Internal Med Rosh Review Flashcards
Describe the typical patient who has a spontaneous pneumothorax.
Tall thin male between 20 and 40 who smoke.
To which side would the mediastinum shift in a tension pneumothorax?
Away from the affected side.
What pathologic finding is associated with Parkinson disease?
Lewey bodies in the substantia nigra.
What are the hallmark features of Parkinson disease?
Resting tremor(pill rolling), cogwheel rigidity, bradykinesia, shuffling gait, masked facies, microphagia, postural instability.
In what disease is atrophy of the caudate nucleus and putamen seen in?
Huntington disease
When do the symptoms of Huntington disease usually present?
30-50
What are the hallmark features of Huntington disease?
Choreiform movements, cognitive and behavioral decline, dementia
Tua tangles in the intercellular spaces of neurons is seen in what disease?
Alzheimer disease
What sign seen in Parkinson disease is characterized by a sustained blink response to repetitive tapping over the bridge of the nose?
Myerson sign.
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
Aortic stenosis
What are the symptoms of aortic stenosis?
Exertional dyspnea, syncope, and angina.
What is the most appropriate therapy for symptomatic aortic stenosis?
Aortic valve replacement with biosynthetic valves.
When is percutaneous balloon valvuloplasty used to treat aortic stenosis?
In young and adolescent patients because it is associated with early restenosis in the elderly.
When is aortic valve replacement with mechanical valves indicated for aortic stenosis?
In patients younger than 50 who can tolerate warfarin therapy.
When is aortic root replacement indicated in aortic stenosis?
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.
What is the Gallavardin phenomenon?
Only the high-pitched components of the murmur of aortic stenosis are heard at the apex, making the murmur sound like mitral regurgitation.
What is the only FDA-approved medication for the treatment of Peyronie disease?
Injectable collagenase Clostridium histolyticum
What physical exam finding is concerning for pyelonephritis?
Positive costovertebral angle tenderness.
What are two first line treatments and durations of therapy for acute uncomplicated cystitis?
TMP-SMX or nitrofurantoin x3-5 days
How many days of treatment are indicated for acute uncomplicated cystitis with comorbid conditions?
7 days
What are the treatment options and durations of therapy for acute uncomplicated cystitis in men?
TMP-SMX or nitrofurantoin for 7 days or a quinolone for 5 days
What is the treatment for reactive arthritis?
Prescription NSAID therapy
What are some common causes of reactive arthritis?
GI infections including Salmonella, Shigella, Yersinia, or Campylobacter.
GU infections such as Chlamydia
What extra-articular symptoms can be caused by reactive arthritis?
Conjunctivitis, uveitis, urethritis, oral lesions, skin changes
Which genetic marker has been linked to reactive arthritis?
HLA-B27.
What is the treatment for superficial thrombophlebitis?
NSAIDs, warm compresses, elevation, and compression.
Where is the most common location for venous stasis ulcers?
The medial malleolus.
What serious complication should be considered when correcting hypernatremia?
Cerebral edema
What serious complication should be considered when correcting hyponatremia?
Osmotic demyelination syndrome
What is the goal rate to correct hypernatremia?
lower serum sodium levels by 10 mEq/L in a 24-hour period
How often should serum sodium and glucose levels be monitored during hypernatremia correction?
Every two to three hours.
What precent of people infected with hepatitis C develop chronic hepatitis C?
85%
What are the long term consequences of chronic viral hepatitis C?
Cirrhosis
How is the diagnosis of chronic viral hepatitis C made?
HCV antibody followed by HCV RNA testing
What is the most frequent indication for liver transplantation in the United States?
Chronic hepatitis C virus infection.
What are the most common viral etiologies associated with acute pericarditis?
Coxsackievirus, echovirus, and cytomegalovirus.
What is the treatment for acute pericarditis?
NSAIDs or colchicine
What EKG findings are expected in acute pericarditis?
Diffuse ST segment elevation and PR segment depressions.
One week after onset, EKG usually becomes isoelectronic, and then T wave inversions may develop.
What are the common causes of acute pericarditis?
acute viral illness is #1
Other etiologies include uremia, autoimmune inflammatory processes, cancer, early-onset MI, and post-MI pericarditis (Dressler syndrome)
List some acute events that can cause thyroid storm?
Surgery, trauma, infection, acute iodine load, parturition
What are some clinical findings consistent with tyroid storm?
