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Internal Medicine Shelf > Internal Medicine Shelf > Flashcards

Internal Medicine Shelf Flashcards

1
Q

How can you differentiate dementia 2/2 pseudodementia & Alzheimers?

A

Dexamethasone Supppression test (DST) may be used clinically to detect endogenous depression. In up to 50% of patients w depression, DST will be abnormal.

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2
Q

What is the pathophysiology of hypertension in a thyrotoxicosis pt?

A
  • Usually systolic HTN and increase in pulse pressure.
  • Hyperdynamic state of hyperthyroidism (increased expression of myocardial sarcoplasmic reticulum calcium-dependent adenosine triphosphatase, although a decrease in the expression of calcium-inhibiting protein and phospholamban may play a role.
  • Also increasing the expression of adrenergic receptors (increased target organ sensitivity to endogenous catecholamines).
  • High output heart failure may develop.

NB: HTN in hypothyroidism due to systemic vascular resistance increase.

Note: Decreased vasular compliance causes isolated systolic HTN with widened pulse pressure in elderly patients.

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3
Q

Contrast-induced nephropathy: pathogenesis, RF, clinical presentation, treatment?

A

Pathogenesis: renal vasoconstriction, tubular injury

  • RF: Hx DM, Chronic renal insufficiency (eg - high baseline Cr)
  • CC: spike in creatinine within 24 hours of contrast admin, followed by a return to normal renal function within 5 days.
  • Tx: adequate pre-CT IV hydration!!!!=prevention; IV isotonic bicarb or normal saline…continue for several hours afterward. Acetylcysteine may also preevnt nephropathy 2/2 vasodilatory and antioxidant properties.
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4
Q

Struvite Crystal shape

A

Coffin lids

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5
Q

HL pts treated with radiation &/or chemo esp before 30 years old risk for…

A
  • solid tumor: lung (esp if smoke), breast, thyroid, bone, GI
  • subsequent acute leukemia or non-HL
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6
Q

What is an aspergilloma?

A
  • Composed of fungal hyphae, inflammatory cells, fibrin, tissue debris that collect ina pre-existing lung cavity (TB, sarcoidosis, bronchial cysts, neoplasm).
  • Mobile intracavitary mass with an air crescent in periphery.
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7
Q

RF for formation of cholesterol gallstones

A

CA race, obesity or rapid weight loss, female sex hormones /OCP, glucose intolerance, hypomotility of gall bladder (pregnancy, advanced age, fasting, hypertriglyceridemia, prolonged total parenteral nutrition, malabsorption of bile acids 2/2 ileal disease or resection, pharmacotherapy with CLOFIBRATE, OCTRETODIE, CEFTRIAXONE.

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8
Q

RF for formation of pigment gallstones

A

chronic hemolysis (sickle cell anemia), chronic biliary tract infection, parasite infestation of biliary tract, advanced age.

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9
Q

Protective factors against the development of gallstones

A

low carb diet, physical activity, consumption of caffeinated coffee, aspirin or other nsaid use

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10
Q

Treatment of acute pyelonephritis?

A

Oral Cipro or IV ampicillin+gentamicin

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11
Q

Drugs that cause interstitial nephritis

A

cephalosporins, PCN, sulfonamides, sulfonamide containing diuretics, NSAIDs, rifampin, phenytoin, allopurinol.

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12
Q

What is required to diagnose subarachnoid hemorrhage?

A

LP
NB: hyponatremia 2/2 SIADH sometimes seen.; also subacute hydrocephalus.
-Rebleeding major cause of death within first 24 hours esp within 1st 6 hours…vasospasm days 3-10 - CT angiography preferred for detecting basospasm (treat with nimodipine).

Treatment endovascular coiling

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13
Q

What is the pathophysiology for nonalcoholic fatty liver disease?

A

Insulin R–>increased peripheral lipolysis, TG synthesis, hepatic uptake of FA.

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14
Q

How long does PNA have to be present for HAP?

A

> 48 hours after admission

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15
Q

What is the diagnosis for ARDS?

A
  • Acute onset.
  • CXR: B/L patchy infilrates.
  • PaO2/FiO218, JVD - cardiogenic pulmonary edema).
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16
Q

When do you decide to treat a patient of chronic hepatitis C?

A

All chronic hepatitis C patients with elevated ALT, detectable HCV RNA, and histologica evidence of chronic hepatitis of at least moderate grade are candidates for antiviral therapy with IFN & Ribavirin.

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17
Q

CT/MRI GBM (Glioblastoma Multiforme)

A

Butterfly apperance w central necrosis; heterogenous serpinginous contrast enhancement typical of high grade astrocytoma.

