Internal Medicine

Front 1

5 things metastasize to vertebral column

Back 1

Brain
Liver
Thyroid
Kidney
Pancreas
(BLT with kosher pickle)

Front 2

Relationship between Digoxin and potassium

Back 2

Dig competes with K for binding site on NA/K pump. So, hypokalemia gives Dig a competitive edge, creating a relative toxicity. When dig levels are too high, K can't bind and hyperkalemia is the result.

Front 3

3 signs of critical Aortic Stenosis

Back 3

1. chest pain
2. syncope
3. heart failure

Front 4

Hypertensive emergency

Back 4

Signs of end-organ damage:
headache, change in vision,
chest pain, EKG changes (ST changes - concave ok, but straight or tombstoning bad)

Front 5

5 Mechanisms of hypoxemia

Back 5

1. Low FiO2 (altitude)
2. Hypoventilation (drugs, CNS, resp fatigue)
3. V/Q mismatch (emphysema, PNA, asthma)
4. Shunt (ARDS, CHF, PE)
5. Diffusion abnl (uncommon and controversial - early PCP maybe)

Front 6

Describe paradoxical respiratory motion

Back 6

Nl: diaphragm contracts down w/ inspiration, pushing abd out
Paradox: diaphragm is tired/ paralyzed, so with inspiration, intrathoracic pressure decreases and diaphragm is sucked up into chest, pulling abd inward

Front 7

Haldane effect

Back 7

deoxygenated hemoglobin has decreased affinity for O2 increased CO2 (if you've let go of your O2 already, you want it to be able to pick up whatever CO2 is around), oxygenated hemoglobin has decreased affinity for CO2

Front 8

Non-gap metabolic acidosis is associated with what?

Back 8

Hyperchloremia

Front 9

How to get rid of excess K? (5 ways)

Back 9

1. Diuretics (pee it out)
2. Kayexalate (bind it up)
3. B-agonist
4. Insulin (+glucose)
5. Bicarb
(these 3 push it into cells)
**give Ca gluconate for cardiac protection (increases firing threshold)

Front 10

Plummer-Vinson Syndrome

Back 10

esophageal webs
burning sensation on tongue
big red tongue
women > men
premalignant

Front 11

Signs of cor pulmonale

Back 11

rvh w/ parasternal lift
loud pulmonic sound
split s2
(neck vein distention, peripheral edema, liver enlargement)

Front 12

bronchiectasis

Back 12

Permanent thick, abnl dilated bronchial walls with destruction of cilia
Marked by excessive sputum and purulent exacerbations with mild hemoptysis.
ppt'd by infection with obstruction or impaired drainage - usu in childhood

Front 13

pneumonia ass'd with bronchiectasis (agents and tx)

Back 13

usu pseudomonas or staph aureus
Tx= resp fluoroquinolone + aminoglycoside

Front 14

bronchiolitis

Back 14

onset after viral URI, may be ass'd with RA
usu self-limited, but may leave perm damage

Front 15

BOOP

Back 15

Bronchiolitis Obliterans Organizing PNA
-inflammatory dz that looks like PNA
-flu-like sx
tx w/ steroids

Front 16

drugs responsible for interstitial lung dz

Back 16

bleomycin
amiodarone
phenytoin
nitrofurantoin

Front 17

CXR has ground glass appearance with bilateral alveolar infiltrates that resemble a BAT

Back 17

Pulmonary Alveolar Proteinosis

Front 18

Histiocytosis X

Back 18

ILD
ass'd with Langerhans cells
Smokers get it and smoking cessation may stabilize or reverse dz
CXR - honeycomb
CT - cystic lesions

Front 19

Lupus in the lung

Back 19

"shrinking lung" due to diaphragmatic dysfn and atelectasis
presents with fever, dyspnea, hemoptysis

Front 20

Flumazenil

Back 20

given for benzo OD

Front 21

3 sx of critical aortic stenosis

Back 21

1. Chest Pain
2. Syncope
3. Heart failure
(also dyspnea, murmur)

Front 22

Sx of pericarditis

Back 22

sudden sharp stabbing substernal pain, radiation to trapezius
-relieved by sitting forward, worse on inspiration/lying flat
*may be preceded by URI

Front 23

EKG signs of pericarditis

Back 23

ST elevation
PR depression

Front 24

Wide mediastinum

Back 24

think about Aortic dissection

Front 25

What do you have to worry about after an MI?

Back 25

Mechanical dysfn (2-7 d out)
1. papillary rupture-->mitral regurg (can--> pulm edema and hypotension)
2. VSD
3. Left Ventricular free wall rupture-->cardiac tamponade

Front 26

Causes of hemolytic anemia

Back 26

1. sickle
2. hereditary spherocytosis
3. g6pd
4. Autoimmune Hemolytic Anemia
5. Paroxysmal Noct Hematuria

Front 27

Spherocytes and Coombs test

Back 27

hereditary sphero = Coombs neg
AHA = coombs pos

Front 28

Which hemolytic anemia can
--> myelodysplasia, aplastic anemia, myelofibrosis, and acute leukemia?

Back 28

Paroxysmal Nocturnal Hematuria
sx include back, abd, msk pain
tx: usu BMT
def of anchor proteins --> chronic intravasc hemolysis and complement mediated lysis of RBCs, WBCs, plts (pancytopenia)

Front 29

Agents & treatment of Spontaneous Bacterial Peritonitis

Back 29

E.coli (also Klebsiella and Strep pneumo)

Empirically treat with 3rd gen ceph or fluoroquinolone while awaiting C&S

Front 30

Volvulus

Back 30

abdominal pain, obstipation
Plain films: omega loop sign (bent inner tube) - sigmoidal (most common) --> non-operative reduction via sigmoidoscopy
coffee bean sign (cecal) - younger pts as congenital lack of fixation --> emergency surgery

Front 31

Crohn's disease associated with

Back 31

strictures, fistulae, noncaseating granulomas, sm bowel fat creeping, pseudomembranes

Front 32

Electrolyte imbalances in bulimia

Back 32

hypochloremia, hypokalemia

Front 33

HACEK bacteria

Back 33

Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella

Front 34

You suspect aortic dissection, confirm it with TEE, now do what?

Back 34

Give IV B-blocker immediately to dec BP and HR
(can later give IV vasodilator, if needed, to control BP)
If it is in the ascending aorta, prep for surgery.