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Internal Med > Medicine Qbank > Flashcards

Medicine Qbank Flashcards

1
Q

2 options for chest pain at rest and no ST-elevation on EKG

A
  1. Unstable angina 2. NSTEMI (see elevated biomarkers)
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2
Q

Acute pericarditis is diagnosed by

A

2 of the 3: 1. pleuritic chest pain 2. friction rub 3. diffuse concordant ST-segment elevation on EKG.

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3
Q

EKG findings of acute pericarditis?

A

(non-diagnostic in 50% of pts): diffuse ST-seg elevation

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4
Q

What is the preferred tx for STEMI?

A

Percutaneous angioplasty and stent (lower 30-day mortality compared to thrombolytic)

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5
Q

2 ways to get relief from angina pectoralis pain

A
  1. rest 2. nitroglycerin
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6
Q

Pt with R-side STEMI has low bp. What is the first step in management?

A

Fluid bolus to improve filling (diastolic problem). If fails, try inotropic support like dobutamine (not first since can extend infarct). Don’t give B blocker as bradycard worsesns HD instability. Don’t give nitroglycerin as venodilation impairs RV filling

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7
Q

What is empiric therapy for GERD?

A

PPI

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8
Q

MSSA peritoneal infx abx?

A

Clinda

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9
Q

What is appropriate therapeutic INR?

A

Normal range for pts not on any meds is 0.8 - 1.2
For pts w/ idiopathic VTE or afib, 2 - 3.
For pts w/ prosthetic heart valves, 2.5 - 3.5.

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10
Q

Abx for cat scratch disease?

A

PO azithromycin for Bartonella henselae

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11
Q

What is bone/joint related abnormality 2/2 steroid use?

A

Osteonecrosis of right femoral head = osteochondritis dessicans

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12
Q

First degree heart block types

A

AV block w/ normal QRS: oft due to delayed AV nodal conduction, no further eval needed
# w/ prolonged QRS: likely conduction delay bleow AV node –> need electrophys test as may unpredictably progress to advanced 2nd degree or complete heart block

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13
Q

What is pathogenesis of renal vein thrombosis as a complication of nephrotic syndrome?

A

Lose antithrombin (which is activated by heparin) III in urine –> incr risk of venous/arterial thrombosis. Sx: sudden onset abd pain, fever, hematuria. Most common w/ membranous glomerulonephritis

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14
Q

“Tea and toast”

A

Folic acid

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15
Q

What are signs/sx of eosinophilic pneumonia?

A

Gradual asthma-like sx, hear diffuse wheezes, fine inspiratory crackles (bronchial/interstiial involvement)

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16
Q

Dx of aspirin exacerbated respiratory disease (AERD) w/ (3)

A
  1. asthma 2. chronic rhinosinusitis w/ nasal polyposis 3. bronchospasm or nasal congestion after asa/NSAIDS
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17
Q

Shunt causes what sort of acid-base disorder?

A

Respiratory acidosis

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18
Q

V/Q mismatch causes what sort of acid-base disorder?

A

Due to decrease in PaCO2, compensatory tachypnea –> resp alk

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19
Q

What are 4 causes of V/Q mismatch?

A

Pulm emb, atelectasis, pleural effusion, pulm edema

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20
Q

First line tx for prolactinoma?

A

Dopaminergic agents - cabergoline

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21
Q

Cutoff for pituitary tumor microadenoma?

A
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22
Q

Treatment of hyperkalemia w/ EKG changes?

A
  1. administer IV Ca gluconate to stabilize cardiac membrane
  2. Lower serum K by driving intracellularly - insulin and glucose, Na bicarb, beta2 (albuterol) - “Get In Bye Bye”
  3. Eliminate excess K from body via kayexalate
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23
Q

What is the mech of nitroglycerine in pain relief of angina?

A

Dilation of veins

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24
Q

Which risk factor has strongest assoc w/ aortic dissection?

A

Htn

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25
Q

Where is the most common site of htn hemorrhage of brain?

A

Putamen. Internal capsule usu involved –> contralat dense hemiparesis

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26
Q

Rx for Nocardia?

A

TMP-SMX

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27
Q

How do you diagnose leprosy?

A

Skin biopsy –> acid-fast bacilli

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28
Q

Asian paitent, hypopigmented patch of skin –> suspect

A

Leprosy

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29
Q

What are the 3 etiologies of acute urinary retention in the elderly?

A
  1. Obstruction (BPH or carcinoma) 2. Neurogenic bladder 3. Detrusor muscle underactivity
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30
Q

What are 4 etiologies of overflow incontinence from acontractile bladder?

A
  1. Diabetic neuropathy, 2. MS, 3. anesthetic drugs, 4. drugs
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31
Q

What’s suspected w/ large amt of blood on UA but few RBCs?

A

Rhabdomyolysis (which –> acute renal failure)

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32
Q

What are classic sx of disk prolapse?

A

Unilateral radicular pain in dermatomal distribution

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33
Q

What are sx of cauda equina syndrome?

A

Saddle anesthesia, lose of sphincter tone, bladder atony w/ overflow incontinence, bilat sciatica

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34
Q

Sx detrusor instability?

A

Incontiencne preceded by sudden urinary urgency

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35
Q

Sx hypertonic bladder?

A

Constant urine dribbling 2/2 unremitting contraction of bladder

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36
Q

Imaging study of choice for suspicion of pancreatic ca?

A

If jaundice - start w/ u/s. If no jaundice but epigastric pain and weight loss - start with CT.

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37
Q

Varying amplitude of QRS complexes is called what?

A

Electrical alternans: pathognomonic for pericardial effusion

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38
Q

What is procainamide used for?

A

Class Ia, used to treat SV and V arrhythmias, particularly Wolff-Parkinson-White

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39
Q

How is SLE arthritis diff from RA?

A

Both affect MCP and PIP, but SLE arthritis is non-deformig

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40
Q

When is parathyroidectomy recommended for asymptomatic patients with primary hyperparathyroidism?

A
  1. Serum calcium level >= 1 mg/dL above upper limit of normal 2. Age
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41
Q

How do you distinguish btw primary hyperpara vs. familial hypocalciuric hypercalcemia?

A

With PH, 24 hr urinary ca >250 mg. With familial,

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42
Q

Varicoceles that don’t empty when pt is recurrent are due to

A

Tumor obstruction of gonadal vein, increased suspicion for mass obstruction to venous flow

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43
Q

New-onset thrombocytopenia, arterial thrombosis (cold extremity), and/or >50% drop in platelet count 2/2 to which drug for DVT?

