internal medicine pearls

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internal medicine pearls
2013-02-25 15:52:36
internal medicine pearls

internal medicine pearls
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  1. What commonly exacerbates psoriasis?
    • Strep infection
    • skin injury (e.g. (sun)burn, drug rxn)
    • HIV
  2. What are common presentations of lichen planus?
    • 5 P's:
    • pruritic
    • purple
    • polygonal
    • planar
    • papules
  3. What condition is associated with heavy alcohol consumption, hepatitis C, and iron overload?
    porphyria cutanea tarda
  4. What are clinical features of porphyria cutanea tarda?
    • facial hirsutism
    • milia
    • erosions
    • scars
    • tense bullae (especially on hands)
    • heavy alcohol consumption
    • hepatitis C
    • iron overload
  5. What is the primary presentation of pemphigus vulgaris?
    • mouth ulcers/lesions
    • high fatality rate if not treated
  6. If a patient presents with chronic mouth ulcers/lesions, what test would diagnose pemphigus vulgaris?
    immunofluorescent studies of perilesional skin
  7. What conditions are associated with ertyhema nodosum?
    • inflammatory bowel disease (esp. Crohn's)
    • sarcoid
    • strep infection
    • drugs (esp OCP)
  8. What are some adverse clinical conditions associated with OCP use?
    • cholestasis
    • erythema nodosum
    • (+ smoking or factor V mutation) DVT, VTE
  9. If a patient develops DVT/VTE soon after starting OCP, what condition should be investigated?
    factor V leiden mutation (i.e. APC resistance)

  10. What conditions are associated with this skin lesion?
    • skin lesions = erythema multiforme
    • associated with:
    • HSV
    • drugs (esp. PCN, sulfa, phenytoin)
    • Mycoplasma

  11. What conditions are associated with this skin finding?
    • skin finding = acanthosis nigricans
    • associated with:
    • insulin resistance
    • occasionally malignancy (60% gastric)

  12. What conditions are associated with this (severe) skin finding?

    • younger person: HIV
    • older person: Parkinson's
  13. What LFT changes do you expect with alcoholic hepatitis?
    • AST levels <300
    • trivial ALT elevation
    • AST/ALT ratio >3
  14. What are some common features to hemochromatosis and alcohol liver disease?
    • hepatomegaly
    • glucose intolerance
    • testicular atrophy
    • cardiomyopathy
  15. What are clinical features of nonalcoholic steatohepatitis?
    • hepatomegaly
    • elevated transaminases (usually AST>>ALT)
    • esp. middle-aged women with obesity, diabetes, and HTN
  16. What are common causes of acute liver failure?
    • #1: drugs (esp. acetaminophen)
    • viral hepatitis
    • ischemia
  17. Who is usually affected by autoimmune hepatitis?  What tests will confirm diagnosis?
    • usually women
    • antinuclear antibodies
    • anti-smooth muscle antibodies
    • hyperglobulinemia
  18. What are key clinical features of Wilson's disease?
    • rare autosomal recessive
    • hepatitis (fulminant, chronic)
    • neurologic symptoms
    • hemolytic anemia
    • Kayser-Fleischer rings around iris
  19. What drugs are associated with cholestasis?
    • OCP
    • chlorpromazine
    • chlopropamide
    • erythromycin
    • amoxicillin/clavulanate
    • gold
  20. What condition is associated with ulcerative colitis, whether or not they underwent colectomy?
    primary sclerosing cholangitis
  21. What is the initial therapy for acute variceal bleeding?
    • sclerotherapy: successful 75-90%, serious complications
    • variceal band ligation: as effective as sclerotherapy with fewer complications
  22. If a patient has EGD confirmed varicosities, what medication should they be put on?
    Beta blockers
  23. What is the initial therapy for most spontaneous bacterial peritonitis?
    • 5d course of 3rd generation cephalosporin
    • (usually caused by gram neg. rod bacteria)
  24. What GI regions are commonly affected by Crohn's disease?
    • terminal ileum
    • cecal region
  25. What are common extraintestinal manifestations of Crohn's disease?
    • uveitis
    • spondyloarthropathy
    • erythema nodosum
    • pyoderma gangrenosum
  26. A patient presents with malabsorptive diarrhea.  What conditions would make you suspect small bowel bacterial overgrowth?
    • scleroderma
    • diabetes
    • high dose PPI's
    • postoperative (Billroth 2)
    • radiation enteropathy
  27. A patient presents with malabsorptive diarrhea.  What conditions would make you suspect Whipple's disease (i.e. Tropheryma whipplei infection)?
    • arthritis
    • fever
    • lymphadenopathy
    • clubbing CNS involvement
    • uveitis
  28. What clinical conditions are associated with celiac sprue?
    • dermatitis herpetiformis
    • small bowel lymphoma
    • selective IgA deficiency
    • (isolated ALT elevation)
  29. What blood tests are used to confirm celiac sprue?
    • IgA endomysial antibody 
    • IgA tissue trans glutamine antibody
  30. A middle aged woman presents with chronic watery diarrhea.  She denies recent weight loss or abdominal pain.  What condition do you suspect?  How would you treat her?
    • microscopic (collaginous) colitis
    • tx: bismuth
  31. A patient presents with malabsorptive diarrhea.  What findings would make you suspect pancreatic insufficiency?
    • greater amount of stool fat
    • normal small bowel absorption tests (D-xylose, Hydrogen breath tests)
  32. What are the most common causes of acute pancreatitis?
    • 60% of causes =
    • alcohol consumption
    • gallstones
  33. What 2 types of infectious colitis are known to mimic ulcerative colitis?
    • campylobacter
    • amebiasis
  34. What is the occurrence rate of pseudocysts with acute pancreatitis?  When would you surgically drain them and why?
    • occurrence rate = 20% of severe pancreatitis
    • drain cysts >6cm
    • risk of perforation, infection, hemorrhage
    • also drain if pseudocysts do no resolve
  35. What is the preferred imaging test to diagnose chronic pancreatitis?
    • X-ray:
    • diffuse calcifications
    • most sensitive test = ERCP
  36. How do patients with ALS initially present?
    • asymmetric weakness
    • bulbar or limb presentation
  37. What heart finding is associated with a patient who presents with stroke with a hx of DVT?
    patent foramen ovale
  38. H. pylori is associated more with duodenal or gastric ulcers?
    • duodenal ulcers (80-95%)
    • gastric ulcers (60-90%)
  39. Should clopidogrel be used with aspirin for stroke prevention?
    • no: aspirin + clopidogrel does not decrease stroke risk
    • (it does increase bleeding risk)
  40. Which patients should receive carotid endarterectomy?
    • symptomatic patients with >70% stenosis
    • asymptomatic patients with >80% stenosis
    • should be done ASAP post-TIA
    • + low surgical risk and good 5yr survival
  41. Do statins reduce stroke risk?
    yes: reduce stroke risk by 20-30%
  42. What are common causes of hypokalemia?

