InternalMed EOR Flashcards
1
Q
Angina pectoris usually last how long?
A
<30minutes
Typically 1-5minutes
2
Q
Pharmacological agents used in stress test are?
A
Adenosine and dipyridamole (vasodilator healthy but not diseased vessels)
3
Q
What is the pharmacological agent used in stress echocardiogram and cardiac MRI?
A
Dobutamine (positive ionitrope and chronotrope)
4
Q
Contraindications for nitrate use are:
A
<90mmHg SBP, RV infarction, PDE-5 inhibitors
5
Q
1st line medication for chronic angina management
A
Beta blocker
6
Q
Treatment of choice for prinzmetals angina
A
Nondihydropyridine CCBs
7
Q
This medication irreversible inhibits a COX enzyme to decrease thromboxane A2
A
Aspirin
8
Q
1st line therapy for unstable Bradycardia
A
Atropine
9
Q
Treatment of unstable tachycardia
A
Synchronized cardioversion
10
Q
Tx for stable wide QRS tachycardia
A
Amiodarone
11
Q
Tx for stable normal QRS tachycardia
A
Vagal maneuvers and adenosine
12
Q
Left axis deviation
A
Positive lead I and negative aVF
13
Q
Right axis deviation
A
Negative lead I and positive lead aVF
14
Q
Left atrial enlargement
A
M shaped p wave in lead II and p wave in V1 more negative
15
Q
Right atrial enlargement
A
Tall p wave in lead II and p wave in V1 more positive
16
Q
LBBB
A
1 wide QRS
2 slurred R in V5&V6
3 deep S in V1
17
Q
RBBB
A
1 wide QRS
2 bunny ears in V1&V2
3 wide S in V6
18
Q
RV Hypertrophy
A
R>S in V1
19
Q
LV Hypertrophy
A
S in V1 + R in V5 are >35mm in men or 30mm in women
20
Q
ST elevations in leads V1-V4 indicate
A
Anterior infarction-LAD blockage
21
Q
ST elevations in leads V1-V2 indicate
A
Septal infarction-proximal LAD
22
Q
ST elevations in leads V5-V4, I, aVL indicate
A
Lateral wall infarction-CFX blockage
23
Q
ST elevations in leads V4-6, I, aVL indicate
A
Anterolateral infarction-mid LAD or CFX
24
Q
ST elevations in leads II, III, aVF indicate
A
Inferior wall infarction-RCA blockage
25
ST DEPRESSION in leads V1-V2 indicate
Posterior wall infarction-RCA, CFX
26
Describe sinus arrhythmia
HE increases during inspiration and decreases on expiration
27
Treatment for SSS
Pacemaker
28
Tx for a flutter
BB or CCB
DEFINITIVE: ablation
29
3 layers of afib tx
1. rate control (BB, CCB, dig)
2. rhythm control( cardioversion, meds, ablation)
3. anticoagulants
30
INR goal in afib
2-3
31
WPW syndrome is caused by this accessory pathway
Bundle of Kent
32
Delta waves
WPW syndrome
33
Most common cause of torsades
Hypomagnesemia
34
This syndrome, most common in Asian males, can cause sudden cardiac death
Brugada
35
Dressler’s syndrome
Post-MI pericarditis
36
Transient ST elevations, non-exertional CP most common in the morning, treated with CCBs=
Prinzmetals/variant angina
37
When is a ICD indicated in HFrEF?
