Internal Medicine Flashcards
1
Q
18 year old comes in with a non productive cough x 3 months. Also has the atopic triad. What will be found on physical exam?
A
wheezing
2
Q
Pt with end stage liver disease what will be found on physical exam?
A
lower extremity muscle wasting (they will try to get you to pick hepatomegaly but remember just like ESRD you get small kidneys, with ESLD you get a small liver - so no hepatomegaly)
3
Q
Genetic d/o with cerebellum and spinal cord demyelination?
A
Friedreich ataxia
4
Q
What disease has increased tactile fremitus?
A
PNA
5
Q
Female with HA, myalgia, fever, increased HR, neg kernig. Rash at wrist and ankles.
A
Rocky Mountain Spotty Fever
6
Q
Pt with 2 months of myalgia, abdominal pain, wt loss, lower leg edema with purpura and ulcers. Dx?
A
polyarteritis nodosa
7
Q
They give a long story about ankylosing spondylitis and even tell you its +HLA-B27 but they want you to describe the spine
A
enthesitis
8
Q
Pt with a URI, what’s the treatment?
A
anticholinergic
9
Q
What is the initial diagnosis of sarcoidosis?
A
chest x-ray
10
Q
MC type of glomerulonephritis?
A
IgA nephropathy
11
Q
Most effective way to avoid a concussion?
A
helmet
12
Q
What is the initial treatment of spinal stenosis?
A
abdominal muscle strengthening, weight loss, bracing, and corticosteroid injections
13
Q
MC malignant solitary pulmonary nodule?
A
adenocarcinoma
14
Q
Pt with emphysema hyperinflated lungs with decreased lung markings, what is on physical exam?
A
hyperresonance to percussion
15
Q
Pt was drinking a lot over the weekend and now has chest pain, SOB…think holiday heart, what would you expect on dx?
A
a-fib
16
Q
Lytic lesions with increased alk-phos?
A
pagets disease of bone
17
Q
What is the number one risk factor for peripheral artery disease?
A
smoking
18
Q
Pt is 5 weeks post MI with no chest pain but is still having increased ST elevation in V2 - V4. Dx?
A
ventricular aneurysm
19
Q
What is the treatment to decrease hepatic complications from hemochromatosis?
A
phlebotomy
20
Q
Cause of increased conjugated bilirubin?
A
hepatic injury or biliary obstruction
21
Q
Pt has an injured finger playing football, a ball hit tip of finger and no he can not extend. What is the dx?
A
mallet finger
22
Q
Pt has severe upper GI bleeding, he is critical and in shock. Tx?
A
immediate endo band ligation, then octreotide
23
Q
Pt has pneumonia and has a pleural effusion that on centesis shows frank pus, low pH, and low glucose. What is the tx?
A
thoracostomy tube
24
Q
What is the tx when a pt with glomerulonephritis from SLE?
A
steroids
25
Pt has a mass on his testicle which gets worse with Valsalva. What is the dx?
varicocele
26
They give you a Hep B panel to interpret, mine was +HbsAg +HbeAg +IgM anti-Hbc
acute hep B
27
What is the def. dx of idiopathic pulmonary fibrosis?
CT scan: diffuse patchy fibrosis with pleural based honeycombing
28
Pt is obese with daytime sleepiness what will you expect to find on physical exam?
a history of snoring (its OSA)
29
When do you begin to admin the PPV vaccine?
65 years old
30
What drug do you not give for a concussion?
hydromorphone
31
What is the best way to decrease chances of getting diabetes if pre-diabetic?
weight loss
32
Elderly female has signs of SOB, sleeps upright on recliner with pillows. They increase her lasix but it doesn't help her. What does she most likely have?
diastolic murmur
33
What disease is due to an increase in conjugated bilirubin?
hepatocellular injuries and biliary obstruction
34
What medication do you avoid in acute glaucoma?
atropine (anticholinergic)
35
MI and now has a murmur?
mitral regurgitation - due to papillary muscle rupture/defect
36
Loss of parietal cells
give vitamin B12
37
Has hypotension and a low sodium
addisons
| -tx hydrocortisone
38
Has high Na
Primary hyperaldosteronism (Conn's syndrome)
39
Swollen big toe
gout
40
EKG ST elevations I, aVL, V5 - V6
lateral circumflex
41
LLQ pain, slight fever
diverticulitis
42
Headache jaw claudication, shoulder pain
giant cell arteritis
43
Patient with a smoking hx with hematuria, what do you do next?
do a cystoscopy next
44
Painful defecation
anal fissure
45
Pain relieved with defecation
IBS
46
Medication to relieve symptoms of BPH
- tamsulosin
| - finasteride treats the actual disease
47
Guy has signs of hypocalcemia (trousseaus, chvostek's etc.) how tx?
calcium gluconate
48
COPD with 2 different P wave morphologies
multifocal arterial tachycardia
49
Progressive lengthening of PR interval and a dropped beat
Mobitz type 1 (second degree type one)
50
What is the criteria of metabolic syndrome?
```
130/85 BP
Triglycerides > 150
Glucose > 100
HDL < 50 females, < 40 males
Truncal obesity
```
51
HA, HTN, diaphoresis, tachycardia, palpitations, what is the dx?
Pheochromocytoma
52
First line tx active seziure
lorazepam
53
Everything is dry and has keratoconjunctivitis sicca
sjogren's
54
Status epilepticus compared to tonic-clonic seizure
no post-ictal phase
55
College student with URI sx and has patchy infiltrates on CXR
mycoplasma
| -treat with macrolide
56
Physical exam of patient with end stage alcoholic liver cirrhosis
esophageal varices
57
What is in a patient's history of painless rectal bleeding?
constipation
58
Nephrotic syndrome
>3.5 proteinuria
hypoalbuminemia
hypertriglyceridemia
hypercoagulable state
59
Describe SVT
narrow QRS with 160 BPM
| -give adenosine
60
Reactive arthritis - cause and symptoms?
dysenteric infection can cause it (like campylobacter)
| -presentation of conjunctivitis, arthritis, urethritis
61
Ileum recently resected, what do you want to replace?
