st degree AV block

A

observation

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42
Q

treatment of 2nd degree type 1 mobitz AV block

A

observation

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43
Q

treatment of 2nd degree AV block Mobitz Type II

A

PPM

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44
Q

treatment of 3rd degree AV block

A

PPM

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45
Q

what is 1st degree AV block

A

this is just prolonged PR, so you have about 1 block between the P and QRS

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46
Q

differentiate between type one and type two 2nd degree block

A

type 1 is constant lengthening of the PR and then dropped QRS and type 2 is when you drop the QRS randomly

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47
Q

size of LA in acute mitral regurgitation

A

normal because this is an acute process so no remodeling has occured yet

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48
Q

LV end diastolic pressure in acute MR

A

there is increased EDV because blood flows from the ventricle to the atrium causing increased atrial pressure, then when diastole occurs, the increased LA pressure causes rapid and increased filling of the LV causing increased end diastolic volume

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49
Q

signs of decompression sickness

A

mottling of the extremities, rapid onset confusion, respiratory distress, stroke, dysarthria, etc

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50
Q

etiology of decompression sickness

A

formation of nitrogen gas bubbles that can get trapped and causes weakness, strokes, etc.

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51
Q

which endocarditis etiology is associated with colon CA

A

strep bovis/gallacticus

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52
Q

hallmark labs of ischemic liver disease

A

rapid elevation in liver enzymes can exceed >10,000

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53
Q

first line therapy for renal artery stenosis

A

ace inhibitor because RAS creates excess RAAS activation so you need to turn it down by

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54
Q

pathophysiology of raynauds phenomenon

A

cold- or stress-induced hyperreactivity of the digital arterial smooth muscle, leading to episodic vasospasm

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55
Q

what is dx of PAD

A

ABI <.9

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56
Q

what area of the lungs get destroyed in alpha-1-antitrypsin deficiency

A

the lower lobes

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57
Q

vision changes associated with idiopathic intracranial hypertension

A

vision loss, diplopia due to abducens nerve palsy

58
Q

signs pointing to multiple myeloma

A

constitutional symptoms, hypercalcemia, constipation, renal insufficiency, bone pain, fractures

59
Q

what is the carotid pulse like in severe aortic stenosis

A

weak and slow rising

60
Q

signs of theophylline toxicity

A

tremors, nausea, vomiting, tachyarrythmia, hypotension

61
Q

what does theophylline do

A

this is a nonspecific phosphodiesterase inhibitor

62
Q

what is lemierre syndrome

A

oropharnygeal infection that turns to a severe infection and causes internal jugular venous thrombosis, pulmonary nodules, and worsening respiratory distress

63
Q

what is the bug that causes lemierre syndrome

A

fusibacterium necrophorum

64
Q

what organs is it normal for FDG to pool in in patients underoing a PET scan

A

brain, kidneys, ureters, bladder etc.

65
Q

what increases risk of MALT gastric cancer

A

h pylori

66
Q

treatment of DVT

A

initiate anti Xa (1st choice) or warfarin, dont necessarily need to give heparin, only for hemodynamically unstable patients.

67
Q

what value is high in hereditary spherocytosis

A

MCHC is increased

68
Q

acute onset onset of palpitations, HTN and fever agitation following CT w/contras

A

thyroid storm from the excess iodine that causes increased release of the thyroid homrone

69
Q

treatment of hyperkalemia with T waves on ECG

A

calcium gluconate and insulin/glucose

70
Q

rare side effect of nitrofurantoin (lungs)

A

acute lung injury- dyspnea fever, bilateral opacities 6-9 days after initiating therpay

71
Q

clinical signs of rhabdomyolysis

A

muscle weakness, dark urine, decreased urine output, elevated creatinine, and

72
Q

Urinalysis of rhabdo

A

blood on urinalysis without a significant number of red blood cells (RBCs) on urine microscopy

73
Q

common variable immunodeficiency signs

A

recurrent respiratory infections, recurrent GI infections, chronic diseases, onset 20-40yo