EF<35%
38
Tx for Dressler’s syndrome
Asa and colchicine
39
Tx for pericarditis
1. NSAIDs
2. Colchicine
3. Steroids
40
Beck’s triad for pericardial tamponade
Muffled heart sounds, increased JVP, hypotension
41
MC cause of myocarditis
Viral infection
42
Myocarditis presents like this disease:
Heart failure
43
Definitive dx for myocarditis
Endomyocardial bx
44
Most common type of cardiomyopathy
Dilated
45
Broken heart syndrome is also known as
Takotsubo cardiomyopathy or apical left ventricular ballooning
46
Broken heart syndrome is caused by a
Catecholamine surge
47
MC cause of restrictive cardiomyopathy
Amyloidosis
48
Restrictive cardiomyopathy echocardiogram shows these 3 things
1. Non dilated ventricles with thick walls
2. Dilation of both atria
3. Diastolic dysfunction
49
First line therapy for HCM
BB
50
AS murmur
Systolic ejection crescendo-decresendo
51
AR murmur
Diastolic blowing decresendo
52
MS murmur
Opening snap with early-mid diastolic rumble
53
MR murmur
Blowing holosystolic murmur
54
MVP murmur
Mid-late systolic ejection click
55
Rheumatic fever
Migratory polyarthritis, active carditis, and erythema marginatum caused by group A beta hemolytic strep
56
PAD ABI value
<0.90
57
When is AAA repair indicated?
>5.5 cm or >0.5cm expansion in 6 months
58
1st line therapy for aortic dissection
Esmolol and labetalol
59
Virchow’s triad for PVD
Intimate damage, stasis, hypercoagulability
60
Samter’s triad
Asthma, nasal polyps, ASA/NSAIDs allergy
61
Elevated immunoglobulin in asthma
IgE
62
Asthma classification
Intermittent: <2d/wk and <2n/m
Mild persistent: >2d/wk and 3-4n/m
Mod persistent: daily and at least 1 night a week
Severe persistent: throughout the day and nightly
63
Noncaseating nonnecrotizing granulomas and bilateral hilar LAD
Sarcoidosis
64
Skin manifestations of sarcoidosis
Erythema Nodosum, lupus perino, maculopapular rash, parotid enlargement
65
Pulmonary nodule v mass
3cm
66
Signs that a pulmonary nodule is benign
Round, smooth, slow growth, calcified, cavitary
67
Signs a pulmonary nodule is malignant
Irregular/speculated boarders, rapid growth, cavitary with thickened walls
68
Most common lung cancer. Associated with gynecomastia.
Adenocarcinoma
69
Lung Adenocarcinoma location
Peripheral
70
Squamous cell lung cancer location
Centrally located
71
Very aggressive lung cancer
Large cell/anaplastic
72
Lung cancer that metastasizes early. Associate with Cushing syndrome, SIADH, SVC compression, and Eaton-Lambert syndrome.
Small cell/oat cell
73
Lung cancer associated with hypercalcemia
Squamous cell
74
Small cell tx of choice
Chemo
75
Non-small cell lung cancer treatment of choice
Surgical resection
76
Diagnostic mean pulmonary arterial pressure for pulmonary hypertension
> 25mmHg (via R heart cath)
77
Idiopathic pulmonary htn is most common in this population
Mild-aged or young women
78
MC cause of CAP
Strep pneumoniae
79
2nd MC cause of CAP
H flu
80
MC cause of atypical pneumonia
Mycoplasm pneumonia
81
Currant jelly sputum
Klebsiella
82
Outpt CAP treatment
Macrolides or doxy
83
Inpt CAP tx
Beta lactam with macrolides or FQ
84
What is Zenker’s diverticulum? Associated symptoms? Initial test?
Poutch at back of throat that food may get lodged in. Pt will complain of bad breath and coughing up food from days ago. Barium swallow
85
What population MC has lupus?
Young 20-40yo females of African American, Hispanic or Native American descent
86
Clinical manifestation of lupus
Joint pain, fever, malar rash
87
Medications that cause lupus
Hydralazine, INH, procainamide, and quinidine
88
How does antiphospolipid syndrome present?
