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Internal Medicine > DIVINE! > Flashcards

DIVINE! Flashcards

1
Q

Sickle cell disease vaccines?

A

SHIN

Streptococcus Pneumonia

Haemophilus influenzae

Neisseria Meningitidis

(also klebsiella and and psuedomonas)

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2
Q

Light’s Criteria!

A
  • Pleural fluid protein/serum protein < 0.5
  • Pleural fluid LDH/serum LDH < 0.6
  • Pleaural fluid LDH < 0.67 ULN of serum LDH.
  • If one of these rules are violated, the fluid is exudative (malignancy, PE, ARDS)
  • Normal pleural fluid pH is 7.6
    • Transudative fluid is 7.4-7.55
    • Exudative is 7.3-7.45
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3
Q

Common causes of pleural effusions?

A
  • Transudative
    • CHF
    • Cirrhosis
    • Nephrotic Syndrome
    • Peritoneal dialysis
  • Exudative
    • infections
    • malignancy
    • Inflammatory disorders
    • Fluid from abdomen to pleural space
    • coronary artery bypass surgery
    • pulmonary embolism
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4
Q

RUQ pain, fever, +ve Murphy’s sign

A

Cholecystitis

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5
Q

RUQ pain, fever, scleral icterus, BP 80/48 (hypotension), altered MS

A

Ascending cholangitis

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6
Q

HLA-B27 diseases?

A

PAIR

Psoriasis

Ankylosing Spondylitis

Irritable bowel disease

Reiter’s Syndrome (reactive arthritis post bacterial infection, re-can’t see; uveitis, can’t pee; urethritis, can’t climb a tree; arthritis)

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7
Q

MEN syndomes?

A
  • MEN1 (3 Ps)
    • Pituitary adenoma
    • Parathyroid hyperplasia
    • Pancreatic islet cell tumors (gastrinoma, insulinoma, glucagonoma)
  • MEN2a (MPH)
    • Calcitonin (medullary carcinoma of the thyroid with elevated calcitonin level)
    • Calcium (parathyroid hyperplasia, which causes elevated calcium levels)
    • Catecholamines which are made in the chromocytes (as in pheochromocytoma)
  • MNE2b (MPM)
    • Medullary thyroid carcinoma
    • Pheochromocytoma
    • Mucosal neuromas

​​​MEN1

  • Hypercalcemia: brittle bones (fractures, due to osteoporosis), kidney stones, abdominal moans (abdominal pain), and psychiatric overtones (confusion).
  • Treatment-resistant peptic ulcer disease (gastrinoma) or hypoglycemia (insulinoma).

MEN2A

  • Hypercalcemia: brittle bones (fractures, due to osteoporosis), kidney stones, abdominal moans (abdominal pain), and psychiatric overtones (confusion).
  • Severe, treatment-resistent hypertension (particularly paroxysmal in nature, with headaches, palpitations, and diaphoresis).
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8
Q

Child with retinoblastoma, cancer later?

A

Osteosarcoma

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9
Q

CLL

A

indolent, derived from B cells, CD5+ (usually only in T cells). smude cells on histology, SEVERE leukocytosis

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10
Q

Multiple myeloma

A

CRAB symptoms

hyperCalcemia

Renal insufficiency

Anemia

Bone pain

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11
Q

65 yo M with pancytopenia. A peripheral smear reveals tear drop shaped RBCs

A

Primary myelofibrosis

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12
Q

88 yo F has a 6 mo hx of recurrent infections. WBC is 87000. A peripheral smear reveals “smudge cells”

A

CLL

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13
Q

78 yo M. A peripheral smear is notable for RBCs stacked like coins

A

Multiple myeloma (Rouleaux formatin)

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14
Q

78 yo M with pancytopenia. Bone marrow aspiration is consistent with a “dry tap”-

A

Primary myelofibrosis

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15
Q

66 yo F presents with a 6 mo hx of recurrent infections, WBC is 47k with a preponderance of cells in different stages of maturation. These cells have reduced leukocyte alkaline phosphatase activity-

A

CML (9/22 translocation, Philadelphbia, give imatinib)

