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Internal Medicine Flashcards

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1
Q

What disorder is commonly caused by pulmonary hypertension from chronic obstructive pulmonary disease (COPD) or hypoxemia?

A

Cor pulmonale (hypertrophy or dilation of the right ventricle)

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2
Q

If a pt is found to have villous adenomatous polyps on a screening colonoscopy, when should they have a repeat screen?

A

3 years

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3
Q

What is seen on physical exam of a pt with hypertrophic cardiomyopathy?

A

Harsh crescendo-decrescendo systolic murmur that increases in intensity with Valsalva maneuver and decreases with squatting
Dyspnea on exertion (most common),
Syncope
Orthopnea
Chest pain
Palpitations

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4
Q

What are the stages of HTN?

A

Normal: < 120/80
Elevated BP:120–129/< 80
Stage 1 HTN: 130-139/80-89
Stage 2 HTN: ≥ 140/≥ 90
Crisis: ≥ 180/≥ 120

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5
Q

What is the criteria for metabolic syndrome?

A

Must have at least 3 of the following:
Abdominal obesity
Serum triglycerides ≥ 150 mg/dL
Serum HDL cholesterol < 40 mg/dL in men and < 50 mg/dL in women
BP ≥ 130/85
Fasting glucose ≥ 100 mg/dL

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6
Q

What is the treatment for coccidioidomycosis (a fungal infection that manifests as a pulmonary disease that is an endemic in the southwestern part of the United States)?

A

Fluconazole

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7
Q

What heart problem presents with a low-pitched mid to late diastolic murmur that is best heard at the apex of the heart with the patient in the left lateral decubitus position, and has an accentuated S1 with an opening snap following S2?

A

Mitral stenosis

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8
Q

What is seen on EKG in a R and L bundle branch block?

A

Right: M in v1, W in v6
Left: W in v1, M in v6

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9
Q

Pts with Sjögren syndrome are at increased of developing what?

A

Non-Hodgkin lymphoma

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10
Q

What is the appropriate fluid restriction for patients with stage D refractory heart failure (pts currently hospitalized with CHF who cannot be dc’d without specialized interventions)?

A

1.5–2.0 L/day

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11
Q

A blood test for plasma fractionated free metanephrines is the most sensitive test for what?

A

Pheochromocytoma

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12
Q

What presents with hypertension, bibasilar rales on auscultation, laterally displaced point of maximal impulse, S3 gallop, peripheral edema, jugular venous distention, and hepatojugular reflux?

A

Systolic heart failure

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13
Q

Distant or muffled heart sounds on physical exam should make you consider what cardiac diagnosis?

A

Pericardial effusion

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14
Q

What presents with chest pain or pressure, facial plethora or dyspnea, a feeling of fullness in the head that is made worse with bending forward, and edema of the head or neck along with distention of the veins in the neck and chest wall?

A

Superior vena cava syndrome

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15
Q

What is the treatment for community-acquired pneumonia in a patient with no significant comorbidities?

A

High dose amoxicillin, doxycycline, or macrolide (clarithromycin, azithromycin, or erythromycin)

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16
Q

What is the most common pathogen responsible for subacute bacterial endocarditis as well as bacterial endocarditis following a dental procedure?

A

Streptococcus viridans

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17
Q

What are the first-line treatments for superficial thrombophlebitis?

A

NSAIDs such as ibuprofen, warm compresses, elevation, and compression

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18
Q

Lewy bodies in the substantia nigra and a decrease in dopaminergic neurons in the substantia nigra are postmortem findings in patients with what disorder?

A

Parkinsons

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19
Q

What lab findings help support a diagnosis of Legionella pneumonia (Legionnaires’ disease)?

A

Elevated liver transaminases and hyponatremia

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20
Q

Calcifications of the peripheral hilar lymph nodes, described as eggshell calcifications on CXR, are pathognomonic for what?

A

Silicosis

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21
Q

What is silicosis caused by and what occupations is it commonly associated with?

A

Inhalation of free silica (silicon dioxide).
Occupational exposures to free silica include stonecutting, rock mining, quarrying, sandblasting, and pottery making

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22
Q

What is the prophylactic treatment of choice for pneumocystis pneumonia in HIV patients who have a sulfa allergy (cannot take Bactrim)?

