INTERNAL MED- EOR QUESTIONS

Treatment for SIADH

Fluid restriction

Heinz bodies

G6PD deficiency

X-linked recessive

Low PTH = low or high Ca

LOW Calcium

Tetany

Chvostek sign (contraction of facial muscles after tapping facial nerve)

Trousseau sign (induction of carpal pedal spasm)

Paresthesias (fingertips and perioral)

Prolonged QT interval

Hypocalcemia

Hypoparathyroidism

PS: high phosphorous

Paresthesias, muscle cramping or spasms, bowel or bladder dysfunction, ataxia, tremor, cognitive changes, facial weakness, and facial muscle twitching

Multiple sclerosis

CSF will show ↑ IgG protein, WBC pleocytosis

Multiple sclerosis

Dry eyes (Xerophthalmia) and dry mouth (Xerostomia)

Sjogrens

Labs for Sjogrens

Labs will show SSA (anti-Ro) or SSB (anti-La)

Dx: + Schirmer test

An 80-year-old woman with a 36-pack-year history of smoking tobacco presents with a chief complaint of increasing dyspnea on exertion over the past six months. Physical exam reveals clubbed digits and bilateral lower lung crackles. Computed tomography shows honeycombing of the lung parenchyma. What is the most likely diagnosis?

Idiopathic pulmonary fibrosis

HIV CD4 related illnesses

< 250: Esophageal candidiasis

< 200: PCP pneumonia

< 100: Cerebral toxoplasmosis, Cryptococcosis

< 50: Mycobacterium avian complex- ppx: Azithro

A 24-year-old woman presents to the Emergency Department with fever and shortness-of-breath for the last 48 hours. Her past medical history is significant for recent IV drug abuse. On physical exam, you auscultate a pansystolic ejection murmur best heard at the left lower sternal border. You also note nontender macular lesions on the palms of her hands and soles of her feet. Laboratory analysis is significant for a white blood cell count of 20,000/mcL, erythrocyte sedimentation rate of 67 mm/hour, and C-reactive protein of 6.5 mg/L. Which imaging modality would be most appropriate to confirm your diagnosis?

TTE

Infective endocarditis is an infection of the endocardium of the heart. In general, this infection occurs at one or more of the valves of the heart. Significant risk factors include advanced age, male gender, injection drug abuse, poor dentition, and prosthetic heart valves. In the setting of injection drug abuse, the tricuspid valve is most commonly affected. Signs and symptoms include fever, malaise, exercise intolerance and a new-onset heart murmur. Janeway lesions (nontender erythematous macular lesions of the palms and soles), Osler nodes (tender lesions on the pads of fingers and toes) and Roth spots (hemorrhagic retinal lesions) may also be found and are highly suggestive of infectious endocarditis. Transthoracic echocardiography is the primary imaging modality indicated for evaluation of infective endocarditis. Transthoracic echocardiography is preferred due to the non-invasive approach combined with high sensitivity and specificity. Many patients may also require transesophageal echocardiography to rule out complications such as abscess, leaflet perforation, and pseudoaneurysm. Due to its invasive approach, however, it is not generally recommended as first-line imaging.

Diagnosis is made by 24-hour excretion of 5-hydroxyindoleacetic acid

Carcinoid Syndrome

Skin flushing

Diarrhea

Blanching maculopapular rash around the wrists and ankles and has a centripetal spread toward the body.

Rocky Mountain spotted fever

Rickettsia rickettsii

Tx: ALWAYS doxy

ANCA negative

HIGH ESR

renal or mesenteric angiography: microaneurysms with abrupt cut-off of small arteries

PE: HTN, nothing on lungs, inflammation of nerve

Polyarteritis nodosa

Management: corticosteroids

Ship builder with pleural plaques, pleural thickening, interstitial fibrosis

Asbestosis

CT= honeycomb lung, primarily lower lobes

Asbestosis

Older M with rectal bleeding with hemorrhoid. Colonoscopy?

Yes!

Guy with high H&H. PE finding:

splenomegaly

Nephrotic syndrome PE

P: Proteinuria

A: low Albumin

L: high Lipids

E: Edema

UA= fat bodies (maltese cross shaped)

Nephrotic syndrome

Kid with gum bleeding after dental surgery who has vWb, what do you give?

