Internal Medicine EOR (193 Topic Quick Cram) (Smarty PANCE)

What is the classic description of stable angina pectoris?

Substernal chest pressure/squeezing (Levine sign), lasting <30 min, precipitated by exertion, relieved by rest/nitroglycerin

What is the gold standard for diagnosing coronary artery disease (angina)?

Coronary Angiography

What is the first-line pharmacologic treatment for chronic stable angina?

Beta-blockers (e.g., Metoprolol, Atenolol)

What is Prinzmetal (variant) angina?

Coronary artery vasospasm causing transient ST elevations, usually at rest/early morning; treat with Calcium Channel Blockers

What is the most common cause of sudden cardiac death in young athletes?

Hypertrophic Cardiomyopathy (HOCM)

What is the classic murmur of Hypertrophic Cardiomyopathy (HOCM)?

Harsh crescendo-decrescendo systolic murmur at LLSB that INCREASES with Valsalva/standing and DECREASES with squatting/handgrip

What is the mainstay of treatment for HOCM?

Beta-blockers (avoid diuretics/nitrates which decrease preload)

What is the most common cause of restrictive cardiomyopathy?

Amyloidosis

What are the classic signs of Left-Sided Heart Failure?

Dyspnea, Orthopnea, Paroxysmal Nocturnal Dyspnea (PND), Rales/Crackles, S3 gallop

What are the classic signs of Right-Sided Heart Failure?

JVD, Peripheral edema, Hepatomegaly, Ascites (often caused by Left Heart Failure)

What is the most useful diagnostic test for diagnosing Heart Failure?

Echocardiogram (to determine Ejection Fraction)

What BNP level supports a diagnosis of Congestive Heart Failure?

BNP > 100 pg/mL (often >400 in acute failure)

What medications provide a mortality benefit in systolic Heart Failure?

ACE Inhibitors/ARBs, Beta-blockers (Carvedilol, Metoprolol succinate, Bisoprolol), Spironolactone, Hydralazine+Nitrates (in African Americans)

What is the most common arrhythmia associated with COPD/Lung disease?

Multifocal Atrial Tachycardia (MAT) - 3 different P wave morphologies

What is the treatment for unstable Atrial Fibrillation?

Synchronized Cardioversion

What is the CHADS2-VASc score used for?

To determine the need for anticoagulation in Atrial Fibrillation (Score ≥2 requires anticoagulation)

What is the hallmark ECG finding in Atrial Flutter?

"Sawtooth" P waves (F waves) at 250-350 bpm

What is the definitive treatment for Supraventricular Tachycardia (SVT) after vagal maneuvers fail?

Adenosine (6mg IV push, followed by 12mg if no conversion)

What is the specific treatment for Torsades de Pointes?

IV Magnesium Sulfate

What defines First Degree AV Block?

Fixed PR interval > 0.20 seconds (one large box) without dropped beats

What is the difference between Mobitz I (Wenckebach) and Mobitz II?

Mobitz I: Progressive PR lengthening until a drop (benign); Mobitz II: Fixed PR interval with random dropped beats (requires pacemaker)

What is the Duke Criteria used for?

Diagnosing Infective Endocarditis (requires 2 Major, or 1 Major + 3 Minor, or 5 Minor)

What are the two Major Duke Criteria?

Positive blood cultures (typical organism) and Evidence of endocardial involvement (Vegetation on Echo or new murmur)

What is the most common organism in native valve endocarditis?

Staphylococcus aureus (acute), Viridans streptococci (subacute/dental procedures)

What is the most common organism in IV drug user endocarditis and which valve is affected?

Staphylococcus aureus; Tricuspid valve

What are the classic physical signs of Infective Endocarditis?

FROM JANE: Fever, Roth spots, Osler nodes (painful), Murmur, Janeway lesions (painless), Anemia, Nailbed hemorrhages, Emboli

What is the antibiotic prophylaxis for endocarditis before dental procedures?

Amoxicillin 2g PO 30-60 min prior to procedure (Clindamycin if PCN allergic)

What is the characteristic murmur of Aortic Stenosis?

Systolic crescendo-decrescendo murmur at RUSB, radiates to carotids

What are the classic symptoms of Aortic Stenosis? Use mnemonic SAD

Syncope, Angina, Dyspnea (indicates valve replacement needed)

What is the characteristic murmur of Mitral Regurgitation?

Blowing holosystolic murmur at the Apex, radiates to Axilla

What is the characteristic murmur of Mitral Stenosis?

Diastolic low-pitched rumbling murmur with an Opening Snap at the Apex (associated with Rheumatic Fever)

What is the characteristic murmur of Mitral Valve Prolapse?

Mid-systolic click followed by a late systolic murmur

What is the gold standard for diagnosing Valvular Heart Disease?

