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Internal Med > Firecracker/Qbank Deck Number Three > Flashcards

Firecracker/Qbank Deck Number Three Flashcards

1
Q

serous/effusive pericarditis

A

transudative or exudative fluid in pericardial sac

SLE, viral, autoimmune, RA, uremia

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2
Q

fibrinous pericarditi

A

fibrin-rich exudate

underlying uremia, MI, acute rheumatic fever, or radiation injury

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3
Q

hemorrhagic pericarditis

A

gross blood
malignancy
tubercular pericarditis in endemic regions

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4
Q

pericarditis presentation

A

sudden onset of chest pain
worse with inspiration
better with leaning forward

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5
Q

pericarditis, pain can radiate to

A

trapezius muscle

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6
Q

pericarditis - PE

A

friction rub

distant heart sounds

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7
Q

Ewart’s sign

A

large pericardial effusion compression LLlobe, bronchial breath sounds at left inferior scapular angle

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8
Q

pericarditis - ECG

A

global st segment elevation
pr depression
low voltage and elctrical alterans

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9
Q

pericarditis - c xray

A

usually normal

can have enlarged cardiac silhouette with >200 cc

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10
Q

pericarditis treatment

A

NSAIDs, steroids

cholchicine

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11
Q

purulent pericarditis treatmetn

A

IV antibiotics

drainage via subxiphoid pericardial windowing/pericariectomy

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12
Q

location of MR murmur

A

apex

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13
Q

nitroglycerin mechanism of action

A

dilation of capacitance vessels

decrease ventricular preload

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14
Q

drugs to hold prior to stress testing

A

BB, CCB, nitrates

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15
Q

test for suspected aortic dissection

A

TEE

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16
Q

cardiac sound that can be heard during acute phase of ACS

A

S4

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17
Q

EKG - post mi

A

PVC (wide qrs)

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18
Q

coronary artery disease

A

plaque formation
narrowing of arteries
mismatch in myocardial oxygen supply and demand

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19
Q

CAD modifiable risk factors

A

tobacco, HTN, sedentary lifestyle, obesity, DM

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20
Q

CAD nonmodifiable risk factors

A

age
sex (men)
family hx (less than 55 in men, less than 65 in women)

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21
Q

takayasu arteritis

A

cell-mediated vasculitis

affects aorta

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22
Q

initial lesion of takayasu arteritis

A

proximal 2/3 of left subclavian artery

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23
Q

takayasu early symptoms

A

constituation - fatigue, wt loss
articular - juvenile idiopathic arthritis
dermatologic - similar to erythema nodosum/pyoderma gangrenosum

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24
Q

cardiac ausculatation of takayasu

A

diastolic murmur of AR

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25
Q

takayasu lab findings

A

elevated inflamm markers

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26
Q

takayasu therapy

A

glucocorticoids

MTX, AZA, DMARDs

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27
Q

side effects of diuretics?

A

contraction alkalosis

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28
Q

myocarditis PE findings

A

S3 or S4 heart sound as signs of ventricular dysfunction
If severely dilated, murmurs of either tricuspid or mitral insufficiency may be present
Pericardial friction rub may be present with myopericarditis.
Edema of the extremities, dull breath sounds at the bases of the lung, and increased JVP may all be present as signs of heart failure due to dilated cardiomyopathy and ventricular dysfunction.

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29
Q

myocarditis chest xray

A

cardiomegaly with or without marked pulmonary vascular markings and edema.

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30
Q

side effect of IFN

A

depression

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31
Q

symptoms associated with viral myocarditis

A

heart failure and dilated cardiomyopathy with fatigue, dyspnea, and decreased exercise capacity being the first signs and symptoms.

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32
Q

drugs that can cause myocarditis

A 
Doxorubicin
Cyclophosphamide
Chloroquine
Penicillins
Sulfonamide
Cocaine
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33
Q

myocarditis arrhythmia

A

atrial tach

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34
Q

What sequelae are associated with stage 2 of lyme disease?

