Internal Medicine Flashcards
What disorder is commonly caused by pulmonary hypertension from chronic obstructive pulmonary disease (COPD) or hypoxemia?
Cor pulmonale (hypertrophy or dilation of the right ventricle)
If a pt is found to have villous adenomatous polyps on a screening colonoscopy, when should they have a repeat screen?
3 years
What is seen on physical exam of a pt with hypertrophic cardiomyopathy?
Harsh crescendo-decrescendo systolic murmur that increases in intensity with Valsalva maneuver and decreases with squatting
Dyspnea on exertion (most common),
Syncope
Orthopnea
Chest pain
Palpitations
What are the stages of HTN?
Normal: < 120/80
Elevated BP:120–129/< 80
Stage 1 HTN: 130-139/80-89
Stage 2 HTN: ≥ 140/≥ 90
Crisis: ≥ 180/≥ 120
What is the criteria for metabolic syndrome?
Must have at least 3 of the following:
Abdominal obesity
Serum triglycerides ≥ 150 mg/dL
Serum HDL cholesterol < 40 mg/dL in men and < 50 mg/dL in women
BP ≥ 130/85
Fasting glucose ≥ 100 mg/dL
What is the treatment for coccidioidomycosis (a fungal infection that manifests as a pulmonary disease that is an endemic in the southwestern part of the United States)?
Fluconazole
What heart problem presents with a low-pitched mid to late diastolic murmur that is best heard at the apex of the heart with the patient in the left lateral decubitus position, and has an accentuated S1 with an opening snap following S2?
Mitral stenosis
What is seen on EKG in a R and L bundle branch block?
Right: M in v1, W in v6
Left: W in v1, M in v6
Pts with Sjögren syndrome are at increased of developing what?
Non-Hodgkin lymphoma
What is the appropriate fluid restriction for patients with stage D refractory heart failure (pts currently hospitalized with CHF who cannot be dc’d without specialized interventions)?
1.5–2.0 L/day
A blood test for plasma fractionated free metanephrines is the most sensitive test for what?
Pheochromocytoma
What presents with hypertension, bibasilar rales on auscultation, laterally displaced point of maximal impulse, S3 gallop, peripheral edema, jugular venous distention, and hepatojugular reflux?
Systolic heart failure
Distant or muffled heart sounds on physical exam should make you consider what cardiac diagnosis?
Pericardial effusion
What presents with chest pain or pressure, facial plethora or dyspnea, a feeling of fullness in the head that is made worse with bending forward, and edema of the head or neck along with distention of the veins in the neck and chest wall?
Superior vena cava syndrome
What is the treatment for community-acquired pneumonia in a patient with no significant comorbidities?
High dose amoxicillin, doxycycline, or macrolide (clarithromycin, azithromycin, or erythromycin)
What is the most common pathogen responsible for subacute bacterial endocarditis as well as bacterial endocarditis following a dental procedure?
Streptococcus viridans
What are the first-line treatments for superficial thrombophlebitis?
NSAIDs such as ibuprofen, warm compresses, elevation, and compression
Lewy bodies in the substantia nigra and a decrease in dopaminergic neurons in the substantia nigra are postmortem findings in patients with what disorder?
Parkinsons
What lab findings help support a diagnosis of Legionella pneumonia (Legionnaires’ disease)?
Elevated liver transaminases and hyponatremia
Calcifications of the peripheral hilar lymph nodes, described as eggshell calcifications on CXR, are pathognomonic for what?
Silicosis
What is silicosis caused by and what occupations is it commonly associated with?
Inhalation of free silica (silicon dioxide).
Occupational exposures to free silica include stonecutting, rock mining, quarrying, sandblasting, and pottery making
What is the prophylactic treatment of choice for pneumocystis pneumonia in HIV patients who have a sulfa allergy (cannot take Bactrim)?
Dapsone 100 mg daily
What treatment for aortic valve stenosis is acceptable for patients at any age for whom anticoagulant therapy is contraindicated, not desired, or cannot be managed, and is preferred in patients older than 70 years of age?
Aortic valve replacement with bioprosthetic valves
What are the treatments for chronic venous insufficiency?