Desmopressin

vWF

Factor VIII concentrate

18 yo M with testicular pain, swelling, redness. Tx?

Surgery!

HIV pt with positive PPD but negative xray. Tx?

INH 300 PO QD +

Pyridoxine 25mg PO QD x 12 months

Rash with central clearing

Lyme Dz

Erythema migrans

Bug for Lyme

Borrelia burgdorferi

Minimum amount of time on Coumadin for DVT

1st episode w/ reversible or time-limiting RF (Trauma, surgery, OCP): 3 months

1st episode w/ idiopathic event= 6 months

Recurrent: 12 months, long term

Surgical resection of ileum, what supplement do you need?

B12

Healthy pt with BP 148/95, labs = hypokalemia. What is it?

Primary Aldosteronism (Conn's)

LT treatment of WPW

Amiodarone

Procainamide

What would you do for someone with Mobitz Type 1 Block

Atropine

Pt comes with 30 sec LOC and confused afterwards. What type of szr is this?

Tonic clonic

Masked facies: loss of facial expressions

Parkinson's Dz

Girl presents with a spot on her cheek that itches, next day she is covered in rash with pustule with erythematous base

Varicella

Pt presents with DKA to ED. What kind of insulin do you give them?

Regular insulin

CXR of emphysema

Hyperinflation: flat diaphragm, inc AP dm, dec vascular markings +/- BULLAE

PE: hyperresonance to percussion, decreased breath sounds, decreased fremitus, increased AP diameter, pursed lip breathing

Emphysema

AP diameter= barrel chest

Pursed lip: pink puffer

LT tx for pt with persistent VTach

Amiodorone

Procainamide

Biopsy for Crohn's?

Skip lesions

Transmural

Cobblestone appearance

Cobblestone appearance on colonoscopy

Crohn's

Barium flow through narrowed inflamed/scarred area due to transmural strictures

Crohn's

IBD P-ANCA, ASCA

P-ANCA: UC

ASCA: CROHN'S

Skip lesions

Crohn's colonoscopy

Initial management for spinal stenosis

Lumbar epidural steroid injection of CTS

Most likely etiology of transudative pleural effusion

CHF

What to give a pt with Lupus reaction (lesions)?

Hydroxychloroquine

For arthritis: NSAIDs or APAP.

+/- pulse dose: corticosteroids, cytotoxic drugs (methotrexate, cyclophosphamide)

Syndrome that causes hypokalemia

Adrenal adenoma

UA shows epithelial cells casts and muddy brown casts, low SG, hyperkalemia, increased phosp

ATN

HTN, edema, azotemia, UA shows hematuria RBC cast, proteinuria, dysmorphic RBC casts

GN

MC murmur after MI

Mitral Regurgitation

Shigellosis tx

Bactrim

DOC for Legionella

Levofloxacin or Azithromycin

PER PAEasy: 1st line: Erythromycin or Doxycycline. Levo or Azithro alternatives or for severe dz!

Girl with GERD. Avoid mint of give h2blockers?

Avoid mint

stage 1: lifestyle modifications

stage 2: PRN H2 receptor antagonists

stage 3: PPI

ALARM sxs: dysphagia, odynophagia, weight loss, bleeding

Man with asthma and on beta agonist using 3-5 times per week. Next?

Add inhaled corticosteroid

Beclomethasone, Flunisolide, Triamcinolone

Tx for Raynauds

Nifedipine

Best drug to prevent remodeling of heart after MI

BB

Adding an ACEI to person with diabetes protects against what

Kidney problems

Recurrent venous/arterial thrombosis or fetal loss

Antiphospholipid syndrome

Pulmonary wedge pressure measures...

Left atria pressure

DM lady who is getting screened for kidney problems. What are you looking for in urine?

Microalbumininuria (first sign of diabetic nephropathy)

Auer rods

AML

Splenomegaly in blood cancers

CML

Best to prevent AAA

smoking cessation

Pleural effusion with low ph, low glucose

Drainage and abx

Increase JVP

Hypotension

Muffled heart sound

Cardiac tamponade

Kid who has recent heart sxs and had URI sxs a few weeks ago. What will you find on echo?

