EH - Internal Medicine Flashcards
1
Q
Best first test for patient who presents with CP?
A
EKG
2
Q
2 criteria for STEMI on EKG?
A
ST segment elevations, New L BBB
3
Q
ST changes in II-III-avF correspond to ___ infarct
A
Inferior
4
Q
Which vessel is affected by infarct in leads II-III-avF?
A
RCA
5
Q
Window of thrombolytics as treatment for MI?
A
Within 6 hours
6
Q
Patient presents with CP; EKG shows alarming findings – next best step?
A
Cardiac enzymes
7
Q
Why are 3 sets of cardiac enzymes checked?
A
Troponins take 4-6 hours to appear
8
Q
Most sensitive cardiac enzyme for repeat MI?
A
CK-MB
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
10
Q
Which 5 medications should patients be discharged with (post-MI)?
A
ACEI, ASA (or clopidogrel), b blockers, Statin, NTG
11
Q
Which 2 medications should be be discontinued before stress test?
A
b blockers, CCBs
12
Q
Contraindications for exercise stress EKG?
A
Old LBBB, Digoxin
13
Q
Best workup for patient who needs exercise stress EKG, but cannot tolerate it?
A
Chemical stress test
14
Q
2 chemicals during Chemical stress test?
A
Adenosine, Dobutamine
15
Q
Alternate for exercise stress EKG?
A
ECHO
16
Q
What constitutes a (+) exercise stress test?
A
CP, ST depression, Hypotension
17
Q
Most common cause of death in post-MI?
A
Arrhythmia
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
19
Q
In post-MI patient, there is a step up in oxygenation between RA and RV – diagnosis?
A
Septal rupture
20
Q
1-month post-MI, patient has persistent ST elevations with MR murmur – diagnosis?
A
Ventricular wall aneurysm
21
Q
Cannon A-waves on JVP – diagnosis?
A
TR … AV dissociation (3rd degree AV block)
22
Q
5-10 weeks post-MI, patient develops pleuritic chest pain with – diagnosis?
A
Dressler Syndrome
23
Q
Best treatment for Dressler Syndrome?
A
ASA, NSAIDs
24
Q
Diffuse ST segment on EKG – diagnosis?
A
Pericarditis
25
Heart sounds associated with Pericarditis?
Friction rub
26
Best treatment for Pericarditis?
NSAIDs
27
Patient presents with vague CP; Reports viral infection a few weeks ago – diagnosis?
Myocarditis
28
Test used to diagnose Prinzmetal angina?
Ergonovine stimulation test
29
2 DOCs for Prinzmetal angina?
CCBs, NTG
30
PE finding associated with 3rd degree AV block?
Cannon A waves
31
EKG shows tachycardia with widened QRS complex?
V-tach
32
Best treatment for V-tach in unstable patient?
Defibrillation
33
Best treatment for V-tach in stable patient?
Lidocaine, Amiodarone
34
DOC for Wolff-Parkinson-White?
Procainamide
35
3 medications that are contraindicated in Wolff-Parkinson-White?
b blockers, Digoxin, Non-DHP CCBs
36
Description of A-Flutter EKG?
Atrial rate \> Ventricular rate
37
Best treatment for A-Flutter in unstable patient?
Cardioversion
38
Best treatment for A-Flutter in stable patient?
Rate control … b blockers
39
2 electrolyte abnormalities associated with torsades?
Hypokalemia, Hypomagnesemia
40
Psych drug that may cause torsades?
TCAs
41
Initial treatment for SVT?
Carotid massage
42
DOC for SVT?
Adenosine
43
In addition to peaked T waves, what are 3 other EKG findings associated with hyperkalemia?
Wide QRS, Long PR, Short QT
44
In addition to electrical alternans, what is another characteristic lab finding of electrical alternans?
Low voltage … blood filling pericardial sac
45
Triad of medications to provide patient with acute pulmonary edema?
NTG, Furosemide, Morphine
46
Young patient appears to have CHF, but has no typical risk factors – diagnosis?
Viral myocarditis … (coxsackie)
47
Important pressure that R heart catheterization measures?
PCWP … LA
48
Difference in R heart catheterization between pulmonary HTN and CHF?
CHF = PCWP is high; Pulmonary HTN = PCWP is normal
49
2 reversible causes of CHF?
ETOH, Hemochromatosis
50
What type of CHF does ETOH cause?
Dilated
51
What type of CHF does Hemochromatosis cause?
Restrictive
52
How is CHF due to Hemochromatosis?