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16
Q

55 yo M is S/P Day 5 from recent treatment for a hematologic malignancy. Plts are 40K, D-dimers are elevated, he is bleeding from every IV Site-

A

Acute promyelocytic leukemia (Auer rods can trigger DIC, low plts, High FDPs/PT/PTT, give ATRA to promote myeloblast maturation)

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17
Q

5 yo F presents with a 6 week hx of weight loss and fever. CBC is notable for pancytopenia. Cytologic studies reveal TDT +ve cells

A

ALL

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18
Q

55 yo M presents with fever, weight loss, and night sweats. Peripheral smear reveals B cells with a bilobate nucleus

A

Hodgkin’s lymphoma

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19
Q

45 yo F with a hx of CML presents with a 3 week hx of diffuse lymphadenopathy and fever-

A

AML

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20
Q

45 yo F with a 6 month history of intense pruritus. BMP is notable for conjugated hyperbilirubinemia. Abdominal imaging reveals dilation of intrahepatic bile ducts

A

This is primary biliary cholangitis associated with anti-mitochondrial antibodies. Treatment involves the use of Ursodiol. Liver transplantation is the only definitive treatment.

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21
Q

45 yo M with a history of ulcerative colitis presents with a 6 month history of pruritus. Abdominal imaging reveals dilation of intra and extrahepatic bile ducts

A

this is Primary Sclerosing Cholangitis associated with p-ANCA. Note the difference in biliary duct pathology. Ursodiol does not work as well here. Liver transplantation and occasionally endoscopic dilation of strictures may suffice.

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22
Q

25 yo M presents with a multi year history of sinusitis, hemoptysis, and hematuria

A

Wegener’s granulomatosis. Associated with c-ANCA. Could present as RPGN. Treat with steroids and cyclophosphamide.

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23
Q

25 yo M presents with new onset asthma. Urinalysis reveals dysmorphic erythrocytes

A

this is Churg-Strauss Syndrome. Associated with p-ANCA (like microscopic polyangiitis). Consider this diagnosis in the setting of asthma and associated RPGN/nephritic syndromes.

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24
Q

35 yo F presents with episodic discoloration of her fingers when she steps out of her home in winter. PE is notable for diffuse skin thickening

A

scleroderma (anticentromere antibodies for CREST scleroderma), anti-SCL 70 (topoisomerase) for diffuse scleroderma.

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25
Q

Recent spleen repair, referred pain to the left shoulder

A

subphrenic abscess

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26
Q

Recent treatment for acute pancreatitis, isolated gastric varices

A

splenic vein thrombosis

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27
Q

Gnawing epigastric pain, on chronic treatment for OA

A

PUD

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28
Q

Epigastric pain radiating to the back, alcoholic/sickle cell patient

A

pancreatitis

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29
Q

Periumbilical pain progressing to the RLQ

A

appendicitis

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30
Q

Flank pain radiating to the groin, hematuria

A

urolithiasis (renal calculi)

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31
Q

23 yo F, severe RLQ pain, inconsistent condom use

A

ectopic pregnancy

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32
Q

15 yo F with hx of adnexal mass, sudden onset severe abdominal pain

A

ovarian torsion

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33
Q

Cervical motion tenderness, adnexal tenderness, vaginal discharge

A

PID

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34
Q

LLQ pain in an 80 yo F with fever

A

diverticulitis

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35
Q

LLQ pain in an 80 yo M, air bubbles/poop in the urine

A

colovesical fistula

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36
Q

Patient on chemotherapy, thickened cecum on abdominal CT

A

typhlitis

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37
Q

What is the bug?

Watery Diarrhea after returning from a trip

A

Enterotoxigenic E. Coli (MCC of Travellers diarrhea)

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38
Q

What is the bug?

Watery Diarrhea with Rice Water Stools

A

Vibrio Cholerae (you lose a ton of fluid, tetracycline or a macrolide may help)

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39
Q

What is the bug?

Watery Diarrhea in a hiker/camper

A

Giardia Lamblia (also consider this in a Q stem detailing an IgA deficiency, give metronidazole)

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40
Q

What is the bug?