A

Dapsone 100 mg daily

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23
Q

What treatment for aortic valve stenosis is acceptable for patients at any age for whom anticoagulant therapy is contraindicated, not desired, or cannot be managed, and is preferred in patients older than 70 years of age?

A

Aortic valve replacement with bioprosthetic valves

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24
Q

What are the treatments for chronic venous insufficiency?

A

Leg elevation, compression therapy, ulcer care, ablation
Vein stripping has largely been replaced with ablation

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25
What is obesity hypoventilation syndrome?
Daytime hypercapnia (PaCO2 over 45 mm Hg) in an individual with obesity that cannot be attributed to any other cause
26
Majority of patients with obesity hypoventilation syndrome also have what other disorder and require what intervention?
Obstructive sleep apnea that requires CPAP use during sleep
27
How is hypertensive urgency defined?
BP greater than 180/110–120 with no signs of acute target organ damage
28
What is the treatment for hypertensive urgency in the outpatient (ambulatory) setting?
Oral agents, such as captopril, labetalol, clonidine, or prazosin
29
How is hypertensive emergency defined?
BP greater than 180/110–120 with evidence of acute target organ damage (hemorrhagic or ischemic stroke, acute coronary syndrome, aortic dissection, diffuse microvascular injury (i.e., malignant hypertension), and hypertensive encephalopathy)
30
What are the current guidelines for lowering blood pressure in a patient with a hypertensive emergency requiring ICU admission?
Decrease BP by no more than 20–25% over one hour, then to 160/100 within six hours, and then to target blood pressure in 48 hours in most patients
31
Patients with what diagnoses require more aggressive treatment for hypertensive emergency?
Aortic dissection, pheochromocytoma, and eclampsia or preeclampsia Reduction to SBP to less than 140 in the first hour and to less than 120 in the case of aortic dissection
32
What IV medications have been shown to be the most effective at lowering blood pressure in most clinical scenarios of hypertensive emergency?
Nicardipine and labetalol
33
What disorder can present with diffuse ST elevations on an EKG?
Acute pericarditis
34
Patients on warfarin should avoid foods that are high in what?
Vit K (kale, dark leafy greens)
35
What findings might be seen in a pt with a Vit B12 (cobalamin) deficiency?
Fatigue, weakness, and peripheral neuropathy Pallor and glossitis MCV > 100 fL, hypersegmented neutrophils, elevated homocysteine, elevated methylmalonic acid
36
Koilonychia (spooning of the nails) and pica are classically seen in patients with what?
Iron deficiency anemia
37
What are the differences between central and nephrogenic DI?
*the Na+ is high in DI* Central: most commonly caused by a decrease in ADH production Diagnosis is made by vasopressin challenge test: > 50% increase in urine osmolality and decreased urine volume Treatment is intranasal DDAVP to reduce nocturia Nephrogenic: history of taking lithium Most commonly caused by kidney unresponsiveness to ADH Diagnosis is made by water deprivation test: no change in urine osmolality Treatment is HCTZ, amiloride, indomethacin
38
What might you hear in a pt with mitral regurg?
Acute: unique, harsh, midsystolic murmur best heard at apex that radiates to the base or axilla Chronic: blowing holosystolic murmur best heard at apex with radiation to axilla
39
Pts who have increased serum calcium levels should have what other test done?
Intact parathyroid hormone levels to r/o primary hyperparathyroidism
40
What tachydysrhythmia is caused by a single excitable electrical focus in the left or right atrium but most commonly in the right atrium?
Atrial flutter (sawtooth pattern)
41
What labs do you find in a pt with anemia of chronic disease?
Normochromic normocytic anemia, low serum iron and TIBC, high or normal ferritin
42
What are the signs/symptoms/treatment for idiopathic pulmonary fibrosis?