A

Heparin –> HIT. Type 1: Due to nonimmune direct effect of heparin on platelet acctivation, happens w/in 2 days. Type 2: Immune-mediated

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44
Q

What is a factorial study design?

A

Involes 2 or more experimental interventions, ea w/ 2 or more variables studied independently

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45
Q

Can steroid use increase Hct?

A

Yes! So don’t think epo use if a pt has gynecomastia

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46
Q

Typical sx of digoxin tox?

A

N/v, decr appetite, confusion, weakness, arrythmias. Can be triggered by volume depletion, renal injury.
# Get blood drug level, EKG, and INR

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47
Q

What is a TACE procedure?

A

Limit blood supply to tumors

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48
Q

What is rifaximin used for?

A

Based on rifamycin, poor GI absorption. Used for traveler’s diarrhea, hepatic encephalopathy

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49
Q

What are the presenting signs/sx of DKA?

A

N/V, thirst, increased urination, abd pain. Labs show anion gap metabolic acidosis

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50
Q

Diagnosis of DK is made by

A
  1. Blood glucose >250, 2. pH
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51
Q

What is pseudodementia/reversible cognitive impairment?

A

Severe depression presenting w/ features similar to dementia. For most, return to baseline w/ rx of dementia

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52
Q

Why are patients w/ RA at increased risk for osteoporosis?

A

Incr proinflammatory cytokines, glucocorticoids, and lack of phys activity –> local/generalized loss of bone

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53
Q

What are the 2 dz associations of steitis fibrosa cystica?

A

aka von recklinhausen disease. Parathryoid carcinoma, hyperparathyroidism

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54
Q

Pts w/ GCA (giant cell arteritis) have what phys exam?

A

Scalp tenderness, decr temporal artery pulse

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55
Q

What is a complication of GCA that warrants monitoring?

A

Aortic aneurysms - need serial cxr’s

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56
Q

What are the criteria for drainage of a pseudocyst?

A
  1. Persists >6wk 2. > 5cm diameter 3. Secondary infx
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57
Q

What is within a pseudocyst?

A

Enzyme-rich fluid, tissue, debris

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58
Q

Arortic artery dissection can extend into

A
  1. Carotid arteries (stroke), 2. renal arteries (AKI), 3. aortic valve (aortic regurge), and/or 4. pericardium (tamponade)
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59
Q

Firm, hyperpigmented nodule that has central dimpling when area is pinched

A

Dermatofibroma

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60
Q

What is the mech of coagulation in antiphospholipid sydnrome?

A

Unknown

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61
Q

Which lab value is changed in antiphospholipid syndrome?

A

Prolonged PTT. 20-40% pts may have thrombocytopenia

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62
Q

What dz defined by inflammation of one eye after penetrating injury to the other?

A

Sympathetic ophthalmia = spared eye injury. Caused by recognition/uncovering of “hidden” antigens

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63
Q

Side effect of hydroxychloroquine?

A

GI disress, visual disturbance, in G6PD pts, hemolysis

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64
Q

Side effect of mtx?

A

Macrocytic anemia (everything is bigger in mTX) Nausea, stomatitis, rash, hepatotoxicity, interst lung dz, alopecia, fever.

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65
Q

What are the pulses associated with aortic regurge?

A

Bounding pulse

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66
Q

What are the pulses assoc with aortic steosis?

A

Pulsus parvus = decreased pulse amplitude and tardus = delayed pulse upstroke

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67
Q

If a test result is negative, the prob of having dz is

A

1 - negative predictive value

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68
Q

Labs of CML?

A

Leukocytosis w/ left shift (myelomonocytes, neutrophils, etc), basophilia, marked splenomegaly

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69
Q

What STD swcreening for all pts (even asymptomatic)?

A

HIV

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70
Q

Which org causes acute retinal necrosis syndrome in HIV+?

A

HSV & VZV - can cause pain, keratitis, uveitis, necrosis

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71
Q

Which org causes benign retinitis in HIV+?

A

CMV

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72
Q

What are ECG findings of afib with RVR?

A

Narrow-complex tachy, irregularly irregular, no organized P waves

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73
Q

What is lidocaine used for in cardiology?

A

Antiarrhythmic for ventricular arrythmia

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74
Q

What is paroxysmal supraventricular tachycardia?

A

Sudden-onset, regular, narrow-complex tachycardia. Use adnosine or carotid sinus massage

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75
Q

Cerebral lesions cause gaze deviation_

A

toward side of the lesion

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76
Q

Pontine and thalamic lesions cause gaze deviation_

A

Away from side of the lesion

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77
Q

Sx of ruptured berry aneurysm?

A

H/a, impaired arousal, seizure, meningismus

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78
Q

Describe lab values of SIADH

A

Euvolemic hyponatremia, decr serum osm, incr urine osm

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79
Q

Pleural effusion on R suggests

A

Hepatoic hydrothorax 2/2 cirrhosis

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80
Q

Moderately elevated AST, ALT, alk phos suggestive of

A
  1. infiltratitive (ie. cancer) 2. cholestatic dz
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81
Q

What are blood test signs of cirrhosis?

A

Thrombocytopenia, coagulopathy

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82
Q

What can cause refractory hypokalemia despite repletion?

A

Hypomag

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83
Q

What is the rx for mild hypovolemic hypernatremia?

A

5% dextrose in 0.45% NS

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84
Q

What is the rx for severe hypovolemic hypernatremia?

A

9% NS (will still be hypotonic in comparison)

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85
Q

What is the rx for hypervolemic hypernatremia?

A

5% dextrose in water

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86
Q

What is the goal rate of sodium correction?

A

no more than 1 mEq/L/h

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87
Q

Which 3 labs are elevated in rhabdo?

A

CK, myoglobin, K+

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88
Q

What are 2 risk factors for rhabdo?

A
  1. immobilization (direct msucle damage) 2. cocaine vasoconstricts –> ischemia, seizure, agitation, hyperpyrexia, myocyte toxicity –> muscle breakdown
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89
Q

Are cholesterol stones visible on xr?

A

No, they’re radiolucent.

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90
Q

What is pathophysiology of pernicious anemia?

A

Autoimmune disorder. Anti-intrinsic factor antibodies

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91
Q

True cirrhosis is characterized by the presence of

A

regenerative nodules

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92
Q

What are the 3 stages to alcoholic liver dz?

