Internal Med Flashcards
1
Q
Features of Mitral Stenosis
A
Mid-diastolic murmur that doesn’t radiate towards the axilla
Opening snap is heard
The 1st heart sound is very loud
2
Q
Features of Mitral Regurgitation
A
Mid-systolic murmur that radiates towards the axilla
It is best heard over the apex
Intensity increases with the Valsalva maneuverer
3
Q
Features of atrial myxoma
A
- the most common form of primary cardiac tumors
- it can be diagnosed with echocardiography
- it can mimic mitral stenosis during physical examination
4
Q
Mechanism of action of Digoxin
A
It reversibly inhibits the Na-K ATPase enzyme. The inhibition of the sodium pump by digoxin increases intracellular sodium and increases the calcium level in the myocardial cells, causing an increased contractile force of the heart
5
Q
Crescendo angina
A
This is another name for unstable angina
6
Q
Ideal target of LDL cholesterol in a diabetic after an MI
A
< 1,8 mmol/l
7
Q
Percutaneous coronary intervention
A
PCIs may dilate the stenosis with drug-eluting balloon (DEB) dilation, and
then insert a stent.
8
Q
Thrombolysis
A
Done in the acute setting if PCI center is > 120 minutes away. Actilyse
is the agent used.
9
Q
Austin-Flint murmur
A
low-pitched rumbling heart murmur which is best heard at the cardiac apex. It is associated with severe aortic regurgitation
10
Q
Wide QRS complexes are seen in
A
A) ventricular tachycardia
B) supraventricular tachycardia with bundle branch block
C) antidromic atrioventricular reentry tachycardia (WPW-syndrome)
D) atrial flutter with bundle branch block
11
Q
What diseases cause systolic hypertension?
A
1) aortic insufficiency
2) thyreotoxicosis
3) beriberi
4) atherosclerosis
12
Q
Glycogenosis
A
This is a group of genetic disorders that cause the abnormal use and storage of glycogen in the body’s tissues
13
Q
Dressler’s syndrome
A
Dressler’s syndrome is believed to be an immune system response after damage to heart tissue or to the pericardium, from events such as a heart attack, surgery or traumatic injury
14
Q
Characteristics of mitral valve prolapse
A
1) it can cause ventricular extrasystoles
2) it can present with chest pain
3) it is common in Marfan’s sydrome
15
Q
Proarrhythmia
A
Proarrhythmia is a new or more frequent occurrence of pre-existing arrhythmias, paradoxically precipitated by antiarrhythmic therapy
16
Q
When do the levels of creatine kinase increase after an AMI?
A
The level of CK starts to elevate 3 hours after the myocardial infarction
17
Q
Action of Beta Blockers
A
β-Blockers decrease myocardial oxygen demand by reducing heart rate and contractility. They increase oxygen supply by increasing diastolic time and reducing ventricular wall stress, especially in patients with left ventricular hypertrophy.
18
Q
Types of CCB
A
- dihydropyridines–> amlodipine, nifedipine
2. Non-dihydropyridines–> diltiazem, verapamil
19
Q
Thallium perfusion scintigraphy
A
A thallium (or cardiolite) scan uses a radioactive tracer to see how much blood is reaching different parts of your heart
20
Q
Is there an apical pulse in cardiac tamponade?
A
NO!!! The apical pulse disappears
21
Q
Complications of aortic dissection
A
A) STE-ACS
B) cardiac tamponade
C) aortic valve insufficiency
D) aortic rupture
22
Q
Indications for pacemaker implantation
A
A) third-degree atrioventricular block
B) bradyarrhythmia
C) carotis sinus hyperaesthesia
23
Q
Where do you positioning the ICD electrode?
A
The right ventricle
24
Q
Causes of ascending aorta dilation
A
A) hypertension
B) chronic aortic valve insufficiency–> due to high volume oscillation
C) Marfan-syndrome
25
Warning signs of GERD
Weight loss, Anemia, Dysphagia
26
Domperidone
This is a medication used as an antiemetic, gastric prokinetic agent, and galactagogue
27
What can glucagon do at pharmacological doses?