Sx: gradual-onset dyspnea and dry cough PE: velcro-like crackles, clubbing in advanced disease High resolution CT: bibasilar reticular opacities, honeycombing, traction bronchiectasis PFT: restrictive pattern: ↓FVC, ↓TLC and normal or increased FEV1/FVC ratio, ↓DLCO Management includes O2, pulmonary rehabilitation, antifibrotic therapy (pirfenidone and nintedanib), possible lung transplant
43
Pts who have an uncal herniation have what physical exam finding?
Unilateral dilated and fixed pupil
44
What is livedo reticualris and what disorder is it commonly associated with?
Mottled, lace-like purple discoloration of the skin seen in polyarteritis nodosa
45
What type of dementia presents with changes in the patient’s behavior, personality, and social conduct?
Frontotemporal dementia
46
What is the treatment for Cushing's disease?
Transsphenoidal surgery to remove the pituitary adenoma
47
What is the treatment for hereditary hemochromatosis?
Phlebotomy to remove excess iron
48
What are the signs/symptoms/treatment for thyroid storm?
Most commonly caused by an acute event (infection, trauma) Sx: tachycardia, hyperpyrexia, agitation, anxiety PE: goiter, lid lag, hand tremor, and warm, moist skin Dx: low TSH and high free T4 or T3 Tx: Beta-blocker (propranolol, esmolol) Thionamide (propylthiouracil, methimazole) Iodine solution Glucocorticoids
49
Hemophilia A is an X-linked recessive inherited disorder that leads to a deficiency in what?
Factor VIII
50
What classically present with sudden onset of gross hematuria 1–2 days after an upper respiratory infection?
IgA nephropathy (Berger disease)
51
What findings on a lumbar puncture are diagnostic for SAH?
Xanthochromia (which is a yellow or pink appearance of the cerebrospinal fluid representing broken down red blood cells) or gross blood in the cerebrospinal fluid
52
What are the signs/symptoms/treatment for Prinzmetal angina?
Hx of HTN, smoking, DM, obesity, or cocaine use Squeezing, pressure-like chest discomfort at rest ECG will show transient ST segment elevations Cardiac enzymes will be normal Diagnosis is made by cardiac stress test Most commonly caused by coronary artery spasm Treatment is calcium channel blockers and nitrates (avoid beta-blockers)
53
The CEA tumor marker is used in diagnosing which cancer?
Colorectal
54
What is the transmission cycle for Lyme disease, which is caused by the spirochete Borrelia burgdorferi?
White-footed mouse to Ixodes scapularis to human
55
What is the first and most important treatment to immediately administer in pts with hyperkalemia?
Calcium gluconate or calcium chloride
56
What is the treatment for SVT?
Vagal maneuvers, drug therapy (adenosine), and cardioversion
57
The BCR-ABL1 gene located on chromosome 22 (known as the Philadelphia chromosome) is associated with what leukemia?
Chronic myelogenous leukemia (CML)
58
What is the treatment for DKA?
Treat precipitating cause Correct volume depletion with NS, add dextrose to fluids once glucose is < 200 mg/dL Replete K+ deficit (usually falsely elevated), do not start insulin if K+ < 3.3 mEq/L IV insulin drip until anion gap closes
59
What are the signs/symptoms/treatment for fibromyalgia?
Risk factors: age 20–55, female sex Widespread or multisite musculoskeletal pain for ≥ 3 months, nonrestorative sleep, and generalized fatigue PE: areas of soft tissue tenderness, no joint swelling Labs: normal CBC, chemistry, acute phase reactants Diagnosis is made clinically Treatment is education, exercise, antidepressants, avoid opioids
60
What are the signs/symptoms/treatment for polymyositis?
Sx: progressive weakness of 3 months' duration PE: diffuse tenderness of proximal muscles in the shoulder girdle and pelvic girdle without rash or joint swelling and neurologic examination yields normal results Labs: positive anti-Jo, anti-SRP Tx: corticosteroids
61
What is heard on auscultation in a pt with tricuspid regurgitation?
Pansystolic murmur that becomes louder with inspiration and reduced with expiration or Valsalva maneuver. It is best heard at the left lower sternal border and radiates to the right lower sternal border.
62
Pts presenting with seizure-like activity that lasts longer than 2 minutes and have their eyes tightly closed should be considered for what?
Psychogenic seizure
63
What biopsy result is a hallmark of Sjögren syndrome?
Mononuclear cell infiltration
64
In patients whose LDL-C is > 190 mg/dL or in individuals aged 40–75 years whose 10-year ASCVD risk is greater than 20%, what is the recommended treatment?
