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Rotay-shuns > Inside Jokes (Internal Med) > Flashcards

Inside Jokes (Internal Med) Flashcards

1
Q

What is Murphy’s sign?

A

RUQ tenderness on inspiration

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1
Q

A pt is on warfarin for a DVT. What is the goal INR?

A

2.0 - 3.0

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1
Q

pellagra is?

A

low vitamin b3 (niacin)

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2
Q

A1C is 8.5%. Estimated average glucose is _______?

A

197 mg/dL

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3
Q

How do you treat hepatic encephalopathy?

A

Lactulose may be given to prevent intestinal bacteria from creating ammonia, and as a laxative to remove blood from the intestines. Neomycin may also be used to reduce ammonia production by intestinal bacteria. Rifaximin, a new antibiotic, is also effective in hepatic encephalopathy.

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3
Q

Name a post renal cause of increased BUN/creatinine ratio.

A

Bilateral ureteral obstruction.

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3
Q

An A1C of greater than _______ indicates diabetes mellitus.

A

6.5%

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4
Q

Valproic Acid (Depakote) is a mood stabilizer and anti-epiletic drug. What lab value do you need to be sure to monitor on these patients?

A

Liver function tests

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4
Q

A1C is 7%. Estimated average glucose is _______?

A

154 mg/dL

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4
Q

A1C is 8%. Estimated average glucose is _______?

A

183 mg/dL

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5
Q

A 20 year patient comes into your office complaining of dyspnea on exertion, palpitations and some angina-like chest pain. He also has a hx of HTN. On PE he has an S4 as well as a harsh SEM along with precordium. What should be highest on your differential?

A

B

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6
Q

What is the Dawn phenomenon?

A

reduced tissue sensitivity to insulin from 5am-8am

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7
Q

Name a pre renal cause of an increased BUN/creatinine ratio.

A

Renal hypo perfusion

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8
Q

According to the JNC - 8 guidelines which two classes of drugs should be used first to treat HTN in the general population?

A

Thiazide Diuretic and ACE inhibitors

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9
Q

Idiopathic Dilated Cardiomyopathy results in:

A

D

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10
Q

A fasting glucose of greater than ________ indicates diabetes mellitus.

A

126 mg/dL

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11
Q

What EKG findings may be seen on a patient with a PE?

A

The limb leads may show S1Q3T3 pattern – that is a large S wave in lead I plus a large Q wave and an inverted T wave in lead III

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12
Q

A1C is 7.5%. Estimated average glucose is _______?

A

169 mg/dL

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13
Q

Name some nephrotoxins.

A

Aminoglycosides (neomycin gentamicin) Radio graphic contrast media Uric acid Myoglobinuria

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14
Q

You have a 78 year old male patient who is being treated for hypertension and was recently diagnosed with a.fib. What is his CHADS2 score? What does this score tell you? What the heck is the CHADS2 score?!

A

The CHADS2 score is a clinical prediction rule for estimating the risk of stroke in patients with non-rheumatic atrial fibrillation. C- congestive heart failure (1 pt) H- hypertension (1 pt) A- age > 75 (1 pt) D- diabetes (1 pt) S2- prior TIA, CVA or thromboembolism (2 pts) Our patient has a score of 2 (age and hypertension)

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14
Q

According to JNC-8, what is the goal BP in a patient > 18 years with diabetes or with CKD?

A

SBP < 140 and DBP < 90.

*There is no evidence demonstrating reduction in mortality with BP < 130/80 and moderate evidence that demonstrates no survival benefit when a patient is < 130/80 compared to 140/90

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15
Q

What effect does decreased urine flow have on BUN/creatinine ratio?

A

Increase

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16
Q

A patient with LVEF of 47% who experiences SOB with walking more than 100ft, has chronic peripheral edema and an S4 falls into which classification of heart failure based on the New York Heart Association Classification system?

A

Class III which carries a 20% yearly mortality rate

17
Q

What is used for heparin overdose?

A

protamine sulfate

17
Q

What is the formula to calculate eAG (estimated average glucose)?

A

(28.7 x A1C) - 46.7

19
Q

What disorder is characterized by: encephalopathy, ataxic gait and some varient of oculomotor dysfunction

A

Wernicke encaphalopathy Treat with thiamine and stop drinking!

20
Q

What is the Somogyi effect?

A

prebreakfast hyperglycemia due to a surge of counter-regulatory hormones in response to nocturnal hypoglycemia

21
Q

A1C is 10%. Estimated average glucose is _______?

A

240 mg/dL

22
Q

A pt. is on warfarin for a mechanical heart valve. What is the goal INR?

A

2.5 - 3.5

23
Q

How is anion gap calculated?

