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Boards Step/Level 2 > Internal Medicine Rapid Review > Flashcards

Internal Medicine Rapid Review Flashcards

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1
Q

Right ventricular infarcts present with hypotension, tachycardia, clear lungs, JVD, and NO pulsus paradoxus. Don’t give nitro. How do you treat?

A

Vigorous fluid resuscitation

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2
Q

How often do you follow cardiac enzymes for suspected NSTEMI?

A

q8hrs x 3

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3
Q

In MI, _____ rises first, peaks in 2 hrs, and is normal by 24 hrs

______ rises within 4-8 hrs, peaks in 24 hrs, and is nl by 72 hrs

_______ rises within 3-5 hrs, peaks at 24-28 hrs, and is normal 7-10 days later

A

Myoglobin

CKMB

Troponin I

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4
Q

Discharge meds if cardiac stent is placed

A

ASA + clopidogrel for 9-12 mos

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5
Q

If pt presents with chest pain but there is no ST elevation and normal cardiac enzymes x3, what is the dx?

A

Unstable angina

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6
Q

Pt presents 5-10 wks after MI with pleuritic chest pain and low grade temp. You dx dresslers syndrome/autoimmune pericarditis. How do you tx?

A

NSAIDs and ASA

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7
Q

Systolic ejection murmur cresc/decresc, louder w/squatting, softer with valsalva, +parvus et tardus

A

Aortic stenosis

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8
Q

Systolic ejection murmur louder with valsalva, softer with squatting or handgrip

A

HOCM

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9
Q

Late systolic murmur with click louder with valsalva and handgrip, softer w/squatting

A

Mitral valve prolapse

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10
Q

Holosystolic murmur radiates to axilla w/LAE

A

Mitral regurg

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11
Q

Holosystolic murmur with late diastolic rumble in kids

A

VSD

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12
Q

Continuous machine like murmur

A

PDA

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13
Q

Wide fixed split S2

A

ASD

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14
Q

Rumbling diastolic murmur with opening snap, LAE, and afib

A

Mitral stenosis

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15
Q

Blowing diastolic murmur with widened pulse pressure and eponym parade

A

Aortic regurg

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16
Q

Causes of systolic heart failure

A 
Viral
EtOH
Cocaine
Chagas
Idiopathic

Alcoholic dilated cardiomyopathy is reversible if you stop drinking

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17
Q

Diastolic heart failure etiologies

A

HTN
Amyloidosis
Hemachromatosis

Hemachromatosis restrictive cardiomyopathy is reversible with phlebotomy

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18
Q

Treatment for heart failure that prevents remodeling by aldosterone

A

ACE-I

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19
Q

Treatment for heart failure that improves survival by preventing remodeling by epi/norepi

A

Beta blockers (metoprolol and carvedilol)

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20
Q

Tx for heart failure that improves survival in NYHA class III and IV

A

Spironolactone

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21
Q

What do you do if you see pleural fluid >1cm on lateral decubitus xray

A

Thoracentesis

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22
Q

Dx if transudative pleural effusion with low pleural glucose

A

Rheumatoid arthitis

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23
Q

Dx if transudative pleural effusion with high lymphocytes

A

TB

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24
Q

Dx if transudative pleural effusion that is bloody

A

Malignant or PE

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25
Q

If pleural effusion has positive gram stain or culture, pH <7.2, or glucose <60, what do you do?

A

Insert chest tube for drainage

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26
Q

Light’s criteria indicates transudative pleural effusion if:

LDH < ______
LDH effusion:serum < _______
Protein effusion:serum < ______

A

200

  1. 6
  2. 5
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27
Q

Treatment for ARDS

A

Mechanical ventilation with PEEP

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28
Q

ARDS is diagnosed if PaO2/FiO2 ______ (<300 means acute lung injury), bilateral alveolar infiltrates on CXR, and PCWP is ______ (means pulmonary edema is noncardiogenic)

A

<200; <18

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29
Q

Indications to start O2 in COPD

A

PaO2 <55 or SpO2 <88%

If cor pulmonale, <59

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30
Q

Treatment for COPD exacerbation

A

O2 to 90%
Albuterol/ipratropium nebs
PO or IV corticosteroids
Fluoroquinolone or macrolide abx

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31
Q

Best prognostic indicator for COPD

A

FEV1

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32
Q

2 things shown to improve mortality in COPD

A

Quitting smoking

Continous O2 therapy >18 hrs/day

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33
Q

2 important vaccines for COPD ptss

A

Pneumococcal w/ 5 year booster

Annual flu

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34
Q

COPD pt presents w/6 wks of clubbing fingers and you diagnose hypertrophic osteoarthropathy. What is the next best step?

A

CXR

[most likely cause is underlying lung malignancy]

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35
Q

How do you treat asthma if pt has sxs twice a week and PFTs are normal?