At pharmacological doses, it relaxes the esophageal smooth muscle and the lower esophageal sphincter, promoting the spontaneous passage of an impacted food bolus
28
When is the most gastric acid produced?
This is in the gastric phase of digestion
29
Phases of food digestion
1. Cephalic phase--> phase of gastric secretion is triggered by stimulation of the taste receptors in the mouth
2. Gastric phase--> More than half of the daily amount of gastric fluids are produced after a meal
3. Intestinal phase --> stage in which the duodenum responds to arriving chyme and moderates gastric activity through hormones and nervous reflexes
30
What increases the risk of developing gastric cancer
A) anemia perniciosa
B) adenomatous polyp in the stomach
C) previous gastric surgery for ulcer
31
Ménétrier disease
This is a gastrointestinal condition characterized by overgrowth of the mucous cells (foveola) in the mucous membrane lining the stomach, causing enlarged gastric folds.
32
Stimulants that increase pepsinogen secretion
The most potent stimulus for pepsinogen release is vagal stimulation. Histamine primarily stimulates hydrochloric acid secretion but also significantly enhances pepsinogen secretion. Gastrin also enhances the secretion of pepsinogen
33
What is the most common gastric polyp?
Hyperplastic polyp
34
Characteristics of NSAID ulcers
* Relatively asymptomatic appearance, often without any complaints (silent ulcers)
* mild dyspepsic complaints
* NSAID ulcers usually appear when complications occur (bleeding and perforation).
* Typically seen in the stomach
35
What is the most common location for the gastrinoma ?
30-60% of gastrinomas are located in the pancreas.
36
Diagnosis of the Zollinger Ellison Syndrome
This is done via the secretin provocation test. This will cause an increase in the gastrin levels
37
Diagnostic methods of GERD
1) proton pump inhibitor test
2) esophageal impedance test
3) 24-hour oesophageal pH monitoring
38
Duodenal ulcer
This will typically cause pain upon fasting & can lead to pyloric stenosis
39
The effects of proton pump inhibitors
1) Proton pump inhibitors act on the H + / K + -ATPase pump.
2) PPIs significantly increase serum gastrin levels--> due to the feedback of the gastric acid inhibition
3) They are among the basic drugs for Helicobacter pylori eradication schemes.
40
What enhances the gastric secretion?
1) gastrin
2) caffeine
3) histamine
41
Treatment options for achalasia
A) diltiazem
B) pneumatic dilatation
C) nitroglycerin
D) cardiomyotomy
42
Where is most of the iron absorbed in the small intestine?
Proximal aspect
43
Where is most of the Vit B12 absorbed in the small intestine?
Distal aspect
44
In which section of the gastrointestinal tract are saturated bile acids absorbed?
Distal small intestine
45
Does dopamine cause constipation?
Yes!
46
Causes of constipation
A) tricyclic antidepressants
B) SSRI type antidepressants
C) persistent hypokalaemia
47
anti-endomysium antibody
This is found in about 90% of ppl with celiac disease
48
Dumping syndrome
This is characterized as after Billrot II. surgery, the function of regulating gastric emptying as a modifying factor is missing during eating. When patients consume a larger amount of sweets, glucose is essentially delivered directly to the intestine, which initiates insulin secretion. Relative hyperinsulinemia and low blood glucose (hypoglycaemic episodes) develop temporarily - approximately 90 to 120 minutes afterwards. Clinical symptoms include: weakness, paleness, dizziness, sweating, tachycardia.
49
cryptogen cirrhosis
This is now known as the NASH--> nonalcoholic steatohepatitis
50
What can trigger hepatic encephalopathy in severe liver cirrhosis?
A) gastrointestinal bleeding
B) aggressive diuretic therapy
C) enteral infection
D) high amount of oral protein intake
51
Benign postoperative cholestasis syndrome
This is a syndrome occurring during the postoperative days following a protracted cardiac surgery is primarily due to hypoxia and hypothermia. There may also be association with medications given pre- or post-operatively
52
Why is TIPs contraindicated in variceal bleeding?