A
  1. Fatty liver 2. Alcoholic hepatitis (Mallory bodies, neutrophil infiltration, liver cell necrosis, perivenular distribution of inflammation). 3. Cirrhosis
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93
Q

What is vitamin def seen with serotonin syndrome?

A

Niacin (due to decr tryptophan used to make serotonin instead)

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94
Q

How can AKI cause metabolic acidosis?

A

Non-anion gap: 1. impaired H+ secretion 2. ammonia generation 3. bicarb reabsorption. # anion gap: retention of uremic toxins –> encephalopathy

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95
Q

How does GI bleed cause elevated BUN?

A

Metabolism of blood proteins –> urea. Pts have NORMAL anion gap compared to AKI –> uremic toxins

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96
Q

What are the 2 interventions tha decrease mortality in COPD?

A

Home O2, smoking cessation

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97
Q

Odds ratio from case-control studies is a good approximation of

A

Relative risk if the outcome is uncommon (rare disease assumption)

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98
Q

Young obese female with a headache

A

Suspect benign intracranial hypertention w/ nl MRI and CSF. Aka pseudotumor cerebri. Caused by impaired absorption of CSF

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99
Q

What are neuro signs for pseudotumor cerebri?

A

Papilledemia, visual field defects, sometimes CN VI palsy

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100
Q

What is the most significant complication of pseudotumor cerebri?

A

Blindness

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101
Q

Pts with new thrombocytopenia should get what lab test?

A

HIV, HCV

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102
Q

What are clinical findings in chronic HIV infx?

A

Oral candida, Peripheral neuropathy, FUO, LAD, etc

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103
Q

Sx of delayed sleep phase syndrome?

A

Pts describe selves as night owls, chronic problems sleeping at socially accepted time, normal when allowed to set own schedule

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104
Q

Pt w/ stone. Urinalysis shows hexagonal crystals. Urinary cyanide nitroprusside is +. Stones are hard and radioopaque. What is cause?

A

Cystinuria: abn amino acid transport in renal tubular and intestinal epithelium

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105
Q

Ddx for fever, night sweats, productive cough, weight loss

A
  1. chronic infx 2. malignancy 3. rheum
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106
Q

Fever, weight loss, lytic bone lesions, well-circumscribed, verrucous, crusted skin lesions

A

Blasto

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107
Q

Eyes: microaneurysms and hemorrhages, macular edema

A

DM retinopathy

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108
Q

Eyes: multiple sores in macular region or new blood vessels that leak/bleed/scar the retina

A

Macular degeneration

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109
Q

What is a lab abnormality caused by hypothyroidism?

A

Hyperlipidemia - met imbalance
# Hyponatremia - decreased free water clearance
# elevated CK and AST and ALT

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110
Q

Complicated pleural effusion defined as

A

pH

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111
Q

HHS typically presents with (3)

A
  1. hyperosm 2. vol depletion 3. severe hypoglycemia w/o ketone
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112
Q

How does dehydration cause HHS?

A

Decr GFR (decr glucose excretion) –> activate counter-reg hormones (incr glucose production, impair utilization) –> hyperglycemia (pts have enough insulin to prevent ketosis)

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113
Q

Dx of HHS

A

Serum glucose >600, plasma osm >320, absent ketons

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114
Q

What is Zollinger-Ellison?

A

Gastrin-secreting tumor of pancreas/duodenum. Acid hypersecretion –> ulcers in distal duodenum, jejunum

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115
Q

What is the most common cause of hc-associated endocard?

A

Staph

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116
Q

Bug of endocard after nosocomial UTI?

A

Enterococci

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117
Q

What is #1 cause of death in endocarditits?

A

CHF

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118
Q

What are the 2 preferred therapies for hep B?

A

(Check hep B viral load!) 1. Entecavir, 2. Tenofovir

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119
Q

Which patients are less likely to respond to hep B therapy?

A

Pts w/ normal ALT

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120
Q

When do you use interferon for hep B?

A

Younger pts w/ compensated liver dz, short-term

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121
Q

Rhizopus found where in DM pts?

A

Paranasal sinuses, extend to orbit and brain

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122
Q

Granulations in L ear canal, facial asymmetry, downward deviating side of mouth concerning for

A

Malignant otitis externa –> osteo of skull, CN damage

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123
Q

Unilateral acoustic neuroma after 40 y.o. assoc w/

A

NOTHING

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124
Q

Daily oral theophylline used as

A

Alt adjunctive for any form of asthma except mild intermittent

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125
Q

Which meds may cause NMS?

A

Typical and atypical antipsych

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126
Q

All pts complaining of wheezing and other complaints of asthma should be screened for

A

GERD, as 75% of asthma pts also have GERD

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127
Q

Think GERD-induced asthma if

A

Sx worse after meals, exercise, laying down

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128
Q

Antidote for CN poisoning?

A

Hydroxocobalamin or sodium thiosulfate

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129
Q

Which antibodies (2) for celiac?

A

Anti-endomysial and anti-tissue transglutaminase

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130
Q

Long-term NSAIDS can cause these 2 conditions

A
  1. CKD 2/2 tubulointerstitial nephritis 2. hematuria 2/2 papillary necrosis
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131
Q

Difference in murmurs of papillary muscle rupture vs. ventricular septal rupture

A

Both have pansystolic murmur. Papillary rupture - heard loudest at apex w/ radiation to axilla (mitral regurge). Ventricular septal rupture - best heard at L sternal border, oft accomp thrill

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132
Q

Ddx of peripheral edema

A

CHF
# Liver dz
# Renal dz
# Venous insufficiency
# Side effect of dihydropyridine CCB (amlodipine)

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133
Q

Bloody diarrhea in HIV pt?

A

CMV colitis - see ulcers

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134
Q

Cutoff size for lung nodule just to warrant obs

A

3cm or less

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135
Q

What are the most common causes of AL and AA amyloid?

A

AL => MM. AA => RA.

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136
Q

Lumbar spinal stenosis is painful with

A

walking and lumbar extension

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137
Q

Lumbar disk herniation is painful with

A

siting and lumbar flexion

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138
Q

Causes of digital clubbing

A

Malignancy, CF, R-to-L cardiac shunts

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139
Q

Change in Ca2+ 2/2 alkalosis?

