Internal Medicine Flashcards
ECG Leads: V1 - V6
Anterior
LAD
ECG Leads: II, III, avF
Inferior
RCA, LCX
ECG Leads: V1 - V3
Posterior
RCA – I, avL (depression)
LCX – I, avL (elevation)
ECG Leads: I, avL, V5, V6
Lateral
LCX, diagonal
ECG Leads: V4-V6R
Right Ventricle
RCA
anasarca + pulmonary/facial edema + hypertension + abnormal u/a with proteinuria and microscopic hematuria =
acute nephritic syndrome
CAP + arthralgias + erythema nodosum/multiforme =
Coccidiodies (Valley Fever)
Development of _____ _____ in a patient with infective endocarditis should raise suspicion for _____ _____ extending into the adjacent cardiac conduction tissues.
AV block
perivalvular abscess
Factors that differentiate tricuspid vs. aortic endocarditis (2)
- TV endocarditis usually presents with a holosystolic murmur (AR)
- Cardiac conduction abnormalities are mrore common with aortic valve involvement
Dobutamine (beta 1 agonist) works by…
improving ejection fraction AND reducing left ventricular end-systolic volume
Liver Failure: Portal HTN Sx
Esophageal varices Splenomegaly Ascites Caput medusae Anorectal varices
Liver Failure: Hyperestrinism Sx
Spider angiomas Gynecomastia Loss of sexual hair Testicular atrophy Palmar erythema
Pathohysiology of AML
atypical promyelocytes in the bone marrow
Malaria prophylaxis for India
Chloroquine resistance; prophylaxis with mefloquine; begins 2 weeks before travel and continued 4 weeks after returning
Sick Sinus Syndrome (SSS) Definition
inability of SA node to generate an adequate heart rate
SSS EKG Findings
3-6 seconds with no sinus nodal activity + dizziness
DX: low cortisol + high ACTH + hyper pigmentation + hyponatremia + hyperkalemia =
Primary Adrenal Insufficiency; likely due to autoimmune etiology
G6PD Deficiency
X-linked; Black men; Episodic hemolysis in response to Rx, illness, etc.; Heinz bodies and bite cells seen on peripheral smear
Management of severe hypercalcemia
Aggressive fluids
Calcitonin
+/- Pamidronate (takes 2-4 days to work)
Round face + bruises think…
Cushing’s
HTN + hyperglycemia + weight gain =
Cushing’s
DOE + HTN + prominent pulmonary arteries + enlarged R heart border =
Pulmonary HTN
Arsenic Poisoning
Polyneuropathy
Pancytopenia
Mild LFT elevation
Skin Lesions
Type of HTN Rx that has been proven to slow the progression of end-organ damage in patients with DM2…
ACE inhibitors
Bilateral hilar adenopathy on CXR
Sarcoidosis
Pathophysiology of sarcoidosis
chronic granulomatous inflammation; noncaseating granulomas
Hypopituitarism Features (3)
Glucocorticoid deficiency
Hypogonadism
Hypothyroidism
Splenic infarction usually occurs due to…
hypercoagulable states
embolic disease
hemoglobinopathy
Usually (this condition) is asx; however, it can be exacerbated by air travel and/or dehydration
sickle cell trait
Elderly patient + severe lymphocytosis + hepatosplenomegaly + lymphadenopathy + bicytopenia (anemia, thrombocytopenia)
CLL
Diagnostic tool for CLL
Flow cytometry of the peripheral blood
Claw toes in an elderly patient are most likely due to…
diabetic neuropathy
Management for acute limb ischemia s/p MI
immediate anticoagulation, vascular surgery consultation, transthoracic echo
Addison’s Disease (AKA primary adrenal insufficiency) presents with this acid-base disturbance:
normal anion gap acidosis
Elevated anion gap metabolic acidosis causes:
DKA
Intoxication
Tissue Hypoxia
Renal Failure
Metabolic alkalosis causes:
Vomiting
Hyperaldosteronism
Excessive Volume Contraction
Respiratory acidosis causes:
Conditions that impair proper ventilation = hypoventilation
Respiratory alkalosis causes:
Conditions that impair proper ventilation = hyperventilation
Leukoplakia
Presents as white patches or plaques over the oral mucosa that usually can NOT be scraped off; R/F include smokeless tobacco and alcohol use
Primary lymphoma of the thyroid is characterized by…