Phlebotomy
53
Which 2 medications in CHF prevent remodeling of the heart?
b blockers, ACEIs
54
How do ACEIs + Spironolactone prevent heart remodeling in CHF?
Inhibit aldosterone
55
How do b blockers prevent heart remodeling in CHF?
Inhibit epinephrine/norepinephrine
56
2 lung conditions that might cause splaying of the carina?
LA enlargement (MS), Malignancy
57
Criteria for tapping pleural effusions seen on CXR?
\>1 cm pleural fluid
58
Transudative effusion with low glucose?
Rheumatoid effusion
59
Gold standard diagnostic test for PE?
Pulmonary angiography
60
Connection between sepsis and ARDS?
Release of LPS from Gram (-) proteins
61
3 diagnostic criteria for ARDS?
PaO2/FiO2 \< 200 ; CXR finding; PCWP \< 18
62
Best treatment for ARDS?
PEEP
63
What sign on PFTs indicates effectiveness of bronchodilators?
FEV1 increased by \> 12%
64
Are bronchodilators effective in treatment of asthma or COPD?
Asthma
65
Clinical presentation of acute COPD exacerbation?
Cough; Change in sputum
66
1st line treatment for COPD?
Ipratropium
67
2nd line treatment for COPD?
b agonists
68
3rd line treatment for COPD?
Theophylline
69
2 criteria for beginning home O2?
Pulse O2 \< 88%; PaO2 \< 55
70
Best treatment for COPD exacerbation?
ABX, Steroids
71
ABX of choice for COPD exacerbation?
Macrolides
72
Best prognostic indicator in COPD?
FEV1
73
2 events that improve COPD long-term prognosis?
Long-term supplemental O2, Smoking cessation
74
Why is goal pulse O2 94-95% instead of 100% in COPD patients?
Need hypoxia to drive respiration … chronic CO2 retention
75
Important vaccination to provide patients with COPD?
Pneumonia vaccine
76
Patient with COPD develops new-onset finger clubbing (quick appearance over ~6 weeks) – diagnosis?
Hypertrophic osteopathy
77
First step of workup for Hypertrophic osteopathy?
CXR … need to evaluate for lung CA
78
Complication of silicosis?
TB infection
79
Berylliosis mimics which lung condition?
Sarcoidosis
80
Which pathogen is usually responsible for HSN Pneumonitis (Farmer’s Lung)?
Thermophilic actinomyces
81
Popcorn calcifications within a pulmonary nodule is suspicious for …
Hamartomas
82
4 locations for metastasis of adenocarcinoma?
Bone, Liver, Brain, Adrenals
83
Characteristic of adenocarcinoma pleural effusion?
Increased hyaluronidase
84
Lung cancer associated with Peripheral cavitation + Widely disseminated metastasis?
Large cell CA
85
Which involves the terminal ileum – Crohn’s or UC?
Crohn’s
86
DOC for fistula formation in Crohn’s disease?
Metronidazole
87
Which involves P-ANCA – Crohn’s or UC?
UC
88
Which involves the Pyoderma Gangrenosum – Crohn’s or UC?
Crohn’s
89
Which involves the String Sign – Crohn’s or UC?
Crohn’s
90
Best management of toxic megacolon?
Surgical intervention
91
Best management of Pyoderma Gangrenosum?
No ABX … Treat underlying Crohn’s Disease
92
2 hereditary conditions associated with direct hyperbilirubinemia?
Dubin-Johnson, Rotor
93
2 hereditary conditions associated with indirect hyperbilirubinemia?
Crigler-Najjar, Gilbert
94
Labs show elevated GGT and elevated Alkaline Phosphatase – diagnosis?
Obstruction
95
Is GGT or Alkaline Phosphatase more specific for gallbladder obstruction?
GGT
96
Antibody associated with autoimmune hepatitis?
Anti-Smooth Muscle Ig
97
Best treatment for autoimmune hepatitis?
Steroids
98
Labs show high serum Fe, low TIBC, low ferritin – diagnosis?
Hemochromatosis
99
Pathogen responsible for meningitis in patient with recent brain instrumentation?
Staph aureus
100
Best treatment for Staph aureus meningitis?
Vancomycin
101
Best treatment for TB meningitis?
Add steroids to RIPE therapy
102
Best first step for patient with suspected meningitis?
Empiric ABX \>\> then head CT \>\> then LP
103
Most common pathogen causing PNA in young, healthy patients?
Mycoplasma pneumoniae
104
3 most common pathogens responsible for hospital-acquired PNA?
E. coli, Pseudomonas, Klebsiella
105
Most common pathogen causing PNA in COPD patients?