Tachycardia, heart failure (high output heart failure), hypotension, a fib, hyperpyrexia, agitation, physchosis, and coma.
What are the 5 steps of treatment for thyroid storm?
Beta blockers (propanolol) Thioamidies (PTU, methimazole) Iodine (given after thionamide) Glucocorticoid (hydrocortisone) Bile acid sequesterant (Cholestyramine)
Name some precipitating factors for myxedema coma.
Infection, cold exposure, stroke, meds (amiodarone, thithium)
Define myxedema.
Thickened, non-pitting edema of skin
What is the common electrolyte abnormality is myxedema coma?
hyponatremia
What blood pressure medications are used in most hypertensive emergency episodes?
Nicardipine and labetalol
What are the first-line antihypertensive agents in patients with acute aortic dissection?
Esmolol or labetalol.
What medication should be coadministered with isoniazid to reduce risk of peripheral neuropathy?
Pyridoxine
What is the most important side effect of isoniazid?
Hepatitis.
What are the size requirements of induration for a positive PPD for people with no risk factors?
15mm
What are the size requirements of induration for a positive PPD for patients with HIV?
5mm
What is the gold standard test for TB?
Culture for acid fast bacilli
What is the treatment for active TB?
RIPE
Rifampin, Isoniazid, pyrazinamide, ethambutol
What is the Gorlin sign?
The ability to touch the tongue to the nose, which is most commonly seen in patients with Ehler-Danlos syndrome.
What is the recommended screening for lung cancer in patients aged 50-80 with current or former heavy history of smoking?
Yearly low-dose helical chest CT
What is the most common form of lung cancer?
Adenocarcinoma, which accounts for 47% of all cases.
What is a Pancoast syndrome?
A tumor in the superior sulcus of the lung causing shoulder pain and Horner syndrome
What is Horner syndrome?
Ptosis, miosis, and anhidrosis.
What is the first line treatment for an essential tremor?
Propanolol or primidone
What exam findings would be consistent with a finger-to-nose exam in a patient with known Parkinson disease?
The tremor will improve as the patient’s finger approaches the target.
What are the mainstays of treatment for chronic venous insufficiency?
Compression stocking and leg elevation
What vascular condition does hair loss on the distal lower extremities indicate?
Arterial insufficiency.
What is common neurologic finding in pernicious anemia?
Stocking-glove paresthesia
What is the most common cause of vitamin B12 deficiency anemia?
Pernicious anemia
Pica is a common complaint in what type of anemia?
IDA
Where in the lungs is small cell lung cancer typically found?
Centrally
Which lung cancer complications make up the SPHERE acronym?
Superior vena cava syndrome, Pancoast tumor, Horner syndrome, endocrine complications, recurrent laryngeal nerve compression, and effusions.
What are common causes of a cough lasting more than four weeks?
Asthma, chronic obstructive pulmonary disease, angiotensin-converting enzyme inhibitor use, gastroesophageal reflux disease, and postnasal drip.
What findings do you expect in plasma and urine osmolality for a patient with diabetes insupidus?
Increased plasma osmolality and decreased urine osmolality
What medication commonly causes nephrogenic diabetes insupidus?
Lithium
How is diagnosis of diabetes insipidus made?
Vasopressin challenge test showing >50% increase in urine osmolality and decreased urine volume
How many hours does a patient have to be hospitalized to be diagnosed with hospital-acquired pneumonia?
48 hours.
What is the class of medications for first line treatment of BPH?
Alpha adrenergic blockers
What ocular complication is associated with tamsulosin use in patients undergoing cataract surgery?
Floppy iris syndrome.
What is the cause of superior vena cava syndrome?
Obstruction of flow through the superior vena cava
What is the most common cause of superior vena cava syndrome?
Malignancy
What physical exam finding is consistent with superior vena cava syndrome?
Distention of chest wall veins
What is the name of the sign for transient bilateral upper lid edema in patients with infectious mononucleosis?
Hoagland sign.
What is the treatment for ventricular tachycardia in a hemodynamically stable patient?
Procainamide 100mg IV over 2 minutes or amiodarone 150mg IV over 10 minutes
What is the treatment for ventricular tachycardia in a patient who is not hemodynamically stable?
synchronized cardioversion at 100-360 joules
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?
Brugada syndrome.