B12
62
What drug do you not give if a person has gout?
Thiazide diuretics
63
Major side effect of inhaler
thrush
64
MCC of lung cancer
adenocarcinoma
65
Progressive dysphagia from solid to liquid, weight loss, what is the dx?
esophageal carcinoma
66
What is seen with aortic regurgitation?
bisferiens pulse
67
(+) ANA, confirm (lupus)?
Anti-double stranded DnS
68
Pt has mild persistent asthma, what to do?
add low dose ICS
69
Nodules on DIPs, dx?
OA - hebertons
70
IVDA, which valve?
tricuspid
71
Mas on tricep, bilateral arthralgia on PIPs, MCPs, dx?
RA
72
Pt was fatigued and weak, rash on face, lesions all over of different appearances (vesicles, papules), what is the cause?
varicella
73
Hyperinflation of lungs on CXR, what additional finding?
hyperresonance to percussion
74
What do you want to give patient with COPD?
Ipratropium (bronchodilators)
75
What is associated with sjogren's?
EBV
76
MC seen with hypercalcemia
nephrolithiasis
77
Ptosis, diplopia, facial nerve sxs, what is the dx?
myasthenia gravis
78
How do you tx Raynaud's?
nifedipine
79
How do you tx prinzmetal angina?
CCB
80
How do you tx hepatic encephalopathy?
lactulose
81
Lab test to monitor with someone who is treated for thyroid problem
TSH
82
Bilateral hilar infiltrates and cough for 2 months. What other manifestation will you see on PE? Sarcoid?
treat with prednisone
83
High trigs can lead to what?
pancreatitis
84
What is the MC physical exam findings in a patient with polyarteritis nodes?
livedo reticularis
85
Pt with kidney stones. Has hypercalcemia to 13.4. What are some symptoms?
constipation
86
What do chief cells secrete?
pepsinogen
87
Pt has CKD, what med to stop?
NSAIDs
88
18 year old with tenderness in the scrotum and mucopurulent discharge
epididymitis
89
Pt with MS. How do you control muscle spasms?
baclofen
90
Pt with obesity, hypertension, cholesterolemia, excessive drinker, current smoker. What are they most at risk for?
coronary vascular disease
91
Pt with obesity hypoventilation syndrome. You suggest they lose weight. What is another initial tx?
positive airway pressure
92
Pt has a CABG 2 days ago and now has chest pain, what is the most likely finding on PE?
mitral regurgitation - holosystolic murmur high pitched and blowing
93
Pt has an MI and now has pleuritic CP and fever
dressler's syndrome
94
Pt that worked in the coal mines for a really long time, and they have stuff in the upper lobs of their lungs, what do they have?
pneumoconiosis
95
Suprucondylar fracture tx
long arm splint
96
Rotator cuff tear
abnormal empty can test
97
Humerus fracture - what nerve are you concerned for injury?
axillary
98
Pt has mild persistent asthma - what is initial step?
inhaled SABA + ICS
99
Echo shows enlarged superior pulmonary vessel
PE
100
Man with large neck circumference
tx with CPAP
101
Pathophysiology of MG
AB against ACH receptors
102
Pathophysiology of DM I
autoimmune pancreatic beta cell destruction
103
Initial test to monitor thyroid problems
TSH
104
High triglycerides lead to
pancreatitis
105
patient with multiple sclerosis
control SPASTICITY - tx with baclofen
106
Patient has lockjaw, trismus, and tetany, what is the causative agent?
C. tetani
107
Pleuritic CP after MI
Dressler's syndrome
108
History of COPD comes to the clinic with increasing dyspnea + productive cough on systemic steroid what do you give them
ipratropium bromide (bronchodilator)
109
Nerve that innervates sticking out the tongue
hypoglossal (12 cranial nerve)
110
What age does a patient get pneumococcal?
65
111
Patient with G6PD what medication should you not give them?
sulfonamides
112
What on EKG shows LVH?
S wave in V1 plus the R wave in V5 or V6 sum > 35
113
What drug should you not be given to a patient with gout?
thiazide diuretics
114
Patient has LLQ, fever, most likely diverticulitis, how do you dx?
CT scan
115
Patient presents with tunnel obesity, HTN, low HDL, what do they have?
metabolic syndrome
116
MC nephropathy?
IgA
117
Patient was sick a couple weeks ago with sore throat, now has kidney problems, what is the dx?
Post-strep glomeruloneprhtis
118
Bilateral ptosis, diplopia, muscle weakness, facial nerve, dx?
MG
119
Lab test to monitor for someone on Valproate?
LFTs
120
What is seen with cardiac tamponade?
pulsus paradoxus
121
Patient in MVA and now has HoTN, JVD, decreased heart sounds (beck's triad), tx?
pericardiocentesis
122
Initial treatment of PUD?
pantoprazole
123
What do you give patients in the ICU to prevent gastric stress?
pantoprazole
124
MC area for polymyalgia rheumatica pain?
shoulders
125
What is the mainstay treatment for someone with polymyalgia rheumatica?
steroids
126
Pt has mild persistent asthma and uses albuterol 4 times a week, what do you want to add?
low dose inhaled corticosteroids
127
How do you treat someone with asterixis (hepatic encephalopathy)?
lactulose
128
IVDA has murmur of what valve?
tricuspid
129
Nodules on DIPs, what is diagnosis?
OA
130
Patient has bilateral pain in shoulder, hips, knees, and swelling of MCP joints, what is the dx?
RA
131
HTN, diaphoresis, HA, dx?
pheochromocytoma
132
Patient has a red papule on face that she scratched and now has papules, vesicles on erythematous bases, what is dx?
varicella
133
Hyperinflation of lungs on CXR, what is physical exam finding?
hyperresonance to percussion
134
Tx of legionella pneumonia?
azithromycin
135
Blood mucous diarrhea, relief with defecation, positive family history for psoriatic arthritis, what is dx?
