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Internal Medicine Flashcards

0
Q

In Mitral Valve Regurgitation, if the murmur radiates to the BASE, what is the leaflet involve?

A

Posterior Leaflet
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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1
Q

In Mitral Valve Regurgitation, if the murmur radiates to the AXILLA, what is the leaflet involve?

A

Anterior Leaflet
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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2
Q

Normal CARINA angle?

A

~60 degrees
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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3
Q

Beta-Blockers that entails good outcomes in px with MI?

A 
Metoprolol
Bisoprolol
Carvedilol
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
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4
Q

Extrapulmonary TB incidence, in decreasing order.

A 
Lymph Nodes
Pleural
Genitourinary
Least: Cardiac
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
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5
Q

Lights Criteria.

A
  • PF/S LDH ratio of 0.6
  • PF/S protein ratio of 0.5
  • PF LDH more than 2/3 the upper limits

!!! if positive in one criteria, fluid is considered EXUDATIVE !!!
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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6
Q

Mean Arterial Pressure (MAP) formula.

A 
Systolic + 2Diastolic
-----------------------
              3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
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7
Q

Cerebral Perfusion Pressure formula.

A

MAP — Intracranial Pressure
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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8
Q

MAP in CVD BLEED?

A

<130 mm Hg
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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9
Q

Pleural Effusion is considered TUBERCULOUS if cell count is?

A

> 85% lymphocytic
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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10
Q

Usual location of CEREBROVASCULAR DISEASE in HYPERTENSIVE patients?

A
  1. Putamen
  2. Cerebellum
  3. Lobes
    __________________
    Jan Patrick Ng, M.D.
    Darleen Sy, M.D.
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11
Q

What stain is commonly used in staining AMYLOIDOSIS?

A

Congo Red
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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12
Q

CVD Hemorrhage appears ______ in cranial CT scan?

A

Hyperdense (white) because it contains CALCIUM
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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13
Q

Early signs of CVD seen in cranial CT scan?

A 
<24hrs cranial CT scan may appear be normal but with subtle signs:
• Compression - sulci are more obscured
• MCA sign (clot)
• Midline is compressed
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
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14
Q

What part of lipid profile when increased predispose patients to PANCREATITIS?

A

Triglyceride
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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15
Q

LDL goals in HIGH risk patients?

A

LDL of <70mg/dl
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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16
Q

Lipid picture of patients with CKD?

A 
Low HDL
Normal/Low LDL
High Triglycerides
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
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17
Q

Primary target of Dyslipidemia therapy?

A

LDL
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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18
Q

Most common cause of death in POST MI?

A

Arrhythmias - Ventricular Fibrillation
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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19
Q

Development of NEW systolic murmur 5-7 days S/P MI indicates?

A

Papillary Muscle Rupture
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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20
Q

Development of acute severe HYPOTENSION in post MI patients?

A

Ventricular Free Wall Rupture
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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21
Q

It is a congenital heart defect in infants of women taking LITHIUM in which septal leaflet of the tricuspid valve is displaced towards the apex of the right ventricle.

A

Ebstein’s Anomaly
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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22
Q

Systolic ejection murmur, crescendo/decrescendo, louder with squatting, softer with valsalva, + parvus et tardus?

A

Aortic Stenosis
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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23
Q

Systolic ejection murmur, louder with valsalva, softer with squatting or handgrip?

A

Hypertrophic Obstructive Cardiomyopathy
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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24
Q

Late systolic murmur with click, louder with valsalva and handgrip, softer with squatting?

A

Mitral Valve Prolapse
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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25
Q

Holosystolic murmur radiates to axilla?

A

Anterior Leaflet Mitral Regurgitation
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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26
Q

Holosystolic murmur with late diastolic rumble?

A

Ventricular Septal Defect
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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27
Q

Continuous machinery-like murmur?

A

Patent Ductus Arteriosus
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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28
Q

Wide fixed and split S2?

A

Atrial Septal Defect
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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29
Q

Rumbling diastolic murmur with an opening snap?

A

Mitral Stenosis
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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30
Q

Blowing diastolic murmur with widened pulse pressure and eponym parade?

A

Aortic Regurgitation
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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31
Q

***PaO2/FiO2 ratio.

A
  • < 200 - Acute Respiratory Distress Syndrome
  • < 300 - Acute Lung Injury

NORMAL?!?
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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32
Q

Neurologic deficits that spontaneously resolves within 24 hours irregardless of the results of diagnostics.

A

Transient Ischemic Attack
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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33
Q

Hypertension with end organ damage?

A

Hypertensive Cardiovascular Disease
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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34
Q

Obliteration of retrosternal area in lateral view chest X-ray?

A

Right Ventricular Hypertrophy
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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35
Q

Obliterated lower third retrocardiac space in lateral view of chest x-ray?

A

Left Ventricular Hypertrophy
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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36
Q

Obliteration of the upper two-thirds of the retrocardiac space in lateral view of chest x-ray?

A

Left Atrial Hypertrophy
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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37
Q

Prominence of the right border of the heart in chest xray PA view?

