Internal Medicine Flashcards
Describe findings in multiple Myeloma
- Old >65 w/ back pain and fatigue
- Will have renal failure, due to bence joyce protein casts
- Hypercalcemia
- Anemia (<12)
What GI bug can result in a liver abscess?
Entamoeba Histolytica
Side effects of amiodarone?
Blue/grey skin QT prolongation increased AST/ALT Hypo/Hyperthyroidism Pulmonary Toxicity (dont use in lung pts.)
What is the DOC for intercerebral HTN (pseudotumor cerebri)?
Acetazolamide
It blocks CA in the brain and lowers ICP
What other organ is most affected by HNPCC/Lynch Syndrome?
Endometrium of Uterus (check for endometrial CA)
MGUS vs Multiple Myeloma vs Waldenstroms Macro
MGUS - mild\no symptoms
MM = IgA/IgG spike, CRAB, etc
Waldenstroms = IgM spike
Hereditary Spherocytosis
- Northern European decent (scottish)
- Anemia (hemolytic and NORMOCYTIC), splenomegaly
- increased MCH
- Gallstones (pigmented)
- Increased reticulocyte count - indicating intrinsic problem with RBC’s (spectrin deficiency)
Fungal infection following DKA and treatment?
Mucormycosis - caused by Rhizorpus.
Will see hyphae
Tx with amphotericin and surgical debridement
Difference in COPD from Asthma based on chemistry?
Both can have reversibility with bronchodilators, but asthma is the leading one
Big difference = low DLCO in COPD, and it will be normal in Asthma pts.
Main killer after MI
2 weeks out?
2 months out?
weeks - papillary muscle rupture/free wall rupture
months - ventricular aneurysm
What is the main cause of Dermatitis Herpatiformus? Tx?
Celiac Dz
Tx - Dapsone
What is the underlying cancer in breast pagets disease?
adenocarcinoma
What is shock liver?
It is a huge rise in AST/ALT directly after experiencing septic shock or heart failure exacerbation etc. anywhere where the liver is poorly perfused
Small cell vs squamous cell CA of the lung
small cell = SIADH or ACTH (cushings syndrome) production
sqaumous cell = hypercalcemia
Anterior, Middle of Posterior Mediastinum?
Thyroid
Esophagus
Broncho
Neuromas
Thyroid = Ant Esophagus = Post Broncho = Middle Neuro = Post
Characteristics of Pagets disease of the bone
Huge spike in Alk Phos
Unorganized remodeling of bone
Enlarged head/Hands
Hearing loss/headaches
How to reverse over-warfarin dosage?
FFP
You can tell if someone has taken too much warfarin if the INR is too high. If 9 = stop warfarin and give Vit K
Warfarin anti-coagulates
What to do with a pregnant with Hep C?
The risk of vertical transmission is 2-5% so NBD.
Make sure she is vaccinized against Hep A and B. Both are safe during pregnancy
What is acalculous cholecystitis?
Acute inflammation of the gallbladder w/o gallstones
Seen in hospitalized pts with:
Burns, Trauma, TPN, fasting, mechanical ventilation
Heart changes in Marfans
Aortic Dilation
Aortic Regurg/Dissection
MVP (diastolic murmur)
Tx for giant cell temporal arteritus?
High dose corticosteroids
Can cause steroid induced myalgias
What is the heart defect seen in carcinoid syndrome?
Right sided valve stuff (TR)
What causes the pancytopenia seen in SLE?
peripheral (immune mediated) destruction
What are the MvO2 levels and PWCP in septic shock?
MvO2 will be high
PWCP will be low
Treatment of cocaine induced chest pain?
IV benzos (diazepam) and supplemental O2
Warfarin induced skin necrosis is due to what?
Often caused by underlying Protein C def.
Initiation of warfain blocks clotting factors (V, VII etc) but blocks anticlotting factors (C and S) first. This can cause a hypercoagulable state to begin with. If person is already low in protein C, thromboembolis or skin necrosis can occur
Presentation of acute closure angle glaucoma?
Pt was just at a movie theater/surprised/on drugs
The pupils were dilated and become perminantly dilated with blurry vision and pain. Tx = acetezolamide to decrease IOP
Malignant Otitis Externa
symptoms: ear pain in elderly exacerbated by chewing.
May see fever, PMHx of diabetes, and GRANULATION IN EARS
Bug: Psuedomonas
Tx: Ciprofloxacin
