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EH Reviews > EH - Internal Medicine > Flashcards

EH - Internal Medicine Flashcards

1
Q

Best first test for patient who presents with CP?

A

EKG

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2
Q

2 criteria for STEMI on EKG?

A

ST segment elevations, New L BBB

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3
Q

ST changes in II-III-avF correspond to ___ infarct

A

Inferior

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4
Q

Which vessel is affected by infarct in leads II-III-avF?

A

RCA

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5
Q

Window of thrombolytics as treatment for MI?

A

Within 6 hours

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6
Q

Patient presents with CP; EKG shows alarming findings – next best step?

A

Cardiac enzymes

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7
Q

Why are 3 sets of cardiac enzymes checked?

A

Troponins take 4-6 hours to appear

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8
Q

Most sensitive cardiac enzyme for repeat MI?

A

CK-MB

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9
Q

When should CABG be performed … instead of PCI (4 options)?

A

LAD; 3-vessel disease in NML patient; 2-vessel disease in DM; >70% occlusion

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10
Q

Which 5 medications should patients be discharged with (post-MI)?

A

ACEI, ASA (or clopidogrel), b blockers, Statin, NTG

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11
Q

Which 2 medications should be be discontinued before stress test?

A

b blockers, CCBs

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12
Q

Contraindications for exercise stress EKG?

A

Old LBBB, Digoxin

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13
Q

Best workup for patient who needs exercise stress EKG, but cannot tolerate it?

A

Chemical stress test

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14
Q

2 chemicals during Chemical stress test?

A

Adenosine, Dobutamine

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15
Q

Alternate for exercise stress EKG?

A

ECHO

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16
Q

What constitutes a (+) exercise stress test?

A

CP, ST depression, Hypotension

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17
Q

Most common cause of death in post-MI?

A

Arrhythmia

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18
Q

Difference in clinical presentation between post-MI ventricular wall rupture vs. Post-MI new MR murmur?

A

Ventricular wall rupture = hypotensive, very ill

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19
Q

In post-MI patient, there is a step up in oxygenation between RA and RV – diagnosis?

A

Septal rupture

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20
Q

1-month post-MI, patient has persistent ST elevations with MR murmur – diagnosis?

A

Ventricular wall aneurysm

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21
Q

Cannon A-waves on JVP – diagnosis?

A

TR … AV dissociation (3rd degree AV block)

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22
Q

5-10 weeks post-MI, patient develops pleuritic chest pain with – diagnosis?

A

Dressler Syndrome

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23
Q

Best treatment for Dressler Syndrome?

A

ASA, NSAIDs

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24
Q

Diffuse ST segment on EKG – diagnosis?

A

Pericarditis

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25
Q

Heart sounds associated with Pericarditis?

A

Friction rub

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26
Q

Best treatment for Pericarditis?

A

NSAIDs

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27
Q

Patient presents with vague CP; Reports viral infection a few weeks ago – diagnosis?

A

Myocarditis

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28
Q

Test used to diagnose Prinzmetal angina?

A

Ergonovine stimulation test

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29
Q

2 DOCs for Prinzmetal angina?

A

CCBs, NTG

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30
Q

PE finding associated with 3rd degree AV block?

A

Cannon A waves

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31
Q

EKG shows tachycardia with widened QRS complex?

A

V-tach

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32
Q

Best treatment for V-tach in unstable patient?

A

Defibrillation

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33
Q

Best treatment for V-tach in stable patient?

A

Lidocaine, Amiodarone

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34
Q

DOC for Wolff-Parkinson-White?

A

Procainamide

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35
Q

3 medications that are contraindicated in Wolff-Parkinson-White?

A

b blockers, Digoxin, Non-DHP CCBs

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36
Q

Description of A-Flutter EKG?

A

Atrial rate > Ventricular rate

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37
Q

Best treatment for A-Flutter in unstable patient?

A

Cardioversion

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38
Q

Best treatment for A-Flutter in stable patient?

A

Rate control … b blockers

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39
Q

2 electrolyte abnormalities associated with torsades?

A

Hypokalemia, Hypomagnesemia

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40
Q

Psych drug that may cause torsades?

A

TCAs

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41
Q

Initial treatment for SVT?

A

Carotid massage

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42
Q

DOC for SVT?

