Internal Medicine Flashcards
Noninvasive coronary heart dz tests
Exercise stress test (EKG or ECHO) Pharmacological stress test Coronary artery calcium scan (CAC) CT Radionucleotide myocardial perfusion imaging Cardiac computed CT angiography
Why are BB contraindicated in patient with cocaine-induced angina/HTN?
Cocaine blocks reuptake of NE + BB + unopposed alpha
= worsening coronary artery vasoCNX –> angina/MI
= worsening peripheral vasoCNX –> HTN
How do you diagnose acute DIC?
decreased PLT (<100K) decreased fibrinogen increased fibrin degredation products (FDP) = D-dimer prolonged PT + PTT decreased ATIII, protein C, protein S
What are the causes of DIC?
sepsis or severe infection (GN + GP) trauma obstetric complications acute pancreatitis malignancy transfusion
Ddx acute RUQ abdominal pain
cholecystitis
ascending cholangitis
liver abscess
Ddx acute LUQ abdominal pain
spleen laceration
Ddx acute RLQ abdominal pain
appendicitis ectopic pregnancy ovarian torsion renal stones PID
Ddx acute LLQ abdominal pain
diverticulitis ovarian torsion ectopic pregnancy renal stones PID
Ddx acute epigastric abdominal pain
pancreatitis
PUD
Difference in clinical presentation spontaneous PTX vs tension PTX
spontaneous: young, tall, male, watching TV, sudden, rupture of emphasematous blebs
tension: blunt trauma
Difference in tracheal deviation spontaneous PTX vs tension PTX
spontaneous: none/towards
tension: away/contralateral, dramatic
Difference in breath sounds spontaneous PTX vs tension PTX
spontaneous: decreaed
tension: absent
Difference in treatment spontaneous PTX vs tension PTX
spontaneous: observe, O2 supplementation, +/- chest tube
tension: needle decompression throacentesis and chest tube/thoracostomy tube
If hypertension + hypokalemia, suspect ____ dz
primary hyperaldosteronism = Conn syndrome
= aldosterone producing adenoma
affects distal tubule (medulla) of glomeruli, keep Na, increased BP
If hyponatremia + hyperkalemia + hyperpigmentation, suspect ____ dz
primary adrenal insufficiency = Addison syndrome
= low aldosterone, low Na, high K, low BP
If hypocalcemia + hyperphosphatemia + low PTH, suspect ____ dz
primary hypoparathyroidism PTH
PTH - phosphate trashing hormone
What are the features of nephrotic syndrome?
proteinuria > 3.5 g / 24 h hypoalbuminemia edema hyperlipidemia hypercoagulability
MC cause of osteomyelitis
s. aureus
MC cause of osteomyelitis in IVDU
s. aureus
pseudomonas
MC cause of osteomyelitis in sickle cell anemia
s. aureus
salmonella
What are the diagnostic criteria for SLE?
4 of 11: malar rash discoid rash photosensitivity oral ulcers arthritis serositis \+ ANA / APA / anti-dsDNA / anti-Smith renal dz neuro d/o heme d/o immuno d/o
What lab abnL expect in patient with DKA?
hyper K --> hypo K (low total body K) high anion gap metabolic acidosis ketonemia ketonuria hyperglycemia (>250 mg/dL) hyperosmolality
Triad of Sjogren syndrome
dry eyes
dry mouth
arthralgias
Dx criteria for DM
- fasting BG > 126 x2
- random BG > 200 + sx
- A1C >6.5
- PO GTT > 200 after 2 h
ACEi first-line tx for HTN in which patients?
CHF or asymptomatic LV dysfxn
hx STEMI
hx NSTEMI with anterior infarct, diabetes, systolic dysfxn
proteinuric CKD
ACEi contraindicated in which patients?
pregnant (cause fetal kidney problems)
angioedema
renal artery stenosis
AKI
A patient presents with profound fatigue after being treated for UTI. Exam of peripheral blood smear reveals Heinz bodies and degmacytes. What is most likely dx?
G6PD deficiency
G6PD —> NADPH –> reduce glutathione –> reduce ROS + H2O2
W/o G6PD, RBCs are susceptabile to oxidation damage –> hemolytic anemia –> Heinz bodies + bite cells (degmacytes)
What drugs provoke G6PD deficiency anemia?
SPLEEN PURGES NASTY INCLUSION FROM DAMAGED CELLS
sulfonamides primaquine nitrofurantoin isoniazid fava beans dapsone chloroquine
EKG leads I, aVL, V5-6 artery
circumflex
lateral wall
EKG leads II, III, aVF
RCA
inferior
EKG leads V1-V4
LAD
anterior
Posterior coronary artery is __% right dominant and __% left dominant
70% right dominant
10% left dominant
What are the HLA-B27-associated spondyloarthropathies?
ankylosing spondylitis
psoriatic arthritis
reactice arthritis
asymmetric arthritis preceded by GI or CU infection is…
reactive arthritis:
uveitis, urethritis, asym arthritis
“Can’t see, can’t pee, can’t climb a tree”
inflammatory back pain + “bamboo spine” on x-ray
ankylosing spondylitis
skin plaques with silvery scaling + pitting of nails + arthritis + pencil in cup of DIP on x-ray
psoriatic arthritis
What tests order to assess pleural effusion?