rapidly progressive thyroid enlargement with compression of surrounding structures; more common in patients with a PMH of Hashimoto thyroiditis
Test to rule in RA =
anti-CCP antibody
When a patient presents with carpal tunnel, you must also r/o this condition
RA (order inflammatory factors, RF, and xrays)
LFTS >3000 think…
Ischemic hepatic injury
Tx for hyperkalemia w/ EKG changes
calcium gluconate
Most common cause of asx elevated alk phos in elderly patient is:
Paget disease of the bone
XR findings for Paget’s disease of the bone:
osteolytic/mixed lytic-sclerotic lesions
All pts with RA should be on…
DMARDS, specifically methotrexate
Dyspepsia + postprandial fullness + nausea in the context of a patient that is from a low income country
Helicobacter pylori
Pathophysiology of H. pylori
urease-producing bacterial infection
Three most common causes of aortic stenosis:
- senile calcific aortic stenosis (>70)
- bicuspid aortic valve
- rheumatic heart disease
Patients with ankylosing spondylitis can develop ______ due to diminished chest wall and spinal mobility.
restrictive lung disease
PFTs for patient with ankylosing spondylitis show…
mildly restrictive pattern with reduced VC and TLC
Wart like “rash” in groin region that is NOT flesh colored…
HIV - Kaposi’s Sarcoma
Acid in eye =
WATER FLUSH
Prevalence is high, _____ is high.
PPV
Prevalence is low, _____ is high.
NPV
Left sided diastolic heart failure due to…
MI
4th heart sound due to…
MI
DX: substernal discomfort + left-sided neck pain + diaphoresis + dyspnea
acute MI
Loss of p waves =
A.Fib
Anion gap =
Na - (Cl + BiCarb)
Winter’s Formula =
1.5 * (BiCarb) + 8 (+/- 2)
Normal pH
7.35 - 7.45
Normal BiCarb
22-28
Normal CO2
33-45
Electrolyte imbalance that is the best predictor for severity of heart failure =
hyponatremia
IBD that is bloody =
UC
IBD that is non-bloody =
Crohn’s
Warfarin + acetiminophen =
BLOOD
Warfarin + green foods =
CLOT
Number Needed to Treat Formula =
Inverse of Absolute Risk Reduction
Tx for minor frostbite
Rapid rewarming with warm water
Acute goat path findings:
needle shaped spindles
HIV patient with multiple non-enhacning brain lesions
PML
Tx for pulmonary HTN
ACE + diuretic
Cor pulmonale is usually caused by…
impaired function of the R ventricle secondary to pulmonary htn
Ejection click + crescendo-decrescendo systolic murmur over L second intercostal speace
Pulmonic valve stenosis
OSA can cause transient periods of hypoxemia which leads to…
polycthemia; the kidney responds by increasing erythropoietin
Drug for recurrent nephrolithiasis secondary to hypercalcemia
Thiazide diuretics
Febrile nonhemolytic transfusion reaction
occurs within 1-6 hours; fever, chills, nausea, and malaise; prevent by leukoreduction
Most common cardiac S/E with SLE
acute pericarditis
Bullae on erythematous background
bullous pemphigoid
Bullous pemphigoid tx
topical clobetasol
Hyperthyroidism + increased RAIU =
de novo thyroid hormone synthesis
Hyperthyroidism + decreased RAIU =
preformed hormone, exogenous hormone intake
Shoulder pain + horner =
pancoast tumor
Choice of drug for patients that are allergic to penicillin but have primary syphillis
Doxycycline
Lithium can cause…
nephrogenic diabetes insipidus
Tx for lithium DI =
d/c lithium, salt restriction
Most common type of cancer associated with asbestos
bronchogenic carcinoma
Pleural plaques
Asbestos
Test for Sjogren Syndrome
Antibodies to Ro/SSA and La/SSB
Sx of Sjogrens
dry mouth difficulty swallowing thrush dental caries dry eyes
Sx of SLE
photosensitive rash
symmetric oligoarthritis
SLE + hx of PE/DVT + hx of miscarriages
antiphospholipid syndrome
Dx finding in patients with antiphospholipid syndrome
prolonged PTT
Unilateral uptake on RAUI scan…
toxic adenoma = autonomous thyroid production
Lynch Syndrome
Colon
Endometrial
Ovarian
What part of the spine does RA affect first?
