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PANCE prep JQ > InternalMed EOR > Flashcards

InternalMed EOR Flashcards

1
Q

Angina pectoris usually last how long?

A

<30minutes

Typically 1-5minutes

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2
Q

Pharmacological agents used in stress test are?

A

Adenosine and dipyridamole (vasodilator healthy but not diseased vessels)

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3
Q

What is the pharmacological agent used in stress echocardiogram and cardiac MRI?

A

Dobutamine (positive ionitrope and chronotrope)

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4
Q

Contraindications for nitrate use are:

A

<90mmHg SBP, RV infarction, PDE-5 inhibitors

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5
Q

1st line medication for chronic angina management

A

Beta blocker

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6
Q

Treatment of choice for prinzmetals angina

A

Nondihydropyridine CCBs

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7
Q

This medication irreversible inhibits a COX enzyme to decrease thromboxane A2

A

Aspirin

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8
Q

1st line therapy for unstable Bradycardia

A

Atropine

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9
Q

Treatment of unstable tachycardia

A

Synchronized cardioversion

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10
Q

Tx for stable wide QRS tachycardia

A

Amiodarone

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11
Q

Tx for stable normal QRS tachycardia

A

Vagal maneuvers and adenosine

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12
Q

Left axis deviation

A

Positive lead I and negative aVF

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13
Q

Right axis deviation

A

Negative lead I and positive lead aVF

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14
Q

Left atrial enlargement

A

M shaped p wave in lead II and p wave in V1 more negative

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15
Q

Right atrial enlargement

A

Tall p wave in lead II and p wave in V1 more positive

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16
Q

LBBB

A

1 wide QRS
2 slurred R in V5&V6
3 deep S in V1

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17
Q

RBBB

A

1 wide QRS
2 bunny ears in V1&V2
3 wide S in V6

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18
Q

RV Hypertrophy

A

R>S in V1

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19
Q

LV Hypertrophy

A

S in V1 + R in V5 are >35mm in men or 30mm in women

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20
Q

ST elevations in leads V1-V4 indicate

A

Anterior infarction-LAD blockage

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21
Q

ST elevations in leads V1-V2 indicate

A

Septal infarction-proximal LAD

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22
Q

ST elevations in leads V5-V4, I, aVL indicate

A

Lateral wall infarction-CFX blockage

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23
Q

ST elevations in leads V4-6, I, aVL indicate

A

Anterolateral infarction-mid LAD or CFX

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24
Q

ST elevations in leads II, III, aVF indicate

A

Inferior wall infarction-RCA blockage

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25
Q

ST DEPRESSION in leads V1-V2 indicate

A

Posterior wall infarction-RCA, CFX

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26
Q

Describe sinus arrhythmia

A

HE increases during inspiration and decreases on expiration

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27
Q

Treatment for SSS

A

Pacemaker

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28
Q

Tx for a flutter

A

BB or CCB

DEFINITIVE: ablation

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29
Q

3 layers of afib tx

A
  1. rate control (BB, CCB, dig)
  2. rhythm control( cardioversion, meds, ablation)
  3. anticoagulants
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30
Q

INR goal in afib

A

2-3

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31
Q

WPW syndrome is caused by this accessory pathway

A

Bundle of Kent

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32
Q

Delta waves

A

WPW syndrome

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33
Q

Most common cause of torsades

A

Hypomagnesemia

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34
Q

This syndrome, most common in Asian males, can cause sudden cardiac death

A

Brugada

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35
Q

Dressler’s syndrome

A

Post-MI pericarditis

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36
Q

Transient ST elevations, non-exertional CP most common in the morning, treated with CCBs=

A

Prinzmetals/variant angina

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37
Q

When is a ICD indicated in HFrEF?

