Internal Medicine Questions Flashcards
23 yo pt with hx of ileal resection for Crohn’s disease presents with a 1 cm kidney stone in the renal pelvis. What is it most likely made of?
A. Cystine B. Oxalate C. Phosphate D. Struvite E. Uric acid
B. Oxalate
Bile acids are absorbed by terminal ileum. Bile salt malabsorption leads to fat malabsorption. With fat malabsorption, calcium in the bowel lumen is bound by fatty acids instead of precipitating with oxalate, which is left free for excessive absorption, leading to oxalate stones
Starts out with multiple lesions, may be over trunk, buttocks, or extremities. Described as papules that become vesicles and may even develop hemorrhagic crusts
Most likely dx?
A. Pityriasis alba B. Pityriasis lichenoides C. Pityriasis rosea D. Pityriasis rubra pilaris E. Tinea versicolor
B. Pityriasis lichenoides
Which of the following is outpatient therapy for pyelo?
A. TMP/SMX
B. Nitrofurantoin
C. Amoxicillin-clav
D. Ciprofloxacin
D. Ciprofloxacin
A positive Nikolsky’s sign refers to sloughing and separation of the epidermis upon gentle pressure to the lesions. Four diseases are associated with this sign. Which of the following is NOT one of them?
a. Bullous pemphigoid
b. Pemphigus vulgaris
c. Toxic epidermal necrolysis
d. Stevens Johnson syndrome
e. Staphylococcal scalded skin syndrome
a. Bullous pemphigoid
Which of the following is tx for severe fistulizing crohns disease?
A. Mesalamine and prednisone
B. Infliximab
C. Azathioprine
D. Cyclosporine
B. Infliximab
Which of the following is associated with hyperkalemia as a side effect?
A. Chlorthalidone B. Furosemide C. Lisinopril D. Metoprolol E. Nifedipine
C. Lisinopril
HLP medication associated with hyperuricemia and predisposing to gout attacks
A. Cholestyramine B. Ezetimibe C. Gemfibrozil D. Niacin E. Simvastatin
D. Niacin
Pt with history of multiple episodes of DVT. Her father had similar episodes. What hereditary disorder is most likely?
A. Activated protein C resistance B. Antithrombin deficiency C. Hyperhomocysteinemia D. Protein C deficiency E. Prothrombin gene mutation G20210A
A. Activated protein C resistance
Aka Factor V Leiden mutation
Characterized by diffusely erythematous skin rash, fever above 38 C, lymphadenopathy, hematologic abnormalities, hepatitis, and involvement of at least 1 organ; carries mortality rate of 10-20% with most fatalities due to liver failure
A. DRESS syndrome B. Red man syndrome C. Stevens-Johnson syndrome D. Toxic epidermal necrolysis E. Toxic shock syndrome
A. DRESS syndrome
Manage with supportive therapy, steroids, and antihistamines
Which of the following treatment regimens is used in AML?
A. Fludarabine, cyclophosphamide, and rituximab
B. Imatinib
C. Vincristine, prednisone, doxorubicin
D. Cytarabine (Ara-C), daunorubicin, cladribine
D. Cytarabine (Ara-C), daunorubicin, cladribine
Pt presents with gastric varices and a thrombus in the splenic vein. What is the most common etiology?
A. Chronic pancreatitis B. Ductal adenocarcinoma of the pancreas C. Factor V leiden D. Intraductal papillary mucinous tumor E. Pancreatic pseudocyst
A. Chronic pancreatitis
Splenic v thrombosis most commonly occurs d/t chronic pancreatitis. This can result in gastric varices without elevation in portal pressures. The tx for isolated gastric variceal bleeding secondary to splenic v thrombosis is splenectomy
A child is suspected to have lead poisoning. In addition to blood lead level, what other study should be done at this time?
A. Capillary blood toxin levels B. EMG C. MRI brain D. Plain film of abdomen E. Radiographs of long bones
D. Plain film of abdomen
This looks for lead-containing objects which may need to be removed. Note that chelation therapy with DMSA or EDTA should be initiated for BLLs greater than 45 ug/dL
Pt presents with palpitations, chest pain associated with painful respiration, temperature of 100.5, O2 sat of 98%. PE reveals normal CV, resp, and abdominal exam. ECG shows ST-elevation in leads I, aVL, II, III, aVF, and V2-6. PR depression is present in lead II and PR elevation in aVR. What is the next step in management?
A. ceftriaxone B. heparin C. indomethacin D. levofloxacin E. percutaneous coronary intervention
C. indomethacin
Diffuse ST-elevation, low-grade fever, and pleuritic chest pain indicate acute pericarditis. Treat with ASA 2-4 g/day, ibuprofen 400-600 mg TID, or indomethacin 25-50 mg TID. Colchicine may also be given or even glucocorticoids if tx has been refractory
HIV pt with CD4 count of 100 presents with AMS, cough, SOB, and headache for several months. He also has blurry vision and vomiting. PE reveals rales, papilledema, and multiple red papules on arms and chest. Most likely organism?
