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UWorld > Internal Medicine > Flashcards

Internal Medicine Flashcards

0
Q

Tx? Pt w/ syphilis allergic to penicillin?

A

Give doxycycline or tetracycline for 14 days

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1
Q

Management? Pt with intestinal obstruction who develops clinical/hemodynamic instability, fail to improve after initial conservative measures, and/or develops s/sx of strangulation

A

Urgent surgical exploration

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2
Q

EKG findings for pericarditis?

A

Diffuse ST elevation in all leads except in aVR, where ST depression is seen

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3
Q

Mainstay of tx for Dressler’s syndrome?

A

NSAID’s

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4
Q

What test would be best to order to rule out PE in a low risk pt?

A

D-dimer (fibrin split products)

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5
Q

3 MCC’s of aortic stenosis in general population

A

Senile calcific aortic stenosis (common over 70), bicuspid aortic valve (common below 70), rheumatic heart disease

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6
Q

Dx? Arthritis mainly affecting DIP joints, morning stiffness, deformity of involved joints, dactylitis (sausage digit), nail involvement (pitting and onycholysis - separation of nail bed)

A

Psoriatic arthritis

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7
Q

CSF findings for viral encephalitis

A

Elevated WBC count with lymphocyte predominance, normal glucose, elevated protein concentration

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8
Q

Confirm diagnosis of viral (HSV)encephalitis with:

A

CSF analysis shows presence of viral DNA on PCR

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9
Q

Clinical appearance of seborrheic keratosis:

A

Waxy, stuck-on, warty, well-circumscribed, greasy; scaling may be present; colors vary: pink/white/brown/black; slow enlargement w/inc thickness

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10
Q

Clinical appearance of acrochordon:

A

Skin tag; uz flesh colored, pedunculated papules in areas subjected to friction: neck, axilla, inner thighs

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11
Q

In acute pyelonephritis, what’s done first? Cultures or IV abx?

A

Cultures! Blood & urine cultures only take a few min—allows u to look for drug-resistant org

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12
Q

Sx: acute epididymitis

A

Fever, painful enlargement of testes (scrotal swelling), irritating voiding sx- inc frequency/urgency

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13
Q

Mobile cavitary mass in the lung, presents w/intermittent hemoptysis

A

Aspergilloma

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14
Q

Lung abscesses typically present w/what on cxr?

A

Air fluid level

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15
Q

First and second line tx for pain relief in OA

A

1- acetaminophen

2- NSAIDs

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16
Q

Prophylaxis for HIV + with: PCP & toxoplasmosis

A

TMP-SMX

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17
Q

Prophylaxis for HIV + with: cryptococcus neoformans & coccidioides immitis

A

Fluconazole

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18
Q

Prophylaxis for HIV + with: MAV complex and cd4+ <50 cells

A

Azithromycin

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19
Q

Prophylaxis for HIV + with: TB

A

Isoniazid

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20
Q

Dx tests to confirm myasthenia gravis

A

EMG and acetylcholine receptor Ab test.

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21
Q

Tx for stye

A

Warm compresses; if it doesn’t resolve in 48 hrs, then incision & drainage

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22
Q

S/sx of angioedema

A

1) non inflammatory edema of face, limbs, genitalia
2) laryngeal edema
3) edema of bowels resulting in colicky, abdominal pain

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23
Q

Hereditary angioedema usually follows:

A

An infection, dental procedure or trauma

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24
Q

Etiology of angioedema:

A

C1 inhibitor deficiency—resulting in elevated levels of edema producing factors–C2b and bradykinin

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25
Q

S/sx of syringomyelia

A

Absent reflexes in upper extremities, dissociated anesthesia (loss of pain and temp w/preserved position and vibration) in a cape distribution

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26
Q

MC pathology of syringomyelia

A

Cord cavitation

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27
Q

Mucopurulent urethral discharge, hx of multiple sexual partners, dysuria, urinary frequency, UA- absent bacteriuria, urine culture - less than 100 colonies/mL

A

Chlamydial urethritis

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28
Q

Fever, n/v, flank pain, dysuria, CVA tenderness, UA - bacteriuria, pyuria, urine culture- greater than 10, 000 colonies/mL

A

Acute pyelonephritis

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29
Q

Dysuria, urinary frequency, suprapubic discomfort, UA- bacteriuria, pyuria, culture- greater than 1000 colonies/mL

A

Acute bacterial cystitis

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30
Q

T or F? Morning headaches are a/w polycystic kidney disease.