UC
136
70 year old patient with 40 year smoking history and microscopic hematuria, what study do you want to do?
cystoscopy
137
Patient has Tissue Transglutaminase (tTG) antibody, IgA in the setting of foul smelling diarrhea, dx?
celiac
138
Patient has BRBPR on toilet paper, toilet and perianal itching, what is dx?
thrombosed hemorrhoid
139
How do you treat PID in nonpregnant patient?
ceftriaxone + doxy + metronidazole
140
How do you treat UTI in a female patient?
nitrofurantoin
141
Patient presenting with symptoms of ITP, how do you treat?
steroids
142
Patient has micrographia, cogwheel rigidity, what else would you see on physical exam?
resting tremor
143
What murmur do you see post MI?
mitral regurgitation
144
Patient presents with HoTN and high K, what is dx?
addisons
145
Patient has bent arms, with legs internally rotates and plantar flexed, what kind of posturing?
decorticate
146
How long after dx RA do you refer to a rehumatologist?
immediately
147
Man goes to Nicaragua and gets nausea, vomiting, and now he has jaundice and scleral icterus, what bug?
hepatitis A
148
Patient has hep B, what is concomitant infection?
Hep D
149
Patient has fever, RUQ pain and positive murphy's, what could have caused her condition?
high triglycerides
150
Patient has spinal stenosis, what is the initial treatment?
NSAIDs, PT, Steroid injections
151
Patient's family history significant for brother at 41 has ESRD and father died young of a cerebral aneurysms, what would you see on physical exam?
palpable kidneys
152
Patient has pain in 14 out of 18 pressure points, what is mainstay of treatment?
amitriptyline
153
Patient in the ICU has sudden onset respiratory distress, looks like ARDS, dx?
ARDS - non invasive or mechanical ventilation with positive end-expiratory pressure
154
Patient has symptoms of PAD, how do you dx?
Ankle-brachial index or arterial doppler
155
Patient presenting with trismus, jaw stiffness, what is the causative agent?
clostridium tetani
156
Patient has rice water stools, what did they most likely ingest?
shellfish - vibrio cholera
157
Patient has restrictive cardiomyopathy due to amyloidosis, what would you see?
rigid ventricles due to scar tissue
158
Patient has delta waves, what is the MOA?
accessory pathway that bypasses the AV node
159
Pericardial knock, radiation, what is the dx?
constrictive pericarditis
160
Patient has auer rods, what is dx?
AML
161
Treatment for sick sinus syndrome?
implantable pacemaker
162
Treatment for patient with life threatening ventricular arrhythmias?
implantable defibrillator
163
Treatment for patient who is pulseless with no discernable P or QRS but has weird waves, tx?
defibrilaate
164
How to dx GERD with normal endoscopy?
pH monitoring
165
Patient has PNA that is gram positive cocci in pairs, what is the dx?
Staph aureus
166
Patient has ST segment depression in leads I and aVL, what is dx?
acute coronary syndrome
167
Patient with HIV and pneumonia, what is tx?
bactrim
168
Patient had lytic lesions with elevated alk phos, dx?
pagets
169
Patient had weakness, sudden onset renal insufficiency (looks like multiple myeloma), how to dx?
serum protein electrophoresis
170
Patient who is an alcoholic with PNA, what is the MCC?
klebsiella
171
Patient from Ukraine lived in Chernobly, what cancer is he most at risk for?
thyroid cancer
172
Patient has no risk factors and is getting a purified protein derivative, what would indicate positive?
>15 mm
173
Healthcare worked getting purified protein derivative, what would indicate positive?
>10 mm
174
HIV patient gets purified protein derivative, what would indicate positive?
>5 mm
175
Mechanism of Graves disease?
antibodies bind to receptors to produce more TSH
176
Patient presents with gastroenteritis and now has ascending weakness, dx?
guillain-barre
177
Patient has been cough for 3 months, dx?
chronic bronchitis
178
Patient has bouts of bradycardia and tachycardia, dx?
sick sinus syndrome
179
Patient has high riding testicle with loss of cremasteric reflex, dx?
testicular torsion
180
Patient has sudden onset SOB and is on oral contraceptive, what is the dx?
pulmonary embolism
181
Patient has ulcer at medial malleolus, what is the dx?
venous stasis
182
What do you see on physical exam for person with venous stasis?
hyperpigmentation
183
Patient with PNA sating at 90%, what do you want to do next?
admit to hospital
184
Patient has petechiae and ulcer on leg, what is the dx?
polyarteritis nodosa
185
Patient is a past smoker, with no issues, what screening do you want to do for him?
CXR or low dose CT scan
186
Kid has sore throat and now has some sequelae, what is the cause?
strep pyogenes
187
What do you tell patient taking iron?
supplement with vitamin C
188
College student with positive brudzinski, what is most common cause?
strep pneumo (without petechial rash = pneumo, with rash = n. meningitis)
189
Patient comes in with uncontrolled DM with family hx of DM and HTN, what is she most at risk for?
CAD
190
Was given an UA to interpret that had 2+ protein, 2 WBC and 20 RBC, what is the dx?
glomerulonephritis
191
Patient with AMS and wrist drop when asked to pronate, what is the dx?
hepatic encephalopathy
192
Treatment of T score of -2.8?
prolia
193
Patient presents with SVT, what is the tx?
adenosine
194
What do you hear on physical exam for CHF?
