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Internal Medicine Flashcards

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0
Q

In Mitral Valve Regurgitation, if the murmur radiates to the BASE, what is the leaflet involve?

A

Posterior Leaflet
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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1
Q

In Mitral Valve Regurgitation, if the murmur radiates to the AXILLA, what is the leaflet involve?

A

Anterior Leaflet
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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2
Q

Normal CARINA angle?

A

~60 degrees
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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3
Q

Beta-Blockers that entails good outcomes in px with MI?

A 
Metoprolol
Bisoprolol
Carvedilol
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
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4
Q

Extrapulmonary TB incidence, in decreasing order.

A 
Lymph Nodes
Pleural
Genitourinary
Least: Cardiac
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
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5
Q

Lights Criteria.

A
  • PF/S LDH ratio of 0.6
  • PF/S protein ratio of 0.5
  • PF LDH more than 2/3 the upper limits

!!! if positive in one criteria, fluid is considered EXUDATIVE !!!
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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6
Q

Mean Arterial Pressure (MAP) formula.

A 
Systolic + 2Diastolic
-----------------------
              3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
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7
Q

Cerebral Perfusion Pressure formula.

A

MAP — Intracranial Pressure
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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8
Q

MAP in CVD BLEED?

A

<130 mm Hg
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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9
Q

Pleural Effusion is considered TUBERCULOUS if cell count is?

A

> 85% lymphocytic
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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10
Q

Usual location of CEREBROVASCULAR DISEASE in HYPERTENSIVE patients?

A
  1. Putamen
  2. Cerebellum
  3. Lobes
    __________________
    Jan Patrick Ng, M.D.
    Darleen Sy, M.D.
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11
Q

What stain is commonly used in staining AMYLOIDOSIS?

A

Congo Red
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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12
Q

CVD Hemorrhage appears ______ in cranial CT scan?

A

Hyperdense (white) because it contains CALCIUM
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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13
Q

Early signs of CVD seen in cranial CT scan?

A 
<24hrs cranial CT scan may appear be normal but with subtle signs:
• Compression - sulci are more obscured
• MCA sign (clot)
• Midline is compressed
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
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14
Q

What part of lipid profile when increased predispose patients to PANCREATITIS?

A

Triglyceride
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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15
Q

LDL goals in HIGH risk patients?

A

LDL of <70mg/dl
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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16
Q

Lipid picture of patients with CKD?

A 
Low HDL
Normal/Low LDL
High Triglycerides
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Jan Patrick Ng, M.D.
Darleen Sy, M.D.
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17
Q

Primary target of Dyslipidemia therapy?

A

LDL
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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18
Q

Most common cause of death in POST MI?

A

Arrhythmias - Ventricular Fibrillation
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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19
Q

Development of NEW systolic murmur 5-7 days S/P MI indicates?

A

Papillary Muscle Rupture
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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20
Q

Development of acute severe HYPOTENSION in post MI patients?

A

Ventricular Free Wall Rupture
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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21
Q

It is a congenital heart defect in infants of women taking LITHIUM in which septal leaflet of the tricuspid valve is displaced towards the apex of the right ventricle.

A

Ebstein’s Anomaly
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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22
Q

Systolic ejection murmur, crescendo/decrescendo, louder with squatting, softer with valsalva, + parvus et tardus?

A

Aortic Stenosis
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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23
Q

Systolic ejection murmur, louder with valsalva, softer with squatting or handgrip?

A

Hypertrophic Obstructive Cardiomyopathy
__________________
Jan Patrick Ng, M.D.
Darleen Sy, M.D.