Portocaval shunt increases the risk of hepatic encephalopathy
53
Peliosis hepatis
This is an uncommon vascular condition characterized by multiple, randomly distributed, blood-filled cavities throughout the liver. It is associated with OCP use
54
Klatskin tumor
Klatskin tumors are the most common type of cholangiocarcinoma that begins in an area called the hilum, where the left and right bile ducts join and leave the liver.
Symptoms:
Jaundice, Itching, Light colored stools and/or dark urine, Abdominal pain, Loss of appetite / weight loss, Fever, Nausea / vomiting
55
Characteristics of hepatic encephalopathy
A) confusion
B) asterixis
C) increased blood ammonia level
D) fetor (foul smell)
56
Interferon therapy side effects
influenza-like fever syndrome, leukopenia, autoimmune thyroiditis and depression
57
When are INF therapy contraindicated?
In autoimmune hepatitis
58
Characteristics of bile excretion issues
A) abdominal distension
B) a feeling of ”fullness”
C) abdominal discomfort
D) pain under the right ribs
59
What decreases the spasm of the Oddi sphincter?
1) nitrates
2) chocolate
3) cholecystokinin
60
Rotor syndrome
Occurs due to mutations in the organic anion transporters which will cause an impaired transport of bilirubin
from the blood and into the hepatocytes.
61
Labs for choleocystsis
1) increase in the white blood cell count
2) increase in the serum-amylase
3) urinalysis
4) increased direct bilirubin
62
hydrops vesicae felleae
This is also known as biliary colic. The painful, fluctuating resistance palpated during physical examination after the colic is gallbladder hydrops, that develops as a consequence of a gallstone stuck in the cystic duct
63
Caroli syndrome
a rare inherited disorder characterized by abnormal widening (dilatation) of the ducts that carry bile from the liver (intrahepatic bile ducts)
Symptoms include shaking chills and fever and the development of septic state
64
Mirizzi’s syndrome
This is defined as common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder.
Symptoms: jaundice, fever, and right upper quadrant pain.
65
Postcholecystectomy syndrome
This describes the presence of abdominal symptoms two years after a cholecystectomy
66
Diagnostic criteria for acute pancreatitis
* Ranson's prognostic criteria
* Glasgow prognostic criteria
* Apache II. prognostic criteria
* markers of the inflammatory reaction (TNF-α, IL-6, CRP etc.)
* CT findings (Balthazar-score) with contrast agent enhancement
* clinical picture
* infected necrosis
67
SPINK1 gene
It is located on chromosome 5.
| It encodes a protein called pancreatic secretory trypsin inhibitor.
68
What is an important diagnostic factor of diabetic nephropathy?
Microalbuminuria
69
Stages in the development of diabetic nephropathy
I. Hyperfiltration, hypertrophy
II. Glomerular tissue damage without clinical symptoms
III. Incipient nephropathy (microalbuminuria) IV. Overt diabetic nephropathy
V. Renal insufficiency
70
Analgesic nephropathy
This is a chronic kidney disease caused by NSAIDs
71
Risk factors for AKI
Dehydration, administration of i.v. contrast agents, drug toxicity (e.g. NSAIDs, cisplatin, aminoglycosides), elderly age, and heart failure
72
Most common type of nephrotic syndrome
minimal change disease
membranous GN
focal segmental glomerulosclerosis (FSGS) mesangiocapillary (membranoproliferative) GN
73
Types of hematuria associated with URT infections
IgA nephropathy
| Post-streptococcal GN
74
The most common causes of secondary hypertension
1. sleep apnoea syndrome
2. renoparenchymal hypertension
3. hyperaldosteronism
4. renovascular hypertension
5. thyroid gland disorders
75
Post-streptococcal glomerulonephritis
1) the serum complement level decreases
2) the serum ASO titer increases
3) oedema around the eyes can be observed
76
What are the causes of anemia in CRF?
1) decreased erytropoietin production
2) decreased iron and B12 absorption
3) uraemic toxins depressing the bone marrow
4) decreased life-span of RBC can be observed
77
Signs of CRF on ultrasound
1) the length of kidneys is 80 mm
2) hyper-reflective parenchyma
3) wave-like appearance of the surface
4) the parenchyma thickness is < 10 mm
78
Factors responsible for the development of diabetic nephropathy
1) glycation end products
2) hyperfiltration
3) genetic factors
4) decreased negative charge of the glomerular basal membrane
79
When should bacteriuria be treated in a young woman?
