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Cam's Cards > Internal Med Rosh Review > Flashcards

Internal Med Rosh Review Flashcards

1
Q

Describe the typical patient who has a spontaneous pneumothorax.

A

Tall thin male between 20 and 40 who smoke.

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2
Q

To which side would the mediastinum shift in a tension pneumothorax?

A

Away from the affected side.

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3
Q

What pathologic finding is associated with Parkinson disease?

A

Lewey bodies in the substantia nigra.

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4
Q

What are the hallmark features of Parkinson disease?

A

Resting tremor(pill rolling), cogwheel rigidity, bradykinesia, shuffling gait, masked facies, microphagia, postural instability.

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5
Q

In what disease is atrophy of the caudate nucleus and putamen seen in?

A

Huntington disease

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6
Q

When do the symptoms of Huntington disease usually present?

A

30-50

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7
Q

What are the hallmark features of Huntington disease?

A

Choreiform movements, cognitive and behavioral decline, dementia

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8
Q

Tua tangles in the intercellular spaces of neurons is seen in what disease?

A

Alzheimer disease

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9
Q

What sign seen in Parkinson disease is characterized by a sustained blink response to repetitive tapping over the bridge of the nose?

A

Myerson sign.

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10
Q

What is the most-likely diagnosis for a crescendo-decrescendo systolic murmur that is heard best in the right second intercostal area. The murmur decreases with the Valsalva maneuver

A

Aortic stenosis

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11
Q

What are the symptoms of aortic stenosis?

A

Exertional dyspnea, syncope, and angina.

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12
Q

What is the most appropriate therapy for symptomatic aortic stenosis?

A

Aortic valve replacement with biosynthetic valves.

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13
Q

When is percutaneous balloon valvuloplasty used to treat aortic stenosis?

A

In young and adolescent patients because it is associated with early restenosis in the elderly.

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14
Q

When is aortic valve replacement with mechanical valves indicated for aortic stenosis?

A

In patients younger than 50 who can tolerate warfarin therapy.

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15
Q

When is aortic root replacement indicated in aortic stenosis?

A

When the maximal dimension of the aortic root is >5,5cm or >5.0cm with family history of aortic dissection, or >0.5 cm increase in 1 year.

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16
Q

What is the Gallavardin phenomenon?

A

Only the high-pitched components of the murmur of aortic stenosis are heard at the apex, making the murmur sound like mitral regurgitation.

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17
Q

What is the only FDA-approved medication for the treatment of Peyronie disease?

A

Injectable collagenase Clostridium histolyticum

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18
Q

What physical exam finding is concerning for pyelonephritis?

A

Positive costovertebral angle tenderness.

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19
Q

What are two first line treatments and durations of therapy for acute uncomplicated cystitis?

A

TMP-SMX or nitrofurantoin x3-5 days

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20
Q

How many days of treatment are indicated for acute uncomplicated cystitis with comorbid conditions?

A

7 days

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21
Q

What are the treatment options and durations of therapy for acute uncomplicated cystitis in men?

A

TMP-SMX or nitrofurantoin for 7 days or a quinolone for 5 days

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22
Q

What is the treatment for reactive arthritis?

A

Prescription NSAID therapy

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23
Q

What are some common causes of reactive arthritis?

A

GI infections including Salmonella, Shigella, Yersinia, or Campylobacter.

GU infections such as Chlamydia

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24
Q

What extra-articular symptoms can be caused by reactive arthritis?

A

Conjunctivitis, uveitis, urethritis, oral lesions, skin changes

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25
Q

Which genetic marker has been linked to reactive arthritis?

A

HLA-B27.

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26
Q

What is the treatment for superficial thrombophlebitis?

A

NSAIDs, warm compresses, elevation, and compression.

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27
Q

Where is the most common location for venous stasis ulcers?

A

The medial malleolus.

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28
Q

What serious complication should be considered when correcting hypernatremia?

A

Cerebral edema

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29
Q

What serious complication should be considered when correcting hyponatremia?

A

Osmotic demyelination syndrome

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30
Q

What is the goal rate to correct hypernatremia?

A

lower serum sodium levels by 10 mEq/L in a 24-hour period

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31
Q

How often should serum sodium and glucose levels be monitored during hypernatremia correction?

A

Every two to three hours.

