Internal Medicine Flashcards
(189 cards)
1
Q
organisms for comm acquired pneumonia
A
strep pneumo, moraxella, h flu, atypicals
2
Q
Tx of comm acquired pneumonia
A
outpt: azithromycin or doxycycline.
inpt: moxifloxacin or levofloxacin
? aspiration: add clindamycin
3
Q
Tx of mucormycosis
A
debridement + IV amphotericin B
4
Q
term for sensorineural high frequency hearing loss seen in aging
A
presbycusis
5
Q
define pulsus paradoxus
A
drop in systolic BP by >10 with inspiration. a/w tamponade
6
Q
AE of hydralazine
A
salt retention, reflex tachycardia, lupus-like syndrome
7
Q
AE of metoprolol
A
impotence, bradycardia, AV node block
8
Q
AE of verapamil
A
constipation, dizziness, flushing, gingival hyperplasia
9
Q
AE of enalapril
A
hyperkalemia, cough, decreased GFR, rash, angioedema
10
Q
AE of digoxin
A
NVD, blurry yellow vision, arrhythmias
11
Q
Tx of QRS widening (as in TCA overdose)
A
sodium bicarb - alleviates depression of fast Na channels caused by TCAs
12
Q
Tx of fibromuscular dysplasia causing renal artery stenosis
A
angioplasty with stent placement
13
Q
meds that improve mortality in CHG
A
ACE/ARBs, B-blockers, spironolactone
14
Q
pathogenesis of tumor lysis syndrome
A
intracellular phosphate/potassium -> hyperphosphatemia, hyperkalemia, and hypocalcemia (binded up by phosphate). Release of proteins -> high uric acid (allopurinol used to reduce urate nephropathy)
15
Q
SIRS criteria
A
temp >38 or 90
RR >20 or PaCO212
WBC >12 or 10% bands
16
Q
top cause of primary adrenal insufficiency in developed world? undeveloped?
A
autoimmune adrenalitis adrenal tuberculosis (others: fungal infxns, CMV)
17
Q
sign of PE on EKG
A
sinus tach with nonspecific ST/T changes. S1Q3T3 (S in I, Q in 3, inverted T in 3), transient RBBB, inverted T in v1-v4
18
Q
prophylactic tx of migraines
A
used if pt has Sx at least 2x per week
evidence based: topiramate, valproic acid, amitriptyline, metoprolol, propranolol, timolol, butterbur root petasites hybidus, relaxation therapy and biofeedback
19
Q
Tx of alzheimers
A
mild (MMSE 20-25): acetylcholinesterase inhibitors: donepezil (aricept), rivastigmine, galantamine
mod-sev (MMSE 0-10 - 11-20): add memantine
20
Q
Tx of drug induced dystonia
A
diphenhydramine, benztropine mesylate, or biperiden
21
Q
non surgical management of gall stones
A
ursodeoxycholic acid and avoidance of fatty foods
22
Q
hepatic adenoma a/w?
complications?
A
OCPs
hemorrhage (40% of symptomatic pts), malignant transformation (10%)
23
Q
drugs that cause hyperkalemia
A
potassium sparing diuretics (amiloride, spironolactone, eplerenone)
ACE-Is / ARBs
NSAIDs
Succinylcholine
Non selective B blockers
TMP-SMX, Heparin, Cyclosporine, Digitalis
24
Q
Tx of hyperkalemia with EKG changes, muscle paralysis, or K>6.5
A
C:calcium gluconate B: B2-agonists, Bicarb I: insulin G: glucose K: kayexalate D: dialysis, diuretics(furosemide)
25
causes of microcytic anemia
iron deficiency
anemia of chronic disease
thalassemia
lead poisoning, sideroblastic anemia
26
test for rapidly developing virilazation in female
testosterone/DHEAS
high testost:ovarian source
high DHEAS:adrenal source
27
indications of chest tube drainage of parapneumonic effusion
glucose<60, or positive gram stain (signs of empyema)
28
causes of pulseless electrical activity
hypovolemia, hypoxia, hydrogen ions (acidosis), hypothermia, hypoglycemia, hyper/hypokalemia
tamponade, tension pneumonthorax, thrombosis (MI/PE), trauma (hypovolemia), tablets (drugs), toxins
29
antihypertensives safe with pregnancy
b-blockers and hydralazine
| not safe: thiazides, ACEI/ARBs, CCBs
30
goals for antihypertensive tx in diabetic/renal insufficiency
<130/80
31
screening for lipids
every five years starting at age 20.
