INTERNAL MEDICINE Flashcards
Inorganic dust causes mesothelioma
Asbestos
Inorganic dust causes Progressive Massive Fibrosis (PMF)
Multioke prominent calcified LN and multiple small pulmonary nodules throughout both lung fields with pleural thickening above both apices
Silica
Inorganic dust causes chronic granulomatous disease
Beryllium
Inorganic dust causes pneumoconiosis
Coal dust
Organic dust that causes Byssinosis or monday fever
Cotton dust
Organic dust causes hypersensitivity pneumonitis
Farmer’s lung
Chest radiographic hallmark of asbestosis
Indistict heart border with ground glass appearance
Most common cancer associated with asbestos exposure
Lung cancer or bronchogenic cancer
What occupation lung disease presents with characteristic HRCT pattern known as “crazy paving”?
Silicosis
Calcification of hilar nodes may occur in as 20% of cases and produces a characteristic pattern
Eggshell pattern
Combination of pneumoconiotic nodules and seropositive rheumatoid arthritis
Caplan syndrome
Rheumatoid arthritis + splenomegaly
Felty syndrome
Case:
Rigidity/ tremors
Parkinsonism
Dysautonomia
Shy- Drager Syndrome or Multiple Systems Atrophy (MSA)
Major cause of chest discomfort
Gastrointestinal
In adults, aortic stenosis occurs due to
Calcified degeneration
This drug stimulates K+ adenosine triphophate channels
Nicorandil
physical exam finding in patients with AORTIC STENOSIS. Auscultation at the cardiac apex reveals a murmur that sounds holosystolic and may mimic the murmur of MITRAL REGURGITATION.
Gallavardin effect
MC drug implicated in toxic cardiomyopathy
Doxorubicin
MC etiology of secondary hypertension
Primary renal disease
Irreversible inhibitor of cyclooxigenase
Acetylsalicylic acid
Time element defines chronic cough
> 8weeks
More than 12% and 200mL increase in FEV1 15 min after the inhaled short acting B2 agonist
2 to 4 week trial of oral corticosteroids
Reversibility ina asthma
Cyanosis and clubbing seen in
CHD with R to L shunt
Lung abscess
Pulmonary AV fistula
Lung cancer
Patients with CAP, how long will the symptoms resolve?
3 months
Exercise induced asthma
Tx
Prevent withinhaled corticosteroids
Ideal tidal volume ventilation for ARDS
6mL/kg predicted body weight
Causes ARDS through indirect lung injury
Flail chest
1st vasopressor administered to a patient with gram negative septic shock
Norepinephrine
Myasthenia gravis will lead to which type of respiratory failure
2
Main cell types harbor HIV in the CNS
Microglia
First line antibiotic for patients with leptospirosis
Ampicillin 0.5-1.0 q6 IV for 7 days
Characteristic of Influenza B of inability ro cause pandemos
Absence of REASSORTMENT with animal reservoir
Hallmark of acne vulgaris
(+) Comedone
Phenomenon where traumatized area often develop lesions of psoriasis
Isomorphic phenomenon
Strongest predisposing factor in contracting melanoma
(+) multiple benign nevi
Most common type of basal cell carcinoma
Nodular
This develops on lower extremity 2ndary to venous incompetence and chronic edema
Stasis ulcer is severe form
DVT and varicose veins are risk factors
Stasis dermatitis
Agents used for treatment in severe, widespread psoriatic disease
Acitretin
Cyclophosphamide
Methotrexate
TOC for Chronic Myelogenous Leukemia in chronic phase
Tyrosine inhibitor
Most cost effective test to evaluate patient with cobalamin deficiency
Serum cobalamin
Tumor lysis syndrome
Hyperkalemia
Hyperphosphatemia
Hyperuricemia
Metabolic acidosis
Marjolin ulcer an important risk factor to
Squamous cell CA
Most common gynecologic cancer in North America
Uterine cancer
MC environment risk factor for pancreatic CA
Smoking
Forrest classification for an ulcer — adherent clot
Type IIB
MC cause of LGIB
Hemorrhoids
Oral contraceptives are associated withincreased risk for
Crohn’s disease
Serologic marker present even at window period
IgM Anti-HBc
Similar pathogenesis in spider angiomas and in cirrhotic patient
Palmar erythema
Liver cirrhosis constitutes how many % as patients with ascites?