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32
Q

What precent of people infected with hepatitis C develop chronic hepatitis C?

A

85%

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33
Q

What are the long term consequences of chronic viral hepatitis C?

A

Cirrhosis

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34
Q

How is the diagnosis of chronic viral hepatitis C made?

A

HCV antibody followed by HCV RNA testing

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35
Q

What is the most frequent indication for liver transplantation in the United States?

A

Chronic hepatitis C virus infection.

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36
Q

What are the most common viral etiologies associated with acute pericarditis?

A

Coxsackievirus, echovirus, and cytomegalovirus.

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37
Q

What is the treatment for acute pericarditis?

A

NSAIDs or colchicine

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38
Q

What EKG findings are expected in acute pericarditis?

A

Diffuse ST segment elevation and PR segment depressions.

One week after onset, EKG usually becomes isoelectronic, and then T wave inversions may develop.

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39
Q

What are the common causes of acute pericarditis?

A

acute viral illness is #1

Other etiologies include uremia, autoimmune inflammatory processes, cancer, early-onset MI, and post-MI pericarditis (Dressler syndrome)

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40
Q

List some acute events that can cause thyroid storm?

A

Surgery, trauma, infection, acute iodine load, parturition

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41
Q

What are some clinical findings consistent with tyroid storm?

A

Tachycardia, heart failure (high output heart failure), hypotension, a fib, hyperpyrexia, agitation, physchosis, and coma.

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42
Q

What are the 5 steps of treatment for thyroid storm?

A 
Beta blockers (propanolol)
Thioamidies (PTU, methimazole)
Iodine (given after thionamide)
Glucocorticoid (hydrocortisone)
Bile acid sequesterant (Cholestyramine)
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43
Q

Name some precipitating factors for myxedema coma.

A

Infection, cold exposure, stroke, meds (amiodarone, thithium)

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44
Q

Define myxedema.

A

Thickened, non-pitting edema of skin

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45
Q

What is the common electrolyte abnormality is myxedema coma?

A

hyponatremia

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46
Q

What blood pressure medications are used in most hypertensive emergency episodes?

A

Nicardipine and labetalol

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47
Q

What are the first-line antihypertensive agents in patients with acute aortic dissection?

A

Esmolol or labetalol.

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48
Q

What medication should be coadministered with isoniazid to reduce risk of peripheral neuropathy?

A

Pyridoxine

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49
Q

What is the most important side effect of isoniazid?

A

Hepatitis.

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50
Q

What are the size requirements of induration for a positive PPD for people with no risk factors?

A

15mm

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51
Q

What are the size requirements of induration for a positive PPD for patients with HIV?

A

5mm

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52
Q

What is the gold standard test for TB?

A

Culture for acid fast bacilli

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53
Q

What is the treatment for active TB?

A

RIPE

Rifampin, Isoniazid, pyrazinamide, ethambutol

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54
Q

What is the Gorlin sign?

A

The ability to touch the tongue to the nose, which is most commonly seen in patients with Ehler-Danlos syndrome.

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55
Q

What is the recommended screening for lung cancer in patients aged 50-80 with current or former heavy history of smoking?

A

Yearly low-dose helical chest CT

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56
Q

What is the most common form of lung cancer?

A

Adenocarcinoma, which accounts for 47% of all cases.

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57
Q

What is a Pancoast syndrome?

A

A tumor in the superior sulcus of the lung causing shoulder pain and Horner syndrome

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58
Q

What is Horner syndrome?

A

Ptosis, miosis, and anhidrosis.

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59
Q

What is the first line treatment for an essential tremor?

A

Propanolol or primidone

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60
Q

What exam findings would be consistent with a finger-to-nose exam in a patient with known Parkinson disease?

A

The tremor will improve as the patient’s finger approaches the target.

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61
Q

What are the mainstays of treatment for chronic venous insufficiency?

A

Compression stocking and leg elevation

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62
Q

What vascular condition does hair loss on the distal lower extremities indicate?

A

Arterial insufficiency.

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63
Q

What is common neurologic finding in pernicious anemia?

A

Stocking-glove paresthesia

64
Q

What is the most common cause of vitamin B12 deficiency anemia?

A

Pernicious anemia

65
Q

Pica is a common complaint in what type of anemia?

A

IDA

66
Q

Where in the lungs is small cell lung cancer typically found?