Watery Diarrhea on a cruise ship

A

Norovirus/Norwalk Virus.

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41
Q

What is the bug?

Watery Diarrhea in an infant

A

Rotavirus (vaccine associated with increased risk of intussusception)

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42
Q

What is the bug?

Watery Diarrhea in an AIDS patient

A

Cryptosporidium Parvum (acid fast, give paromomycin or nitazoxanide)

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43
Q

What is the bug?

Bloody Diarrhea after consuming beef

A

Shigella (maybe EHEC/Campylobacter as well)

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44
Q

What is the bug?

Bloody diarrhea after consuming poultry/eggs

A

Salmonella (Enteritidis)

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45
Q

What is the bug?

Bloody diarrhea in the setting of a Lactose Fermenter

A

EHEC

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46
Q

What is the bug?

Most common cause of bloody diarrhea in the US

A

Campylobacter Jejuni

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47
Q

What is the bug?

Diarrhea and Ascending Paralysis

A

Campylobacter Jejuni (Guillain Barre Syndrome)

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48
Q

What is the bug?

Diarrhea after treatment for an anaerobic infection

A

Clostridium Difficile (re-Clindamycin and above the diaphragm).

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49
Q

What is the bug?

Diarrhea that feels like Appendicitis (after Pork Consumption)

A

Yersinia Enterocolitica (RLQ pain, mesenteric adenitis, terminal ileitis)

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50
Q

What is the bug?

Protozoal cause of bloody diarrhea

A

Entamoeba Histolytica (give metronidazole, iodoquinol if theres liver abscesses).

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51
Q

What is the bug?

Bloody Diarrhea requiring a small inoculum

A

Shigella

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52
Q

What is the bug?

Bloody Diarrhea and Hemolytic Uremic Syndrome (kidney issues)

A

EHEC

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53
Q

What is the bug?

Diarrhea after consuming Oysters/Seafood

A

Vibrio Parahaemolyticus

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54
Q

What is the bug?

Diarrhea after consuming Oysters + Elevated Liver Function Tests

A

Vibrio Vulnificus

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55
Q

What is the bug?

Diarrhea after swimming in freshwater

A

Aeromonas (theres also an Aquarium association)

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56
Q

What is the bug?

Diarrhea with massive amounts of fluid/electrolyte loss

A

Vibrio Cholerae (most likely cause)

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57
Q

What is the bug?

Diarrhea after consuming reheated rice

A

Bacillus Cereus (theres also an Asian, usually Chinese restaurant association).

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58
Q

What is the bug?

Diarrhea 2 hours after consuming potato salad

A

S. Aureus

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59
Q

What is the bug?

Diarrhea 6-15 hours after consuming meat/poultry left out for long

A

Clostridium Perfringens (nonspecific, but they may say something about an anaerobe causing diarrhea/an organism that forms spores).

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60
Q

HY association?

Refractory HTN, hypokalemia, mild hypernatremia

A

Conns Syndrome.

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61
Q

HY association?

Patient looks tan, hyperkalemia, hypoNa, hypoTN

A

Addisons disease (eosinophilia).

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62
Q

HY association?

High PTH, high phosphate, low Ca

A

kidney disease/pseudohypoparathyroidism.

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63
Q

HY association?

Albumin 1.5, peripheral edema, foamy urine, HIV patient

A

FSGS.

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64
Q

HY association?

HTN, Hep B patient, hematuria, dysmorphic RBCs

A

MPGN.

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65
Q

HY association?

Hirsutism, lesions on the hands, Hep C patient

A

Porphyria Cutanea Tarda (UROD).

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66
Q

HY association?

GI bleeding, old guy, systolic murmur at RUSB with radiation to the carotids

A

Vascular ectasia (Heydes syndrome).

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67
Q

HY association?

Offending bug in a sickle cell patient with osteomyelitis

A

Salmonella.

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68
Q

HY association?

MCC of Osteomyelitis

A

S. Aureus.

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69
Q

HY association?

Flushing, chronic diarrhea, wheezing on PE

A

Carcinoid syndrome.

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70
Q

HY association?