A

Na - (Cl+HCO3)

25
Q

What are the 2 most common causes of acute renal failure?

A
  1. Acute tubular necrosis secondary to ischemia (shock, sepsis, cardiac arrest) or nephrotoxins. 2. Prerenal disease with decreased renal perfusion (heart failure).
26
Q

According to the JNC 8 guidelines (these are new!) what is the goal BP in a 68 year old male with BP of 158/94?

A

SBP < 150 and DBP < 90.

*If treatment lowers their BP to < 140 and < 80 and the patient tolerates treatment well and is asymptomatic it is ok to maintain at that level

28
Q

What are the inferior limb leads?

A

II, III, AVF

29
Q

A pt. is on warfarin for atrial fibrillation. What is the goal INR?

A

2.0 - 3.0

29
Q

beriberi is?

A

low vitamin B1 (thiamine)

30
Q

What is the calculation for MAP?

A

DBP + [(SBP-DBP)/3]

32
Q

What is the Wells criteria used to assess?

A

Pulmonary embolism The Wells score:[13] clinically suspected DVT — 3.0 points alternative diagnosis is less likely than PE — 3.0 points tachycardia (heart rate > 100) — 1.5 points immobilization (≥ 3d)/surgery in previous four weeks — 1.5 points history of DVT or PE — 1.5 points hemoptysis — 1.0 points malignancy (with treatment within 6 months) or palliative — 1.0 points Traditional interpretation[8][9][14] Score >6.0 — High (probability 59% based on pooled data[15]) Score 2.0 to 6.0 — Moderate (probability 29% based on pooled data[15]) Score 4 — PE likely. Consider diagnostic imaging. Score 4 or less — PE unlikely. Consider D-dimer to rule out PE.

33
Q

What hormone is responsible for contraction of the gallbladder?

A

CCK

35
Q

A 38 year old patient presents with complains of recurrent upper abdominal pain for several weeks. He states that the pain is worse > 1 hour after eating, at night, and early in the morning. The pain is relieved with food or antacids. He has been working long hours til late some nights. He denies NSAID use, diarrhea, changes in diet, hematochezia.. He is guiac negative. What is the most likely diagnosis? Which test can be used to confirm your suspicion? What is the best course of treatment?

A
  1. PUD most likely a duodenal ulcer
  2. H. Pylori breath test (current infection) or a H. Pylori antibody test (positive for life once you have the infection)
  3. Triple therapy for 14 days with PPI, Clarithromycin, Amoxicillin
37
Q

What’s the upper limit if normal for the BUN/creatinine ratio?

A

20:1

39
Q

What is the most common cause of Gastroparesis?

A

Diabetes mellitus

40
Q

A1C is 9.5%. Estimated average glucose is _______?

A

226 mg/dL

42
Q

TCAs can have what cardiac side effect?

A

Slows conduction through the AV node

43
Q

What has a triad of: urethritis, conjunctivitis and septic arthritis?

A

Reactive arthritis (Reiter syndrome) (can’t see, can’t pee, can’t climb a tree and don’t sleep with me!)

44
Q

Would a patient with severe liver disease have a high or low blood urea nitrogen/creatinine ratio?

A

Low because of an impaired hepatic production of urea.

46
Q

A1C is 6%. Estimated average glucose is _______?

A

126 mg/dL

47
Q

How do you calculate serum osmolality?

A

2(Na+) + glucose/18 + BUN/2.8

48
Q

A1C is 9%. Estimated average glucose is _______?

A

212 mg/dL

49
Q

Which heart valves have a sub-valvular apparatus?

A

semilunar valves or the atrioventricular valves

50
Q

Which class of drug is the initial drug of choice in treating CHF?

A

ACE Inhibitors –> They reduce preload and afterload and demonstrate survival advantage

*ARBs and some Beta Blockers (carvedilol, metoprolol) also reduce mortality. Though ACE is considered first line it is likely you would be using a beta blocker in many instances as well or an ARB in those who do not tolerate ACEs

51
Q

Patient with G6PD can develop hemolytic reactions when exposed to these (4)?

A

sulfonomides, antimalarials, nitrofurontoin and dapsone

52
Q

What cancer drug can cause pulmonary fibrosis?

A

bleomycin

53
Q

A1C is 6.5%. Estimated average glucose is _______?

A

140 mg/dL

54
Q

Name 2 anticoagulants that are can be used long term in place of Coumadin and do not need to be monitored frequently?

A
  1. Apixaban (Eliquis) –> Factor Xa Inhibitor
  2. Rivaraxoban (Xerralto) –> Factor Xa Inhibitor
  3. Dabigatran (Pradaxa) –> Direct Thrombin Inhibitor
55
Q
A

Rotay-shuns (10 decks)

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