medicine 1

Question 1

audible S4, think…

Answer 1

aortic stenosis

Question 2

pulsus parvus et tardus

Answer 2

diminished (amplitude) and delayed (upstroke) of carotid pulse

in aortic stenosis

Question 3

exercise stress test or echo for syncope?

Answer 3

echo 1st, prior to exercise stress test

echo- for cardiomyopathy, valvular heart dz (eg. aortic stenosis)

exercise stress test: for known coronary dz (contraindicated in aortic stenosis)

Question 4

acute arterial limb ischemia (6 P’s) post-MI is from thrombus or embolus?

Answer 4

embolus

Question 5

what intervention post-STEMI can improve CV outcomes and overall mortality?

Answer 5

restore coronary blood flow with:

• primary percutaneous intervention
• fibrinolysis

Question 6

etiologies of pericarditis

Answer 6

viral

autoimmune (SLE)

uremia (renal failure)

post MI

• early: peri-infarction pericarditis
• late: dressler syn

Question 7

bounding pulses seen in

Answer 7

aortic regurgitation

Question 8

aortic regurg is systolic or diastolic murmur?

Answer 8

diastolic

Question 9

strongest predictors of AAA expansion/rupture

Answer 9

**smoking
large aneurysm diameter
rate of expansion

others: age, family hx, white, atherosclerosis

Question 10

abrupt onset of tachycardia that resolves with cold water immersion. think…

Answer 10

supraventricular tachycardia-

more specifically, atrioventricular nodal reentrant tachycardia

Question 11

how does cold water help SVT?

Answer 11

vagal maneuver

increase parasympathetic tone –> slow AV conduction and increase refractory period

Question 12

wilson disease symptoms

Answer 12

hepatic (liver failure, cirrhosis, chronic hepatitis)

neuro (parkisonism, abnl gait, dysarthria)

psych (depression, personality changes)

Question 13

wilson disease treatment

Answer 13

chelators (d-pencillamine, trientine)

zinc - interferes with Cu absorption

Question 14

zencker diverticulum presentation

Answer 14

> 60 yo male

halitosis
dysphagia
regurgitation
neck mass

Question 15

where is zencker diverticulum

Answer 15

above upper esophageal sphincter

with posterior herniation between crichophryngeal muscle

Question 16

what causes zencker diverticulum

Answer 16

sphincter dysnfunction and dysmotility

Question 17

diagnosis and treatment of zencker diverticulum

Answer 17

dx: barium esophogram
tx: surgery- excision or cricopharyngeal myotomy

Question 18

how to improve steatorrhea in patients with chronic pancreatitis?

Answer 18

pancreatic enzyme supplementation

Question 19

acute pancreatitis treatment

Answer 19

resolves in 4-7 days

supportive care, IVF, analgesics

Question 20

elevated alk phosphatase and positive AMA. think…

Answer 20

primary biliary cholangitis (autoimmune)

Question 21

primary biliary cholangitis symptoms

Answer 21

pruritus, fatigue

jaundice, hepatomegaly, steatorrhea, xanthelasma

Question 22

primary biliary cholangitis treatment

Answer 22

ursodeoxycholic acid

• decreases biliary injury by hydrophobic bile acids
• increases biliary secretion
• anti-inflammatory

Question 23

urinary outflow obstruction symtpoms

Answer 23

flank pain

low urinary output with periods of post-obstructive diuresis

–> potassium wasting –> weakness

Question 24

is there screening for bladder cancer?

Answer 24

no

Question 25

what is this: bladder pain, worse with filling, relief with voiding. frequency and urgency. also dyspareunia.

Answer 25

interstitial nephritis

Question 26

how does acyclovir cause crystal-induced acute kidney injury?

Answer 26

acyclovir excreted into urine but has low urine solubility --> precipitates --> renal obstruction --> AKI within 24-48 hours

Question 27

symptoms of aut dom `polycystic kidney disease

Answer 27

intermittent flank pain and mass hematuria UTIs nephrolithiasis

Question 28

workup of BPH

Answer 28

1. UA and PSA 2. if significant symptoms or risk factors, test Cr 3. if Cr elevated, do renal US to r/o hydronephrosis

Question 29

most sensitive test for diabetic nephropathy

Answer 29

random urine for microalbumin/Cr ratio

Question 30

multiple peptic ulcers and diarrhea. think...

Answer 30

zollinger-ellison (excess gastrin can cause ulcers and inactivate pancreatic enzymes)

Question 31

first degree relative with colon cancer should make patient get screened when

Answer 31

age 40 or 10 years before diagnosis

Question 32

what type of blood should be given to patient with low Hgb from upper GI bleed?

Answer 32

packed RBC

Question 33

when is fresh frozen plasma given

Answer 33

severe coagulopathy (DIC, liver dz) with active bleeding

Question 34

when are platelet transfusions given

Answer 34

<10,000 or <50,000 + bleed

Question 35

when is whole blood transfusion given

Answer 35

severe hemorrhage

Question 36

standard of care for pateints with FAP

Answer 36

annual c-scopes starting in childhood elective proctocolectomy screen for upper GI tumors

Question 37

diarrhea, weight loss, and apthous ulcers. think...

Answer 37

Crohn's

Question 38

how is BUN/Cr ratio increased in someone with upper GI bleed?

Answer 38

increased urea production (from Hgb breakdown) increased urea absorption (from hypovolemia)

Question 39

can IBS diarrhea have mucous?

Answer 39

yes