What neoplasm increases risk of developing myesthenia gravis?
A thymoma
What are the symptoms of myasthenia gravis?
Proximal muscle weakness and fatiguability that improves with rest, ptosis, diplopia, blurred vision, difficulty chewing or swallowing, and respiratory muscle weakness.
What is the physiologic cause of myasthenia gravis?
Antibodies against acetylcholine receptors and muscle specific tyrosine kinase
What is the treatment of myasthenia gravis?
IVIg and plasmapheresis
What is Lambert-Eaton syndrome?
An autoimmune neuromuscular condition associated with small cell lung cancer that causes proximal muscle weakness
What is Lhermitte sign?
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.
In DKA, potassium should be corrected before insulin administration if K is < ____.
3.3
What are the five I’s of causes for DKA?
Infection Ischemia Iatrogenic (steroids) Insulin deficit Intoxication/Illegeal drugs
What is the Carvallo sign?
The murmur in tricuspid regurgitation becomes louder with inspiration.
What is a common laboratory finding on a complete blood count that supports coccidioidomycosis as the cause of pneumonia?
Eosinophilia.
What parts of the US is coccidioidomycosis endemic?
The southwest
What is the treatment for chronic tension headaches?
Amitriptyline or SSRIs
What is the appearance of strep pneumo on gram stain?
Gram positive cocci in pairs
What is the appearance of H. flu on gram stain?
Gram negative rods
What is lupus pernio?
Chronic, violaceous, raised plaques and nodules commonly found on the cheeks, nose, and around the eyes.
What is lupus pernio pathognomonic for?
Sarcoidosis
What is the criteria for metabolic syndrome?
- abdominal obesity waist >40inches for men, 35 inches for women
- serum triglycerides >150
- HDL <40 in men <50 in women
- BP >130/85 or on a BP medication
- Fasting plasma glucose >100
Which viral condition is associated with an estimated one-third of all cases of polyarteritis nodosa?
Hepatits B
Hypersensitivity vasculitis
Clinical appearance?
Dx?
TX?
- Palpable purpura
- Skin biopsy
- Prednisone
Henoch-scholen purpura
Clinical appearance?
Dx?
TX?
- Palpable purpura, Abdominal pain, Hematuria, N/V/D
- Skin biopsy, rectal biopsy
- Prednisone supportive
Good pasture syndrome
Clinical appearance?
Dx?
TX?
- Cough dyspnea, hemoptysis, glomerulonephritis
- renal or lung biopsy showing basement membrane antibodies
- Supportive, prednisone, cyclophosphamide, plasma
What are all the small vessel vascular diseases?
- Good pasture
- Henoch-scholen
- hypersensitivity vasculitis
- granulomatosis with polyangitis
What are the medium cell vascular diseases?
- polyarteritis nodosa
- Behcet disease
- Microscopic polyangitis
What are the large vessel vascular diseases
- Giant cell arteritis
2. Takayasu arteritis
Clinical findings with Polyarteritis nodosa?
Skin ulcers
Nephritis
Mesenteric ischemia
Clinical findings with Behcet disease?
- Recurrent painful oral and genital ulcers
2. Uveitis, Iritis, optic neuritis
Clinical findings of microscopic polyangitis
Pulmonary infiltrates
Nephritis
What are basically the two main treatments for the vascular diseases?
Prednisone and cyclophosphamide
Which serum test can be used to distinguish type 1 and type 2 diabetes mellitus?
C-peptide protein which can be either low or absent in type 1
What are the three subtype for non-small cell lung cancer?
- Adenocarcinoma- most common, starts peripherally
- Squamous cell carcinoma- starts centrally
- Large cell carcinoma
What are the two major categories for lung cancer?
Small cell and non-small cell.
Small cell starts centrally
What is the management of polymyositis?
- gluccocorticoids
2. azathropine, methotrexate
What are the clinical findings associated with polymyosistis?
- proximal muscle weakness like the shoulders and hips.
- Grotten papules- like a scaly rash thats symmetrical and located near MCP and IP joints
- Heliotrope eruption
- facial erythema
- Interstitial lung disease
What musclar related labs will be elevated with polymyositis?
CK and aldolase
What is the only diagnostic marker for polymyositis?
Anti-jo-1 antibodies
Anti-La antibodies are seen in patients with?
lupus and Sjӧgren syndrome
Anti-SCL-70 antibodies are considered a specific marker for?
