IM Flashcards
1
Q
Score for afib anticoagulation
A
CHADSVAS if 1 or less ASA, 2 or more blood thinner
CHF
HTN
Age over 75
Diabeetus
Stroke
Vascular disease
Age 64-75
Sex is female
2
Q
Strep pharyingitis treatment
A
Amoxicillin/ PCN
3
Q
Migraine criteria
A
POUND
Pulsitile
One day duration
Unilateral
Nausea
Debilitating
4
Q
Pneumonia criteria for inpatient treatment
A
CURB65
Confusion
Urea >7
RR over 30
BP below 90
65 years or older
5
Q
Typical pneumonia abx first line
A
Amoxicillin
6
Q
Atypical pneumonia first line abx
A
Azithromycin
7
Q
SIRS Criteria
A
Fever
Tachycardia
Tachypnea (or low EtCO)
White count
8
Q
Pleural effusion transudate characteristics
A
less than .5 protein
less than .6 LDH
9
Q
Pleural effusion transudate characteristics
A
more than .5 protein
more than .6 LDH
10
Q
COPD long term oxygen if
A
SpO2 less than 88
PaO2 less than 55
11
Q
in ascites, 250+ neutrophils is indicative of
A
Peritonitis, bacterial infection
12
Q
Stable angina next step
A
Stress test: EKG, if abnormal ECHO
13
Q
Pharamacologic stress test drug
A
Dypiridamole
14
Q
First line treatment stable angina
A
Nitro
ASA
Beta blockers
15
Q
Indication for CABG
A
Proximal LAD or 3 vessel disease
16
Q
Prinzmetal angina precipitated by
A
acetylcholine
17
Q
Drugs with mortality benefit in MI
A
Aspirin
Beta blockers
ACE inhibitors
18
Q
Post MI pericarditis AKA
A
Dressler syndrome
19
Q
Dressler syndrome (+time frame)
A
Autoimmune pericarditis post MI
2 weeks
20
Q
Dressler syndrome treatment
A
Aspirin
21
Q
Viral pericarditis treatment
A
NSAIDs
22
Q
Restrictive cardiomyopathy causes
A
Hemocrhomatosis
Amyloidosis
Sarcoidosis
23
Q
Restrictive cardiomyopathy presentation
A
Diastolic heart failure w reduced EF
24
Q
Hemochromatosis sx
A
Diabetes, bronze skin, elevated LFTS
25
CHF drugs with mortality benefit
ACE inhibitors
Beta blockers
Spiranolactone
26
Metformin contraindications
Renal disease, CHF
bc lactic acidosis
27
Constrictive pericarditis imaging
Calcifications on XRAY
28
Constrictive pericarditis causes
TB or LUPUS
29
Treatment for constrictive pericarditis
Pericardiectomy
30
Main cause of acute pericarditis
Cocksackievirus
Treat w NSAID
31
Kussmaul sign
JVD worse on inhalation
32
Mitral stenosis causes
Rheumatic
33
Aortic stenosis progresses to
Dilated cardiomyopathy
34
Aortic stenosis sound
Soft S2
35
Tricuspid endocarditis causes
IV drug use or carcinoid syndrome
36
Carcinoid syndrome symptoms
Bronchospasm
Flushing
Diahrreah
R heart murmur
37
Causes of holosystolic murmur
Mitral regurg
Tricuspid regurg
VSD
38
Infective endocarditis empiric treatment
Vanc + aminoglycoside (gentamycin, tobramycin, neomycin, streptomycin)
39
Hypertensive emergency treatment
Hydralazine
Nitroprusside
Labetalol
40
SAH suspected but CT is negative
Lumbar pucture to look for billirubin (xanthochromia)
41
Aortic disection type A treament
Surgery
42
Aortic dissection type B treament
Beta blockers
B B B B B B B B B B
43
Peripheral artery disease diagnosis
Ankle brachial index
BP ratio less than 0.9
Severe if less than 0.4
44
45
Peripheral artery disease symptoms
Claudication
46
Peripheral vascular disease treatment (if not severe)
Excercise
47
Peripheral artery disease treatment (severe)
Vascular intervention
48
Acute limb ischemia treatment
Heparin or embolectomy
49
LaRouche syndrome
Clot at aortic bifurcation
Bilateral and buttock leg pain
50
IVC filters placed when
Heparin or warfarin contraindicated or not effective
51
PE suspected first step
Heparin then CT angio
52
LMW contraindicated in
renal disease
53
Medial malleolus ulcer think
Venous insufficiency
54
Cardiogenic shock first treatment
Dobutamine
55
COPD variations
Chronic bronchitis: too much mucous
Emphysema: alveolar destruction
56
Things that decrease COPD mortality
