IM pearls

obinno59's version from 2015-12-24 17:33


Question Answer
The three most common causes of chronic cough in immunocompetent nonsmokers who are not taking ACE inhibitors are ___postnasal drip, asthma, and gastroesophageal reflux disease.
Asymptomatic hypercalcemia is most likely caused by _____primary hyperparathyroidism.
The most common inherited thrombotic conditions are the____factor V Leiden mutation and the prothrombin gene mutations .
______is the leading cause of cancer deaths in both men and women.Primary lung cancer, or bronchogenic carcinoma,
Lung CA =_____ is three to four times more common than____1. NSCLC
_____usually is metastatic at the time of diagnosis and not resectable______may be curable by resection if it is early stage, and the patient has sufficient pulmonary reserve.1. SCLC
The pattern of infiltration can yield diagnostic clues. Infection with______ classically presents with a dense lobar infiltrate, often with an associated parapneumonic effusion.S pneumoniae
Appearance of cavitation suggests a necrotizing infection such as_____Staphylococcus aureus , tuberculosis, or gram-negative organisms such as Klebsiella pneumoniae
Aspiration Pneumonia vs PneumonitisPneumonitis= chemical injury to the lungs caused by aspiration of acidic gastric contents into the lungs. Because of the high acidity, gastric contents are normally sterile, so this is not an infectious process but rather a chemical burn that causes a severe inflammatory response, Tx: Supportive

Pneumonia=process caused by inhalation of oropharyngeal secretions that are colonized by bacterial pathogens.
A 65-year-old cigarette smoker with a history of hypertension and mild congestive heart failure presents to the emergency room with worsening cough, fever, diarrhea, and dyspnea at rest. The illness began 1 week ago with fever, this case?

A. Chlamydia pneumoniae B. Mycoplasma pneumoniae C. Legionella pneumophila D. Coccidiomycosis E. Aspergillus fumigatus
Legionella typically presents with myalgias, abdominal pain, diarrhea, and severe pneumonia.
A 56-year-old man is brought into the emergency room intoxicated with alcohol. He has repeated bouts of emesis and is found choking. Lung examination reveals some crackles in the right lung base. Which of the following is the most appropriate management?Antibiotic therapy is generally not indicated for aspiration pneumonitis, but patients need to be observed for clinical deterioration.
A 30-year-old woman takes prednisone 15 mg/d for systemic lupus erythematosus. She is admitted to the hospital for a cholecystectomy. Which of the following is the most important intervention for her?Hydrocortisone intravenously before surgery and every 6 hours for 24 hours.
Treatment of adrenal crisisIs immediate administration of salt (saline), sugar (glucose), and steroids
Fasting glucose of 120: TxNo t DM yet but impaired glucose regulation. Lifestyle changes: (diet and exercise for 30 minutes per day, 5 days per week)
Which of the following distinguishes hyperthyroidism from thyroid storm?Fever and delerium=Storm
In patients with Graves disease, thyrotoxic symptoms may be treated with antithyroid medication or by thyroid gland ablation by radioactive iodine or surgery, but the _____ may not improve.ophthalmopathy
exudate =must meet at least one of the following criteria (transudates meet none of these criteria):1. Pleural fluid protein/serum protein ratio >0.5
2. Pleural fluid LDH/serum LDH ratio >0.6
3. Pleural fluid LDH >2/3 the upper limit of normal for serum LDH
The following fluid characteristics suggest chest tube drainage is necessary:

What if they don't meet these criteria?
CT drainage= Thoracostomy should be done if..

Empyema (frank pus in the pleural space)
Positive Gram stain or culture of fluid
Presence of loculations
pH less than 7.10
Glucose less than 60 mg/dL
LDH more than 1000 U/L

