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M3 Clerkships > Internal medicine uworld > Flashcards

Internal medicine uworld Flashcards

1
Q

Charcot triad for Acute cholangitis

A
  1. Jaundice
  2. Fever
  3. RUQ pain
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2
Q

Diagnosis and treatment of Acute cholangitis

A

Diagnosis:

  • Biliary dilation on U/S or CT scan
  • High Alk phos, gamma-glutamyl transpeptidase, direct bilirubin
  • Leukocytosis, High CRP

Treatment: Biliary drainage: ERCP with sphincterotomy or percutaneous transhepatic cholangiography
- Broad spectrum antibiotics: Beta-lactam/lactamase inhibitor, 3rd generation cephalosporin + metronidazole

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3
Q

Oropharyngeal dysphagia vs. esophageal dysphagia

A

Oropharyngeal presents as difficulty with initiating swallowing assocaited with cough, choking or nasal regurgitation

Esophageal dysphagia can initiate swallowing but have difficulty passing food down the esophagus.

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4
Q

Dysphagia of both solids and liquids at onseit favor which type of disorder vs. Initial dysphagia to solids and now liquids

A

Motility disorder vs. mechanical obstruction (tumor – progressive, rings)

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5
Q

what kind of test can you evaluate motility disorders of esophagus?

A

Barium swallow

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6
Q

Distinguish Cholecystitis vs. Cholendoclithiasis

A

Cystic duct obstruction = RUQ/ epigastric colicy pain 2/2 fatty meal that radiates to scapula.

Common bile duct can cause obstructive jaudice

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7
Q

75 yo male presents to ED with BP: 70/40. He is treated for pneumonia with IVG, abx, vasopressors, and mechanical ventilation. The next day on lab : Ast and ALT are in 2,000s, AlkP 162, Bili is 1.2. What accounts for this abnormal liver function?

A

Ischemic hepatic injury ( aka liver shock due to hypotension). Liver enzymes usually return to normal within 1-2 wks

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8
Q

What is D-xylose test used to diagnose? how dose it work?

A

Celiac disease
- pt with celiac cannot absorb the D-xylose in the intestine, and urinary and venous D-xylose levels will be low (blunting of villi).

_ patients with malabsorption due to enzyme deficiencies (chronic pancreatitis) will have normal absorption of the D-xylose.

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9
Q

32 yoM in ED with CP and diaphoresis of 4hr duration. N/V after party prior to CP. Alcohol abuse, alcohol hepatitis, Cocaine. CXR: widened mediastinum and moderate left-sided pleural effusion. Pleural fluid is yellow, high amylase. Diagnosis?

A

Boerhaave Syndrome – transmural esophageal tear. Leakage of fluid to pleura. Very high amylase (>2500IU/L due to saliva).

CT or contrast esophagography with Gastrografin confirms diagnosis.

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10
Q

Status epilepticus can cause what type of necrosis in brain?

A

cortical necrosis

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11
Q

Parkinson disease

-symptoms:

A 
Mask-like facies
Bradykinesia
Hypokinetic mobility
cog-wheeling
resting tremor
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12
Q

Pure motor hemiparesis

  • location?
  • clinical features?
A
  • Posterior limb of the internal capsule
  • contralateral weakness (face, arm leg)
  • No sensory deficit
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13
Q

Ataxic hemiparesis

  • location?
  • Clinical features?
A
  • Posterior limb of internal capsule
  • contralateral weakness and limb ataxia (leg>arm)
  • No sensory deficits.
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14
Q

Pure sensory stroke

  • location?
  • Clinical features?
A

Posterior thalamus

  • contralatereal hemisensory loss (face, arm, leg)
  • no motor deficits
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15
Q

Dysarthria-clumsy hand syndrome
location
clinical symptoms

A
  • Basis pontis
  • facial weakness and dysarthria
  • contralateral hand weakness and clumsiness
  • No sensory deficits
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16
Q

Shy-Drager syndrome:

A
  1. Parkinsonism
  2. Autonomic dysfunction – postural hypotension, abnormal sweating, disturbance of bowel or bladder control, abnomral salivation / lacrimation, impotence, Gastroparesis
  3. Widespread neurological signs (cerebellar, pyramidal or lower motor neuron)

Parkinson symptoms + orthostatic hypotensions, impotence, incontinence, autonomic symps.
* multisystem atrophy

tx: intravascular volume expansion with fludrocortisone, salt supplementation, alpha-adrenergic agonists, and application of constructive garments to the lower body.

