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Internal Medicine Shelf Exam > Internal Medicine > Flashcards

Internal Medicine Flashcards

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1
Q

ECG Leads: V1 - V6

A

Anterior

LAD

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2
Q

ECG Leads: II, III, avF

A

Inferior

RCA, LCX

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3
Q

ECG Leads: V1 - V3

A

Posterior
RCA – I, avL (depression)
LCX – I, avL (elevation)

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4
Q

ECG Leads: I, avL, V5, V6

A

Lateral

LCX, diagonal

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5
Q

ECG Leads: V4-V6R

A

Right Ventricle

RCA

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6
Q

anasarca + pulmonary/facial edema + hypertension + abnormal u/a with proteinuria and microscopic hematuria =

A

acute nephritic syndrome

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7
Q

CAP + arthralgias + erythema nodosum/multiforme =

A

Coccidiodies (Valley Fever)

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8
Q

Development of _____ _____ in a patient with infective endocarditis should raise suspicion for _____ _____ extending into the adjacent cardiac conduction tissues.

A

AV block

perivalvular abscess

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9
Q

Factors that differentiate tricuspid vs. aortic endocarditis (2)

A
  1. TV endocarditis usually presents with a holosystolic murmur (AR)
  2. Cardiac conduction abnormalities are mrore common with aortic valve involvement
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10
Q

Dobutamine (beta 1 agonist) works by…

A

improving ejection fraction AND reducing left ventricular end-systolic volume

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11
Q

Liver Failure: Portal HTN Sx

A 
Esophageal varices
Splenomegaly
Ascites
Caput medusae
Anorectal varices
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12
Q

Liver Failure: Hyperestrinism Sx

A 
Spider angiomas
Gynecomastia
Loss of sexual hair
Testicular atrophy
Palmar erythema
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13
Q

Pathohysiology of AML

A

atypical promyelocytes in the bone marrow

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14
Q

Malaria prophylaxis for India

A

Chloroquine resistance; prophylaxis with mefloquine; begins 2 weeks before travel and continued 4 weeks after returning

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15
Q

Sick Sinus Syndrome (SSS) Definition

A

inability of SA node to generate an adequate heart rate

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16
Q

SSS EKG Findings

A

3-6 seconds with no sinus nodal activity + dizziness

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17
Q

DX: low cortisol + high ACTH + hyper pigmentation + hyponatremia + hyperkalemia =

A

Primary Adrenal Insufficiency; likely due to autoimmune etiology

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18
Q

G6PD Deficiency

A

X-linked; Black men; Episodic hemolysis in response to Rx, illness, etc.; Heinz bodies and bite cells seen on peripheral smear

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19
Q

Management of severe hypercalcemia

A

Aggressive fluids
Calcitonin
+/- Pamidronate (takes 2-4 days to work)

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20
Q

Round face + bruises think…

A

Cushing’s

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21
Q

HTN + hyperglycemia + weight gain =

A

Cushing’s

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22
Q

DOE + HTN + prominent pulmonary arteries + enlarged R heart border =

A

Pulmonary HTN

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23
Q

Arsenic Poisoning

A

Polyneuropathy
Pancytopenia
Mild LFT elevation
Skin Lesions

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24
Q

Type of HTN Rx that has been proven to slow the progression of end-organ damage in patients with DM2…

