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PGY-2 > Inpatient Medicine > Flashcards

Inpatient Medicine Flashcards

1
Q

Anti-Hu Antibodies

A

small cell lung carcinoma

encephalopathy/neuropathy

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2
Q

Anti-NDMA

A

encephalopathy

autoimmune or paraneoplastic

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3
Q

Hutchinson’s sign

A

vesicle on nose

may indicate ophthalomogical zoster

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4
Q

Leimerre Syndrome

A
  • septic emboli in IJV
  • sore throat, tonsillar abscess
  • fusobacterium
  • thrombophlebitis, septic pulmonary emboli, septic arthritis
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5
Q

Shingles treatment timeline

A

start if less than 72 hour or new lesions erupting

otherwise limited benefit

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6
Q

VAP

A

48-72h after endotracheal intubation

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7
Q

Definitive Infectious Endocarditis

A

2 major
1 major + 3 minor
5 minor

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8
Q

Saddle Nose in GPA

A

bone and cartilage destruction

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9
Q

Osler Nodes

A

subcutaneous violet nodules on pads of fingers and toes

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10
Q

Rhythm complications of endocarditis

A

AV or complete block, or BBB

due to paravalvular extensions

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11
Q

Janeway Lesions

A

nontender erythematous macules on palms and soles (clots in capillaries)

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12
Q

Hep C Antibody Positive w/ Positive RNA

A

acute or chronic infection

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13
Q

Hep C Antibody Positive w/ Negative RNA

A

cleared infection or false positive

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14
Q

Classic Leukomid Reaction

A

WBC more than 50k, early precursors

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15
Q

HAP- Risk Factors for MRSA

A
  • IV antibiotic use in last 90 days
  • Hospital w/ more than 20% MRSA isolates
  • High risk for mortality
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16
Q

Acute DHF, preload reduction

A

diuretics

nitrates

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17
Q

When to consider cardioverter-defibrillator (ICD) in HF

A

EF at or below 35%

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18
Q

HF in African americans, consider…

A

hydralazine isosorbide dinitrate

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19
Q

Cardiac resynchronization therapy in HF

A

ef below 35% + QRS more than 120 + LBBB

or 150 w/o LBBB

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20
Q

Causes of hypovolemic hyponatremia - RENAL

A

Nephropathies

ATN recovery

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21
Q

Causes of hypovolemic hyponatremia - NONRENAL

A

Dehydration

Vomiting/Diarrhea

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22
Q

MEN type 1

A

parathyroid, pancreatic islet cell tumors, pituitary tumors

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23
Q

Men type IIA

A

MTC
pheo
hyperparathyroidism

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24
Q

Men type IIB

A

MTC
mucosal neuromas
marfonid like habitus
pheo

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25
Q

Aspergillus- clinical syndromes

A

allergic bronchopulmonary aspergillus
pulmonary aspergilloma (fungus ball)
invasive aspergillus

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26
Q

air cresent sign =

A

aspergillus fungal ball

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27
Q

Aspergillus Rx

A

IV amph or vori

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28
Q

Cryptococcus Rx

A

fluconazole for mild

severe: amph+flucytosine x 2 weeks then fluconazole

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29
Q

Cryptococcal Meningitis

A

india ink w/ encapsulated organisms

latex agglut w/ cryptococcal antigen

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30
Q

Pigeon Dropings

A

cryptococcus

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31
Q

Histoplasmosis Rx

A

PO itraconazole

Amph B if severe

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32
Q

Differential of High Ferritin

A

HLH - hemophagocytic lymphohistoryctosis
Hemochromatosis
Still’s Disease

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33
Q

Thrombotic Thombocytopenia Purpura

A

Fever, AMS, thrombocytopenia, AKI, MAHA

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34
Q

Most common form of erythema multiforme

A

HSV

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35
Q

Hepatopulmonary Syndrome

A

platypnea
orthodeoxia
dx w/ echo w/ bubble to see transplumonary shunting

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36
Q

treatment myxedema coma

A

IV steroids

IV synthroid

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37
Q

thyroid storm treatment

A

propranolol
PTU or methimazole
steroids

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38
Q

Diagnosis of Cryptococcoal Pneumonia

A

culture in immunocompetent persons

serum antigen in immunocompromised

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39
Q

Adrenal Incidentaloma workup

A
  • BMP for glucose, potassium
  • Low dose cortisol stimulation test
  • consider PRA/PAC if HTN or hypokalemia
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40
Q