Dilated ventricles (dilated CM due to viral infxn)

????????

DOC for elderly insomnia

DON'T USE BARBS, BENZOS, BB

?????????????

What kind of testosterone is CI'ed in ED?

Oral tablets (PDE-5-inhibitors)

Dx for MS

MRI (white matter plaques-hyperdensitivies)

Lady with as'ic bradycardia and p waves before QRS. What do you do?

Atropine if HD unstable

Tx underlying cause if HDS

What lab test picks up degraded catecholamines?

?

Low specific gravity in UA

ATN

DM1 vs DM2

DM1: pancreatic beta cell destruction (pt can't produce insulin). Onset <30yo

DM2: insulin resistance and relative impairment of insulin secretion. Weight gain and decreased physical activity. Overweight >40yo

What lab test do you order before giving PTU

LFTs

Woman with stiffness in bilateral shoulders, elbows, wrists, fingers, and tender over MCP joint. Diagnosis?

Rheumatoid Arthritis

Tx for RA

DMARDs: methotrexate

Confirm pericardial effusion

Echo

Pt with ulcer on foot, but its numb. What condition does this pt have?

Diabetes, venous stasis ulcer????????

Venous insufficiency: leg pain/color worse with prolonged standing/sitting; improved with leg elevation and walking

Pt with deviated tongue, CN?

XII

Small cell carcinoma will present with what pulmonary finding on xray

Central

20 old with PNA sxs, healthy, what type?

Mycoplasma

Positive cold agglutinin

Mycoplasma PNA

Treatment: macrolide

Pt lives in Arizona. Fever, night sweats, decreased weight, cough. CXR shows single pulmonary nodule. What med will best alleviate sxs?

Octreotide????????????

Arizona, sob

sarcoidosis

Pt has 75% blockage of L main coronary artery. Tx?

CABG (if LMA involvement, >70% stenosis, 3-vessels dx of s;ic, EF <40%)

Pt on h2 blocker which relieves his sxs slightly. Aside from lifestyle modification, pt to begin..

PPI

Pt with pain in 14 different points. What med?

TCA

SNRI: duloxetine

SSRI: fluoxetine

Gabapentin, PREGABALIN

only non-statin lipid-lowering agent that has proven to have additive effects on the prevention of cardiovascular adverse events

ezetimibe

Polydipsia, polyuria, weight loss, fatigue, polyphagia, frequent mycotic infections, neuropathy and blurry vision + random plasma glucose test above 200.

DM diagnosis

Total parenteral nutrition can be considered as an alternative to what in Crohn's?

chronic low-dose glucocorticoids.

Asymptomatic patients may also be diagnosed with diabetes mellitus if they have a fasting plasma glucose level of 126 mg/dL or higher,

a hemoglobin A1C of 6.5 percent or higher, or

a two-hour oral glucose tolerance test plasma glucose of 200 mg/dL or higher.

OK

midsystolic click and late systolic murmur

mitral valve prolapse

Meds for UC and Crohn's

UC: sulfasalazine

Aminosalicylates (sulfasalazine, mesalamine) -> corticosteroids -> immune modifying agents (azathioprine, 6-mercaptoprine, cyclosporine)

ASA helpful

AMINOSALICYLIC ACID: anti-inflammatory agent. good for flares and remission

CORTICOSTEROIDS: rapid acting antiinflammatory drugs used for acute flares only.

IMMUNE MODIFYING AGENTS

ANTI-TNF AGENTS: inhibits proinflammatory cytokines (adalimumab, infliximab, certolizumab)

Harsh systolic crescendo-decrescendo murmur LOWERS intensity with handgrip, squatting, supine

Hypertrophic Cardiomyopathy

murmur increases intensity with Valsalva and standing

Pt with hematemesis after forceful retching.

Mallory weiss tear

Pt with RUQ pain. What PE test would help confirm?

US

Pt with celiac dz. What lab test is most supportive?

Small bowel bx

Which lung cancers have worst prognosis?

Small cell

Pt has CHF sxs, which dietary modification do you suggest

Salt reduction

Pt had MI. They are on 3 meds already, which should be added

???????

Rheumatologic conditions that have nodular changes in DIP

Osteoarthritis