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SHELF EXAMS > IM > Flashcards

IM Flashcards

1
Q

Crescendo-decrescendo, soft S2, loudest @ base

A

Aortic stenosis

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2
Q

Holosystolic murmur, loudest @ apex, radiates to axilla

A

Mitral regurgitatioin

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3
Q

Late systolic crescendo murmur, midsystolic click,

A

Mitral valve prolapse

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4
Q

High pitched, blowing, diastolic decrescendo murmur @ LSB

A

Aortic regurgitation

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5
Q

Murmur follows opening snap, rumbling diastolic murmur

A

Mitral stenosis

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6
Q

Murmur that radiates to carotids

A

Aortic stenosis

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7
Q

Cardiac tamponade

A

-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

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8
Q

DDX pulsus paradoxus

A

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

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9
Q

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

A

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

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10
Q

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

A

hepatomegaly

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11
Q

Which Biliary tract disease associated with Ulcerative Colitis

A

Primary Sclerosing Cholangitis

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12
Q

Which gallbladder condition associated with Crohns

A

pigment gallstones

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13
Q

Triad of jaundice, fever, RUQ pain

A

Cholangitis (charcots triad)

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14
Q

Jaundice, fever, RUQ pain, AMS, hypotension

A

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

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15
Q

MCC lower GI bleeding (bright red blood) in adults

A

diverticulosis

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16
Q

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

A

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

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17
Q

Which bacterias cause bloody diarrhea?

A

E.coli , Campylobacter jejuni, Shigella

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18
Q

LFTs in alcoholic hepatitis

A

LFTs < 500 with AST: ALT > 2

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19
Q

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

A

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

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20
Q

Raised LFTs plus tremor/ involuntary movements in a young adult

A

Wilsons Disease

21
Q

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

A

Wilsons Disease

22
Q

Ascites, fever, abdo pain, altered mental status

A

Spontaneous Bacterial Peritonitis

23
Q

Villous atrophy is the hallmark of which disease?

A

Celiac Disease

24
Q

Prolactinoma

A

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

25
Q

How does dopamine decrease estrogen and testosterone?

A

Because dopamine inhibits GnRH –> decreased estrogen and testosterone

26
Q

ADH

A

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

27
Q

SIADH

A

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

28
Q

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

A

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

29
Q

stones, bones, psychiatric undertones

A

primary hyperparathyroidism (symptoms from hypercalcemia)

30
Q

HTN, depression, kidney stones, increased Ca2+

A

primary hyperparathyroidism

31
Q

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

A

hypothyroidism

32
Q

What is this called?

What conditions do you see this in?

A
  • Electrical alternans = varying amplitude to QRS complexes
  • seen in Pericardial Effusion, Cardiac Tamponade
33
Q

Which types of murmurs tend to be pathologic?

A

Diastolic and continuous murmurs

–> prompts further workup with transthoracic echocardiogram

34
Q

Diagnosis? why?

A

A-fib: because

  • irregularly irregular R-R intervals
  • No discernable P-waves, and no proper isoelectric baseline
  • Narrow QRS (approx 80 ms)
35
Q

Describe CXR

Diagnosis

A

Pulmonary venous congestion occurs in patients with CHF.

Characteristic CXR findings include cardiomegaly, cephalization of pulmonary vessels with prominent vascular markings, and pleural effusions.

36
Q
A

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

37
Q

Describe CXR

Diagnosis?

A

Sarcoidosis

B/L hilar LAD

38
Q

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

A

Adrenal insuff

39
Q

Electrolyte abnormality in rhabdomyolysis?

A

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

40
Q

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?

A

Urge incontinence: “hyperactive detrusor,” or “detrusor instability”

  • Multiple sclerosis
  • Menopause
41
Q

Type of incontinence where PVRV is 300-400 mL?

A

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
42
Q

Tx for overflow incontinence

A

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!
43
Q

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

A

Catheterization

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

44
Q

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

Tx?

A

Diverticulitis

  • Tx: Bowel rest, ABX

vs Diverticulosis: mostly asympto or LLQ pain w/ painless bleeding

45
Q

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

A

Disseminated Gonorrhea

46
Q

Raloxifene MOA?

A

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

47
Q

Suspect cholecystitis in a pt, NBSM?

A

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

48
Q

60 yo-f

A

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)

SHELF EXAMS (2 decks)

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