Leg elevation, compression therapy, ulcer care, ablation
Vein stripping has largely been replaced with ablation
What is obesity hypoventilation syndrome?
Daytime hypercapnia (PaCO2 over 45 mm Hg) in an individual with obesity that cannot be attributed to any other cause
Majority of patients with obesity hypoventilation syndrome also have what other disorder and require what intervention?
Obstructive sleep apnea that requires CPAP use during sleep
How is hypertensive urgency defined?
BP greater than 180/110–120 with no signs of acute target organ damage
What is the treatment for hypertensive urgency in the outpatient (ambulatory) setting?
Oral agents, such as captopril, labetalol, clonidine, or prazosin
How is hypertensive emergency defined?
BP greater than 180/110–120 with evidence of acute target organ damage (hemorrhagic or ischemic stroke, acute coronary syndrome, aortic dissection, diffuse microvascular injury (i.e., malignant hypertension), and hypertensive encephalopathy)
What are the current guidelines for lowering blood pressure in a patient with a hypertensive emergency requiring ICU admission?
Decrease BP by no more than 20–25% over one hour, then to 160/100 within six hours, and then to target blood pressure in 48 hours in most patients
Patients with what diagnoses require more aggressive treatment for hypertensive emergency?
Aortic dissection, pheochromocytoma, and eclampsia or preeclampsia
Reduction to SBP to less than 140 in the first hour and to less than 120 in the case of aortic dissection
What IV medications have been shown to be the most effective at lowering blood pressure in most clinical scenarios of hypertensive emergency?
Nicardipine and labetalol
What disorder can present with diffuse ST elevations on an EKG?
Acute pericarditis
Patients on warfarin should avoid foods that are high in what?
Vit K (kale, dark leafy greens)
What findings might be seen in a pt with a Vit B12 (cobalamin) deficiency?
Fatigue, weakness, and peripheral neuropathy
Pallor and glossitis
MCV > 100 fL, hypersegmented neutrophils, elevated homocysteine, elevated methylmalonic acid
Koilonychia (spooning of the nails) and pica are classically seen in patients with what?
Iron deficiency anemia
What are the differences between central and nephrogenic DI?
the Na+ is high in DI
Central: most commonly caused by a decrease in ADH production
Diagnosis is made by vasopressin challenge test: > 50% increase in urine osmolality and decreased urine volume
Treatment is intranasal DDAVP to reduce nocturia
Nephrogenic: history of taking lithium
Most commonly caused by kidney unresponsiveness to ADH
Diagnosis is made by water deprivation test: no change in urine osmolality
Treatment is HCTZ, amiloride, indomethacin
What might you hear in a pt with mitral regurg?
Acute: unique, harsh, midsystolic murmur best heard at apex that radiates to the base or axilla
Chronic: blowing holosystolic murmur best heard at apex with radiation to axilla
Pts who have increased serum calcium levels should have what other test done?
Intact parathyroid hormone levels to r/o primary hyperparathyroidism
What tachydysrhythmia is caused by a single excitable electrical focus in the left or right atrium but most commonly in the right atrium?
Atrial flutter (sawtooth pattern)
What labs do you find in a pt with anemia of chronic disease?
Normochromic normocytic anemia, low serum iron and TIBC, high or normal ferritin
What are the signs/symptoms/treatment for idiopathic pulmonary fibrosis?
Sx: gradual-onset dyspnea and dry cough
PE: velcro-like crackles, clubbing in advanced disease
High resolution CT: bibasilar reticular opacities, honeycombing, traction bronchiectasis
PFT: restrictive pattern: ↓FVC, ↓TLC and normal or increased FEV1/FVC ratio, ↓DLCO
Management includes O2, pulmonary rehabilitation, antifibrotic therapy (pirfenidone and nintedanib), possible lung transplant
Pts who have an uncal herniation have what physical exam finding?
Unilateral dilated and fixed pupil
What is livedo reticualris and what disorder is it commonly associated with?
Mottled, lace-like purple discoloration of the skin seen in polyarteritis nodosa
What type of dementia presents with changes in the patient’s behavior, personality, and social conduct?