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17
Q

What is a myasthenic crisis and how to do you treat it?

A

respiratory failure with hx of MG

Tx: plasmaphoresis (therapeutic plasma exchange) + corticosteroids

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18
Q

drug-eluting stent anticoagulation

A

Dual antiplatelet therapy: asparin and P2y12 receptor blocker for at least 12 months

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19
Q

Chalazion

A

meiobmian gland becomes obstructed. Recurrent may be due to meibomian gland carcinoma.

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20
Q

Valsava

A

increase VR

increase HCM and MVP, all others get softer

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21
Q

Standing

A

Decrease VR,

HCM, MVP louder

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22
Q

Squating

A

Increase VR, increase Afterload, Increase regurgitant fraction

  • increase AR, MR, VSD
  • decreases HCM, MVP
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23
Q

Hand grip

A

Increase afterload
Increase BP
Increase Regurgitant fraction

  • increase AR, MR, VSD
  • decrease HCM, AS
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24
Q

Polycythemia vera tx

A

Phlebotomy

Hydroxyurea (if high risk of thrombus)

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25
Q

Malignant otitis externa

A

discharge and severe ear pain

  • radiates to temporomandibular joint
  • granulation tissue
  • caused by pseudomonas aeruginosa
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26
Q

Person on ventilation and signs of ARDS. What vent change do you do?

A

Increase Peep so that it can re-open the alveoli that have collapsed due to ARDS

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27
Q

Amaurosis Fugax

A

retinal emboli

“a curtain falling down”

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28
Q

Microbiology of Infectious endocarditis: (6)

A
  1. Staph aureus – prosthetic valves, IV catheters, implanted device, IV drug users
  2. Viridans group/ Streptococci – dental procedures, procedures involving incision and biopsy of respiratory tract
  3. Strep epidermis: prostetic valves, pacemakers/ defibrillators
  4. Enterococci: nosocomial UTI
  5. Strep bovis: colon carcinoma, IBD
  6. Fungi: chronic indwelling catheters, prolonged antibiotic therapy
29
Q

Cyanide toxicity from house fire. Treatment?

A

hydroxocobalamin or sodium thiosulfate OR nitrates to induce methemoglobinemia

30
Q

Polymyalgia rheumatica

A 
age >50, 
bilateral pain and morningin stiffness
Involvement of 2 of the following:  
Neck or torso, 
shoulders or proximal arms, 
thigh or hip, 
constiutionaly( fever, malase, weightloss)

ESR >40
Elevated CRP

Tx: glucocorticoids

31
Q

which type of nephrotic syndrome is associated with Hep B, C and lipodystrophy?

A

Membranoproliferative glomerulonephritis

32
Q

Pharmacological treatment for cancer-related anorexia/cachexia syndrome?

A

Progesterone analogues (megestrol acetate)
or
Corticosteroids

both increase appetite

33
Q

Management for symptomatic hypertrophic cardiomyopathy

A

Beta blockers as monotherapy

34
Q

If suspicious of follicular thyroid carcinoma, what is necessary to make the diagnosis of follicular thyroid carcinoma after FNA biopsy?

A

Invasion of tumor capsule and blood vessels.

- early hematogenous spread to lung, brain and bone

35
Q

Classical presentaiton of lewis body dementia:

A
  • AMS
  • Disorganized speech
  • Visual hallucinations **
  • Extrapyramidal symptoms
  • alpha-synuclein protein

Rx: acetylchoinesterase inhibitors (rivastigmine) or atypical antipsychotics for refractory hallucinations

36
Q

CML

  • clinical
  • diagnosis
  • complications
A
  • lymphadenopathy (cervical, supraclavicular, axillary)
  • Hepatosplenomegaly
  • Anemia and thrombocytopenia
  • Severe lymphocytosis and smudge cells
  • flow cytometry
  • infections, Autoimmune hemolytic anemia and secondary malignancies
37
Q

statistical test to compare two means?