84%
Mainstay treatment of portosystemic encephalopathy
Lactulose
Loss of P wave seen in this level of potassium
6.5 - 7.5 mM
Loss of P wave seen in this level of potassium
6.5 - 7.5 mM
Renal tubular defect causes hypokalemia also presents with hypertension
Liddle syndrome
Hx recurrent UTI
Placed on antibiotics
Year later, complaining of progressive dyspnea
Cxr pulmonary fibrosis
What antibiotic?
Nitrofurantoin
+ carpopedal spasm after wering BP cuff inflated for 3 mins
What electrolyte abnormality
HypoMagnesemia
Hx of seizure
Now has excess facial hair and body hair
Drug?
Phenytoin
In management of thyroid storm, PTU is administered before SSKI to prevent which mechanism
Incorporation of iodine into new thyroid hormone
HbA1c goal of patient with DM2
<7.0%
Patient apparently well but has hypoglycemia
Nesidioblastosis
Amyloidosis from deposition of B2-microglobulin is associated with?
Patient on long term hemodialysis
A soluble fusion protein consisting of the extracellular domain of human CTLA-4 linked to the modified portion of human IgG
Abatacept
TB arthritis primarily affects what joint
Hips
Serum antibody correlates with depression or psychosis due to CNS lupus
Anti-ribosomal P
MC manifestation of diffuse CNS lupus
Cognitive dysfunction
Earliest manifestation of colchicine toxicity
Diarrhea
Malar skin rash
Generalized lymphadenopathy
Proteinuria
Joint pain
Nephritis and vasculitis
Antibody?
Anti-dsDNA
MC primary immunodeficiency
IgA deficiency
Major histocompatibility complex cobtains HLA class 1 and 2 genes whose products are critical for immunologic specificity and transplantation histocompatibiliyy. What chromosome?
Chromosome 6
MC site of angioedema
Periorbital area
Lips
Halesdache characterized by daily bouts of 1-2 attacks of relatively short-duration unilateral pain with at least 1 attack recurring at about the same hour each day
Cluster headache
Causes of dementia
Normal pressure hydrocephalus with triad of
Ataxic gait
Dementia
Urinary incontinence
Harvard criteria for definition of irreversible coma
Unreceptivity
No breathing
No reflexes with further delineation of brainstem reflexes
No movement
Chemoattractant for leukocytes
Degranulation of mast cells
Increase production and release of inflammatory mediators
Vasodilation
Substance P
Difference of hyperthermia and fever
Fever - increased hypothalamic temperature setting
Hyperthermia - unchanged
Anatomical structure of the system is unaque because the afferent projections bypass the thalamus and synapse directly with the primary olfactory cortex
Olfactory system
Hyponatremia
Suppression of circulating antidiuretic hormone levels
Dx?
Psychogenic polydipsia
Condition contraindicated to smallpox vaccination
Eczema
Most common drug induced skin reaction
Diffuse morbiliform rash
Laboratory tests helpful in determining the cause of photosemsitivity in a patient
Antinuclear antibody (ANA)
Anti-La
Anti-Ro
Plasma porphyrins
Drugs associated with photosensitivity reaction
Hydrochlorothiazide
A normal red blood cell is approximately the size of
Normal lymphocytes
Most abundant receptor on platelet amd therefore a target for antiplatelet therapy
Glycogen IIb/IIIa
Prevention of development of risk factors for disease
Primordial prevention
Attempts to reduce the risk of incident disease among individual with a risk factor
Primary prevention
Avoiding recurrence of disease and death in an individual who is already affected
Secondary prevention
Requires rapid action to prevent imminent death in the setting of acute illness
Tertiary prevention
Opioid overdose?
Tx
Nalaxone
Benzodiazepine overdose?
Tx
Flumazenil
(GABA receptor antagonist)
Acetaminophen overdose?
N-acetylcysteine
Acute
Maximal in <5mins
Severe headache laating >5mins
Stiff neck no fever
Dx?