Erhlichiosis tick

A

lone star tick

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41
Q

Erhlichiosis possible lab abnormalities

A

leukopenia, thrombocytopenia
transaminitis
peripheral blood smear- buffy coat

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42
Q

rocky mountain spotted fever rash

A

maculopapular 4 days following exposure
progresses to petechiae or purpura
starts and wrists and ankles, spreads centrally and to palms and soles

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43
Q

E/e’ ratio

A

greater than or equal to 15 in DHF

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44
Q

E/A

A

greater than 2

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45
Q

hematuira

A

greater than 3 RBC

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46
Q

Loop diuretic side effects

A

OH DANG

Ototoxicity, hypokalemia, dehyadration, allergy (sulfa), Nephritis (AIN), Gout

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47
Q

Mentzer Index

A

MCV/RBC

more than 13 - IDA

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48
Q

myxedema coma treatment

A

IV synthroid

IV steroids

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49
Q

HIT treatment

A

Direct thrombin inhibitors

Factor Xa inhibitor

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50
Q

Contraindications to TIPS

A

pulmonary HTN, heart failure

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51
Q

Main Indications for TIPS w/ data that shows efficacy

A

recurrent/uncontrolled variceal bleeding

refractory ascites

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52
Q

Hydralazine + CAD/Angina

A

increases arterial vasoconstriction –> worsening chest pain

use in combination with nitrate

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53
Q

Susceptibility of Clindamycin

A

check if organism is susceptible to erythromycin

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54
Q

Autoimmune Pancreatitis- IgG

A

IgG4

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55
Q

transmission of hepatitis B and C

A

B: paraenterally, sexually, perinatal
C: parenterally&raquo_space;> sexually + perinatal

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56
Q

Acute Liver Failure Definition

A

coagulopathy + encephalopathy

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57
Q

When to fluid restrict cirrhortics

A

if sodium less than 130 (dilutional hyponatremia) and/or ascites

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58
Q

Cirrhosis, ratio of spirolactone and lasix

A

40mg:100mg

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59
Q

Indications to discontinue BB in cirrhosis

A

SBP less than 90
Na less than 120
AKI

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60
Q

Treatment of Varices

A

IV antibiotics, ceftriaxone

IV octreotide

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61
Q

Variceal Prevention with beta blockers

A

primary and secondary prevention

window period is with mod-to-large varices w/o bleeding

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62
Q

SBP Organisms

A

E coli
Strep Pneumo
Klebsiella

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63
Q

SBP Diagnosis

A

PMN > 250

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64
Q

SBP Treatment

A

third generation cephalosporin

albumin to prevent HRS on d1 and d3

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65
Q

Stigmata of Liver Disease

A

caput medusa
spider angiomas
gynecomastia
palmar erythema

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66
Q

Lung Cancer- Common Metasasis

A

Brain
Bone
Adrenal Glands Liver

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67
Q

Nerve Palsies associated with lung cancer

A

phrenic nerve: hemidiaphragmatic paralysis

Recurrent laryngeal nerve: hoarseness

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68
Q

Horner Syndrome

A

apical tumor invading CERVICAL SYMPATHETIC chain
Anhidrosis (no sweating)
Miosis
Ptosis

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69
Q

Pancoast Tumor

A

Tumor of C8, T1-T2 nerve roots
Shoulder/arm pain, UE weakness
+/- Horner Syndrome

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70
Q

Paraneoplastic Syndromes associated with lung cancer

A

Small cell: ACTH, SIADH

NSCLC/Squamous: PTH

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71
Q

Hypertrophic pulmonary osteoarthropathy

A

bone pain, associated with SCC

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72
Q

Eaton-Lambert Syndrome

A

small cell lung cancer

similar to MG, muscle weakness, decreased deep tendon reflexes

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73
Q

Risk Factors for Pancreatic Cancer

A

Smoking&raquo_space;>
Chronic Pancreatitis
Alcohol

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74
Q

Syndromes associated with Pancreatic Cancer

A

Migratory thrombophlebitis

Courvoisier sign

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75
Q

Aldosterone: what causes excretion, function

A
  • Stimulated by angiotensin (RAAS)
  • Acts on distal tubules and collecting ducts
  • Reabsorb Na
  • Excretion of K
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76
Q