A

ACE inhibitors

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25
Bilateral hilar adenopathy on CXR
Sarcoidosis
26
Pathophysiology of sarcoidosis
chronic granulomatous inflammation; noncaseating granulomas
27
Hypopituitarism Features (3)
Glucocorticoid deficiency Hypogonadism Hypothyroidism
28
Splenic infarction usually occurs due to...
hypercoagulable states embolic disease hemoglobinopathy
29
Usually (this condition) is asx; however, it can be exacerbated by air travel and/or dehydration
sickle cell trait
30
Elderly patient + severe lymphocytosis + hepatosplenomegaly + lymphadenopathy + bicytopenia (anemia, thrombocytopenia)
CLL
31
Diagnostic tool for CLL
Flow cytometry of the peripheral blood
32
Claw toes in an elderly patient are most likely due to...
diabetic neuropathy
33
Management for acute limb ischemia s/p MI
immediate anticoagulation, vascular surgery consultation, transthoracic echo
34
Addison's Disease (AKA primary adrenal insufficiency) presents with this acid-base disturbance:
normal anion gap acidosis
35
Elevated anion gap metabolic acidosis causes:
DKA Intoxication Tissue Hypoxia Renal Failure
36
Metabolic alkalosis causes:
Vomiting Hyperaldosteronism Excessive Volume Contraction
37
Respiratory acidosis causes:
Conditions that impair proper ventilation = hypoventilation
38
Respiratory alkalosis causes:
Conditions that impair proper ventilation = hyperventilation
39
Leukoplakia
Presents as white patches or plaques over the oral mucosa that usually can NOT be scraped off; R/F include smokeless tobacco and alcohol use
40
Primary lymphoma of the thyroid is characterized by...
rapidly progressive thyroid enlargement with compression of surrounding structures; more common in patients with a PMH of Hashimoto thyroiditis
41
Test to rule in RA =
anti-CCP antibody
42
When a patient presents with carpal tunnel, you must also r/o this condition
RA (order inflammatory factors, RF, and xrays)
43
LFTS >3000 think...
Ischemic hepatic injury
44
Tx for hyperkalemia w/ EKG changes
calcium gluconate
45
Most common cause of asx elevated alk phos in elderly patient is:
Paget disease of the bone
46
XR findings for Paget's disease of the bone:
osteolytic/mixed lytic-sclerotic lesions
47
All pts with RA should be on...
DMARDS, specifically methotrexate
48
Dyspepsia + postprandial fullness + nausea in the context of a patient that is from a low income country
Helicobacter pylori
49
Pathophysiology of H. pylori
urease-producing bacterial infection
50
Three most common causes of aortic stenosis:
1. senile calcific aortic stenosis (>70) 2. bicuspid aortic valve 3. rheumatic heart disease
51
Patients with ankylosing spondylitis can develop ______ due to diminished chest wall and spinal mobility.
restrictive lung disease
52
PFTs for patient with ankylosing spondylitis show...
mildly restrictive pattern with reduced VC and TLC
53
Wart like "rash" in groin region that is NOT flesh colored...
HIV - Kaposi's Sarcoma
54
Acid in eye =
WATER FLUSH
55
Prevalence is high, _____ is high.
PPV
56
Prevalence is low, _____ is high.
NPV
57
Left sided diastolic heart failure due to...
MI
58
4th heart sound due to...
MI
59
DX: substernal discomfort + left-sided neck pain + diaphoresis + dyspnea
acute MI
60
Loss of p waves =
A.Fib
61
Anion gap =
Na - (Cl + BiCarb)
62
Winter's Formula =
1.5 * (BiCarb) + 8 (+/- 2)
63
Normal pH
7.35 - 7.45
64
Normal BiCarb
22-28
65
Normal CO2
33-45
66
Electrolyte imbalance that is the best predictor for severity of heart failure =
hyponatremia
67
IBD that is bloody =
UC
68
IBD that is non-bloody =
Crohn's
69
Warfarin + acetiminophen =
BLOOD
70
Warfarin + green foods =
CLOT
71
Number Needed to Treat Formula =
Inverse of Absolute Risk Reduction
72
Tx for minor frostbite
Rapid rewarming with warm water
73
Acute goat path findings:
needle shaped spindles
74
HIV patient with multiple non-enhacning brain lesions
PML
75
Tx for pulmonary HTN
ACE + diuretic
76
Cor pulmonale is usually caused by...
impaired function of the R ventricle secondary to pulmonary htn
77
Ejection click + crescendo-decrescendo systolic murmur over L second intercostal speace
