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Flashcards in Deck 1 Deck (222)
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1

What is a mnemonic for the causes of clubbing?

CLUBBING ABCDEF

Cyanotic heart disease
Lung disease
UC + Crohn's
Biliary Cirrhosis
Birth defects
Infective Endocarditis
Neoplasm
GI malabsorption syndrome (celiac)

Abscess
Bronchiectasis
Cystic Fibrosis
DONT SAY COPD
Empyema
Fibrosis

2

DDx lower GI bleeding

Colorectal cancer or polyps
Diverticulosis
Angiodysplasia
Anorectal disease
Enterocolitis
Brisk bleeding from upper GI
Rectal trauma

**pay particular attention to the hemodynamics lily unstable patient

3

DDx upper GI bleed

1. Ulcerative or erosive processes--> PUD, esophagitis, gastritis
2. Portal HTN
3. Trauma (I.e Mallory Weiss tear)
4. Tumours

4

DDx hemoptysis

1. Airway disease--> inflammatory (bronchiectasis, bronchitis); neoplasms (bronchogenic carcinoma); other (foreign body, trauma)
2. Pulmonary parenchymal disease--> infectious (TB, necrotizing pneumonia); inflammatory/immune (vasculitis); other (coagulopathy)
3. Cardiac/vascular--> PE with infarction; elevated capillary pressure (mitral stenosis, LV failure); AV malformation

5

DDx abdominal distension

1. Ascites--> low serum to ascites albumin ratio = exudative (peritoneal carcinomatosis); high serum to ascites albumin ratio = transudative (portal HTN)
2. Bowel dilation--> mechanical obstruction (adhesions, volvulus); Paralytic (toxic megacolon, neuropathy)
3. Other--> abdominal mass, IBS, organomegaly (hepatomegaly), pelvic mass (I.e ovarian cancer or others)

6

DDx hematuria

1. Glomerular disease--> SLE, hemolytic uremic syndrome, vasculitis
2. Post renal--> stones, bladder tumour, BPH, cystitis
3. Haematological--> coagulopathy, sickle hemoglobinopathy

7

DDx cardiac arrest

CAD
Cardiac conduction abnormalities
Myocardial abnormalities
Non cardiac (I.e PE)

8

DDx chest pain

1. Cardiac
--A. Ischemic --> ACS, stable angina pectoris
--B. Non-ischemic--> aortic aneurysm, pericarditis
2. Pulmonary or mediastinal
--PE or pulmonary infarct
--Pleuritis
--Pneumothorax
--Malignancy
3. GI
--esophageal spasm or esophagitis
--PUD
--Mallory Weiss syndrome
--biliary disease or pancreatitis
4. Anxiety disorders
5. Chest wall pain (I.e costochondritis)

9

DDx dyspnea

1. Cardiac
-myocardial dysfunction (I.e ischemic cardiomyopathy)
-valvular heart disease
-pericardial disease (I.e tamponade)
-increased cardiac output (I.e anemia)
-arrhythmia
2. Pulmonary
-upper airway (foreign body, anaphylaxis)
-chest wall and pleura (pleural effusion)
-lower airway (asthma, COPD)
-alveolar (pneumonia)
3. Central (metabolic acidosis, anxiety)

10

DDx lymphadenopathy

1. Localized
-Reactive (I.e tonsillitis)
-Neoplasticism (metastatic cancer)
2. Diffuse
-infectious (I.e viral)
-inflammatory (I.e sarcoidosis)
-neoplastic (I.e lymphoma)

11

DDx pleural effusion

1. Transudative--> I.e CHF, nephrotic syndrome, cirrhosis
2. Exudative-->
-A. Infectious (parapneumonic, empyema, TB)
-B. Neoplastic (primary, mets, mesothelioma)
-C. Cardiac/vascular (I.e PE, collagen vascular disease)
-D. GI (I.e ruptured esophagus, pancreatitis, chylothorax)

12

DDx hyperkalemia

1. Increased intake (usually associated with low excretion)
2. Redistribution
-A. Decreased entry into cells--> I.e insulin deficiency, beta 2 blockade
-B. Increased exit from cells--> I.e metabolic acidosis, rhabdomyolysis
3. Reduced urinary excretion
-A. Decreased glomerular filtration rate-->I.e acute or chronic kidney disease
-B. Decreased secretion--> I.e aldosterone deficiency, drugs (I.e spironolactone)
**dont forget to order and ECG to look for changes! ("T waves you wouldn't want to sit on")

13

DDx hypokalemia

1. Decreased intake (I.e anorexia nervosa)
2. Redistribution (I.e alkalemia, insulin, beta 2 adrenergic stimulating drugs)
3. Increased losses, either renal or GI (I.e vomiting/diarrhea)