Arterial and/or venous thrombosis and frequent miscarriages
89
Labs for lupus
Positive ANA, anti-dsDNA, and anti-smith
90
Labs for drug induced lupus
Anti-histone ABs
91
Tx for lupus associated skin lesions
Hydrocychloroquine
92
CREST syndrome
MC type of scleroderma
Calcinosis cutis, raynauds, esophagus motility disorder, sclerodactyly, telangiectasia
93
Raynauds treatment
CCBs or postacyclin
94
Scleroderma labs
Anti-centromere AB, ANA positive, and if diffuse dz anti-scl70
95
Autoimmune attack of exerocrine glands causing xerosis, dry eyes, and parotid enlargement
Sjögren’s syndrome
96
Increased risk associated with Sjögrens
Non-Hodgkin lymphoma
Interstitial nephritis
Pneumonitis
97
Specialized test and labs for Sjögrens
Schirmer test
RF
AntiSS-a(Ro)
AntiSS-b(La)
98
Medications for Sjögrens
Pilocarpine-cholinergic
| Cevimeline-stimulates muscarinic cholinergic receptors
99
What substance associated with pain perception is elevation in people with fibromyalgia?
Substance P
100
What will a muscle biopsy in pts with fibromyalgia look like?
“Moth eaten” appearance due to type I muscle fiber damage
101
Fibromyalgia management
Swimming’s
Antidepressants
Gabapentin\pregabalin
102
Polymyalgia rheumatica presentation
Bilateral proximal joint PAIN and STIFFNESS due to synovitis/bursitis/tenosynovitis
103
What disease is polymyalgia rheumatica associated with?
Giant cell arteritis
104
Polymyalgia rheumatica labs
Elevated ESR, normochromic normocytic anemia, elevated platelets
105
Tx for polymyalgia rheumatica
Low dose corticosteroids (10-20mg/day)
106
Polymyositis presentation
Progressive symmetrical muscle WEAKNESS, usually painless
107
Dermatomyositis presentation
Polymyositis with heliotrope rash, gotton’s papules, malar rash that does not spare nasolabial folds, shawl sign/photosensitivity
108
Why is dermatomyositis scarier than polymyositis?
Increase incidence of occult malignancy
109
Labs for polymyositis and dermatomyositis
Elevated aldolase and CK
Anti-Jo 1 Ab
Anti-SRP Ab
Anti-Mi2 Ab(specific for dermatomyositis)
110
Tx for polymyositis and dermatomyositis
High dose corticosteroids are 1st line
111
Podagra
Gout in first MTP
112
Compare radiographs in advanced gout to advanced psuedogout
Gout radiograph will show “rat bite” erosions of bone
| Psuedogout will show chondrocalcinosis
113
Rhematoid arthritis presentation
Soft warm boggy tender joint pain starting distally but skipping DIP. Worse in the morning for >1hr and improves throughout the day.
114
Labs for rheumatoid arthritis
RF
| Anti-CCP
115
1st line therapy for RA
Methotrexate
116
Methotrexate SE
```
Hepatotoxic
Stomatitis
Leukopenia
Bone marrow suppression
Interstitial pnemonitis
```
117
Hydrocychloroquine toxicity
Retinal toxicity (fundoscopy q6-12m)
118
T cell mediated inflammation and joint destruction
RA
119
Systemic vasculitis of medium/small arteries leading to renal HTN and necrotizing inflammatory lesions
Polyarteritis nodosa(PAN)
120
PAN is associated with these 2 things
Hepatitis B and microaneurysms
121
PAN labs
ANCA negative
| Elevated ESR
122
Tx for PAN
Corticosteroids
123
Can’t see, can’t pee, can’t climb a tree
Reactive/Reiter’s arthritis
124
Reactive arthritis most commonly presents after this infection
Chlamydia
125
Hyper keratitis lesions on palms and soles associated with reactive arthritis
Keratoderma blennorrhagicum
126
HLA-B27 associated seronegative spondyloartgropathies
Psoriatic arthritis
Enteropathic arthritis(IBD)
Ankylosis spondylitis
Reactive arthritis
127
Describe a Mallory-Weiss tear
Longitudinal mucosal laceration from persistent fetching/vomiting after ETOH binge
128
Plummer-Vinson syndrome
Dysphasia, esophageal webs, and iron deficiency anemia
129
Schatzki rings (lower esophageal webs and constructions) are MC associated with this disorder
Sliding hiatal hernia
130
Treatment for esophageal varices
Endoscopic ligation
Pharm:octreotide
131
Prevention of esophageal varice rupture
Nonselective BB (propranolol or nadolol)
Isosorbide mononitrate if pt intolerant to BB therapy
132
Most common cause of fulminant hepatitis
Acetaminophen
133
Reyes syndrome
Fulminant hepatitis in children seen with asa use during viral infection
134
Which rival hepatitis become chronic?