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24
Late systolic murmur with click, louder with valsalva and handgrip, softer with squatting?
Mitral Valve Prolapse __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
25
Holosystolic murmur radiates to axilla?
Anterior Leaflet Mitral Regurgitation __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
26
Holosystolic murmur with late diastolic rumble?
Ventricular Septal Defect __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
27
Continuous machinery-like murmur?
Patent Ductus Arteriosus __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
28
Wide fixed and split S2?
Atrial Septal Defect __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
29
Rumbling diastolic murmur with an opening snap?
Mitral Stenosis __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
30
Blowing diastolic murmur with widened pulse pressure and eponym parade?
Aortic Regurgitation __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
31
***PaO2/FiO2 ratio.
* < 200 - Acute Respiratory Distress Syndrome * < 300 - Acute Lung Injury NORMAL?!? __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
32
Neurologic deficits that spontaneously resolves within 24 hours irregardless of the results of diagnostics.
Transient Ischemic Attack __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
33
Hypertension with end organ damage?
Hypertensive Cardiovascular Disease __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
34
Obliteration of retrosternal area in lateral view chest X-ray?
Right Ventricular Hypertrophy __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
35
Obliterated lower third retrocardiac space in lateral view of chest x-ray?
Left Ventricular Hypertrophy __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
36
Obliteration of the upper two-thirds of the retrocardiac space in lateral view of chest x-ray?
Left Atrial Hypertrophy __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
37
Prominence of the right border of the heart in chest xray PA view?
Left Atrial Hypertrophy __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
41
What portion of the heart is hypertrophied if apex is displaced downwards and laterally in chest xray?
Left Ventrical Hypertrophy __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
42
What cardiac chamber is enlarge if there is increase carina angle and obliteration of cardiac waistline?
Left Atrial Hypertrophy __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D
43
Chronic cough?
Cough persist for 8 weeks __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
44
Scybalous stools?
Goat-like stools __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
45
Left sided colonic mass vs Right sided colonic mass?
``` Left - obstruction Right - bleeding __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D. ```
46
Most common glands found in Colonic Diverticula?
Gastric and Pancreatic Glands __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
47
Diagnostic to differentiate AKI vs CKD?
Ultrasound __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
48
**CKD ultrasound findings?
``` • Kidney size of < 10cm • Cortical thickness of > 1cm • Corticomedullary Junction __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D. ```
49
Management for Hyperkalemia?
``` 1. Cardiac Protection • Calcium Gluconate 2. Shift potassium into the cell • Glucose-Insulin Drip • Sodium Bicarbonate • Nebulize with Salbutamol 3. Dialysis __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D. ```
50
Most common cause of death worldwide?
Cardiovascular Disease __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
51
Caused by an imbalance between the heart's oxygen supply and demand, and most frequently manifest as chest discomfort?
Ischemia __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
52
Elements of complete cardiac diagnosis?
1. Underlying etiology - congenital, hypertensive, ischemic or inflammatory? 2. Anatomic abnormalities - chambers involve, hypertrophied, dilated? valves affected, regurgitant or stenotic? pericardial involvement? myocardial infarction? 3. Physiologic disturbances - arrhythmia, congestive heart failure or ischemia? 4. Functional disability __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
53
Ankle-Brachial Index?
systolic BP of the ANKLE –––––––––––––––––––––––– higher systolic BP of ARMS n > 0.9 __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
54
How much glucose infused in 1L of D5 containing fluid?
50 grams __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
55
Calorie per glucose molecule?
1g = 4 calories __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
56
3 substances that reflect liver function?
Albumin Prothrombin Time Bilirubin **SGPT/ALT only reflect hepatocellular damage __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
57
Diseases that cause Microcytic Hypochromic Anemias?
``` Mnemonic: CLITS H ------------- Chronic Disease Lead Poisoning Iron Deficiency Anemia Thalassemia Sideroblastic Anemia Hookworm Infection __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D. ```
58
Beta blockers are contraindicated for?
Asthmatics __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
59
Most common side effects of CLONIDINE?
Rebound Hypertension __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
60
More sensitive index of cardiac function is?
Ejection Fraction (n=67 +/- 8%) __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
61
What is Blood Pressure?
BP = Cardiac Output X Peripheral Resistance Cardiac Output = Stroke Volume x Heart Rate __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
93
Radiologic signs of LEFT ATRIAL HYPERTROPHY?
``` • Increase carina angle • Obliteration of cardiac waistline __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D. ```
94
How many weeks inorder to label a patient to have CHRONIC DIARRHEA?
>4weeks __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
95
Differentials for CHRONIC DIARRHEA?
``` Inflammatory Bowel Disease Malignancy Irritable Bowel Disease __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D. ```
96
What is IRRITABLE BOWEL DISEASE?
Chronic diarrhea associated with abdominal pain which usually resolves on flatus and defecation. __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
97
Which INFLAMMATORY BOWEL DISEASE involves the liver?
Primary Sclerosing Cholangitis is due to CHRON'S DISEASE __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
98
Consideration in patients with Iron Deficiency Anemia in elderly?
Malignancy __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
99