| earlier/more freq if obese or with strong FHx
32
signs of constrictive pericarditis
volume overload due to decr CO
| sharp "x" and "y" descents on central venous tracing along with pericardial knock (sound heard soon after S2)
33
types of crigler najjar
1 is severe with infantile kernicterus. no change with phenobarbital
2 is milder with survival into adulthood. phenobarbital lowers bilirubin
34
AE of amiodarone
pulmonary fibrosis (assoc w cumulative drug dose)
elevated LFT (discontinue if 2 fold increase)
Thyroid: hypo(85%) hyper (15%)
corneal deposits (dont have to discontinue)
blue gray skin discoloration
35
MEN 1
pituitary adenoma
pancreatic islet cell tumor
parathyroid tumor (hyperparathyroid)
36
MEN 2a
Medullary thyroid cancer
pheochromocytoma
parathyroid tumor
37
MEN 2b
Medullary thyroid cancer
pheochromocytoma
mucosal neuromas and marfanoid habitus
38
Tx of molluscum contagiosum
```
umbillicated nodules (sexually transmitted or seen with CD4<100)
curretage or liquid nitrogen
```
39
tests for screening for acute hep B
HBsAg and IgM anti-HBc (covers window period)
40
use of handgrip with murmurs
AS: decreases
MR: increases
41
Dx of ARDS
acute dyspnea
inciting incident (sepsis, severe bleed, trauma, toxic injury)
bilat infiltrates on CXR
PCWP < 200
42
electrolyte changes with CKD
hyper K, hyperphosphatemia, hypocalcemia, metabolic acidosis
43
Tx of meniere's disease
avoid triggers that incr endolymphatic retetion: alcohol, caffeine, nicotine, high salt.
diuretics, antihistamines, anticholinergics
44
bone pain, renal failure, hypercalcemia
multiple myeloma
45
narcotic used in acute pancreatitis
meperidine or fentanyl
46
source of A-fib
ectopic foci in pulmonary vein (myocardial sleeves)
47
source of atrial flutter
rentrant circuit that rotates around the tricuspid annulus
48
Tx of polymyalgia rheumatica
low dose prednisone followed by taper as tolerated. methotrexate is effective steroid sparing agent.
49
Sx of hypokalemia
weakness, fatigue, muscle cramps
severe: flaccid paralysis, hyporeflexia, rhabdo, arrythmias
EKG: broad flat T waves, u waves, ST depression, PVCs
50
Multiple myeloma signs/Sx
```
CRAB: calcium(hyper), renal impairment(myeloma kidney), anemia, bones (back pain, lytic lesions/fractures)
paraprotein gap (total protein-albumin>4)
recurrent infections (ineffective antibodies produced)
```
51
Sx of heat stroke? Tx?
temp >40.5(105), AMS, HA, dizziness, dry skin, hypotension, tachycardia, tachypnea.
systemic damage: rhabdo, ARF, DIC
evaporative cooling: spray with luke warm water and run fans.
52
cause of acute necrotizing mediastinitis
spread of infection from retropharyngeal abscess into posterior mediastinum
53
differential for thrombocytopenia
bone marrow: aplastic anemia, heme malignancies, megaloblastic anemia, alcohol, myelodysplasia
non bone marrow: ITP, HIT, hypersplenism, DIC, sepsis, viral infection, HIV, SLE, TTP, HUS
54
Tx of legionella pneumonia
macrolides (azithromycin) or newer generation fluoroquinolones (levofloxacin/moxifloxacin)
55
antiarrythmics more efficacious at higher heart rates due to use dependence
class I (especially IC i.e. flecanide) and class 4 (CCBs)
56
correction for hypocalcemia in liver disease
0.8(normal albumin(4.0) - measured albumin) + measured Ca
57
goal for LDL level in pt with Hx of stroke/TIA
<100 mg/dl
58
medical Tx of graves disease
b-blocker + methimazole/propylthiouracil
59
Dx of aortic dissection
TEE or chest CT with contrast
60
asymptomatic alk phos elevation
pagets disease of bone
61
Tx of V-tach
hemodynamically stable: amiodarone (DOC) or lidocaine
| unstable: cardioversion
62
requirements for 2 sample t-test
means, variances, samples sizes
63
major side effect of hydroxychloroquine
retinopathy
64
AE of cyclophosphamide
hemorrhagic cystitis and bladder ca (prevent w/ fluids and mesna)
others: sterility, myelosuppression
65
when is goal INR 2.5-3.5?
