Internal Medicine Flashcards
Some SLE patients with dyspnea, persistent episodes of pleuritic chest pain, a progressive decrease in lung volume, and no evidence of interstitial fibrosis or significant pleural disease on chest CT have … (dz).
Vanishing lung syndrome
Causes of primary HYPER-coagulable states
Antithrombin III deficiency, Protein C or S deficiency, Fibrinolytic abnormalities AND Homocystinuria AND Antiphospholipid Antibody Sdr.
Anticoagulation during pregnancy - 2 options
LMWH throughout the pregnancy AND AND LMWH until the 13th week, a change to warfarin until the middle of the third trimester, and then restart LMWH until delivery
ITP definition
isolated thrombocytopenia AND no peripheral smear abnormalities found AND no clinically apparent conditions causing thrombocytopenia
Acute rheumatic fever (ARF) major manifestations are: …
Migratory arthritis predominantly involving the large joints / Carditis and valvulitis / Central nervous system involvement (eg, Sydenham chorea) / Rash
Anterior hip pains are …
true hip pains.
Migratory polyarthritis is characteristic for … and …
gonococcal AND AND rheumatic fever
The peak incidence of West Nile virus infection arises at the end of … and early… ( month).
August / September
Anti-ds DNA and anti-Smith antibodies are specific for…
SLE
Carpal tunel sdr in HD patients denotes
amyloidosis
Erythema migratum with migratory large joints arthritis occurs in…
acute rheumatic fever.
Worsening back pain with walking, but improving with back flexion or walking uphill
spinal stenosis
The definitive Tx for CML is…
BMT (hematopoietic cell transplantation)
… and … are the two major clinical findings in primary aldosteronism.
Hypertension AND AND hypokalemia
Hypersegmented NFs are strongly sugestive of…
vitamin B12 or folate deficiency
Patients with the full Wiskott-Aldrich syndrome are cured by …
bone marrow transplantation
Low … is associated with increased risk for Alzheimer’s dz in elderly.
diastolic BP
… vaccine is recommended for terminal complement or properdin def., asplenics and travelers to endemic areas.
Meningococcal
… is the best first test for excluding or confirming pheochromocytoma (sens 99, spec 89).
Plasma metanephrins
Screening with … is done in women 40-69.
mammography
Endemic areas for … infections are: sub-Saharan Africa extending from Guinea in the west to Ethiopia in the east and pilgrims who make the hajj to Mecca, Saudi Arabia.
Meningococcal
Neurologic symptoms after a benign respiratory or gastric infection: fine paresthesias followed by LEs weakness that may ascend is typical for…
Guillan-Barre sdr
…consists of: yellow nails, lymphedema, and pleural effusion.
Yellow nail syndrome
…has been commonly isolated in patients who suffered plantar puncture while wearing tennis shoes.
P. aeruginosa
When osteomyelitis arises following a puncture injury, … is the most common pathogen in diabetic patients and … in nondiabetics.
S. aureus AND AND P. aeruginosa
Three phase bone scan difference between ostemyelitis and cellulitis occurs in phase … when only osteo results in increase uptake.
three
The initial Tx of spontaneous pneumothorax in a COPDer consists of…
tube placement followed by pleurodesis
The only useful Rx for gastroparesis is…
nutritional support
c-ANCA positive suggests…
Wegener granulomatosis
Anemia-pancytopenia, dementia, irritability, fatigue, weakness, constipation, dandruff, menstrual problems are all symptoms of …
Vitamin B12 deficiency
The most common cause of hemoptysis in HIV patients is…
bacterial infection
This sleep disorder occurs in the first third of the night and is rarely violent:
sleep walking
Inflammatory bowel dz, SLE, Behcet, and Reiters’ sdr. cause … in the oral cavity.
Ulcers (aftous stomatitis)
Erythema multiforme, …, and toxic epidermal necrolysis (TEN) are three disorders that have similar clinical features, including lesions of the skin and mucous membranes and induction by exposure to drugs or infections.
