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Internal Med
Rotation
222
Medical
Graduate
07/05/2019

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Cards

Term
What is the diagnostic FEV1/FVC ratio in COPD per GOLD guidelines?
Definition
<0.7
Term
What is Miller Fisher syndrome?
Definition
A variant of Guillain-Barre that starts in the head, resulting in weakness of extraocular muscles and balance.
Term
What is Rhett syndrome?
Definition
Childhood illness- unstable gait, abnormal speech/social skills starting after first few months of development.
Term
What is fragile X syndrome?
Definition
Caused by decreased or absent levels of fragile X mental retardation protein (FMRP) due to a loss-of-function mutation in the fragile X mental retardation 1 (FMR1) gene. Caused by an unstable expansion of a trinucleotide (cytosine-guanine-guanine, CGG).
Term
Imaging of choice to diagnose MS?
Definition
MRI- ovoid lesions in white matter
Term
What are typical physical features of fragile x?
Definition
Long, narrow face, prominent forehead/chin, large ears, pale blue irises
Term
What is pseudophakia?
Definition
having an artificial lens implanted after the natural eye lens has been removed
Term
What medication is indicated for absence seizures?
Definition
Ethosuximide
Term
What is the pathogenesis for ARDS?
Definition
Lung inflammation (MC due to pneumonia) triggers macrophages/neutrophils --> damage to endothelial cells --> fluid leakage into alveoli = NONCARDIOGENIC PULMONARY EDEMA
Term
Classic CXR/CT finding in ARDS?
Definition
Interstitial infiltrates/ground glass appearance
Term
Which antiseizure med can cause gingival hypertrophy?
Definition
Phenytoin
Term
Which antiseizure med can cause weight loss?
Definition
Topiramate
Term
Which antiseizure med can cause hair loss and easy bruising?
Definition
Valproate
Term
What is Muir-Torre syndrome?
Definition
Subtype of Lynch (hereditary nonpolyposis colorectal cancer) syndrome
Term
What is the most common organism responsible for pneumonia in young, healthy adults?
Definition
Mycoplasma
Term
What organism are we concerned about with pneumonia in alcoholics?
Definition
Klebsiella
Term
What organism is associated with pneumonia in people exposed to bats?
Definition
Histoplasma capsulatum
Term
Do people under 65 w/ diabetes get PSV13 or PPSV23
Definition
23
Term
What etiology is commonly responsible for fine crackles?
Definition
Idiopathic pulmonary fibrosis
Term
What are common causes of coarse crackles?
Definition
COPD, bronchiectasis, asthma (along w/ wheezing), pneumonia
Term
Typical causes of pleural friction rub?
Definition
Pleuritis, mesothelioma
Term
What is Boaerhaave syndrome?
Definition
Effort rupture of the esophagus
Term
What medication is administered following cardiac surgery to prevent post-cardiac injury syndrome?
Definition
Colchicine
Term
What components comprise the qSOFA score for sepsis?
Definition
1) Altered mental status
2) Systolic BP <100
3) RR > 22
Score of 2 or above is concerning
Term
what's the time limit to administer tpa in a stroke patient?
Definition
Up to 4.5hrs since onset of symptoms
Term
What type of crystals are negatively birefringent and needle-shaped: gout (MSU) or pseudogout (CPP)?
Definition
Gout
Term
What disease is associated w/ a Ghon complex?
Definition
Tuberculosis
Term
What is takayasu arteritis?
Definition
Granulomatous inflammation of the aorta and its major branches
Term
What are key symptoms of Behcet's disease?
Definition
Mouth and genital sores that keep coming back; joint pain; uveitis
Term
What is a positive pathergy test?
Definition
Exaggerated skin injury following minor trauma
Term
Tx for Behcet's?
Definition
Corticosteroids (since it is due to inflammatory vasculitis)
Term
What antibiotic might you use for isospora/cyclospora diarrhea infection?
Definition
Bactrim
Term
What antibiotic might you use for microsporidium diarrhea infection?
Definition
Albendazole
Term
What antibiotic might you use for travelers' or bloody diarrhea?
Definition
Cipro
Term
Does IBS present with positive or negative fecal calprotectin?
Definition
Negative
Term
What is a Sudan stain for stool?