prosthetic heart valve, prophylaxis of recurrent MI, Tx of antiphospholipid antibody
66
AE of b-agonists (ie albuterol)
tremor, palpitations, headache, hypokalemia (->weakness, arrhythmia, EKG changes)
67
arrhythmia specific for digitalis toxicity
atrial tachycardia (increased ectopy) with AV block (increased vagal tone)
68
AE of trastuzumab
cardiac toxicity
69
pentad of thrombotic thrombocytopenic purpura
```
fever
microangiopathic hemolytic anemia (schistocytes, reticulocytosis, increased LDH)
thrombocytopenia (w normal coagulation)
CNS Sx
renal failure
```
70
Tx of pyelonephritis in non pregnant?
fluoroquinolones 7-14 days
71
distinguishing normal anion gap metabolic acidosis of extrarenal vs renal origin
extrarenal: largely negative urine anion gap
renal: positive urine anion gap
gap = urine NA+K-Cl
72
predicted compensation in respiratory acidosis
acute: incr bicarb by 1 for every 10 increase in PCO2
chronic: incr in bicarb by 4 for every 10 increase in PCO2
73
predicted compensation in respiratory alkalosis
decr bicarb by 2 for every 10 decrease in PCO2
74
Tx of mycobacterium avium complex
clarithromycin + ethambutol
| prophylaxis: azithromycin
75
preferred Tx of hyperthyroidism
radioactive iodine (with pretreatment of methimazole to avoid thyrotoxicosis as thyroid cells are destroyed)
76
Sx of hypocalcemia
```
neuromuscular irritability
perioral tingling/numbness
muscle cramps
tetany
carpopedal spasms
seziures
prolonged QT
```
77
loss of hearing in HIV pt
serous otitis media (due to obstruction of lymph flow due to lymphoma or lymphadenopathy) - not infectious
78
Tx of psoriatic arthritis
NSAIDs, anti-TNFs, methotrexate. corticosteroids relatively contraindicated
79
a thyroid nodule is (in order of decr frequency)
colloid nodule, follicular adenoma, papillary carcinoma, follicular carcinoma, anaplastic, medullary. (less than 10% of nodules are cancer)
80
Tx of restless leg syndrome
dopamine agonists - roperinole, pramipexole
| levodopa
81
physical exam test for differentiating between hepatic and cardiac source of BLE edema
hepatojugular reflex - pos in cardiac, neg in liver
82
smoker who develops clubbing, sudden onset joint arthropathy
hypertrophic osteoarthropathy - assoc w/ lung cancer, TB, bronchiestasis, emphysema
83
systemic effects of heat stroke
seizure, ARDS, DIC, hepatic/renal failure
84
indications for dialysis
a - refractory Acidosis
e - refractory Electrolyte abnormality (hyperK)
i - intoxication (ethylene glycol, methanol, ASA)
o - fluid Overload
u - uremic symptoms (pericarditis, seizure, coma)
85
Sx of acute rheumatic fever
```
group A BHS pharyngitis 2-4 weeks prior
migratory arthritis of large joints
erythema marginatum rash
subcutaneous nodules
carditis
syndenham chorea
```
86
Tx of essential tremor
propranolol
primidone (antiepileptic that may precipitate acute intermittent porphyria)
gabapentin
topiramate
87
empiric Tx of bacterial meningitis
vanc + ceftriaxone - covers neisseria and penicillin resistant strep pneumo
ampicillin - covers listeria
dexamethasone
88
medications that turn the stool black
iron
| bismuth (pepto bismol)
89
define orthostatic hypotension
lightheaded/dizziness
>20 systolic or >10 diastolic drop
>20 increase in HR
90
pts with hemochromatosis at risk for which infections?
