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Internal Medicine Flashcards

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0
Q

Prominent A Wave

A

Tricuspid Insufficiency

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1
Q

Top two causes CRF

A
  1. HTN 2. DM
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2
Q

Canon A Wave

A

Heart Block

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3
Q

Soft P2

A

Pulmonary Stenosis

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4
Q

2 Causes Webbed Neck

A
  1. Turner’s (coarctation) 2. Noonan’s (pulm stenosis)
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5
Q

Signs Constrictive Pericarditis

A
  1. X and Y descent 2. Square Root Sign 3. Calcification
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6
Q

Beck’s Triad for Cardiac Tamponade

A
  1. Distant Heart Sounds 2. Hypotension 3. JVD
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7
Q

MCC HTN young people

A

women: OCPs men: alcohol

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8
Q

Most important cause of chronic glomerulonephritis

A

DM

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9
Q

MC kidney stones

A
  1. Calcium oxolate 80% increased urine pH radiopaque 2. Uric Acid 5% Decreased urine pH Radiolucent 3. Struvite 15% Mg ammonium phosphate Proteus radiopaque
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10
Q

HyperCalcemia Causes

A

VITAMIN TRAPS -Vitamin A and D intox -Immobilization -Thyrotoxicosis -Addison’s/Acidosis -Milk Alkali -Inflammatory disorders -Neoplastic disease -Thiazides -Rhabdo -Aids -Paget’s/Parenteral Nutrition/ParaTH dz -Sarcoid

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11
Q

HyperCalcemia Sx’s

A

Bones, Stones, Groans, Moans

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12
Q

RTA with abnormal H+ secretion and kidney stones

A

Type I (distal) RTA

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13
Q

RTA with abnormal HCO3- and rickets

A

Type II (proximal) RTA

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14
Q

RTA with aldosterone defect

A

Type IV (distal) RTA

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15
Q

Hypervolemic Hyponatremia

A
  1. Cirrhosis 2. CHF 3. nephritic syndrome
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16
Q

Hyperkalemia EKG

A

Peaked T waves and widened QRS

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17
Q

Hypokalemia EKG

A

T waves flatten; U waves

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18
Q

ARF with FeNa <1%

A

PreRenal

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19
Q

Nephritic Syndrome

A
  1. Hematuria 2. HTN 3. Oliguria
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20
Q

MC nephritic Syndrome

A

Membranous Glomerulonephritis

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21
Q

MC form glomerulonephritis

A

IgA nephropathy (Berger’s)