Echocardiogram

What defines Hypertensive Urgency vs. Emergency?

Urgency: BP >180/120 without end-organ damage; Emergency: BP >180/120 WITH end-organ damage (stroke, MI, AKI, papilledema)

What is the first-line hypertension treatment for non-African Americans?

Thiazide, ACEI/ARB, or CCB

What is the first-line hypertension treatment for African Americans?

Thiazide diuretics or Calcium Channel Blockers (ACEI less effective unless CKD present)

What is the blood pressure goal for most patients according to ACC/AHA?

< 130/80 mmHg

What is the lipid guideline for starting statin therapy in diabetics (age 40-75)?

Moderate-to-high intensity statin regardless of ASCVD score

What are the classic signs of Xanthomas?

Lipid deposits in skin/tendons suggestive of familial hypercholesterolemia

What is the gold standard for diagnosing Myocardial Infarction?

Cardiac Troponin (I or T) - rises in 3-4 hours, peaks 12-24 hours

What ECG leads indicate an Inferior Wall MI?

II, III, aVF (supplied by Right Coronary Artery)

What medication is contraindicated in Inferior Wall MI (Right Ventricular Infarct)?

Nitroglycerin and Morphine (preload dependent - can cause severe hypotension)

What is the classic ECG finding for STEMI?

ST elevation >1mm in 2 contiguous leads + reciprocal changes (ST depression)

What is the immediate treatment for STEMI? Use mnemonic MONA-B + Reperfusion

Morphine, Oxygen, Nitroglycerin, Aspirin, Beta-blocker + PCI (within 90 min) or Thrombolytics (within 30 min)

What is Dressler Syndrome?

Post-MI pericarditis occurring 2-10 weeks after MI (fever, pericarditis, leukocytosis)

What is the classic presentation of Acute Pericarditis?

Pleuritic chest pain (worse with inspiration), worse supine, relieved by sitting forward

What is the pathognomonic ECG finding in Acute Pericarditis?

Diffuse ST elevation (concave up) and PR depression

What is the first-line treatment for Acute Pericarditis?

NSAIDs (Ibuprofen/Indomethacin) + Colchicine

What is Beck's Triad for Cardiac Tamponade?

Hypotension, JVD, Muffled heart sounds

What is the classic presentation of Peripheral Arterial Disease (PAD)?

Intermittent claudication (leg pain with walking, relieved by rest), atrophic skin changes, weak pulses

What is the gold standard diagnostic test for PAD?

Arteriography (though ABI < 0.9 is the best initial screening test)

What is the classic presentation of Acute Arterial Occlusion? Use mnemonic 6 Ps

Pain, Pallor, Pulselessness, Paresthesia, Poikilothermia (cold), Paralysis

What is Virchow's Triad?

Stasis, Hypercoagulability, Endothelial injury (risk for DVT/PE)

What is the Jones Criteria used for?

Diagnosing Rheumatic Fever (2 Major or 1 Major + 2 Minor + evidence of recent Strep infection)

What are the Major Jones Criteria? Use mnemonic JONES

Joints (migratory polyarthritis), Oh my heart (Carditis), Nodules (subcutaneous), Erythema marginatum, Sydenham chorea

What is the most common valvular defect caused by Rheumatic Heart Disease?

Mitral Stenosis

What is the screening test for Abdominal Aortic Aneurysm (AAA)?

Abdominal Ultrasound (Men 65-75 who have ever smoked)

At what size is surgical repair indicated for AAA?

> 5.5 cm or expanding >0.5 cm in 6 months

What is the classic presentation of Aortic Dissection?

Sudden onset severe tearing/ripping chest or back pain, unequal BP in arms

What is the gold standard diagnostic test for Aortic Dissection?

CT Angiography (CTA) of the chest/abdomen

What is the treatment for Type A (Ascending) Aortic Dissection?

Surgical Emergency

What is the treatment for Type B (Descending) Aortic Dissection?

Medical management (IV Beta-blockers like Labetalol/Esmolol to lower HR and BP)

What is the clinical definition of Chronic Bronchitis?

Productive cough for at least 3 months a year for 2 consecutive years

What is the most common cause of Acute Bronchitis?

Viral infection (Adenovirus, Parainfluenza, Influenza, Rhinovirus)

What is the gold standard for diagnosing Asthma?

Spirometry showing reversible obstruction (FEV1 increases >12% after bronchodilator)

What is Samter's Triad?

Asthma, Nasal Polyps, Aspirin/NSAID Sensitivity (Atopic triad)

What is the most effective long-term maintenance medication for persistent asthma?

Inhaled Corticosteroids (ICS) - e.g., Fluticasone, Budesonide

What is the classic HRCT finding in Bronchiectasis?

