Internal Medicine Flashcards
Tx? Pt w/ syphilis allergic to penicillin?
Give doxycycline or tetracycline for 14 days
Management? Pt with intestinal obstruction who develops clinical/hemodynamic instability, fail to improve after initial conservative measures, and/or develops s/sx of strangulation
Urgent surgical exploration
EKG findings for pericarditis?
Diffuse ST elevation in all leads except in aVR, where ST depression is seen
Mainstay of tx for Dressler’s syndrome?
NSAID’s
What test would be best to order to rule out PE in a low risk pt?
D-dimer (fibrin split products)
3 MCC’s of aortic stenosis in general population
Senile calcific aortic stenosis (common over 70), bicuspid aortic valve (common below 70), rheumatic heart disease
Dx? Arthritis mainly affecting DIP joints, morning stiffness, deformity of involved joints, dactylitis (sausage digit), nail involvement (pitting and onycholysis - separation of nail bed)
Psoriatic arthritis
CSF findings for viral encephalitis
Elevated WBC count with lymphocyte predominance, normal glucose, elevated protein concentration
Confirm diagnosis of viral (HSV)encephalitis with:
CSF analysis shows presence of viral DNA on PCR
Clinical appearance of seborrheic keratosis:
Waxy, stuck-on, warty, well-circumscribed, greasy; scaling may be present; colors vary: pink/white/brown/black; slow enlargement w/inc thickness
Clinical appearance of acrochordon:
Skin tag; uz flesh colored, pedunculated papules in areas subjected to friction: neck, axilla, inner thighs
In acute pyelonephritis, what’s done first? Cultures or IV abx?
Cultures! Blood & urine cultures only take a few min—allows u to look for drug-resistant org
Sx: acute epididymitis
Fever, painful enlargement of testes (scrotal swelling), irritating voiding sx- inc frequency/urgency
Mobile cavitary mass in the lung, presents w/intermittent hemoptysis
Aspergilloma
Lung abscesses typically present w/what on cxr?
Air fluid level
First and second line tx for pain relief in OA
1- acetaminophen
2- NSAIDs
Prophylaxis for HIV + with: PCP & toxoplasmosis
TMP-SMX
Prophylaxis for HIV + with: cryptococcus neoformans & coccidioides immitis
Fluconazole
Prophylaxis for HIV + with: MAV complex and cd4+ <50 cells
Azithromycin
Prophylaxis for HIV + with: TB
Isoniazid
Dx tests to confirm myasthenia gravis
EMG and acetylcholine receptor Ab test.
Tx for stye
Warm compresses; if it doesn’t resolve in 48 hrs, then incision & drainage
S/sx of angioedema
1) non inflammatory edema of face, limbs, genitalia
2) laryngeal edema
3) edema of bowels resulting in colicky, abdominal pain
Hereditary angioedema usually follows:
An infection, dental procedure or trauma
Etiology of angioedema:
C1 inhibitor deficiency—resulting in elevated levels of edema producing factors–C2b and bradykinin
S/sx of syringomyelia
Absent reflexes in upper extremities, dissociated anesthesia (loss of pain and temp w/preserved position and vibration) in a cape distribution
MC pathology of syringomyelia
Cord cavitation
Mucopurulent urethral discharge, hx of multiple sexual partners, dysuria, urinary frequency, UA- absent bacteriuria, urine culture - less than 100 colonies/mL
Chlamydial urethritis
Fever, n/v, flank pain, dysuria, CVA tenderness, UA - bacteriuria, pyuria, urine culture- greater than 10, 000 colonies/mL
Acute pyelonephritis
Dysuria, urinary frequency, suprapubic discomfort, UA- bacteriuria, pyuria, culture- greater than 1000 colonies/mL
Acute bacterial cystitis
T or F? Morning headaches are a/w polycystic kidney disease.
True. PKD a/w intracerebral aneurysms.
Fam hx for PKD?
AD dz. Hx of stroke or sudden death.
Diagnostic test for PKD
Abdominal US
Most appropriate initial intervention for acute aortic dissection?
IV beta-blockers.
Type A involve ascending aorta - tx: medical & surgery
Type B involve descending only - tx: medical
Most common origin of ectopic foci that cause AFib?
Pulmonary veins
Drug of choice for pts w/htn and a benign essential tremor.
Propranolol
Triad for Leriche syndrome:
Bilateral hip/thigh/buttock pain, impotence, symmetric atrophy of bilateral LE d/t chronic ischemia (dec femoral, popliteal, DP pulses)
What is the CI in systolic heart failure?