1) in the case of complaints suggestive of a urinary tract infection
2) in pregnancy
80
Characterises of acute tubulointerstitial nephritis
fever, maculopapular rash, arthralgia, eosinophilia, eosinophiluria, sterile pyuria, and urinary leukocyte casts may develop
81
Which of the following factors can attenuate the progression of chronic kidney disease?
1) RAAS inhibitor therapy
2) dietary protein restriction
3) regular blood pressure control
4) statin therapy
82
Are thiazide diuretics successful in CRF?
No, they are ineffective! So loop diuretics are given
83
MEN 1
This is an endocrine tumor syndrome with autosomal dominant inheritance.
The symptoms: hyperparathyroidism, pancreas neuroendocrine tumor, pituitary adenoma
84
MEN 2
Parathyroid tumors, pheochromocytoma and medullary thyroid cancer
85
Subclinical primary hypothyroidism
Normal free T4 and free T3 levels with elevated serum TSH
86
Tumor suppressor genes
MEN1
| VHL
87
Glycoprotein hormones
1) TSH (thyroid-stimulating hormone)
2) LH (luteinizing hormone)
3) hCG (human chorionic gonadotropin)
4) FSH (follicle-stimulating hormone)
88
Chromogranin A
Chromogranin A examination is used as a specific serum marker of neuroendocrine tumors. High serum chromogranin A concentration is found in carcinoid tumors, gastrinoma, insulinoma and pheochromocytoma.
89
Graves’ disease
TRAK (TSH receptor antibody)
| It is a common cause of hyperthyroidism
90
Hashimoto’s thyroiditis
Due to anti-TPO (thyroid peroxidase antibody). It starts off as a hyperthyroidism and eventually becomes hypothyroidism
91
Cushing’s disease
This is a serious condition of an excess of the steroid hormone cortisol in the blood level caused by a pituitary tumor secreting adrenocorticotropic hormone (ACTH).
92
Carney complex
This is a rare genetic disorder characterized by multiple benign tumors (multiple neoplasia) most often affecting the heart, skin and endocrine system and abnormalities in skin coloring (pigment) resulting in a spotty appearance to the skin of affected areas.
It is due to PRKAR1A (protein kinase type I regulatory subunit alpha coding gene)
93
Nelson syndrome
Nelson syndrome is a disorder characterized by abnormal hormone secretion, enlargement of the pituitary gland (hypophysis), and the development of large and invasive growths known as adenomas. It occurs in an estimated 15 to 25 percent of people who undergo surgical removal of the adrenal glands for Cushing disease.
94
The normal daily protein requirement of a healthy adult
0.8 g/body weight kg
95
Most common cause of 2nd gout
diuretic treatment
96
Urate crystal formation is promoted by:
A) decreased pH
B) decreased temperature
C) high urate level of the solution
97
Ochronosis
Ochronosis is a syndrome caused by the accumulation of homogentisic acid and its derivatives in connective tissues. It is caused by the disturbed catabolism of tyrosine (homogentisate oxidase defect, alkaptonuria). The disease results in early appearance of joint degeneration (arthrosis).
98
Prevalence of type 1 (insulin-dependent) diabetes mellitus
0.2%
99
Nutritional balance of a diabetic patient
50-60% carbohydrates, 10-20% proteins and 20-30% lipids (with less than 1/3 saturated fat)
100
How much is the daily insulin secretion in a healthy adult?
20–40 U
101
What is the distribution of prandial and basal insulin need?
Basal insulin secretion is responsible for 40%, whereas prandial secretion for the 60% of all insulin secretion.
102
How one should administer insulin in diabetic ketoacidosis?
Intravenously
103
Which of the following drives the bedtime insulin dose in a patient with type 2 diabetes?
morning fasting blood glucose level
104
How many units (U) of insulin can be found in one ml of an insulin vial in Hungary
40 (U)
105
How many units (U) of insulin can be found in one ml of an insulin penfill in Hungary
100 U
106
Hodgin III/A Ann Arbor stage
pathological lymphnodes at the neck and inguinal region without fever and weight loss
107
Therapies to prolong multiple myeloma survival
1. bortezomib, proteasome inhibitors
2. high dose melphalan with autologous
3. stem cell transplantation
thalidomide, revlimide
108
Factor XIII deficiency
an extremely rare inherited blood disorder characterized by abnormal blood clotting that may result in abnormal bleeding.