Definition
Qualitative fecal fat
Term
What is an SBFT test?
Definition
Small bowel follow-through: radiograph with barium contrast
Term
What are the 6 categories of the SOFA score for sepsis?
Definition
Respiration (PAO2/FiO2)
Coag (Platelets)
Liver (Bilirubin)
Kidneys (Crn)
Mentation (Glasgow coma scale)
BP
Term
What is the diagnostic limit of troponin levels?
Definition
0.04 ng/mL
Term
What defines septic shock?
Definition
SOFA sepsis + difficulty maintaining MAP >/=65 w/o vasopressors and lactate >/=2
Term
Which cephalosporins have antipseudomonal activity?
Definition
Ceftazadime, cefepime
Term
What is apical ballooning syndrome?
Definition
AKA Takotsubo cardiomyopathy- LV systolic dysfunction in the absence of coronary artery occlusion or plaque rupture. Typically transient and triggered by a physical or emotional stress
Term
What genetic disorders are associated w/ pheochromocytoma?
Definition
MEN2, NF (neurofibromatosis) type 1, VHL (von Hippel Landau)
Term
What meds do we start in patients with new-onset HF?
Definition
ACEi, diuretic, B-blocker
Term
What is Wegener's and some common clinical manifestations?
Definition
Granulomatosis with Polyangiitis- pulmonary infiltrates (hoarseness, cough, etc.), glomerulonephritis, ENT (runny nose, hearing loss)
Term
What causes GPA?
Definition
Antineutrophil cytoplasmic autoantibody vasculitis
Term
GPA treatment?
Definition
Immunosuppression w/ corticosteroids plus rituximab or cyclophosphamide
Term
What are clinical manifestations of Kawasaki Disease (KD)?
Definition
Mucocutaneous lymph node disease predominantly affects children- fever plus: characteristic bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, rash, extremity changes, and cervical lymphadenopathy typically develop after a brief nonspecific prodrome of respiratory or gastrointestinal symptoms
Term
What is the underlying pathophys of KD?
Definition
Widespread inflammation of medium-sized muscular arteries
Term
KD treatment?
Definition
IVIG and aspirin
Term
What are possible adverse effects of IVIG?
Definition
Hemolytic anemia, aseptic meningitis, transmission of bloodborne pathogens
Term
What are sequestra in osteomyelitis?
Definition
Pieces of necrotic bone that fracture off from viable bone
Term
What is the most common organism implicated in hematogenous osteomyelitis?
Definition
S. aureus
Term
Most common sites of hematogenous OM in adults vs children?
Definition
Adults- vertebrae followed by sternoclavicular/pelvis
Children- appendicular long bones
Term
What is a Brodie abscess?
Definition
a region of suppuration and necrosis encapsulated by granulation tissue within a rim of sclerotic bone.
Term
MC organisms implicated in sickle cell OM?
Definition
Gram-negative, such as salmonella and e. coli
Term
What is empiric abx therapy for OM?
Definition
Vanco plus 3rd or 4th-gen ceph (ceftriaxone, cefepime, ceftazadime)
Term
Which type of CXR film casts a heart shadow and should be avoided?
Definition
AP
Term
What are the three MC causes of pleural effusion?
Definition
Heart failure, pneumonia, malignancy
Term
What supplementary action is provided by adding clavulanate to amoxicillin?
Definition
Beta lactamase inhibition
Term
What are the antipseudomonal penicillins?
Definition
Piperacillin, ticarcillin, carbenicillin
Term
What beta lactam abx can be given to a pt with type I hypersensitivity to penicillin?
Definition
Aztreonam (monobactam)
Term
1st gen cephs coverage and examples?
Definition
Ancef, keflex- cover staph for skin
Surgery prophylaxis
Term
2nd gen cephs indication and examples?
Definition
Cefotetan, cefoxitin- URI, PID (for B. fragilis)
Term
3rd gen cephs- indications & examples?
Definition
Ceftriaxone, ceftazadime- anti-pseudomonal, good CNS penetration (pneumonia, meningitis)
Term
Which ceph has a risk of developing gallstones?
Definition
Ceftriaxone (rocephin)
Term
Which cephs cover MRSA?
Definition
Cefepime, ceftaroline
Term
What are some PE tests to evaluate piriformis syndrome?
