Internal Medicine Rosh Boost Exam

is RA more common in men or women?

women

what ages is RA most common?

40-50 years

RA

morning stiffness lasting > 30 minutes

RA PE

symmetrical soft, red, tender swelling in joints: MCP, PIP

-b/l ulnar deviation at MCP, boutinniere deformity and swan neck deformity

RA labs

postive RF or anti-cyclic cirullinated peptide antibodies, inc ESR, inc CRP

RA most commonly caused by

autoimmune destruction of synovial joints

RA tx

DMARDs (methotrexate)

lung cancer rf

hx of smoking, asbestos exposure

lung cancer symptoms

cough, hemoptysis, dyspnea, cp, weight loss, back pain, neurologic symptoms (CNS mets, paraneoplastic syndromes like Lambert-Eaton myasthenic syndrome)

pancoast tumor

tumor in the superior sulcus, shoulder pain, horner syndrome

lung cancer labs

hypercalcemia (PTHrP or bone mets), hyponatremia (SIADH), exudative effusion

lung cancer dx

CXR, CT scan, bx

what is the most common form of lung cancer?

non-small cell

types of non-small cell lung ca

adenocarcinoma, squamous cell, large cell

tx of non-small cell lung cancers

depends on staging, surg, chemo, or tyrosine kinase inhibitors if positive for ALK or EGFR mutations

what is small cell lung cancer associated with?

neuroendocrine and paraneoplastic syndromes

tx of small cell lung cancer

mets early, chemo, XRT, or whole brain radiation

what is the leading cause of cancer related death among men and women?

lung ca

lung cancer screening recs

50-80 yrs old with 20 pack year hx or who currently smoke or who have within the last 15 years (low dose CT)

sepsis

infxn that leads to systemic inflammation

SIRS criteria

temp >38C (100.9) <36, WBC >12 <4, HR>90, RR>20 (consider infection, need 2/4)

what pathogen is the mcc of acute cystitis?

e. coli

transudative pleural effusion causes

Hydrostatic and osmotic factors - CCF, hepat and renal failure

exudative pleural effusion causes

infection, malignancy, trauma

hypocalcemia signs

Trousseau's sign

Chvostek's sign

how does vitamin d help increase calcium levels in the body?

by facilitating gastrointestinal calcium absorption

hypocalcemia sx

seizures, parasthesia's

hypocalcemia labs

Ca+ <8.5

hypocalcemia ekg

prolonged QT interval

hypocalcemia tx

Ca+ replacement orally for mild, Vitamin D for better Ca+ absorption

what are the two conditions associated with COPD?

emphysema and chronic bronchitis

gout

characterized by monosodium urate crystal deposition in the bones, soft tissues, and joints

what meds can contribute to acute gout flares?

loop and thiazide diuretics such as chlorthalidone

gout PE

stiff, tender, hot, erythematous and swollen joint

acute gout tx

oral NSAIDS, steroids, colchicine

chronic gout tx

xanthine oxidase inhibitors (e.g., allopurinol, febuxostat)

what will a synovial fluid analysis show for pseudogout?

positively birefringent, rhomboid shaped crystals

most common cause of minor hemoptysis

acute bronchitis

acute bronchitis mcc

virus

acute bronchitis sx

productive cough > 5 days

acute bronchitis PE

wheezing and rhonchi

acute bronchitis CXR

thickening of the bronchial walls in the lower lobes

acute bronchitis tx

symptomatic management (guaifenesin)

glioblastoma multiforme clinical

headache, seizure, cog or personality changes, focal weakness, visual changes

most common brain tumor in children

medulloblastoma

myasthenia gravis pathophysiology

formation of antibodies against postsynaptic acetylcholine receptors

myasthenia gravis sx

ocular or generalized muscle weakness, bulbar weakness (dysarthria/dysphagia), ptosis and diplopia that is worse at the end of the day or following exertion

myasthenia gravis PE

applying ice pack to eyelid improves diplopia

myasthenia gravis dx

serologic testing for antibodies: anti-nAChR, anti-MuSK

electrophysiologic studies: repetitive nerve stimulation, single-fiber electromyography

myasthenia gravis tx

acetylcholintesterase inhibitors (pyridostigmine)

myasthenia gravis is associated with what conditions?

thymoma, thyroid disease, autoimmune disorders

CREST syndrome

Calcinosis, Raynaud's, esophageal dysmotility, Sclerodactyly, Telangiectasia

CREST syndrome is for what condition?

systemic sclerosis

what are the three major features of scleroderma-related renal crisis?

abrupt onset of moderate to severe hypertension, acute kidney injury, and proteinuria

what two electrolyte side effects are seen with thiazide diuretics?

hypokalemia and hyponatremia

zollinger-ellison syndrome (ZES)

hypersecretion of gastric acid, fasting serum hypergastrinemia, and peptic ulcer disease with diarrhea

zollinger-ellison syndrome labs

fasting serum gastrin concentration and gastric pH level

what is ZES associated with?

