IM Flashcards by Stephanie Tilberry

Prevent post-op DVT/PE

Warfarin

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Chest tightness
Nonproductive cough worse at night
B/l end-expiratory wheezes
Underlying mechanism?

Activation of mast cells (asthma)

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Acute unstable angina

Next step?

Admit to hospital for workup

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Acute hypercalcemia

First step in tx?

IV 0.9% normal saline

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55 y/o w hx of HTN
Ripping CP
CXR - wide aortic root, dilated ascending aorta
Most likely cause?

Medial degeneration of the aorta - dissection

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Suspect CVID

Next step in dx?

Serum Ig levels

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Inflammatory arthropathy tx?

Oral NSAID

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Perforated esophagus from upper endoscopy

Next step?

Operative repair of esophageal injury

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B12 deficiency

Mechanism of anemia?

Impaired DNA synthesis

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Best study to evaluate effectiveness of a new therapy

RCT vs standard therapy

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Lipid surveillance for those under 40

Every 4-6 years

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77 y/o F 3 months SOB on exertion
Relief with rest
EKG LBBB unchanged from 1 year ago
Next step to dx SOB?

exercise stress echo

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47 y/o M progressive DOE for 6 months 
Murmur dx'd in high school 
Slow carotid upstroke 
Systolic murmur at RSB radiates to apex 
No change with valsalva 
Paradoxical splitting of S2 
EKG LVH 
Underlying cause of murmur?

Congenital bicuspid aortic valve

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32 y/o G1P1 F w b/l milky breast d/c
Stopped breastfeeding 1 year ago
Elevated prolactin, normal TSH
Tx?

Bromocriptine

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Acid base disturbance in cardiogenic shock?

Primary metabolic acidosis (anion gap lactic acidosis)

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47 y/o M w 4 days of bloating and diarrhea 
watery, non bloody, foul smell 
Recent travel to Middle East 
No F 
Organsim?

ETEC

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ABX tx for pyelo

IV ceftriaxone

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50 y/o M massive hematemesis
Then faint, cold, sweaty
Tachycardia, low BP, low Hct
Next tx step?

Rapid infusion 0.9% isotonic saline (hemorrhagic shock)

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Failure to void after removing indwelling foley

Post-catheter urethral inflammation with resultant acute urinary obstruction

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Acute urinary obstruction tx?

Urologic emergency - place Foley to prevent bladder rupture

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57 y/o F in MVC 
RUE swelling and crepitus 
Extends DIP and PIP joints
Can't extend MCP of wrist 
XR mineshaft fx of humerus 
Dx?

Radial nerve injury

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68 y/o M severe CP 2 hours, SOB 30 minutes
Hx DM2 and HTN
JVD, b/l crackles, S3 and S4 gallop
SpO2 88%
CXR perihilar infiltrates and enlarged silhouette
EKG ST elevations and T inversions V1-V6
Dx?

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65 y/o M w + routine heme occult

Next step in evaluation?

Colonoscopy

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32 y/o F w polyuria, blurry vision, rapid breathing
Tachycardia and tachypnea
Glucose 783
Cause of acidosis?

Accumulation of B-hydroxybutyric acid (DKA)

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27 y/o F w face and leg swelling 2 weeks Face decreases and legs increases over day Low albumin Cause of edema?

Nephrotic syndrome

27 y/o M with MR 3 weeks vomiting after eating Partially digested food and weight loss Area of scalp alopecia Dx and tx?

Gastric bezoar | Supportive tx w EGD or surgery for removal

37 y/o M w F and rash for 2 days after 6 weeks of Nafcillin for staph endocarditis UA findings?

2+ protein, WBC's, eosinophils (acute interstitial nephritis)

23 y/o M w 2 months of pain and swelling above R knee Hx retinoblastoma in infancy tx w enucleation Elevated Alk phos XR lytic lesion with periosteal new bone at margins Dx?