A

True. PKD a/w intracerebral aneurysms.

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31
Q

Fam hx for PKD?

A

AD dz. Hx of stroke or sudden death.

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32
Q

Diagnostic test for PKD

A

Abdominal US

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33
Q

Most appropriate initial intervention for acute aortic dissection?

A

IV beta-blockers.
Type A involve ascending aorta - tx: medical & surgery
Type B involve descending only - tx: medical

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34
Q

Most common origin of ectopic foci that cause AFib?

A

Pulmonary veins

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35
Q

Drug of choice for pts w/htn and a benign essential tremor.

A

Propranolol

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36
Q

Triad for Leriche syndrome:

A

Bilateral hip/thigh/buttock pain, impotence, symmetric atrophy of bilateral LE d/t chronic ischemia (dec femoral, popliteal, DP pulses)

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37
Q

What is the CI in systolic heart failure?

A

Always decreased. It’s a measure of cardiac output.

38
Q

Is the TPR inc or dec in systolic heart failure?

A

It’s increased d/t neurohumoral activation that includes sympathetic hyperactivity and activation of renin-angiotensin-aldosterone system.

39
Q

Common causes of exertional syncope:

A

Ventricular tachycardia and left ventricular outflow obstruction (aortic stenosis or hypertrophic obstructive cardiomyopathy)

40
Q

Typical sx and PE findings: aortic stenosis

A

Exertional dyspnea, syncope, angina; PE: systolic ejection murmur radiating to apex and carotid arteries

41
Q

Common cause of aortic stenosis in young adult:

A

Bicuspid aortic valve

42
Q

Mechanism of nitroglycerin:

A

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

43
Q

Strongest predictor of AAA expansion/rupture:

A

Large aneurysmal diameter, rapid rate of expansion, current cigarette smoking

44
Q

Current indications for operative/endovascular repair of AAA:

A

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)

45
Q

Secondary causes of HTN

A

Renal parenchymal dz, renal artery stenosis (renovascular dz), primary aldosteronism, pheochromocytoma, Cushing’s syndrome, hypothyroidism, primary hyperparathyroidism, coarctation of the aorta

46
Q

S/sx: renal parenchymal dz

A

Elevated serum creatinine, abnormal urinalysis (proteinuria, red blood cell casts)

47
Q

S/sx: renal artery stenosis

A

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

48
Q

S/sx: primary hyperparathyroidism

A

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

49
Q

S/sx: dermatomyositis

A

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

50
Q

Common causes of esophagitis in HIV pts

A

Candida albicans; herpes simplex; CMV; idiopathic/aphthous ulcers

51
Q

Signs of esophagitis w/CMV

A

Deep, linear ulcers; distal esophagus

52
Q

Repeated vomiting causes what metabolic state?

A

Hypokalemic, hypochloremic, metabolic alkalosis

53
Q

Sx: Postcholecystectomy syndrome

A

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

54
Q

Post-op measures used to decrease risk of pneumonia in pts at risk

A

Incentive spirometry, deep breathing exercises, continuous positive airway pressure (PAP), intermittent PAP

55
Q

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

A

Atelectasis

56
Q

Ankle-brachial index calculation

A

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

57
Q

Post-op mediastinits requires what tx?

A

Drainage, surgical debridement, prolonged abx tx

58
Q

Metabolic acidosis during DKA is typically accompanied by??? (Very HY!)

A

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.

59
Q

Melena

A

Upper GI bleeding

60
Q

Pain from duodenal ulcers usually ______ w/food. Pain from gastric ulcers _____ w/food.