A

two-sample T test

38
Q

Statistical test to comparetwo means of population variances?

A

two-sample Z test

39
Q

statistics test to compare three or more means?

A

ANOVA

40
Q

Statistical test to compare categorical data/proportions?

A

Chi-square test

41
Q

Meniere disease tx:

A
  • benzodiazepines, antihistamines, and antiemetics can relieve acute symptoms. Diuretics can be considered for long-term management.
42
Q

what is another name for wilson disease?

A

hepatolenticular degeneration

43
Q

treatment of toxic megacolon:

A
  1. IV fluids
  2. Broad-spectrum antibiotics,
  3. bowel rest
  4. IV corticosteroids are preferred for IBD induced TM
  5. NG decompression
44
Q

manifestation of cyanide toxicity

A
  1. cherry-red facial flushing, cyanosis later
  2. CNS: HA, AMS, seizures, coma
  3. Arrhythmias
  4. tachypnea followed by respiratory depression, pulm edema.
  5. GI: abdominal pain, nausea, vomiting
  6. Renal: metabolic acidosis (form lactic acidosis), renal failure
45
Q

medications that cause hyperkalemia

A
  • non selective BB
  • ACEi, aldosterone inhib such as K+ sparing diuretics, ARBs
  • TMX-SMP (blocks epitherlial sodium channel in collecting tubule)
  • Digitalis
  • Cyclosporine (blocks aldosterone activity)
  • Heparin : blocks aldosterone production
  • NSAIDs: decrease renal perfusion resulting in decreased K+ delivery to the collecting ducts
  • Succinylcholine: causes extracellular leakage of potassium through acetylcholine receptors.
46
Q

Signs of caustic poisoning

A
  1. no CNS alterations
  2. dysphagia, heavy salivation and mouth burns
  3. severe pain

White tongue, drooling, necrosis of the GI tract. Watch out for peritonitis or mediastinitis

47
Q

Carcinoid syndrome

A

skin: flushing, telangiectasias, cyanosis

GI: diarrhea, cramping

Cardiac: valvular lesions (right>Left)

Pulm: bronchospasm

Miscellaneous: Niacin deficiency (DDD)

48
Q

Treatment of joint point associated with Osteoarthritis:

A

1 . exercise, weight loss

2. NSAIDS: Diclofenac are the drug of choice for relief of pai in OA but do not alter the progression of the disease.

49
Q

Pronator drift in physical exam

A

Upper motor neuron or pyramidal/corticospinal tract disease

upper motor neuron = more weakness in supinator muscles – arm drifts downared and the palm turns toward the floor (pronates)

50
Q

ARDS causes what type of alveolar damage:

A
  1. cytokines released – alveolar collapse due to loss of surfactant, and diffuse alveolar damage. Gas exchange is impaired
  2. Lung compliance is decreased due to loss of surfactant and increased elastic recoil
  3. Pulm arterial pressure is increased (pulm HTN) due to hypoxic vasoconstriction, destruction of lung parenchyma, and compression of vascular structures from positive airway pressure in mechanically ventilated patients.
51
Q

SLE

A

RASH and PAIN – female of reproductive age, AA descent

Rash: malar
Arthritis
Soft tissues/serositis
Hematological disorders (cytopenia)
Photosensitivity/ +- VDRL/RPR
Antinuclear antibodies
Immunosuppressants
Neurologic disorders (seizures, psychosis)
52
Q

leydig cell tumor

A
  • most common testicular sex cord stromal tumor
  • all age groups (including children)
  • testosterone
  • Estrogen
  • gynecomastica in men; precocious puberty in boys
53
Q

Seminoma

A 
malignant
Painless
Homogenous testicular enlargment
most common in 3rd decade, never infancy
beta-HCG may be elevated
54
Q

Glucagonoma

A

rare pancreatic neuroendocrine tumor.
Erythematous papules/plaeus that coalesce to form a large, painful, and inflammatory blister/cursting with central clearing. – usually onperineum, extremities, and face.

