Internal Medicine GI, Endo, Rheuma

Question 1

Aluminum hydroxide side effect

Magnesium hydroxide side effect

PPI side effect

Sucralfate side effect

Bismuth side effect

Answer 1

Constipation

Diarrhea

Angioedema

Constipation

Black tarry stool, neurotoxicity

Question 2

If unresponsive to therapy after ____ days

What test

Answer 2

ZES, 14

Secretin test

Question 3

Dieulafoy lesion. What?

Answer 3

Large caliber arteriole in LESSER curvature

Question 4

AST/ALT >1000

Answer 4

Viral hepatitis
Ischemic liver injury
Toxin

Question 5

AST:ALT > 2
AST:ALT < 1

Type of liver disease

Answer 5

Alcoholic liver disease

NAFLD, chronic viral

Question 6

Budd Chiari syndrome

Triad

Patho

Answer 6

Ab pain, hepatomegally, ascites

Venous thrombus / embolus in hepatic veins

Question 7

ALD

Cut off for glucocorticoids

How to compute

Answer 7

Discriminant function > 32

(PT - control) + serum bilirubin

Question 8

ALD

MELD score

Answer 8

PT INR Serum bilirubin, Serum creatinine

Question 9

Child pugh score

Answer 9

Bilirubin
Ascites
INR PT
Encephalopathy
Albumin

Question 10

Spontaneous bacterial peritonitis

Value of PMN in ascitic fluid

> 2 organisms =

Answer 10

250/uL

Secondary bacterial peritonitis (perforation)

Question 11

Hepatic encephalopathy

Is only diagnosed in ________

Usually increase in blood ______

Answer 11

Fulminant liver disease

Ammonia

Question 12

First indication of portal hypertension

Answer 12

Splenomegaly

Question 13

Diagnosis of acute pancreatitis

Answer 13

1. Epigastric pain radiating to back
2. Amylase and/or lipase x3
3. Imaging

Question 14

Pain medication of choice in acute pancreatitis

Answer 14

Meperidine

Question 15

Most important intervention in pancreatitis?

Answer 15

Fluids: pNSS or Lactated ringers

Question 16

Metabolic syndrome

Answer 16

Central obesity
Hypertriglyceridemia
Low HDL cholesterol
Hypertension
Fasting glucose

3/5

Question 17

Metabolic syndrome

Central obesity

Answer 17

South asians
M >90cm
F >80cm

US
M> 102
F> 88

Question 18

Metabolic syndrome

TAG

Answer 18

Serum TG > 150mg/dL

Question 19

Metabolic syndrome

Low HDL

Answer 19

<40 males

<50 females

Question 20

Metabolic syndrome

Bp

Answer 20

> 130, >85

Question 21

Metabolic syndrome

Fasting Blood glucose

Answer 21

FBS > 100

Type 2 DM

Question 22

DM diagnosis

FBS impaired

OGTT 75g

Hba1c

RBS

Answer 22

100-125 impaired fasting glucose

140-199

5.7-6.4

> 200 + polyuria polydipsia, polyphagia

Question 23

FBS, OGTT fasting time

Answer 23

At least 8 hours

Question 24

DM screening

1. Usual start
2. Earlier screen if?

Answer 24

> 45years every 3 years

Overweight + 1 risk factor

Question 25

DM drugs that cause Weight loss? Weight gain?

Answer 25

Weight loss: biguanides metformin Weight gian: insulin secretagogues. Glip glic glim + repaglinide

Question 26

Treatment goals of DM ``` Hba1c Preprandial glucose Post prandial glucose BP LDL HDL TAG ```

Answer 26

1. <7% 2. 80-103mg/dL 3. <180mg/dL 4. <140/90 5. <100 LDL 6. >40 mg/dL 7. <150mg/dL

Question 27

Lab testing for DM patients 1. Hba1c testing 2. DM nephropathy 3. Lipid profile , creatinine

Answer 27

1. 2-4 times ayear 2. Annual 3. Annual

Question 28

Hypoglycemia diagnosis

Answer 28

<55mg/dL + symptoms

Question 29

Whipples triad

Answer 29

Hypoglycemia Low plasma glucose Relief of symptoms after correction

Question 30

Body hormones to prevent hypoglycemia

Answer 30

1. Decrease insulin 2. Incrase glucagon 3. Increase epinephrine

Question 31

Absolute contraindication for radioactive iodine therapy.

Answer 31

Pregnancy, lactation, thyroid storm

Question 32

Most common cause of hypothyroidism

Answer 32

Iodine deficiency

Question 33

Most common cause of hypothyroidism in iodine sufficient areas

Answer 33

Hashimoto

Question 34

Sick euthyroid disease lab findings 1. TSH 2. FT4

Answer 34

1. Normal | 2. Decreased

Question 35

Sites of DEXA scan

Answer 35

1. Femoral neck 2. Total femur 3. Lumbar spine

Question 36

Screening for osteoporosis Riskfactors present.

Answer 36

``` Low BMI Fragility fracture Parental history of hip fracture Current smoking Glucocorticoid treatment RA Alcohol intake >70 in males > 65 women ```

Question 37

DEXA scan values Osteopenia Osteoporosis

Answer 37

1. -1 to - 2.5 SD | 2. <2.5 SD

Question 38

If BMD not available 2 test available 1

Answer 38

1. OSTA | 2. FRAX

Question 39

First line pain meds for osteoarthritis?

Answer 39

Paracetamol

Question 40

Asymptomatic hyperuricemia lab value

Answer 40

1. >7mg/dL male | 2. >6mg/dL female

Question 41

Crystals seen on synovial fluid analysis in gout.

Answer 41

Strongly negative birefringent needle shaped crystals.

Question 42

Indication for medical therapy for gout 1. what lab value? 2. Clinical

Answer 42

Serum uric acid >11-13 mg/dL Tophi

Question 43

Common joint involvement in RA

Answer 43

Wrist PIP MCP

Question 44

Deformities in RA 1. Swan neck 2. Boutonniere 3. Z line 4. Hallmark of RA

Answer 44

1. Hyperextension of PIP flexion of DIP 2. Flexion of PIP hyperextension of DIP 3. Subluxation of 1st MCP, extension of 1st IP joint 4. Flexor tendon tenosynovitis

Question 45

Most frequent site of cardiac involvement in RA

Answer 45

Pleuritis/pericarditis

Question 46

Earliest finding in imaging of RA patients

Answer 46

Juxtaarticular osteopenia

Question 47

DMARD of choice in RA and its contraindication.

Answer 47

Methotrexate. Contraindication in pregnancy

Question 48

Empiric of Septic arthritis. 1. Gram + 2. Gram - 3. Pseudomonas

Answer 48

1. Oxacillin, naficillin 2. Cefotaxime, ceftriaxone 3. Cefipime

Question 49

Contraindications to percutaenous liver biopsy.

Answer 49

1. Prolonged INR | 2. Significant ascites

Question 50

Criteria for DKA resolution 1. Plasma glucose 2. Serum HCO3 3. Venous pH 4. Anion gap

Answer 50

1. <200 2. >15meq/L 3. >7.3 4. <= 12

Question 51

Criteria for resolution of HHS

Answer 51

1. Normal serum osmolarity | 2. Improvement of mental status.

Question 52

Treatment of hypothyroidism Drug Monitor

Answer 52

Levothyroxine 1.6mcg/kg/day Monitor TSH every 3-4 months if primary Monitor t4 if secondary