Stevens-Johnson syndrome (SJS),
Clinical criteria for… include fever, tonsillar exudates, tender anterior cervical lymphadenopathy, and absence of cough.
acute streptococcal pharyngitis
… represents 85% of brain infections in Mexico City.
Cysticercosis
In the perineal area, penetration of the gastrointestinal or urethral mucosa by enteric organisms can cause…, an aggressive infection
Fournier’s gangrene
… is done in pts with unilateral tinnitus to rule out acoustic neuroma or a cerebellar-pontine angle tumor.
Gadolinium MRI
…therapy is given to most patients with COP (Cryptogenic organizing pneumonitis also called bronchiolitis obliterans organizing pneumonia - BOOP).
Corticosteroid
…is the antibiotic of choice, based upon its in vitro activity and the results of clinical trials in pertussis or “whooping cough”.
Erythromycin
…is the second most common cause of disabling daytime sleepiness after sleep apnea.
Narcolepsy
The typical symptoms in… are excessive daytime sleepiness, hypnagogic, sleep paralysis, cataplexy and insomnia.
narcolepsy
Gamma hydroxybutyrate is especially useful in patients with severe cataplexy, but it can also improve daytime sleepiness in…
narcolepsy.
… arthropathy usually occurs in the 2nd and 3rd MCP joint.
Hemochromatosis
Abdominal pain or vaginal bleeding in a fertile woman raises concern for …
Ectopic pregnancy
Any new HA associated with seizure should prompt investigation with … and …
Neuroimaging / LP
To prevent endometrial carcinoma, women with these symptoms… should take PG with EG unless they had hysterectomy.
Hot flashes perimenopausal
…is a key predictor for poor outcome in patients with work-related back pain.
Low job satisfaction
… is very sensitive and specific for complete rotator cuff tears, less for partial.
MRI
… tears occur with twisting injuries (such as stopping short and turning).
Anterior cruciate ligament
Patients with … complain of recurrent episodes of vertigo lasting one minute or less provoked by specific types of head movements, such as looking up while standing or sitting, lying down or getting up from bed, and rolling over in bed.
Benign paroxysmal positional vertigo (BPPV)
… is most commonly used to palliate pain from pancreatic cancer but has also been used for relieving pain in chronic pancreatitis.
Celiac plexus neurolysis (CPN)
Patients with celiac disease should omit …, … and … from their diet.
wheat AND rye (orz) AND barley (secara)
When more than one household has pruritus, Rx for … may be appropriate even when typical burrows are absent.
scabies
… is the Rx of choice in head lice, with lindane and benzyl benzoate also effective.
Permethrin
…, an emergency, is Rx with IV acetazolamide, osmotic diuresis, topical pilocarpine and laser peripheral iridotomy.
Acute angle closure glaucoma
… is usually unilateral and presents with halos around objects, worsening eye pain, HA, N&V, and red eye.
Acute angle closure glaucoma
Fosphenytoin with ECG monitoring is an important step in the treatment of… due to ease of administration (high rate IV or IM).
status epilepticus
High grade gliomas are removed surgically then treated with…
external beam radiation.
… (location) seizures are characterized by the sudden occurrence of visual phenomena (flashing lights, hallucinations, or loss of vision).
Occipital
The most common manifestation of neurocysticercosis are… due to parenchymal involvement.
seizures
To prevent aspiration in a weak patient when emesis occurs, patient has to be placed in… position.
lateral decubitus
A patient with… can only move the eyes vertically and blink.
locked-in syndrome
One single seizure does not prompt to institution of antiepileptic meds in the absence of…
risk factors.
Conservative Rx with … is effective in reducing the bleeding episodes in patients with internal hemorrhoids.
Fiber supplementation
Diarrhea within 12 hours of ingestion of preformed bacterial toxins occurs in … and …exposure.