Frontotemporal dementia
What is the treatment for Cushing’s disease?
Transsphenoidal surgery to remove the pituitary adenoma
What is the treatment for hereditary hemochromatosis?
Phlebotomy to remove excess iron
What are the signs/symptoms/treatment for thyroid storm?
Most commonly caused by an acute event (infection, trauma)
Sx: tachycardia, hyperpyrexia, agitation, anxiety
PE: goiter, lid lag, hand tremor, and warm, moist skin
Dx: low TSH and high free T4 or T3
Tx:
Beta-blocker (propranolol, esmolol)
Thionamide (propylthiouracil, methimazole)
Iodine solution
Glucocorticoids
Hemophilia A is an X-linked recessive inherited disorder that leads to a deficiency in what?
Factor VIII
What classically present with sudden onset of gross hematuria 1–2 days after an upper respiratory infection?
IgA nephropathy (Berger disease)
What findings on a lumbar puncture are diagnostic for SAH?
Xanthochromia (which is a yellow or pink appearance of the cerebrospinal fluid representing broken down red blood cells) or gross blood in the cerebrospinal fluid
What are the signs/symptoms/treatment for Prinzmetal angina?
Hx of HTN, smoking, DM, obesity, or cocaine use
Squeezing, pressure-like chest discomfort at rest
ECG will show transient ST segment elevations
Cardiac enzymes will be normal
Diagnosis is made by cardiac stress test
Most commonly caused by coronary artery spasm
Treatment is calcium channel blockers and nitrates (avoid beta-blockers)
The CEA tumor marker is used in diagnosing which cancer?
Colorectal
What is the transmission cycle for Lyme disease, which is caused by the spirochete Borrelia burgdorferi?
White-footed mouse to Ixodes scapularis to human
What is the first and most important treatment to immediately administer in pts with hyperkalemia?
Calcium gluconate or calcium chloride
What is the treatment for SVT?
Vagal maneuvers, drug therapy (adenosine), and cardioversion
The BCR-ABL1 gene located on chromosome 22 (known as the Philadelphia chromosome) is associated with what leukemia?
Chronic myelogenous leukemia (CML)
What is the treatment for DKA?
Treat precipitating cause
Correct volume depletion with NS, add dextrose to fluids once glucose is < 200 mg/dL
Replete K+ deficit (usually falsely elevated), do not start insulin if K+ < 3.3 mEq/L
IV insulin drip until anion gap closes
What are the signs/symptoms/treatment for fibromyalgia?
Risk factors: age 20–55, female sex
Widespread or multisite musculoskeletal pain for ≥ 3 months, nonrestorative sleep, and generalized fatigue
PE: areas of soft tissue tenderness, no joint swelling
Labs: normal CBC, chemistry, acute phase reactants
Diagnosis is made clinically
Treatment is education, exercise, antidepressants, avoid opioids
What are the signs/symptoms/treatment for polymyositis?
Sx: progressive weakness of 3 months’ duration
PE: diffuse tenderness of proximal muscles in the shoulder girdle and pelvic girdle without rash or joint swelling and neurologic examination yields normal results
Labs: positive anti-Jo, anti-SRP
Tx: corticosteroids
What is heard on auscultation in a pt with tricuspid regurgitation?
Pansystolic murmur that becomes louder with inspiration and reduced with expiration or Valsalva maneuver. It is best heard at the left lower sternal border and radiates to the right lower sternal border.
Pts presenting with seizure-like activity that lasts longer than 2 minutes and have their eyes tightly closed should be considered for what?
Psychogenic seizure
What biopsy result is a hallmark of Sjögren syndrome?
Mononuclear cell infiltration
In patients whose LDL-C is > 190 mg/dL or in individuals aged 40–75 years whose 10-year ASCVD risk is greater than 20%, what is the recommended treatment?
High-intensity statin (e.g., atorvastatin 40–80 mg or rosuvastatin 20–40 mg)
What is dressler syndrome?
AKA postmyocardial infarction syndrome is a pericarditis usually seen one to two weeks after an acute myocardial infarction or cardiac procedure
What is pernicious anemia?