S3
195
Patient had hypertension and low K, what is the dx?
primary hyperaldosteronism
196
Patient had thyroidectomy and now has perioral paresthesia and positive Chvostek's, what is the tx?
calcium gluconate
197
Fever, RUQ pain, jaundice, what is the dx?
ascending cholangitis
198
Patient drank a lot and now has chest pain and SOB, what is the dx?
a. fib
199
What is the treatment to decrease hepatic complications from hemochromatosis?
phlebotomy
200
Patient injured his finger and now has a mallet finger, what is the tx?
hyperextension splint
201
What does a patient with IBS present with?
relief with defecation
202
What is the tx for a supracondylar fracture?
posterior splint
203
What is RA associated with?
older aged Caucasian
204
What is a complication of trigeminal neuralgia?
double vision, jaw weakness, loss of corneal reflex, dysesthesia
205
How do you treat SIADH?
hyponatremia replenished - H2O restriction
206
How do you treat hypoglycemia when the pt has collapsed and is having seziures?
dextrose 50% IV
207
Amyloidosis symptom?
diastolic dysfunction
208
What is the initial step in atherogenesis of CAD?
endothelial damage
209
What is a risk factor of Alzheimer's?
dementia
210
Increased PT, AST, ALT, bilirubin and decreased albumin, what is the dx?
cirrhosis
211
How do you dx sarcoidosis?
biopsy
212
Diastolic rumble that radiates to carotids, how do you definitively dx?
angio
213
What is the tx of sarcoidosis?
steroids
214
What is the microorganism of pericarditis?
coxsackie
215
18 year old with 1 week/3 month symptoms, 2x per month night time awakening, what is the tx?
albuterol
216
18 year old dx with asthma, what do you do next?
asthma action plan
217
What is the tx for gouty arthritis?
indomethacin
218
What is seen with acute bronchitis?
white clear sputum, nocturnal dyspnea, fever
219
Behavioral changes, dancing like movements, what is the dx?
huntington's
220
Med that should be removed in CKD?
NSAIDs
221
What is the landmark that differentiates upper GI bleed form lower GI bleed?
ligament of treitz
222
SOB, no edema, jvd or other symptoms, what is the dx?
PE
| -very vague vignette
223
What is the tx for Myasthenia gravis?
pyridostigmine
224
JVP and murmur that is on the right side?
tricuspid
225
Radio ablation cause?
pericarditis
226
Sick sinus syndrome initial tx?
radioablation
227
Gonococcal arthritis, what is the initial dx?
arthrocentesis or urethral swab
228
What is the definitive tx for a fissure?
sphincterotomy
229
Eosinophilia in urine, what is the dx?
allergic interstitial nephritis
230
Pt extreme SOB walking two blocks, hx of alcohol consumption, what is the initial management?
regular exercise or alcohol cessation
231
Kidney stone 6 mm already on Tamsulosin, what is the next tx?
lithotripsy
232
Pt has COPD, what med will change the course of their disease?
home oxygen
233
What cranial nerve is involved in sticking out your tongue?
XII
234
How do you dx sarcoid?
CXR
235
What is the tx of chronic bronchitis?
LABA
236
What is Charcot triad?
RUQ pain, jaundice, fever
237
Finding on PE with cerebellar tumor?
abnormal gait
238
What is the causative agent of glomerulonephritis?
strep pyrogens
239
What are the sxs of sick sinus syndorme?
dizzy, syncope, bradycardia, tachycardia
240
What is the pathophysiology of Wolff-Parkinson-White?
accessory pathway that bypasses the AV node
| -delta wave
241
What is the first line tx for symptomatic bradyarrhythmia due to sick sinus syndrome?
pacemaker
242
What is the dx characterized by RVH due to chronic hypoxia?
pulmonary hypertension
243
32 year old male with cough, malaise, fever, chills, night sweats, anorexia, weakness, arthralgias, native of AZ and worked for 10 years in construction, no smoking hx, CXR show solitary pulmonary nodule. What tx options most likely result in clinical improvement?
radiation and chemo
244
Well circumscribed mass in right lung periphery, how do you definitively diagnosis?
FNA and biopsy
245
34 year old worsening dyspnea, dyspnea brought on by activity relieved with rest, S4, echo shows LVH and thickening of septum, what additional symptom?
exertional syncope
246
History of a. fib significant dyspnea on exertion, chronic cough, hemoptysis occasional, physical exam reveals crackles, loud first heart sound, diastolic rumble, which murmur?
mitral stenosis
247
DM II, dyslipidemia, not getting adequate glucose control with metformin, diet and exercise. Which medicine should be added to help with his hyperlipidemia?
colesevelam
248
Patient has a blood pressure of 212/144. what is the tx?
labetalol
249
Most likely risk factor for intrinsic sinoatrial node?
increased age
250
CSF panel findings for bacterial meningitis?
elevated opening pressure and protein, decreased glucose
251
A question on a classic picture of meningitis, pt has a rash, what is the causative organism?
Neisseria meningitidis
252
What is the long term treatment for Wolff-Parkinson-White?
radiofrequency ablation
253
What increases NA reabsoprtion?
aldosterone
254
What is the tx of sexual caused epididymitis?
doxy + ceftriaxone
255
What is a symptom of venous ulcer?
hyperpigmentation
256
What is the function of urine specific gravity?
measures concentration of urine
257
What is the tx of ventricular aneurysm?
defibrillation
258
What is the finding of EKG for ventricular aneurysm?
persistent ST elevation, VI, V2 6 weeks post MI
259
What is a side effect of rifampin?
discoloration of body fluids
260
What should all patients with SLE be placed on?
hydroxychloroquine
261
Woman is 9 months post/op/injury to her arm. She starts to develop erythema, paresthesia, swelling and pain. What is the dx?
complex regional pain syndrome
262
Patient has thickened skin on distal fingers, what is the dx?
systemic sclerosis (scleroderma)
263
Patient went to a foreign country (Caribbean) and returned with bloody diarrhea. What is the causative agent?
shigellosis
264
Patient received radiation therapy for cancer, now has cardiac complaints and pericardial friction rub (constrictive pericarditis), what are you most likely to see on echo?
diastolic dysfunction from pericarditis
265
Patient with transmural inflammation of intestines and patches of separate ulcerations (skip lesions), what is the dx?