RAAS activated by

A

low sodium

low blood pressure (decreased RBF)

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77
Q

ACE

A

converts angiotensin I to angiotensin II

78
Q

Plasma Osmolality in DI vs Primary Polydipsia

A

PP: 255-280
DI:280-310

79
Q

Most common cause of nephrogenic DI

A

lithium use

80
Q

Cushing Disease =

A

ACTH-secreting adenoma of pituitary
high cortisol, high ACTH, no suppression w/ low dose,
suppression w/ high dose

81
Q

Low Dose Dexamethasone Testing

A

initial screening test for CS
1mg dex at 11pm; measure cortisol next morning at 8am
Normal response is cortisol <5
High normal = CUSHING SYNDROME

82
Q

High Dose Dexamethasone Testing

A

8mg after 11pm, measure cortisol at 8am
low cortisol = Cushing Disease
normal/high = Adrenal Cushings or Ectopic ACTH

83
Q

Anterior MI- leads and vessel

84
Q

Lateral MI- leads and vessel

A

I, avL, V5-V6

left circumflex

85
Q

Inferior MI- leads and vessel

A

II, III, avf

RCA > LCX

86
Q

Septal MI- leads and vessel

A

VI, V2

LAD

87
Q

Normal Axis in EKG

A

positive in I and AVF

88
Q

LAD in EKG

A

positive in I, negative in AVF

89
Q

RAD in EKG

A

negative in I, positive in AVF

90
Q

Extreme RAD in EKG

A

negative in I and aVF

91
Q

Acute onset atrial fibrillation IV medications

A

metoprolol 5mg, repeat x1

dilt 10mg

92
Q

P2Y12 Blockers in STEMI

A

PCI- ticagrelor or prasugrel
Fibrinolytics- clopidogrel
No intervention- ticagrelor

93
Q

DAPT following Stents

A

DES: 1 year

Bare Metal: 1 year for ACS, 1 month for non-ACS

94
Q

Sensitivity, mnemonic

A

SNOUT:

high sensitivity rules out a disease

95
Q

Specificity, mnemonic

A

SPIN: high specificity to rule IN a disease

96
Q

LIver Disease with extremely elevated AST, ALT ddx

A

Viral hepatitis
Toxins
Shock Liver
Autoimmune

97
Q

Albumin/Cr Ratio in DM

A

less than 30 - normal A1
A2 - 30-300
A3 300+

98
Q

Non di hydropyridine CCB

A

verapamil, dilt

99
Q

Thiazide and CKD

A

ineffective when GFR less than 30

100
Q

ACEI and Cr

A

initial 30% decrease

101
Q

HIV screen in CAP pts

A

all pts 13-75

102
Q

MM Symptoms

A 
CRAB HIP
Hypercalcemia, renal failure, anemia, bone lesions or bence jones proteinuria
Hyperviscotity
Infection
Plasmacytosis
103
Q

CHADSVASC - when to consider anticoag

A

1 - consider (unless just female)

2 - recommend

104
Q

Wernicke encephalopathy triad

A

delirium
oculomotor disturbances
ataxia

105
Q

Thiamine def can cause

A

neuropathy
cardiomyopathy
Wernicke’s

106
Q

Choice for asymptomatic HTN

A

PO hydra 10
PO clonidine .1 mg
PO lasix

107
Q

HTN Emergency- End organ damage

A 
pulm edema
encephalopathy
MI
Retinopathy
Renal failure
108
Q

ACS therapy

A

MOAN: nitro, aspirin, o2, morphine

consider BMOAANS: bb, ACEI, statin

109
Q

cardiac tamponade

A

hypotension
pulsus paradoxus
elevated JVP

110
Q

Spirolactone in HF

A

Systolic, Class III or IV

CI in renal failure

111
Q

BB and heart failure

A

reduce mortality w/ POST MI heart failure

112
Q

Hypervolemic Hyponatremia - RENAL

113
Q

Hypervolemic Hyponatremia - NONRENAL

A

CHF
Ascites/CIrrhosis
(increased RAS/Aldo)