    • alcoholism
    • hyperaldosteronism
    • renal artery stenosis
  43. What condition would you suspect in a patient with hypertension and orthostatic hypotension?
  44. What symptoms are associated with pheochromocytoma?
    • think H's:
    • hypertension
    • hypotension (orthostatic)
    • hyperhydrosis
    • hyperglycemia
    • headache
  45. What condition would you suspect in a patient with hypertension and hypokalemia?

    (renal artery stenosis, alcoholism)
  46. Why are nephrotic patients at increased risk for infections? What other conditions are they at risk for?
    • urinary loss of IgG and complement
    • also at risk for thrombosis: urinary loss of anti-thrombin III, increase in coagulation factors
  47. What are prominent clinical features of renal vein thrombosis?
    • flank pain
    • hematuria
    • enlarged kidney (ultrasound)
  48. What conditions are associated with adult onset minimal change disease?
    • atopy/allergy
    • NSAID use
    • Hodgkin's disease
  49. What condition is associated with young male smokers with a history of hydrocarbon exposure?
    Goodpasture's disease
  50. What is the most common cause of nephritis worldwide?  How does this condition present?
    • IgA nephropathy:
    • micro/macroscopic hematuria
    • usually presents <48hrs post-URI
  51. What imaging tests should be avoided in patients with chronic renal insufficiency? Why?
    • gadolinium-contrast imaging (some MRI's):
    • risk of nephrogenic fibrosing dermopathy
  52. What are clinical findings with atheroembolic renal disease?
    • livedo reticularis
    • purple toes
    • progressive renal dysfunction
    • eosinophilia: peripheral >> urinary
  53. What procedures carry a risk of developing atheroembolic renal disease?
    • angiography
    • aortic surgery
    • initiation of anticoagulation
  54. What condition would you investigate in a patient who presents with acute renal failure and thrombocytopenia?
    • microscopic angiopathy:
    • hemolysis
    • schistocytes
  55. Which patients with thrombotic microangiopathy do you definitely plasmaphorese?
    • TTP
    • antiphospholipid antibody syndrome
    • complement disorders
  56. What commonly causes acute interstitial nephritis?
    • drugs:
    • beta lactams (esp. PCN)
    • NSAIDs
    • dilantin
    • allopurinol
  57. A patient presents with ARF.  What findings would make you suspect ethylene glycol toxication?
    • oxalate crystals in urine
    • anion gap acidosis
    • osmolar gap
  58. What are the clinical features of SLE?
    • "SOAP BRAIN MD":
    • Serositis (lung or heart)
    • Oral ulcers
    • Arthritis
    • Photosensitivity
    • Blood (Coombs+ hemolytic anemia, leukopenia)
    • Renal (casts or proteinuria)
    • ANA
    • Immune abnml. (FP, VDRL, anti-DNA, anti-sm)
    • Neurologic abnml. (seizures, psychosis)
    • Malar rash
    • Discoid rash

    (+/- alopecia, Raynaud's)
  59. What drugs are associated with lupus-like syndromes?
    • Hydralazine
    • INH
    • Procainamide
    • Phenytoin
    • Penacilamine