Crohn's disease
266
Patient has anal fissure (or hemorrhoids) what is the best tx?
increased fiber in diet or sphincterotomy
267
Patient has right handed worsening tremor, what is the best tx?
beta blockers
268
Patient has mildly erythematous right eye upon waking, also complains of pain, no history of infection or trauma, unilateral symptoms only. What else do you expect to find on exam?
fixed, mild dilated pupil on right
269
Patient is post CABG, develops chest pain, EKG shows low voltage and electrical alternans, what else do you expect to find on exam?
pericardial effusion - JVD
270
Patient has heart failure, what do you see on CXR?
cephalization of flow
| -due to pulmonary vasculature dilation
271
What is the presentation of Hodgkin's lymphoma?
bimodal, EBV association, painless mediastinal lymphadenopathy, pain with alcohol, b- symptoms, reed Stenberg cells
272
What is the tx for angina pectoris?
MONA, beta blocker, statin if high LDL and low HDL
273
How do you dx sick sinus syndrome?
tachy then brady on EKG
| -risk factor is age due to SA node pulmonary fibrosis
274
How do you dx tricuspid regurgitation?
- blowing holosystolic murmur
- LLSB
- carvallo's sign: increased with inspiration
- decreases with Valsalva
275
What are the dx study findings for restrictive cardiomyopaty?
- Echo = diastolic dysfunction with preserved contractility, S4 heart sound
- CXR = dilated atria, normal ventricles
- ventricular rigidity impedes ventricular filling
- R sided heart failure
276
What are the clinical therapeutics for hyperlipidemia?
- niacin, nicotinic acid, vitamin B3 - best drug to increase HDL
- Side effects: hyperglycemia, hyperuricemia, gout
- niacin causes hyperglycemia so use in caution in patients with diabetes
277
How do you dx Dressler syndrome?
pericarditis 2-5 days status post MI associated with fever and pulmonary infiltrates
278
What is the tx for Dressler syndrome?
colchicine, indomethacin, NSAIDs
279
How do you dx secondary hypertension?
MC: CKD
- hypertension due to renal artery stenosis
- severe refractory hypertension
- abdominal: renal bruit
280
What are the dx studies for LVH?
Sokolow - Lyon Index
| -measure lowest S in V1 or V2 + tallest R in V5 or V6 if > 35 mm = LVH
281
What is heard on auscultation with aortic stenosis?
- crescendo decrescendo at RUSB
- paradoxically split S2
- pulsus parvus et tardus = weak delayed pulse = narrow pulse pressure
- radiated to carotids: delayed carotid pulse
282
What are the sxs of CHF?
syncope, angina, dyspnea on exertion
283
What is central diabetes insipidus?
deficiency of ADH from posterior pituitary/hypothalamus
-no ADH production most common type: idiopathic, autoimmune destruction of posterior pituitary from head trauma, brain tumor, infection, or sarcoidosis
284
What is nephrogenic diabetes insipidus?
lack of reaction to ADH
-partial or complete insensitivity to ADH: caused by drugs (Lithium, amphoterrible), hypercalcemia and hypokalemia after the kidney's ability to concentrate urine, acute tubular necrosis
285
What is the tx for central diabetes insipidus?
desmopressin
286
What is the tx for nephrogenic diabetes insipidus?
sodium and protein restriction, HCTZ, indomethacin
287
What medication is contraindicated in pregnancy?
cipro
288
What is the presentation of testicular torsion?
- asymmetric high riding testicle
- sudden, severe pain and swelling in the testicle
- associated with nausea and vomiting
- cremaster reflex is absent
289
What is the tx of epididymitis?
supportive care: bed rest, scrotal elevation, analgesics
- > 35 years = levofloxacin
- < 35 years = ceftriaxone+ doxy
290
What is status epilepticus?
a single epileptic seizure lasting more than five minutes or two or more seizures within a five-minute period without the person returning to normal between them
291
How do you dx diverticulitis?
abdominal/pelvic CT scan revealing fat stranding and bowel wall thickening
292
What is the treatment of celiac?
lifelong gluten free diet
293
What is the risk of resected brain tumor?
cerebral aneurysm. dementia, seizures
294
What is the most common cause of aseptic meningitis?
viral - enteroviruses, HSV, HIB, mumps, West Nile
295
What drug is use to treat a bleeding PUD?
pantoprazole (protonix)
296
What is the tx for pyelonephritis?
ciprofloxacin
297
Patient has a hx of GERD, takes ASA, clopidogral, atorvastatin, lisinopril, metoprolol succinate. What drug should be avoided?
omeprazole
298
What are the symptoms of BPH?
decreased force of urinary stream, hesitancy (stop and start) and straining, postvoid dribbling, incomplete emptying, frequency, nocturia, urgency, recurrent UTIs
299
What are the funduscopic findings of hypertension retinopathy?
arteriolar constriction, arteriovenous nicking, vascular wall changes, flame-shaped hemorrhages, cotton-wool spots, yellow hard exudates, and optic disk edema.
300
3 months burning pain in 2nd and 3rd toes, numb, what is the dx?
morton's neuroma
301
What is the presentation of systemic sclerosis (scleroderma)?
- Tight, shiny, thickened skin due to fibrous collagen buildup
- Limited cutaneous systemic sclerosis "CREST SYNDROME" - Calcinosis cutis, Raynaud's phenomenon, esophageal motility disorder, sclerodactyly (claw hand), telangiectasia
302
Signs, symptoms and treatment for pericarditis?
- Pleuritic Persistent chest pain
- Pericardial friction rub
- Better leaning forward
- Persistent ST elevations in precordial leads and PR depression in same leads
- Tx: NSAIDS
303
Signs and symptoms of renovascular HTN?
- Bruit over Epigastrium
- AKI w/ initiation of ACE
- Severe refractory HTN and HA
304
Signs and symptoms of constrictive pericarditis?
- Pericardial Knock - high pitched 3rd heart sound
- Right sided heart failure, Dyspnea
- S4
- Kussmaul’s sign - increased JVD during inspiration
305
Signs and symptoms of acute arterial occlusive disease?