S. aureus / enterotoxigenic E. coli
Antiperistaltic agents and intraluminal adsorbents can be safely used in diarrhea without…, with the exception of enterohemorrhagic Escherichia coli infection.
slowing the clearance of pathogens
In patients younger then 35 YO, … or … is adequate to assess hemorrhoids unless the patient has risk factors for CA.
Anoscopy / sigmoidoscopy
Perianal area application of … relieves the pain, reduces the anal canal pressure and improves the anodermal blood flow in patients with anal fissures.
NTG or nifedipine
The positive serologic markers in acute hepatitis C are: …
HCV IgM
The positive serologic markers in acute hepatitis A are: …
HAV IgM
Disabling painful condition that occurs after a minor/major injury and is associated with vasomotor changes, skin and muscle atrophy and osteopenia is…
Reflex sympathetic dystrophy
Patients have an inability to localize precisely the pain and have characteristic tender points in …
Fibromyalgia
Anal fissures that do not occur in … (location) are more likely to be due to a secondary cause and need investigation.
the posterior midline
A person with low risk for cervical CA and in a monogamous relation with many normal Pap smears, it is appropriate to screen every… .
3 years
HIV infection and any immunosupression state increases the speed of human papillomavirus tumor growth, so women will have to be screened for … more often.
cervical CA
A recent diagnosis of … (group of dz) is a risk factor for cervical CA.
STD
All these disorders cause … HA (timing): migraine, cluster, chronic paroxysmal, OSA (Sleep apnea syndrome) and increased intracranial pressure.
morning/nocturnal
… (drug) is the most helpful in both labyrinthitis and Menièr’s.
Meclizine
Recurrent episodes of tinea versicolor is Rx with … (drug class).
oral antifungal agents
… can reduce the risk of hip fracture among patients who are at risk for falls and fractures.
Hip protectors
… has been shown to reduce the time to hematopoietic recovery in recipients of autologous and allogeneic bone marrow transplantation.
G-CSF
The majority of cases have been due to … microti, (first described in 1966) and occur predominantly on the NE US coast: Massachusetts, particularly Cape Cod, Nantucket and Martha’s Vineyard, Long Island, and recently also New Jersey, Block Island, off of
Babesia
… is the most common cancer in man and the second most common cause of CA death.
Prostate CA
Patients with… (location) metastases of malignant melanoma can be treated with surgery, radiation therapy, and/or stereotactic radiosurgery.
Brain
All abnormal PSA screening lead to … except in very elderly and infirm men.
US guided transrectal biopsy of the prostate
An enlarged supraclavicular node in a patient with testicular mass suggests…
metastasized testicular CA.
… is the most common CA in the young man, and 95% of cases can be cured.
Testicular CA
Patients with … (electrolyte imbalance) should be Rx with volume repletion and a loop diuretic to maximize renal excretion.
hypercalcemia
Hypokalemia is difficult to correct in the presence of … because the latter causes renal potassium wasting through an unknown mechanism.
hypomagnesemia
The signs and symptoms of … (electrolyte imbalance) include lethargy, anorexia, neuromuscular disorders (Chvostek and Trousseau’s signs) and cardiac arrhythmias, even in the absence of hypocalcemia.
hypomagnesemia
Most cases of traveler’s diarrhea are caused by… .
enterotoxigenic E. coli
Most cases of traveler’s diarrhea are responsive to Rx with … (ABx class).
fluoroquinolones
… (dz) is the most common primary immune defect.
Selective IgA deficiency
… (complement component range) and factor D and properdin deficiency lead to increased neisserial infections.
C5-C9
… is the ratio between the change in anion gap and the change in plasma HCO3 and should be 1-2; when is not, in a high anion gap metabolic acidosis, a concurrent non-anion gap metabolic acidosis exists.
Delta-Delta
Diuretic-induced metabolic alkalosis occurs through increased… delivery to the collecting tubules where its reabsorption increases H and K secretion.