A

Adenosine

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43
Q

In addition to peaked T waves, what are 3 other EKG findings associated with hyperkalemia?

A

Wide QRS, Long PR, Short QT

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44
Q

In addition to electrical alternans, what is another characteristic lab finding of electrical alternans?

A

Low voltage … blood filling pericardial sac

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45
Q

Triad of medications to provide patient with acute pulmonary edema?

A

NTG, Furosemide, Morphine

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46
Q

Young patient appears to have CHF, but has no typical risk factors – diagnosis?

A

Viral myocarditis … (coxsackie)

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47
Q

Important pressure that R heart catheterization measures?

A

PCWP … LA

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48
Q

Difference in R heart catheterization between pulmonary HTN and CHF?

A

CHF = PCWP is high; Pulmonary HTN = PCWP is normal

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49
Q

2 reversible causes of CHF?

A

ETOH, Hemochromatosis

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50
Q

What type of CHF does ETOH cause?

A

Dilated

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51
Q

What type of CHF does Hemochromatosis cause?

A

Restrictive

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52
Q

How is CHF due to Hemochromatosis?

A

Phlebotomy

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53
Q

Which 2 medications in CHF prevent remodeling of the heart?

A

b blockers, ACEIs

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54
Q

How do ACEIs + Spironolactone prevent heart remodeling in CHF?

A

Inhibit aldosterone

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55
Q

How do b blockers prevent heart remodeling in CHF?

A

Inhibit epinephrine/norepinephrine

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56
Q

2 lung conditions that might cause splaying of the carina?

A

LA enlargement (MS), Malignancy

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57
Q

Criteria for tapping pleural effusions seen on CXR?

A

>1 cm pleural fluid

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58
Q

Transudative effusion with low glucose?

A

Rheumatoid effusion

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59
Q

Gold standard diagnostic test for PE?

A

Pulmonary angiography

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60
Q

Connection between sepsis and ARDS?

A

Release of LPS from Gram (-) proteins

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61
Q

3 diagnostic criteria for ARDS?

A

PaO2/FiO2 < 200 ; CXR finding; PCWP < 18

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62
Q

Best treatment for ARDS?

A

PEEP

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63
Q

What sign on PFTs indicates effectiveness of bronchodilators?

A

FEV1 increased by > 12%

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64
Q

Are bronchodilators effective in treatment of asthma or COPD?

A

Asthma

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65
Q

Clinical presentation of acute COPD exacerbation?

A

Cough; Change in sputum

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66
Q

1st line treatment for COPD?

A

Ipratropium

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67
Q

2nd line treatment for COPD?

A

b agonists

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68
Q

3rd line treatment for COPD?

A

Theophylline

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69
Q

2 criteria for beginning home O2?

A

Pulse O2 < 88%; PaO2 < 55

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70
Q

Best treatment for COPD exacerbation?

A

ABX, Steroids

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71
Q

ABX of choice for COPD exacerbation?

A

Macrolides

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72
Q

Best prognostic indicator in COPD?

A

FEV1

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73
Q

2 events that improve COPD long-term prognosis?

A

Long-term supplemental O2, Smoking cessation

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74
Q

Why is goal pulse O2 94-95% instead of 100% in COPD patients?

A

Need hypoxia to drive respiration … chronic CO2 retention

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75
Q

Important vaccination to provide patients with COPD?

A

Pneumonia vaccine

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76
Q

Patient with COPD develops new-onset finger clubbing (quick appearance over ~6 weeks) – diagnosis?

A

Hypertrophic osteopathy

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77
Q

First step of workup for Hypertrophic osteopathy?

A

CXR … need to evaluate for lung CA

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78
Q

Complication of silicosis?

A

TB infection

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79
Q

Berylliosis mimics which lung condition?

A

Sarcoidosis

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80
Q

Which pathogen is usually responsible for HSN Pneumonitis (Farmer’s Lung)?

A

Thermophilic actinomyces

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81
Q

Popcorn calcifications within a pulmonary nodule is suspicious for …

A

Hamartomas

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82
Q

4 locations for metastasis of adenocarcinoma?

A

Bone, Liver, Brain, Adrenals

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83
Q

Characteristic of adenocarcinoma pleural effusion?

A

Increased hyaluronidase

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84
Q

Lung cancer associated with Peripheral cavitation + Widely disseminated metastasis?