A

Improves; worsens

61
Q

Clinical presentation of ischemic hepatic injury:

A

Hypotension; acute, massive increases in AST/ALT w/milder increases in total bilirubin and alkaline phosphatase

62
Q

Effective and rapid tx for acute attack of cluster HA

A

100% oxygen

63
Q

Most common organism a/w Guillain-Barré syndrome

A

Campylobacter jejuni

64
Q

Metformin should not be given to pts with:

A

Acute renal failure, hepatic failure or sepsis. All these increase risk of developing lactic acidosis

65
Q

Subtle signs of SBP: spontaneous bacterial peritonitis

A

Fever and mental status changes (along with cirrhosis and ascites)

66
Q

Test of choice for spontaneous bacterial peritonitis

A

Diagnostic paracentesis

67
Q

Bone pain, renal failure, hypercalcemia

A

Multiple myeloma (look for paraproteinemia—bence jones proteins)

68
Q

Presbyopia

A

Loss of elasticity of lens, seen in middle aged, problems w/near vision (holds book far away to read)

69
Q

Causes of alveolar hypoventilation and respiratory acidosis

A

COPD; OSA; scoliosis; myasthenia gravis; lambert-eaton syndrome; Guillain-Barré syndrome; anesthetics; narcotics; sedatives; brain stem lesion; infection; stroke

70
Q

Normal A-a gradient

A

30 is elevated regardless of age

71
Q

Ethylene glycol poisoning

A

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

72
Q

Metaclopramide-induced dystonic reaction

A

Meto: dopamine receptor antagonist used to treat n/v and gastroparesis
Pts taking this may get drug induced extrapyramidal sx (neck stiffness/tenderness)

73
Q

Psuedodementia is reversible by treating …

A

Depression (use SSRI’s)

74
Q

Screen for colon CA in pts w/ulcerative colitis once..

A

UC has been present for at least 8 years regardless of age of pt

75
Q

Nonspecific, but very sensitive finding of ATN on UA:

A

Muddy brown granular casts consisting of renal tubular epithelial cells

76
Q

Type of anemia that is a common side effect of methotrexate:

A

Macrocytic anemia ( Hb 100)

77
Q

**HY: 24 hr urine collection in a DM II pt reveals microalbuminuria. What med can slow end-organ damage?

A

Adding an ACE-I (these drugs slow progression of diabetic nephropathy)

78
Q

Waldenstrom’s macroglobulinemia: what is it?

A

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

79
Q

Waldenstrom’s macroglobulinemia:S/Sx

A

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

80
Q

Definition of heat stroke

A

Body temp above 40.5 C (105 F)

81
Q

Indications for use of thrombolytics in stroke

A

Nonhemorrhagic ischemic stroke; symptom onset <3-4.5 hours before treatment initiation

82
Q

Symptomatic aortic stenosis (AS)

A

Harsh systolic murmur over right substernal edge, LV hypertrophy, classical indicators for surgery: syncope, angina, dyspnea; any one of these is enough

83
Q

Virchow’s triad

A

Stasis, endothelial injury, hypercoagulable state

84
Q

2 MC explanations for inflammatory mono arthritis (a single red, swollen, painful joint):

A

Septic arthritis and crystal-induced arthritis. RA predisposes you to develop septic arthritis.

85
Q

Clinical features of melanoma

A

ABCDE: Asymmetry, Border irregularity, Color change (pink to blue to black), Diameter > 6mm, Elevation - typically raised

86
Q

Renal transplant dysfunction in early postop period explained by:

A

Ureteral obstruction, acute rejection, cyclosporine toxicity, vascular obstruction and ATN

87
Q

How to diagnose differentials in renal transplant dysfunction? (Imaging/tests)

A

Radioisotope scanning, renal US, MRI, renal biopsy

88
Q

HYHow to treat acute rejection following organ transplant:

A

High dose IV steroids

89
Q

*HY herpetic whitlow

A

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.

90
Q

Skin findings in acute meningococcemia:

A

Petechial rash that progresses to ecchymosis, bullae, vesicles and ultimately gangrenous necrosis

91
Q

Classic tetrad for multiple myeloma (s/sx)

A

CRAB: hypercalcemia, renal impairment, anemia, bones (bone pain, lytic lesions, fractures)

92
Q

Observer bias

A

When an investigator’s decision is adversely affected by knowledge of the exposure status

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