A

Albuterol only

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36
Q

How do you treat asthma if pt has sxs 4x a week, night cough 2x a month, and PFTs are normal?

A

Albuterol + inhaled CS

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37
Q

How do you treat asthma if pt has sxs daily, night cough 2x a week and FEV1 is 60-80%?

A

Albuterol + ICS + LABA (salmeterol)

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38
Q

How do you treat asthma if pt has sxs daily, night cough 4x a week and FEV1 is <60%?

A 
Albuterol
ICS
LABA (salmeterol)
Montelukast
Oral steroids
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39
Q

Restrictive lung disease with 1 cm nodules in upper lobes w/eggshell calcifications

A

Silicosis

Get yearly TB test and give INH for 9 mos if >10mm

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40
Q

Restrictive lung disease with reticulonodular process in lower lobes w/pleural plaques

A

Asbestosis

[most common ca is bronchogenic carcinoma but increased risk for mesothelioma]

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41
Q

Restrictive lung disease with patchy lower lobe infiltrates, thermophilic actinomyces

A

Hypersensitivity pneumonitis (farmers lung)

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42
Q

Adenocarcinoma of the lung exhibits exudative effusion with elevated ____

A

Hyaluronidase

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43
Q

Pt presents with weight loss, hemoptysis, kidney stones, constipation, malaise, low PTH, and central lung mass. Dx?

A

Squamous cell carcinoma

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44
Q

Pt with lung mass, shoulder pain, ptosis, constricted pupil, and facial edema dx?

A

Superior sulcus syndrome from small cell carcinoma

45
Q

Old smoker presenting w/ Na of 125 with moist mucous membranes and no JVD

A

SIADH from small cell carcinoma

46
Q

CXR showing peripheral cavitation and distant mets?

A

Large cell carcinoma

47
Q

IBD involving terminal ileum and associated with iron deficiency

A

Crohns

48
Q

IBD continuous involving rectum

A

Ulcerative colitis

49
Q

IBD at increased risk for PSC

A

Ulcerative colitis; increased risk of cholangiocarcinoma

50
Q

IBD most likely to fistulize, how to tx

A

Crohns; give metronidazole

51
Q

IBD with granulomas and transmural inflammation on bx

A

Crohn’s

52
Q

Smokers have lower risk of what IBD?

A

Ulcerative colitis

53
Q

Which IBD has higher risk for colon ca?

A

Ulcerative colitis

54
Q

Which IBD is associated with p-ANCA?

A

Ulcerative colitis

55
Q

AST and ALT in the 1000s after surgery or hemorrhage

A

Ischemic hepatitis (shock liver)

56
Q

Elevated direct bili

A

Obstructive (stone/cancer), Dubin johnson, rotor

57
Q

Elevated indirect bili

A

Hemolysis, gilberts, crigler najjar

58
Q

Elevated alk phos and GGT

A

Bile duct obstruction

If pt has IBD, think PSC

59
Q

Elevated alk phos, normal GGT, normal calcium

A

Paget’s disease (increased hat size, hearing loss, HA) — tx with bisphosphonates

60
Q

Primary biliary cirrhosis is associated with ____ abs and is treated with _____

A

Antimitochondrial; bile resins

61
Q

Elevated LFTs, ANA positive, anti-smooth muscle ab positive

A

Autoimmune hepatitis - tx with steroids

62
Q

3 most common bugs causing meningitis

A

S.pneumo
H.flu
N.meningitidis

63
Q

Tx for meningitis

A

Ceftriaxone and vanc

64
Q

Lysteria can cause meningitis in old and young — how to tx?

A

Ampicillin

65
Q

Staph can cause meningitis in pts with brain surg, how to tx?

A

Vanc

66
Q

Tx of TB meningitis

A

RIPE + steroids

67
Q

Tx of Lyme meningitis

A

Ceftriaxone IV

68
Q

MCC of PNA in healthy young ppl; assoc with cold agglutinins

A

Mycoplasma

Tx with macrolide, FQ, or doxy

69
Q

Pseudomonas, klebsiella, e.coli, MRSA are causes of hospital acquired PNA — how to tx?