A

Large cell CA

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85
Q

Which involves the terminal ileum – Crohn’s or UC?

A

Crohn’s

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86
Q

DOC for fistula formation in Crohn’s disease?

A

Metronidazole

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87
Q

Which involves P-ANCA – Crohn’s or UC?

A

UC

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88
Q

Which involves the Pyoderma Gangrenosum – Crohn’s or UC?

A

Crohn’s

89
Q

Which involves the String Sign – Crohn’s or UC?

A

Crohn’s

90
Q

Best management of toxic megacolon?

A

Surgical intervention

91
Q

Best management of Pyoderma Gangrenosum?

A

No ABX … Treat underlying Crohn’s Disease

92
Q

2 hereditary conditions associated with direct hyperbilirubinemia?

A

Dubin-Johnson, Rotor

93
Q

2 hereditary conditions associated with indirect hyperbilirubinemia?

A

Crigler-Najjar, Gilbert

94
Q

Labs show elevated GGT and elevated Alkaline Phosphatase – diagnosis?

A

Obstruction

95
Q

Is GGT or Alkaline Phosphatase more specific for gallbladder obstruction?

A

GGT

96
Q

Antibody associated with autoimmune hepatitis?

A

Anti-Smooth Muscle Ig

97
Q

Best treatment for autoimmune hepatitis?

A

Steroids

98
Q

Labs show high serum Fe, low TIBC, low ferritin – diagnosis?

A

Hemochromatosis

99
Q

Pathogen responsible for meningitis in patient with recent brain instrumentation?

A

Staph aureus

100
Q

Best treatment for Staph aureus meningitis?

A

Vancomycin

101
Q

Best treatment for TB meningitis?

A

Add steroids to RIPE therapy

102
Q

Best first step for patient with suspected meningitis?

A

Empiric ABX >> then head CT >> then LP

103
Q

Most common pathogen causing PNA in young, healthy patients?

A

Mycoplasma pneumoniae

104
Q

3 most common pathogens responsible for hospital-acquired PNA?

A

E. coli, Pseudomonas, Klebsiella

105
Q

Most common pathogen causing PNA in COPD patients?

A

Haemophilus influenza

106
Q

Most common pathogen causing PNA in ETOH patients?

A

Klebsiella

107
Q

Most common pathogen causing PNA after hot-tub exposure?

A

Legionella

108
Q

Next step after (+) PPD?

A

CXR

109
Q

Next step after (+) CXR in patient with (+) PPD?

A

Sputum culture

110
Q

Next step after (-) sputum culture in patient with (+) CXR and (+) PPD?

A

Need 3 (-) sputum cultures

111
Q

Best treatment for (+) CXR in patient with (+) PPD?

A

RIPE therapy

112
Q

Who are the only patients that receive chemoprophylatic INH for close contact exposure to TB?

A

Infants

113
Q

AE of Rifampin?

A

Orange fluids, CYP450 inducer

114
Q

AE of INH?

A

Neuropathy

115
Q

AE of Pyrazinamide?

A

Hyperuricemia

116
Q

AE of Ethambutol?

A

Eye problems

117
Q

Most common pathogen responsible for acute IE affecting native valve?

A

Staph aureus

118
Q

Most common pathogen responsible for subacute IE affecting native valve?

A

Strep viridans

119
Q

Most common valve affected by IE?

A

Mitral

120
Q

Most common pathogen responsible for IE in IVDU?

A

Staph aureus

121
Q

Most common valve affected by IE in IVDU?

A

Tricuspid

122
Q

Most common cause of death in IE?

A

CHF … destruction of heart valves

123
Q

3 indications for ABX prophylaxis in IE?

A

Prosthetic valve; HX of IE; Congenital heart murmur

124
Q

Acute Retroviral Syndrome (presenting sign of HIV infection) mimics which condition?

A

Infectious mononucleosis

125
Q

2 other signs of new-onset HIV infection?

A

New Bell’s palsy, Thrombocytopenia (suspected ITP), Opportunistic infection

126
Q

CD4 count that indicates HAART?

A

CD4 < 350

127
Q

Viral load that indicates HAART?

A

Viral load > 55,000

128
Q

AE of Zidovudine?

A

Macrocytic anemia

129
Q

AE of Abacavir?

