General Medicine

CARDIOLOGY

1.Which of the following are not used to control angina symptoms?
A) Nitro
B) Iso Sulfide
C) digoxin
D) beta blocker

2.A 70 year old pt presents with diffuse pain from shoulder muscles and pelvic. She is taken to the ER and admitted for generalized weakness. Test come back unremarkable, but her SED rate is 120. Which of the following are most likely diagnosis?
A) polyneuritis nodosa
B) Anemia
C) polymyalgia rheymatica
D) Cancer
E) atherosclerosis

3.Which of the following entities are associated with polymyalgia rheumatica?
A)
B) polymyositis
C) giant cell arteritis

4.Pt complains of severe tender large temporal arteries, and  has high SED rate. Which of the following is the most worrisome following symptom?
A) Urinary contusion
B) Memory Loss
C) Blindness
D) Stroke

5.Patient has chest pain, what would you order to differentiate between heart and pulmonary dz?
A) CBC
B) WBC
C) Troponin
D) BNP

6.Patient has chest pain, how do you differentiate between ischemia or MI?
Troponin

7.Which is not indicated in CHF?
A) ACE inhibitor
B) Diuretics
C) Digoxin
D) Tylenol
E) Beta-blockers

8.Patient with radiating pain beginning from the 5th intercostal space has a systolic heart murmur. He also has b/l rales present at the lower aspect of his lungs. What is the dx?

MITRAL REGURGITATION → Why? During systole the mitral should be closed but in mitral regurg, the valve stays open. So what happens is when the heart contracts during systole, blood flows in both directions.

9.Name 3 risk factors for vasculopathies?
HTN, DM2, Tobacco usage, high cholesterol

10.Which of the following are common sites for DVT?
A) Brachia
B) Iliofemoral
C) Calf
D) Brain

11.Give 3 risk factors for vasculopathy(artherosclerosis)?
HTN, hyperlipidemia, smoker, family history

12.A 75 year old male complains of SOB, has severe venous stasis, chronic ulcer and his Right leg is bigger than his left. Diagnosis?
DVT with worrying Pulmonary Embolism

13.Most likely reason that exacerbates CHF?

any fluid overload, such as 4-5 units of blood transfusion

14.Patient presents with episode of syncopy. You auscultate and hear a murmur in his 2nd intercostal space. What is your diagnosis?

Aortic stenosis

BLOOD TESTS

1.True or False: abnormally low albumin can suggest poor wound healing?
True — because malnutrition leads to poor wound healing

2.True or False: abnormally low albumin can be indicative of edema?
True — due to a decrease in oncotic pressure

3.What is normal albumin?
3.5-5 g/dL. Low albumin correlates with edema and poor wound healing

4.Post TMA, what do you want to keep your BG under?
<200  mg/dL

5.What can cause hyponatremia?
SIADH from tumor. Plan is slow sodium repletion, if you go too fast can cause nerve degeneration

6.WBC 13 (normal shift)   Hct 30 and platelet 4,000. Does this person have an infection if he just had surgery 1 week ago?
No, because he has normal shift of WBC, expect to be high and elevated post op

7.When is it contra indication to get a CT scan?
Renal, so instead do VQ scan

8.Formula to calculate how much fluid a 70 kg person with 25% second and third degree burns needs?

Volume= 4ml x Mass (kg) x Area burned (% x 100).

4ml x 70kg x 25 = 7000ml

8. A patient has a Hemoglobin of 10, and hematocrit of 27, MCV is high 120, what is their diagnosis? Megaloblastic anemia

RENAL

1.What can cause SIADH?
HypoNatremia

2.How do you treat hyponatremia?
Slow infusion of normal saline (No more than 8 mg/day)

3.What will happen if you infuse saline too quickly?
Grand Mal Seizure (due to cerebral edema)

4.What are causes of Hypokalemia?
A) Diuretics
B) Vomiting
C) Diarrhea
D) All of the above

5.What can HTN result from?

  1. HTN meds
  2. Deconditioned (low BP because the patient doesn’t move much)

6.Which of the following are causes of secondary HTN?
A Renal stenosis
B Renal muscle hyperplasia
C Adrenal Medulla Tumor
D All of the above

7.True or false, parathyroid hormone is elevated with renal osteodystrophy?
True

8.What are contraindications for apixibam?
Age and renal failure

9.What antibiotics have a specific renal dosing requirement?