Home oxygen
Quitting smoking
57
COPD stages
FEV1 >80 mild
FEV1 50-80 moderate
FEV1 30-50 severe
FEV1 <30 very severe
58
COPD treatment by severity (outpatient)
Mild: albuterol
Moderate: duoneb
Severe: duoneb + steroids
Very severe: duoneb+ steroids+ home oxygen
59
COPD exacerbation treatment in hospital
NIPPV
steroids
ABX (azithromycin or floroquinolone)
60
COPD w/ pneumonia abx
Cefepime or zosyn
61
COPD w/ pneumonia most common bug
Psedomonas
62
Acute asthma with increased PCO2 next step
intubate
63
64
Asthma stages
Intermittent: less than 2x a week
Mild: 3-7 a week
Moderate: daily
Severe: more than daily
65
Outpatient asthma treatment by severity
Intermittent: albuterol
Mild: albuterol +low dose steroid
Moderate: albuterol + medium dose steroid
Severe: albuterol + high dose steroid
66
Acute asthma exacerbation tx
Albuterol, IV steroids, Oxygen
67
Bronchiectasis caused by
Recurrent infections
68
Most common cause of bronchiectasis
Cystic fibrosis
69
Cystic fibrosis infection bug by age
Less than 20: staph aureus
More than 20: pseudomonas
70
Pancoast tumor complications
Phrenic nerve palsy
Horner syndrome
Recurrent laryngeal nerve palsy
71
72
Smoker tumor most common location and types
Central
Squamous and small cell
73
Squamous cell carcinoma produces ___ leading to ____
PTHRP
hypercalcemia, hypophosphetemia (low pth)
74
Lambert eaton vs myasthenia gravis
Lambert eaton better with use
Myasthenia worse with use
75
Adenocarcinoma of lung associated with
Non smokers
76
Nodule on chest xray next step
Compare to previous chest Xray
CT if changed or cant find prior xray
77
Interstitial lung disease causes
Asbestosis : also pleural plaques
Beryllium: aircraft workers
Coal: seen in miners, black lung
Silicosis: eggshell calficications, upper lobe
Sarcoidosis: hypercalcemia, elevated ACE
78
Pulmonary hypertension cuttoff
Pulmonary artery pressure >25mmhg
79
Normal lactate
Less than 1
80
Aspiration pnuemonia seen in
Bad gag reflex or mechanical ventilation
81
Aspiration pneumonia treament
Clyndamycin
82
P. jiroveci treatment
Bactrim TMP-SMX
Steroids if PaO2 less than 70
83
P. jiroveci presentation
Fever, non productive cough, interstitial pneumonia
84
Who gets p. jiroveci prophylaxis (with what drug)
CD4 <200
with bactrim
85
86
87
88
Cancer best next step after diagnosis
CT for staging
89
Diverticulosis diagnosis via
barium enema
90
Diverticulitis diagnosed by
CT w/ contrast
91
Acute mesenteric ischemia diagnosed via
Angiogram
92
Mesenteric ischemia symptoms
sudden onset severe pain w normal exam
93
Post op ileus vs ogilvie syndrome
Post-op affects colon and intestine, no bowel sounds
Ogilvie colon only
94
Esophageal varices first line med
Ocreotide
95
Esophageal varices prohylaxis
Beta blockers
96
Cihrrosis with fever, diffuse abd pain think
SBP
Spontaneous bacterial peritonitis
97
Spontaneous bacterial peritonitis diagnosis
Paracentesis w/ neutrophil >250
98
Spontaneous bacterial peritonitis tx
ceftriaxone
99
New liver mass in young female on birh control think
hepatic adenoma
100
When to resect a hepatic adenoma
Greater than 5 cm
101
Hydatid cyst caused by (pathogen)
Echinococcus
Latin america w/ dog contact
102
Hydatid cyst in liver treatment
Mebendazole resection
103
Hydatid cyst imaging
Lots of cysts seen on ultrasound
104
Pyogenic liver absess is a complication of
ascending cholangitis
105
Pyogenic liver absess most common bug
e. Coli
106
Liver absess with fever, RUQ pain, diahrreah think
Entomoeba histolytica
107
Amoebic liver abscess treatment
Metronidazole
108
Physiologic jaundice vs pathologic
Physiologic few days after birth
Pathologic at birth (needs coombs test)
109
Crigler najar due to
Glucoronyl transferase deficiency
110
Gilbert vs crigler najjar