A

Incr in Ca2+ bound to albumin

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140
Q

Cervical LN > 2.0 cm associated with

A

greater likelihood of malignancy or granulomatous dz

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141
Q

Otosclerosis - hearing loss due to bony overgrowth of stapes - charcteristic

A

Low-freq hearing loss, in middle-aged individuals

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142
Q

Murmur worsens in pts with hypertrophic cardiomyopathy w/ maneuvers that

A

decrease preload –> smaller LV volume –> more obstruction

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143
Q

What are first line agents for hypertrophic cardiomyopathy?

A

BB or CCB to slow the heart and prolong diastole

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144
Q

MOA of nitrates?

A

“lmNOP” - Nitrates lOse Preload - primary venodilator

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145
Q

MOA of digoxin?

A

Positive inotrope

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146
Q

Upper vs. lower throacic spinal cord?

A

Dermatomes: upper = nipples, lower = umbilicus

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147
Q

Does hyper or hypocalcium cause stones?

A

Both!! Decr dietary ca –> Incr oxalate absorption in gut –> incr excretion in urine that binds to urinary Ca

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148
Q

Subacromial bursitis is seen with and presents as

A

Result of repetitive overhead motion of arm, pain w/ internal rotation and forward flexion of shoulder

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149
Q

What are the criteria for Behcet’s syndrome?

A

Recurrent oral ulcers and 2 of the following: recurr genital ulcers, eye lesions (uveitis), retinal vascularization, skin lesions, +pathergy test

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150
Q

Pts w/ CKD have hypocalcemia

A

Because unable to form 1,25 vit D –> decr intestinal absorption of Ca

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151
Q

Anterior uveitis vs. keratitis vs. episcleritis

A

Anterior uveitis: conjuctival inflammation, but cornea usu spared
# Episcleritis: common cause of red eye that’s localized, patchy, mild pain and d/c. Doesn’t affect vision or cornea
Conjunctivitis = no cornea. Keratitis = yes cornea

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152
Q

Positive straight leg test suggests

A

Disk herniation

153
Q

Perianal area is not intact

A

Cauda equina syndrome (S2-S4). S for Sly wink

154
Q

Characteristics of analgesic abuse nephropathy

A

Primarily tubulointerstitial, focal glomerulosclerosis

155
Q

Signs/sx of ADPKD

A

Most asymptomatic. But hematuria, flank pain, htn, proteinuria, CKD, palpable abd mass

156
Q

Tx for ADPKD?

A

Follow BP and renal fn. Prefer ACE inhibitors.

157
Q

UC is associated with this other autoimmune dz

A

Primary sclerosing cholangitis (90% of PSC have IBD)

158
Q

Presentation of polyarteritis nodosa?

A

Systemic (fever, malaise, weight loss), neuropathy, hep B assoc, arthralgias/myalgias, cutaneous (livedo reticularis), renal dz

159
Q

Which autoimmune condition of common bile duct more common in women?

A

pBc before pSc

160
Q

What are seen with thrombotic microangiopathy?

A

Commonly seen with TTP, HUS, and DIC. Pts have thrombocytopenia and microangiopathic hemolytic anemia.

161
Q

Mild thrombocytopenia, giant platelets, bleeding out of proportion to degree of thombocytopenia

A

Bernard-Soulier syndrome

162
Q

What do nitrites and LE detect?

A

LE = pyuria. Nitrites = E. coli

163
Q

Exertional sx, delayed/diminished carotid pulse (pulsus parvus et tardus), audible S4

A

Aortic stenosis

164
Q

What are major side effects of cyclosporine?

A

Nephrtox, htn, neurotox, glucose intolerance, infx, malignancy, gingival hypertrophy, hirsutism, GI manifestations

165
Q

What are major side effects of tacrolimus?

A

Nephrotox, hyperkalemia, higher risk of neurotox, diarrhea, glucose intolerance, NOT hirsuitism or gum hypertrophy

166
Q

What are major side effects of azathioprine?

A

Dose-related diarrhea, leukopenia, hepatotox

167
Q

What is the major toxicity of mycophenolate?

A

BM suppression

168
Q

Why hypoxia in astham exacerbation?

A

Hyperventilation –> V/Q mismatch –> decr pO2

169
Q

pCO2 levels in asthma exacerbation are_

A

Low initially with tachypnea, then normal/high w/ retention or muscle fatigue

170
Q

Chlordiazepoxide is used for

A

Treating EtOH withdrawal in hospitalized pts

171
Q

Naloxone is used for

A

Narcotic overdose

172
Q

Why UTI in young infants?

A

Bacteria can disseminate hematogenously to the kidneys via renal artery

173
Q

What are the signs of impending strangulation in an SBO that warrant surgical exploration?

A

Fever, tachycardia, leukocytosis, metabolic acidosis

174
Q

What is lidocaine used for?

A

Ventricular arrhythmias. When used ppx, it may decr frequency of VPB and risk of vfib, but overall prognosis unaffected, and can incr risk of asystole

175
Q

Lewy body dementia vs. Alzheimer’s dimentia

A

Lewy body: fluctuating cognitive impairment, visual hallucination
# Alz: memory loss –> impaired judgment, personality changes –> +/- psychosis

176
Q

Tx for Prinzmetal’s angina?

A

CCB or nitrate

177
Q

What are the most common causes of AR?

A

Rheumatic heart dz, aortic root dilation, congen bicuspid valve

178
Q

What is the characteristic water hammer pulse of AR?

A

Rapid, abrupt upstroke w/ rapid collapse of periph pulse. Due to wide pulse pressure

179
Q

What predisposes patients to molluscum contagiosum?

A

Cellular immunodef, corticosteroid use, chemo

180
Q

What are the electrolyte abnormalities of tumor lysis syndrome?

A

HypER phos and K as they’re intracellular, hyPO calc as it is bound to excess phos

181
Q

Why are typical EKG features of acute pericarditis absent in uremic pericarditis?

A

Lack of involvement of epicardium

182
Q

What are the typical ECG features of acute pericarditis?

A

Diffuse concave upwards Stsegment elevation, PR depression

183
Q

What are the indications for urgent dialysis?

A

“AEIOU”
# Acidosis - met acidosis pH 6.5) hyperK
# Ingestion - toxic alcohols, salicylate, lithium, valproate
# Overload - vol overload refractory to diuretics
# Uremia - sympatomatic (encephalopathy, pericarditis, bleed)

184
Q

What’s initial tx of choice for acute viral/idiopathic pericarditis?

A

NSAID + colchicine

185
Q

What are the types of antipsychotic extrapyramidal effects?

