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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
Q

ACEi first-line tx for HTN in which patients?

A

CHF or asymptomatic LV dysfxn
hx STEMI
hx NSTEMI with anterior infarct, diabetes, systolic dysfxn
proteinuric CKD

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26
Q

ACEi contraindicated in which patients?

A

pregnant (cause fetal kidney problems)
angioedema
renal artery stenosis
AKI

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27
Q

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?

A

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)

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28
Q

What drugs provoke G6PD deficiency anemia?

A

SPLEEN PURGES NASTY INCLUSION FROM DAMAGED CELLS

sulfonamides
primaquine
nitrofurantoin
isoniazid
fava beans
dapsone
chloroquine
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29
Q

EKG leads I, aVL, V5-6 artery

A

circumflex

lateral wall

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30
Q

EKG leads II, III, aVF

A

RCA

inferior

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31
Q

EKG leads V1-V4

A

LAD

anterior

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32
Q

Posterior coronary artery is __% right dominant and __% left dominant

A

70% right dominant

10% left dominant

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33
Q

What are the HLA-B27-associated spondyloarthropathies?

A

ankylosing spondylitis
psoriatic arthritis
reactice arthritis

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34
Q

asymmetric arthritis preceded by GI or CU infection is…

A

reactive arthritis:
uveitis, urethritis, asym arthritis

“Can’t see, can’t pee, can’t climb a tree”

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35
Q

inflammatory back pain + “bamboo spine” on x-ray

A

ankylosing spondylitis

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36
Q

skin plaques with silvery scaling + pitting of nails + arthritis + pencil in cup of DIP on x-ray

A

psoriatic arthritis

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37
Q

What tests order to assess pleural effusion?

A

needle thoracentesis/chest tube drainage
serum protein
serum LDH

pleural studies:
cell count
diff
culture
cytology
TG
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38
Q

Exudative pleural effusion etiologies

A

infection
malignancy
ARDS
lymph

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39
Q

Transudative pleural effusion etiologies

A

Na+ retention
decreased oncotic pressure
increased hydrostatic pressure

40
Q

Specific gravity exudate vs. transudate pleural effusion

A

exudative > 1.020

transudative < 1.012

41
Q

Protein content and cellularity exudate vs. transudate pleural effusion

A

exudative high protein + highly cellular

transudative low protein + hypocellular

42
Q

pf LDH/sLDH > 0.6

A

exudate

43
Q

pf LDH > 2/3

A

exudate

44
Q

if bloody chest tube drainage/thoracentesis, get

A

HCT

RBC ct

45
Q

if cloudy chest tube drainage/thoracentesis, get

A

TG

46
Q

if putrid odor chest tube drainage/thoracentesis, get

A

gram stain

culture

47
Q

exudative =

A

EXtra stuff

48
Q

What organisms are associated with struvite renal stones?

A

urease positive –> splits urea –> 2 ammonia

MC: proteus

Also: klebsiella, enterobacter, pseudomonas

  • may form staghorn caliculi
49
Q

What is achalasia?

A

failure of LES to relax

impaired peristalsis

50
Q

How diagnose achalasia?

A

dysphagia to solids AND liquids
regurgitate undigested food
esophogram “birds beak”

51
Q

Anti-dsDMA

A

SLE

52
Q

Anti-histone

A

drug-induced lupus

53
Q

Anti-La

A

= Anti-SSB

Sjogren

54
Q

Anti-Smith

A

SLE

55
Q

Anti-topoisomerase 1

A

Diffuse cutaneous systemic sclerosis (scleroderma)

56
Q

Anti-SCl 70

A

Diffuse cutaneous systemic sclerosis (scleroderma)

57
Q

Anti-centromere

A

Limited cutaneous systemic sclerosis (CREST scleroderma)

58
Q

CREST syndrome

A 
calcinosis cutis
raynaud phenomena
esophageal dysmotility
sclerodactyly
telangietasia
59
Q

Safe antihypertensives in pregnancy?

A

labetalol
methyldopa
hydralazine
nifedipine

NO ACEi/ARB
NO thiazides

60
Q

Imaging for suspected pulmonary embolism?

A

CT PE angiogram *** CHOICE
V/Q scan
traditional pulmonary angiography

61
Q

1st degree AV block

A

prolonged PR

62
Q

2nd degree AV block type I

A

Wenkebach

increasing PR interval then drop

63
Q

2nd degree AV block type II

A

random QRS drops

may progress to 3rd degree

64
Q

3rd degree AV block

A

completely separate atria and ventricles

65
Q

In systolic CHF, what meds are indicated to reduce mortality in this patient?