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22
Q

Glomerulonephritis with deafness

A

Alport’s

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23
Q

Glomerulonephritis with hemoptysis

A

Wegener’s or Goodpasture’s

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24
salicylate ingestion
anion gap acidosis and primary resp alkalosis due to central resp stimulation
25
AntiCentromere Ab's
Scleroderma (CREST)
26
ANA
SLE
27
Antihistone
Drug Induced Lupus
28
Anti IgG
Rheumatoid
29
Antimitochondrial
Primary Biliary Cirrhosis
30
Aschoff Bodies
Rheumatic Fever
31
Mamillary Body Atrophy
Wernicke's
32
BUN : Creatinine Elevation
Azotemia Bledding (GI) Catabolic state Diet (high protein, TPN)
33
A Fib Causes
PIRATES Pulmonary: PE, COPD Iatrogenic Rheumatic heart (mitral regurg) Atherosclerosis: MI, CAD Thyroid(hyper) Endocarditis Sick Sinus
34
Atherosclerosis RF's
SHIFT MAID Smoking/ HTN/ (n)IDDM/ Fam hx/ Triglyerides/ Male/ Age/ Inactivity/ Diet and drinks
35
RSR' in V1
RBBB
36
1st degree AV block
PR >200msec NO TRX
37
Second degree AV block Type 1
PR gradually increases until dropped beat/ Caused by drugs (digoxin, beta blockers, CCBs) or vagal increase, STOP DRUG
38
Second degree AV block Type II
PR doesn't change, unexpected dropped beat PACER!
39
MCC 2* dilated cardiomyopathy
1. ischemia 2. Long standing HTN
40
S3 gallop
dilated cardiomyopathy
41
S4
stiff ventricle "atrial kick" maybe hypertrophic cardiomyopathy
42
Impaired diastolic filling without significant systolic dysfxn
Restrictive Cardiomyopathy
43
MCC Restrictive Cardiomyopathy
1. Infiltrative Dz (sarcoid, hcm, amyloidosis) 2. scarring (radiation, doxorubicin)
44
apical holosystolic murmur
mitral regurg from ischemia
45
Pain better when sitting forward
Pericarditis and Pancreatitis
46
TTP
PARTNER Platelets low/ Anemia hemolytic/ Renal failure/ Temp rise/ Neuro defecits/ ER
47
Treatment of TTP
Plasmapheresis
48
Heinz bodies
G6PD heinz bodies are conc. Hb when spleen clears them they become BITE cells hemolysis in G6PD usually from viral or bacterial infection
49
Oat Cell Lung CA (small cell) secretions
1. ADH 2. ACTH 3. Eaton Lambert NOT HYPERCA!
50
Heliotrope rash and Gottron's papules
Dermatomyositis
51
free water deficit
current TBW = .6 x weight; desired TBW= (Na/140) x current TBW
52
Hypotension, Hyponatremia, Hyperkalemia
Possible Adrenal Crisis IV HYDROCORTISONE
53
delta wave
WPW
54
trx of torsades de pointes
magnesium and external pacing
55
V Tach trx
Lidocaine
56
CHF Causes
FAILURE Forgot meds/ Arrhythmia, Anemia/ Ischemia, Infection, Infarction/ Lifestyle (salt)/ Up CO (preg, hyperthy)/ Renal Failure/ Embolism pulm
57
prox muscle weakness, dusky malar rash, periorbial edema
Dermatomyositis (10%increased risk of malignancies)
58
DOC raising HDL
fibrates
59
Lone A Fib Trx
ASA only
60
Symptomatic sinus bradycardia
IV atropine followed by transcutaneous pacing
61
Bone Marrow Profile on Glucocorticoids
Neutrophilia (increase release and demargination); low eosinophils and lymphocytes
62
Trx MS flares
Corticosteroids
63
Fatty Liver with encephalopathy
Reye Syndrome trx: glucose with FFP and mannitol to decrease cerebral edema
64
TCA OD EKG
QRS prolongation Sodium Bicarbonate!!
65
Flushing Diarrhea Wheezing
Carcinoid
66
plaque like deposits of fibrous tissue on the endocardium on the Right heart
Carcinoid
67
PAO2 equation
150 - (PCO2 X1.25)
68
Nml A-a gradient
5-20
69
hypoxemia nml A-a gradient
1. Low FIO2 2. Hypoventilation
70
Hypoxemia abnml A-a gradient
1. diffusion 2. v/q mismatch 3. true shunt
71
Will V/Q mismatch or shunt respond to O2?
V/Q mismatch
72
Only trx for shunt
Positive Pressure Ventilation
73
True Shunts
1. collapse atelectasis 2. CHF 3. ARDS 4. PNA lobar 5. AV malformation
74
Respiratory Alkalosis
RAAP ICE acute: Asthma Attack/ PE chronic: ILD/ CNS/ End stage liver
75
sputum tastes salty
bronchoalveolar cell CA
76
Causes Unexplained Chronic Cough (3 weeks nml CXR)
1. sinusitis with PND (cobblestone) 2. asthma (PFT, eosinophilia) 3. GERD (Positional, regurg, nocturnal)