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18
Q

Treatment of AFib

A
  • BB or CCB in hemodynamically stable patients. Digoxin if + HF or can’t tolerate BB or CCB.
  • ER synchronized electrical conversion for hemodynamic instability or active ischemia….or 3-4 weeks of anticoag first….TEE to R/O LA appendagethrombusbefore attempted cardioversion.
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19
Q

If aldosterone secretion is normalish with exogenous steroids causing deficiency of ACTH since it is controlled more so by angiotensin II & potassium, where does the hyponatremia come from?

A

Hyponatremia in central adrenal insufficiency iis due to excessive ADH production from the posterior pituitary (cortisol suppresses the secretion of ADH*)–>water retention….

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20
Q

Cause of campylobacter as one of the most frequent causes of acute infectious diarrhea in the US?

A

Undercooked infectedpoultry

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21
Q

What puts a patient at an increased risk for the development of sporadic yersiniosis?

A

Eating undercooked pork

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22
Q

Anticholinergic symptoms

A

Mnemonic: “red as a beet, dry as a bone, hot as a hare, blind as a bat, mad as a hatter, and full as a flask”
-Flushing, anhidrosis/dry mouth, hyperthermia, mydriasis/vision changes, delirium/confusion, urinary retention/constipation.
-also h/a, dizziness, tachycardia.
eg- h/a + retroorbital pain attributable to precipitation of acute glauucoma by trihexyphenidyl’s anticholinergic effects.

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23
Q

Advantages of renal transplantation over dialysis

A
  1. Better survival, quality of life.
  2. Anemia bone dz HTNdoesn’t persist as much
  3. Transplantpatients have a return of normal endocrine, sexual, and reproductive f(x)s and ehanced E levels…
    • In diabetics, autonomic neuropathy persist or worsen after dialysis….it stabilizes or improves with transplantation.
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24
Q

Disadvantages of renal transplantation

A

Finding a donor, surgical risk and cost, side effects of immunosuppression….

*Transplantation from living related door least graft rejection & best graft survival>living non-related donor>cadaver graft.

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25
Q

How to treat cocaine with complications

A

Initially with IV BDZ to improve Sx of pyschomotor agitation, reduce myocardial oxygen demand, and alleviate CV Sx.

  • ASA, NG, CCB effective in initial management of cocaine-associated CP (coronary artery vasoconstriction).
  • BB CONTRAI - unopposed alpha adrenergic stim can worsen!!!
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26
Q

Treatment of aortic dissection

A

BB (slow HR so less work to shear & lowers HTN - most likely etiology). CCB only if need further anti-HTN but avoid vasodilators bc reflex tachycardia.

Type A (ascending) requires BB + surgery; Type B (descending) just BB.

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27
Q

Regulations of fibrinolytic therapy

A
  • improves neurologic outcomes in patients with ischemic strokes when given within 3 -4.5 hours of Sx onset.
  • Before administering tPA, a non-contrast head CT should be performed to r/o hemorrhagic stroke. screen for other contraindications to therapy!!
  • BP control critical - t confer same benefits for neurologic recovery.
  • urgent anticoag w hep not recommended even if cardioembolic bc increased risk for ICH but can use warfarin 2 weeks after an acute cardioembolic stroke to prevent recurrence.
28
Q

Causes of angioedema (rapid onset non-inflammatory edema of face/acral extremities/genitals, trachea, abdominal organs - colicky pain).

A

-Acquired isolated angioedema in ACEi use.
-Hereditary angioedema usually presents in late childhood. 2/2 C1 esterase inhibitor defect or deficiency–>edema-producing factors C2b and bradykinin.
*C1q levels normal in hereditary angioedema and depressed in acquired forms. C4 levels depressed in all forms of angioedema.
NB: in hereditary angioedema,episodes usually follow an infxn, dental procedure or trauma.

NB: Low C1q levels are also a/w familial SLE.

29
Q

What is the lupus anticoagulant?

A

It is an IgM or IgG imunoglobulin that prolongs the activated partial thromboplastin time (aPTT) by binding thephospholipids used in the assay. THus it is a laboratory artifact resulting in a prolonged aPTT. In fact, it is not an inticoagulant at all and is associated with an increased risk of thrombosis and psontaneous abortion.

30
Q

Migraine treatment

A
  • In adjuvant to NSAIDs or triptans, IV antiemetics can be helpful or can use them as monotherapy even! (chlorpromazine, prochlorperazine, metoclopramide).
  • PPx: amitriptyline, propranolol.
31
Q

What are the RF for bleeding while on warfarin?