High-intensity statin (e.g., atorvastatin 40–80 mg or rosuvastatin 20–40 mg)
65
What is dressler syndrome?
AKA postmyocardial infarction syndrome is a pericarditis usually seen one to two weeks after an acute myocardial infarction or cardiac procedure
66
What is pernicious anemia?
Autoimmune destruction of cells that produce intrinsic factor (IF), resulting in vitamin B12 deficiency
67
What are the signs/symptoms of B12 deficiency?
Sx: fatigue, weakness, and peripheral neuropathy PE: pallor and glossitis Labs: MCV > 100 fL, hypersegmented neutrophils, elevated homocysteine, elevated methylmalonic acid
68
What surgical procedure can eradicate the carrier state of Salmonella and is an alternative to treatment with ciprofloxacin?
Cholecystectomy
69
What are the signs/symptoms/treatment for multifocal atrial tachycardia (MAT)?
Associated with older patients and those with COPD Rate 100–200 beats/min PR interval will differ Notable feature: at least three different P wave forms Tx: treat the underlying cause, calcium channel blockers
70
What is recommended as part of dietary management to slow CKD progression?
Restricted protein intake to 0.8 g/kg/day
71
What is the test of choice for patients with typical symptoms of autosomal dominant polycystic kidney disease and a positive family history?
CT or MRI
72
What presents in pts with a history of taking antimalarials, sulfonylureas, quinolones, nitrofurantoin, or eating fava beans and have labs with Heinz bodies/bite cells on the smear?
G6PD deficiency
73
What medication is prescribed with Isoniazid when treating latent TB?
Pyridoxine (Vit B6) to avoid neuropathy
74
What is the treatment for hospital acquired pnemonia?
Choose 1 abx from each category 1. cefepime, pip/taz, ceftazidime 2. cipro, levofloxacin, azithromycin 3. vanc, linezolid
75
What 2 labs are commonly drawn in pts suspected of having scleroderma?
Anti-topoisomerase I (anti-Scl-70) antibody (specific for diffuse disease) Anticentromere antibody (specific for limited disease)
76
What are the symptoms and treatment for an essential tremor?
Tremor that is exacerbated by action and improved after alcohol consumption Tx: propranolol
77
What are signs/symptoms of a pituitary prolactinoma?
Galactorrhea, amenorrhea, irregular menses, and infertility Headache and vision loss (bitemporal hemianopsia) occur Erectile dysfunction, reduced sperm count, infertility, decreased libido, gynecomastia Elevated serum prolactin levels (> 200 ng/mL)
78
What is the treatment for hypercalcemia (bones, stones, groans, thrones, psychiatric overtones)?
IV fluids, bisphosphonates, calcitonin, denosumab (refractory disease)
79
What is the test for evaluating ischemic damage and subsequent stroke risk after a TIA?
Diffusion-weighted MRI
80
What are the signs/symptoms of chronic bronchitis?
Chronic productive cough for at least 3 months in at least 2 successive years PE: decreased breath sounds, increased resonance upon percussion of the lung fields Diagnosis: FEV1/FVC ratio < 0.7 post bronchodilator
81
Patients with chronic hypernatremia are at risk for what with rapid correction of sodium levels?
Cerebral edema
82
What is the classic pentad of TTP?
Anemia Thrombocytopenia Neuro findings Kidney injury
83
According to the ADA, how is diabetes diagnosed?
1. symptomatic (has polyuria, polydipsia, thirst, weight loss) and has a random blood glucose ≥ 200 mg/dL 2. asymptomatic patient, diabetes (often type 2) fasting blood glucose ≥ 126 mg/dL on more than one occasion 3. 2-hour plasma glucose value ≥ 200 mg/dL (11.1 mmol/L) during a 75 g oral glucose tolerance test (OGTT) 4. A1C values ≥ 6.5%
84
According to the ADA, what is the criteria for prediabetes?
Impaired fasting glucose with fasting plasma glucose of 110–125 mg/dL, impaired glucose tolerance with 2-hour glucose value of 140–199 mg/dL after a 75 g OGTT, and A1C values of 5.7 to < 6.5%
85
What labs are seen in pts with interstitial nephritis?
↑ Cr; WBCs, RBCs, and WBC casts in urine sediment; eosinophilia
86
What are common causes of interstitial nephritis?
Medications (e.g., NSAIDS, antibiotics, PPIs), infections, autoimmune disorders
87

Clinical Rotations (9 decks)

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