A

Centrally

67
Q

Which lung cancer complications make up the SPHERE acronym?

A

Superior vena cava syndrome, Pancoast tumor, Horner syndrome, endocrine complications, recurrent laryngeal nerve compression, and effusions.

68
Q

What are common causes of a cough lasting more than four weeks?

A

Asthma, chronic obstructive pulmonary disease, angiotensin-converting enzyme inhibitor use, gastroesophageal reflux disease, and postnasal drip.

69
Q

What findings do you expect in plasma and urine osmolality for a patient with diabetes insupidus?

A

Increased plasma osmolality and decreased urine osmolality

70
Q

What medication commonly causes nephrogenic diabetes insupidus?

A

Lithium

71
Q

How is diagnosis of diabetes insipidus made?

A

Vasopressin challenge test showing >50% increase in urine osmolality and decreased urine volume

72
Q

How many hours does a patient have to be hospitalized to be diagnosed with hospital-acquired pneumonia?

A

48 hours.

73
Q

What is the class of medications for first line treatment of BPH?

A

Alpha adrenergic blockers

74
Q

What ocular complication is associated with tamsulosin use in patients undergoing cataract surgery?

A

Floppy iris syndrome.

75
Q

What is the cause of superior vena cava syndrome?

A

Obstruction of flow through the superior vena cava

76
Q

What is the most common cause of superior vena cava syndrome?

A

Malignancy

77
Q

What physical exam finding is consistent with superior vena cava syndrome?

A

Distention of chest wall veins

78
Q

What is the name of the sign for transient bilateral upper lid edema in patients with infectious mononucleosis?

A

Hoagland sign.

79
Q

What is the treatment for ventricular tachycardia in a hemodynamically stable patient?

A

Procainamide 100mg IV over 2 minutes or amiodarone 150mg IV over 10 minutes

80
Q

What is the treatment for ventricular tachycardia in a patient who is not hemodynamically stable?

A

synchronized cardioversion at 100-360 joules

81
Q

What disorder is characterized by an incomplete right bundle branch block with saddleback ST elevations that can cause sudden death, often during sleep, and is more common in Asian men?

A

Brugada syndrome.

82
Q

What neoplasm increases risk of developing myesthenia gravis?

A

A thymoma

83
Q

What are the symptoms of myasthenia gravis?

A

Proximal muscle weakness and fatiguability that improves with rest, ptosis, diplopia, blurred vision, difficulty chewing or swallowing, and respiratory muscle weakness.

84
Q

What is the physiologic cause of myasthenia gravis?

A

Antibodies against acetylcholine receptors and muscle specific tyrosine kinase

85
Q

What is the treatment of myasthenia gravis?

A

IVIg and plasmapheresis

86
Q

What is Lambert-Eaton syndrome?

A

An autoimmune neuromuscular condition associated with small cell lung cancer that causes proximal muscle weakness

87
Q

What is Lhermitte sign?

A

An electrical sensation down the back of the neck to the spine, trunk, and extremities occurring with neck flexion that is associated with multiple sclerosis.

88
Q

In DKA, potassium should be corrected before insulin administration if K is < ____.

A

3.3

89
Q

What are the five I’s of causes for DKA?

A 
Infection
Ischemia
Iatrogenic (steroids)
Insulin deficit
Intoxication/Illegeal drugs
90
Q

What is the Carvallo sign?

A

The murmur in tricuspid regurgitation becomes louder with inspiration.

91
Q

What is a common laboratory finding on a complete blood count that supports coccidioidomycosis as the cause of pneumonia?

A

Eosinophilia.

92
Q

What parts of the US is coccidioidomycosis endemic?

A

The southwest

93
Q

What is the treatment for chronic tension headaches?

A

Amitriptyline or SSRIs

94
Q

What is the appearance of strep pneumo on gram stain?

A

Gram positive cocci in pairs

95
Q

What is the appearance of H. flu on gram stain?

A

Gram negative rods

96
Q

What is lupus pernio?

A

Chronic, violaceous, raised plaques and nodules commonly found on the cheeks, nose, and around the eyes.

97
Q

What is lupus pernio pathognomonic for?

A

Sarcoidosis

98
Q

What is the criteria for metabolic syndrome?

