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Boards Step/Level 2 > Internal Medicine Rapid Review > Flashcards

Internal Medicine Rapid Review Flashcards

(109 cards)

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1
Q

Right ventricular infarcts present with hypotension, tachycardia, clear lungs, JVD, and NO pulsus paradoxus. Don’t give nitro. How do you treat?

A

Vigorous fluid resuscitation

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2
Q

How often do you follow cardiac enzymes for suspected NSTEMI?

A

q8hrs x 3

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3
Q

In MI, _____ rises first, peaks in 2 hrs, and is normal by 24 hrs

______ rises within 4-8 hrs, peaks in 24 hrs, and is nl by 72 hrs

_______ rises within 3-5 hrs, peaks at 24-28 hrs, and is normal 7-10 days later

A

Myoglobin

CKMB

Troponin I

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4
Q

Discharge meds if cardiac stent is placed

A

ASA + clopidogrel for 9-12 mos

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5
Q

If pt presents with chest pain but there is no ST elevation and normal cardiac enzymes x3, what is the dx?

A

Unstable angina

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6
Q

Pt presents 5-10 wks after MI with pleuritic chest pain and low grade temp. You dx dresslers syndrome/autoimmune pericarditis. How do you tx?

A

NSAIDs and ASA

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7
Q

Systolic ejection murmur cresc/decresc, louder w/squatting, softer with valsalva, +parvus et tardus

A

Aortic stenosis

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8
Q

Systolic ejection murmur louder with valsalva, softer with squatting or handgrip

A

HOCM

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9
Q

Late systolic murmur with click louder with valsalva and handgrip, softer w/squatting

A

Mitral valve prolapse

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10
Q

Holosystolic murmur radiates to axilla w/LAE

A

Mitral regurg

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11
Q

Holosystolic murmur with late diastolic rumble in kids

A

VSD

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12
Q

Continuous machine like murmur

A

PDA

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13
Q

Wide fixed split S2

A

ASD

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14
Q

Rumbling diastolic murmur with opening snap, LAE, and afib

A

Mitral stenosis

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15
Q

Blowing diastolic murmur with widened pulse pressure and eponym parade

A

Aortic regurg

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16
Q

Causes of systolic heart failure

A 
Viral
EtOH
Cocaine
Chagas
Idiopathic

Alcoholic dilated cardiomyopathy is reversible if you stop drinking

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17
Q

Diastolic heart failure etiologies

A

HTN
Amyloidosis
Hemachromatosis

Hemachromatosis restrictive cardiomyopathy is reversible with phlebotomy

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18
Q

Treatment for heart failure that prevents remodeling by aldosterone

A

ACE-I

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19
Q

Treatment for heart failure that improves survival by preventing remodeling by epi/norepi

A

Beta blockers (metoprolol and carvedilol)