A

Acute dystonia - sustained twisting/abnormal
# Akathisia - subjective restlessness
# Parkinsonism - gradual-onset tremor, rigidity, bradykinesia

186
Q

Permethrin cream is used for this skin condition

A

Scabies

187
Q

Dapsone is used for this skin condition

A

Dermatitis herpetiformis, leprosy (when combined with rifampin)

188
Q

Tx of choice for uric acid stones?

A

Potassium citrate to alkalinize urine

189
Q

What are sx of intracranial htn?

A

Headache (worse @ pm, change w/ position), n/v, mental status changes

190
Q

What are signs of brainstem compression?

A

Cushing reflex: 1. htn, 2. bradycard, 3. resp depression

191
Q

What are causes of intracranial htn?

A

increased volume of any of 1. brain parenchyma 2. CSF 3. blood

192
Q

What can be used for SIADH unresponsive to fluid restriction and high salt intake?

A

Demeclocycline

193
Q

What is Felty syndrome?

A

Clinical disorder seen in pts w/ >10 yrs of RA - neutropenia AND splenomegaly

194
Q

What is De Quervain tenosnovitis?

A

Classically effects new mothers (she made the Daquiri in Vain). Effects abductor pollicis longus and extensor pollicis brevis –> stretch elicits pain. Due to thumb abducted + extended

195
Q

What is cardiac asthma?

A

Wheezing due to heart failure

196
Q

Pt w/ SOB w/ ABG showing hypoxia, hypocapnia, and resp alk

A

Most likely 2/2 CHF (rather than COPD, which is resp acidosis)

197
Q

ABG for PE?

A

Hypoxemia, resp alkalosis, widened A-a gradient

198
Q

Patients with worsening CHF will have these PE signs

A

Decreased breath sounds at bases from pleural effusions, bibasilar crackles, wheezing

199
Q

What is the neoplasm assoc w/ MG?

A

Thymoma

200
Q

How to distinuguish MG from muscle problem?

A

Normal CK w/ MG

201
Q

Transcutaneous pacing is used for management of

A

symptomatic bradycardia

202
Q

What are 2 options for pharm cardioversion?

A

amiodarone and quinidine

203
Q

Where’s most frequent loc of ectopic foci that cause AFib?

A

Pulm veins

204
Q

Where’s most frequent cause of aflutter (anatomically)?

A

Reentrant circuit around tricuspid annulus

205
Q

Define AVNRT (atrioventricular nodal reentry tachycardia)

A

Reentrant circuit made by 2 separate conducting pathways w/in AV node. = Paroxysmal SVT

206
Q

What causes hydatid cyst (round big cyst w/ daughter cysts within, in the liver)

A

E. granulosus (a type of tapeworm due to sheep strain)

207
Q

What is the cause of trigeminal neuralgia?

A

Unknown. Tx: carbamazepine

208
Q

What is carotidynia?

A

Neurologic condition caused by inflamm of carotids and vagus

209
Q

0.1-0.5% pts w/ hep B will develop fulminant hepatic failure, defined as

A

Hepatic encephalopathy that develops w/in 8 weeks of onset of acute liver failure. Tx: emergent liver transplnt.

210
Q

Use FFP for

A

Active bleeding, not ppx

211
Q

What is used in tx of acute hep B?

A

Interferon alpha, Lamivudine

212
Q

Lab values in microangiopathic hemolytic anemia, prosthetic distruction?

A

Decr haptoglobin, incr LDH, incr bili

213
Q

Screening recommendation for osteoporosis?

A

One-time bone scan for all women >= 65. Repeat scanning protocols unclear atm

214
Q

What is Winter’s formula?

A

Arterial pCO2 = 1.5*HCO3 + 8 +/- 2

215
Q

Elderly patient with bone pain, renal failure, hypercalcemia

A

Multiple myeloma until proven otherwise. Paraproteinemia

216
Q

What is a hepatic hydrothorax?

A

Plerual effusions in liver patients not secondary to underlying cardiac or pulmonary abnormality. Thought to occur 2/2 small defects in diaphragm –> permit abd ascites to pass into pleural. Rx: diuretics_ TIPS_ liver transplant

217
Q

Lambert-Eaton causes not only musc weakness but also

A

Loss of DTR

218
Q

How does stress triger HHS?

A

Incr serum cortisol and catecholamine levels, which are insulin counterregulatory hormones

219
Q

Young healthy patient who develops CHF

A

Viral myocarditis (esp Coxsackie B)

220
Q

How does pneumocystis penumonia present?

A

Dry cough, dyspnea. Cxr usu demonstrates bilateral diffuse infiltrates, pleural effusion not a common finding

221
Q

What are secondary causes of restless legs syndrome?

A

Iron deficiency anemia
# Uremia (ESRD, CKD)
# DM
# MS, Parkinson
# Pregnancy
# Drugs - entidepressants, metoclopramide (dopamine antag)

222
Q

What is the tx for persistent-severe symptoms of restless legs?

A

First-line: dopamine. Alternate: alpha-2-delta ca channel ligands

223
Q

What is the most common cause of chronic MR in developed countries?

A

Mitral valve prolapse, due to myxomatous degen of MV leaflets/chordae. May also be 2/2 calcification in elderly

224
Q

Pts w/ paget disease of bone usu asymptomatic, but may show

A

H/a, deafness, neuropathy (2/2 nerve impingement), bone pain

225
Q

TIPS is used to

A

Reduce portal pressure

226
Q

How can proteinuria develop from endocarditis?

A

Immune complex dz or septic emboli

227
Q

Todd’s palsy is usually preceded by

A

a focal motor seizure

228
Q

What are common drugs (2) that may trigger asthma?

A

Aspirin and beta block

229
Q

What is the tx of choice for renal artery stenosis 2/2 fibromuscular dysplasia?

A

Percutaneous angioplasty w/ stent placement

230
Q

Canon waves

A

AV block (ie. 3rd degree)

231
Q

Where in the axial skeleton does RA affect?

A

Cervical spine joints

232
Q

What are the sx of vascular dementia (aka stroke)?

A

Stepwise decline, early executive dysfunction, cerebral infarct or other deep white matter changes on neuroimaging

233
Q

Lentigo simplex

A

Due to intraepidermal melanocyte hyperplasia

234
Q

Mole screening mnemonic

A

Asymmetry, Border irregularities, Color variegations, D >6mm, Enlargement

235
Q

What is uremic coagulopathy?