114
Q

Causes of Euvolemic Hyponatremia

A 
SIADH
Addison's
Hypothyroidism
Beer Potamania
Psychognic Polydypsia
HCTZ/meds/diuretics
115
Q

Hyperparthyroidism symtpoms

A

stones - nephrolithiasis
bones - aches, pains, osteitis fibrosa cystica
groans - muscle pain, weakness, pancreatitis, PUD, gout, constipation
psych overtones - fatigue, dperesseion etc

116
Q

Diverticulosis imaging

A

barium enema

117
Q

Diverticulitis imaging

A

CT w/ contrast

118
Q

Acute Mesenteric Ischemia imaging

A

mesenteric angiography

119
Q

CAP diagnosis

A

new infiltrate + 2 symptoms consistent with PNA

120
Q

Prinzmetal

A

coronary vasospasm
transient ST elevation
treat w CCB

121
Q

Spinal Stenosis

A

narrowing of spine due to deg changes
neurogenic claudication
broad base gait

122
Q

neurogenic claudication

A

leg buttock pain
worse w/ walking
relieved with sitting
improves with forward flexion/leaning on grocery cart

123
Q

SBP Prevention

A

Cipro weekly or nofloxacin daily

124
Q

Virchow’s triad

A

endothelial injury
venous stasis
hypercoagability

125
Q

MGUS diagnosis

A

less than 10% plasma cells

no end organ damage

126
Q

MM diagnosis

A

10%+ plasma cells + 1 of the following

  • bone lesions
  • M protein in urine
  • M protein in serum
127
Q

MM Ig Spike

A

IgG or IgA

128
Q

Waldenstrom’s Macroglobulinemia

A

malign prolif of plasmacytoid lymphocytes
IgM para protein
hyperviscoity

129
Q

Most common pancreatitis complications

A
  • necrosis
  • pseudocyst
  • hemorrhagic pancreatitis
130
Q

Grey Turner’s Sign

A

flank ecchymoses, pancreatitis

131
Q

Cullen’s Sign

A

periumbilical ecchymoses, pancreatitis

132
Q

Fox’s Sign

A

ecchymosis of inguinal ligament, pancreatitis

133
Q

Thiamine supplementation in hospitalized alcholics

A

100mg daily

thiamine prior to IV infusion to prevent precipitation of Wernicke

134
Q

Aortic Stenosis symptoms

A

syncope
angina
DOE

135
Q

Aortic Stenosis Murmur

A

mid SEM, RSB, radiates to right neck

early peaking less severe, late peaking more severe

136
Q

Diastolic Heart Failure on Echo

A

E/e’ more than 15 (elevated LAP, elevated PCWP)

E/e’ more than 8 and BNP >200

137
Q

CRP in monitoring IBD

A

associated more with TRANSMURAL than mucosal inflammation

138
Q

Boerhaave’s Syndrome

A

acute chest pain following vomiting (esophageal perforation)

139
Q

Peritonitis vs Renal Colic

A

lying still vs writhing around

140
Q

achalasia

A

LES doesn’t relax

141
Q

abnormal ABI

A

less than 0.9

142
Q

severe seborrheic dermatitis with what diseases

143
Q

Ecthyma gangrenosum

A

Pseudomonas infection

hemorrhage, ulceration, necrosis

144
Q

Duke Major Criteria

A

1) Positive blood cultures

2) Echo w/ vegetation, abscess, dehiscence of prosthetic valve or new valvular regurg

145
Q

Minor Duke Criteria

A 
Predipsoition
Fever
Vascular Phenomena
Immunologic Phenomena
Microbiologic Evidence
146
Q

IE Immunologic phenomena

A

GN
osler nodes
roth spots
RF

147
Q

IE Vascular phenomena

A 
arterial emboli
pulmonary infarcts
mycotic aneurysm
ICH
conjunctival hemorrhage
Janeway lesions
148
Q

Time for HIV EIA to become positive

149
Q

Hydromorphone, ratio to morphine

A

1mg = 7mg morphine

150
Q

Tramadol risks

A

seizures, serotonin syndrome

151
Q

When to treat asymptomatic HTN

A

multiple readings >180/110

152
Q

anemia of chronic dz

A

hepcidin-induced block on iron release from stores

153
Q

Acute Mesenteric Ischemia Causes

A
  • arterial thrombus (arteriosclerosis)
  • Venous thrombus (hypercoagulable)
  • arterial occlusion from emboli
  • hypoperfusion (blood loss, CHF)
154
Q