"Tram-tracking" and "Signet-ring sign" (dilated airway larger than adjacent artery)

What is the most common cause of Bronchiectasis in the US (non-cystic fibrosis)?

H. influenzae infection (Pseudomonas is most common in Cystic Fibrosis)

What is Carcinoid Syndrome?

Paraneoplastic syndrome from carcinoid tumors causing flushing, diarrhea, wheezing, and hypotension (excess serotonin)

Where are Bronchial Carcinoid Tumors typically located?

Central airways (pink/purple well-vascularized lesion on bronchoscopy)

What spirometry finding is diagnostic for COPD?

FEV1/FVC ratio < 0.70 (irreversible obstruction)

What are the two main types of COPD?

Emphysema ("Pink Puffer" - barrel chest, pursed lips) and Chronic Bronchitis ("Blue Bloater" - obese, cyanotic, productive cough)

What is the only therapy proven to decrease mortality in COPD?

Supplemental Oxygen (in patients with resting hypoxemia SaO2 <88%) and Smoking Cessation

What is Cor Pulmonale?

Right ventricular hypertrophy and failure resulting from pulmonary disease (pulmonary hypertension)

What is the classic ECG finding in Cor Pulmonale?

Right axis deviation, P-pulmonale (peaked P waves), RVH (tall R wave in V1)

What is Obesity Hypoventilation Syndrome (Pickwickian Syndrome)?

Obesity (BMI >30), hypoxemia, and hypercapnia (PaCO2 >45) due to hypoventilation during sleep

What is the classic CT finding in Idiopathic Pulmonary Fibrosis (IPF)?

Honeycombing and ground-glass opacities (restrictive pattern on PFTs)

What are the classic PFT findings in Restrictive Lung Disease (like IPF)?

Normal/High FEV1/FVC ratio, but decreased Total Lung Capacity (TLC) and FVC

What is the hallmark chest X-ray finding in Asbestosis?

Pleural plaques (thickening/calcification) in lower lobes; history of insulation/shipyard work

What is the hallmark chest X-ray finding in Silicosis?

"Eggshell" calcifications of hilar lymph nodes; history of sandblasting/quarry work

What is Caplan Syndrome?

Rheumatoid Arthritis + Pneumoconiosis (usually coal worker's) + Pulmonary nodules

What is the most common organism causing Community Acquired Pneumonia (CAP)?

Streptococcus pneumoniae (Gram+ diplococci, "rusty" sputum)

What is the most common cause of "Atypical" (Walking) Pneumonia?

Mycoplasma pneumoniae (young patients, bullous myringitis, cold agglutinins)

What pneumonia organism is associated with alcoholics and "currant jelly" sputum?

Klebsiella pneumoniae

What pneumonia organism is associated with contaminated water sources/AC units and GI symptoms?

Legionella pneumophila (causes hyponatremia)

What is the treatment of choice for Pneumocystis jirovecii Pneumonia (PJP) in HIV patients?

Trimethoprim-Sulfamethoxazole (Bactrim) + Steroids if PaO2 <70

What defines Pulmonary Hypertension?

Mean Pulmonary Arterial Pressure (mPAP) > 20 mmHg at rest (diagnosed by Right Heart Catheterization)

What physical exam finding suggests Pulmonary Hypertension?

Loud P2 (accentuated pulmonary component of S2) and parasternal lift

What is the most common type of lung cancer?

Adenocarcinoma (Peripheral lesion, most common in non-smokers/women)

Which lung cancer is centrally located and associated with hypercalcemia (PTHrP)?

Squamous Cell Carcinoma (Think "CC": Central, Calcium, Cavitary, Cigarettes)

Which lung cancer is most aggressive and associated with paraneoplastic syndromes (SIADH, Cushing's)?

Small Cell Carcinoma (Central lesion, early metastasis)

What is a Pancoast Tumor?

Tumor at the lung apex causing Horner's Syndrome (Ptosis, Miosis, Anhidrosis) and shoulder/arm pain

What is the classic Chest X-ray finding in Sarcoidosis?

Bilateral Hilar Lymphadenopathy (BHL)

What is the hallmark pathology finding in Sarcoidosis?

Non-caseating granulomas

What dermatologic finding is associated with Sarcoidosis?

Erythema Nodosum (painful shin nodules) and Lupus Pernio (purple face lesions)

What lab value is often elevated in Sarcoidosis?

ACE (Angiotensin Converting Enzyme) levels and Calcium

What characteristics suggest a Pulmonary Nodule is benign?

Size < 3cm, "Popcorn" calcification (Hamartoma), concentric calcification, patient <30 yo

What is the first step in evaluating a Solitary Pulmonary Nodule found on CXR?

Compare with old imaging; if new/changing or no prior films -> CT Chest

What serologic marker indicates active Hepatitis B infection?

HBsAg (Hepatitis B Surface Antigen)