55
Q

Extrahepatic manifestations of chronic hep C

A
  • Heme: essential mixed cryoglobulinemia – low serum complement levels due to circulating immune complexes that deposit into small/medium vessels. Develop palpable purpura, arthralgias and renal complications
  • Renal: membranoproliferative glomerulonephritis
  • Skin: porphyria cutanea tarda, lichen planus
56
Q

Tabes dorsalis – clinical findings?

A

Neurodegeneration of posterior spinal columns and nerve roots

  • sensory ataxia
  • Lancinating pains
  • Neurological urinary incontinence
  • Argyll Robertson pupils (miotic and constriction with accomodation but not with light).

Tx: IV penicillin 10-14 days

57
Q

Juvenile angiofibroma:

A

Nasal obstruction
Visibile nasal mass
Frequent nose bleeds
bony erosion on the back of nose

Dangerous for surgery: bleed readily.

58
Q

Infectious Endocarditis – Duke’s criteria

A

Major:

  • blood culture of usual microorganisms
  • Echocardioram showing valvular vegetation

Minor:

  • predisposing cardiac lesion
  • Fever > 38C
  • IV drug use
  • Embolic phenoma
  • Immunologic phenomena (glomerulonephritis)
  • Positive blood culture not meeting above criteria

Definitive IE:
2 major + 1 minor or 3 minor

Possible IE:
1 major + 1 minor or 3 minor

59
Q

Clinical signs of endocarditis

A 
Fever
Heart murmur (new)
Petechiae
Subungual splinter hemorrhages
Olser nodes, Janeway lesions
Neurologic phenomena (embolic)
Splenomegaly
Roth spots (retinal hemorrhages)
60
Q

Milk-Alkali syndrome

A

patients (usually women with osteoporosis) take excessive amounts of calcium and absorbable alkali. ex calcium bicarbonate

  • results in hypercalcemia, metabolic alkalosis, and acute kidney injury.
  • nausea, vomiting, constipation, polyuria, polydipsia, neuropsychiatric symptoms.
61
Q

Spread of rubella rash:

A

Cephalocaudal spread of blanching, erythematous maculopapular rash
(head to toe).

62
Q

Drug of choice for hairy cell leukemia:

A

cladribine

63
Q

Attributable Risk percentage

A

excess risk in a population that can be explained by exposure to a RF.

ARP: (risk exposed- risk unexposed)/risk exposed

or
ARP: (RR-1)/RR

64
Q

Relative Risk

RR=1
RR1

A

Risk of an outcome in the exposed group

R=1 (null value) then there is no assocaition between the exposure and outocme

R1 exposure is associated with increased risk of disease.

65
Q

First line therapy of reactive arthritis:

A

NSAIDS

*recall these are seronegative spondyloarthropaty

66
Q

Clinical findings of acute bronchitis

Diagnosis:
Tx:

A
  • cough >5 days to 3 weeks
  • cough can be productive ( yellow, green, or purulent)
  • Absent systemic findings (fever, chills)
  • wheezing or rhonchi, chest wall tenderness

-CXR only if suspected pneumonia

-Tx: NSAIDs/ acetaminophen or bronchodilators
ANTIBIOTICS ARE NOT RECOMMENDED

67
Q

Recommended treatment for ALS

A

Riluzole: glutamate inhibitor – slows progression and time needed to do tracheostomy

68
Q

Treatment for botulism

A

Equine serum heptavalent botulinum antitoxin

69
Q

treatment of acute pyelonephritis in adults

mild-moderate vs severe

A

mild to moderate:
- TMP-SMX, Fluoroquinolones orally

Severe:
- ceftriaxone, fluoroquinolones, TMP-SMX IV

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