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DIT Step 2 > Internal Medicine > Flashcards

Internal Medicine Flashcards

1
Q

Noninvasive coronary heart dz tests

A 
Exercise stress test (EKG or ECHO)
Pharmacological stress test
Coronary artery calcium scan (CAC) CT
Radionucleotide myocardial perfusion imaging
Cardiac computed CT angiography
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2
Q

Why are BB contraindicated in patient with cocaine-induced angina/HTN?

A

Cocaine blocks reuptake of NE + BB + unopposed alpha
= worsening coronary artery vasoCNX –> angina/MI
= worsening peripheral vasoCNX –> HTN

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3
Q

How do you diagnose acute DIC?

A 
decreased PLT (<100K)
decreased fibrinogen
increased fibrin degredation products (FDP) = D-dimer
prolonged PT + PTT
decreased ATIII, protein C, protein S
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4
Q

What are the causes of DIC?

A 
sepsis or severe infection (GN + GP)
trauma
obstetric complications
acute pancreatitis
malignancy
transfusion
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5
Q

Ddx acute RUQ abdominal pain

A

cholecystitis
ascending cholangitis
liver abscess

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6
Q

Ddx acute LUQ abdominal pain

A

spleen laceration

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7
Q

Ddx acute RLQ abdominal pain

A 
appendicitis
ectopic pregnancy
ovarian torsion
renal stones
PID
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8
Q

Ddx acute LLQ abdominal pain

A 
diverticulitis
ovarian torsion
ectopic pregnancy
renal stones
PID
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9
Q

Ddx acute epigastric abdominal pain

A

pancreatitis

PUD

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10
Q

Difference in clinical presentation spontaneous PTX vs tension PTX

A

spontaneous: young, tall, male, watching TV, sudden, rupture of emphasematous blebs
tension: blunt trauma

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11
Q

Difference in tracheal deviation spontaneous PTX vs tension PTX

A

spontaneous: none/towards
tension: away/contralateral, dramatic

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12
Q

Difference in breath sounds spontaneous PTX vs tension PTX

A

spontaneous: decreaed
tension: absent

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13
Q

Difference in treatment spontaneous PTX vs tension PTX

A

spontaneous: observe, O2 supplementation, +/- chest tube
tension: needle decompression throacentesis and chest tube/thoracostomy tube

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14
Q

If hypertension + hypokalemia, suspect ____ dz

A

primary hyperaldosteronism = Conn syndrome
= aldosterone producing adenoma

affects distal tubule (medulla) of glomeruli, keep Na, increased BP

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15
Q

If hyponatremia + hyperkalemia + hyperpigmentation, suspect ____ dz

A

primary adrenal insufficiency = Addison syndrome

= low aldosterone, low Na, high K, low BP

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16
Q

If hypocalcemia + hyperphosphatemia + low PTH, suspect ____ dz

A

primary hypoparathyroidism PTH

PTH - phosphate trashing hormone

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17
Q

What are the features of nephrotic syndrome?

A 
proteinuria > 3.5 g / 24 h
hypoalbuminemia
edema
hyperlipidemia
hypercoagulability
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18
Q

MC cause of osteomyelitis

A

s. aureus

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19
Q

MC cause of osteomyelitis in IVDU

A

s. aureus

pseudomonas

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20
Q

MC cause of osteomyelitis in sickle cell anemia

A

s. aureus

salmonella

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21
Q

What are the diagnostic criteria for SLE?

A 
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
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22
Q

What lab abnL expect in patient with DKA?

A 
hyper K --> hypo K (low total body K)
high anion gap metabolic acidosis
ketonemia
ketonuria
hyperglycemia (>250 mg/dL)
hyperosmolality
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23
Q