A
  1. abdominal obesity waist >40inches for men, 35 inches for women
  2. serum triglycerides >150
  3. HDL <40 in men <50 in women
  4. BP >130/85 or on a BP medication
  5. Fasting plasma glucose >100
99
Q

Which viral condition is associated with an estimated one-third of all cases of polyarteritis nodosa?

A

Hepatits B

100
Q

Hypersensitivity vasculitis
Clinical appearance?
Dx?
TX?

A
  1. Palpable purpura
  2. Skin biopsy
  3. Prednisone
101
Q

Henoch-scholen purpura
Clinical appearance?
Dx?
TX?

A
  1. Palpable purpura, Abdominal pain, Hematuria, N/V/D
  2. Skin biopsy, rectal biopsy
  3. Prednisone supportive
102
Q

Good pasture syndrome
Clinical appearance?
Dx?
TX?

A
  1. Cough dyspnea, hemoptysis, glomerulonephritis
  2. renal or lung biopsy showing basement membrane antibodies
  3. Supportive, prednisone, cyclophosphamide, plasma
103
Q

What are all the small vessel vascular diseases?

A
  1. Good pasture
  2. Henoch-scholen
  3. hypersensitivity vasculitis
  4. granulomatosis with polyangitis
104
Q

What are the medium cell vascular diseases?

A
  1. polyarteritis nodosa
  2. Behcet disease
  3. Microscopic polyangitis
105
Q

What are the large vessel vascular diseases

A
  1. Giant cell arteritis

2. Takayasu arteritis

106
Q

Clinical findings with Polyarteritis nodosa?

A

Skin ulcers
Nephritis
Mesenteric ischemia

107
Q

Clinical findings with Behcet disease?

A
  1. Recurrent painful oral and genital ulcers

2. Uveitis, Iritis, optic neuritis

108
Q

Clinical findings of microscopic polyangitis

A

Pulmonary infiltrates

Nephritis

109
Q

What are basically the two main treatments for the vascular diseases?

A

Prednisone and cyclophosphamide

110
Q

Which serum test can be used to distinguish type 1 and type 2 diabetes mellitus?

A

C-peptide protein which can be either low or absent in type 1

111
Q

What are the three subtype for non-small cell lung cancer?

A
  1. Adenocarcinoma- most common, starts peripherally
  2. Squamous cell carcinoma- starts centrally
  3. Large cell carcinoma
112
Q

What are the two major categories for lung cancer?

A

Small cell and non-small cell.

Small cell starts centrally

113
Q

What is the management of polymyositis?

A
  1. gluccocorticoids

2. azathropine, methotrexate

114
Q

What are the clinical findings associated with polymyosistis?

A
  1. proximal muscle weakness like the shoulders and hips.
  2. Grotten papules- like a scaly rash thats symmetrical and located near MCP and IP joints
  3. Heliotrope eruption
  4. facial erythema
  5. Interstitial lung disease
115
Q

What musclar related labs will be elevated with polymyositis?

A

CK and aldolase

116
Q

What is the only diagnostic marker for polymyositis?

A

Anti-jo-1 antibodies

117
Q

Anti-La antibodies are seen in patients with?

A

lupus and Sjӧgren syndrome

118
Q

Anti-SCL-70 antibodies are considered a specific marker for?

A

the diffuse type of systemic scleroderma but can also be seen in a subset of patients with lupus. Their presence in scleroderma carries a poorer prognosis.

119
Q

Anti-double stranded DNA antibodies are antinuclear antibodies that target double-stranded DNA. They are associated with?

A

systemic lupus erythematosus, an autoimmune disorder characterized by chronic inflammation, positive ANA, and multiorgan involvement

120
Q

Rat bite lesions on x-ray are associated with? White lines of chondrocalcinosis are seen with?

A

Rat bite is gout, white lines pseudogout

121
Q

What is the most common abnormal lab finding with padget disease?

A

Elevated serum alkaline phosphatase

122
Q

High ferritin and low MCV is what?

A

Anemia of chronic disease

123
Q

High RDW, TIBC, Transferrin and low MCV is what?

A

Iron deficiency anemia

124
Q

a high Iron level, low MCV and normal everything else is what?

A

Thalassemia

125
Q

coccidioidomycosis X-ray findings that support the diagnoses?

A

unilateral infiltrates in the upper lobes and the presence of hilar or mediastinal adenopathy support the diagnosis

126
Q

How do you definitively diagnose coccidioidomycosis

A

serologic testing or cultures

127
Q

what is the characteristic rash for rocky mountain spotted fever?

