Deck 77: Internal Medicine Flashcards
what causes markedly impaired alveolar ventilation in acute pneumonia? What does this result in?
alveolar consolidation
- hypoxemia
- intrapulmonary shunting
Dead space ventilation
ventilation of ares of lung that are not perfused with blood
headache that manifests as constant pressure in the temporal and occipital regions without nausea or visual symptoms and that are unchanged of quality from prior
tension-type headache
what can cause tension headaches
stress
what can cause cluster headaches
sleep
Unilateral recurrent periorbital headache pain that resolves and recurs with associated ipsilateral miosis and ptosis
Cluster
Headaches that are pulsatile and throbbing in character, often unilateral
Migraine
what is often associated with migraine without arura
nausea, vomiting, and photophobia
how is leprosy diagnosed
biopsy from active edge of lesion
symptoms for leprosy
chronic, anesthetic, hypopigmented lesions with peripheral nerve involvement
Ichthyosis vulgaris
diffuse dermal scaling
coarsening of facial features, pharyngeal crowding, and enlargement of hands and feet
acromegaly
heart problem in acromegaly
concentric myocardial hypertrophy
diastolic dysfunction
left ventricular dilation
global hypokinesis
typical presentation of anaphylaxis
hypotension
tachycardia
urticarial rash
wheezing
fat embolism that occurs following a long-bone fracture has what clinical symptoms
dyspnea
neurological impairment ( confusion, seizure)
petechial rash
Timing difference between fat embolism from bone fracture and anaphylaxis reaction
anaphylaxis: quickly
fat embolism: 12-24 hours
Acanthosis nigricans is associated with what
younger patients: insulin resistance states
Older: GI malignancy
characterize laxative abuse
frequent, watery, nocturnal diarrhea
how do you diagnose positive laxative abuse
positive laxative screen
colonoscopy: melanosis coli ( dark brown discoloration with pale patches of lymph follicles)
characterize VIPoma diarreha
tea-colored
hypokalemia with hypochlorhydria
What distinguished peritonsillar abscess from epiglottis
Pertonsillar abscess: deviation of uvula and unilateral lymphadenopathy
what cancers are associated with lynch syndrome
colorectal cancer
endometrial carcinoma for female carriers
ovarian cancer
associated cancer with familial adenomatous polyposis
colorectal
desmoid and osteomas
brain tumors
cancer associated with von Hippel-Linau syndrome
Hemangioblastomas
Clear cell renal carcinoma
pheochromocytoma
MEN1
parathyroid ademona
pituitary adenoma
pancreatic adenomas
MEN2
Meduallary thyroid cancer
pheochromocytoma
Parathyroid hyperplasia
BRCA1 and BRCA2
breast and ovarian cancer
X-ray finding for osteomalacia due to vitamin D deficiency
decreased bone density with thinning of cortex
pseudofractures (Looser zones)
absence of identifiable bacteria on culture or gram stain, a mucopurulent urethral discharge in a patient who is sexually active suggests? what tests confirms diagnosis
chlamydial urethritis
Nucleic acid amplification
which drugs have survival benefit in CHF ? which help symptoms
survival: ACE inhibitors, ARB, beta blockers, spironolactone
symptomatic: Digoxin, furosemide
treatment for papillary thyroid cancer?
surgical resection
if high recurrence rate: radioiodine and thyroid replacement to suppress TSH
what is performed for initial evaluation of thyroid nodules
thyroid scintigraphy
thyroid peroxidase is marker for
hashimoto thyroiditis
presentation of cyanide toxicity
altered mental status
lactic acidosis
seizures
coma
what causes cyanide toxicity
nitroprusside
how does respiratory alkalosis impact Calcium
Hydrogen ions dissociate from albumin
calcium binds albumin
PE causes what acid base disturbance
respiratory alkalosis
Most effective intervention in overweight patients for controlling hypertension
weight control
other ideas: DASH diet
when can an abnormal S4 be heard in a person with CAD
acute phase of myocardial infarction due to ischemia induced Myocardial dysfunction
when should an HIV patient get the live attenuated varicella vaccine
CD4 count greater than 200
patient outstretch arms with palms up and eyes closed. Arm drifts downward and palm turns (pronates) toward the floor
Pronator drift
Upper motor neuron or pyramidal tract disease
what is romberg test and what does it test for
stand with feet together, arms to the sides and eyes closed.
propioception
Treatment for Dressler syndrome
NSAID
what lab value is elevated in pneumocysitis pneumonia
lactate dehydrogenase
is a lupus patient what is the difference ebtween pneumocysitis and pulmonary fibrosis
same except timing
pulmonary fibrosis shows up later
Common cause of cyclic breast pain in women of reproductive age? PE?
fibrocystic breast: nodular breasts with non-focal tenderness, no nipple discharge or lymphadenopathy
Treatment for costochondritis
reassurance and symptomatic pain management
What will cause decrease airflow rate during inspiration and expiration, flattening both the top and bottom of the flow-volume loop
fixed upper-airway obstruction
Mild persistent asthma? treatment
2 day per week
3-4 nightly awakenings per month
inhaled corticosteroid
short-acting beta-2 agonist
exaggerated fall in systemic blood pressure (10 or more) during inspiration
Pulsus paradoxus
when can you find pulsus paradoxus
cardiac tamponade
severe asthma
COPD
how does aortic regurgitation prevent pulsus paradoxus
- increase left ventricular end-diastolic pressure
- precludes interventricular septum to shift left
Light criteria
exudative if
- pleural fluid protein/ serum protein .5 or more
- pleural fluid LDH/ serum LDH .6 or more
- pleural fluid LDH greater 2/3 of upper limit of normal for serum LDH
heart failure and hypoalbuminemia are associated with what type of effusion
transudative
most common cause of liver mass in the US
matastatic disease
what is Beck’s triad? and what is it associated with
hypotension, distended neck veins, muffled heart sounds
- cardiac tamponade
What causes symptoms in cardiac tamponade
- exaggerated shift of interventricular septum toward left
- reduces left ventricular preload, stroke volume and cardiac output
Strongyloides stercoralis causes
mild intermittent skin, GI, and pulmonary symptoms
Immediate treatment for frostbite
WATER bath rewarming
most common cause of constrictive pericarditis in developing countries
TB