A

Pip/tazo or imipenem + vanc

70
Q

Cause of PNA in old smokers with COPD

A

H.flu — tx with 2nd-3rd gen cephalosporin

71
Q

Cause and tx of PNA in alcoholics with currant jelly sputum

A

Klebsiella; tx w/ 3rd gen cephalosporin

72
Q

Cause and tx of PNA in old men w/HA, confusion, diarrhea, and abd pain

A

Legionella; dx with urine Ag

Tx with macrolide, FQ, or doxy

73
Q

Tx for PNA in someone who just had the flu

A

Vanc (for MRSA)

74
Q

Pt with PNA that just delivered a baby cow and is now having vomiting and diarrhea

A

Q-fever — coxiella burnetti

Tx with doxy

75
Q

Pt with PNA w/ rabbit exposure

A

Francisella tularensis

Tx with streptomycin, gentamycin

76
Q

TB screening guidelines in following groups:

Regular ppl

Prison, healthcare, nursing home, DM, etoh, chronically ill

AIDS, immunosuppressed

A

> 15 mm

> 10 mm

> 5 mm

77
Q

Workup for positive PPD

A

CXR

If CXR positive, do acid fast stain of sputum

Tx with RIPE for 6 mo (12 for meningitis and 9 if preggo)

78
Q

RIPE drug that causes orange body fluids and induces CYP450

A

Rifampin

79
Q

RIPE drug that causes peripheral neuropathy, sideroblastic anemia, and hepatitis

A

INH

80
Q

RIPE drug that causes benign hyperuricemia

A

Pyrazinamide

81
Q

RIPE drug that causes optic neuritis and color vision abn

A

Ethambutol

82
Q

Number one cause of death in endocarditis

A

CHF

Other complication is septic emboli to lungs/brain

83
Q

Tx for strep viridans endocarditis

A

PCN x4-6 wks

84
Q

Tx for staph endocarditis

A

Nafcillin + gent or vanc

85
Q

Pt with endocarditis and strep bovis bacteremia — next step?

A

Colonoscopy

86
Q

Young pt with new/bilateral bells palsy. What do you suspect

A

HIV

87
Q

Post exposure ppx for HIV

A

AZT
Lamivudine
Nelfinavir

X4weeks

88
Q

When do you start HAART for HIV?

A

When CD4 <350 or viral load >55,000

89
Q

HIV tx that causes GI sxs, leukopenia, macrocytic anemia

A

Zidovudine

90
Q

HIV tx that causes pancreatitis and peripheral neuropathy

A

Didanosine

91
Q

HIV tx that causes HS rash, fever, n/v, myalgia, SOB in first 6wks

A

Abacavir

92
Q

HIV tx that causes nephrolithiasis and hyperbilirubinemia

A

Indinavir

93
Q

HIV tx that causes somnolence, confusion, psychosis

A

Efavirenz

94
Q

HIV pt with PCP PNA. Best test after CXR?

A

Bronchoscopy wtih BAL

95
Q

1st line tx for PCP PNA in HIV pt

A

TMP SMX

2nd line is TMP-dapsone or primaquine-clinda or pentamidine

96
Q

HIV pt with PCP PNA being tx with abx. When do you add steroids?

A

When PaO2 <70, A-a gradient >35

97
Q

Ppx for PCP PNA when HIV pt has CD4<200

A 
1st = TMP-SMX
2nd = atovaquone
3rd = dapsone
4th = aerosolized pentamidine (causes pancreatitis!)
98
Q

HIV pt with MAC having diarrhea, wasting, fevers, night sweats. Tx?

A

Clarithromycin and ethambutol +/- rifampin

Prophylax with azithromycin when CD4<50

99
Q

HIV pt with multiple ring enhancing lesions is dx with toxo. Tx?

A

Empiric pyramethamine sulfadiazine (+folic acid) for 6 wks

100
Q

HIV pt with one ring enhancing lesion

A

CNS lymphoma (assoc with EBV) tx with HAART

101
Q

HIV pt with seizures w/deja vu aura and 500 rbcs in CSF

A

HSV encephalitis (temporal lobe) give acyclovir

102
Q

HIV with s/s meningitis and +india ink

A

Crypto — tx with ampho IV x2 weeks then fluconazole maintenance

103
Q

HIV pt with hemisensory loss, visual impairment, babinski+, what do you do?

A

Brain bx

Think PML - JC polyomavirus demyelinates grey-white jxn

104
Q

Workup for neutropenic fever

A
  1. Get blood culture
  2. Start 3rd or 4th gen cephalosporin (ceftazidime or cefepime)

Add vanc if line infx suspected or septic shock develops
Add ampho B if no improvement and no source found in 5 days

105
Q

Target rash, fever, VII palsy, meningtis, AV block

A

Lyme disease

Tx with doxy (amox for <8); heart or CNS dz needs IV ceftriaxone

106
Q

Rash at wrists and ankles (palms and soles) fever, and HA

A

Rickettsia

Tx with doxy

107
Q

Tick bite, no rash, myalgias, fever, HA, decreased plts and WBC, increased ALT

A

Erlichiosis

Dx with morulae intracell inclusion

Tx with doxy

108
Q

Immunosuppressed, cavitary lung lesion, purulent sputum, wt loss, fever, gram positive aerobic branching partially acid fast

A

Nocardia

Tx with TMP SMX

109
Q

Neck or face infxn w/ draining yellow material with sulfur granules gram positive anaerobic branching

A

Actinomyces

Tx with high dose PCN for 6-12 wks

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