Internal Medicine EORE Flashcards by Nicole Quinn

What is the most appropriate first-line therapy for a Black Patient with HTN?

thiazide type diuretic or calcium channel blocker (amlodipine) as initial monotherapy

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What two electrolyte side effects are seen with thiazide diuretics?

hyponatremia and hypokalemia

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What is the most common side effect of finasteride and why?

decreased libido, sexual dysfunction due its reduction in the conversion of testosterone to dihydrotestosterone preventing prostatic gland growth which is suspected to decrease nitric oxide in the corpus cavernosum

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Most common side effects of tamsulosin?

orthostatic hypotension and floppy disc syndrome

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What is the recommended screening age for prostate cancer?

55-65 and should be determined with shared decision making

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Treatments for SIADH (5)

treat underlying cause
water restriction to approximately 500-1500mL per day
correct sodium deficit
vasopressin receptor antagonists
Loop diuretic

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Dilated cardiomyopathy may have coexisting

dysrhythmias such as atrial fibrillation due to dilated ventricles

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adenocarcinoma is typically found in the _____ of the lung and is more common in patients who _______.

periphery of the lung and is more common in patients who do not smoke

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Large cell lung cancer is typically located in

the outer regions of the lungs causing SOB and fatigue

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Pancoast tumors are found in the ____ of the lung

apex of the lung and commonly cause symptoms of pain in the shoulder, neck, and shoulder blade

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Small cell lung cancer is most closely associated with ______ and demonstrates ______ growth

smoking exposure
rapid

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Types of non-small lung cancer

adenocarcinoma
squamous cell
large cell

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location of small cell carcinoma

arise in central airways (hilar mass/ bulky mediastinal lymphadenopathy)

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Treatment for prolactinomas

dopamine agonists:
cabergoline
bromocriptine

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Transsphenoidal surgery indications for pituitary ademonas

with pituitary adenomas that do not respond to initial management with medications, large, or causing significant visual field deficits may be candidates for surgery

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symptoms of a prolactinoma

galactorrhea
amenorrhea
loss of libido
vaginal dryness
dyspareunia
osteoporosis

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What is contraindicated in a patient that is experiencing acute-closure glaucoma

atropine

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what is it called when you have an incomplete relaxation of the lower esophageal sphincter and aperistalsis in the distal two-thirds of the esophagus

achalasia

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best treatment for this condition (achalasia)

pneumatic balloon dilation
if refractory to this procedure then surgical intervention can be performed

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What can cause pseudoachalasia

primary or metastatic tumors

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What is the appearance on a barium swallow that indicates achalasia

bird-beak appearance

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diagnostic test that confirms achalasia

esophageal manometry - shows increased LES pressure

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what is the most common central nervous system infection in pts with AIDS who are not receiving appropriate ppx?

Cerebral toxoplasmosis

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What is the imaging modality of choice for suspected cerebral toxoplasmosis? and what does it show?

MRI
often shows multiple ring-enhancing brain lesions which are assosicated with edema

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treatment for cerebral toxoplasmosis

sulfadiazine and pyrimethamine as well as antiretroviral therapy for immune recovery

what is used for treatment of hepatic encephalopathy?

lactulose

what is the treatment for wernicke enceohalopathy

thiamine

What are two idiopathic inflammatory myopathies and are characterized by bilateral proximal muscle weakness?

polymyositis and dermatomyositis

Polymyositis is

disease with symmetrical, progressive proximal muscle weakness that occurs over a period of weeks to moths that affects the neck and muscle groups of the upper and lower extremities face and eyes are spared

dermatomyositis is

polymyositis symptoms along with a dusky red heliotrope rash commonly seen around the eyes and facial erythema that mimics a butterfly shaped rash seen in patients with systemic lupus erythematosus however this rash includes the nasolabial folds unlike the malar rash in lupus

Polymyositis and dermatomyositis are associated with an increase incidence of

malignancy

how to test for polymyositis and dermatomyositis

EMG abnormalities muscle bx shows chronic inflammation elevated muscle enzymes

management of dermatomyositis

glucocorticoids azathioprine, methotrexate

what drug is known to cause myopathy

statins

What medication therapies are avaiable to aid in smoking cessation?

bupropion varenicline nicotine replacement therapy

Risk factors for stroke

older age HTN Hyperlipidemia DM History of cigarette smoking

Most common cause of acute bronchitis

viruses

What diagnosis should be suspected if the patient has a hx of cough with a fever and rales on PE?

pneumonia

What is the recommended anticoagulation for a patient that has a. fib and a score greater than or equal to 2

apixaban or rivaroxaban (DOACs)

What disease has the classic hallmark of morning stiffness that improves with movement when compared to other causes of joint pain.

