Internal Medicine – Flashcards
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Top two causes CRF
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1. HTN 2. DM
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Prominent A Wave
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Tricuspid Insufficiency
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Canon A Wave
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Heart Block
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Soft P2
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Pulmonary Stenosis
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2 Causes Webbed Neck
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1. Turner's (coarctation) 2. Noonan's (pulm stenosis)
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Signs Constrictive Pericarditis
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1. X and Y descent 2. Square Root Sign 3. Calcification
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Beck's Triad for Cardiac Tamponade
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1. Distant Heart Sounds 2. Hypotension 3. JVD
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MCC HTN young people
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women: OCPs men: alcohol
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Most important cause of chronic glomerulonephritis
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DM
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MC kidney stones
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1. Calcium oxolate 80% increased urine pH radiopaque 2. Uric Acid 5% Decreased urine pH Radiolucent 3. Struvite 15% Mg ammonium phosphate Proteus radiopaque
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HyperCalcemia Causes
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VITAMIN TRAPS -Vitamin A and D intox -Immobilization -Thyrotoxicosis -Addison's/Acidosis -Milk Alkali -Inflammatory disorders -Neoplastic disease -Thiazides -Rhabdo -Aids -Paget's/Parenteral Nutrition/ParaTH dz -Sarcoid
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HyperCalcemia Sx's
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Bones, Stones, Groans, Moans
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RTA with abnormal H+ secretion and kidney stones
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Type I (distal) RTA
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RTA with abnormal HCO3- and rickets
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Type II (proximal) RTA
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RTA with aldosterone defect
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Type IV (distal) RTA
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Hypervolemic Hyponatremia
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1. Cirrhosis 2. CHF 3. nephritic syndrome
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Hyperkalemia EKG
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Peaked T waves and widened QRS
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Hypokalemia EKG
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T waves flatten; U waves
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ARF with FeNa <1%
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PreRenal
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Nephritic Syndrome
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1. Hematuria 2. HTN 3. Oliguria
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MC nephritic Syndrome
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Membranous Glomerulonephritis
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MC form glomerulonephritis
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IgA nephropathy (Berger's)
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Glomerulonephritis with deafness
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Alport's
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Glomerulonephritis with hemoptysis
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Wegener's or Goodpasture's
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salicylate ingestion
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anion gap acidosis and primary resp alkalosis due to central resp stimulation
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AntiCentromere Ab's
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Scleroderma (CREST)
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ANA
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SLE
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Antihistone
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Drug Induced Lupus
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Anti IgG
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Rheumatoid
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Antimitochondrial
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Primary Biliary Cirrhosis
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Aschoff Bodies
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Rheumatic Fever
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Mamillary Body Atrophy
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Wernicke's
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BUN : Creatinine Elevation
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Azotemia Bledding (GI) Catabolic state Diet (high protein, TPN)
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A Fib Causes
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PIRATES Pulmonary: PE, COPD Iatrogenic Rheumatic heart (mitral regurg) Atherosclerosis: MI, CAD Thyroid(hyper) Endocarditis Sick Sinus
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Atherosclerosis RF's
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SHIFT MAID Smoking/ HTN/ (n)IDDM/ Fam hx/ Triglyerides/ Male/ Age/ Inactivity/ Diet and drinks
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RSR' in V1
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RBBB
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1st degree AV block
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PR >200msec NO TRX
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Second degree AV block Type 1
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PR gradually increases until dropped beat/ Caused by drugs (digoxin, beta blockers, CCBs) or vagal increase, STOP DRUG
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Second degree AV block Type II
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PR doesn't change, unexpected dropped beat PACER!