A

Bell’s palsy
Aseptic meningitis
Sensory-motor neuropathies
Cardiac involvement (most commonly myocarditis and AV block)

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35
Q

causes of a hemothorax

A

Trauma
Aortic dissection
Tuberculosis
Malignancy

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36
Q

mitral regurg

A

backflow of blood into LA from LV during systole

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37
Q

MR caused by disease that dilate LV

A

aortic stenosis, aortic regurg

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38
Q

drugs that can cause MR

A

ergotamine
pergolide
cabergoline

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39
Q

MR murmur

A

holosystolic
apex
radiates to the axilla

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40
Q

MR EKG findings

A

P mitrale
notched P waves
also seen in mitral stenosis

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41
Q

other heart sounds with MR

A
  • widely split S2
    aortic valve closing before pulmonic valve
  • s3
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42
Q

medical management of symptomatic MR patients - goal

A

reduce afterload

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43
Q

medical management of MR - how to reduce afterload

A

diuretics
nitrates (also reduce preload)
ACEIs
carvedilol

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44
Q

AR

A

blood into LV from aorta during diastole

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45
Q

acute AR cause

A

damage to valve - endocarditis, rheumatic fever

aortic dissection, trauma

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46
Q

chronic AR cause

A

dilation of aortic root: CTD, symphilis, aging

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47
Q

acute AR symptoms

A

severe LSHF
cardiovascular collapse
cardiogenic shock

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48
Q

chronic AR symptoms

A

can be asymptomatic until they can no longer compensate and get LSHF

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49
Q

AR exacerabted by

A

volume overload
- high salt diet
strenuous exercise

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50
Q

AR mrumur

A

diastolic murmur

enhanced by leaning forward

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51
Q

AR 2/2 valvular insuff

A

left sternal border at the third or fourth interspace

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52
Q

AR 2/2 aortic root diltation

A

right sternal border or the apex

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53
Q

Austin-Flint murmur

A

low-pitched mid- to late-diastolic rumble best heard at the apex observed in severe regurgitation which results from turbulence of the anterograde stream from the left atrium competing with retrograde flow across the insufficient aortic valve.

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54
Q

AR ECG

A

LV hypertrophy
LA dilation
ST depression at rest/exercise

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55
Q

chronic AR heart sound

A

S3

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56
Q

goal of AR medical management

A

reduce afterload

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57
Q

treatment for acute decompensated AR

A

surgery for replacement

IV afterload reduction - nitroprusside + inotropes (dobutamine)

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58
Q

medical management for which AR pts

A

chronic, asymptomatic, EF >50%

vasodilators, low salt diet, diuretics, CCB

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59
Q

late presentation of aortic coarctation

A

asymptomatic HTN
headache
epistaxis

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60
Q

Aortic coarctation - blood pressures

A

HTN in UE

hypotension in LE

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61
Q

Aortic coarctation - ECG

A

LVH

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62
Q

acute limb ischemia treatment

A

IV heparin + embolectomy

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63
Q

syncope due to bradycardia, look for

A

prolonged PR or QRS

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64
Q

PAD treatment

A

low dose ASA
statin
exercise therapy

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65
Q

HCM mitral valve

A

movement abnormality

systolic antermior motion

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66
Q

most common liver mets

A

GI
lung
breast

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67
Q

porcelin gallbladder - risk for

A

gallbladder carcinoma

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68
Q

NAFLD most likely due to

A

insulin resistance

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69
Q

acute bleeding in liver failure treatment

A

FFP

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70
Q

amebic liver mass treatment

A

metronidizaole

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71
Q

fulminant hep failure - def

A

hep encephalophy within 8 weeks

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72
Q

chronic constrictive pericarditis

A

chronic inflamm process involing pericardial space –> consolidation, scarring

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73
Q

dysfunction w/ constrictive pericarditis

A

diastolic

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74
Q

constrictive pericarditis - clinical picture

A

symptoms of decrease CO and increase systemic venous pressure

  • fatigue, hypotension, reflex tachy
  • JVD, HSM, ascites, edema
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75
Q

constrictive pericarditis can be mistaken for

A

cirrorsis

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76
Q

constrictive pericarditis PE

A

JVD
kussumal’s sign
pulsus paradoxus
early diastolic knock, friction rub

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77
Q

kussmaul’s sign

A

neck vein distention with inspiration

kussmauls sign

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78
Q

constrictive pericarditis CT

A

thicken pericardium >2mm

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79
Q

confirmation of constrictive pericarditis

A

cardiac catheterization
rapid early diastolic filling
prominent y descent on RAP tracing

