Internal Medicine

Question 1

Describe findings in multiple Myeloma

Answer 1

• Old >65 w/ back pain and fatigue
• Will have renal failure, due to bence joyce protein casts
• Hypercalcemia
• Anemia (<12)

Question 2

What GI bug can result in a liver abscess?

Answer 2

Entamoeba Histolytica

Question 3

Side effects of amiodarone?

Answer 3

Blue/grey skin
QT prolongation
increased AST/ALT
Hypo/Hyperthyroidism
Pulmonary Toxicity (dont use in lung pts.)

Question 4

What is the DOC for intercerebral HTN (pseudotumor cerebri)?

Answer 4

Acetazolamide

It blocks CA in the brain and lowers ICP

Question 5

What other organ is most affected by HNPCC/Lynch Syndrome?

Answer 5

Endometrium of Uterus (check for endometrial CA)

Question 6

MGUS vs Multiple Myeloma vs Waldenstroms Macro

Answer 6

MGUS - mild\no symptoms

MM = IgA/IgG spike, CRAB, etc

Waldenstroms = IgM spike

Question 7

Hereditary Spherocytosis

Answer 7

• Northern European decent (scottish)
• Anemia (hemolytic and NORMOCYTIC), splenomegaly
• increased MCH
• Gallstones (pigmented)
• Increased reticulocyte count - indicating intrinsic problem with RBC’s (spectrin deficiency)

Question 8

Fungal infection following DKA and treatment?

Answer 8

Mucormycosis - caused by Rhizorpus.

Will see hyphae

Tx with amphotericin and surgical debridement

Question 9

Difference in COPD from Asthma based on chemistry?

Answer 9

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.

Question 10

Main killer after MI

2 weeks out?
2 months out?

Answer 10

weeks - papillary muscle rupture/free wall rupture

months - ventricular aneurysm

Question 11

What is the main cause of Dermatitis Herpatiformus? Tx?

Answer 11

Celiac Dz

Tx - Dapsone

Question 12

What is the underlying cancer in breast pagets disease?

Answer 12

adenocarcinoma

Question 13

What is shock liver?

Answer 13

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

Question 14

Small cell vs squamous cell CA of the lung

Answer 14

small cell = SIADH or ACTH (cushings syndrome) production

sqaumous cell = hypercalcemia

Question 15

Anterior, Middle of Posterior Mediastinum?

Thyroid
Esophagus
Broncho
Neuromas

Answer 15

Thyroid = Ant
Esophagus = Post
Broncho = Middle
Neuro = Post

Question 16

Characteristics of Pagets disease of the bone

Answer 16

Huge spike in Alk Phos
Unorganized remodeling of bone
Enlarged head/Hands
Hearing loss/headaches

Question 17

How to reverse over-warfarin dosage?

Answer 17

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

Question 18

What to do with a pregnant with Hep C?

Answer 18

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

Question 19

What is acalculous cholecystitis?

Answer 19

Acute inflammation of the gallbladder w/o gallstones

Seen in hospitalized pts with:

Burns, Trauma, TPN, fasting, mechanical ventilation

Question 20

Heart changes in Marfans

Answer 20

Aortic Dilation
Aortic Regurg/Dissection
MVP (diastolic murmur)

Question 21

Tx for giant cell temporal arteritus?

Answer 21

High dose corticosteroids

Can cause steroid induced myalgias

Question 22

What is the heart defect seen in carcinoid syndrome?

Answer 22

Right sided valve stuff (TR)

Question 23

What causes the pancytopenia seen in SLE?

Answer 23

peripheral (immune mediated) destruction

Question 24

What are the MvO2 levels and PWCP in septic shock?

Answer 24

MvO2 will be high

PWCP will be low

Question 25

Treatment of cocaine induced chest pain?

Answer 25

IV benzos (diazepam) and supplemental O2

Question 26

Warfarin induced skin necrosis is due to what?

Answer 26

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

Question 27

Presentation of acute closure angle glaucoma?

Answer 27

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

Question 28

Malignant Otitis Externa

Answer 28

symptoms: ear pain in elderly exacerbated by chewing.

May see fever, PMHx of diabetes, and GRANULATION IN EARS

Bug: Psuedomonas
Tx: Ciprofloxacin