Definition
Freiburg test (hip in extension/internal rotation, pain upon resistance of external rotation)
Pace test (seated, pain upon resisted abduction/external rotation)
Term
What is the wallet sign and what disorder is it associated with?
Definition
Male patient can no longer sit on their wallet w/o pain (may indicate piriformis syndrome)
Term
What benefit is conferred by adding cilastatin to imipenem?
Definition
Prevents imipenem breakdown by the kidneys
Term
Which abx is associated w/ gray baby syndrome?
Definition
Chloramphenicol
Term
Chloramphenicol MOA?
Definition
Binds to ribosomal 50S subunit
Term
Tetracycline MOA?
Definition
Binds to ribosomal 30S subunit
Term
What's the drug of choice for brain abscess?
Definition
Chloramphenicol (good penetration of CNS)
Term
Which is longer-acting: doxy or tetracycline?
Definition
Doxy
Term
Treatment of choice for chlamydia infection?
Definition
Azithromycin or doxy
Term
What is the drug of choice to cover pseudomonas in cystic fibrosis?
Definition
Tobramycin
Term
Fluoroquinolone MOA?
Definition
Binds to DNA gyrase
Term
What antibiotics should not be taken w/ dairy?
Definition
Tetracyclines & fluoroquinolones
Term
What antibiotics should not be taken w/ dairy?
Definition
Tetracyclines & fluoroquinolones
Term
Can fluoroquinolones be administered <18y.o?
Definition
No due to cartilage damage (except cipro)
Term
Sulfa drugs plus hypoglycemic agents?
Definition
Can potentiate hypoglycemia
Term
Sulfa drugs plus thiazides?
Definition
Thrombocytopenia and bruising
Term
What drug is often used in prophylactic UTI therapy?
Definition
Nitrofurantoin
Term
Rifampin MOA?
Definition
Inhibits DNA-dependent RNA polymerase
Term
Indication for pyrazinamide?
Definition
anti-tuberculosis drug
Term
Which TB drug causes optic neuropathy?
Definition
Ethambutol- alters color vision
Term
Which antiviral agent should you use in pts w/ asthma?
Definition
Oseltamavir (since zanamavir can cause bronchospasm)
Term
What is the most common risk factor for small bowel obstruction?
Definition
Prior abdominal surgery
Term
What are MC sites of volvulus?
Definition
Sigmoid colon & cecum
Term
What is obstipation?
Definition
Inability to pass gas or stool
Term
What is the clinical picture of a pt w/ acute SB obstruction?
Definition
N/V, crampy periumbilical paroxysmal pain, abdominal distention
Term
With what type of malignancy is Necrolytic Migratory Erythema associated?
Definition
Glucagonoma
Term
What are common organisms causing spontaneous bacterial peritonitis (SBP)?
Definition
E. coli, streptococcus, klebsiella pneumoniae
Term
What antibiotic therapy is used empirically in pts w/ SBP?
Definition
IV cefotaxime
Term
What is the significance of Hesselbach's triangle?
Definition
Direct inguinal hernias protrude here
Term
What are the borders of Hesselbach's triangle?
Definition
Inguinal ligament inferiorly, inferior epigastric vessels laterally, rectus abdominis muscle medially
Term
Do indirect inguinal hernias develop more frequently on the right or the left?
Definition
Right
Term
Are femoral hernias more common in men or women?
Definition
Women
Term
What is a diospybezoar?
Definition
Gastric bezoar formed from persimmon fruit
Term
What is the most common type of bezoar?
Definition
Phytobezoar (composed of vegetable matter)
Term
What is Peutz-Jeghers syndrome?
Definition
Genetic abnormality in tumor suppressor gene --> hamartomatous GI polyps (may present w/ GI bleeding) with mucocutaneous pigmented macules (MC oral mucosa)
Term
what is the ligament of treitz?
Definition
suspensory ligament of duodenum connecting it to diaphragm
Term
What is superior mesenteric artery syndrome?
Definition
Narrowing of duodenum due to compression of angle between superior MA and aorta due to loss of intervening mesenteric artery fat pad
Term
What are risk factors for superior mesenteric artery syndrome?
Definition
Extreme weight loss due to malignancy or aids most commonly
Term
Empiric therapy for community-acquired pneumonia?