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80
Q

constrictive pericarditis with calcifcation of pericardial space

A

accompanied by early diastolic knock

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81
Q

untreated chronic constrictive pericarditis

A

decreased RVEDV
rise in systemic pressue
RHF signs

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82
Q

constrictive pericarditis treatment

A

surgical removal of pericardium

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83
Q

causes of constrictive pericarditis

A

viral
cardiac surgery
radiation therapy
TB

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84
Q

Dubin JOhnson

A

conjugated/direct bilirubinemia
black / dark pigmented liver
benign

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85
Q

cryoglobulinemia

A

blood contains large amounts of proteins insoluble at cold temps
associated with Hep C, MM

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86
Q

heb B virus type

A

dsDNA

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87
Q

antigen associated with hep b infectivity

A

HBeAg

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88
Q

HBsAg

A

Surface antigen, indicates active infection or carrier state (HBsAg: virus is preSent)

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89
Q

HBcAb

A

Antibody against core antigen. Critical for diagnosis during the window phase, when HBsAg is absent but HBsAb isn’t detectable yet. Doesn’t confer immunity.

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90
Q

HBeAg

A

Core antigen. Presence indicates transmissibility (HBeAg=rEplication)

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91
Q

HBeAb

A

Antibody against HBeAg, indicates low transmissibility

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92
Q

chronic Hep B infection

A

+ HBeAg
+ HBsAg
greater than 6 months

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93
Q

inactive Hep B carriers

A

+HBsAg

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94
Q

Prior HBV infection

A

anti-HBs (IgG) and anti-HBc (IgG)

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95
Q

HBV immunization

A

+ anti-HBs AB

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96
Q

treatment of Hep B in unvaccinated pts

A

immedate Hep B vaccine + Hep B IG following expsoure

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97
Q

chronic active Hep B treatment

A

PEG-IFN-a
entecavir
tenofovir

98
Q

gastrinoma stomach biopsy

A

multiple stomach ulcers + thickened gastric folds

99
Q

diagnosis of gastrinoma

A

fasting gastrin level >1000

if less than 1000, do secretin stimulation test

100
Q

vit d def lab values

A

decrease Ca + Phosphate

increased PTH

101
Q

disseminated gonogoocal infection triad

A

polyarthyalgia
tenosynvitis
painless skin lesions

102
Q

increased homocysteine treatment

A

pyridoxine and folate

103
Q

increased homocystine predisposes to

A

thrombosis

104
Q

massive PE echo findings

A

acute RV dilation and ventricular hypokinesis

105
Q

vasovagal maneuvers in SVT - mechanism

A

increase vagal tone

decrease conductivity thru AV node

106
Q

systemic scleroderma antibody

A

topoisomerase-I

107
Q

2nd amyloidosis treatment and prophylaxis

A

colchicine

108
Q

2ndry amyloidosis causes

A

inflamm arthritis, IBD, chronic infections, malignancy, vasculitis

109
Q

complications of untreated gonorrhea in females

A

disseminated infection
PID
TOA
Fitz-Hugh-Curtis syndrome

110
Q

diagnosis of gonorrhea

A

gram stain of urethra discharge

culture: cervix

111
Q

resp acidosis defined as

A

ph <7.37 with increase in pco2

112
Q

cause of resp acidosis

A

hypoventiatlion

  • CNS depression
  • neuromuscular failure
  • decreased resp system compliance (restrictive lung dz)
  • increased airway resistance (obstrutive lung dz)
  • increased dead space
113
Q

resp acidosis treatment symptoms

A 
restlessness
headache
hyperreflexxia
asterixis
coma
114
Q

bicarb given in pure resp acidosis?