A

HSN reaction

130
Q

AE of Didanosine?

A

Pancreatitis

131
Q

AE of Indinovir?

A

Nephrolithiasis, Hyperbilirubinemia

132
Q

Indinovir belongs to which class of HAART?

A

Protease inhibitor

133
Q

AE of Efavirens?

A

Hallucinations

134
Q

Efavirens belongs to which class of HAART?

A

NNRTIs

135
Q

Best treatment for needle stick from patient with (+) HIV patient?

A

4 weeks of HAART

136
Q

HIV patient presents with DOE, non-productive cough – diagnosis?

A

PCP

137
Q

Unique lab finding in PCP infection?

A

Increased LDH

138
Q

Definitive step of workup for suspected PCP pneumonia?

A

Bronchoscopy with BAL + silver stain

139
Q

Best treatment for suspected PCP pneumonia?

A

TMP-SMX

140
Q

Best treatment for suspected PCP pneumonia in patient with sulfa allergy?

A

Dapsone, Pentamidine

141
Q

3 pathogens that can cause diarrhea in HIV patient?

A

CMV, MAC, Cryptosporidium

142
Q

Best test for diarrhea in HIV patient, likely caused by CMV?

A

Colonoscopy + biopsy

143
Q

Appearance of CMV infection in HIV patient with diarrhea, likely caused by CMV?

A

Intranuclear inclusion

144
Q

Best test for diarrhea in HIV patient, likely caused by Cryptosporidium?

A

Stool culture showing acid-fast (+) oocysts

145
Q

De-ja-vu aura before seizure is associated with which type of encephalitis?

A

Temporal … caused by HSV

146
Q

Best treatment for suspected HSV-associated encephalitis?

A

Immediate acyclovir

147
Q

Most common cause of meningitis in HIV patient?

A

Strep penumoniae

148
Q

Opportunistic pathogen that can cause meningitis in HIV patient?

A

Cryptococcus

149
Q

Best stain for Cryptococcus meningitis?

A

India ink

150
Q

DOC for Cryptococcus meningitis?

A

Amphotericin B

151
Q

HIV patient presents with hemi-sensory loss, (+) Babinski, vision loss?

A

PML (similar to MS)

152
Q

Why does PML present similar to MS?

A

PML is demyelinating

153
Q

Which pathogen causes PML?

A

JC virus

154
Q

30 yo patient with HIV presents with worsening dementia, unsteady gait – diagnosis?

A

AIDS dementia

155
Q

Best treatment for AIDS dementia?

A

Supportive care

156
Q

Patient presents with neutropenic fever – which aspect of workup should NOT be performed?

A

Digital Rectal Exam

157
Q

Why should DRE NOT be performed in patients with neutropenic fever?

A

Risk for inducing sepsis … Translocation of gut flora across cell wall

158
Q

CBC finding that defines neutropenic fever?

A

WBC < 500

159
Q

Most common cause of sepsis in patients with neutropenic fever?

A

Mucositis

160
Q

2 most common pathogens responsible for Mucositis in neutropenic fever?

A

Pseudomonas, MRSA

161
Q

Best treatment for Lyme disease – Stage 1 or 2?

A

Doxycycline

162
Q

Best treatment for Lyme disease – Stage 1 or 2 in child < 8 yo?

A

Amoxicillin

163
Q

Best treatment for Rickettsia infection?

A

Doxycycline

164
Q

Best treatment for Rickettsia infection in child < 8 yo?

A

Doxycycline ANYWAY … Amoxicillin won’t work

165
Q

Patient presents with fever, myalgias, rash; Reports recent tick bite; Labs show thrombocytopenia – diagnosis?

A

Ehrlichiosis

166
Q

Hallmark lab finding associated with Ehrlichiosis?

A

Thrombocytopenia

167
Q

Best treatment for thrombocytopenia?

A

Doxycycline

168
Q

Best treatment for Nocardia?

A

TMP-SMX

169
Q

Best treatment for Actinomyces?

A

Penicillin

170
Q

Cause of hypervolemic hyponatremia?

A

CHF, Cirrhosis, Nephrotic Syndrome

171
Q

Cause of euvolemic hyponatremia?

A

SIADH

172
Q

Cause of hypovolemic hyponatremia?