Gilbert only presents when patient is under stress
111
Dubin johnson syndrome pathology
Black liver
Can conjugate but not get rid of billirubin
112
Cholecystitis next best step
U/S
113
if ultrasound is normal with suspected cholecystitis
HIDA scan
114
Diagnosis of cholecystitis w/ U/S requires
2/3:
-Pericolycystic fluid
-Wall thickening
-Gallstones
115
RUQ, fever and jaundice triad
Charcot’s triad for ascending cholangitis
116
Ascending cholangitis tx
IV fluids
IV antibiotics
ERCP
117
Pancreatitis best imaging step
RUQ U/S to look for stone as source
118
Pancreatitis due to gallstone also requires
cholecystectomy to prevent reoccurence
119
Gallstone ileus findings
Air in gallbladder +SBO
120
ICU patient on TPN is predisposed to
Acalculus cholecystitis (no stone)
121
122
Acalculus cholecystitis treatment
Percutaneous drain
123
Primary sclerosing cholangitis associated with
Ulcerative colitis
124
Primary biliary cholangitis antibody + buzzword symptom
Anti-mitochondrial
ITCHY ITCHY
125
Primary billiary cholangitis treatment
Ersodiol
126
Apendicitis next best step
Surgery if obvious, CT if unsure
127
Carcinoid tumor secretes
Serotonin
128
Carcinoid tumor patients suceptible to ____ deficiency
niacin B3
129
Niacin deficiency sx
Diahreah
Dermatitis
Dementia
130
Carcinoid tumors presentation
BFDR
Bronchospasm
Flushing
Diahrreah
Right heart failure
131
Pancreatic pseudocyst timeline
2-3 weeks post pancretitis
132
Pancreatic pseudocyst steps
Observe if less than 5cm
Drain if more than 5 cm
133
Chronic pancreatitis vs acute
Chronic has calcifications
134
Patient post aorta surgery with GI bleed
aorto-enteric-Fistula
135
Achalasia mechanism
Failure of lower esophageal sphincter to relax
136
Problems swallowing next best step
Barium swallow
137
138
Most common peptic ulcer causes
H. pylori or NSAIDs
139
GERD/gastritis symptoms next best step
PPI if north american
H. pylori test if third world (urease breath)
If alarm symptoms, endoscopy
140
Older than 50yo microcytic anemia next best step no known bleed
Colonoscopy
141
Colonoscopy screening by age
50yo
unless family hx then 40years or 10 years before family
142
Chron’s characteristics ()
Skip lesions
Oral mucosa
Associated w/ stricture and fistula
Transmural
143
Ulcerative characteristics
Continous lesions
Down to rectum
Mucosal
144
IBD treatment
Sulfasalzine
Steroids if acute
145
Pyoderma gangrenosum
Sterile wound associated with IBD
Treat w steroids
146
New thyroid nodule next step
TSH and ultrasound
147
Euthyroid nodule cancer risk
Euthyroid are malignant
148
U/S of thyroid is cystic think
Cancer
149
Hyperthyroid nodule next step
Radioactive iodine uptake
150
Radioactive iodine takeup is diffuse think
Graves
151
Radioactive iodine takeup single area think
Toxic adenoma
152
Radioactive iodine takeup multiple area think
Nodular toxic goiter aka plummer
153
Euthyroid nodule next step
more than 1cm biopsy
less than 1cm wait for followup
154
Excess estrogen thyroid effect
Estrogen binds thyroid to cause defficiency, hypothyroid patients are affected
155
Thyroid lymphoma associated with
Hashimotos
156
157
158
Hyperthyroid patient with painful thyroid and recent infection
Subacute dequervain thyroiditis
159
Dequervain thyroiditis treatment
Aspirin or NSAID
160
Medullary thyroid cancer think of
MEN2a or MEN2B
161
Medullary thyroid cancer next step
Check for MEN2a/b (PHEOCROMOCYTOMA- urine metanephrine)
THEN surgery
162
Diagnose pheochromocytoma via
Urine metanephrines
163
Acromegaly first test
IGF-1
164
SIADH first line treatment
Water restriction
165
Cushing syndrome first step
Overnight dexamethasone or cortisol level
166
Adrenal insufficiency tests (and what they say)
Urine cortisol and ACTH stimulation