A

EF<35%

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38
Q

Tx for Dressler’s syndrome

A

Asa and colchicine

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39
Q

Tx for pericarditis

A
  1. NSAIDs
  2. Colchicine
  3. Steroids
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40
Q

Beck’s triad for pericardial tamponade

A

Muffled heart sounds, increased JVP, hypotension

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41
Q

MC cause of myocarditis

A

Viral infection

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42
Q

Myocarditis presents like this disease:

A

Heart failure

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43
Q

Definitive dx for myocarditis

A

Endomyocardial bx

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44
Q

Most common type of cardiomyopathy

A

Dilated

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45
Q

Broken heart syndrome is also known as

A

Takotsubo cardiomyopathy or apical left ventricular ballooning

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46
Q

Broken heart syndrome is caused by a

A

Catecholamine surge

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47
Q

MC cause of restrictive cardiomyopathy

A

Amyloidosis

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48
Q

Restrictive cardiomyopathy echocardiogram shows these 3 things

A
  1. Non dilated ventricles with thick walls
  2. Dilation of both atria
  3. Diastolic dysfunction
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49
Q

First line therapy for HCM

A

BB

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50
Q

AS murmur

A

Systolic ejection crescendo-decresendo

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51
Q

AR murmur

A

Diastolic blowing decresendo

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52
Q

MS murmur

A

Opening snap with early-mid diastolic rumble

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53
Q

MR murmur

A

Blowing holosystolic murmur

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54
Q

MVP murmur

A

Mid-late systolic ejection click

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55
Q

Rheumatic fever

A

Migratory polyarthritis, active carditis, and erythema marginatum caused by group A beta hemolytic strep

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56
Q

PAD ABI value

A

<0.90

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57
Q

When is AAA repair indicated?

A

> 5.5 cm or >0.5cm expansion in 6 months

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58
Q

1st line therapy for aortic dissection

A

Esmolol and labetalol

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59
Q

Virchow’s triad for PVD

A

Intimate damage, stasis, hypercoagulability

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60
Q

Samter’s triad

A

Asthma, nasal polyps, ASA/NSAIDs allergy

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61
Q

Elevated immunoglobulin in asthma

A

IgE

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62
Q

Asthma classification

A

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

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63
Q

Noncaseating nonnecrotizing granulomas and bilateral hilar LAD

A

Sarcoidosis

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64
Q

Skin manifestations of sarcoidosis

A

Erythema Nodosum, lupus perino, maculopapular rash, parotid enlargement

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65
Q

Pulmonary nodule v mass

A

3cm

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66
Q

Signs that a pulmonary nodule is benign

A

Round, smooth, slow growth, calcified, cavitary

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67
Q

Signs a pulmonary nodule is malignant

A

Irregular/speculated boarders, rapid growth, cavitary with thickened walls

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68
Q

Most common lung cancer. Associated with gynecomastia.

A

Adenocarcinoma

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69
Q

Lung Adenocarcinoma location

A

Peripheral

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70
Q

Squamous cell lung cancer location

A

Centrally located

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71
Q

Very aggressive lung cancer

A

Large cell/anaplastic

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72
Q

Lung cancer that metastasizes early. Associate with Cushing syndrome, SIADH, SVC compression, and Eaton-Lambert syndrome.

A

Small cell/oat cell

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73
Q

Lung cancer associated with hypercalcemia

A

Squamous cell

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74
Q

Small cell tx of choice

A

Chemo

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75
Q

Non-small cell lung cancer treatment of choice

A

Surgical resection

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76
Q

Diagnostic mean pulmonary arterial pressure for pulmonary hypertension

A

> 25mmHg (via R heart cath)

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77
Q

Idiopathic pulmonary htn is most common in this population

A

Mild-aged or young women

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78
Q

MC cause of CAP

A

Strep pneumoniae

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79
Q

2nd MC cause of CAP

A

H flu

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80
Q

MC cause of atypical pneumonia

A

Mycoplasm pneumonia

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81
Q

Currant jelly sputum

A

Klebsiella

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82
Q

Outpt CAP treatment

A

Macrolides or doxy

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83
Q

Inpt CAP tx

A

Beta lactam with macrolides or FQ

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84
Q

What is Zenker’s diverticulum? Associated symptoms? Initial test?

A

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

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85
Q

What population MC has lupus?

A

Young 20-40yo females of African American, Hispanic or Native American descent

86
Q

Clinical manifestation of lupus

A

Joint pain, fever, malar rash

87
Q

Medications that cause lupus

A

Hydralazine, INH, procainamide, and quinidine

88
Q

How does antiphospolipid syndrome present?