A. Cryptococcus neoformans B. Histoplasma capsulatum C. Mycobacterium tuberculosis D. Neisseria meningitidis E. Cytomegalovirus
A. Cryptococcus neoformans
Consider this dx in any pt presenting with s/s of chronic meningitis. Pts with underlying HIV should be tx with amphotericin B, flucytosine, AND fluconazole.
CMV can cause CNS sxs, but not usually until CD4 is less than 50. Also presents with more GI sxs including bloody diarrhea
Presents as pulmonary-renal syndrome with nonspecific symptoms like fever, myalgias, and arthralgias. Pts have a history of asthma and present with eosinophilia
A. Churg Strauss B. Goodpastures C. Microscopic polyangiitis D. Wegener’s granulomatosis E. Rheumatoid arthritis
A. Churg Strauss
Otitis media is an infection of middle ear cavity common in children. Common pathogens are strep pneumo, H. influenzae, and M. catarrhalis. What is the treatment of choice?
Amoxicillin 80-90 mg/kg/day for 10 days
Presents with hemoptysis and hematuria; often triggered by infections like streptococci or drugs like penicillin. P-ANCA positive.
A. Churg Strauss B. Goodpastures C. Microscopic polyangiitis D. Wegener’s granulomatosis E. Rheumatoid arthritis
C. Microscopic polyangiitis
Note: Churg strauss is also p-anca positive. Also note that presentation of microscopic polyangiitis is almost identical to wegener’s, but wegener’s is c-anca positive
A 78 y/o male presents for routine checkup. PMH significant for HTN, dyslipidemia, and obesity. He is found to be in afib. What is his CHADS2-VaSc score?
A. 1 B. 2 C. 3 D. 4 E. 5
C. 3
CHF = 1 HTN = 1 Age > 75 = 2 Diabetes = 1 Stroke or TIA = 2 Vascular disease = 1 Age 65-74 = 1 Sc (sex) = 1 if female
This guy gets 1 for HTN and 2 for age >75 = 3 points
Which of the following is most likely to be found in a braindead patient?
A. Corneal reflex B. Oculocephalic reflex C. Reactive pupils D. Spinal reflexes to pain E. Spontaneous respiration
D. Spinal reflexes to pain
13 y/o male immigrant from China dx with congestive cardiomyopathy
What is the deficiency?
A. Calcium B. Selenium C. Vitamin B1 D. Vitamin B3 E. Zinc
B. Selenium
Pt presents with complaint of vertigo, nausea, vomiting, and tinnitus in the setting of recent viral illness. Pt has mild hearing loss and positive Dix Hallpike. Dx?
A. BPPV B. Labyrinthitis C. Meniere’s disease D. Vascular insufficiency E. Vestibular neuritis
B. Labyrinthitis
If there were NO hearing loss, this would be vestibular neuritis. Meniere’s disease presents with triad of vertigo, tinnitis, and hearing loss - but is NOT associated with recent URI
Which of the following is a Duke’s major criteria for infective endocarditis?
a. Fever of 102.2 F
b. History of IV drug use
c. Evidence of endocardial involvement on TEE or other imaging
d. Long standing myalgias
e. Cavitary lesions on CXR
c. Evidence of endocardial involvement on TEE or other imaging
Major criteria = Positive blood culture (typically S.viridans, S.gallolyticus, HACEK, or S.aureus); Evidence of endocardial involvement
Minor criteria = predisposing condition (heart damage, hx IV drug use), fever, vascular phenomena, immunologic phenomena, microbiologic evidence (positive blood culture, but not of typical bug associated with endocarditis)
Characterized by flushing, erythema, and pruritis, usually affecting upper body, face, and neck. Pain and muscle spasms of back and chest, dyspnea, and hypotension may also occur; commonly due to vancomycin
A. DRESS syndrome B. Red man syndrome C. Stevens-Johnson syndrome D. Toxic epidermal necrolysis E. Toxic shock syndrome
B. Red man syndromeq
Which of the following is characterized by sudden death and is associated with one of several ECG patterns characterized by incomplete RBBB and ST-elevations in the anterior precordial leads?
a. Wolf Parkinson White
b. Brugada syndrome
c. Orthostatic hypotension
d. Postural tachycardia syndrome
e. Vasovagal events
b. Brugada syndrome
Pt presents with asymptomatic hypotonic hyponatremia. A TSH is normal, her urine does not have evidence of renal tubular acidosis, and her cortisol is normal. What is the next best step in management?
A. 3% normal saline B. CT scan chest C. Water restriction D. MRI brain E. Normal saline infusion
B. CT scan chest
She has SIADH — CT chest to look for small cell cancer. DDx for euvolemic hypotonic hyponatremia is RATS: Renal tubular acidosis, Addison’s disease, thyroid disease, and SIADH.
Antibodies found in systemic scleroderma/systemic sclerosis
A. Antihistone Abs B. Anticentromere Abs C. Anti-Jo1 Abs D. Anti-smith Abs E. Anti-topoisomerase Abs
E. Anti-topoisomerase Abs