Subarachnoid hemorrhage
– lumbar puncture
Narrowed lumbas spinal canal
Neurogenic claudication
Back and buttock or leg pain induced by walking or standing and relieved by sitting
Lumbas spinal stenosis
German measles
RuBella
Measles
RubeOLA
Koplik spot
Pathognomonic for measles
1 -2 mm white or bluish lesions with an erythematous halo on the buccal mucosa
Fordyce spots
Ecropic sebaceous glands
No erythematous halos
Found in healthy individual’s mouth
Feared complication of measles
Subacute sclerosing Panencephalitis
Mosquito bite in tropical and subtropical region
Maculopapular eruption
Severe polyarticular small joint arthralgia
Chikungunya fever
Caused by Coxsackie A16 or Enterovirus71
Tender vesicles distributed on hand, feet and mouth
Hand foot and mouth disease
Generalized rash
Prominent on palms and soles
Caused by treponema pallidum
Secondary syphilis
Rash begins at wrist and ankles and spread centripetal
Blanchable macules to petechiae
Rash in palms and soles later in the disease
Spread by ticks
Rocky mountain spotted fever
Rickettsia rickettsii
Septic shock
No positive blood cultures
Diffuse rash
Lack of primary infected site
STAPHYLOCOCCUS AUREUS
retained tampon
Toxic shock syndrome
Erythema migrans
Erythematous annular patch
Central erythematous focus at tick bite
Affects CNS, articular and cardiac – COMPLETE HEART BLOCK
Lyme disease
Borrelia burgdorferi
Individual who cannot detoxify arene oxides present in anticonvulsants (PHENOBARBETAL)
Desquamative rash
Eosinophilia
Hepatic involvement
Facial edema
Hypotension
Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome (DRESS)
Erythematous indurated plaque with pseudovesicular border
Sweet syndrome /
Acute Febrile Neutrophilic Dermatosis
Fever of Unknown Origin
Fever >=38.3°C (>=101F) on at least 2 occasions
Illness duration of >=3weeks
No known immunocompromised state
Dx remains uncertain after a thorough hx taking, PE and following obligatory investigations
Deficiency of ______ may play a key role in pathogenesis of delirium
Acetylcholine
Prominent memory deficit
Family hx of dementia
(+) apolipoprotein E4 allele
Small hypocampal volumes
AD-like signature of cortical atrophy
Low CSF AB and elevated tau
(+) brain amyloid deposition
Alzheimer’s disease
Alpha-synuclein neuronal inclusions
Lewy bodies
Neurofibrillary tangles -hyperphosphorylated tau filaments
Accumulation of amyloid in blood vessel walls in cortex and leptomeninges
Alzheimer’s diasease
Bilateral disorder of parietofrontal area of the brain
Inability to orderly scan the environment (oculomotor apraxia)
Inacurate manual reaching for objects (optic apraxia)
Inability to integrate info in center of gaze w peripheral info (Simultanagnosia)
Balint syndrome
Left/ right relative afferent pupilary defect
Marcus gunn pupil
Asymmetric sizes of pupil
Anisocoria
Defect in the direct response. It is due to damage in the inoptic nerve or severe retinal disease.