Watery diarrhea, K is 2.8, achlorhydria

A

WDHA syndrome (VIPoma).

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71
Q

HY association?

30 yo F, pleuritis, photosensitivity, hematuria, Hct is 24%

A

Lupus.

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72
Q

HY association?

pH is 7.17, blood glucose is 398, Na is 133, vomiting, diarrhea, ketonuria

A

DKA.

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73
Q

HY association?

Painful oral/genital ulcers, patient speaks Farsi

A

Behcets disease (pathergy testing).

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74
Q

Causes of secondary HTN?

35 yo F, BP is 151/90. Her PE is completely benign

A

most likely OCP use.

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75
Q

Causes of secondary HTN?

23 yo F, BP is 175/110. She has received HCTZ, losartan, and amlodipine which have all failed to control her pressures. A bruit is heard on abdominal auscultation

A

Fibromuscular dysplasia, stent the vessel, plasma renin and aldo are high.

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76
Q

Causes of secondary HTN?

69 yo M, BP is 175/110. He has received HCTZ, losartan, and amlodipine which have all failed to control his pressures. A bruit is heard on abdominal auscultation. Arteriovenous nicking is observed on funduscopic exam

A

Renal artery stenosis.

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77
Q

Causes of secondary HTN?

34 yo M, BP is 160/95 poorly controlled on multiple meds. Na 147, K is 2.9, HCO3- is 29

A

Conn Syndrome. Aldosterone high, renin appropriately low. Contrast with RAS and FMD. Surgery preferred, give Spironolactone/eplerenone as a bridge. PAC/PRA > 30.

78
Q

Causes of secondary HTN?

35 yo M presents with severe headache. His BP is 220/130. 30 mins later his BP is 130/80. 3 hrs later his BP is 230/150. These headache episodes occur without warning about 4x a month

A

Pheochromocytoma. Dx with urine VMA/HVA/metanephrines. Block alpha receptors first before beta (e.g. phenoxybenzamine before metoprolol).

79
Q

Causes of secondary HTN?

35 yo F has cool extremities. BP is 167/110 in her left arm. There is a bruit heard over the scapula

A

coarctation of the aorta. Common in Turners syndrome.

80
Q

Causes of secondary HTN?

40 yo F presents with a BP of 159/99. PE is notable for bilateral flank masses. BUN and Cr are elevated. She recently had an aneurysm of the anterior communicating artery clipped. Her father died of a hemorrhagic stroke at 45

A

ADPKD. Remember association with circle of willis aneurysms, liver cysts, and renal disease

81
Q

Causes of secondary HTN?

23 yo M has a BP of 167/95. PE reveals facial and UE plethora. There are purple streaks on his abdomen. Na is 147, K is 3.1, HCO3- is 28

A

Cushings syndrome. MCC is iatrogenic use of steroids. Steroids have mild mineralocorticoid receptor activity.

82
Q

Causes of secondary HTN?

13 yo M has a BP of 170/110. He had a URI 6 weeks ago. UA is notable for dysmorphic RBCs

A

PSGN, a kind of nephritic syndrome. HTN is common with nephritic syndrome.

83
Q

Causes of secondary HTN?

73 yo M has a BP of 155/85. He was previously healthy and has no history of HTN. He recently started taking a standing dose of naproxen for chronic knee pain

A

NSAIDs can cause HTN secondary to hypoperfusion of the afferent arteriole and subsequent RAAS activation (also systemic vasoconstriction). Remember the other HY NSAID associations-ATN, renal papillary necrosis (also sickle cell dz/trait), GI bleeds, first line tx of acute gout/CPPD, tx of pericarditis, tx of superficial thrombophlebitis, etc

84
Q

27 yo F with dry eyes and difficulty swallowing

A

Sjogrens syndrome (Anti Ro/SSA-can cross the placenta and cause heart block in neonates of SLE moms, La/SSB antibodies)

85
Q

Asymmetric arthritis in the setting of Campylobacter Jejuni infection

A

Reactive arthritis (re-cant see uveitis, cant pee (urethritis), can’t climb a tree (arthritis)