a 1-week trial of antibiotics is indicated, with close reevaluation of those patients who do not respond or who clinically deteriorate.
The recommended interval for cholesterol screening in this population of healthy adults is_______Every 5 years.
CEA indicationsclear benefit - symptomatic patients with >70% stenosis
marginal benefit - symptomatic patients with >50-69% stenosis
small benefit - asymptomatic patients with >60% stenosis
CEA CONTRAcontraindications
100% carotid stenosis
previous stroke with persistent neurological symptoms
poor surgical candidacy
Stroke prevention begins with_____ therapy ______Antiplatelet
, and aspirin/ aspirin + Clopidrogel should be used in all cases unless there is a CONTRA
AMAUROSIS FUGAX:Transient monocular blindness that often is described as a gray shade being pulled down over the eye caused by ischemia to the retinal artery.
Cerebral infarction, transient ischemic attack, and amaurosis fugax all may be symptoms of ____carotid stenosis.
_____ is an immune complex-mediated disease that may include fever, cutaneous eruptions, lymphadenopathy, arthritis, and glomerulonephritis.Serum sickness
Erythema multiform HSV vs Drug rxnsDrug rxns(ex SJS) will include both cutaneous and MUCOSAL involvement
______are effective in improving cognitive function and global clinical state in patients with Alzheimer disease. The ______ is added in more advanced disease.1. Cholinesterase inhibitors: Donepezil, ___stigmine
2.NMDA receptor antagonist: Memantine
The serum levels of calcium, phosphorus, and alkaline phosphatases in patients with osteoporosis,all normal
In patients with a pathologic fracture, ______is a diagnosis of exclusion; ______also must be considered.1. osteoporosis
2. osteomalacia, Paget disease, and metastatic malignancies
Delirium tremens is the most severe and dramatic form of alcohol withdrawal, with abrupt onset from_____ after cessation of drinking and sudden resolution several days later, and is associated with a mortality rate of_____1. 2 to 4 days
2. 5%-10%.
Mammo Ca screeningannual mammography is no longer recommended for women aged 40 to 49 years,
DEXA scan for osteoporosis is recommended for women starting at age_____65, or earlier for patho fractures
The varicella zoster vaccine is a live attenuated vaccine, recommended for individuals aged_______60 and above,
Asymptomatic bacteriuria is a common finding among_______and requires no treatment; it is only routinely treated in_____ and ____1. Elderly patients
2. Pregnancy
3.Transplant recipients.
In healthy women with symptoms of acute uncomplicated cystitis, cultures are not routinely sent, and treatment can be initiated based on symptoms and on a urine dipstick finding of ____leukocyte esterase or nitrites.
Diarrhea <_____ vs > ____1. 2 weeks= acute=infectious
2. 4 weeks=Chronic
If testing suggests an inflammatory diarrhea , empiric therapy is usually instituted, often with_______. An exception to this strategy is in patients with suspected ______ infection bc _____1. Quinolone antibiotics such as ciprofloxacin or norfloxacin
2.Enterohemorrhagic E coli (EHEC)
3. There is no evidence of benefit from antibiotics for EHEC infections such as the O157:H7 strain, and there is concern about increased risk of hemolytic uremic syndrome due to an increase in the production of Shiga toxin when antibiotics are administered, so antibiotics are not recommended.
Suspect Celiacs in pts with ___ that fails to correct with tx. Dx should be made with a ___ diet.
Unexplained _____ and ______ in a young woman
unexplained ______ in any patient, and the classic presentation with steatorrhea and weight loss should all be investigated.
1. Iron
2. Gluten-RICH!
3. Osteopenia and vitamin D deficiency
4. iron deficiency anemia
_____ and ___ are NOT sx's of IBS1. Bloody diarrhea
2.Nocturnal awakening with pain or diarrhea
Normal stool osmolality is equal to plasma, about______. In secretory diarrhea, most of the osmotically active particles are electrolytes, and can be calculated as 2 × [Na + K].

Stool osmotic gap of gap >_____ is indicative of osmotic diarrhea).
1. 290 mOsm
Most cases of acute infectious diarrhea in the US cause mild to moderate illness that is self-limited, and can be managed with ___ or _____1. Oral rehydration solution
2. With antimotility agents such as loperamide.
Osteoarthritis is the most common articular disease of adults, most often affecting these 4____Distal interphalangeal joints > proximal interphalangeal joints > knees > hip joints.
HIT vs other Thrombocytopenia'sHIT differs from other drug-induced causes of thrombocytopenia in that it is not associated with bleeding, but rather with increased risk of thrombosis .
The 4 T’s are a useful mnemonic of the diagnostic criteria for HIT:
T hrombocytopenia (nadir rarely <20 000/μL).
T iming of platelet count drop (usually 5-10 days).
T hrombosis. O T her causes of thrombocytopenia are not likely.
_______ is the most common inherited bleeding disorder. It's inheritance is _____.