77
staging of asthma
clinically 1. #attacks/week 2. # awakenings/month 3. daily PEFR measurements and diurnal variation
78
ABPA dx
Positive Prick Test
79
MCC hemoptysis
Bronchitis
80
Bullae in upper lobes
acquired emphysema
81
trx congenital emphysema
prolastin weekly
82
water blister on tympanic membrane
Mycoplama pneumonia
83
Post-transplant PNA
CMV
84
pulmonary infiltrates in AIDS
HIV seropos- pneumococcus/ <400 T cells TB/ <200 PCP/ <100 MAI
85
Cancer assoc. Hypercalcemia
Squamous Cell Lung
86
Cancer Hyperprolactin
Large Cell Lung
87
Cancer SIADH
Small Cell Lung
88
Cancer cerebellar ataxia
Squamous Cell Lung
89
Drug Induced ILD
Bleomycin, Nitrofurantion, Amiodarone
90
abdominal pain, bloody diarrhea, minimal physical exam findings in person with CAD
ischemic bowel most likely splenic flexure
91
Carcinoid syndrome causes what vitamin deficiency
niacin
92
Cat scratch dz trx
azithromycin
93
drug contraindicated in STEMI bc it causes vasodilation and reflex tachycardia
nifedipine
94
two ways to increase oxygenation
1. FiO2 2. PEEP
95
Granulation tissue in ear canal
Malignant Otitis Externa common in diabetics caused by pseudomonas
96
Pleural fluid indications for chest tube
pH < 7.2 Glucose <60
97
Winter's Formula
PaCO2 = 1.5 (HCO3-) + 8
98
SBE on predamaged valve
Strep Viridans
99
dx test for chronic pancreatitis
stool elastase
100
DOC fibromyalgia
TC AD's i.e. amitriptyline
101
DOC psuedotumor cerebri
acetazolamide
102
cocaine OD complication
rhabdomyolysis leading to myoglobinuria and ATN
103
Guillian Barre CSF
Increased Protein, nml WBC RBC Glucose
104
Subarachnoid hemorrhage electrolyte abnormality
hyponatremia
105
Celiac AB
anti-endomysial
106
NNT
1/ARR ARR = CER (control event rate) - ERR (Experimental Event Rate)
107
contraindication to nitroprusside
renal insufficiency, CrCl <10 Used in hypertensive emergency (diastolic >130 with end organ damage, induce hypotension to control bleeding in surgery, acute CHF)
108
contraindication to labetalol
asthma (nonselective beta blocker)
109
DOC SVT
1. Adenosine 2. Verapamil
110
DOC for A fib resulting from WPW
Procainamide
111
Drug to avoid in WPW
Digoxin blocks AV node and may speed up accessory pathway
112
sudden onset tachycardia (~188 bpm), palpitations, dizziness
PSVT trx 1. vagal maneuvers 2. adenosine or verapamil cure = albation
113
Drug to avoid in VTach
IV Verapamil
114
abnormal p wave earlier than expected
PAC BENIGN CONDITION trx= avoid caffeine
115
cardiomegaly and low voltage on EKG
suggests infiltrative process in the heart i.e. hemochromatosis, sickle cell with multiple blood transfusions
116
abx prophylaxis for IE
2. hx of infective endocarditis 2. prosthetic heart valves 3. unrepaired congenital cyanotic heart disease 4. 6 months out from placement of prosthetic graft material
117
diabetes and hypertension goal bp and trx
goal <130/80 use ACE-I
118
Trx of claudicion
exercise and cilostazol (phosphodiesterase inhibitor)
119
trx hyperkalemia
calcium gluconate
120
EKG hypocalcemia
prolonged QT >.45
121
prolonged QT and congential deafness, maybe hx of sudden cardiac death
Romano-Ward syndrome
122
decreased vision, water hammer pulse, diastolic murmur
aortic regurg in Marfan's pt
123
treatment of vtach in context of ishemia
amiodarone
124
microcytic anemia with low ferritin
Iron Deficiency Anemia anisocytosis and poikilocytosis MCC GI bleed test stool for occult blood
125
urticaria association
Hepatitis B
126
Kussmaul's sign
Increase JVP with inspiration 1. constrictive pericarditis 2. Restrictive cardiomyopathy
127
"sentinel loop"
air filled loop of small bowel in the LUQ RADIOLOGIC MARKER OF PANCREATIC DAMAGE
128
lab values in pancreatitis
Neutrophilic leukocytosis, hyperglycemia, hypocalcemia, Elevated CRP
129
watery diarrhea in AIDS pt
cryptosporidium or isospora need to acid fast stain of stool
130
DOC pneumococcus
Penicillin
131
RF for papillary carcinoma of the thyroid
previous neck radiation
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