listeria monocytogenes (cirrhotics too)
yersinia enterocolitica
vibrio vulnificus septicemia
91
measurement used in guillian barre to monitor for respiratory compromise
vital capacity (downward trend falling below 15 ml/kg)
92
treatment of bacterial vaginosis
metronidzole 500 mg 2x daily for 7 days
93
Tx of trichomoniasis
single dose of 2 g metronidazole
94
Tx of cat scratch disease (Bartonella)
5 days of azithromycin
95
Sx of retropharyngeal abscess
fever, dysphagia, neck pain worse with extension, trismus (inability to open mouth)
96
Tx of acute COPD exacerbation
O2, inhaled bronchodilators (B2 agonists and anticholinergics), broad spectrum abx, 2 week corticosteroid taper
97
Tx of wolf parkinson white
cardioversion or antiarrhythmic like procainamide.
| AV nodal blocers (B-blockers, CCBs, digoxin, adenosine) avoided due to worsening WPW accessory pathway
98
differential for mediastinal mass
4 T's: thymoma, teratoma (and other germ cell tumors), thyroid neoplasm, terrible lymphoma
99
anticoagulation in A-Fib
```
depends on CHADS2 score:
CHF, HTN, Age>75, DM - 1 pt each
Prior stroke - 2 pts
0 - aspirin alone
1-2 - either aspirin or warfarin
2+ - warfarin
```
100
AE of cyclosporine
Nephrotoxicity, hyperK, hyperglycemia, hyperuicemia, htn, gum hypertrophy, hirsutism, tremor, gi sx
Tacrolimus the same minus gum hypertrophy and hirsutism
101
AE of azathioprine
Diarrhea, leukopenia, hepatotoxicity
102
AE of mycophenolate
Marrow suppression
103
Sx of primary hyperaldosteronism? Dx?
Htn, muscle weakness, numbness
High aldosterone/renin ratio is used for screening. non suppressibility of aldosterone with NaCl loading confirms Dx. f/u with adrenal imaging.
104
Dx of PBC? Tx?
antimitochondrial Abs
| ursodeoxycholic acid. advanced cirrhosis: liver transplant
105
Tx of TTP-HUS?
plasma exchange
106
indications for home O2 therapy in COPD
any one of:
1. PaO2< 88%
2. hematocrit > 55%
3. cor pulmonale / pulmonary hypertension
4. nocturnal hypoxia
107
Tx options for acute glaucoma
```
IV mannitol (first line, works immediately)
topical pilocarpine
topical timolol
acetazolamide
AVOID atropine and epinephrine
```
108
Tx of toxoplasmosis
Sulfadiazine plus pyrimethamine and folinic acid
109
Tx of fibromyalgia
TCA
| cyclobenzaprine (flexeril)
110
Sx of niacin deficiency
diarrhea, dermatitis, dementia, death
111
AE of succinylcholine
can cause lifethreatening hyperkalemia
contraindicated in pts with hyperkalemia or at high risk of developing it: crush injuries, burns, guillain-barre, tumor lysis syndrome. use non depolarizing agents (vecuronium)
Can cause malignant hyperthermia
112
Tx of acute migraine
triptans
NSAIDs
antiemetics - chlorpromazine, prochlorperazine, metoclopramide
113
Tx of babesiosis
quinine-clindamycin
| atovaquone-azithromycin
114
causes of secondary htn
renal - stenosis, CRF, polycystic disease
endocrine - hyperaldosteronism, thyroid/parathyroid disease, cushing, pheo, acromegaly
meds - OCPs, NSAIDs, decongestants, appetite suppressants, steroids, TCAs
coarctation of aorta
cocaine, other stimulants
sleep apnea
115
Tx of hepatic encephalopathy
lactulose
reduced protein diet
antibiotics: rifaximin, neomycin, metronidazole
116
Dx of acromegaly
growth hormone level after oral glucose load
117
Tx of wilson's
chelators: d-penicillamine, trientine
oral zinc (decreases copper absorption)
liver transplant if decompensated or fulminant
118
Tx of hypercalcemia in sarcoidosis
prednisone - decreases number of activated macrophages responsible for producing 1a-hydroxylase
119
AE of lidocaine anesthetic
Seizure
120
Drugs causing methoglobulinemia? Tx?