Cervical
Obesity hypoventilation syndrome
high BMI
daytime hypercapnia
alveolar hypoventilation
Erysipelas
superficial skin rash that has raised, sharply demarcated borders; caused by Group A Strep
Cardiac index = reduced; PCWP = increased
Cardiogenic shock secondary to MI
Cold water immersion works by…
slowing AV node conduction
Massive PE would cause this heart problem…
RV dysfunction
Metabolic acidosis to alkalosis in a patient with ascites…
+ loop diuretic
Slowly growing papule with irregular borders
BCC
Familial hypocalciuric hypercalcemia
mutation in the calcium-sending receptor; benign d/o characterized by elevated calcium, normal/elevated parathyroid hormone, low calcium excretion
Most common cause of back pain
lumbosacral strain
Felty Syndrome
inflammatory arthritis
splenomegaly
neutropenia
Achalasia
chronic dysphagia with both solids and liquids; better when standing up; classic bird beak finding on barium swallow
Tx of uric acid stones
high fluids
potassium citrate
Dx test for fibromuscular dysplasia
CT angio of abdomen
Medications shown to improve long-term survival in patients with L ventricular systolic dysfunction:
Beta blockers ACE inhibitors ARBs mineralcorticoid receptor antagonist AA -- hydralazine + nitrates
Examples of MRAs
spironolactone
eplerenone
HFpEF AKA
diastolic dysfunction
Basal insulin should cover patients for…
24 hours
Dull, hypomobile TM
serous otitis media
HIV patient on horse farm with diarrhea…
Cryptosporidium parvum
Isolated thrombocytopenia =
ITP
Once a patient is diagnosed with ITP, they should undergo screening for… (2)
Hep C, HIV
Acute MI + MR =
papillary wall rupture
HIV associated nephropathy =
focal segmental glomerulosclerosis (FSGS)
Thyroiditis s/p URI
subacture/ de Quervain
Tx for subacute thyroiditis
beta blockers, NSAIDs
Early decrescendo diastolic murmur best heard at RUSB
aortic regurgitation
S/E of chlorthalidone
hyperglycemia (insulin resistance)
Common causes of exudative pleural effusion
Infection (PNA)
RA
Malignancy
Patients with RA are at a higher risk for…
osteoporosis
Drug to prevent DVT in patient with A.Fib =
anticoagulant
Patient with upper lobe PNA + cavitary lesion + HIV =
reactivated TB, mycobacterial infection
Aortic stenosis + early peaking systolic murmur =
mild - moderate
Aortic stenosis + late peaking systolic murmur =
severe
Severe aortic stenosis additional sound
soft S2
Metformin can cause lactic acidosis in patients with…
acute renal failure
liver failure
sepsis
Recent anticoag + new thrombocytopenia =
heparin induced thrombocytopenia (HIT)
Back pain + hypercalcemia + anemia + renal insufficiency =
Multiple myeloma (monoclonal protein)
Liver + kidney stuff =
Goodpasture’s
calcitonin + thyroid nodule
medullary thyroid carcinoma
If pt has medullary thyroid carcinoma, worry about this other cancer…
pheochromocytoma
Prophylaxis for esophageal varices
nadolol
Mechanism of aplastic anemia
acquired deficiency of pluripotent stem cells
Recurrent bacterial infections in an adult should raise suspicion for…
CVID
Dx test for CVID
quantitative measurement of serum immunoglobulin levels
Glucagonoma
rare neuroendocrine tumor on pancreas; presents with mild DM2, eczema, weight loss, and diarrhea; dx with glucagon level (>500)
Erythema nodosum
Sarcoid
TB
Behcets
IBD
If secreting renin, you can expect the efferent arteriolar resistance to _____ and the tubular sodium reabsorption to _____.
