Internal Medicine Flashcards Preview

Step 2 > Internal Medicine > Flashcards

Flashcards in Internal Medicine Deck (667)
Loading flashcards...
1

acute angle-closure glaucoma

symptoms: headache, ocular pain, nausea, decreased visual acuity
signs: conjunctival redness, corneal opacity, fixed/mid-dilated pupil
dx: tonometry (intraocular pressure) and goniscopy (measures corneal angle)
treatment
1. topical- multidrug (timolol, pilocarpine, apraclonidine)
2. systemic- acetazolamide (consider mannitol)
3. laser iridotomy

2

what can lead to hepatorenal syndrome

risk factors: advanced cirrhosis with portal hypertension and edema
precipitating factors: reduced renal perfusion, GI bleed, vomiting, sepsis, excessive diuretic use, spontaneous bacterial peritonitis, reduced glomerular pressure and GFR possibly by NSAIDS (constrict afferent arteriole)

3

what maneuvers increase parasympathetic tone to the heart

carotid sinus massage
cold water immersion or diving reflex
valsalva maneuver
eyeball pressure

4

Chronic Lymphocytic Leukemia

Clinical
-lymphadenopathy and hepatosplenomegaly
-mild thrombocytopenia and anemia
-could be asymptomatic

Diagnostic
-severe lymphocytosis and smudge cells
-flow cytometry (clonality of mature B cells)

Prognostic
-median survival 10 years
-worse with: multiple chain lymphadenopathy, hepatosplenomegaly, thrombocytopenia, anemia

Complications
-infection
-autoimmune hemolytic anemia
-secondary malignancies (richter transformation)

5

how to evaluate elevated alk phos

1. check GGT (if normal then its likely due to bone abnormality)
2. if elevated then its likely due to biliary problem so check RUQ ultrasound and anti-mitochondrial antibody
3. AMA+ or abnormal hepatic parenchyma on US do liver biopsy
4. dilated bile ducts do ERCP (endoscopic retrograde cholangiopancreatogram)
5. both normal then consider liver biopsy, ERCP, observation

6

asymptomatic patient with elevated alk phos, normal AST and ALT, normal RUQ ultrasound, and positive anti-mitochondrial antibody assay, severe hypercholesterolemia
patient might have pruritus and fatigue

primary biliary cholangitis (previously, primary biliary cirrhosis)
-chronic progressive liver disease with cholestasis and autoimmune destruction of intrahepatic biliary ducts
-give patient ursodeoxycholic acid (hydrophilic bile acid)
-down the line most of these pts will need liver transplants
-complications: malabsorption of fat-soluble vitamins, metabolic bone diseases (osteoporosis/malacia), hepatocellular carcinoma

7

kidney problem that causes persistent activation of the alternative complement pathway

membranoproliferative glomerulonephritis, type 2
-immunofluorescence will show C3

8

patient with loss of motor and sensory function, loss of rectal tone, and urinary retention

acute spinal cord compression
-manage with emergency surgical consultation, neuroimaging, and possibly IV glucocorticoids

9

what is the most common cause of ascites

liver cirrhosis/chronic liver disease

10

next step for all patients who newly present with ascites

paracentesis is required to determine the cause

11

main complications after MI

0-24hrs: arrhythmia
1-3days: fibrinous inflammatory pericarditis
3-14days: pseudoaneurysm of inferior wall, free wall rupture, papillary muscle rupture, septal/VSD rupture
2weeks-3months: Aneurysm in anterior wall, dressler syndrome/immune pericarditis

12

intermittent claudication, diminished pulses, and abnormal (<1) ankle brachial index
-can be in one limb

Peripheral artery disease
-intermittent claudication = 20% 5-year risk of nonfatal MI and stroke AND 15-30% 5-year risk of death due to CV causes AND 1-2% critical limb ischemia with risk of limb amputation

-treat pt with statin and low-dose aspirin then start supervised exercise therapy

13

nonpupil sparing cranial nerve 3 palsy is concerning for what

aneurysmal compression (get MR or CT angiography immediately)
-most commonly caused by microvascular ischemia
-associated with diabetes mellitus, hypertension, hyperlipidemia

14

what are the nonosmotic reasons ADH can be stimulated for release

nausea
pain
physical/emotional stress
hypotension
hypovolemia
hypoxia
hypoglycemia

15

localized pain and tenderness over the medial tibial condyle in a runner

pes anserinus pain syndrome
-associated with overuse
-risk factors: obesity, DM, knee osteoarthritis, angular deformity
-dx: clinical
-treatment: quad strength training and NSAIDs

16

what does a third heart sound indicate

decompensated heart failure
-give dobutamine which stimulates myocardial contractility leading to improved ejection fraction, reduce LVESV, and symptomatic improvement

17

most common skin malignancy in US

basal cell carcinoma
-slow growing papule with pearly rolled borders

18

what is primary sclerosing cholangitis associated with

ulcerative colitis

19

how to diagnose multiple sclerosis

-T2 MRI lesion disseminated in space and time
-oligoclonal IgG bands on CSF lumbar puncture

20

patient with acute onset headache, sensation of the room spinning, nystagmus

stroke or hemorrhage affecting the cerebellum

21

pt with flank pain and hematuria and palpable abdominal mass
-left scrotal varicoceles

renal cell carcinoma
-paraneoplastic syndromes: anemia/erythrocytosis, thrombocytosis, fever, hypercalcemia, cachexia

22

aquagenic pruritus

polycythemia vera
-treat with phlebotomy

-one major complication is budd-chiari syndrome

23

budd-chiari syndrome

hepatic venous outflow obstruction usually due to myeloproliferative disorders (PV), malignancy (hepatocellular carcinoma), OCP use/pregnancy

acute signs: jaundice, hepatic encephalopathy, variceal bleeding, prolonged INR/PTT, elevated transaminases

chronic signs: abdominal pain, hepatosplenomegaly, ascites, elevated bilirubin and transaminases

dx: abdominal doppler ultrasound showing decreased hepatic vein flow then investigate for underlying causative disorders

24

single most important prognostic consideration for pts treatment with cancer

TNM staging, stage 4 is the worst

25

good and bad prognostic factors in breast cancer

good
ER+
PR+

bad
overexpression of HER2/neu oncogene
poorly differentiated tumors

26

endemic locations of systemic mycoses

histo- mississippi and ohio river valleys
blasto- eastern and central US and great lakes
coccidio- southwestern US and california
paracoccidio- latin america

27

clinical features of blasto

lung- acute/chronic pneumonia
skin- wart like lesions, violaceous nodules, skin ulcers
bone- osteomyelitis
genitourinary- prostatitis, epididimo-orchitis
CNS- meningitis, epidural or brain abscesses

28

what does an S4 mean?

-AKA atrial gallop
indicates a stiff LV (the sound is atrial contraction and blood is hitting the stiffened LV)
-restrictive cardiomyopathy
-can be heard in acute phase of myocardial infarction
OR
-LV hypertrophy from prolonged hypertension

29

acute lead toxicity vs chronic

GI: constipation
Neuropsych: sensorimotor neuropathy, short-term memory loss
Heme: microcytic anemia with basophilic stippling, hyperuricemia

treat with chelation therapy with calcium disodium EDTA

Chronic is the same but it can also lead to hypertension, nephropathy, hyperuricemia, and microcytic anemia

30

pronator drift

both arms out and palms up then one arm drifts down and palm turns toward the floor
sensitive and specific for upper motor neuron or pyramidal/corticospinal tract disease