Osteosarcoma

35 y/o F collapsed in restaurant Tachycardic, tachypneic, low BP Labored breathing, diffuse bronchospasm, continuous cough Dx?

Anaphylactic shock

Post-transplant pt w tremor and glucose intolerance Gingival hypertrophy Drug responsible?

Tacrolimus, Cyclosporine (calcineurin inhibitors)

``` 45 y/o F with 3 months of virilization LNMP 4 months ago, 2 prior pregnancies Muscular with large clitoris Temporal balding Next step to evaluate? ```

Testosterone and DHEAS levels (rapid onset hirsutism concerning for androgen-secreting ovarian or adrenal tumor)

46 y/o M with days of intermittent R flank pain Decreased urine output with episodes of high output and generalized weakness Hx of L nephrectomy after MVC years ago Recently started Lisinopril for HTN Cause of sx's?

Urinary outflow obstruction due to renal calculi

Paradoxical S2 split - heard during expiration, disappears during inspiration Causes?

Aortic stenosis, HOCM, LBBB

Wide fixed split S2

ASD

35 y/o African American F w DOE and lightheadedness Hx Raynaud's and GERD Finding on cardiac exam?

RV heave - pulmonary arterial HTN in CREST due to intimal hyperplasia leads to RV enlargement and R heart failure

Increased thirst and urination Low urine osm and spec gravity - dx? High urine osm and spec gravity - dx?

Low - diabetes insipidus (ADH def or resistance) | High - diabetes mellitus (hyperglycemia, osmotic diuresis)

``` 57 y/o M w 4 weeks progressive constant thoracic pain Worse at night when lying down Weight loss and fatigue 40 year smoker No focal TN, FROM Normal strength, DTR's, sensation, XR CBC and Cr WNL Next step in management? ```

Abdominal CT (concern for pancreatic cancer)

56 y/o M w DOE, palpitations, dry cough, LE edema for 1 month Hospitalized for MI 4 months ago Hx HTN, DM2, HLD, asthma, gout JVD, bibasilar crackles, LE pitting edema EKG persistent ST elevations w deep Q waves Dx?

LV aneurysm (progressive LV enlargement and dyskinetic wall)

38 y/o F ran high-altitude marathon, nauseous at the end, vomited twice, GTC seizure Aggressively hydrated before and during race Confused, withdraws to pain, low Na+ Most likely cause?

Hypotonic fluid loading with non osmotic release of ADH | exercise-associated hyponatremia

45 y/o M w epigastric pain and diarrhea Hx of PUD EDG prominent gastric folds w multiple peptic ulcers Next step in management?

Serum gastrin levels (suspect gastrinoma = Zollinger Ellison)

Isoniazid hepatotoxicity management

Severe - d/c drug | Mild subacute hepatic injury - continue tx w close f/u (usually self-limited)

Chronic cough w copious yellow sputum Sinus congestion, hemoptysis, SOB Diffuse rhonchi and wheezes w bibasilar crackles Bacterial exacerbations that improve w abx's CXR linear atelectasis Next step to confirm dx?

High-resolution chest CT - bronchiectasis (bronchial thickening and dilation due to recurrent infection and inflammation)

67 y/o M 2 days of BLE weakness and urine incontinence Prostate CA for 2 years, pelvic mets for 6 months Can't lift legs, no LE DTR's Next step?

MRI of lumbosacral spine (acute cauda equina)

72 y/o F with 1 day of F/C, cough Strep pneumo PNA 1 year ago Right lung base bronchial breath sounds and increased dullness/egophany WBC 87K with 82% lymphocytes Sputum gram stain - G+ lancet diplococci Confirm deficient host defenses?

Quantitative immunoglobulin assay (CLL)

Greatest RF for IPH

HTN | Lisinopril most likely to reduce risk of recurrent IPH

Treatment for choledocolithiasis

ERCP with sphincterotomy followed by cholecystectomy

72-hour test for fecal fat = 12 g/d (2-6) D-xylose absorption 4 mg/dL (25-40) Most likely underlying cause of malabsorption?