86
Q

Sacroiliitis, XR reveals a bamboo spine

A

Ankylosing spondylitis (HLA-B27, PAIR mnemonic)

87
Q

Pencil in cup nail deformity, silvery scale on extensor surfaces, arthritis

A

Psoriatic arthritis

88
Q

Autoantibodies associated with SLE (4)

A

ANA, anti-dSDNA (nephritis), anti-smith, anti-histone (Drug induced lupus-INH, hydralazine, procainamide)

89
Q

Autoantibodies associated with diffuse scleroderma

A

anti-topoisomerase antibodies (SCL-70)

90
Q

Autoantibodies associated with limited cutaneous systemic sclerosis

A

anti-centromere antibodies

91
Q

Autoantibodies in Mixed Connective Tissue Disease

A

Anti U1-RNP

92
Q

Autoantibodies associated with poly/dermatomyositis

A

anti-Jo/Mi-2

93
Q

Autoantibodies in Rheumatoid arthritis

A

Anti CCP AND rheumatoid factor (IgM against IgG)

94
Q

Antibodies against the glomerular basement membrane

A

Goodpastures syndrome

95
Q

c-ANCA associated

A

Wegeners granulomatosis (Granulomatosis with polyangiitis)

96
Q

p-ANCA associated (3)

A

Churg Strauss (EGPA), microscopic angiitis, polyarteritis nodosa

97
Q

HLA-B57 association

A

Severe hypersensitivity to Abacavir

98
Q

Confusion, ophthalmoplegia, ataxia/+amnesia, confabulation

A

Wernickes/Korsakoff Syndrome (B1)

99
Q

Fever, RUQ pain, jaundice/+hypotension, Altered mental status

A

Charcots triad/Reynolds pentad of ascending cholangitis (NBSIM is an emergent ERCP, give Cipro + MTZ as well)

100
Q

Antihypertensives that are safe in pregnant women

A

hydralazine, methyldopa, labetalol, nifedipine

101
Q

Antihypertensives that are contraindicated in pregnant women

A

ACE-I, ARBs, Thiazides

102
Q

Grouped vesicles on the penis/vagina, Tzanck smear, PCR, give acyclovir -> foscarnet

A

HSV

103
Q

Most important bug implicated in PUD, urea breath test, IgG antibody testing, antigen in stool, MALToma, EGD with biopsy, triple therapy (clarithromycin, amoxicillin, and omeprazole)

A

H. Pylori

104
Q

Unilateral headache, 50 yo F, pain with chewing

A

Temporal arteritis (ESR will be elevated, give high dose steroids as an early step, confirm with temporal artery biopsy later, associated with polymyalgia rheumatica)

105
Q

Pallor, fatigue, MCV is 110, smear reveals hypersegmented neutrophils

A

Megaloblastic anemia.

106
Q

Megaloblastic anemia, loss of vibratory sense, methylmalonic acidemia, vegan, hyperhomocysteinemia

A

B12 deficiency.

107
Q

Megaloblastic anemia, neural tube defects, no peripheral neuropathy, alcoholic, hyperhomocysteinemia

A

Folate deficiency.

108
Q

SIADH, Cushings syndrome, muscle weakness that improves with use

A

Small cell lung cancer.

109
Q

Cavitary central lesion in a smoker, hypercalcemia with low PTH

A

Squamous cell lung cancer.

110
Q

Anti endomysial antibodies, IgA against tissue transglutaminase, anti gliadin antibodies, chronic malabsorption, biopsy reveals villous atrophy and blunting

A

Celiac disease (gluten sensitive enteropathy, d. herpetiformis)

111
Q

High CO, low PCWP, low SVR, recent history of infection, warm extremities

A

septic shock.

112
Q

Low CO, low PCWP, high SVR

A

hypovolemic shock.

113
Q

Low CO, High PCWP, High SVR

A

cardiogenic shock.

114
Q

DOC in the setting of anaphylactic shock

A

Epinephrine.

115
Q

DOC in the setting of septic shock

A

Norepinephrine.

116
Q

Low SVR, bradycardia, unresponsive pregnant woman after epidural placement

A

Neurogenic shock.