A

-DM, >60 yo, HTN, alcoholism, supratherapeutic INR (for retroperitoneal hematoma, even therapeutic levels).

32
Q

Renal Cell Carcinoma

A
  • Triad: hematuria, abdominal mass, flank pain.

- Abd CT: lesion within kidney parenchyma that enhances w contrast adminstration.

33
Q

Retroperitoneal hematoma

A

Back pain & signs and symptoms of hemodynamic compromise should raise suspicion for retroperitoneal hematoma.
-Risky even at therapeutic range INR if pt on warfarin.

34
Q

What are the most common tumors to metastasize to bone?

A

Lung, breast, prostate, thyroid, kidney

NB: bone pain caused by mets typically constant and worse at night

35
Q

Most widely used criteria to clinically diagnose toxic megacolon (sometimes presenting sx of IBD):

A

Radiographic evidence (Abd XRay dilation >6 cm)of colonic distension + at least 3 of the following:

  • fever >38C, HR>120 bpm, Neutrophilic leukocytosis>10500/mL, anemia.

+ at least one of the following:

-Volume depletion, AMS, electrolyte disturbances, hypotension.

36
Q

***What are the dietary recommendations for patients with renal calculi?

A

1) Decreased dietary protein and oxalate - esp for calcium stones.
2) Decreased sodium intake - increased sodium intakeenhances calcium excretion, also calcium reabsorption follows sodium and water reabsorption. Patients whypercalciuria and recurrentstones should be placed on HCTZ to prevent recurrentstone formation. If a pt on adequate HCTZ develops recurrent calcium stones, hisurine sodium levels hould be checked to make sure that he is compliant with the sodium - restricted diet.
3) increased fluid intake.
4) increased dietary calcium!

37
Q

What is the most appropriate screening test for HIV infection?

A

Answer: HIV serology by ELISA. Large SN. This is then confirmed byWestern blot (high Specificity when combined w ELISA).

HIVviral load is an indicator of dz progression, associated with poor prognosis. Absolute CD4 count is also an indicator of dz progression. Determines opportunistic infections….if <200 cells/microL, start on antiretroviral therapy.

38
Q

What are common triggers for Meniere’s disease?

A

Alcohol, caffeine, nicotine, foods high in salt.

  • A strict, salt-restricted diet of 2-3 g of sodium per day is recommended as initial therapy….
  • Medical therapy with diuretics, antihistamines, anticholinergics.
39
Q

How does a patient with Meniere’s dz typically present?

A

Vertigo + ear fullness + tinnitus + hearing loss.

40
Q

What are the contraindications to radioactive therapy?

A

Pregnancy & very severe opthalmopathy

41
Q

What is the pathogenesis of iopanoic acid’s role in controlling severe symptoms of thyrotoxicosis?

A

Iodinated contrast agents such as iopanoic acid decrease the releaseof thyroid hormone from the thyroid gland and decrease the peripheral conversion of T4 to active hormone T3.

42
Q

How do you diagnose Lynch syndrome? (Hereditary Non-Polyposis Colorectal Cancer)

A

1) At least 3 relatives with colorectal cancer, one of whom must be a 1st degree relative of the other 2.
2. Involvementof 2+generations.
3) At least one case diagnosed before age 50.
4) FAP excluded.

Lynch syndrome I - hereditary site specific colon cancer. Lynch syndrome II cancer family syndrome - distinctly a/w high risk of extracolonic tumors, the most common of which is endometrial carcinoma.

43
Q

Treatment for HIV PPD+

A

Isoniazid (++pyridoxine for possible neuropathy) x 9 months.

  • Alternatives: pyrazinamide + rifampin or rifabutin x 2 mo. or just rifampin x4 months alone.
  • 3-4 drugs for active TB infxn.
44
Q

What drugs trigger Bullous Pemphigoid?

A

Furosemide, NSAIDs, captopril, penicillamine, various aBx.

45
Q

What are the precautions to know about Sildenafil? (PDE5i)?

A

1) Contraindicated in patients beingtreated with nitrates, and in those who are HSN to sildenafil.
2) Used with precaution in conditions predisposing to priapism.
3) Concurrent useof drugs which interfere with the metabolism of sildenafil (eg - erythromycin, cimetidine) may predispose to adverse rxns by prolonging its plasma half life.
4) while combining with an alpha blocker, it is important to give the drugs with at least a 4 hours interval to reduce the risk of hypotension.

46
Q

Should you reduce BP in acute ICH?

A

Rapid reduction of BP not recommended - giving nitroprusside to rapidly reduce the BP may lead to cerebral hypoperfusion and make matters worse.