A

Abnormal hemostasis in pts w/ CKD. Several uremic toxins have been implicated in pathogenesis of platelet dysfunction (chiefly guanidinosuccinic acid) –> platelet DYSFUNCTION
# DDAVP is tx of choice

236
Q

Are platelet counts affected in DIC?

A

Yes –> low platelets

237
Q

Tx of Lyme?

A

Doxy, UNLESS children or pregnant/lactating women –> amoxicillin

238
Q

Pulsitile h/a associated with nausea, awaken pt from sleep

A

Pseudotumor cerebri = idiopathic intracranial htn. Pts have no focal neuo signs (except CN VI palsy), norm CSF.
# Tx = acetazolamide

239
Q

Is there a screening test for ovarian cancer?

A

Pelvic u/s and CA125 antigen only for symptomatic pts

240
Q

What are most common signs of hemophilia?

A

Recurrent hemarthrosis, sk musc hemorrhage, +/- hematuria

241
Q

How can vasospasm after a subarachnoid hemorrhage (SAH) be prevented?

A

Nimodipine

242
Q

A woman w/ irregular vaginal bleeding, enlarged uterus, and pelvic pain post-partum.

A

Suspect gestational trophoblastic dz (which includes choriocarcinoma vs. gestational trophoblastic neoplasia). Choriocarcinoma is highly metastatic to lungs.
# Detect with beta-HCG

243
Q

In treating a pt w/ both sildenafil and alpha-block, separate by at least 4 hrs to

A

reduce risk of hypotn

244
Q

What skin condition has dimpling in the center when area is pinched?

A

Dermatofibroma

245
Q

Warm, swollen limb after starting heparin

A

HIT - usu occurs 5-10 d after starting heparin, and pts are prone to thrombosis (venous > arterial)

246
Q

What test is effective in screening for pancreatic ca in asymptomatic adults?

A

Nothing :(

247
Q

Multiple episodes of thrombosis w/o clear precipitate should raise concern for hypercoag 2/2_

A

If young: genetic defect. Otherwise: primary malignancy (particularly visceral adenocarcinomas (gastric, pancreatic, ovarian)

248
Q

What is preferred screening test for MEN 2?

A

PCA-based genetic testing with peripheral blood

249
Q

What is a pathologic abnormality seen in UC and Crohn’s?

A

Neutrophilic cryptitis (transmural in Crohn’s). Also, while usu presents around age 20, 2nd peak ~60 (bimodal)

250
Q

Common signs/sx of malignant hyperthermia?

A

Hypercarbia, sinus tachy, musc rigidity, high CK, hyperthermia

251
Q

Common signs/sx of thyroid storm?

A

Tachycard, htn, arrythmias. High fever, tremor, AMS, lid lag.
# May see in pts after acute illness, iodine contrast, surgery

252
Q

Modified CHADS2 score?

A

CHA2DS2VASc. V=vascular dz, A65-74 (vs. first A is >74), Sex

253
Q

How does acute pancreatitis cause ARDS?

A

Pancreatitis –> incr [pancreatic enzymes] –> leak across pulm capillaries –> damage surfactant in alveoli

254
Q

ARDS is dx of exclusion. What test is needed?

A

Echo needed to exclude hydrostatic pulm edema in pts w/o ARDS risk factors

255
Q

Circopharyngeal dysfunction

A

Due to failure of cricopharyngeus to relax during swallowing. Sx: choking, food-sticking, pain w/ swallow. Dx: video fluoroscopic swallow study

256
Q

Accurate = this other term

A

Valid

257
Q

Specificity and sensitivity are measures of

A

Validity

258
Q

5 causes of dilated HF?

A

Viral, Ischemic, EtOH (reversible), Cocaine, Chagas. “Don_t touch that TV dial as Miami VICCE is on.”

259
Q

3 causes of diastolic HF?

A

Htn, hemochromatosis (reversible), amyloid

260
Q

Prinzmetal’s angina is assoc with which 2 other vasospasms?

A

Raynauds, mgraine h/a

261
Q

EKG of Prinzmetal’s?

A

Transient ST elevations (vs. ST dep seen in unstable angina)

262
Q

Tx of Prinzmetal’s?

A

CCB or nitrates

263
Q

What is intermittent claudication?

A

Leg pain occuring w/ exercise 2/2 atherosclerotic narrowing of arteries feeding leg - similar mech to typical angina

264
Q

What are 2 complications of mono?

A
  1. Autoimmune hemolytic anemia 2. Thrombocytopenia
265
Q

Diffuse, confluent erythematous macules on trunk and extremities

A

TSS

266
Q

What is the 1st line therapy for torsades - HD stable?

A

Mg SO4

267
Q

CSF of Guillain Barre?

A

Incr protein, everything else normal.

268
Q

Tx for Guillain Barre?

A

IVIG or plasmapheresis

269
Q

Elevated EKG voltage

A

LVH

270
Q

New htn tx options

A
  1. D/c offending agents (ie. OCP can cause htn) 2. Consider diet and exercise (but less effective in nonobese) 3. low-dose HCTZ
271
Q

Why is NaHCO3 used ot treat cardiac toxicity in TCA o/d?

A
  1. Incr serum pH and 2. extracellular Na to alleviate cardio-depressant action on Na channels
272
Q

What is a common side effect of methotrexate (a dz-mod drug)

A

Macrocytic anemia

273
Q

What is normal JVP?

A
274
Q

What is MOA of ursodeoxycholic acid for cholelithiasis?

A

Bile salt. It reduces hepatic secretion and intestinal reabsorption of cholesterol. Used to disolve small gallstones

275
Q

Preferred treatment for Graves, and contra?

A

Radioactive iodine therapy. Pregnancy, severe ophthalmopathy

276
Q

Blood smear shows spherocytotis. Ddx?

A

Autoimmune hemolytic anemia vs. hereditary spherocytosis

277
Q

LE DVTs are divided into 2 categories:

A
  1. Proximal deep veins (iliac, femoral, popliteal) cause >90% of acute Pes. 2. Calf veins
278
Q

What med can be used in cystitis but not pyelo?

A

Nitrofurantoin

279
Q

What is Whipple’s dz?

A

Infection that can cause multi-systemic illness. Can cause (non-GI): chronic cough, myocard/valvular involvement, arthritis

280
Q

PAS + material in lamina propria of small intestine

A

Whipple’s dz

281
Q

Steps for melanoma.

A

If depth of lession 1mm depth –> sentinel LN study

282
Q

Use dependence with 1C antiarrhythmics?