increase
increase
Hypocalcemia next step (dx)
PTH
high = vit d def
low = autoimmune
Systemic sclerosis
Raynaud
esophageal dysmotility
skin thickening
interstitial lung disease
COPD + digital clubbing =
hypertrophic osteoarthropathy
Dx test for hypertrophic osteoarthropathy
CXR
______ is the most common cause of death in patients with end-stage renal disease.
Cardiovascular disease
Definition of acute liver failure
acute onset of severe liver injury with encephalopathy and impaired synthetic function in a patient w/o cirrhosis/underlying liver disease
difficulty breathing/wheezing + nasal polyps + angina =
AERD (aspirin exacerbated respiratory disease)
Mechanism for AERD
pseudoallergic drug reaction
HA + dizziness + blurry vision + large gamma gap (difference b/w protein and albumin) + retinal changes =
Waldenstrom macrogloblinemia
S/E of HIT
arterial and venous thrombus
HIV + central/midwestern area + fever + cough + papules/nodules + hepatosplenomegaly + pancytopenia =
Histoplasma capsulatum
Tx for Histoplasma capsulatum
amphotericin b
Thyroid scintigraphy shows decreased radioiodine uptake =
Painless/silent thyroiditis
Thyroid scintigraphy shows increased radioiodine uptake…
Graves
Pathoyphysiology of statin induced myalgia
inhibition of intracellular synthesis pathway
Medications that can trigger bronchoconstriction in a patient with asthma
aspirin
beta blockers
This lab is elevated in hereditary spherocytosis
mean corpuscular hemoglobin concentration (MCHC)
Young patient with refractory hypertension, suspect _____ and dx with _____.
primary hyperaldosteronism
PRA, PAC
Transudative effusions are commonly caused by…
decreased intrapleural or plasma oncotic pressures; elevated hydrostatic pressure
Exudative effusions are often the result of…
increased capillary or pleural membrane permeability or disruptions to lymphatic outflow
Calciphylaxis (AKA calcific uremic arteriolopathy)
systemic arteriolar calcification and soft-tissue calcium deposition with local ischemia and necrosis
Humoral hypercalcemia of malignancy is characterized by…
severe, symptomatic hypercalcemia that has a rapid onset
Pathophysiology of humoral hypercalcemia of malignancy
elevated parathyroid hormone-related protein
Pathophysiology of analgesic nephropathy
papillary necrosis; chronic tubulointerstitial nephritis
Lab that is high for patients with iron deficiency anemia
TIBC
oral and genital ulcers + erythema nodosum =
Behcet’s disease
Erectile dysfunction with normal TSH but decreased T3/T4 =
chronic liver failure
Pleural effusions with low glucose concentrations (<30) are often due to…
empyemas, rhuematoid pleurisy; high metabolic activity in fluid
Suspect BPH? Order…
U/A, PSA
Common cause of endocarditis associated with nosocomial UTIs
Enterococci
Heartburn + dysphagia + hypomotility and LES problems =
systemic sclerosis = smooth muscle atophy and fibrosis
Epitrochlear lymphadenopathy =
syphillis
RA + enlarged kidneys + hepatomegaly + nephrotic syndrome =
amyloidosis
The kidney compensates for respiratory alkalosis by preferentially excreting _____ in the urine.
bicarb (increases pH)
Overuse of steroids can cause _____ Cushing’s. Lab studies typically show:
central
decreased ACTH and cortisol levels
Patients with primary adrenal insufficiency have the following lab findings:
low ACTH
low cortisol levels
normal aldosterone
Legionnaires disease
bilateral lung infiltrates
confusion
diarrhea
Tx for Legionnaires disease
Levofloxacin
Patient with HIV and multiple ring enhancing lesions on MRI
Toxo
Tx for toxo encephalitis
sulfadiazine and pyrimethamine
Really high calcium with low PTH =
hypercalcemia of malignancy
Anticholinergic drug =
benadryl!