A

Arterial and/or venous thrombosis and frequent miscarriages

89
Q

Labs for lupus

A

Positive ANA, anti-dsDNA, and anti-smith

90
Q

Labs for drug induced lupus

A

Anti-histone ABs

91
Q

Tx for lupus associated skin lesions

A

Hydrocychloroquine

92
Q

CREST syndrome

A

MC type of scleroderma

Calcinosis cutis, raynauds, esophagus motility disorder, sclerodactyly, telangiectasia

93
Q

Raynauds treatment

A

CCBs or postacyclin

94
Q

Scleroderma labs

A

Anti-centromere AB, ANA positive, and if diffuse dz anti-scl70

95
Q

Autoimmune attack of exerocrine glands causing xerosis, dry eyes, and parotid enlargement

A

Sjögren’s syndrome

96
Q

Increased risk associated with Sjögrens

A

Non-Hodgkin lymphoma
Interstitial nephritis
Pneumonitis

97
Q

Specialized test and labs for Sjögrens

A

Schirmer test
RF
AntiSS-a(Ro)
AntiSS-b(La)

98
Q

Medications for Sjögrens

A

Pilocarpine-cholinergic

Cevimeline-stimulates muscarinic cholinergic receptors

99
Q

What substance associated with pain perception is elevation in people with fibromyalgia?

A

Substance P

100
Q

What will a muscle biopsy in pts with fibromyalgia look like?

A

“Moth eaten” appearance due to type I muscle fiber damage

101
Q

Fibromyalgia management

A

Swimming’s
Antidepressants
Gabapentin\pregabalin

102
Q

Polymyalgia rheumatica presentation

A

Bilateral proximal joint PAIN and STIFFNESS due to synovitis/bursitis/tenosynovitis

103
Q

What disease is polymyalgia rheumatica associated with?

A

Giant cell arteritis

104
Q

Polymyalgia rheumatica labs

A

Elevated ESR, normochromic normocytic anemia, elevated platelets

105
Q

Tx for polymyalgia rheumatica

A

Low dose corticosteroids (10-20mg/day)

106
Q

Polymyositis presentation

A

Progressive symmetrical muscle WEAKNESS, usually painless

107
Q

Dermatomyositis presentation

A

Polymyositis with heliotrope rash, gotton’s papules, malar rash that does not spare nasolabial folds, shawl sign/photosensitivity

108
Q

Why is dermatomyositis scarier than polymyositis?

A

Increase incidence of occult malignancy

109
Q

Labs for polymyositis and dermatomyositis

A

Elevated aldolase and CK
Anti-Jo 1 Ab
Anti-SRP Ab
Anti-Mi2 Ab(specific for dermatomyositis)

110
Q

Tx for polymyositis and dermatomyositis

A

High dose corticosteroids are 1st line

111
Q

Podagra

A

Gout in first MTP

112
Q

Compare radiographs in advanced gout to advanced psuedogout

A

Gout radiograph will show “rat bite” erosions of bone

Psuedogout will show chondrocalcinosis

113
Q

Rhematoid arthritis presentation

A

Soft warm boggy tender joint pain starting distally but skipping DIP. Worse in the morning for >1hr and improves throughout the day.

114
Q

Labs for rheumatoid arthritis

A

RF

Anti-CCP

115
Q

1st line therapy for RA

A

Methotrexate

116
Q

Methotrexate SE

A 
Hepatotoxic 
Stomatitis
Leukopenia
Bone marrow suppression 
Interstitial pnemonitis
117
Q

Hydrocychloroquine toxicity

A

Retinal toxicity (fundoscopy q6-12m)

118
Q

T cell mediated inflammation and joint destruction

119
Q

Systemic vasculitis of medium/small arteries leading to renal HTN and necrotizing inflammatory lesions

A

Polyarteritis nodosa(PAN)

120
Q

PAN is associated with these 2 things

A

Hepatitis B and microaneurysms

121
Q

PAN labs

A

ANCA negative

Elevated ESR

122
Q

Tx for PAN

A

Corticosteroids

123
Q

Can’t see, can’t pee, can’t climb a tree

A

Reactive/Reiter’s arthritis

124
Q

Reactive arthritis most commonly presents after this infection

125
Q

Hyper keratitis lesions on palms and soles associated with reactive arthritis

A

Keratoderma blennorrhagicum

126
Q

HLA-B27 associated seronegative spondyloartgropathies

A

Psoriatic arthritis
Enteropathic arthritis(IBD)
Ankylosis spondylitis
Reactive arthritis

127
Q

Describe a Mallory-Weiss tear

A

Longitudinal mucosal laceration from persistent fetching/vomiting after ETOH binge