Indication for thoracentesis?
``` • Fever (Infection) • Discrepancy of pleural effusion (> 1 ICS) __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D. ```
100
Pathophysiology of Pneumonia?
1. Edema 2. Red Hepatization • transudation of fluids (RBC) to alveolar space 3. Gray Hepatization • infiltration of neutrophils and fibrin, no new bacteria 4. Resolution __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
101
Why there is hypoxemia in Pneumonia?
due to alveolar filling/flooding therefore compromised exchange of oxygen and carbon dioxide __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
102
Acute and Chronic COUGH?
Chronic Cough >8 weeks __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
103
In Pneumonia, what chemokines stimulate the release of neutrophils and their attraction to the lungs, producing both leukocytosis and increase purulent secretions?
``` IL 8 Granulocyte Colony Stimulating Factor __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D. ```
104
Target organisms of MACROLIDE on CAP Management?
``` Legionella Mycoplasma Chlamydia Virus (RSV, Influenza, Adenovirus) __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D. ```
105
What is Bronchiectasis?
Permanent dilatation of bronchi with excessive mucus production __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
107
**Functional Class in Congestive Heart Failure.
``` Class 1 Class 4 __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D. ```
108
How many weeks inorder to label a patient to have CHRONIC DIARRHEA?
>4weeks __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
109
Differentials for CHRONIC DIARRHEA?
``` Inflammatory Bowel Disease Malignancy Irritable Bowel Disease __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D. ```
110
What is IRRITABLE BOWEL DISEASE?
Chronic diarrhea associated with abdominal pain which usually resolves on flatus and defecation. __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
111
Which INFLAMMATORY BOWEL DISEASE involves the liver?
Primary Sclerosing Cholangitis is due to CHRON'S DISEASE __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
112
Consideration in patients with Iron Deficiency Anemia in elderly?
Malignancy __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
113
Indication for thoracentesis?
``` • Fever (Infection) • Discrepancy of pleural effusion (> 1 ICS) __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D. ```
114
Pathophysiology of Pneumonia?
1. Edema 2. Red Hepatization • transudation of fluids (RBC) to alveolar space 3. Gray Hepatization • infiltration of neutrophils and fibrin, no new bacteria 4. Resolution __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
115
Why there is hypoxemia in Pneumonia?
due to alveolar filling/flooding therefore compromised exchange of oxygen and carbon dioxide __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
116
Acute and Chronic COUGH?
Chronic Cough >8 weeks __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
117
In Pneumonia, what chemokines stimulate the release of neutrophils and their attraction to the lungs, producing both leukocytosis and increase purulent secretions?
``` IL 8 Granulocyte Colony Stimulating Factor __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D. ```
118
Pathophysiology of LEPTOSPIROSIS?
Vasculitis __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
119
What happens to the liver due to LEPTOSPIROSIS?
Coagulative Necrosis __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
120
What happens to the kidneys in LEPTOSPIROSIS?
Interstitial Nephritis due to Vasculitis __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
121
What happens to the lungs in LEPTOSPIROSIS?
Pulmonary Hemorrhage __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
122
WEIL'S disease/ Severe Leptospirosis vs Mild Leptospirosis?
``` Weil's disease • Kidney injury • Hepatic Injury • Bleeding diathesis __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D. ```
123
Significant weight loss?
>10% of Total Body Weight in 3 months __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D
124
Role of Nitrates?
- vasodilation - reduce preload and afterload - decrease myocardial oxygen demand __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D
125
Symptoms of Tetanus?
- Lock Jaw - Difficulty of Swallowing - Muscle Spasms - Back Pain __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D
126
Target organisms of MACROLIDE on CAP Management?
``` Legionella Mycoplasma Chlamydia Virus (RSV, Influenza, Adenovirus) __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D. ```
127
What is Bronchiectasis?
Permanent dilatation of bronchi with excessive mucus production __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D.
129
Antibiotics of choice for Tetanus?
Metronidazole __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D
130
Level of blood glucose where it will show symptoms of hypoglycemia?
70 mg/dl __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D
131
Diagnostics that assess synthetic function of the liver?
``` Protime Albumin Bilirubin __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D ```
132
>1000 SGPT, differentials?
``` Ischemic Drug Induced (Acetaminophen) Viral Hepatitis __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D ```
133
Spirinolactone in Heart Failure?
Prevents LV remodeling __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D
134
Most common cause of lower GI bleed on young adults?
Hemmorhoids __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D
135
Most common cause of lower GI bleed in elderly?
Malignancy __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D
136
Dilated Cardiomyopathy Ejection Fraction?
Ejection Fraction <30% __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D
138
Orthopnea vs Platypnea?
Orthopnea - redistribution of fluid from the splanchnic circulation and lower extremities into the central circulation during recumbency, with a resultant increase in pulmonary capillary pressure Platypnea - dyspnea in the upright position with relief in the supine position __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D
139
What is Chronic Bronchitis?
Chronic bronchitis is defined by excessive mucus production with airway obstruction and notable hyperplasia of mucus-producing glands. __________________ Jan Patrick Ng, M.D. Darleen Sy, M.D
140
Significant change in Spirometry in reading obstructive defect to differentiate COPD and ASTHMA?
change of >= 12% and change in 200ml in FVC or FEV1
141
Parts of Cardiac Diagnosis?
Etiology Anatomy Physiology Functional Classification

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