- Pallor, pain, pulselessness, paresthesia, paralysis, poikilothermia
- Lateral malleolus ulcer
306
Clinical Interventions for Wolff parkinson white syndrome?
- Pharm Tx: Procainamide or Amiodarone
| - Definitive: radiofrequency ablation of the accessory pathway
307
Signs and symptoms of Mitral Stenosis?
- Enlarged/Dilated LA on CXR
- CHF sx’s of right sided heart failure
- Opening snap
- Diastolic rumble
- Associated with Afib
308
Signs and symptoms of Peripheral Arterial Disease?
Intermittent Claudication, mc pain brought on by exercise relieved with rest
309
What are characteristics of systolic CHF?
- MC CHF
- Low EF
- S3 -filling of dilated ventricle
310
What are characteristics of Diastolic CHF?
- Normal EF
| - S4 - atrial contraction into stiff ventricle
311
Signs and symptoms of L sided HF?
- Fluid backs up to lungs, increased pulmonary venous pressure
- Dyspnea MC sx
- Pulmonary congestion- pink frothy sputum Orthopnea, PND
312
Signs and symptoms of R sided HF?
- Systemic fluid retention- increased systemic venous pressure
- Peripheral pitting edema
- JVD
- GI/Hepatic congestion: Ascites
313
What is becks triad for cardiac tamponade?
Distant muffled heart sounds, increased JVP, Hypotension
314
Cardiac Tamponade echo finding and tx?
- Diastolic collapse of cardiac chambers
| Tx: Pericardiocentesis
315
Signs and symptoms of Acute glaucoma?
- Increased intraocular pressure
- Sudden severe unilateral eye pain, watery, tunnel vision, foggy, injected
- “Steamy Cornea” (cloudiness)
- Mid dilated non-reactive pupil
- Hard to palpation
316
Clinical Therapeutics for Acute angle closure glaucoma?
- Acetazolamide IV - 1st line
- Topical BB: Timolol
- Miotics/cholinergics: Pilocarpine, Carbachol
317
Clinical Therapeutics for Acute Adrenal Insufficiency?
- IV fluids: NS (D5NS if hypoglycemic)
- Glucocorticoids: Hydrocortisone- if dx, if undx: Dexamethasone
- Reverse electrolyte abnormalities
0 Give Fludrocortisone
318
Signs and symptoms of Adrenal Insufficiency?
Shock, hypotension, hypovolemia = Severe DEHYDRATION
319
Lab studies for Adrenal Insufficiency?
- Hypoglycemia
- Hyponatremia
- Hyperkalemia
- Hypercalcemia
320
Signs and symptoms of Addisons disease?
- Hyperpigmentation: due to increased ACTH production
- Low Aldosterone - Can’t hold onto Sodium
- Decreased sex hormones: low lobido, Amenorrhea, loss of axillary and pubic hair
321
Graves disease laboratory concepts?
- Igg Antibody --> binds to TSH receptors and triggers synthesis of excess thyroid hormone
- Circulating TSH receptor ab --> causes increase thyroid hormone synthesis
322
Most common thyroid cancer?
Papillary 80%: MC after radiation exposure, young females, local cervical LN mets
323
Signs and symptoms of Hypercalcemia?
- Stones : kidney stones
- Bones: fractures
- Abdominal Groans: Constipation, Ileus
- Psychiatric overtones: HA, weakness, fatigue, decreased DTR
- Shortened QT interval
324
Causes of hypocalcemia?
- Hypoparathyroidism , post surgical
- Chronic Renal Dz
- Vitamin D deficiency : Rickets, Osteomalacia
325
+ Chvostek and Trousseau is a sign of what?
Hypocalcemia
326
Signs and symptoms of Acromegaly?
- Enlargement of Hands, feet, and skull
- Coarsened facial features
- Micrognathia - enlarged jaw
- Organomegaly
- DM, Kidney stones
- HA, visual defects
327
How do you diagnoses metabolic syndrome?
- HDL <40 men and <50 women
- BP 135/85
- TG >180
- Fasting blood sugar 100-135
- Waist circumference > 35 women, > 40 men
328
Signs and symptoms of Paget disease of bone?
- Abnormal bone remodeling
- MC > 40y
- MC in Western European descent
- High Alk phos with normal calcium & phosphate
329
What are the imaging finding and tx for Paget disease of bone?
- XRay: blade of grass/flame shape lucency
- Skull have cotton wool appearance
- Tx: Bisphosphonates & calcitonin
330
Signs and symptoms of DiverticulOsis?
- LLQ pain
- Bright red blood per rectum
(low fiber diet, constipation, obesity)
- MC cause of acute lower GI bleed
331
Diagnostic studies of diverticulitis?
- CT scan is test of choice
- Elevated WBC
- +Guaiac
332
Signs and symptoms of diverticulitis?
- Fever, LLQ Pain, N/V/D/C, flatulence, bloating
333
Tx for diverticulitis?
- IV fluids + ABX
| - Broad spectrum Abx: Cipro or Bactrim + Metronidazole
334
What are the diagnostic studies for crohns disease?
- Colonoscopy: “Skip lesions” w/ Cobblestone appearance
- Barium study: “String sign” Ba flow through narrowed ileum
- Acute dz: Upper GI series with Small bowel follow through: test of choice Labs: +ASCA (Anti-Saccharomyces Cerevisiae Antibody)
335
Signs and symptoms of Cirrhosis?
- Ascites and gynecomastia
- Fatigue, weakness, weight loss, muscle cramps, anorexia
- Skin: Spider angioma, caput medusae, muscle wasting, palmar erythema,
hepatosplenomegaly, jaundice
- Dupuytren's contractures
336
Diagnostic studies for colon cancer?
- Colonoscopy with Biopsy
- Barium Enema: Apple Core Lesions
- Elevated CEA tumor marker
337
Diagnostic studies for ulcerative colitis?