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MCC 2* dilated cardiomyopathy
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1. ischemia 2. Long standing HTN
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S3 gallop
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dilated cardiomyopathy
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S4
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stiff ventricle "atrial kick" maybe hypertrophic cardiomyopathy
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Impaired diastolic filling without significant systolic dysfxn
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Restrictive Cardiomyopathy
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MCC Restrictive Cardiomyopathy
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1. Infiltrative Dz (sarcoid, hcm, amyloidosis) 2. scarring (radiation, doxorubicin)
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apical holosystolic murmur
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mitral regurg from ischemia
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Pain better when sitting forward
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Pericarditis and Pancreatitis
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TTP
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PARTNER Platelets low/ Anemia hemolytic/ Renal failure/ Temp rise/ Neuro defecits/ ER
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Treatment of TTP
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Plasmapheresis
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Heinz bodies
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G6PD heinz bodies are conc. Hb when spleen clears them they become BITE cells hemolysis in G6PD usually from viral or bacterial infection
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Oat Cell Lung CA (small cell) secretions
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1. ADH 2. ACTH 3. Eaton Lambert NOT HYPERCA!
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Heliotrope rash and Gottron's papules
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Dermatomyositis
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free water deficit
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current TBW = .6 x weight; desired TBW= (Na/140) x current TBW
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Hypotension, Hyponatremia, Hyperkalemia
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Possible Adrenal Crisis IV HYDROCORTISONE
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delta wave
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WPW
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trx of torsades de pointes
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magnesium and external pacing
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V Tach trx
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Lidocaine
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CHF Causes
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FAILURE Forgot meds/ Arrhythmia, Anemia/ Ischemia, Infection, Infarction/ Lifestyle (salt)/ Up CO (preg, hyperthy)/ Renal Failure/ Embolism pulm
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prox muscle weakness, dusky malar rash, periorbial edema
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Dermatomyositis (10%increased risk of malignancies)
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DOC raising HDL
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fibrates
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Lone A Fib Trx
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ASA only
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Symptomatic sinus bradycardia
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IV atropine followed by transcutaneous pacing
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Bone Marrow Profile on Glucocorticoids
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Neutrophilia (increase release and demargination); low eosinophils and lymphocytes
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Trx MS flares
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Corticosteroids
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Fatty Liver with encephalopathy
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Reye Syndrome trx: glucose with FFP and mannitol to decrease cerebral edema
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TCA OD EKG
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QRS prolongation Sodium Bicarbonate!!
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Flushing Diarrhea Wheezing
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Carcinoid
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plaque like deposits of fibrous tissue on the endocardium on the Right heart
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Carcinoid
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PAO2 equation
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150 - (PCO2 X1.25)
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Nml A-a gradient
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5-20
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hypoxemia nml A-a gradient
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1. Low FIO2 2. Hypoventilation
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Hypoxemia abnml A-a gradient
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1. diffusion 2. v/q mismatch 3. true shunt
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Will V/Q mismatch or shunt respond to O2?
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V/Q mismatch
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Only trx for shunt
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Positive Pressure Ventilation
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True Shunts
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1. collapse atelectasis 2. CHF 3. ARDS 4. PNA lobar 5. AV malformation
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Respiratory Alkalosis
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RAAP ICE acute: Asthma Attack/ PE chronic: ILD/ CNS/ End stage liver
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sputum tastes salty
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bronchoalveolar cell CA
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Causes Unexplained Chronic Cough (3 weeks nml CXR)
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1. sinusitis with PND (cobblestone) 2. asthma (PFT, eosinophilia) 3. GERD (Positional, regurg, nocturnal)
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staging of asthma
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clinically 1. #attacks/week 2. # awakenings/month 3. daily PEFR measurements and diurnal variation
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ABPA dx
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Positive Prick Test
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MCC hemoptysis
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Bronchitis
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Bullae in upper lobes
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acquired emphysema
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trx congenital emphysema
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prolastin weekly
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water blister on tympanic membrane
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Mycoplama pneumonia
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Post-transplant PNA
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CMV
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pulmonary infiltrates in AIDS
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HIV seropos- pneumococcus/ <400 T cells TB/ <200 PCP/ <100 MAI
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Cancer assoc. Hypercalcemia
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Squamous Cell Lung