A

Decr in impulse conduction w/ incr HR –> Widening QRS

283
Q

Use dependence with IV antiarrhythmics?

A

Prolonged refractory pd of AV node –> incr PR interval

284
Q

Development of CHF from MI?

A

After MI, ventricular remodeling occurs –> dilation of LV w/ thinning of ventricular walls –> CHF. ACE inhibitors inhibit this, thus start w/in 24h of pt’s MI.

285
Q

Ppx for transplant pts (4)?

A
  1. PO TMP-SMX –> prevent Pneumocystis pneumonia (PCP)
  2. Vacc vs. influenza
  3. Pneumococcus
  4. Hep B
286
Q

Workup for dysphagia?

A

Upper GI endoscopy –> barium swallow. Unless motility disorder, then barium swallow first –> esophageal motility study

287
Q

Pt has tender, erythematous, palpable cord-like veins on L arm and upper chest. Indicates

A

Superficial thrombophlebitis = Trousseau’s syndrome. Hypercoag d/o as seen w/ ca of pancreas (most common), lung, prostate, stomach, colon, acute leukemia.

288
Q

Causes of non-menstrual TSS

A

Surgical wound infx, sinusitis, septorhinoplasty

289
Q

What meds should be held prior to a stress test?

A
  1. BB, 2. CCB, 3. Nitrates
290
Q

Common cause of non-asthma wheezing

A

Bronchitis

291
Q

What is a common side effect of chloroquine?

A

Eye (retinopathy, corneal damage)

292
Q

What are some signs of hypertensive emergency involving kidneys and heart?

A

Renal failure, signs of congestive heart failure

293
Q

Metabolism of nitroprusside releases_

A

NO and CN ions

294
Q

CN toxicity sx

A

AMS, lactic acidosis, seizures, coma

295
Q

What is most common cause of nursing home pneumonia?

A

S. pneumo

296
Q

Myocytes causing esophageal spasm (which is a type of motility disorder) can be relaxed by (2)

A

Nitrates, CCB

297
Q

What does pulmonary capillary wedge pressure measure?

A

LA pressure - aka preload

298
Q

Weakness, tremors, palp, h/a after albuterol treatment?

A

B2 agonists drive K into cell –> may cause hypokalemia

299
Q

T/F: In ARDS, pulm arterial pressure is increased.

A

True in 25% pts with ARDS - due to hypoxic vasoconstriction, compression of vascular structures from pos pressure, and lung parenchymal distruction

300
Q

What are the presentation signs for MM?

A

CRAB: # hyperCalcemia, # Renal impairment, # Anemia, # Bones - pain, lesions, fractures

301
Q

Pts w/ MM are at incr risk of infx b/c

A
  1. Tot decr in fnl Ig and 2. Leukopenia as BM filled w/ plasma cell
302
Q

What is superior vena cava syndrome?

A

Impairment of blood drainage from head/neck/upper extr, usu 2/2 malignancy vs. thrombosis from indwelling cath

303
Q

What is the compensatory response of the kidney to bicarb retention in OSA?

A

Increased bicarb retention and decreased chloride

304
Q

Impaired bone mineralization due to

A

Most commonly, severe vit D deficiency (osteomalacia)

305
Q

Loss of distal peristalsis of esophagus

A

Scleroderma

306
Q

Lower esophageal sphincter doesn’t relax

A

Achalasia

307
Q

If OA refractory to acetaminophen, consider

A

Ketorolac, colchicine

308
Q

Tx for nonallergic rhinitis (congestion, rhinorrhea, sneezing, post nasal drip w/o eye sx, no obvious allergic trigger)

A

Intranasal antihistamine, glucocorticoids, or both

309
Q

What is myasthenia crisis?

A

Char by diplopia, ptosis, weakness of proximal muscles, weakness of bulbar muscles and diaphragm –> resp distress. Tx: intubation, AChE inhib (pyridostigmine), add steroids + IVIG or plasmapheresis. Sx improve with edrophonium - worsens with MG cholinergic crisis

310
Q

3ad of mono

A

Fever, cervical lad (posterior), pharyngitis

311
Q

Fasciulations - UMN or LMN?

A

Lower!!!

312
Q

Spasticity, bulbar sx

A

UMN

313
Q

45 yo m w/ excessive wasting of extremity muscles, weakness began distally and asymmetrically. Difficulty with facial/throat movements. Fasciculations and hyperreflexia of all extremities.

A

ALS

314
Q

Hx of anticoagulation, sx of weakness/dizziness, and anemia/tachycardia should raise concerns for

A

Internal hemorrhage

315
Q

The risk of bleeding while on warfarin greatest in pts w/

A

DM, age >60, htn, EtOH abuse

316
Q

Enoxaparin (LMWH), fondaparinux, rivaroxaban can’t be used in pts w/

A

Severe renal insufficiency (GFR incr anti-Xa activity and bleeding risk

317
Q

Diff btw CNIII neuropathy 2/2 DM vs. compression

A

Diabetes - affects only somatic fibers. Therefore accommodation and response to light remain intact.

318
Q

Membranoproliferative glomerulonephritis is assoc with this liver infx

A

Hep C

319
Q

Renal vein thrombosis presents with

A

Abd pain, hematuria

320
Q

Which med o/d can cause anti-cholinergic effects, and tx?

A

Diphenhydramine. Tx: physostigmine

321
Q

Sx of theophylline o/d

A

Seizure, hyperthermia, cardiac arrhythmia, hypotn

322
Q

Which rx decr frequency of relapse and reduces diability in pts w/ relapsing-remitting form of MS?

A

Interferon-beta. What is used in acute attack? High dose steroids

323
Q

Causes of v. high AST and ALT?

A

Think toxin, viral, ischemic

324
Q

3ad of ascending cholangitis? (Charcot’s 3ad)

A

Fever, severe jaundice, RUQ abd pain. Think of Ms. Gill!

325
Q

5ad of ascending cholangitis?

A

Charcot triad + confusion and hypotn = Reynold’s 5ad

326
Q

What is the diagnostic test of choice for MS?

A

MRI. Then CSF (not serum) will show oligoclonal IgG bands in >95% pts

327
Q

What are signs of post-transfusion acute hemolysis?

A

Fever, chills, flank pain, hemoglobinuira w/in 1 hr of transfusion, may progress to renal failure, DIC. +Coombs, plasma free Hb >=25

328
Q

Tx options for Legionella?