needle thoracentesis/chest tube drainage
serum protein
serum LDH
pleural studies: cell count diff culture cytology TG
Exudative pleural effusion etiologies
infection
malignancy
ARDS
lymph
Transudative pleural effusion etiologies
Na+ retention
decreased oncotic pressure
increased hydrostatic pressure
Specific gravity exudate vs. transudate pleural effusion
exudative > 1.020
transudative < 1.012
Protein content and cellularity exudate vs. transudate pleural effusion
exudative high protein + highly cellular
transudative low protein + hypocellular
pf LDH/sLDH > 0.6
exudate
pf LDH > 2/3
exudate
if bloody chest tube drainage/thoracentesis, get
HCT
RBC ct
if cloudy chest tube drainage/thoracentesis, get
TG
if putrid odor chest tube drainage/thoracentesis, get
gram stain
culture
exudative =
EXtra stuff
What organisms are associated with struvite renal stones?
urease positive –> splits urea –> 2 ammonia
MC: proteus
Also: klebsiella, enterobacter, pseudomonas
- may form staghorn caliculi
What is achalasia?
failure of LES to relax
impaired peristalsis
How diagnose achalasia?
dysphagia to solids AND liquids
regurgitate undigested food
esophogram “birds beak”
Anti-dsDMA
SLE
Anti-histone
drug-induced lupus
Anti-La
= Anti-SSB
Sjogren
Anti-Smith
SLE
Anti-topoisomerase 1
Diffuse cutaneous systemic sclerosis (scleroderma)
Anti-SCl 70
Diffuse cutaneous systemic sclerosis (scleroderma)
Anti-centromere
Limited cutaneous systemic sclerosis (CREST scleroderma)
CREST syndrome
calcinosis cutis raynaud phenomena esophageal dysmotility sclerodactyly telangietasia
Safe antihypertensives in pregnancy?
labetalol
methyldopa
hydralazine
nifedipine
NO ACEi/ARB
NO thiazides
Imaging for suspected pulmonary embolism?
CT PE angiogram *** CHOICE
V/Q scan
traditional pulmonary angiography
1st degree AV block
prolonged PR
2nd degree AV block type I
Wenkebach
increasing PR interval then drop
2nd degree AV block type II
random QRS drops
may progress to 3rd degree
3rd degree AV block
completely separate atria and ventricles
In systolic CHF, what meds are indicated to reduce mortality in this patient?
ACEi
BB
spironolaactone
***thiazides + digoxin may help, but do not decrease mortality
What lab markers suggest hemolytic anemia?
decreased H&H decreased haptoglobin nL MCV indirect hyperbilirubinemia increased LDH increased reticulocytes
How diagnose HSV?
- requires vesicular fluid of active lesion
- viral culture
- PCR
- direct florescent antibody
- sHSV antibody
- Tzanck smear
RF assoc with PUD
MC: h. pylori NSAIDs EtOH tobacco corticosteroids male
Lab to dx PUD
h. pylori blood test (IgG antibody OR urea breath test)
EGD +/- biopsy
70 F, how dx temporal arteritis?
temporal artery biopsy
ESR (very sensitive)
Signs and sx of hypothyroidism
hair loss weight gain depressed mood constipation bradycardia fatigue cold intolerance dry, coarse skin menorrhagia delayed DTRs
Etiology high anion gap metabolic acidosis
MUDPILES methanol uremia DKA propylene glycol isoniazid/iron tabs lactic acidosis EtOH starvation ketosis/ethylene glycol salicylates
Signs/sx of infective endocarditis
Janeway lesions Osler nodes Roth spots splinter hemorrhages new mitral regurg new heart failure
VAGUE: fever, weakness, anorexia, fatigue
What history or exam findings may help identify the cause of megaloblastic anemia?
MCV
B12 def neuro deficits peripheral neuropathy hyperhomocysteinemia increased methylmalonic acid
Folate def
hyperhomocysteinemia
Thiamine def
vegan, alcoholic, starvation
Small cell lung cancer paraneoplastic syndromes
ADH –> SIADH
ACTH –> cortisol –> Cushing
Lambert-Eaton –> ab against presynaptic Ca2+ channels
Squamous cell lung cancer paraneoplastic syndromes
PTHrP –> hypercalcemia
pancoast tumor –> Horner syndrome (ptosis, miosis, anhydrosis)
Celiac disease antibodies
anti-endomysial antibody = transglutaminase
anti-gliadin antibody
Celiac disease intestinal biopsy would show
villous atrophy (blunting of duodenal and jejunal villi)
mech of cardiogenic shock
hypoperfusion
failure myocardial pump
mech septic shock
vasodilation
decreased TPR
mech hypovolemic shock
hypoperfusion
mech anaphylactic shock
vasodilation
type I HSR
mech neurogenic shock
autonomic dysfunction
peripheral vasodilation
bradycardia
causes cardiogenic shock
MI arrhythmias cardiac tamponade PE cardiac contusion
causes septic shock
sepsis (GNR)
DIC
endotoxins
causes hypovolemic shock
dehydration
hemorrhagic
severe burns
trauma
causes anaphylactic shock
allergic reaction
causes neurogenic shock
CNS injury (brain and spinal)
Following successful tx of syphilis, what lab results would you expect to see?
RPR and VDRL become negative
FTA-ABS remains positive for life
MC causes of pancreatitis
alcohol
gallstones
PANCREATITIS mnemonic
P hyperPTH/hypercalcemia Alcohol Neoplasm, pancreatic tumor block Choledocoholitiasis Rx (reverse transcriptase) ERCP Abd surgery T hyperTG Infection (mumps) Trauma Idiopathic Scorpion sting
Signs/sx of pancreatitis
severe epigastric abd pain N/V Cullen's sign Grey-Turner's sign sitophobia
Cullen’s sign
ecchymosis @ umbilicus
assoc with pancreatitis
Grey-Turner’s sign
ecchymosis on flank
assoc with pancreatitis
Rx with highest risk drug-induced lupus
SHIPP
sulfonamides hydralazine isoniazid phenytoin procainamide