A

ACEi
BB
spironolaactone

***thiazides + digoxin may help, but do not decrease mortality

66
Q

What lab markers suggest hemolytic anemia?

A 
decreased H&amp;H
decreased haptoglobin
nL MCV
indirect hyperbilirubinemia
increased LDH
increased reticulocytes
67
Q

How diagnose HSV?

A
  • requires vesicular fluid of active lesion
  • viral culture
  • PCR
  • direct florescent antibody
  • sHSV antibody
  • Tzanck smear
68
Q

RF assoc with PUD

A 
MC: h. pylori
NSAIDs
EtOH
tobacco
corticosteroids
male
69
Q

Lab to dx PUD

A

h. pylori blood test (IgG antibody OR urea breath test)

EGD +/- biopsy

70
Q

70 F, how dx temporal arteritis?

A

temporal artery biopsy

ESR (very sensitive)

71
Q

Signs and sx of hypothyroidism

A 
hair loss
weight gain
depressed mood
constipation
bradycardia
fatigue
cold intolerance
dry, coarse skin
menorrhagia
delayed DTRs
72
Q

Etiology high anion gap metabolic acidosis

A 
MUDPILES
methanol
uremia
DKA
propylene glycol
isoniazid/iron tabs
lactic acidosis
EtOH starvation ketosis/ethylene glycol
salicylates
73
Q

Signs/sx of infective endocarditis

A 
Janeway lesions
Osler nodes
Roth spots
splinter hemorrhages
new mitral regurg
new heart failure

VAGUE: fever, weakness, anorexia, fatigue

74
Q

What history or exam findings may help identify the cause of megaloblastic anemia?

A

MCV

B12 def
neuro deficits
peripheral neuropathy
hyperhomocysteinemia
increased methylmalonic acid

Folate def
hyperhomocysteinemia

Thiamine def

vegan, alcoholic, starvation

75
Q

Small cell lung cancer paraneoplastic syndromes

A

ADH –> SIADH

ACTH –> cortisol –> Cushing

Lambert-Eaton –> ab against presynaptic Ca2+ channels

76
Q

Squamous cell lung cancer paraneoplastic syndromes

A

PTHrP –> hypercalcemia

pancoast tumor –> Horner syndrome (ptosis, miosis, anhydrosis)

77
Q

Celiac disease antibodies

A

anti-endomysial antibody = transglutaminase

anti-gliadin antibody

78
Q

Celiac disease intestinal biopsy would show

A

villous atrophy (blunting of duodenal and jejunal villi)

79
Q

mech of cardiogenic shock

A

hypoperfusion

failure myocardial pump

80
Q

mech septic shock

A

vasodilation

decreased TPR

81
Q

mech hypovolemic shock

A

hypoperfusion

82
Q

mech anaphylactic shock

A

vasodilation

type I HSR

83
Q

mech neurogenic shock

A

autonomic dysfunction
peripheral vasodilation
bradycardia

84
Q

causes cardiogenic shock

A 
MI
arrhythmias
cardiac tamponade
PE
cardiac contusion
85
Q

causes septic shock

A

sepsis (GNR)
DIC
endotoxins

86
Q

causes hypovolemic shock

A

dehydration
hemorrhagic
severe burns
trauma

87
Q

causes anaphylactic shock

A

allergic reaction

88
Q

causes neurogenic shock

A

CNS injury (brain and spinal)

89
Q

Following successful tx of syphilis, what lab results would you expect to see?

A

RPR and VDRL become negative

FTA-ABS remains positive for life

90
Q

MC causes of pancreatitis

A

alcohol

gallstones

91
Q

PANCREATITIS mnemonic

A 
P hyperPTH/hypercalcemia
Alcohol
Neoplasm, pancreatic tumor block 
Choledocoholitiasis
Rx (reverse transcriptase)
ERCP
Abd surgery
T hyperTG
Infection (mumps)
Trauma
Idiopathic
Scorpion sting
92
Q

Signs/sx of pancreatitis

A 
severe epigastric abd pain
N/V
Cullen's sign
Grey-Turner's sign
sitophobia
93
Q

Cullen’s sign

A

ecchymosis @ umbilicus

assoc with pancreatitis

94
Q

Grey-Turner’s sign

A

ecchymosis on flank

assoc with pancreatitis

95
Q

Rx with highest risk drug-induced lupus

A

SHIPP

sulfonamides
hydralazine
isoniazid
phenytoin
procainamide

DIT Step 2 (8 decks)

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