14

DDx weight loss

1. Decreased nutritional intake--> psychiatric disease (anorexia, bulimia, depression), medical disease (chronic illness, esophageal cancer), illicit drugs or meds (alcohol, opiates, cocaine, amphetamines, anti cancer drugs)
2. Increased energy expenditure--> hormonal (I.e hyperthyroid), chronic illness (COPD, HF), malignancy, infection, excessive physical activity (I.e runners)
3. Caloric loss--> malabsorption (I.e diarrhea), diabetes

15

Define heart failure

Occurs when the hearts function as a pump is inadequate to maintain adequate perfusion, or the heart is only able to do so at HIGHER FILLING PRESSURES

SYNDROME not a diagnosis -->must determine underlying etiology

CLINICAL dx, do not need to wait for an echo to diagnose (though an echo can give further info on the underlying pathology behind the clinical presentation of heart failure)

16

What are the two key questions to ask yourself about HF?

1. What type of HF is it
2. What is the etiology

17

what should you ask on history for an upper GI bleed?

1. blood--> hematemesis, coffee ground emesis, melena, hematochezia (if brisk)
2. abdominal pain
3. hx of gerd
4. medications
5. EtOH consumption

18

what to look for specifically on physical exam for an upper GI bleed

1. vitals--> tachy? hypotension or HTN?
2. signs of anemia
3. signs of liver disease
4. FOB

19

investigations for upper GI bleed

CBC and diff
chem-7
LFTs and lipase
INR, PTT, group and screen
urea breath test
serology

20

how would you manage an upper GI bleed?

1. keep patient NPO--> send for EGD--> can be either diagnostic only or therapeutic i.e bleeding control with epinephrine/thermal hemostasis, endoclips, hemospray
2. pantoloc 80 mg IV bolus then 8mg/hr thereafter
3. variceal bleeds require octreotide
4. consider iron supplements and fluids--> transfusion if hemoglobin drops and/or symptomatic and/or large bleed
5. advise patient of lifestyle changes
6. hold offending meds i.e NSAIDs, bisphosphonates, anticoagulants
7. if H. Pylori is a factor--> triple therapy: PPI +amoxicillin + clarithromycin // quadruple therapy: PPI + bismuth + tetracycline +metronidazole

21

DDx for lower GI bleed

Common:
diverticulosis--> CT to assess
ischemic bowel--> lactate and CT angio
infectious--> SECSY bacteria
hemorrhoids, fissure

Less common:
brisk UGIB
IBD (UC>CD)
CRC or bleeding polyps

Other: coagulopathy/thrombocytopenia, post surgical bleed

22

what to ask on history for a LGIB

characterization of blood

abdominal pain

PMHX--cancer, IBD, diverticulosis

medications--anticoagulants, NSAIDs

anemia sx

B symptoms

infection sx

23

what to look for on physical for LGIB

are they hemodynamically stable?--vitals
signs of anemia
abdominal tenderness/masses
rectal exam

24

investigations for a LGIB

CBC and diff
chem 7
PTT, INR, group and screen, lactate
liver panel
stool C+S, FOB
colonoscopy, consider and EGD if suspect UGI etiology
consider angiography if suspect ischemic bowel or vasculitis

25

treatment for LGIB

IV fluids--> transfuse if necessary
hold anti hypertensives and diuretics
consider vitamin K, FFP if needed

26

DDx of chronic/recurrent abdominal pain

1. inflammatory
-PUD
-biliary colic
-IBD
-chronic pancreatitis

2. neoplastic or vascular
-recurrent bowel obstruction
-mesenteric ischemia
-sicke cell anemia

3. toxin
-lead poisoning

4. other
-mittleschmertz
-endometriosis
-porphyria
-IBS
-radiculopathy
-abdominal wall pain syndrome

27

what should you make sure to rule out in acute upper abdo pain?

make sure you rule out thoracic sources like MI, pneumonia, dissecting aneurysm

28

DDx for acute inflammatory diarrhea

1. bacterial
-shigella
-salmonella
-campylobacter
-yersinia
-E. coli (hemorrhagic)
-C. diff

2. protozoal
-entamoeba histolytica
-strongyloides

3. others
-NSAIDs
-IBD
-ischemic

29

define inflammatory diarrha

when there is damage to the mucosal lining or brush border which leads to passive loss of protein rich fluids and a decreased ability to absorb these lost fluids

**blood only found in inflammatory diarrhea

diarrhea may be perfuse or very small in volume

often associated with abdominal pain and fevers/chills

30

define non inflammatory diarrhea

no damage to the mucosal lining... N/V may be present

NOT present: fevers, chills, blood in stool, severe abdo pain or tenderness