A

no

hco3 + H -> co2 + h2o

115
Q

causes of resp alkalosis

A

hyperventilation

  • cns stimulation
  • hypoxemia
  • anxiety
116
Q

resp alk general values

A

low h
low bicarb
low co2
compensate with decreased hco3 reabsorp

117
Q

increased pH can cause

A

hypocalcemia
hypophosphatemia
hypokalemia

118
Q

resp alkalosis on ventilators

A

decrease their settings

119
Q

aortic stenosis

A
  • calcification of valve leafets with age

- 7th decade

120
Q

aortic stenosis presenting at an early age

A

congenital bicuspid aortic valves

121
Q

symptoms of aortic stensosis

A

classic syncope, angina, dyspnea

122
Q

aortic stenosis can lead to what heart pathology

123
Q

aortic stenosis murmur

A

systolic cresendo-decrescendo

2ICS at RSB

124
Q

aortic stenosis murmur radiates to

A

carotid arteries

125
Q

aortic stenosis murmur decreases with

A

valsalva/decrease preload

126
Q

aortic stenosis - other heart sounds

A 
s4
weak pulse (pulsus parvus et tardus)
127
Q

aortic stenosis CXR

128
Q

aortic stenosis echo

A

possible LAE

increased pressure gradient (best assessed with cath)

129
Q

aortic stenosis ECG

A

LVH
LAE
LBBB

130
Q

cardiac insuff in aortic stenosis

A

leds to ischemic heart disease, heart failure

131
Q

medical management of aortic stenosis

A 
control HTN - diuretic, ACEI
avoid vigorous activity
avoid venodilators (nitrates)
negative inotropes (CCB/BB)
132
Q

aortic valve replacement

A

only treatment for aortic stenosis

  • symptoms
  • asymptomatic underoing cabg
  • sever with systolic failure
133
Q

Anserine Bursitis

A

located anteriomedial below knee

134
Q

anklyosing spondylitis extra-articular finding

135
Q

murmur in marfan’s patients

A

AR –> diastolic

136
Q

Rosacea symptoms

A

flushing, teleangiectasia

137
Q

hypercalcemia >14 treatment

A

NS + calcitonin
loops only if volume overload
if chronic problem - bisphosphonates

138
Q

Familial Hypocalciuric Hypercalecmia

A

high normal PTH
high, asymptomatic calcium
low urine calcium

139
Q

viral causes of thrombocytopenia

A

EBV, HepC, HIV

140
Q

achalsia symptoms

A

dysphagia to solids and liquids

141
Q

villous atrophy

142
Q

anti-tissue transglutaminase ab

143
Q

anti-endomysial ab

144
Q

foul smelling sputum

A

aspiriation

145
Q

uncomplicated cystitis treatment

A

nitrofuratonin x5
tmp smx x 3
fosfomycin x 1

146
Q

complicated cystitis treatment

A

fluro 5-14d

147
Q

pyelonephritis treatment outpatient

148
Q

pyelonephritis treatment inpatient

A

IV fluro or ceftriaxone

149
Q

UTI during pregnancy, treatment

A

nitrofurantoin
amoxicillin
cephalexin

150
Q

pityriasis rosea, most common in

A

older children + young adults

women

151
Q

what is pityriasis rosea

A

acute inflamm skin dz
papular lesions on trunk, proximal areas of extremities
viral origin

152
Q

What typically precedes a pityriasis rosea eruption?

A

single round lesions

“herald patch”

153
Q

how is pityriasis rosea treated?

A

Topical steroids
Phototherapy
Erythromycin
Recent studies have also found antiviral treatment with acyclovir to be effective in accelerating improvement.

154
Q

How can pityriasis rosea be differentiated from tinea corporis?

A

negative potassium scrape (not fungus)

155
Q

What is the typical presentation of pityriasis rosea?

A

pruritic, oval erythematous papules that are covered by white scale. T

156
Q

thrombocytopenia =

A

less than 150,000
less than 10,000 spontaneous bleeding
less than 50,000 surgical bleeding

157
Q

broad categories of thrombocytepenia due to

A

platelet underproduction
platelet destruction
dilutation
sequestration

158
Q

diagnosis of thrombocytopenia

A

repeat cbc

peripheral smear to r/o pseudothrombocytopenia

159
Q

TB, positive with 5+ induring

A

TB contacts
HIV
immunosuppression/organ transplant
CXR changes

160
Q

meningitis prophylaxis 2-50 yr

A

vanc + 3 degree cephalopsorin

161
Q

meningitis prophylaxis greater than 50 yr

A

vanc + 3 degree cephalosporin + ampicllin

162
Q

meningitis prophylaxis immunosuppresion

A

vanc + amp + cefepime

163
Q

cryptococcal meningitis treatment

A

amphotericine + flucytosine

164
Q

UTI - pyruia

A

> 10 leukocytes

165
Q

HIV dysphagia

A

CMV, HSV, candida

166
Q

CMV colitis in AIDs pts

A

owl’s eyes - inclusion bodys

mouth ulcers

167
Q

CMV treatment

A

ganciclovir

168
Q

HIV needle stick

A

draw serologies and start 3 drug regimen

169
Q

Bartonella treatment

A

azithromycin

170
Q

aspergillus – invasive

A

immunocompromised
bilateral lung infiltrates
fungal ball
pulmonary nodule with halo sign