Affected pupil WILL NOT CONSTRICT to light when light is shone in the that pupil
However, it will constrict if light is shone in the other eye (consensual response)
Relative Afferent Pupillary Defect (RAPD, Marcus Gunn Pupil)
Common in women in the 3rd/4th decade of life (but also can be present in men)
Either no or sluggish response to light (both direct and consensual responses)
Adie’s (Tonic) Pupil
Hallmark of tertiary neurosyphillis
Pupils will NOT constrict to light but they WILL constrict with accommodation
Argyll Robertson Pupil
Results from injury of cochlear apparatus or disruption of neural pathways from the inner ear to the brain
Site of damage: hair cells of the inner ear
Semsoryneural hearing loss
Impairment of external ear and auditory canal to transmit and amplify spund through the middle ear to the cochlea
Conductive hearing loss
Tuning fork at mastoid process then front of external ear
Conductive - intensity of sound is louder when placed on BONE
Sensoryneural - louder at external ear
Rinne test
Tuning fork at midline of head
Unilateral conductive - intensity of sound at affected ear
Unilateral sensoryneural - loudest at UNaffected ear
Weber test
Test for evaluation of dry eyes to quantify adequate tear production
Schirmer test
Rapidly progressive
Potentially fulminant form of cellulitis
Bilateral sublingual and submandibular spaces
Hx recent extracted tooth (lower 2nd/3rd molar)
Woody edema of sublingual
Hot potato voice
Ludwig angina
Thumbprint sign
Edematous epiglottis
Cellulitis of epiglotis and adjacent structures
Group A Streptococcus
Strep pneumonia
Haemophilus influenza
Staph aureus
Acute epiglottitis
Type of Cyanosis
Etiology- reduced oxygen saturation or abnormal hemoglobin
Bluish discoloration of both mucous membrane and skin
Central cyanosis
Type of cyanosis
Normal O2 sat but slowing of blood flow and increased fraction of oxygen extraction from blood
Only in skin and extremities
Peripheral cyanosis
Loss of 10pounds (4.5kg) or >5% of one’ body weight over a period kf 6-12 months
Clinically important weight loss
Yellowing of skin due to ingestion of excess amount of vegetables and fruits that contain carotene (carrots, leafy veg, squash, peach, orange)
Palms, soles, forehead, nasolabial folds
Carotenoderma
“6Fs”
Causes of abdominal swelling
Fluid
Fetus
Fat
Feces
Flatus
Fatal mass
Coexistence of hyponatremia with a normal or increased plasma tonicity
Pseudohyponatremia
Border of untreated active ulcer – undermined necrotic violaceohs edge and a peripheral erythematous halo
Associated with UC and Crohns
Pyoderma gangrenosum
Non scarring hair loss due to synchronus hair growth cycle
Normal in postpartum
High fever, infection, medication or chabges in hormone
Telogen effluvium
Subepidermal blisters with dense eosinophilic-rich infiltrate
Autoimmune cutaneous disease
Tense blisters on either a normal or erythematous base
Linesr deposits of IgG and/or C3 in epidermal basement membrane
bullous pemphigoid
Severe pruritus
Skin lesion symmetrically distributed along extensor surface, buttocks, back, scalp, posterior neck
Papular, papulovesicular, utricarial plaques
Burning and stinging
Gluten sensitive
Neutrophilic inflammatory infiltrate in dermal papillae
Granular deposits of IgA found in papillary dermis and alongepidermal basement membrane
Dermatitis herpetiformis (DH) / Celiac disease
Tx- Dapsone
Hypersegmented neutrophils (multilobed polymorphonuclear leukocytes) commonly seen in
Folic acid or Vit B12 deficiency
Vacuolated neutrophils or bands
(Immature neutrophils that have not completed nuclear condensation and have a U-shaped nucleus)
Sign of bacterial sepsis
Uniform population of primitive myeloblasts with immature chromatin, nucleoli in some cells and primary cytoplasmic granules
Acute myeloid leukemia
Increased number of small lymphocytes, many are ruptured in making the blood smear leaving a smudge of nuclear naterial without surrounding cytoplasm or cell membrane (SMUDGE CELLS)
Chronic Lymphoid Leukemia
Microcytic hypochromic red cells with marked variation ib size (anisocytisis) and shape (poikilocytosis)
Iron deficiency anemia
Microcytic or normkcytic normochromic anemia
Sickling of RBC in capillaries
Howell-jolly bodies
Sickle cell disease
Burr cells - multiple spiny projections
Uremia
Schistocytes - helmet shaped cells that reflect microangiopathic hemolytic anemia or fragmentation on an artificial heart valve
Disseminated intravascular coagulation
Spherocytes - small dense RBCs that lack central pallor and biconcavity
Hereditaru spherocytosis
Autoimmune hemolytic anemias
Target cells
Bulls eye appearance
Thalassemia
Liver disease
Large granules in neutrophils
Defect in lysosomal transport protein LYST, encoded by gene CHSI at 1q42
Nystagmus
Partial oculocutabeous albinism
Infection
Chediak-Higashi syndrome
Bilobed granulocytes
Nucleus has spectacle-like or pince-nez configuration
Pelger-huet anomaly
(Neutrophil <100/uL)
Near complete absence of neutrophils and neutrophil precursors
Fatal
Mutation in gene HAX-1
Kostmann syndrome