If cortisol goes up, pituitary if stays low then adrenal (adison’s disease)
167
Patient w hypernatremia, hypokalemia and HTN next step
Renin/Aldosterone ratio to see if its due to perfusion or renal issue (high Renin in renal artery stenosis)
168
Renal artery stenosis classic patient
Older patient w/ HTN, refractory to treatment
169
Fibromuscular displasia classic patient
Young female with subauricular bruit, HTN, renal bruit
170
Metformin contraindicated in
CHF and kidney failure
Creat greater than 1.5
171
Metformin effects
Increases insulin sensitivity
Blocks gluconeogenesis
Blocks GI glucose absorption
172
Most common cause of death in DM
MI
173
Most common cause of death in rheumatoid arthritis
MI
174
DKA vs HHS
DKA anion gap metabolic acidosis
HHS much higher BGL
175
DKA treatment
Insulin, IV fluids, Potassium if below 5.2
176
Zollinger ellison tumor secretes
Gastrin
177
Zollinger ellison diagnosis
Gastrin levels over 1000, does not reduce with secretin challenge
178
Zollinger ellison treatment
Surgery or PPI
179
Hyperglycemia w/ rash (necrotizing erythema) think
Glucagonoma
180
181
182
Fetus w/ congenital heart block associated with
Lupus
183
Rheumatoid arthritis treatments
NSAID (mild)
Methotrexate (disease modifying
Steroids (flairs)
184
Lupus treatments
NSAID (mild)
Hydroxchloroquine (disease modifying)
Steroids (flairs)
185
Rheumatoid arthritis diagnosis
Proximal joint, worse in morning, spares DIPs
Anti-CCP
186
Female with recurrent miscarriage and thrombosis think
Anti-phospholipid syndrome
187
VDRL elevated in
Syphilis and anti-phospholipid syndrome
188
Gout next step
Arthrocentisis
189
Neg vs pos birefringent joint crystal
Neg gout
Pos pseudogout
190
Patient with gout and CKD treatment
Intraarticular steroids (colchicine and NSAID contraindicated)
191
Symetric weakness with elevated CPK, orbital or hand rash think
Polymyositis
192
Polymyositis associated with
Underlying malignancy
193
Elderly patient with hip and shoulder stiffness, normal CPK, elavated ESR think
Polymyalgia rheumatica
194
Polymyalgia rheumatica treatment
Steroids
195
Polymyalgia rheumatica associated with
Temporal arteritis (elevated ESR)
196
Pain over pressure points, constant think
Fibromyalgia
197
Sudden onset of psoriasis associated with
HIV (test for HIV as next step)
198
WBC casts in urine think
Acute interstitial nephritis
or
Pyelonephritis
199
Uremia manifestations that are indication for dialysis
-Hemolytic uremic syndrome
-Pericarditis
-Platelet dysfunction
-Confusion w/ asterixis
200
2 causes of CKD
HTN or diabetes
201
Acute interstitial nephritis presentation
FEAR
Fever
Eosiniphilia
Azotemia
Rash
Recent medication, hematuria w WBC casts, rash
202
Acute tubular necrosis causes
Hypoxia (hypoperfusion)
Toxins
203
Prerenal azotemia criteria
BUN/Creat ratio more than 20
204
Non-anion gap acidosis causes
Diahrreah (poop out bicarb)
Renal tubular acidosis
205
RTA 1 caused by
Under excretion of H+
stONEs
206
RTA type 2 cause
BI carb pissed out too much
207
Type 4 RTA caused by
Hypoladosterone
Hyponatremia, hyperK,
**Not enough H+ excretion**
208
Metabolic alkalosis next best step
Check urine chloride
(if high then kidneys not reabsorbing it)
(if low then from vomitting)
209
Kidney stone diet
Low salt, low fat, high calcium
210
Elderly smoker with painless hematuria think
Bladder cancer or Renal cell carcinoma (flank pain)
211
Suspect renal cell carcinoma next step
CT abdomen, then surgery
212
Suspect bladder cancer next step
Cystoscopy
213
Young male w painless mass in testicle next step
U/S scrotum
214
Testicular mass cancer suspect next step
Orchiectomy
(dont biopsy b/c seeding)
215
Testicular tortion cremasteric reflex
Gone
216
Epydidimitis features
Tender spermatic cord, improves with testicular elevation