171
Q

adverse effect of fluroquinolones

A

achilles tendinopathy

172
Q

oseltamivir use within

A

48 hrs of symptoms

173
Q

food poisoning from rice

A

bacillus cereus

174
Q

Histoplasmosis location

A

central and southern US (ohio and miss river valleys)

175
Q

Coccidioidomycosis symptoms

A

nonspecific: joint pains, chest pain, etc

176
Q

Nocardia - type of organism

A

gram positive, acid fast

177
Q

Nocardia symptoms

A

lung nodules

brain abscesses

178
Q

Nocardia treatment

A

tmp-smx for long duration

179
Q

exudative =

A

increased capillary permeability

180
Q

lung symptoms + pain in arm

181
Q

COPD air trapping during

A

expiratory phase

182
Q

bronchogenic cyst

A

middle mediastinum

183
Q

pulmonary fibrosis, A-A gradient

A

increased alevolar-arterial gradient

184
Q

most common cause of inherited hypercoagulability

A

factor V leiden

185
Q

hodgkin’s lymphoma treated when less than 30, at risk for

A

secondary malignacy

186
Q

What are examples of disease states that can cause an increased A-a gradient?

A

pulmonary edema
PE
R to L vascular shunts

187
Q

What can cause a falsely normal A-a gradient?

A

hypoventilation

high altitudes

188
Q

definitive diagnosis of Histoplasma

A

tissue biopsy of lung

lymph nodes that demonstrate granulomas

189
Q

splenic and liver calcifications

190
Q

On microscopy, how does Histoplasma capsulatum appear at varying temperatures

A

mold at ambient temps

yeast at body temps

191
Q

Where are Histoplasma capsulatum cells found on microscopy?

A

facultative intracellular yeast (2 - 4 microns in diameter) found inside macrophages.

192
Q

populations predisposed to diseeminated histo

A

infants or immunocompromised

193
Q

two general manifestations of histo?

A

pulmonary infection or disseminated

194
Q

What causes erythema nodosum

A

delayed hypersensitivity reaction to antigens

195
Q

What is erythema nodosum?

A

inflammation of subcutaneous fat that results in painful erythematous nodules, usually in a pretibial location.

196
Q

What is the single most frequent condition associated with the development of erythema nodosum?

A

streptococcal pharyngitis

197
Q

What is the typical presentation of erythema nodosum?

A

the typical presentation of erythema nodosum involves painful erythematous nodules, usually on the anterior portion of the tibia with possible malaise, fatigue, and polyarthralgia.

198
Q

Amongst whom is erythema nodosum most common?

A

women ages 15-40

199
Q

What laboratory findings are associated with erythema nodosum?

A

antistreptolysin o ab

ESR

200
Q

Rx treatment of erythema nodosum

A

nsaids
potassium iodide
corticosteroids

201
Q

What are two causes of failure of muscle relaxation in achalasia?

A

dysfunction of NO synthase producing neurons

denervation of esophageal muscle

202
Q

diagnosis of achlasia

A

barium swallow

esophageal manometry

203
Q

What is the cause of achalasia?

A

failure of LES to relax

204
Q

What three things does manometry demonstrate in achalasia?

A

Impaired peristalsis
↓ Relaxation of lower esophageal sphincter (LES) after swallowing
↑ Resting tone of LES

205
Q

achalasia treatments

A

esophagomyotomy, botulinum toxin injections, nitrates and calcium channel blockers.

206
Q

Patients with achalasia have an increased risk of what condition?

A

esophageal squamous cell carcinoma

207
Q

What is seen on barium swallow in a patient with achalasia?