HBV 10%
| HCV 80%
135
Hep A transmission
Fecal oral
136
Hep E transmission and biggest concern
Fecal oral
Risk of fulminant hepatitis with high mortality in pregnancy
137
Hep C transmission
Parenteral
138
Hep B transmission
Parenteral, sexual, perinatal, and percutaneous
*beware the asymptotic carrier
139
Blood marker associated with hepatocellular carcinoma
Alpha fetoprotein
140
Treatment options for hepatic encephalopathy
Lactulose, rifiximin, neomycin
141
Primary biliary cirrhosis population
MC in middle aged women
142
Primary biliary cirrhosis labs
Elevated ALP and GGT with anti-mitochondrial Ab**
143
Autoimmune destruction of intrahepatic small bile ducts
Primary biliary cirrhosis
144
Primary biliary cirrhosis tx
URSODECUCHOLIC ACID
Cholestyramine and UV light for pruritis
145
Autoimmune diffuse fibrosis of intrahepatic and extrahepatic ducts
Primary sclerosis cholangitis
146
Primary sclerosis cholangitis labs
ALP 3-5xnormal, with elevated GGT and P-ANCA positive
ERCP is gold standard for dx
147
Primary sclerosis cholangitis population and associated dz
MC in men 20-40 with ulcerative colitis
148
Wilson’s disease labs
Decreased ceruloplasm and elevated urinary copper excretion
149
Wilson’s dz tx
D-pencillamine
150
MC cause of esophagitis
GERD
151
Endoscopic finding in eosinophillic esophagitis
Multiple corrugated rings
152
Tx for eosinophilic esophagitis
Swallow inhaled corticosteroids
153
MC causes (7) of pill induced esophagitis
NSAIDs, bisphosphonates, KCl, Fe pills, vit C pills, BB, and CCBs
154
Endoscopic finding for pill induced esophagitis
Small well-defined ulcers of varying depths
155
4 complications of GERD
Esophagitis
Strictures
Barrett’s esophagus
Esophageal adenocarcinoma
156
Histologic finding with Barrett’s esophagus
Squamous cells replaced by columnar
157
What is pyrosis?
Heart burn
158
Gold standard for dx of GERD
24hr ambulatory pH monitoring
*although dx is usually clinical and EGD is usual test of choice for r/o complications
159
MC esophageal cancer worldwide, associated with tobacco/ETOH, and usually in upper 1/3 of esophagus
Squamous cell carcinoma
160
MC esophageal cancer in the US, seen in younger pts, obese, caucasians, associated with GERD, can lead to Barrett’s esophagus, is lower 1/3 esophagus
Adenocarcinoma
161
What are the 3 MC causes of gastritis?
H pylori
NSAIDs/asa
Acute stress
162
H pylori tx
Clarithromycin, Amoxicillin, PPI
OR
PPI, bismuth, tetracycline, metronidazole
163
How to you differentiate a gastric ulcer from a duodenal ulcer with history?
