IM

Question 1

Crescendo-decrescendo, soft S2, loudest @ base

Answer 1

Aortic stenosis

Question 2

Holosystolic murmur, loudest @ apex, radiates to axilla

Answer 2

Mitral regurgitatioin

Question 3

Late systolic crescendo murmur, midsystolic click,

Answer 3

Mitral valve prolapse

Question 4

High pitched, blowing, diastolic decrescendo murmur @ LSB

Answer 4

Aortic regurgitation

Question 5

Murmur follows opening snap, rumbling diastolic murmur

Answer 5

Mitral stenosis

Question 6

Murmur that radiates to carotids

Answer 6

Aortic stenosis

Question 7

Cardiac tamponade

Answer 7

-compression of the heart by fluid (caused by hemopericardium or pericardial effusion) –> decreased ventricle diastolic filling –> decrease CO -becks triad = hypotension, distended neck veins, muffled/ distantt heart sounds -Pulsus paradoxus = decreased SBP by 10 mmHg on inspiration

Question 8

DDX pulsus paradoxus

Answer 8

Pericarditis, obstructive pulmonary disease (COPD, OSA, Asthma, Croup), cardiac tamponade = decreased SBP by 10 mmHg on inspiration

Question 9

38 yo, B/L progressive hand pain and MCP pain, DM2, joint space narrowing, osteophytes, increased LFTs

Answer 9

Hereditary Hemochromatosis Arthropathy (tx oral analgesics plus phlebotomy) vs RA = B/L, MCP, joint space narrowing, osteopenia, bony erosions

Question 10

When the liver is palpable below the right coastal margin, it indicates?

Answer 10

hepatomegaly

Question 11

Which Biliary tract disease associated with Ulcerative Colitis

Answer 11

Primary Sclerosing Cholangitis

Question 12

Which gallbladder condition associated with Crohns

Answer 12

pigment gallstones

Question 13

Triad of jaundice, fever, RUQ pain

Answer 13

Cholangitis (charcots triad)

Question 14

Jaundice, fever, RUQ pain, AMS, hypotension

Answer 14

= Raynauds pentad for Cholangitis (charcots triad + AMS + shock)

Question 15

MCC lower GI bleeding (bright red blood) in adults

Answer 15

diverticulosis

Question 16

RUQ pain, fever, jaundice, hypotension, difficult to arouse, occasional bloody stools, normal RUQ US

Answer 16

Primary Sclerosing Cholangitis (raynauds pentad). -associated with Ulcerative Colitis -Perform MRCP if suspect and the ultrasound looks normal

Question 17

Which bacterias cause bloody diarrhea?

Answer 17

E.coli , Campylobacter jejuni, Shigella

Question 18

LFTs in alcoholic hepatitis

Answer 18

LFTs < 500 with AST: ALT > 2

Question 19

Which antibodies would you test for if you suspect acute hepatitis infection?

Answer 19

HbsAg and anti-Hbc are most useful markers for acute hep B infection, also anti-Hbc remains elevated during window period

Question 20

Raised LFTs plus tremor/ involuntary movements in a young adult

Answer 20

Wilsons Disease

Question 21

Non-infectious liver disease with extrapyramidal movement (i.e. parkinsonism, tremor, dysarthria) in a pt < 35 yo

Answer 21

Wilsons Disease

Question 22

Ascites, fever, abdo pain, altered mental status

Answer 22

Spontaneous Bacterial Peritonitis

Question 23

Villous atrophy is the hallmark of which disease?

Answer 23

Celiac Disease

Question 24

Prolactinoma

Answer 24

bitemporal hemianopsia, hypothyroidism -Treat with DA agonist (bromocriptine, canergoline) o DA inhibits PRL (vs TRH stimulates PRL)

Question 25

How does dopamine decrease estrogen and testosterone?

Answer 25

Because dopamine inhibits GnRH --\> decreased estrogen and testosterone

Question 26

ADH

Answer 26

decreases serum osmolarity & increases urine osmolarity (by inserting aquaporins). ADH is decreased in central DI. Treat with desmopressin (ADH analog)

Question 27

SIADH

Answer 27

-euvolemic hyponatremia (excessive free water absorption) -chest (TB, COPD), SCLC

Question 28

What condition should you suspect in a patient with acute onset A-fib?