117
Q

Painless chancre, +ve RPR and VDRL, +ve FTA-ABS, tx with penicillin G (or doxycycline in PCN allergic), Tabes dorsalis, rash on the palms and soles, Argyll Robertson pupils

A

Syphilis (T. Pallidum).

118
Q

Can be caused by hypercalcemia, hypertriglyceridemia, scorpion bites, didanosine, gallstones, extensive ROH consumption, handlebar injury, recent ERCP

A

Pancreatitis.

119
Q

Malar rash in a patient being treated for a UTI

A

Drug induced lupus (TMP-SMX, hydralazine, INH, Phenytoin, Procainamide), remember the association with anti-histone antibodies

120
Q

Recent MI, patient suddenly drops down and dies

A

Ventricular Fibrillation.

121
Q

Recent MI, bilateral crackles on lung auscultation, hypotension

A

Cardiogenic shock.

122
Q

Recent MI, holosystolic murmur at the left sternal border

A

Interventricular septal rupture.

123
Q

Recent MI, holosystolic murmur at the apex with radiation to the axilla

A

Mitral regurgitation (papillary muscle rupture).

124
Q

Recent MI, BP 80/50, JVD, alternating amplitudes of QRS intervals on EKG

A

Ventricular free wall rupture (presenting as cardiac tamponade, dont give steroids-impairs wound healing).

125
Q

Recent MI, 4 days after revascularization, CKMB begins to rise again

A

reinfarction.

126
Q

Recent MI, sudden onset abdominal POOP to exam findings

A

Acute mesenteric ischemia.

127
Q

2 days after an MI, pleuritic chest pain worsened by lying back

A

Postinfarction pericarditis (NSAIDS).

128
Q

3 weeks after an MI, pleuritic chest pain worsened by lying back

A

Dresslers syndrome (NSAIDS).

129
Q

Evolving MI, patient becomes unresponsive after nitroglycerin is administered

A

RCA infarct (2, 3, avF these patients are preload dependent).

130
Q

NBSIM of a patient that snores loudly during the night, BMI is 32

A

OSA, Polysomnography (CPAP, lose wt.)

131
Q

HR 150, palpitations, sawtooth pattern on an EKG

A

atrial flutter.

132
Q

Palpitations, wide complex, regular tachyarrhythmia

A

Ventricular tachycardia.

133
Q

Wide QRS, no P waves, HR 25 bpm

A

Ventricular escape rhythm (SA node is gone, ventricles setting the tone). If the QRS was narrow and HR was 60ish, this would be a junctional escape rhythm (AV junction).

134
Q

Bizarre appearing wide QRS with increased amplitude, different from preceding QRS complexes

A

PVC

135
Q

DOC in the treatment of a lady with hypogonadism and VF deficits

A

bromocriptine, cabergoline (prolactinoma)

136
Q

DOC in the tx of chest pain brought on by exercise and relieved with rest

A

Nitroglycerin (stable angina, reduces myocardial workload).

137
Q

Needle shaped, negatively birefringent crystals

A

Gout (first MTP, NSAIDs->colchicine->steroids).

138
Q

Positively birefringent rhomboid shaped crystals

A

CPPD (Ca-Pyrophosphate deposition disease, shows up as thin lines of Ca on an XR in bone-chondrocalcinosis)/Pseudogout/associated with hemochromatosis

139
Q

NBSIM of a crush injury patient with peaked T waves on EKG

A

IV Ca gluconate (also insulin w/glucose, albuterol, Na bicarb, dialysis, kayexalate-bowel necrosis, loop diuretics).

140
Q

Episodic HTN, diaphoresis, and headache, urinary metanephrines +ve

A

Pheochromocytoma (give phenoxybenzamine and then add a beta blocker).