Autoimmune destruction of cells that produce intrinsic factor (IF), resulting in vitamin B12 deficiency
What are the signs/symptoms of B12 deficiency?
Sx: fatigue, weakness, and peripheral neuropathy
PE: pallor and glossitis
Labs: MCV > 100 fL, hypersegmented neutrophils, elevated homocysteine, elevated methylmalonic acid
What surgical procedure can eradicate the carrier state of Salmonella and is an alternative to treatment with ciprofloxacin?
Cholecystectomy
What are the signs/symptoms/treatment for multifocal atrial tachycardia (MAT)?
Associated with older patients and those with COPD
Rate 100–200 beats/min
PR interval will differ
Notable feature: at least three different P wave forms
Tx: treat the underlying cause, calcium channel blockers
What is recommended as part of dietary management to slow CKD progression?
Restricted protein intake to 0.8 g/kg/day
What is the test of choice for patients with typical symptoms of autosomal dominant polycystic kidney disease and a positive family history?
CT or MRI
What presents in pts with a history of taking antimalarials, sulfonylureas, quinolones, nitrofurantoin, or eating fava beans and have labs with Heinz bodies/bite cells on the smear?
G6PD deficiency
What medication is prescribed with Isoniazid when treating latent TB?
Pyridoxine (Vit B6) to avoid neuropathy
What is the treatment for hospital acquired pnemonia?
Choose 1 abx from each category
1. cefepime, pip/taz, ceftazidime
2. cipro, levofloxacin, azithromycin
3. vanc, linezolid
What 2 labs are commonly drawn in pts suspected of having scleroderma?
Anti-topoisomerase I (anti-Scl-70) antibody (specific for diffuse disease)
Anticentromere antibody (specific for limited disease)
What are the symptoms and treatment for an essential tremor?
Tremor that is exacerbated by action and improved after alcohol consumption
Tx: propranolol
What are signs/symptoms of a pituitary prolactinoma?
Galactorrhea, amenorrhea, irregular menses, and infertility
Headache and vision loss (bitemporal hemianopsia) occur
Erectile dysfunction, reduced sperm count, infertility, decreased libido, gynecomastia
Elevated serum prolactin levels (> 200 ng/mL)
What is the treatment for hypercalcemia (bones, stones, groans, thrones, psychiatric overtones)?
IV fluids, bisphosphonates, calcitonin, denosumab (refractory disease)
What is the test for evaluating ischemic damage and subsequent stroke risk after a TIA?
Diffusion-weighted MRI
What are the signs/symptoms of chronic bronchitis?
Chronic productive cough for at least 3 months in at least 2 successive years
PE: decreased breath sounds, increased resonance upon percussion of the lung fields
Diagnosis: FEV1/FVC ratio < 0.7 post bronchodilator
Patients with chronic hypernatremia are at risk for what with rapid correction of sodium levels?
Cerebral edema
What is the classic pentad of TTP?
Anemia
Thrombocytopenia
Neuro findings
Kidney injury
According to the ADA, how is diabetes diagnosed?
- symptomatic (has polyuria, polydipsia, thirst, weight loss) and has a random blood glucose ≥ 200 mg/dL
- asymptomatic patient, diabetes (often type 2) fasting blood glucose ≥ 126 mg/dL on more than one occasion
- 2-hour plasma glucose value ≥ 200 mg/dL (11.1 mmol/L) during a 75 g oral glucose tolerance test (OGTT)
- A1C values ≥ 6.5%
According to the ADA, what is the criteria for prediabetes?
Impaired fasting glucose with fasting plasma glucose of 110–125 mg/dL, impaired glucose tolerance with 2-hour glucose value of 140–199 mg/dL after a 75 g OGTT, and A1C values of 5.7 to < 6.5%
What labs are seen in pts with interstitial nephritis?
↑ Cr; WBCs, RBCs, and WBC casts in urine sediment; eosinophilia
What are common causes of interstitial nephritis?
Medications (e.g., NSAIDS, antibiotics, PPIs), infections, autoimmune disorders