Na
… is the most common cause of acute renal failure due to intrinsic renal disease in hospitalized patients.
ATN (acute tubular necrosis)
Rx with … as doxazosin, prazosin or tamsulosin is the most effective in BPH.
alpha-1-antagonists
MAOI are effective in depression but are not used b/o risk for… .
hypertensive crisis
… is defined as extreme mood swings, with mania plummeting into a major depressive episode.
Bipolar I disorder
… and … are the first line classes of drugs used for generalized anxiety disorder.
SSRIs / NRIs (norepinephrine reuptake inhibitors)
Symptoms of … may include refractory hypotension, obtundation, circulatory collapse, and severe abdominal pain with nausea and vomiting.
adrenal insufficiency
… can be used in adrenal crisis because it does not interfere with cortisol measurements.
Dexamethasone
… (bacteria) meningitis is an important cause of infection in neonates, with a mortality rate of 7-27%.
Group B strep (Streptococcus agalactiae)
Adjunctive … (drug) is recommended for infants/children with Hib meningitis and for children/adults with pneumococcal meningitis if initiated with or just prior to ABx.
dexamethasone
Infections with these 2 bugs, Clostridium septicum and Strep bovis are signaling the possible presence of a … (dz).
GI malignancy
The typical rash of … begins on the ankles and wrists and spreads both centrally and to the palms and soles. It often begins as a macular or maculopapular eruption and then usually becomes petechial.
Rocky Mountain spotted fever (RMSF)
Current Rx of an otherwise healthy, nonpregnant woman with uncomplicated UTI is Spectra or fluoroquinolones without a preceding … (test).
urine Cx
Primary TB usually involves the … lung zones and is associated with hilar adenopathy.
middle and lower
Reactivation TB commonly involves the … and is associated with cavitation.
upper lobes
The clinical picture of … (dz) is most commonly caused by Salmonella typhi, or Salmonella paratyphi A, B, or C, with some geographic variation.
typhoid fever
The incidence of coccidioidomycosis is increasing in older adults traveling to … areas in the winter months.
desert
The causative agent in plague is… , a gram negative cocobacillus.
Yersinia pestis
All … (dz group) are characterized by high fever, HA, arthralgias, myalgias, abdominal pain, conjunctivitis, pharyngitis, with petechia and purpura of mucosae.
viral hemorrhagic fevers
… (test) is indicated in acute or rapidly progressive glomerulonephritis and in elevated serum creatinine concentration in renal transplant recipients.
Kidney biopsy
These third-generation cephalosporins, cefoperazone and ceftazidime, have activity against… (bug).
P. aeruginosa
Multiplex polymerase chain reaction — M-PCR is a technique currently employed in research to detect the presence simultaneously of all three of the most common causes of … in the United States.
genital ulcers
… remains the mainstay of therapy for genital HSV infections.
Acyclovir
Systemic … has also been tried with some success for E. bieneusi infections
fumagillin
Any cranial nerve may be affected by Lyme disease, but … neuropathy is most common; involvement can be bilateral, and may occur in association with meningitis or other cranial neuropathies.
facial - differentiated from patients with Bell’s palsy by the presence of other clinical features of Lyme disease
Although … (path finding) were exceedingly rare in syphilis the penicillin era before the onset of HIV disease, many case reports in HIV-infected persons have appeared in the last decade. Most of these have involved internal organs and seldom the skin.
gummas
Cardiovascular … classically involves the ascending thoracic aorta resulting in a dilated aorta and aortic valve regurgitation. It may involve the coronary arteries, resulting in coronary thrombosis.
syphilis
Viral load influence the probability of developing an opportunistic infection in HIV, which, for unclear reasons, appears to be unusual with viral loads
5000
The … syndrome is a form of progressive decrease renal perfusion in patients with advanced liver disease.
hepatorenal
Target daily protein intake should be … to be safe (well tolerated and not leading to malnutrition) in CRF.