A

Fluid loss … (diuretics, vomiting)

173
Q

What is the only indication for 3% hypertonic saline in patients with hyponatremia?

A

Symptomatic hyponatremia (AMS, seizures); Na+ < 120

174
Q

Risk of correctly hypernatremia too quickly?

A

Cerebral edema

175
Q

Risk of correctly hyponatremia too quickly?

A

Central Pontine Myelinolysis

176
Q

First step of treatment for hyperkalemia?

A

Calcium gluconate … protects cardiac membrane

177
Q

Location of RTA – Type 1?

A

Distal Convoluted Tubule

178
Q

Change to serum K+ in RTA – Type 1?

A

Low

179
Q

Change to urine pH in RTA – Type 1?

A

Alkalosis

180
Q

2 medications associated with RTA – Type 1?

A

Lithium, Amphotericin B

181
Q

Best treatment for RTA – Type 1?

A

HCO3-

182
Q

Etiology of RTA – Type 1?

A

Problem with H+ excretion

183
Q

Location of RTA – Type 2?

A

Proximal Convoluted Tubule

184
Q

Change to serum K+ in RTA – Type 2?

A

Low

185
Q

Change to urine pH in RTA – Type 2?

A

Acidosis

186
Q

Cause of RTA – Type 2?

A

Multiple Myeloma, Fanconi Syndrome

187
Q

Best treatment for RTA – Type 2?

A

Diuretic

188
Q

Etiology of RTA – Type 2?

A

Problem with HCO3- resorption

189
Q

Location of RTA – Type 4?

A

Distal Convoluted Tubule

190
Q

Change to serum K+ in RTA – Type 4?

A

High

191
Q

Change to urine pH in RTA – Type 4?

A

Acidosis

192
Q

Cause of RTA – Type 4?

A

DM

193
Q

Etiology of RTA – Type 4?

A

Inadequate aldosterone response

194
Q

Cause of renal failure in patient with muddy brown casts?

A

ATN

195
Q

Most common cause of CKD?

A

DM

196
Q

2nd most common cause of CKD?

A

HTN

197
Q

Most common cause of death in CKD?

A

Cardiovascular complications

198
Q

Most common cause of terminal hematuria … (few blood clots at end of micturition)?

A

Bladder CA

199
Q

Definition of Nephritic Syndrome?

A

Proteinuria, Hematuria, HTN, ESRD

200
Q

Most common cause of Nephritic Syndrome?

A

IgA Nephropathy

201
Q

When does IgA Nephropathy present after URI?

A

1-2 days after URI symptoms

202
Q

When does PSGN present after URI?

A

1-2 weeks after URI symptoms

203
Q

Hematuria + deafness – diagnosis?

A

Alport’s Syndrome

204
Q

Common AE of Ticlopidine … (grandfather of Clopidogrel)?

A

TTP

205
Q

Best treatment for TTP?

A

Emergent plasmapheresis

206
Q

How can you tell the difference between TTP and DIC?

A

TTP = coagulation studies are NML

207
Q

Classic urine casts seen in Nephrotic Syndrome?

A

Waxy casts

208
Q

Nephrotic Syndrome patient suddenly develops flank pain – diagnosis?

A

Renal vein thrombosis

209
Q

2 hematologic lab values associated with Thalassemia?

A

Very low MVC; Low RDW … (all RBCs are small, little variation)

210
Q

Medication that can cause sideroblastic anemia?

A

Isoniazid

211
Q

Antibody associated with cold AIHA?

A

IgM

212
Q

Pathogen associated with cold AIHA?

A

Mycoplasma pneumoniae

213
Q

Antibody associated with warm AIHA?

A

IgG

214
Q

Medication associated with warm AIHA?

A

Penicillin, TMP-SMX

215
Q

Why would Clindamycin cause Vitamin K deficiency?

A

Wipes out all gut bacteria producing Vitamin K

216
Q

CBC change in chronic liver disease?

A

Thrombocytopenia

217
Q

Which coagulation factor is depleted first in chronic liver disease?

A

Factor 7

218
Q

Which 2 coagulation factors are unaffected by chronic liver disease?

A

VWF, Factor 8 … produced by endothelial cells

219
Q

Low platelets + Arterial thrombosis – diagnosis?

A

HIT

EH Reviews (4 decks)

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