**Goal systolic BP in such patients is 140-160.

47
Q

1) What drugs are associated with SJS?
2) What is pathognomonic for SJS?
3) What is the difference to erythema multiforme minor?

A

1) immune complex mediated HSN - sulfonamides, NSAIDs, phenytoin.
2) “target” appearance.
3) s/p Herpes simplex infection, mucosal involvement rare, systemic systems not as severe as SJS

48
Q

What is impetigo?

A

Occurs commonly in children, caused by coag+ staph aureus. Red macules & papular lesions w honey colored crusts.

49
Q

What is the first line treatment for duodenal PUD?

A

Eradicate H Pylori: amoxicillin + clarithromycin + PPI.

50
Q

Possible PPx for cluster h/a?

A
  • Verapamil.
  • Other options: prednisone, ergotamine, methysergide, cyproheptadine, indomethacin.
  • Llithium forPPx of chronic form of cluster headaches.
51
Q

What lab findings are there in almost every chronic inflammatory disease?

A

Anemia and reactive thrombocytosis.

52
Q

Aspergilloma

A

-Fungal infxn, coarse fragmented septae; hyphae.
*CXR: crescent readioucency nextto rounded mass…cavitary lesion may form bc of destruction of the underlying pulmonary parenchyma, and debris and hyphae may coalesce and form a fungus ball, which lies free in the cavity and moves around with position change.
-PPx resection iscontroversialalthough some recommend resection if isolated dz is present ingood risk patients.
HINT: a mobile cavitary mass with intermittent hemoptysis.

53
Q

Lung abscess

A

CXR air fluid level

-Tx: aBx, postural drainage bronchoscopy

54
Q

Histoplasmosis

A

Calcified nodes in lung, mediastinum, spleen, liver.

  • CXR: central or target calcification.
  • not typically cavitary lesions.
55
Q

Causes of non-traumatic avascular (aseptic) necrosis? CC avascular necrosis? Dx?

A

=Causes: chronic corticosteroid therapy, alcoholism, hemoglobinopathies.

  • CC: progressive hip pain without restriction of motion range and normal radiograph on early stages.
  • MRI & scintography to confirm Dx.
56
Q

moa Colchicine?

A

Inhibits PMN activity

57
Q

Treatment of ALS?

A

Riluzole -

58
Q

Pelvic inflammatory dz

A

Tx - azithromycin (chlamydia) & ceftriaxone (gonorhea)….gram stain inadequate to ID chlamydia.

  • sexual partners from past 60 days….
  • Screened for HIV, syphilis, hpep B, cervical cancer (pap smear) and hep C if Hx IVDU.
59
Q

Diagnosis of Cushing’s Syndrome

A
  • 24-hour urinary cortisol excretion
  • Late evening salivary cortisol
  • Low dose dexamethasone suppression test.
60
Q

Criteria for initiating LT Oxygen therapy in COPD patients?

A

1) All COPD patients with PaO255% should be startedon home oxygen therapy even when PaO2 is 56-59 mmHg with SaO2>89%
3) Home oxygen may also be used in patients who has resting awake PaO2>60 mmHg with SaO2>90% if they become hypoxic during exercise or sleep (nocturnal hypoxia).

-Doseof oxygen should be titrated such that SaO2 is maintained at >90% during sleep, normal waking, and at rest.
-Survival benefits of home oxygen are significant when it is used for minimum of 15 hours/day.
^Patients with signs of pulmonary hypertension or Hct>55% should be started on home oxygen when the PaO2<60 mmHg.

61
Q

Treatment of neuroleptic malignant syndrome (which Sx begin within 2 weeks of initiation of precipitating agent)

A 
#1 - Dantrolene (m relaxant)
#2 - Bromocriptine (DA agonist)
#3 - Amantadine (antiviral drug w dopaminergic properties)
62
Q

What do you use to Dx acute choleccholecystitis (acalculous)?

A

Cn use U/S but CT and HIDA more SN & sp.

63
Q

In what scenarios does acute acalculous cholecystitis occur?

A

Extensive burns, severe trauma
prolonged TPN, prolonged fasting
mechanical ventilation

64
Q

Medical therapy for hepatorenal syndrome?

A

Midodrine (alpha agonist - for severe hypotension thatcauses dizziness), octreotide.

65
Q

Screening/treatment of AAA?

A

Screen male active or forer smokers aged 65-75 with 1 time abdominal U/S to evaluate for an AAA. Surgical repair of large AAAs (5.5 cm + ).

Internal Medicine Shelf (1 decks)

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