Vancomycin, Gentamycin, Zosyn

PULMONARY

  1. What makes you breath? Hypercarbon CO2 levels
  2. Differentiate COPD vs asthma?
  3. Difference blue bloater vs pink puffer? Both caused from smoking. Blue bloater- has lower extremity edema, and pulmonary HTN from CHF. Pink puffer – emphysema.
  4. What test for heart differential? BNP(<100)- when ventricles swell, it releases this
  5. Upper lungs most likely diagnosis? Bronchitis (most common)
  6. Lower lungs? Pneumonia (most common)
  7. Patient states “I can’t catch my breath”? Think SOB, think PE.
  8. What causes nosocomial pneumonia? ICV, septic, smoking, usually gram (-)
  9. Aspiration pneumonia? Feeding tubes, alcoholics, strokes, presents with FCNV
  10. Community acquired pneumonia? Gram (+) or legionella
  11. CXR shows streaking and the report says possible atelectasis vs pneumonia. What clinical findings would help you diagnose pneumonia?
    1. Constitutional symptoms with phlegm
  12. What is atelectasis? Tx?
    1. Collapsed alveoli → Tx: Spirometer or breath deeply
  13. McDaniel gained weight, you ordered a chest xray and showed streaking and reor pneumonia or possible atelectasis. What information do you need to say she has pneumonia? Sputum, fevers, CBC for elevated WBC
  14. A 12 year old patient presents with wheezing, difficulty breathing upon excessive, what do you suspect? Asthma
  15. 44 year old patient presents with elevated WBC count and productive cough, what do you suspect? Pneumonia
  16. Patient presents with history of smoking for 30 years and now has a productive cough, what is the diagnosis? Chronic bronchitis

DISEASES

  1. What exam is most precise for RA? CCP, apparently Rh factor is old now
  1. What test do you use to know a patient is septic? You could test with blood culture and sensitivity but zier says that an actual lab results is Lactic Acidosis level (normal is 4) if it is elevated = septic.
  1. What is renal osteodystrophy? Chronic renal failure hold on to P+ so Ca+ is excreted more. This causes PTH to be elevated. Treatment is to give phosphate binding medication, it binds in the gut and eliminated in feces.
  1. Who gets FOURNIER’S GANGRENE? DIABETIC PATIENTS. This presents as ulcers on the pelvic area/scrotal sac. May lead to sepsis.
  1. Which of the following is NOT associated with HIV?

A) Thrush
B) CMV
C) Pneumocystitis jiroveci pneumonia
D) Cellulitis

  1.  Patient with NV and dehydrated from drinking. He has been vomitting from 2PM-9PM. What is on your differential and what is the lab test you are going to order?

Differential: Gastritis, Pancreatitis. Blood Test: Lipase and Amylase ← Pancreatitis test

  1.  Pt with PURPLE, nonpainful, RUBBERY mass on his foot that abruptly appeared, this is the first time seeking treatment. PMH showed that he has lost a significant amount of weight over this past week. SHx found that he works at a pornshop and does meth. Vitals show WBC 2,000 (leukopenia). What is your dx and what is the underlying dz?

KAPOSI SARCOMA → HIV

  1. A vietnamese veteran stepped on the floor ad has severe pain on the back of his foot, it is chronic and sometimes resonds to NSAIDS. He has a history of UTI and has severe dysentery. Upon radiographs he has periostal fluffing. Diagnosis?

Reactive arthritis, (AKA Reiter’s syndrome)

9. A patient goes hiking and comes to clinic complaining of body rash and diarrhea, what is the most likely microbe causing this?

Ricketssia rickettsi

10. A patient goes camping into the woods, returns to clinic complaining of non-bloody watery diarrhea, what is the most likely diagnosis?

Giardia

11. Patient presents with a positive Babinski sign, scanning speech, and nystagmus, what is their diagnosis?

Multiple Sclerosis

12.Name as many diseases associated with upper motor neuron lesions.

Friedreich’s ataxia, Cerebral Palsy, ALS. Not Charcot Marie Tooth is a lower motor neuron.

13.A patient takes a urine analyses and is positive for alkaline phosphatase and hydroxyproline. What is his diagnosis? Paget’s Disease

DRUGS

1.What should be your initial treatment for HTN?
Diuretics

2.Which of the following is used as secondary treatment for HTN?
A) B Blockers
B) ACE inhibitors
C) Amylodipine
D) All of the above

3.What is side effect associated with beta-blockers?
Bradycardia, remember “B” causes “B”

4.What PT/INR level do you want on a patient with coumadin?
2-3

5.What is the most concerning side effect for Heparin?

Thrombocytopenia, that is why we prefer to give Lovenox since it doesn’t cause this!

6.What lab to order always with Heparin?
PTT, always!

7.Patients with atrial fibrillation require what drug?
anticoagulants

8.Pt going to get hardware surgery in knee/ankle. What drug to prophylaxis DVT?
30 day Lovenox subcutaneous

9.Pain scale from Dr. Zier, start low and increase:
Tylenol -> Norco or Vicodin (Hydrocodone) -> Percocet (Oxycodone) -> Dilaudid

10.What is the contraindication for APIXABANs?
Renal failure

11.Chronic NSAID usage should be avoided in which population?
ELDERLY and RENAL FAILURE → Elderly should be placed on Tylenol or something stronger like Opioid

12.Drug of choice for aortic senosis?
Coumadin

13.Patient has a history of alcoholism, his breath smells like beer and comes in stumbling unable to walk correctly?

Thiamine or Vit B1

14.Symtoms of Vit B3 deficiency (niacin)?

Diarrhea, vomiting, fatigue, idigestion, Muscle weakness

Miscellaneous

  1. A patient returns from fishing and presents with redness and random serpent like tunneling, what is diagnosis? Cutaneous migra larvans, treat with Thiobendazole an anti-helminthic
  2. A homeless male presents with frost bite in toes, what is the initial treatment? Rapid rewarming
  3. What is the best test in a frost bite to asses viable tissue? Tcpo2