AMI treatment

A

fluid resuscitation, NG tubes, IV antibiotics

embolectomy + thrombolytic agent

155
Q

CMI - classic age

156
Q

CMI - vessels

A

celiac trunk
SMA
IMA

157
Q

CMI - symptoms

A

post-prandial pain

weight loss, N/V diarrhea

158
Q

Kerley B lines

A

thin pulmonary opacities caused by fluid in the interstitium of the lung

159
Q

anterior mediastinal mass

A

lymphoma
thyoma
thoracic aorta
teratoma

160
Q

Choledocholithiasis

A

gallstole impacted in CBD

ERCP, no antibiotics

161
Q

Diverticulitis- antibiotics

A

GN + anerobes

Cipro + flagyl

162
Q

Pulm HTN pathophys

A

increased pulmonary arterial pressure leads to RV dysfxn

163
Q

Diagnostic Criteria for Pulm HTN

A

pulm arterial pressure >25

164
Q

HIT - antibody

A

IgG aginst PF4 on platelets

165
Q

Drugs associated with interstitial lung disease

A

amiodarone
nitrofuratonin
izoniazide

166
Q

When to consider measuring alpha-1 levels

A

less than 50 with emphysema

167
Q

COPD - acid base status in long term

A

respiratory acidosis w/ metabolic alkalosis as compensation

168
Q

Criteria for oxygen supplementation in COPD

A

o2 less than 88%

or PaO2 55

169
Q

Budd-Chiari Syndrome

A

occlusion of hepatic venous outflow –> ischemia

170
Q

Bigeminy

A

sinus beat followed by PVC

171
Q

trigeminy

A

two sinus beats followed by PVC

172
Q

couplet

173
Q

Pericarditis - EKG

A

diffuse ST elevation and PR depression

174
Q

Types of Stroke

A
  • Embolic
  • Thrombotic
  • Lacunar Stroke
175
Q

Embolic stroke

A

embolis from heart w/ a fib

paradoxical (blood clots in peripheral veins, go through ASD/PFO or pulm AVF)

176
Q

Thrombotic Stroke

A

atherosclerotic lesions in large arteries

177
Q

Lacunar Stroke

A

small vessel thrombotic disease (basal ganglia, thalamus, brain stem, etc)
HTN is main RF

178
Q

Polymyalgia Rheumatic Symptoms

A

hip and shoulder muscle pain
normal muscle strength
+/- systemic symptoms, joint pain

179
Q

Pre-renal AKI urine analysis

A 
hyaline cases 
BUN/Cr ratio >20:1
Fena <1%
Urine osm >500
Urine Na <20
180
Q

Intrinsic Renal AKI urine analysis

A

Bun/cr <20:1
FeNa 2-3%+
Urine osm 250-300
Urine Na >40

181
Q

Causes of Intrinsic Renal Disease

A

Tubular (ATN)
Glomerular
Vascular (RAoccl, TTP, HUS)
Intersitital (AIN)

182
Q

Causes of ATN (two categories)

A

Ischemic (severe decline in renal blood flow)

Nephrotoxic

183
Q

ATN phases

A

onset
oliguric phase
diuretic phase
recovery phase

184
Q

Muddy brown casts

185
Q

RBC casts

A

glomerular disease

186
Q

WBC casts

A

pyelo or AIN

187
Q

Polyarteritis Nodosa

A

vasculitis associated with hep B, HIV, drug reactions

often involves nervous system, GI tract (bowel angina)

188
Q

Pancolitis Ddx

A

IBD
Infectious - E coli
Ischemia - hypotension or drugs

189
Q

Vasculitis (small vs medium vs large)

A

Small: Palpable Purpura
Medium: Thrombosis/Infarction
Large: Pulseless

190
Q

Factors for Complicated UTI

A

Flank pain, CVA tenderness

Systemic symptoms- fever, chills

191
Q

Central Vein Stenosis

A

vein dilation –> chronic edema, recurrent infections after HD catheter placement

PGY-2 (21 decks)

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