128
Q

Plummer-Vinson syndrome

A

Dysphasia, esophageal webs, and iron deficiency anemia

129
Q

Schatzki rings (lower esophageal webs and constructions) are MC associated with this disorder

A

Sliding hiatal hernia

130
Q

Treatment for esophageal varices

A

Endoscopic ligation

Pharm:octreotide

131
Q

Prevention of esophageal varice rupture

A

Nonselective BB (propranolol or nadolol)

Isosorbide mononitrate if pt intolerant to BB therapy

132
Q

Most common cause of fulminant hepatitis

A

Acetaminophen

133
Q

Reyes syndrome

A

Fulminant hepatitis in children seen with asa use during viral infection

134
Q

Which rival hepatitis become chronic?

A

HBV 10%

HCV 80%

135
Q

Hep A transmission

A

Fecal oral

136
Q

Hep E transmission and biggest concern

A

Fecal oral

Risk of fulminant hepatitis with high mortality in pregnancy

137
Q

Hep C transmission

A

Parenteral

138
Q

Hep B transmission

A

Parenteral, sexual, perinatal, and percutaneous

*beware the asymptotic carrier

139
Q

Blood marker associated with hepatocellular carcinoma

A

Alpha fetoprotein

140
Q

Treatment options for hepatic encephalopathy

A

Lactulose, rifiximin, neomycin

141
Q

Primary biliary cirrhosis population

A

MC in middle aged women

142
Q

Primary biliary cirrhosis labs

A

Elevated ALP and GGT with anti-mitochondrial Ab**

143
Q

Autoimmune destruction of intrahepatic small bile ducts

A

Primary biliary cirrhosis

144
Q

Primary biliary cirrhosis tx

A

URSODECUCHOLIC ACID

Cholestyramine and UV light for pruritis

145
Q

Autoimmune diffuse fibrosis of intrahepatic and extrahepatic ducts

A

Primary sclerosis cholangitis

146
Q

Primary sclerosis cholangitis labs

A

ALP 3-5xnormal, with elevated GGT and P-ANCA positive

ERCP is gold standard for dx

147
Q

Primary sclerosis cholangitis population and associated dz

A

MC in men 20-40 with ulcerative colitis

148
Q

Wilson’s disease labs

A

Decreased ceruloplasm and elevated urinary copper excretion

149
Q

Wilson’s dz tx

A

D-pencillamine

150
Q

MC cause of esophagitis

151
Q

Endoscopic finding in eosinophillic esophagitis

A

Multiple corrugated rings

152
Q

Tx for eosinophilic esophagitis

A

Swallow inhaled corticosteroids

153
Q

MC causes (7) of pill induced esophagitis

A

NSAIDs, bisphosphonates, KCl, Fe pills, vit C pills, BB, and CCBs

154
Q

Endoscopic finding for pill induced esophagitis

A

Small well-defined ulcers of varying depths

155
Q

4 complications of GERD

A

Esophagitis
Strictures
Barrett’s esophagus
Esophageal adenocarcinoma

156
Q

Histologic finding with Barrett’s esophagus

A

Squamous cells replaced by columnar

157
Q

What is pyrosis?

A

Heart burn

158
Q

Gold standard for dx of GERD

A

24hr ambulatory pH monitoring

*although dx is usually clinical and EGD is usual test of choice for r/o complications

159
Q

MC esophageal cancer worldwide, associated with tobacco/ETOH, and usually in upper 1/3 of esophagus

A

Squamous cell carcinoma

160
Q

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

A

Adenocarcinoma

161
Q

What are the 3 MC causes of gastritis?

A

H pylori
NSAIDs/asa
Acute stress

162
Q

H pylori tx

A

Clarithromycin, Amoxicillin, PPI

OR

PPI, bismuth, tetracycline, metronidazole

163
Q

How to you differentiate a gastric ulcer from a duodenal ulcer with history?