141
Q

Bug->50 yo M or HIV patient with high fever, lobar consolidation on CXR

A

S. Pneumoniae.

142
Q

Bug->23 yo college student, low grade fever, 2 wk hx of cough, interstitial infiltrates on CXR

A

M. Pneumoniae.

143
Q

Bug->Consolidation on CXR, ICU patient on a ventilator, fruity smell”

A

P. Aeruginosa (also otitis externa).

144
Q

Bug->High LDH, interstitial infiltrates, significant hypoxia, HIV patient

A

P. Jirovecii (steroids, TMP-SMX).

145
Q

Bug->erythema nodosum, bilateral interstitial infiltrates, earthquake victim in California

A

C. Immitis (spherules)

146
Q

Bug->Class trip to watch bats at the mammoth caves in Kentucky, pneumonia

A

H. Capsulatum.

147
Q

Bug->Pet store owner, low grade fever, bilateral interstitial infiltrates on CXR

A

Chlamydia Psittaci.

148
Q

Patient being treated for atypical pneumonia has a QT interval of 700 ms

A

Macrolide toxicity.

149
Q

Midsystolic click at the apex, history of ADPKD

A

Mitral valve prolapse (regurgitation if holosystolic).

150
Q

Afib, diastolic murmur with an opening snap at the apex

A

Mitral Stenosis.

151
Q

DOC in the tx of transient STEMI that is worse at night in a 23 yo smoker

A

Diltiazem (variant angina)

152
Q

Patient population with high incidence of skin necrosis on Warfarin

A

Protein C deficiency.

153
Q

35 yo F, history of recurrent URIs, pneumonia, and Giardia infections

A

IgA deficiency.

154
Q

Class trip to Vermont 2 months ago, seizures, bilateral facial weakness

A

Lyme disease (for this stage, give Ceftriaxone, doxycycline is for earlier stages like the bulls eye rash).

155
Q

NBSIM of a chronic alcoholic with malabsorption and steatorrhea

A

Pancreatic enzyme supplementation.

156
Q

Pain worse with activity, weight bearing joints, minimal morning stiffness, acetaminophen is the DOC, bony outgrowths on the PIPs (Bouchards) or DIPs (Heberdens), joint space narrowing, subchondral cysts, osteophytes, risk reduced with weight loss

A

Osteoarthritis.

157
Q

Morning stiffness > 1hr, small joints, symmetric arthritis, PIP extension with DIP flexion (Swan-Neck deformity), PIP flexion with DIP extension (Boutonnieres deformity), start with MTX

A

Rheumatoid arthritis.

158
Q

Deafness, abnormal synthesis of T4 collagen, visual problems

A

Alport Syndrome (COL4A5 mutation)

159
Q

Unpredictable episodes of chest pain, no troponin elevation

A

Unstable angina.

160
Q

Bloody diarrhea, recent use of antibiotics

A

C. Difficile (pseudomembranous colitis-MTZ, PO Vancomycin, Fidaxomicin).

161
Q

Severe, tearing chest pain with radiation to the back

A

Aortic dissection (HTN is a RF, IV Labetalol).

162
Q

T score on a DEXA scan = -2.6 in a 66 yo F

A

Osteoporosis (screen women > 65 or < 65 with risk factors).

163
Q

Drug to be started in a HIV patient with a CD4 < 50

A

Azithromycin (MAC)

164
Q

Psychosis, liver failure, Kayser-Fleischer rings

A

Wilsons disease.

165
Q

DM, facial and extremity plethora, restrictive cardiomyopathy

A

hereditary hemochromatosis (phlebotomy)

166
Q

Buffalo hump, purple abdominal striae, osteonecrosis, osteoporosis, DM, VF deficits

A

Cushings disease.

167
Q

Sudden onset of “worst headache of my life”, loss of consciousness, may have stiff neck/photophobia?

A

Subarachnoid hemorrhage (SAH)

Usually located in anterior portion of circle of willis

Get CT first

Most accurate is LP showing blood (xanthrochromia)

168
Q

Trauma to the sphenoid bone with tearing of the middle meningeal artery

Brief loss of consciousness with lucid interval

Biconvex shape

Impaired consciousness, HA N V (increased ICP)

A

Epidural hematoma

169
Q

Rupture of the bridging veins

Elderly and alcoholics (cerebral atrophy), fall risk

anticoagulant use

Gradual onset (1-2 days) after injury

Impaired consciousness, confusion, HA N V (increased ICP)