74
Q

causes of recurrent pneumonia in the same anotomic location

A

foreign body, malignancy, dysphagia

75
Q

treatment of delierium in an agitated elderly patient

A

haloperidol

76
Q

what is the phlebitis assiciated with pancreatic cancer

A

migratory thrombophlebitis

77
Q

dx of polymyositis

A

EMG
and elevated CK, muscle bx

78
Q

extrarenal manifestations of PCKD in adults

A

liver cysts, cerebral berry aneurysms, hypertension

79
Q

what is the difference between painless thyroiditis and subacute thyroiditis

A

both will cause decreased iodine uptake but with painless thyroiditis you have no pain on palpation and in subacute you do have pain

80
Q

what changes do you see on EKG with hyper/hypokalemia

A

hypo- you see flat T waves, hyper - you see peaked T waves

81
Q

skin manifestations of blasto

A

wart-like lesions, violaceous nodules, skin ulcers

82
Q

where is blasto vs. histo

A

blasto extends up in to the midwest more than histo

83
Q

what is the pathophysiology of hepatorenal syndrome

A

this is where you have splanchnic dilation which causes decreased renal perfusion which then causes activation of RAAS which then causes massive renal vasoconstriction which causes AKI

84
Q

features of pemphigus vulgaris

A

painful flaccid bullae that erupt on skin and mucosa

85
Q

mucosal involvement in pemphigus vulgaris vs. bullous pemphigoid

A

PV has mucosa BP no mucosa

86
Q

age of onset for pemphigus vulgaris vs. bullous pemphigoid

A

PV 40-60yo, BP 60+

87
Q

who has negative CXR but will still likely have pneumonia given the right clinical picture

A

pts on immunosuppressants (steroids rejection meds etc) because they cant mount an immune response to create an infiltration to be seen on CXR

88
Q

treatment for acute bronchitis

A

supportive unless they have wheezing then you can do a bronchodilator

89
Q

what systems are involved in granulomatosis with polyangiitis

A

respiratory, renal, skin

90
Q

dx of vertigo after viral illness

A

vestibular neuritis- abnormal head thrust test and vertigo

91
Q

treatment of TTP

A

plasma exchange, steroids, then immunosuppressant

92
Q

initial workup of syncope

A

ambulatory ECG

93
Q

where do you hear aortic regurg

A

left sternal border

94
Q

what is a common complication of people with aortic valve endocardiits if it gets bad

A

perivalvular abcess

95
Q

what is shown on radionucleotide myocardial imaging

A

these are the coronary arteries that you can see

96
Q

what does it mean if there is less flow after exercise in a radionuleotide myocardial scan

A

this means there is an obstruction in the coronary arteries which needs to be treated with statin and antiplatelet therapy

97
Q

what age group gets hemangiomas

A

mostly infants

98
Q

who gets kaposi sarcoma

A

people on immunosuppresants, HIV, organ transplant,

99
Q

what is the main source of thrombus for PEs

A

the femoral or popliteal veins

100
Q

where do most foci for atrial fibrillation occur

A

in the pulmonary vein ostia

101
Q

first step after dx of cirrhosis due to alcohol

A

upper GI endoscopy

102
Q

prophylaxis of non bleeding esophageal varices

A

non selective beta blocker like nadolol

103
Q

lab abnormalities in tumor lysis syndrome

A

hyperphosphatemia, hyperuricemia, hypocalcemia (due to Ca-P preciptation), hyperkalemia

104
Q

when do you administer hypertonic saline for hyponatremia

A

<120meq

105
Q

treatment of SIADH

A

fluid restriction and salt tablets

106
Q

what valves are typically effected for rheumatic heart disease

A

aortic or mitral regurg or stenosis

107
Q

what is hypertrophic osteoarthopathy

A

this is bilateral enlaragment of wrists and ankles with digital clubbing and is typically associated with pulmonary etiology like adenoCA or CF etc.

108
Q

what drugs need to be held in AKI

A

metformin, ace/arb etc.

