Internal Medicine

Question 1

Chronic Cough - first symptom frequently discounted
Dyspnea - most characteristic finding
Sputum production

Answer 1

COPD Cardinal Manifestation

Question 2

60 % - 70 % of smoking related to

Answer 2

COPD

Question 3

Drugs Narrow Therapeutic Index

Answer 3

Theophylline
Digoxin
Warfarin
Lithium

Mnemonic: TDWL This Drugs Were Lethal

Question 4

Pathophysiology of COPD

Answer 4

1. Airway Limitation and Obstruction
2. Gas exchange Abnormality
3. Hyperinflation

Question 5

Conditions where dyspnea in upright position with relief in supine (Platypnea)

Answer 5

Left Atrial Myxoma

Hepatopulmonary syndrome

Question 6

Chest thightness

Answer 6

Bronchoconstriction / Bronchial Asthma

Question 7

Inability to take a deep breath

Answer 7

COPD

Question 8

CHF, Obesity (diaphragm pressing), Asthma, GERD

Answer 8

Orthopnea

Question 9

Nocturnal Dyspnea or Paroxysmal Nocturnal Dyspnea

Answer 9

CHF or Asthma

Question 10

Acute Intermittent episodes of Dyspnea

Answer 10

Myocardial Infarction, Bronchospasm, Pulmonary Embolism

Question 11

COPD, Interstitial Lung Disease, Chronic Thromboembolic Disease

Answer 11

Chronic Persistent Dyspnea

Question 12

In lung palpation, decrease tactile fremitus is?

Answer 12

Effusion

Question 13

In lung palpation, increase tactile fremitus is?

Answer 13

Consolidation

Question 14

Pleural Effusion (large), mediastinum will shift where?

Contra or ipsi?

Answer 14

Contralateral side

Question 15

Atelectasis (lobar obstruction), mediastinum will shift where?

Contra or ipsi?

Answer 15

Ipsilateral side

Question 16

Most Common Adverse Reaction of drug-susceptible TB

Answer 16

Symptomatic Hepatitis

• Jaundice, ALT 3x high

Or Asymptomatic ALT 5x high

Question 17

Toxicity TB Meds

Red color to body secretions

Answer 17

Rifampicin

Question 18

Rifampicin Toxicity Management

Answer 18

None. Benign condition

Question 19

Toxicity TB Meds

Peripheral Neuropathy

Answer 19

Isoniazid

Question 20

Isoniazid Toxicity Management

Answer 20

Take Pyridoxine

Question 21

Toxicity TB Meds

Hyperuricemia

Answer 21

Pyrazinamide

Question 22

Pyrazinamide Toxicity Management

Answer 22

If symptomatic, discontinue drug then give NSAIDs for pain

If asymptomatic, no treatment

Question 23

Toxicity TB Meds

Optic neuritis / Color Vision

Answer 23

Ethambutol

Question 24

Ethambutol Toxicity Management

Answer 24

Decrease dose in renal failure

Question 25

Most toxic TB meds

Answer 25

Pyrazinamide *Resumption of TB meds: Rifampicin (RIF) (R), Ethambutol (EMB) (E), Isoniazid (INH) (H), Pyrazinamide (PZA) (Z)

Question 26

Size of induration of tuberculin PPD: >5mm

Answer 26

HIV or risk factors, close TB contact, CXR evidence of TB

Question 27

Size of induration of tuberculin PPD: >10mm

Answer 27

Indigent / Homeless, residents of developing nations, IV drug users, chronic illness, residents of health and correctional institutions and health care workers

Question 28

Size of induration of tuberculin PPD: >15mm

Answer 28

Everyone else including with no known risk factors

Question 29

Tuberculin PPD (TST) is used for

Answer 29

Screening of LATENT Tuberculosis Infection TST - skin IGRA - blood

Question 30

Chest Xray Findings in Pulmonary Embolism Peripheral Wedged - Shaped density above diaphragm

Answer 30

Hamptom’s Hump

Question 31

Chest Xray Findings in Pulmonary Embolism Focal Oligemia

Answer 31

Westermark’s sign

Question 32

Chest Xray Findings in Pulmonary Embolism Enlarged Right Descending Pulmonary Artery

Answer 32

Palla’s sign

Question 33

Chest Xray Findings in Pulmonary Embolism HYPERkinesis of the RV free wall with normal or HYPER

Answer 33

McConnell’s sign

Question 34

Pneumonia Risk Factor

Answer 34

C - CONFUSION U - BUN >30mg/dl R - RR >30 bpm B - SBP >90 mmHg, DBP <60 mmHg Age 65 older

Question 35

ARDS Stage 1st 7 days symptomatic with alveolar edema and neutrophil-rich leukocyte infiltration of lungs Formation of hyaline membranes from diffuse alveolar damage

Answer 35

Exudative phase

Question 36

ARDS Stage Day 7 - 21 Prominent Interstitial Inflammation and Early Fibrotic Phase Also, most patient recover on this stage and usually intubated patients liberated from mech vent

Answer 36

Proliferative Stage

Question 37

ARDS Stage >3 weeks Substantial Fibrosis and Bullae Formation

Answer 37

Fibrotic Phase

Question 38

NYHA Classification No limitation

Answer 38

Class I

Question 39

NYHA Classification With Limitation of 2 flights of stairs

Answer 39

Class II

Question 40

NYHA Classification With Limitation of 1 flight of stairs

Answer 40

Class III

Question 41

NYHA Classification With Limitation on rest

Answer 41

Class IV

Question 42

Dyslipidemia Drug to increase HDL

Answer 42

Fibrates - Increase incidence of gallstone, caution in CKD patient Niacin - cause hyperuricemia and cause gout

Question 43

5 - 10 days post MI New Onset Murmur and Pulmonary congestion 5 days post MI

Answer 43

Left Ventricular Septal Wall Rupture Papillary muscle rupture - Acute Mitral Regurgitation Septal rupture

Question 44

First day post MI complications

Answer 44

Heart Failure

Question 45

2-4 days post MI complications

Answer 45

Arrhythmia, Pericarditis

Question 46

Weeks to months post MI complications

Answer 46

Ventricular aneurysm

Question 47

Heart Failure with Reduced Ejection Fraction

Answer 47

``` ACE inhibitors - 23% reduction in mortality - ALL class will do Beta Blocker - 35 % ```

Question 48

Beta Blockers used in HF

Answer 48

Metoprolol succinate Bisoprolol Carvedilol *MsBC Heart Fails

Question 49

Pain reaches peak intensity immediately

Answer 49

Pneumothorax Pulmonary Embolism - hypercoagulable, surgery, stasis Aortic Dissection - sudden severe chest pain, Marfan syndrome complains of pain