MEN-1

causes of pill esophagitis

abx, nsaids, aspirin, bisphosphonates, ferrous sulfate, ascorbic acid (vit c), potassium chloride

what category of meds is the most frequent etiology of pill esophagitis in younger adults?

abx

what is the goal level with uric maintenance therapy?

serum uric acid at or below 6mg/dL

how would an osteoarthritis flare present on synovial fluid analysis?

clear, colorless, or straw-colored fluid, low white blood cell count (< 2,000/µL), low polymorphonuclear leukocytes (< 25%), negative crystals, and negative culture

mc bacterial cause of CAP

streptococcus pneumonia

CAP sx

fever, productive cough, dyspnea, fatigue

pneumonia dx

lobar consolidation

mc causitive pathogen

E. coli

tx for chronic prostatitis

levofloxacin x 6 weeks or bactrim

what is a graham steell murmur?

pulmonic regurgitation

bronchiectasis sign

signet ring sign

signet ring sign

dilated, air-filled bronchus that is contiguous with the smaller nodular opacity of a pulmonary artery

tram track appearance is associated with what condition?

bronchiectasis

what is the most common pathogen recovered from patients with bronchiectasis who do not have cystic fibrosis?

haemophilus influenzae

what additional meds should the pt with a STEMI be on post discharge?

lisinopril, metoprolol, atorvastatin

what are the recommended high-intensity statins?

atorvastatin 80mg or rosuvastatin 20-40mg

what are the four stages of metabolism of bilirubin by the liver?

uptake from the circulation, intracellular storage, conjugation with glucuronic acid, and biliary excretion

kernig sign

inability to fully extend the knees with hips flexed.

Brudzinski's sign

pain with resistance and involuntary flex of hip/knee when neck is flexed to chest when lying supine

neisseria meningitis meningitis

young, outbreaks in close quarters, septicemia

neisseria meningitidis tx

third gen cephalosporin, rifampin

what is the main risk factor for htn?

hypertension

what assessment tool is used in patients with transient ischemic attack to determine if they are at high risk of ischemic stroke?

age, blood pressure, clinical features, duration of symptoms, and diabetes (ABCD2) score.

multiple myeloma pt

older

mutiple myeloma sx

back pain

multiple myeloma s/sx

CRAB: hypercalcemia, renal insufficiency, anemia, lytic bone lesions or back pain

multiple myeloma xray

lytic lesions

multiple myeloma peripheral blood smear

rouleaux formations

multiple myeloma serum protein electrophoresis

M spike

multiple myeloma protein electrophoresis urine analysis

Bence Jones proteins

what is multiple myeloma most commonly caused by?

single close plasma cell malignancy

what diuretics may be use in the setting of hypokalemia?

spironolactone, eplerenone, and triamterene

fibromuscular dysplasia

noninflammatory and nonatherosclerotic condition that can cause arterial stenosis, occlusion, aneurysm, dissection, and toruosity.

what are the mc involved arteries in FMD?

renal arteries

who is mc affected by FMD?

female pts

vit b12 deficiency lab findings

elevated MMA and elevated homocysteine levels

what valve is most commonly affected in infective carditis?

mitral valve

what pharmacologic therapies are available to aid in smoking cessation?

bupropion, varenicline, and nicotine replacement therapy.

what is the chief histologic pattern associated with idiopathic pulmonary fibrosis?

a heterogenous appearance with alternation areas of normal lung, fibrosis, fibroblast foci, and honeycomb change

which class of blood pressure medications should be avoided in patients on albuterol?

non-selective betablockers such as propranolol shoul be avoided due to opposing mechanisms of action

symptoms caused by atenolol

fatigue

sleep disturbance

bronchospasm

bradycardia

heart failure

impaired peripheral circulation

decreased exercise tolerance

true or false: beta-3 receptor beta blockers induce the breakdown of fat cells

true