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Cancer Hyperprolactin
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Large Cell Lung
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Cancer SIADH
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Small Cell Lung
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Cancer cerebellar ataxia
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Squamous Cell Lung
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Drug Induced ILD
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Bleomycin, Nitrofurantion, Amiodarone
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abdominal pain, bloody diarrhea, minimal physical exam findings in person with CAD
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ischemic bowel most likely splenic flexure
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Carcinoid syndrome causes what vitamin deficiency
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niacin
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Cat scratch dz trx
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azithromycin
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drug contraindicated in STEMI bc it causes vasodilation and reflex tachycardia
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nifedipine
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two ways to increase oxygenation
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1. FiO2 2. PEEP
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Granulation tissue in ear canal
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Malignant Otitis Externa common in diabetics caused by pseudomonas
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Pleural fluid indications for chest tube
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pH < 7.2 Glucose <60
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Winter's Formula
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PaCO2 = 1.5 (HCO3-) + 8
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SBE on predamaged valve
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Strep Viridans
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dx test for chronic pancreatitis
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stool elastase
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DOC fibromyalgia
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TC AD's i.e. amitriptyline
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DOC psuedotumor cerebri
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acetazolamide
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cocaine OD complication
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rhabdomyolysis leading to myoglobinuria and ATN
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Guillian Barre CSF
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Increased Protein, nml WBC RBC Glucose
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Subarachnoid hemorrhage electrolyte abnormality
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hyponatremia
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Celiac AB
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anti-endomysial
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NNT
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1/ARR ARR = CER (control event rate) - ERR (Experimental Event Rate)
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contraindication to nitroprusside
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renal insufficiency, CrCl 130 with end organ damage, induce hypotension to control bleeding in surgery, acute CHF)
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contraindication to labetalol
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asthma (nonselective beta blocker)
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DOC SVT
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1. Adenosine 2. Verapamil
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DOC for A fib resulting from WPW
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Procainamide
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Drug to avoid in WPW
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Digoxin blocks AV node and may speed up accessory pathway
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sudden onset tachycardia (~188 bpm), palpitations, dizziness
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PSVT trx 1. vagal maneuvers 2. adenosine or verapamil cure = albation
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Drug to avoid in VTach
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IV Verapamil
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abnormal p wave earlier than expected
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PAC BENIGN CONDITION trx= avoid caffeine
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cardiomegaly and low voltage on EKG
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suggests infiltrative process in the heart i.e. hemochromatosis, sickle cell with multiple blood transfusions
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abx prophylaxis for IE
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2. hx of infective endocarditis 2. prosthetic heart valves 3. unrepaired congenital cyanotic heart disease 4. 6 months out from placement of prosthetic graft material
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diabetes and hypertension goal bp and trx
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goal <130/80 use ACE-I
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Trx of claudicion
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exercise and cilostazol (phosphodiesterase inhibitor)
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trx hyperkalemia
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calcium gluconate
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EKG hypocalcemia
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prolonged QT >.45
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prolonged QT and congential deafness, maybe hx of sudden cardiac death
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Romano-Ward syndrome
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decreased vision, water hammer pulse, diastolic murmur
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aortic regurg in Marfan's pt
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treatment of vtach in context of ishemia
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amiodarone
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microcytic anemia with low ferritin
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Iron Deficiency Anemia anisocytosis and poikilocytosis MCC GI bleed test stool for occult blood
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urticaria association
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Hepatitis B
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Kussmaul's sign
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Increase JVP with inspiration 1. constrictive pericarditis 2. Restrictive cardiomyopathy
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"sentinel loop"
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air filled loop of small bowel in the LUQ RADIOLOGIC MARKER OF PANCREATIC DAMAGE
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lab values in pancreatitis
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Neutrophilic leukocytosis, hyperglycemia, hypocalcemia, Elevated CRP
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watery diarrhea in AIDS pt
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cryptosporidium or isospora need to acid fast stain of stool
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DOC pneumococcus
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Penicillin
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RF for papillary carcinoma of the thyroid
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previous neck radiation