Pulmonic valve stenosis
78
OSA can cause transient periods of hypoxemia which leads to...
polycthemia; the kidney responds by increasing erythropoietin
79
Drug for recurrent nephrolithiasis secondary to hypercalcemia
Thiazide diuretics
80
Febrile nonhemolytic transfusion reaction
occurs within 1-6 hours; fever, chills, nausea, and malaise; prevent by leukoreduction
81
Most common cardiac S/E with SLE
acute pericarditis
82
Bullae on erythematous background
bullous pemphigoid
83
Bullous pemphigoid tx
topical clobetasol
84
Hyperthyroidism + increased RAIU =
de novo thyroid hormone synthesis
85
Hyperthyroidism + decreased RAIU =
preformed hormone, exogenous hormone intake
86
Shoulder pain + horner =
pancoast tumor
87
Choice of drug for patients that are allergic to penicillin but have primary syphillis
Doxycycline
88
Lithium can cause...
nephrogenic diabetes insipidus
89
Tx for lithium DI =
d/c lithium, salt restriction
90
Most common type of cancer associated with asbestos
bronchogenic carcinoma
91
Pleural plaques
Asbestos
92
Test for Sjogren Syndrome
Antibodies to Ro/SSA and La/SSB
93
Sx of Sjogrens
``` dry mouth difficulty swallowing thrush dental caries dry eyes ```
94
Sx of SLE
photosensitive rash | symmetric oligoarthritis
95
SLE + hx of PE/DVT + hx of miscarriages
antiphospholipid syndrome
96
Dx finding in patients with antiphospholipid syndrome
prolonged PTT
97
Unilateral uptake on RAUI scan...
toxic adenoma = autonomous thyroid production
98
Lynch Syndrome
Colon Endometrial Ovarian
99
What part of the spine does RA affect first?
Cervical
100
Obesity hypoventilation syndrome
high BMI daytime hypercapnia alveolar hypoventilation
101
Erysipelas
superficial skin rash that has raised, sharply demarcated borders; caused by Group A Strep
102
Cardiac index = reduced; PCWP = increased
Cardiogenic shock secondary to MI
103
Cold water immersion works by...
slowing AV node conduction
104
Massive PE would cause this heart problem...
RV dysfunction
105
Metabolic acidosis to alkalosis in a patient with ascites...
+ loop diuretic
106
Slowly growing papule with irregular borders
BCC
107
Familial hypocalciuric hypercalcemia
mutation in the calcium-sending receptor; benign d/o characterized by elevated calcium, normal/elevated parathyroid hormone, low calcium excretion
108
Most common cause of back pain
lumbosacral strain
109
Felty Syndrome
inflammatory arthritis splenomegaly neutropenia
110
Achalasia
chronic dysphagia with both solids and liquids; better when standing up; classic bird beak finding on barium swallow
111
Tx of uric acid stones
high fluids | potassium citrate
112
Dx test for fibromuscular dysplasia
CT angio of abdomen
113
Medications shown to improve long-term survival in patients with L ventricular systolic dysfunction:
``` Beta blockers ACE inhibitors ARBs mineralcorticoid receptor antagonist AA -- hydralazine + nitrates ```
114
Examples of MRAs
spironolactone | eplerenone
115
HFpEF AKA
diastolic dysfunction
116
Basal insulin should cover patients for...
24 hours
117
Dull, hypomobile TM
serous otitis media
118
HIV patient on horse farm with diarrhea...
Cryptosporidium parvum
119
Isolated thrombocytopenia =
ITP
120
Once a patient is diagnosed with ITP, they should undergo screening for... (2)
Hep C, HIV
121
Acute MI + MR =
papillary wall rupture
122
HIV associated nephropathy =
focal segmental glomerulosclerosis (FSGS)
123
Thyroiditis s/p URI
subacture/ de Quervain
124
Tx for subacute thyroiditis
beta blockers, NSAIDs
125
Early decrescendo diastolic murmur best heard at RUSB
aortic regurgitation
126
S/E of chlorthalidone
hyperglycemia (insulin resistance)
127
Common causes of exudative pleural effusion
Infection (PNA) RA Malignancy
128
Patients with RA are at a higher risk for...
osteoporosis
129
Drug to prevent DVT in patient with A.Fib =
anticoagulant
130
Patient with upper lobe PNA + cavitary lesion + HIV =
reactivated TB, mycobacterial infection
131
Aortic stenosis + early peaking systolic murmur =
mild - moderate
132
Aortic stenosis + late peaking systolic murmur =
severe
133
Severe aortic stenosis additional sound