A

Macrolides, fluoroquinolones

329
Q

Febrile illness with cervical lymphadenopathy. Can be mono vs. HIV. How to distinguish?

A

Mono - tonsillar exudate more common. HIV - rash, diarrhea more common

330
Q

Lab findings of bowel ischemia?

A

Leukocytosis, elevated amylase, metabolic acidosis from increased lactate

331
Q

What is first line treatment for stable angina?

A

Beta blocker. Can combine with CCB and niatrates for persistent

332
Q

What are side effects of metoclopromide?

A

Agitation, loose stool, extrapyramidal

333
Q

Positive predictive value =

A

TP / (TP + FP)

334
Q

What symptoms suggest agranulocytosis in pts taking PTU? Regular CBC is not recommended.

A

Fever, sore throat

335
Q

Med options for toxo?

A
  1. Ppx: TMP-SMX. 2. Rx: Sulfadiazine, pyrimethamine
336
Q

Which lung cancer causes paraneoplastic ACTH or SIADH?

A

Small cell

337
Q

Which lung cancer causes hypercalcemia?

A

sCa2+mous

338
Q

Aspergilloma looks like

A

Mobile, intra-cavitary mass w/ air crescent in periphery

339
Q

Secondary malignancies are common in pts w/ PMH Hodgkin lymphoma 2/2 chemo and/or radiation in

A

Lung, br, thyroid, bone, GI, leukemia

340
Q

MMSE of less than_ suggests dementia

A

24

341
Q

Pt w/ mild DM, migratory erythema, diarrhea, anemia, weight loss

A

Glucagonoma

342
Q

Signs of benzo intoxication

A

Drowsiness, slurred speech, unsteady giat

343
Q

Important sign of opioid (ie. heroin) intoxication

A

Depressed RR

344
Q

What is metabolic syndrome that predisposes to hyperglyc?

A

Htn, dyslipidemia, abd obesity

345
Q

Why folate def in pts with sc?

A

Pts compensate for hemolysis by increasing rbc production, recommend folate supp

346
Q

What’s alternative to penicillin for syphilis?

A

Doxy, unless preggers, then desensitizatoon

347
Q

What’s most effective in lowering sbp?

A

dash diet

348
Q

How to distinguish btw hematuria from glomeruli vs not?

A

Blood and protein with glomerular

349
Q

Risks for papillary necrosis?

A

mnemonic nsaid- nsaid, sickle cell, analgesic, infection(pyelo), diabetes

350
Q

Nephrotic syndrome in the setting of palpable kidneys, hepatomegaly, and ventricular hyper trophy given chronic inflammatory dz

A

Secondary amyloidosis

351
Q

Acute back pain and point tenderness after a fall

A

Vertebral compression

352
Q

What must be avoided in pts w/ cocaine cardiomyopathy?

A

BB

353
Q

Lambert eeeeeaton affects which part of nerve?

A

Preeeesynaptic

354
Q

What is Alprazolam used for?

A

Short acting benzo to tx panic attacks, anxiety

355
Q

What is amitriptyline used for?

A

Neuropathic pain, depression

356
Q

Secondary amyloidosis (AA) can cause multi-organ dysfn. Tx?

A

Colchicine for both tx and ppx

357
Q

Pts w/ nephrotic syndrome have incr risk of accelerated atherosclerosis b/c

A

Elevated LDL and/or low HDL, also hypercoagulable –> incr risk of stroke or MI. Put on statins!!

358
Q

Urinary impairment in pts w/ SCD?

A

Hyposthenuria - impairment in kidney’s ability to concntrate urine. Sickling in vasa rectae of inner medulla –> impair countercurrent exchange and free water reabs

359
Q

MOA of hyponatremia in adrenal insufficiency (2)?

A
  1. Vol contraction 2/2 mineralocorticoid def and 2. incr vasopressin secretion 2/2 lack of cortisol suppression
360
Q

Initial tx of frostbite?

A

RAPID re-warming with warm water

361
Q

First line tx for essential tremor?

A

Propranolol

362
Q

First line tx for Parkinson’s, esp in younger pts?

A

Trihexyphenidyl

363
Q

How to detect HER2 in br ca?

A
  1. immunohistochemical staining 2. FISH
364
Q

Lab values in Cushings?

A

Hypokalemia + hypernatremia. As corticosteroids will hav esome binding to aldosterone receptors in kidney

365
Q

Classic 3ad of disseminated gonococcal infx

A
  1. Polyarthralgia 2. tenosynovitis 3. Painless skin lesions
366
Q

Why microcytic anemia in naproxen use?

A

Incr risk peptic ulcer/gastritis –> chronic GI blood loss –> Fe def

367
Q

Dermatomyositis is also associated with this

A

Malignancy

368
Q

What is most common neuro complication of Lymes?

A

Uni or bilateral CN VII palsy

369
Q

What can decr nephropathy in contrast-induced?

A
  1. Non-ionic contrast agents 2. Adequate IVF 3. Acetylcysteine
370
Q

Tx for MALT lymphoma w/o LN involvement

A

Treat for H. pylori - omeprazole PPI, clarithromycin, amoxicillin

371
Q

What do hep C pts need before starting tx?

A

Liver biopsy - best clinical predictor of dz progression, assess likelihood of response to tx. Pts w/ mod-severe inflamm/fibrosis have higher chance progressing to cirrhosis & respond better to tx

372
Q

Meltzer’s triad of polyclonal cryoglobulinemia?

A

Purpura, arthralgia, weakness

373
Q

What are the criteria for supplemental O2 in COPD?

A
  1. PaO2 55%, 4. Cor pulmonale
374
Q

Which 4 abx commonly cause C. diff?

A
  1. Fluoroquinolones 2. Penicillins 3. Cephalosporins 4. Clinda
375
Q

Why does polycythema frequently cause pruritis w/ hot bath?

A

Histamine release from incr number of circulating basophils

376
Q

In DIC, everything is elevated except (2)

A
  1. Fibrinogen 2. Platelet count
377
Q

What are some pulmonary-renal syndromes (5)?

A
  1. Goodpastures (requires emergency plasmapheresis) 2. Wegener’s 3. SLE nephritis 4. polyarteritis nodosa 5. RPGN
378
Q

What are options for afib rate control?

A
  1. Beta blocker
  2. Diltiazem
  3. Digoxin
  4. Verapamil
379
Q

What are options for afib rhythm control?

A
  1. Amiodarone
  2. Sotalol
  3. Propafenone
  4. Procainamide

Internal Med (1 decks)

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