Always decreased. It’s a measure of cardiac output.
Is the TPR inc or dec in systolic heart failure?
It’s increased d/t neurohumoral activation that includes sympathetic hyperactivity and activation of renin-angiotensin-aldosterone system.
Common causes of exertional syncope:
Ventricular tachycardia and left ventricular outflow obstruction (aortic stenosis or hypertrophic obstructive cardiomyopathy)
Typical sx and PE findings: aortic stenosis
Exertional dyspnea, syncope, angina; PE: systolic ejection murmur radiating to apex and carotid arteries
Common cause of aortic stenosis in young adult:
Bicuspid aortic valve
Mechanism of nitroglycerin:
Dilation of veins (capacitance vessels) and decrease in ventricular preload; also causes arterial dilation (resistance vessels) –decreasing ventricular afterload, but this has less effect on relieving anginal pain
Strongest predictor of AAA expansion/rupture:
Large aneurysmal diameter, rapid rate of expansion, current cigarette smoking
Current indications for operative/endovascular repair of AAA:
Aneurysm size > 5.5cm, rapid rate of aneurysm expansion (>0.5 cm in 6 months or >1 cm/yr) and presence of symptoms (abd/back/flank pain, limb ischemia)
Secondary causes of HTN
Renal parenchymal dz, renal artery stenosis (renovascular dz), primary aldosteronism, pheochromocytoma, Cushing’s syndrome, hypothyroidism, primary hyperparathyroidism, coarctation of the aorta
S/sx: renal parenchymal dz
Elevated serum creatinine, abnormal urinalysis (proteinuria, red blood cell casts)
S/sx: renal artery stenosis
Severe HTN (>180mm Hg systolic and/or 120mm Hg diastolic) after age 55; poss recurrent flash pulmonary edema or resistant heart failure, unexplained rise in serum creatinine; abdominal bruit
S/sx: primary hyperparathyroidism
Hypercalcemia (polyuria, polydipsia); kidney stones; neuropsychiatric sx (confusion, depression, psychosis); muscle weakness
Bones, stones, abdominal moans, psychic groans
Also a/w MEN type II w/pheochromocytoma
S/sx: dermatomyositis
Autoimmune; proximal symmetrical muscle weakness w/vasculitis; heliotrope sign - reddish/purple rash/edema around eyes; shawl sign- rash over lateral neck; gottren’s papules - scaly, red patches over knuckles, elbows, knees; F>M; autoAB: anti-Mi-2; a/w malignancy (ovarian, breast, lung); pulmonary fibrosis
Common causes of esophagitis in HIV pts
Candida albicans; herpes simplex; CMV; idiopathic/aphthous ulcers
Signs of esophagitis w/CMV
Deep, linear ulcers; distal esophagus
Repeated vomiting causes what metabolic state?
Hypokalemic, hypochloremic, metabolic alkalosis
Sx: Postcholecystectomy syndrome
Persistent abd pain or dyspepsia (nausea) that occurs post-op or months or yrs after a cholecystectomy; d/t biliary (retained common bile duct or cystic duct stone, biliary dyskinesia) or extra-biliary (pancreatitis, PUD, CAD) causes; diagnostic tests: endoscopic US, endoscopic retrograde cholangiopancreatography
Post-op measures used to decrease risk of pneumonia in pts at risk
Incentive spirometry, deep breathing exercises, continuous positive airway pressure (PAP), intermittent PAP
One of the MC post-op complications d/t airway obstruction from retained airway secretions, decreased lung compliance, post-op pain, and medications that interfere w/deep breathing. ABG: hypoxemia, hypocapnia, resp alkalosis
Atelectasis
Ankle-brachial index calculation
Divide higher ankle (dorsalis pedis or posterior tibial) systolic pressure in each LE by the higher brachial artery (Lt or Rt) systolic pressure
1.3 suggestive or calcified or incompressible vessels
Post-op mediastinits requires what tx?
Drainage, surgical debridement, prolonged abx tx
Metabolic acidosis during DKA is typically accompanied by??? (Very HY!)
Hyperkalemia (paradoxical - bc body K reserves are actually depleted d/t inc GI losses and osmotic diuresis). Mainly d/t extra cellular shift of potassium in exchange for hydrogen ion w/resultant intracellular K deficit. Also d/t impaired insulin-dependent cell entry of K ion.
Melena
Upper GI bleeding
Pain from duodenal ulcers usually ______ w/food. Pain from gastric ulcers _____ w/food.