Gastric: pain worse with meals for 1-2hr
Duodenal:pain better with meals but worse 2-5hr afterwards
164
Gastric secreting neuroendocrine tumor
Zollinger-Ellison syndrome
165
Dx of zollinger-Ellison syndrome
Elevated fasting gastrin level above 1000
Secretin test stimulates gastrin release
166
MC gastric cancer type
Adenocarcinoma
167
Risk factors for gastric carcinoma
H pylori(most important), salted/cured/smoked/pickled foods containing nitrates/nitrites
168
Virchows node
Supraclavicular LAD
169
Sister Mary Joseph’s node
Umbilical LAD
170
Clinical presentation of gastric carcinoma
Dyspepsia, weight loss, early satiety, iron deficiency anemia
171
Black gallstones are caused by
Hemolysis or ETOH cirrhosis
172
Brown gallstones are caused by
Parasites or bacteria
*more common in Asians
173
Gallstones in the gallbladder without inflammation
Cholelithiasis
174
Gallstones in the common bile duct
Choledocholithiasis
175
Biliary tract infection secondary to obstruction
Acute cholangitis
176
Cystic duct obstruction with gallbladder inflammation
Acute cholecystitis
177
Abx for acute cholangitis
Ceftriaxone or fluoroquinolone with metronidazole
178
MC 2 causes of acute pancreatitis
Gallstones or ETOH
179
Labs for acute pancreatitis
Elevated lipase
Amylase 3x ULN
AST 3x increase
Hypocalcemia
180
Tx of acute pancreatitis
NPO, IV fluids and supportive care
Generally abx not required
181
Chronic pancreatitis MC etiology
ETOH abuse
182
Chronic pancreatitis clinical manifestation triad
Calcifications
Steatorrhea
DM
183
Chronic pancreatitis dx
Calcification on imaging(CT test of choice)
Amylase and lipase usually normal
184
MC type of pancreatic carcinoma
Ductal adenocarcinoma in head of pancreas
185
Radical pancreaticoduodenal resection
Whipple procedure
186
Dermatitis herpatiformis
Specific for celiac dz
187
Dx of celiacs
Endomysial IgA Ab
Transglutaminase Ab
Bx is difinitive dx
188
Diverticular dz is most common in what part of the GI tract?
Sigmoid
189
Tx for diverticulitis
Clear liquid diet
Metronidazole with cipro or bactrim
190
Abd pain with altered bowel habits at least 1 day/week in the last 3 months
IBS
191
Uniform inflammation of rectum and colon mucosa and submucosa
Ulcerative colitis
192
Clinical manifestation of UC
Tenesmus, fecal urgency, bloody diarrhea
193
Transmural mouth to anus inflammation with skip lesions and cobblestone appearance
Crohn disease
194
Complications of UC
PSC, colon cancer, toxic megacolon
195
Complications of CD
Perinatal dz, Fe&b12 malabsorption
196
Extragastrointestinal manifestations of UC and CD
ARTHRITIS, episcleritis, uveitis, erythema nodosum, pyoderma gangrenosum
197
4 layers of tx for IBD
1. aminosalicylic acids( oral mesalamine best for maintenance, topical mesalamine for anal/rectal dz, sulfasalazine for UC)
2. corticostetoids for flares
3. immune modifying/steroid sparing meds(6MU, azathioprine, Methotrexate)
4. Anti-TNF agents
198
Elevated CEA
Colon cancer
199
Elevated CA 19-9
Pancreatic cancer
200
Colon cancer tx
Chemotherapy with 5FU
201
Anal fissures are most common where?
Posterior midline
202
Anal fissure tx
Usually supportive (>80%) resolve spontaneously
2nd line topical vasodilators (nitro or nifedipine)
203
MC cause of gastroenteritis in N America
Notovirus
204
Travelers diarrhea is caused by
Enterotoxigenic E. coli
205
Diarrhea w/i 6hr of eating dairy products, Mayo, meats or eggs is likely caused by
Staph aureus
206
Tx for c diff
Oral vanco or flagyl
207
Tx of choice for colon cancer
Surgical resection
Neither chemo(5FU) or radiation have been shown to be effective
208
Hepatocellular pattern on labs
Elevated ALT and AST
| AST associated with ETOH
209
Cholestatic pattern on labs
Elevated total bili, Alk Phos, and GGT
210
Cirrhotic pattern on labs
Low albumin, high PR/INR, elevated bili, normal or elevated ALT/AST
211
Hemolytic pattern on labs
Elevated unconjugated/indirect bilirubin, AST, and ALT