Haemophilus influenza
106
Most common pathogen causing PNA in ETOH patients?
Klebsiella
107
Most common pathogen causing PNA after hot-tub exposure?
Legionella
108
Next step after (+) PPD?
CXR
109
Next step after (+) CXR in patient with (+) PPD?
Sputum culture
110
Next step after (-) sputum culture in patient with (+) CXR and (+) PPD?
Need 3 (-) sputum cultures
111
Best treatment for (+) CXR in patient with (+) PPD?
RIPE therapy
112
Who are the only patients that receive chemoprophylatic INH for close contact exposure to TB?
Infants
113
AE of Rifampin?
Orange fluids, CYP450 inducer
114
AE of INH?
Neuropathy
115
AE of Pyrazinamide?
Hyperuricemia
116
AE of Ethambutol?
Eye problems
117
Most common pathogen responsible for acute IE affecting native valve?
Staph aureus
118
Most common pathogen responsible for subacute IE affecting native valve?
Strep viridans
119
Most common valve affected by IE?
Mitral
120
Most common pathogen responsible for IE in IVDU?
Staph aureus
121
Most common valve affected by IE in IVDU?
Tricuspid
122
Most common cause of death in IE?
CHF … destruction of heart valves
123
3 indications for ABX prophylaxis in IE?
Prosthetic valve; HX of IE; Congenital heart murmur
124
Acute Retroviral Syndrome (presenting sign of HIV infection) mimics which condition?
Infectious mononucleosis
125
2 other signs of new-onset HIV infection?
New Bell’s palsy, Thrombocytopenia (suspected ITP), Opportunistic infection
126
CD4 count that indicates HAART?
CD4 \< 350
127
Viral load that indicates HAART?
Viral load \> 55,000
128
AE of Zidovudine?
Macrocytic anemia
129
AE of Abacavir?
HSN reaction
130
AE of Didanosine?
Pancreatitis
131
AE of Indinovir?
Nephrolithiasis, Hyperbilirubinemia
132
Indinovir belongs to which class of HAART?
Protease inhibitor
133
AE of Efavirens?
Hallucinations
134
Efavirens belongs to which class of HAART?
NNRTIs
135
Best treatment for needle stick from patient with (+) HIV patient?
4 weeks of HAART
136
HIV patient presents with DOE, non-productive cough – diagnosis?
PCP
137
Unique lab finding in PCP infection?
Increased LDH
138
Definitive step of workup for suspected PCP pneumonia?
Bronchoscopy with BAL + silver stain
139
Best treatment for suspected PCP pneumonia?
TMP-SMX
140
Best treatment for suspected PCP pneumonia in patient with sulfa allergy?
Dapsone, Pentamidine
141
3 pathogens that can cause diarrhea in HIV patient?
CMV, MAC, Cryptosporidium
142
Best test for diarrhea in HIV patient, likely caused by CMV?
Colonoscopy + biopsy
143
Appearance of CMV infection in HIV patient with diarrhea, likely caused by CMV?
Intranuclear inclusion
144
Best test for diarrhea in HIV patient, likely caused by Cryptosporidium?
Stool culture showing acid-fast (+) oocysts
145
De-ja-vu aura before seizure is associated with which type of encephalitis?
Temporal … caused by HSV
146
Best treatment for suspected HSV-associated encephalitis?
Immediate acyclovir
147
Most common cause of meningitis in HIV patient?
Strep penumoniae
148
Opportunistic pathogen that can cause meningitis in HIV patient?
Cryptococcus
149
Best stain for Cryptococcus meningitis?
India ink
150
DOC for Cryptococcus meningitis?
Amphotericin B
151
HIV patient presents with hemi-sensory loss, (+) Babinski, vision loss?
PML (similar to MS)
152
Why does PML present similar to MS?
PML is demyelinating
153
Which pathogen causes PML?
JC virus
154
30 yo patient with HIV presents with worsening dementia, unsteady gait – diagnosis?
AIDS dementia
155
Best treatment for AIDS dementia?
Supportive care
156
Patient presents with neutropenic fever – which aspect of workup should NOT be performed?
Digital Rectal Exam
157
Why should DRE NOT be performed in patients with neutropenic fever?
Risk for inducing sepsis … Translocation of gut flora across cell wall
158
CBC finding that defines neutropenic fever?
WBC \< 500
159
Most common cause of sepsis in patients with neutropenic fever?
Mucositis
160
2 most common pathogens responsible for Mucositis in neutropenic fever?
Pseudomonas, MRSA
161
Best treatment for Lyme disease – Stage 1 or 2?