A

Left Atrial Hypertrophy
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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41
Q

What portion of the heart is hypertrophied if apex is displaced downwards and laterally in chest xray?

A

Left Ventrical Hypertrophy
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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42
Q

What cardiac chamber is enlarge if there is increase carina angle and obliteration of cardiac waistline?

A

Left Atrial Hypertrophy
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D

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43
Q

Chronic cough?

A

Cough persist for 8 weeks
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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44
Q

Scybalous stools?

A

Goat-like stools
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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45
Q

Left sided colonic mass vs Right sided colonic mass?

A 
Left - obstruction
Right - bleeding
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
46
Q

Most common glands found in Colonic Diverticula?

A

Gastric and Pancreatic Glands
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

47
Q

Diagnostic to differentiate AKI vs CKD?

A

Ultrasound
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

48
Q

**CKD ultrasound findings?

A 
• Kidney size of < 10cm
• Cortical thickness of > 1cm
• Corticomedullary Junction
 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
49
Q

Management for Hyperkalemia?

A 
1. Cardiac Protection
   • Calcium Gluconate
2. Shift potassium into the cell
   • Glucose-Insulin Drip
   • Sodium Bicarbonate
   • Nebulize with Salbutamol
3. Dialysis
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
50
Q

Most common cause of death worldwide?

A

Cardiovascular Disease
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

51
Q

Caused by an imbalance between the heart’s oxygen supply and demand, and most frequently manifest as chest discomfort?

A

Ischemia
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

52
Q

Elements of complete cardiac diagnosis?

A
  1. Underlying etiology
    • congenital, hypertensive, ischemic or inflammatory?
  2. Anatomic abnormalities
    • chambers involve, hypertrophied, dilated? valves affected, regurgitant or stenotic? pericardial involvement? myocardial infarction?
  3. Physiologic disturbances
    • arrhythmia, congestive heart failure or ischemia?
  4. Functional disability
    __________________
    Jan Patrick Ng, M.D.
    Darleen Sy, M.D.
53
Q

Ankle-Brachial Index?

A

systolic BP of the ANKLE
––––––––––––––––––––––––
higher systolic BP of ARMS

n > 0.9
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

54
Q

How much glucose infused in 1L of D5 containing fluid?

A

50 grams
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

55
Q

Calorie per glucose molecule?

A

1g = 4 calories
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

56
Q

3 substances that reflect liver function?

A

Albumin
Prothrombin Time
Bilirubin

**SGPT/ALT only reflect hepatocellular damage
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

57
Q

Diseases that cause Microcytic Hypochromic Anemias?

A 
Mnemonic:
CLITS H
-------------
Chronic Disease
Lead Poisoning
Iron Deficiency Anemia
Thalassemia
Sideroblastic Anemia 
Hookworm Infection
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
58
Q

Beta blockers are contraindicated for?

A

Asthmatics
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

59
Q

Most common side effects of CLONIDINE?

A

Rebound Hypertension
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

60
Q

More sensitive index of cardiac function is?

A

Ejection Fraction (n=67 +/- 8%)
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

61
Q

What is Blood Pressure?

A

BP = Cardiac Output X Peripheral Resistance

Cardiac Output = Stroke Volume x Heart Rate
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

93
Q

Radiologic signs of LEFT ATRIAL HYPERTROPHY?

A 
• Increase carina angle
• Obliteration of cardiac waistline
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
94
Q

How many weeks inorder to label a patient to have CHRONIC DIARRHEA?

A

> 4weeks
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

95
Q

Differentials for CHRONIC DIARRHEA?

A 
Inflammatory Bowel Disease
Malignancy
Irritable Bowel Disease
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
96
Q

What is IRRITABLE BOWEL DISEASE?

A

Chronic diarrhea associated with abdominal pain which usually resolves on flatus and defecation.
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

97
Q

Which INFLAMMATORY BOWEL DISEASE involves the liver?

A

Primary Sclerosing Cholangitis is due to CHRON’S DISEASE
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

98
Q

Consideration in patients with Iron Deficiency Anemia in elderly?

A

Malignancy
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

99
Q

Indication for thoracentesis?

A 
• Fever (Infection)
• Discrepancy of pleural effusion (> 1 ICS)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
100
Q

Pathophysiology of Pneumonia?

A
  1. Edema
  2. Red Hepatization
    • transudation of fluids (RBC) to alveolar space
  3. Gray Hepatization
    • infiltration of neutrophils and fibrin, no new bacteria
  4. Resolution
    __________________
    Jan Patrick Ng, M.D.
    Darleen Sy, M.D.
101
Q

Why there is hypoxemia in Pneumonia?

A

due to alveolar filling/flooding therefore compromised exchange of oxygen and carbon dioxide
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

102
Q

Acute and Chronic COUGH?

A

Chronic Cough >8 weeks
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

103
Q

In Pneumonia, what chemokines stimulate the release of neutrophils and their attraction to the lungs, producing both leukocytosis and increase purulent secretions?

A 
IL 8
Granulocyte Colony Stimulating Factor
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
104
Q

Target organisms of MACROLIDE on CAP Management?