A

Gastric: pain worse with meals for 1-2hr

Duodenal:pain better with meals but worse 2-5hr afterwards

164
Q

Gastric secreting neuroendocrine tumor

A

Zollinger-Ellison syndrome

165
Q

Dx of zollinger-Ellison syndrome

A

Elevated fasting gastrin level above 1000

Secretin test stimulates gastrin release

166
Q

MC gastric cancer type

A

Adenocarcinoma

167
Q

Risk factors for gastric carcinoma

A

H pylori(most important), salted/cured/smoked/pickled foods containing nitrates/nitrites

168
Q

Virchows node

A

Supraclavicular LAD

169
Q

Sister Mary Joseph’s node

A

Umbilical LAD

170
Q

Clinical presentation of gastric carcinoma

A

Dyspepsia, weight loss, early satiety, iron deficiency anemia

171
Q

Black gallstones are caused by

A

Hemolysis or ETOH cirrhosis

172
Q

Brown gallstones are caused by

A

Parasites or bacteria

*more common in Asians

173
Q

Gallstones in the gallbladder without inflammation

A

Cholelithiasis

174
Q

Gallstones in the common bile duct

A

Choledocholithiasis

175
Q

Biliary tract infection secondary to obstruction

A

Acute cholangitis

176
Q

Cystic duct obstruction with gallbladder inflammation

A

Acute cholecystitis

177
Q

Abx for acute cholangitis

A

Ceftriaxone or fluoroquinolone with metronidazole

178
Q

MC 2 causes of acute pancreatitis

A

Gallstones or ETOH

179
Q

Labs for acute pancreatitis

A

Elevated lipase
Amylase 3x ULN
AST 3x increase
Hypocalcemia

180
Q

Tx of acute pancreatitis

A

NPO, IV fluids and supportive care

Generally abx not required

181
Q

Chronic pancreatitis MC etiology

A

ETOH abuse

182
Q

Chronic pancreatitis clinical manifestation triad

A

Calcifications
Steatorrhea
DM

183
Q

Chronic pancreatitis dx

A

Calcification on imaging(CT test of choice)

Amylase and lipase usually normal

184
Q

MC type of pancreatic carcinoma

A

Ductal adenocarcinoma in head of pancreas

185
Q

Radical pancreaticoduodenal resection

A

Whipple procedure

186
Q

Dermatitis herpatiformis

A

Specific for celiac dz

187
Q

Dx of celiacs

A

Endomysial IgA Ab

Transglutaminase Ab

Bx is difinitive dx

188
Q

Diverticular dz is most common in what part of the GI tract?

189
Q

Tx for diverticulitis

A

Clear liquid diet

Metronidazole with cipro or bactrim

190
Q

Abd pain with altered bowel habits at least 1 day/week in the last 3 months

191
Q

Uniform inflammation of rectum and colon mucosa and submucosa

A

Ulcerative colitis

192
Q

Clinical manifestation of UC

A

Tenesmus, fecal urgency, bloody diarrhea

193
Q

Transmural mouth to anus inflammation with skip lesions and cobblestone appearance

A

Crohn disease

194
Q

Complications of UC

A

PSC, colon cancer, toxic megacolon

195
Q

Complications of CD

A

Perinatal dz, Fe&b12 malabsorption

196
Q

Extragastrointestinal manifestations of UC and CD

A

ARTHRITIS, episcleritis, uveitis, erythema nodosum, pyoderma gangrenosum

197
Q

4 layers of tx for IBD

A
  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
Q

Elevated CEA

A

Colon cancer

199
Q

Elevated CA 19-9

A

Pancreatic cancer

200
Q

Colon cancer tx

A

Chemotherapy with 5FU

201
Q

Anal fissures are most common where?

A

Posterior midline

202
Q

Anal fissure tx

A

Usually supportive (>80%) resolve spontaneously

2nd line topical vasodilators (nitro or nifedipine)

203
Q

MC cause of gastroenteritis in N America

204
Q

Travelers diarrhea is caused by

A

Enterotoxigenic E. coli

205
Q

Diarrhea w/i 6hr of eating dairy products, Mayo, meats or eggs is likely caused by

A

Staph aureus

206
Q

Tx for c diff

A

Oral vanco or flagyl

207
Q

Tx of choice for colon cancer

A

Surgical resection

Neither chemo(5FU) or radiation have been shown to be effective

208
Q

Hepatocellular pattern on labs

A

Elevated ALT and AST

AST associated with ETOH

209
Q

Cholestatic pattern on labs

A

Elevated total bili, Alk Phos, and GGT

210
Q

Cirrhotic pattern on labs

A

Low albumin, high PR/INR, elevated bili, normal or elevated ALT/AST

211
Q

Hemolytic pattern on labs

A

Elevated unconjugated/indirect bilirubin, AST, and ALT

PANCE prep JQ (15 decks)

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