Definition
Ceftriaxone plus azithromycin
Term
Rust-colored sputum is associated with what type of pneumonia?
Definition
Strep pneumoniae
Term
Which is associated with optic neuritis: MS or Guillain Barre?
Definition
MS
Term
Auer rods are associated with what type of leukemia?
Definition
AML
Term
Antibiotic of choice for campylobacter diarrhea?
Definition
Cipro
Term
Cold-reacting antibodies, such as that seen with Mycoplasma infection, affect which type of immunoglobulin antibody?
Definition
IgM
Term
MC cause of ring-enhancing lesions on CT in pts with HIV?
Definition
Toxoplasmosis
Term
Empirical tx for possible toxoplasmosis?
Definition
sulfadiazine, pyrimethamine, and leukovorin
Term
Empirical tx for possible histoplasmosis?
Definition
Amphotericin B
Term
What is the flutamide MOA?
Definition
Blocks androgen receptors
Term
What is the MC cause of painful thyroiditis?
Definition
Subacute thyroiditis
Term
Cause of hyperthyroidism in subacute thyroiditis?
Definition
Destruction of thyroid follicular cells --> release of stored thyroglobulin --> increased T3/T4 levels with low TSH and decreased radioiodine uptake
Term
MC organisms in infectious thyroiditis?
Definition
Staph and strep
Term
Thyroid levels in infectious thyroiditis?
Definition
Usually normal
Term
Does painless thyroiditis present w/ hyper or hypothyroid?
Definition
Hyper
Term
Common drugs that induce thyroiditis?
Definition
Amiodarone, lithium, interferon alpha, interleukin-2
Term
What organism MC causes enteric fever?
Definition
Salmonella typhi
Term
Clinical presentation of enteric fever?
Definition
Abdominal pain, fever, chills, may have salmon spots rash
Term
Empiric antibiotic of choice for enteric fever?
Definition
Fluoroquinolones (cipro)
Term
What artery is likely involved in stroke if there is leg weakness: anterior cerebral, posterior cerebral, middle?
Definition
Anterior
Term
What is the MC leukemia in Western countries?
Definition
CLL
Term
Which type of leukemia is associated w/ the philadelphia chromosome?
Definition
CML
Term
What is Leser-Trelat sign?
Definition
Sudden eruption of SKs, associated w/ malignancy
Term
MC site of extrahepatic metastases from heptocellular carcinoma?
Definition
Lung
Term
What is the go-to blood test for HCC?
Definition
alpha fetoprotein (AFP)
Term
What does the Braden score assess?
Definition
Sore risk
Term
MOA and application for precedex?
Definition
Alpha-2-agonist used for sedation in alcohol w/drawal
Term
What do ringed sideroblasts on peripheral smear indicate?
Definition
Abnormal accumulation of iron in the mitochondria around the nucleus of erythroid precursors
Term
What drugs are MC associated w/ sideroblastic anemia?
Definition
Isoniazid, chloramphenicol, linezolid
Term
What does a Howell-Jolly body represent?
Definition
Spleen dysfunction (not clearing damaged RBCs from circulation)
Term
What is RDW on CBC?
Definition
Red cell Distribution Width- variation in size of RBCs (may be elevated in iron deficiency anemia)
Term
What is the MC cause of Heinz bodies on peripheral smear?
Definition
G6PD deficiency
Term
What is the classic sign of b12 deficiency on peripheral smear?
Definition
hypersegmented neutrophils
Term
What are you assessing when you measure methylmalonic acid?
Definition
b12 (bc b12 is required to metabolize it)
Term
What type of anemia is present in multiple myeloma?
Definition
Normocytic, normochromic
Term
What is rouleaux formation on peripheral smear?
Definition
RBCs look like stack of coins- may be seen in MM
Term
What is G6PD and what does it do?
Definition
RBC enzyme, generates NADH and protects them from oxidative damage
Term
What is the inheritance pattern for G6PD deficiency?
Definition
X-linked
Term
What type of food MC triggers hemolysis in pts w/ G6PD deficiency?
Definition
Fava beans
Term
Which is associated with neurological symptoms: b12 or folate deficiency?
Definition
b12
Term
Which is associated w/ angular cheilitis: b12 or folate deficiency?