A 
Legionella
Mycoplasma
Chlamydia
Virus (RSV, Influenza, Adenovirus)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
105
Q

What is Bronchiectasis?

A

Permanent dilatation of bronchi with excessive mucus production
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

107
Q

**Functional Class in Congestive Heart Failure.

A 
Class 1
Class 4
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
108
Q

How many weeks inorder to label a patient to have CHRONIC DIARRHEA?

A

> 4weeks
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

109
Q

Differentials for CHRONIC DIARRHEA?

A 
Inflammatory Bowel Disease
Malignancy
Irritable Bowel Disease
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
110
Q

What is IRRITABLE BOWEL DISEASE?

A

Chronic diarrhea associated with abdominal pain which usually resolves on flatus and defecation.
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

111
Q

Which INFLAMMATORY BOWEL DISEASE involves the liver?

A

Primary Sclerosing Cholangitis is due to CHRON’S DISEASE
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

112
Q

Consideration in patients with Iron Deficiency Anemia in elderly?

A

Malignancy
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

113
Q

Indication for thoracentesis?

A 
• Fever (Infection)
• Discrepancy of pleural effusion (> 1 ICS)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
114
Q

Pathophysiology of Pneumonia?

A
  1. Edema
  2. Red Hepatization
    • transudation of fluids (RBC) to alveolar space
  3. Gray Hepatization
    • infiltration of neutrophils and fibrin, no new bacteria
  4. Resolution
    __________________
    Jan Patrick Ng, M.D.
    Darleen Sy, M.D.
115
Q

Why there is hypoxemia in Pneumonia?

A

due to alveolar filling/flooding therefore compromised exchange of oxygen and carbon dioxide
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

116
Q

Acute and Chronic COUGH?

A

Chronic Cough >8 weeks
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

117
Q

In Pneumonia, what chemokines stimulate the release of neutrophils and their attraction to the lungs, producing both leukocytosis and increase purulent secretions?

A 
IL 8
Granulocyte Colony Stimulating Factor
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
118
Q

Pathophysiology of LEPTOSPIROSIS?

A

Vasculitis
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

119
Q

What happens to the liver due to LEPTOSPIROSIS?

A

Coagulative Necrosis
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

120
Q

What happens to the kidneys in LEPTOSPIROSIS?

A

Interstitial Nephritis due to Vasculitis
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

121
Q

What happens to the lungs in LEPTOSPIROSIS?

A

Pulmonary Hemorrhage
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

122
Q

WEIL’S disease/ Severe Leptospirosis vs Mild Leptospirosis?

A 
Weil's disease
• Kidney injury
• Hepatic Injury
• Bleeding diathesis
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
123
Q

Significant weight loss?

A

> 10% of Total Body Weight in 3 months
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D

124
Q

Role of Nitrates?

A
  • vasodilation
  • reduce preload and afterload
  • decrease myocardial oxygen demand
    __________________
    Jan Patrick Ng, M.D.
    Darleen Sy, M.D
125
Q

Symptoms of Tetanus?

A
  • Lock Jaw
  • Difficulty of Swallowing
  • Muscle Spasms
  • Back Pain
    __________________
    Jan Patrick Ng, M.D.
    Darleen Sy, M.D
126
Q

Target organisms of MACROLIDE on CAP Management?

A 
Legionella
Mycoplasma
Chlamydia
Virus (RSV, Influenza, Adenovirus)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
127
Q

What is Bronchiectasis?

A

Permanent dilatation of bronchi with excessive mucus production
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

129
Q

Antibiotics of choice for Tetanus?

A

Metronidazole
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D

130
Q

Level of blood glucose where it will show symptoms of hypoglycemia?

A

70 mg/dl
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D

131
Q

Diagnostics that assess synthetic function of the liver?

A 
Protime
Albumin
Bilirubin
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D
132
Q

> 1000 SGPT, differentials?

A 
Ischemic
Drug Induced (Acetaminophen)
Viral Hepatitis
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D
133
Q

Spirinolactone in Heart Failure?

A

Prevents LV remodeling
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D

134
Q

Most common cause of lower GI bleed on young adults?

A

Hemmorhoids
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D

135
Q

Most common cause of lower GI bleed in elderly?

A

Malignancy
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D

136
Q

Dilated Cardiomyopathy Ejection Fraction?

A

Ejection Fraction <30%
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D

138
Q

Orthopnea vs Platypnea?

A

Orthopnea - redistribution of fluid from the splanchnic circulation and lower extremities into the central circulation during recumbency, with a resultant increase in pulmonary capillary pressure
Platypnea - dyspnea in the upright position with relief in the supine position
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D

139
Q

What is Chronic Bronchitis?

A

Chronic bronchitis is defined by excessive mucus production with airway obstruction and notable hyperplasia of mucus-producing glands.
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D

140
Q

Significant change in Spirometry in reading obstructive defect to differentiate COPD and ASTHMA?

A

change of >= 12% and change in 200ml in FVC or FEV1

141
Q

Parts of Cardiac Diagnosis?

A

Etiology
Anatomy
Physiology
Functional Classification

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