Improves; worsens
Clinical presentation of ischemic hepatic injury:
Hypotension; acute, massive increases in AST/ALT w/milder increases in total bilirubin and alkaline phosphatase
Effective and rapid tx for acute attack of cluster HA
100% oxygen
Most common organism a/w Guillain-Barré syndrome
Campylobacter jejuni
Metformin should not be given to pts with:
Acute renal failure, hepatic failure or sepsis. All these increase risk of developing lactic acidosis
Subtle signs of SBP: spontaneous bacterial peritonitis
Fever and mental status changes (along with cirrhosis and ascites)
Test of choice for spontaneous bacterial peritonitis
Diagnostic paracentesis
Bone pain, renal failure, hypercalcemia
Multiple myeloma (look for paraproteinemia—bence jones proteins)
Presbyopia
Loss of elasticity of lens, seen in middle aged, problems w/near vision (holds book far away to read)
Causes of alveolar hypoventilation and respiratory acidosis
COPD; OSA; scoliosis; myasthenia gravis; lambert-eaton syndrome; Guillain-Barré syndrome; anesthetics; narcotics; sedatives; brain stem lesion; infection; stroke
Normal A-a gradient
30 is elevated regardless of age
Ethylene glycol poisoning
This substance and methanol are used as substitutes for alcohol. Sx: flank pain, hematuria, oliguria, acute renal failure, anion gap metabolic acidosis, hypocalcemia, calcium oxalate crystal deposition. Tx: fomepizole or ethanol
Metaclopramide-induced dystonic reaction
Meto: dopamine receptor antagonist used to treat n/v and gastroparesis
Pts taking this may get drug induced extrapyramidal sx (neck stiffness/tenderness)
Psuedodementia is reversible by treating …
Depression (use SSRI’s)
Screen for colon CA in pts w/ulcerative colitis once..
UC has been present for at least 8 years regardless of age of pt
Nonspecific, but very sensitive finding of ATN on UA:
Muddy brown granular casts consisting of renal tubular epithelial cells
Type of anemia that is a common side effect of methotrexate:
Macrocytic anemia ( Hb 100)
**HY: 24 hr urine collection in a DM II pt reveals microalbuminuria. What med can slow end-organ damage?
Adding an ACE-I (these drugs slow progression of diabetic nephropathy)
Waldenstrom’s macroglobulinemia: what is it?
Rare, chronic plasma cell neoplasm. Abn plasma cells multiply out of control and invade bone marrow, lymph nodes and spleen. Also production of excessive IgM Ab in blood–causes hyperviscosity of blood
Waldenstrom’s macroglobulinemia:S/Sx
Increased size of spleen/liver/lymph nodes; tiredness–uz d/t anemia; tendency to bleed/bruise easily; night sweats; H/A and dizziness; various visual probs; pain/numbness in extremities
Definition of heat stroke
Body temp above 40.5 C (105 F)
Indications for use of thrombolytics in stroke
Nonhemorrhagic ischemic stroke; symptom onset <3-4.5 hours before treatment initiation
Symptomatic aortic stenosis (AS)
Harsh systolic murmur over right substernal edge, LV hypertrophy, classical indicators for surgery: syncope, angina, dyspnea; any one of these is enough
Virchow’s triad
Stasis, endothelial injury, hypercoagulable state
2 MC explanations for inflammatory mono arthritis (a single red, swollen, painful joint):
Septic arthritis and crystal-induced arthritis. RA predisposes you to develop septic arthritis.
Clinical features of melanoma
ABCDE: Asymmetry, Border irregularity, Color change (pink to blue to black), Diameter > 6mm, Elevation - typically raised
Renal transplant dysfunction in early postop period explained by:
Ureteral obstruction, acute rejection, cyclosporine toxicity, vascular obstruction and ATN
How to diagnose differentials in renal transplant dysfunction? (Imaging/tests)
Radioisotope scanning, renal US, MRI, renal biopsy
HYHow to treat acute rejection following organ transplant:
High dose IV steroids
*HY herpetic whitlow
Common viral infection of the hand, caused either by herpes simplex 1or 2. Uz self-limiting. Tzanck smear of the vesicles shows multi-nucleated giant cells. Uz seen in health-care workers d/t exposure.
Skin findings in acute meningococcemia:
Petechial rash that progresses to ecchymosis, bullae, vesicles and ultimately gangrenous necrosis
Classic tetrad for multiple myeloma (s/sx)
CRAB: hypercalcemia, renal impairment, anemia, bones (bone pain, lytic lesions, fractures)
Observer bias
When an investigator’s decision is adversely affected by knowledge of the exposure status