A

The characteristic rash starts as a blanching and maculopapular rash that becomes petechial and begins on the wrists and ankles before spreading to the trunk

128
Q

Fill in the blanks. Transudative fluid according to the light criteria?

Plueral:serum protein _______
Pleural: serum LDH _______
Pleural: Fluid LDH _______

A
  1. <0.5
  2. <0.6
  3. <2/3 upper limit of normal
129
Q

Fill in the blanks. exudative fluid according to the light criteria?

Plueral:serum protein _______
Pleural: serum LDH _______
Pleural: Fluid LDH _______

A
  1. > 0.5
  2. > 0.6
  3. > 2/3 upper limit of normal
130
Q

Carcinoid tumors typically secrete which hormones?

A

Seretonin, ACTH, melanocyte stimulating hormome

131
Q

what is the definitive treatment for a carcinoid tumor?

A

surgery, can use octreotide to reduce symptoms

132
Q

Which part of the lung will be most severely affected by idiopathic pulmonary fibrosis?

A

The peripheral subpleural parenchyma.

133
Q

What are the clotting factors involved in the extrinsic pathway?

A

VII and III

134
Q

What clotting factors are involved in the intrinsic pathway

A

XII, XI, IX, VIII

135
Q

If the intrinsic pathway is effected will the PT or PTT be elevated?

A

The PTT (play table tennis) which is usually done inside

136
Q

If the extrinsic pathway is effected which will be prolonged? PT or PTT

A

PT (play tennis) done outside

137
Q

What is the triad for WPW?

A
  1. Delta wave
  2. Widened QRS >120ms
  3. short PR interval
138
Q

When is CT-scan for PCOS indicated?

A

When they have a GFR >60, are symptomatic with signs of autosomal dominant symptoms and have history of first degree relative with it.

139
Q

What two structures cause compression of the left renal vein in nutcracker syndrome?

A

aorta and superior mesenteric artery

140
Q

Treatment for community-acquired pneumonia in a patient with no significant comorbidities is?

A

high dose amoxicillin, doxycycline or a macrolide (azithro, clarithromycin, erythromycin)

141
Q

What is the most common organism found in aspiration pneumonia?

A

Klebsiella

142
Q

Intermittent asthma is defined as?

A

2 or less daytime episodes a week
2 or less nighttime episodes a month
use of rescue inhaler 2 or less times a week

143
Q

Mild persistent asthma is defined as?

A

More than 2 day time episodes a week but not daily,
3-4 nightly episodes a month
use of rescue inhaler more than 2 times a week

144
Q

Tx for mild persistent asthma?

A

SABA and low-dose ICS

145
Q

Moderate persistent asthma is defined as?

A

Daily daytime symptoms
nighttime symptoms more than once per week
use of rescue inhaler daily

146
Q

Tx for moderate persistent asthma?

A
  1. SABA
  2. Low/medium dose ICS
  3. LABA
147
Q

Characteristics of secondary syphillis?

A
  1. diffuse maculopapular rash on palms and soles

2. condylomata lata

148
Q

Gummas are found in where and with what disease process?

A

They are small benign tumors found in the brain, bone skin, liver or other tissue.

Associated with tertiary syphilis

149
Q

What is the only pharmacological treatment for sickle cell that has constantly shown to help improve outcomes?

A

Hydroxy urea

150
Q

How does hydroxyurea work?

A

It increases hemoglobin F and decreases Hemoglobin S

151
Q

About half of all bronchiectasis cases are secondary from what disease process?

A

cystic fibrosis

152
Q

If someones urine osmolality goes to normal after receiving desmopression would you think nephrogenic or central diabetes insipidous?

A

Central because the kidneys responded. If it was nephrogenic they dont respond to desmopression

153
Q

what is the most prevalent endemic fungal infection in the United States?

A

histoplasmosis

154
Q

Which microangiopathy is Shiga toxin-mediated and results after ingestion of undercooked ground beef contaminated with Escherichia coli

A

Hemolytic uremic syndrome

155
Q

Classic pentad of TTP

A
  1. Anemia
  2. Neurological finding
  3. Decreased platelet count
  4. Kidney injury
  5. Fever

Cam's Cards (103 decks)

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