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20
Q

Tx for heart failure that improves survival in NYHA class III and IV

A

Spironolactone

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21
Q

What do you do if you see pleural fluid >1cm on lateral decubitus xray

A

Thoracentesis

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22
Q

Dx if transudative pleural effusion with low pleural glucose

A

Rheumatoid arthitis

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23
Q

Dx if transudative pleural effusion with high lymphocytes

A

TB

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24
Q

Dx if transudative pleural effusion that is bloody

A

Malignant or PE

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25
If pleural effusion has positive gram stain or culture, pH <7.2, or glucose <60, what do you do?
Insert chest tube for drainage
26
Light’s criteria indicates transudative pleural effusion if: LDH < ______ LDH effusion:serum < _______ Protein effusion:serum < ______
200 0. 6 0. 5
27
Treatment for ARDS
Mechanical ventilation with PEEP
28
ARDS is diagnosed if PaO2/FiO2 ______ (<300 means acute lung injury), bilateral alveolar infiltrates on CXR, and PCWP is ______ (means pulmonary edema is noncardiogenic)
<200; <18
29
Indications to start O2 in COPD
PaO2 <55 or SpO2 <88% If cor pulmonale, <59
30
Treatment for COPD exacerbation
O2 to 90% Albuterol/ipratropium nebs PO or IV corticosteroids Fluoroquinolone or macrolide abx
31
Best prognostic indicator for COPD
FEV1
32
2 things shown to improve mortality in COPD
Quitting smoking Continous O2 therapy >18 hrs/day
33
2 important vaccines for COPD ptss
Pneumococcal w/ 5 year booster Annual flu
34
COPD pt presents w/6 wks of clubbing fingers and you diagnose hypertrophic osteoarthropathy. What is the next best step?
CXR [most likely cause is underlying lung malignancy]
35
How do you treat asthma if pt has sxs twice a week and PFTs are normal?
Albuterol only
36
How do you treat asthma if pt has sxs 4x a week, night cough 2x a month, and PFTs are normal?
Albuterol + inhaled CS
37
How do you treat asthma if pt has sxs daily, night cough 2x a week and FEV1 is 60-80%?
Albuterol + ICS + LABA (salmeterol)
38
How do you treat asthma if pt has sxs daily, night cough 4x a week and FEV1 is <60%?
``` Albuterol ICS LABA (salmeterol) Montelukast Oral steroids ```
39
Restrictive lung disease with 1 cm nodules in upper lobes w/eggshell calcifications
Silicosis Get yearly TB test and give INH for 9 mos if >10mm
40
Restrictive lung disease with reticulonodular process in lower lobes w/pleural plaques
Asbestosis [most common ca is bronchogenic carcinoma but increased risk for mesothelioma]
41
Restrictive lung disease with patchy lower lobe infiltrates, thermophilic actinomyces
Hypersensitivity pneumonitis (farmers lung)
42
Adenocarcinoma of the lung exhibits exudative effusion with elevated ____
Hyaluronidase
43
Pt presents with weight loss, hemoptysis, kidney stones, constipation, malaise, low PTH, and central lung mass. Dx?
Squamous cell carcinoma
44
Pt with lung mass, shoulder pain, ptosis, constricted pupil, and facial edema dx?
Superior sulcus syndrome from small cell carcinoma
45
Old smoker presenting w/ Na of 125 with moist mucous membranes and no JVD
SIADH from small cell carcinoma
46
CXR showing peripheral cavitation and distant mets?
Large cell carcinoma
47
IBD involving terminal ileum and associated with iron deficiency
Crohns
48
IBD continuous involving rectum
Ulcerative colitis
49
IBD at increased risk for PSC
Ulcerative colitis; increased risk of cholangiocarcinoma
50
IBD most likely to fistulize, how to tx
Crohns; give metronidazole
51
IBD with granulomas and transmural inflammation on bx
Crohn’s
52
Smokers have lower risk of what IBD?
Ulcerative colitis
53
Which IBD has higher risk for colon ca?
Ulcerative colitis
54
Which IBD is associated with p-ANCA?
Ulcerative colitis
55
AST and ALT in the 1000s after surgery or hemorrhage
Ischemic hepatitis (shock liver)
56
Elevated direct bili
Obstructive (stone/cancer), Dubin johnson, rotor
57
Elevated indirect bili
Hemolysis, gilberts, crigler najjar
58
Elevated alk phos and GGT
Bile duct obstruction If pt has IBD, think PSC
59
Elevated alk phos, normal GGT, normal calcium
Paget’s disease (increased hat size, hearing loss, HA) — tx with bisphosphonates
60
Primary biliary cirrhosis is associated with ____ abs and is treated with _____
Antimitochondrial; bile resins
61
Elevated LFTs, ANA positive, anti-smooth muscle ab positive
Autoimmune hepatitis - tx with steroids
62
3 most common bugs causing meningitis
S.pneumo H.flu N.meningitidis