Triad of Sjogren syndrome

A

dry eyes
dry mouth
arthralgias

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24
Q

Dx criteria for DM

A
  • fasting BG > 126 x2
  • random BG > 200 + sx
  • A1C >6.5
  • PO GTT > 200 after 2 h
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25
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
26
ACEi contraindicated in which patients?
pregnant (cause fetal kidney problems) angioedema renal artery stenosis AKI
27
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)
28
What drugs provoke G6PD deficiency anemia?
SPLEEN PURGES NASTY INCLUSION FROM DAMAGED CELLS ``` sulfonamides primaquine nitrofurantoin isoniazid fava beans dapsone chloroquine ```
29
EKG leads I, aVL, V5-6 artery
circumflex | lateral wall
30
EKG leads II, III, aVF
RCA | inferior
31
EKG leads V1-V4
LAD | anterior
32
Posterior coronary artery is __% right dominant and __% left dominant
70% right dominant | 10% left dominant
33
What are the HLA-B27-associated spondyloarthropathies?
ankylosing spondylitis psoriatic arthritis reactice arthritis
34
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"
35
inflammatory back pain + "bamboo spine" on x-ray
ankylosing spondylitis
36
skin plaques with silvery scaling + pitting of nails + arthritis + pencil in cup of DIP on x-ray
psoriatic arthritis
37
What tests order to assess pleural effusion?
needle thoracentesis/chest tube drainage serum protein serum LDH ``` pleural studies: cell count diff culture cytology TG ```
38
Exudative pleural effusion etiologies
infection malignancy ARDS lymph
39
Transudative pleural effusion etiologies
Na+ retention decreased oncotic pressure increased hydrostatic pressure
40
Specific gravity exudate vs. transudate pleural effusion
exudative > 1.020 transudative < 1.012
41
Protein content and cellularity exudate vs. transudate pleural effusion
exudative high protein + highly cellular transudative low protein + hypocellular
42
pf LDH/sLDH > 0.6
exudate
43
pf LDH > 2/3
exudate
44
if bloody chest tube drainage/thoracentesis, get
HCT | RBC ct
45
if cloudy chest tube drainage/thoracentesis, get
TG
46
if putrid odor chest tube drainage/thoracentesis, get
gram stain | culture
47
exudative =
EXtra stuff
48
What organisms are associated with struvite renal stones?
urease positive --> splits urea --> 2 ammonia MC: proteus Also: klebsiella, enterobacter, pseudomonas * may form staghorn caliculi
49
What is achalasia?
failure of LES to relax | impaired peristalsis
50
How diagnose achalasia?
dysphagia to solids AND liquids regurgitate undigested food esophogram "birds beak"
51
Anti-dsDMA
SLE
52
Anti-histone
drug-induced lupus
53
Anti-La
= Anti-SSB | Sjogren
54
Anti-Smith
SLE
55
Anti-topoisomerase 1
Diffuse cutaneous systemic sclerosis (scleroderma)
56
Anti-SCl 70
Diffuse cutaneous systemic sclerosis (scleroderma)
57
Anti-centromere
Limited cutaneous systemic sclerosis (CREST scleroderma)
58
CREST syndrome
``` calcinosis cutis raynaud phenomena esophageal dysmotility sclerodactyly telangietasia ```
59
Safe antihypertensives in pregnancy?
labetalol methyldopa hydralazine nifedipine NO ACEi/ARB NO thiazides
60
Imaging for suspected pulmonary embolism?
CT PE angiogram *** CHOICE V/Q scan traditional pulmonary angiography
61
1st degree AV block
prolonged PR
62
2nd degree AV block type I
Wenkebach increasing PR interval then drop
63
2nd degree AV block type II
random QRS drops may progress to 3rd degree
64
3rd degree AV block
completely separate atria and ventricles
65
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
66
What lab markers suggest hemolytic anemia?
``` decreased H&H decreased haptoglobin nL MCV indirect hyperbilirubinemia increased LDH increased reticulocytes ```
67
How diagnose HSV?
* requires vesicular fluid of active lesion - viral culture - PCR - direct florescent antibody - sHSV antibody - Tzanck smear
68
RF assoc with PUD
``` MC: h. pylori NSAIDs EtOH tobacco corticosteroids male ```
69
Lab to dx PUD
h. pylori blood test (IgG antibody OR urea breath test) EGD +/- biopsy
70
70 F, how dx temporal arteritis?
temporal artery biopsy | ESR (very sensitive)
71
Signs and sx of hypothyroidism
``` hair loss weight gain depressed mood constipation bradycardia fatigue cold intolerance dry, coarse skin menorrhagia delayed DTRs ```
72
Etiology high anion gap metabolic acidosis
``` MUDPILES methanol uremia DKA propylene glycol isoniazid/iron tabs lactic acidosis EtOH starvation ketosis/ethylene glycol salicylates ```
73
Signs/sx of infective endocarditis
``` Janeway lesions Osler nodes Roth spots splinter hemorrhages new mitral regurg new heart failure ``` VAGUE: fever, weakness, anorexia, fatigue
74
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
75
Small cell lung cancer paraneoplastic syndromes
ADH --> SIADH ACTH --> cortisol --> Cushing Lambert-Eaton --> ab against presynaptic Ca2+ channels
76
Squamous cell lung cancer paraneoplastic syndromes
PTHrP --> hypercalcemia pancoast tumor --> Horner syndrome (ptosis, miosis, anhydrosis)
77
Celiac disease antibodies
anti-endomysial antibody = transglutaminase anti-gliadin antibody
78
Celiac disease intestinal biopsy would show
villous atrophy (blunting of duodenal and jejunal villi)
79
mech of cardiogenic shock
hypoperfusion | failure myocardial pump
80
mech septic shock
vasodilation | decreased TPR
81
mech hypovolemic shock
hypoperfusion
82
mech anaphylactic shock
vasodilation | type I HSR
83
mech neurogenic shock
autonomic dysfunction peripheral vasodilation bradycardia
84
causes cardiogenic shock
``` MI arrhythmias cardiac tamponade PE cardiac contusion ```
85
causes septic shock
sepsis (GNR) DIC endotoxins
86
causes hypovolemic shock
dehydration hemorrhagic severe burns trauma
87
causes anaphylactic shock
allergic reaction
88
causes neurogenic shock
CNS injury (brain and spinal)
89
Following successful tx of syphilis, what lab results would you expect to see?
RPR and VDRL become negative FTA-ABS remains positive for life
90
MC causes of pancreatitis
alcohol | gallstones
91
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 ```
92
Signs/sx of pancreatitis
``` severe epigastric abd pain N/V Cullen's sign Grey-Turner's sign sitophobia ```
93
Cullen's sign
ecchymosis @ umbilicus assoc with pancreatitis
94
Grey-Turner's sign
ecchymosis on flank assoc with pancreatitis
95
Rx with highest risk drug-induced lupus
SHIPP ``` sulfonamides hydralazine isoniazid phenytoin procainamide ```

DIT Step 2 (8 decks)

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