Doxycycline
162
Best treatment for Lyme disease – Stage 1 or 2 in child \< 8 yo?
Amoxicillin
163
Best treatment for Rickettsia infection?
Doxycycline
164
Best treatment for Rickettsia infection in child \< 8 yo?
Doxycycline ANYWAY … Amoxicillin won’t work
165
Patient presents with fever, myalgias, rash; Reports recent tick bite; Labs show thrombocytopenia – diagnosis?
Ehrlichiosis
166
Hallmark lab finding associated with Ehrlichiosis?
Thrombocytopenia
167
Best treatment for thrombocytopenia?
Doxycycline
168
Best treatment for Nocardia?
TMP-SMX
169
Best treatment for Actinomyces?
Penicillin
170
Cause of hypervolemic hyponatremia?
CHF, Cirrhosis, Nephrotic Syndrome
171
Cause of euvolemic hyponatremia?
SIADH
172
Cause of hypovolemic hyponatremia?
Fluid loss … (diuretics, vomiting)
173
What is the only indication for 3% hypertonic saline in patients with hyponatremia?
Symptomatic hyponatremia (AMS, seizures); Na+ \< 120
174
Risk of correctly hypernatremia too quickly?
Cerebral edema
175
Risk of correctly hyponatremia too quickly?
Central Pontine Myelinolysis
176
First step of treatment for hyperkalemia?
Calcium gluconate … protects cardiac membrane
177
Location of RTA – Type 1?
Distal Convoluted Tubule
178
Change to serum K+ in RTA – Type 1?
Low
179
Change to urine pH in RTA – Type 1?
Alkalosis
180
2 medications associated with RTA – Type 1?
Lithium, Amphotericin B
181
Best treatment for RTA – Type 1?
HCO3-
182
Etiology of RTA – Type 1?
Problem with H+ excretion
183
Location of RTA – Type 2?
Proximal Convoluted Tubule
184
Change to serum K+ in RTA – Type 2?
Low
185
Change to urine pH in RTA – Type 2?
Acidosis
186
Cause of RTA – Type 2?
Multiple Myeloma, Fanconi Syndrome
187
Best treatment for RTA – Type 2?
Diuretic
188
Etiology of RTA – Type 2?
Problem with HCO3- resorption
189
Location of RTA – Type 4?
Distal Convoluted Tubule
190
Change to serum K+ in RTA – Type 4?
High
191
Change to urine pH in RTA – Type 4?
Acidosis
192
Cause of RTA – Type 4?
DM
193
Etiology of RTA – Type 4?
Inadequate aldosterone response
194
Cause of renal failure in patient with muddy brown casts?
ATN
195
Most common cause of CKD?
DM
196
2nd most common cause of CKD?
HTN
197
Most common cause of death in CKD?
Cardiovascular complications
198
Most common cause of terminal hematuria … (few blood clots at end of micturition)?
Bladder CA
199
Definition of Nephritic Syndrome?
Proteinuria, Hematuria, HTN, ESRD
200
Most common cause of Nephritic Syndrome?
IgA Nephropathy
201
When does IgA Nephropathy present after URI?
1-2 days after URI symptoms
202
When does PSGN present after URI?
1-2 weeks after URI symptoms
203
Hematuria + deafness – diagnosis?
Alport’s Syndrome
204
Common AE of Ticlopidine … (grandfather of Clopidogrel)?
TTP
205
Best treatment for TTP?
Emergent plasmapheresis
206
How can you tell the difference between TTP and DIC?
TTP = coagulation studies are NML
207
Classic urine casts seen in Nephrotic Syndrome?
Waxy casts
208
Nephrotic Syndrome patient suddenly develops flank pain – diagnosis?
Renal vein thrombosis
209
2 hematologic lab values associated with Thalassemia?
Very low MVC; Low RDW … (all RBCs are small, little variation)
210
Medication that can cause sideroblastic anemia?
Isoniazid
211
Antibody associated with cold AIHA?
IgM
212
Pathogen associated with cold AIHA?
Mycoplasma pneumoniae
213
Antibody associated with warm AIHA?
IgG
214
Medication associated with warm AIHA?
Penicillin, TMP-SMX
215
Why would Clindamycin cause Vitamin K deficiency?
Wipes out all gut bacteria producing Vitamin K
216
CBC change in chronic liver disease?
Thrombocytopenia
217
Which coagulation factor is depleted first in chronic liver disease?
Factor 7
218
Which 2 coagulation factors are unaffected by chronic liver disease?
VWF, Factor 8 … produced by endothelial cells
219
Low platelets + Arterial thrombosis – diagnosis?
HIT