soft S2
134
Metformin can cause lactic acidosis in patients with...
acute renal failure liver failure sepsis
135
Recent anticoag + new thrombocytopenia =
heparin induced thrombocytopenia (HIT)
136
Back pain + hypercalcemia + anemia + renal insufficiency =
Multiple myeloma (monoclonal protein)
137
Liver + kidney stuff =
Goodpasture's
138
calcitonin + thyroid nodule
medullary thyroid carcinoma
139
If pt has medullary thyroid carcinoma, worry about this other cancer...
pheochromocytoma
140
Prophylaxis for esophageal varices
nadolol
141
Mechanism of aplastic anemia
acquired deficiency of pluripotent stem cells
142
Recurrent bacterial infections in an adult should raise suspicion for...
CVID
143
Dx test for CVID
quantitative measurement of serum immunoglobulin levels
144
Glucagonoma
rare neuroendocrine tumor on pancreas; presents with mild DM2, eczema, weight loss, and diarrhea; dx with glucagon level (>500)
145
Erythema nodosum
Sarcoid TB Behcets IBD
146
If secreting renin, you can expect the efferent arteriolar resistance to _____ and the tubular sodium reabsorption to _____.
increase | increase
147
Hypocalcemia next step (dx)
PTH high = vit d def low = autoimmune
148
Systemic sclerosis
Raynaud esophageal dysmotility skin thickening interstitial lung disease
149
COPD + digital clubbing =
hypertrophic osteoarthropathy
150
Dx test for hypertrophic osteoarthropathy
CXR
151
______ is the most common cause of death in patients with end-stage renal disease.
Cardiovascular disease
152
Definition of acute liver failure
acute onset of severe liver injury with encephalopathy and impaired synthetic function in a patient w/o cirrhosis/underlying liver disease
153
difficulty breathing/wheezing + nasal polyps + angina =
AERD (aspirin exacerbated respiratory disease)
154
Mechanism for AERD
pseudoallergic drug reaction
155
HA + dizziness + blurry vision + large gamma gap (difference b/w protein and albumin) + retinal changes =
Waldenstrom macrogloblinemia
156
S/E of HIT
arterial and venous thrombus
157
HIV + central/midwestern area + fever + cough + papules/nodules + hepatosplenomegaly + pancytopenia =
Histoplasma capsulatum
158
Tx for Histoplasma capsulatum
amphotericin b
159
Thyroid scintigraphy shows decreased radioiodine uptake =
Painless/silent thyroiditis
160
Thyroid scintigraphy shows increased radioiodine uptake...
Graves
161
Pathoyphysiology of statin induced myalgia
inhibition of intracellular synthesis pathway
162
Medications that can trigger bronchoconstriction in a patient with asthma
aspirin | beta blockers
163
This lab is elevated in hereditary spherocytosis
mean corpuscular hemoglobin concentration (MCHC)
164
Young patient with refractory hypertension, suspect _____ and dx with _____.
primary hyperaldosteronism | PRA, PAC
165
Transudative effusions are commonly caused by...
decreased intrapleural or plasma oncotic pressures; elevated hydrostatic pressure
166
Exudative effusions are often the result of...
increased capillary or pleural membrane permeability or disruptions to lymphatic outflow
167
Calciphylaxis (AKA calcific uremic arteriolopathy)
systemic arteriolar calcification and soft-tissue calcium deposition with local ischemia and necrosis
168
Humoral hypercalcemia of malignancy is characterized by...
severe, symptomatic hypercalcemia that has a rapid onset
169
Pathophysiology of humoral hypercalcemia of malignancy
elevated parathyroid hormone-related protein
170
Pathophysiology of analgesic nephropathy
papillary necrosis; chronic tubulointerstitial nephritis
171
Lab that is high for patients with iron deficiency anemia
TIBC
172
oral and genital ulcers + erythema nodosum =
Behcet's disease
173
Erectile dysfunction with normal TSH but decreased T3/T4 =
chronic liver failure
174
Pleural effusions with low glucose concentrations (<30) are often due to...
empyemas, rhuematoid pleurisy; high metabolic activity in fluid
175
Suspect BPH? Order...
U/A, PSA
176
Common cause of endocarditis associated with nosocomial UTIs
Enterococci
177
Heartburn + dysphagia + hypomotility and LES problems =
systemic sclerosis = smooth muscle atophy and fibrosis