Dx test for chronic arterial insufficiency
ankle brachial index
Chronic venous stasis can be diagnosed with…
venous doppler
_____ cardiomyopathy should be suspected in patients with unexplained CHF, proteinuria, and left ventricular hypertrophy in the absence of HTN.
amyloid (restrictive)
ABI =
PAD
First step in diagnosing Cushing’s
Low-dose dexamethasone suppression test OR late nate salivary cortisol assay OR 24 hour urine cortisol excretion
Recommendation for patients with calcium oxalate stones
Eat less salt
Ramsay Hunt Syndrome
vesicles in ear
facial droop
Polymyositis + anxiety + tachycardia + weight loss =
hyperthyroidism
Pathophys for bleeding in hereditary hemorrhagic telangiectasia
AV malformations
Patients with restrictive lung disease have an _____ A-A ratio
increased
Tx for PMR
lose dose steroids
Pleural effusion lung sounds
decreased breath sounds
decreased tactile fremitus
dullness to percussion
Young patient with + smoking history, episodes of nighttime chest pain, ST elevations, and no blockages…
vasospastoc angina
Tx for vasospastic angina =
CCB (dilt) and smoking cessation
R/F for C. Diff
PPI use
Early decrescendo diastolic murmur (LSB)
Aortic regurgitation (young person = bicuspid valve)
Harsh crescendo-decrescendo systolic murmur (LSB)
HOCM
Muscle weakness + recurrent nephrolithiasis + neuropsych sx + hypercalcemia =
primary hyperparathyroidism
Fun saying for primary hyperparathyroidism
bones, stones, abdominal moans, and psychic groans
Majority of primary hyperparathyroidism due to…
parathyroid adenoma
Most common cause of hemoptysis
chronic bronchitis
cancer
bronchiectasis
Most common cause of acute urinary retention in men
bladder outflow obstruction (BOO)
Restrictive lung disease PFT findings
decreased lung volume
decreased diffusion lung capacity
normal FEV1/FVC
Immediate treatment for aortic dissection
beta blocker
Leukocyte count > 50,000
leukemoid reaction
Yellow-red papules on extensor surfaces
xanthomas
Xanthomas can be seen when…
hypertriglyceridemia (which can lead to acute pancreatitis)
Nephrogenic DI tx
HCTZ
SIADH tx
Demeclocycline
SLE can initially present as…
generalized tonic clonic seizures
Lab findings for patient’s with pagets disease of the bone
elevated alk phos and urine hydroxyproline; normal calcium and phosphorus
Acromegaly can demonstrate the following finding on echo
Concentric myocardial hypertrophy
Coarsening of facial features + pharyngeal crowding + enlargement of hands and feet =
Acromegaly
Chondrocalcinosis =
pseudogout
Pseudogout + diabetes =
hereditary hemochromatosis
Drugs for cancer patients that can’t gain weight
progesterone analogues
Hep B serology for patient recovering from acute infection
HBsAg -
HBsAb +
HBcAb +
Weight loss + tachycardia + tremor + lid retration
thyrotoxicosis
Systolic hypertension in thyrotoxicosis is caused by…
increased myocardial contractility and heart rate
Early onset hypertesnion and bilateral upper abdominal masses =
autosomal dominant polycystic kidney disease
Antibiotic that can cause hyperkalemia
Bactrim
Early septic shock is associated with a hyperdynamic CV state that results in…
bounding peripheral pulses
In patients with severe liver cirrhosis, the cause of an AKI is…
renal hypoperfusion
Unprovoked DVT/PE in young white population
Factor V Leiden
Factor V Leiden pathophys
activated protein c resistance
Tx for alcoholic cardiomyopathy
Stop drinking alcohol
GVHD is caused by…
activation of donor T lymphocytes
1st line for A.Fib with RVR
Beta blockers (unless CHF exacerbation then give furosemide)
epistaxis + tremor + tachy + new-onset htn =
cocaine use
Coarse facial features + uncontrolled htn + carpal tunnel =
acromegaly
Dx test for acromegaly
IGF1
Cardiac monitoring for vasovagal syncope =
sinus bradycardia and sinus arrest
Chronic COPD leads to hyperinflation of the lungs, which causes a ….
