Emma Ramahi Internal Medicine Review

Question 1

Which leads indicate left circumflex occlusion?

Answer 1

I
aVL
V4-V6

Question 2

Symptoms of a right-sided MI include _______________.

Answer 2

• JVD
• Hypotension
• Tachycardia
• No pulsus paradoxus
• Lungs clear

Treat with fluids –NO nitro.

Question 3

Contraindications to thrombolytic therapy in MI include _______________.

Answer 3

bleed, recent surgery, and CHI

Question 4

The most sensitive marker of a repeat MI within two days is _________________.

Answer 4

myoglobin (normalizes within 24 hours –faster than CKMB at 72 hours)

Question 5

List three indications for CABG.

Answer 5

• Left-main disease
• ≥3 vessel disease
• ≥ 2 vessel disease in a diabetic

Question 6

What medicines must you discontinue before a stress test?

Answer 6

• Beta-blockers
• CCBs
• Digoxin

Question 7

Describe some features that make a stress test undoable.

Answer 7

• LBBB

* Baseline ST elevation

Question 8

Positive stress test is given by _______________.

Answer 8

hypotension, ST elevation, or pain

Question 9

The most common cause of death post-MI is ____________.

Answer 9

arrhythmia

Question 10

Persistent ST elevation 1 month after an MI is ____________.

Answer 10

ventricular aneurysm

Question 11

“Cannon A waves” (prominent JVD pulsations) after an MI could indicate ____________.

Answer 11

3rd-degree heart block

Question 12

Prinzmetal angina is usually worse _____________.

Answer 12

at night

Question 13

The diagnostic test for Prinzmetal angina is ____________.

Answer 13

ergonovine

Question 14

The delta wave passes through the bundle of ____________.

Answer 14

Kent

Question 15

What drugs are contraindicated in WPW?

Answer 15

Anything that slows conduction through the AV node. Doing this causes a greater dissociation between the bundle of Kent and the AV node, thus increasing the likelihood of arrhythmia.

• Beta-blockers
• CCB
• Digoxin

Question 16

Low amplitude QRS waves could indicate?

Answer 16

Tamponade

Question 17

Late systolic murmur that increases with valsalva?

Answer 17

Mitral valve prolapse

Question 18

The trifecta of medicines for acute pulmonary edema is ____________.

Answer 18

Lasix, morphine, and nitrates

Question 19

What are the two reversible causes of dilated cardiomyopathy?

Answer 19

Alcoholic anc hemochromatosis

Question 20

What two bacteria can cause lung abscesses?

Answer 20

• S. aureus

* Anaerobes

Question 21

If a pleural effusion is transudative and has low glucose, then it is likely _____________.

Answer 21

RA

Question 22

The three criteria that define ARDS: ____________.

Answer 22

• PaO2/FiO2 < 200
• PCWP < 18
• Bilateraly infiltrates on CXR

Question 23

The best prognostic indicator for COPD is _____________.

Answer 23

FEV1

Question 24

Upper lobe lesions with eggshell calcifications?

Answer 24

Silicosis

Question 25

In addition to pleural plaques, those with asbestosis also have ____________.

Answer 25

reticulonodular opacifications

Question 26

Lower lobe infiltrates with thermophilic actinomyces?

Answer 26

Farmer's lung (aka hypersensitvity pneumonitis)

Question 27

Popcorn calcifications in the lung are indicative of ___________.

Answer 27

hamaromas

Question 28

Concentric lung calcifications are indicative of ____________.

Answer 28

granulomas

Question 29

Ptosis that improves with upward gaze is suggestive of ______________.

Answer 29

LEMS

Question 30

Peripheral cavitations with early mets is characteristic of ______________.

Answer 30

large cell carcinoma

Question 31

What does an ALT>AST ratio suggest?

Answer 31

HAV

Question 32

Antimitochondrial antibody is positive in ___________.

Answer 32

PBC

Question 33

Meningitis in a person who's recently had brain surgery is likely caused by ___________.

Answer 33

Staph

Question 34

The most common cause of pneumonia in young, healthy people is _____________.

Answer 34

Mycoplasma

Question 35

Old smokers with COPD are more likely to get pneumonia from ____________.

Answer 35

H. influenzae

Question 36

The best first step in evaluating PNA is ______________.

Answer 36

CXR

Question 37

List three indications for prophylactic antibiotics for endocarditis.

Answer 37

*  Mechanical valve *  Prior endocarditis *  VSD/ASD

Question 38

What are some of the more obscure presentations of HIV?

Answer 38

*  Thrombocytopenia and fatigue | *  Bilateral Bell's palsy

Question 39

What HAART drug causes macrocytic anemia and GI upset?

Answer 39

Zidovudine

Question 40

HAART drug most likely to cause pancreatitis?

Answer 40

Didanosine

Question 41

Psychotic symptoms from HAART?

Answer 41

Efavirenz

Question 42

Kidney stones and HAART?

Answer 42

Indinavir

Question 43

Pneumonia and elevated LDH?

Answer 43

PCP

Question 44

Add ________________ to PCP that is progressively getting worse.

Answer 44

steroids

Question 45

Which diarrhea is acid-fast positive?

Answer 45

Cryptosporidium

Question 46

AIDS and multiple ring-enhancing lesions?

Answer 46

Toxo Lymphoma is usually singular.

Question 47

HSV encephalitis often causes what neuro symptom?

Answer 47

Deja vu

Question 48

Never do __________ on a patient with neutropenic fever.

Answer 48

DRE

Question 49

Tick bite with elevated ALT?

Answer 49

Ehrliciosis (give doxycycline)

Question 50

Describe the pathophysiology and treatment of RTA I.

Answer 50

*  Failure of the distal tubule to acidify the urine, resulting in buildup of acid in the blood. *  Give bicarb.