0.6-1 g/kg
… is a form of renal bone disease characterized by low bone turnover and increased osteoid levels secondary to aluminum deposition in the bone.
Osteomalacia
Cadaveric kidney transplant has shown to have a survival advantage over … in patients matched for age and renal disease.
HD
Low dietary intake of … is a risk factor for nephrolithiasis.
calcium
… (infection) in pregnancy should be treated b/o the risk for premature labor and delivery of infants who are small for gestational age.
Asymptomatic bacteriuria
… are needed after completion of ABx in pregnant women with asymptomatic bacteriuria.
Regular urine cultures
Noninfectious etiologies of … (gyn path) include fixed drug reactions, Behcet’s disease, neoplasms, and trauma.
genital ulcers
The … should be suspected in any patient with hyponatremia, hypoosmolality, a urine osmolality above 100 mosmol/kg, a urine sodium concentration that is usually above 40 meq/L, normal acid-base and potassium balance, and frequently a low plasma uric aci
syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Head and neck zoster of immunosuppressed patients should always be Rx with …
IV acyclovir to prevent zoster ophtalmicus
SIADH results in … (main electrolyte imbalance).
hyponatremia
High dietary intake of calcium is a protective factor for… (renal ds.).
nephrolithiasis
The… is a disorder in which water excretion is partially impaired because of the inability to shut off the secretion of ADH.
syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
… contained in chewing tobacco cause HTN and hypokalemia by inactivating cortisol.
Licorice
… is a granulomatous dz of medium-sized to small arterioles and venules.
Wegener granulomatosis
AL amyloidosis is associated with increased secretion of a … lymphoid product.
monoclonal
… (food) has been shown to slow the progression of renal failure in IgA nephropathy (Berger’s dz).
Fish oil
Circulating anti-glomerular basement membrane antibodies confirms … (dz).
Goodpasture’s syndrome
Presenting symptoms in … (disease) most often involve the URT and include rhinorrhea, sinusitis, ulcerations, cough, SOB and hemoptysis.
Wegener granulomatosis
An irregular contour of the kidneys on CT helps to confirm a clinical suspicion in … (drug class) nephropathy.
analgesic
Very low levels of BUN and uric acid in an euvolemic patient suggest … (syndrome).
SIADH
… should be suspected in hypokalemic patients because these intracellular ions are lost together.
Hypomagnesemia
A serum potassium level of 3 meq/L is equivalent to … meq potassium deficit.
200-400
The key features of the … syndrome are: absence of fever, symmetric neurologic deficits, patient remains responsive with normal or slow heart rate and normal blood pressure and no sensory deficits with the exception of blurred vision.
botulism
A positive nitroblue tetrazolium test establishes the diagnosis of…
chronic granulomatous disease
Ciprofloxacin is still the most potent fluoroquinolone for… (infectious agent).
P. aeruginosa.
Valacyclovir is a pro-drug that gets converted to … in the intestinal wall and liver.
acyclovir
Rx of sensitive Strep. viridans endocarditis on native valves is done with penicillin or ceftriaxone for… weeks.
4
IgA deficiency is usually … with multiple bacterial infections.
not associated
Drusen deposits are localized deposits of extracellular material concentrated in the macula, some of the earlier signs in patients with…
age-related macular degeneration (ARMD).
Parenteral therapy in severe hypoglycemia for patients who cannot take oral glucose is…
IV D50 and IM glucagon.
Decreasing dietary protein to less than… improves creatinine clearance and proteinuria.
0.8g/kg weight/day
… BMT is used in the treatment of certain patients with leukemias, lymphomas, multiple myeloma.
Autologous
The only known effect of prolactin deficiency is the inability…
to lactate after pregnancy.
The first step in evaluating… is measurement of target gland or tissue secretion or function.
pituitary function
