Internal Medicine

Question 1

Name the 2 gut complications of C. diff infections

Answer 1

1. Toxic megacolon
2. Pseudomembranous colitis

Question 2

Synovial fluid shows needle shaped, negatively birefringent, monosodium urate crystals. Diagnosis?

Answer 2

Gout

Question 3

Describe the classic appearance of gout crystals in the synovial fluid

Answer 3

Needle shaped, negatively birefringent, monosodium urate crystals

Question 4

Synovial fluid shows rhomboid shaped, positively birefringent crystals. Diagnosis?

Answer 4

Pseudogout / CPDD

Question 5

Describe the classic appearance of pseudogout crystals in synovial fluid

Answer 5

Rhomboid shaped, positively birefringent crystals

Question 6

Name the 5 types of lacunar infarctions

Answer 6

1. Pure motor
2. Pure sensory
3. Mixed sensory-motor
4. Ataxic hemiparesis
5. Dysarthria-Clumsy Hand Syndrome

Question 7

Name the 6 red flag headaches

Answer 7

1. Raised intracranial pressure (ICP)
2. Stroke
3. Meningitis
4. Subarachnoid hemorrhage / intracranial bleeds
5. Giant cell arteritis / Temporal arteritis
6. Acute narrow angle glaucoma / Acute angle closure glaucoma

Question 8

Diagnostic criteria for diabetic ketoacidosis (DKA)

Answer 8

1. Blood glucose >11.0 mmol/L or Hx of DM
2. Significant ketonemia (>3.0 mmol/L) or significant ketonuria (2++ on urine dipstick)
3. Venous pH <7.3 or Bicarbonate <15.0 mmol/L

Question 9

Diagnostic criteria for hyperosmolar hyperglycemic state (HHS)

Answer 9

1. Blood glucose >33.3 mmol/L
2. Calculated effective serum osmolality >300 mOsm/kg OR total serum osmolality >320 mOsm/kg
3. (Absent ketosis) Beta-hydroxybutyrate <3mmol/L or Ketonuria <2+
4. (Absent acidosis) pH >3 OR Bicarb >15.0 mmol/L

Question 10

What are the components / parameters of the Child-Pugh score for liver disease?

Answer 10

ABCDE!
1. Albumin
2. Bilirubin
3. Coagulopathy: INR
4. Distension (ie ascites)
5. Encephalopathy

Question 11

Spot Dx: Chest auscultation reveals ejection systolic murmur loudest at aortic area, with radiation to carotids, crescendo-decrescendo

Answer 11

Aortic stenosis

Question 12

Describe the typical character of an aortic stenosis murmur

Answer 12

Ejection systolic murmur loudest at aortic area, with radiation to carotids, crescendo-decrescendo

Question 13

Spot Dx: Chest auscultation reveals a pansystolic murmur loudest at mitral area, radiation to axilla

Answer 13

Mitral regurgitation

Question 14

Describe the typical character of a mitral regurgitation murmur

Answer 14

Pansystolic murmur loudest at mitral area, radiation to axilla

Question 15

Spot Dx: Chest auscultation reveals an opening snap, mid-diastolic murmur with a rumble over the mitral area

Answer 15

Mitral stenosis

Question 16

Describe the typical character of a mitral stenosis murmur

Answer 16

Opening snap, mid-diastolic murmur with a rumble

Question 17

Name the causes of acute pancreatitis

Answer 17

“I GET SMASHED”
Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps and other infections
Autoimmune
Scorpion toxin
Hypercalcemia, Hypertriglyceridemia
ERCP
Drugs