Definition
Folate
Term
What is the genetic dysfunction in sickle cell disease?
Definition
Substitution of valine for glutamic acid at position 6 on the beta chain --> beta chain binds w/ alpha chain to form hemoglobin S
Term
What lab test do we order to assess for autoimmune hemolytic anemias?
Definition
Direct Coombs test- check for warm and cold antibodies
Term
How do we diagnose paroxysmal nocturnal hemoglobinuria?
Definition
Check for CD55 and CD_ (proteins on RBCs)
Term
What is the screening vs diagnostic test for sickle cell disease?
Definition
Screening- sickledex
Diagnostic- hemoglobin electrophoresis
Term
What value of corrected reticulocyte count indicates decreased production vs increased destruction of RBCs?
Definition
<2% = decreased production
>2% = increased destruction
Term
What type of anemia is caused by alcoholism?
Definition
Macrocytic
Term
What does a positive Coombs test indicate?
Definition
Autoimmune hemolytic anemia (presence of antibodies on RBCs)
Term
What is the inheritance pattern of pyruvate kinase deficiency?
Definition
Autosomal recessive
Term
How does pyruvate kinase function in RBCs?
Definition
Participates in ATP generation
Term
What are ferritin levels like in anemia of chronic disease?
Definition
High
Term
What do we see on peripheral smear in lead poisoning?
Definition
Basophilic stippling
Term
S&S of lead poisoning in children?
Definition
Encephalopathy (vomiting, altered LOC, seizures, coma); hearing loss; peripheral neuropathy
Term
Intervention is indicated at what blood lead level (BLL)?
Definition
5mcg/dL
Term
Treatment for pneumocystis jirovecii pneumonia?
Definition
bactrim
Term
Indications for pyrimethamine?
Definition
Toxoplasmosis, malaria
Term
Pyrimethamine MOA?
Definition
Inhibits parasitic dihydrofolate reductase
Term
Possible toxicity of nitroprusside therapy?
Definition
Cyanide poisoning (gets metabolized to cyanide)
Term
Nitroprusside indications?
Definition
Acute decompensated HF, hypertensive emergency
Term
Isoproterenol indications?
Definition
Bradycardia, cardiogenic shock
Term
Tx for entamoeba histolytica diarrhea?
Definition
Metronidazole
Term
First-line tx for hyperprolactinemia?
Definition
Dopamine agonists- cabergoline followed by bromocriptine
Term
Tx for hepatic encephalopathy?
Definition
Lactulose
Term
What is Zollinger-Ellison syndrome?
Definition
Gastric acid hypersecretion due to gastrinoma
Term
What diseases can cause secondary Immune Thrombocytopenia Purpura (ITP)?
Definition
HIV, HCV, SLE, CLL
Term
What age group has the highest incidence of ITP?
Definition
Children (0-14)
Term
What platelet count is the cutoff for thrombocytopenia?
Definition
<150,000
Term
What is the MC symptom in pts w/ ITP?
Definition
Fatigue
Term
First-line therapies for ITP?
Definition
Glucocorticoids and IVIG
Term
What is Fanconi syndrome?
Definition
Genetic disorder manifesting with bone marrow failure and endocrine anomalies (short stature, hypogonadism, etc)
Term
What are the 3 major types of von Willebrand disease VWD?
Definition
1- quantitative reduction in VWF
2- Dysfunctional VWF
3- Absent or severely reduced VWF
Term
What is the inheritance pattern for VWD?
Definition
Autosomal dominant
Term
How does Russell viper venom affect clotting cascade?
Definition
Activates factor X
Term
What does prolonged Russell viper venom test indicate?
Definition
Lupus anticoagulant
Term
Indication for fresh frozen plasma?
Definition
Replace clotting factors
Term
What is amicar?
Definition
Antifibrinolytic therapy
Term
How can DDAVP (desmopressin) help with clotting?
Definition
Stimulates release of VWF from platelets
Term
What is octreotide and what are its common indications?
Definition
Somatostatin analog
Used to tx acromegaly and also watery diarrhea associated w/ GI tumors
Term
What is Charcot Marie Tooth disease and how does it present?
Definition
Genetic peripheral demyelinating disorder- presents w/ distal weakness including foot drop & pes cavus
Term
What type of medication is vincristine?