Symptoms:
1. severe bleeding tendency
2. repeated spontaneous abortions
3. increased keloid scars at surgical wounds
109
Macrocytic anemia can be found in:
anemia perniciosa
| hypothyroidism
110
Mantle cell lymphoma
1. Dense CD 20+ lymphoma so anti CD20 based intensive immunochemotherapy should be applied
2. Autologous transplant should be performed in first remission
3. Aggressive course is typical in vast majority
111
Gumprecht shadows
Gumprecht shadows : Smudge cells. These are chronic lymphocytic leukaemic cells ruptured during peripheral blood smear preparation.
112
Most frequent hereditary thrombophilia in Europe
Leiden mutation
113
Medicine that causes SLE
A) Etanercept
B) Procainamide
C) Infliximab
D) Hydralazine
114
what percent of patients with undifferentiated autoimmune diseases (NDC) develop definitive autoimmune disease?
50-60%
115
what percent of patients with undifferentiated autoimmune diseases (NDC) regress?
10-15 %
116
what percent of patients with undifferentiated autoimmune diseases (NDC) have long standing disease?
30-35%
117
Which systemic vasculitis affects the medium-sized vessels?
Kawasaki disease and Polyarteritis nodosa
118
Watermelon-stomach
GAVE (Gastric Antral Vascular Ectasia), also known as “Watermelon Stomach”, is a condition in which the blood vessels in the lining of the stomach become fragile and become prone to rupture and bleeding.
119
Dystelectasis
Improper inflation of the lungs quotations
120
At which pregnancy age is amniocentesis recommended?
15–17 weeks
121
what is the frequeny of a mutation?
<1%
122
Disorders due to trinucleotide repeats
A) fragile X syndrome
B) myotonic dystrophy
C) Huntington’s disease
D) Friedreich’s ataxia
123
At which pregnancy week is chorionic villus sampling recommended to be performed?
10–12 weeks
124
RECIST-staging system
RECIST (Response Evaluation Criteria In Solid Tumors) is used for evaluating the therapeutic response in solid tumors
125
overall response rate
ORR= CR+PR
126
Mechanism of action of irinotecan & topotecan
Inhibition of topoizomerase I. inhibitors
127
CA-15-3 tumor marker
breast cancer
128
What is the most common histological type of malignant oesophageal cancer?
Squamous cell carcinoma (80-90%)
129
Krukenberg tumor
Krukenberg tumor (metastases in the ovaries) is the result of a gastric cancer in ca. 75% of the cases, the rest is in majority a metastasis of colon cance
130
Notthingham Prognostic Index
refers to the long-term prognosis of breast cancer.
It takes account of the size of the tumor, the lymph node status, and the histological grade.
If the Nottingham Prognostic Index is below 3, we see excellent prognosis. Btw 3-5.4 is moderate & above 5.4 is a poor prognosis
131
Types of testicular cancer
1. Seminoma--> classical (typical) seminomas are more likely to occur in men between ages of 30 and 50. Spermatocytic seminomas are less common and are found more frequently in men 55 years and older.
2. Non-seminoma--> embryonal carcinoma, yolk sac carcinoma, choriocarcinoma and teratoma.
132
COPP chemotherapy protocol
cyclophosphamide, vincristine, procarbazine, prednisolone
133
Difference in treatment of non-seminomas and seminomas
Non-seminomas do not respond to radiation therapy, seminomas are characterized by radiation-sensitivity.
134
Lentigo maligna
This is an early form of melanoma in which the malignant cells are confined to the tissue of origin, the epidermis, hence it is often reported as 'in situ' melanoma
135
Ascariasis
Ascariasis is an infection of the small intestine caused by Ascaris lumbricoides, which is a species of roundworm.
136
Bernstein-test
Bernstein –test serves for the evaluation of the esophageal acid sensitivity