178
Epitrochlear lymphadenopathy =
syphillis
179
RA + enlarged kidneys + hepatomegaly + nephrotic syndrome =
amyloidosis
180
The kidney compensates for respiratory alkalosis by preferentially excreting _____ in the urine.
bicarb (increases pH)
181
Overuse of steroids can cause _____ Cushing's. Lab studies typically show:
central | decreased ACTH and cortisol levels
182
Patients with primary adrenal insufficiency have the following lab findings:
low ACTH low cortisol levels normal aldosterone
183
Legionnaires disease
bilateral lung infiltrates confusion diarrhea
184
Tx for Legionnaires disease
Levofloxacin
185
Patient with HIV and multiple ring enhancing lesions on MRI
Toxo
186
Tx for toxo encephalitis
sulfadiazine and pyrimethamine
187
Really high calcium with low PTH =
hypercalcemia of malignancy
188
Anticholinergic drug =
benadryl!
189
Dx test for chronic arterial insufficiency
ankle brachial index
190
Chronic venous stasis can be diagnosed with...
venous doppler
191
_____ cardiomyopathy should be suspected in patients with unexplained CHF, proteinuria, and left ventricular hypertrophy in the absence of HTN.
amyloid (restrictive)
192
ABI =
PAD
193
First step in diagnosing Cushing's
Low-dose dexamethasone suppression test OR late nate salivary cortisol assay OR 24 hour urine cortisol excretion
194
Recommendation for patients with calcium oxalate stones
Eat less salt
195
Ramsay Hunt Syndrome
vesicles in ear | facial droop
196
Polymyositis + anxiety + tachycardia + weight loss =
hyperthyroidism
197
Pathophys for bleeding in hereditary hemorrhagic telangiectasia
AV malformations
198
Patients with restrictive lung disease have an _____ A-A ratio
increased
199
Tx for PMR
lose dose steroids
200
Pleural effusion lung sounds
decreased breath sounds decreased tactile fremitus dullness to percussion
201
Young patient with + smoking history, episodes of nighttime chest pain, ST elevations, and no blockages...
vasospastoc angina
202
Tx for vasospastic angina =
CCB (dilt) and smoking cessation
203
R/F for C. Diff
PPI use
204
Early decrescendo diastolic murmur (LSB)
Aortic regurgitation (young person = bicuspid valve)
205
Harsh crescendo-decrescendo systolic murmur (LSB)
HOCM
206
Muscle weakness + recurrent nephrolithiasis + neuropsych sx + hypercalcemia =
primary hyperparathyroidism
207
Fun saying for primary hyperparathyroidism
bones, stones, abdominal moans, and psychic groans
208
Majority of primary hyperparathyroidism due to...
parathyroid adenoma
209
Most common cause of hemoptysis
chronic bronchitis cancer bronchiectasis
210
Most common cause of acute urinary retention in men
bladder outflow obstruction (BOO)
211
Restrictive lung disease PFT findings
decreased lung volume decreased diffusion lung capacity normal FEV1/FVC
212
Immediate treatment for aortic dissection
beta blocker
213
Leukocyte count > 50,000
leukemoid reaction
214
Yellow-red papules on extensor surfaces
xanthomas
215
Xanthomas can be seen when...
hypertriglyceridemia (which can lead to acute pancreatitis)
216
Nephrogenic DI tx
HCTZ
217
SIADH tx
Demeclocycline
218
SLE can initially present as...
generalized tonic clonic seizures
219
Lab findings for patient's with pagets disease of the bone
elevated alk phos and urine hydroxyproline; normal calcium and phosphorus
220
Acromegaly can demonstrate the following finding on echo
Concentric myocardial hypertrophy
221
Coarsening of facial features + pharyngeal crowding + enlargement of hands and feet =
Acromegaly
222
Chondrocalcinosis =
pseudogout
223
Pseudogout + diabetes =
hereditary hemochromatosis
224
Drugs for cancer patients that can't gain weight
progesterone analogues
225
Hep B serology for patient recovering from acute infection
HBsAg - HBsAb + HBcAb +
226
Weight loss + tachycardia + tremor + lid retration
thyrotoxicosis
227
Systolic hypertension in thyrotoxicosis is caused by...
increased myocardial contractility and heart rate
228
Early onset hypertesnion and bilateral upper abdominal masses =
autosomal dominant polycystic kidney disease
229
Antibiotic that can cause hyperkalemia
Bactrim
230