Definition
Antineoplastic agent (used to tx leukemia & lymphoma)
Term
MOA of vincristine?
Definition
Prevents microtubule formation
Term
What is the Mantoux test?
Definition
PPD skin test for Tb
Term
What is lutein?
Definition
Eye vitamin
Term
What is midodrine?
Definition
Alpha-1-agonist used as vasopressor
Term
What is a MELD score used for?
Definition
Model for End-stage Liver Disease
Term
What serum levels are calculated into the MELD score?
Definition
Bilirubin, Crn, INR
Term
What are manifestations of Korsakoff syndrome?
Definition
Selective anterograde and retrograde amnesia
Term
What drug is used to treat acetaminophen OD?
Definition
Acetylcysteine
Term
What is the dagger sign on frontal spine xray?
Definition
Radiodense line of spinous processes- indicates ankylosing spondylitis
Term
What is Schober's test?
Definition
Mark off 10cm above L5 spinous process, have pt maximally flex spine. Normal is >5cm increase, AS will have less
Term
What is bamboo spine on x ray?
Definition
Bumpy outer edges of vertebral bodies = osteophytes- indicates AS
Term
What does shawl sign indicate?
Definition
Dermatomyositis
Term
What are Gottron papules?
Definition
Red bumps over knuckles- seen in dermatomyositis
Term
MOA of allopurinol?
Definition
Xanthine oxidase inhibitor- lowers uric acid (use for long-term management of gout)
Term
What is the role of allopurinol in pts w/ cancer?
Definition
Tumor lysis syndrome- chemo destroys WBCs causing them to leak uric acid
Term
First-line tx of acute gout flare?
Definition
Indomethacin
Term
What are lab features of nephrotic syndrome?
Definition
Massive proteinuria (>3g/24h), hypoalbuminemia (<2.5g/dL), edema, hypercholesterolemia
Term
Is hyperpigmentation associated w/ primary or secondary adrenal insufficiency?
Definition
Primary
Term
What class of drugs are flecainide and procainamide?
Definition
Na channel blockers (antiarrhythmics)
Term
What organs are primarily affected by MEN type 1?
Definition
3 Ps: Parathyroid, pituitary, pancreas
Term
Clinical features of MEN2A?
Definition
Medullary thyroid cancer (MTC), pheochromocytoma, primary parathyroid hyperplasia
Term
Clinical features of MEN2B?
Definition
MTC, pheochromocytoma, mucosal neuroma
Term
What cause of diarrhea and crampy abdominal pain is made worse by stress and mealtimes?
Definition
IBS
Term
Pathophys of acute tubular necrosis?
Definition
Decreased GFR due to hypotension/dehydration/sepsis leads to breakdown of renal epithelium/necrosis
Term
Urinalysis findings in acute tubular necrosis (ATN)?
Definition
Muddy brown granular, epithelial cell casts
Term
What is the diagnostic test of choice for Wegener’s granulomatosis disease?
Definition
Antineutrophil cytoplasmic autoantibody
Term
Antibiotic of choice for campylobacter?
Definition
Cipro
Term
What is trihexyphenidyl indicated for?
Definition
Antimuscarinic agent used to tx spasms in Parkinson's disease
Term
What type of drug is pimavanserin?
Definition
Atypical antipsychotic used to tx Parkinson's hallucinations
Term
What features are necessary for a clinical diagnosis of parkinson disease?
Definition
Bradykinesia plus either tremor or rigidity
Term
What is anterocollis?
Definition
Involuntary flexion of the neck
Term
Is PD usually bilateral or unilateral?
Definition
Unilateral
Term
What is leflunomide used to tx?
Definition
RA (immunosuppressant)
Term
What type of drug is amantadine?
Definition
Dopamine promoter (used in PD)
Term
What is macroglobulinemia?
Definition
IgM monoclonal gammopathy
Term
Clinical manifestations of Waldenstrom macroglobulinemia?
Definition
Hyperviscosity- vision changes, tinnitus, deafness, etc
Peripheral neuropathy (due to IgM attack of nerve cells)
Rouleaux formation on periph blood smear
Term
What is the MOA and indication for bendamustine?
Definition
Alkylating agent (mustard derivative)
Used to tx CLL
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