dapsone
local anesthetics (bezocaine spray, lidocaine)
Tx: methylene blue
121
Opioids that you don't give to crf pts
Codeine and morphine
122
pt with hand weakness and mild motor aphasia. localize lesion
basal pons - dysarthryia-clumsy hand syndrome
123
hemisensory deficit. localize lesion
VPL nucleus of thalamus
124
unilateral motor/coordination deficit LE>UE. localize lesion
ant limb of internal capsule
125
unilateral motor deficit UE>LE. localize lesion
post limb of internal capsule
126
what's in cryoprecipitate?
rich in factor VIII, fibrinogen, vWF, factor XIII. used if pt is deficient in any of these
127
Sx of trichinellosis (parasitic roundworm infection)
```
phase 1(invasion into intestinal wall): eosinophilia, abd pain, NVD
phase 2(hypersensitivity due to larval migration): splinter hemorrhages, retinal hemorrhages, periorbital edema, chemosis
phase 3(muscle invasion): muscle pain, weakness
```
128
marker for androgen producing adrenal tumor
DHEA-S (other androgens made in gonads and adrenals)
129
1st and 2nd line Tx of status epilepticus
1st- benzos
| 2nd- phenytoin
130
Tx of hypercalcemia due to malignancy
bisphosphonates
131
lead poisoning Sx? Tx?
abd pain, constipation, diff concentrating, myalgias, anemia, renal failure, neurological dysfunction often with extensor weakness
EDTA or succimer
132
infxn of tear duct
dacryocystitis
133
cause of bleeding in CRF? Tx?
uremia -> decr platelet function (normal platelet count but prolonged bleeding time)
Tx: desmopressin (DDVAP) - releases factor VIII and vWF multimers from storage sites
134
Tx of cellulitis
w/ systemic Sx: nafcillin or cefazolin
mild: dicloxacillin
if MRSA suspected: vanc or TMP-SMX
135
Tx of guillain barre?
IVIG or plasmapharesis
136
test for de quervain tenosynovitis
flex thumb into palm, close fingers around it, bend wrist towards ulnar side. Stretches extensor pollicus brevix and abductor pollicus longus
137
Tx of human/dog bite
amox clav. need to cover mixed flora (gram +, -, anaerobes)
138
metabolic derangement caused by vomiting
hypokalemic hypochloremic metabolic alkalosis
139
COPD pt develops clubbing
lung cancer
140
bugs causing malignant otitis externa? Tx?
pseudomonas. typically seen in poorly controlled DM. can invade -> osteomyelitis or destruction of facial nerve.
Tx: Ciprofloxacin
if fungal, aspergillus
141
differentiate leukemia vs leukemoid rxn
leukocyte alkaline phosphatase is high in leukemoid rxn, low in leukemia
142
Tx of diabetic peripheral neuropathy
```
DOC: TCAs (may worsen autonomic neuropathy - urinary retention, orthostatic hypotension, gastroparesis, etc)
Gabapentin
NSAIDs (avoid in renal disease)
```
143
AE of macrolides
QT prolongation
| cholestasis
144
drug that causes artificial rise in creatinine
TMP-SMX. inhibits creatinine clearance but doesn't change GFR
145
Sx of acute intermittent porphyria? Dx?
abd pain, neuro and psych abnormalities
| presence of urine porphobilinogen
146
adverse effects of hctz
adverse effect on glucose, LDL, and triglyceride levels
| hyponatremia, hypokalemia, hypercalcemia
147
screening for AAA is required for ...?
male pt's 65-75 w/ hx of smoking - one time US
| repair if greater than 5.5 cm, rapidly growing(1cm/yr), or symptomatic
148
Dx of measles
Maculopapular rash w cough, conjunctivitis, coryza
149
hepatic hydrothorax due to cirrhosis occurs on the...
right
150
Tx of hypertrophic cardiomyopathy
B-blockers or cardiac acting CCBs (diltiazem, verapamil)
151
metabolism of non depolarizing neuromuscular blocking agents
pancuronium and mivacurium - excreted unchanged in urine (effect prolonged in renal failure)
rocuronium - cleared by liver
atracurium - metabolized in plasma. DOC if renal and liver dysfunction
152
Tx of htn due to pheo
alpha blocker, then b-blocker. or labetalol, which has a and b activity. giving b-blocker alone INCREASES BP (unapposed alpha vasoconstriction)
153
tx of hypertensive aortic dissection
iv labetalol
154
Tx of right ventricle infarct
IV fluids to increase preload. avoid nitro and diuretics which decr preload
155
Tx of early rheumatoid arthritis
ibuprofen + either hydroxycholorquine or methotrexate (contraindicated w regular alcohol use due to hepatotoxicity)
156
Tx of scabies
5% permethrin cream
157
ECG finding in pericardial effusion
electrical alterans (beat to beat variation in QRS) with compensatory tachycardia. can also see low voltage.
