Internal Medicine End of Rotation

Name some symptoms of BPH.

Frequency, Urgency, hesitancy, incomplete emptying, dribbling, straining

How can we test for BPH?

DRE, UA (blood), leukocytes, cx), PSA, U/S Cystoscopy, flow rate, PVR, pressure flow

What are the three options to treat BPH medically?

Alpha blockers: Terazosin, Doxazosin, Tamsulosin (flomax - 3rd gen) - relax smooth muscle

5 alpha reductase: finasteride, dutasteride - shrink it

PD51: Tadalafil (cialis)

Name some s/s of MM.

bone pain, fracture, recurrent infxn from leukopenia, hypercalcemia, anemia, kidney failure

How can you diagnose MM?

SPEP, UPEP (Bence Jones protein), CBC = rouleux formation, increased ESR (hence rouleux), Skull x-ray = punched out lesions

How do you manage MM?

STEM TRANSPLANT (+/- chemo and bisphosphonates)

What is the most common valve affected in endocarditis?

Mitral, except in IVDA ---> Tricuspid

Name the organism in endocarditis that is most common for acute? Subacute? IVDA? Prosthetic?

Staph Aureus

Strep Viridians

MRSA

Staph Epi

What is HACEK?

Organisms associated with large vegetations in endocarditis. Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Klingella

How can we diagnose endocarditis?

Blood cx (3 sets), EKG, Echo (TTE-->TEE), Labs: CBC

What is the MCC of myocarditis?

VIRAL- enterovirus

How do you diagnose myocarditis?

Gold standard: endomyocardial bx, CXR = cardiomegaly, EKG/cardiac enzymes + CKMB/troponin due to necrosis, ehco,

How do you treat myocarditis?

supportive: diuretics, ACE, if severe, inotropic drugs

How do you treat diverticulitis?

clear liquid diet, broad abx like Cipro or Metro

What are some s/s of diverticulitis?

fever, LLQ pain, N/V/D, constipation, flatulence, bloating

How can we diagnose diverticulitis/osis?

CT scan, increased WBCs, + Guaiac

T or F: Essential tremor is an autosomal recessive disorder that you can treat with CCB.

FALSE, it is AD and you treat it with propanolol and only if severe.

How do you treat cholera?

REHYDRATE!!!, if severe, water and abx (doxy, erythro, aziythro, cipro)

How do you dx cholera?

Stool cx/ rectal swab

What CD4 count qualifies as AIDS?

less than 200

How can we diagnose HIV?

Antibody testing (ELISA), Confirm with a western blot, HIV RNA viral load

What is the gold standard of diagnosis for COPD?

Pulmonary function tests

How do you diagnose gout?

arthrocentesis showing negative birefringent needle crystals, Xray = moust/rat bite punch out lesions, increased serum uric acid, increased ESR/WBC

How do you treat an acute flair of gout?

Chronic?

NSAIDS

Allopurinol, Febuxostat, Probenecid, Colchicine, Vit C

What are the levels for cholesterol?

Trigs?

HDL?

LDL?

<200

<150

>45

goal of 100 but 70 is even better!

What are the 6 Ps of PAD?

Pain, pallor, pulseless, paresthesias, poikilothermia, paralysis

How do you treat PAD?

CIlostazil (mainstay)

ASA

Clopidogril

Possible revascularization

With UC, what layer of the bowel is it contained to? What is affected?

Mucosal layer, colon, rectum always involved

Name some s/s of UC

Abd pain, LLQ = MC, colick, tenesmus, urgency, hematochezia, BLOODY DIARRHEA

How do you diagnose bladder cancer?

Cystoscopy with a bx, IVP

What are some s/s of bladder cancer?

painless, micro hematuria, if advanced: irritative symptoms of dysuria, urgency, frequency, hesitancy

90% of bladder cancer is what type?

Transitional cell

What are some causes of AACG?

Mydriasis from DIM light (dilating), anticholinergics

What are some s/s of AACG?

unilateral ocular pain, N/V, HA, intermittent blurry vision, halos, peripheral vision loss, conjunctival erythema, steamy cornice, increased IOP, peripheral loss of vision

What is the treatment of AACG?

1. Acetazolamide (Diamox)

2. Timolol (topical BB) to decrease IOP

3. Miotics/cholinergics (Pilocarpine)

Alpha 2 agonists

may consider peripheral iridotomy as a definitive treatment

What is thought to be associated with Bell's Palsy? What side is the most common?

HSV, or VZV, lyme

Right

What is the Bell phenomenon?

In Bell's palsy where the eye on the affected side moves laterally and superiorly when eye closure is attempted

How do we diagnose EBV?

Heterophile Monospot Ab test, peripheral smear >50 lymphocytes, rapid viral capsid antigen test

How do you treat a mallory weiss tear?

if no active bleed --> supportive

if bleeding --> epi injxn, sclerosing agent, band ligation, hemo clipping or balloon tamponade

How do you diagnose Celiac?

Endomysial IgA ab, transgluatminates, small bowel bx = deifinitive

where do carcinoid tumors mets to?

Liver, bone, brain, lymph, adrenal

How do you definitively diagnose cardiac tamponade?

Echo

How do you manage cardiac tamponade?

immediate pericardiocentisis with or without pericardial window drainage

How do you treat Pyelonephritis?

Fluoroquinolone PO or IV Aminoglycoside

What is the gold standard of PUD?

Endoscopy

What is the most common cause of angina pectoris?

CAD

What are some s/s of angina pectoris?

substernal CP

extertional, non pleuritic

radiates to the arm, lower jaw, back, shoulder

<30 min duration typically 1-5 min

relieved by rest or nitrates

dyspnea, N, diaphoresis, numbness

How do we diagnose angina pectoris?

History, ECG = ST depression, T wave inversion, Stress test, Coronary Angiography (GOLD STANDARD!!!)

How do we manage angina?

NTG, BBs, CCB, ASA, stop smoking, control risk factors

Classic regimen = daily ASA + BB, sublingual NTG as needed for pain, and a Statin.

What is the MCC of heart failure?

CAD

What is the MCC of left sided HF?

Right?

CAD & HTN

Left sided or pulmonary disease

Name some types of high output heart failure?

Low?

anemia, thyrotoxicosis, beribei, pagets dz

HTN, CAD

What are some clinical manifestations of cardiac tamponade?

Beck's triad: distant heart sounds, hypotension, increased JVP

Pulsus Paradoxus, dyspnea, fatigue, peripheral edema, reflex tachy, cool extremities