Early septic shock is associated with a hyperdynamic CV state that results in...
bounding peripheral pulses
231
In patients with severe liver cirrhosis, the cause of an AKI is...
renal hypoperfusion
232
Unprovoked DVT/PE in young white population
Factor V Leiden
233
Factor V Leiden pathophys
activated protein c resistance
234
Tx for alcoholic cardiomyopathy
Stop drinking alcohol
235
GVHD is caused by...
activation of donor T lymphocytes
236
1st line for A.Fib with RVR
Beta blockers (unless CHF exacerbation then give furosemide)
237
epistaxis + tremor + tachy + new-onset htn =
cocaine use
238
Coarse facial features + uncontrolled htn + carpal tunnel =
acromegaly
239
Dx test for acromegaly
IGF1
240
Cardiac monitoring for vasovagal syncope =
sinus bradycardia and sinus arrest
241
Chronic COPD leads to hyperinflation of the lungs, which causes a ....
flattened diaphragm and increased WOB
242
Milk-alkali syndrome
abdominal pain, constipation, polydipsia
243
Peripheral edema, ascites, elevated JVP, pericardial knock, pericardial calcifications =
Constrictive pericarditis
244
Prophylaxis for MAC in patients with HIV
Azithromycin
245
Fever, cough, abdominal pain, diarrhea, night sweats, weight loss in an HIV patient...
MAC
246
Earliest renal abnormality seen in diabetic nephropathy...
glomerular hyperfiltration
247
Liver dysfunction + psych symptoms (chorea) =
Wilson Disease
248
Sjrogen syndrome in old people =
Age related sicca syndrome
249
Patellofemoral pain syndrome
knee pain; problems with climbing stairs/squatting; dx with isometric pain upon contraction; tx = strengthening the quadriceps and hip abductors
250
Two causes of hypoglycemia in patients without DM
1. insulinoma (high CCP) | 2. Insulin/sulfonylureas (low CCP)
251
Persistant EKG findings s/p MI
Ventricular aneurysm
252
This drug can cause renal tubular obstruction, which looks like prerenal azotemia...
acyclovir
253
Increased pigmentation in the palmar creases
Addison's Disease
254
Lab findings in Addison's Disease
Hyponatremia | Hyperkalemia
255
Sever aortic stenosis will present with this cardiac finding:
slow-rising, weak carotid pulse = pulsus parvus et tardus
256
Calcium oxalate crystals are this shape
Envelope
257
HIV + patients with severe throat pain =
Viral esophagitis
258
HIV + patients with moderate throat pain and difficulty swallowing =
Candida
259
Old guy with hx of pancreatitis and new onset diarrhea think...
chronic pancreatitis
260
Analgesic nephropathy
Tubulointerstitial nephritis; U/A shows blood, wbc casts, trace protein)
261
U/A blood, WBC casts, trace protein =
analgesic nephropathy
262
HIV patient with bloody diarrhea
CMV
263
Method to reducing mortality in patients with ARDS:
low tidal volume ventilation, which prevents overdistending alveoli
264
Population at risk for SLE
Young, African American women
265
Young patient with murmur that is best heard at URSB
Supravalvular aortic stenosis
266
Most common cause of gross lower GI bleeding in adults
Diverticulosis
267
Aquagenic pruritus, facial plethora, increased hematocrit =
polycthemia vera
268
Budd-Chiari Syndrome
obstruction of hepatic venous outflow + polycthemia vera
269
tinnitus + fever + tachypnea + OD
salicylates
270
Cyclophosphamide S/E
bladder carcinoma
271
Wartlike lesions, violaceous nodules, skin ulcers, mid-western farmer =
Blasto!
272
+ antimitochondrial antibody and pruitis =
primary biliary cholangitis
273
Best medication for a patient with COPD (inhaled)
SAMA (ipatropium)
274
Tx for esophageal varices in patient with PMH of alcoholism and hematemesis
Fluids Ceftriaxone Ocreotide
275
Carcinoid Syndrome
flushing diarrhea bronchospasm cardiac valve abn
276
Carcinoid syndrome leads to a deficiency in...
niacin
277
Trichinellosis
GI complaints periorbital edema myositis eosinophilia
278
Chronic Mesenteric Ischemia
chronic abdominal pain weight loss food aversion
279
Chronic Mesenteric Ischemia - Pathophysiology
atherosclerotic changes of celiac or SMA
280
#1 S/E of ADPKD
ruptured berry aneurysm

Internal Medicine Shelf Exam (1 decks)

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