158
Tx of neuroleptic malignant syndrome
dantrolene (DOC)
bromocriptine (dopamine agonist)
amantadine (has dopaminergic properties)
159
Dx of cystinuria
hexagonal cyrstials. positive urine cyanide nitroprusside test.
160
when does odds ratio best approximate relative risk?
rare disease
161
Tx of cryptococcal meningitis
induction tx: amphotericin + flucytosine
| after clinical improvement, maintenance therapy with oral fluconazole
162
Drugs that cause hyperlipidemia
Glucocorticoids, estrogen, thiazide diuretics, b blockers
163
Tx of myelodysplastic syndrome
azacitidine - cysteine analog that delays progression to leukemia
164
Tx of raynaud's phenomenon
gloves, avoidance of cold
| amlodipine
165
differentiating seminoma vs nonseminomatous germ cell tumor
HCG positive in both. AFP only positive in nonseminoma
| Teratomas are neg for HCG and AFP
166
Tx of tinea versicolor
selenium lotion and ketoconazole shampoo
167
Tx of acne
from mild to severe (scarring) - topical retinoids, topical abx, oral abx, oral isotretinoin
168
Tx of dermatitis herpetiformis (other than avoid gluten)
dapsone
169
AE of metformin
lactic acidosis - espec in pt w/ renal failure, liver failure, or sepsis
170
predicted respiratory compensation in metabolic acidosis
PCO2 = 1.5 * bicarb + 8 +/- 2
171
tx of prolactinoma
cabergoline or bromocriptine - dopamine agonists
172
Tx of organophosphate poisoning
atropine
| removing clothes and cleansing skin (stop more poison from being absorbed)
173
Sx of osler weber rendu
aka hereditary telangectasia
| diffuse telangectasias, reccurent epistaxis, widespread AVMs
174
Indications for bariatric surgery
BMI of 35 with obesity related comorbidities or 40 without after failing other methods of wt loss
175
Cutoffs for obesity for BMI and waist circumference
BMI overwt is 25-30, obese is >30
| Waist >40 in in men and >35 in in females
176
Tx of tb
Active - Four drug therapy for 2 months (RIPE) followed by de-escalation usually to isoniazid + rifampin (depending on sensitivity report) for 7 months.
Latent - 9 months of isoniazid
177
AE of orlistat (obesity drug)
common: GI Sx-abd pn, incr defecation freq, steatorrhea
serious: liver failure, oxalate nephropathy w/ renal failure
178
Tx of diabetes inspidius
central: intranasal desmopressin (DDAVP)
nephro: NSAIDs, indomethacin. if due to lithium: amiloride
179
Tx of anorexia due to advanced cancer
progestin (megestrol acetate / medroxyprogestereone) or steroids
180
Dx of chronic pancreatitis
stool elastase
181
abnormal grid test (straight lines appear wavy)
macular degeneration. will see drusen deposits in macula on ophtho exam
182
AE of erythropoietin
worsening of HTN(30%)
headaches(15%)
flu like Sx (5%)
red cell aplasia (rare)
183
causes of transient, reversible incontinence
DIAPERS: drugs, infection, atrophic vaginitis, psych (depression, delirium, dementia), endo (hyperglycemia, hypercalcemia), restricted mobility, stool impaction
184
Dose for fluid bolus for peds
20 ml/kg. in trauma give 2 then packed rbcs
185
Tx of urge urinary incontinence
anticholinergics oxybutynin or tolterodine
186
drugs to avoid w/ coronary vasospasm (cocaine or prinzmetals)
b-blockers, aspirin
187
Tx of hairy cell leukemia
purine analog cladribine
188
parkinsonism + autonomic Sx (orthostatic hypotension, impotence, incontinence)
consider Dx of multiple system atrophy (shy drager syndrome)
189
Tx of travelers diarrhea
1st line is cipro or other fluoroquinolonea. 2nd is Bactrim or azithromycin.