Crescent shaped density on CT crossing suture lines

A

Subdural hematoma

170
Q

abx CAP

A

ceftriaxone (3rd gen cephalosporin) and azithromycin (macrolide)

(or moxifloxacin)

171
Q

abx HAP

A

vancomycin AND zosyn (piperacillin and tazobactam)

172
Q

abx UTI

A

Ceftriaxone inpatient

Ciprofloxacin ambulatory pyelonephritis

nitrofurantoin cystitis

173
Q

abx meningitis

A

Vancomycin and ceftriaxone and steroids

+ampicillin in immunocompromised

174
Q

abx cellulitis

A

vancomycin or clindamycin (MRSA)

Cephalexin (keflex) or cefazolin (ancef) for strep

175
Q

Furosemide side effects

A

Loop diuretics most commonly cuases hypokalemia and hypomagnesemia

176
Q

Spironolactone side effects

A

Potassium sparing diuretic

177
Q

Eosinophilia DDX?

A
  1. Drugs, methicillin, ceftriaxone
  2. Neoplasms
  3. Addison’s disease
  4. Asthma
  5. Acute interstitial nephritis
  6. Colleagen vascular disaease
  7. Parasites
178
Q

H pylori treatment?

A

CAO (think Holy Cow, like H pylori cao)

clarithomycin, amoxicillin, omeprazole

179
Q

HUS/TTP

A

Deificiency of ADAMTS-13

HUS - e coli 0157:H7

TTP (neuro + fever) - ticlopidine, clopidogrel, AIDS, SLE

schistocytes, thrombocytopenia, renal insuffiency, normal PT/aPTT (DIC has prolonged)

180
Q

DIC

A

think sepsis, burns, cancer

elevation of PT/aPTT (not so in TTP/HUS)

thrombocytopenia

elevated d-dimer and fibrin split products

decreased fibrinogen

Tx with FFP

181
Q

Refractory hypertension and hypokalemia

Mild hypertension and hypokalemia and striae

Hypotension and hyperkalemia and tan skin

A

Conn’s Syndrome (Hyperaldosterone)

Cushing’s Syndrome

Addison’s Disease (adrenal insufficiency, hypoaldosterone, high ACTH)

182
Q

Which do you defibrillate?

A

Ventricular fibrillation

Pulseless VT

(DO NOT cardiovert PEA or asystole, use epi and amiodarone)

183
Q

amiodarone side effects?

A

lung fibrosis

Thyroid disorders (thyrotoxicosis and hypothyroidism)

liver damage

184
Q

Metabolic acidosis acryonym

A
  • Methanol
  • Uremia
  • DKA, drugs (metformin)
  • Paracetamol (acetaminophen)
  • Iron, INH
  • Lactic acidosis
  • Ethlyene glycol, ethanol tox
  • Salicylates (ASA)
185
Q

Normal anion gap acidosis acronym

A
  • Diarrhea
  • Ureteral diversion
  • Renal tubular acidosis
  • Hyperalimentation
  • Addison’s disease, acetazolamide, ammonium chloride
  • Misc (VIPoma, amphotericin B, topiramate)
186
Q

Squamous cell carcinoma

A

PTHrP (High parathyroid, High calcium, low po4)

187
Q

small cell lung cancer

A

super sulcus tumor (SVC syndrome)

Lambert eaton syndrome (ab to pre-synaptic calcium channel)

SIADH (euvolemic hyponatremia, fluid restrict patient)

188
Q

Renal tubular acidosis

A
  • Type 1 (distal)
    • Urine pH >5.4, can’t excrete H+, tx with oral bicarb
    • Hypokalemia
  • Type II (proximal)
    • Urine pH variable, can’t resorb bicarb, tx with thiazides
    • Hypokalemia
  • Type IV (hypoaldosterone)
    • Hyperkalemia
    • Urine pH <5.4, 50% caused by DM, then Addisons and SSD
    • Tx with fludrocortisone
189
Q

Viral ulcers

A

CMV - linear (gancyclovir, gang up on CMV)

HSV - punched out (acyclovir)

190
Q
A

Internal Medicine (13 decks)

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