IM essentials

Question 1

Goal SBP for a pt >60 being tx for HTN

Answer 1

<150/90

Question 2

Echo - asymmetric basal and midseptal hypertrophy, thick septum, increased LV outflow tract gradient

Answer 2

Hypertrophic cardiomyopathy
high risk pts need ICD
High risk RF’s: Fhx of sudden cardiac death in first degree relative, significant LV wall thickening
Doesn’t matter if symptomatic or not

Question 3

p waves not followed by QRS

Answer 3

Second degree AV block
Type I - Wenckeback (progressive prolongation of PR interval until beat drop)
Type II - Morbitz (constant PR interval with dropped beats)
Can be caused by combo of atenolol and diltizaem (decrease conduction w/in AV node)

Question 4

acute management of afib in symptomatic but hemodynamically stable

Answer 4

Rate control w/ B block or CCB (diltiazem)

Question 5

Pt w/ AV replacement has new dyspnea. Which PE finding would suggest prosthetic valve dysfunction?

Answer 5

New diastolic murmur

Suggests aortic regurg

Question 6

Tx for HF s/t perpipartum cardiomyopathy

Answer 6

Systolic HF

ACEI (postpartum only), Bblock, spronolactone

Question 7

EKG with three or more P waves morphologic patterns and variable P-R intervals in a pt with lung dz

Answer 7

Multifocal atrial tachycardia

Often see in lung dz or electrolyte abn

Question 8

Opening snap follwed by diastolic rumble. Loud S1

Answer 8

Mitral stenosis

Question 9

CHF w/ LV dysfunction should be tx w/?

Answer 9

Bblocker

Question 10

What study do you order first for suspected DVT?

Answer 10

Ddimer

Question 11

Management for symptomatic PVC’s

Answer 11

Bblock

Question 12

HTN
HA
Palpitations
Diaphoresis

Answer 12

Pheo
tumor of chromaffin cells -> over produce NE, epi, DA
Originate in the adrenals

Question 13

Flushing

hypotension

Answer 13

Carcinoid

Question 14

Pt on hydrocortisone for adrenal insufficiency gets a URI. How do you manage?

Answer 14

Increase dose of hydrocortione during even minor intercurrent illness x 3 days

Question 15

USPTF recommendaitn on DEXA scans

Answer 15

Women 65 +

Younger women w/ fx risk

Question 16

HTN

Hypokalemia

Answer 16

Hyperaldosteronism

Measure aldosterone:renin activity

Question 17

TSH <10

T4 WNL

Answer 17

Sub clinical hypothyroid

Repeat study in 6 months

Question 18

Testing for incidental adrenal gland mass

Answer 18

O/n dexamethasone suppression test (cushing)
24 hour metanephrines (pheo)
Measure renin:aldosterone (aldosteronoma)
10% of incidentalomas are functional

Question 19

Insulin therapy in hyperlgycemic hyperosmolar syndrome

Answer 19

IV insulin drip (not bolus)
IV faster onset than sub Q
t1/2 = 9 min

Question 20

How do you manage a pt w/ hypothyroidism that is in the first trimester?

Answer 20

Levothyroxine requirements are increased by 30-50% in preggos w/ hypothyroidism

Question 21

PT is on glyburide and metformin and having episodes of dizziness etc. A1C 6%

Answer 21

Stop the glyburide, she is probably having hypoglycemic episodes

Question 22

high TSH

+ thyroid peroxidase

Answer 22

Hashimoto thyroiditis

Start levothyroxine

Question 23

T1DM should have which screening after puberty?

Answer 23

Lipid panel

Question 24

When do you start a bisphosphanate?

Answer 24

10 yr fx risk is 20% or >

OR risk of hip fx over the next 10 years is 3% or greater

Question 25

Amenorrhea

Galactorrhea

Answer 25

Get a Sr prolactin

Question 26

Elevated indirect bili after surgery, stress

Answer 26

Gilbert

Question 27

Malaise
Jaundice
LFT’s up to 15x NL

Answer 27

Viral hepatitis