- Flex Sigmoidoscopy : Uniform inflammation - Sandpaper appearance
- Pseudopolyps
- BLOODY DIARRHEA
- Diffuse ulceration- bleeding
- Sheets of WBC- inflamed mucosa
338
What causes Zollinger Ellison syndrome?
Gastrin secreting neuroendocrine tumor
339
what is the Zollinger Ellison syndrome triad?
- Peptic ulcers
- Gastric acid hypersectretion
- Tumor of pancreas
340
What are the urine and serum protein electrophoresis findings for multiple myeloma?
- Urine: Bence-Jones Proteins: Kappa or Lambda light chains
| - Serum: monoclonal protein spike (IgG: 60%, IgA: 20%)
341
Peripheral smear finding for CLL?
Well differentiated lymphocytes w/ scattered SMUDGE CELLS
342
What are the lab and bone marrow findings for AML?
- Pancytopenia
| - Bone marrow: auer rods
343
Lab findings for CML?
- Increased WBC : 100,000
- Blastic crisis
- Philadelphia Chromosome
344
Health maintenance protocol for Hemolytic Anemia in a pt with sickle cell?
IV hydration, Oxygen, Morphine or Hydrocodone, Hydroxyurea, Folic acid,
Blood transfusion, Allogeneic stem cell transplant
345
Health maintenance protocol for Hemolytic Anemia in a pt with G6PD?
Avoid offending foods and sulfa drugs Fe/Folic acid supplement, blood
transfusion if severe
346
Health maintenance protocol for Hemolytic Anemia in a pt with Hereditary Spherocytosis?
Folic acid, Splenectomy is tx of choice if severe.
347
Health maintenance protocol for Hemolytic Anemia in a pt with Alpha Thalassemia?
- Mild: no tx mod:Folate, avoid oxidative stress
- Severe: Blood transfusions, Iron Chelating agents (Deferoxamine), Splenectomy, Bone marrow transplant, Vitamin C, Folate.
348
Health maintenance protocol for Hemolytic Anemia in a pt with Beta Thalassemia?
- Minor: no tx
| - Major: Weekly blood transfusions, Deferoxamine, Bone marrow transplant, Vitamin C, Folate, Splenectomy.
349
Health maintenance protocol for autoimmune Hemolytic Anemia?
- Warm: Steroids, Immunosuppressants,
Splenectomy
- Cold: Avoid cold exposure, drink warm fluids, Rituximab.
350
Health maintenance protocol for Hemolytic Anemia in a pt with TTP?
Plasmapheresis is tx of choice, steroids, Cyclophosphamides, Splenectomy if refractory
351
Health maintenance protocol for Hemolytic Anemia in a pt with DIC?
- Platelet transfusion if <20K, FFP if severe bleeding, Cryoprecipitate to replace
fibrinogen, +/- Heparin for thrombosis
352
Health maintenance protocol for Hemolytic Anemia in a pt with HUS?
Observation (in children), Plasmapheresis +/- FFP if severe.
353
Treatment for Pneumocystitis?
- Bactrim is tx of choice.
- Add Prednisone if O2 Sat is <80%
- Other regimens: Clinda + Primaquine, Trimetrexate, Dapsone
- Use Itraconazole for Histoplasmosis
354
Treatment for Pertussis?
- Erythromycin is drug of choice
- Bactrim is 2nd line
- Tdap for booster tetanus shots
355
Tuberculosis is spread via what mechanism and leads to what in the lungs?
- Via airborne droplets
| - Granuloma formation in the lungs
356
Which phase is Tuberculosis most contagious?
Primary phase
357
Signs and symptoms of Syphilis?
- PAINLESS chancre (genital ulcer)
| - Maculopapular rash on palms and soles
358
Signs and symptoms of Guillain Barre Syndrome?
Ascending symmetrical muscle weakness, without fever or sensory deficits
359
What are CSF findings in a pt with Guillain Barre Syndrome?
- High protein ( >400)
- Normal WBC
- Normal Glucose
360
Signs and symptoms of Myasthenia Gravis?
- Generalized weakness
- Reduced exercise tolerance- improves with rest.
- Bilateral eyelid ptosis, proximal muscle weakness
- Normal reflexes.
361
Diagnostic studies for Myasthenia Gravis?
- Edrophonium ( Tensilon test) rapid response to short acting IV edrophonium
- + Ach-receptor Ab
- Ice pack test - ocular MG improves with cold
362
Signs and symptoms of benign essential tremor?
- Intentional tremor
- Bilateral action tremor of hands, forearms, head, neck or voice
- Tremor is worse with emotional stress & intentional movement
- Tremor can be relieved by alcohol ingestion
363
What medication is used to manage severe essential tremors?
Propranolol
364
CSF finding for subarachnoid hemorrhage?
Xanthochromia - yellow color
365
Signs and symptoms of Parkinsons?
- Tremor at rest - pill rolling tremor
- Bradykinesia - slowness of voluntary movement
- Shuffling gait, lack of swinging of arms while walking
- Masked Facies: Face involvement: immobile face, wide palpebral fissures
- Myerson sign: tapping the bridge of the nose repetitively causes a sustained blinking
366
What antibody lab are most specific for observing RA?
+ Anti-citrullinated peptide antibodies
367
What are imaging findings for RA?
subluxation, deformities, ulnar deviations of hands, narrow joint space
368
Signs and symptoms of polymyositis?
- Muscle weakness affecting both sides of your body. - Difficult to climb stairs
- Rise from a seated position
- Lift objects
- Reach overhead
369
Lab test used to diagnose polymyositis?
- Increase Aldolase and creatine kinase
- + anti-Jo 1 Ab
- + anti SRP Ab - specific
370
How do you treat polymyalgia rheumatica?
- Low dose corticosteroids ( 10-20mg/d)
| - Methotrexate
371
What medications are used for chronic management of gout?
Allopurinol or Colchicine
372
What medications are used for acute management of gout?
Indomethacin
373
Tx for Sjogrens syndrome?
PILOCARPINE - increased lacrimation & salivation
374
Signs and symptoms of reactive arthritis?