Villous atrophy in small bowel | Celiac sprue

``` 57 y/o M with 3-min LOC Felt ill while watching tv Hx HTN, MI 4 years ago EKG - Q waves in II, III, aVF Most likely explanation? ```

Paroxysmal v-tach

Slowing of left eye adduction during saccadic movement of eyes to the right Site of lesion?

Left MLF

PCOS tx if not trying to conceive

Weight loss, OCP's, Metformin

PCOS if trying to conceive

Weight loss, Clomiphene, Metformin

First medication for aortic dissection?

Labetalol

67 y/o M with 2 days of vomiting blood Hx esophageal adenocarcinoma, HTN, DM2, OA, CAD Mechanical aortic valve Getting radiation, makes him tired, naps for hours Strongest indication for anticoagulation?

Prosthetic aortic valve

HIT treatment?

Switch Heparin to direct thrombin inhibitor

Severe hypercalcemia treatment?

IVF, IV bisphosphonate and/or calcitonin

HTN primarily with isolated systolic BP (increased pulse pressure) Most critical factor in etiology?

Decreased vascular compliance

58 y/o M with 3 weeks fatigue and malaise Root canal 5 weeks ago Hx of murmur at 19 y/o Systolic murmur at right second space, S4, ejection click Low hemoglobin and hemoglobinuria Underlying cardiac abnormality?

Calcification of bicuspid aortic valve | aortic stenosis, risk of endocarditis after dental procedure, hemolytic anemia

HHS Glucose - Osmolality - Acidosis - Y/N

Glucose > 500 Osmolality > 320 No acidosis

``` 20 y/o to ED with sore throat Hoarseness and dysphagia for 8 hours Appears toxic with fever Pharyngitis and stridor Next step? ```

Laryngoscopy and ET intubation | epiglottitis

Pancreatic pseudocyst from recurrent acute pancreatitis | Next step in diagnosis?

ERCP for diagnostic and therapeutic function

HIDA scan diagnosis of?

Acute cholecystitis

Visualize billiard tree further after ERCP or MRCP | Placement of biliary drains/stents

Percutaneous transhepatic cholangiography

Decrease risk of renal failure in chronic HTN already on Lisinopril

Increase dose of Lisinopril

Carotid sinus massage to slow which arrhythmia?

Supraventricular tachycarrythmias (e.g. AV nodal reentrant tachycardia)

Direct current counter shock indicated in tachyarrhythmias presenting with? (4)

1. No pulse 2. Hypotension 3. End-organ failure 4. AMS

22 y/o M with 1 month malaise, F, night sweats, pruritus Low F, anterior cervical lymph node Diagnosis?

Hodgkin

Hodgkin pel-ebstein fevers

Recurrent high fevers for 1-2 weeks followed be 1-2 afebrile weeks

Specific sign for Hodgkin-associated LAD

Alcohol-induced pain at the enlarged lymph node

``` 30 y/o M with recurrent aching right shoulder pain with reaching overhead Occurs at night in bed Most pain in the deltoid area Elicited by shoulder abduction Site of underlying condition? ```

Supraspinatous tendon

Biceps tendon injury

Weak elbow flexion and forearm supination

Two causes of renal artery stenosis and secondary HTN

1. FMD in younger pt's | 2. Atherosclerosis in older pt's

21 y/o F with 8 days of sore throat, cough, F Nonproductive, keeps her awake at night Subsequent hoarseness Crackles over right posterior lower chest CXR - patchy lower right alveolar infiltrates with increased interstitial markings Infection?

Mycoplasma PNA

57 y/o F with ABD cramps & watery D 5 days after returning from business trip Cough 24 hours later 20 pack-years Diffuse crackles b/l CXR - alveolar infiltrates in RUL, RLL, LLL Gram stain - segmented NP's, no organism Infection?

Legionella

IM Flashcards

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