63
Tx for meningitis
Ceftriaxone and vanc
64
Lysteria can cause meningitis in old and young — how to tx?
Ampicillin
65
Staph can cause meningitis in pts with brain surg, how to tx?
Vanc
66
Tx of TB meningitis
RIPE + steroids
67
Tx of Lyme meningitis
Ceftriaxone IV
68
MCC of PNA in healthy young ppl; assoc with cold agglutinins
Mycoplasma Tx with macrolide, FQ, or doxy
69
Pseudomonas, klebsiella, e.coli, MRSA are causes of hospital acquired PNA — how to tx?
Pip/tazo or imipenem + vanc
70
Cause of PNA in old smokers with COPD
H.flu — tx with 2nd-3rd gen cephalosporin
71
Cause and tx of PNA in alcoholics with currant jelly sputum
Klebsiella; tx w/ 3rd gen cephalosporin
72
Cause and tx of PNA in old men w/HA, confusion, diarrhea, and abd pain
Legionella; dx with urine Ag Tx with macrolide, FQ, or doxy
73
Tx for PNA in someone who just had the flu
Vanc (for MRSA)
74
Pt with PNA that just delivered a baby cow and is now having vomiting and diarrhea
Q-fever — coxiella burnetti Tx with doxy
75
Pt with PNA w/ rabbit exposure
Francisella tularensis Tx with streptomycin, gentamycin
76
TB screening guidelines in following groups: Regular ppl Prison, healthcare, nursing home, DM, etoh, chronically ill AIDS, immunosuppressed
>15 mm >10 mm >5 mm
77
Workup for positive PPD
CXR If CXR positive, do acid fast stain of sputum Tx with RIPE for 6 mo (12 for meningitis and 9 if preggo)
78
RIPE drug that causes orange body fluids and induces CYP450
Rifampin
79
RIPE drug that causes peripheral neuropathy, sideroblastic anemia, and hepatitis
INH
80
RIPE drug that causes benign hyperuricemia
Pyrazinamide
81
RIPE drug that causes optic neuritis and color vision abn
Ethambutol
82
Number one cause of death in endocarditis
CHF Other complication is septic emboli to lungs/brain
83
Tx for strep viridans endocarditis
PCN x4-6 wks
84
Tx for staph endocarditis
Nafcillin + gent or vanc
85
Pt with endocarditis and strep bovis bacteremia — next step?
Colonoscopy
86
Young pt with new/bilateral bells palsy. What do you suspect
HIV
87
Post exposure ppx for HIV
AZT Lamivudine Nelfinavir X4weeks
88
When do you start HAART for HIV?
When CD4 <350 or viral load >55,000
89
HIV tx that causes GI sxs, leukopenia, macrocytic anemia
Zidovudine
90
HIV tx that causes pancreatitis and peripheral neuropathy
Didanosine
91
HIV tx that causes HS rash, fever, n/v, myalgia, SOB in first 6wks
Abacavir
92
HIV tx that causes nephrolithiasis and hyperbilirubinemia
Indinavir
93
HIV tx that causes somnolence, confusion, psychosis
Efavirenz
94
HIV pt with PCP PNA. Best test after CXR?
Bronchoscopy wtih BAL
95
1st line tx for PCP PNA in HIV pt
TMP SMX 2nd line is TMP-dapsone or primaquine-clinda or pentamidine
96
HIV pt with PCP PNA being tx with abx. When do you add steroids?
When PaO2 <70, A-a gradient >35
97
Ppx for PCP PNA when HIV pt has CD4<200
``` 1st = TMP-SMX 2nd = atovaquone 3rd = dapsone 4th = aerosolized pentamidine (causes pancreatitis!) ```
98
HIV pt with MAC having diarrhea, wasting, fevers, night sweats. Tx?
Clarithromycin and ethambutol +/- rifampin Prophylax with azithromycin when CD4<50
99
HIV pt with multiple ring enhancing lesions is dx with toxo. Tx?
Empiric pyramethamine sulfadiazine (+folic acid) for 6 wks
100
HIV pt with one ring enhancing lesion
CNS lymphoma (assoc with EBV) tx with HAART
101
HIV pt with seizures w/deja vu aura and 500 rbcs in CSF
HSV encephalitis (temporal lobe) give acyclovir
102
HIV with s/s meningitis and +india ink
Crypto — tx with ampho IV x2 weeks then fluconazole maintenance
103
HIV pt with hemisensory loss, visual impairment, babinski+, what do you do?
Brain bx Think PML - JC polyomavirus demyelinates grey-white jxn
104
Workup for neutropenic fever
1. Get blood culture 2. Start 3rd or 4th gen cephalosporin (ceftazidime or cefepime) Add vanc if line infx suspected or septic shock develops Add ampho B if no improvement and no source found in 5 days
105
Target rash, fever, VII palsy, meningtis, AV block
Lyme disease Tx with doxy (amox for <8); heart or CNS dz needs IV ceftriaxone
106
Rash at wrists and ankles (palms and soles) fever, and HA
Rickettsia Tx with doxy
107
Tick bite, no rash, myalgias, fever, HA, decreased plts and WBC, increased ALT
Erlichiosis Dx with morulae intracell inclusion Tx with doxy
108
Immunosuppressed, cavitary lung lesion, purulent sputum, wt loss, fever, gram positive aerobic branching partially acid fast
Nocardia Tx with TMP SMX
109
Neck or face infxn w/ draining yellow material with sulfur granules gram positive anaerobic branching
Actinomyces Tx with high dose PCN for 6-12 wks

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