A

Classic “Bird’s beak” appearance at the lower esophageal sphincter (LES)
Proximal esophageal dilation

208
Q

What are some causes of “secondary” achalasia?

A

cancer
chagas
diabetic neuropathy
amyloidosis, sarcoidosis

209
Q

What complication can result from balloon dilation treatment in a patient with achalasia?

A

esophageal rupture

210
Q

What are three ways to biochemically reduce LES tone in patients with achalasia?

A

botox
nitrates
CCB

211
Q

What is the presentation of diffuse esophageal spasm?

A

chest pain and dysphagia

precipitants: rapid eating, extreme food temps, heart burn, stress

212
Q

What is diffuse esophageal spasm?

A

abnormal (non-peristaltic) contractions of esophagus

213
Q

What is seen on manometry in diffuse esophageal spasm?

A

uncoordinated, nonperistaltic contractions

214
Q

diffuse esophageal spasm treatment

A

CCB, Nitrates, TCAs

215
Q

esophageal spasm imaging

A

corkscrew pattern

216
Q

OSA - increased hematocrit

A

hypoxemia –> increased EPO from kidneys

217
Q

spherocytes w/o central pallor + positive coombs test

A

autoimmune hemolytic anemia

218
Q

Hairy Cell Leukemia

A

positive tartrate resistance acid phosphatase

219
Q

diarrhea for >2 weeks

A

cryptosporiduium
cyclopsora
giardia

220
Q

Baker’s cysts

A

inflammed synovium from RA/OA/cartilage tears

popliteal fossa

221
Q

ABG on CHF pt in resp distress

A

resp alkalosis

hypocapnia

222
Q

sporotrichosis

A

gardener’s dz

223
Q

treatment of cocaine related chest pain

A

benzos, aspirin, nitroglycerin, CCB

do not give BB

224
Q

hydatid cyst

A

cyst with eggshell calcifications

associated with echinococcus granulosis (dogs!)

225
Q

itching after hot bath

A

polycythemia vera

226
Q

uremic coagulopathy due to

A

platelet dysfxn
BT is prolonged
treat with DDAVP

227
Q

What interventional studies may be used in the evaluation of hematuria?

A

cytoscopy - bladder cancer
retrograde pyelogram - ureteral malignancy
kidney biopsy - GN or vasuculitis

228
Q

What imaging studies may be used in the evaluation of hematuria?

A

xray - kidney stone
ultrasound - renal masses
CT - renal malignancy

229
Q

What do you suspect with painful hematuria? Painless hematuria?

A

painless - bladder cancer, renal cell carcinoma

pain - kidney stone, renal infarction, cystitis/kidney infection

230
Q

ultrasound in hematuria

A

cystic vs solid masses

231
Q

In general, what is the cause of hematuria?

A

whole RBCs leak into urine

232
Q

If a patient has grossly bloody-appearing urine but a urine dipstick negative for blood, what does this mean?

A

substances from food/beets

no follow up needed

233
Q

What is the treatment for myoglobinuria secondary to rhabdomyolysis?

A

Start IV normal saline to help preserve kidney function, and correct electrolyte abnormalities

234
Q

What is the role of abdominal x-ray in the evaluation of hematuria?

A

kidney stones

235
Q

What are some specific causes of hematuria?

A

malignancy (bladder and renal cell carcinoma), infection, stones, glomerulonephritis, vasculitis, and trauma.

236
Q

What is the main focus of the treatment of hematuria?

A

underlying cause

237
Q

What does a urine dipstick positive for blood tell you? What is the next step?

A

detects heme
could also be from hemoglobinuria or myoglobinuria
need urine microscopy to detect RBC

238
Q

What is the treatment for hemoglobinuria secondary to intravascular hemolysis?

A

start intravenous saline to preserve kidney function and correct electrolyte abnormalities (eg, hyperkalemia) if present.

239
Q

What is the difference between gross hematuria and microscopic hematuria?

A

gross - urine is pink/red

micro - >3 RBC

240
Q

What would you expect to find on urine microscopy in all cases of true hematuria?

A

greater than 3 rbcs

241
Q

tests for hemoglobinuria

A

ldh

indirect bilirubin

242
Q

tests for rhabdomyolysis

A

CPK
hyperkalemia
hyperuricemia
renal failure

Internal Med (23 decks)

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