flattened diaphragm and increased WOB
Milk-alkali syndrome
abdominal pain, constipation, polydipsia
Peripheral edema, ascites, elevated JVP, pericardial knock, pericardial calcifications =
Constrictive pericarditis
Prophylaxis for MAC in patients with HIV
Azithromycin
Fever, cough, abdominal pain, diarrhea, night sweats, weight loss in an HIV patient…
MAC
Earliest renal abnormality seen in diabetic nephropathy…
glomerular hyperfiltration
Liver dysfunction + psych symptoms (chorea) =
Wilson Disease
Sjrogen syndrome in old people =
Age related sicca syndrome
Patellofemoral pain syndrome
knee pain; problems with climbing stairs/squatting; dx with isometric pain upon contraction; tx = strengthening the quadriceps and hip abductors
Two causes of hypoglycemia in patients without DM
- insulinoma (high CCP)
2. Insulin/sulfonylureas (low CCP)
Persistant EKG findings s/p MI
Ventricular aneurysm
This drug can cause renal tubular obstruction, which looks like prerenal azotemia…
acyclovir
Increased pigmentation in the palmar creases
Addison’s Disease
Lab findings in Addison’s Disease
Hyponatremia
Hyperkalemia
Sever aortic stenosis will present with this cardiac finding:
slow-rising, weak carotid pulse = pulsus parvus et tardus
Calcium oxalate crystals are this shape
Envelope
HIV + patients with severe throat pain =
Viral esophagitis
HIV + patients with moderate throat pain and difficulty swallowing =
Candida
Old guy with hx of pancreatitis and new onset diarrhea think…
chronic pancreatitis
Analgesic nephropathy
Tubulointerstitial nephritis; U/A shows blood, wbc casts, trace protein)
U/A blood, WBC casts, trace protein =
analgesic nephropathy
HIV patient with bloody diarrhea
CMV
Method to reducing mortality in patients with ARDS:
low tidal volume ventilation, which prevents overdistending alveoli
Population at risk for SLE
Young, African American women
Young patient with murmur that is best heard at URSB
Supravalvular aortic stenosis
Most common cause of gross lower GI bleeding in adults
Diverticulosis
Aquagenic pruritus, facial plethora, increased hematocrit =
polycthemia vera
Budd-Chiari Syndrome
obstruction of hepatic venous outflow + polycthemia vera
tinnitus + fever + tachypnea + OD
salicylates
Cyclophosphamide S/E
bladder carcinoma
Wartlike lesions, violaceous nodules, skin ulcers, mid-western farmer =
Blasto!
+ antimitochondrial antibody and pruitis =
primary biliary cholangitis
Best medication for a patient with COPD (inhaled)
SAMA (ipatropium)
Tx for esophageal varices in patient with PMH of alcoholism and hematemesis
Fluids
Ceftriaxone
Ocreotide
Carcinoid Syndrome
flushing
diarrhea
bronchospasm
cardiac valve abn
Carcinoid syndrome leads to a deficiency in…
niacin
Trichinellosis
GI complaints
periorbital edema
myositis
eosinophilia
Chronic Mesenteric Ischemia
chronic abdominal pain
weight loss
food aversion
Chronic Mesenteric Ischemia - Pathophysiology
atherosclerotic changes of celiac or SMA
1 S/E of ADPKD
ruptured berry aneurysm