rheumatoid arthritis

mainstay treatment of RA

medication management which includes NSAIDs, corticosteroids and disease-modifying antirheumatic agents (DMARDs)

recommendations of preventing the recurrence of diverticulitis

high fiber diet smoking cessation wt loss reduced meat intake regular physical activity

True or false: Diverticulosis is associated with an increased risk of colorectal cancer

false

a decrease in parathyroid hormone causes a decrease in what vitamin

calcium

What mineral, if deficient, can cause a functional hypoparathyroid state?

magnesium, since severe hypomagnesemia inhibits PTH secretion

What is Chvostek sign

contraction of the facial muscles after tapping the facial nerve

What does Chvostek sign occur in

hypocalcemia

The classic presentation of chronic bacterial prostatitis is symptoms of recurrent ________?

urinary tract infection, such as dysuria, frequency, urgency, perineal discomfort, and low-grade fever

Chronic bacterial prostatitis treatment

fluoroquinolone bactrim (trimethoprim-sulfamethoxazole)

What medication prevents the progression of BPH? and what is the most common side effect?

Finasteride Decreased libido

What medication decreases the symptoms of BPH but NOT the progression of BPH? and what are the most common side effects?

tamsulosin floppy iris syndrome and orthostatic hypotension

dilated cardiomyopathy should be treated with which two medication classes?

beta blockers and ACEi

What labs are usually seen in thyroid storm

high free t4/t3 low TSH

treatment for thyroid storm

beta blockers PTU*** or methimazole glucocorticoids bile acid sequestrants

reactive arthritis is an arthritis that develops soon after ________

an infection

positive testing for human leukocyte antigen B27 usually indicates what dx

reactive arthritis

what does this presentation indicate: - galactorrhea, amenorrhea, loss of libido, vaginal dryness, dyspareunia, osteoporosis

prolactinoma

what is indicated for patients who have been dx with achalasia who are not good candidates for pneumatic balloon dilation?

botulinum toxin (but this is considered a short-term solution of the symptoms)

How does vit D help facilitate calcium levels in the body

facilitates gastrointestinal calcium absorption

following induction of chemotherapy what can occur that would cause, cough, fatigue, and diarrhea?

Neutropenic fever

in the setting of neutropenic fever, what are important in initial steps when they come into the ER?

Obtain blood cultures and start IV antibiotics

What is the treatment for keratosis?

First line treatment is 5-Fu cream, 5%

Reed-Sternberg cells seen in

Hodgkin's lymphoma

What are the two most common causes of Cushing's syndrome?

Pituitary, adenoma, or ingestion of oral steroid medication's

what is the main state treatment for thrombotic thrombocytopenic purpura

Plasma exchange

what is the definitive treatment of choice for elderly patients diagnosed with grave disease??

Radioactive iodine

what is the topical treatment of choice for rosacea?

metronidazole

what is the topical treatment for acne

tretinoin

what is the treatment for scabies

permethrin

What are common aboard of agents for migraines?

celecoxib and sumatriptan

what is a prophylactic agent for migraines that also treats insomnia?

Amitriptyline

what office or laboratory test could be done initially and periodically on diabetic patients who are at risk for diabetic neuropathy?

Dipstick or laboratory test for diabetic microalbumin

Forman is associated with what vitamin deficiency and may rarely cause what anemia?

Vitamin B 12 deficiency Microcytic anemia

what is the treatment for Wolff-Parkinson-White syndrome?

Flecanide, procainamide, sotalol and amiodarone

Patients with a platelet count above 50,000 require what kind of treatment?

Observation, no treatment required

at what number of platelets do patients require therapy

If they develop bleeding problems or platelet count drops to below 20,000

What medication used for hyperlipidemia should be avoided in pregnancy?

Statins

what medication for hyperlipidemia is preferred during pregnancy?

Colesevelam

what are three things that support a diagnosis of cor pulmonal?

The presence of chronic lung disease, a holosystolic murmur, and right heart changes on ECG

what laboratory test can be supportive of a diagnosis of pernicious anemia?

Presence of Anti-intrinsic factor antibodies

What type of fluids should be given to a patient in diabetic ketoacidosis before treating with insulin?

2 L 0.9% normal saline

What is the most appropriate procedure for a patient with recurrent symptomatic episodes related to a. fib?

Ablation therapy

what is the best? Initial treatment for a patient with acquired nephrogenic diabetes insipidus as a result of chronic lithium use

Low protein and low sodium diet, thiazide, and potentially a potassium sparing diuretic like amiloride

What is the most common benign esophageal neoplasm?

Leiomyoma

If a patient is being placed on TNF therapy what testing should you obtain?

PPD since they are at higher risk of getting opportunistic infections, like TB

what food barn illness can you get through eating raw oysters?

Cholera