Answer 28

hyperthyroidism check all pts w/ new onset AF with TSH + T4

Question 29

stones, bones, psychiatric undertones

Answer 29

primary hyperparathyroidism (symptoms from hypercalcemia)

Question 30

HTN, depression, kidney stones, increased Ca2+

Answer 30

primary hyperparathyroidism

Question 31

Muscle weakness, fatigue, weight gain, high cholesterol (total, LDL, TAG)

Answer 31

hypothyroidism

Question 32

What is this called? What conditions do you see this in?

Answer 32

* Electrical alternans = varying amplitude to QRS complexes * seen in Pericardial Effusion, Cardiac Tamponade

Question 33

Which types of murmurs tend to be pathologic?

Answer 33

Diastolic and continuous murmurs --\> prompts further workup with transthoracic echocardiogram

Question 34

Diagnosis? why?

Answer 34

**A-fib**: because - irregularly irregular R-R intervals - No discernable P-waves, and no proper isoelectric baseline - Narrow QRS (approx 80 ms)

Question 35

Describe CXR Diagnosis

Answer 35

Pulmonary venous congestion occurs in patients with CHF. Characteristic CXR findings include cardiomegaly, cephalization of pulmonary vessels with prominent vascular markings, and pleural effusions.

Question 36

Answer 36

Necrotizing pulmonary vasculitis occurs in **Granulomatosis with Polyangiitis** (formerly Wegener granulomatosis). Fever, weight loss, and rhinosinusitis are commonly seen on presentation. Pulmonary nodules and alveolar consolidation are typical findings on CXR

Question 37

Describe CXR Diagnosis?

Answer 37

Sarcoidosis B/L hilar LAD

Question 38

Pt presents w/ hypoglycemia, weakness, variable metabolic acid/base derangements, hypotension, hypothermia

Answer 38

Adrenal insuff

Question 39

Electrolyte abnormality in rhabdomyolysis?

Answer 39

hyperkalemia (cell lysis + renal failure; myoglobin causes ATN)

Question 40

Pt needs to run to the bathroom when sticking a key in the front door; needs to run to bathroom when opening car door Possible causes of this type incontinence?

Answer 40

**Urge incontinence:** “hyperactive detrusor,” or “detrusor instability” * Multiple sclerosis * Menopause

Question 41

Type of incontinence where PVRV is 300-400 mL?

Answer 41

Overflow Incontinence * normal PVRV should be \<50-75 mL * caused by DM or BPH * DM: neurogenic bladder 2ndry to myelin damage from sorbitol (glucose enters myelin, causing osmotic damage) * BPH: merely d/t outlet obstruction —leads to detrusor burnout

Question 42

Tx for overflow incontinence

Answer 42

Overflow incontinence is caused by DM or BPH, tx depends on cause * DM bladder: neurogenic bladder 2ndry to myelin damage from sorbitol (glucose enters myelin, causing osmotic damage) * Tx: bethanecol (muscarinic agonist) * BPH bladder: merely d/t outlet obstruction —leads to detrusor burnout * Tx: **insert catheter first always!**

Question 43

bladder obstruction presents w/ dysuria and suprapubic mass —\> NBSM?

Answer 43

Catheterization -I think it's overflow incontinence d/t BPH (so always catherization first!) if d/t Diabetic neurogenic bladder then bethanechol (M-agonist)

Question 44

78 yo c/o LLQ pain + fever + vomit + ileus (peritoneal irritation) Tx?

Answer 44

Diverticulitis * Tx: Bowel rest, ABX vs Diverticulosis: mostly asympto or LLQ pain w/ painless bleeding

Question 45

24 yo-m c/o pustular skin lesions, left knee sore yesterday and right wrist today, tenosynovitis

Answer 45

Disseminated Gonorrhea

Question 46

Raloxifene MOA?

Answer 46

a SERM (increases osteoblasts) helps prevent osteoporosis; but 3rd line after bisphosphonates

Question 47

Suspect cholecystitis in a pt, NBSM?

Answer 47

Cholecystitis is dx with U/S → HIDA scan if U/S is inconclusive

Question 48

60 yo-f

Answer 48

pt Severe HTN after age of 55 w/ carotid or abdo bruit (which indicates atherosclerosis), diag? Renal artery stenosis Tx 1st line- ACE-i (unless it’s B/L)