The platelet count is usually _____, bleeding time is______, and pTT _____. Treatment is ______ , , or use of_____
1. vWD
2. AD
3. Normal
4. Increased
5.may or may not be prolonged
6. desmopressin acetate (DDAVP)= which causes release of vWF from endothelial stores
7. factor VIII concentrate, which contains a large amount of vWF.
Thrombocytopenia and elevated WBC suggest______Acute Leukemia vs SLE: Thrombocytopenia and Low WBC
RA and Splenomegaly think______FELTY syndrome
S – Splenomegaly=sequestration
A – Anemia
N – Neutropenia
T – Thrombocytopenia
A – Arthritis (Rheumatoid)
RA and Pulm involvement think_____CAPlan syndromme
Coal worker pneumoconiosis
Arthritis (rheumatoid)
Pulmonary nodule
Pt's undergoing splenomegaly should receive what prior?Pneumococcal vaccine 2 weeks prior
1mary vs 2ndary hemostasisDisorders of primary hemostasis (thrombocytopenia or von Willebrand disease) are characterized by mucosal bleeding and the appearance of petechiae or superficial ecchymoses.

Disorders of secondary hemostasis (coagulation factor deficiencies such as hemophilia) usually are characterized by the development of superficial ecchymoses as well as deep hematomas and hemarthroses.
If CML is suspected, the diagnostic test of choice is an assay for the presence of the ______ Progression?Philadelphia chromosome t(9;22) , using either cytogenetics or fluorescence in-situ hybridization (FISH), or polymerase chain reaction (PCR) for the BCR-ABL fusion

Can eneter Blast phase= Acute leukemia present with marked leukocytosis but with anemia and thrombocytopenia , or with pancytopenia
Dx CLL/SLL Progression? When to txFlow cytometry of peripheral blood to demonstrate an increased number of monoclonal B-cell population expressing CD 5

Is an indolent disease so no tx till progression to altered immune responses including
-Autoimmune hemolytic anemia (AIHA)
-Autoimmune thrombocytopenia, as well as recurrent viral and bacterial infections.
-May transform into an aggressive Large cell lymphoma (Richter syndrome)(RARE) characterized by constitutional symptoms (fever, night sweats), progressive lymphadenopathy, and often extranodal (eg, liver) involvement.
The diagnosis of acute myeloid leukemia (AML) or acute lymphoid leukemia (ALL) is _____Established by bone marrow biopsy using morphologic, cytogenetic, and molecular analysis.
Lymphocytosis is most frequently found in______L.

ALC = Total WBC (cells/μL) × % lymphocytes ÷ 100. Lymphocytosis is present if the ALC >4000/ μ L. So greater than ____
Viral infections and only rarely in bacterial infection except pertussis. Pertussis (whooping cough) is often associated with ALC of 20 000-30 000/μ

ALC >40%

Left shift vs Right shiftPrecursors -> band neutrophil -> segmented neutrophil

On a blood smear, if you see more band neutrophils than usual (>10% of total), it means the bone marrow is producing more cells (usual response to an infection).
A right shift would mean an increase in number of segmented neutrophils (bone marrow insufficiency).
____ leukocyte alkaline phosphatase (LAP) and presence of _____ are seen in CML, and help distinguish it from leukemoid reaction (____ LAP).1. Low
2. Basophilia
A young woman presents to your office complaining of dizziness. When asked to describe the feeling, she gives a vague story of just feeling like “her head is too big.” The feeling is associated with palpitations, sweating, and nervousness, and is almost constant. Her examination, including neurologic evaluation, is completely normal. Which of the following is the best next step?Vertigo: Obtaining a thorough psychosocial history.
Central vs Peripheral vertigo

If Central is suspected, what next?
The first task in evaluating a patient with vertigo is to try to distinguish:

Peripheral (labyrinthine apparatus or vestibular nerve)
Central (brain stem or cerebellum) causes of vertigo. Central causes, such as cerebellar hemorrhage or infarction, can be immediately life-threatening or signify serious underlying disease and require urgent investigation.
-HA, Incr ICP sx, FND
-Suspect Central: Get MRI/MRA..... CT is not good enough for examining brain stem
Sx to suspect Acoustic neuroma?
-Persistent low-grade feelings of dysequilibrium and the finding of probable sensorineural hearing loss
BPH tx?-Dix-Hallpike test
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