109
Q

clinical course of hyperthyroidism after radioactive iodine treatment

A

takes about 6 weeks for hyperthyroidism to resolve, and then >90% of patients develop hypothyroidism

110
Q

what test do you need to do dx spontaneous bacterial peritonitis

A

cell count with diff of the peritonitic fluid

111
Q

what is the sodium level like in diabetes insipidus

A

it is high because water is not being retained

112
Q

what is sodium level like in primary polydipsia

A

it is low because the patient is just taking in a bunch of water

113
Q

what would the EKG show of a patient with viral myocarditis

A

non specifc ST segment changes

114
Q

alternate treatment of syphillis if pt cannot do penicililn

A

doxy

115
Q

acute management of acute coronary syndrome

A

nitrates (if chest pain), beta blocker, antiplatelet therapy, anticoagulation, statin therapy, coronary reperfusion

116
Q

extrahepatic manifestations of wilsons

A

parkinsonism, gait disturbances, depression, psychosis, etc.

117
Q

management of HHS

A

aggressive rehydration with normal saline and then IV insulin

118
Q

clinical signs of bronchietasis

A

chronic daily production of thick occosionally blood tinged mucus

119
Q

what area of lymphadenopathy is indicative of secondary syph

A

epitrochlear (above elbow)

120
Q

what infection can you get from cave exploring

A

histoplasma

121
Q

what is light’s criteria for pleural effusion

A

pleural: serum protein ratio >0.5 OR pleural:serum lactate ratio >0.6 OR greater than 2/3 upper limit normal of serum lactate pleural lactate

122
Q

what is becks triad for cardiac tampanode

A

distended neck veins, muffled heart sounds, hypotension

123
Q

hypothyroidism effect on LH and FSH levels

A

this causes increased prolactin because there is increased TRH which increases both TSH and prolactin and prolactin suppresses LH and FSH

124
Q

hallmarks of amyloidosis due to dialysis

A

carpal tunnel, bone cysts, shoulder pain and hypertrophy

125
Q

what is broken heart syndrome

A

this is stress induced cardiomyopathy which is where you get a surge of catecholamines which causes chest pain like an MI

126
Q

EKG changes in broken heart syndrome

A

can show ischemic changes like t wave inversions or ST changes

127
Q

CT scan of acute aspergillosis

A

nodules with surrounding ground-glass opacities (“halo sign”

128
Q

leukemoid vs. CML LAP score

A

LAP is decreased in CML vs. leukemoid reaction

129
Q

metamyelocytes in CML vs. leukemoid

A

in CML there are more immature cells which are the metamyelocytes and in leukemoid there are more myelocytes which are mature

130
Q

what type of nephritis do patients with RA get

A

amlyloid nephritis (nephrotic)

131
Q

are deep or superficial infections for diabetic foot ulcers poly or monomicrobial

A

superficial are mono and deep are poly

132
Q

management of vfib

A

defibrillation

133
Q

what is the main cause of intrinsic AKI

A

ATN (85%)

134
Q

muddy brown casts what do they MEANNNN

A

ATN

135
Q

why do you get secondary mitral regurg in heart failure

A

as the ventricle dilates, it pulls the chordae tendinae due to papillary muscle displacement which causes continual opening of the valves resulting in regurgication

136
Q

peripheral pulses in HCM vs. AS

A

in HCM they are brisk and rapid, in AS they are soft and delayed

137
Q

what is the calcium like in hyperparathyroidism due to CKD

A

it is low or low normal because it is not high bc the kidney is not converting VitD to active form

138
Q

is raynaouds painful

A

yes

139
Q

what is a poor prognostic indicator for heart failure (labs)

A

hyponatremia

140
Q

acute kidney injury pathogenesis IV acyclovir

A

the IV acyclovir precipitates and causes obstructive damage to the tubules

141
Q

enlarged lymph nodes, night sweats, HIV patient

A

non hodgkins lymphoma due to EBV

142
Q

management of chemotherapy induced diarrhea

A

loperamide

Internal Medicine (6 decks)

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