- Conjunctivitis - cant see
- Urethritis - cant pee
- Arthritis - cant climb a tree
375
Most common cause of asymmetric inflammatory arthritis?
Chlamydia
| - MC in males 20-40y
376
Clinical intervention for carpal tunnel syndrome?
Volar splint & NSAIDs
377
Diagnostic findings for acute gout?
- Arthrocentesis - negatively birefringent needle shaped urate crystals
- Xray - shows mouse/rat bite “ punched out erosions”
378
What clinical interventions for SLE?
- Hydroxychloroquine for skin lesions (s/e: Impaired night vision/retinal toxicity)
- NSAIDs or Acetaminophen for arthritis
379
What is that pathophysiology for cor pulmonale?
- RVH with eventual RV failure resulting from Pulm HTN secondary to Pulm disease
- MC from COPD: May have Polycythemia with increased HCT
380
Signs and symptoms of cor pulmonale?
- Accentuated increased S2
- Increased JVP
- Peripheral edema
- Ascites
381
Signs and symptoms of emphysema?
- Dyspnea on exertion : hallmark sx
- Accessory muscle use, prolonged expiration, mild cough
- Hyperinflation: Barrel chest→ increased AP diameter
- Hyperresonance to percussion
- Decreased/ Absent breath sounds: quiet chest
- Appearance: Cachectic with pursed lip breathing: PINK PUFFERS
382
ABG finding for emphysema?
Respiratory Alkalosis, normal CO2
383
Diagnostic studies and PE finding in pt with renal artery stenosis?
- Renal Angiography - gold standard
| PE finding: Abdominal bruit
384
Signs and symptoms of bladder cancer?
Painless Hematuria, Hx of smoking
385
Diagnostic study for bladder cancer?
Cystoscopy with biopsy
386
Signs and symptoms of epididymitis?
- Scrotal pain, Erythema, Swelling
- + Prehn’s sign: Relief of pain with scrotal elevation
- + Cremasteric Reflex
387
Treatment for epididymitis?
- Bed rest, scrotal elevation, cool compresses, NSAIDS
- Gonorrhea/Chlamydia: Azithromycin+Ceftriaxone
- E COli/Klebsiella: FQ
388
Signs and symptoms of prostatitis?
- Tender, normal or hot boggy Prostate
- Fevers, frequency, urgency, dysuria
- Perineal pain
389
Treatment for prostatitis?
Bactrim or FQ + doxy
390
Diagnostic findings for acute interstitial nephritis?
- UA: WBC casts, urine eosinophils
| - Increased serum IgE
391
Signs and symptoms of acute interstitial nephritis?
Fever, eosinophilia, maculopapular rash, arthralgias
392
Treatment for second degree AV block?
Pacemaker
393
Signs and symptoms of second degree AV block?
Fainting, chest pain and feeling dizzy, tired or SOB
394
Patient with gout should avoid what foods?
Purine rich food ( alcohol, liver, yeast, oily fish)
395
Pt with Hepatic encephalopathy presents with asterixis on PE what does this mean?
Inability to keep hands dorsiflexed
396
Murmur heard is opening snap is a sign of what?
Mitral stenosis
397
Patient hand trembling when reaching for object is what type of tremor?
Benign essential tremor
398
Patient presented with pericarditis after MI is diagnosed with what?
Dressler syndrome
399
Flattened t wave what's the tx?
Potassium?
400
Side effect of ace inhibitors?
Tachycardia, Cough, Angioedema
401
What medication is used to treat rickettsia rickettsii bite?
Doxy
402
Man with metastatic colon cancer what do u recommend?
Hospice
403
Severe cough what's the likely causitive bacteria?
Bordetella pertussis
404
HIV pt with Pneumocystis pneumonia, what do you treat with?
Trimethoprim / Sulfamethoxazole - Bactrim
405
Who is at risk for RA?
- +HLA
- Smoking
- Obesity
406
What is the number one thing that decrease mortality in COPD?
O2
407
PPD sizes in a healthy patient?
>15mm
408
Male pt with unilateral groin pain. Negative prehn sign. Tx?
- Orchiopexy
| - Orchiectomy if >6 hrs
409
Mechanism of graves dz?
Antibodies attacking tsh receptors
410
1.5 solid nodule in thyroid. Diagnostic exam?
Needle aspiration
411
Patient has big hands and arms what's wrong with the patient?
Pituitary adenoma
412
Tremor healed with alcohol?
Essential Tremor
413
A patient elbows extended, wrist pronate and arms in adduct position what is this
called?
Decerebrate posturing
414
Multiple sclerosis dx?
MRI w/ gadolinium shows white matter plaques
415
Prophylaxis for seizure?
Phenytoin
416
Tx for Von Willebrand?
Cryoprecipitate
417
Diagnostic finding for Von Willebrand?
Decreased Ristocetin activity
418
Pt has T-wave flattening, viral gastro and V/D what do you give them?
Vitamin K
419
Tx for Giant Cell arteritis?
High dose corticosteroids like Prednisone
420
Pt with dislipidemia, what med worsens hyperglycemia?
Niacin
421
Coal miner - eggshell calcification indicates what?
Silicosis
422
What is Chylothorax?
Lymphatic flow disorder where lymphatic fluid leaks into the space between the lung and chest wall. When this fluid builds up in the lungs, it can cause a severe cough, chest pain and difficulty breathing
423
Polyarteritis nodosa - skin manifestation is called?
Livedo Reticularis- netlike pattern of reddish-blue skin discoloration
424
Anterior wall MI is seen in what leads?
V1-V4
425
Deep voice, moist hands, large hands and feet what's the dx?
Acromegaly
426
What medications are C/I in gout?
Loop diuretics, thiazide diuretics and thiazide-like diuretics
427
What is increased in lab values for folate deficiency?
MCV is increased since it is a macrocytic anemia
428
Pt has decreased pulses what diagnostic study is done?
DOPPLER do not do ABI
