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