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.
Anti-double stranded DNA antibodies are antinuclear antibodies that target double-stranded DNA. They are associated with?
systemic lupus erythematosus, an autoimmune disorder characterized by chronic inflammation, positive ANA, and multiorgan involvement
Rat bite lesions on x-ray are associated with? White lines of chondrocalcinosis are seen with?
Rat bite is gout, white lines pseudogout
What is the most common abnormal lab finding with padget disease?
Elevated serum alkaline phosphatase
High ferritin and low MCV is what?
Anemia of chronic disease
High RDW, TIBC, Transferrin and low MCV is what?
Iron deficiency anemia
a high Iron level, low MCV and normal everything else is what?
Thalassemia
coccidioidomycosis X-ray findings that support the diagnoses?
unilateral infiltrates in the upper lobes and the presence of hilar or mediastinal adenopathy support the diagnosis
How do you definitively diagnose coccidioidomycosis
serologic testing or cultures
what is the characteristic rash for rocky mountain spotted fever?
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
Fill in the blanks. Transudative fluid according to the light criteria?
Plueral:serum protein _______
Pleural: serum LDH _______
Pleural: Fluid LDH _______
- <0.5
- <0.6
- <2/3 upper limit of normal
Fill in the blanks. exudative fluid according to the light criteria?
Plueral:serum protein _______
Pleural: serum LDH _______
Pleural: Fluid LDH _______
- > 0.5
- > 0.6
- > 2/3 upper limit of normal
Carcinoid tumors typically secrete which hormones?
Seretonin, ACTH, melanocyte stimulating hormome
what is the definitive treatment for a carcinoid tumor?
surgery, can use octreotide to reduce symptoms
Which part of the lung will be most severely affected by idiopathic pulmonary fibrosis?
The peripheral subpleural parenchyma.
What are the clotting factors involved in the extrinsic pathway?
VII and III
What clotting factors are involved in the intrinsic pathway
XII, XI, IX, VIII
If the intrinsic pathway is effected will the PT or PTT be elevated?
The PTT (play table tennis) which is usually done inside
If the extrinsic pathway is effected which will be prolonged? PT or PTT
PT (play tennis) done outside
What is the triad for WPW?
- Delta wave
- Widened QRS >120ms
- short PR interval
When is CT-scan for PCOS indicated?
When they have a GFR >60, are symptomatic with signs of autosomal dominant symptoms and have history of first degree relative with it.
What two structures cause compression of the left renal vein in nutcracker syndrome?
aorta and superior mesenteric artery
Treatment for community-acquired pneumonia in a patient with no significant comorbidities is?
high dose amoxicillin, doxycycline or a macrolide (azithro, clarithromycin, erythromycin)
What is the most common organism found in aspiration pneumonia?
Klebsiella
Intermittent asthma is defined as?
2 or less daytime episodes a week
2 or less nighttime episodes a month
use of rescue inhaler 2 or less times a week
Mild persistent asthma is defined as?
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
Tx for mild persistent asthma?
SABA and low-dose ICS
Moderate persistent asthma is defined as?
Daily daytime symptoms
nighttime symptoms more than once per week
use of rescue inhaler daily
Tx for moderate persistent asthma?
- SABA
- Low/medium dose ICS
- LABA
Characteristics of secondary syphillis?
- diffuse maculopapular rash on palms and soles
2. condylomata lata
Gummas are found in where and with what disease process?
They are small benign tumors found in the brain, bone skin, liver or other tissue.
Associated with tertiary syphilis
What is the only pharmacological treatment for sickle cell that has constantly shown to help improve outcomes?
Hydroxy urea
How does hydroxyurea work?
It increases hemoglobin F and decreases Hemoglobin S
About half of all bronchiectasis cases are secondary from what disease process?
cystic fibrosis
If someones urine osmolality goes to normal after receiving desmopression would you think nephrogenic or central diabetes insipidous?
Central because the kidneys responded. If it was nephrogenic they dont respond to desmopression
what is the most prevalent endemic fungal infection in the United States?
histoplasmosis
Which microangiopathy is Shiga toxin-mediated and results after ingestion of undercooked ground beef contaminated with Escherichia coli
Hemolytic uremic syndrome
Classic pentad of TTP
- Anemia
- Neurological finding
- Decreased platelet count
- Kidney injury
- Fever
